VALLEY MEDICAL BLOG

CHF Clinical Champion Update

VMG COVID-19 UPDATE

Friday, October 16, 2020                                                                                                       Issue # 88

 

 

 

 

Let’s start on the up side. Here’s some positivity to start your weekend: Keb’ Mo’, the Boston Children’s’ Chorus (BCC) and choirs from around the world singing let Your Light Shine. BCC says that the song is a timely reminder that despite the challenges that the world throws at us, we all have the ability to make the world a better place, and share our light with the people around us.

https://www.youtube.com/watch?v=QTCNPZEsLF0&feature=youtu.be

 

The number one responsibility of leadership in a crisis, especially a pandemic, is to tell the truth so that people can begin to deal with reality. That was true in 1918 and it’s still true now. Most of us want all this to be over yesterday. But it’s not. So we will have to make, and continue to make, hard choices based on facts, science, and faith in each other to do the right thing for each other.

 

The news is hard to take in these days. We are about 9 months into this pandemic and, as a country we have not been able to come to agreement on what we need to do. This is partly the result of bad leadership. Anyone who says the pandemic is about to end or that there is a cure or, worse, that the answer is to let the virus infect as many people as it can so that we can reach herd immunity is just plain wrong (or worse).

 

National

 

Yesterday, there were more than 62,000 new cases reported (the worst day since mid-July when 66,000 new cases were reported) (reported in the Washington Post). Wisconsin, Idaho, Ohio, Indiana, North Dakota, Montana, New Mexico and Colorado had single day highs in positivity rate reports. Hospitalizations are also rising again with deaths following. The CDC is now estimating 23,000 more deaths in the next 30 days and the current death toll is more than 218,000.  This is not the result of more testing (which is still inadequate, btw). And yet, we still see large gatherings (political rallies) with many people crowding shoulder to shoulder, unmasked.

 

We have some harder choices to make. Just as the holiday season is coming and we feel the greater need to be with family and friends because we miss them, need their comfort, and want to provide them with solace, we see infection rates going the wrong way and a denial of reality by large numbers of the population. Here’s what Dr. Jonathan Reiner, a respected infectious disease specialist is saying: “the consequences of this virus, particularly for older folks -- the people that we really want to gather with on Thanksgiving -- can be really dire," he said. And, frankly, I'd rather do a Zoom Thanksgiving with people that I love than expose them to something that might kill them," he said. "Next year is going to be much better. Let's get through this, and let's get through it safely."

 

I know this is a hard message. Maybe it’s especially hard since the infection rates around here seem relatively low. But this is a virus. It spreads person to person and people can be infectious without symptoms and even a presumed negative test. And we have to remember that it’s not just the people in the room you have to be concerned with. It’s the people they were in a room with and the people those people were in a room with, etc., etc.

 

Some of you have had an “early Thanksgiving,” outside while the weather still permits. Consider this as an alternative to Thanksgiving weekend celebrations, especially if you will be having extended family and friends from outside your household.

 

Local

 

Here’s the latest information available from DPH, town by town, risk levels:

https://www.mass.gov/info-details/community-level-covid-19-data-reporting

 

While most of our local communities are not at the higher risk rates, Holyoke, Amherst, Sunderland, and Springfield are at higher risk. The positivity rate for the State of Massachusetts as of 10.14.20 (7 day rolling average) was 1.17%.  This is an increase from last week. At Valley Medical group, for all patient tests completed the week ending 10/2/20, the positivity rate was 0.47%.  And Vermont now has quarantine restrictions for anyone from MA traveling to VT (with the exception of Franklin and Hampshire Counties).

 

These low rates are good. Can we count on them staying that way? We don’t know.

 

Watching the rest of the state and the rest of the country seeing increases in cases, we have to be concerned especially with increased travel to and from our area during the holidays. Please consider Dr. Reiner’s recommendations and avoid travel and large gatherings (even holiday celebrations, in person) if you can. The safest gatherings are virtual, then small outdoor celebrations, then indoor (small numbers) with windows and doors open, for as short a period of time as possible, etc. And, everyone wears a mask, washes their hands frequently, and stays at least 6 feet apart. And if you travel, check our quarantine guidelines for your return.

 

From Gina:

 

·         There is increased availability of testing in our area now. Anyone with symptoms or concerns should be tested.

·         We will be transitioning most care from our tents to the buildings as of November 1.

·         Flu vaccine is now available at all centers and practitioners and staff are now being vaccinated (remember, vaccines don’t save lives; vaccination saves lives).

 

 

OK. We are all connected and we have to act that way and protect each other.

 

https://www.youtube.com/watch?v=ouclNLG0ppI

 

That’s all for now. Thank you again for all you do,


Please stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, October 9, 2020                                                                                           Issue # 87

 

 

 

 

Good afternoon and thank you again for all your efforts this past week and in these highly unusual times.

 

Marta Tellado, President and CEO of Consumer’s Union wrote recently about one of Aesop’s Fables, The Boy Who Cried Wolf (the one where the boy convinces his neighbor that his sheep are being killed – so often that he is not believed). It’s 2,600 years old and Tellado’s point is that misinformation, and the chaos it creates, is as old as information itself. Only now, it’s complicated and accelerated by social media and by the violation of multiple norms by many “in charge” resulting in all sorts of conspiracy theories and false assertions. This creates a dangerous situation, especially in the midst of a pandemic, when we need people to make choices on a daily basis to protect their health and the health of their neighbors.

 

So, some very basic facts (actual facts):

 

·         The virus is in our populations; it did not go away

·         There is no “cure” and no vaccine (yet)

·         It spreads by droplets and also by aerosol (think of what smoke “looks like”), passed from person to person (this is why we stress wearing a mask or face covering over the mouth and nose; at least this reduces the droplets and some of the “smoke”)

·         So being in proximity to someone who is transmitting the virus is dangerous (that’s why we stress social distancing; at least 6 feet and no crowds)

·         People can spread the virus even before they themselves are symptomatic (so you may not know who has the virus which is why we stress, again, no crowds, wear a mask)

·         Concentrations of the virus matter; so outdoors in open air is safer than indoors with poor air flow

·         Although it is true that most cases are mild to moderate, we have seen, and are still seeing, large numbers of deaths and hospitalizations; it is not true that very few are affected (by the time you read this, the U.S. alone will have had 212,000 deaths) and we are seeing in excess of 40,000 new cases per day this past week

·         It’s not always easy to predict who will be most vulnerable; on average, elderly men with underlying conditions and people who cannot social distance and may have poor access to good housing, food, and medical care are two groups at high risk (and there are many others). But we don’t know what we don’t know (it’s only been with us since February-March) and other groups may also be at high risk

 

Our best defense so far is to wear masks, social/physical distance, meet virtually or outdoors (with masks and social distance), wash our hands a lot, and don’t go out if sick. Yes, we have lost jobs and businesses and wearing a mask can be “a pain” but, as Tom Friedman said in the NYT a few days ago “it was never a choice between masks OR jobs but rather masks FOR jobs (the more we keep people healthy the faster our businesses get back to normal and jobs return). Wearing a mask is not a sign of weakness. Wearing a mask is a sign of strength, being in touch with reality, and civic duty as those who wear them are doing what they can to protect others.

 

One other thing. Don’t listen to junk science or self-serving propaganda from people who don’t know science and don’t deal in facts. This is telling: Scientific American endorsed a presidential candidate for the first time in 100+ years of publication and the New England Journal of Medicine did the same.

 

If you want a close look at facts and trends, the link to this infographic is informative (it’s updated daily): https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/

 

COVID-19 #CoronaVirus Infographic Datapack - Information is Beautiful

UPDATE 21st Apr: Reinstated our NEW trajectories chart.Now tracks average daily deaths, active cases as well as total cases and total deaths. Great work by Omid Kashan.Inspired the excellent Financial Times team.: updated ‘Those aged 60+’ graphic with new UK data: added new risk data by biological sex (men more likely to die) (): added new dataviz on DIY mask materials ()

informationisbeautiful.net

It also has a graphic presentation of activities rated by COVID risk.

 

National and State

 

The Midwest and great plains states are seeing a steep rise in cases, hospitalizations, and deaths. The Northeast which, as we know, was first hit the hardest and then seemed to contain the virus and reduce spread (mainly by social distancing and masking), may now be seeing an increase in cases. Some major cities including New York and Boston are now rolling back some reopening or halting plans for increased activity (including school attendance). New Jersey has begun to close parks and picnic areas trying to cut down on gatherings.

 

In Massachusetts a total of 167cases among students and 92 among staff members have been reported since school reopening began (very likely an under-count as many cases were probably not reported). This is likely to increase as there is a lag between reported cases and opening of schools.

 

Why? Probably, the colder weather is forcing people indoors. Students are now back at many schools and colleges reopened. But it is probably also lowered vigilance and tolerance for the work of staying safe. In today’s NYT, Danielle Ompad, an epidemiologist at NYU was quoted as saying “we’re all kind of exhausted with it. We have to acknowledge that this is not easy.”

 

At VMG

 

We continue to do the work of providing needed services to patients while trying to keep them and our staff and practitioners as safe as possible.

 

We continue to monitor the positivity rates for the virus in our local areas and in the tests we do at VMG. For last week, no test done at VMG was positive. We are not seeing large increases in our immediate communities (except for some increase in the town of Amherst reported in college students living off campus).

 

Gina shared the latest version of our safety guidelines earlier this week. Please make sure to follow these practices and politely remind others when you see lapses; it’s good for them and for all of us.

 

As the weather gets colder (and stormier), a lot of work is going on to prepare to bring a higher proportion of care indoors, in as safe a way as possible.

 

More flu vaccine is arriving and we’ve begun and are continuing to plan for more patients getting vaccinated. And, as a reminder, all staff and practitioners are required to be vaccinated against flu this year (unless you meet exclusion criteria). We don’t yet have the plan for staff vaccination yet; soon.

 

Thanks again to the Facilities Team and all the “outdoor workers” as the recent storms came through forcing us to improvise and respond.

 

We’ll be sending our next communication to patients by the end of next week. We’ll send you a copy also. Here are some of the things we’re planning to let them know:

  • VMG is following the state’s mandatory safety standards including providing healthcare as much as possible by virtual means (video with audio preferable)

  • When you come to a VMG Health Center, please arrive ten minutes early. Screening will take place at the entrance (including temperature check, screening questions, hand hygiene, social distancing, and masks for all over 2 years of age)

  • Patients will be asked to wait in their vehicle if they arrive early. We’ll explain that, for patients with cars, this is the safest waiting area

  • Patients will be asked to bring their cell phone (if they have one). We’ll use their cell as the way to contact them when it’s time to enter for their services

  • Patients will be told that, when in the health center for an appointment, measures will be taken to continue to protect them. We will be careful to limit time in exam rooms and we’ll use available technology (iPad or other devices or cell phone to complete part of the visit

  • VMG has a separate and distinct section for all patients who are being seen for illness in Greenfield, Northampton and Amherst

  • Testing for symptoms of flu, strep throat, COVID-19, will be completed as self-testing, outside, guided by a VMG staff member

  • We will be stressing the importance of flu vaccination for all patients

  • We’ll be reminding patients to try to be in quiet, private spaces during virtual visits.

OK, that’s all for now. Get outdoors this weekend, listen to some good music, read, see friends and family safely and have a good weekend.


Please stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you feel sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, October 2, 2020                                                    Issue # 86

 

 

 

 

We all woke up to the news this morning that the President, First Lady, White House Aides and members of Congress have tested positive for coronavirus and some are experiencing symptoms of COVID-19. I wish them all well and a complete recovery. The situation is a good reminder that anyone can get this virus (setting aside the White House refusal to wear masks and stay out of crowds) and that the virus is still in the world’s population and will not disappear. We know how to be careful. And we all should continue to be careful.

 

We missed my favorite “holiday” last month (well, maybe my second favorite; Thanksgiving is my favorite). National Ampersand Day was September 8. Why do I like National Ampersand Day? First, if you don’t recognize the word, the ampersand is this character: “&”. We use it as a way to say “and” as in Johnson & Johnson, for instance.

 

But here’s the reason I think it’s important to think about the ampersand. We can hold two, sometimes contradictory, ideas as valid at the same time. This is not only true in culture and politics. It’s also true in medicine and science (this is sometimes why we run experiments). And it’s also true in organizations (on teams) as well as in close relationships (well, maybe not with kids, but go ahead and proceed as if…maybe your kids are exceptional). It’s a way to keep a conversation going, to learn better and more. Instead of laying out opinions as the only truths, instead of saying “yes, but,” we can say “yes, and.” Two things can seem irreconcilable but both can sometimes be true at the same time. Or maybe conducting discussions (when differences are apparent) with an ampersand can lead to better decisions, compromises, or at least to understanding the other person. And from that understanding, we can move past seeming impasses. Hold these thoughts, please.

 

On my way into work Thursday morning I had a near accident at an intersection. You know how when you approach a traffic light and it’s yellow and you go through it just as it’s turning red? We all do this, I’m sure, lots of times without accident. Well, Thursday morning a car approaching a light that was turning red picked up speed through the intersection just as I was turning left into his/her path. My brakes worked, the pickup truck behind me swerved and braked, and the car running the light also swerved and made it through. I’m sure my heart rate was through the roof. Someone told me this was my stress test for the day. Anyway, once I calmed, I couldn’t help thinking about the number of times I saw a light turn yellow and, without thinking, went through without incident. Almost every time it works out well so I don’t think about it much. (Remember how good the turkeys feel until Thanksgiving…). Having an accident in this situation is such a low frequency event for most of us we don’t consider what to do. We’re on autopilot. And that works until it doesn’t. Stay aware in those intersections.

 

One other example: most people who have a glass of wine or a beer or two at dinner don’t consider ourselves drunk. We might get in the car to drive home. And most of the time we don’t get in an accident. We make it home without harm to ourselves or others. Until….

 

Here’s the point I’m trying to make. We’re in that situation now with COVID-19. Since most of us are not infected (and maybe we don’t even know someone who is or was infected), we may be tempted to get lax about gatherings, traveling, wearing our masks, etc. We see other medical groups bringing in more and more patients to in-person visits to “get back to normal.” But maybe there is no “normal” until we have a vaccine and enough of us get vaccinated (“vaccines don’t save lives; vaccination saves lives”).

 

So as we approach what Steve called the “high risk season” (colder weather driving us indoors in enclosed spaces, windows closed, maybe not the best air flow for long periods of time while the virus is with us), we see two necessities: keep slowing transmission of the virus AND provide necessary services in volumes that move us toward “normal.” I’m sure this is true in your homes and personal lives too. You want to keep safe AND you want to enjoy your loved ones and friends. Let’s try to find reasonable paths to do both, as possible.

 

Maybe the most famous person in the world getting infected will help us all keep thinking that the virus is here AND we have to make good decisions. Read this:

 

https://www.cnn.com/2020/09/29/health/how-to-stay-safe-covid-fall-autumn-wellness-trnd/index.html

 

And this may help with perspective also:


https://www.cnn.com/2020/09/30/health/back-to-normal-bias-wellness/index.html

 

 

National and State

 

Half the states are experiencing increased cases and hospitalizations. The national death toll is now 208,000.

 

In our state, Boston and Springfield are now “red zones” meaning that DPH sees statistical increases of concern. The case positivity rate for the State of Massachusetts as of 9/30/20 (14 day rolling average) was 0.87% (still pretty low). However, yesterday that rate rose to 1.1% causing some localities to hold on or role back reopening plans. It’s too soon to know if this trend will continue but the fall is here, the weather is changing, and we’ll all have to be more careful.

 

At VMG

 

Since we are now doing COVID testing, we can report on our own small sample of test results. The Valley Medical Group rate for all patient tests completed the week ending 9/23/20 was 0.52%. We’re not sure what to make of that because the numbers of people tested are still relatively small but at least it’s not higher than the state. We are monitoring our own test results as well as the state and regional averages to make judgments about our own plans to continue bringing in more patients.

 

Flu clinics are in process and the plan is to continue to roll out more messaging and clinics as we get more vaccine. We’ll be updating employees about getting vaccinated in the next few days.

 

The storm Tuesday blew down our tent in Easthampton (again). Thanks to all the staff who worked on getting operations back up and running as the weather threw us a curve ball (I do wish we could just talk baseball – normality envy).

 

From the Concert in Central Park, 1991…We need bridges, ampersands, friends.

 

https://www.simonandgarfunkel.com/video/simon-garfunkel-bridge-troubled-water-concert-central-park/

 

 

Please stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

RAF Clinical Champion Update

VMG COVID-19 UPDATE

Friday, September 25, 2020                                                        Issue # 85

 

 

 

 

There’s a thing about turkeys that are raised on farms. They get fed and fed and fed and they must “think” that will always happen. And then…….Thanksgiving. We are not there now, though I must admit, it sometimes feels that way (and I know that these newsletters play a part).

 

We have been in COVID-19 “Ground Hog Day” for many months now. What must people who lived through the Great Influenza of 1918-20 have been thinking?  About a third of the world’s population became infected by the H1N1 virus, 50 million died worldwide and 675,000 died in the U.S. According to the CDC, mortality was highest in children less than 5, adults age 20-40 and over 65.

 

But this is 2020, not 1918. We know more about transmissibility now than we did back then. We have the ability to make a vaccine now that we did not have back then. And our scientific abilities and infrastructure is stronger now than it was then. We don’t have to have similar results. We can do better.

 

But to do better, we have to take advantage of what we know from science and public health. And we will have to be willing to take care of each other by doing the things that will slow the spread. We know we can do better and we know how we can do better. But are we? Will we?

 

Just today, looking at a map of rising infections across the country mostly west of the Mississippi river, you have to wonder why people are not taking the reasonable precautions that are easy to take and will get us lives saved (you know what they are). We now have passed 7 million cases of COVID and 203,000 deaths. Twenty three states are reporting rising numbers. Are people just believing the loudest voices and the politically induced anesthesia to scientific reality? Causing people to “rally” elbow to elbow, unmasked, for prolonged periods of time (even if outdoors) is a recipe for a viral fog that will  cause increased cases and deaths. But we are seeing that where people are taking reasonable precautions, case counts are lowest.

 

So the good news, at least so far, is that Massachusetts and much of New England are seeing case positivity rates less than 1.0. That’s pretty good considering the contagion. Here in Western Massachusetts, with the exception of an occasional spike, we’re in the .8% range. And here at VMG, we are, based on the recent COVID testing we are now doing, at about .8% for patients getting tested (with zero positive tests last week).

 

Let’s talk about vaccines. The work is being done. There are now assurances from the FDA that no vaccine will be released unless the rigorous scientific processes to assure that it works against the virus and that it is safe to use are followed. So, will you and your family “get in line” to get the vaccination (remember: vaccines don’t save lives; vaccination saves lives) when it’s finally available  I’m sure that will depend on what you hear and read about effectiveness and safety.

 

Dr. Ali Kahn, infectious disease specialist at the University of Nebraska, has been talking about three criteria for the vaccine: proven effectiveness, proven safety, and just as important, TRUSTWORTHINESS. With all the political interference (or attempted interference) with the FDA and the CDC, and with the public pronouncements of people in government with no scientific training and no regard for public health, trustworthiness is in question just when we will need it to be as certain as possible.

 

What this means is: put on your public health hat, read the science or the trustworthy summaries of the science and become a public advocate of science and health. For most patients, and most of our friends, neighbors and relatives, what we tell them may carry more weight than those who have not, or will not, read the science and speak only from their self-interest. That’s where we are today. Who would have thought?

 

At VMG

Since controlling flu outbreaks will be especially important this fall and winter, we’re arranging flu clinics now and awaiting vaccine shipments. The flu clinic outside at GHC recently went very well. We’re going to ramp this up as much as we can while the reasonable weather is with us. Our use of the Carebot texting platform for reserving vaccine and scheduling without having to go through reception is working well. Patients appreciate this.

Steve reminded us that the #1 cause of death remains heart disease and stroke with cancer at number two. COVID-19 is now number three. We need to continue to provide services to screen, protect and treat people for these conditions. So, we are working on plans for increased in person visits and services so long as we continue to see case positivity rates that are reasonably safe. If we see our rates in our communities rising to unsafe levels, we’ll make other plans.

 

 

 

Pete Seeger died in 2014 of natural causes. He was 94. He used his talents and following to protest against war and hunger and for civil rights and environmental causes (particularly in his home region of the Hudson Valley of New York, being a key contributor to the Hudson River cleanup). He wrote this song in 1967 as an anti-war protest of the time but it still has relevance today in our antiracism efforts and in combatting anti science.

 

https://www.youtube.com/watch?v=24VOo7-ctKU

 

Pete Seeger - Waist Deep in the Big Muddy

Vietnam War songs: https://rateyourmusic.com/list/JBrummer/vietnam_war_song_project/ Iconic American folk singer, Seeger played a key role in the 1950s folk revival and the 1960s anti-war movement. He often wrote political songs, protesting against war, segregation, and calling for environmental protection. The song "Waist Deep in the Big Muddy ...

www.youtube.com

 

So please stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Thank you, thank you, and thank you for all you do. Have a great weekend.

 

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, September 18, 2020                                                               Issue # 84

 

 

 

It’s been about 7 months since the COVID-19 pandemic came to our region. It feels like 7 years. Every day I get up, turn on the news, and hope for some really good news about a vaccine, a treatment, something. But what I know is that this is a very new virus and it’s only been 7 months.

 

 

 

Science takes time. I have to be patient; we have to be patient. We got through the pandemic of 1918 and 1919 (no, I don’t mean literally we; none of us are that old) and we will get through this one as well. But what can we learn and how can we make the outcome as good as possible?

 

One thing I know for sure is that kindness, cooperation, and being empathic really helps. Togetherness helps. Finding “common ground” helps. Picking up the spirits of someone else helps. I’ve seen this in our company, in the way we treat our patients and in the way we treat each other and that is really heartening and good for the soul.  And I see it in the “Tiger Box” responses. That’s an “old trick;” let’s keep doing it.

 

Now about the virus, what we know is a lot less than what we don’t know at 7 months in.

 

·         We know we can reduce transmission by wearing masks. Let’s keep doing that and help others to do that

·         We know that social distancing helps. Let’s keep doing that and help others to do that

·         We know that small gatherings, with social/physical distance really helps. Let’s keep doing that and help others to do that

·         We know that outdoors, with lots of air flow, is better than indoors with limited air flow for people to be together. Let’s keep doing that and help others to do that

·         We know that large gatherings without social distancing and mask protection do not work. Let’s not do that and try to remind others not do to that.

 

We know that the virus is here, in our world, and not going away. In Europe, there are now several countries that were doing well before the end of the summer that are now seeing an increase in cases (France and Spain are examples). This is probably due to travel and people feeling more complacent and loosening restrictions during the summer. In the U.S., we’re seeing rises in the Midwest and some less populous states. And, as you know we saw an outbreak in Millinocket, Maine from an indoor wedding without social distance and masks that has spread to relatives and families that were not even at the wedding. We do know how to prevent that kind of spread.

 

We’re learning as we go. There were reports that neck gaiters (the cylindrical materials worn by runners, bikers, skiers to keep their necks warm and now used as masks) were actually spreading virus at higher rates than masks. We learned that was not true. We heard that nearsighted people wearing eyeglasses were more protected from the virus. Nobody is sure of that yet, but probably not. There were reports of drugs that worked (e.g., hydroxychloroquine, Metamucil, Pepcid). Those have been disproven. On the other hand, we learned that some drugs do help to reduce stays in ICU’s and hospitals and lessen symptoms for some (Remdesivir, steroids). More to come, I’m sure.

 

There will be a vaccine. We don’t yet know when it/they will be proven safe and effective and how long it will take to manufacture enough for what the world will need (it’s not just about us; this is a pandemic). This will be a lesson not just in science, but in how we handle scarcity across the globe. Already there are reports that the richest countries are buying up future supplies at the expense of poorer countries. We have to deal with that as humankind (and we don’t have a good record of that by history). But we have the opportunity to change.

 

And finally for today on the opportunity to change and the need to change….

 

One million people lost their health insurance last year. We’re now in the midst of a pandemic. Can we use this “opportunity” to do what every other country with resources has done and provide access to healthcare for all?

 

We’ve learned, because the pandemic has further uncovered the inequities in resources, what we probably already knew but, as a country did not address: that people with poor access to uncrowded housing, good food, jobs with benefits, education, health insurance and healthcare providers, are getting sicker more often and dying at much higher rates than those with access. In our country, that means people of color, Native Americans, and many rural white Americans are suffering from these inequities at much higher rates than would be seen if inequities were lessened.

 

For a specific example, we’ve learned that “Black, Hispanic, and American Indian children are dying of coronavirus at much higher numbers than whites. For children, they account for 75% of the deaths but only 41 percent of the population. It may be true that these groups have higher rates of underlying health conditions. But what’s the cause of that? The most likely answer is unequal access to the resources of the richest large country on earth. Racism.

 

We have the opportunity to change. Please talk with each other. Join us in discussing at our upcoming VMG Community Forum. Vote for candidates who will take this on and move us to get better. Speaking up will help. The following is from UMass Basketball:

 

https://www.youtube.com/watch?v=bsIA6xenK70  

 

At VMG

 

We are ramping up testing for COVID-19 for symptomatic and asymptomatic patients of VMG, for any reason. Our most recent patient newsletter, going out now by email, is informing our patients.

 

Flu clinics are starting soon. Even though there are reports of milder flu this year form the southern hemisphere (e.g. Australia), that’s probably more true in places where they took mask wearing and social distancing more seriously. Complicating all this is that we are beginning to see the effects of the western wildfires on air pollution even in our area. We’ll need to be able to distinguish illness from COVID-19 and influenza. So let’s do what we can to lessen respiratory illness this fall and winter and getting vaccinated against the flu is something we can all do. For these reasons, as Gina’s email announced, we are now requiring all VMG staff and practitioners to get the flu vaccine prior to December 1 of this year (there are exceptions for medical and religious reasons – see Gina’s email for more information).

 

By the way, because the logistics of running flu clinics are much more complicated in the pandemic, we are looking to places like the GCC nursing program and the Westfield State PA program to help us “staff” the clinics.  Thanks to Mary, Rachel and Gina for pursuing these resources.

As previously announced, we’re using Carebot to automatically send texts to patients asking them to reserve and schedule flu vaccination (remember that “vaccines don’t save lives; vaccination saves lives”). Patients are responding well to the texts (30% response rate to reserve vaccine and half of responses have scheduled). 

 

A lot of work has been going on behind the scenes at investigating and regulating our HVAC systems to provide better air flow (and increase the mix of outside air) in our buildings. You’ll be seeing a few changes soon to make use of areas that are more optimal. This is important especially as we begin to increase the number of people in our buildings as we anticipate the winter months and the closing and/or reduction in use of our outdoor spaces.

 

Finally, our optical shop, Valley Opticare, is now fully opened for business in our Easthampton Health Center.

 

 

 

 

OK. How are virtual choirs created? https://www.youtube.com/watch?v=uS0ioMnVdHw

 

Stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

Asthma Clinical Champion Update

VMG COVID-19 UPDATE

Friday, September 10, 2020                                                                                       Issue # 83

 

 

 

 

I think we are all ready for the weekend. Thanks for another great week of taking care of our patients and each other. And that’s the good news of today and during these crises. Day after day you and we demonstrate we can do both. It means a lot to our communities and to our Board and we thank you for all your efforts.

 

There are some things and times that call for neutrality in business (most things, probably). We generally don’t want to confuse our mission and focus with politics. But we’re in much different times now in health care. We have numerous crises to deal with. So this is my opinion. It is well past time for change.

 

One thousand. That’s the number of deaths now attributable to COVID-19 per day in the U.S. for the last several days.

1209 = number of deaths in U.S. yesterday. The U.S. population is 328 million.

75 = number of total deaths yesterday in Spain, Italy, Japan, Canada, the UK, and Germany. The total population in those countries is 420 million. Finally,

53 is the number of days until the U.S. Presidential election.

 

Why am I starting with these numbers? Because it’s about all our health. Because it is undeniably clear that the outsized number of deaths and serious impact on health from COVID-19 are the result of incompetence, dishonesty, and failure to lead of this administration. If you haven’t seen the news in the last few days, in his own voice, our president has admitted to not telling the truth about the seriousness of this illness, about how it spreads, about whom it affects. And worse, he took no reasonable actions to mitigate and protect against this virus and LEAD by telling the truth and making the case for simple and effective means of protecting the country (masks, social distancing) and allowing the scientists to take center stage and communicate with the public. And worse than that, he’s still doing it (“we’ve rounded the corner”). And he’s still holding large, super-spreader, events.

 

The number one lesson we “learned” from the 1918 flu pandemic, in the words of historian John Barry, is “Tell the truth. People in authority need to tell the truth.” It’s the only way people can be roused to take action when faced with hard choices and maintain trust in the agencies charged with promoting health and keeping us safe.

 

Let’s connect some other dots. Black people, people of color, people with poor access to resources, people with less or no ability to stay home, people in overcrowded housing, people who rely on public transportation and with poor access to good food and supplies are still getting sick and dying in numbers 2-4 times higher than white people generally, and people with resources in particular. And the current administration says, in his own voice again, there is no systemic bias or racism. So the alternative facts might be that people of color and those without access to resources are choosing to get infected and die? Or they are the result of “random,” non-systemic factors? Let’s tell the truth here too. The answer is no. The data show the truth. Time to work on this, together. And about “together…”

 

What can a president do to “bring us together” to create a safer society in the face of a national tragedy? Here’s an example we’ve lived through (and probably not from someone you first thought I’d mention). Today is the 19th anniversary of 9/11. After the shock and profound sadness and grief over the loss of life in that horrific and unjustified attack on our country, there were many people who were set to start and amplify attacks on Muslim citizens (and our current president lied about seeing crowds of Muslims cheering at the burning buildings in NYC). What did our then President do? George W. Bush, almost immediately, went to a mosque in Washington D.C. to affirm that we would not be starting a war with Islamic peoples, though we would fight the terrorists. He understood that, while there were some people of the faith that committed these crimes, there were millions of others of that faith who were appalled and horrified by those crimes (and many who were killed in the attacks). He understood the need to keep our citizens together and focused on the real crimes and not a war on millions of innocent people. He told the truth about this at that time and did what he could initially to deal with our grief and wounds. He did not inflame the situation. He did this symbolically (by going to the mosque) and by his words. Words have meaning and consequences and he understood that.

 

What does this administration do when people are feeling vulnerable? He amplifies fear. He builds literal and figurative walls. He blames people who are victimized. He lies about the causes of disruption and demonstrations. He uses language that is misleading, full of bias and denigration.

 

Last number for today. 53 days until the election. Tom Seaver, one of the greatest and most reliable pitchers of all time, died almost two weeks ago of Lewy body dementia and COVID-19. He led the “Amazin” Mets in 1969 as they won the World Series. Back then, in anti-war demonstrations, there were signs that said “If the Mets can win the series, we can stop the war.” There is no “real” World Series this year (my opinion) and no “Amazin Mets.” But we can take a big step to stop what’s happening in our country at the ballot box in 53 days. Our democracy rests on citizen participation. Whether you agree with me or not, please vote as you will (and only once please).

 

As you know, the VMG Board has made a commitment to do what we can to counter bias in health care, systemic and personal, and become an antiracist organization. You’ll see a plan over the next few weeks to get us there and we are holding another VMG “community forum” on 9/29 to make sure we hear you and your concerns and share the work of our antiracism committee. We believe that listening to each other is the first step in this work. More details to follow. But first, if you will, watch this video and consider what it might mean:

https://www.pbs.org/video/pov-implicit-bias-peanut-butter-jelly-and-racism/

 

Now about the virus. “What we are dealing with is a giant tube of glitter. You open a tube of glitter in your basement, then two weeks later you are in the attic and all you find is glitter and have no idea how it got there,” Dr. Nirav Shah, the Maine CDC director, said this in a briefing a few days ago as the virus spread through a rural Maine community. The source was determined to be a wedding at a local church and venue. The state had marked Penobscot County as “green,” meaning there was a low risk of COVID-19 and students could likely return to school in person. The seclusion and self-dependence of Millinocket seemed to insulate it from the pandemic’s perils. But after the wedding, it became clear that in small towns built on close personal connections, those virtues could be hazards, too. We need to learn from this, probably over and over again.

 

Now some good news about vaccines in development (and this may not seem good, but it is). Several key manufacturers of vaccines publicly stated that they would not seek approval or release a vaccine until they followed all the rigorous steps in proving safety and efficacy. In addition, one trial was halted to investigate an unusual illness in a trial participant. That’s really good because the consequences of releasing a vaccine before establishing safety and efficacy are severe. As reported in a recent article, one, the vaccine may not be safe. Two, if it is not safe, people will lose faith in vaccines. Three, if a vaccine doesn't offer complete protection, people will have a false sense of security and increase their risk. Four, if a substandard vaccine gets an Emergency Use Authorization (an FDA approval to release a drug or vaccine “early”), a better vaccine may never get approval, because people would be reluctant to enroll in trials and risk getting a placebo instead of a vaccine. So good news there. Let’s be certain we’re doing it right.

 

State and Local

 

Massachusetts generally, and  our locations specifically, are still doing well with case positivity rates that are well below where they were in the worst months of the pandemic. There are outbreaks from time to time, usually traced to large gatherings without proper precautions (parties, etc.). Check out the community by community map at the DPH website (see previous editions for the link). Staying cautious about traveling, wearing masks, small gatherings outdoors, social distancing are still the rule of the day and our best defense against viral spread (remember the tube of glitter above).

 

At VMG

 

We are now doing two types of testing at VMG. First is PCR testing by nasal swab. This test detects the presence of viral genetic material and is a good test, at a point in time, to determine if someone has the virus. We’re doing this for VMG patients only. The second type of test is for antibodies to the virus. This test may have some clinical utility but, as Steve pointed out in an email to practitioners this morning, the clinical meaning is still of limited value since we don’t know if the antibodies detected actually man the patient is now protected from the virus and we don’t want people thinking that they can then “let down their guard.” We all still need patients to take the precautions we have relied on (you know what they are).

 

The AMC Optical Shop is now moved to EHC where we now have our only Eye Care practice. Hours are being determined and patients will be notified.

 

Our RN Team Leaders and Health Center Managers are working on bringing up plans for flu clinics. More information is coming (as is the vaccine). As you know, we want this to be an especially good year for flu vaccinations since we need to be able to reduce the impact of respiratory disease during the pandemic. Remember that “vaccine does not save lives. Vaccination saves lives.” And, “the most dangerous vaccines are the ones you don’t take.”

 

Our use of Carebot, a platform used to text patients to reserve their flu vaccine, is going well.  So far, 20,000 texts have been sent to our “highest risk” patients and 28% have reserved vaccine.  We want to remind everyone of the importance of getting patients’ mobile numbers for texting.  Medium risk patients will be contacted next week.

 

 

OK, just for fun, there are so many flash mob videos now out there. Here’s one from Japan.

 

https://www.youtube.com/watch?v=3lNaajK3Scc

 

Stay safe and well. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Have a great weekend.

 

 

Joel

Be patient; be mindful

Diabetes Clinical Champion Update

Friday, August 28, 2020                                                                                                                     Issue # 82

 

 

 

 

Thank you for another week of taking care of our patients and each other. The weekend is just about here and I hope you will enjoy it.

 

First some good news. The 7 day positivity rate fell to below 1% in Massachusetts yesterday. But that’s for the state as a whole. There are communities that DPH sees as higher risk (see the interactive map I sent last week). We’ll come back to this in a minute.

 

Some things about the pandemic are complex. There are many things we still don’t know about this virus and its effects on our bodies. We will learn more, I’m sure, the hard way (through experience) and by study (science).

 

But some things are not at all complex; they are simple. The virus spreads best in prolonged and close contact with people who have it, whether they are symptomatic or not. It spreads best when those people are not wearing masks and are in close proximity to each other. It spreads best when they are singing, talking loudly, yelling, etc. It spreads best when in enclosed spaces with less ventilation. So why are we, as a society, not avoiding these situations? There is a theory that the closer we get to a vaccine or treatment, the more these are discussed as “just around the corner,” the more risk people are taking in being exposed or in taking fewer precautions. The main problem with this thinking is that the virus is still there just as before and we are months away if not a year or more from widely available and effective treatments and vaccines.

 

Here are some recent examples. Close to home, a cluster of new cases and illness in Massachusetts was found for a group of people who attended a “bachelorette” party in RI in the last few weeks. More recent: forget the politics but look at what happened on the White House lawn last night. Hundreds of people, sitting inches apart, talking loudly, singing, without wearing masks (and almost all were not tested – I mean for coronavirus, not IQ -- prior). These were avoidable situations. This did not have to happen this way. We’ll see what happens a few weeks from now. Maybe they will learn “the hard way.”

 

There are unavoidable situations. A Harvard study reported by Dasia Moore in the Boston Globe yesterday (https://www.bostonglobe.com/2020/08/27/nation/new-study-finds-staggering-racial-disparities-covid-19-cases-massachusetts/?s_campaign=breakingnews:newsletter) “absolutely confirms and demonstrates what we saw [in Massachusetts] and the reasons why we saw it.” “Dr. Joseph Betancourt, vice president and chief equity and inclusion officer of Massachusetts General Hospital said that communities of color experience a “perfect storm of conditions for the spread of coronavirus,” including less access to health care and public health information, broken trust with medical communities, environmental and public health factors that contribute to poor overall health, and — in the case of COVID-19 — work and living conditions that increase exposure to the virus.

 

From the early days of the pandemic, Massachusetts cities with large Latino and Black populations have suffered high infection rates and death tolls. Chelsea, the city with the highest number of total cases per capita in the state, is 66.9 percent Hispanic or Latino. Of Massachusetts COVID-19 cases where the infected person’s race is known, 45.6 percent are non-Hispanic white, a group that makes up 71.1 percent of the state’s population. Similar patterns have played out nationally.”

 

Additionally reported, was the finding that “higher average household size and larger shares of food service workers, foreign-born noncitizens, and non-high school graduates across cities were all independent predictors of higher COVID-19 infection rates. A city’s foreign-born noncitizen population proved to have an especially strong correlation with higher COVID-19 case rates.”

 

Finally, they stated that because race is a social concept not based in biology or genetics, it does not by itself make a person more susceptible to COVID-19.

 

So what does this all mean? We have demonstrated an outsized proportion of cases (and deaths) in communities of color. You can choose whether or not to go to a bachelorette party (or a wedding) where people are not masked and crowded together. You can choose whether or not to go to a political rally and sit inches from others without masks, singing, talking loudly. But many cannot choose a less crowded living situation or choose a job that does not place them in close proximity with others having to get there by public transportation and without adequate masking. Many cannot choose to stay home for fear of losing a job or not having enough money to feed their families. Choices are less available in communities of color and economic disadvantage.

 

We believe that solutions to these situations will have to be found in making the vast resources of our society more evenly available to all, and without bias. We believe in becoming anti-racist.

 

The VMG Board of Directors has endorsed the following statement:

 

“Valley Medical Group stands against racism. We believe that racism and prejudice cause poor health and shortens lives. Valley Medical Group reaffirms its opposition to violence, hatred, and discrimination of any kind. We aspire to educate, discuss, and practice an anti-racist approach in all areas of our medical practices. We welcome feedback in support of our goal. Black Lives Matter.” 

 

Dr. Gump has already written to all of us inviting our participation in our efforts. You’ll be hearing more about opportunities in the next few weeks. I hope you will all join us in helping to create better communities, a better society, and healthcare that is even more welcoming, accessible and delivered to all equally.

 

At VMG

 

You’ll soon be hearing about COVID-19 PCR testing available at VMG. Testing will be for VMG patients only. It will be by nasal swab, “self-administered” during observation, and sent out to a national lab for reporting. Our thanks to Debbie Bolognani and the lab staff for the work in getting this going.

 

We are just now sending a special addition of our patient newsletter encouraging all to get flu shots beginning in a few weeks. (You can read the letter on the landing page for our VMGMA.com website). Plans are underway for flu vaccination clinics. You’ll hear more about this also very soon.

 

We are working with some new software to help us with managing access to the buildings and with appointments for flu clinics. You’ll be hearing more about “OhMD” (currently being trialed at EHC) and about CareBot (a system for texting patients to “reserve” their flu vaccine and notify them when it is available and avoiding phone calls to reception).

 

Dr. Mandile and Dr. Cai and our Eye Care Staff have reopened our Eye Care practice now in the Easthampton Health Center. She is seeing in person patients as well as virtual visits. Thanks to the Eye Care Staff and the Optometrists for getting us up and running. The first week went well. We’ll soon be moving our Optical Shop to EHC as well.

 

 

Keep together.

https://www.youtube.com/watch?v=foyH-TEs9D0

 

And please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

VMG COVID-19 UPDATE

Friday, August 21, 2020                                                                                                                                  Issue # 81

 

 

I’m going to start today with something on Public Health because, well:

 

·         It’s a societal good; it should be seen as basic infrastructure that allows us to grow and “live longer, better”

·         It needs work and funding; it is not “distributed evenly” and those with less means (money, housing, food, access to healthcare) don’t’ fare as well as those with greater means (

·         And, we’ve learned that in addition to honest, clear, and direct leadership in pandemics and health crises, it’s all we have

 

Ed Young, a really good science writer for The Atlantic, recently published an article called How the Pandemic Defeated America. Some excerpts:

At the end of the 20th century, public-health improvements meant that Americans were living an average of 30 years longer than they were at the start of it. Maternal mortality had fallen by 99 percent; infant mortality by 90 percent. Fortified foods all but eliminated rickets and goiters. Vaccines eradicated smallpox and polio, and brought measles, diphtheria, and rubella to heel. These measures, coupled with antibiotics and better sanitation, curbed infectious diseases to such a degree that some scientists predicted they would soon pass into history. But instead, these achievements brought complacency. “As public health did its job, it became a target” of budget cuts, says Lori Freeman, the CEO of the National Association of County and City Health Officials.

Today, the U.S. spends just 2.5 percent of its gigantic health-care budget on public health. Underfunded health departments were already struggling to deal with opioid addiction, climbing obesity rates, contaminated water, and easily preventable diseases. Last year saw the most measles cases since 1992. In 2018, the U.S. had 115,000 cases of syphilis and 580,000 cases of gonorrhea—numbers not seen in almost three decades. It has 1.7 million cases of chlamydia, the highest number ever recorded.

And some comments on some “special” populations:

 

America’s neglect of nursing homes and prisons, its sick buildings, and its botched deployment of tests are all indicative of its problematic attitude toward health: “Get hospitals ready and wait for sick people to show,” as Sheila Davis, the CEO of the nonprofit Partners in Health, puts it. “Especially in the beginning, we catered our entire [COVID‑19] response to the 20 percent of people who required hospitalization, rather than preventing transmission in the community.” The latter is the job of the public-health system, which prevents sickness in populations instead of merely treating it in individuals. That system pairs uneasily with a national temperament that views health as a matter of personal responsibility rather than a collective good.

 

You can read more here: https://link.zixcentral.com/u/2883b7bc/duJmxHPa6hG-VjfkMy1kxg?u=https%3A%2F%2Fwww.theatlantic.com%2Fmagazine%2Farchive%2F2020%2F09%2Fcoronavirus-american-failure%2F614191%2F%3Futm_source%3Dnewsletter%26utm_medium%3Demail%26utm_campaign%3Dmasthead-newsletter%26utm_content%3D20200808%26silverid-ref%3DNjY0MTI3MzYzMzk5S0

 

If you were wondering how we, at VMG, became public health workers, this is why. Now that we’re in it, let’s continue to avoid complacency and keep to facts, science, and making the difficult decisions necessary to provide needed care in the safest possible way.

 

Some words about flu (which is on the way). We’ve gotten some good questions lately about the coming together of flu season and COVID-19 outbreaks. They are separate illnesses. You can get then both. Having had one does not protect from having the other. And it’s probably true that If your lungs and other systems are weakened by one, you can be more vulnerable to the other and the effects can be more severe.

 

There are questions about whether getting the flu immunization will protect from getting COVID. It does not work that way; separate diseases. There are questions about whether getting the flu immunization during the pandemic can make you more vulnerable to COVID. Not so. So while the flu vaccine will not keep you from getting COVID, we believe that preventing flu by getting immunized will keep you from getting sick and being more vulnerable to COVID and other illnesses. As Dr. Maroun reminded me, the most dangerous vaccines are the ones you don’t take. So, as we prepare to vaccinate as many of our patients as we possibly can against the flu, please, please protect yourself and your families by getting the flu shot. More on our process for vaccinating staff will be coming shortly.

 

International and National

 

This continues to be a global pandemic. There are now more than 22 million cases and about 795,000 deaths attributed to COVID-19. You can see the effects here:

 

https://nytimes.com/interactive/2020/world/coronavirus-maps.html

 

As reported by the NYT,” The virus continues to affect every region of the world, but some countries are experiencing high rates of infection, while others appear to have mostly controlled the virus.” Much of South America, the U.S., Iraq and Spain appear to be global hot spots. There are more than 200,000 new cases reported, daily. The virus does appear, overall, to be showing a slight downward trend in the U.S. because of some slowing in the southern states that were hit the hardest (though Florida, Texas, California, and Arizona still have a lot of infections, hospital admits and high case positivity rates).

 

So while some countries and states are reporting recent downward trends (especially in places that were first to experience the pandemic), this pandemic is far from being controlled. New virus, no vaccine, no good treatments = Wear a mask, keep social distancing and avoiding crowds, wash your hands, stay isolated when sick.

 

In Our State and Region

 

While there is still a lot of political fighting about opening schools in the U.S. (and the results have not been good at some colleges and school systems across the country), NYC teachers are threatening to strike if the city persists with its plan to open to in-person instruction.

 

In our state, Boston public schools will start the school year with remote learning and then bring students back as conditions permit. Across the state, about 70% of school systems were planning at least partial in person instruction and the Governor has plans to deploy “mobile rapid testing units” to schools that may have outbreaks. It’s a good idea, but why not avoid the need?

 

Big picture in Massachusetts: the Governor reports that “73 percent of communities have seen a decrease or no change in daily average cases in the last two weeks” as reported in the Boston Globe yesterday. The 7 day weighted average of positive tests was 1.3% (that’s a good number). Locally, South Hadley was raised to high risk while Holyoke was lowered to moderate risk. Springfield, Chicopee, Holyoke, Easthampton were steady at 4-8 cases per 100,000; Northampton was at <4 cases per 100,000. These are relatively good numbers.

 

Hampshire and Franklin counties are still experiencing among the lowest rates in the state.

 

At VMG

 

Jim Wood and Greg Folta have been working with our HVAC companies to monitor and understand air flow and air exchanges in rooms across out centers. They have already adjusted the systems to increase the amount of outside, fresh air in the buildings. This helps to reduce risk of transmission along with our previously established processes: screening all who enter the buildings, using our outdoor “facilities” for lab, nursing, and other visits as much as possible, creating separate “pathways” for those with respiratory symptoms or suspected cases, and reducing time in exam rooms by hybrid visits and telehealth. We are doing well with virtual visits (but please remember to make sure that we are using video for all possible virtual visits; it’s better for “seeing” and understanding patient symptoms and better for our finances). We have adequate supplies of PPE and we are ordering “in advance” to maintain inventory.

 

We are considering the best methods for increasing in person visits over the next few months and in preparation for late fall and winter (when our tents will be difficult or impossible to use). We will proceed slowly and deliberately and monitor case positivity rates in our towns (and for patients where we have test results) and proceed or reduce our in-person access as the data suggest. You’ll hear more about this in the next few weeks.

 

None of us have been through this before. I am daily impressed by your efforts, your willingness to take on this public health mission and continued care, and our ability to change processes and do the best we can for all. Thank you again for your continued efforts to provide the care our patients need in the safest possible way for patients and your colleagues.

 

 

You’ve seen the numbers. We’ve lost many. But we go on and do better and remember:

 

https://www.youtube.com/watch?v=uFvHeqMfsJQ

 

And while we’ve lost many to the virus, we’re still aware of what we all have lost to systemic racism, and in discrimination in access to healthcare and public health. But this will change and the hope and work is uplifting:

 

https://www.youtube.com/watch?v=nPBi88v7adM

 

Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

Friday, August 14, 2020                                                                                                                         Issue # 80

 

 

 

 

Let’s start with something lighter. The pandemic has forced lots of us to think in new ways and create new uses for established processes. Well watch this video from KLM for contactless return of lost items at the airport:

 

https://www.youtube.com/embed/NK-T_t166TY?feature=player_embedded

 

I was walking after work in my town yesterday. I was thinking about my day, what I was going to do that night, looking down at the ground, and then in front of a neighbor’s house, I looked up and saw…a good sized black bear about 10 feet from me. She was chomping on something from a garbage can. She looked at me, I looked at her and thought “that’s a big dog.” And then, snapped back to reality, I began backing up. She was too involved in scarfing up whatever and I walked away. Reality has a way of catching you when you’re not paying attention, especially if you’re in the midst of established routines.

 

This is the situation we are in. We’ve gotten used to, adapted to, this pandemic in many ways. It’s harder to maintain attention. But that’s what is required of us if we want to stay safe. You can see a bear. Not so much a virus. Stay vigilant, please, and help others to stay vigilant also.

 

But vigilance is not all that’s required. As we’ve seen with entrants to Phil Murphy’s (Governor of NJ) “Knucklehead Hall of Fame,” people are, for whatever reasons, just ignoring pandemic safety in favor of…large gatherings, COVID parties, and “valuing their freedom” by refusing to wear a mask. And to take it a step further, there are many incidents now of people punching workers in stores, amusement parks and restaurants who ask them to wear a mask. Airline passengers are becoming “unruly,” challenging flight attendants and personnel trying to keep people safe.

 

How can this be? Maybe they just don’t know anyone who has gotten really sick or died (yet). Maybe they just believe the anti-science propaganda. I don’t know. Could it be they just don’t care enough about other people’s safety, too selfish, etc.?

 

If you listen to podcasts, you may have come across one called “The Oath” with Chuck Rosenberg. I really recommend it. Season 3, episode 10 is an interview with “Sully” Sullenberger, the pilot who worked with his crew to land his passenger jet in the Hudson River in 2009 after losing both engines on a takeoff from a NYC airport. It’s an exciting real, real-life story (made into a movie starring Tom Hanks) and it’s worth listening to the podcast just for that reason. But more to the point, he talks about teamwork, being dedicated to his role, his team, and to his passengers and crew. The skills necessary to bring that plane in safely (all 150+ passengers and crew were safe) were not individual; they were team related. And the team was not just in the plane. The captains of New York Waterways ferries immediately coordinated and left their routes to get to the plane. And finally, he talks about what “we owe each other” as a society to be safe and healthy. What he calls “little gifts of civility” make civilization possible. We take care of each other. “As citizens we have things we owe to each other, in spite of how it seems in this winner take all world.” It’s not just about our rights. it’s also about our duties.” Leadership, teamwork, civic duty and responsibility, honesty, clear and open communication, and integrity make civilization work. “Independent, critical thought with decisions based on facts, not fears or falsehoods, no matter how loud they are told, make for bringing out the best in us. Good lessons in these times. (Oh, and see the movie, Sully, it’s really good. I saw it just before I got on a flight to Ireland – not a good idea).

 

National and International

 

Bottom line: new virus, no good treatments, no vaccine, community spread. This is a bad public health recipe.

 

Several of you have reminded me of the meaning of “pandemic” (from the Greek, “pan” – all; “demos” – people) and this is truly a worldwide catastrophe. Spain is considering shutting down. The UK, France, Russia, Australia just a few of the most heavily impacted countries. African nations are also affected though cases seem to be rising more gradually. And New Zeeland, which had escaped much of the early pandemic by shutting out travelers, is now seeing an outbreak. We are all connected for the good and the bad.

 

In the U.S., California, Texas, and Florida are the most affected states but other states continue to see outbreaks. In the Northeast, RI is now on the Massachusetts Governor’s “red list” meaning travel is restricted from RI to MA because of their rising numbers.

 

And, somewhat shockingly, some of the states with the highest increase in case, death, and case positivity rates are now reducing testing. I know there are times when we close our eyes in the face of danger. But that is not a public health strategy.

 

And as states push to reopen schools, more than 2000 students, teachers and staff have been quarantined in five states with more than 230 positive cases.

 

Pro sports are also seeing impacts at the player and team levels though some owners are insisting on opening (and even traveling). Many players are giving up playing this season.

 

There are hopeful signs. Many college football and athletic conferences are shutting down for the year.

 

In the State

 

Here is the latest color-coded map showing the incidence of cases across the state. Red areas are highest risk followed by yellow, green, and white:

 

https://www.mass.gov/doc/covid-19-average-daily-incidence-rate-august-11-2020/download

 

Yesterday, DPH and the Governor raised the number of higher risk communities by four for a total of 11 towns at highest risk. Two towns in our region were added as yellow: Holyoke and Granby. Northampton, Easthampton, South Hadley, Chicopee, Springfield, and Longmeadow are now in the yellow or green category. The incidence rates are still low compared to eastern Massachusetts and other states. The message is keep alert and take precautions (wear masks and face coverings when social distancing is challenging).

 

The good news is that some of our local colleges are taking more protective actions now. Smith College announced it will open but only for remote learning. UMass reversed an earlier decision to open for in person instruction but is now opening remotely for almost all students. The Greenfield schools will open remotely.

 

At VMG

 

Our patient newsletter, being sent over the weekend, has the following information on testing:

 

“We are getting many, many calls requesting referrals for COVID-19 testing. As you probably know, due to the pandemic erupting across the country, there are shortages of test kits, supplies, and longer than expected turn-around times. Because of this, we do not yet have the capacity at VMG to test everyone requesting testing. But we are working on bringing both point-of-care testing and PCR testing (more accurate; sent to national labs) in house. We anticipate having this capacity in September and we will keep you informed of progress. In the meantime, here is the best information on where and how to get tested: https://memamaps.maps.arcgis.com/apps/webappviewer/index.html?id=eba3f0395451430b9f631cb095febf13

 

We also included information on services that are expanding or reopening:

 

·         Blood pressure clinics are being held in our outdoor offices (tents) at each of our health centers

·         Bone density testing will resume in late September (we’ll let you know)

·         All other radiology services (x-ray, ultrasound, and mammography) are now available with all services adjusted for safety in the pandemic

·         Our optometry services are beginning to reopen beginning with our Easthampton Health Center; available now

·         Our Optical Shop in Amherst is now open, by appointment only. Call 413 282 4409 for an appointment

·         Diabetes Education classes will be offered this fall on Zoom, Wednesday mornings beginning 9/16, taught by Sara Anderson, RD and Marjorie Sobel, RD

·         Reminder that Physical Therapy is available by virtual visits or in-person, as determined by our therapists

 

Here’s some information about our case management services provided by Baycare:

 

“The Baycare Care Management program has relocated to working from home since the start of the pandemic.  We have modified our activities to keep the team and patients safe but continue to have regular communication with patients and the VMG teams.  The team consists of a Medical Assistant (Care Coordinator) and Registered Nurse (Care Manager) that focus on the following activities in conjunction with the providers and clinical staff:

  • Transitions of care – tracking/monitoring/communicating with all entities involved in the care as well as patients that go to the ER, Observation, Inpatient and SNF

  • Quality – outreach to patients in need of certain testing/screening for designated measures and disease management for those patients with elevated A1C’s, etc.

  • Complex/Disease Management

  • Care Coordination

 

All activities are visibly documented in the EMR.  You can send your designated CM/CC a patient case in Athena to make a referral.  Please do not pass up these valuable resources for your patients!

 

Here is the breakdown for coverage:

 

Amherst:  Laurie Runkle & Erika Olson

Easthampton:  Louise Whitworth & Erika Olson

Florence:  Maria Bianciardi & Erika Olson

Greenfield:  Galina Agapov, Lorrie McGrath & Melody Blanchette

 

Similarly, as a reminder, here’s some information from the iCMP staff from CDH working with our Medicaid ACO patients:

 

The Cooley Dickinson Integrative Care Management Program (iCMP) provides support to chronic and complex patients within the Medicaid ACO. The team is made up of two Social Workers, one Nurse Care Manager, and one Community Health Worker to support eligible patients. The goal of this program is to improve clinical outcomes for patients while improving patient quality of life.

 

iCMP is able to support patients with a multitude of needs including health coaching, accessing mental health resources, and supporting psychosocial needs including food and housing insecurity. There are designated Social Workers for each practice. Kevin Verni LICSW works with NHC and EHC while Nancy Delabarre LCSW works with AHC and GHC. Sara White RN is the iCMP Nurse Care Manager and Francheska Martinez is the iCMP Community Health Worker. Sara and Francheska work with all practices. If you have a patient that you think would benefit from additional support, please send a patient case to one of those listed above and they will be happy to consult with you.

 

The weekend is here and after all the news, you may need something magical to change your mood:

 

https://www.youtube.com/watch?v=Z8Ws4PEky28&feature=youtu.be

 

Right now our biggest risks are from lapses. So please remain vigilant. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

VMG COVID-19 UPDATE

Friday, August 7, 2020                                                                              Issue # 79

 

 

 

 

 

Happy Friday and thanks for your work again during this unusual week.

 

The great philosopher, Bob Dylan, once said “There’s too much confusion, I can’t get no relief.” (https://www.youtube.com/watch?v=bT7Hj-ea0VE)

With no clear, consistent, and accurate leadership across the federal government, with so much politicization of simple, important steps that can save lives (wearing masks), and with the added burden of hurricane season, flu season, and the election season, there is sure to continue to be “too much confusion.” This is a shameful situation since we’ve been here before; a hundred years ago, and we should have learned. (Read The Great Influenza, by John Barry for more).

 

Around the world, we stand out---for all the wrong reasons. From the NYTimes, yesterday:

 

“Nearly every country has struggled to contain the coronavirus. But only one affluent nation has suffered a severe, sustained outbreak for more than four months: the United States.”

 

“First, the United States has a tradition of prioritizing individualism over government restrictions. That aversion to collective action helped lead to inadequate state lockdowns and inconsistent adherence to mask wearing based on partisanship instead of public health.

 

“Second, many experts agree, America’s poor results stem in substantial measure from the performance of the Trump administration. “If you had to summarize our approach, it’s really poor federal leadership — disorganization and denial,” said Andy Slavitt, who ran Medicare and Medicaid from 2015 to 2017.

 

The administration’s travel restrictions were insufficient. Health officials initially gave confusing advice around wearing masks in public. And the president’s public statements — including claiming that the virus wasn’t serious and would disappear — regularly spread misinformation. In no other high-income country have political leaders so frequently departed from expert advice.

Together, skepticism toward collective action and the administration’s scattered approach have undermined the national response to the pandemic. True, the United States has made some improvements, including on mask wearing and testing. But unlike in South Korea, Germany and other countries, the virus continues to overwhelm daily life for Americans.

 

The frustration for many experts is that this outcome was avoidable. As one said: “This isn’t actually rocket science. We know what to do, and we’re not doing it.”

 

And, a recent survey showed:

“Two-thirds of Americans say they would likely accept a vaccine against the coronavirus for themselves or their children, and vaccination acceptance varies by geography, political affiliation, and race or ethnicity, according to a national survey released Thursday.

 

The findings are not good news for the vaccine effort. Experts estimate that 70 percent to 90 percent of people would need to be vaccinated to get the virus under control. But the survey provides a more encouraging number than a poll in May that found half of Americans would reject a vaccine against coronavirus.”

 

 

Finally, about schools… The city of Chicago just canceled its plans to open schools for in person learning and will open remotely. Of all the largest cities, only NYC is still planning to open in person. If in fact they open, the hope is that we can learn what works and what can be done safely. But, aside from the risk of spread, if they have to about face, confidence in public health and education authorities will fall (for contrast, the country of Kenya canceled their coming school year and will require students to repeat a year when it is safer). And if confidence falls in public health and other officials, wait for the controversy (which shouldn’t be) about getting vaccinated. We need confidence in officials, and a clear, consistent, science and fact-based set of messages to get through this. From The Great Influenza, the number one thing we need to do in a pandemic is “tell the truth” so that people can know what they hear is reliable.

 

One more school-related thing. Most schools that are opening are emphasizing wearing masks and social distancing. North Paulding High School in Dallas, Georgia, just suspended a student for sharing a photo of a hall way packed with students, shoulder to shoulder, not wearing masks. How is that helping to save lives?

 

There are more reports of promising vaccine trials. It’s just too early to tell but Dr. Fauci has been saying that a vaccine could be available by the first half of 2021. That would be a record-breaking time for a vaccine but any good news is welcome. And then we all have to remember that “Vaccines don’t save lives; Vaccination saves lives.”

 

In the State

 

Massachusetts is seeing a steady increase in case positivity. Deborah Birx, M.D., Coordinator of the White House Coronavirus Task Force, identified four major cities that now have increasing cases and increasing positivity of cases: Boston, Chicago, Detroit and D.C. And today, Governor Baker announced that he is slowing the reopening process.  The limit on the size of outdoor gatherings has been reduced from 100 to 50. In order to prevent restaurants from acting like bars, food prepared on site must now accompany any order of alcoholic beverages. He is also authorizing all state and local police to enforce the regulations and he is creating a COVID enforcement and intervention Team. Finally he is postponing going to step 2 of Phase 3 of reopening. He said that he is doing this because “now we are seeing the virus escalate in certain communities around the commonwealth and we have to put together a plan to stop it. This fight against COVID-19 is far from over.”

 

You already know about the travel ban and the requirements to quarantine if you travel to other states not on the “safe list.” That list is updated regularly and will change over time. Rhode Island is no longer a “safe state” and travelers to Massachusetts form RI will have to quarantine (or produce at negative COVID-19 test within 72 hours). Here’s the list: https://www.mass.gov/info-details/covid-19-travel-order#lower-risk-states-

 

So, how do we get back to lowering the positivity and case rates? One way is for all of us in this country to wear a mask (not a surprise). The latest data from the U of Washington (which has been among the leading institutions tracking and forecasting the pandemic) is that we could save 70,000 lives by the end of the year if 95% of us wore masks. I think we could agree that is well worth the inconvenience.

 

At VMG

 

First, thanks to all of you, and especially Jim Wood, for going the extra mile during and after the storm on Tuesday. The EHC tent essentially blew away and was back up and running the next day. And, all the other tents needed work too. Thanks to all staff involved.

 

We know the burden being placed on reception and clinical staff with all the requests for referrals and information on COVID testing. See above for the statement about confusion. We’re working to get the best information available to you and to patients. The hospitals, labs, retail pharmacies are all coping with shortages of some supplies and therefore turnaround time delays. Ultimately, we know that we will need to do testing at VMG for our patients and we are working toward that goal. We’ll keep updating as we have more information.

 

For the moment, we are pretty well stocked with PPE and, thanks to Val Felton, Amy Rice and Greg Folta, we have good processes in place to keep our supplies available.

 

Finally, flu season will be here soon and there is a lot of work going on to develop new processes for vaccinating what we hope will be a record number of our patients.

 

 

OK. We can adapt and still be in connection with each other. Here’s a video of a creative way two teenagers in Italy are playing tennis. And they got a surprise visit:

 

 

https://www.independent.co.uk/sport/tennis/roger-federer-italy-rooftop-tennis-match-vittoria-oliveri-carola-pessina-a9652626.html (You may have to scroll down to get to the video on rooftop tennis).

 

 

 

Right now our biggest risks are from lapses. So please remain vigilant. Please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works), and avoid large gatherings and crowds

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Tuesday August 4, 2020                                       Issue # 78

 

 

 

 

 

 

 

I hope you are all well. It’s been about a week since the last Update. Unfortunately, the coronavirus did not take a week off.

 

As you probably know by now, there are outbreaks in many states in the Midwest and south that were “spared” earlier in the pandemic. The west, including California, Arizona, Texas and New Mexico continue as hot spots. And we are seeing rising cases in New Jersey and Rhode Island with many cases attributed to what New Jersey Governor Phil Murphy called “knuckleheads” attending large parties. Massachusetts is also seeing some rising numbers in the Boston area and the Cape (though not yet at the level that would cause Governor Baker to roll back the Reopen Massachusetts plan).

 

What to do about schools. Prior to last week, it was said that reopening schools in states where new cases were low and the case positivity rate was low, was acceptable. There may be some re-thinking of that for in-person instruction now. The few school districts across the country that have opened already for in person instruction are finding viral outbreaks. And kids can get sick from coronavirus and they can also spread the virus. I think we’ll see some reconsideration soon. At the least, there will have to be much more support to school systems for equipment, sanitizing, training, and testing/contact tracing to make school reopening safe and successful.

 

What can be done? Short of a vaccine, the best things to do are what we already know: wear masks, socially distance, wash your hands, don’t come to work if sick, AND definitely do not attend large gatherings (especially indoors); that would qualify for the “Knucklehead Hall of Fame” that the NJ Governor is opening.

 

Here’s what wearing a mask can do to make you a life saver (sent to me by Stephanie, an article by John Bollard in the Daily Hampshire Gazette):

 

 

 

 

So help yourself (and others) save lives! (and pass the article along to family and friends who may need convincing).

 

Or do what Major League Baseball (MLB) is doing. Is anyone surprised that ballplayers are getting sick in record numbers? The virus spreads like a ….. virus. And even great athletes get sick (who, presumably, are strong and have “good immune systems). MLB should have a whole floor reserved in the KHOF (Knucklehead Hall….).

 

OK. The “Good News.” Yesterday, the President signed an executive order that effectively makes Medicare payments for telehealth permanent for most recipients. That is especially good news now but also into the future. And the federal government is now working on plans for vaccine distribution (when it becomes available) based on previous plans for large scale flu vaccine distribution. Let’s hope they have it ready in time and that it is well thought out.

 

At VMG

 

Not surprisingly then, masks are required at Valley Medical Group for staff, practitioners, patients, and visitors. Gina reports that a question arose regarding exception for religious reasons. There is no exception for religious reasons. The only exceptions identified by Massachusetts DPH are for situations that may inhibit an individual from wearing a face-mask safely. These may include, but are not limited to:  

  • Those who cannot breathe safely;  

  • Those who, due to a behavioral health diagnosis, are unable to do so;  

  • Those communicating with people who rely upon lip-reading;  

  • Those who require supplemental oxygen to breathe; and  

  • Those who are exercising outdoors and are able to keep physical distance from others.  

If a patient is not able to wear a mask they should be scheduled for a virtual visit. See Gina’s recent emails for more information. 

 

Flu season is coming. We’re planning for procedures to vaccinate lots of patients this year, and, lots of staff also. We’ll have more to say about how we’re going to do this soon.

 

We’re also beginning to plan for COVID testing. More to come on that as well in the next few weeks.

 

From Colleen: “The Eye Care/Optical departments have faced our own unique struggles with the pandemic the past 4 plus months and we are now preparing to reopen for in person patient care on August 11th in EHC. The Eye Care department in NHC has been moved to EHC, to support NHC's respiratory unit. Significant work has taken place to support this move and prepare for patient care. 

 

The optical shop at NHC has closed and we are preparing to reopen the Amherst Optical shop, which has been redesigned to be able to support customers during the pandemic.  Anticipated opening is the week of August 11th, by appointment only.

 

Here’s a graph, from Isaac Allen, showing VMG charges over time since the pandemic began. The green line is 2020; the red line (not the MTA) is 2019. We are recovering our charges mostly due to virtual visits.

 

 

Podiatry and Radiology continue to grow in number of visits, and Physical Therapy is increasing past 60%. Behavioral Health, Diabetes Education and Nutrition, Endocrinology, Rheumatology, Sports Medicine, Ambulatory Surgery (ASPC), and primary care are either at or above 2019 levels or climbing to get there. Eye Care, as above, will begin recovery later this month. Thanks to all of you for providing access for our patients and teamwork (including reception and clinical staff) to get them in.  We’ve all changed a lot of processes and workflows in the last few months and it is paying off.

 

Right now our biggest risks are from lapses. So please continue to do what works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good), (and for those patients and others who wear their masks without covering their mouth and nose, help them understand that both are necessary)

·         Don’t come to work if you fell sick,

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Monday, July 27, 2020                                                                                            Issue # 77

 

 

 

 

 

 

 

 

Here are the headlines:

  • The virus is still here. It is still highly contagious

  • We will see infections again

  • Baystate Medical Center just reported an outbreak of more than 30 staff and patients attributed to visiting from hot spots and “forgetting” to use masks and social distancing

  • The Governor has issued new travel rules for anyone entering Massachusetts from most other states and there are significant fines for violating the guidelines

  • These rules do apply to our staff and practitioners

 

Mistakes were made (but not by me). This is the title of a book by Carol Tavris and Elliot Aronson about “why we justify foolish beliefs, bad decisions, and hurtful acts.” This is what we are hearing now from policy makers at the federal level and in some states. It’s a step, I guess, but it’s had a cost in lives and misery. But that’s not my concern today.

 

My concern today is that it’s hard for all of us humans to remain vigilant, deliberate, and careful when things appear to be “calming down,” “when we need a break,” “when we’ve got things to do.” Sometimes this is especially true if we compare what we see “over there” (other cities, states, countries where things are “really bad”) with what we see with our own eyes around us. It’s a blessing and a (potential) curse that we have gotten through the early stages of this pandemic with as little in our region as we’ve seen. Up to this point, most of us don’t know anyone who has had COVID-19 or died from the disease (though some of us do and I’m sorry for the pain). And we have been relatively good about wearing masks or face coverings, hand hygiene, socially/physically distancing, and staying home when sick.

 

But now it’s easy to fall into the business as usual mindset and that’s when mistakes get made. There was an outbreak traced to a party on the Cape a few weeks ago. Visitors from “out of town” probably transmitted the virus. And we are seeing that here (at Baystate, for example) too as we see visitors and family from out of town or when we travel. As hard as it is, PLEASE stay alert: even, and perhaps especially, with family and friends who visit or whom we may visit. And remember that as you are interacting with your family and friends, you are also at risk from their contacts with family, friends, and acquaintances who may not have been as observant of the measures we take to avoid viral spread.

 

Baystate did a really great job of making risks known to staff and patients, setting up all the necessary systems for controlling, and reminders about, viral spread and they still had this outbreak. It can happen here but let’s make sure it doesn’t happen because we let our concentration lapse. When you see someone at VMG forgetting to wear a mask (or not wearing it properly – covering the nose and mouth), getting too close for social/physical distancing, gathering in groups in enclosed spaces, please remind them of our need to protect each other, our relatives and friends, and our patients and communities. If you need help, let one of our supervisors know. If you are the receiver of a reminder like this, please accept it graciously. It’s meant for the good of all of us. We all forget (30 minutes ago, I left the office without a face mask). We all make mistakes. It’s not just “them, out there.”

 

As for the new travel guidelines, you can read them here: https://www.mass.gov/info-details/covid-19-travel-order

Here’s the quick summary:

All visitors entering Massachusetts, including returning residents, who do not meet an exemption, are required to:

·        Complete the Massachusetts Travel Form prior to arrival, unless you are visiting from a lower-risk state designated by the Department of Public Health.

·        Quarantine for 14 days or produce a negative COVID-19 test result that has been administered up to 72-hours prior to your arrival in Massachusetts.

 

If your COVID-19 test result has not been received prior to arrival, visitors, and residents must quarantine until they receive a negative test result.

Failure to comply may result in a $500 fine per day.

Exemptions are for people

·         Traveling through the state or to a transportation connection (plane, rail, etc.)

·         Traveling from a low risk state (currently New England, Hawaii, New Jersey, NY)

·         Commuting for work or school

·         Patients seeking or receiving medical treatment

·         Military personnel required to travel to Massachusetts

·         Workers providing critical infrastructure

 

At VMG

 

We are in agreement with, and complying with, the Governor’s travel restrictions. If you are a VMG staff member or practitioner and you travel to any of the states that Massachusetts deems a “hot spot,” please consult the information in the mass.gov link above and consult with your manager or supervisor about return to work plans.

 

 

 

It has been almost 6 months of pandemic now. It’s been a long time:

 

https://enchantmentathamilton.org/20200601ForTheLongestTime.mp4

 

 

That’s it for today. Do what we know works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Don’t come to work sick

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Tuesday, July 23, 2020                                                                                           Issue # 76

 

 

By now, you have all heard that Congressman John Lewis died last weekend at age 80. He died from something he could ultimately do nothing about – pancreatic cancer. He spent his life working for things he could do something about: the struggle for human dignity, equal rights in voting, housing, and for decency amongst all of us.

 

“We are one people with one family. We all live in the same house… and …..we must find a way to say to people that we must lay down the burden of hate. For hate is too heavy a burden to bear.” 

 

We use the word “hero” a lot. And there are many heroes in healthcare, the military, first responders, law enforcement and public service. But Congressman Lewis, from a very young age, repeatedly and persistently, put his life on the line for the cause of civil and human rights and helped to spark and keep alive the movements that led to progress. He would be the first to say that there is so much more to do. But that does not take anything away from his commitment to make things better. Many of you will have seen, and some of you will remember, the video clips from “Bloody Sunday,” March 7, 1965, when he and other leaders and many extraordinary citizens were savagely beaten by state troopers and KKK on the Edmond Pettus bridge in Selma, Alabama, while they marched for voting rights. https://www.nytimes.com/2020/07/18/us/politics/edmund-pettus-bridge-renamed-john-lewis.html That video did spark an increase in action and legislation that moved us all as citizens.

 

There is so much more to do. He would have us continue on with decency and love, but continue on and march forward.

 

“Do not get lost in a sea of despair. Be hopeful, be optimistic. Our struggle is not the struggle of a day, a week, a month or a year, it is the struggle of a lifetime. Never, ever be afraid to make some noise and get in good trouble, necessary trouble.”

 

It’s up to us.

 

National, State, and Regional

 

The map of states with increasing cases, case positivity, hospitalization and death rates is widespread. The worst situations continue to be in Florida, Texas, Arizona and California. PPE is in short supply in those areas. Healthcare workers are exhausted. Some communities with few resources to begin with are struggling and approaching being devastated by COVID-19.

 

There is some “good” news. There is now a national consensus that the measures we have taken in the northeast generally seems to be effective in controlling and suppressing the spread of the virus. You know what they are:

Keep the message going on this. If you want to use this graphic as a “signature” in your emails, we can show you how to do that.

 

There is a lot of talk in the news about several vaccine “candidates.” Some very early results have shown effectiveness in producing antibodies without too many/serious side effects. These candidates are now moving to phase III trials which will involve much larger numbers of patients. If they “pass” these trials, there will be a rush to get them approved and/or further evaluated. Some companies are already moving to produce the vaccines so that they could be available quicker if they do get approved. This is a good first step, but we have months or longer to go for an answer on safety and effectiveness. And then we have to face the production, delivery, and vaccination challenges. Remember that “vaccines don’t save lives; vaccination saves lives.”

 

Schools are an issue. There is pressure to open schools for good reasons: better learning, social development, “freeing up” parents, etc. But there is also a lot of concern for parents (a recent poll suggested about 60% of parents would prefer to delay school opening; that number is much higher for persons of color) and teachers (many teachers are worried about safety) and staff. And the science is not clear about the risks to children of all ages as well as how they might spread the virus to adults and to those at home who may be vulnerable.

 

The Boston public schools released a tentative plan to reopen but to reduce the number of students on the buses to one per seat. That will mean more bus runs and/or more parents transporting kids themselves. That will lead to more traffic and, of all things, air pollution. So this is all complicated and will need further decision making very soon.

 

At the state level, the Governor is continuing in Phase 3 of the reopening plan and will probably stay with this phase much longer since the next phase was labeled “the new normal.” It’s too soon for that.

 

Our region and the state are generally seeing lower rates of infection though there was a report of a cluster of cases from a party on the cape a week ago. Those people are in contact tracing now. It is still clear that the virus is here, despite our low prevalence in our communities. So, keep to the plan.

 

At VMG

 

We are working to support everyone with the proper use of PPE, especially for staff that are not used to wearing it.

 

A lot of work is being done on hybrid visits (part  in person and part by telehealth) and the use of our outdoor offices (tents) for nurse visits, CSRP, and vital signs.

 

We reviewed recent data produced by Isaac Allen showing that our charge rate is about 85% of 2019 at this time; pretty good given the pandemic but we have room to increase to improve. Primary Care, Behavioral Health, Endocrinology, Rheumatology are all getting very close or exceeding 2019 rates at this time of year. Lab, Radiology, Podiatry, PT, Sports Medicine are all continuing to rise now.

 

Here’s a quick inspiration:

https://www.youtube.com/watch?v=BFkTu8Y1KLs

 

 

 

 

 

That’s it for today. No Update tomorrow. Have a great weekend and, do what we know works:

 

Please wash your hands (often),

Don’t’ touch your face,

Maintain social/physical distancing (it works),

Definitely wear a mask (it is not a political statement; it’s a public health good),

Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

 

Be patient; be mindful

Thursday, July 16, 2020                                                                                                  Issue # 75

 

 

“We believe in science.” I hope we can all agree on that. And where science is not clear, we rely on scientists for the best information available. We make decisions about our work and how we live based on our capabilities and the best information available, guided by our values and mission. We know that we don’t know everything about the novel coronavirus and COVID-19. We do know enough to help prevent spread. But there is still confusion across the country.

 

National, State and Regional

 

The latest news is that the virus is spreading, with a rate and ferocity we saw in places like NYC early in the pandemic. We’re seeing this in the south and west and in some states in the Midwest and on the east coast. Arizona, Florida, Texas, and California are in crisis. Alabama just issued an order to wear masks across the state after refusing to do so earlier.

 

And despite a steep rise in infections and hospitalizations, some states and localities are either ignoring what we know or valuing an individual’s “right” not to cover their face higher than public health and safety (they do still have seatbelt laws). The Governor of Georgia issued an order PREVENTING towns and cities from ordering masks to be worn. The Orange County, California Board of Education issued an advisory for all schools to open on time this fall and WITHOUT REQUIRING FACE MASKS OR COVERINGS AND SOCIAL DISTANCING.

 

Maybe this captures the situation:

To repeat: no vaccine, no readily available good treatments. Face coverings/masks vs. “freedom” not to cover your face?

 

There is some good news on the horizon (several months to a year or two). Work is proceeding on more than 10 vaccines. There may be some therapeutics that work before a vaccine is available. But even as these things gear up, we’ll still need to slow the spread, drive down infection rates, and protect the most vulnerable. We know how. (And, to paraphrase a line from the movie City Slickers, by now, even the camels know how). And, despite the above, some polls and data suggest that more and more people are in favor of wearing masks. Walmart and some other large corporations are requiring face coverings now to enter their stores. That should help.

 

Massachusetts is still holding steady with a relatively low infection rate. Western Massachusetts, our two counties in particular, has a very low prevalence rate now. The risk is, as you know, that visiting and visitors to and from other states may bring the virus back. So we need to remain vigilant and keep practicing the things we know work.

 

At VMG

 

We are keeping to what we know. Access policies (temp checking at our buildings and tents, screening questions, assuring all patients and visitors wear masks, limiting the number of patients who can be in the facilities at any time) have been revised (and are available on the share drive). Heath care greeters are being hired to help direct traffic/access at our entry points. Scheduling is being evaluated and monitored to help assure we don’t bring too many people in at any given time. And we are continuing our efforts to make as many visits as possible “Video Visits.”

 

A word about Video Visits. We want to change the way we speak with patients about telehealth. Many patients and many of us are not clear about the exact meaning of telehealth.  Some are confusing phone calls, or video chats, with medical visits. What we want to focus on is “VIDEO Visits.” Why? Our experience so far has taught us that we can discern more of a patient’s concerns and problems when we have both video and audio during the visit. We will also get paid a higher rate for video together with audio. So please use the language “VIDEO VISIT” when talking with patients about being seen virtually. Do not use the terms “chat,” “telehealth,” “virtual visit,” or “phone visit.” If it’s absolutely not possible for a given patient to have a VIDEO VISIT because they don’t have broadband or supporting equipment, we will still schedule visits by phone, but please make every effort to talk with patients about VIDEO VISITS being preferred. Your team leaders and supervisors should have “scripts” to help explain this to patients.

 

As you already know, we are moving the NHC Eye Care practice to EHC so that we can preserve the area in NHC for our respiratory patients. The set up at EHC is proceeding (equipment has already been moved) and the target date for opening in Easthampton is August 3.

 

 

OK. We all have problems, from time to time, with memory. Here’s a musical “exploration:”
 

https://www.youtube.com/watch?v=9yN-6PbqAPM

 

OK. One more. Kennedy Center honors  Stairway.

 

https://www.youtube.com/watch?v=2cZ_EFAmj08

 

That’s it for today. No Update for tomorrow. Have a great weekend and, wait for it, do what we know works:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Thursday, July 10, 2020                                                                                  Issue # 73

 

 

OK. It’s time to say it clearly. Too much is at stake. He’s just wrong! The President says that the virus is 99% harmless. He says it will just disappear. He says that cases are going up because we are testing too much. He said the warm weather would kill the virus. He says he disagrees with the scientists. He’s just wrong! And his being wrong is getting people sick and people may die as followers insist on NOT taking the only steps we have to control the virus.

 

He says that mask wearing is optional. Yet he wants people attending his rallies to sign a waiver giving up their rights to sue if they get sick. Some people not wearing masks at the rallies say it’s about their freedom. They can waive their rights to sue if they wish. But when they leave the rallies and go home or to work or they’re with a neighbor, did the people at home or work or in the neighborhood waive their rights? Because those are the people who are then at risk.

 

We’re now seeing infections spike in Tulsa, the site of a rally 2-3 weeks ago. Few were wearing masks or social/physical distancing. We’re seeing spikes, outbreaks really, and big ones, in states and cities that “opened up” quickly (following the White House advice but not the Public Health advice). Phoenix is in crisis. Arizona, Florida, California also on the brink. Puerto Rico is approaching another crisis with COVID-19 while still trying to recover from storms in 2017. An incoming class of recruits at Fort Benning, Georgia had to quarantine because of infection. Iowa cancelled summer schools because of infection. Professional sports (and college) teams are cancelling or delaying training camps and practices because of infection. This is still a widespread and serious pandemic in the U.S. And outside the U.S., the only countries who are doing relatively well are the ones who shut down early, stayed shutdown until they isolated and traced cases, and then opened only when infections were way down and opened slowly. Hot spots around the globe now include several South American countries, India, Hong Kong, and even parts of Australia.

 

And, as we’ve said, it’s summertime and we’re having tourists and visitors. And colleges are planning to reopen in the fall. And we’re planning to reopen schools in the fall. Yes, some countries have reopened schools successfully so far. Germany has. But they drove their infection rates way down BEFORE reopening. And they were prepared with people and supplies to check students and staff. And they have leaders with clear and consistent messages and national plans. We are not prepared and we have no clear national plan or direction.

 

Atul Gawande said recently that one of the most important Public Health measures is communication: clear, consistent, instructive, from the top leaders on down. We don’t have that in the U.S. now.

 

So without clear and unified leadership across the country and especially at the national level, It’s up to us. We need to be vigilant and take on a public health role. Being vigilant means always wearing a mask when in public, social/physical distancing, hand hygiene, etc. And when you have visitors, as difficult as it is, insisting that visitors take these measures as well. And you may have to ask folks to self-quarantine if they are coming from areas that are known to be hotspots.

 

In the movie Crimson Tide, at a point where an invalid order is given by an American nuclear submarine captain to launch nuclear weapons without confirmation of the need, the Executive Officer intervenes and tells his weapons officer (nicknamed “weps”), “it’s up to you weps.” “You’re the only one with the key to unlock the weapons. It’s up to you.” Well, we’re not unleashing nuclear weapons. But we do have to contradict the misinformation about this virus and give a clear public health message to family, friends, neighbors, patients, colleagues, and communities. You know the message:

 

·         The virus is here; it’s not going away

·         We have no vaccine and no reliable and readily available treatments

·         It is potentially deadly; it is not 99% harmless

·         You can transmit it even when you don’t have symptoms

·         Wearing a mask will help to stop you from unknowingly infecting someone else (and if they wear a mask, they can protect you also)

·         Social/physical distancing decreases the odds of transmission

·         Outdoor gatherings are safer than indoor (with physical distancing and wearing masks)

 

Should you “fire” friends and family?  No, but please help to educate them. Please consider yourselves “healthcare ambassadors.”

 

State and Regional

 

Massachusetts is doing relatively well now and western Massachusetts especially well now. That could change with visiting this summer.

 

Massachusetts is continuing with a slower than most reopening plan. The Governor currently plans to allow schools to reopen in the fall (or maybe later this summer). There is some disagreement about classroom limits and social/physical distancing requirements (the state says 3 feet is enough; the CDC says 6 feet). There are some concerns about whether schools should reopen at all. Data on infection rates and the ability to supply and staff schools will likely determine this question.

 

Here’s a quote from an article in the New York Times:

 

“The good news is that the experience in other countries suggests that it may be possible to reopen schools. Germany, Denmark and others have done so without causing big new virus outbreaks, as President Trump noted yesterday.

But those other countries have taken two steps that the U.S. has not.

One, they have first reduced the overall rate of new infections to low levels: Germany reported 35 new cases per million residents over the past week; the U.S. had almost 1,100. (The Times updates this map every day, tracking the virus around the world.)

Two, some of those other countries have allocated new money for schools, as I heard after surveying some of my Times colleagues around the world.”

The “new money” was for extra staffing and supplies to check for fevers and symptoms multiple times per day, etc.

As far as we know, there are no plans for that here (yet); but it may be necessary.

One consequence of school reopening in this atmosphere of uncertainty as well as the arrival of cold and flu season will be a lot of anxiety (parents and kids) that we, as healthcare workers, will have to understand and respond to.

 

At VMG

 

Please make sure to review the email Gina just sent on the management of patients within the health centers.

 

You’re seeing reminders sent by the Health Center Managers about wearing masks in the health centers. Please be sure to observe this policy. It’s a part of our best defense against the virus and in line with our goal about providing the best care while keeping patients, staff and practitioners as safe as possible.

 

News from Gina on Operations:

 

·         ASPC doing well: now on 30 minute scheduling.  Outreach is being done for routine and higher risk colonoscopy

·         Radiology – available for mammograms: routine screening, along with high risk.

·         The outdoor lab facilities are doing well

·         Tents up and running at all 4 sites.  Expanding care carefully and thoughtfully. 

·         Health Center Managers and Reception Coordinators reviewed in-house visit scheduling

·         BP clinics are being arranged.

·         Plans for the move of Eye Care from NHC to EHC are underway.

·         We are having difficulty ordering “purple” and “green” top wipes. Please use the “white tops” and observe the instructions on “dwell time.”

 

News from Greg:

 

Hall Drive at AMC will be paved. Work will start early August. And, when complete, paving will begin at NHC. This should allow enough time to complete these projects while our in person volume is lowest and before winter storms.

 

News from Steve:

 

·         As a Group we want to avoid putting up barriers to COVID testing. Please review testing guidelines Gina has made available.  

·         There is a lot of Lyme disease showing up.  We will need to  keep index of suspicion up for Lyme

 

And News from Martha:

 

·         The alpha and beta test of athena telehealth is now complete. Go live for the full product is scheduled for July 20th.  Training for standard workflow of telehealth/calls to take place prior

·         There has been erroneous language emailed or texted to patients re: appointments.  Patients are being confused because the language suggests these reminders are for in person appointments. We may need to discontinue these reminders until this is resolved.

·          athena will change the way names of providers are displayed (finally). The full name of provider and degree will now be seen instead of just initials.  This will be helpful with cross-center scheduling.

 

Have a great weekend and let’s all stay safe, connected and remember,

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well. Help others to stay safe and be well.

 

 

 

Joel

Be patient; be mindful

 

 

 Oh, and watch this……thanks to Claudia

 

https://www.youtube.com/watch?v=uL52AuF4QzY

VMG COVID-19 UPDATE

Tuesday, July 7, 2020                                                                      Issue # 72

 

 

I hope everyone had a great Independence Day Weekend and that you connected with others and stayed safe.

 

Every holiday now is certainly different from before COVID. We have memories (and, no, I’m not including a link to the Streisand tune) of past get-togethers, trips, time with local and distant friends and family, etc. Zooming is good but limited (and you can’t really share a BBQ or go strawberry picking on Zoom).  So we all get antsy, itchy, or whatever visceral reaction you pick for life that was only recently taken away and now is on hold (without hold music). Until there is an effective and safe vaccine that most people will take, and probably even after that, we’re going to have to get used to living differently. This is the way it is. We can adapt. We will adapt. But we have to adapt wisely.

 

And speaking of independence….. The events of the last week seem to be confirming that opening states quickly, each on their own without a national plan, and especially if people were not willing to physical distance and wear masks, has led/is leading to viral spread and infection. States that seemed like they were avoiding the worst, and reopened on faith that the White House was right, are now deep in the pandemic. Testing supplies and PPE are once again going to get short as demand increases to handle surges in ERs, hospitals, ICUs, in those states.

 

The death rates seem to be holding steady or declining in some areas but rising in others. And even as some death rates decline, it is most likely due to better handling of the hospitalized patients and better protocols for treatment. It does NOT mean the virus is “totally harmless” as the President said at Mount Rushmore and in D.C. on the 4th. Yes, some people are asymptomatic and some still have mild infections (but are capable of spreading the virus to those who may have more serious infections). But people are still dying. And some of those who get sick and don’t die are beginning to report lasting effects on their lungs and other organ systems. So let’s not pretend this will go away by itself or that it is harmless.

 

We’re not built for good risk assessment; especially for things that we almost do automatically. Our brains take short cuts when we are “not looking.” So we have to keep looking. Have a mask in your car, at your front door, on your kitchen counter with your car keys, etc. We don’t want to be reminded of the times we’re in but we have to be reminded. And, when out, remember to wear the mask effectively (it does little good if noses are not covered along with mouths) and keep to physical distancing (at least six feet).

 

Since “everyday activities” will require some risk assessment on our part (and that assessment should include knowing your own risk based on age and health conditions), here’s a graphic from the Texas Medical Association showing relative risks:

 

 

 

CNN Health has a good piece today on 7 myths fueling new COVID-19 surges: https://www.cnn.com/2020/07/01/health/reopening-economy-false-sense-of-security/index.html

 

Here’s one story from the article from a young woman who went out with 15 friends to celebrate a birthday. No one was wearing a mask. “The virus seemed out of sight, out of mind because they didn’t know anyone who contracted it. The group also had a false sense of security because their governor (Florida) said it was safe to reopen. All 15 came down with the virus. “I feel foolish,” the woman said. And “young patients” are reporting serious conditions after infection (including lung damage, strokes, etc.).

 

Just because the Governor says it’s OK to do things, just because a person is young(er), just because we’ve checked temps at the doors, does not mean the virus can be ignored. Let’s help everyone not get fooled by these myths.  

 

At VMG

 

We are continuing our current approach to providing needed care in the safest possible setting for our patients, staff, and practitioners. I’ll have more about VMG in Thursday’s update.

 

 

 

Here’s a Jimmy Fallon, Roots, and cast of Hamilton virtual chorus of Helpless from the play.

 

https://www.youtube.com/watch?v=vo_s6PsVogI&feature=youtu.be

 

 

So let’s all stay safe and connected and remember,

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well. Help others to stay safe and be well.

 

 

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

VMG COVID-19 UPDATE

Monday, June 29, 2020                                                                                                                  Issue # 70

 

 

Good Monday to you all.

 

Here’s the latest national and international look at confirmed virus cases (per million people) in the last seven days (data from Johns Hopkins University and the New York Times):

 

 

 

The pandemic is still clearly not controlled in our country. And this is not the result of more testing and case identification since deaths from COVID are following the same general curves.

 

Several states that were proceeding to reopen have now gone back a step. It will take an obvious but courageous position on the part of governors and mayors to institute the required steps to save lives now: ordering social distancing, wearing masks, and probably partial lockdowns along with more testing, contact tracing and isolation of found cases. The federal government will not do this so it will be left to more local authorities.

 

Massachusetts continues to be one of the states with steady or decreasing key metrics and our region, in particular, has done well so far. But given the data from other states and regions, we still need to stick with the things that work to contain the virus, wearing masks and social distancing, especially as more restaurants and other public places keep opening.

 

At VMG

 

Although there are reports nationally that some medical groups and health systems are reversing course and doing less telehealth as their states reopen, we are sticking with our plans to continue to use telehealth widely (and hybrid visits including telehealth) to provide care our patients need while keeping patients, staff, and practitioners as safe as possible. We are also going ahead with offering more services outside and with providing Vital Signs clinics outside as well.

 

Using telehealth has allowed us to gradually increase our patient “visits” and charges. The latest COVID dashboard report (available to you on our intranet page under the Quality Reporting tab) shows increasing trends this past week with primary care up to about 97% of 2019 visits, lab at about 80%, radiology over 50% as well as more increases in PT and other departments. So our practices have been better for patients, and better for us.

 

 

 

OK. You have to see this as you start your week (thanks to Martha for finding this):

 

https://www.youtube.com/watch?v=NMvVgpqQE6U#action=share

 

The Muppets & James Corden: 'With a Little Help from My Friends'

Although James Corden, Reggie Watts and The Muppets can't be together in a studio, the group comes together on video chat to sing The Beatles classic "With a Little Help from My Friends." Sing along with Kermit, Fozzie, Miss Piggy, Swedish Chef, Animal, Gonzo and so many more. More Late Late Show: Subscribe: http://bit.ly/CordenYouTube Watch ...

www.youtube.com

 

And now, once again, with 5 part harmony:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, June 26, 2020                                                                                                                      Issue # 69

 

 

There was a brush fire on Joshua Hill in Leverett yesterday continuing into the evening and still today. Crews are working to extinguish it and so far no loss of property or life is reported or expected. Even though I don’t live near the fire, I could see and smell the smoke all night and this morning.

 

Amy said something a few days ago to help us understand why people may not take reasonable precautions in the pandemic. She likened it to a day at the ocean, everything looks great, and then you’re suddenly in a rip tide. If you’ve never had that experience, you may not connect emotionally. It’s something you can’t see until you feel it.

 

But there are some things you can see; directly and indirectly. The smell and visible smoke last night was unavoidable where I live. Getting updates on my phone from the Fire Department (and in the media) helped me feel safe (it’s the whole living in the woods in a wooden house thing) and I knew, if I needed to take action and leave, I’d have some warning.

 

That’s where we are, and have been, with the pandemic. If you lived in NY City a few weeks back, you could see (and feel) the deaths, the disease, the anxiety and depression, following  hospital admissions, ICUs overwhelmed, first responders and hospital staff exhausted but working anyway, etc. (and not living in NYC, you could see it on the news, every day for what seemed like forever). Not so much in our neck of the woods. But we know it’s possible.

 

No vaccine, No treatments, No unnecessary risk is a reasonable mantra for us and the country. Our top leaders are denying the risk, ignoring it, refusing to model very reasonable and necessary behaviors to keep this virus from spreading further. I won’t try to guess why. They’re also pretending it’s going to go away by itself, without any scientific reason to believe that will happen. No masks, no social distancing, 120,000 dead with estimates of 180,000 by October.

 

But there is science. There are facts. There are deaths and illness we can observe. Without national leadership, we all have to take on new responsibilities. We have been, in effect, tasked to be public health workers in our own spheres of influence: families, friends, neighbors. Summer is here. We will have visitors, tourists, increased encounters with people, each with their own histories of contact with others who may not have been paying attention or who have been influenced by the anti-science, anti-fact crowd and leaders on the national scene.

 

I’m suggesting that we all “screen” and educate our visitors (whether family or friends) and make sure they have been and are wearing masks and observing social distancing in public. You can empathize with their situation (“it is hard to stay distant when we want a hug from a loved one we have not seen in some time,” “it is hard to have to wear a mask in hot weather,” etc.). And as hard as it may be, if they have not been as careful as necessary, find ways to help them isolate for the required time (14 days) and/or get tested. It’s time for reasonable steps we can all take to keep each other safe. If I wear a mask and you wear a mask, we are protecting each other. This is not an issue of liberty. It is a safety issue. Isn’t that what we do with family and friends? Keep each other as safe as possible.

 

I hope I am “preaching to the choir.” We all have greater responsibilities now whether we want them or not. No vaccine, no treatments, no unnecessary risks. Be in touch but be well and stay safe.

 

And speaking about “greater responsibilities,” here’s a recording that aired on NPR this morning of a father and daughter coming to terms with the issues of wanting to be family while the father also has another responsibility:

 

https://www.npr.org/2020/06/26/883280686/for-hospice-physician-patient-care-means-walking-the-path-with-them

 

National, State, and Regional

 

I wish I had better news on a Friday. You can call it a slow moving train coming right at us or a fire burning in our direction, but that’s what we are seeing across the country now with positive viral cases and hospital admissions. And deaths follow those trends. Many states that were not feeling it when NY, MA, NJ, CT were “burning” are surely feeling it now. Some governors are halting plans to reopen, freezing in place. Others will have to consider rolling back reopening. Arizona, Texas, and Florida have all seen their public health officials and heads of ERs and hospital systems practically crying out for (and literally crying on TV) greater cooperation from citizens and government. The governor of Texas just ordered new limits on some small business and activity reopening including bars.

 

Massachusetts numbers continue to be stable at below thresholds for pausing reopening plans. But it’s just the beginning of the summer. Out state government seems to be appropriately monitoring and reporting.

 

In our areas, we still have relatively little infection (though there have been some reported small spikes). But remember the rip tide situation, especially with increased tourism and travel and visiting.

 

At VMG

 

Message from Steve:

 

 

“Each day I have at least a few patients asking why we aren’t seeing more patients in person and have had some providers asking as well. Unfortunately, medical issues aren’t so straightforward and most things in medicine have gray zones and require risk/benefit analysis.

 

 I ascribe to the approach outlined by the director of the CDC (paraphrased and connected to health care visits below):

 

1.       The safest place for our patients and us is to be at home (seeing patients on the internet).

2.       The second safest place is to be outside (our outdoor clinics)

3.       The third safest place is to be six feet apart with masks

4.       The least safe patient-seeing location is in a closed exam room.

 

Although presently the numbers in Western Mass seem to be doing well with only 17 new cases in Hampshire County in the last week (back in February it was likely much less but it didn’t take more than 2 months to get to a peak), we see what is happening in the Southwest and will be seeing more news coverage of people mourning and overworked, scared health care workers like we saw from New York and Italy.  Just 4 weeks ago folks in Texas and Arizona were feeling pretty secure. 

 

I don’t think we should be sanguine about the low numbers at the moment here in Western Massachusetts. Likely 95-99% of us have no immunity to COVID-19 and the only protection we have is our neighbors and fellow citizens keeping distant and wearing masks (it gets harder for folks to wear masks as the weather gets hotter and as folks go to the beach or eat out). We’ve also learned it is a much smaller country and world then it used to be and we are all interconnected.   I think the numbers will almost certainly increase over the coming months. We absolutely need to counsel patients and staff with symptoms to quarantine- and have a low threshold for ordering covid tests.

 

We do need to be able see more patients in person for clinical reasons – we don’t want to miss infections, skin cancers, congestive heart failure diagnoses, atrial fibrillation, eye problems, or have diabetics develop foot infections etc. We can’t leave folks with knee pain, foot pain or back pain unable to walk for months on end.

 

We are, and will be, opening more in person visits– many of which will be outside – but some will be in exam rooms. Likely over the next week or two we will go from an average of about 6-10 patients seen per day in each center in primary care to about 20-24 patients. Eye Care, Podiatry, Endocrine, Rheumatology, PT and Sports Medicine are also working on reopening plans and will be seeing more in person visits as well.

As we go, we will need to monitor COVID infection rates closely and, if they rise, we will quickly move to limit visits as needed. In the meantime all face to face exam room visits require PPE - in particular surgical masks on patient and providers and staff.

 

We should be driven by clinical decision making and should see patients in person because the clinical situation requires it and not just personal preference (by provider or patient).

 

The DPH guidelines for stage 2 continued opening does allow us to incrementally see more elective patients and do more elective surgery – but the key word is incrementally and the move forward needs to be driven by need and by the continued importance of maintaining flow in a way that always allows appropriate social distancing, screening, air exchange time and PPE.  As we develop and set guidelines in place we need to hold to them as much as possible but allow common sense exceptions when necessary.  Exceptions cannot become the rule.

 

It will take time to allow us to work out the tools- flow- greeters- cleaning and disinfection processes that will allow us to see more patients safely.  And we need to be quick about changing policies that don’t work - but doing so as a system not individually over-riding them.

 

Our leadership in the centers and staff has been amazing – we need to protect them, ourselves and our patients at all times. We also need to be patient as systems take time to put in place.”

 

Other news from Steve:

 

The CDC has now listed sore throat, URI, and GI symptoms as significant symptoms of COVID-19. We will need to make sure that we are carefully considering our diagnoses for these common complaints.

 

And Also at VMG:

 

Outside office visits are being scheduled and are ramping up. These visits are for immunizations, some treatments, and other procedures that may be part of wellness visits now and going forward.

 

Lab now has dedicated outdoor space at all of our centers except NHC (which will be open on Monday).

 

We now have Blood Pressure and vital signs clinics opening. EHC started today. Our other health centers will be scheduling these visits soon.

 

Physical Therapy is now seeing some patients, as determined by patient need and practitioner confirmation, in the outdoor offices.

 

Special thanks go to Jim Wood and the Maintenance crews who have been working diligently to set up the outdoor offices and then secure and modify them as needed.

 

 

This is the end of the week and the end of the Update. Here are two treats for you for getting this far.

 

Emmanuel Henreid: “Make sure you listen louder than you speak.” A lesson for all of us and an amazing chance encounter duet. (You may need to click on the unmute button on the video).

 

https://twitter.com/ProjectLincoln/status/1276195129779458048?s=20

 

What The World Needs Now Is Love’ is the charity single sung by Broadway for Orlando, an all-star group of artists from the theatre and pop world: Sara Bareilles, Idina Menzel, Audra McDonald, Gloria Estefan, Carole King, Sarah Jessica Parker, and many more. The single was created to honor the victims of the Orlando shooting massacre at the Pulse Nightclub.

 

https://www.youtube.com/watch?v=t5AyGvJcyoU&list=RDxlET8mUe3Ow&index=28

 

 

And now, more than ever:

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Wednesday, June 24, 2020                                                                                          Issue # 68

 

 

Happy Wednesday to you and thank you again for keeping VMG open and in the lead on providing the right care to our patients and keeping our patients, staff, and practitioners as safe as possible.

 

National, State and Regional

 

News from Texas, Florida and Arizona is not good. It is now clear that at least in these states that reopened early or never really took effective measures to prevent spread, there is not only a steep rise in average 7 day new infection rates, there is also a steep rise in hospitalizations. And yet you still see images of crowds, not wearing masks, and packed together shoulder to shoulder at rallies, meetings, and other events.

 

Seven states have reported record hospitalizations: AZ, AK, CA, NC, SC, TN, and TX. And the NYT reports that Tuesday saw the third highest single day total of new cases since the pandemic started. And 26 states are seeing rising rates of infection causing some public health officials and even Governors to say that they may be losing control of the pandemic in their areas.

 

New York, New Jersey and Connecticut are now requiring travelers from states with high coronavirus rates to quarantine for two weeks.

 

You can see Governor Baker’s remarks on the findings of the report investigating the debacle at the Holyoke Soldiers’ Home in handling COVID-19 here: https://www.mass.gov/covid19-updates “The report is devastating.” In addition to replacing personnel, the Governor states that he will implement all of the report’s recommendations for change.

 

There have been no significant changes recently in our region’s preparedness or rates of infection. The summer is just starting and places are opening with visitors still coming in to the state so rises in infections are still possible and maybe even likely. You know the best defenses.

 

I know that many of you are encountering relatives and friends who see the idea of wearing masks as an infringement on their freedom. I think we need, to the extent possible, to be educators about this. The key point is that wearing a mask may not help the wearer to avoid infection. But it does help to prevent the wearer from possibly spreading the infection to others. And it’s also important to let people know they can be spreading the virus even if they themselves are not sick or do not feel sick. And, here’s the thing. If we all wore masks and social/physical distanced, we’d reduce the spread significantly.

 

At VMG

 

As Amy Rice announced this morning in her email, “an update has been made to the process for patients who are receiving care in the health centers.  The change is that going forward VMG will provide these patients with a surgical mask to wear while in the building.  Patients will still be required to wear their own face covering to enter the building and then will be given a surgical mask as part of the screening process.  

 

The access control policy has also been updated to include information for when it is appropriate for patients to use VMG bathrooms to collect a specimen.  

 

You should also have seen Mary Mitchel’s email this morning about our decision to move the NHC Eye Care Department to EHC this summer. As you may remember, when we had to create a “respiratory clinic” area at Northampton, the space the Eye Care Department and Optical Shop occupy at NHC was the best site for this service. The EYE Care Department at NHC was effectively closed as a result. At the beginning of the pandemic, Eye Care could not operate in person anyway because of the close contact required by the Optometrists and patients without a good way to protect both patients and staff. Eye Care at NHC is the highest volume Eye Care practice and we want to get it open again as soon as we can so the move to EHC, which already has space designed for Eye Care, is the best way to do this. To get this done, we will have to move some staff currently using that space to other offices. We have that space at this time due to the high volume of telehealth we’re doing and the low volume of in-person care in parts of the health center.

 

Mary, Colleen, and others are working out a transition plan now. The plan at this time does not include reopening the NHC Optical Shop. The AMC optical shop will continue to be available for our patients and staff.

 

 

OK for today. Here’s a video of an amazing performance of a song from “Wicked.” We’ve all changed each other for good……

 

https://www.youtube.com/watch?v=xlET8mUe3Ow&list=RDxlET8mUe3Ow&index=1

 

Finally,

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Tuesday, June 23, 2020                                                                                                                  Issue # 67

 

 

It’s getting to be the same theme every day. It’s a beautiful day. You look outside and everything seems so ….. normal. Places are opening. Cars are coming back to the roads. Boats on the rivers. You can even get your hair cut, nails done, tattoos…..

 

And the numbers keep going in the right direction. The state sponsored “pop-up” testing sites last week and the results are in. Of the more than 17,000 tests done, only a 2.5% infection rate for those who attended demonstrations and protests in the days prior. And that’s pretty close to the general infection rate in Massachusetts.  That’s good. Or is it? We just don’t really know because there are a lot of things we don’t know still about the virus. Apparently you can get antibodies without showing a lot of symptoms. But how long to they last? And how long do they keep you safe? Should the quarantine period still be 14 days? Or should it be 28 days? Just examples of what we don’t yet know.

 

We know that other states are now seeing rising infection rates after they opened up.  Will we see that too? We think that sticking with masks and physical distancing will keep us safe. Why take chances then? Stay with what seems to be working. Amy Rice said today “it’s like going in the ocean and getting caught in the riptides.” You don’t see them until you’re caught in them. So let’s all “swim safely.”

 

National, State, and Regional

 

We’re waiting to see the “results” from places that have allowed crowds, indoor crowds, and have not required masks or distancing. It’s a 2-4 week wait now and we should know.

 

The state will stick with the reopening plan but some other states are having second thoughts and may step back. Some small towns in Kansas and Maine are reconsidering requirements for mask wearing as they either continue reopening or reverse for a while. And governors in Texas and Arizona (and to some extent, even Florida) are also trying to see if they can stay with their plans. A lot of uncertainty continues to be the norm.

 

At VMG

 

Gina’s last email, sent on Sunday contains revised information on prioritizing care. The main changes are a change to the section for physical therapy (clinicians to decide which patients need in-person visits) and a change to the lab section about lavatory use for patients with transportation difficulties to use for specimen collection.

 

Mary Mitchel reports that she and others are continuing to work on creating and modifying schedules for outdoor and indoor care. Tents are up for all centers and work is being done to get organized in preparation for both types of visits.

 

Cleaning and sanitizing requirements continue to be adjusted. Custodians and cleaners are now working new shifts to cover our daytime needs as well as early evenings and Urgent Care coverage is being discussed.

 

Athena telehealth is about 85% rolled out. A few problems have been encountered but, in general, it’s going very well. We are also trying a new program/app for texting patients once they appear in our parking areas. This App also has capability to pre-fill forms on the web and get them into athena.

 

  1. Mary: Busy with discussing schedules for outdoor and indoor care.  Tents are up, work being done to get organized in preparation of visits.

  2. Amy:  Will provide full PPE report next Tuesday, June 30th.  Supplies good.  N95 mask alternatives for those unable to use them being assessed.  Ordering returned to health centers for specific supplies; details provided.  Greg: Work in progress for daytime cleaning schedules.  Jim Wood working on staffing workflows and needs for weekend coverage. 

  3. Lisa: No new updates.

  4. Martha: Continuing rolling out Athena telehealth – 85% completed.  A few glitches being smoothed out.  Program trial being run at AMC next week for texting patients and document communication.

 

That’s it for today.

 

We could all use a little bridge now….

 

https://www.youtube.com/watch?v=nNq3c0NVhzA

 

Paul Simon and Art Garfunkel - "Bridge Over Troubled Water" (6/6) HD

From the DVD "Paul Simon and Friends" Buy the DVD here: http://www.shoutfactory.com/?q=node/1... Lyrics: When you're weary Feeling small When tears are in your eyes I will dry them all I'm on your side When times get rough And friends just can't be found Like a bridge over troubled water I will lay me down Like a bridge over troubled water I ...

www.youtube.com

 

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Monday, June 22, 2020                                                                     Issue # 66

 

 

Welcome to a new week. I hope everyone had a good Father’s Day weekend.

 

Face coverings and face masks have been in the news again with “positions” being taken on “both sides” of the argument. One position is that personal freedom is more important than “conforming” to someone else’s idea of what’s right. “I can choose not to wear a facemask since I’m willing to take the risk.” The other position is that wearing a facemask is a “public good;” it protects others from possible harm. You can see both sides of the argument. But should you?

 

There are now studies showing that states and localities requiring the use of facemasks are seeing lower incidence of new cases of COVID-19 after the requirement is enacted. One estimate is that anywhere from 230,000 to 450,000 new cases may have been prevented (Community Use of Face Masks and COVID-19: Evidence From a Natural Experiment of State Mandates in the U.S., Lyu, W and Wehby, G, Health Affairs, June 16, 2020). So while it is true that an individual could take the risk for her/himself, s/he may also be spreading the disease to others who did not get to make a choice. In times of increased risk and danger of infection, wearing a mask does not seem to be too big a burden to protect others and the freedom not to wear a mask seems less important.

 

National, State and Regional

 

Watch for changes in the CDC recommendations on wearing face masks and other public health measures to slow the spread as states including Florida, Arizona, and North Carolina see increases in cases. These increases are not just the result of more testing as they are also seeing more hospitalizations and a higher rate of positivity of testing.

 

Massachusetts continues to reopen in Phase 2. Restaurants can now have indoor seating with tables at least 6 feet apart and a limit of 6 people per table. The Governor decided not to impose maximum capacity limits (other than previous fire codes) as restaurant sizes vary. Bar seating is still not allowed. Offices can “repopulate” to 50% capacity. Hair, nail, and other grooming and self-care services can reopen with precautions. Key metrics will be monitored ahead of any decision to reopen further.

 

Regionally, our hospitals are still in good shape with capacity and with return of services in many areas.

 

At VMG

 

Our plans for reopening continue as discussed last Friday. We’re continuing to see patients by telehealth (athena telehealth is still expanding with the goal to be through the whole company by the month’s end or early July). We’re continuing to see some adult and pediatric patients with hybrid, part telehealth and part in-person (limiting the time of exam room exposure).

 

Here’s a chart showing our charges by month (the green line is total for 2020 and you can see it is on the rise):

Summer is here and it’s getting hot out there. Thank you again to all those involved in our “outdoor care.” We’re looking into ways to do this better, including dealing with the weather, for staff and patients. It’s an important part of our safety plan to reduce the risk of infection during  this pandemic.

 

 

That’s it for today.

 

As always, please continue to be careful and….

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, June 19, 2020                                                      Issue # 65

 

 

“Do the best you can until you know better; then when you know better, do better.” ……Maya Angelou

 

On June 19th, 1865 General Gordon Granger and 2000+ union troops landed on Galveston Island in Texas. General Granger read “General Order No. 3” “The people of Texas are informed that, in accordance with a proclamation from the Executive of the United States, all slaves are free.” Celebration of Juneteenth (combining the words June and Nineteenth) began in 1866, one year and a day later. (From DeNeen L, Brown, the Washington Post, 6/19/20).

 

It’s important to understand that General Granger’s reading of the order took place two years after the Emancipation Proclamation was issued by President Abraham Lincoln. Some have said that the slaves in Texas didn’t know about the Emancipation Proclamation and that they were already freed. However, Texas slave owners had refused to acknowledge Emancipation and the end of the Civil War. Freed slaves therefore could not be free in Texas until they had the muscle of the Union Army with them on Galveston that day. And then what? “Between 1865 and 1930, more than 450 lynchings were recorded in Texas.” What have we learned? What can we do better?

 

That many Americans do not know about Juneteenth and its significance other than seeing a note in their printed calendars says something about where we are. However, most Americans of color recognized Juneteenth many years ago. It was not “made famous” recently. CNN reports that in 1997 a “Juneteenth Flag” was created by Ben Haith. “It is red, white, and blue in color to remind us all that slaves and their descendants were, and are, American.” “And while African Americans today are still fighting for equality and justice,” Haith said “those colors symbolize the continuous commitment of people in the United States to do better – and to live up to the American ideal of liberty and justice for all.”

 

I recommend an article by Adrian Walker in today’s Boston Globe, “What we celebrate this Juneteenth.” And here’s link to a New York Times article today for different views of Juneteenth:

https://www.nytimes.com/interactive/2020/06/18/style/juneteenth-celebration.html

 

To do better when we know better. That’s what we should be about. These ideals are easy to talk about. Acting on them is more difficult. But learning to be better should not be so difficult. It’s what we do, though not always with ease. On Monday, in a separate email, I’ll tell you about some beginning steps we can and will take at VMG to do better.

 

Please remember this IS a healthcare issue. As the rates of infection and hospitalization rise across the country, there is still a disproportionate impact on people of color and lower income. We’ll talk more about that in the coming weeks.

 

National, State and Regional

 

Across the country (literally across the country if you look at the map), we are seeing spikes and outbreaks in areas that were previously relatively unaffected. This makes sense since there is no immunity to the virus (no vaccine and it is a new virus for humans; that’s the meaning of the term “novel” in this case). For example, Florida just reported a single day increase of 4,000 cases; a single day record in Florida. And this is not just the result of more testing. Florida’s DPH is concerned that they may be the next epicenter; much like NYC in the early days of the pandemic. And Florida was one of the states that “reopened” quickest, despite the “numbers” going in the wrong direction.

 

Massachusetts is still going ahead with reopening. People will be out and about. But we will also see vacationers, family visits from other places, etc. And then some colleges have announced that they will be opening in person in the fall. Without a vaccine (which is not going to happen in the fall) we will see spread of the virus from students, families, staff and faculty coming from other parts of the country (and even other parts of the state). That will certainly affect all of us.

 

So this just means that wearing a mask, frequent hand-washing, physical/social distancing is going to be even more important. Please take care of yourselves and help others to do the same. Mask wearing (and the other precautions we talk about all the time) is NOT political. It may be life-saving.

 

At VMG

 

If you have not yet read Gina’s email about “Safety First and PPE at VMG” please read it and remind yourself of the safety standards. In the whirl of work during the day, it’s easy to slip your mind.

 

Also from Gina:

 

Prioritizing care during phase 2 of Reopening Massachusetts and the current state of the pandemic is actively reviewed.  The VMG approach to slowly expanding care is described by our medical director, Dr. Esrick below.  In addition we have worked on the attached summary that provides greater detail, by clinical area, to expand care very slowly and safely at VMG.

 

Guiding Principles:

 

·         We do want to slowly open the doors to more in person care over the next weeks.

·         We want to continue our safety first philosophy.

·         We do not want to compromise our ability to maintain full social distancing.

 

Please review below for changes we will start to put into place:

Visits in the Health Center:

 

·         Almost all in-person visits that occur should be the result of a virtual visit.

·         In person visits should be done at car side or outside, when appropriate.

·         Each provider will be responsible for designating who they see in these in- house visits.

 

We will see how we do with these visits and slowly increase numbers as seems reasonable and as we learn to manage getting patients in from the parking lot, without waits in waiting area or patients grouping in hall ways etc.


 

 

Like jazz? Some jazz for Father’s Day, a live recording of Horace Silver’s Song for My Father:

https://www.youtube.com/watch?v=NFjmWI-d6d4

 

 

As always, please continue to be careful and….

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Thursday, June 18, 2020                                                               Issue # 64

 

 

Good afternoon.

 

Several media outlets and university models predict that the virus is now a growing problem in Florida, Texas, Oklahoma and other states. And we see pictures, even from places where the virus numbers are going the right way, of people out and about, in crowds, eating and drinking, without masks and without social/physical distancing. There should be a sign on restaurants and bars: “No Vaccine, No Treatments -- No Mask, No Distancing, NO SERVICE.”

 

 

 

It seems so obvious. The virus is not just going to go away because we don’t like it. Or because we are tired of it. Why would people hold a huge rally in a crowded auditorium in a city where the cases are spiking and the hospitals are nearly filled? Or a non-COVID example: why would people with no medical contraindications refuse vaccinations that have been well-studied, have minimal if any side effects, and saves lives (especially when in other societies younger people see it as a duty to older people to get vaccinated and not put seniors at risk)? (And, BTW, when there is a COVID vaccine, you can bet that some percent of the population will refuse that too, even after it is well-studied). Excluding any possible political motivations, why?

 

Let’s go to the oracle: the nation's top infectious disease expert Dr. Anthony Fauci says that anti-science bias in the country is causing problems. "One of the problems we face in the United States is that unfortunately, there is a combination of an anti-science bias that people are — for reasons that sometimes are, you know, inconceivable and not understandable — they just don't believe science and they don't believe authority," "So when they see someone up in the White House, which has an air of authority to it, who's talking about science, that there are some people who just don't believe that -- and that's unfortunate because, you know, science is truth," said Fauci, director of the National Institute of Allergy and Infectious Diseases.

 

Fauci, who has served six US administrations so far, was seemingly referring to his appearances in White House press conferences during the coronavirus pandemic.

 

"It's amazing sometimes the denial there is, it's the same thing that gets people who are anti-vaxxers, who don't want people to get vaccinated, even though the data clearly indicate the safety of vaccines," Fauci added. "That's really a problem."

 

Here’s another reason. Something bad happens. Its cause can’t be seen. It’s relatively rare but it causes pain and grief. Someone comes up with a theory about something that can’t be definitively and easily disproved quickly. The theory propagates itself or is promoted by people in pain who feel something must be done (and people who want to capitalize on their pain). And then some people who should know better pass it on. Sound familiar? It’s hard to convince people in pain and grief that the theory, any theory, is just not right because something must be causing their pain. And if we don’t have good science to be clear about the cause……

 

OK. So we work in a field based on science and accumulated wisdom. Sometimes we, or the science, is wrong. We learn new things from careful observation, new experience, experiments, etc. Open minds. That’s how science works. That’s how we went from masks don’t help much to masks are essential (in a very short time).

 

But here’s the thing right now. We do know that promoting people being in crowds, without masks, indoors or even outdoors, without social/physical distancing, shouting, singing, is going to promote the virus. That’s for sure. There is no doubt. Some people will get lucky and not get the virus. Others won’t be so lucky. All will pass on their virus to others who were not exercising their freedom to go to the rally or bar without the right precautions.

 

This is not a matter of personal freedom. I can choose to wear a mask because I am free to do so. This is a matter of promoting public health because of the way the virus spreads. You may not care if you get sick, or you may be willing to take the risk, but what about the 10-20 people you pass it to? What’s their choice? And then the hundreds they may pass it to?

 

OK. End of rant. I should try not to watch the news when I get up (at least some days). But as you consider going back to normal activities, please read the “guide” from yesterday’s Update for recommendations on how to do so as safely as possible.

And, in case you need more visualization to help talk with family and friends about the spread issue, Gina shared this:

 

Video by the National Institutes for Technology demonstrates high-speed visualizations illustrating a flow when breathing and coughing using home-made masks. Powerful to see the importance of a mask at all times at work and out in the community.

https://www.nist.gov/video/cover-smart-do-your-part-slow-spread

 

State

 

From the Washington Post today:

 

Massachusetts is setting an example on how to do contact tracing.

The state, the first to create a statewide contact tracing system, organized the Community Tracing Collaborative led by its individual insurance marketplace and its public health department. The collaborative has hired more than 1,000 people working on contact tracing who are supporting more than 1,000 additional contact tracers working through the state's 351 boards of health.

The collaborative consistently has fewer than 50 confirmed cases and contacts that are awaiting outreach, according to Jason Lefferts, communications director for the Commonwealth Health Connector. It has made more than 318,000 calls to cases and contacts, he said. “At this point, Massachusetts is able to keep up on contact tracing.”

 

At VMG

 

Here are some photos of the AMC “Outdoor Office.” Thanks to all of you who have quickly set up these new “facilities” and are staffing them. They will really help us deliver on our promise to get patients the care they need while keeping patients, staff, and practitioners as safe as possible.

 

 

 

 

 

 

 

Our third patient newsletter is “in the mail” (email, that is) this week. If you didn’t get a copy in your email, it will be on our VMG website soon.

 

We will soon begin piloting a new texting platform for communicating with patients at the time of their appointments. It will eliminate the need for patients calling from and to the parking lot when they arrive and it will allow the completion of documents and forms in advance of the visit. It’s from a company called “OhMD” (we’ll take suggestions for a better name later) and it’s HIPAA compliant. We’ll pilot at one health center to prove that it works and that it’s an improvement from what we have now. This is not replacing our use of athena telehealth which is currently rolling out across VMG and is working very well.

 

 

That’s it for today.

 

As always, please continue to be careful and….

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Wednesday, June 17, 2020                                                                                          Issue # 63

 

 

Happy Wednesday. There were no bats hanging around the entrance when I came in this morning. Either they found other places to hang or they can’t afford the copay.

 

At first patients were reluctant to seek care due to anxiety about catching the virus in healthcare facilities. With time passing and with healthcare facilities taking actions to reduce risk, we’re now finding indications across the country that many patients are delaying seeking care because they are concerned about deductibles, copays, and about getting laid off and losing insurance, or both. In Massachusetts, that may not be as big a factor as health plans have communicated that they will suspend most copays and deductibles, at least for COVID-related services, but patients may still have that worry.

 

National

 

Anthony Fauci, the nation's top infectious-disease expert who hasn't been put in front of the public lately, told NPR that vaccine development efforts are proceeding but will take time to meet reasonable scientific standards. And he warned against the idea the United States is in the midst of a second wave, when the first wave isn't over yet. “When I look at the TV and I see pictures of people congregating at bars when the location they are in indicates they shouldn’t be doing that, that’s very risky,” Fauci said in an interview with the Wall Street Journal. “People keep talking about a second wave,” he added. “We’re still in a first wave.”

 

British scientists say the 60-year-old drug, dexamethasone, reduced the risk of death for patients on ventilators by a third, and reduced the risk for patients on oxygen by a fifth. That’s encouraging news because the drug is in plentiful supply (now), cheap, and proven safe. More details about the studies are needed because so far this is just a press release.

 

We will probably see reports, press releases, in the next few weeks about possible other drugs that may be effective in treating COVID-19. We’ll want to make sure that the research is valid and that the data is published and not just in the form of a press release.

 

For now, we need to remember (and help our patients, families and friends remember) that there are not available proven treatments and no vaccine.  So the virus will continue to spread.  Which makes it important to avoid high risk activities.

 

Here’s an article from the Wall Street Journal summarizing what is generally known about how the virus is actually transmitted. Close, sustained and unprotected contact with infected people is the main way to spread the virus. Cleaning high touch surfaces, especially in higher risk areas, can still be important, but “unsafe contact” (unprotected, as in not wearing masks) in enclosed spaces with poor circulation of air (and fresh air) for longer periods in larger groups or crowds is most risky. We need to minimize time in these situations.

 

https://apple.news/AY8ibSXEGQ3mtsxaXlas48w

 

And finally, from The Atlantic magazine, “the theme of the next chapter of the pandemic, then, is choice: Local and state governments are now presenting Americans with a menu of things they can do again. But should they? Because different parts of the country are (and will continue to be) in different stages of their outbreaks, there generally aren’t yes-or-no answers that apply nationwide—in general, it’s better to err on the side of caution. But there are guidelines that can help you think about the safety of everyday activities.”

 

Here’s that link to a very handy guide, by type of activity, as to what’s risky and what’s relatively safe:

 

https://www.theatlantic.com/family/archive/2020/05/restaurants-stores-reopen-dos-and-donts/611314/?utm_source=share&utm_campaign=share    

 

At VMG

 

From Gina:

 

We are now in the second week of Phase 2 reopening of the state, with additional openings on June 29th.  The state is pushing to maximize testing by offering free COVID-19 testing for people who have been in large group gatherings in the past two weeks.  Tests to be done on June 17th & 18th – Please check Gina’s email sent yesterday for locations.  Massachusetts also maintains a robust list of testing locations on DPH website.

 

In operations news, the first day in the ASPC went well thanks to excellent work in planning reopening. 

 

A call with Baycare confirms that VMG is in-step with colleagues in our area re: providing care with VV and gradual approach to opening.

 

We continue to develop a summary of reopening by department; to be available soon. If all goes well, we may potentially have 30-40% of care in health centers returned by fall. 

 

We are continuing with the plan to transition Pedi visits to each health center by July. 

 

VMG Outdoor Offices are continuing to roll out The EHC tent was set up this week. The NHC tent should be set up by the end of this week or the next. We are also working to have BP clinics under the tents. The Outdoor Offices are being used by nursing for immunizations, some treatments and other nurse visits. Some of our specialties are also beginning to use the Outdoor Offices slowly.

 

Lab spaces outdoors continue to be advanced in their “set up” to provide additional safety and space to staff and patients.

 

We are continuing to roll out Athena telehealth across all departments. 

 

We are also working on processes for use of interpreters.

 

Massachusetts had the lowest number of new cases and deaths reported June 16th.

 

 

 

 

 

A little energy from South Africa:

https://www.youtube.com/watch?v=Fmf9ZJ_Yn0A&list=PL1Rse_MfhxenM93JSmAoQNbvvAZhBhD1w&index=14

 

 

 

 

OK. What will I say now? Please continue to be careful and….

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Monday, June 15, 2020                                                                                     Issue # 62

 

 

I hope you all had a good weekend.

 

On Saturday, it was possible to get in your car on the Outer Banks of North Carolina and drive west to Los Angeles and never go through a state where the pandemic numbers were going in the right direction. And this is happening as we are “opening up” for the summer months, demonstrating and protesting in crowds, and contemplating opening of movie theaters (among other public spaces).

 

I heard a discussion this morning about what life was like prior to the discovery of antibiotics and vaccines. We built railroads, mines, and factories. We built and then densely populated cities. And we had a grudging acceptance that some numbers of us were going to die from diseases we could not prevent nor cure. What is different today is that we expect to be able to prevent, if not treat, communicable diseases so that we minimize mortality. Yet we are living with a virus that has no vaccine (the best prevention) and no cure.

 

So all we have is the litany of things under our control that will delay being inundated by the virus. You already know what they are. You just have to remember to use them. And that is the message again, and for quite some time. Even as we “open up,” even as the weather gets better, even as we are out doing more “normal” things, stay alert, stick with what we can do to prevent infection, and stay safe.

 

National, State and Regional

 

On the national scene, people are tired of the pandemic. “Quarantine fatigue” is now a thing. The weather gets better and people wish to resume normal life. The White House Task Force is not visible. Key leaders don’t wear masks in public. People want to bend science to meet public expectations.

 

Politico this morning reports that “52% of reported coronavirus cases in the U.S. are missing information on race and ethnicity.” Why is this important? “We’re flying blind until this comes in,” said Brett Giroir, Assistant Secretary of HHS and coronavirus testing czar. “It’s a flaw in the system. We can’t develop a national strategy to reach the underserved, or know how well we’re doing, until we have the data that shows us if we’re reaching them or not.”

 

Contact tracing is greatly underfunded but states are not waiting to reopen.

 

The good news is that there are now legislative efforts in Congress to make Telehealth a permanent tool in healthcare.

 

Massachusetts is currently one of the states where the numbers are going in the right direction. If you want to see the latest statistics in Massachusetts, go to the DPH Dashboard at: https://www.mass.gov/doc/covid-19-dashboard-june-14-2020/download

 

Looking at statistics from Baystate and Cooley, our local hospital systems are not overwhelmed.

 

At VMG

 

Our third edition of our VMG Patient Newsletter is going to be emailed to patients beginning tomorrow. The Newsletter discusses what we have all done to continue to provide care while keeping our patients, staff and practitioners as safe as possible.

 

Our Ambulatory Surgery and Procedures Center (ASPC) in Amherst reopened today for colonoscopy at a somewhat reduced schedule. The plan is to continue at a slower pace for a while and then open to increased volume as we prove we can handle that volume.

 

On the lighter side of things, a winged visitor was successfully removed from a vestibule at GHC today (he was just hanging around). Thank you, Randy, for your service.

 

 

 

Margit Walker sent me this chart of activities, ranked by risk level, from Yahoo Finance as you consider which activities to resume.

https://scontent.fbed1-2.fna.fbcdn.net/v/t1.0-9/fr/cp0/e15/q65/104236249_10220464215368877_7785438317916658267_n.jpg?_nc_cat=111&_nc_sid=110474&efg=eyJpIjoidCJ9&_nc_ohc=gh6rwn7ogM8AX82kqEZ&_nc_ht=scontent.fbed1-2.fna&_nc_tp=14&oh=ae85c7a1e6d52dd961a9baad0b9e5ce0&oe=5F0D2EE0
 

And, for those of you with children of the Sesame Street age at home, here’s a link to the ABC’s of COVID-19 from Saturday. It should help. https://www.cnn.com/2020/06/13/app-news-section/cnn-sesame-street-abcs-of-covid-19-town-hall-june-13-2020-app/index.html

 

 

And again, please continue to be careful and….

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, June 12, 2020                                                                      Issue # 61

 

 

Good afternoon and happy Friday.

 

In a strange twist on what reopening means for certain providers in states that are “ahead” of Massachusetts, there are reports that doctors are informing patients that they “aren’t doing telehealth anymore because of reopening. So you can’t stay home.” I’m not sure how widespread this is, but it is clearly the wrong direction. I’m certain that we will be doing telehealth either instead of some visits or as part of hybrid visits on into the future. A lot will depend on whether the payers will support these visits but, even if they don’t’, we’ll be finding a way to continue to incorporate some forms of telehealth going forward.

 

National, State and Regional

 

More states (Massachusetts is not one of them) are reporting either “spikes” in cases of COVID-19 or hospitalizations. Most of them were in reopening phases and some never effectively shut down. Texas, Florida, Georgia, Arizona, and California are on this list. Utah is one of the few states that have halted its reopening plans, though others are considering. The key point here is that it is very difficult to go backwards once you’ve gone ahead too far.  It’s hard for businesses, the public and even healthcare providers to “yo-yo” on reopening once the door has been reopened.

 

I’m sure you already know this. Here’s what we know for sure. The virus is still here and “out there.” It’s still highly contagious and dangerous. There is no vaccine and no real treatments. And the good news is: masks really do help and social/physical distancing really does help. And this is more and more important as people “widen their circle of contacts” with reopening. That’s what we have for tools now. That’s what we have to use (and VMG’s plans for “reopening” rely on these tools). Please guard against complacency. And help your patients, family and friends to do the same.

 

Oh, and even the Queen of England is doing video calls. CNN reports today that Queen Elizabeth, age 94, conducted her first-ever virtual conference.

 

There have been some news reports on the use of “convalescent plasma” to treat or reduce the symptoms of COVID-19. To date, there have been no reliable studies indicating that this is an effective treatment. There are also news reports today that use of the polio and/or TB vaccines in patients with COVID-19 may amp up the immune system so that cases are briefer and/or less damaging. There are no studies yet to prove these theories.

 

Our state continues its reopening plan. We’ll know how well this works in 2-4 weeks. Our region, so far, has been spared the worst of the pandemic with very low numbers of cases per capita compared to the rest of the state.

 

At VMG

 

We are continuing to redesign or modify our processes of care to reduce time spent in enclosed spaces in or buildings (15 minutes or less) and proximity for patients and staff, as possible. The “dream” of not having waiting rooms has been achieved by necessity.

 

We will continue telehealth and hybrid visits as much as possible and we should be bringing patients into the centers only for conditions and instances in which the clinicians and practitioners believe it is necessary for care.

 

Our goal is to do most in person care outside where open air helps to dilute the viral content. And when we do bring patients in, we have to guard against bottlenecks at the front doors, on the way to exam rooms, and on the way back out. That is why we are planning more hybrid visits: do whatever we can virtually pre-visit, limit time in exam rooms, and do virtual visits for post-exam discussions and recommendations.

 

We’ll be increasing the number of virtual wellness visits over the summer. These visits are especially well-suited for the current necessity.

 

We are working hard to increase our supply of necessary PPE for all clinical situations, the ASPC (which reopens Monday), and staff and patients. Thanks again to Val Felton and Amy Rice for all the work on inventory and supply management of PPE.

 

Some news from some of our sub-specialties:

 

Rheumatology is accepting new patient consults, virtually. They are also doing follow-ups and some injections for urgent clinical needs (while observing all the cautions for PPE, time in rooms, etc.). They are also seeing some patients in patient cars in the parking lot to get a look at inflammations, etc. when necessary.

 

Podiatry is also seeing new patients virtually as well as follow-ups. For patients with infections, pain, trauma, and for wound care, visits can be arranged in person observing all the cautions. EHC is their main location for now.

 

Sports Medicine is seeing new patients by virtual visit. Dr. Murphy is doing injections for patients in significant pain or, as necessary, after clinical prioritization and virtual evaluation/consult. He is only seeing patients in-person, when necessary, at EHC.

 

Finally, we’re hearing good reports about the video component integrated with athena. It provides better video clarity, seems more stable than some of the platforms we’ve been using and, for patients, no downloading of apps or programs are required. It’s been rolling out through primary care the past week or so and we expect it to be VMG-wide in the next few weeks. Once we are all up on athena video, it will be the only platform we’ll support. So, as your opportunity arises, please learn the steps to make it work (it’s pretty easy).

 

 

OK. Have a great weekend; the weather should be good so try to get outside.

Here are a few tunes, including one of my favorites, Brothers in Arms.

 

https://www.youtube.com/watch?v=Z3_HTGdLXL4

 

 

And let’s not forget Paul…..and friends….

 

https://www.youtube.com/watch?v=-mJt_T0N0mQ

 

 

And again, as usual but even more important now as things continue to open up, please be careful and….

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Thursday, June 11, 2020                                                                                                Issue # 60

 

 

Good afternoon. We made it to Thursday again. The latest high level information on the pandemic, from Politico, follows.

 

“It’s too early to talk about the pandemic’s second wave: The United States has yet to emerge from its first wave of coronavirus.

 

Covid-19 has now spread to every state — and almost every county — in the country. About 5,000 to 6,000 Americans are expected to die every week from Covid from now until July 4, said Nicholas Reich, a professor of biostatistics and epidemiology at the University of Massachusetts, Amherst, who has been aggregating Covid forecasts.

 

Because the virus has been on the decline in New York, total Covid case counts and deaths in the U.S. don’t seem to be steeply rising. But in many places they are: New hotspots are continuously emerging across the country. Eighteen states are seeing an increase in Covid case counts, including sharp increases in Arizona, Florida and Texas, according to Covid Exit Strategy. Hospitalizations have been rising rapidly in at least nine states since Memorial Day. The country is rapidly approaching 2 million cases.”

 

I was on the phone with someone from Arizona this morning who said that people there are “complacent” and mostly acting as if nothing was happening. And yet they all know that their hospitals are being overwhelmed.

 

The key message is stay aware and stay safe.

 

State and Regional

 

Key metrics for reopening Massachusetts continue to move in the right direction. The Governor’s plan is continuing. You’ll see more road and foot traffic as the month goes on.

 

At VMG

 

As we continue to slowly reopen (remember the SOCHO: provide the best care as safely as possible for patients, staff, and practitioners), it may get confusing about where we are in the process. We are working on a document that will list services by departments and their status at VMG. In the meantime, here are some current highlights.

 

From Steve:

 

Although schedules had been light in April and May, we are seeing significant increases in numbers. Overall, VMG family practice is booking about 90% of last year’s volume with some practitioners booking 125%. Coming up, there are 1400 virtual prevention visits scheduled June thru July –these were not being scheduled in previous months.

 

For the short term it is important that we all work to get schedules filled, practitioners working with assistants and reception to make sure all of our high risk and chronic disease patients are scheduled for virtual visits. Please make sure that our messages to patients about video and telephonic visits include the feedback from patients that they are helpful and productive for patients.

 

Lab volume is presently at 2/3 of last year and rising. Having labs available will

Continue to help make virtual visits more productive.

 

We are also working on developing Vital Sign stations in our VMG Outdoor

Offices. The availability of vital signs will also help make virtual visits more

productive.

 

From Gina:

 

As we continue to schedule virtual visits, it is very important to convey key

information to each patient with every appointment made:

 

     Video visits are preferred over telephone visits, and whenever possible, when scheduling offer video as the preferred appointment type.

     Please thank the patient for scheduling the video/telephone appointment, and state that their insurance will be billed as we ordinarily bill for appointment in the health center.

     If a patient were to have additional questions about insurance, you may share: “Most payers are not imposing cost sharing (copayments, coinsurance, or deductibles) for virtual visits.  However, please check with your insurance on whether your insurance has any cost associated with the visit.” Many payers have already communicated with their members about their copay and patient responsibility policies.

 

We are getting requests for many documents utilized in clinical care to be

made available on the internet for patient access.  Work is being done to

identify key document to be placed on line.

 

Finally, planning underway for the Lab Draw station to open in Greenfield at

7am for additional patient appointments.

 

 

 

OK. So let’s say you are tired of being stuck at home and you find a way to travel to a national park to observe wildlife. Here’s a piece from National Geographic with some advice on caution for these activities:

 

“By Rachael Bale, ANIMALS Executive Editor

The first day of summer is almost here, and people are eager to get out in nature. National parks in the U.S. are slowly starting to open, and that means wildlife once again will be sharing their habitat with tourists. Already some trails are crowded and people are behaving recklessly. And I’m not talking about a lack of social distancing from fellow humans in the parks. People aren’t keeping their distance from wildlife.

There already has been at least one injury this season because someone wanted to get up close and personal with a dangerous animal in a park: In Yellowstone last month, a woman was knocked down by a bison after getting too close.


With that in mind, please do not touch/feed/attempt to take selfies with wild animals. Squirrels look cute, but they won’t hesitate to bite. Bison look slow-moving, but they’ll charge in a split second. Elk will gore you, and moose will trample you. No matter how long you’ve been stuck inside your home, don’t greet alligators. And bears ... well, everyone knows bears can be dangerous.

To stay safe around wildlife, use common sense and give animals a lot of room. Remember, approaching an animal doesn’t just put you at risk—it puts the animal at risk, too.”

 

 

Here’s a different take on Imagine….

https://www.youtube.com/watch?v=mVAQl7qq-aI

 

Finally, as usual but even more important now as things begin to open up, please be careful and….

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Wednesday, June 10, 2020                                                                                          Issue # 59

 

 

We’ve all been coping with this pandemic for about 3 months now. It’s forced an enormous amount of change and worry in healthcare and across the country. And as you know, there are no great answers now to how we will “get back to normal.” We will go slow and steady, balancing patient needs with risks to patients, staff, and practitioners.

 

We’ve been coping with the economic crisis caused by the pandemic for about the same amount of time and we are now officially in a recession. And there are no clear answers to how long it will go on and to the best steps to improve the economy in a way that lifts everyone up and is as safe as can be for now.

 

We’ve been trying to cope with racism, overt and systemic, for the last 400 years and we know we have not solved that problem. We see it when incidents of brutality are caught on camera. We know there is more that we don’t see….unless we look. And we, as a country, are now looking. And we know it’s uncomfortable (though not nearly as uncomfortable as years of discrimination) but it must be done.

 

I watched video of the funeral of George Floyd yesterday and heard the sermons, saw the anguish, but also the possibility for hope. Martin Luther King Jr. said “God has a way of wringing good out of evil.”

 

The pandemic. The economy. Racism, policing. We can feel overwhelmed. We will feel overwhelmed. But we must not allow ourselves to stay overwhelmed.  There’s much to do. All the time. Steps are required. Small steps are better than no steps. Talking with each other is a step. Next week I’ll be sending you an invitation to a “VMG Community Forum” to discuss what we are learning and what we can do. I hope you will join me.

 

National, State and Regional

From the Washington Post:  More than a dozen states and Puerto Rico saw their highest new case averages since the beginning of the pandemic. In nine states — Texas, North and South Carolina, California, Oregon, Arkansas, Mississippi, Utah and Arizona — hospitalizations have seen an uptick since the holiday weekend.

Massachusetts continues its reopening plan in Phase 2. You’ll see more and more people out and about, hopefully wearing masks and keeping their distance. More retail is open. Movie theaters are talking about reopening in July. More choices mean more need to balance risks with economic improvement and comradery and enjoyment.

Locally, I heard that one of our hospitals had very few COVID-19 cases two weeks ago and now has 20 or so. We’re not certain as to whether this is just a random change or the beginnings of a more widespread uptick.

At VMG

 

The third edition of our patient newsletter will be going out via email blast early next week. We will again be talking with patients about our availability to meet their needs balanced with our precautions to keep them, staff, and practitioners as safe as possible.

 

From Gina:

 

VMG has reviewed all the requirements for Phase 2 reopening and signs are going up attesting that we met DPH expectations.

 

Significant planning and preparations for ASPC reopening has been completed and the first patients are scheduled for June 16.

 

“The VMG Outdoor Offices,” tents, in each of our center’s parking lots is continuing to expand and proceeding slowly to expand care with nursing visits.  We are working on providing some cooling for the hotter days ahead.

 

From Debbie Bolognani:

 

Effective Monday 6-15-20, the EHC Phlebotomists will be located under the white and black tent in the front of the building.

 

  • There will be lab signs posted out front.

  • Patients will be directed upon scheduling and arrival to call the lab phone number x3808 (413-282-3808).

    • When scheduling a patient for MO-10(outside draw), please direct the patient to park in the parking space nearest the front of the tent on the other side of the handicap spaces.

    • Upon arrival patient will call 413-282-3808 and check-in with the phlebotomist.

    • Make sure that patient waits in their car until phlebotomist comes to get them.

    • Face covering is mandatory.

    • Patients picking up collection containers or dropping off specimens should use the same process.

  • Lab will continue to utilize drawing station to accession and process specimens.

 

There will be a bit of a transition with patients presenting to the front of the building because they were scheduled prior to Monday. Please be kind, and patient, and help our patients learn the new process.

 

 

 

Here’s a link to a WBUR (Boston) Town Hall on How America's History With Race And Policing Holds Us Back From Reform:

 

https://www.wbur.org/radioboston/2020/06/03/americas-history-race-policing

 

How America's History With Race And Policing Holds Us Back From Reform | Radio Boston - wbur.org

As we continue our discussion about race and policing in America, we look at the issue from a historical perspective with Khalil Gibran Muhammad. He is a professor of history, race and public ...

www.wbur.org

 

 

Finally, as usual but still as important now, please be careful and….

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Tuesday, June 9, 2020                                                                                                                    Issue # 58

 

 

We continue to “reopen” across the country while the virus is still here and there are no effective treatments and no vaccine. And in addition, what some have called the “urgent moral stakes” of our time is forcing many to make choices between staying safe (or safer) and participating in vital protests and calling for reform in public spaces.

 

Arizona and other previously “safer” states are now experiencing a surge in COVID-19. Probable cases have been undercounted in many other states. We have not yet begun to see the effects of the protest marches and responses to the marches on the rates of infection. Add to that the effects of tear gas and pepper spray on the lungs of protestors, and crowding of those arrested, and you have what Anthony Fauci calls the perfect recipe for spread of the virus.

 

Yet some hopeful things are happening. First we have the public protests and outcry to finally deal with racism and racial disparities in health as well as in policing. The governor of Kentucky, Andy Beshear, cited the racial disparities in health care that have been underlined in the state by the pandemic. 

 

“In our health-care system, the inequalities have been laid bare and exposed by this covid-19 pandemic and the results of inequality in health care have been shown in depth,” Beshear said. “By allowing this type of inequality to exist for as long as it has, we see African Americans dying at twice the rate that they make up of the population … it shouldn't have taken this pandemic or these demonstrations for us to commit to ending it." He is calling for providing health insurance to all black (and presumably all) residents in his state.

 

Around the country there is finally some acknowledgment of the effects of racism on health and mortality. Gaps of 10 or more year’s life expectancy in nearby or neighboring zip codes are not uncommon. Why? It’s what we’ve called “social determinants” and the “social gradient.” The social gradient in health is a term used to describe the phenomenon whereby people who are less advantaged in terms of socioeconomic position have worse health (and shorter lives) than those who are more advantaged. There is good data that early child development and the future ability to function fully in society is related to poverty and the social determinants. This suggests that education, in our traditional view, is not enough. Early childhood education benefits all children. And the benefit for children in poverty is greater (and therefore a help in later efforts to take advantage of education).

 

A final sad irony: It’s been reported that George Floyd survived COVID-19 in April but died under the knee of police in May.

 

Some people are finding ways to protest more safely. In Oakland, the “caravan for justice” has protesters in cars gathering to be part of the movement. And many protesters are now wearing masks (after going without for a while).

So we have the pandemic, the economic meltdown (which affects minority neighborhoods and families more), and the realization of years and years of social injustice coming to everyone’s attention now.

 

What to do? Keep talking, keep activating whatever channels you have to not let this moment slip and finally, let’s consider restorative justice. Here’s an idea that’s been discussed before and may be closer to reality now. In South Africa they started a Truth and Reconciliation Commission after Apartheid. Here’s a link: https://www.justice.gov.za/trc/  Think about it. Consider this approach (or something like it for the U.S.) and talk with your neighbors and your senators and representatives.

 

State and Regional

 

The state now has the capacity for about 30,000 tests per day but only about 8000 are being done. We’re not sure why, especially since we were an early “leader” in testing.

 

The governor is proceeding wit Phase 2 reopening. This is the second day. Across the Commonwealth, business owners are trying to consider all the steps in reopening as safely as possible. But there really is no roadmap in our times for this. We’re going to learn what works and does not work as we go. But it does seem certain that social/physical distancing will be with us for a long time.

 

At VMG

 

Our SOHCO (Single Overriding Healthcare Communication Objective) remains provide necessary care as safely as possible for our patients, staff, and practitioners. Practically, that means staying vigilant for possible improvements and spotting problems as they develop.

 

Information for Gina:

 

Governor Baker announced Phase ll for reopening the State bringing additional requirements to health care.  These are being reviewed by the Senior Leadership Team and appropriate guidelines are in development.

 

ASPC is opening scheduled for June 15th. Patients are being notified.

 

Even though some parents are still hesitant to schedule Pedi Wellness visits we are ready for them. Both EHC & NHC are now ready for these important Pedi visits.

Mobile lab draws at AMC started yesterday and went well.  We are fine tuning lab station placement today.

 

Athena telehealth continues to be going well with EHC & AMC starting today. GHC will be next.

 

 

 

Please be careful and….

 

·         Please wash your hands (often),

·         Don’t’ touch your face,

·         Maintain social/physical distancing (it works),

·         Definitely wear a mask (it is not a political statement; it’s a public health good),

·         Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Monday, June 8, 2020                                                                                                                    Issue # 57

 

 

I hope everyone had a restful weekend. Massachusetts is “reopening” the economy today. We’re in Phase 2 of the Reopen Massachusetts Plan. You can see an extensive list of what’s allowed to open and restrictions here: https://www.mass.gov/news/reopening-massachusetts-baker-polito-administration-initiates-transition-to-second-phase-of

 

With everything reopening here and around the country, and with all the protesting and marches, it’s still very important to remember that there is no treatment and no vaccine. We all need to keep up our vigilance and avoid spreading the virus as best we can.

 

In an article in the New York Times on Saturday, Roni Caryn Rabin wrote that reopening is far more complicated than locking down. When we closed the economy, the rules were simpler. Stay home. Only go to work if you have an essential job. But reopening requires a lot of planning and thinking about decisions and things that used to be “automatic.” So she suggests remembering the 4 C’s to help think about what to do and what not to do:

 

  • Contact

  • Confinement

  • Crowds

  • And reasonable Choices.

 

It’s not unlike what we’ve been talking about for the last 7 weeks or so. For Contact, maintain social distancing, always use masks, wash your hands a lot and no handshakes.

 

Avoid sustained contacts (15 or more minutes) in Confined spaces. Use the open air wherever possible. If indoors and social distancing is limited, open windows and make sure air circulation and venting is good.

 

Avoid Crowds whenever possible. People like to go to restaurants and bars and the reopening plan permits outdoor dining now. But remember that we still have to think about how we interact and that alcohol tends to get in the way of judgment.

 

Finally remember that when you make Choices you’re not just choosing for yourself. When you make a choice to relax social distancing or get into crowed spaces, you’re also bringing that “choice” home to your families, neighbors and friends.

 

 

The Boston Globe released a brief video detailing how the virus spread in Massachusetts. You can see that video here:

https://www.facebook.com/globe/videos/259758518464773/

 

There’s going to be a lot of pressure to get “back to normal.” Hundreds of thousands of people will be returning to work or out and about in cities across Massachusetts, New York and New England. Watch the video and let’s be more careful now.

 

National, State, Regional

 

There is still varied experience with the coronavirus across the country. Some areas, including most of the northeast, are seeing declines in new cases while others are seeing increases. We don’t yet know the effects of the mass protests on viral spread but we can expect it may be significant.

 

There continues to be talk about a “candidate vaccine” being ready for early 2021 but it really is too soon to tell how much of this is wishful and desperate thinking, how much is tactical marketing and promotion, and how much is scientifically feasible.

 

The focus has shifted in our region and across the state to bringing patients back to care as safely as possible (for patients, staff, and practitioners).

 

At VMG

 

From Gina:

 

We are in the process of continuing to review Phase 2 requirement for healthcare organizations and for VMG.

 

Our Severe Weather Conditions policy will be revised to provide guidance for care being provided outside of the health centers and for steps to support safety for staff and patients at all times. The revised policy will be sent out as soon as revisions are completed.

 

We have developed a role for a Health Care Greeter to support main entrance screening functions and foot traffic control. This will be a temporary position for the summer months.

 

 

Finally for today, Anne Applebaum, writing in The Atlantic about how politicians and others have “collaborated” on supporting positions and actions that would have been considered antithetical to their beliefs. Here’s her final thought from that article:

 

“I leave anyone who has the bad luck to be in public life at this moment with a final thought from Władysław Bartoszewski, who was a member of the wartime Polish underground, a prisoner of both the Nazis and the Stalinists, and then, finally, the foreign minister in two Polish democratic governments. Late in his life—he lived to be 93—he summed up the philosophy that had guided him through all of these tumultuous political changes. It was not idealism that drove him, or big ideas, he said. It was this: Warto być przyzwoitym—“Just try to be decent.” Whether you were decent—that’s what will be remembered.”

 

Good advice, I think.

 

And now, this….

 

  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  •  Definitely wear a mask (it is not a political statement; it’s a public health good),

  •  Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, June 5, 2020                                                                                            Issue # 56

 

 

 

We’ve reached the end of a very somber week. But not the end of our hope for progress against racism, health and social inequities, and brutality in all its forms. I was listening/participating in a town hall last night with some very angry young black men, ex-gang bangers. It was difficult to listen to the pain and despair. But then, in the midst of all the invective, you could hear the wishes to be a part of things, to participate, to provide for their families and children.  One of the key things talked about was health care access. And access to good food (“not the bodega on the corner filled with junk food”). And safe streets. And good, public education. Those are the hopes. Sound similar to your hopes? Can we find a way to help people participate in the promise of our society? Can we stand together?

 

Having participated in the 60’s struggles for equality, this all feels eerily familiar. But my wife has pointed out to me that there is something this time that does seem different. There are a lot more younger people, people of all races, involved. Maybe that will do it, move us forward. We’re going to find out. Let’s work together.

 

For those of you with young children (or even for those that don’t have young children at home), CNN and Sesame Street are presenting a Town Hall tomorrow morning, Coming Together: Standing Up to Racism. It’s on CNN at 10AM. I’d recommend it for all of us.

 

Paul Carlan told me about a story on NPR yesterday entitled Too Much To Lose: How A 'Very Strategic' Holyoke Protest Delivered Message Without Incident. There are ways to come together that work for all. Here’s a link to the story:

 

https://www.nepr.net/post/too-much-lose-how-very-strategic-holyoke-protest-delivered-message-without-incident#stream/0

 

National, State and Regional

 

It’s been about 2.5 months since the pandemic “hit.” That’s enough time for the word to get out about the measures we have taken (social distancing, etc.) as well as for fatigue to set in with those measures. And then we have the more recent demonstrations for social justice that have, to a large extent, captured us all and led to many people “relaxing” the social distancing, mask wearing, precautionary measures against the virus. Here is the message again: stay vigilant. If you (or friends or family) are going to protest, stick with wearing a mask, try to stay at a distance wherever possible and help others to do the same, as possible.

 

We’re starting to see reports in the news about vaccine production starting. That’s good for the supply line getting established but the vaccines have not yet been studied enough and they have not yet been proved safe and effective. It will be many months before that is established. So, as a reminder, the vaccine producers are starting the supply chain hoping to be ready if and when they are proven. We can’t count on that yet.

 

In the meantime (or in “quarantine time” as Stephen Colbert says), across the country, the Washington Post reports that at least 1,864,000 cases have been reported; at least 106,000 have died. And the CDC Director testified that he is worried that Americans are not following COVID-19 advice whether because they are participating in rallies protesting racial injustice, crowding into pools and parties (as they did recently in Missouri) or watching the recent SpaceX launch together. “Public health messages on masks and social distancing are not resonating with the public.” We can do something about that. Talk it up. As gamblers return to Las Vegas, they are probably gambling on more than just their short term “fortunes.”

 

We’ll hear from the Governor tomorrow about whether Massachusetts will continue to Phase II of reopening on Monday. Cases and mortality numbers in the state seem to be going in the right direction for now. Our region is especially stable for now.

 

At VMG

 

There is not much new at VMG today compared with yesterday. We are continuing our plans for slow and steady return of services and providing services in alternative, safer-in-a-pandemic ways. Another example from AMC about accommodations, from Amy Rice:

 

“As you know we are moving forward with our outdoor care in the back parking lot with Mobile lab draws starting on Monday June 8th.  The large Outdoor Office tent is also now up in the back, which has displaced Amherst Pediatrics from using the back parking lot.   As of Monday June 8th, Amherst Pediatrics will move to occupy 4 parking spots in the front lot. Amherst Pediatrics will have signs up on Monday designating their spots as their outdoor care parking spots.”

 

From Gina:

 

Staff across Valley Medical Group (reception, triage nurses, medical assistants and even practitioners) schedule appointments with patients. As we do this, in this new world of virtual visits (video and telephone) it is very important to convey key information to each patient:

 

  • Video visits are preferred over telephone visits, and whenever possible when scheduling offer video as the preferred appointment type.

 

  • Please thank the patient for scheduling the video/telephone appointment, and state their insurance will be billed as occurs with an appointment in the health center.

 

  • If a patient were to have additional questions about insurance (reception staff may hear this more often), you may share: “M

 

That’s all for today. Have a great weekend and……

 

  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  • Definitely wear a mask (it is not a political statement; it’s a public health good),

  • Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

 

P.S. Here are a few videos. The first is something/someone we should all watch, listen and hear from time to time but especially now:

 

https://www.youtube.com/watch?v=130J-FdZDtY

 

https://www.youtube.com/watch?v=Aor6-DkzBJ0

 

And finally, to another place:

 

https://www.youtube.com/watch?v=xctzp0dp9uc

VMG COVID-19 UPDATE

Thursday, June 4, 2020                                                                                                                  Issue # 55

 

 

 

“So we beat on, boats against the current, borne back ceaselessly into the past.”

                                F. Scott Fitzgerald, the Great Gatsby

 

This is our tendency; over and over. We get activated, make progress, and then when we lose focus or “return to normal,” we lose that progress. This may be true of how we are dealing with the virus (see below) and it may also be true of how our outrage, concern, and commitment to make change about social injustice, racism, and inequality could get lost and be “borne back ceaselessly into the past.” And we have quite a past. This is our work now as part of our society: for both the pandemic and for social and racial justice. It’s all our responsibility to move forward and continue to move forward.

 

And again, there are continued signs of hope. “It’s a broken window, it’s not a life.” This is a headline in today’s Boston Globe. It’s a statement from a woman who owns a liquor store that was vandalized during the events of Sunday evening in Boston. Here’s how she described what happened (from the Globe story by Janelle Nanos):

 

“When the text message about the looting came, Hadley Douglas, who is white, stayed home with their kids while TJ, who is Black, drove from their home to the South End to check on the store. Then her phone rang: Someone had tripped the store’s alarm, and the representative from the security company needed a password to turn it off. Her mind went blank — they usually called TJ first — and the dispatcher told her she would have to call the police.

“You can’t call the police," she sobbed. Her husband, she explained, "is Black and in a broken-into liquor store the night after protesting and rioting. I need you to hear me when I say you can’t send the police,” she told the dispatcher. “If you call them, you have to understand what you’re condemning him to.”

The dispatcher was sobbing, too — she was torn, and had to do her job — when suddenly the alarm stopped.

TJ had arrived at the store and typed in the security code to disarm it. But the moment underscored the importance of the protests, Hadley says. And it helped inspire the message that she posted to social media that morning. “[W]endows are not lives. Dreams deferred cause rage. Our window is broken but the roots of this are in 400 years of knees on necks.”

The message resounded with Urban Grape’s customers, who responded on Tuesday with the store’s single highest day of sales in its 10-year history. It was one of several area businesses which, despite experiencing theft and damage during the protest’s aftermath, chose to use the moment to help amplify the message of the Black Lives Matter movement.”

 

So that we try not to let the current carry us back into the past, here are some resources sent to me by John Novo this morning:

 

75 things white people can do for racial justice:

https://medium.com/equality-includes-you/what-white-people-can-do-for-racial-justice-f2d18b0e0234

 

Podcast By Malcolm Gladwell - I would also highly recommend his book Talking to Strangers:

http://revisionisthistory.com/episodes/13-miss-buchanans-period-of-adjustment

 

National, State and Regional

 

Let’s start with international, actually. An epidemiologist in Sweden issue an apology for championing the “herd immunity” approach to dealing with the virus. You may know that Sweden was among the most lax governments in ordering social distancing (very little) and protective measures. It appeared for a while that it was working but in the last few days, there are indications that Sweden’s mortality rate is higher than its neighbors. A useful experiment, perhaps, but not a very good result. Elsewhere in the world, the virus is now spreading rapidly in Latin America, South America and the Middle East.

 

In the U.S., the number of confirmed cases is rising but this may be partially the result of increased testing. Another indication of how social policy can affect disease conditions, the number of testing sites available is lower in minority communities.

 

And while testing capacity is up, there are reports that not enough people are seeking testing. Maybe this is the result of anxiety, transportation and other issues, and maybe the result of the economic and social turmoil of late.

 

ER visits across the country have plunged but are now coming back slowly. This is almost certainly due to people being wary of going to the ER and getting exposed and the social restrictions on the ER use (no companions or visitors in places).

 

Another study confirms that Hydroxychloroquine is not effective at preventing COVID-19.

 

And finally, while time has gone by and social unrest has increased and the weather has gotten better and who knows what other factors are at work, there are places that were vigilant before that seem less so now. The virus is still there. Let’s not get “borne back into the past.” Stay vigilant.

 

At VMG

 

From Gina:

 

  • AMC “Outdoor Office” tent in place as well as new tented space for lab draws; both behind the center.

  • Pediatric visits for children 0-2 years of age proceeding well in EHC and GHC.

  • It’s important for all services to work closely in each health center to discuss patient care and those entering the center to maximize social distancing upon entering the health center. 

 

 

That’s the update today.

 

  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  • Definitely wear a mask (it is not a political statement; it’s a public health good),

  • Continue to be in touch with and take care of each other, and help to educate everyone

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Wednesday, June 3, 2020                                                                                            Issue # 54

 

 

 

“Daddy changed the world.” Six year old Gianna Floyd, George Floyd’s daughter, spoke these words yesterday on national TV. (you can Google the video). It is a hopeful wish, one that I hope we’d all like to believe. And there are hopeful signs that this may be one of those moments; that we are at a positive tipping point.

 

There have been others, as well. We’ve seen nurses and doctors joining demonstrations and issuing their own “7 PM tribute” to protestors. We’ve seen police officers taking a knee and joining in walking with protestors. Nike, Netflix, Twitter, Disney, Facebook and Intel all issued statements condemning racism and brutality. President George W. Bush issued a statement saying that “achieving justice for all is the duty of all” and calling for an end to systemic racism. Ben and Jerry’s (btw, new flavor: Justice Remix’d) issued a particularly forceful statement that Mr. Floyd’s death was not just the result of a “bad apple,” but the result of the continued effects of systemic racism and brutality. In other words, these particular policemen on his neck and body is the immediate cause but the hundreds of years of history, inequality and discrimination that created the conditions for those particular officers to treat him this way is, what Michael Marmot, author of The Health Gap: the Challenges of an Unequal World, calls the “cause of the causes.” It’s not enough just to ask what caused a particular incident or condition. You have to ask what led to those causes and what can we do about those.

 

Marmot writes about class differences in key health indicators including life expectancy. There is a reliable and significant difference in life expectancy based on race and class in many “advanced” societies. Usually people agree on the data for these differences but then point to underlying causes, conditions like diabetes and obesity. But what causes, for the most part, those causes? Poor nutrition (“eating wrong”) may be one. But what causes poor nutrition (and “eating wrong”)? It’s not just about choices. It may be about not having affordable and reliable food sources somewhere in the neighborhood. You get the point. We have to learn to think differently about disease and the conditions that make those diseases more likely (it’s what we now call the social determinants of health). And then we have to think about how inequality and particularly historic and systematic inequality caused that.

 

Some telling data can be found at: https://www.cnn.com/2020/06/03/politics/black-white-us-financial-inequality/index.html

 

Closer to issues in our pandemic, so far the death rate for African Americans is about 23% but their percent of our population is about 13%. This is a public health emergency just as is the pandemic.

 

What to do? Today President Bush said “the only way to see ourselves in a true light is to listen to the voices of so many who are hurting and grieving. Those who set out to silence those voices do not understand the meaning of America – or how it becomes a better place.” So please listen, consider, and talk with each other, friends, neighbors and family. It’s a process and talking and listening and dialogue is important.

 

National, State and Regional

 

The original hotspots for the pandemic are all showing signs, for now, of improvement (meaning lowered 7 day averages of new cases and deaths). However, we are seeing increasing rates in places that were not as affected previously (mostly in the west and southwest but also in the heartland).

 

You’ve also seen pictures of police and demonstrators out without masks. They are outdoors but we don’t know what will happen to new cases of COVID-19 as a result. It seems that there will be increased transmission of the virus.

 

Anthony Fauci, M.D. is saying that we will have 100 million doses of a “candidate coronavirus vaccine” ready by the end of the year. That is good news but it does not mean that the vaccine will be safe and effective. The vaccine will go into Phase 3 trials (with volunteers) this summer. The news here is that the company/companies are going ahead with production even before the vaccine is proven so that it can be ready if it works. Hope is good, but be ready for the need for more time.

 

At the state level, the governor is still hopeful that Phase II of Reopen Massachusetts will begin next Monday (he’ll make an announcement on Saturday).

 

At VMG

 

We are continuing to phase in services that have been reduced or postponed since the start of the pandemic. We need to make sure that you and our patients know that our overriding objective is to continue with necessary care while keeping patients, staff and practitioners as safe as possible. That’s the reason for the slow and steady approach.

 

An example of a changed but safer lab process, at AMC, from Debbie Bolognani:

 

“Effective Monday 6-8-20, the AMC Phlebotomists will be located at the back of the building under the white and black tent closest to the back door.

 

  • There will be lab signs posted around the building to direct patients to the reserved lab parking spaces.

  • Lab Check-in will be occupying the back entrance space at phone number x4317 (413-256-4317)

  • Patients will be directed to drive to the designated parking space in the back parking lot

  • Upon arrival, they will call 413-256-4317 and check-in with the phlebotomist

  • Patients will be asked to wait in their car until a phlebotomist comes to get them

  • Face coverings are mandatory

  • Patients picking up collection containers or dropping off specimens, should use the same process

 

There may be a bit of a transition with patients presenting to the front of the building because they were scheduled prior to Monday. Please be kind, and patient, and help our patients learn the new process.

 

Thank you in advance for all your help and flexibility during this transition.

Please let Debbie or Meghan Hart know if you have any questions or concerns.”

 

 

 

OK. That’s it for today. Here’s something from Alvin Ailey:

 

https://www.youtube.com/watch?v=TqfBIdHJnho

 

And, of course,

 

  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  • Definitely wear a mask (it is not a political statement; it’s a public health good),

  • Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Monday, June 1, 2020                                                                                                    Issue # 53

 

 

 

I usually start by hoping that you had a great weekend. And I do hope that is true. But how to start our work following a week of multiple and ongoing tragedies? So here is my opinion.

 

I know that most of us were watching and reading about the events in Minneapolis (and across the country) this week. We were all affected: maybe disheartened, maybe anxious, maybe depressed, maybe heartbroken. The pandemic, the economic fallout of the pandemic, and now the ongoing and brutal effects of discrimination and its results gets to us. And yet we have to go on and do our jobs.

 

I was talking with my son this weekend. He founded and runs a non-profit, helping former gang members and felons in the Boston area to cope with life and re-enter the community focused on participating in society, working, and avoiding recidivism. His students, his “guys” he says, are not particularly angry right now. They just don’t expect much to get better based on history (the recent week, the past months, the past one hundred years).

 

As we were talking, I realized that not expecting better is almost worse than giving in only to anger or violence. They should expect better. We should all expect better. We are all affected. Not just by riots, arrests, and the economic fallout. It’s also the psychological damage. And the lost hope for better lives and a better world for all our kids, our friends and neighbors and our families. And that is another public health emergency and tragedy.

 

How does this relate to us in healthcare? At VMG? It’s a matter of public health. The

American Academy of Pediatrics, American Medical Association and American College of Physicians – this morning are all emphasizing that racism is a public health issue. Incidents of brutality and abuses of power are a public health issue. Lost hope and despair are public health issues (anybody ever thought something like why bother to exercise or “eat better” if….?). 

 

These are hard issues. But there are some great signs of hope even in the midst of the chaos. You might have seen them. There were police chiefs in several cities walking into crowds of protestors starting conversations, talking, and really listening. There were police officers “taking a knee” with protestors, marching with protestors. There were mayors inviting discussion while insisting on saving their communities from destruction.

 

Owners and managers of some of our biggest corporations are speaking out, with their employees, and to their customers to embrace change at a basic level and work against racism. Here’s an example from a letter to the employees of Nordstrom:

” This is a painful time for our country and for us. The events going on around all of us are heartbreaking and we want to share a few thoughts with you. 

Like so many of you, we have been deeply saddened and angered by recent events in our country. The senseless deaths of George Floyd, Breonna Taylor, Ahmaud Arbery and too many others reflect the deeply ingrained racial prejudice and injustice that still exists in our communities today. 

It is stirring many emotions, which it should. The unnecessary and unjust killing of anyone must not be accepted. The issue of race and the experiences of too many people of color cannot be ignored. We owe it to our employees, our customers and our communities to be very clear in condemning these acts of violence. They represent a disregard for basic human rights that has no place in our communities or country.”

What to do? Read President Obama’s piece published today for a start. This is not political. It’s human rights, basic and necessary. And necessary for public health and child and family development.

 

https://medium.com/@BarackObama/how-to-make-this-moment-the-turning-point-for-real-change-9fa209806067

 

I’m happy to talk and hear what you are thinking, if you wish.

 

State and Regional

 

Our state is still on track with reopening statistics. We may see some spikes in infections as we go and the Governor is going to pace reopening based on the key numbers (average infection rates, hospitalizations, etc.). Social/physical distancing, wearing masks, handwashing, etc. are the key tools we have now and we know that they have helped so far (but as we reopen or as we abandon these tools in large gatherings, we may see some spikes, as well).

 

Locally there have been no big changes. We still see more fallout in nursing homes but the hospitals are doing well in keeping up with cases (and some hospital are actually seeing decreased admissions compared to a “normal” time).

 

News from Gina follows:

 

 

 

 

Here’s a piece of music that seems appropriate for now. Sting had been rehearsing with an incredible band at a property in Tuscany for a concert. They were ready to go the next day. The concert was scheduled for about 200 people. The date was September 11, 2001.

 

https://www.youtube.com/watch?v=ubWucJtio0M&feature=youtu.be

 

Here we are twenty years later. I hope we can all recognize how fragile we are and bring all our will and purpose together… together… to find a better way to be with each other, and for each other.

 

 

Be well,

 

Joel

Be patient; be mindful

 

P.S. Last week, Friday, I said that the Big E and the Three County Fair were canceled. I mis-read the article in the Recorder. Actually it said that planning was continuing but that they were continuing to monitor the effects of the pandemic on the plans.

VMG COVID-19 UPDATE

Friday, May 29, 2020                                                                                       Issue # 52

 

 

 

It’s Friday and it looks like a beautiful weekend with lower temperatures and humidity. Please enjoy it.

 

National, State and Regional

 

The pandemic is not over and it’s not time to take off the parachute (see yesterday’s Newsletter). Some states are still seeing rises in cases and hospitalizations. Others are seeing slow decreases. The advice is still the same: No treatments yet, No vaccines yet, keep wearing masks and social/physical distancing.

 

The Boston Marathon, rescheduled to the fall, has now been cancelled (this has never happened before). The Big E and the Tri County Fair have also been cancelled. The Franklin County Fair is still scheduled but being considered.

The state is still in first phase, “Start,” of the Reopen Massachusetts plan. That plan guides our reopening as well. The Governor has just announced that, if the health metrics continue to look good, restaurants in the state could reopen for outdoor service as soon as June 8.

 

Locally, our hospitals are still in good shape with just a few COVID -19 cases. They are all considering and/or encouraging starting up high priority procedures and hospitalizations that were cancelled earlier or postponed. It’s too soon to know how many patients will want to have those procedures at this time.

 

At VMG

 

We’ve just completed our second series of Virtual Brown Bags and I want to thank you all for participating. We’ve had some good questions and ideas and we’ll work on those going forward.

 

Diane Alpern shared a resource for food. Go to foodbankwma.org and click on “get help” to see a listing of available food resources for patients and others by zip code. Thanks, Diane.

 

Here’s our SOCHO (Single Overriding Health Communication Objective) for ourselves and our patients: we want to provide necessary care to those in need while keeping our patients, staff, and practitioners as safe as possible. Here is the plan, from our Medical Director:

 

We are slowly moving forward on bringing some patients and procedures back into the health centers. This process will move forward slowly and methodically.

 

We are still in Massachusetts stage 1 reopening- the emphasis is still emergent and semi-urgent care, we should not be doing routine procedures or routine in person visits.

 

We will be starting diagnostic mammograms for 6 month follow-ups this week.

 

We will likely be starting colonoscopy for bleeding or cancer follow-up mid-June.

 

We will see some non-routine eye care visits starting end of June.

 

All specialty and primary care visits should start with a virtual visit. Patients should only be scheduled for an in-person visit for a significant need such as persistent pain that cannot be managed by home/self-care. An example is ear lavage – not hearing due to cerumen impaction should be considered routine – encourage home care such as “debrox,” etc.  Significant ear pain which cannot be resolved virtually or with home care can be seen, if needed.

 

Another example: routine nail care even, if nails are quite big, can be considered routine care. However, toe pain interfering with the ability to walk, evaluated after a virtual visit, would be something which could be seen in-person, if deemed necessary.

 

These are examples at this stage of reopening. The principle involved is our SOCHO. We need to be balancing the risks of spreading infection with the necessity to deal with a condition that is significantly hurting or interfering with the patient’s life. Things will change at the next stage and as we gain experience in improving processes for care in the COVID-19 world.

 

An example of the complexity involved: as we open AMC to more radiology, more cases in the ASPC, more primary care, we’ll have more patients at the front door. There is also a pediatric and dental practice in the building. Prior to COVID we didn’t think much about foot traffic entering the building. Now we have to do screening and we have to manage the foot traffic so that patients are appropriately spaced coming into the building and not lining up and bunched for screening. And we don’t want patients in the waiting areas. This will require re-thinking how we space appointments and also allow enough time for exam rooms to be “refreshed” and cleaned. We have several work groups on this now. We’ll be ready. And thanks in advance for your help and ideas.

 

As an example of the work and complexity involved, I’m attaching a plan sent by Amy Rice for our Outdoor Office at AMC and all the changes necessary to make that work safely.

OK. That’s it for today. Have a great weekend and…wait for it….

 

 

  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  • Definitely wear a mask (it is not a political statement; it’s a public health good),

  • Continue to be in touch with and take care of each other, and help to educate everyone.

 

Let’s find our way together:

 

https://www.youtube.com/watch?v=G8nWtXp7ns4

 

Outdoor care and back parking/entrance update

 

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Thursday, May 28, 2020                                                                                                                 Issue # 51

 

Here’s an analogy for you:

 

"The curve is flattening so we can start lifting restrictions now" = "The parachute has slowed our rate of descent, so we can take it off now". 

 

No. We can’t do that. Yes, we see the Massachusetts numbers improving with lower numbers of deaths and hospitalizations. But, no, this is not over, the virus is still here, and we have to help our families, friends, and neighbors understand the analogy. The most risky time is when we go on auto pilot, get back into routines without looking for risky exposures, and “not think about it.”

 

You may hear people say “but I don’t want to think about it.” “I’m tired of this.” We are all tired of this and I’m all for hoping we can get to a time where we are not always “thinking about it” but that time is not now. So let’s stay vigilant, help our families, friends and neighbors stay vigilant, and stay safe and well together.

 

Steve told us today that Mass. General did a prevalence study across the state and in our area recently and found the prevalence in our area as less than 1%. That’s low (and good). But remember Memorial Day weekend? Lots of activity with people, many of whom, not observing social distancing. Some visiting from other areas of the country. It will be a few more days or weeks to see what happens as a result. So, again, keep the parachute on until we touch down safely on the ground.

 

Here’s one last thought and opinion about where we are as a society and culture right now. You might  think about it as just a political statement. But as healthcare leaders and workers, we have a responsibility to speak out when we hear mistakes or, worse, lies about public health matters.

 

It’s hard to watch the news. We’ve hit 100,000 lost lives (and there will be more). It did not have to be this way. We have leaders who are more interested in their political survival than our real survival. First, pretending that this virus was “just a little flu” and would “go away” when the scientists who knew better were clearly saying this was not true. It was a calculated effort to keep popular. Then, making an issue out of wearing a mask, implying that this is just a matter of political correctness when all of the scientists and public health officials say it’s one of the only things we can do to protect each other is not only foolish and selfish; it’s also a public health hazard and bound to cost more lives. Keep each other safe from foolishness! Please think about that when you vote and talk with your families, friends and neighbors.

 

National, State and Regional

 

I’ve already talked about the national situation above.

 

The Massachusetts numbers continue to improve and the Governor is sticking with the phased reopening plan. It will be a few more weeks before “routine care” will be permitted. We’re on track to make judgments considering the Governor’s plan and our own assessment of when things will be clinically necessary and safe enough for our patients, staff, and practitioners as the state reopens.

 

Regionally, as noted above, the prevalence rate in our area is very low now. We’re watching to see about changes given the start of summer, the first phase of the Governor’s reopening plan, and the recent relaxation for the Memorial Day holiday weekend.

 

At VMG

 

Updates from Gina:

 

 

VMG Patient Newsletter, Issue 2, will start going out by email blast (and be posted to our website) on Monday, June 1. Attached is the most recent draft.

 

 

Now for some quarantine humor (from, where else, the internet):

“Breaking News:  Wearing a mask inside your home is now highly recommended.  Not so much to stop COVID-19, but to stop eating.

I stepped on my scale this morning.  It said: "Please practice social distancing. Only one person at a time on the scale." 

Never in a million years could I have imagined I would go up to a bank teller wearing a mask and ask for money. (this is my favorite)

Coronavirus has turned us all into dogs.  We wander around the house looking for food.  We get told "No" if we get too close to strangers and we get really excited about going for walks and car rides. 

      I was in a long line at 7:45 am today at the grocery store that opened at 8:00 for seniors only.  A young man came from the parking lot and tried to cut in at the front of the line, but an old lady beat him back into the parking lot with her cane.
      He returned and tried to cut in again but an old man punched him in the gut, then kicked him to the ground and rolled him away. 
      As he approached the line for the 3rd time he said, "If you don't let me unlock the door, you'll never get in there."   
  

And, hey:

 

  • Please wash your hands (often),

  • Don’t’ touch your face,

  • Maintain social/physical distancing (it works),

  • Definitely wear a mask (it is not a political statement; it’s a public health good),

  • Continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Wednesday, May 27, 2020                                                                       Issue # 50

 

 

 

Good afternoon and happy Wednesday.

 

I’m sure it’s occurred to you that the pandemic has changed many things, seemingly forever. Even after we have a vaccine that works, some changes will remain. But which ones?

 

Worldwide, we can expect changes maybe greater than what we saw from 911. Air travel will certainly be different, and not just from the sustained financial effects of the business interruption. More screening at the airport seems highly likely. Temperature checks, medical history questionnaires and screening, antibody certificate/passports? Cruise ships???

 

Schools and colleges will change for at least a year. For schools, consider how hard it will be to get second graders, for instance, on and off a bus while social distancing. And how about getting kids to wear masks? And what about the lunch lines?

 

Colleges will be challenged to pay their own bills and maintain their physical plants with fewer on campus activities and classes. What will students and parents be willing to pay for on line classes?

 

Most other institutions will be (or should be) forever changed. Think of Nursing Homes and other long term care. Jails and prisons have been crying out for change for a very long time. Hospitals are already changing as are our outpatient facilities.

 

Public transportation will need to look different with better service (to avoid crowds where possible).

 

The Governor got a haircut yesterday. Here’s his description: “It wasn’t a typical visit,” the governor told reporters. “I showed up at 7 a.m. They took my temperature,” Baker said. “The place where I got my hair cut had Plexiglas between the chairs. I had to wet my hair before I got there.” Baker said he wore a mask the entire time and the man who cut his hair also wore a mask and a gown. “I was out in 20 minutes.”

 

In medicine, telehealth is certainly here to stay, at least in some form (and that’s good – more convenient for patients, better access, and many providers really like it). How will it be paid and regulated? So far, because of the pandemic crisis, we have a pass on (most) restrictions. In time, will more telehealth mean that we will see sicker patients in the health centers? How will we orchestrate the telehealth and in person visits? A lot to think about and implement in a relatively short period.

 

How will we manage our specialties that require physical presence (think about PT and Optometry, for instance) with the patient over time? And for those that don’t require physical presence, under what conditions do we actually see patients (during and “after” the pandemic)?

 

I got an email today from Affordable Funeral Supplies asking if we needed to purchase PPE and Body Bags.

We’ve had dozens of emails about “contactless patient experience” platforms.

These are just some examples. Perhaps the biggest “system” that desperately needs changing is the way we finance and access healthcare. With job loss from the pandemic, millions of people lost employer sponsored health insurance. Many states were not ready to, or did not want to, expand Medicaid.

 

The debacle in supplying hospitals (aside from the political theatrics) is one effect of our uncoordinated, one person at a time, healthcare system. This pandemic should, if we are all paying attention, trigger a really serious look at a plan to create a coordinated health system at the national level.

 

This does not have to be controversial. There are dozens of models all over the world. Some are government run and some retain elements of private insurance (and even some employer payments). But they all are capable of coordinating responses and insuring everyone. Oh, and, they all get better results (clinical and financial) than we do. This is my opinion. But think about this as you think about voting. And whether you agree or disagree, get the facts and talk with friends and family. (If you want to read more about this, start with a very readable book written by T.R. Reid called The Healing of America. It reads kind of like a novel or investigative journalism. I have copies and I’m happy to lend them.

 

At VMG

 

Remember our goals: provide the right clinical care at the right time in the right way while keeping patients, staff and practitioners as safe as possible.

 

We are continuing to work on developing “VMG Outdoor Office.” The “tent” is up in the main parking lot of GHC. You’ll see work on this at your health center soon. We’re already expanding lab draws outside. We’re already doing pediatric wellness visits and immunizations and we’ll be bringing back adult wellness visits soon. The ASPC has a tentative start date for high risk colonoscopy of June 15.

 

We want to see all of our patients in the best way possible. We have multiple groups working on this objective now.

 

We will be sending the second edition of our VMG Patient Newsletter on June 1 to make sure our patients know what we can do for them.

 

OK. That’s it for today. One last Goat Rodeo song, Farewell Angelina, a Dylan tune. https://www.youtube.com/watch?v=QoULbn-P4d0

 

 

And, my usual message (and I really, really mean it), please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask (it is not a political statement; it’s a public health good), continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Tuesday, May 26, 2020                                                                                  Issue # 49

 

 

 

I hope you had a good holiday weekend.

 

Yesterday was Memorial Day; the holiday dedicated to remembering the lost lives of those who served in our armed services. The event is usually celebrated in many ways. A visit to Arlington National Cemetery has always been center stage…but not yesterday. Yesterday, only those who were visiting relatives were allowed to enter, all wearing masks, all due to COVID-19.

 

Beaches reopened. Picnics happened. Pool parties were seen on TV. Many people celebrated the traditional start of the summer season. People wanted to get back to normal. And that was, and is, necessary. And, we also should remember….

 

Let’s remember them as we start our summer because it’s what we do to go on living with purpose and appreciation.

 

National, State and Regional

 

Controversy continues to build across the country between people who want to continue precautions and those who want to “reopen.” The economic toll is pressing. The death toll is still rising. We all need to find the right balance between having life go on, work happen, and reducing infection rates, hospitalizations and deaths. It can’t be one or the other. And that’s why “reasonable precautions” need to be taken.

 

Wearing a mask has become a symbol of being cautious AND a symbol of infringing on liberty. There are those who still don’t believe in wearing seat belts but we have adjusted to that over time. We don’t have as much time as we’d like so we need to do our part to encourage reasonable precautions for preventing transmission of this coronavirus now. Our job is to think about health and safety and be good educators now: for our patients, our families, and our friends and neighbors. Please keep talking with people (while wearing a mask and social distancing).

 

The Governor has changed his stay-at-home advisory to a “safer-at-home” advisory. The Massachusetts key indicators continue going in the right direction. Reopening phase “Start” will continue. It’s too soon to tell what effect the weekend’s activities (and the reopening activities themselves) will have on the metrics being used to guide continued reopening.

 

Our region continues stable.

 

At VMG

 

The pandemic has hit all medical groups very hard for revenue generation. Most groups are on the virtual visit journey and we are certainly there as well. Virtual visits have allowed us to continue to see our patients and keep everyone as safe as possible.

 

At VMG, Lab volume is growing. Primary care is about 86% of the visit rate at this time last year. Behavioral Health is now at about 96% of last year. We are planning to cautiously reopen our Ambulatory Surgery Center on June 15. The “VMG Outdoor Office” will be open soon. I’ll provide more data in coming updates but you can see it now on the COVID Dashboard on the intranet page under the Quality and Reporting tab (first link on the page).

 

Year to Date, with the combination of our work pre-COVID and our work in mostly the virtual visit mode since COVID, we are now at about 75% of the similar period in 2019. That’s pretty good for now given the major disruption caused by the pandemic. However, our budget was more aggressive this year even before the pandemic hit so we continue to need your help in filling our schedules for two reasons. First, there are lots of patients who delayed getting care when the pandemic broke out. They still need care now to prevent worsening of their conditions. Second, we need to get our revenue generation back up as soon as we can.

 

Our next edition of the VMG Patient Newsletter will be sent on June 1. I’ll have it attached to this newsletter when it’s ready (by the end of this week). If you have a topic or topics that patients keep asking you about, let us know so we can address it in a coming patient newsletter.

 

 

 

Here’s a link to one of my favorite pieces of music, a Welsh folk song usually sung as a lullaby. It’s a live Goat Rodeo performance, All Through the Night. Yo Yo Ma, Stuart Duncan, Edgar Meyer, with Chris Thiele and Aoife O’Donovan in a live performance at the Hollywood Bowl. Unfortunately, the video is not great. Start at about 3:26 for the song.

 

https://www.youtube.com/watch?v=Io_3kG2HYwY

 

 

And, as always, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, continue to be in touch with and take care of each other, and help to educate everyone.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Thursday, May 21, 2020                                                                                           Issue # 48

 

 

It’s almost the holiday weekend and I hope you are looking forward to some time off, time with loved ones, and some good weather.

 

Some of you may remember a TV show called Hill Street Blues. It was a groundbreaking, genre creating show that featured an ensemble cast, multiple story lines that continued through the show, new technology (for the time) (hand held cameras) that gave it a very different feel from other TV shows. And this was before cable TV and streaming, of course.

 

Hill Street was a police show set in a large city (take your pick, they never revealed it) and it was very gritty. It always began at roll call for the day shift (grubby room, shift commander at a lectern) with the sergeant (Phil Esterhaus) updating on what officers might face that day. At the end of the meeting, as everyone was getting up to get on the streets, he would always stop them by saying, “Hey, hey, hey, let’s be careful out there.” (BTW, if you’ve never seen the show, get it on Netflix –it’s really great).

 

So Memorial Day weekend is almost here. And I’m channeling Sergeant Esterhaus when I say let’s be careful out there. It is supposed to be great weather. We all miss the people we used to (literally) see all the time. We all want to and should stay connected. And we also want to resume “normal activity,” at least when we can. But please, please, please, stick with what’s kept us safe: make sure your mates are six feet apart (at least), wash your hands a lot, don’t, touch your face, keep gatherings small (10 or less), outdoors if possible, and wear a mask. Don’t let up.

 

Also it’s your chance to take a job you may not have “signed up for.” Be a health ambassador, coach, and if you have a friend or family member who is not observing the things that have kept us safe so far, talk with them about it. It does not have to be a confrontation, just a conversation beginning with something like “I’m so glad to see you and I’m also concerned about your and our safety in these unusual times, so please…..” This is especially true if you’re with people from another part of the country where COVID may not be as front and center on their minds.

 

Here’s an item from a CNN story this morning with advice on having Memorial Day gatherings in as safe a way as possible:

 

https://www.cnn.com/videos/health/2020/05/21/safely-celebrate-memorial-day-weekend-erin-bromage-new-day-vpx.cnn

 

National, State, Regional

 

“There must be some kind of way outta here
Said the joker to the thief
There's too much confusion
I can't get no relief…

 

OK. I’ve gone a little wild about lyrics. Many of you will recognize this from the Dylan song, All Along the Watchtower. This is the state of our existence today. This is still true today. States are going in different directions even as the pandemic outbreak rises in some places and falls in others. It’s going to take months to see the results and many are worried that the results are not going to be good.

 

Devra First, a restaurant critic writing in the Boston Globe this morning, was saying the she is not ready to eat in a restaurant yet and was relieved to see that was not on the Governor’s phase one list of activities allowed. She has every reason to want to go back to dining in restaurants; it’s her job and her passion. But she can’t bring herself to think about anything more than take out. And for the reasons we’ve talked about. It’s a closed, usually small space, with lots of people in attendance, lots of comings and goings and all kinds of “opportunities” for viral spread.  And the virus can be spread by asymptomatic people. When will she (and we) go back? We simply don’t know yet. But just because we are allowed to do something does not mean we should do it or that we are ready to deal with it.

 

There is still not much change in our region which may be a good sign.

 

At VMG

 

From Gina:

 

We have completed a review of all aspects of the Reopening Massachusetts guidelines, directives, and regulations. Signage is being placed, as required, in the health centers, posted for patients to see. We have also completed a Mandatory Safety Standard policy which is to be shared with all VMG staff and practitioners for review and sign off in ADP.

 

Gina continues to share the great care being provided at VMG via social media (Facebook). If you have a story to share in this regard let her know.

 

Radiology will expand services slowly the week of May 25th  to include diagnostic and high risk mammograms.

 

As plans to conduct care outdoor progresses, the name to be used will be ‘VMG Outdoor Care”. We are erecting a tent in the GHC parking lot today (see below).

 

Lab has increased capacity to draw more patients with a 2nd chair operational in the outdoor lab in Greenfield. 

 

From Tim Sweeney: “Especially now, I'm committed to helping folks make some comfortable, gradual changes on their way toward abstinence. Apart from epiphanies and miracles (which I love) almost all human learning occurs in small incremental steps. These aren't "baby steps," they're human steps. We all need to make this journey at our own pace and on our own terms.” Tim has continued to work “Quitters Win” on Zoom with great results. This work is critical in the COVID era. If you have a patient, send him a patient case.

 

The construction crew in the GHC parking lot early this morning setting up the first VMG Outdoor Office:

 

 

 

 

 

 

With the weekend almost here now, I’m recommending this Commencement Ceremony from the Berklee College of Music honoring several great singers, dancers, and musicians. It’ about an hour (so please don’t watch it at the office) and it’s filled with really great music and musicians.

 

https://www.youtube.com/watch?v=fUw4AAIXDSA&list=PLG0f76gvWfh_uVyS4tNPVNHFgElR7eOTt

 

If you don’t have the time, then here’s a different virtual choir:

 

https://www.youtube.com/watch?v=GginQZcP24Q&app=desktop

 

 

And again, so important, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

 

p.s. no update tomorrow – day off – have a great holiday weekend.

VMG COVID-19 UPDATE

Wednesday, May 20, 2020                                                                                           Issue # 47

 

 

Good afternoon. It’s my oldest son’s birthday today and my one year old grandson’s birthday was yesterday. So I started the day in good times. But then, thoughts turn to the news of the day and it’s easy to get a bit lost.

 

When I find myself in times of trouble
Mother Mary comes to me
Speaking words of wisdom, let it be
And in my hour of darkness
She is standing right in front of me
Speaking words of wisdom, let it be

 

Most of you, I hope, will recognize this as the lyric to Let it Be by the Beatles. I never knew the source or inspiration for the song. I had assumed it was vaguely religious. But it turns out that Paul McCartney had a dream and his mother, Mary (who died when he was 14), told him that despite his worries and concerns, things would be OK and just go on with your life. He was comforted by this (and of course the song did pretty well, too). Good to think on.

 

I think this is the position a lot of our patients are in: Troubled, times of darkness. Certainly many are broken hearted, having experienced a loss of family, friends, hope, etc. And don’t forget confusion. There’s lots of that as we try to evaluate what we hear from the news, politicians, scientists and pundits. We all want certainty, even those of us who like roller coasters.

 

Charles Duhigg, writing in The New Yorker recently, talks about the role of epidemiologists in these times. He says “epidemiology is a science of possibilities and persuasion not of certainties or hard truth. Quoting the Scottish epidemiologist, John Cowden, “being approximately right most of the time is better than being precisely right occasionally.” “You can only be sure when to act in retrospect.” Duhigg says epidemiologists must persuade people to upend their lives – forgo travel and socializing, submit themselves to blood draws and immunization shots (not yet)—even when there’s scant evidence that they’re directly at risk.” That’s our job too.

 

The CDC, in better times, planned for how to handle epidemics. It turns out that in addition to the science, in times of trouble, communication is key. One of most important things in the playbook is to have one person in charge of the message and the message is what they call a SOHCO (sock-O) which stands for Single, Overriding, Health Communication Objective. The Field Manual for the CDC says that it should be repeated at the beginning and end of every communication with the public. It’s important to have a message, to express empathy with people’s confusion and concerns, acknowledge what we know and what we don’t know and be as transparent as possible. That’s how persuasion should work. This is the business we are all now in.

 

So keep thinking not just about the clinical care but also about the messages we need to send, expressing empathy for the confusion everyone feels, and tell folks what we know and what we don’t know. They are looking for words of wisdom. You can help a lot just by being there! That’s what gets me in a better mood.  Let it be.

 

National, State, and Regional

 

The national scene remains chaotic with lots of opening up in many different directions. We’re going to learn a lot from these “natural experiments” within weeks.

 

The state seems to have stabilized with hospitalizations going down as well as deaths. Much of this has been achieved by physical/social distancing and good hand hygiene and wearing masks and staying at home when sick. However many people are still concerned that we are going too fast given that this is a new virus, there is no treatment and no vaccine. With the state beginning a phased reopening we’ll soon have a sense of what happens. An article in today’s Boston Globe by Jenee Osterheldt suggests that Congresswoman Presley has been saying that “opening the state could close more caskets.” And communities of color and lower economic status have been doubly harmed by the pandemic; medically with greater death rates and hospitalizations and, economically (loss of jobs and support programs). She is calling for slowing down until we have better social and economic supports to help all citizens be able to stay at home when necessary, social distance, stay out of crowds, etc.

 

Memorial Day weekend is upon us and we may soon find out if even this slow, phased plan is too fast. In the meantime, we need to keep with the things that have begun to bring the deaths and hospitalizations down: social/physical distancing, frequent hand washing, wearing masks, don’t touch the face, staying out of larger gatherings, staying home if sick, etc. Please talk with family and friends about observing these reasonable precautions.  The virus is not taking a holiday.

 

At VMG

 

We are working on expanding our “Outdoor Office” initiative to reduce the chance of exposure and keep us all (patients, staff, practitioners) as safe as possible while providing important and needed care. That is our SOHCO.

 

We are “continuing to begin” to work on expanding services, slow and steady, to get back to most of the things our patients and practitioners need in a manner that is efficient and as safe as possible. We won’t jump ahead until we are reasonably certain it’s safe and in all our best interests. You’ll hear more about this in the coming weeks.

 

Val Felton and Amy Rice continue to work on acquiring and maintaining the right PPE for current services and for expanded services, when we get to them.

 

In the meantime, consistent with the Governor’s reopening plan beginning with Phase One on Tuesday, you will see signs posted on our entrances telling patients that we have met requirements for hygiene protocols, social distancing, training of staff and practitioners, and cleaning and disinfecting. If anyone gets an email or request from a state agency to sign a document about the above, please forward it to me ASAP.

 

 

 

OK, we’re heading for the weekend soon. I want you to see a photo of some of our clinical staff at AMC with a message to our patients and to all of us. We appreciate all your essential work. This is what helps to get us through. Here you go:

Finally, here’s James Corden and a surprise guest, in case you haven’t seen it before. Watch it through to the end (it’s a little long so you may want to watch this at home).

 

https://www.youtube.com/watch?v=QjvzCTqkBDQ

 

 

 

Once again, and this remains so important, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Tuesday, May 19, 2020                                                                            Issue # 46

 

 

Good afternoon. I hope you are all well. I want to share one quick thought for today and then an opinion.

 

The quick thought is about innovation and, in this case, innovation that is based in necessity. An item on the news is about training dogs to sniff out COVID-19. There have been reports for years about dogs and cats in nursing homes being able to detect when a resident was about to die. Whatever the validity of those claims, there are now several projects training dogs to somehow detect people who have been exposed to the coronavirus and are asymptomatic. They would be used in airports, public gatherings (think sports, concerts, etc.). Who knows if this could work but the extension of the idea to try it is the key thing. At the end of this newsletter, I’ll provide a link to a Brazilian pianist who had to get creative to finish a piece.

 

My Opinion

 

Here’s the opinion part. Following up on my thoughts about healthcare disparities and COVID-19, two additional groups that are struggling are, not surprisingly, Native Americans and migrant workers. Tribal areas have been struggling with getting money due from the stimulus and relief packages to fund testing, care, and environmental modifications to support stopping the spread. That’s affecting care of COVID patients. And think of the migrant workers who pick our fruits and vegetables. While they are mostly working outdoors, many sleep in bunkhouses without many resources, social distancing and PPE. Now think about the workers in our meatpacking plants that have been ordered back to work without protective measures in place working long hours, shoulder to shoulder. We do need a clear and consistent approach to these populations on par with our more privileged segments of the population. They don’t have much choice or freedom in their environments.

 

Paul Krugman, a Nobel economist, has written that “Plato, prefiguring Dr. King by a few thousand years, wrote in “The Republic” that “any city, however small, is in fact divided into two, one the city of the poor, the other of the rich.” This is true today and we’re seeing the results in our state in the cities where density forces exposure. But what should we do about it? Not enough serious attention and discussion has happened to force innovation and/or the will to change.

 

Seeing access to better education as a key to reducing disparities in health and economics, in The Netherlands, schools are funded at a standard level per student, plus a 25 percent bonus for each student whose parents did not graduate from college.” Whether that’s the right metric for judging social inequity and disparity, and for improving, is up for grabs. But it is an approach to lowering the divide as education seems to be a factor for reducing inequalities. There are many others, I’m sure. But to find them we have to, as a society, look for solutions in places we are not used to looking and have the will to try.

 

In “normal times” in our democracy, if enough people raise ideas and start talking about them, and are willing to engage in private and public discourse and debate, we can change minds (and hearts) over time. This is not a normal time and we have a long and troubled history of ignoring “social determinants” and social injustices. Whatever your opinions, keep talking with friends and family. Every discussion can be a start of an improvement.

 

National, State, and Regional

 

There is mixed news coming out of states that have reopened at least a few weeks ago. There are some spikes in spread. However, even in states that have reopened, many people have not taken reopening as a sign to resume normal activities and that may be reducing the risk of transmission. We’ll have to wait longer to see what happens when the weather gets better and people decide for themselves about the social end to the pandemic. We know that the virus will still be there and that there are no treatments and no vaccine.

 

Governor Baker’s reopening plan is all over the media. There will of course be more to say about it but many large employers across the state are sticking with their work at home plans for now even with the reopening permitted. They and their employees are hesitant to risk further spread and the resulting possibility of another shutdown. Here’s a link to the Governor’s reopening plans:

 

https://www.mass.gov/info-details/reopening-massachusetts

 

 

Starting on May 18, the MA DPH COVID-19 Command Center will give updates on six key public health indicators. Before and during reopening, these metrics must continue to show progress to allow reopening to continue.

 

Nothing much has changed regionally. Mark Kerouac, CEO of Baystate Health, was on the news this morning as a member of the Governor’s reopening task force. He said that hospitalizations are not now in the way of reopening and supported the current plan with the important proviso that we all follow social distancing and wear masks.

 

At VMG

 

Some current news from Gina follows. We are currently reviewing all aspects of the Governor’s reopening plans to ensure that VMG meets or exceeds the requirements of the plan when we do bring back services. However, we will still be making our own judgments, within those guidelines, about how and when we restart all our services.

 

GHC is preparing to see 0-2 year old patients.  Practice visits are happening today with first visits for patients scheduled for tomorrow.  GHC will install the first tent on the property to conduct care outside the health center and work through all the processes involved and then share with our other health centers.

 

Lab volumes continue to grow, especially in Greenfield, where schedules are booked solid this week with one “chair” operational. Work is underway at GHC to add a second chair.

 

 

 

 

OK. Here’s an example of necessity pushing innovation in a musical “experiment.”

 

https://www.youtube.com/watch?v=VBbRTRBY4D4

 

Finally, here’s a great musical reminder about being together in a time of social distancing.

 

https://www.youtube.com/watch?v=Jnhsk70XuCc

 

 

Once again, and this is important, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Monday, May 18, 2020                                                                                                                  Issue # 45

 

 

Happy Monday to you. We’re back, aren’t we? So, here’s a Question for you:

 

Q: Why is the Racoon the mascot of this era?

 

A: They always wear a mask, they wash their “hands” a lot, and rearrange the letters of racoon, and you get corona.

 

Now that’s out of the way, there’s a lot of “reopening” going on and it’s going to get a bit confusing. As you know, we are beginning to bring back some services (like lab and pediatric wellness with immunizations) but in an “alternative way” (mostly outdoors). At the same time, states are reopening, including Massachusetts, in a limited and phased way.

 

Our two guiding principles at VMG are: provide needed care in the best way available now, and, keep patients and staff as safe as possible. It will still be several months, if not longer, before things begin to look more like they were.

 

More broadly speaking, things may never look exactly like they were and that will be both tough for all of us but may also present some opportunities for some positive change. In an article in The Washington Post over the weekend, Tom Frieden, former Director of the CDC, wrote that the “familiar stages of grief have been visible. At first, world leaders and even many experts in respiratory disease were in denial, hoping that the coronavirus would disappear. The pandemic provoked anger — at China, immigrants and the (essential) public health measures imposed to reduce spread. Some have tried to bargain, suggesting that the pandemic would be mild, harming “only” the elderly and infirm, or might even fizzle. Others succumbed to depression and considered giving up on control measures, hoping to magically achieve “herd immunity.

 

These responses are understandable. But the sooner people come to terms with the reality of the pandemic, the quicker we can prepare for lasting changes to the ways we work, learn, relax, govern ourselves and even treat one another.

 

But at this point it’s clear: Our lives will be altered by the pandemic for months or years to come. As a society, we may become more reliant on younger people and those already exposed to the virus, and more attentive to shielding the vulnerable. Caring for others and prioritizing the collective good could lead to a positive societal change: First by necessity and then by choice, we may come to accept that we are all in this together.”

 

Let’s hope and work toward that goal.

 

National, State, and Regional

 

States continue on the course of reopening with a few actually having met the federal guidelines. We don’t yet know what will happen for those who meet the guidelines and those who do not. With no treatments and no vaccine, we will have to watch carefully and be ready to close down again because the road to “herd immunity” is built on a lot of illness and death.

 

Today, Governor Baker disclosed the Massachusetts plan. In Phase One, called Start (great name, right), permitted to open this week are:

 

  • Construction sites

  • Manufacturing

  • Houses of worship

 

There will be restrictions on capacity and modifications to work sites and places of worship.

 

Starting May 25 offices outside of Boston can begin reopening at 25% capacity and also next week, other businesses like retail, hair salons (maybe I can get my haircut but will I be ready?), pet grooming. And beginning May 25 hospitals can resume some high priority preventive care. We are not yet sure what that means for our Ambulatory Surgery Center but it will take us a while to gear up anyway.

Outdoor activities including parks, zoos, and beaches can reopen in time for Memorial Day (did anyone else besides me forget that there is a 3 day weekend coming up?).

 

And then if all the metrics keep going in the right direction, we may enter Phase two which will include restaurants, more retail, some hotel space, playgrounds, youth sports and day camps for the summer.

 

Daycares will stay closed but the state is expanding the capacity of “emergency daycare facilities.” We’ll know more about what that means soon. The Governor said that plans for school reopening will be announced soon.

 

During all this, gatherings are still limited to 10 or less, citizens are still required to wear masks in public when they can’t keep at least 6 feet from others and people age 65 and older and with underlying health conditions are urged to stay home (except for going grocery shopping or visits to doctors and pharmacies).

 

It’s going to be a go slow approach and it may have to be modified or withdrawn if there is a rise in cases and hospitalizations. And of course, citizens will make their own judgments (within the Governor’s guidelines) about when we think it’s “safe to go back in the water” (remember when sharks were what kept people from the beaches?) and resume close to usual activities.

 

At VMG

We are not yet certain about what all this means for VMG visits and services yet. Our Incident Command Team is meeting at least three times per week to review what’s allowed, what’s possible, and what’s safe. We are continuing on our current plan and we’ll go slow in considering what to do next. For now we want to emphasize the “worthwhileness” of our video visits (let’s encourage patients who can to use the video visits as opposed to phone) and our plan for safety and caring.

 

Gina reports that we are working on Outreach calls to support schedules, developing templates for increasing visits, continuing to work for providing outdoor care and continuing pediatric wellness visits by expanding to GHC with a practice run this week. We are developing guidelines for in-person visits when we can return to them for more services. In addition, we are continuing to work towards using one telehealth platform and, right now, that looks like the one that will be available in athena. We have three practitioners in the trial now and we see many positive aspects. 

 

Finally, this past Friday, May 15th, our first bi-monthly patient communication was sent to about 70,000 patients (it will take several days for all to receive them).

 

 

OK. I think it’s safe to say that our heads will be spinning in the next few weeks as the reopening of Massachusetts plan unfolds. We’ll work together on the healthcare and business part of this.

 

Personally, for getting centered in confusing times I look for guidance from others who have “been there,” often in other fields. Andre De Shields is a singer, dancer, actor, director and choreographer with a major contribution on Broadway and in film. Andre was one of five artists honored at the Berklee College of Music’s virtual graduation this year (I’m partial to Berklee; my son went there).His three rules for reaching your goals are:

 

1. Surround yourself with people whose eyes light up when they see you

2. Slowly is the fastest way to get where you want to be

3. The top of one mountain is (often) the bottom of the next, so keep climbing

 

Good advice, I think.

 

Here’s a link to the finale of that ceremony. I think you’ll like it:

 

https://www.youtube.com/watch?v=WxXAUeMe3wc

 

 

 

 

And, as usual, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, May 15, 2020                                                                                                                       Issue # 44

 

 

Well, we’re heading into the weekend and the sun will shine again -- after the storms today. Ain’t that like real life now?

 

National, State, and Regional

 

The story continues to be “reopening” across the country. We’re going to see a variety of approaches and therefore a variety of unplanned experiments in how this virus will continue to affect lives. There is some hope that, for most of the country, who have taken social distancing seriously, there might be smaller and more delayed outbreaks. The forces for the social end of the pandemic (when people “decide” that the losses from staying home outweigh the risk of getting sick) seem to be pushing decisions forward. But there will still be virus and outbreaks and hospitalizations and deaths. We’ll know how this works soon.

 

Governor Baker will release the plan for reopening Massachusetts on Monday. He has said he wants to go slow and careful and rely on the scientific data to go further. We’ll get details Monday. I don’t expect to see major changes in this first phase, at least as they might affect us directly.

 

There is not much new to report regionally. Hospital systems are stable in our area (but taking very big financial hits – we don’t’ know the extent yet nor do we know what steps they may have to take to mitigate these losses).

 

At VMG

 

I talked with several colleagues at other Groups and hospital systems in the last few days. We are “ahead” of others in the use of virtual visits and getting positive feedback from patients (see below). But, according to preliminary patient feedback collected across the state by the Massachusetts Healthcare Quality Partners (a quality improvement organization sponsored by health plans and the state), virtual visits work well for many with limitations for others. Here are some of their early key findings:

 

  • Medication reconciliation visits can be simplified because patients can more easily identify what is in their medicine cabinet when they are at home.

  • Some patients with certain conditions prefer telehealth. For example, one clinician reports that she has a patient with agoraphobia who is much happier with a telehealth visit and might not get care at all if an office visit was required. Another clinician states that her older patients with dementia find it disorienting to come into the office and seem much calmer in telehealth visits.

  • Telehealth visits are working better than in-person visits for some end-of-life discussions where members of a patient’s family who are located elsewhere (anywhere in the world) are able to join the conversation in ways they would not have been included before.

  • It is easier for some patients to talk about sensitive topics by phone or video from home where they are more comfortable and at ease.

  • It is easier for some clinicians to get to know some of their patients better by seeing them in their home environment, getting to meet their pets, etc.

 

At the same time, we have discovered some dissatisfaction with telehealth visits. Examples include:

 

  • Patients report concern that, since their doctor couldn’t do a physical exam or other tests that might have been performed at an in-person visit, they may not have gotten the diagnosis or treatment plan right.

  • Phone calls or video visits that use up patients’ limited data or phone minutes may not be viewed favorably, possibly raising some equity issues.

 

The key thing for us is to stay in touch with patients, see how well it’s working for them and make adjustments as we can. On the whole, telehealth is finally taking off and vital to our clinical work given the limitations imposed by the pandemic. And, I believe, even after the pandemic, it’s here to stay.

 

Here’s some feedback from one of Carol Carson’s IBH patients:

 

“I so appreciate that Valley Medical is providing such accessible mental health care right now. It is so important to be able to talk with someone who doesn’t judge me and offers real ideas to help me cope better. I actually really like talking with you on video!”

 

 

There are a few positive things that have happened as a result of people working together during this pandemic. Telehealth is one of them. Another is the advent and promotion of the “virtual chorus.” Here’s another example:

 

https://www.youtube.com/watch?v=CDdxXL6fdwA

 

And now here’s James and family:

 

https://www.upworthy.com/james-taylor-and-family-perform-from-home

 

Thank you, Martha, for finding this.

 

OK. Enjoy the weekend and Hey, hey, hey, as usual, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Thursday, May 14, 2020                                                                                                                 Issue # 43

 

 

Happy Thursday. Almost the weekend but there’s still a lot of “good to do” and you all are getting really good at that. We keep getting patient comments about how we are doing and almost all of it is, well, good. People are surprised and delighted at our being in touch, providing care and connection. Care and connection: both are really important now.

 

Julia Marcus, a Boston epidemiologist, discussing the need for people to restart their lives while staying safe has said that “what Americans need now is a manual on how to have a life in a pandemic.” That’s a recognition both of our current reality (that there is a pandemic, that’s its’ going to be a “long haul,” that there are things we must do to stay as safe as possible while accepting what we can’t change) as well as the probability that we will face this again and we need to learn how to change and adapt.

 

State and Regional

 

The Governor will release the recommendations from his reopening task force on Monday. He’s already suggested this is going to be slow and methodical (so probably no haircut for me yet) and based on data. What we might see are some restrictions loosening for different risk groups: younger people in lower risk occupations may be able to go back to work sooner than older people, older people may still be under a “stay-at-home” advisory, activities in the open air may be permitted by small groups, etc. There will likely be increased contact tracing.

 

In our region, relative to the rest of the state, there are fewer cases and deaths. Our health systems are still not overwhelmed and that’s good.

 

We are hearing about increased concern and demand for more testing and we’ll have to navigate that. The tests themselves are not “perfect” (whatever that means in the face of a pandemic) and there are probably still too many false results (positive and negative depending on the test). But they will get better.

 

At VMG

 

From Gina:

 

Finally for today, as the man says, “keep taking another step, one day at a time, and we’ll get through this together.”

 

https://www.youtube.com/watch?v=xgMxJSHxtPc

 

Thanks to Margit for suggesting this.

 

Hey, hey, hey, as usual, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Tuesday, May 12, 2020                                                                                                                                  Issue # 41

 

 

Good Tuesday afternoon to you.

 

Here’s something to think about. Looking back at past pandemics (plague, smallpox, various flus, others) shows us that pandemics end in different ways. And the whole concept of “pandemic end” is an interesting idea.

 

An article by Gina Colata over the weekend in the NYT suggests that there are two types of endings: the medical end and the social end. We usually think about the medical end (when new infections wane and deaths rates go way down). But there is a social end when fear of the disease and all the consequences of that fear dissipate. And there is the time in the middle which may be where some people think we are now. In other words, comes a time when people “get tired” of not being able to do things and, in the absence of seeing the severe medical effects with their own eyes, they begin to judge the risks to be lower than the benefits of resuming life as it was. This may be what we are facing in the country now.

 

The lesson is, be careful in making these judgments about the pandemic “end” (sometimes they don’t end at all; we just learn to accommodate) and the reasonable things to do to preserve and resume life. And, we don’t think we are there yet.

 

National, State and Regional

 

Nationally there are certain groups of citizens especially disadvantaged and at risk in the pandemic. I focused on racial and socioeconomic inequities yesterday. Domestic violence rates and reports are increasing now as people are “shut in” with their partners and can’t easily get away (or don’t feel empowered to get away). We should be on the lookout and be open to hearing if this is the case with patients now. Nursing home residents are at risk both for illness and increased isolation from family. Prisoners and others who are confined institutionally are at risk while incarcerated and also as released (due to lack of resources and connections in the community for healthcare and other services). We’re also hearing about treatment facilities and programs for opioid users not being eligible for stimulus and relief funds – that will impact this vulnerable population as services are reduced.

 

One other national item of interest. Politico reports that you might think that cutting edge technology would be employed for national and state agencies in fighting the coronavirus. But that’s not the case:

 

“Public health departments are unable to share data on cases, persons under investigation, laboratory tests and person-to-person transmission with the CDC seamlessly — instead they are forced to rely on a combination of methods: antiquated pen and paper, faxes, excel spreadsheets, phone calls, and manual entry.” We have a long way to go.

 

In Massachusetts, the Governor has published an outline for how the state might reopen business. He’s setting out four phases: Start, Cautious, Vigilant and New Normal. He has not yet said which businesses and activities would come back first and there is currently no timeline released. It will depend on the medical data and a balancing of risk of an increase in infections and hospitalizations against the benefit of starting up.

 

Hospitals and health systems continue to suffer financially from lost procedure and admission revenues. It’s true that some additional revenue is coming in from treating COVID patients, but there are also additional costs for PPE, modifications of facilities, IT, staffing, etc.

 

In our counties, hospitals remain with capacity and PPE seems to be adequate for the moment.

 

At VMG

 

We are trying out the new video capability within athena. Three practitioners are using “the platform” and providing feedback. We’re hoping this turns out to be our platform for the near and distant future.

 

Be aware that there is a COVID folder on our intranet page with lots of useful information and policies. It’s updated often.

 

I’m attaching a draft of a communication, fyi, to our patients (here). This is the first edition of a patient newsletter that will be sent by email every 15th and 1st of the month inviting patients back to the practice and describing our services. We’ll “feature” new and/or returning services and department updates, a few at a time. We’ll also use the newsletter as a basis for updating our web page and FB page.

 

There continues to be a lot of work going on for using spaces outside the buildings for clinical services that can be done more safely than in the buildings.

 

 

 

That’s it for today. Thank you once more for your dedication and creativity. We’re still, and especially, all in this together.

 

As usual, please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Monday, May 11, 2020                                                                                         Issue # 40

 

 

Good Monday afternoon. I hope you had a good weekend.

 

My Voice

 

I realize that in addition to updates about what’s happening in the country, the state, our region, and at VMG, I’ve been talking with you about some matters that are important to me in my role as the President of a regional healthcare organization but also about what’s important to me as a citizen. The Pandemic is forcing us to uncover some aspects of our culture and society we’ve either missed or failed to keep in focus.

 

First is the inadequacy of our healthcare financing system to meet the needs of our population and, especially now, during the pandemic. The fractured response to the pandemic, state by state, business by business, health plan by health plan, hospital by hospital and group by group is now fairly obvious (although hospitals and groups have rather quickly evolved their services to match new demands for care and safety). The other problem that has been re-exposed is the problem with paying for care service by service (Fee for Service) as opposed to by patient panel (capitation). If the patient doesn’t come in under a Fee for Service system, healthcare providers are not paid and the cost of maintaining the system is not reimbursed and new ways to see people don’t get invented and/or sustained.

 

The second “revelation” is that our public health systems have been too long neglected. We’re trying to cobble together a unified approach to contain the virus without the public health tools, systems and staff to support a unified approach. The controversy over testing is just one example. These issues will require a societal fix. It’s worth our attention (all of us) and we should demand more of each other and our elected officials.

 

The most uncomfortable of all revelations, I think, is that the hospitalization and death rates for this pandemic get worse as you go “down” the socioeconomic ladder. In Washington D.C., for instance, if  you take the Metro from the inner city out to Bethesda in the suburbs, for every mile you travel, the residents of that community lose 1-2 years of life expectancy (if not more). An article in The Boston Globe by Andrew Ryan and Kay Lazar on May 9 reports on a Harvard study showing that death rates, in this pandemic, by level of poverty dramatically increase as the poverty level goes up. The same is true when you look at rates comparing towns with higher share of people of color. Why did I say “uncomfortable?” We typically want to think that the virus affects us all equally and that we are an equal opportunity society. It’s uncomfortable when we are forced to think about how unequal we are in the conditions that lead to disease and burden of illness. And it’s even more uncomfortable when we think about what to do about it. Here’s a link to the article: https://www.bostonglobe.com/2020/05/09/nation/disparities-push-coronavirus-death-rates-higher/?event=event12

 

Let’s keep these realizations in mind as we talk with family and friends and with our leaders in our towns and state. If you want to talk more, I can host a zoom discussion or get you further information outside of this newsletter.

 

National, State, and Regional

 

As many states start to reopen, we are beginning to see a spike in infections. And although the current national infection, hospitalization and death rates seem to be holding steady that’s mainly due to the rates in NYC and NJ coming down slowly. Those rates are actually increasing in other parts of the country.

 

Massachusetts numbers for new infections seem to be declining slowly. Hospitals are seeing a slowing of admissions (current rate is down to 4%) and most still have capacity. Deaths are still high but deaths decline slower than admissions. Nevertheless, the pandemic is far from over and the pressure, as you know, is on for “opening the economy.” Many infectious disease experts are warning about going too quickly. Several have published a list (in today’s Globe) of what they believe healthcare organizations should do:

 

“· We must closely monitor any uptick in influenza-like illness in office and emergency department visits and hospital admissions.

· We must have clear criteria for when to reinstate restrictive measures for worrisome trends so we can act swiftly and decisively.

· We must expand testing and track new infections, following up with an aggressive public health response of contact tracing, testing, and, where appropriate, quarantine.

· We must secure adequate supplies of personal protective equipment, ventilators, and dialysis machines, assess the workforce and capacity at our health care facilities, and study how to protect our most vulnerable communities, including those in nursing homes and other congregate facilities.

· We should continue to build upon the successful expansion of telehealth visits, and not require patients to come to the doctor’s office for an appointment unless necessary.”

 

At VMG

 

We are continuing to look at our workflows for safety and effectiveness as we consider “bringing back” services based on need. We want to encourage our patients who may have delayed getting care because of fear of contagion to come back for needed follow up and care. An email blast will be sent each 15h and 1st of the month with information about what we are bringing back, new processes, safety and access. The first blast will to out this Friday. We hope this helps to fill the schedules and keep our patients attached to VMG. We want patients to “stay safe, stay well, and stay in touch.”

 

In the near term, we don’t anticipate a lot of new traffic in the buildings but we do anticipate more literal traffic outside the buildings as we do more labs, wellness visits, and other services in the “open air” to reduce the risk of infection.

 

Most of our work continues to be virtual visits. Last week I showed you the chart for primary care. Below you can see the impact of virtual visits in a few other departments.

 

 

 

 

Here you can see some recovery of our charges since March. We expect this trend to continue (it looks like we had a lot of unfilled appointments in the last few days of last week and that is bringing the recent trend in virtual visits down).

 

A few of our services are actually doing better than last year. Behavioral Health, Diabetes Education and Nutrition are in this category (see below for these departments). And lab visits are on the upswing again.

 

 

 

 

 

 

 

 

 

 

 

 

 

I’ll show you the trends in other departments next week. But you don’t have to wait for this newsletter to see these charts. They are published on our intranet page under the Quality and Reporting tab.

 

Thanks to all the clinical staff and practitioners in these departments for creating this improved performance.

 

Finally, a messy reminder. We had a problem in Amherst this morning with a backed up sewer and septic system. Jim Wood emailed all about this earlier but I want to remind you once again. When the plumber got there, they found the sewer pump clogged with rubber gloves, plastic bags and baby wipes. Please remind all to keep these out of the toilets and drains.

 

 

 

Thank you again for all you do. We’re all in this together. Here’s another reminder (click on the Virtual Choir video in the article):

 

https://www.cnn.com/2020/05/10/us/music-student-virtual-choir-trnd/index.html

 

 

 

Oh and I almost forgot (well, not really). Please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, May 8, 2020                                                                                         Issue # 39

 

 

It’s Friday. I hope you will enjoy your weekend.

 

I promise there is an uplifting video link at the end of this Update but please stick with me first. I want a haircut. I need a haircut. It’s a free country, right? I should be able to get a haircut when I want to and the person who cuts my hair is going broke because she can’t open her store. If someone else doesn’t want a haircut, that’s their business. Besides, this virus thing is not as dangerous as “the government” says. Right? ABSOLUTELY AND COMPLETELY WRONG!

 

This virus is absolutely dangerous. It’s already killed more than 76,000 people in this country. Yet a bunch of “conspiracy theorists” produced a slick video with absolutely incorrect, vicious, yet persuasive (to some) arguments about the need to not only “reopen” the country but to distrust those who say otherwise.

 

To be sure, we are dealing with two major crises at the same time: the pandemic and the economy. Both are critical now. But we need to stay focused on the facts and the science. If significant parts of the country start (or continue) believing this pandemic is not real, people will continue to die. And the economy will not improve.

 

And now, back to me and my haircutting needs. I have a responsibility to you and every other citizen to deal with managing my needs in a way that does not threaten your health and life. We used to understand public health as a greater goal. And, in times of crisis we usually pull together. We need to again. And ironically, this is V-E day (talk about pulling together).

 

So I have a responsibility to speak out to anyone who is ignoring the truth of this pandemic. And so do we all. Please, if you know someone who is claiming this is not real or does not feel the need to safeguard us all as best we can, use the talking points I sent you yesterday (they are on the intranet page). We can all help out for our greater good. You don’t have to be confrontational. Just be calm and fact-based. Or send them the information if you don’t think you can discuss it.

 

National, State, and Regional

 

I’ve already talked about the national scene. The state may be seeing some continued improvement in rates of known infections and in hospital admissions. That’s good for now. We’ll wait to see if it really is a confirmed trend.

 

Regionally we remain stable with our hospitals open and not overwhelmed. Testing is slowly becoming more available. We’ll have more information on that soon.

 

At VMG

 

The results of the trial of pediatric visits are generally positive. It’s a good start to resuming this important service. And testing in the open air is going well. On Monday we’ll share the trends for increasing business activity by department.

 

A reminder to observe social (physical distancing) in our common areas such as break and lunch rooms. You should soon see some reminder signs about the number of people who can be in these areas at one time. Please respect these safety steps.

 

 

OK. As I said, this is Friday. Here’s something to bring you up as you head into the weekend (thanks to Diane Fisher-Katz for finding this).

 

https://vimeo.com/413671073/290058eecb?fbclid=IwAR2Fz7tTMrkF_9MwbdfLvNgNCGc_o9J6J8ZuxB-NqCdd_YA-2h1zy5Ra-cUh

 

 

And here’s my Mister Rogers moment. You are all great and valuable and we really appreciate all your efforts on behalf of our patients and our communities. And again, Happy Nurses Week and now Happy Mother’s Day.

 

Please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to be in touch with and take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Thursday, May 7, 2020                                                                                                    Issue # 38

 

 

News reports this morning contained this headline: “Nursing home residents may account for up to half of all U.S. fatalities from COVID-19.” While you might say this could be expected given the average age and vulnerabilities of patients in these facilities, it is hard to think about this without feeling pained. And there are other inequities in the way the pandemic is being experienced in our country. I’ll be discussing that in an issue soon. In the meantime, please keep the residents of these facilities (and the staff) in your hearts and minds.

 

National, State, and Regional

 

As you know, the controversy about reopening states continues. The latest wrinkle is the abandonment of CDC guidelines and the conflicts between some mayors and governors.

 

Governor Baker is expected to put out a list of the types of businesses that might reopen “in a limited fashion” once the May 18 stay at home advisory is canceled. The seven day average of positive virus test rates had been declining steadily until yesterday so this is still a cautious possibility. He may elect to continue the stay at home advisory. That’s what just happened in Washington State. Everyone wants to “get back to normal” but that’s still up in the air.

 

And, as I think you already know, the Governor has mandated that, effective May 6, all Massachusetts residents older than 2 are to wear face coverings when out in places where social distancing is not possible.

 

At VMG

 

We’re going to stay steady with our current approach until we think it’s safe to return to more typical operations. And then, we’ll be returning in phases. Here’s an example of our approach.

 

At EHC, we’ve piloted pediatric vaccinations and well visits and learned a lot about those new processes, limiting exposures for staff and patients, using our telehealth platforms to gather and give information and reserving contact time with practitioners and staff to the minimum necessary. We’ll be expanding to GHC next and then to other age groups.

 

We are looking again at our approach to reaching out to patients to let them know we are here for them virtually and/or in-person as needed and as safe. We are working on using our internet site (“vmgma.com”), email blasts, and FB page to get messages to patients about our status with common procedures, departments, and services as we are beginning to bring them back. We’ll be updating these methods twice a month with new messages. You’ll hear more about this soon. We will also want to engage you as ambassadors to your friends and families, as you feel comfortable.

 

 

 

There are so many people to thank for all your efforts to keep us running and safe. Everyone in the company is contributing. It’s really heartening.

 

Here’s something from one of our local hospitals:

 

https://www.cnn.com/videos/us/2020/05/07/doctor-nurse-sing-hospital-massachusetts-mh-eg-orig.cnn

 

 

Please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Wednesday, May 6, 2020                                                                                                 Issue # 37

 

 

Good afternoon.

 

Around the country people are beginning to realize the impact of the pandemic and the tension almost every segment of society is experiencing. What began as a regional outbreak on the west and east coasts and then in the south in places like Texas and Louisiana is spreading to the entire country.

 

There is a very real toll on the economy with high numbers of unemployment and job loss. There is also the very real toll in lives lost and burden of illness and isolation. These are not easily reconciled and we will be living with this tension for many months.

 

There are now more people who are pushing the idea that this virus is no worse than the flu (which, by the way, is pretty bad in lives lost, illness, and jobs impaired). But the flu has a vaccine and there are some treatments to lessen the symptoms and shorten the course. COVID-19 is worse. The Boston Globe published an article today on “what to tell people who think this is no worse than the flu.” Here are the five things to say:

 

Five things to tell someone who does not believe the coronavirus is more than the flu.

 

“1. The coronavirus is more severe than the flu, more deadly than the flu, and it appears to spread more easily

 

2. Even with severe lockdown measures, the virus has killed nearly 70,000 Americans in just over three months

 

3. There’s still a lot we don’t know about how the virus behaves

 

4. It is true younger people are at a much lower risk of death from the coronavirus — but that doesn’t tell the whole story. They can still spread the virus and many are getting very sick (just not at the rates of higher risk populations).

 

5. There’s no proven treatment and no vaccine”

 

If that’s not enough, we’ll have to agree to disagree AND continue the policy of the Governor and public health officials.

 

National, State, and Regional

 

At his press conference yesterday, the Governor acknowledged that there is some potential good news. The rate of infection seems to now be going down. However, he warned, “we’re still very much in the fight.”

 

Regionally, our hospitals still have capacity despite a recent increase in admissions from nursing home (which seems to be resolving some now).

 

At VMG

 

First, a praise passed along by one of our ICMP Care Managers (from the Medicaid ACO), Sara White:

 

“I noticed throughout my calls and chart reviews that you all have been very busy with virtual visits. I also spoke to one of our iCMP patients this morning who was raving about your drive-thru lab team, I believe at the Florence office. Way to go VMG!”

 

And another one from Sara Boisvert who was working with a patient on scheduling a virtual visit:

 

The patient wanted to thank Sara and everyone here at VMG – she said “thank you to all our healthcare workers for getting up every day and doing all of our hard work to keep all of them safe.” 

 

Sara was grateful to hear this from our patient and mentioned it even made her a little teary eyed!  We are doing great things and it’s always so nice to receive these sincere messages from our patients!

 

Department Updates:

 

Eye Care. The department is actively considering other models that would allow them to safely return to seeing some patients including some forms of barrier protection to allow use of their equipment. They are also considering (and have piloted) using internet tools to do some exams. Other things being considered are spacing appointment to allow for sanitizing equipment and rooms, changes in hours, and running the optical shops on an appointment only basis.

 

Ambulatory Surgery and Procedure Center. The Center has been ordered closed by the Department of Public Health (DPH) (as have all ambulatory procedure centers in the state) since the early days of the pandemic. We are now working with staff and the GI and Anesthesia consultants on an action plan for reopening once the DPH gives the OK. It’s a bit more complicated than other departments due the regulatory burden and oversight as well as the nature of the patients and procedures themselves.

 

 

 

Billing has told me that they are getting calls from some patients who are receiving statements (bills) for virtual phone calls and visits and who say that they were not informed there are charges for these services. We are seeing language in some notes saying that the patient was informed and agreed. However, it is not clear if the language was from a macro and discussed or not. So this is a reminder that patients should be informed that we will bill a virtual visit (either for a phone or video/audio visit) for services that qualify.

I’m sure that virtual visits will remain with us after the pandemic subsides and it will become more standard of care and “ordinary” over time. But for now, while patients still experience them as novel, please remember to make sure they understand these are services and will be billed as services.

 

The trial of pediatric wellness visits outdoors yesterday went well. Mary Mitchel reports that we have a few more visits scheduled to continue to confirm the best processes and then we’ll be in position to start scaling up.

 

Val Felton and Amy Rice report that we will continue to distribute face shields to staff requiring them and that we will have that done within a few days.

 

And now, this….

 

 

 

 

Thanks to the clinical staff at GHC for reminding us and our patients.

 

Remember that if you have a specific question about our processes or about COVID-19, you are welcome to use the “covidquestions” email address in the global address list.

 

Thanks once again for all you do for our patients, our colleagues and our communities.

 

I almost forgot. Please wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Tuesday, May 5, 2020                                                                                           Issue # 36

 

 

Happy nurses week to all nurses and clinical staff!

 

And thanks to all of you, who have donated PPE, crafted by you, or gifted from your relatives and friends.

 

National, State, and Regional

 

There ae some improving signs on the east and west coasts and social distancing has helped, but the hoped for steep decline in new cases and deaths does not appear to be happening yet. Instead, we are seeing them plateau while we are seeing hot spots appearing in the Midwest and south and in about 20 states numbers are still rising (though they are starting from a lower baseline).

And this is in the context of relaxing stay-at-home guidelines and reopening of activities.

 

Governor Baker yesterday said that May 18th is not the date to “reopen” the state though he will allow certain businesses to open to employees (unclear which). Rather that date is when we will hear from his task force on reopening and get their recommendations.  In the meantime, as he was making his public announcement, a few people attending the event were shouting “it’s a hoax.” They apparently have not been to the hospitals, ER’s, and morgues to see that this is not a hoax.

 

There is nothing new in our region overnight. We still have capacity in the hospitals and testing is available for symptomatic patients by appointment.

 

At VMG

 

News from Gina: We are seeing the first three patients, ages 0-2, today for wellness visits including vaccines. We’ll see how the process works and scale it up as possible.

 

Seven infrared thermometers have been received and we are testing them to validate results. They should be in use for screening soon.

 

The lab is able to do mobile lab draws outside the centers for any labs ordered for patients.  All patients must have scheduled appointments. We cannot do walk-ins. 

 

Finally, work to develop criteria for the use of antibody testing at VMG is underway.  More information will follow.

 

Podiatry is seeing virtual visits and please refer patients as appropriate. They will also see in-person visits for patients with infections, wound care needs, trauma and severe pain, and for certain diabetic care. Contact the podiatrists or their staff for more information.

 

Sports Medicine is also seeing virtual visits and Dr. Murphy says these are good opportunities to discuss other methods of pain and injury management prior to considering injections. He is able to see some small number of patients with severe pain who have first tried other ways to manage.

 

Endocrinology is seeing virtual visits and using these for advice, consultation, and for follow-up. They are also doing some training and education virtually and they can point patients to internet resources and You Tubes for teaching and training as well. They can also see some in person visits for concerns about infection, new thyroid nodules, and new teaching for insulin and pump management.

 

Rheumatology is seeing virtual visits for new patients (with Dr. Maroun) and follow-ups. There are a few patients that may need to be seen in person for severe pain and injections, medical decision-making and/or for new medication starts and we are discussing ways to see them outside the building, if possible.

 

 

 

This is Mental Health month and this year it has special significance as the rates of anxiety and depressive symptoms climb due to the COVID-19 pandemic and the resulting isolation for many.

 

Boston.com is on line this morning with an article how to maintain your mental well-being during the COVID-19 crisis. They interviewed Ethan Seidman and Daphne Holt and got “6 tips” (including practicing mindfulness, adjusting expectations, being intentional, helping others, building resilience, and focusing on the moment) for “weathering this challenging time.” The advice on “setting intentions” seemed especially good to me. For those behaviors we’ve adopted to get by and deal with stress (like eating or drinking more) it means “feeling better down the line” and asking yourself “if this is what I do for the next two months, is that going to feel good? If not, how do I want to spend the next two months?”

 

Here’s the link:

 

https://www.boston.com/news/coronavirus/2020/05/04/mental-health-tips-covid-19

 

And finally for today, if you know someone who’s been quarantined (or if you have been quarantined), here’s your anthem:

 

https://www.youtube.com/watch?v=LpAKcQufacc

 

OK. Thanks once again for all you do for our patients, our colleagues and our communities.

 

And as my mother used to say, “you (meaning me) sound like a broken record,” but: wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Monday, May 4, 2020                                                                                        Issue # 35

 

 

I hope you had a great weekend and were able to go outside and walk, hike, or whatever you like to do outside. Sunlight and exercise really do work to improve mood and perspective.

 

National, State, and Regional

 

Calls and texts to national hotlines about anxiety and depression have been increasing rapidly (one report said about 1000% this past week). Almost all of the increases are related to the COVID-19 pandemic and the changes to our activities and support systems.

 

Despite the “reopening” of several states, we continue to see new cases and deaths plateau in our state. One positive note, Massachusetts statewide hospitalization rates are declining and are now at 5%. The impact on Western Massachusetts is still not as severe with both hospital systems continuing to report that capacity is still available. The number of COVID-19 patients in the hospitals is however holding steady.

 

Please stay available to your family, friends and colleagues. We’re in a phase where we are “getting used” to things as they are and although that may help get us through our days, it does not mean that everyone is OK and accepting. Kind words and inquiries, zoom or other virtual contacts, walking outside at safe physical distances, really do help.

 

At VMG

 

Below are some charts (thanks to Isaac Allen our Data Analyst) showing our business slowly coming back, mostly in virtual form. The green line represents total 2020 business (you can see the effect of the pandemic since about March 15 – the vertical dashed line) and the blue line is virtual business. We’re still way below 2019 and our budget but there is some improvement recently, particularly in primary care and a few other departments (where virtual visits have become commonplace – I can report on those next week).

 

 

 

 

 

 

 

 

 

 

 

We are, as you know, continuing to develop our capacity to do labs and immunizations outside of exam rooms (in the “open air” of the parking lot – to reduce potential concentrations of the virus) and to do other necessary in person visits in the least concerning way for patients and staff. Beginning tomorrow, we’re trying out pediatric wellness visits. We’ll see how well that goes and learn from this “pilot.”

 

We want to continue to be vigilant, be safe, and be effective in providing care. That’s the vision as we continue through this pandemic.

 

 

 

There are some interesting things going on to try to ease the loneliness and burden of hospitalized COVID patients. Here’s a story from the New York Times over the weekend with one approach:

 

https://www.nytimes.com/2020/05/03/nyregion/coronavirus-doctor-musician-rachel-easterwood.html

 

And more locally, here’s something from Scott Meyers:

 

I am doing live “mini-concerts” on Instagram every week or two after work and on weekends. Next one is Thursday at 5:30PM. For folks who use Instagram (I imagine there are a few) they might enjoy “tuning in” at @scottmeyersmusic

 

 

I can’t say it enough. Thanks again for all you do for our patients, our colleagues and our communities.

 

And need I say this again: wash your hands (a lot), don’t’ touch your face, maintain social/physical distancing (it works), wear a mask, and continue to take care of each other.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, May 1, 2020                                                                                              Issue # 34

 

 

Happy May Day! In some countries, May Day is celebrated by dances, parties, cakes etc. at large social gatherings to welcome spring. Well, we can’t do the large social gatherings, but please enjoy the warmer weather.

 

National, State, and Regional

 

There are more news reports today on many companies and countries involved in working on a vaccine. Some are skipping animal studies and going to human trials. Despite this, we are months and maybe years away from having a safe and effective and widely available vaccine. So, again, physical (social) distancing is the main tool we have to prevent spread of the virus.

 

There will continue to be tension between wanting to follow public health advice about slowing the virus and keeping safe on the one hand and “opening up” the economy (travel, restaurants, movies, visiting, shopping, etc.) on the other. We’re going to have to live with this tension for many months. By the way, this is why Harry Truman once said he wanted a one-armed economic advisor. His economic advisors were always saying “on the one hand….and on the other hand…”  

 

We all want clear direction and certainty. But we have little certainty with the virus now other than it is highly contagious and, in some cases, it can be deadly. So balancing this tension, we think continuing physical (social) distancing makes sense. This will be “the VMG way” until we feel that safety can be managed differently.

 

There was a great article in the Boston Globe this morning about why Massachusetts seems to be staying at a plateau in new cases and deaths. When the pandemic “hit” our state about 8 weeks ago, there was talk about a rapid increase in cases, a peak, and then a decline. Instead we have had the rapid increase and now we may be in a period of staying at peak with a slow decline. The writer explained this as a car with the accelerator stuck to the floor. It speeds off and the first step is to get it unstuck. We seem to have reached that point. Now we have to find a way to tap the brakes. The only tool for that for now is, you guessed it.

 

At VMG

 

I think that many of us are “getting used to” working in this new way, wearing masks in the health centers and when out and about with other people. It may provide some sense of control and calm.

 

But there is another type of “being mindful” we need to observe. Let’s remember that we may find ourselves inadvertently disrupting physical distancing or doing things “the old way.” So let’s be certain that we realize that things we used to do automatically may carry some risks and keep finding new ways. This is particularly true about deciding to bring folks into the health centers. But it’s also true about small gatherings. The question to ask, is it worth the risk? Let’s reduce the chance for inadvertent risk. We’ll be working on that.

 

Next week we will begin piloting some pediatric wellness visits. We’ll be monitoring how it works and after a debriefing, make whatever work flow changes are necessary to do this safely and scale up as necessary.

 

Amy Rice received 7 infrared thermometers. We will be making sure they work well and then figuring out where to deploy them for screening.

 

We’ve received 250 additional face shields donated from Oxbow Design (300 total from Oxbow Design).  Distribution to clinical staff will take place next week so everyone will have their own face shield.  Proper care and cleaning instructions will be provided.

 

Greg Folta reported that we are seeing changes in telehealth reimbursements. This is good news. We are seeing some payers reimbursing at the same rates for phone visits as for VV.  These changes will be retroactive to March 1st. There is also good news with PT Dept. billing changes.

 

 

All of this change can certainly be very tiring. So we have a weekend coming up. Please enjoy the weather, go out for walks, “see people” at a distance or by phone, Face Time or Zoom, talk with family and friends, etc. Be socially closening while physical distancing. One of the morning news anchors was talking about her daughters missing their grandparents. So they set up a Yahtzee game over social media with the grandkids and grandparents. Maybe a tournament?

 

 

 

Oh, and hey, hey, hey, remember: wash your hands (a lot), don’t touch your face, maintain social-physical distancing (it works), and wear a mask, stay home if you’re sick/leave work if you’re feeling sick.

 

Be well,

 

Joel

Be patient; be mindful

 

 

P.S. Some ideas and thoughts:

VMG COVID-19 UPDATE

Thursday, April 30, 2020                                                                    Issue # 33

 

 

Good Afternoon. It's the last day of April. Hard to keep track of time in this era.

 

We are still here and working. That’s good. We’re still innovating and finding new ways to do essential work. That’s good too. And I think we are learning that we can depend on our colleagues and that’s very good. So while we have a long way to go to get through COVID-19, we can rely on our strengths and each other.

 

We talk about “social distancing” a lot because it’s the main tool we have now. But Robin McKeon reminded me that term is not really what we mean. What we really mean is physical distancing – staying at least 6 feet apart and avoiding direct contact so as to reduce the possibility of spreading the virus. In fact what we need is more social closening (a term I wrote about in a previous edition). We need to continue to rely on each other, avoid getting and being isolated, and use our social supports to care for ourselves and others.

 

John Novo found this. Here’s a link to a WHO illustrated guide on Doing What Matters in Times of Stress.   https://www.who.int/publications-detail/9789240003927

 

National, State, and Regional

 

Testing is still the major issue at the national level. There is no one coordinated policy and set of resources in a time that we need just that. We have CEOs of major corporations beginning to speak up and that is good.

 

The Massachusetts trends don’t seem to be decreasing yet. That’s not good though there are some hot spots that are driving those numbers. The Governor has already announced that stay at home advisories continue until May 18.

 

Testing continues to be available at the local hospital systems by referral.

 

At VMG

 

Here’s Gina’s update for today:

Highlights from Governor’s Office

     Closure of non-essential businesses, stay at home advisory and no gatherings over ten people extended by the Governor 4/18

     State updates available by text.  Text “COVIDMA” to 888777.  (charges may apply based on your cell phone carrier.

Operations Update: Highlights

 

On this last item, we met today and decided to continue to allow multiple telehealth platforms (Zoom, Doxy, Skype, Facetime, etc.) for the time being. And we are going to participate in a test of an athena version of telehealth very soon. That’s potentially very good news.

 

That’s it for today. Thanks for reading and thanks, as usual, for all you do.

 

Oh, and hey, hey, hey, remember: wash your hands (a lot), don’t touch your face, maintain social-physical distancing (it works), and wear a mask, stay home if you’re sick/leave work if you’re feeling sick.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Wednesday, April 29                                                                                                             Issue # 32

 

 

Good afternoon. While it looks like a great day out there, maybe that’s what the dinosaurs also thought one afternoon. Asteroid 52768 (1998 OR2), first spotted in 1998, will pass within 3,908,791 miles of Earth today, moving at 19,461 miles per hour. That's still 16 times farther than the distance between Earth and the moon. So, OK, no dinosaurs will be harmed and neither will we. I hope you were not alarmed.

 

However, the novel coronavirus causing COVID-19 is still here and will likely be part of our human experience for many months and beyond. You know that it has radically altered the way we work and care for our patients.

 

There has been some progress reported in dealing with the virus but the headline is that it’s too soon to tell how it might alter the course of the pandemic. There are reports of human vaccine trials starting now in England and Germany and some in the U.S. but even if the trials show that the vaccine is safe and effective, it will take a long time to produce enough doses to essentially offer it to the world. There are very preliminary reports on some therapeutics that might work to reduce symptoms in hospitalized patients who are severely affected. There are also reports of testing becoming more available but not at the scale that we will need yet. And there are plans for contact tracing but it will take many months to scale that up too. So the best we can say is that there are some signs of progress and hope. 

 

We think that we will be working in essentially our current mode (social distancing, almost all visits by telehealth) to protect patients and staff for at least another 6 – 18 months. See below for what we are planning.

 

National and State Scene

 

Not much new to report. Some states are continuing to “reopen.” They are hopeful but the concern is that this will become a big natural experiment in how resilient we are and how persistent the virus remains. We’ll see the results in 2-4 weeks.

 

Massachusetts remains a “hot spot” for infections recorded and deaths attributed to the virus. Some of the increased reporting is the result of increased testing for the virus (Massachusetts currently has the second highest rate of testing in the country). We may be in an “extended peak or plateau.” No cause for reopening Massachusetts yet.

 

Our two counties in Western Massachusetts are still showing better than statewide results in numbers of cases and deaths. But we also have lower population density than much of the state so maybe this is a denominator effect (fewer cased but many fewer people compared to other regions of the state).

 

There is more testing available now compared with several weeks ago. We are continuing to refer testing for COVID to the local hospital systems.

 

At VMG

 

Meghan, Steve and I have been checking in with colleagues and reports of health systems across the country and we are reassured that we are doing all the right things at least compared to other Groups and systems. In many areas we may be ahead of the rest of the country. That’s cause for pride in what you have accomplished. Of course, there’s a lot more to do in adapting to our new environment of COVID.

 

You already saw Stephanie Pick’s email about our work on CCM. She reports that we “broke our record” in March for number of CCM services. And this is, to quote Stephanie, “in spite of workflows being disrupted, work being done from home, and the many changes that have occurred in the past 6-8 weeks. You have been documenting the time you spend taking care of some of our more vulnerable patients. Well done!”

 

We continue to get praise and appreciation from our patients. Lisa Dumas in Radiology had this to say this morning: “I just x-rayed a patient who told me that she really liked her recent virtual visit.  She said, “That’s my kind of visit.  It was fantastic!”

 

As you know, we’re thinking of the need to begin bringing back services, but doing that in a way that continues to protect patients and staff as much as possible. We’re looking at using “temporary” structures (i.e. tents and car ports) in our parking lots for use for lab draws, immunizations, injections, and perhaps some evaluation and treatments. We’re thinking of this being a priority well into the fall and winter of next year, as necessary, especially when we start providing flu vaccine (more on that in days to come).

 

Another central idea is to find ways to reduce patient and staff time in exam rooms by doing whatever work can be done (gathering information and history, for example) by telehealth and reserving time in the building for when we actually need to see and touch patients.

 

Of course we’ll need to have adequate supplies of necessary PPE. Val Felton and Amy Rice have been doing a great job keeping a central inventory and reporting on the status of our supplies of masks, gloves, gowns, face masks, thermometer covers, etc. (We’re stocked adequately for now).

 

Jean Wilder in Billing suggested that it might be helpful to us and to the community to keep track of how VMG staff have been helping out in the pandemic (in addition to the work they are doing for VMG). If you have been making masks, headbands, working at food pantries, etc., and you are willing to share, please get me this information. We can compile and report on your efforts (we won’t reveal your names).

 

 

 

Although the emotional strain caused by the pandemic really is no laughing matter, it does help to be able to acknowledge it and talk about it, and sometimes a humorous approach makes it more acceptable to discuss. Here’s something that may help:

 

https://www.youtube.com/watch?v=uEMiTACTBhI

 

 

Thanks, as usual, for all you do.

 

And hey, hey, hey, remember: wash your hands (a lot), don’t touch your face, maintain social distancing (it works), wear a mask, stay home if you’re sick.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Tuesday, April 28, 2020                                                                     Issue # 31

 

 

Good afternoon to all. 

 

Consider This

 

You’re going to be hearing a lot about vaccine development in the coming months and that is a very good thing. It normally takes anywhere from 1.5 to 4 years to develop and produce, at scale, a safe and effective vaccine. There are reports from the UK today that an Oxford lab may actually be able to prove a vaccine is safe and effective by September. That would also be good but we’ll have to wait for the trials to conclude and the results to be known. And then it will take time for production. In the meantime, we continue social distancing to keep our medical resources available and slow the spread of the virus and see if a safe and effective treatment emerges from clinical trials. And we, as a nation and world, need to devote lots of resources to testing.

 

So how could vaccine development have been different? Aside from the political “mistakes” of not paying enough attention to new viral threats, there are the wrong incentives “built in” to the funding of these efforts. In an article in the NY Times this weekend by Jennifer Kahn reports on efforts to create a panviral vaccine. This is a kind of default vaccine structure that could be relatively easily customized to fight almost any new virus. The biggest problem is that no one was willing to pay for it. Drug companies would have to spend millions on development of a vaccine that individuals would get once a year or not at all (in some years). Not much financial payback from that kind of use.

 

You might think that this would be a role for governments to take on rather than “the private sector.” But new diseases emerge “in other countries” and some never reach certain shores. And it’s all very expensive and which taxpayers want to pay for some previously believed remote possibility? Do you? I do?

 

In that article, Peter Daszak, a scientist presenting at a WHO conference is quoted as saying “we don’t think twice about the cost of protecting from terrorism. We go out there, we listen to whispers, we send out the drones—we have a whole array of approaches. We need to start thinking about pandemics the same way.”

 

OK. I’ll stop there. But think about it please. Especially as you prepare to vote.

 

National and State Scene

 

I’m going to pass on the national scene today except to say that testing is key and rather than having 50 approaches, one national approach would be better.

 

At the state level, Governor Baker has just extended the Stay at Home advisory at least to May 18. This continues the order for the closure of all non-essential businesses and the ban on gatherings of 10 or more people. I think that’s a good decision and I would not be surprised if, as that time approaches, it was extended into June.  We all want to get out, go to the beach, the movies, restaurants, ball games, etc. but let’s be safe.

 

At VMG

 

The Greenfield (and other towns) police and fire did a drive by salute to healthcare workers at VMG and elsewhere this morning. It was quite the scene (unless you are spooked by sirens) on Conway Street. Many of our staff were out there to return the salute. We’ll try to post the video on the intranet page (the file was too big to include here). We thank them for their recognition and we should salute them as well as first responders.

 

Gina prepared this concise chart of operations updates at VMG this morning. I’m passing it on here:

 

 

 

 

 

 

 

And Elsewhere

 

Here’s a link to a NYC nurses journal published in the New Yorker  to keep us aware.

 

https://www.newyorker.com/magazine/2020/05/04/a-city-nurse?utm_source=nl&utm_brand=tny&utm_mailing=TNY_Magazine_Daily_050420&utm_campaign=aud-dev&utm_medium=email&bxid=5be9e5663f92a40469faf69c&cndid=21488249&hasha=f1f07c005d3d7d2d87c7750cb90cd973&hashb=111400a8beefab12a9a2b4299df70b8f471f4012&hashc=bcc031ec8a3f5143606ac370d40121bf376c99b55fc0788b756d0f2c93f10b23&esrc=&utm_term=TNY_Daily

 

And finally….as you are staying at home...to lighten it up…..

 

Excerpts from an “Isolation Diary”

 

Day 1 – “I can do this. Got enough food and wine to last a month.”

 

Day 3 – “Strawberries. Some have 210 seeds. Some have 255 seeds. Who knew?”

 

Day 4 – “8:00 pm. Removed my day pajamas and put on my night pajamas.”

 

Day 6 – “Today I get to take the garbage out. I’m so excited. I can’t decide what to wear.”

 

Day 8 – “Went to a new restaurant called “The Kitchen.” You have to gather all the ingredients and make your own meal. I have NO clue how this place stays in business.”

 

Day 10 – “Struck up a conversation with a spider. Seems nice. He’s a Web Designer.”

 

Day 12 – “I realize why dogs get so excited about something moving outside, going for walks, taking car rides. I think I just barked at a squirrel.”

 

Day 13 – “If you keep a glass of wine in each hand, you can’t accidentally touch your face.”

 

Day 14 – “Watched the birds fight over a worm. The Cardinals lead the Blue Jays, 3 to 1.”

 

Day 15 – “Anybody else feel like they’ve cooked dinner about 395 times this month?”

 

 

 

Thanks once more for all you do.

 

And remember: wash your hands (a lot), don’t touch your face, maintain social distancing (it works), wear a mask, stay home if you’re sick.

 

Be well,

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Monday, April 27, 2020                                                                                                  Issue # 30

 

 

I hear the phrase “new normal” all the time now. I heard this plane overhead near my house. We’re in the woods. Most airplane noise is distant but this was doing loops, engine stalls (sounded that way) and noisy. So what bothered me? Not the noise. It was the normalcy of it. This plane comes every spring day (and summer and fall), kind of like the bears. And the contrast between life going on and life mothballed was striking.

 

This is where we are. The normal things like birds, flowers coming up, trees budding and the “new normal” things like no traffic, no school, and (almost) no in-person patient visits. Not too hard to social distance when there are only 10 people on a floor of a building meant for 50-100.

 

Summer will be here soon.

 

And then there’s the tortuous political scene. Quite the contrast between the heroic and courageous “front-line” workers and the inept politicians, scammers and conspiracy theorists.

 

National and State Scene

 

Some states are reopening. We’ll see what the results of those experiments are. Massachusetts, as a state, is not reopening at least through May. We’re still near the peak of infections. Hospitalizations seem to be improving but we’ll know more next week.

 

Some communities are getting tougher. Somerville will be fining people $300 for being in a public space, indoor or outdoor, without a mask. On the other hand, they are also offering “on-demand” testing for anyone. Just walk in.

 

Testing, in general, while improving slowly, is nowhere near the scale it needs to be. Dr. Fauci is talking about at least doubling the current availability and rate across the country. Massachusetts is testing more than most other states and so our rates of infection may be higher because we know about and can see more. It’s probably higher still.

 

Regional

 

In Franklin and Hampshire counties, our hospitals are still reporting availability in ICU and other beds.

 

Drive in/up testing for virus is available now in both our counties through the hospital systems, still on referral and by appointment.

 

At VMG

 

From Gina: “The VMG Lab Team has done an outstanding job of redesigning the work to be able to perform mobile lab draws, outside the health centers to meet the needs of our patients for urgent lab work.  The team continues to revise their procedures to ensure safety for all.”

 

Mobile lab draws are for urgent and semi-urgent labs determined to be needed by a practitioner and disease management labs for our diabetic patients.  All labs must be scheduled, no walk in appointments are available.  The phlebotomy team is also able to go to radiology or the respiratory unit as needed to draw a patient with urgent lab needs to minimize traffic in the center. We’ll be scaling this capacity up in the next few weeks and months as we learn what works and what does not work as well.

 

I continue to hear reports of incredible teamwork and devotion to patients. Reception was challenged today in Northampton due to staffing. Early this morning, colleagues from around the company got together, pitched in and arranged for coverage just in time. Thanks to everyone for coming together.

 

In Amherst late last week, the clinical team in the center that late afternoon worked together for a newly diagnosed diabetic patient who needed urgent treatment and training in managing his disease. In addition to bringing him in with the now “new normal” cautions, starting an IV, treating his ketoacidosis, providing medication and support, he also was taught the basics of caring for himself with his new illness. Staff stayed late (around 6, I think) to make sure he could go home safely. Because of everyone’s efforts, he was able to avoid an unpleasant ER visit. Thanks to everyone for coming together.

 

 

 

I saw an article on line in The Boston Globe over the weekend by Hannah Krueger. She was writing about, Liz Adams, from Alabama who drove north in this pandemic to take a position at MGH as a travel nurse. This is most of the article.

 

“My dad passed away suddenly last year. I watched the amazing care he got, and I’ve felt so empty since. I saw what was happening, and I realized I could be the person to treat a patient like they treated my father, especially because family cannot be with patients right now,” she said.

 

“I get chill bumps even saying it. As someone whose father was in their shoes, that’s everything to me," said Adams. "We’re not doing it to put on a show — there is no one there to even impress — we are doing it because it is the right thing to do.”

 

To date, with just 5,654 positive tests, the entire state of Alabama has registered fewer coronavirus cases than Suffolk County alone. Just 197 have died statewide. Adams admits that for many in Alabama, the reports out of New York and Boston differ greatly from their own experience, meaning “you can’t help but wonder if this is all being exaggerated.”

 

But now she sees daily consequences of a contagion allowed to spread and how quickly and mercilessly the virus can ravage patients. The ICU unit is full of worst-case scenarios and patients teetering on the brink. Those fortunate enough to recover even slightly are moved to step-down units and replaced by more dire cases. Adams’s Facebook posts double as a form of catharsis and a way to give her friends and family a voice they can trust. “I’ve seen sick. . . . This is different. It hurts me when people say this is just like pneumonia or it’s not that bad. Because no it is not. No the hell it is not,” she said, her voice shaky.

 

Travel nursing assignments typically last 13 weeks, but the length of COVID positions is contingent on the trajectory of the outbreak. Analysts at Mass. General believe that the crush of very sick patients at its doors is unlikely to get worse, but data still show 100 to 150 state residents dying daily from the virus. Adams, who added two weeks to her contract Monday, plans to return to Huntsville mid-May.”

 

More heroes in the world, speaking up, pitching in, coming together.

 

 

Thanks again for all you are doing for our patients, our communities, and each other.

 

And hey, wash your hands (a lot), don’t touch your face, maintain social distancing (it’s working), wear a mask.

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Friday, April 24, 2020                                                                     Issue # 29

 

 

I’ll bet everybody’s glad it’s Friday. I am too.

 

Unfortunately, a somber note to start: fifty thousand dead in the country; 195,000 worldwide. So let’s take a minute to remember. We feel for all who have died, lost loved ones, or been wounded, physically or psychologically, by this pandemic. We go on though, because that’s what we do. We try to learn and we keep to our mission to help and heal. 

 

National and State Scene

 

At the national level, the most credible spokesperson, Dr. Fauci, is convinced that we will be dealing with COVID-19 come fall. The difference in the fall, and this is a hope as well as a plan, is that we will be better prepared: more tests (for antibodies as well as for the virus), more beds, perhaps an approach to contact tracing, and, in general, an improved public health approach at the national, state, and local levels.

 

Massachusetts cases are still growing, though our area remains in a plateau. Keep social distancing. It works and it’s all we have now.

 

At VMG

 

You should see some photos in the local papers of lab staff working in their mobile station with some appreciative patients (Debbie sent them earlier). Good job all. I know we’re planning on scaling this up over the next weeks and months.

 

We’re also thinking about how we’ll be administering flu shots by the end of the summer or early fall as that will be even more important this year.

 

And a letter will be going out to parents of VMG patients about our plans to catch up with immunizations and pediatric wellness.

 

 

 

OK, it is the weekend now. Thanks for doing a “good job.” In case you didn’t see it last night, to take you into your weekend, here is some timely great music and video that captures our mood and our inspiration:

 

https://www.cnn.com/videos/entertainment/2020/04/24/alicia-keys-visual-premiere-good-job-coronavirus-town-hall-vpx.cnn

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Thursday, April 23, 2020                                                                                                                   Issue # 28

 

 

It’s almost the weekend. Breathe. I hope you are well.

 

Why is the picture below scary?

 

 

 

This is the scene yesterday outside a beachside restaurant in Jacksonville, Florida. I see 3 masks in the crowd. And the crowd is pretty much shoulder to shoulder, within a few inches of each other. It looks like normal times at the beach town. But…these are not normal times.

 

Here’s my concern. Actually, two concerns. First, these folks are betting their health and the health of their families, friends, and co-workers on the theory that the virus is not going to get them. It’s a bad bet.

 

Second, people seeing this might start thinking “if they can do it, I can do it, and wouldn’t this be a great time to go to the beach in Jacksonville? OK, but when they come home, they may be bringing back more than just some sand in their shoes and sea shells in their luggage.

 

Let’s tell ourselves, our families, and our friends: stay home, stay safe, and protect our loved ones. Don’t travel (yet) unless absolutely necessary.

 

National and State Scene

 

The news on the national scene is about the above: maybe too much reopening on too little data. With no reliable, wide-spread testing, we don’t know the extent of the virus spread and where the next hot spot might be. We do know that the virus did not go away. And we know the history. Places that opened too quickly in the 1918 flu pandemic saw a rise in cases and deaths. History has a way of, well, predicting the present (in this case). A recent early study of NYC residents showed about 21% in the sample had antibodies for the virus (which means they were already infected).

 

ER visits are down in the state and across the country. It’s probably not that the “worried well” (whatever that means these days) are staying away. The concern is that people with conditions that might have brought them in for acute care in the past are staying away for fear of COVID-19. Potential heart attacks, strokes, and even acute psychiatric patients may be choosing to stay home, wait it out, and see what happens. Some are saying there are now two epidemics: the COVID-19 epidemic and an epidemic of COVID anxiety.

 

This just came in from the Boston Globe. ”Governor Charlie Baker on Thursday said the latest statewide death figures from the coronavirus are “staggering,” but he also urged residents to continue to visit hospitals for necessary treatment for other serious ailments and sought to assure the public that the health care system isn’t being overrun.”

“And in a Globe town hall on Thursday afternoon, Boston Mayor Martin J. Walsh cautioned against ending social distancing too soon, adding, "We’re probably in for another four, five, six weeks of what we’re going through today."

 

Regional Scene

 

Locally, our hospital systems are working on getting the message out that they are open and safe to care for non-COVID emergencies.

 

Our two counties remain at the low end of cases and deaths in the state. Our hospital systems are reporting they still have capacity for COVID and non-COVID cases. There are some models predicting that the peak of COVID cases will be next week in Massachusetts. We’ll see if anything changes locally. Social distancing and other cautions should continue.

 

At VMG

 

Just to confirm how our clinical practice is now “inside out” (in a good way given the pandemic), here are the visit numbers for last week in primary care:

 

 

We still have room in our schedules and many of you are working on filling those slots with patients who need them. One EHC patient brought in a drawing of a heart with the words “thanks for being there for me.”

 

And speaking of turning the practice inside-out, a Gazette photographer visited NHC this morning (for a series documenting the effect of COVID-19) to photograph a few of our mobile lab draws in patient cars. (She got staff and patient permissions). The patient in one of the cars was highly complementary of our staff for their kindness and for finding this way to safely carry out this essential function.

 

Our nurses have also been giving specialty injections in the parking lots for endocrine patients in need of these treatments and there are plans to expand the types of injections and treatments in the mobile office (cars).

 

And then we’re repurposing some of our outdoor space to make it more convenient and safe for lab draws and treatments. In Greenfield, lab staff and maintenance staff have worked together to create new work processes to make this work outside our building (on the back porch, actually) for patients and lab staff. That site will begin operating on Monday.

 

Thanks to all the phlebotomy, clinical and nursing, maintenance, and reception staff involved.

 

 

 

Finally for today, if you are an Alicia Keyes fan, she’s premiering a new song on the CNN Pandemic Global Town Hall tonight at 8 PM on CNN.

 

Be well. Oh and hey, wash your hands (a lot), don’t’ touch your face, maintain social distancing (it’s working), wear a mask, don’t travel.

 

Joel

Be patient; be mindful

VMG COVID-19 UPDATE

Wednesday, April 22, 2020                                                                                             Issue # 27

 

 

Welcome to Earth Day, number 50. I wish we could say things are better today than they were when Earth Day was first celebrated but this is forecast to be the warmest year on record. Some are hoping that the COVID-19 shutdown that has caused improvements in air quality might spur us on to make more permanent changes.

 

National and State Scene

 

As of today, more states are pushing to “reopen.” Some still are seeing rising cases. Here’s what happened in 1918 during the Great Influenza pandemic. In Denver, the mayor gave in to the pressures of “businessmen” and opened the city back up on Armistice Day (celebrating the end of WWI), presumably to allow citizens to celebrate. Denver had observed effective social distancing until then. They were not “celebrating” in the weeks and months that followed. Many deaths followed. That was 1918.

 

Today we see states like Georgia and cities like Las Vegas ignoring guidelines and history and moving to reopening (without adequate testing, contact tracing, treatment, or a vaccine). In fact, the mayor of Las Vegas said that they should open the casinos (? next week), let people come and smoke and gamble, and “see what happens.” I don’t think they teach this stuff in Public Health school (or any school) and I know that this bet is not a good one (even for Las Vegas).

 

As you know, our Governor has extended the state of emergency through the end of the school year. That probably means no “reopening” unless the situation changes. The city of Worcester has been identified as an emerging hot spot.

 

Regional Scene

 

Our local hospitals still have capacity and are not seeing a surge in cases (this does not mean we are in the clear; just that we don’t see a surge coming for now). Social distancing, reduced travel, community cooperation, wearing face masks in high density areas, and keeping folks out of the ER who don’t need to be there are probably helping. The local hospital systems continue to discuss bringing back some elective surgeries and other services in the next several weeks to care for patients who have been put off by preparation for COVID-19 patients.

 

Here’s a chart taken from a daily briefing at Baystate Franklin showing the “plateauing” of cases (I assume a chart from Cooley would look pretty similar).

Face masks are available in the community for those who need them

More information on face masks and coverings is available on our internet page and intranet page.

 

At VMG

 

In keeping with the continued state of emergency, we are continuing our Work from Home efforts at least through the month of May. If you have questions, please contact your supervisor.  We may need to bring some people back as we gradually bring some services back.

 

Here are our latest guidelines and requirements for the wearing of facemasks in the health centers (from Gina’s email, earlier today):

 

Patients 

  •  All patients who are going to be seen in the health center, receive care in the parking lot, receive care outside the center on the property, for all services, are to be informed at the point of scheduling they must wear and arrive for their appointment with their personal facemask/face covering.

  •  All patients must have a facemask/face covering when they present to the health center main entrance, care in the parking lot, receive care outside on the property, for all care and services.  A patient may not access the center or receive care if they do not have facemask/face covering.

  • When a patient presents to the respiratory entrance at GHC, AMC, NHC they should be wearing their personal facemask/covering, and will be provided a surgical mask to enter the respiratory unit.

  • When VMG is able to begin pediatric visits for children 0-2 years the parent/caregiver will be requested and required to wear a mask.

 

Staff and practitioners

  • All staff and practitioners are to wear their personal facemask/face covering upon entering the health center.

  • Following screening at the designated entrance, temperature being taken, and being cleared to enter the center, staff and practitioners will be provided one surgical face mask to wear for the day.

 

Vendors

  • All vendors who need to enter the center, must wear their personal facemask/face covering to enter.

 

These guidelines will be adjusted as necessary.

 

We have now completed our “Virtual Brown Bags” for this month. Thanks to all of you who participates. We’ll get you information on how to listen to the recordings, if you wish, in the next few days.

 

Reminders about Coping

 

Tim Sweeney reported that there is a renewed interest in “Quitters Win” smoking cessation support. That’s good because we know that smokers are at increased risk given the nature of this disease in particular. The same can be said about overeating (or eating for “comfort”). Our dieticians can help with that too. Keep working those referrals.

 

There are several mindfulness apps that are “surging” in the app stores (and on Wall Street) now. Calm, Headspace, and an app called Ten Percent Happier. They are all similar and, depending on personal preference, all good for helping guide patients in mindfulness, meditation, relaxation.

 

So, Be patient; be mindful.

 

Thanks again for your continued dedication and work for our patients, communities, and each other.

 

Joel

 

Oh and hey, wash your hands (a lot), don’t’ touch your face, maintain social distancing (it’s working), wear a mask.

VMG COVID-19 UPDATE

Tuesday, April 21, 2020                                                                                        Issue # 26

 

 

Good afternoon. I hope you are all well.

 

National and State Scene

 

We’re about to get a live experiment in what happens when social distancing stops without vaccine or treatment for a new virus. Georgia is about to reopen lots of businesses (even though their infection rates are still rising). This follows smaller re-openings of specific locales in places like Florida and Texas (or perhaps its failure to close in the first place).

 

In Massachusetts, Governor Baker today ordered the continued closing of schools through the end of the school year and day care centers through June 29 (the only exception being for daycare for children of healthcare workers and first responders). The Governor is responding to high rates of infection continuing, especially in the eastern part of the state.

 

Regional Scene

 

In our counties, ER and Hospital admissions and ICU beds remain stable. There are discussion going on about bringing back some services, and messages going to patients about seeking or returning to care, especially for the patients with conditions other than COVID-19 who may still be suffering or need follow-up of chronic conditions.

 

At VMG, we have workgroups going through lists of patients who need services for chronic conditions such as hypertension, diabetes, etc. and there are planning groups working to bring those services back in a safe and efficient way over time. Several people have asked about pediatric and other immunizations as an example of a service that we need to get back to and there are staff working on planning for this now.

 

We are working on continuing to accumulate PPE (our supplies are good right now) so that when we do bring patients back into the building for treatment, we can give them a mask to use if they do not have a proper mask of their own. (But for right now, please do not give out VMG PPE to patients).

 

For the few patients whom we are seeing in the centers, we’ve “discovered” a problem of having family members or partners or rides bringing patients in and then staying in our reception areas (aka “waiting rooms”). We want to avoid having unnecessary contacts for folks in the reception areas so we are asking to have patients told to have those providing rides to wait in their cars for the visit to be over. We can then call or motion for them to come and meet the patient. Where that does not seem possible (e.g. the patient and a companion are dropped off by the bus), please discuss with your Nursing Team Leader, Health Center Manager, or Reception Supervisor.

 

Our Patients Continue to Send Appreciation

 

We continue to get thank you notes from patients for the care and consideration they are receiving from staff and practitioners. One recent note thanked the medical assistant who spent a lot of time “walking the patient through” getting their computer set up so that the patient could do a virtual visit. Other notes of appreciation are less specific and say things like “you guys are simply awesome,” “are the gold standard,” for communication and helpfulness.  Thank you all for that.

 

 

That’s it for today.

 

And, hey, you know what to do: wash your hands (a lot), don’t’ touch your face, observe social distancing (it’s working) (even as others may be rejecting it), wear a mask or face covering and stay home if you’re sick.

 

Joel

 

Be patient; be mindful

 

Here’s a positive outcome of this pandemic….from our very own Dr. Scott Meyers:

 

https://www.youtube.com/watch?v=RznW-4mREik&feature=youtu.be

VMG COVID-19 UPDATE

Monday, April 20, 2020                                                                                     Issue # 25

 

 

Well this was going to be the beginning of a vacation week, the Boston Marathon, the celebration of Patriots’ Day. Not this year.

 

National and State Scene

 

You’ve seen the protests to stay at home orders and the calls of demonstrators to “reopen.” Much of that was happening in places that did not see much incidence of COVID. That’s a problem for them as they will soon see cases emerge. However, we’re now seeing those protests in some states where COVID-19 is more endemic. And that’s a problem for all of us as it can lead to a resurgence of cases where the virus has already “died down” as people travel. Most of us believe that social distancing should not stop yet and will need to continue for many months until there is better testing and contact tracing, treatment, and, ultimately, a vaccine.

 

Boston has been identified as a “hot spot” along with D.C., Baltimore and Philadelphia. Many of us know people in the Boston area. We should support and encourage them in social distancing.

 

For those who do not have health insurance during this time (because of job loss or for other reasons), the Massachusetts Health Connector is running a special enrollment period through May 25. Please spread the word if you know anyone to whom this might apply.

 

Regional Scene

 

Not too much new here and that’s relatively good news. ER’s are steady and handling the load (Baystate estimates that 22% of ER admits are COVID-19 positive here and across the state). ICU’s have capacity and the local systems are reporting what looks like a plateau in admissions. That’s good but it’s too early to tell so let’s not let down.

 

There is some expanded testing available in the hospital systems and we are taking advantage of their capability for now. Most of that testing is still for high risk groups, symptomatic patients, and health care and first responders. There is currently no testing for antibodies available.

 

What about non-COVID Patients?

 

Most Groups and hospital systems are thinking about and planning for bringing up some services that were stopped because of the pandemic. The services will have to allow for seeing COVID patients as well as these other patients because the virus is not going away. But also not going away are heart attacks, strokes, high blood pressure, diabetes, smoking, etc. With all the emphasis on social distancing (necessary), PPE, etc. will some patients “not want to bother us” or feel uncomfortable seeking care? Will their conditions worsen?

 

Dave Kaufman told me to read an editorial in the April 20 edition of New England Journal of Medicine by Lisa Rosenbaum, M.D. (I can send you a copy of you wish). It’s called The Untold Toll – The Pandemic’s Effects on Patients without COVID-19 and it outlines concerns of actual patients without COVID, and their caregivers and providers, struggling with decisions about care, sometimes critical.

 

Returning to the “normal world” of giving care is going to be long and difficult as we confront unprecedented challenges and decisions about how to bring back what worked to keep patients healthy or improve their conditions in the world with COVID. I know we are all “on this” and we’ll work hard together to find solutions.

 

Longer Term Untold Tolls

 

We know from learning about trauma that it’s not always visible right away but nevertheless there. Patients experience trauma in different ways and at different times. And with so much disruption, stress, pain, and loss, we know that psychological disorders and adjustments to life with and post-COVID will be difficult for many. We’ll see more signs of anxiety, depression, grief, and somatic symptoms as time goes on. We’ll have to remain alert for opportunities to be with these patients even while social distancing and when social distancing can be relaxed.

 

One thing we’re hearing from patients is that even though we’re not seeing them in person a lot, they really appreciate being listened to, heard, reassured when possible, and struggling together with us with the truth of their situation when reassurance is not possible. We’ll do some more work and training on this going forward.

 

And Now, This…

 

We’re going to keep social distancing because it’s what we can do and it’s the right thing to do now. Here’s a video from today’s Boston Globe on how staying home is staying strong. (You may have to click on the photo that you’ll see to start it).

 

https://www.bostonglobe.com/2020/04/17/sports/boston-is-still-running/?event=event12

 

Here’s a link, suggested by Scott Ackley, Amy Rice, and Diane Alpern, to help patients stay safe and strong by finding face coverings:

 

https://9463294b-8f5d-4a04-a7f8-71e16af3968e.filesusr.com/ugd/032981_e82054021dfe44fca8dddf3eced851b1.pdf

 

 

 

Thanks again for all you do for patients, community, and each other. Be well.

 

And you know what to do: wash your hands (a lot), don’t’ touch your face, observe social distancing (it’s working) (even as others may be rejecting it), wear a mask or face covering and stay home if you’re sick.

 

Joel

 

Be patient; be mindful

Friday, April 17, 2020                                                                                   Issue # 24

 

 

Good to be at Friday, right?

 

The National and State Scene

 

It’s now clear that state Governors will decide about when, how, and at what pace to lift stay at home directives and closings of institutions and businesses. There will be variation, but it seems that Governor Baker will try to align with the governors of RI, CT, NY and NJ in which case, though not yet announced, we’re talking middle of May at the earliest. I doubt that schools will reopen until the fall at the earliest and maybe later.

 

Social distancing efforts will continue/should continue throughout this year and probably into next year unless a vaccine is developed very soon and that probability is very low. And whenever a vaccine is developed, it will take many months to immunize all who need it (just about everyone for whom it’s safe).

 

In our areas it seems that social distancing has been adopted and observed reasonably well. That may be one of the reasons that our hospital and ICU admissions have stabilized relatively quickly and that our hospital capacity is so far doing well to the point that at least one of the hospital systems is now considering that we may not see a surge in cases here.

 

So if social distancing is one of the few tools we have (at this time) for slowing the spread of the virus, why are we hearing about areas in the country where people are openly violating stay at home directives and going back to large gatherings and social events? Aside from every action has an equal and opposite reaction (someone famous passed that law once), there has been such a mixed message at the federal (and some state) governments and not enough solidarity in Congress to set a clear and consistent course and stick with the message that social distancing works.

 

My daughter-in-law, who is from Texas (outside of San Antonio) tells me that even her friends and family back home, who should know better, are partying, BBQing, etc. and some still believe the virus is a hoax. It’s hard to believe that we can’t have agreement about this being real at this stage of the pandemic. So we have to be clear with each other, talk with any of our friends and relatives who may not be taking this seriously, stand up to and for them, and stay the social distancing course (this is, after all, an act of love).

 

 

At VMG

 

We are working on prioritizing the clinical operations that we need to start up again sooner rather than later. Plans are in the works and you’ll be hearing about them soon. It will take continued creativity and perseverance (but you’re already getting really good at that) in how to deliver those services and we’ll be hearing more about some of this next week.

 

A final note about enabling this next phase of our work. You saw Gina’s note this morning about making sure we reserve the VMG supply of PPE (masks, gowns, gloves, shields, etc.) for VMG use. “These supplies are for VMG use only, and those patients we need to mask due to their clinical condition upon arrival to the health centers.  PPE is not to be taken home or provided for patients to use at home.”

 

Please observe this restriction. Our supplies remain adequate for our current needs and it is important for each of us to safeguard this resource as we go forward and expand in-person services in the weeks and months to come. Until there is a vaccine we have to remember that the virus isn’t going away and our PPE can’t go away either. Thanks for your help with this.

 

 

 

OK. It’s the weekend. Have a virtual rock concert if you wish, below, for your enjoyment (and you have to play through it to see Prince; go ahead, drop that mic or guitar).

 

https://www.youtube.com/watch?v=6SFNW5F8K9Y

 

 

Be well, and hey, hey, wash your hands (a lot), don’t’ touch your face, maintain social distancing (it works), wear a mask connect with friends and family. Have a weekend.

 

Joel

 

Be patient; be mindful

VMG COVID-19 UPDATE

Thursday, April 16, 2020                                                                    Issue # 23

 

 

 

So much has changed, it seems, in such a short time. Yes, we are still here “seeing patients,” we’re still going (or staying home) after work, we’re still walking in the woods or in our neighborhoods, and maybe you can imagine our worlds coming back again to something like what we had before. I saw some neighbors planting a garden yesterday with their one year old while out for my walk after work. It just seemed “so normal.” And then there’s the news, the press briefings, the drone of news about COVID and Coronavirus. It seems so not normal. It’s overwhelming sometimes and surreal. But we go on. We get better. We imagine our way back and maybe even improved, better, more together.

 

What are we learning? About the things that drive us apart. About the things that bring us together? I think we all want to know how to improve. We’re learning about staying in touch with patients by reaching out, by video visits, phone contacts. We’re seeing patients in Behavioral Health by video and guess what? Almost no no-shows. Our Advanced Care Planning Committee (the Committee that plans and teaches us how to have conversations with patients about their wishes at the end of life, among other things) is continuing their important work, maybe even more important and immediately meaningful now. Our telehealth visit rate continues to increase, as it should, but we didn’t know we could do this just 6 weeks ago. We’re standardizing plans for “parking lot care” including safely administering injections and drawing blood. We’ll be working on giving recommended immunizations again to children.

 

What other things can we learn in good time? What other things can we imagine and “bring to life” now that we have the need? Keep your eye on what you’ve learned. What can you do now that you didn’t know you could do?

 

Steve talked about us being in a kind of “maintenance phase” right now in our work during the pandemic. Rates of ER visits, admissions, seem to be flattening out (for now). Hospital ICUs are stable and continue to have capacity. We’re not ready yet to go back to “normal business” but it’s a good time to plan for “reopening” and what that might look like and we are working on that. We’ll be sharing more in the coming days and weeks. And we have to remain prepared for the possibility of this phase continuing; rates may slow but there will still be a lot of need and pain to cope with and adapt to. And if things calm down, return to a new kind of normal in the next few months, there may be a return in flares of the virus that might bring us back to what we look like now. We’ll need to remember how we are working and learn to improve.

 

Here’s note from one of our Social Workers at VMG working through our Medicaid ACO:

 

As an iCMP social worker I am contacting VMG patients daily to make sure they have the resources and supports they need. My team members are getting a lot of feedback from our patients - how they are so grateful that they are able to have medical appointments via phone or through virtual visits.

 

As you know, all of iCMP Pts have Medicaid insurance and the majority are low income. Many patients we work with will share their experiences of trying to access good health care. They often feel marginalized and judged when they don't follow through with recommendations by providers. Often this is due to economic issues of not being able to afford healthier food to make better food choices. Many of our patients struggle with mental health needs. They will often report "not wanting to bother" their provider or not wanting to go to a health center and wait around to be seen or be around other people.

 

Now that providers have had to restructure appointments, including changing to virtual and telephonic appointments, many of our patients are reporting being "surprised" that their providers are providing this additional service to them. It is often described as a "personal touch." 

 

I just wanted to share this with you as I think it is important our providers know that what they are doing is making a difference. I started an email chain with my team to say, we aren't together, but let's remember to say hi every day and encourage each other.

 

She also pointed me to this:

 

https://www.youtube.com/watch?v=qh2LHaFpE_k

 

 

Be well, and hey ….., wash your hands (a lot), don’t touch your face, maintain social distancing, wear a mask.

 

Joel

 

Be patient; be mindful

VMG COVID-19 UPDATE

VMG COVID-19 UPDATE

Wednesday, April 15, 2020                                                                                                   Issue # 22

 

 

 

Let’s start with some patient feedback. One of our Greenfield staff passed along this comment of appreciation yesterday:

 

“Just wanted to share more thanks for us all from a patient today. She called specifically just to let us know how much she appreciated Dr. Reeves going above and beyond during a recent VV with her. She really appreciated his help. She wanted to thank all of us for the work we're doing here and wanted me to let everyone know.”  

 

"You guys rock!" (I’m not sure if this was from the staff member or the patient, but either way, you guys rock!).

 

Local Scene

 

Both hospital systems in our area are reporting they still have capacity, including ICU beds. Admissions seem stable for now. There are plans for surge capacity, if necessary.

 

Cooley now has testing up for patients on referral from PCPs and other staff. There are criteria for which patients will be tested but they appear to not be very stringent.

 

There is also testing available at The Big E (but I’m not sure about who is running the site and about criteria).

 

Regional

 

The Governor of New York is saying that state may be past the peak infection/admission rate now. However, the ICU’s are still full and people are still dying. New Jersey, however, is still reporting increasing infections and admissions. Massachusetts is still seeing increasing admissions and infection rates though the Governor reports that the curve may be flattening.

 

“Reopening” the Country

 

Several governors are talking about plans to reduce restrictions and stay-at-home orders in phases. They are weighing the possible benefits against the costs of increasing infection rates again and subsequent additional spikes in the disease. When that occurs, and in the absence of a vaccine, we’d have to start over again with more restriction.

 

There are still areas of the country where infections were reportedly low but it is probably more the case that there is not enough testing to confirm and that they have not begun to see the effects from the spread of the virus to their locales.

 

We believe that it’s going to be at least several months before we’ll see enough reductions to feel comfortable and safe in reopening our businesses to “look like normal,” whatever that definition becomes.

 

The best case scenario is that we have an effective (proven) vaccine available for the whole population and proven, effective, and safe medications to treat those who do become sick. That is at least months away if not a year or two.

 

In the meantime, we are beginning to discuss plans for a phased reopening at VMG, depending on local trends, the Governor’s lifting of restrictions, etc. These are just beginning discussions to prepare. We’re still at least weeks away.

 

A Few Words about “Herd Immunity”

 

The definition of herd immunity is “the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination. The level of vaccination needed to achieve herd immunity varies by disease but ranges from 83 to 94 percent."

 

You are probably beginning to hear about “herd immunity” on the news and in the media. Some sources are suggesting that promoting herd immunity (presumably by letting people get infected) is a “preventive” health measure in that people who survive will be immune. That is not a preventive health measure (what about those that do not survive?). Rather it’s an outcome of not having an effective vaccine and good treatments to prevent the worst outcomes (death and disability) as well as an indifferent attitude to preventing infection (by, you guessed it, hand-washing, social distancing, etc.).

 

So, let’s keep focused on slowing the spread of the virus by the measures you know very well by now.

 

 

Thanks again for all you do. Be Patient; Be Mindful

 

Joel

Tuesday, April 14, 2020                                                                            Issue # 21

 

 

 

Happy Tuesday. I hope you and your families are well.

 

Testing News

 

Baystate Health is doing limited testing in our area. Baystate will be providing testing to patients referred by a practitioner, by appointment only, in Greenfield and Springfield meeting the following criteria only:

 

  •          symptomatic patients, age 65 and older

  •          symptomatic patients between the ages of 17-65 who have significant chronic conditions

 

Turnaround time will be between 24 and 48 hours. New sites are being planned for testing in Ware and Westfield by next week.

 

Some Words About Testing

 

The testing being done is called RNA testing. It’s done vis nasopharyngeal swabs and it determines if the patient, at the time of the test, has the coronavirus. While this is a good thing, it does not mean that the patient does not have the virus; just that at the time of the test, the virus was not detected. Some patients might need more than one test, over time, to be more certain of the result.

 

The other type of test is what’s being called antibody testing. It’s a blood test that looks for antibodies created by a patient’s immune system. If antibodies are detected, the test is suggesting that the patient already had the virus. It is currently assumed that having antibodies detected implies that the patient may have immunity to future infections by this version of the virus. These tests are not yet available, though they are being developed and validated.

 

Ultimately, we want to have both types of tests available to patients, and eventually, to broader populations. The idea is that we want to know if a patient has the infection and is infectious and we also want to know if the patient may be immune. Testing, when broadly available, will help in determining future hot spots (places of high infection probability) as well as when it is safer to resume ordinary activities. Without testing, we as a society will be making “best guesses” about these changes to our lifestyles, hopefully as suggested by epidemiologists and other scientists. Of course, what we also need is a vaccine to prevent infections as well as good therapeutics (medications) to treat infections once they occur. Work is proceeding on both. It will take more time.

 

In the meantime, and you know what’s coming: wash your hands (a lot), don’t touch your face, stay away from people (social distancing), don’t come to work or go out when sick, wear a mask.

 

At VMG

 

Since we want everyone to wear a mask when out and about and we want to conserve our medical single use masks, we’re working to put together people who are making cloth masks (washable) for use when going shopping or out in general with people who need them. Gina sent an email about this earlier this afternoon.

 

Here is some information on helping to keep people, including ourselves, well from our Physical Therapists.

 

 

 

The Value of Exercise in Dealing with COVID- 19

Exercise advice from the Valley Medical Group’s Physical and Occupational Therapy Team

 

 

At a time when we need to protect ourselves by staying at home and practicing social distancing, how can we use physical activity to enhance and maintain our health?

 

… make up your own  routine to music you enjoy that uses major muscle groups and raises your heart rate……CDC Guidelines

 

 

What is physical Activity? 

 

According to the World Health Organization “Physical activity includes all forms of active recreation, sports participation, cycling and walking as well as activities you do at work and around the home and garden.  It doesn’t have to be exercises or sport – play. Dance, gardening, and even house cleaning and carrying heavy shopping are all part of being physically active.”

 

 

Set the timer on your phone or kitchen timer every 45 minutes to remind you to walk 2-3 minutes -Diane Gray, PT

 

 

It is important for people of all ages and abilities to move and be active.  Walking, stretching, getting up from sitting and taking short walks, adding a few squats every time you stand up from a chair, all contribute to your well-being.

 

The Benefits from Physical Activity

 

 

“Take care of your body, Take deep breaths, stretch, or meditate.  Try to eat healthy, exercise regularly, get plenty of sleep…”   CDC.gov, Advice on delaying with stress from the pandemic.

 

 

According to the American Family Physician, regular exercise maintains strength, decreases the risk of depression, and cognitive decline, and helps to maintain a healthy body weight.  From the WHO,  “Regular physical activity benefits both the body and the mind.”   The list goes on. It can: reduce high blood pressure, reduce the risk of heart disease, stroke, type 2 diabetes and various cancers.  Activity improves bone and muscle strength, increases balance, flexibility and fitness.  For older adults it can help to prevent falls and injuries and in children it enhances healthy growth and development.

 

How much Physical Activity is Recommended?

 

 

…. Do some muscle strengthening activities such as lifting weights or improvise using full bottles of water or simply use your own body weight.., make it fun, such as dancing to music….  WHO Guidelines

 

 

The American Heart Association recommends 150 minutes of moderate activity or 30 minutes of activity 5 times a week.  If you are not used to doing this level of exercise you should contact your health provider to see if this is appropriate for you.  Moderate activity is defined as walking cycling, gardening and housework.   It might be an exercise class on TV.  It might be light weight lifting with water bottles.

 

 

How do I get started?

 

Spring is here, get outside and garden, even small tasks can be a good activity…, Michelle Kofler, PT

 

 

 From the WHO:

 

“Try and reduce long periods of time spent sitting, whether for work, studying, watching TV, reading or using social media,...take short 3-5 minute breaks, simply stand up and stretch or even better , take a walk.”

 

“Set up a regular routine to be active every day, by planning a physical activity or exercise break by yourself, by joining an on line class,... making a specific time to be active helps ensure you get your daily physical activity.”

 

“Be active with your family and friends, connecting with others can help you and your family:  in the home and elsewhere spend time together and be active” (Be careful to maintain social distancing and wear face masks when out in public)

 

“Set yourself goals”, by choosing specific activities, done at specific times, you will increase your chances of success.  Some folks find keeping exercise logs or lists of when and of what activities they complete helpful.

 

The bottom line is find something you enjoy, something you find peace and satisfaction completing, either by yourself or around others you care for.  In that way you can enhance and maintain your health.

 

 

If you have specific exercise needs please contact your Valley Medical Group Primary Care Provider.  The Valley Medical Group Physical and Occupational (Hand) Therapy Team remains available by referral during this time thru telehealth platforms by  phone, Face Time, Zoom and Doxy.

 

 

 

 

That’s it for today. Be Well.

 

Joel

Be patient; Be mindful

VMG COVID-19 UPDATE

Monday, April 13, 2020                                                                                                  Issue # 20

 

 

 

I hope you all had a 3R weekend (Rest, Recharge and Rejuvenate). 

 

The National Scene

 

New “hot spots” are popping up around the country. We’re all aware of the effects of the pandemic on the NYC and the New Jersey areas. Boston, Philadelphia, Miami, New Orleans, Chicago, Detroit and cities in Texas are still not at their peaks yet. The West Coast may have reached their peak infection rates for now. But that’s not certain. The most likely scenario is a continuing rolling set of outbreaks and peaks across the country for several months.

 

There are reports in the news of multiple vaccine formulations and therapeutics being sent to clinical trials. There is still not reliable treatment or vaccine at this time. Without a vaccine and without therapeutics (medicines that have proven effectiveness and safety), the only tools we have remain techniques and processes to slow the virus and reduce spread. And these remain social distancing, hand washing, avoiding touching the face and wearing masks.

 

The Local Scene

 

Massachusetts confirmed and suspected cases continue to rise each day. Deaths also continue to rise. There is some hope that the curve in Massachusetts is beginning to flatten. The significance of this is that it will allow our hospitals and healthcare systems to maintain or improve supply and capacity for sick patients. It does not mean that people are not getting sick with COVID-19.

 

Our local hospitals are reporting that they still have capacity of some vital resources: hospital beds, ICI beds and ventilators.

 

Remember that our efforts are focused on keeping people out of the hospital and ER’s to help them maintain their capacity.

 

At VMG

 

We are continuing to work on switching in-person visits to virtual visits. Here’s a graphic showing the recent trend.

 

 

 

You can see the beginning of recovering some of our business in the form of virtual visits (the blue line) though we are not at all close to where we were last year (the red line).

 

Ross Midler who retired but is doing some per diem work for us was at AMC last week. Here’s what he observed:  

 

“I was in AMC today for the first time since COVID 19 started. I was impressed how all the staff, and I mean everyone, has assumed "battle stations" and appeared very up for the battle. I always knew we had good people. This just demonstrates it.”

 

 

Finally, here’s a hopeful quote from a recent article in The New Yorker magazine (hopeful in the sense that we will eventually get there if we continue our social distancing and other measures):

 

“These next weeks and months will be demanding in ways that are hard to fathom. If New Yorkers are in hiding, the virus has shown a knack for seeking. But, with time, life will return to the city. Our city and your city. The doors will open and we will leave our homes. We will meet again. We will greet our friends, face to face, at long-delayed Easter services and Passover Seders. Children will attend class with their teachers. Sidewalks and stores and theatres will fill. Remnants of the crisis—a box of nitrile gloves, a bag of makeshift masks; containers of drying Clorox wipes—will be tucked away, out of sight and out of mind. We’ll forget a lot about our city’s suspended life. But we will remember what, and who, we lost. We’ll remember the cost of time squandered. And we will remember the sound of seven o’clock.”

 

https://www.nytimes.com/interactive/2020/04/10/nyregion/nyc-7pm-cheer-thank-you-coronavirus.html

 

Thanks again for all you are doing for our patients, our communities, and each other.

 

Joel

 

Be Patient; Be Mindful

VMG COVID-19 UPDATE

Friday, April, 2020                                                                                                                                                                                           Issue # 19

 

 

 

It’s Friday. We’re all ready for the weekend.

 

The latest federal projections suggest that lifting the stay at home orders in the next 30 days would likely lead to a new spike in cases during the summer. I think we are going to hold steady with social distancing for some time to come even if we do see a peak in the next few weeks. And we can do that because…….

 

Gina tells me it’s now been one month since several of us looked at each other and said we’re going to have to go to another model of care delivery. By now, you’re all acquainted with how we are adjusting. One consequence of all this change is that we’re learning some new things which should eventually be helpful going forward.

 

First, we’re learning that seeing patients by video and even by phone is appropriate and appreciated by most patients in times of crisis and maybe even when the crisis passes. It’s hard to imagine now that patients will want to give this up entirely. Authors like Eric Topol have been writing about this for years but now, because of COVID, it’s actually happening at some scale.

 

Second, we are all capable of adapting, and adapting quickly, once we see and feel the need to change. The emotional weight of the pandemic (the world wide reports, the news coverage, the patient concern and illnesses, the loss of so many) and our commitment to the mission of health care work together to tip the scales to action. A patient wrote about how we shine in these times and I think that shine is as contagious as the virus. Amidst all the anxiety and hard work, it is invigorating to see we can thrive for the good of our patients, communities, and ourselves.

 

Third, as I read Meghan’s email yesterday, I thought when you’re in the thick of your work, you may not notice the incredible dedication and togetherness of the team. But this is a time when the team always wins and pulls you through. Please appreciate your contributions and each other.

 

I heard Andrea Bocelli performing the Ave Maria at his home on the radio this morning. He’ll be performing to an empty Duomo Cathedral in Milan, Italy, Sunday. This is the pandemic in action. The performance will be live streamed on You Tube. I’m sure it will be worth listening, no matter your religion. Solace: comfort or consolation in a time of distress or sadness.

 

Gina coined a term: R3, for Rest, Recuperate, and Rejuvenate. And here’s a fourth R - Rise up (suggested by Amy Rice).

 

https://www.youtube.com/watch?v=G_YDpP-nU6w

 

So I wish you all R3 this weekend.

 

Joel

 

Oh, and hey: Be Patient; Be Mindful. And wash your hands (a lot), don’t touch your face, maintain social distancing (it is working) and wear a mask.

VMG COVID-19 UPDATE

Thursday, April 9, 2020                                                                      Issue # 18

 

 

 One of the things about working in a time of prolonged crisis is that it can be hard to maintain focus and sometimes even harder to get the big picture. And then there can be the fatigue. I recently started thinking about a phrase: Every day like a week, every week like a month. Time can be distorted and the usual touch points we all have that get us through our days can be disrupted: going for your cup of coffee, a movie, shopping, haircuts, going for a walk at lunch time or break time, etc.

 

I’ve gotten texts, emails, and calls from places that didn’t used to “stay in touch.” Restaurants, dry cleaners, all the supermarkets, even hotels I visited a year ago saying they were sorry they haven’t “seen me.” Of course they know why and they just want to let us all know they expect to be back. It just gives me a sense of how much life has been disrupted. It can be depressing and lead to just getting through (which works for a while until doesn’t).

 

So, for now, take a deep breath and let it out (really). Download a meditation app like Calm and use it. It does not take much time and it does really help. And restore whatever touch points you can: take your walks, get your cup of coffee or tea. Call someone and check in. I’d say “smoke em if you got em” (a line from The Bottomless Lake, John Prine) but we still, even now, don’t do that. Right, Tim Sweeney?

 

The point is, we’re going to be in this for the foreseeable future so go back to the things you can do and try some new things to help you through.

 

Local Updates

 

We’re in touch with our local hospital systems, as you know, and they still have capacity. They are concerned about a possible surge and are planning accordingly.

 

There will be a few testing sites coming on line in the next few weeks. They will be reserved for first responders, front line health care workers (e.g., ER and Hospital personnel) and high risk patients. That will be a help. They will require something like an appointment. We’ll keep you updated.

 

We still think we will have to maintain our COVID status and precautions at least through the middle of summer.

 

We’re still working to convert almost all of our visits to virtual. Many patients are responding well to them and they are efficient and safe.

 

VMG Department Update: Diabetes Education and Nutrition

 

Diabetes Educators Sarah Anderson and Bonnie Grenier are working from home and able to do virtual visits using Doxy.me for both new referrals and established patients. They are also able to do telephone follow up and check in, (using CCM coding if appropriate) with any patients that have received Diabetes Education services.  Bonnie Grenier is able to continue to support our patients on Insulin Pumps via virtual visits.  Other proactive outreach is happening in the form of lists generated of patients with A1c >8.0, and generating referrals to DM education for virtual visits as appropriate.   PCP’s can continue to refer any patients who need Diabetes Education services, and we will find a way to work with these patients using telephone or video visits and follow up. 

  

Similarly, our nutritionists, Diane Alpern and Margie Sobil, are working from home, doing virtual visits, telephone follow ups and checking in on patients, and working with the A1c>8 (and BMI over 30) lists for their respective health centers. Some things that the nutritionists are noting from more recent patient contact since we went virtual, is that there appears to be a greater need than ever for people to get support around food and nutrition because of the additional stress that the pandemic is placing on them:  d/t food insecurity, people not knowing how to shop amidst shortages or because they have relied previously on takeout and dining out and lack cooking skills. They are finding that many patients’ weight reduction efforts are being sabotaged due to emotional eating, and probably diabetes patients' blood sugars may be increasing due to self-care challenges. 

 

For these reasons and many more, we encourage providers to emphasize and encourage Diabetes Ed and Nutrition services at this time, and continue to refer patients to the program.

 

Feedback from Patients

 

A patient’s wife called to say that she wanted you all to know what a wonderful job she witnessed when her husband came in to have his labs drawn. 

She was very worried at first. “Isn't it dangerous for him to come down?” But once she saw what “those ladies” were doing, “well I just couldn't believe it!”  “They were wonderful! They wiped down the wheelchair before he got in it, then after he got out. I though, WOW, they've really got it together, they've got this down!"

 

She was very very pleased with how we are "Just handling everything just so well! From you girls in the front desk to lab, nurses. We are there a lot, so we see how well you all work together!  I want them to know what a good job you all do!  And thank you for everything!"

 The receptionist who received this feedback said: **just thought, in these trying times, what a nice thing to bring to our attention.  Even during a pandemic, we SHINE~!!!**

 

 

That’s a good way to say good night. Get some rest. Be well and….wash your hands a lot, don’t touch your face, maintain social distancing (it is clearly working), and wear a mask (in VMG) and a face covering outside of VMG.

 

Be Patient; Be Mindful.

 

Joel

VMG COVID-19 UPDATE

VMG COVID-19 UPDATE

Wednesday, April 8, 2020                                                                                                                                                            Issue # 17

 

 

 

Hello! I hope you had a good evening. This is issue 17. It’s been three weeks of almost unbelievable stress, adaptation, and change.

 

We continue to be in touch with the local hospital systems to cooperate in planning and to learn about how the pandemic is affecting our communities. Both systems are preparing for a surge, in case that happens. There is the hope that the early and sustained efforts at social distancing might reduce the need to the level of the current capacity of hospital beds, ICU beds, PPE, etc. One of the hospital systems has reported the good news that of all the patients they’ve seen who tested positive for the novel coronavirus, up to 2/3 never needed admission or were discharged and recovering at home.

 

There are more reports in the media of COVID scams for equipment and “treatments.” There are no known and approved treatments at this time and there is no vaccine now (though there are trials being developed for some drug treatments and vaccines).

 

VMG Department Information

 

Here’s some updated information from Dr. Merlin, our Eye Care Team Leader and our Optometrists:

“During the COVID pandemic, eye care services are reduced to urgent care and consultation throughout the country. The same is true at VMG. 

The best way to contact us is through our technicians who are responsible for triaging cases. The technicians have the best ability to contact the ODs should the need arise. Or send us a patient case, urgent as necessary. We have two technicians at home constantly monitoring our inboxes.

At this time most urgent cases are being referred out to local ophthalmology practices for care. However, consults with primary care are always welcome.

So far the COVID virus has shown a very small incidence of a viral conjunctivitis that is indistinguishable from any viral conjunctivitis. It is unknown, but likely, that the virus is transmitted through the tears as well. There appears to be no other ocular manifestations at this time. Please feel free to contact us if you have any questions.

Thanks for all you do. We are proud to be a part of this community.”

Smoking Cessation Services 

While times of crisis sometimes have smokers clinging more tightly to their packs, the respiratory concerns of our patients have some of them ready to get serious about quitting.

Our Tobacco Treatment Specialist (aka Quit Coach) Tim Sweeney continues to serve our patients with a focus on flexibility. At no cost to the patient regardless of insurance, Tim provides: 

  • PRN phone coaching (Monday, Tuesday, & Wednesday, 7:30 am - 3:00 pm)

  • Text message support (2-3 positive messages/wk to 1300+ patients)

  • QuittersWin weekly meetings (on Zoom!). There's a video on the QuittersWin site that shows folks how to install and use Zoom.  https://quitterswin.blog/get-and-use-zoom/

Just send a case and Tim will reach out to our patients. He sends all staff his thanks and best wishes.

 

We learn to cope and survive sometimes just by getting through and we connect to our feelings when we can, sometimes by being mindful and sometimes by being “triggered.” Music works that way for me.

 

One of my favorite performers died of COVID-19 last night. John Prine was 73. Early in his career, he did gigs in the evening while he held his day job as a letter carrier in the Chicago area. He was sometimes known then as the Singing Mailman. Since then he won Grammy’s performed with many greats, and wrote songs covered by dozens of artists. He survived several cancers and kept performing almost no matter what.

 

Here’s a link to one of his earliest and, I think, best songs (supposedly inspired by his observations delivering the mail):

 

https://www.youtube.com/watch?v=RfwGkplB_sY

 

So just say Hello in there, hello, to all.

 

Wash your hands.  Don’t touch your face. Maintain social distancing (it works). Wear a mask (if you’re in our buildings) and a face covering everywhere else. Stay home as much as you can (though get out and walk or exercise in the good weather). Stay home if you are sick. Don’t fall for scams.

 

Be patient; be mindful And, be well.

 

Joel

Tuesday, April 7, 2020                                                                       Issue # 16

 

 

I hope you had a good night and got some rest.

 

There continue to be several “confusing” stories about the spread, impact, and trends for the pandemic on the national scene. But no matter which story you believe, it is clear that we have a long way to go in time, and, in dealing with the suffering and anxiety that this pandemic is causing.

 

It's still true that most cases will be mild to moderate. But there will still be some suffering. Although Hampshire (147) and Franklin counties (107) have fewer identified cases of COVID-19 compared to the rest of the state (except for the islands), we will see an increase and we have to assume that the lower numbers, to some extent, reflect less testing. The numbers of deaths from COVID-19 in our counties is still among the lowest in the state but we can expect those numbers to rise also. Those are just statistics. Behind the numbers are families and friends suffering losses and pain.

 

In terms of time, the safest assumption is still that we won’t see much significant “on the ground” slowing of the pandemic until mid or late summer. I say “safest” because what I mean is that we have to remain vigilant, cautious and continue the measures we know will work to slow the virus at least through that time frame. You’re probably tired of hearing/reading this, but they are:

 

  •          Wash your hands often!

  •          Don’t touch your face!

  •          Maintain social distancing (at least six feet apart no matter inside or outside)!

  •          Wear a face covering!

  •          And stay home if you are sick!

 

As of now, there still is NO medicine and NO vaccine against this novel coronavirus. Encouraging patients who are desperate and scared to try an unproven remedy is at best foolish and, at worst, very dangerous. We won’t do that! At VMG, we will continue social distancing and seeing almost all patients virtually. We will continue, through your efforts to innovate and change our workflows to keep our patients and ourselves as safe as possible. We will also continue to work in our communities to help out as necessary and to make sure that we will be available when the pandemic lets up and we can return to some new normal state of providing healthcare.

 

Some Words from Our Patients

 

Given how hard everyone is working to continue to provide care in a very changed environment, it’s good to hear what our patients think. Here are two comments from just the last few days:

 

The first is from one of our adult patients and she said she had her “first telemed appointment this week.  I was impressed with the organization and the quality of service.  One good thing to come out of this horror, Valley continues to provide great care”

 

Next is from a school age child who sent us a note to NHC. And he said “Dear vmg staff, thank you for keeping us all happy and healthy. I really appreciate your work. And he signed it with a heart.

 

VMG Departments: Endocrinology

 

Drs. Chipkin and Spitzer are seeing follow-ups and new patients and consults almost exclusively by Virtual Visits now. There may be a few situations in which they will have to see a patient in person and those visits will be consolidated at either AMC or GHC to lessen the risk.

 

Staff are coordinating the Virtual Visits, working inboxes, doing intakes and nurse advice and visits (virtually), getting information to patients on pumps and insulin, etc. We are working to develop work flows and practices for doing needed injections for certain medicine in the parking lots, again to reduce risks of exposure.

 

They are also working with reception to move patients scheduled in the future because of previous wait lists to current virtual visits to fill the schedules now.

 

Thanks for all your work to change the Endocrine work flows in such a short space of time (and need).

 

Coping in Unusual Times

 

Here’s a quote from an article in today’s Washington Post by Amanda Ripley. She began by talking about some patients who were “over-cleaning,” using bleach to “clean” things that did not need to be cleaned or cleaned with bleach. She writes about our responses to fear:

 

“Fear requires two elements: a perceived threat and a sense of powerlessness to defeat that threat. Since the feeling of fear is distinctly unpleasant, most of us will try to counter it in the days to come — by turning down the threat level or by amping up our sense of control.


 

In the first category, we might convince ourselves this is all an overreaction. I did this in the beginning, I admit. The whole thing felt like a giant snow day, or so I told myself. The Internet is happy to help with this, as is the brain. Denial is the most common human response to all kinds of disasters, from fire to floods to pandemics. We might also use food, drugs or alcohol to take the edge off the threat. (My current preference is chocolate chip cookies.)


 

In the second category of options, we might try to reclaim some sense of control over the threat. This is the beginning of an excellent plan. (Take back the blight!) But it can also backfire, as it did for the bleach patients. It’s easy to overcorrect in a time of high anxiety.”

 

So, what to do. Ginny Chandler, who is a professor at UMass College of Nursing, published a piece in the Daily Hampshire Gazette yesterday recommending ABCS (Active coping, Build strength, Cognitive Awareness, and Social support).

 

The first question when stressed is to ask yourself “Am I actively coping?” What do you need to do to cope better? Consider a walk, music, reading, tackling a problem.

 

Build Strength. She states that we more readily focus on our vulnerabilities and weaknesses rather than what we do well. Make sure that if you are focusing on areas of weakness that you also consider your strengths. “Write down what you do well” and focus here too.

 

Cognitive Awareness. If you find yourself “catastrophizing,” stuck on the worst possible outcome and misses, give yourself a break and get perspective.

 

Finally, social support. Don’t isolate, find a friend, family member, and talk or share an experience.

 

Check out Ginny’s column in the April 6 Daily Hampshire Gazette: https://www.gazettenet.com/Chandler-column-33656308

 

Here’s a term you don’t hear much anymore: Steadfast. The definition is “firm and unwavering in purpose, loyalty and resolve.” I think that describes what you all are doing for our patients, our communities, and each other. We thank you for that.

 

Have a good night. Be Patient; Be Mindful.

 

Joel

VMG COVID-19 UPDATE

Monday, April 6, 2020                                                                                                                                                                    Issue # 15

 

 

 

I hope everyone had a good weekend. We all need to recharge.

 

IF YOU WANT TO THINK MORE ABOUT THE HEALTHCARE SYSTEM AND WHAT CAN BE DONE…

 

Here’s a link to a Washington Post article on “smart solutions to mitigate the effects of COVID-19. Some of these seem like winners.

https://www.washingtonpost.com/opinions/2020/03/20/coronavirus-is-upending-society-here-are-ideas-mitigate-its-impact/?arc404=true

COVID-19 CASES AROUND THE STATE COMPARED TO FRANKLIN AND HAMPSHIRE COUNTIES.

 

The Boston Globe had a graphic over the weekend showing cases of COVID-19 on a state map, county by county. (I tried to copy it here but it would not copy – you can check for it in copies of the Globe on Sunday). It was striking and showed that neighboring counties were much higher than our two counties. Of course, we don’t know why that is (it might just be a matter of fewer tests being done in our counties). Death rates also were less.

 

That our counties report fewer cases might be seen as some “good news.” But please do not let down on your/our social distancing, masking, hand-washing, “don’t touch your face efforts.” We still have a long way to go before the pandemic winds down and we’ll need to maintain our vigilance for many months. Some projections now have the new cases winding down through June but that still means a lot of illness and potential loss. We’re working with community groups and the local hospital systems on preparing and participating in “surge plans” (helping out) should they be needed.

 

VMG Virtual Visits

 

I talked with Karen Brown, a reporter for NPR, this morning about a story she was doing on how the pandemic was affecting primary care. As we were talking it was clear that we have essentially turned our approach inside out in the span of 3 weeks (going from “we’ll see you in the office for that” to “we’ll see you by virtual visit and at your convenience”). That’s a lot of change in a short time. And we’re hearing that, in many cases, patients really appreciate it. Here’s a quote from John Prinzivalli, DPT about his experience in Physical Therapy:

 

“When I first heard we were doing virtual visits I was very doubtful about what this was going to accomplish and how effective this was going to be.  After doing this for a few weeks I have been surprised and pleased at just how much we can get done.  Certainly we have doxy, and Zoom but for those who are less tech savvy the phone and Face Time has proven to be clinically effective. To date I personally have treated an acute post reduction shoulder dislocation, a post quad tendon rupture and repair, patella femoral syndrome, low back and knee pain.  Certainly there are limitations by not having your hands on folks but with some creativity and time we can be effective clinically. 

 

I hope is some way you may find this reassuring about what we can still do; it's certainly opened my eyes to other treatment possibilities.”

 

Virtual Visits Compared to In-person Visits

 

Here’s a chart, prepared by Isaac Allen our Data Analyst, showing how our total Virtual Visits (total for all VMG) are increasing since we began. The thicker red line shows our face to face visits for 2019. The thicker green line shows our face to face visits in 2020. The thicker blue line shows our virtual visits this year since February. You can see quick and continuing increase of virtual visits as our face to face visits declines quite a lot.

 

 

 

 

 

 

 

This is a good trend because much of our FFS revenue comes from Office Visits. As they go down, we lose a lot of revenue. Virtual Visits are mainly paid similar to Office Visits so we are potentially replacing much of that lost revenue which, of course, we need.  We’ll have more information on how significant this is in the next couple of weeks as the bills get paid by the commercial and government payers.

Copays, Coinsurance, and Deductibles for Virtual Visits

Because of concern about social distancing and helping people to stay at home, the Governor’s Office and the Division of Insurance in Massachusetts have directed that most patient copay, coinsurance, and deductibles should not apply during the pandemic (for COVID related services and other healthcare services we offer as well). The same is true for Medicare. However, the health plans have not completed adjusting their systems for these changes yet and we’re hearing that some patients, after being told by us that they would have no patient responsibility for virtual visits, are being charged for some patient responsibility once their claims are processed by their health plans.

While we expect this to be resolved soon, we want to be clear that we don’t have the authority to “waive copays” so please don’t use that language. Look for a message from Billing on what to say and on the resolution of this issue. Patients can also always be referred to their health plans for coverage questions.

Services at VMG during COVID: Rheumatology

Our Rheumatologists, Drs. Brown and Maroun, are both seeing new and established patients and consults almost exclusively by virtual visits. A few patients with acute need are being seen in the health centers after being triaged by the practitioners and their staff.

Their schedules are being converted from previously scheduled in-person visits to virtual so they do have room (“there’s room for Rheum”) for patients and will welcome referrals.

General Reactions to Handling the Stress of the Pandemic and the “Learning Curve”

John Novo passed this graphic on to me. It shows how people move to adjust to the stresses of working (and living) in the age of COVID-19 and how we develop and learn about our roles and “who we want to be.” It also helps to define some things about what it means to “be Mindful.” 

 

Good news is that we already see many of our colleagues and our Group moving in the right direction. We hear every day of how people are “jumping in” to help teammates triage, schedule, see patients, work lists, keep the buildings clean, keep the operations and finances growing and adapting, etc.

Finally on this note, here’s a quote from Fred Rogers:

“In times of stress, the best thing we can do for each other is to listen with our ears and our hearts and to be assured that our questions are just as important as our answers.”

And some good ideas from the Fred Rogers center for how to help children during this time:

https://www.fredrogerscenter.org/what-we-do/child-wellness/coronavirus-response

 

 

Finally for today:

Bill Withers died last week (of heart disease, not COVID-19). Here’s a different take on what standing together means:

https://www.youtube.com/watch?v=f7P8wusL1Z0

 

Be Patient; Be Mindful.

Thanks again,

 

Joel

VMG COVID-19 UPDATE

Friday, April 3, 2020                                                               Issue # 14

 

It’s Friday afternoon and most of VMG will have the weekend off. We all need time to recharge, relax, distance from the pangs of social distancing at work for a while. The news continues to worsen, as expected. The scammers are out there selling miracle cures, “game changers,” and the hoarders of needed equipment, supplies, food (anyone seen a chicken recently? They’re not all crossing the road).

Despite this, maybe because of this, we’re seeing a remarkable coming together by all of you, our communities and services, and it is heartening, fulfilling, and reinforces the values of healthcare. A quote from a New Yorker article by a NYC doctor, Dhruv Khullar, working as a hospitalist in an unnamed hospital:  

The “burnout-inciting frustrations of billing and documentation and electronic medical records have, for the moment, receded. Now, when I’m in the hospital, the focus is so singular, the mission so clear, that nothing else seems important. There is nowhere that I, or my colleagues, would rather be. There’s an odd sense in which the pandemic has made the practice of medicine into what many doctors hoped it would be.” He also goes on to talk about concerns about being able to sustain and that is a real concern for everyone. But coming together, having a unified purpose, and talking with each other and offering support and “being there” will help.

Local Initiatives

There are a number of task forces getting together in our communities to plan for and cope with “surge” concerns. The latest status of our hospitals is that they have capacity now. Steve is participating for us in meeting of the Hampshire County group today. We’re also participating with Baystate Franklin in some “emergency credentialing” in case we need to be available to help out.

Checking In is More Than Just That

One of our practitioners learned of a message from a patient in response to a check-in call by another practitioner. The patient said that she was moved to tears and also said “what medical group does this?” I’m glad it’s us.

Language about Virtual Visits

We were told that some patients don’t fully understand what we mean by a “virtual visit.” It’s a good shorthand for us but it may sound to some patients like a video game or something less than a healthcare service. We’re looking to change our language to patients probably to something like video or phone visit (that’s what they are, after all).

To Mask or Not to Mask

We are already committed to wearing surgical masks at all times in the health centers. We should probably also be wearing masks (homemade ones will do for the purpose) in public.

There has been some conflicting messaging about this since the start of the pandemic. But as information changes, so do the recommendations. There may be a national or state recommendation today or tomorrow.

The mask will likely not prevent us from getting the virus. But it will help to prevent us from transmitting the virus to others if we have it. So break out the creativity and fashion sense if you choose but mask up. And it is a sign of social solidarity which is also needed.

Lab Draws

Another sign of how quickly things change and how our staff are adapting. We are now doing a majority of our lab draws in the parking lot. Thank you to the phlebotomists and other staff involved in making this happen. You’re making everyone safer.

Department Updates

Eye Care: Our Optometrists are not seeing patients in their offices now for social distancing reasons. And the NHC Eye Lane and Optical Shop have been repurposed for our NHC Respiratory Symptoms Unit. However our Optometrists are available for consults to primary care and patients. We’ll have more information on the best way to reach them soon but, for now, please contact any of the Eye Care staff who are either working from home or in the centers working on managing in boxes and patient cases to the practitioners.

Podiatry: Dr. Erskine and Dr. Dinnall are both doing visits by video and/or telephone (aka Virtual Visits -- VV) in increasing numbers. They will both see urgent visits (infections, ingrown toenails, post-ops, wound care, etc.) in the office (though we may be consolidating these in person visits to EHC and GHC). All future visits for the next few months are being converted to VV. New patients are also being accepted.

Sports Medicine: Dr. Murphy is seeing more and more visits by video or telephone and finding many patients who really appreciate the opportunity to discuss their pain or other symptoms. He is also seeing new patients by video or phone. Please keep referring. Injections and other hands-on treatments will be postponed or scheduled for a few months out (or longer).

 

So it is now almost the weekend. Again, thanks for all you do, for coming together and showing your True Colors. Here’s a video of appreciation to take you into the weekend (you can skip the ads if you wish): https://youtu.be/lqWQCWc_zCc

Be Patient; Be Mindful.

 

Joel

VMG COVID-19 UPDATE

VMG COVID-19 UPDATE

Thursday, April 2, 2020                                                                                                                                                                                  Issue # 13

 

I hope you are well. Those words, which only four weeks ago, were a simple greeting now take on even more meaning. Nevertheless, that is my hope for you.

Some Updates

With the expected peak in cases a few weeks away, the local hospitals and medical groups are getting together to talk about organizing a community wide response. This may involve some sharing of information (there are already conference calls to update people) and resources. We’ll know more in the next few days. We want to participate with others in keeping our communities as health as possible.

Expected Impact

You’ve heard a lot about the “peak” of the illness curve and that’s it’s expected in the next two to three weeks in our area. But what does that really mean? Practically speaking it means that we have not yet reached the point of all the symptomatic people with COVID-19 being identified to the healthcare system by being sick. Also getting to peak does not mean the illness and its effects go away. Individuals will still be getting sick and some will still be dying for weeks and perhaps months after peak.

Still it’s important to remember that not everyone who gets sick will get very sick. Most will not and will make a full recovery. And even most of those who get admitted to the hospital will recover well. Perspective is important.

Important Steps You Can Take To Keep Us All Well

Gina sent an email earlier today stressing the importance of a few things we can all do to keep us all well.

  • If you are sick, stay home. Your job is not threatened by being out sick. If you need benefits under the Emergency Sick Leave acts, please contact HR.

  • Wear your masks in the health centers even if you are only out walking in the building for a short time.

  • Social distancing is just as important in the health center as it is in the supermarket. Even when wearing masks, stay at least 6 feet apart from other staff and patients in the building.

  • You know what I’m going to say next: wash your hands often, don’t touch your face, cough or sneeze into your elbow.

  • Oh, and don’t try to drink coffee while wearing your mask (I tried. It doesn’t work. Twice.)

FYI, here’s the link again to the CDC Symptom Checker for COVID-19.

https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

And here’s the link I sent earlier to a helpful article from the New York Times on things you can do to stay healthy.

https://www.nytimes.com/interactive/2020/world/coronavirus-preparation-preparedness.html

Zoom Brown Bags

One of the things about social distancing is that it keeps us from visiting the health centers as often as we’d like. So we’d like to try something different.

We’ll be scheduling some Zoom Brown Bags in the next few weeks; one at each health center. We’ll structure them as Town Hall meetings and ask for questions in advance and discuss anything those attending have on their minds.

Look for the invitations next week.

 

 

Thanks again for all you do. Be Patient, Be Mindful. We’ll get through this together.

 

Joel

VMG COVID-19 UPDATE

Wednesday, April 1, 2020                                                                                                                                                            Issue # 12

 

The VMG Board of Directors met this morning (virtually). All Board members wished to pass on their appreciation for all of your dedication, creativity, and willingness to step up during this public health emergency. Thank you from the VMG Board of Directors.

Regional and Local News

There is some cautious good news to share about social distancing effects, local hospitals and ICU availability. Some in state government are now saying that they are seeing early signs that social distancing seems to be working to slow the spread. It’s too early to confirm and they are still predicting the peak effects of the virus for mid-April.  As you know by now, the Governor has extended the Stay at Home guidance through May 4.

Local hospitals (Cooley, Franklin, Baystate) are reporting that they have increased their ICU capacity and have some room for a surge (so long as it is not a surge the size of NYC); they are not yet seeing a great increase in demand. We will keep trying to keep patients who don’t need it from the ER. Also, some area nursing homes are setting aside areas (floors or buildings) for COVID cases.

So while these are good signs about impact and readiness, we still have a long way to go. And there are still areas of the country like Florida (whose governor just now issued a stay at home message) and Texas in which the need for social distancing has not taken hold. That means that travelers, if there are any, could carry back the infection. It’s uncertain how big a threat that is to us but it is certainly a threat in those states. If you have family or friends in those areas, pass on the advice about social distancing. Maybe that will help.

Virtual Visits (VV) Increasing

We are seeing an increase in virtual visits in most departments. We are beginning to track them weekly and we can report on that by next week sometime. This is important for several reasons. First, we want to stay connected with our patients and virtual visits do bring in revenue. Second, almost all patients have concerns and anxieties about the pandemic and we can help provide perspective for them. Perhaps most important, our patients still have other (than COVID) medical problems with needs for care. Think of the folks with high blood pressure, diabetes, heart disease, for example. They all need monitoring and time to check-in, review medications and symptoms, etc. VVs are a good way to see them for now and most patients appreciate the opportunity.  

Behavioral Health and Integrated Behavioral Health Update

Here’s an update from John Novo and Suellen Walsh. All Behavioral Health and IBH providers are working from home providing regular therapy sessions over the telephone or telemedicine platforms. We are providing services to new and existing patients. Providers have reached out to patients who have cancelled and reception has been actively calling patients and converting already scheduled in-office appointments to Virtual appointments.

There has been a decrease in patient's flow for some BH providers. We are working hard to be flexible and accessible. Our goal is to support primary care and VMG in general as much as possible and to keep our schedules full. Please continue to make referrals and let us know of any problems in having access to our services. We are here to help and want to do our part to support our patients and the practice in this very difficult time.

Referrals should be made by instructing patients to call the usual behavioral health phone numbers (AMC 256-4441, EHC 282-3858, NHC 586-8400, GHC 772-3367) to leave a message. For IBH, a reception staff member has been designated at each health center to schedule virtual visits. Please contact them.

 

 

Ordinarily, this being April 1, I would think about adding some kind of “foolish thing” right now (These Foolish Things; great song). Instead, here’s a link to a video from students and faculty at Berklee College of Music in Boston. It’s really good and I think inspirational.

https://www.golocalprov.com/articles/what-the-world-needs-now-bostons-berklee-college-of-music-video-goes-viral

Thanks again for all you do. And….wash your hands, don’t touch your face, maintain social distancing.

Be Patient. Be Mindful.

Joel

VMG COVID-19 UPDATE

Tuesday, March 31, 2020                                                                               Issue # 11

 

I wish we could all go back to a time when most of us didn’t know what “PPE” meant. But we can’t.

The news on TV remains difficult to watch. The concerns of front-line healthcare and first responders, the lack of necessary supplies and ICU beds, and of course the numbers of reported cases and deaths. We may want to ignore it all, but it’s hard. Reminders are everywhere (work, grocery stores, the UPS guy, etc.).

Our brains are usually able to compartmentalize difficult information and emotions and a certain amount of that may be necessary. But since we are in healthcare, we all have stories about how our patients, colleagues, and families are doing. We do our best work by relating to patients and their situations. It’s important to go on but it’s also just as important not to succumb to “compassion fatigue.”

So if you get to the point where you feel “a cloud” over your caring and concern for others and their situations, make sure to find someone to talk with, take a break, stretch, walk, and give yourself a chance to breathe and recharge. It happens to all of us. Remember to Be Patient and Be Mindful. You can also contact HR for information on the Employee Assistance Program.

Local Situation

Unlike the metro areas of NY and Boston, we may be a bit protected by our geography and lower population densities. But that does not mean we won’t see the effects of this epidemic here. We are seeing some cases in all of our communities of patients with confirmed COVID as well as presumed. Our hospitals are gearing up but are not yet overwhelmed. The ERs, for the most part, are functioning well. They are not yet overwhelmed. As of today, the state still expects the peak of the pandemic to reach Massachusetts by mid to late April.

We are doing what we can, as you probably know, to preserve the capacity and capabilities of our hospitals and ERs by seeing our own urgent patients as much as we can. Also, it’s important to remember that keeping in touch with our patients by Virtual Visits helps to provide needed medical advice and calm anxieties and perhaps prevent an unnecessary ER visit.

Updates from our Specialty Departments

During the “early” part of our pandemic work, we’ve been necessarily focused on primary care and our workflows in primary care. This week, Gina, Martha and I began to meet with our specialty departments to stay in touch, learn more about their work and needs, and make sure we could get information out to VMG about what they are already doing and what they can do for our patients and our staff. I’ll try to update on each department over the next several issues of this newsletter.

I’ll begin with some information on Physical Therapy. All of our therapists are working from home though there is someone in the buildings on a daily basis or close by and on-call for any urgent needs that they can help with. They have geared up to do scheduled Virtual Visits by audio/video or telephone and their schedules reflect those changes.

Here’s some more detailed information:

 

·    Scheduled virtual Physical Therapy appointments are available from all VMG Health Centers. These are provided through an internet video application, easily accessed by a hyperlink sent via email to patients by Reception staff. Virtual appointments are also available by telephone, which are also scheduled by Reception staff.  

 

·      Virtual Physical Therapy evaluations may include:

o   A detailed injury and medical history

o   Postural, mobility, gait, and balance assessment

o   Range of motion and strength assessment

o   Neurological assessment

o   Special tests and measures

o   Home safety assessment

o   Discussion of findings, establishing goals, and determining treatment plan.

 

·      Virtual Physical Therapy treatments may include:

o   Selfcare training, e.g. RICE, activity limitations, etc.

o   Postural awareness training

o   Stretching and strengthening training

o   Mobility, gait, and balance training

o   Soft tissue/fascial mobilization training

o   Vertigo, BPPV CRM training

o   Other specialized treatments

o   Review and progression of written home exercise program.

 

·      Virtual Physical Therapy treatments do not provide:

o   Manual therapy treatments

o   Mechanical spinal traction

o   Clinical modalities

 

·      Advantages of virtual Physical Therapy:

o   Decreased Covid-19 exposure risk

o   Access to treatment for patients with shelter in place or quarantine restrictions

o   Therapists are available for questions via the patient portal or email as needed between visits

Thanks to Jeffrey Reed and the PT department for the information above. Please consider sending patients to virtual PT and contact a PT Team Member for any questions about suitability for treatment.

 

Once again, thanks to all of you for stepping up in this public health emergency. Wash your hands, don’t touch your face, and observe social distancing.

And, Be patient; Be Mindful.

 

Joel

VMG COVID-19 UPDATE

Monday, March 30, 2020