The following is a guest article by Joel Diamond, MD/FAAFP, Primary Care Physician and Chief Medical Officer for 2bPrecise and Bryon Cipriani, Executive Vice President for AccessDx Laboratory.
For the first time in two years, Health IT executives and clinical leaders are polishing their comfortable conference shoes while vendors check their SWAG inventories. With two major healthcare conferences in March (and countless others on their heels), industry leaders are making plans to avail themselves of overdue and sorely missed educational and networking opportunities.
But, wait…
They are also mired in the latest demands of the COVID19 pandemic. With healthcare facilities nearing (or at) capacity and available statistics showing cases still on the rise, many leaders are evaluating whether it is safe to attend – and, if they do, how to keep their representatives healthy both during the events and when they return home.
Be realistic about the risk
Most healthcare leaders watch national and local COVID19 dashboards religiously. But it is important to understand what the statistics actually represent and what factors influence conclusions that can be drawn.
Consider the differences between antigen (aka rapid, at-home) and PCR tests. Briefly put, antigen tests detect the presence of one or more specific proteins from a virus particle. However, they lack the degree of sensitivity required to discern small quantities of the virus, which means that larger numbers of false negatives are generated and early cases may go undiagnosed. PCR tests, on the other hand, identify the presence of the virus’s RNA, replicating and amplifying it to verify its existence at even the smallest levels. This equips providers and their patients with the diagnosis they need to intervene sooner and curtail activities that might further spread the infection.
Recognize the likelihood that case volume is underreported. With increased reliance on at-home antigen tests – understandable since they may be more convenient – leaders must assume cases of COVID19 are underreported. By definition, at-home antigen tests are often done outside a clinical setting with no associated public health reporting mechanism. This skews current data, which in turn may undermine projections about the duration and peak of current cases.
It is likewise important to remember that Omicron has produced a subset of cases where individuals are asymptomatic and therefore may not seek testing – either antigen or PCR. Nevertheless, they may be infected and infectious.
Avoid false assumptions about dominant COVID19 variants. The unprecedented volume of testing in general, along with the prevalence of at-home antigen kits, have diminished the proportion of viral samples that additionally undergo next-generation sequencing (NGS). This is a step beyond antigen and PCR testing, and represents the only mechanism to positively identify specific variants. Because of current media attention, many infected individuals assume they are afflicted with the Omicron variant. But with NGS lagging, that might be erroneous. Current statistics in fact may reflect cases caused by other coronavirus variants such as Delta and, disconcertingly, may include emerging variants that have yet to be named. It is important to remember that the rapid identification of Omicron was due to aggressive sequencing protocols in South Africa. The commitment to public health exhibited by that scientific community helped prepare the world for the wave of coronavirus that quickly ensued.
Make a plan
Sometimes a reality check like the one above raises so many red flags that decisionmakers hastily and dramatically alter course. But, in actuality, it simply supplies additional information that better equips them to proceed with eyes wide open.
Certainly, healthcare organizations should consider all factors before authorizing travel and large group gatherings. COVID19 impacts their workforce and ability to fulfill their core mission in ways unlike other industries. That said, practical and thoughtful preparation may enable their teams to reap the long-awaited benefits of in-person conferences.
The most obvious strategy, of course, is to critically assess how many attendees are required for the organization to reap significant value. Perhaps the anticipated list of representatives could be trimmed, and those individuals tasked with bringing insights back to a larger audience through planned debrief sessions.
Of course, most major events require that attendees show proof of vaccination, which delivers a modicum of assurance that negative impact may be reduced. It might be wise for healthcare leaders who feel comfortable doing so to urge conference representatives to likewise get available boosters at least two weeks in advance for maximum protection.
Some events also are offering onsite COVID19 testing, which delivers dual benefits: Not only can attendees learn their own status before circulating more broadly at the conference and returning home, but conference organizers themselves can better assess if they need to tighten infection protocols or curtail potential “super spreader” opportunities such as evening social affairs.
A key consideration related to the availability of onsite testing, of course, should be whether organizers offer antigen or PCR tests. If the conference offers only antigen tests, organizations seeking extra assurance might ask attendees to seek out PCR tests themselves before returning to work following the event.
The final strategy might be the most important: Proper masking. It is clear that even the vaccinated become infected with Omicron – and may be at risk for other variants, as well as more “conventional” viruses like influenenza A and B. Both clinical and anecdotal evidence have demonstrated that the right mask (i.e., three-ply surgical masks, KN95 and N95) offer the best protection, if worn properly to cover both the nose and mouth and replaced every few hours. Cloth masks do not provide the same protection.
Even those who wear masks religiously may inadvertently increase their risk. They must remove masks to eat and drink, for instance, becoming exposed to the virus from others nearby who also have removed their masks. Individuals attending conferences this year might want to consider eliminating gatherings where food and beverages are served. Similarly, it is tempting to remove masks during smaller meetings or one-on-one conversations, especially in venues where vaccination status is assumed. Nevertheless, with variants like Omicron, vaccination alone does not offer protection against infection.
These are sobering thoughts and may erode understandable excitement about the prospect of attending conferences again. Nevertheless, they are important considerations – and may actually contribute to an organization’s ability to reap the greatest value at lowest risk when participating in these events. In turn, they might also help accelerate a return to normal activity sooner rather than later and for the long term.
About Joel Diamond, MD
Dr. Joel Diamond has extensive clinical and technology experience. He formerly served as CMIO and chairman of the Physician Advisory Board at the University of Pittsburgh Medical Center, St. Margaret Memorial Hospital, where he facilitated 100% adoption of CPOE in a community hospital. He helped develop dbMotion, a solution for health information exchange and population health. He is a diplomat of the American Board of Family Practice and a fellow in the American Academy of Family Physicians while continuing to care for patients at Handelsman Family Practice in Pittsburgh, PA.
About Bryon Cipriani
Bryon brings to AccessDx a vast knowledge of the healthcare industry from his nearly 30 years of experience with clinical, revenue cycle, and technology companies, leveraging his skill set to focus the company’s strategic vision. His background includes designing medication management solutions, implementing accountable care programs to physician groups, and consulting for molecular diagnostic laboratories and healthcare organizations.
