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Update: 3600 new infections. Lines are all swabbing stations in town and at my hospital were exceptionally long. I think the numbers are higher than reported and there is a huge lag.
 

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Question for the forum: Is telemedicine's resurgence here to stay? The reason physicians have not grasped this technology is a lack of compensation for providing it. Do you think that will change?
 

John Kemker

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Question for the forum: Is telemedicine's resurgence here to stay? The reason physicians have not grasped this technology is a lack of compensation for providing it. Do you think that will change?
I think that physicians are now starting to see the benefits of telemedicine. Don't know if they'll stick with it, though.
 

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Question for the forum: Is telemedicine's resurgence here to stay? The reason physicians have not grasped this technology is a lack of compensation for providing it. Do you think that will change?
I hope they stick with and can be compensated. It is nice as a patient to schedule a telemedicine visit for more simple issues and avoid the waiting room. My insurance covers them, but my wife's employer will not accept these visits for sick time.

On the other end, we have used telemedicine to consult with specialists before we transport patients. We have pretty wide protocols, but once in a while a quick consult and assessment from a specialist can get us different orders and save time for the patient.
 

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How do morbidity and mortality statistics of SARS-CoV-2 compare to Influenzas A & B? Or is the current data on SARS-CoV-2 insufficient to make a comparison at this time?
COVID has a higher death rate, but I am nto sure it is a fair comparison.

I think that physicians are now starting to see the benefits of telemedicine. Don't know if they'll stick with it, though.
This physician will. I prefer virtual. Less chance to catch something that way. I am not much on physical contact so I like to limit it. If I could find a way, I would prefer 100% vitual.

I hope they stick with and can be compensated. It is nice as a patient to schedule a telemedicine visit for more simple issues and avoid the waiting room. My insurance covers them, but my wife's employer will not accept these visits for sick time.

On the other end, we have used telemedicine to consult with specialists before we transport patients. We have pretty wide protocols, but once in a while a quick consult and assessment from a specialist can get us different orders and save time for the patient.
I agree.
 

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Question for the forum: Is telemedicine's resurgence here to stay? The reason physicians have not grasped this technology is a lack of compensation for providing it. Do you think that will change?
Not sure, really depends on the purpose? What if your only reason for seeing a doctor is for annual physical or a prostate exam? These events require the need for "in person" exams.
 

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Not sure, really depends on the purpose? What if your only reason for seeing a doctor is for annual physical or a prostate exam? These events require the need for "in person" exams.
Funny. Many annual exams are worthless and only a way to pad a doc’s bank account. There is no evidence that universal annual exams do anything. In the military, we no longer do them. There is an annual assessment of your health needs. All exams and labs are focused based on the results of that assessment. Often, the assessment is virtual.
 

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Funny. Many annual exams are worthless and only a way to pad a doc’s bank account. There is no evidence that universal annual exams do anything. In the military, we no longer do them. There is an annual assessment of your health needs. All exams and labs are focused based on the results of that assessment. Often, the assessment is virtual.
I get an annual physical for work with a hearing test, updated flu shot, immunity checks, labs, etc... Occupational health "owns" that exam and doesn't release it to my provider. I normally see an FNP, but I prefer a virtual appointment when it is an option. We chat for a few minutes and I get to stay on as a patient. I still think my medical director has a better grasp on my health than my actual provider. We talk more due to work and he is willing to see us to address concerns too.
 

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I think that *if* insurers will continue to pay, tele-medicine and virtual doctor visits are here to stay. Obviously, there are some things that need to be done in person, but many office visits are a waste of everyone's time. I see an endocrinologist twice a year to review and update my prescription for thyroid maintenance medication. Typically, I go to a local lab (1/2 mile from my house) two weeks prior to my visit to get labs drawn. When I show up at the doctor's office, they ask me how I feel, take my blood pressure, palpitate my neck, and I'm out of the office literally within ten minutes. With a blood pressure cuff, or if the phlebotomist could have sent in my blood pressure from two weeks prior, there is almost no reason at all for me to drive a half hour into the city to be physically seen.

My wife is a transplant recipient. In the midst of this pandemic The Cleveland Clinic docs do not want these immune-suppresed patients exposed to all the nasty bugs that live in hospitals so almost all of her visits have been virtual. As long as the (monthly) labs are good, and things are going well, why would she need to drive an hour plus to downtown Cleveland?

Similarly, while there are advantages for mental health professionals to physically see patients for counseling, certainly all visits need not be in-person visits. But again, insurers only agreed to cover tele-medicine because of the Coronavirus, and when (and if) things return to some semblance of "normal" I have my doubts that insurers will allow virtual visits to continue for all these cases, though I hope that some will.
 

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Modern a vaccine moving forward.

Good news, but not without a downside. They say that they’ll be able to produce 500 million doses/year starting in 2021, with two doses/person. That means we’re looking at seeing this in the rear view mirror about 18 months from now assuming everything goes perfectly.
 

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I think that *if* insurers will continue to pay, tele-medicine and virtual doctor visits are here to stay. Obviously, there are some things that need to be done in person, but many office visits are a waste of everyone's time. I see an endocrinologist twice a year to review and update my prescription for thyroid maintenance medication. Typically, I go to a local lab (1/2 mile from my house) two weeks prior to my visit to get labs drawn. When I show up at the doctor's office, they ask me how I feel, take my blood pressure, palpitate my neck, and I'm out of the office literally within ten minutes. With a blood pressure cuff, or if the phlebotomist could have sent in my blood pressure from two weeks prior, there is almost no reason at all for me to drive a half hour into the city to be physically seen.

My wife is a transplant recipient. In the midst of this pandemic The Cleveland Clinic docs do not want these immune-suppresed patients exposed to all the nasty bugs that live in hospitals so almost all of her visits have been virtual. As long as the (monthly) labs are good, and things are going well, why would she need to drive an hour plus to downtown Cleveland?

Similarly, while there are advantages for mental health professionals to physically see patients for counseling, certainly all visits need not be in-person visits. But again, insurers only agreed to cover tele-medicine because of the Coronavirus, and when (and if) things return to some semblance of "normal" I have my doubts that insurers will allow virtual visits to continue for all these cases, though I hope that some will.
100% agree. It is more than convenience.
 

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Good news, but not without a downside. They say that they’ll be able to produce 500 million doses/year starting in 2021, with two doses/person. That means we’re looking at seeing this in the rear view mirror about 18 months from now assuming everything goes perfectly.
This is what I hinted at about a page ago. It is not the only vaccine moving forward.
 

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Question for the forum: Is telemedicine's resurgence here to stay? The reason physicians have not grasped this technology is a lack of compensation for providing it. Do you think that will change?
I hope not. I much prefer face to face with my Doc. I've had one tele-medicine appt so far. Not impressed.

I wonder if visiting your Doc on a computer screen is more or less expensive than visiting a lady of ill repute on a computer screen.
 

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Good news, but not without a downside. They say that they’ll be able to produce 500 million doses/year starting in 2021, with two doses/person. That means we’re looking at seeing this in the rear view mirror about 18 months from now assuming everything goes perfectly.
If you are interested you can go to clinicaltrials.gov and search “Moderna” in the “other” field. They have 29 trials listed, but this is the only one with a “New” tag. They list the 80-some sites for the trial. One is in the Dallas, so I submitted my info to that site as a potential volunteer. I probably won’t be selected as they are understandably enrolling folks with greater chance of exposure. A friend of mine who is a high school teacher also submitted her info, she probably has a better shot at making the trial. Enrollment formally begins July 21.
 

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I hope not. I much prefer face to face with my Doc. I've had one tele-medicine appt so far. Not impressed.

I wonder if visiting your Doc on a computer screen is more or less expensive than visiting a lady of ill repute on a computer screen.
+1 for this, I prefer seeing the Doc as well, also if I am paying a $100 for a doctors visit I damn well want to see a doc, the darn telemed visits are still costing me a $100 (they bill them just like a regular visit). IMO the doc actually should be seeing someone as they might spot really important signs of something else while visiting with the patient.
 

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+1 for this, I prefer seeing the Doc as well, also if I am paying a $100 for a doctors visit I damn well want to see a doc, the darn telemed visits are still costing me a $100 (they bill them just like a regular visit). IMO the doc actually should be seeing someone as they might spot really important signs of something else while visiting with the patient.
That is a pretty expensive visit. My Dad is an ENT surgeon and only charges 110.
 

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Are you seeing patients that are sicker because they delay their care?
Yes, but I am not sure how much of a change there is today. Patients always delay care. I have had the patient dray a 90 day prescription out for a year to avoid coming back. I think that is human nature. I have seen at least one patient that I can attribute his death to a delay in care. The patient died because of a fear of COVID and did not have COVID at the time of their death. A simple surgery earlier than the presentation would have saved their life. Instead, the patient died of an infection caused by the illness.

I think I can that post avoid all privacy issues.
 

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Chuck, a question on the body's antibody reaction to a vaccine shot.
I've seen a news article that casts doubt on how long the antibodies remain in the system of those who have been exposed to the virus. For some it may only be weeks or months.
What are the implications for the efficacy and length of protection of any vaccine?
Thanks.
 

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Chuck, a question on the body's antibody reaction to a vaccine shot.
I've seen a news article that casts doubt on how long the antibodies remain in the system of those who have been exposed to the virus. For some it may only be weeks or months.
What are the implications for the efficacy and length of protection of any vaccine?
Thanks.
Obviously, I'm not a doctor, but from what I'm reading, those results will almost certainly have an effect on the ongoing vaccine trials because everyone is going to want to know the answer to that. But, I have seen discussions that the immune response to typical vaccines tends to be stronger and more long lasting than the normal immune response from having, and recovering from, the same illness/disease. Some have suggested that we might have to get a vaccine booster twice annually instead of once. Of course, I look forward to Chuck's reply as well.
 

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Chuck, a question on the body's antibody reaction to a vaccine shot.
I've seen a news article that casts doubt on how long the antibodies remain in the system of those who have been exposed to the virus. For some it may only be weeks or months.
What are the implications for the efficacy and length of protection of any vaccine?
Thanks.
The problem with the news is they assume that the Antibodies produced by the vaccine will have the same lifespan as the once produced by the virus. This is very rare. Herd immunity from a virus, although possible, is not as common as herd immunity from a vaccine. Often the vaccine produced virus responses are stronger and longer-lasting.
 

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Obviously, I'm not a doctor, but from what I'm reading, those results will almost certainly have an effect on the ongoing vaccine trials because everyone is going to want to know the answer to that. But, I have seen discussions that the immune response to typical vaccines tends to be stronger and more long lasting than the normal immune response from having, and recovering from, the same illness/disease. Some have suggested that we might have to get a vaccine booster twice annually instead of once. Of course, I look forward to Chuck's reply as well.
Bingo.
 

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The Moderna trial specifies repeated blood draws running out through 2 years to specifically test for antibody levels. This is the only way to know for sure how durable the vaccine induced antibody response will be.
 

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Yes, but I am not sure how much of a change there is today. Patients always delay care. I have had the patient dray a 90 day prescription out for a year to avoid coming back. I think that is human nature. I have seen at least one patient that I can attribute his death to a delay in care. The patient died because of a fear of COVID and did not have COVID at the time of their death. A simple surgery earlier than the presentation would have saved their life. Instead, the patient died of an infection caused by the illness.

I think I can that post avoid all privacy issues.
We noticed this when the proven cases first appeared in our area. Now, while we still battle delays, I haven't had someone tell me they waited because of Covid in a while.

We did have someone recently come to a rural ER immediately after experiencing chest pain. We were called immediately after they did an EKG and while other labs were drawn. The door to balloon time ended up right at 90 minutes (from the time the patient walked into the outlying hospital until the time the stent was placed), but the patient was a long ways away from a cath lab. There was a 100% blockage to an artery and due to the timeliness, no permanent damage and the patient was discharged to home. I assume most of us here are typical stubborn males, but calling for help when needed can save your life.
 

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The Moderna trial specifies repeated blood draws running out through 2 years to specifically test for antibody levels. This is the only way to know for sure how durable the vaccine induced antibody response will be.
Yes, but with the EUA, we will not have to wait that long to administer the vaccine. That will determine if we need a second or third dose.
 

Cl(VII)

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Yes, but with the EUA, we will not have to wait that long to administer the vaccine. That will determine if we need a second or third dose.
Absolutely, there will certainly be an unblinded safety monitoring group that looks at the trial data in real time. I would guess there will also be a 3rd party unblinded group that will be monitoring for efficacy also. As time sensitive as this trial is, the data will be unblinded the moment it hits statistical efficacy (if it does hit that point that is).

We will almost certainly need a 2nd dose of the Moderna vax at 1 mo as the only two arms in the trial are 2 dose Vax and 2 dose placebo. Single dose is not even being evaluated. Also, the primary efficacy endpoint (what they have agreed with the FDA they will be measuring for approval) is:
  1. Number of Participants with a First Occurrence of COVID-19 Starting 14 Days after Second Dose of mRNA-1273 [ Time Frame: Day 29 (second dose) up to Day 759 (2 years after second dose) ]
There is a secondary endpoint (“extra stuff we will look at and tell you about, but not really the primary point of the trial“ in FDA speak) that looks at COVID infection 14 day post 1st dose, but it is unlikely that would reach statistical significance as that is only a 14 day window for infection to arise.

This trial is setup for maximum chance of success, not for optimized dosing. Each arm has 15k patients, and every dose or dose regimen evaluated would need an additional 15k participants.

Word is the start was delayed a few weeks from start of a July until the 21st because they had to hire a bunch of clinical research staff to oversee such a large trial. This is a place where Pfizer and AZ have big advantages over Moderna, ie been there, done that on gigantic trials.
 

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Absolutely, there will certainly be an unblinded safety monitoring group that looks at the trial data in real time. I would guess there will also be a 3rd party unblinded group that will be monitoring for efficacy also. As time sensitive as this trial is, the data will be unblinded the moment it hits statistical efficacy (if it does hit that point that is).

We will almost certainly need a 2nd dose of the Moderna vax at 1 mo as the only two arms in the trial are 2 dose Vax and 2 dose placebo. Single dose is not even being evaluated. Also, the primary efficacy endpoint (what they have agreed with the FDA they will be measuring for approval) is:
  1. Number of Participants with a First Occurrence of COVID-19 Starting 14 Days after Second Dose of mRNA-1273 [ Time Frame: Day 29 (second dose) up to Day 759 (2 years after second dose) ]
There is a secondary endpoint (“extra stuff we will look at and tell you about, but not really the primary point of the trial“ in FDA speak) that looks at COVID infection 14 day post 1st dose, but it is unlikely that would reach statistical significance as that is only a 14 day window for infection to arise.

This trial is setup for maximum chance of success, not for optimized dosing. Each arm has 15k patients, and every dose or dose regimen evaluated would need an additional 15k participants.

Word is the start was delayed a few weeks from start of a July until the 21st because they had to hire a bunch of clinical research staff to oversee such a large trial. This is a place where Pfizer and AZ have big advantages over Moderna, ie been there, done that on gigantic trials.
Great stuff
 
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