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My Office in a Treehouse? Pandemic Reflections

Over the years, I have had the luxury of working from home when inclement weather or other circumstances dictated that I do so. Other than making sure that I had my laptop and a reliable internet connection, I was good to go.

This past February, my wife had her knee replaced, requiring us to make necessary changes within the living space at home to ensure a safe and convenient recovery. During this period, I worked remotely without any hiccups. A few days a week, I would stop by the office – just 12 minutes away from home – to pick up the mail and water a few plants.

On March 11, the World Health Organization declared the relatively little-known coronavirus outbreak to be a worldwide pandemic. Two days later, President Trump declared the pandemic a national emergency. Within days, our state and country ground to a halt, profoundly altering our personal and professional lives. ‘Social distancing’ became the new norm. Businesses shut down and our once-busy streets resembled something out of an old western movie, minus the tumbleweeds.

We all painfully know the story since March: Millions of Americans lost their jobs or were furloughed. Those employees fortunate to continue working were relegated to finding new ways to operate out of their homes. For many of us, working remotely continues to this day – and will likely continue into the foreseeable future.

During the last seven months, I have had ample time to reflect on whether or not working in an office – along with its’ associated costs – made economic sense. Much of the work I do revolves around research and analysis – some is outsourced to trusted partners. In short, my work requires a quiet workspace with internet access, a coffee maker and a phone for periodic conversations. Being tethered to a formal office space is optional.

Over time, I have found that phone calls were becoming about as frequent as using the fax (remember that relic?).  Prior to the pandemic, most in-person meetings were conducted over coffee or lunch. It really was that simple.

After weighing the pros and cons, the necessity of having a separate office suite became a very easy decision. Paying office rent and utilities, phone and internet, renter’s insurance and, to a minor extent, fuel to commute to and from the office, was a personal preference – but not a business necessity. All of this can be accomplished from home – or perhaps a slightly advanced treehouse.

In the not too distant past, I may have confused my work-based livelihood with where I worked rather than what I did at work. For me, I have sorted out this seemingly razor-thin difference and have reconciled what is most desirable. I can easily perform this same work in the confines of my home and not skip a beat on my output. The pandemic has proven to be a helpful audition, guiding me to feel more comfortable with this eventual change of converting to a full-time remote workplace.

I recently spoke with a local commercial realtor who told me that office space may become more plentiful because of the pandemic. This glut of office space, however, has not hit the commercial market quite yet, primarily due to the Paycheck Protection Program (PPP) helping offset payroll costs, rent, interest and utilities for small businesses. But with a prolonged pandemic, decisions similar to mine will likely follow. A Des Moines Register article on September 3 approached this topic, using some interesting national statistics.

My office conversion has already begun, and in about eight months when my lease expires, I will be sitting in my home den, lakeside or in other locations – performing the ‘what’ regardless of ‘where.’ I’m very comfortable knowing that making ‘sausage’ in the backroom will be no different from home versus an office suite some 12 minutes away. The treehouse idea, however, may need to wait.

Working remotely will be seamless, while wearing pajamas has yet to be decided!

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Meager Spending on Behavioral Health Treatments Appears to Result in Higher Healthcare Costs

Since the Covid-19 pandemic began this past March, we have all been forced – seemingly on a week-by-week basis – to adapt to whatever the ‘new normal’ has been prescribed for us at work, home and in our respective communities.

For many of us, change from the status-quo has been difficult to confront and accept. In fact, living in a perpetual ‘snow globe’ that is constantly shaken keeps us from digging out of a never-ending blizzard of newness. ‘Taking things day-by-day,’ a commonly-used phrase, is perhaps an understandable approach for each of us during these uncertain times.

It is no surprise then, that our behavioral health has been adversely impacted during 2020.

This Should be Important to Employers because…

A direct result of people with behavioral health conditions – such as anxiety, depression or a substance abuse disorder – can relate to low job performance, whether it be through absenteeism, presenteeism, or negatively impacting relationships with co-workers and peers.

Employers know that anxieties – regardless of the source – cause stress in the workplace and can negatively affect the entire business operation. Some undesired effects of this stress include:

  1. Higher Employee Turnover – Chronic stress may lead to high employee turnover because job satisfaction is compromised, and employees don’t feel fulfilled or satisfied with their work. Hiring and training of employees is expensive, both in time and money.
  2. Missed Deadlines – Low job performance equates into missing key deadlines, which can reduce overall organization effectiveness with customers, etc.
  3. Overall Company Reputation Suffers – An organization’s highly-regarded image – carefully earned over years and decades – cements the treasured trust given by the public. However, having a high rate of employee turnover may taint the perceptions of prospective employees, who may question if the organization is deficient in offering the ‘right’ kind of engaging and collaborative workplace culture.

Pandemic, Civil Unrest and Political Divide

According to a Boston University study published in the medical journal JAMA Network Open, anxiety and depression are rising among Americans due to the Covid-19 pandemic. Half of U.S. adults surveyed reported at least some signs of depression, such as hopelessness, feeling like a failure or getting little pleasure from doing things. For many, the problem is considered mostly angst rather than full-blown psychiatric illness, but it still requires genuine professional help.

Feelings of isolation and interpersonal concerns related to physical distancing fuels anxiety and depression. The study found the symptoms to be most common in young adults, low-income study participants and those who lost jobs or experienced Covid-19 deaths of friends and relatives. Even though the study was performed prior to the recent spike of civil unrest beginning in late May, other research suggests that racial unrest also contributes to angst and depression symptoms.  Additionally, the lack of civil discourse found in our political system causes anxiety for a growing number of Americans.

A New Source of Concern for Employers – Being Penny Wise, but Pound Foolish

Consulting firm, Milliman, recently analyzed commercial insurance claims for 21 million people and determined that employers and commercial insurers spend meager amounts of money on behavioral health treatments, even though people with behavioral health conditions tend to have higher healthcare costs from other medical conditions.

Is this a causality dilemma also known as the ‘chicken or the egg?’ Which comes first, the behavioral health condition(s) or other non-behavioral medical condition(s)?

At least with the Milliman study, there appears to be little consensus.

A key finding from the Milliman report was that 27 percent of the people who had a behavioral health condition (e.g. anxiety, depression or a substance use disorder) in addition to other medical problems accounted for 57 percent of the total annual healthcare costs across the entire study population. In other words, the annual costs for people who had a behavioral health condition were about 3.5 times higher than costs for people WITHOUT those conditions.

Under this context, it was determined that spending on behavioral health treatment was a mere fraction (4.4 percent) of total healthcare costs for the 21 million people. In fact, half of people with behavioral health issues had less than $68 of total annual costs for behavioral health treatment. Another 25 percent of behavioral patients had very limited spending on behavioral treatment, amounting to $68 and $502 per year.

The study’s findings may suggest that to reduce total healthcare costs, payers must ensure that people with behavioral health conditions receive appropriate treatment. Oftentimes, behavioral conditions exacerbate medical conditions, causing the cost for medical conditions to increase much greater than for those without behavioral conditions. Effectively coordinating treatment for those who have both behavioral and medical conditions may significantly help reduce the overall costs.

Most health insurers include behavioral health as a covered benefit, but according to a 2019 study by the Congressional Budget Office, commercial insurers and Medicare Advantage plans pay in-network behavioral health providers lower rates than Medicare – about 13 percent less for common mental health services. Because of this, behavioral health providers are inclined to stay out-of-network, making treatment more expensive for insured patients, who may forgo seeking appropriate care. A shortage of behavioral providers certainly contributes to the problem, but telehealth can help increase the availability of care.

It certainly does not help that, due to the pandemic, more employees are working remotely making it difficult to gauge their behavioral needs and deficiencies.

This study was commissioned by The Path Forward for Mental Health and Substance Use and funded by the Mental Health Treatment and Research Institute LLC. The National Alliance of Healthcare Purchaser Coalitions was one of the groups that launched the Path Forward initiative, and you can learn more about this study here.

Going Forward

Employers should work with their insurers and community health providers to explore new ways for employees and their family members with behavioral conditions to receive the most appropriate care from the provider community.  Perhaps consider using the collaborative care model in which primary care clinicians work closely with care managers and psychiatric consultants to care for patients and to monitor their progress over time.

Making your workplace less stressful can include keeping your lines of communication open.  Perhaps offer ‘lunch and learn’ sessions to talk about how to manage work tasks effectively, help set boundaries to separate work from family life, and develop an overall culture of wellbeing for all employees.

Carefully bridging the gap between mental and physical health is certainly worth the effort.

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Trusting Science – Who will be the next ‘Elvis’ in 2020-21?

Unfortunately, the race for a Covid-19 vaccine is sounding so political that it is proving to divide Americans by party voting preference. As we are now keenly aware, science and politics do not mix well.

Following the Democratic National Convention, V.P. Mike Pence told CNN: “We think there is a miracle around the corner. We believe it’s very likely that we’ll have one or more vaccines for the coronavirus before the end of this year.  All of that’s attributed to President Trump’s leadership.”

As of August 31, the number of confirmed Covid-19 infections in the U.S. has topped 6 million, while national fatalities approach 183,000. Based on state sources in Iowa, there have been 64,102 confirmed cases and 1,110 deaths.

Vaccine speed is desperately needed, but will it come at the expense of accuracy and safety? Should Americans be concerned? Yet, just as important as having an effective vaccine, is the trust that Americans have in believing that government officials will do what’s right, not just what is most expedient for political purposes.

Trusting science during this era of social media and partisan politics may be very difficult to overcome. But 64 years ago this coming October, Elvis Presley stepped up. The eventual King of Rock-and-Roll became an influencer for a segment of Americans. More on that later…

Herd Immunity

Having trust in our national infrastructure to develop and distribute effective and safe vaccines is paramount to reaching herd immunity, which is having enough people become immune to a disease to make its spread unlikely. Many experts estimate between 60% and 70% of the population need to be immune in order to achieve herd immunity.

Here’s the growing concern: We could have the most effective and safe vaccine available, but if few Americans take it, then it won’t matter.

During the past six months, Americans have seen highly-touted solutions fall short of the hype. The U.S. and the world are starving for good news concerning a Covid-19 vaccine. The haste for finding the silver bullet is causing both confusion and hesitation for Americans to feel comfortable enough to eventually obtain a vaccine when it does become available.

As intent as one political party is for news of a year-end vaccine that could help ‘save’ the presidential election, the opposing party is nervously hoping any promising news does not occur until AFTER the election. Both parties are in precarious and compromised positions. This tug of war competition uses science as the rope.

Polling on ‘Vaccine Hesitancy’

Vaccine hesitancy is showing up in national polling during August. The results indicate that about half of Americans are ‘highly likely’ to get vaccinated for Covid-19. An Associated Press/NORC Center for Public Affairs online poll in May indicated that half of Americans would hesitate to take or refuse a vaccine, while a King’s College London study found similar numbers in the United Kingdom. To make matters worse, a vaccine may likely need two doses, not just one. Convincing people to seek a vaccine twice will be quite challenging.

According to scientists and America’s own Dr. Anthony Fauci, a widespread uptake of a coronavirus vaccine is the most effective tool in combating infectious diseases. But so far, the type of information being shared with Americans is both inconsistent and, in many cases, inaccurate. This is not a good combination needed to build the necessary trust in achieving herd immunity.

Below is a short list of examples that will erode American public trust if and when a proven vaccine becomes available.

1. Operation Warp Speed (OWS)

Introduced in early April 2020, Operation Warp Speed was initiated by the Trump Administration to facilitate and accelerate the development, manufacturing, and distribution of Covid-19 vaccines, therapeutics, and diagnostics. As a public-private partnership consisting of federal agencies and private pharmaceutical firms, OWS promotes mass production of multiple vaccines based on preliminary evidence allowing for faster distribution if clinical trials confirm one of the vaccines is safe and effective. Congress has directed nearly $10 billion to fund OWS so that any vaccine or therapeutic doses purchased with U.S. taxpayer money will be given to Americans at little or no cost.

Four coronavirus candidate vaccines are expected to be in large-scale clinical trials by the middle of September – a remarkable timeline since the SARS-CoV-2 virus was discovered in December. However, the marketing of “Warp Speed” causes concerns for critics and some science experts that the government and its research partners may cut corners that would increase the likelihood that chosen vaccines are not really safe and effective.

2. Convalescent Blood Plasma Treatments

On the eve of the Republican National Convention, the FDA Commissioner, Dr. Stephen Hahn, reiterated President Trump’s proclamation that 35 people out of 100 (35 percent) would survive the coronavirus if they were treated with convalescent plasma. This “historic breakthrough” was based on preliminary findings of Mayo Clinic observations.

However, medical experts and scientists – including former FDA officials – pushed back saying the treatment’s value has not been established, and the claims vastly overstated preliminary findings of the Mayo Clinic.  One day later, Hahn backtracked from his comments, stating, “…The criticism is entirely justified. What I should have said better is that the data show a relative risk reduction not an absolute risk reduction.”

The FDA is under intense pressure from the White House to move the approval process along when deciding whether upcoming vaccines are safe and effective for Covid-19.

3. CDC Using Yesterday’s Technology to Fight Covid-19

The Centers for Disease Control and Prevention (CDC) is the federal agency that has primary responsibility for handling infectious diseases, which is a huge lift during this pandemic. Yet, according to authors Joel White and Doug Badger in a recent Op-Ed in the Chattanooga Times Free Press, “the CDC uses an antiquated system to collect information essential to fighting the coronavirus.” The CDC, since 2006, has ignored four separate laws requiring it to build a modern, efficient system for collecting information to combat disease. Currently, they argue that “medical workers literally phone or fax in their data. And when they do, it’s not the data we need.” Fax???

During the week of August 24, the CDC quietly released controversial new guidelines that caused an outcry from various medical groups and allegations of political intervention. The agency dropped its previous recommendation to test everyone who’s come into close contact with a person infected with Covid-19 – even those who don’t have symptoms. Confusion reigns on what one should do if they become recently exposed but have no symptoms.  In fact, several large states and providers rebuke this latest testing plan.

4. Hydroxychloroquine

On May 18, President Trump claimed that he has been taking doses of hydroxychloroquine, a drug he has highly touted as a potential coronavirus cure despite concerns from medical experts and the FDA, specifically regarding its efficacy and potential harmful side effects.

Initial data from observational studies have shown this drug has limited or unproven benefits for Covid-19 patients, and could be harmful when used in certain combinations.

5. Reporting Glitches from the Iowa Department of Public Health

Not to be outdone by the CDC, according to an August 28 Des Moines Register article authored by Lee Rood, the state health department has drawn widespread criticism from other Iowa county authorities because of data collection and reporting problems, resulting in thousands of coronavirus infections being misreported. The accuracy of underreported new infections has plagued the state for months.

6. U.S. Postal Service Delivery Problems

This summer, U.S. Postmaster General Louis DeJoy, a Republican, has been slashing budgets and services due to poor finances, causing concern on whether the USPS can handle mailed-in ballots of three-quarters of the voting population this coming November. In fact, the Postal Service informed 46 states and the District of Columbia that it did not have service capacity to meet the deadlines for voters to request and send in ballots, prompting almost two dozen states to sue DeJoy and the Postal Service. The fundamental infrastructure for voting now becomes highly questionable because the mail service has become politicized.

Who will be the next ‘Elvis Presley’?

The first half of the 20th century saw a series of polio epidemics affect hundreds of thousands of children across the world. As a result, many were left seriously incapacitated, with one victim being Franklin D. Roosevelt, the future U.S. president.  Major research was launched to combat polio, and in 1955, Dr. Jonas Salk announced that he developed a vaccine, that provided more than 90 percent protection after three shots.

At that time in America, the American public was somewhat indifferent towards the importance of vaccinations, in fact, there were organizations that lobbied against vaccinations in general, including polio.

Initiatives were launched for children to take the vaccine, but few U.S. teenagers and adults sought to be immunized, most believing they were not at risk. To boost teenager take-up of the polio vaccine, Elvis Presley was recruited, receiving massive media coverage while receiving the shot prior to his appearing on the Ed Sullivan Show 64 years ago this coming October 28. Newspapers all over the country published photos of the Presley vaccination. This publicity ‘stunt’ suggested that the vaccine was safe and helped promote public confidence. Presley, it should be mentioned, continued to work on behalf of the National Foundation for Infantile Paralysis and the vaccination became one of his advocacies.

Moving Forward

Even in ‘better’ times, there is a segment of the American population that believe vaccinations are not safe and can cause dangerous health problems, such as autism. In 2015, a Pew Research Center study found that about one in 10 Americans believe vaccines for diseases such as measles, mumps and rubella are not safe for healthy children.

By this November, the U.S. Department of Health and Human Services plans to launch a public-awareness campaign across television, radio and social media, with the intent of focusing on vaccine safety and efficacy. Medical experts will be paired with celebrities to help these messages resonate with the public. Based on the confusion, doubts and concerns mentioned earlier, this will be a formidable challenge to overcome.

Several health policy experts envision vaccine ‘mandates’ coming from the government, much like the current vaccine requirements for school-age children, military personnel, and hospital workers. Imagine restaurants and bars having signs at the entrance saying, “No Shirt, Not Shoes, No Inoculation, No Service.” Providing proof of inoculation (and booster shots) could be mandatory before entering the establishment. In essence, being inoculated becomes your reward for doing the right thing.

It’s time to put science ahead of politics. Trust, as we all know, must be diligently earned.

Will the next ‘Elvis’ be able to restore our sagging confidence?

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