 Good afternoon, and thank you for joining our COVID-19 vaccination and flu speaker series. We have three timely topics and three knowledgeable and engaging panelists. I'm looking forward to the next 90 minutes. We're taking time this afternoon to provide data and an evidence-based perspective for you and your enterprises, so you can be safe, healthy and productive. For those of you who have not met, I'm Keith Forrester, Vice President of Marketing, Sales and Business Development at Kaiser Permanente. Before I introduce our panel, there's just two housekeeping items. One is that this webinar will be recorded so that we continually improve the way that we bring messages and information to the market. So what did you know that? The other is that while cameras are turned off and phones are muted to focus our attention, you can submit questions and we encourage you to do that via the Q&A function. We'll weave these into our conversation and we receive several ahead of time, and so we'll plan to weave those in, but we'll take more as they come along and we'll have time at the end of our preparatory remarks to have those questions addressed as well. So let me turn to our panelists and introduce them. So on the left hand side, you see Jennifer Stacey, so it's my privilege to work with Jennifer. She's the Director of Strategic Accounts and Dental, and so what that means is she oversees our Dental Line of Business from Sales and Account Management Perspective, and then her and her team work with our largest customer, so welcome her. We're also joined by Dr. Bachman and Dr. DeConis. Dr. Bachman is a primary care internist practicing at Portland since 1998. In addition to his clinical work, he serves as a Permanente Quality Ambassador connecting the needs of our group customers to Kaiser Permanente care delivery. He's also the Medical Director of the Kaiser Permanente Northwest Workforce Health Team, and that's a team that works with some of our largest employers about how to keep their workforce as healthy and as productive and engaged as possible. Dr. DeConis is the CEO of Northwest Permanente, and that means that she leads more than 1700 physicians, clinicians, and administrators at Permanente Medicine. She's a passionate advocate for addressing the social and environmental determinants of health, and is working to transform the culture, practice, and business of medicine at Northwest Permanente as well as the entire Northwest and even wider. Many of you may not know that Northwest Permanente, which is actually a separate entity than Kaiser Permanente Northwest Hospitals, which is where Jennifer and I work, not to get too much in the weeds, but they're an independent organization that we have a mutual exclusive relationship with around practicing medicine and fighting care for you and for your employees. You may not know that Northwest Permanente is a B Corporation, and I encourage you to look into that, and with that, they were honored in three categories in 2019. They were recognized for the best for the world overall, best for customers, and best for workers certified, again by the B Lab. Dr. DeConis was instrumental in that B Corp status and designation, so I appreciate her work in advocating and bringing about more sustainability in all that we do. With that, it's just an introduction to our panelists. I'll turn this over to Dr. Bachman to go through our agenda. Great. Thank you very much, Keith. We'll be talking about three things today. We'll be updating you with information about COVID, where things are standing now, both in our care delivery system and in the broader world of COVID. Second thing we'll be talking about is influenza, and what we think will happen this flu season when the pandemic of COVID is the seasonal influenza season. Dr. DeConis will be talking about the second topic, and the third topic will be how do we support employees and family through this pandemic? We've really seen the market social stress that COVID is playing on our society with lots of concerns about job security, financial security, education of children, and all that will affect employees and our approaches to keeping people healthy. That's what the next 90 minutes looks like. Thanks, Dr. Bachman. To get us started, would you give us the latest on COVID-19 testing and vaccinations? Let's be a great place to start. Great. Well, last night after the debate, I decided to liven things up and look at the epidemiology of COVID to cheer me up but I wasn't too successful at that, but I was able to find a few bright spots as well, which will come out. But let's just start out with the epidemiology. Currently in the world, in international perspective, there's 33 million cases. All continents and countries have been affected, and the U.S. accounts for more than 20% of those world cases. Sadly, in the world, we reached a milestone of 1 million deaths earlier this week. In the United States, we reached a milestone of more than 7 million cases and 200,000 deaths. Currently in the United States, there's 45,000 cases per day. In April, what kind of what we thought was going to be the peak, there was about 32,000 cases a day. May and June in the spring, things got better. I think we were thinking maybe we were over it, but then come July, things got worse, and there was increasing numbers of cases in the end of July and August, up to 70,000 cases a day, and more than 1,000 deaths weekly. Now, COVID is the fur-leading cause of death by cancer and heart disease, and more people are currently dying of COVID than lung disease, accidents, or Alzheimer's. Residents in the United States are more than eight times as likely to die of COVID than residents of Europe. Turning a little bit closer to home in Oregon and Washington, Oregon said 33,000 cases and Washington 90,000 cases, but we're lucky overall. Oregon ranks number 41 in cases per capita, ranked in the United States and Washington 39. A little bit of concern in the future, Oregon had its peak cases for the entire COVID epidemic last Friday with 457 cases. Resink some evolving patterns, higher intensity of outbreaks in rural, greater than urban areas. Mallard County's heavily affected, Umatilla, and Boardman. Younger people, we know, are more likely to get the virus, but less likely to get sick from it, hospitalized, or die. Last week at University of Oregon, there were 22 cases. Go Ducks and OSU, 13 cases. Go Beavers. We know the outbreaks are tied to certain work environments. This is pretty predictable. We've seen this around the country. These are environments where social distance is challenging, corrections facilities, food processing facilities, warehouses, senior living facilities, and long-term care facilities. One thing that's been consistent through the outbreak is the marked disparities based on race and ethnicity. We see similar patterns in the United States and Oregon and Washington. For instance, in Oregon, white and Asian individuals have about four cases per thousand. Pacific Islanders and multiracial individuals, six cases per thousand. Black individuals, 14 cases per thousand. And Hispanic and Latino ethnicity, 23 per thousand. Hospital rates are at 8%, so you can just see that's a lot of people getting sick and not fairly distributed. That's kind of a summary, Keith, of what's going on with the epidemiology. We're in a phase we're concerned about what's going to happen in October, but also we may see things stabilize as well. Yeah, it's staggering to hear that something we weren't really even aware of at this point a year ago is now the third leading cause of death in America and just the disparity that has across our population. Turning to testing, a lot of news and a lot of coverage on testing. Can you give us an update and let us know kind of where members can get tested safely and conveniently? Yeah, so we're really running a successful PCR-based testing program. The PCR is the nasal swab that detects virus particles. We're doing this in our emergency care facilities. We're doing this in our clinics. If positive, it generates kind of an immediate clinical follow-up. The testing is available to people who have all people who have symptoms related to COVID. It's also available to people who have contacts, family members or work contacts who've had COVID. It's also available from asymptomatic people with public health requests and even for college students and those needed to travel. We test prior to certain kinds of surgeries that we do and certain kind of procedures. So we know early testing is important after exposures and we do want to catch everybody if they've had an exposure. We know if we can catch people in those first few days before they have symptoms, they'll be much less likely to infect other people. So currently we have adequate capacity to meet the needs of our members. The supply chain related to COVID testing, it's all the different things that need to be done. The swabs, the reagents, the tubes or reagents go in, all that stuff. It's a pretty tenuous supply chain and we have multiple systems online right now to meet the needs. There was about six weeks ago, there was a couple weeks where some of the reagents didn't come through and we actually had to be a little bit nervous about testing and we thought we were maybe difficult with capacity, but that's better now. Finally, we are able to provide this data to large employer groups about their group's experience with COVID, with hospitalizations, with positive versus negative test results. That's the main test that we're using. There's also an antibody test that is available when a member requests it, but there's some lab builds of that test. I think we'll talk about that a little bit later. Next slide, I think. We've done to date almost a million tests within Kaiser Permanente and the current total positive rates almost 10%. That's a pretty high rate and we're not worth not seeing numbers that high. Initially, at the beginning of the outbreak, only people who really were quite sure had COVID were testing. In the Northwest region, we've done more than 117,000 tests and we're doing that with a turnaround time much quicker than the community. We're currently able to turn a test result around from the time when someone comes in, gets that swab done maybe through a drive-through program with urgency care, and really within 16 hours we're able to get that test result back to somebody electronically on kp.org. If it's positive, they get an immediate clinical follow-up to make sure that they're educated about what that means, how to protect their family members, what kind of symptoms to follow up with. You can see the national average there is four days and we're stories about people waiting 10 days and 14 days for their COVID test result. At that point, it's really not adding any useful information. In the last two weeks at Kaiser Permanente Northwest, we've had 4% positive rate, 6.4% of people who were symptomatic were positive, and 1.2% of people who were asymptomatic were positive. It's out there, but really the majority of people, even who have symptoms, really have something else going on and it's not COVID. Next question, Keith? Well, I guess if you could just walk through kind of what are the what are the steps that we're taking to keep us safe. A number of people are concerned with we're staying safe during COVID and what are the steps that we're taking to keep our patients and our members safe. Yeah, so lots, really we've seen market changes in care delivery. Some of the things that we were already doing were able to leverage in the context of COVID to keep people safe. And one of those is telehealth and really that's a different than the way we're doing telehealth is really different than the rest of the industry. Telehealth at Kaiser Permanente is really connected with somebody's overall care. It can be a primary care telehealth visit, urgency telehealth, urgency care telehealth visit, or specialty care telehealth visit. And there's telehealth going on in all those different dimensions. Telehealth can look like a video visit, which is something that's really increased markedly. I think people are getting more and more comfortable with video visits, both patients and physicians. And I know my patients are commenting even ones that were skeptical commenting really how useful the video visit is finding we're doing mental health by video visits. It's really great to make that eye contact. Telehealth can also look like email, can also look like phone appointments. We, before COVID, we initiated an e-visit program, which is an algorithmic primary care visit for a whole list about 60 different common primary care conditions, whether it's rash, headaches, UTI symptoms, allergy symptoms, cough and colds. And a member kind of goes through that algorithm answers the questions. And then when they get to the end of it, a Kaiser physician follows Kaiser Permanente physician follows up with them within an hour or so to make sure that the algorithm worked, follow up with any prescriptions, other advice, or follow up care. That was really quickly configured for COVID. And it's been a very successful way to help people sort through their symptoms, determine who needs to be testing, whether the care is necessary. From the e-visit, somebody could be resolved situation just with home care advice, or they could need an office visit appointment, a follow up appointment, or referral to the emergency room, all the things you would get at a regular phone visit or office visit. Other things that we were able to leverage were our mail order pharmacy, which were already market leading. We were able to expand that even further during COVID. And that has worked out well with really rapid turnover of mail order pharmacy time. Other telehealth could look like an emotional wellness online support resources, which are apps, which would be the calm app is one of them. And then there's other other ones as well to help support emotional wellness. There is also a telehealth online screening tool to help kind of sort out COVID symptoms and who needs testing. Since someone comes to the office, they really do see a different environment. It's much there's always a greeter who makes sure that they're wearing a mask, provides a mask if someone's not wearing one, checks the temperature, make sure that somebody doesn't have a fever. Well, then in the waiting rooms are empty, the high level of sanitation going on in the facility, visitors are limited. And then we're offering curbside pickup for pharmacy as well. So it's a whole different feeling right now. It's quieter, it's calmer, lots of room in the waiting area and lots of parking as well. So one of the questions that came in and I just remind you to take advantage of the Q&A option is what about for members who are patients who have tested positive about going back in and when do they get retested? Do they get retested before they go back to work or what's kind of the protocol and recommendations there? That's one of the most common questions that we're getting from employer groups right now is how to deal with returning people to work after a diagnosis of COVID. So the recommendations are pretty clear on that that after somebody has symptomatic COVID, they need to stay off work for 10 days and have no fever for 24 hours. And at that point, they can return to work. At that point, they're not infectious. Although intuitively, you'd say, well, let's do a test to make sure somebody's not infectious. It turns out that that test is pretty unreliable. The test measures virus particles and people frequently can't have for weeks particles in their nose or so where the test is done, which would then be a false positive test. So it's considered to be very uncommon to have somebody if not impossible for somebody to be infectious following 10 days of isolation after a diagnosis. In fact, the recommendation from the CDC is not to retest somebody for 90 days after a COVID diagnosis. But that employee could feel even if they're asymptomatic, maybe not feel well for another 21 days. I think I heard you say earlier. Yeah, that's I that was just to me that was in the CDC website as I was preparing for this that the average or the Oregon Health Authority website, excuse me, the average number of days Oregonians report being ill after COVID diagnosis for people who have symptoms is 21 days and 26 or longer for people who have been in the hospital. So that's just a long time. So maybe people may be well beyond that 10 days of necessary being off work and still not feeling well and not able to go back to work because they can't meet their job demands. Okay, let's switch to the topic of vaccinations. There's multiple vaccinations that are in development. Can you share any news on the treatment for COVID-19 and when we might or when a vaccine might be available? Well, that's the the the billion dollar question is when a vaccine is going to be available and I wish I had an answer for that. But it is really good good news in that part. The CDC thinks that vaccines hopefully will be available by second or third quarter in the 20 in 2021. And several of vaccine manufacturers say they can produce up to a billion vaccines per year. But it's not easy work and there's still challenges there. And historically up to 90% of vaccines that have been tested have failed Luckily, we have more than 200 vaccine candidates. One bit of concerning news, though, is that the Pew Research Foundation found that the number of U.S. adults who state they will accept the COVID-19 vaccine reduced from 72% in May to 50% in September. So three vaccines to know about one is the Banderna vaccine. This was initially tested at Kaiser Permanente, Washington. It's an mRNA vaccine. And it's currently in phase three tests. mRNA, this is the first use of mRNA vaccines, which is a newer technology for vaccines. mRNA actually is a is just a chemical molecule of RNA that is in the vaccine. It doesn't need egg or animals to be developed. So it really can be synthesized in a chemistry laboratory from RNA pieces. And then those get into the cells and the cell starts creating the protective proteins against the spike protein. Second vaccine to know about is the Pfizer vaccine that's also mRNA. And that's a phase three trial at the Kaiser Permanente Center for Health Research is ongoing. I think they're no longer recruiting local Northwest patients for that, but the trial is going on around the world. It'll be tested on 44,000 people. And then just mentioning CHR, our research center, they are, although the local Pfizer trial is concluding their planning or expecting to land contracts and grants to participate in two additional trials as part of the NIH operation warp speed. And the third vaccine to know about is the Oxford AstraZeneca vaccine. And that's the one that hit the news recently because there was a pause for about a week after a side effect developed in one participant. It's restarted in Europe, but not in the United States. And that's not an mRNA virus. That's an adenovirus based vaccine. Turning to treatments. This is another sort of bright spot. I think we are getting better for people that do have COVID and require the hospital care. I think it's a place where we're getting better. So dexamethasone, which is a steroid that's inexpensive has been shown to be effective. So that's now standard of care at Kaiser Permanente as part of our COVID treatment protocol. The second new part of standard of care is remdesivir, which we were involved in the randomized control trial that showed that it was effective at decreasing severe COVID disease. Currently at our hospitals, there is a randomized control trial, which is the highest quality trial going on that's combining remdesivir for everybody with other immune modulators. One of them being interferon, which is a drug that's used to treat MS. And another medication, veracitinib, which is a rheumatoid arthritis drug. Convalescent serum is something that's being talked about. There's been studies showing a modest effectiveness. And then there's some other treatments that are being used selectively as well. Okay. One reason that COVID deaths from COVID is going down is due to better hospital care. We are getting better at it. Kaiser Permanente. I know our physicians feel fortunate that it's not they have a great deal of expertise and they're able to share ideas, best practices with their intensive care and pulmonology colleagues around the country. I know we were, had one of the first experiences with severe COVID based on their experience in the West Side Hospital in with really the first diagnosis of COVID in the Northwest region and really have learned a lot since that time on how to most effectively manage COVID and prevent complications. Okay. Thank you, Dr. Bachman. We'll get back to you with questions. Appreciate the update on COVID-19, a lot taking place there. Dr. Dakota, I just want to transition to you now. And anything that you would add as we've had this conversation around the latest on COVID and vaccines from your perspective? Yeah. Hi. Hi. Thanks, Keith. Can you hear me okay? Coming through loud and clear. Great. So, yeah, so thank you everybody for joining us for this speaker series. And I know that you are all busy individuals. So I really appreciate and will appreciate the conversation, particularly your feedback and input on what you would like to continue to engage us with and talk about. Just to follow up on that slide about the treatment, you know, at the beginning, we did not know much about this virus and COVID-19, the syndrome that it causes. So if you were to get acutely ill today, for example, with COVID-19, you would have 30 to 50 percent less risk of dying if you are one of those people who are so severely ill that you needed to be hospitalized or be in the ICU, just because of all the treatments that and the treatment protocols that we have been putting together and continuing to enhance and iterate as we learn more about this virus and the syndrome that causes. Thank you. So it's it's great to see the progress we've been making and the greater life expectancy and that's so critical, you know, that we learn as quickly as we can. Let's again turn to the flu season. So many of the health concerns in 20 affect our lungs. So we have COVID-19, there's smoke from the fires and there's a flu season that's coming. So how are these related in their impact to us and their symptoms? And then how are they different? Yeah, if we could go to the next slide. I'm a visual learner. So as somebody's talking to me, it's good to have something to look at. And so you know, who knew not only would we be dealing with a pandemic, but along the West Coast and certainly here in Oregon, we had another crisis with the historic wildfires. So this table hopefully summarizes and gives you an overview of some of the differences. And if it appears, I think we if you look at boxes don't exist or where they exist. If you look at influenza and COVID can you hear me now? We lost you for a little bit there. We can hear you now. We lost you up for a little bit for them on the check the boxes. Yeah. So if you look at the comparison between influenza and COVID-19, you know, the GI symptoms predominate in the COVID-19 more compared to influenza and just the loss of taste or smell. We typically don't see that in influenza, whereas in some reported cases of COVID-19 that that is apparent, right? You've heard that in the media. And then and then just about the smoke for a little bit. So we know that wildfires happen year over year. And part of this is because of climate change. Now, having said that, we also know that the particulate matter that that bad air that is produced from these wildfires upwards up to 400,000 premature deaths are attributed year over year just to wildfires because of this particulate matter that's in that air. And all of us who have lived through the days of when we've looked at the air quality of hazardous or very unhealthy air, we have some really real time acute impact to that, particularly in the individuals with chronic lung illness. So COPD, chronic obstructive pulmonary disease, people with emphysema, people with asthma, and yes, chronic heart disease, because a lot of those patients, people have also these concomitant lung illness issues. And so there were acute and there are acute impact from these days of bad air and smoke. And then really only time will tell what the long-term impact of the hazards of breathing that file air for days, particularly for young children and infants where their lungs are still developing. So remains to be seen what happens there. Now, this slide talks about the fatalities of these conditions COVID-19 influenza. And as Dr. Bachman already reported, unfortunately we've surpassed the 200,000 deaths in this country alone and globally a million and probably more so because that's an underestimate given that certain countries report deaths differently. And when you think about the fact that United States, as you heard in other places, is 4% of the population, but we account for 20% of those deaths. And so we have many opportunities as a country, as communities to absolutely continue to work on masking, physically distancing, frequent hand washing. If you look at the flu fatalities, similarly year over year upwards of 30,000, 60,000 in the last three flu seasons deaths. And that's just in the United States. And what's more with this graph doesn't show is the millions of people who get sick and seek care. So 12 to 16 million people in the last three flu seasons have sought care for flu related symptoms. And of that nearly half a million requiring hospitalization. So a lot of toll on human suffering. And for the businesses, for us businesses, and some of us are essential workers and essential businesses. When you think about months lost in just human suffering, but also in productivity of the workforce. So there are ways, you know, these are preventable, many of these are preventable. And maybe the next slide can just look at it's not that they look blue or red, but this is just to distinguish the two in terms of infectiousness transmission as you see there. And the vaccines that we talked about it really target those proteins on the RNA virus. Well, let's, we can move then to the benefits of the flu vaccine. I mean, I think there's one is to talk about what, what are the benefits of the vaccine is it is it really worth it. And then I think the other is there's concerns, I think often with patients that stay in age thinking is is the risk of visiting a medical facility worth it to get a flu shot, given that we have COVID. So I think it will just the discussion on the benefits of the flu shot itself. And then that risk around going to medical facilities in some way to get to get a flu shot. Yeah, so so pandemic or not, it's always always a good idea to get your flu shot. And let's just clear the urban myth. Just right now, you cannot get the flu from the flu shot. The flu shot is composed of inactive parts of the virus. So you cannot get the flu from the flu vaccine. Now, having said that, can you have some symptoms after getting the flu shot? I get them. I get the achy arm, maybe sometimes malaise where I feel like, you know, oh, I feel round down. But, you know, every year when I get it, I premedicate or maybe this is TMI, but I medicate with ibuprofen, just anticipating that I might get those achiness and things like that. And so I got my flu shot yesterday, for example. And ibuprofen within the hour of getting it and had to take another dose of ibuprofen this morning. And I'm fine. And so so urban myth aside, now we have this pandemic on top, right? So so I would say let's protect ourselves and remove the confounding factor of if and when you do develop symptoms. Is this COVID, is this flu? What do I have? I mean, you just saw the table about the intersection and about the flu symptoms as well as COVID-19 symptoms, a lot of overlap. So why torture yourself with this confounding thing of is this COVID-19, is this flu? The other thing is, again, as you saw the burden, the burden of illness, not just on humans, on us people, but also as businesses, you are business owners, you are business leaders. Think about the burden of either getting COVID or the flu are at the same time, right? So why wouldn't we, we have this vaccine, we're talking about this this billion dollar question of when are we going to get COVID-19 vaccine? And really, we're going to forgo getting the flu vaccine that's right in front of us and right is available to us now. So it really doesn't make sense on many fronts. And lastly, it's a plea, it's a plea from healthcare systems, just like we talked about at the beginning of the pandemic surge, let's flatten the curve, let's not overwhelm the health system. So imagine a flu season where if it remains like it normally does in other seasons where a vast majority of people don't get vaccinated, we will be overrun with testing for COVID-19, the flu, PPE, hospital beds, etc. So I am not overstating the risks when I say that there is there is a risk of overwhelming the healthcare system if you don't get the flu and it's a horrible flu season. Yeah, that's important to point out that we don't want to overwhelm the flu because we could have another COVID surge and what we don't want then is a surge of just regular flu that is highly, highly preventable. But that's an important point. Right. And it is safe. So here on the list, you asked me earlier about the safety of getting the flu vaccine for those who are concerned about coming to a facility. So more than other times we've stood up more drive-thru clinics this flu season and also other ways that you can get the flu shot without being around many, many people. We're still following the CDC, I mean the guidelines about physical distancing and the like. And so we are providing more options in our facilities, particularly as the facilities are also using different protocols in terms of maintaining how many people in there as well as the how frequently we disinfect and sanitize. Yeah, great to see you happen to be at a clinic last Wednesday. And a number of people coming in to get the flu shots and having it as segregated, so it was safe, it was accessible. And then looking at, you know, other ways that we can make it even safer, whether that's drive-thru, easy convenient flu clinic. So I'd say, you know, to our employers, continue to watch for what we'll be continuing to evolve to make the flu vaccines as easy, safe and convenient to get as we possibly can. Before we go forward though, have there been predictions for the severity of the flu season this year? Dr. DeConis, have you seen that? How reliable is that or what are you hearing? So I just had this conversation with the chief of our infectious diseases department yesterday, Dr. Spindel, and his answer to that is how I can predict or how I can tell how severe the flu season is because it's past. There are no predictors. There's no markers of how the flu season will be. You know, we can look at the southern hemisphere and say, oh, it went this way. But honestly, year over year, there is no way of predicting how severe the flu season will be. And there has been one case in Oregon documented so far. All right. We have had our first case of the flu. Yep. Interesting. So maybe we'll go to the next slide. Yeah, so this is just hopefully it's ingrained on us. After this talk today, maybe, you know, let's aim for the triple aim at the bottom or quadruple aim if you add frequent handwashing. It's continue the physical distancing, the masking, and the flu vaccine. The hole is greater than the sum of the parts where you put it all together for protecting yourselves, as well as the community and your family. So sometimes there's concern. We talked about this a little bit beforehand of parents bringing their children in for flu shots. But it's not, as I understand, it's not just about those children getting the flu, but they can spread and carry it to others. And there is a significant portion of the population in the Northwest that is not in favor of vaccine. So just a little bit on that and from a clinician's point of view. Yeah. I mean, hopefully the measles outbreak that happened here in the Northwest and in Washington will be a lesson on, you know, here's a very preventable illness. We have a vaccine available. Why wouldn't be it's there, all the scientific data is available about the safety of these vaccines. And so I would just urge us as we are talking about COVID-19, let's use science as our guide and evidence as our guide. And particularly as the knowledge about COVID-19 and flu vaccine continue to expand. Let's use science to make those choices. Okay. So take a little bit of a turn here on similar themes around the pandemic. But you know, I think, you know, you, Dr. DeConis, me, Dr. Bachman, Jennifer, those on this webinar are all facing unique high levels of sustained stress since March. And it's just been a world that we have not been used to. We had to find new ways to balance remote working. So we're having to do homeschooling, not by choice, but just that's where kids are safe. We have to do social distancing. So we're often not as connected to our support structures and all of this amid political turmoil or social unrest. It's a, it's a unique year to say, to state the obvious. But as a care provider, tell what perspective and advice can you add for those who are experiencing that, particularly around those who are providing care, because we might we're taking care of often our loved ones. And so what's your perspective and advice there? Yeah, so some sobering numbers, maybe we'll go to the next slides. So I'm just going to let our viewers just marinate in in some of these numbers, because those situations that you describe, you know, we're all living it, it's impacting not not only the population, but also the caregivers, the population of caregivers. So in addition, you know, addiction is up, alcohol use disorder is on the rise, over 240% increase online sales of alcohol. Social media is also normalizing alcohol use as a coping mechanism. There are posts out there and cartoons about when people start drinking in the day. And so it's all in us to figure this out and really lean on one another for support more than ever. And, you know, some of the digital therapeutics available there. So on KP app, for example, your access to my strength or calm, we've had a lot of favorable feedback from our members and patients about just access to that for free, as opposed to paying a subscription. Also our clinicians are using it and especially our primary care docs who are recommending it to their patients, their own experience in using it, their own families experience in using it has been a helpful way to experience it so that when they're engaging with patients or our members, they know, you know, really what the experience is like. I know my son likes calm, the app calm that he has access to. And, and so it's the digital therapeutics is just the basic thing that the people can access. And certainly we have moved a lot of our behavioral health consultants, touchpoints to video and virtual as well as our mental health therapists and our psychiatrists. And really what the white paper what the evidence shows about mental health help is that the sooner you intervene, the sooner the symptoms are shorter and the more you can prevent escalation of symptoms. And so access to behavioral health consultants in KP is is now widespread and we're looking to recruit more of them as that first front door of complimenting the the digital therapeutics with the apps in addition to primary care in addition to them, even before they need help getting to the mental health therapist. So that's been very helpful to expand our capacity and and group visits group visits both for addiction medicine therapy and group visits for mental health therapy groups I think may have lost an elder for a little bit. Just cut out people who can I think you in in the Hi, can you hear me now? Yeah, we hear you now. Just watch it there by 20 seconds. I'd say just to emphasize that point that you know what I'm seeing with with my employees. And I think hearing from others is just the pervasiveness of the stress and how that comes out as you know it's illustrated here in terms of childcare caring for others and then balancing so much and then being disconnected from others is you know it's very timely in terms of how do we reinforce for our employees and for others the removing the stigma to ask for help right so that's been something we've really wanted to do for some time and it's so important here that they hear that from multiple channels that it's the brave thing to do is to reach out and to ask for help and to seek seek some assistance as we confront these new times and these new stresses which you know none of us have really been prepared for for this magnitude or for this long and it looks like it's going to continue certainly for the foreseeable future. So thanks Dr. DeConas I'll come back to you with some questions and just a little bit I wanted to take a turn now and go to Jennifer and I think it weaves in nice with what we were just talking about Jennifer which is you know we see this as our employees and as they're having to provide care take care of themselves take care of their family the additional stress and we're thinking part of our mission is to help employers have a productive engaged workforce and in doing that that is part of their their health care part of the way that we've addressed that is is through our our playbook and so I'm sure as many have seen this before but could you share any updates for the COVID-19 workforce health playbook a long name for trying to make resources available Jennifer? Yes absolutely so thank you Keith the playbook provides a framework curated resources and ideas as we all consider that we can all consider as we evolve to what we're considering the next normal so if you haven't seen it yet it's massive it currently runs about 150 pages but it is divided into chapters to help you drill down into the information that's most relevant to you easily the chapters run the gamut they cover HR policies safety plans and returns to work screenings mental health and emotional well-being the social drivers of health as well as monitoring regulatory and legal changes and more and as you mentioned we're continuing to update the playbook as the science evolves and as we receive feedback from our partners about what would be most useful to them so the most recent iteration includes updates on sanitation and masking guidance around contact tracing and how to support that in the workforce and employee resources I'd note that we also have a playbook that's focused on return to school which I know is heavy on everybody's minds so we'll send out the link to the playbook with the survey but you can also contact your account manager to get the most updated versions now we've been talking about support for employees and that's a huge topic and we mentioned that many workers are taking on additional caregiving responsibilities in 2007 the EEOC provided some best practice guidance that's incredibly incredibly relevant in today's environment and the baseline is making sure that your managers and leaders are really familiar with the laws protecting workers that have caregiving responsibilities and that they understand the type of behavior that may constitute unlawful discrimination so when you're making an effective policy it's helpful to define relevant terms like caregiver and caregiving responsibilities and to include a definition of family that extends to any individual for whom the employee has primary caretaking responsibilities so really updating that definition for the world we live in today it can be helpful to help to describe common stereotypes or biases that result in unlawful conduct such as assuming that maybe male workers do not or should not have significant caregiving responsibilities I think the last study I saw is about 45 percent of male co-workers do have significant caregiving responsibilities now and then on the flip side that females would prefer or should prefer to spend time with families versus work so you really want to make sure people understand what that looks like and what to avoid so I'd say in addition to legal protections we know that supportive workplace policies increase productivity reduce absenteeism and appear to positively impact the bottom line now not all employers can provide flexible work scheduling but this can be life changing for those who need the additional flexibility to arrange for medical appointments provide care for a parent or these days simply attend a fourth grade math class to get somebody through for those less flexible roles consider offering caregiver benefits for example our Kaiser Permanente clinical workers now have access to temporary child care grants and there's a call resource support to help them with needs during the pandemic like hotel support child care mental health concerns and social needs finally I'd say when an employee does need to take a leave of absence for their caregiving responsibilities it's recommended that they have dedicated there's a dedicated resource to really help them navigate the policy and that policies are fair and available to all impacted workers now you'd mentioned about and I think everybody knows that we've all experienced increased emotional demands over the last month so or months as this case may be so strong mental health support is critical in addition to providing benefits to support access both to mental health and substance abuse clinical care if you have EAP conducting a campaign to raise awareness about EAP services and to reduce the stigma associated with using those services can be very helpful and we talked a little bit about self-care and how that's become an important addition to supporting emotional wellness I'd recommend that you reach out to your partners to determine what's already available you know Kaiser Permanente has a range of self-care resources open to everyone community members members and employees that help build resilience develop coping skills sleep better manage stress you name it just to help feel more mentally and emotionally refreshed Dr. Dakonis mentioned that our members also have access to my strength and the calm apps to help support mental health and to class pass which helps support physical health now educating your employees about the benefits you offer not only help them manage their care more effectively but it can also increase the perceived value of the benefits that employers pay so much to provide their employees next I'd say I mentioned EAP but there are also alternatives to help provide support such as national nonprofit resources community organizations or other health care organizations like I mentioned Kaiser Permanente has many publicly available resources so you don't have to create everything from scratch you can really lean on partners far and wide to help you provide those resources to employees and then finally we've talked about the use of telehealth and it really has impacted all health care providers so Kaiser Permanente you know you can access primary and specialty care you can get routine care your mental health therapy treatments you name it you're able to get it with telehealth and no matter how you connect or who you connect with the care providers have access to the health histories can make appointments for you and can will update the records in support of the next visit now to that end employers can help support their employees by making sure their policies are up to date so for instance most employers allow an employee to take time off to go to an in-person medical visit but do you allow your employees to simply step away from work for a much less disruptive telehealth visit and if you do do they have a private space they can cut these visits so overall it's really about looking hard at the world we live in and then thinking of ways both big and small that we can make it possible for employees to stay as healthy and as productive as possible no matter what 2020 continues to throw our way thank you Jennifer so I just you oversee a number of employees and part of a larger organization that works with employees many so in your management of employees during 2020 what have you found to be important for sustaining both you and your team during these challenging times yeah first of all shout out because I have such awesome employees that you know having them there does help sustain me and really really importantly and this is hard to do is to try to work out time carve out time to connect so making sure that it's not always business and it's not always just a you know march through the day one meeting after another but that you you know ask how somebody's doing you can connect in different ways whether it's you know text and sharing what did you do this weekend it's really those small things that you would naturally do during the course of a day when you're face to face but then I would say also as important is to recognize that you know people are fatigued they're fatigued by this video kind of environment they're fatigued by constant meetings and we're seeing it bleed into before work after work all over the place so it's really trying to find that balance of connecting regularly but then giving people some space and realizing exactly what we've been talking about their worlds don't look the same as they did before and it's hard to deprioritize things but if there are areas to do so I think now it's the time yeah I think that's a good point is building in that water cooler time for lack of a better term so you didn't have those hallway you're not having those hallway conversations unless you're more intentional about it now I know we've seen our calendar J fill up with meetings and meetings and the days kind of extend because why not you're at home you can work as well but then being intentional about making sure there's connections the really power people and keep them committed to the work that they're doing and the company they're doing it with so yeah thank you so we do have several questions here so I think I'll go back actually and start out with Dr. DeConis so what innovations and care delivery have you have been kind of been revealed or highlighted during COVID-19 that you think will then be applied going forward so there's some learnings that take place with COVID-19 and what's what are some of the maybe the positive aspects of that that are going to change the way we provide care not just for COVID patients but for all the populations going forward yeah so so something quick might be the dermatology consultations so pre-pandemic we were already working out workflows about how do we do video visits using pictures you know as the iPhone and other devices get better and better cameras on them how might we improve the accessibility to dermatology so so pre-pandemic we had a workflow where you would see your primary care doc or somebody in primary care and you might have a worrisome thing of concern and in the moment our primary care docs with you can take a picture put it on the electronic health record have it reviewed by dermatologists but really as with the shelter in place where we are at now is a patient can take a picture it gets sent to a pool and from that there's a review and it goes directly to the dermatologist so so it's made it much more seamless and certainly quicker to to get that consultation with with dermatology and and you said earlier in my introduction that Northwest Permanente is a B core so one of the things that we work on is how do we how do we get to a climate friendly practice and so these telehealth visits really you know we're it's reducing our green health gas emissions and our footprint right because you're not driving around going from clinic to your work or to home it's really you can from where you're at you can do the video visits and so so that's one way to connect it the other big thing is that I'm not sure you're aware when you have a patient with complex cancer diagnosis just to give you a real example we had a patient with cancer of the what we thought was pancreas and and this is pre-pandemic so this is what integrated care looks like so pre-pandemic cancer of the pancreas because we're all on electronic health the same electronic health record because we're one medical group the the oncologist sends the the note to the cancer surgeon cancer surgeon looks at the images yeah it could be this it it's suspicious for that and they look at the other scans and then we discover in the patient that he also could have an additional cancer of the the bladder so so we can have all of these interactions behind the scenes as one medical group and then come back with a proposal to the patient on the treatment plan but back in the day those same cancer surgeons and oncologists would also be in a room and do what we call a tumor board TUMOR so tumor board and discuss complex cases so much like what I just described and what with the the video meeting the teams meetings you know everything is in front of a video conference so so we now have tumor boards between our cancer surgeons our oncologists hematologists in a quicker fashion not you know people doctors are not traveling to to go to the conference and so again it's it's freeing up time to not only see patients instead of driving around but also get into a quicker care conference about these complex patients so those are just kind of a I guess the spectrum yeah that's that's helpful to see and to understand how it works on the dermatology and and the tumor boards you know one of the questions that they came in they had to do with um once we get a vaccination so how do you see and this would be for the physicians you know how do you see the community in KP dispensing and prioritizing once we have a vaccine so as imagine it won't be available for everyone right away it's going to take some production time so so what's your early thinking on how that might play out yeah so there's already a playbook so you know prior to the disbanding of the pandemic team at the federal level there have been 15 plus years of planning for a pandemic believe it or not so so there's already a playbook of how do you distribute vaccines in a pandemic um and and so we would we would use that playbook and coordinate the work with the CDC with the state authorities and public health and exactly what you said is is triage it this is we're very good at this in health care is you know what are the priority people that we need to vaccinate like health care workers uh and then the most vulnerable so there's already a playbook um and then a distribution plan for for the country uh if and when the vaccines um come out and as you can imagine uh the complexity of logistics and operations it'll take months it'll take months so it's not just you know okay we have a vaccine it's ready to go and unvaccinated next day right so is that is that something that we work in terms of the community so with the other health care providers because I would guess there's kind of a supply so whether that you know all of all of those health care providers province legacy you know um and others yeah how does that happen yeah there would be coordination of efforts right because again let's identify who are the tier one or who are the priority people we need to vaccinate and then it's a matter of working the logistics between the health care systems and the systems that would be providing the vaccine uh and what I'm really proud of as an Oregonian is that in Oregon our health systems are um we're very collaborative we're very close knit so at the very beginning of the surge for example you know our CMOs uh you know both from Northwest Permanente from OHSU, Providence, Legacy, Peace Health you know it was really talking about sharing best practices and collaborating and and um because this is you know uh doctors we're used to it's all about teamwork right so so it's so nice to see and and as I know the operates in other states it's not like that in other states I it's not like that in other states and so we are I am so proud that that our community is that um purpose driven and and uh community centric and person centric yeah that's uh that's good to hear that the real strength of the community is that collaboration because that's one we need at the most exactly so uh Dr. Bachman you do go out and meet with a number of our groups um and well now it might not be going out and meeting with them but meeting with them virtually I've got to change my vocabulary as well so these are virtual meetings but kind of wonder a couple of the uh common questions that you're fielding from them that might be helpful for everyone calling in today and and what's your advice on that just wanted to kind of pick your brain on what you're hearing and what the concerns are and that advice yeah it's certainly the one thing that's really top of mind and hasn't gone away is how do we how do I as an employer keep my employees safe um when somebody thinks they may have COVID when somebody has COVID uh when somebody has a health condition that may make getting COVID higher risk and how to work through those issues in a fair compliant uh HR appropriate way we do have support for that we do have a series of templated letters that all the all the physicians and the providers have access to and then we are also able to field calls from HR directors and employer group leads uh related to those it is complicated there are some great algorithms in the in the playbook uh that Jennifer mentioned that can be super helpful uh there's great information on the CDC website but there's also scenarios where you we all look at it and puzzle through it and try to figure out what the best thing to do is so I just want to normalize if it gets confusing it's not clear what to do that's a pretty normal response and we're there to help support that um that's probably the first question and the second question is really about the emotional wellness and trying to rethink um uh worksite wellness and employer-based programs that help keep people healthy in the context of stress and the emotional demands of uh dealing with COVID uh homeschooling uh and just didn't increasingly uh frighten anxiety-provoking environment that we're living in I think we went through kind of the response to that uh whether it's checking in with people uh recognizing the social aspects of worth that need to be changed now uh and then uh really good mentoring okay thank you yeah uh Jennifer uh questions for you so uh will Kaiser Permanente provide on-site blue clinics so sometimes we've done this for large employers yes so we have and we will continue to um but what we really are advising is for employers to let their employees know when the flu clinics for their health plan partners are so as we talked about you know clinics are safe but we have made a lot of changes to make sure that we reduce the number of people in them and we uh prevent exposure so part of this is that we have we are standing up walk up and drive in uh flu clinics and they start this Saturday and they run through the month they've got you know convenient hours so we have them in the different areas to cover all over through our service area and so people can really come through with their families get those uh flu shots they can also if they have an appointment in a clinic they can get it with the doctor um but really those drive through and walk up clinics i think are going to be the most efficient and the least expensive way for employers to make sure that we raise the percentage of the population that has the flu vaccine this year yeah i'd say it is a kind of a classic example if you will about how we're trying to fulfill our mission of being convenient accessible and affordable clearly we can't do flu shots at you know four to five thousand employers and so what we can do is provide it through the facilities we have and encourage people to drive through there which we'll have this year or to stop in make an appointment or drop in and make those as safe as possible um and there are some cases where we will do that for the largest employers that have a concentration but it's on a pretty very limited basis um and we want to fully support that so i where should employers go to stay attuned and to get the latest so they want is they know where to send their employees their employees know where to go and they understand the safety precautions that are being taken uh to keep them healthy right so um you can always your account manager will always have the most recent information but probably the easiest way is to go to kp.org where we include information regarding how to get your flu shot the flu clinics that are occurring including those drive a drive through or walk up clinics um the hours so you can really put it in by where you live or where you work however you're trying to locate your services um kp.org and you'll be able to see the flu clinics those will be available at 63 or 64 hours a week it's pretty long hours six days a week eight to seven during the week so that's great up great hoping for great convenience yeah and and nine to five on Saturdays as well so yeah looking to make it even more convenient i think we will just continually assess that because we want a high vaccination rate as we possibly can so you know balanced on the demand um but also we want to make this uh the more convenient than any time in the past uh to get the uh the flu vaccine uh dr bachan i'll go to you oh go ahead melinda yeah i was just going to say that uh and then you know sometimes soon and and uh when we have the dates uh we're certainly share is that if you have the app uh the the app will have the upgraded capability of of geosensing so that um you will have based on where where you're located uh just a listing of the closest clinics uh flu clinics where you can get your flu vaccine hours of operation and such and miguel did add into the q and a so the the the function there the kp.org slash flu so you can go there as well so so that's that's available dr bachman wanted to turn to you a couple of questions on uh antibody testing so how effective is the covet antibody testing and related to that will kp be offering the 15 minute covet test so first the covet antibody test so that test is available and our members can request the antibody test at the lab that's the good news the bad news is we're not quite sure what it means um we when we see a positive antibody test we think somebody either has had covet or they may have had another coronavirus so it's not 100 specific for covet the other issue with is we don't know how long people are immune from covet so even if they have an antibody we don't know how long it's protective for and we think it's probably three months maybe more uh but we can't be certain about the yet so at the current time we really can't recommend making any changes in somebody's lifestyle behaviors work setting on the basis of a positive or negative covet antibody test so that's why we're not recommending it um uh it might be useful i mean the only places i've recommend had someone get it or to think about getting it is somebody had a covet like syndrome in january february early march for we had more testing available to see if they may have had it but it's really more just to fill in that piece of their life and to see why uh why they felt so bad it really doesn't have any clinical um usefulness we definitely would not recommend people going out without appropriate PPE if they're with the public we're going out without a mask or things like that so that's the antibody test uh the antigen test is a another test that looks for viral particles and it can be done with rapid turnaround time but again we're still not quite at the point where we're recommending that test where do we have the um supply chain or the the technology in place yet to provide the antigen test um so right now we really still think that the covet pcr uh RNA test is the best test to do which is done through a nasal swab okay uh here's what i thought was interesting do you think the social distancing will help with minimizing or reducing the impact of the flu season this year just all the precautions we're taking around covet i do absolutely i think the same the hand the hand washing the social distancing wearing masks to protect other people all those things are going to be i think helpful at preventing flu if you went back to that slide that we saw at the beginning the differences sort of virologically between uh flu and covet one difference is the super spreader events uh that are noted uh in covet so that those are thought more to relate to something that's going on where somebody's highly infectious uh or there's some sort of other kind of spread um and that's something that but really but everything else um there's really no differences in the way that it's spread and those same things that we would do to prevent covet should also help prevent influenza let's still get your flu shot so so yes yeah you know it's the quintuple aim so wash your hands physically distance mask and get your flu shot yeah take every precaution that you can it's just a big the big thing is so it's those indoor environments keep coming up in super spreading events people packed into a bar people packed impact into an event where they're singing or a religious event where people are singing uh or another kind of event where people are shouting indoors in closed spaces um so that's really something to to focus in on um the question came in um Dr. DeConis what's the impact of poor air quality and smoke exposure to COVID risk I would guess it just makes it worse but yeah no I mean so so worst-case scenario is you know I have asthma or emphysema and had to endure the the the poor air quality and then I was evacuated from my home so then I'm in this congregate setting of big groups in in a church or a high school gym or some of these places where our unfortunate families and people had to be evacuated to so so you take all those together and you know the risks are are additive uh because because as you heard me say the particulate matter in poor air quality harms our lungs and then you have the specter of COVID-19 and if you're in a in a group in that super spreader situation because you've been evacuated so so all of those things add up unfortunately for poor poor outcomes. Another question came in so if say there's an employer that has employees that's not they're not covered by KP or the maybe they don't have coverage um and anywhere so they're not meeting the work requirement is there a place that we steer them in the community that they might be able to get a flu shot or what kind of recommendation might we have there? Yeah I mean there are community resources. Yeah so there are community clinics um Keith that we can direct uh non AP members to you know however they might end up in our facility or um because they're community benefit partners that that we we help we give grants to all throughout Oregon for example that that we can direct them to for that. So I think what we'll do is we'll I'll work with uh with our team and we could put some of those resources and make those available uh it's kind of the follow-up here so um that people would have access to those community resources that's good question. And certainly because we're trying to get to that third. Pharmacists pharmacists in Oregon I'm not sure about Washington can do flu shots as well. Another question came in it's the Red Cross is doing antibody tests when people donate blood is there a way to get those results transferred into KP.org? The best the best individual would just be to scan that and then send that in as part of an email. Can scan it attach it and then send it to us it's not going to people are asking if we want their COVID results as well for swab tests it's again the antibody test isn't going to change management and a COVID swab test really doesn't tell us too much more than what was going on that day in the next few days that individuals health. So there's not a whole lot of value in that but I think if somebody does have a positive antibody test it'd be nice to let their physician know about that. Okay antibody testing is more regularly used in the pediatric population because there's a multi-inflammatory organ syndrome where using that plus the COVID test helped to make the diagnosis so in pediatrics there is utility in that in terms of this diagnosing this very rare syndrome. I would urge anyone who is interested in getting antibody testing is is really to participate in research studies right now the most useful for adults in terms of what to do with antibody testing is to participate in research studies. Red Cross is participating in one of those for example but as Dr. Bachman said it helps it doesn't help in any shape or form determining how you adjust PPE use or not in you know any of those things. So one nice thing in the port at least in the Portland metro area that Providence and OHSU and Adventist legacy are all electronically interconnected with their labs so somebody does have a positive COVID test in any of the systems we have access to it actually triggers all the same alerts and prompts and next steps in care that they would get if they had the test done through Kaiser Permanente. Okay, any closing comments? If not I'll wrap up I just wanted to see if there are any additional comments you had. Wash your hands and wear a mask. Physically distanced. Get your flu shot. Yeah yeah thank you again everyone for joining I mean I really appreciate these series if there are any comments or feedback about the content we cover any other future opportunities for other topics that we should be talking with you as employers, as brokers, as businesses, please you know totally open and continue to learn together. Thank you. Yeah I just just to echo and to build on that we see it as our part of our mission is to make businesses successful by having a healthy engaged and productive workforce and it's beyond just providing health insurance but it's connecting with providers, evidence-based medicine and being a positive force within our community and we take that very seriously and this is one way that we can do that so if there's other topic issues that you would like us to address please send those in we take those seriously and shape these to be as productive as possible. We part of this series is then we start out with the speaker series on equity inclusion and diversity and touched on that a little bit today in terms of the disproportionate effect that COVID has had on minority populations and it's not only that but how do we have a a care delivery system that reflects the values, the colors, the shapes, the beliefs of our community and that's something that we're working at. We have a long way to go but it's at the core of what we want to do and so we had a speaker series on that this one obviously we just had on COVID vaccines and the flu and then next will be on behavioral health, mental health and addiction related to the day but also much broader than than that. If you go to the the next slide I'd encourage you if you have a desire to learn more about Kaiser Permanente one of the ways that you can do that is through an experience KP, a VIP pass and it is a a tour if you will of our facilities and we do this virtually but more important than the facilities which are interesting in and of themselves but also it's the interaction with the clinicians to understand how they're practicing medicine and using evidence and also being very patient and customer centric so I encourage you to do that contact your account manager and they can help to schedule that it's a valuable opportunity so in closing again I want to thank you for your time your engagement we will for those we weren't able to answer questions we will follow up with those and I'd also say if you need anything don't hesitate to reach out to your account manager they can be very helpful and helping navigate and that's what they're there for so they're willing able to assist you thank you again for your time and for your help in keeping a healthy northwest and we certainly appreciate that and thanks again to Jennifer, Dr. Bachman, Dr. DeConis I wish you all the very best today be well and thrive thank you