Practice English Speaking&Listening with: Understanding the Impact of Telehealth Usage During COVID-19

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>> Afternoon, everyone.

My name is Nora Spencer Loveall, and I'd like to welcome you today

to today's CDC partner update call on COVID 19.

This call serves as a way for CDC to share weekly updates on COVID 19

and our latest resources and guidance, and to answer questions submitted by our participants.

On today's call, we'll be discussing telehealth usage during the COVID 19 pandemic.

First, we'll hear from one of our science officers on CDC's COVID 19 emergency response.

We'll describe where we are in the response and give us insight into recent scientific findings.

Then we'll hear from the implementation and telehealth unit on the emergency response

for CDC as part of the healthcare systems and worker safety unit.

We'll share the impact of telehealth usage during the pandemic.

Afterward, our speakers will answer questions we received over the last week via e mail.

If you experience technical difficulties or otherwise would like to review today's call,

you can find the recording on, and on YouTube in eight to ten days.

All past partner calls can be found there, so please take some time

to review and share as you see fit.

If this is your first webinar with us, welcome.

These calls generally occur every Monday at 3:00 p.m. eastern standard time.

Please see the link on the slide to subscribe and receive future call invitations.

Please note that this call is not intended for media, although we welcome you who may be here.

Should you be a reporter and have questions, we invite you to reach out to

Also, we'll have two short polls; one now and another at the end of the presentation

to get feedback about the effectiveness of these calls.

Please feel free to answer as we get started and then again before we start the Q&A section.

As I noted, these calls are designed to share the latest science,

guidance, and resources from CDC.

CDC has issued over 2,000 resources and guidance materials for individuals, businesses,

and the public on our website,

Here are some highlights on just a few of our recent web editions.

First, we'd like to draw your attention

to a recent CDC webpage outlining COVID 19 vaccinations in the United States.

This webpage features COVID 19 vaccines delivered

and administered with maps, charts, and data.

On a similar note, CDC has provided guidance on how to prepare for your COVID 19 vaccination

as many states begin to open up eligibility for all adults.

This guidance features the different vaccines that are available and how they work.

Even if your state hasn't opened up eligibility yet, it's a good time to start planning now.

Take some time to see the many resources available.

And check out vaccine finder for your vaccine eligibility and availability near you.

Finally, CDC has released SARS CoV 2 variant classifications and definitions.

Genetic variance of SARS CoV 2 have been emergent, emerging, excuse me,

and circulating around the world throughout the COVID 19 pandemic.

Viral mutations and variants in the United States are routinely monitored

through sequence based surveillance, laboratory studies, and epidemiological investigations.

CDC and other U.S. government partners developed a variant classification scheme

that defines three classes of SARS CoV 2 variants; variants of interest,

variants of concern, and variant of high consequence.

This update shows there are no variants classified as variants of high consequence,

showing clear evidence that prevention measures

or medical countermeasures have significantly reduced effectiveness,

such as vaccine's effectiveness.

Well, today, I'm so pleased to be joined by two CDC experts,

excuse me, more than two, four CDC experts.

Dr. Kyle Bernstein is a science officer serving in support of the chief medical officer

on the CDC's COVID 19 emergency response.

Dr. Hanna Demeke is a clinical, is a clinician for the Core Clinical Unit on the response.

Dr. Param Sandhu is the Implementation

and Telehealth Unit Lead on the COVID emergency response.

And Dr. Antonio Neri is the telehealth lead on the emergency response.

First, I'm going to turn it over to Dr. Bernstein for some general updates.

>> Thank you, Nora, and welcome to everyone joining us today.

My name is Dr. Kyle Bernstein, and as mentioned, I'm a science officer serving in support

of the chief medical officer for the response.

Today, I'd like to provide a brief update on the response and review some

of the latest scientific developments.

First, a situational update.

You can see from the slide that national COVID 19 cases and deaths have both decreased slightly

over the past week as compared to the previous week.

As of March 27th, the seven day average in cases increased by 10.7%

over the previous seven day average.

The seven day average in deaths decreased by 2.6% over the previous seven day average.

These slight increases in cases and decreases

in deaths follow a downward trend of reported COVID 19 deaths.

These statistics provide us with valuable information.

When these percentages are decreasing, this tells us that mitigation efforts are working.

When case counts increase, this tells us that we need to step

up mitigation efforts to slow the spread of COVID 19.

As of March 28th, 143.5 million vaccine doses have been administrated in the United States.

About 93.6 million people, or approximately 28.2% of the total U.S. population,

has received at least one COVID 19 vaccine dose,

and 15.5% of the U.S. population is fully vaccinated.

It's also important to note that there are continued evidence that some racial

and ethnic minority groups, particularly black or African American, Hispanic or Latino,

and American Indian or Native Alaskan people are disproportionately affected by COVID 19.

Inequities in the social determinants of seventh, such as poverty,

access to culturally appropriate information, working conditions,

and quality healthcare influence a wide range of health and quality of life outcomes and risks.

We encourage you to visit CDC's data tracker and the new weekly review for the latest stats

and key indicators for the pandemic.

New this week, I want to share some of what we've learned from a couple reports released

in CDC's morbidity and mortality weekly report, or MMWR.

In the interest of time, I will briefly touch on the high points of these reports.

But I encourage you to visit to read the full reports.

The first MMWR we'd like to highlight is on the effectiveness

of the Pfizer BioNTech COVID 19 vaccine among residents

of two skilled nursing facilities experiencing COVID 19 outbreaks.

During COVID 19 outbreaks in two skilled nurses facilities, the Connecticut Department

of Public Health, in partnership with CDC, assess the effectiveness

of the Pfizer BioNTech COVID 19 vaccine, which is given as a series

of two doses separated by 21 days.

This investigation assessed vaccine effectiveness among residents who were defined

as partially vaccinated in the investigation, which means they received one dose

of the vaccine or two doses of the vaccine less than seven days after that second dose.

Investigators found that partial vaccination had an estimated effectiveness of 63%

against infection among facility residents, which is comparable

to other first dose vaccine efficacy and effectiveness estimates for the same vaccine

in the broader adult population outside of congregate living settings.

The findings also suggest that complete two dose vaccination can play an important role

in preventing COVID 19 in this population at increased risk for severe illness.

Long term care facilities, which include skilled nursing facilities, and jurisdictions,

should actively ensure that they have plans in place for continued allocation

and administration of COVID 19 vaccines

for skilled nursing facility residents and staff members.

Second, we'd like to highlight an MMWR entitled counties with high COVID 19 incidence

and relatively large racial and ethnic minority populations.

Longstanding systemic health and social inequities have placed many racial

and ethnic minority groups at increased risk for COVID 19.

Using data from all 50 states and the District of Columbia, CDC identified counties

where five racial and ethnic minority groups might have experienced high COVID 19 impact

between April 1st and December 22nd, 2020.

These counties had high rates of COVID 19, and percentages of people in the five racial

and ethnic groups were larger than the national percentages.

This report highlights how the relative impact of COVID 19 among racial

and ethnic minority groups might have changed throughout the U.S. pandemic.

Public health efforts, including vaccination administration, as well as prevention measures,

including correct and consistent mask use, handwashing, physical distancing,

avoiding crowds, and limiting non essential travel, can be tailored to the needs

of communities of color that may be experiencing high COVID 19 impact and can be integrated

with community plans to improve health equity.

Third, we'd like to share an MMWR on COVID 19 entitled primary

and secondary school settings during the first semester of school reopening in Florida.

Although COVID 19 can and does occur in school settings, this study indicates

that schools can reopen without resulting

in rapid disease spread among students in K through 12 school settings.

To assess the occurrence of COVID 19 in Florida schools following reopening

of in person instruction, CDC and the Florida Department

of Health reviewed school related cases

and outbreaks during August through December of 2020.

Fewer than 1% of registered students were identified as having school related COVID 19

and fewer than 11% of K through 12 schools reported outbreaks.

Lower rates among students were observed in larger districts,

districts with mandatory mask use policies, and those with a higher proportion

of students participating in remote learning.

Successful school reopening depends on controlling community transmission and adhering

to prevention measures in schools, particularly masking, physical distancing, testing,

and increasing room air ventilation.

The last MMWR we'd like to highlight is on symptoms of anxiety or depressive disorder

and use of mental healthcare among adults during the COVID 19 pandemic.

Between August, 2020 through February, 2021, the percentage of adults reporting symptoms

of anxiety or depressive disorders and reported unmet health, mental health needs,

including needing care but not receiving it, increased.

Previous large scale outbreaks have been associated

with mental health problems, such as fear and grief.

The Census Bureau conducted an online survey to monitor the impacts of COVID 19 pandemic

on households, and CDC partners with them to monitor changes

in mental health and access to care.

The percentage of adults with symptoms of an anxiety or depressive disorder

in the last seven days increased from 36% to 42%.

And those reporting an unmet mental healthcare need

in the last four weeks increased from 9% to 12%.

The largest increases were seen in adults aged 18 to 29,

and in people with less than a high school education.

CDC, How Right Now Campaign, and SAMHSA have resources

to address increased mental health risks associated with COVID 19.

With that, it's now pleasure to hand over the call to my esteemed colleagues

in the implementation and telehealth unit.

>> Thank you, Dr. Bernstein.

My name is Dr. Antonio Neri.

And I am joined here by colleagues Dr. Sandhu and Dr. Demeke

who were presenting subsequent sections of this.

First of all, we'd like to thank you for this opportunity to present today to Justin, Nora,

and all the other staff involved in putting this together.

Secondly, this work is the result of many staff who put in long hours at CDC, as well as state,

tribal, and territorial health departments.

And we wish to recognize them.

Thirdly, we wish to recognize these efforts and sacrifices of the many public health

and healthcare workers who have participated in addressing this pandemic,

and very much appreciate both theirs and their families' sacrifices in trying to do so.

Lastly, we'd like to thank you, the audience, for taking time to listen to our presentation

and participate in the discussion.

Next slide, please.

Next, we will define telehealth and what it is and how it is practiced.

Next slide.

The fundamental aspects in telehealth, in telemedicine provision, is that you as a patient

and you as a provider are not in the same location, or possibly not at the same time.

We will see in subsequent slides how the contribution of telehealth allows you

to expand access to the care continuum, to incorporate wellness,

but also contributes throughout the entire care continuum from disease prevention

to disease control and management.

Next slide, please.

These are the common approaches to provide telehealth.

They are decided upon by a number of federal, public, private, and academic agencies.

First note that the real time, or synchronous activities, involve things that you probably do

on a regular basis, whether you call people, you're talking and video chat,

you're talking with them, you're texting back and forth with them, those are real time

or synchronous activities for telehealth delivery.

When you're not in the same time, those are called asynchronous activities.

Some examples of that are e mails or voice mails

or have recorded videos that you exchange with people.

You can also send pictures.

And certainly with teledermatology, you can send pictures of dermatologic conditions.

A dermatologist can evaluate those and send back their diagnosis or potential diagnosis.

Remote patient monitoring is a third level of telehealth methods.

Here is where the healthcare provider can see or watch the patient's signs and symptoms

to monitor them from a remote location.

That can involve visual observation.

It can involve monitoring blood glucose monitors,

blood pressure, heart rate, or stethoscopes.

And that can occur from just outside an emergency room door

to help evaluate patients before they enter that waiting room to across the world

where care can be provided from a very remote location,

as long as there's appropriate monitoring equipment there.

Lastly, we include automated or semi automated approaches to telehealth methods.

There is debate within the telehealth and telemedicine world

as to whether these should be included in telehealth methods.

But I wanted to point out that these are applications or bots that are used by public,

private, and academic agencies to provide healthcare guidance.

Later in this presentation, we will see examples of this from CDC's symptom checker

or resafe [phonetic], both of which have been used extensively during the pandemic.

The semi automated components of this activity can also lead

to interaction with a human down the stream.

So, say your symptoms indicate a higher degree of need to interact with a care provider.

Then these semi automated systems can eventually lead you to communication with a care provider,

and further escalation of the intensity of which you have the interaction with the care provider.

Next slide, please.

CDC, as a public health agency, has key roles that are focused on assessment,

assurance, and policy development.

Telehealth affects the population's health through the following activities.

So, in terms of health equity, there's been a lot of discussion about health equity.

And you can see from the prior MMWRs that Dr. Bernstein mentioned,

the agency puts considerable time and effort into understanding what the issues are

and trying to address health equity across the spectrum of person, place, and time.

In terms of telehealth, telehealth likely and most certainly does impact healthcare access

and equity, but it may have times improved access inequity or addressed inequities,

but it also could make things worse and exacerbate existing inequities.

That is not entirely clear at this point, and CDC is working to try to understand that.

Secondly, telehealth has the possibility in application of preventing disease,

but also controlling it through improved monitoring, better triage to reduce spread

of infectious disease, more frequent monitoring,

and ideally better control of long term health conditions.

Telehealth would likely increase the volume and sources of data that CDC works

with its partners to understand and report out on.

And that will be a public health and population health issue.

Resource usage is another way in which telehealth affects population health.

Both in the conservation or potential conservation of personal protective equipment

by not having have providers in the room with a patient and use up scarce quantities

of personal protective equipment.

But also in being able to leverage the skills of providers that would otherwise be unavailable

through a distance geographically or those who are at risk for disease who cannot see patients

in person, but can readily see them in the comfort and safety of their own locations.

And lastly, telehealth improves or addresses population health

by affecting the quality of healthcare that is provided.

And CDC works hard to understand how healthcare is provided,

and ensuring that there is a quality of care provided to that patient.

Next slide, please.

This slide encompasses the factors that involve telehealth usage.

You can see on the left side are the patients.

On the right side are the providers.

And in the middle are factors that affect both patients and providers.

You can see that all providers and patients are affected

by whether they have equipment available, whether they have the technological skills,

and whether they have access to the internet.

And particularly broadband internet, which is between [inaudible] a social

or super social determinant of health, something that affects not only a person's health,

but affects their education, their employment, a number of other things.

You can see on the right side, the providers are affected by payments,

and whether they receive payment, and whether that payment is in parity or it is equal

to that amount which you should see for an in patient, in person visit,

affects whether providers are using telehealth.

It also affects whether providers use telehealth as to the disease or condition being treated.

And in addition to their clinical expertise.

Providers, especially in the recent increase in telehealth usage, are working on trying

to address and make sure that the care that they're providing is within the scope

and comfort range of their care's capabilities.

Similarly, patients struggle with the same issues of having insurance

that will support telehealth usage, the cost to provide therein, and the trust in patients,

in providers that provide that telehealth care.

You can see in the purple boxes highlight the three key factors that preliminarily CDC

and a number of other organizations believes affects whether people choose

to use or not use telehealth.

Next slide, please.

So, telehealth has a long history from the time

of the telegraph all the way to the current [inaudible].

But there are three factors that increase the usage of telehealth.

And we'll see the market increase in telehealth in subsequent slides.

But first of all, we wanted to note that the increased need

for telehealth was driven, in part, by stay at home owners.

Patients had to stay at home because of laws or policies

that required them to do so during the pandemic.

Secondly, changes in medical licensure, particularly the ability of providers,

healthcare providers, to see patients across state lines or in different geographic regions,

provided increased access to providers for people who had not otherwise been able

to see patients because of their limitations and their state medical licensure.

And finally, one of the key drivers, which is noted here on this slide, and notice the date,

March 17th of 2020, is a change by the Centers for Medicaid

and Medicare services towards what is called an 1135 waiver, which provided that care providers

who are seeing Medicare patients would be reimbursed at approximately the same rate

for telehealth visits as they would per in person visits.

And this was a key factor that drove, in addition to the other two,

that drove usage from amongst the Medicare populations, with a very quick following

of private insurers along these same policies to allow parity or equal pay

or approximate equal pay for a Medicare visit or an insurance visit for in person

versus an insured visit for those people who will only be seen through telehealth.

Next slide, please.

I will now pass the baton to my colleagues

to finish those two subsequent parts of the presentation.

>> Thank you, Dr. Neri.

Hi, everyone.

My name is Hanna Demeke, and I am pleased to present [inaudible] trends

in telehealth usage during the COVID pandemic.

Next slide, please.

So, the next three slides present data on Medicare claims filed between January and June,

2020, and how Medicare telehealth usage increased rapidly in the same year.

Just to orient you to describe the bottom of the graphics indicates the first day

of the week being reported, while the vertical line indicates the number

of Medicare claims in millions for each week.

Gray line indicates in person and [inaudible] care visits.

And the blue line indicates telehealth visits.

Next slide.

Next slide.

The COVID pandemic resulted in an approximately 60% reduction of in person

and [inaudible] care visits for Medicare patients

as indicated by the green, the gray line.

Next. During this same time, telehealth visits came to account for approximately 50%

of all Medicare visits by mid April 2020.

This means that approximately 1.7 million cumulative weekly fee for services claims

for telehealth, which is a market contrast from a long trend of nearly zero visits

from before February, 2020, as you can see.

Next slide.

Now, let's see the percent change of in person visits among a large group

of outpatient U.S. providers.

This graph is a summary of percent of change and then percent

of [inaudible] care visits abstracted from data obtained from 50,000 outpatient care providers

in the U.S. for the entirety of the year 2020.

The week number is depicted on the bottom of the graphic with zero indicating the start of 2020

and the percent change in the, on the vertical line.

All percent change are in relation to the number of visits for in person

and [inaudible] care visits on Week 10 of 2020.

This is the first week of March, 2020.

The yellow line indicates the change in person and [inaudible] care visits for an average

of weekly visit between 2016 to 2019 in comparison to the number of visits

that occurred the first week of March, 2020.

The gray line indicates the percent change in a person visits in 2020, again,

using Week 10, 2020 as a comparison.

Finally, the blue line indicates the percentage of all visit that occurred by telehealth.

Next slide.

The gray line indicates that in person and [inaudible] care visit declined 58%

in comparison to in person and [inaudible] care visits the first week of March.

This decline was coupled with 12% increase in telehealth visits as a percentage

of all visits indicated by the blue line by the 16th week of the year.

Note that this data indicates a similar trend to that shown in the data for Medicare

and [inaudible] care visits claim presented on the previous slide.

Next. Now, I would like to bring your attention to one of our morbidity

and mortality weekly reports that looked at the percent change

in telehealth visits among four telehealth providers the first three months

of 2020, January to March.

This figure published in MMWR showed a similar trend using data

from four large telehealth providers.

Note that the bottom of the graphic indicates the surveillance week being reported was the

first week of 2020 as number one.

The vertical line then indicates the number of patient encounters provided via telehealth.

The solid black line indicates telehealth visits.

And the dashed black line indicates emergency department visits.

The light blue bar shows telehealth encounter in 2019,

while the darker blue bar shows telehealth encounter in 2020.

The arrow shows, the arrows indicates sentinel events,

such as change to the CMS reimbursement policy and congressional actions as they were known

at the time of publication, and that was presented earlier by my colleague, Dr. Neri.

So, this data indicates 154% increase in telehealth visits during the last week of March,

2020, compared with the same period in 2019.

Again, this finding shows a similar trend reported in a previous slide

with a rapid increase in telehealth visits right

after the same telehealth waivers went into effect in March, 2020.

Next slide.

Now, let me summarize findings from two MMWR, my colleagues and I reported on telehealth trained

by regions in [inaudible] in the United States.

Using weekly health center COVID 19 survey,

we assessed telehealth usage trends among health centers funded by the Health Resources

and Services Administration, also known as HRSA, in the United States.

And we looked up by regions in [inaudible] city.

In early 2020 and continuing up to now,

HRSA has administered a voluntarily weekly health center COVID 19 survey

to track health centers COVID 19 testing capacity and the impact of COVID

on its operations, patients, and staff.

CDC partnered with HRSA to develop and publish two of these reports in CDC MMWR

that can be accessed through the links at the bottom of the slide.

So, the key findings from these two reports were in July, 2020,

greater than 95% of the health centers provided telehealth services.

This was more than twice the number of health centers that reported being capable

of providing telehealth just the year before in 2019,

which was 43% of the health centers reported capacity.

However, in July, it was more than 95% that reported providing the service via telehealth.

Health centers in the south, census regions and rural areas,

reported the lowest average percentage of weekly telehealth visits compared

with the health centers in other census regions and urban areas.

In addition, telehealth visit to these sites decreased as the number

of new COVID 19 cases decreased, as you can imagine, but then stayed constant

as the number of cases increased.

This is through the second MMWR that we looked at that trends over time.

And, again, you can access those reports through the link in the, in this site.

With that now, it's now my pleasure to hand the call over to my colleague to Dr. Sandhu.

>> Thanks, Hanna.

Good afternoon, everyone.

My name is Dr. Paramjit Sandhu, and currently serving as implementation

and telehealth activities lead on the response.

In the next few slides, I will be highlighting some of the CDC's efforts to promote

and optimize the use of telehealth services, including collaborations with other federal

and non federal [inaudible], and the development of various COVID 19 resources

and telehealth tools for clinicians and telehealth providers that provide guidance

on telehealth policies, practices, and protocols for using telehealth services.

Next slide, please.

So, most recently, CDC has been heavily engaged with key health, telehealth, federal,

and non federal partners to monitor the trends and impact

of telehealth since the start of the pandemic.

We have used these partnerships to inform our guidance

and disseminate information we are conducting and [inaudible] in webinars.

For example, participation in clinical outreach and community activity calls,

and by publishing articles, highlighting the telehealth landscape

over the course of the pandemic.

These are some of the key federal partners, including Department of Defense,

substance abuse, and Mental Health Services Administration, Centers for Medicare

and Medicaid Services, Health Resources and Services Administration,

that we have been closely collaborating with to promote and support telehealth utilization.

In addition, CDC also collaborate with number of other professional organizations,

including the American Telemedicine Association, environmental medical organizations,

such as American Hospital Association,

to determine how to best integrate telehealth into the practice of medicine.

Next slide, please.

Now I will share information on some of the main CDC's COVID 19 resources and telehealth tools

that have been developed for clinicians and telehealth providers.

Most of these tools fall under the automated,

semi automated telehealth modalities, as Dr. Neri described earlier.

The first one is Corona self checker, Coronavirus self checker.

It is an interactive clinical assessment tool that assist individuals aging 13 and older

and parents and caregivers of children age 2 to 12 on deciding when to seek testing

or medical care if they suspect they or someone they know has contracting COVID 19 or has come

into close contact with someone who has COVID 19.

This online mobile friendly tool asks a series of questions.

And based on users' responses, provides recommended actions and resources.

This self checker was launched on March 23rd last year

and was the first COVID 19 symptom screener deployed by U.S. government.

The tool is available in multiple languages, including English,

Spanish, Chinese, Korean, and Vietnamese.

As of March 21 of this year, there has been 43 million visitors from worldwide.

Next slide, please.

Text illness monitoring is another tool also known as TIM.

This is a text messaging platform that helps monitor symptoms

on daily basis during the infectious disease outbreak.

Public health officials have traditionally done symptom monitoring via telephone calls,

which can be time consuming process, and also require intensive resources.

Whereas TIM allows a two way SMS text messaging to help public health organizations

to quickly identify [inaudible] symptoms.

TIM can be used to monitor an organization's workforce or other specified populations,

such as context of an identified case.

Also to add, this tool is available at no cost.

And at this time is primarily intended for public health organizations at federal, state,

tribal, local, and territory levels.

Between May 11th, 2020 and March 4th, 2021, the team system has monitored the health

of more than 146,000 staff members.

Next slide, please.

V safe is another smartphone based tool used

for the health check ins after the COVID 19 vaccination.

Through V safe, participants can quickly tell CDC if they have any side effects

after getting COVID 19 vaccine via text message or by web service.

Depending on the answers, someone from CDC follow up to get more information if needed.

V safe also reminds participants to get their second COVID 19 vaccine dose

if they require one.

We encourage everyone to receive a vaccine to participate in V safe.

All you need to register is you need a smartphone.

You can talk to your vaccine provider about enrolling when you get your vaccine,

or you can visit CDC's website for more information.

As of March 16th, 2021, more than 5.6 million users have used V safe,

including over 52,000 users who identified themselves as pregnant.

Next slide, please.

Similarly, vaxText is a free text messaging platform for vaccine recipients.

Vaccine recipients can opt in to conveniently receive text message reminders

to get their second dose of COVID 19 vaccine.

In addition, vaxText offers the added benefit of reminding the CPNs to sign up for V safe.

Next slide, please.

As I mentioned earlier, CDC has developed a number of resources

to support healthcare providers and healthcare systems with the most up to date information.

On this slide, you can find some of the guidance resources,

including the COVID 19 vaccination communication toolkit.

This toolkit provides guidance designed to educate healthcare teams,

as well as tools needed for providers to educate patients.

CDC also has support lines and resources for healthcare workers' questions

and [inaudible] directly submitted to clinician on quality center,

or electronically via the CDC info submission, submission page.

Then there is a guidance for confidence consults,

the vaccine confidence experts use this tool very frequently.

These consults are designed to provide technical assistance,

specifically to public health professionals to help build vaccine confidence

and promote COVID 19 vaccine acceptance in their jurisdictions.

To request a 60 minute consult with a vaccine confidence expert,

state and local jurisdictions can send an e mail to

So, with this now, I will hand it over to Nora Spencer.

>> Thank you so much, Dr. Bernstein, Dr. Demeke, Dr. Sandhu, and Dr. Neri,

for those excellent presentations.

I know I look forward daily to my TIMs checks and regular V safe alerts.

Before we move onto the Q&A portion of the call, please take a moment

to answer the questions through the poll on your screen.

Now, for those of you who submitted questions in advance of this call, thank you so much.

As usual, we received many, many questions, and we'll try to answer as many as we can today.

So, first, I'm going to turn it to our presenters, Dr. Demeke, Dr. Sandhu,

and Dr. Neri, if you wouldn't mind answering the following.

First is easy.

Where can I access more information about the COVID 19 surveys and health centers?

>> That's a great question.

This is Hanna Demeke, and I will answer that.

The health center program has a dashboard that provides [inaudible] information,

which includes the survey questions,

the guide and the national summary report updated on a regular basis.

To access that dashboard, I am just seeing that it is seen through the chat,

so use that link to access the dashboard.

If you do not have that link or you are somewhere and you just need it,

you have to use the

BPHC as in Bureau of Primary Health Care.

When you do that, you see the COVID health center survey data as one tab,

and you click there and it will take you to the full page.

And, again, you will get a ton of information in that dashboard,

and also the summary of reporters.


>> Thank you, Dr. Demeke.

Let's see, Dr. Neri, could you tell us a little bit more about what CDC is doing

to increase our understanding of the current use of telehealth in the U.S.?

>> Thank you so much, Nora.

So, CDC, in our usual activities, partners with public, private, and academic organizations

to better understand how telehealth is impacting population health.

We have hosted a series of four clinician, clinician outreach

and communication activity goals, COCAs, that are largely focused

on telehealth and equity, health equity.

We have published three morbidity and mortality weekly reports.

We've hosted at least five webinars with private and public, private, and academic partners

to better understand the impact of telehealth on population health.

And we continue to partner on a routine basis with public, private, and academic sectors

to better understand the impact of telehealth

and disseminate promising practices related to it.

Finally, we've also worked with our National Center for Health Statistics,

who's working to incorporate telehealth questions into a majority

of its national surveys that are focused on health.

That's a lot.

But that's, that's our, that's our start.

>> It is a lot.

Thank you.

And we'll stay with you, Dr. Neri.

Can you tell us a little bit more about what the main issue, main issues are,

the main factors that increase adoption for telehealth use?

>> Certainly.

So, I think the key factors, we talked a little bit about in the presentation,

but really internet access becomes a very crucial factor.

In particular, that of broadband access.

And furthermore, in rural locations.

Because not only does broadband or internet access provide access to healthcare data,

which healthcare, to healthcare provision, but it also offers a wide range of opportunities

that affect one's social determinants of health.

Reimbursement for care provided via telehealth is another major factor and barrier.

Prior to the pandemic, less than 1% of Medicare, of Medicaid, I'm sorry,

Medicare reinsures reimbursed visits were via telehealth,

and it's because there was not the same degree of reimbursement for Medicare telehealth visits

versus those who were in person care.

And then subsequently, private insurers also did not pay telehealth visits at all,

or in some ways, at the same level as you would for a telehealth,

for an in person visit, versus a telehealth web visit.

The Centers for Medicaid and Medicare Services current waiver is in place through the end

of the public health emergency, and it continues to work with public and private partners

to understand what solutions it can provide to improve the health of the population,

as well as address healthcare equities and access.

While the government has provided opportunities in long term solutions to these issues,

there's an ongoing evaluation and discussion about reimbursement, the economic impact

for telehealth, and the efficiency of telehealth care.

That's our start.

>> Thank you so much, Dr. Neri.

Okay, Dr. Sandhu, I'll turn to you.

Can you speak a little bit about telehealth approaches

to appropriately protect patient information?

>> Sure. Thank you so much, Nora.

And thanks for a great question.

So, as there are a variety of telehealth providers, we cannot answer definitely

for the entirety of the U.S. But [inaudible] major healthcare systems that have,

they have an obligation to protect patient information.

And also they have developed opportunities telehealth services

that do protect patient information.


>> Thank you.

And I'll stick with you, Dr. Sandhu.

Okay, we know V safe can be used on telephones, or smartphones, excuse me.

But can it be used on iPads?

>> V safe was created for mobile phones.

But, and it has not been usable on iPads in the past.

However, this is an ever evolving situation, so maybe in future it will be expanded

to include more platforms, including iPads.

So, we encourage you to check V safe website, or for more information and updates as it evolves.


>> Great. Thank you.

And finally, Dr. Demeke, could you please tell us more about the health centers

that were mentioned in the MMWRs published by your team?

>> Absolutely.

These are a collection of health centers and healthcare facilities funded and supported

by HRSA that focus on providing care to underserved patient population.

One example of a health center that is very well known is federally qualified health centers.

Sorry, for [inaudible].

Honestly, these health centers are, about 1,400 of them are known

to deliver community based patient direct,

patient directive services regardless of patient's ability to pay.

Often reaching the most vulnerable and underserved communities and population.

We provided a detailed context of what these health centers are and what they provide

in that MMWR report if you would check it out.

But really they reached out about 9% of the U.S. population,

among which one in [inaudible] residents, which is an excellent reach for our citizens.

Thank you.

>> Thank you so much to Dr. Demeke, Dr. Sandhu, and Dr. Neri.

All right, so the next set of questions are for you, Dr. Bernstein.

And the first one is about institutions of higher education.

So, what guidance is CDC providing for testing in institutions of higher education

for those who have been vaccinated?

>> Thanks for that question.

CDC doesn't currently have further testing guidance

for vaccinated persons in higher education.

However, we continue to recommend that any fully vaccinated person

who experiences symptoms consistent with COVID 19 should isolate themselves from others,

be clinically evaluated and tested.

Fully vaccinated people with no COVID like symptoms do not need to quarantine

or be tested following an exposure to someone with suspected or confirmed COVID 19

as their risk of infection is low.

We recommend that institutions of higher education continue following guidance

that has been previously provided on March 17th that was meant to help college

and university administrators protect their students, faculty, staff,

and adjacent communities to slow the spread of SARS CoV 2, the virus that causes COVID 19.

Institutions of higher education should implement an entry screening prior

to the beginning of each term,

and should implement a universal serial screening testing strategy in the context

of moderate, substantial, or high community transmission of SARS CoV 2

if sufficient testing capacity is available.

All COVID 19 prevention plans should be developed in consultation

with local public health authorities

and should include testing strategies and actions to support testing.

For example, isolation and quarantine.

In the context of substantial or high community transmission,

CDC recommends universal entry screening and expanded serial screening testing

at least twice weekly if sufficient testing capacity is available.

>> Great.

Thank you so much.

Okay, Dr. Bernstein, the next question is what does CDC define as a medium or large gathering

in which fully vaccinated people should avoid?

>> A recent guidance about large gatherings, CDC defines these gatherings as those

that are attended by staff, including folks such as waiters, ticket takers,

security, and other staff events.

For example, like a music concert or a professional football game or large wedding.

Small gatherings are defined as those that occur among peer participants.

All people, regardless of vaccination status, should adhere to current guidance

and consider avoiding medium or large sized in person gatherings,

and to follow any applicable local guidance restricting the size of gatherings.

If you choose to participate, fully vaccinated people should continue to adhere

to prevention measures that reduce spread.

And this includes wearing a well fitted mask, maintaining physical distance

from others, and washing hands frequently.

>> Great. Great to know.

Okay, next question, Dr. Bernstein.

Are some blood types less susceptible to contracting COVID?

>> So, yes.

What we know from various sources of research is that patients with blood types B

and AB are more likely to test positive for SARS CoV 2, as were those who were Rh-positive.

Patients with blood type O were less likely to test positive for SARS CoV 2.

However, blood type was not associated with risk of progression to severe COVID 19,

which required intubation or subsequently death.

This evidence supports that blood type is associated with susceptible

to SARS CoV 2 infection, although the strength of the association is small.

There's no evidence to suggest that blood type affects the illness severity

or outcomes from a SARS CoV 2 infection.

>> Thank you.

Okay, I believe this is the final question.

Dr. Bernstein, how effective are the vaccines since they were first approved?

Has vaccine effectiveness changed since the original vaccine trials?

>> So, all three FDA authorized vaccines are effective in preventing hospitalization

and death from COVID 19 and may be given to any person eligible to receive a COVID 19 vaccine.

The FDA carefully evaluated and analyzed the safety and effectiveness data for all

of the COVID 19 vaccines and determined that all of the available data for each

of the three vaccines provides clear evidence that the known

and potential benefits outweigh the known and potential risk for each vaccine's use.

Experts continue to conduct more studies about the effect of COVID 19 vaccination on severity

of illness from COVID 19, as well as its ability to keep people

from spreading the virus that causes COVID 19.

Although COVID 19 vaccines are effective at keeping you from getting sick,

scientists are still learning how well vaccines prevent you from spreading the virus

that causes COVID 19 to others even if you don't have symptoms.

Early data show the vaccines do help keep people with no symptoms from spreading COVID 19,

but we're learning more as more and more people get vaccinated.

We're also still learning how long COVID 19 vaccines protect people.

>> Thank you so much.

Thanks to Dr. Bernstein and also to all of our presenters; Dr. Demeke, Dr. Sandhu, Dr. Neri.

Are there any closing remarks or additional thoughts

that anyone wants to add before we close?

>> This is Dr. Neri.

No, thank you, Nora, I really appreciate all of you

and your staff's opportunity for us to present today.

>> Thank you.

It's our pleasure.

And thank you to you, everyone who's joined the call today.

Don't forget a recording will be posted online

on CDC's COVID 19 webpage and on YouTube in a few days.

There's a subscription link, excuse me, to receive future updates

and invitations is listed on the slide.

Enter your e mail and then search for COVID 19 Coronavirus partners.

Sidenote, we are about to publish a new website that will make all of this much easier.

So, we'll share that probably in our next call.

Speaking of our next call will take place on Monday, April 5th.

More details to come.

Until next time, stay safe, stay six feet apart, get a vaccine, wear a mask, and be well.

Thanks, everyone.

The Description of Understanding the Impact of Telehealth Usage During COVID-19