Business as Usual: AHN COVID-19 Update

 

Transcription: 

So good afternoon, everyone, it is Monday, and I believe it's the second week of December. I honestly can never remember I know that today is December 14, because the 15th is our pay day. So I'm pretty simple like that. I'm Audrey resaw, I run the Pittsburgh Technology Council, thrilled to be here very excited and timely on today's guests. We're going to get to them in a moment, I want to give a shout out to HSN for their partnership with us and in so many things, but in a moment, we will meet two individuals who really have the pulse on what's happening right now in our health care system here in across Southwestern Pennsylvania and further. So I want to give a shout out to Huntington bank thanking them for the work that they've done since the onset of COVID. And even before that they've been tremendous partners with the small business community. But they in particular, have been amazing partners in terms of the cares Act and the work that was being done to make sure that our businesses were thriving right at the onset of COVID. And to this day, there, I also want to give a shout out and appreciation for the underwriting from the Jewish health care foundation. And if you don't know anything about them, they have three distinct operating arms. One is called the Pittsburgh Regional Health Initiative. They have a health careers future, and the women's health activist movement global. So they actually provide a unique brand of activism of philanthropy to advance health care, innovation, advocacy, collaboration and education in the interest of better population health. They have helped us for the last nine months addressing many of the issues that are facing all of us today in one way or another, whether it's personally or across our families and our neighbors and friends 40 by 80, that's the wholly owned subsidiary of the Pittsburgh Technology Council. It's our 501 c three nonprofit. And we lead a lot of efforts. And you're going to see more from us in 2021, as we continue to support not just on only entrepreneurship, but workforce development in the region. And then I also want to tell everyone that next Monday, we are going to have Paul mango, he is he works at operation warp speed. And he's going to give us an update for all the work that they've been doing there. So we're really going to be getting immersed in all things related to our health, COVID and the vaccine, etc over this next week. So I've muted your microphones, that's only to make sure that we don't hear things in the background, and we give honor to our guests. And we've enabled the chat session in the chat session is going to allow us to ask questions of our guests. Jonathan kersting is with us today's vice president of all things media and marketing, he's gonna keep his eyes peeled on the chat. And the chat is not to be used to sell your wares. So I am going to jump right in now. And I am very thrilled to welcome back because right at the onset of COVID, as well as the onset of business as usual, we have Dr. Donald Whiting on and he is the chief medical officer at Allegheny Health Network. So welcome Dr. Whiting, we're thrilled to have you back. We're thrilled to have all the work that you've been doing and very excited to catch up. And then I'd like to introduce Brian Parker, he's chief quality learning officer, also from the Allegheny Health Network. But his title, he's going to tell you a little bit more about what his title means and all the things that he touches. So thank you both for being with us today. And I really want to talk about so many different things, I'm going to try to pack in as much as we can. But we are you know, there's there's a surge you you both know more than us, we want to know about the impact and the regional hospitals, the vaccines, etc. We're gonna jump into all that before we do. Let's just set the table and talk about yourselves. So if we can start with Dr. Whiting, just tell us a little bit about yourself, and how are you doing, I really want to know how you're holding surgery.

And thanks for inviting us. It's always a great show to be on and really good to get the word out. I'm the Chief Medical Officer at Allegheny Health Network. And so my responsibility is overall the clinical operations in the Health Network and particularly with COVID, a lot of my responsibility is the preparedness, the rollout of the different scaling that we do as the COVID numbers grow and we accommodate those patients. And then also I do a lot of work with the regional cmo group, so that all of our regional hospitals communicate regularly and we have sort of a communication so that the entire region is taken care of. So that's that's kind of what I've been Lately,

that's hardly anything. That's just like, That's hardly anything. So thank you. And now I'd like to introduce Brian Parker, how are you? Thank you so much for being here. You're new to the show, but certainly not new to the work that you're doing. So just give us a little bit about what you do, who you are, and how you're doing. Sure.

So in my role, Andrea, I oversee all the quality operations for the network, both in the inpatient and outpatient space. So that's all the quality and safety measures and things that hospitals are, are graded on, or compared to both that federal level like CMS, the LeapFrog group, US News and World Report lots of different ways that hospitals and systems get get graded and measured. I also oversee all of the learning that goes on across our network. So with 22,000, folks, we're always looking to make sure that they're educated, able to work top of license certified for the things that they need to be able to practice and those sorts of things. And then lastly, is oversee pharmacy operations for the organization. And that's going to play into what we talked about today, which I'm sure you know, as we talk about vaccines and, and possible therapies and things like that. So that's, that's my background, in terms of what's keeping me busy these days.

Okay, you're busy, hopefully, you're getting some sleep, I want you to know that we care about your health as well. But let's just jump in and talk about some of the matters at hand. So last week, you know, Governor Wolf, and Secretary Levine issued a new set of, you know, public health orders and restrictions, and in large part, to prevent any kind of onslaught or, you know, unusual demand on our healthcare systems, right, or hospital systems in particular. So hearing this and seeing the level of new cases, right, even today, the case numbers were high, we've seen a lot of deaths that have been reported. So hearing that, you know, we're all concerned, right, so how concerned First of all, should we be the state of our health system in the region? And what are you seeing and remind everyone why it's so important that why this piece of sort of the healthcare supply chain is so important to pay attention to? Okay, Brian,

Scott, with you, I'll start with that. Sure. So what the governor's order actually was, we're appreciative of that. I know, it's not the best thing for businesses, but what we were seeing was increasing numbers higher and higher numbers of people coming into the hospital requiring more and more significant amounts of care. And, and, you know, like I said, we in the region talk a lot, us and UPMC, and all the other regional hospitals work together, and talk about our capacity and our escalation plans. And we all have plans to accommodate higher and higher numbers. But then, as we were getting to the projections of what it would look like, after the Christmas holiday, and after the New Year holiday, it was going to be a pretty high number of people, we could still likely accommodate them, but then it would eliminate a lot of the other critical care that we do for other people, it sort of start crowding that out. And also, with the vaccine coming on board, one of our biggest issues is having health care workers at work, because they can't fault it and be off of work. So with the vaccine coming out this order, sort of, there's usually about a two week lag before we start seeing the effect in the hospital. So we'll start seeing the benefit of this in a week or two. But that'll give us some extra time to get our healthcare workers vaccinated and be able to be back at work. So so the the, the order for us is is was kind of a helpful reprieve for a little while, because the numbers were getting pretty good, pretty high. And part of that was that the message of masking and hand washing wasn't being taken seriously. A lot of people around the area and that's what was making the numbers go up.

And so why don't you remind everyone what it means. The definition of elective surgery is used very loosely. Sure.

A lot of surgery is a little bit of a moving target in the sense that, you know, removing up a nine mole is an elective surgery. But, you know, a heart catheterization isn't an elective surgery. Getting your cancer treated isn't an elective surgery and and moving those kind of things to a later date is an okay thing, the elective things, but but when you're starting to cut into the things that still need to be done, because of other people's health, but but you can't because the beds are being utilized by COVID patients. That becomes where we started to start crossing a line of What's not as safe anymore?

Okay, so thank you so so Brian, what about you? What do you what are you seeing in regards to the question that I just posed?

So I think there's a, you know, a couple of things. One is, you know, we talk a lot around pandemic fatigue. And and people getting sort of, you know, you know, I've done my part, but enough is enough, I need to get on with my life sort of thing. And what I've been telling folks is, you know, this is the homestretch. Right, we've got a vaccine that's approved, it's, you know, it's shipping, it's being received, it's being given in different parts of the country already. So this isn't the time to start to say, Well, guess what, I'll take my chances. And we'll let the hospitals fill up. Right, or, you know, we'll, we've got to refocus the efforts, roll up your sleeves, to do the hard thing now, which is continue to mask social distance, don't go into those those situations or large gatherings, or is there where there's the potential for spread, because we want you to be able to roll up your arm later, roll up your sleeves, and get the vaccination and the people around you as well. So with the numbers that we're seeing, we're setting a record every day, nationally, in some days here in the state and in the county, for the number of cases and deaths. So if we don't take this seriously, that means unfortunately, less people are going to get vaccinated, because folks didn't do the right thing. And they're not going to need a vaccination, they're gonna they're no longer going to be with us. So I think, you know, with these days of 220,000 230,000 new cases, you know, it was a month and a half ago, and we were wondering when we were going to break 100,000. Now we're wondering, when are we going to break 300,000 these are astronomical numbers to see a million new cases, every four or five days. So it's really concerning to me that we don't want to confuse getting a vaccine, whether it's from one or two manufacturers like Pfizer and Madonna, with, we're done with this, take off your mask, go do what you want to do and move about freely. That's that's not the message right now.

And it's really hard this time of year, this is a festive time of year where people fly. And people come to see their family or get together and multi households. Right. So are you seeing delays in surgeries already in some of these quote unquote, electives? Are you seeing any delays?

So in Allegheny Health Network, not as yet, what we are doing is looking ahead in our schedules and adjusting to our other locations to make sure we maximize the the breadth of what we have available, but we haven't as yet had to worry about that. That's good. That's good.

So now let's just talk about the vaccine. Today's a big day in the United States. You know, there's there's trucks out there, there's planes flying, even our local, FedEx is very active, and all this along with all the others. So but let's let's just talk about the vaccine. First of all, will both of you either you'd be taking the vaccine of any hesitancy?

That's a yes. Taking it.

Yes. Me too.

Absolutely. As soon as possible, as soon as possible. And so what is that, and let's just talk about the end, you feel safe about it. your feeling about the vaccines? Is your feeling safe?

Yes. Very much. So.

Okay, that's, that's great. And you're obviously you're both health health care providers and workers. So hopefully, you'll be right in the front line. So how is the vaccine? And I, Brian, we talked a little bit about this, how is the decision being made across the United States and then and then talk about Pennsylvania, in terms of who gets the vaccines. So here we are day one, people are out there disseminating these vaccines.

So the the way this has worked is the CDC has been prior to last week in this weekend, been making preliminary recommendations around vaccination protocols, and making it available to certain high risk groups and populations. That being said, their guidelines, it's not a mandate. It's not like what Governor Wolf did last week in terms of making mandates around what we can and can't do for the next three weeks through January 4. The CDC is issuing guidelines, and they do that in conjunction with an advisory group of the CDC around immunization practice. That being said, the states are supposed to take that information in and in a decentralized federated model, go ahead and make decisions for their population about how best to go about that. So what we've seen is sort of a tale of two cities around prioritization in the country. Some of the states have made the decision that they've seen some signals can, you know, morbidity and mortality in their in their long term care and nursing homes and in their workers in the populations of the caregivers, and so they're putting them at the top of their list to receive the vaccine. And then health care workers as in a very short order, you know, number two, in the state of Pennsylvania and like other states around the country, as well, we've put healthcare workers at the top, and then in very short order afterwards, making access for those long term care and nursing home facilities. In reality, based on supply and demand, the state's plan here in Pennsylvania is that those two things are going to go on simultaneously. We're seeing vaccine distribution happening this week to hospitals, we're expecting to see the pharmacies that have been contracted with the state to start going out and being mobilized next week to start administering vaccine to those facilities that aren't hospitals, but do have residents in them in congregate care facilities. So there's there's some variation on a theme out there. But you're seeing the same sort of philosophy, which is, the health care system in the US has to be stabilized. We can't continue to lose workers because of community spread, to end up being at home, when we know the pressure of COVID patients and also providing medical care for non COVID patients doesn't go away. And at the same time, those patient those residents in those nursing homes who are vulnerable and older, are very likely if they do get COVID to come to our hospitals as well. So one of the strategies around this is turn that spigot off, right, there's a flow of patients who can come to us and the folks that take care of them in those facilities, that if we can take them off the table. That was one of the major sources of deaths on the eastern seaboard in the in the in the early spring. And in a place like Allegheny County has accounted for approximately 80% of the deaths in the county, from folks from facilities like that. So turning that off, is going to have a big impact on health care facilities to continue to make beds available, because those folks will now have the vaccination.

We'll give a few questions. Let's Let's run to some questions real quick. And then I'll go back to mine. Yeah,

so let's start with Kenny sir wants to know is Deuce number two, the same formulation is the initial vaccination. And what is the timing of that second dose?

So for Pfizer, the answer is yes. The timing is 21 days between doses the CDC has recommended over the weekend with the hcip that that dose be administered 17 to 21 days after the first dose. Pfizer's initial recommendation was 19 to 23 days, the CDC is silent on if you go beyond day 21, they still want you to get the second dose, but they're not making a recommendation that you have to start the series over again. But they really feel you'll get the most benefit day 17 to 21. Right.

So where will people go to get the vaccine would just be hospitals? Well, we need to.

So the the models that are being looked at for vaccination beyond hospitals, which is what's happening right now in the state, is the state has also contracted with pharmacies just like they did with flu vaccination, to be able to provide it in the community. We expect that outpatient clinics and health care systems that have offices for primary care will eventually get access to the vaccines as well. The issues that we have with both Madonna and Pfizer is the cold chain issue with ultra low storage. So a regular you know, internal medicine or family practice is not going to have the ability to store that vaccine, but we'll have to rely on distribution from another source in order to get it because once it's thawed, the clock is ticking. So it's actually okay that healthcare systems and hospitals are getting the most complex vaccines first, because they've got the capabilities to actually deal with it through their pharmacy. And through the the having that sort of equipment, as we get further along. They AstraZeneca and the Johnson and Johnson vaccine require refrigeration now we're looking more like other types of vaccine storage and transport that we're used to seeing for the other things that we get vaccinated for throughout our lifetimes. And then lastly, all of them with the exception of j&j are two dose vaccines. So there's the initial and there's the booster. The j&j is a single dose, and really, that one is most well fashioned for general population vaccination. Because you don't have to send out the reminder card, make the second appointment, and do all of those things. It's really a one and done and so We're looking forward to seeing that one hopefully coming to evaluation sometime in early 2021. Because by the time we get to the springtime distribution of a single dose, instead of always knowing, hey, 20 million doses were just distributed. But that only means 10 million people. Right? So, but when you get the J and J, and they send 20, it's for 20 million. So that's, that's what we're looking forward to in the early spring. Hopefully,

I like the one and done that's for sure. So how will we know when we were eligible to get the vaccine? Should we contact our PCP.

So the the state has produced a pretty extensive document that was released over the weekend, that shows the populations and the way that we're going to methodically move through the vaccination process. So part of what's going to happen are the health department at the state level, at the county level, and then providers like ourselves, as well as payers, like Hi Mark are going to also message the same information. So this is really going to be a mass marketing campaign that's going to be undertaken to create public awareness, with everyone's singing off the same sheet of music. So we understand what we're all saying together, and how we can educate the public around when that vaccine will become available to them, and why it's not available right now, to them, and when it is available to them, where they'll need to go to get it. So that information cascade is being built right now. And we expect that we're going to have more information from the county health department and the state in the next several weeks as we make our way through the vaccination process, as I said, currently with the hospitals and these other long term care facilities within the state.

Oh, do you think that in terms of your frontline workers, how long do you think it will take to vaccine, you know, vaccinate your team, your group of health care workers, and however,

you know, it's good, you know, it's gonna it's gonna take a while. And the reason why it's gonna take a while is not just because it's two doses or because there's logistical issues with the vaccine. That adds to the complexity of it. But it's certainly not the only reason. The other reason is because the CDC recommendations and what Pfizer also saw is that folks are going to get some degree of side effects, typically with the second dose, not what the first. And so what we want to be cognizant of is we don't cause a staffing issue in our facilities and in our clinics by coming in and vaccinating everybody in a single day, in a particular nursing unit, or an ICU, or or particular outpatient office. So we're going to be intentionally staggering the vaccine administration, so that maybe those groups are broken up into quarters or thirds. So that as we move through, everybody's got a staggered vaccination schedule, and they're not experiencing a side effect, either on the same day or a couple of days, right in a row, that suddenly puts a staffing strain, where the cure is actually mimicking some of the issues we had with the disease, which was seeing people out as a result of COVID exposure in the community, we don't want to cause that same ripple effect as a result of administering the vaccine.

So we won't come to the general public. Until all right, until all the health care workers,

correct. So it'll have to go through health care workers, and it'll have to go what's considered to be what are critical workers is part of the infrastructure of the state. So all of a sudden, you see things like utility workers, transportation, power companies, the things that keep the wheels on the bus, and making sure that we're able to get those populations safe, frontline responders, police, Ms fire, we're going to have to get to folks who are providing health care in the community who aren't necessarily associated with a health care system or a hospital in homeless shelters, dialysis centers. So there's a lot of there's a lot of work to be done. And to get those particular jobs and roles in the communities stabilized and vaccinated for those that take it and want to take it before we can get out to the level where the general population will get will get their chance. And the faster that more vaccine manufacturers come with an approved FDA product. And the faster the companies that are already either approved or seeking approval, ramp up their vaccinations, the more people will be able to do this for more quickly. So the supply and demand piece, really the state is estimating that by the time we get to the general public, the supply and demand will be much more equivalent. Whereas right now we have not a lot of supply. About 2.9 million doses were just distributed nationwide. wide, with way more health, about 20 million health care workers in the US that need to be vaccinated.

So we have we have some good questions, Jonathan, maybe you start with Tom fry. And then I want to just tell everyone that sending him Dorfman, I think is somewhere in this crowd. And she runs all of Allegheny Health Network. And without her, we wouldn't not only be doing the show, but a lot of this great work that's happening across the system is due to her leadership. So Jonathan, Tom frei has a cool question

of this question here. Tom wants to know, will there be a registry to prove and certify vaccinations that have been received on will airlines be mandating new vaccinations for travel and so forth?

So a couple couple answers to that question, a couple parts there. So one is the state is requiring that we send the vaccination information for every one we provide it to, to the state information in the state immunization information system. So that's a statewide database that all vaccine information for anyone, children and otherwise gets uploaded into. So we have an interface with that, and we'll be providing that information to the state as we provide it. So that's the proof electronically, as well as what will be placed in either an employee or individuals health record. To prove, then you the second question is What about this passport, right, this immunisation passport. And we've already seen some airline companies united i think is one, I think JetBlue is another and southwest, are also considering rolling out an app that would allow you to prove vaccination status, less likely to be important for domestic travel, quite frankly, because we've got the state's taking somewhat differing approaches around doing it. So timing is going to be a consideration. And as we've already seen, preventing travel across state lines, although whether done through an advisory or a mandate is incredibly difficult for law enforcement to really deal with. That being said international travel is certainly I think, on the table around whether or not other countries will allow an individual to come into there, what I'm seeing right now Australia, New Zealand degree to, which is essentially a travel bubble between those two countries, will they allow someone to come inside that bubble who hasn't been vaccinated, I think those are going to be decisions that you're going to see government's making over the course of the next several months, and the transportation industry to also look at their liability for bringing people to and from those locations, with or without either vaccination or proof that they've actually had COVID-19 and did test positive for it. So there's a couple of different routes, they can go with the passport. And we'll see how it develops right now, that was sort of breaking news over the weekend.

He give us more details around side effects. And also anything around allergies, especially those who have like not allergies.

So side effects are pretty common. But not everyone gets all the side effects. And as I said before, it's it's related more to the second dose soreness at the site of injection is the most common side effect. So if you've got a flu shot, and you're going to get this shot, it's going to be pretty much the same you're going to have you're going to have a sore or sore sore arm at the site. low grade fever is a potential to see some fatigue, maybe some muscle aches. But nothing that's really, really out of the ordinary that you wouldn't typically get after something that's foreign has been introduced into you that's supposed to mount an immune response. And if you talk to our infectious disease, Doc's here at HSN, they're going to tell you that they think that's great news, that you're actually getting some side effects from the vaccine, because it's proof that, that your body's reacting to it, and it's mounting the response that you want to protect you. So, you know, for anybody that participated in a vaccine trial, and they know someone who got side effects and they didn't, it's they pretty likely know which which one they got. Which arm of the study they were in, right. So. So that's really the the crux of the side effects. The other piece around severe reaction. You know, there were two individuals in the UK, who had a history of severe anaphylaxis. They both carried epinephrine pens, they both took the vaccine, use their pens, were evaluated, treated and released and did find that being said the the UK and the CDC have both said, if you have a serious history of anaphylaxis reactions in your prior history, it's best to have a conversation with your physician around whether or not you should go ahead and get. And there's different classes and types of vaccines. So these two vaccines that are coming out, are not the only two types that we're going to be available. So choosing the vaccine that may be right for you might be part of that discussion. And the CDC did make recommendations for folks that have had serious reactions, to choose to go ahead and get it, that they're observed longer than folks who have not had an allergic reaction, serious one before, they're going to be able to leave the observation area after vaccination sooner. And we're gonna keep an eye on those folks who've had serious reactions longer as part of part of the safety net.

So there's a good question, Jonathan, from LA Gordon. Yes.

Here we go. Some she says, um, first off to thanks you for joining us today and wants to know, see here, Can't read my thing with my screen. Here it is, window individuals with a higher risk for a poor outcome of COVID due to asthma or seizures, be able to get the vaccine.

Yeah, so those groups are identified in the state plan after the one A's are done. And so that access is actually going to be out there as as outlined in there sort of phased approach. And so they're captured in phase one, B. And they're also captured in part of phase two. And so and it's also important to note that they're also being captured within the healthcare setting for individuals who might have high risk, and maybe aren't taking care of COVID patients. But if they were to be exposed, so the state's been very prescriptive, about laying out this plan in terms of sort of what we would refer to as fair and equitable distribution, as we move through stabilizing different parts of the infrastructure of healthcare, and then the state in general, before we get to the general population, which is phase three, which is essentially, everyone who wasn't vaccinated in phase one, a one B or two. So they're trying to catch all the folks that are high risk, or a really, from a provision of care standpoint get captured first, before we get to the general population.

So if I already had COVID, what about if I already had COVID?

Yeah, good point.

What do you say Dr. winders? Already have COVID? Should I be in line to get the shot?

I'd ask Brian, cuz he's my expert. But yeah,

I think man,

yeah, man about his. I think it's still a debate. But I'll let Brian, take a drink again.

So the CDC recommended, and our ID folks believe the same and we were messaging this before the CDC recommendations over the weekend, that prior exposure to COVID, natural exposure gives a really wide variety of immune responses and individuals. And so if you got it and you were exposed to somebody, and they told you, hey, through contact tracing, you need to get a test, but you never got symptoms, and you went and got screened after a week and you tested positive, that's great. But if you never really had symptoms, we would call that probably a pretty weak response, because you didn't have anything. On the other end, if you spent some time in an ICU, unfortunately, as a result of being exposed, you know, even if you're elderly, you probably don't, you don't amount the same kind of immune response as you would if you were, you know, in your 20s 30s or 40s, which is why there's been such focus on administering it to individuals aged 65 or older. And it's why the flu vaccine is typically four times stronger for that same group than it is for the rest of us that receive it. So the CDC recommendation is is even if you had natural exposure to COVID, that they would recommend you get it after 90 days, because you probably have some conferred immunity and those first three months, but after that the jury's out. And we know that the responses that the individuals are getting from the vaccine are very vigorous responses to producing an immune response.

So are we are we seeing any influx of flu right now? Are we seeing like that twin demick that they're talking about?

so are our flu numbers in the United States right now are the lowest we have seen in decades. The number of flu cases in our network. I believe, as of last Friday, we had seen 25 positive tests for flu. It's way under what we would see at this time of year going into the holidays, because typically by the time the schools have come together, everyone's sort of been congregating inside again. You typically see the flu ramping up now after Thanksgiving into the holidays. And then really staying a steady course until we get to the end of March. beginning of April. Nationally the National Map for all of the states is essentially almost all green. Meaning that it's way under what we would typically see it this time. And looking at year over year, the number of cases that are positively being tested in emergency rooms, or in doctor's offices, it's just not there.

Right? Someone was questioning whether or not they were missed. Could it be due to misdiagnosis?

And so the twin demmick? You know, there's no guarantee. There's nothing that says that it, you know, if if we get pandemic fatigue, and as we talked about earlier in the show, folks let their guard down, it opens the door for both, right? So, so the possibility doesn't go away. So just another reason to, to keep doing what we've been doing, because it has had an impact on something that we were very worried about just a few months ago.

So we're gonna wrap up, we've kept you longer than we anticipated, but I know that there's so much information to pack in, is there anything that either of you just want to reinforce to all of us that either we didn't cover or you want to say again,

I would just reiterate the masking handwashing, Moller scholarship, smaller social gatherings over the holidays. Like Brian said, we're on the homestretch. Let's get through this together and do those simple things.

Okay, Ryan, Tim, anything you want to add?

Yeah, these next three weeks are what's going to give us you know, either a really good January, or it's gonna make January be a repeat of November in the beginning of December. This is the opportunity to make the difference.

All right. Well, I want to thank both of you. Thank you for your leadership. Thank you for your relentless work. Thank you, Dawn for being back on the show. And joining us. Thank you, Brian. Thank you to Cindy endorphin thank you to everyone over at at Highmark for everything that you're doing for the community, stay safe. Listen to them read from good sources. And let's make sure that our frontline workers are safe. So I can't thank you all enough.

Thank you.

I will see everyone here tomorrow, same time. Jonathan. What's up for tomorrow?

Morrow is Gerardo interio new from Aurora. Aurora visionary. Yeah.

Don and Brian, you might want to join in. They just they just bought part of Uber. So it'll be a good shift for you guys. Instead of your day to day I

encourage you to tune in.

Yeah. Thank you. Thank you all so much. We'll see everyone here tomorrow.

Thank you.

Thank you, Audrey.

Thank you. Hi.

Transcribed by https://otter.ai