I was surprised to learn from a recent press release that the American College of Cardiology is planning to have some live participants at its annual scientific sessions meeting in May. The college said it is also partnering with a technology company to offer these participants a wearable monitoring device “as an added safety measure for monitoring possible COVID-19 symptoms.”
In my view both decisions are mistaken and send messages that are the exact opposite of what responsible medical and scientific organizations should be promulgating during the pandemic.
It is of course completely understandable that the ACC is eager to resume normal activities, including live meetings. But it’s also true that we are still in the grip of a still growing, still uncontrolled pandemic, and these moves by the ACC contradict the essential public health message that the ACC should fully support.
“The ACC,” according to its press release, “is committed to creating a healthy and safe environment for attendees, exhibitors and staff in line with all current directives and recommendations that will enable attendees to make informed and safe decisions about their attendance.” But the ACC makes no effort to explain or justify its decision to plan for a partially live meeting.
Most years the ACC’s scientific sessions take place in March or early April. “We made the decision early last fall to push our meeting to May of 2021 to potentially allow more people to attend in person, while always planning a comprehensive and simultaneous virtual conference.” said the ACC President, Dr. Athena Poppas, in a statement.
This may have been a reasonable position to take last year, but it is now clear that the ACC’s hopes will be dashed, given the current horrific state of the pandemic. There is no reasonable expectation that the situation will have improved enough in the next few months to allow a conference that includes physical attendance for some attendees. Moreover, as a leading medical organization it sends the wrong message to the rest of the population, suggesting either that the rules are different for the privileged classes or, perhaps worse, that every group and individual should feel free to make up their own public health policy.
“The ACC dragged their feet last year before canceling the 2020 meeting and while I wish it would be possible to bring thousands of people together in May for a meeting it’s just not feasible,” said George Washington University cardiologist Jonathan Reiner, who has emerged as a leading commenter on the pandemic on CNN. “If President-elect Biden’s plan to give 100 million shots in 100 days comes to fruition, by May 1 we will still be far from enough vaccinations for herd immunity. A large indoor meeting is simply not going to happen. Whose interests are best served by having an in person meeting during a pandemic? The attendees or the organization?”
One defense of a live meeting I heard raised on Twitter is that most cardiologists will have been vaccinated by May. But this argument doesn’t withstand scrutiny. For one, even if the cardiologists who are ACC members will have received vaccinations by May, it is certainly true that this will not be the case for the vast majority of other workers without whom the meeting could not be held, including transportation and hospitality workers, as well as the numerous representatives from industry (who often outnumber cardiologists at these meetings). Moreover, the consistent message I’ve heard from the experts is that people who have been vaccinated are not supposed to behave any differently from those who have not been vaccinated. We know that the vaccine dramatically reduces the incidence of severe disease but the degree to which it reduces transmission is uncertain, and even if it did cut transmission it’s unclear at this point if it makes sense to have different rules for different classes of people based on vaccination. Furthermore, at this moment there is a tremendous amount of uncertainty over the impact of new, emerging strains of the virus. Unfortunately, at the present time we still need to work under the assumption that anyone at all could be the source of infection.
Can a BioButton Help?
The strangest part of the ACC press release is the announcement of a collaboration with a company called BioIntelliSense. The ACC will make available to attendees the optional use of the company’s BioButton, which is a wearable personal monitoring device. The press release describes it “as an added safety measure for monitoring possible COVID-19 symptoms.”
I asked the ACC to explain the rationale behind the partnership with BioIntelliSense and the scientific basis for their assertion that the BioButton could enhance the safety of ACC participants. “This is a cutting-edge technology, and it’s a natural fit for ACC to not only support this technology but also put it to use in keeping conference attendees safe,” said ACC president in a statement. But when I asked the ACC to elaborate on this thinking they referred me to the company.
The BioIntelliSense website describes the BioButton as “a scalable and cost-effective solution for COVID-19 symptom monitoring at school, home and work” that provides “continuous temperature, respiratory rate and heart rate at rest measurements.” The device, according to the company, establishes “COVID-19 risk status with ‘Cleared’ and ‘Not Cleared’ notifications before leaving for work or school. BioButton’s continuous temperature and vital signs monitoring, combined with advanced analytics, enables the BioButton to identify statistically meaningful trends and screen for early potential COVID-19 infection.”
To be clear: neither the ACC nor the company provide scientific evidence that the BioButton can enhance the safety of the ACC meeting. Currently there is absolutely no test or device or other medical protocol that can reliably tell individuals on a daily basis that they can safely participate in a group activity.
In the absence of evidence that the BioButton can actually enhance safety it seems to me that what the BioButton does provide is the public performance of a meaningless measure and the consequent illusion of safety. What’s really needed is a credible, scientifically validated method to enhance safety. Instead of insisting on the highest scientific standards, the ACC has compromised its integrity to abet the PR campaign of the company, and it has enlisted its own members to assist in this effort. (One positive note: the ACC assures me that “there is no financial commitment between BioIntelliSense and ACC for use of the BioButton at ACC.21. This a strategic collaboration to employ the latest wearable technology in support of healthy and safe meetings and events.”)
Supporting “healthy and safe meetings and events” is a laudable goal, but an organization like the ACC should know more than others that this is a goal that can only be achieved through rigorous science. There is simply no way to ensure the safety of large real world meetings at this time.