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Covid Vaccine: when/where/and how to get it
EDIT FOR IMPORTANT UPDATE: the "Philly fighting covid" website, that was claiming to be associated with the city and had local papers reporting the same thing, is now apparently NOT officially associated with the city. More info coming. Hey everyone! Since the rollout of the vaccine 🎁💉 has started, I thought this would be a good place to gather information on how to access it. I'll do my best to keep this updated with current information. Edit: To clarify, I'm not a person with any sort of inside knowledge of how this is all going to go. None of this information is guaranteed, I tried to provide links for everything so you can see updates for yourself.
One of the vaccines is available for people 16 years and older, the other is 18 and older, so make sure your provider is aware if you're between 16-18.
Let your provider know (they should ask) if you've had another vaccine (like your flu shot) within the last two weeks.
What if I don't have insurance? Be aware that while the vaccine is NOT currently guaranteed to be free, per the CDC:, there is a resource available for financial support; additionally as far as I know right now, no one in Philadelphia has had to pay for it (even the uninsured).
Vaccine doses purchased with U.S. taxpayer dollars will be given to the American people at no cost. However, vaccination providers will be able to charge an administration fee for giving the shot to someone. Vaccine providers can get this fee reimbursed by the patient’s public or private insurance company or, for uninsured patients, by the Health Resources and Services Administration’s Provider Relief Fund.
What to expect when recieving the vaccine:
The two available vaccines are "experimental" and granted only emergency FDA approval. You'll be informed of this verbally and have to sign a waiver acknowledging that. There are long packets of information, reading them before your appointment might help lines move faster, HOWEVER, you should be given a chance to have any questions answered. The vaccine is a series of two shots spaced 3-4 weeks apart. I understand some places are making you schedule the second visit before your first shot, while others are not. I would recommend having an idea of your availability just in case. The convention center did have a fairly long line outside this past weekend. So be prepared for a long outdoor wait. CDC warns of arm soreness and temporary flu like symptoms. Anecdotally, I can confirm most people I know who have recieved it DID experience these things. Check out the CDC guidelines to know what you should and should not worry about!
LOBE SCIENCES LTD. Some DD on the trails and stuff
LOBE SCIENCES LTD. CSE: LOBE / OTC: GTSIF Share Price (CAD): $0.10 (As of Feb 3, 2020) https://www.lobesciences.com/about Company History GreenStar (Formerly Bethpage Capital Corp):
May 30, 2019: The company completed a reserve takeover (RTO) with Green Star Biosciences Inc. The company changed its name to GreenStar.
Growth-oriented technology and services company that provides real estate, financial, management, IP, and branding support to licensed cannabis businesses.
Has exclusive licensing arrangements for proprietary technologies that support product development and operational efficiencies for its operations.
Facilitate growth through acquisitions and development of additional assets, products, and technologies in legal cannabis markets by leveraging its capital markets, branding, and operational expertise.
November 16, 2020: The company changed its name to Lobe Sciences Ltd.
Lobe is working to develop effective psilocybin-based therapeutics for the treatment of mild traumatic brain injuries and post-traumatic stress disorder.
Lobe is working to develop devices for the efficient application of medications.
The company also provides real estate, financial, management, IP, and branding support for the development of transformational medicines.
2021 Business Development and Overview: Cowlitz County Cannabis Cultivation, Inc.
The company owns the property leases and brands of Cowlitz County Cannabis Cultivation Inc. (Licensed cannabis producer and processor in Washington State)
November 30, 2020: The company received and signed a non-binding letter of intent with IONIC Brands Corp for the proposed sale of certain assets held by the company related to Cowlitz.
The sale price for the assets shall be a minimum of $23 million, payable through the issuance of Ionic post-consolidation common shares (~49% of Ionic’s market cap).
Eleusian Bioscience Corp.
July 31, 2020: The company acquired 100% interest in Eleusian Biosciences Corp.
Brings seasoned pharmaceutical leader and executive Maghsoud Dariani in as Chief Science Officer.
Expands the Company’s portfolio of brands in life sciences, opening access to the emerging psychedelic medicine sector.
Expands IP portfolio to include five provisional patent applications already filed by Eleusian in the US.
Pre-Clinical studies already in progress.
December 3, 2020: Engaged VisionWorks Engineering to complete and test a proof-of-concept prototype of its nasal mist device.
Delta One Consultant LLC.
February 26, 2019: Before RTO (Bethpage Capital Corp – Greenstar) Greenstar entered into a non-binding LOT for a partnership agreement with Delta One whereby the company is seeking to secure a 51% ownership interest in Inkster indoor grow facility.
The company paid $201,435 to Delta One. The company no longer anticipates the completion of the acquisition of a 51% interest and has written off $139,930 as not being recoverable, and doubts they will be able to recover the remaining $68,935.
Financial Stuff: Liquidity, Cash, and Capital as of November 30, 2020:
$1,271,216 in Total Current Assets
$107,091 in Cash
$664,779 in Receivables
$499,346 in Prepaid Expenses and Deposits
$371,281 in Total Current Liabilities
$184,452 in Accounts Payable and Accrued Liabilities
$186,829 in Lease Liabilities
Working Capital of $899,935
$12,364,607 in Equity (Less Cash)
**Should the deal with Ionic go through, LOBE’s assets would grow by a minimum of CAD 23 million. Q1 2021: Advertising Costs were $603,236
Attributed these costs to rebranding. Seems a little high but I’m sure fully rebranding is expensive. (New website, new logo, new fees, etc.)
Research Costs were $165,072
Relates to a preclinical study in collaboration with the University of Miami Miller School of Medicine.
Professional Fees were $121,136
Attributed to legal fees for general corporate matters and rebranding.
Consulting Fees were $221,257
Attributed to the rebranding and development of the Eleusian patent applications.
Revenues were $180,618
License royalty revenue ($69,560), earned based on Cowlitz per-unit sales.
Lease revenue ($111,058), monthly over the lease term; expiring in 2022.
*Net Loss of $1,245,192\* Non-Brokered Private Placement:
December 14, 2020: Lobe intends to raise up to $2,000,000 through a non-brokered private placement of 20,000,000 units at $0.10/unit.
Warrants will be issued alongside the units with an exercise price of $0.25 over two years.
December 24, 2020: Lobe announced upsizing and first closing of NBPP. Upsized the NBPP from $2 million to $2.7 million. (23,271,000 units)
January 6, 2021: Lobe announced that due to strong investor interest, they further upsized the initial NBPP from $2.7 million to $3,445,847.
Additionally, they completed a second and final tranche closing raising $1,118,747 at the same unit price.
Total: $3,445,847 through the issuance of an aggregate of 34,458,475 units.
Thoughts LOBE was strapped for cash last year. They spent quite a lot of advertising and rebranding after the name change and the pivot into the psychedelic space. Not much was spent on research in 2020 but that’s understandable I guess given that they only acquired Eleusian in July of 2020. They gave themselves some solid breathing room by raising capital via the issuance of shares. Having 32x the cash on hand compared to November 30, 2020, is always a good thing. The deal with Ionic would increase their assets by a minimum of CAD 23 million. LOBE doesn’t have a ton of liabilities either. If this deal goes through, it appears that LOBE’s book value will be higher than its market value (AT THE CURRENT SHARE PRICE). Given that they are in the pre-clinical stages of therapy development I would expect further financing deals moving forward. This is to be expected in emerging biotech companies since without revenue they need some way of financing trials. Pipeline, Trials, Patents, and Stuff: Psilocybin + NAC
The company has launched a preclinical research study using psilocybin with N-Acetylcysteine (NAC) to treat mild traumatic brain injuries/concussions (mTBI) and PTSD.
The study is in collaboration with the University of Miami’s Miller School of Medicine.
MDMA + NAC:
The company is said to be looking into investigating combining MDMA with NAC for the same two conditions (mTBI and PTSD)
Additional Compounds:
The use of other compounds to create memory odor imprint pairing.
Nasal Mist Transducer Device:
The company has started to work with Visionworks Engineering to commence work to complete and test a proof of concept prototype of its nasal mist device.
Deliver medicines right to the Olfactory bulb.
Virtual Reality Headset:
I’m assuming this will be something used in the therapeutic process.
The Focus of Trials: LOBE is investigating the use of N-Acetylcysteine (NAC) paired with either Psilocybin or MDMA for the treatment of Mild Traumatic Brain Injury (mTBI) or PTSD. Before we dive into the science it’s important to get a grasp of the scope of these two conditions and their economic impact. I’ve sourced and linked a bunch of studies from all over the web look at both the human impact and financial impact that these diseases have. Long story short, they affect a ton of people and cost both the patients and population at large a lot of money in both direct (medical) and indirect (external) costs. Furthermore, they don’t have any standard effective treatments. LOBE is trying to fill this gap. Let’s take a look at the prevalence and costs now. Brain Injury Stats and Economics: Epidemiology of mTBI and Neurodegenerative Disease: It is estimated that 42 million people worldwide suffer some form of mild traumatic brain injury (mTBI) every year. It is also estimated that 100-300 people per 100,000 population seek out medical attention for mTBI every year. However, studies suggest that the true number of cases could exceed 600/100,000 annually. Causes include:
Falls
Motor Vehicle Accidents
Sports-Related Injuries (Concussions)
Work-Related Accidents
Prior brain injuries are known to be a risk factor for future brain injuries. Some studies have found that football players can sustain thousands of sub-concussive impacts throughout the season. While many argue that these should not be considered to be mTBI’s, the repeated impacts have been shown to lead to serious neurodegenerative disorders later in life; such a chronic traumatic encephalopathy (CTE). Repetitive mTBI (sub-concussive hits) in NFL players found a 3x greater rate of dying from neurodegenerative diseases, like AD and ALS, when compared to the general population. Some studies have also linked mTBI as a risk factor for developing dementia later in life. A study out of Taiwan found that mTBI was associated with a 3-fold increase in the risk of developing dementia. A study of 800,000 male military personnel over 30 years found that mTBI was related to a 70% increase in the risk of developing young-onset non-AD type dementia before the age of 65. Incidence of mTBI:
This study evaluated the incidence of mTBI based on gender and age. The overall reported incidence rate was found to be 302 per 100,000 person-years. This rate was 357 in males and 242 in females. The rate was found to be the highest in the age group of 16-20-year-olds. In this age group, males had an incidence rate of 835 per 100,000 person-years, and females had a rate of 752.
Between 2000 and 2014, more than 300,000 military personnel were diagnosed with a traumatic brain injury. Of this group, 80% were concussions. 82.4% of the traumatic brain injuries reported in the military over the 14 years were mTBI.
The risk of being diagnosed with a TBI after being deployed is estimated to be as high as 8.4 times that of the risk of TBI before deployment.
TBI is the leading cause of death and disability globally. TBI is involved in ~50% of yearly trauma deaths. TBI is estimated to result in 1.3 million visits to the emergency department every year in the United States.
Lifetime costs of TBI related to medical treatment are estimated to be anywhere between $600,000 and $1,800,000 per person.
A study evaluating the costs of mTBI in Ontario in 1996 found that direct costs (medical-related costs) were $125 million annually. Adjusted for inflation, that number would be $190 million per year now.
The same study estimated that the annual indirect costs related to mTBI at that time were $441.7 million. Adjusted for inflation those indirect costs would be ~$676.6 million.
The NCS-R estimated the lifetime prevalence of PTSD among adult Americans to be 6.8%. Lifetime prevalence is estimated to be 9.7% among women and 3.6% among men.
The 6-month prevalence of PTSD among US adolescents (12-17) has been estimated to be 3.7% for boys and 6.3% for girls.
The lifetime estimated prevalence of PTSD among Veterans was estimated to be 30.9% for men and 26.9% for women. Of Vietnam theater Veterans, 15.2% of surveyed men and 8.1% of surveyed females had PTSD at the time of the study.
The prevalence of PTSD in Gulf War veterans was estimated to be 12.1%. The current prevalence of PTSD in veterans who served in Operation Enduring Freedom or Operation Iraqi Freedom was estimated to be 13.8%
Economic Burden of PTSD: *Quick point here. Direct costs are things like medication, medical visits, and care. Indirect costs are things like lost productivity.
A study out of Northern Ireland estimated that annual healthcare-related costs from PTSD were £27,317,184. Of that total, £5,658,406 were estimated to be from medication-related costs (anti-depressants, anti-psychotics, and anxiolytics).
Another study reported that the mean annual medical costs for Vietnam Veterans with PTSD were $16,750 per person.
SCIENCE: NAC: NAC is used to treat acetaminophen overdoses. It’s also used to loosen thick mucus in people with disorders like pneumonia and bronchitis. It can be inhaled as a mist. NAC has recently been studied for its effects on psychiatric disorders. A quick check on Wikipedia shows the following:
Alzheimer’s
Autism
Bipolar Disorder
Major Depressive Disorder
Obsessive-Compulsive Disorder
Schizophrenia
Drug Addictions: Cocaine
Anxiety Disorder
ADHD/ADD
Mild Traumatic Brain Injury
Since Lobe seems to be prioritizing mTBI and PTSD, I’m going to focus the research here on the disorders most closely related to mTBI and PTSD and the evidence NAC has in helping with them. NAC in Traumatic Brain Injuries: Ischaemic (Stroke) Brain Injury: Neural damage resulting from strokes is thought to be the result of overexcitation caused by a massive release of excitatory neurotransmitter glutamate acting on NMDA receptors and subtypes. NMDA receptor antagonists have been found to block neuronal damage following strokes in animals. This study looks at the protective effects NAC has against the oxidative stress in the brain during ischemia in gerbils. The findings of the study support the conclusion that NAC mitigates the degree of brain injury caused by bilateral carotid occlusion. The study found a reduction in neuronal loss in the animal that received NAC. NAC and Cerebral Inflammation Following TBI: The study starts by explaining how inflammation plays an important role in the development of secondary diseases related to traumatic brain injuries. This study sets out to determine what role NAC has on the brain's inflammatory response after TBI. It has been theorized that NAC plays a protective role in protecting the brain after TBI. Most studies have focused on the oxidative stress the brain is under after TBI with good results. NAC increases the pool of glutathione, an important cellular antioxidant. The study showed that NAC administration following TBI could reduce cell death in the brain around the injured location. Inflammatory-related factors stemming from TBI could be suppressed using NAC. Furthermore, TBI-related brain swelling and cell death were both ameliorated after NAC administration. TBI damages the blood-brain barrier which allows for blood cells to accumulate in the brain, ultimately sustaining brain inflammation. NAC was found to ameliorate BBB permeability. The study ultimately found that NAC administration could reduce cell death following a TBI and also reduce secondary brain damage following the event. NAC and Probenecid for TBI in Children: This study was conducted to evaluate any adverse effects related to the administration of NAC with Probenecid in children with TBI. Ultimately it was found that the combination resulted in no adverse outcomes in the children who were treated. The study did not follow the impact that this treatment had on the injury itself or its chronic outcomes. NAC and Minocycline for mTBI in Rats: The purpose of this study was to determine if this drug combination could be used to control inflammation and prevent cognitive/memory deficits resulting from mTBI. This study gives a good overview of the current evidence for NAC in brain injuries. NAC is an antioxidant, modulates glutamatergic neurotransmission, and has been shown to produce anti-inflammatory activity. The study ultimately found that cognitive and memory deficits were limited by the combination of the drugs in rats. Behavioral and histological impairments were alleviated by the combination. NAC and PTSD: NAC for PTSD and Substance Use Disorders in Veterans: Oxidative stress has been implicated in the pathophysiology of PTSD. NAC has been theorized to alleviate oxidative cellular damage in the brain. The study aimed to explore the efficacy of NAC as adjunctive therapy in treatment-resistant PTSD. Replenishing glutathione is thought to diminish oxidate cellular damage and improve PTSD symptoms. NAC is a precursor to glutathione and can help restore its supply. Another exciting point about NAC is that it is thought to be able to cross the blood-brain barrier. For those who don’t know, this barrier prevents several possibly effective brain treatments from being viable. This is the first RCT to investigate NAC for PTSD. The study found a significant treatment effect on symptoms of PTSD and drug cravings. Furthermore, the study mentions that it could be a useful tool in combination with cognitive-behavior therapy in patients with PTSD and SUD. Self-Reported PTSD symptoms were reduced by 32% in the NAC group over 8 weeks compared to 3% in the placebo group. Clinician-Rated PTSD symptoms were reduced by 46% in the NAC over 8 weeks compared to 25% in the placebo group. The amount of substance craving was reduced by 81% from baseline over 8 weeks in the NAC group compared to 32% in the placebo group. The frequency of craving was reduced 72% from baseline in the NAC group compared to 29% in the placebo group. The NAC group also has a significantly lower frequency of cravings at week 12. Depressive symptoms scores were reduced by 48% in the NAC group from baseline to week 8 compared to 15% in the placebo group. There were 31 adverse events noted in the study, 66.7% being reported in the NAC group. Common events were dry mouth and heartburn. NAC for treatment-resistant PTSD in Humans (Trial Design): Looks as if this is a trial design submission. There is still some cool information included in it that might be worth reading if you’re interested. (2020) NAC for Alcohol Use Disorder and PTSD (Trial Design): This study is another trial design submission. Again it has some cool information you can read if you feel so inclined. (2020) MDMA: MDMA-Assisted Psychotherapy for the treatment of PTSD: The paper is a study design and rationale submission for phase 3 clinical trials based on the success of previous phase 2 RCT’s. It describes the success of previous trials which I will describe here. Six previous RCTs at 5 sites were conducted over 13 years from April 2004 to February 2017. Active groups were given MDMA and participated in 2 or 3 psychotherapy sessions. Each session was 8 hours and was spaced one month apart. Leading up to the active therapy sessions, patients underwent three non-drug sessions. After two sessions, 54.2% of patients in the active group did not meet the CAPS-IV PTSD diagnostic criteria. Symptoms of depression were alleviated more in the active group than in the placebo group. All doses were well-tolerated. The beneficial effects of MDMA for treating PTSD are theorized to be found in their ability to enhance the psychotherapeutic process. MDMA is said to facilitate communication and connection between therapist and patient. MDMA and PTSD Treatment: This paper gives a great overview of the use of MDMA in PTSD treatment. PTSD has a light level of treatment resistance with over half of suffers enduring significant challenges after completing therapy. A serious challenge with conventional PTSD therapy is that patients are so overwhelmed by the negative memories that they can effectively engage in the therapeutic process. Plenty of treatment drops out as well as substance use problems. The effects of MDMA include euphoria, extroversion, and empathy. MDMA reduced fear of recalling traumatic memories strengthens the connection between therapist and patient while allowing the patient to remain alert. Through the mechanisms of the drug of action, patients can experience reduced depression and anxiety and increases in a positive mood. Furthermore, the drug affinity for 5-HT2A receptors causes alterations in meaning for patients. This lets people form new ideas about their memories and experiences moving forward. The increases in dopamine from MDMA also increases a patient's motivation to engage in therapy. MDMA is theorized to contribute effectively to facilitating fear extinction learning. Psilocybin: Psilocybin and PTSD: Psilocybin temporarily suppresses the brain's fear response through its impact on the amygdala. The reduction in the amygdala’s activity reduces the fear responses communication with the frontal cortex. Psilocybin is therefore presumed to be effective in assisting in therapeutic sessions involving the recall of challenging memories. However, there haven’t been many clinical trials to determine whether it will be effective in practice. Psychedelics and Neuroplasticity: Beautiful Systematic Review of the Evidence: Neuroplasticity refers to the ability of the nervous system to respond to internal and external stimuli through a remodulation of its physical structure and functional connections (rewiring the brain). A lot of psychiatric disorders share some neuroplasticity-related impairments. (Including PTSD) Neurogenesis-enhancing treatments have been found to be useful in dealing with PTSD. This means that there is the potential that psychedelics could contribute to ameliorating neurodegenerative conditions. The neuroplastic and cognition-enhancing effects of psychedelics could be used to increase neurogenesis and to create new neurotrophic pathways. The neuroplastic effects of psilocybin were associated with fear extinction in patients at lower doses. Another Study on Psychedelic Neuroplasticity: This study concludes that many classical psychedelic substances might be useful in treating cognitive impairments as a result of their ability to promote structural and functional plasticity in prefrontal cortical neurons. Discussion on Science: For this part, I’m going to focus on the combination of MDMA/Psilocybin with NAC for treating either PTSD or mTBI. I think it's an incredibly novel idea since they are trying to tackle two different aspects of the conditions. NAC has already been proven to be a promising compound that can be used to treat PTSD and mTBI. Its ability to attenuate the oxidative/inflammatory stress of mTBI and PTSD is very interesting. It is also something that the psychedelics compounds are unable to do. NAC has already been shown to be a compound that can be combined alongside another. The inclusion of either Psilocybin or MDMA appears to fill a lot of the gaps in the treatment process. Cell death caused by mTBI forces the brain to rewire and find new neural pathways. There is a bunch of evidence that psychedelics are useful in helping this process along. As far as PTSD goes, the evidence is clear. These drugs have some serious potential to help create much better therapeutic outcomes. What you have here is an interesting approach to dealing with the physiological aspects of mTBI/PTSD while also improving therapeutic outcomes by way of more effective therapy sessions. The efficacy of MDMA for PTSD is currently being proven by MAPS Canada. The results should be out soon. The efficacy of NAC has been demonstrated already in clinical settings. The use of psilocybin for mTBI and PTSD has yet to be proven which is why I am guessing that is the study LOBE is focusing on first. Looking Forward: Brain injuries are a huge deal in the sports world. The UFC has already taken note of the potential psychedelics to have. Former NHL player Daniel Carcillo has spoken publically about the impact magic mushrooms have had on his life. I can only imagine that as things progress you will begin to see adoption in a wider range of athletes (NFL, MMA, Boxing). Mike Tyson has also been vocal about his use of psychedelics. The evidence looks strong for LOBE’s scientific endeavors based on what I have read/listed here. Sports are an incredibly large market with a ton of capital to throw at effective treatments. With the MAPS trials paving the way for the entire sector with their MDMA trials, I think LOBE could see a decent bump once those results come out (should they be good). They don’t have a ton of capital on hand as of now. The prices are exactly where the last NBPP was ($0.10/unit). Would 100% lookout for more offerings moving forward. Small guys with some big potential. What they do have are 5 provisional patents on the compounds and delivery mechanisms. Good IP, Novel Treatments, but poopy financials. Also at the start it didn't seem like they were putting much money into research. However, now that they've raise funds I'm sure their next financial report will show more being put into that side of thing. Bear Points:
Pre-Clinical trials only
Not much money on hand (risky) and kind of weird financials
Shitty website (not great for investor relations)
No delivery plans (clinics)
Bull Points:
Really novel and cool trials/pipeline
Cheap play
Good partnerships (University of Miami)
Good exposure to large markets like sports
Solid team backing them up after the new CEO came in recently
Seem to be focused on M&A, could get picked up by someone else?
Gonna make this one risky play. TL;DR - They hold 5 provisional patents on some pretty cool therapies combining promising compounds. Mild traumatic brain injuries don't have any current standard treatment and there's a big market for it. Also taking a novel approach to PTSD; going above and beyond MAPS. They don't have a lot of money though.
Covid-19 Update for February 1: 355 new cases, 463 recoveries, 10 deaths
Data is taken from the Covid-19 portal and today's media availability by Dr Deena Hinshaw. Dr Hinshaw's next availability will be tomorrow. There are currently enhanced measures in effect for the province of Alberta. This link provides a quick summary of which ones are in effect for the province. Alberta is currently on "Early Steps", with the goal of reaching Step 1 on February 8th. Top line numbers:
For values where "Current" and "Total" are the same, I have left results under Total
Value
Current
Change
Total
Total cases
—
+355
124,563
Active cases
7,387
-118
—
Cases with "Unknown source"
1,051 (34.3%) in last 7 days
-33 (-1.0%)
—
Tests
—
+7,318 (~4.85% positive)
3,180,848
People tested
—
+2,062
1,757,371 (~402,052/million)
Hospitalizations
556
-5/-9 based on yesterday's post/portal data
5,434 (+25)
ICU
102
+1/+2 based on yesterday's post/portal data
872 (+7)
Deaths
—
+10
1,649
Recoveries
—
+463
115,527
Recoveries and Deaths
Age Bracket
New Recoveries
Total Recoveries
New Deaths
Total Deaths
<1
+1
635
+0
0
1-4
+13
3,644
+0
0
5-9
+34
5,054
+0
0
10-19
+45
13,524
+0
0
20-29
+84
21,961
+0
7
30-39
+87
22,393
+0
8
40-49
+79
18,541
+0
18
50-59
+46
13,855
+0
52
60-69
+28
8,413
+1
167
70-79
+13
3,824
+1
327
80+
+33
3,645
+8
1,069
Unknown
+0
38
+0
1
Vaccinations
Value
Change
Total
Vaccinations
+93
106,347 (~24,330/million)
Albertans with 2 vaccinations
+91
16,209 (~3,708/million)
Reported UK and South Africa Variants
The value is updated by Alberta Health twice a week
Last update: January 29
In the media availability, Dr Hinshaw reported that 51 total cases were identified, a mix of historical (previously awaiting sequencing) and newly identified cases. This will apparently be reflected on the portal tomorrow
Variant
Change since last update (January 25)
Cases
United Kingdom (B.1.1.7)
+11
31
South Africa (B.1.351)
+1
6
Effective Reproductive Number (R, or Rt)
The value is updated by Alberta Health on Mondays
Last update: February 1
What % the confidence interval represents isn't stated
Zone
R Value (Confidence interval)
Change since last week
Province-wide
0.83 (0.81-0.87)
+0.02
Edmonton
0.74 (0.70-0.80)
-0.07
Calgary
0.83 (0.80-0.89)
+0.00
Rest of Province
0.90 (0.85-0.96)
+0.13
Spatial distribution of people tested, cases, and deaths:
All other values are compared with respect to yesterday
Zone
Active Cases
People Tested
Total
New Cases
Total
New Deaths
Total
Calgary
2,950 (-76)
+863
711,056
+128
47,802
+4
515
Central
709 (+9)
+172
156,409
+63
8,939
+0
87
Edmonton
2,439 (-36)
+550
583,165
+106
51,570
+4
862
North
934 (-13)
+228
165,140
+49
10,229
+2
114
South
330 (-4)
+133
108,569
+13
5,886
+0
71
Unknown
25 (+2)
+116
33,032
-4
137
+0
0
Spatial distribution of cases for select cities and regions (cities proper for Calgary and Edmonton):
Note: I have changed High River + County to just the city of High River. It and "Rest of Alberta" have changed somewhat because of that
City/Municipality
Total
Active
Recovered
Deaths
Edmonton
42,072 (+92)
1,932 (-28)
39,419 (+116)
721 (+4)
Calgary
40,183 (+117)
2,479 (-48)
37,242 (+161)
462 (+4)
Red Deer
1,887 (+12)
190 (+3)
1,678 (+9)
19 (+0)
Lethbridge
1,733 (+8)
144 (+3)
1,577 (+5)
12 (+0)
Fort McMurray
1,689 (+3)
82 (-9)
1,604 (+12)
3 (+0)
Brooks
1,361 (+0)
2 (+0)
1,345 (+0)
14 (+0)
Grande Prairie
1,193 (+10)
151 (-5)
1,021 (+14)
21 (+1)
High River
677 (+0)
9 (+0)
662 (+0)
6 (+0)
Mackenzie county
560 (+4)
43 (+3)
502 (+1)
15 (+0)
Medicine Hat
527 (+0)
16 (-1)
498 (+1)
13 (+0)
Cardston county
490 (+1)
83 (-2)
401 (+3)
6 (+0)
I.D. No 9 (Banff)
431 (+0)
32 (-3)
399 (+3)
0
Wheatland county
233 (+1)
11 (-2)
222 (+3)
0
Warner county
158 (+0)
4 (+0)
152 (+0)
2 (+0)
Wood Buffalo municipality
132 (+0)
9 (+0)
123 (+0)
0
Rest of Alberta
31,237 (+107)
2,200 (-29)
28,682 (+135)
355 (+1)
Other municipalities with 10+ active cases is given at this link Schools with outbreaks are listed online. Quick numbers (changes since January 29th):
139 school are on alert (2-4 active cases) (+25)
18 schools are on outbreak with 5-9 active cases (+3)
5 schools are on outbreak with over 10 active cases (+1)
Spatial distribution of hospital usage (change as of yesterday's post):
Hospitalization zone are where the patient is receiving care, not zone of residence
Zone
Hospitalized
ICU
Calgary
187 (+0)
44 (+0)
Edmonton
225 (-3)
38 (+1)
Central
46 (+2)
6 (+0)
South
35 (+1)
7 (-1)
North
63 (-5)
7 (+1)
Statements by Dr Hinshaw Cases
Active cases in 298 schools (~12%) with 701 combined cases
In-school transmission has detected in 66 schools with 51 with only 1 new case
New cases in school aged population is dropping week over week (~71/day last week, down from ~131/day the week before school started)
We are at a place where easing on February 8th appears attainable
However, there is work to do and the province cannot let up
Q&A - Variant Cases
Additional information on variants?: 51 total cases of variants detected (6 in 3 households with no clear travel link) and will be updated tomorrow on the portal. Has not identified a source to the case not linked to travel
Are there new variant cases linked to travel?: Was just informed of two households are being investigated (3 cases total) and were confirmed to be variant. Don't know if there is a travel history in either household
Has province reached desired testing capacity?: Has reached goal (300/day to detect UK/South Africa variants). As case counts drop, will be able to screen more tests. Has also reached test for full genome sequencing (400/week, allows for detection of all variants and mutations). Looking into expanding capacity further
*Level of concern with number of variant cases?: The cases not related to travel is very concerning. Wants to clarify that some results are historical as sequencing was completed. This isn't escalating local transmission
When do we say it's community spread?: Doesn't directly answer (was asked in addition to the previous question); mostly speaks to the potential for enhanced protocols when variants are identified
Q&A - Health Orders Enforcement
Details on AHS' actions against Parkland County church (story here)?: Cannot speak as they executive officers and doesn't get details of their plans
Followup: Why is punishment so light to non-compliant industries?: Critical that enforcement is independent and with a full legal framework . It wouldn't be appropriate for her to dictate what punishments are given in a specific case. Has spoken to police chiefs and AHS to be clear that it is an escalating process (education -> support -> penalties)
Q&A - Other
Why is the test count dropping?: Believes it could be related to a couple factors: (1) Dramatic decline in all respiratory viruses, (2) People staying at home instead of getting tested. Independent of testing behaviour, positive rate should be somewhat independent and it is positive to see it decline (though it has plateaued recently). Hospitalization should also be independent of community testing and those have continued to drop...though some regions are increasing
Timeline for loosening visiting restrictions for elderly (long term care and community)?: Recognizes the burden held by these individuals. Encouraging to have a vaccine for these groups, but a lot to do still (e.g. - vaccination of potential visitors). Little data on long term care groups in specific for accepted vaccines (as well as their potential use to limit asymptomatic spread). Hopes to develop herd immunity via vaccine to loosen this
Why not "drive to zero"?: Depending on when it was implemented, it has differing impacts and harms to the region. The deployment of vaccines and interconnected nature to other provinces/US would make a zero case situation would make it extremely difficult and costly to many Albertans
What will be used to determine if more restrictions are required?: Will use "leading indicators" like cases, positive test rate, R value
Is there potential for restrictions to loosen quicker than 3 weeks?: The waiting period is a critical element to ensure there is no increasing spread
Covid-19 Update for January 29: 543 new cases, 765 recoveries, 14 deaths + Outline of Relaunch Plan + Announced Relaxation for In-Person Dining Restrictions/Indoor Fitness
Data is taken from the Covid-19 portal and today's media availability with Premier Jason Kenney, Minister of Health Tyler Shandro, and Dr Deena Hinshaw. Dr Hinshaw's next availability it will be Monday. There are currently enhanced measures in effect for the province of Alberta. This link provides a quick summary of which ones are in effect for different regions of Alberta. Alberta is currently on "Early Steps", with the goal of reaching Step 1 on February 8th. Top line numbers:
For values where "Current" and "Total" are the same, I have left results under Total
Value
Current
Change
Total
Total cases
—
+543
123,364
Active cases
7,805
-236
—
Cases with "Unknown source"
1,129 (34.8%) in last 7 days
-49 (-0.3%)
—
Tests
—
+11,608 (~4.68% positive)
3,154,153
People tested
—
+3,029
1,749,944 (~400,353/million)
Hospitalizations
594
+3/-7 based on yesterday's post/portal data
5,326 (+33)
ICU
110
-2/-3 based on yesterday's post/portal data
858 (+7)
Deaths
—
+14
1,620
Recoveries
—
+765
113,939
Age Range of Deaths
Age Bracket
New Deaths
Total Deaths
20-29
0
7
30-39
1
8
40-49
0
18
50-59
0
51
60-69
1
164
70-79
3
321
80+
9
1,050
Unknown
0
1
Vaccinations
Value
Change
Total
Vaccinations
+1,803
104,327 (~23,868/million)
Albertans with 2 vaccinations
+1,680
14,352 (~3,283/million)
Reported UK and South Africa Variants
The value is updated by Alberta Health weekly
Last update: January 29
Variant
Change since last update (January 25)
Cases
United Kingdom (B.1.1.7)
+11
31
South Africa (B.1.351)
+1
6
Spatial distribution of people tested, cases, and deaths:
All other values are compared with respect to yesterday
Zone
Active Cases
People Tested
Total
New Cases
Total
New Deaths
Total
Calgary
3,138 (-64)
+1,203
708,112
+223
47,320
+1
505
Central
692 (-18)
+290
155,673
+67
8,777
+3
87
Edmonton
2,662 (-102)
+834
581,259
+155
51,266
+9
848
North
957 (-53)
+350
164,314
+58
10,049
+1
109
South
340 (+4)
+179
108,042
+39
5,822
+0
71
Unknown
16 (-3)
+173
32,544
+1
130
+0
0
Effective Reproductive Number (R, or Rt)
The value is updated by Alberta Health on Mondays
Last update: January 25
What % the confidence interval represents isn't stated
Zone
R Value (Confidence interval)
Province-wide
0.81 (0.79-0.84)
Edmonton
0.81 (0.77-0.85)
Calgary
0.83 (0.79-0.87)
Rest of Province
0.77 (0.73-0.82)
Spatial distribution of cases for select cities and regions (cities proper for Calgary and Edmonton):
City/Municipality
Total
Active
Recovered
Deaths
Edmonton
41,833 (+122)
2,134 (-87)
38,987 (+204)
712 (+5)
Calgary
39,762 (+185)
2,592 (-41)
36,718 (+225)
452 (+1)
Red Deer
1,844 (+17)
174 (+2)
1,651 (+14)
19 (+1)
Lethbridge
1,704 (+29)
133 (+15)
1,559 (+14)
12 (+0)
Fort McMurray
1,681 (+2)
92 (-10)
1,586 (+12)
3 (+0)
Brooks
1,361 (+0)
3 (-1)
1,344 (+1)
14 (+0)
Grande Prairie
1,150 (+7)
147 (-5)
984 (+12)
19 (+0)
High River + county
769 (+0)
24 (-3)
738 (+3)
7 (+0)
Mackenzie county
553 (+7)
40 (+4)
498 (+3)
15 (+0)
Medicine Hat
527 (+2)
21 (+0)
493 (+2)
13 (+0)
Cardston county
466 (+4)
83 (-7)
377 (+11)
6 (+0)
I.D. No 9 (Banff)
423 (+11)
29 (+11)
394 (+0)
0
Wheatland county
232 (+2)
14 (+1)
218 (+1)
0
Warner county
158 (+0)
6 (+0)
150 (+0)
2 (+0)
Wood Buffalo municipality
133 (+2)
9 (+2)
124 (+0)
0
Rest of Alberta
30,768 (+153)
2,304 (-117)
28,118 (+263)
346 (+7)
Other municipalities with 10+ active cases is given at this link Schools with outbreaks are listed online. Quick numbers (changes since yesterday):
114 school are on alert (2-4 active cases) (+4)
15 schools are on outbreak with 5-9 active cases (+2)
4 school is on outbreak with over 10 active cases (+0)
Spatial distribution of hospital usage (change as of yesterday's post):
Hospitalization zone are where the patient is receiving care, not zone of residence
Zone
Hospitalized
ICU
Calgary
199 (+8)
48 (+2)
Edmonton
246 (-9)
38 (-4)
Central
45 (-1)
7 (+0)
South
34 (+3)
8 (-1)
North
70 (+2)
9 (+1)
Statements by Premier Kenney Opening Remarks
Alberta must continue to proceed cautiously
System is managing as a province, but some hospital facilities is still significant
Peak reached in early January (>90% Covid capable bed occupancy)
Problem in every region of the province as many rural regions are cared for in Calgary/Edmonton
All healthcare workers have limits and we must protect capacity
Notes (i) Peter Lougheed and Butterdome field units, (ii) AHS having no budget limits at the moment, and (iii) limited staff available
Restrictions
Recognizes that stress that comes with economic and employment instability
Why a "lockdown" has never been imposed with curfews, closed schools, and business closure
Broad public support and compliance is important
To strike this balance, wants to show a path forward...that bending curve lets public health measures lift
Must be carefully, slowly, and data driven
Restriction Metrics
Restrictions will be lifted in a stepped approach based on hospitalizations (ICU and general acute) values. It is a lagging indicator of healthcare capacity
When a benchmark is reached, discussion will be considered for further advancement of relaxation. Hospitalizations will be primary factor, but growth of cases will also be considered
Hospitalizations will be reviewed 3 weeks later. If hospitalizations have continued to fall, further progression will be considered
Case numbers represent recent trends and will be used to determine if relaxations need to be paused or if additional restrictions are needed
If cases surge to exponential growth and if a variant begins to increase spread, restrictions will be imposed again
Details of Relaxation Plan
Some restrictions will apply in all steps and at least 3 weeks are place in between each step
Early Steps: Schools open, outdoor gatherings up to 10 people, personal and wellness by appointment only, funerals up to 20 people
Step 1 - Begins February 8th: Some easing in school function (indoooutdoor sports, performance activities), some indoor fitness, some dine-in options for restaurants/cafes/pubs bound by clear limitations (e.g. - distancing requirements, group size, masking, etc).
Step 2 - Requires: Average hospitalization <450: Some easing for retail, banquet halls, community halls, hotels, conference centres. Some further easing on children sports/performance, indoor fitness
Step 3 - Requires: Average hospitalization <300: Consider places of worship and limited reopening of museums, libraries, casinos, and indoor seated events. Consider indoor indoor social gatherings with limitations. All that are considered will have restrictions still
Step 4 - Requires: Average hospitalization <150: Restrictions will exist, but will be closer to last summer. Wide range of indoor and indoor activities would be considered. Wedding/funeral receptions, trade shows, are on the table at this point
Requires buy in from Albertans
As measures are eased, community spread can occur
Moving from 1 stage to another will not be automatic - it will be open for discussion
Leading indicators will be used to warn of "red flags" for pausing relaxation
Closing Remarks
Minister of Jobs Doug Schweitzer will make announcements for support in coming days
Hopes that this will be a boost to Albertans and Albertan businesses
We are not at the end and it will be a while until we see a real effect from vaccines. Variants add to the challenge
This is not "back to normal" and if we think so, we'll start rolling back steps of the above plan again
Q&A
There are people who willingly ignore restrictions. What should be done here?: Enforcement is last resort. Regrettable to see that people are doing this and it is disrespectful to healthcare staff; they are saying they are more important than healthcare and can hurt the entire province. Understands the frustration, but things won't improve if people continue to break rules. Calls politicians who support ignoring restrictions "irresponsible" and thinks stronger enforcement is required
(Upon prompting, Dr Hinshaw added that most Albertans are following restrictions and cannot let the minority dictate the actions of the majority - more compliance results in higher potential for restrictions down the road)
How much decision making is politics in UCP strongholds?: Decisions in Covid cabinet are data driven. One factor is population compliance; polling say it's about 20% of Albertans think restrictions are too stringent, 40% say it's about right, 40% not strong enough (believes there is no strong consensus). Believes vast majority of Albertans are compliant
Who will get delayed with limited vaccine doses?: Defers to Minister Shandro. Notes he is worried about EU restricting exports of vaccine and asks federal government put pressure on Pfizer
(Minister Shandro: Still reviewing. Will follow recommendations of health officials and defers to Dr Hinshaw)
(Dr Hinshaw: Risk of severe outcomes driven. Still need to review)
Statements by Dr Hinshaw Cases
~12% of schools have active cases (607 cases combined)
Active cases in 291 schools
12 cases of variants identified: 31 UK total, 6 from South Africa
All but 3 linked to travel and from same household (1 was the community spread case)
No evidence of further community spread
Relaxations
Knows many Albertans are keen to return to activities they have missed
Most important step will be following restrictions in spirit
If in-person interactions can be replaced, cases will further reduce and prevent spread of variants
Q&A
What data is being used for deciding Step 1?: Uses BC as an example for successful limited service in these activities and did study of where spread can occur. Group fitness events are high spread (especially high intensity). Opening for fitness will be to bar high intensity fitness. Opening only low risk parts (e.g. - only a single household at a table). More information next week.
(Premier Kenney added that global data was used)
How much did Covid variant affect this plan?: Key part of plan is followed by 3 weeks of observation. A part of the 3 week timeline is to monitor for rising cases. This will allow for monitoring
How confident are you in containing variant?: Concerning in case identification. Significant testing of incoming travellers has allowed for early containment of most cases
(Premier Kenney added: Concerned for widespread risk of variant. Also considers some positives in vaccines being rolled out and increased contact tracing)
Statements by Minster Shandro
Proud of progress of vaccination
Notes Moderna's cut; it feels like Alberta isn't a priority
Alberta Health was informed that it will reduce from 24,600 to 18,800 doses (5,800 fewer. ~23.5%)
Informed all February Moderna deliveries being accessed, so unknown how much Alberta will receive in that time
Accessing impact on first and second doses
Knows the frustration from Albertans and thinks new from federal governments continues getting worse
Wants a national strategy for vaccine supply
Q&A
Does reopening 1 week from now contradict previous comments from Dr Hinshaw/Minister Shandro?: 2 important messages about "stepping up and stepping down". Trying to show Albertans how it could happen and separate from message of potential for further restrictions if cases spread further
(Upon request from Minister Shandro, Premier Kenney added: The approach is very gradual and are already available in neighbouring provinces of BC and Saskatchewan. Will monitor closely as to best balance multiple pressure on the province. Notes mental health has worsened because of economic stresses for business owners)
(Dr Hinshaw was asked to add by Premier Kenney: Notes that significant restrictions will exist in the sectors that reopen. But to get more than that will take more work from Albertans to reduce cases and hospitalization)
Additional information will be logged below:
The final question was for Premier Kenney in French. While I cannot translate, the reporter stated it was about the compliance of Albertans on vaccines.
New deaths by county: 81 F Bath, 81 F Christian, 88 F Fayette, 55 F Grayson, 78 M Grayson, 64 F Marshall, 90 F Marshall, 79 M Marshall, 89 F Mason, 60 M Mason, 90 M Mercer, 93 M Muhlenberg, 83 F Wayne
The slide that describes all of the folks that the CDC has defined as essential workers is on the left side of your slide and on the right side are those health conditions that the CDC is defined as being proven to elevate your risk for severe disease for COVID. Those are taken directly from CDC materials without editing. And what we would ask any vaccine administration site to do is to follow those if an individual says “I'm in those categories”, then we would honor the person's request and we would offer them the access to the vaccine if we have the doses to give.<...>We understand that there is a need to make it more clear for people who want and need the vaccine, where they go to get the vaccine. This is part of the challenge in building an entirely new network to deliver novel and innovative vaccines that we previously didn't have. So this is our first attempt, it will get better from here. This is the first attempt on our website under the healthcare tab, only for healthcare personnel, please, this is not for the general public. This is for health care personnel only for the next few weeks, please. I've said all along it would take all of January to reach most of healthcare personnel. If later today you go on the website https://kycovid19.ky.gov, and you look under the health care tab, there will be a new map, and that map when you click the link, you can find locations. If you find one nearest to you, and you sign up I don't know whether it will be within the next week or two weeks but they will take your name and they will allow you to register and you can get scheduled for your vaccine. <...> I am certainly, at least peripherally aware, of the activities of the legislature and I would just caution all Kentuckians, please this is a time for you to exercise your civic duty and to be informed.You can find the text of every one of these bills online at the legislative resource commission. You can find the text online. I urge you, I urge you when you see in the newspaper discussion about healthcare related and public health related bills to go and read those bills. I think if you read some of them you would share my concern. For some of those to be passed, we would have absolutely, I'm absolutely confident, had much worse outcomes at this point. I wouldn't be standing here with the governor, we would be announcing much higher death tolls, we would have had the same or worse economic harm, and arguably it could have been worse.
So, what efforts have you made, if any, to get the Republicans to revise their bills aimed at reducing your emergency powers and is there really any hope of that happening? -- Well, certainly those debates have been going on and we'll have an opportunity after seeing what does or doesn't pass. We have not been invited to testify on bills that tear powers away from the governor. So it really raises the question of “Did you want consultation, or just control?”. The bills that we're talking about are unconstitutional as well.
We have a decent stretch of no holidays where we'll have these get-togethers and whatnot, like Christmas and New Year's and even Thanksgiving just a month and a little over a month ago. If the positivity rates continue to stay as high as they are, what's the threshold to where you will look to, you know, shut down restaurants again, shut down bars? You know, obviously this high rate here is unsustainable if we want to control this virus at all. So just wondering what you and the staff will look at in terms of more restrictions and more shutdowns that sort of thing? -- I appreciate the question. Before the internet goes crazy. Let me just make sure I say we don't have any plans at this moment, for any of those steps. It is still very new in the data, the data looked really good a week ago going in a better direction. So we need more time to see it, we need to see where it's going and to talk to experts like Dr Stack and on the federal side, about what they believe could be causes, whether it's a mutated strand, whether it's these private get-togethers.
Good afternoon everybody. We are coming to you from a different time, but this has been a different week. A different week, in that we had the state of the Commonwealth and state of the budget, but also a different week because we witnessed a domestic terror attack on our US Capitol, that has now led to the death of one of the Capitol Police officers. To that family, we are thinking and praying for you. To those terrorists, no, never again, what you're doing is not patriotic. You are terrorists, it cannot be allowed. Every elected official, every leader that's out there, has a duty, a duty to this country, a duty to their faith and values. We are all responsible for our words. We cannot fann the flames and condemn the fire. Our country, we all care so much about, but what we saw on Wednesday and what we've seen in other states and even what we saw here, not too long ago on our Capitol grounds-- those are attacks on our country intended to intimidate and create terror. We will not be intimidated, we will not back down. So no more supporting these groups. No more blatant hate and disrespect in the way that we speak as leaders-- that cannot be allowed. No more questioning the people's elections. Now ought to be the moment, and the point, where we restore our democracy, where we remember that being Americans is more important than being Democrats and Republicans. Your most important team is this country and don't think you're for this country if you've just attacked our US Capitol.
So today's briefing is primarily about COVID but then we will take questions on anything ranging from a domestic terror attack to legislation that's going through our general assembly right now. We will talk about the piece that's related to COVID on that to any other questions that folks may have. We are at a really tough point, once again, in our war against COVID-19. We have successfully stopped three waves of this virus, but we are now seeing a real and significant increase in cases, and our positivity rate from people's gatherings around the holidays. I wish it hadn't happened. And we’ve got to make sure that moving forward we are not gathering in that way and we got to be really careful with as much virus that’s out there and, I'm going to show you some statements that the White House has made in their most recent report to us, but we've got to know now, we wear a mask now to protect ourselves. You have to assume if you're indoors with other people that someone has the virus, and you need to be wearing that mask outside of your own household. It's gotten that significant and these mutated versions appear to be spreading really fast.
The next piece they talk about is that aggressive mitigation must be used to match a more aggressive virus. In other words, states have to have the tools to react and to put in place, when needed, the steps that we know reduce the spread. We've shown the Commonwealth that three straight times. It includes uniform implementation of effective face masking, which we've been able to do through executive order; strict social distancing, and without the ability to enforce that, again, we're going to be in a very concerning place.
White House is also looking at some of the same vaccination challenges we are, though we've got real good news in that area. They're recommending the creation of high throughput vaccination sites. We're actively working on this right now. I believe Louisville is beta testing one at the moment, where we can get 1000s of people through every day in a site that can operate, day after day after day until the day we defeat this virus. We're going to want to make sure that when we're operationalizing this, it is regional and so every region of the state has real access and ability to get this vaccine. They also are concerned about vaccine hesitancy-- it's real, we're seeing it in some of the staff members in long term care. And so they tell me, and Dr Stack and others, to continue to message about the safety of this vaccine-- 95% effective, and to take it ourselves and to televise it and to show people that it's safe, and we're willing to do it. More than that, I'm willing to have my family vaccinated, my wife Britainy has taken it, I would never, never have recommended that to her if I did not believe that it was fully safe. We have real vaccine hesitancy that we're going to have to push through.
Federal report also went through where we rank on some different things across the country. We are 29th in the highest rate for cases. When you look at our neighbors it's pretty good comparatively and again it's hard to be any better on this list when we have so much virus around us.
Alright, in some good news. Northern Kentucky has been hit really hard recently by this virus; Cincinnati, of course, hit worse. In Northern Kentucky, we are now moving a federal surge testing to provide a, I believe, this is the third testing location in Northern Kentucky, the other two run by St. Elizabeth. So beginning on Monday, January 11th, in the Covington West IRS parking lot, the federal government, in partnership with us, is going to be providing additional testing for residents of Northern Kentucky. You can register at: http://doIneedaCOVID19test.com/. So to our officials, our communities, the media up in Northern Kentucky-- please spread this far and wide. It's open, the portal is open now, people can sign up. We want to make sure that it is full beginning on Monday, and that we take advantage of this real help that we are grateful for from the federal government.
I’m going to move now to vaccines, also some good news. So on Monday, Dr Stack and I talked about how, the speed, that we were vaccinating people in Kentucky wasn't acceptable, that we had to push harder, and that we were going to provide new goals and new guidance to do that. I can tell you since that day, it's picked up measurably. Today, the total doses administered here in Kentucky: 107,799. So on Monday we were at about 66,000. These numbers don't include half of yesterday or today. More than 47,385 vaccinations, in the last three days now. We've got to pick up our pace, even from here, but that shows that providers saw the guidance, that got clarity in that “if we can't find any more people in 1A at the moment, what do we do?” And now they have, I think, the instructions to where we can truly reach that goal: we hope 90% of all doses received, put in somebody's arm in the first week. And this is even more critical with the virus and how it appears across the country to be escalating. Of course, my hope is we're seeing a bump from Christmas that won't continue to grow, but in a minute we'll report that today's our third highest day ever. Of course the last two highest days were the last two days. So cause for concern that we will be watching closely. We're next going to have two reports on our vaccination efforts. Dr Stack is going to talk about our health care worker vaccination efforts and give a resource to those workers that have not received a vaccine yet. And then, Adam Mather from our cabinet for Health and Family Services is going to talk about our long term care program, and we got Dr Stack for the first time in a while, here with us.
Thank you very much Governor, it's nice to actually be here in person- it's a lot easier to talk to the camera straight. I'm going to show you four slides today. These are going to have to do with vaccine rollout, three of them we have already previously shared with you.
The first one, are the phases. So on Monday, this past Monday January 4th, Governor Beshear and I announced all four phases for the vaccine rollout in Kentucky.
Phase 1A healthcare workers and long term care facility residents.
Phase 1B, which is K-12 teachers, our first responders, and people 70 and older. Remember we gave the rationales for these, we need to get our kids back in school- that's absolutely essential. So they can get back to learning, and so parents have their children in a safe environment where they can be out working and doing their jobs, immunizing the adults in the building is a way to open those schools as safely as we possibly can. We also need to get to the individuals who are 70 and older. 75% of the people who have died from COVID-19 in Kentucky, are 70 and older that's another reason why we work so hard to get the long term care facilities. And then the first responders obviously we rely on to keep us safe and protected and help respond in our time of needs. And I think all of us have understood the importance of getting these populations.
After that, we announced on Monday phase 1C, which is the rest of 1B, as the CDC defined it, plus parts of the next phase in the CDC plan, that would capture all of the folks who are in the CDC bucket for either essential worker category, and those people at most high risk for severe COVID disease. Anyone with the conditions that the CDC defined on its website, at the time that we published these guidelines these phases, who has health conditions who are proven to result in more severe disease. And that's for anyone 16 and older who has any of those highest risk conditions.
When you move to phase 3 and phase 4, at that point we're talking about healthy individuals who do not meet any of the other criteria, and then it's an age based tiering where you go to people between 40 to 59 for phase 2 and then phase 3 would be 16 to 39 years of age. We won't get to the phase 3 as soon as probably until sometime in summer, and phase 4 is not even eligible for the vaccine now because the vaccine is not authorized for anyone under the age of 16.
This next one is really important. A shot that sits in a freezer for an extended period of time is no use to anyone. And because it is incredibly difficult to find people who meet very specific, very discrete, descriptions it's hard to locate all of them; and because unfortunately there's a substantial proportion of the population who is opting to wait for the vaccine later or has some concern or hesitancy. It's very difficult because when we allocate certain proportions or numbers of vaccines for specific purposes, not all of the population always accept the vaccine when offered initially. And so for this reason it's absolutely important that while every week a vaccine administration site starts at the top and works from 1A to 1B to 1C, and they go in that order, always trying to reach the highest priority people first, and always promoting to the people in only the open tier, that at the end of the day, every week, we want every administration site to give 90% or more of the vaccine that reaches the state within seven days. So the goal is a willing arm is a ready arm to receive the vaccine. Use the vaccine, give the vaccine, do your very best to target and reach the highest risk individuals as defined in the phasing, but at the end of the day, every week you should use all the vaccine you receive to the best of your ability. And then next week if you get more than we move forward and we keep that process up until we get to everybody who wants to be vaccinated.
The next slide is my one new slide for this week. We understand that there is a need to make it more clear for people who want and need the vaccine, where they go to get the vaccine. This is part of the challenge in building an entirely new network to deliver novel and innovative vaccines that we previously didn't have. So this is our first attempt, it will get better from here. This is the first attempt on our website under the healthcare tab, only for healthcare personnel, please, this is not for the general public. This is for health care personnel only for the next few weeks, please. I've said all along it would take all of January to reach most of healthcare personnel. If later today you go on the website https://kycovid19.ky.gov, and you look under the health care tab, there will be a new map, and that map when you click the link, you can find locations. If you find one nearest to you, and you sign up I don't know whether it will be within the next week or two weeks but they will take your name and they will allow you to register and you can get scheduled for your vaccine. So we have guaranteed to provide a steady supply of vaccine. It's not as much as I want to supply. We get 53,000 doses a week every week in the state and that's likely to stay that way well into February. It's only so much to go around. But we have committed to supplying these locations with at least some steady reliable supply, so they know how many appointments they can schedule. If you consider yourself healthcare personnel, that does include doctors and nurses, but also social workers and therapists and people who care for vulnerable people and home-based care, hospice workers. It includes dentists and hygienists and psychologists and podiatrists, optometrists. It includes Health Sciences students, Medical Laboratory workers. I'm giving a long list, so that if you think you are a health care personnel. Please identify yourself as such, register, and go get the vaccine. We are trying to prioritize that as much as possible but every site is to use all their vaccine within seven days of getting it, and at least hit 90%. Before I step down, I want to emphasize what the governor said. I think that the rise in our test positivity rate is very concerning. I think we definitively stopped, we halted, the third climb before the holidays. I feel very confident about that and I think the data shows that very soundly. I think unfortunately over those two holidays, back-to-back, what ended up happening is people socialized and they spread disease in ways that are now resulting in an increase in our positivity rate. Our hospitalization data suggests that there could be the beginning of a new increase, we know that hospitalizations probably follow around two weeks or so, or more, after the positivity in the new cases. So we will now see over the next few weeks how bad it gets. I urge you, I urge you: please wear your mask, wash your hands, keep your six foot distance, and please, if you are sick, stay home. Do not go out until you feel better or unless you need to seek medical care, and get tested. If you believe you've been exposed, or think you have COVID please get tested. Be informed and take the necessary steps.
My final point for today is though I've been pretty overwhelmed with the vaccine rollout, and obviously still overseeing some of these other operations, I am certainly, at least peripherally aware, of the activities of the legislature and I would just caution all Kentuckians, please this is a time for you to exercise your civic duty and to be informed. You can find the text of every one of these bills online at the legislative resource commission. You can find the text online. I urge you, I urge you when you see in the newspaper discussion about healthcare related and public health related bills to go and read those bills. I think if you read some of them you would share my concern. For some of those to be passed, we would have absolutely, I'm absolutely confident, had much worse outcomes at this point. I wouldn't be standing here with the governor, we would be announcing much higher death tolls, we would have had the same or worse economic harm, and arguably it could have been worse. Our hospitals would have been overrun by this point like they were in the spring in some places, the summer in others, and right now in the winter. I'm standing here today, able to tell you we've not had a single hospital collapse or get overrun this entire response because we have responsibly navigated this and worked in partnership with you, the people of the Commonwealth of Kentucky, to keep yourselves and your neighbors and family and friends and loved ones safe. I urge you to be informed and to express your opinions, so that your opinions are heard. Because if we allow ourselves to be uninformed and not exercise our civic duty, I am concerned that some things could be passed that could make it very very difficult for us to help work together with you to keep everyone safe and get through this intact and in a better condition on the other side. It remains a privilege to serve, and thank you for your patience with the vaccine folks. 53,000 is 53,000 there's only so many ways to divide the doses we get. We're doing the best we can, we will get to everybody but it's going to take some time. So, thank you very much governor.
Now, last night in the state of the Commonwealth, I talked about the fact that we as a Commonwealth have learned that an effective management, an effective approach, an effective public health approach to this virus is necessary to sustain and rebuild our economy. In fact, just today. I read a news story about how one of Ford's plants, which employs 1000s of people, is having to shut down because the virus swept through one of the auto parts suppliers that it needs. Failure to manage and to have the tools in place for this virus, is going to have significant economic impact and just-- it's going to take us a lot longer to recover; but we'll talk about that a little more in a minute. Next is Adam Mather. He is with our Cabinet for Health and Family Services, and he is one of our point people on the long term care vaccinations. Remember, this is 66% of our deaths, so it's absolutely critical that this piece run smoothly and Adam is working real hard on it, Adam.
Thank you Governor. I also want to thank you in working with our national partners at CVS and Walgreens, in respect to authorizing and initiating the skilled nursing facility in the assisted living facilities at the same time. That is to be considerably more effective and more efficient at distributing the vaccine to our most vulnerable populations.
I'll just go over these very quickly and I'm sure there'll be questions at the end and I'll stick around for them to answer. And so when you look at the facilities that have been vaccinated thus far we're sitting around 287, these numbers are from yesterday. There will be, in discussions with CVS and Walgreens, significant ramp ups and a pledge by both partners to be finished by January 25th for skilled nursing facilities. You can see the doses administered are a little less than 24,000, a pretty significant number but we're looking to ramp that up with our national partners over the next couple of weeks. And then residents vaccinated, we are seeing some differences there. Some of that is due to COVID outbreaks in facilities where they've been unable to vaccinate those individuals when they're on site for their clinic, but they are offering three clinics and so they will be able to do that appropriately. And then, as the governor mentioned, staff vaccinations remain a bit of an issue. Some of that caveat some of that is that some of the facilities have decided to split their staff in half in case there are any reactions, or call outs that they have enough staffing. A note with that is we have not seen any significant call outs or reactions from vaccination. And anecdotally nationally they've seen on the second round of clinics that staff are more willing to take the vaccine, so we should see a significant ramp up there, and hopefully in the next couple of weeks we will see it increase significantly. And with that I will give it back over to you Governor I appreciate all your help on this project.
Thank you to Adam and I know he's going to stay on the line. Just yesterday Operation Warp Speed had a call with the head officials from the federal government; we had numerous people on it. The head of Walgreens and CVS were on it. It was very positive in that real commitments to do better, not shying away from the fact that we need to speed up, everybody accepting the task ahead of us and that's the most important thing is how do we improve day in and day out.
A Canadian's Guide to Applying to US MD/DO | Overview of the Process
Hello everyone! I made a post a couple of weeks ago about my journey to getting accepted at a US MD school as a Canadian [https://www.reddit.com/premedcanada/comments/kunf98/504_502_512_accepted_canadian_at_us_md/]. Many of you asked about a subsequent post to walk through the process of applying to the US as a Canadian – so here we go! Just a heads up, I’m going to be highlighting a lot of differences when applying to the US, and my point of comparison will always be OMSAS (the Ontario medical school portal). However, I think this post is beneficial to anyone applying from Canada, regardless of what province you are in! Disclaimer: This post is not meant to flaunt privilege, finances, or anything of that sort. I understand, and so will you by the end of this, that the process of applying to the US requires a lot of resources, money, and time. The sole purpose of this post is just to inform all of you of the process, and if YOU have the time and resources to go ahead with it, then I hope it will be helpful to you 😊 With the being said, my advice and knowledge below is based on my experience and solely that. Please always do your own research before committing to anything, as this is just a starting point to give you a basic idea of what it’s like to apply to the US. Lastly, this post really is for beginners who have never applied to the US before, so if you already have, a lot of this may be redundant for you – but feel free to keep reading! :)
MD vs. DO
Firstly, understand that there are 2 types of schools in the US. Allopathic medical schools grant you an M.D. and Osteopathic medical schools grant you a D.O (in Canada we currently only have allopathic schools). The portal for the MD schools is known as AMCAS (https://auth.aamc.org/account/#/login?goto=https:%2F%2Fapps.aamc.org%2Famcas%2F) and the portal for DO schools is known as AACOMAS (https://aacomas.liaisoncas.com/applicant-ux/#/login). I am not going to get into the details of the differences (there are several YouTube videos and Reddit posts about this), but just know that there are two kinds of schools in the US. The process of medical school, the curriculum, applying to residency is largely similar, with some notable differences. In both cases, you become a physician at the end of your training. Do your own research to see what you think about both types of schools and make informed decisions. For what it’s worth, I know Canadians who have pursued MD and DO in the US, and both are thriving with successful careers today. There may be some challenges when it comes to competitive residencies, but I’ll let you be the judge of that. My personal advice – if you are open to pursuing primary care and/or are not entirely sure on what kind of specialty you may want to pursue one day (aka have an open mind atm) – then apply to both. The larger school list you have, the greater your chances are to get an interview from somewhere. The portals for MD and DO are largely similar in their framework, so my advice below can be applied to AMCAS and AACOMAS.
Rolling Admissions
Unlike OMSAS where everyone basically submits by October 1st and there isn’t really any advantage of submitting early – the US is completely different. They work on a rolling admissions basis, which essentially is a first-come, first-serve basis. Timing is very important when applying to the US, and if you want to maximize your chances, you want to apply early. The portals open up in the first week of May every year. At this point, you can go into AMCAS/AACOMAS and start to enter all of your information. People usually use the month of May to gather all of their materials and work on their application (or you can be really ahead of the game and prep all of this now, so May is less stressful). The portal lets you submit your application in the first week of June. To have the best shot of getting an interview, you want to ensure you press submit in early June. What happens next is that the portal takes about 3-4 weeks to process your application – this is usually the rate-limiting step. The faster you press submit, the sooner they can start processing your application, and the sooner your selected schools can receive your application and get the ball rolling. Unlike OMSAS, the US portals are open for a LONG window of time. Many schools will let you submit your primary application anywhere between June and December (and beyond). That is a very large window, but to maximize your chances you want to submit in June. You can still submit whenever you want technically speaking, but I would advise against it as you’re only making it harder on yourself. Many schools in the US will start interviewing as early as August, and some may even have a majority of their class filled by December (the year before you matriculate), so timing is important! Although you will see application deadline dates for various schools to be very late (some are even like 3 months before matriculation), do not be fooled by this - apply early to have the best shot!
Primary vs. Secondary Application
Unlike OMSAS where you basically enter everything at once and you’re done with the application (upon completing CASPER), the US has two kinds of applications. Primary Application: You use AMCAS/AACOMAS to fill out your primary application. The following points are for AMCAS in particular, but AACOMAS is largely similar. AMCAS consists of the following information: · Identifying information (standard) · Schools attended (standard) · Biographic information (standard) · Course work (standard) · Work/Activities (a lot like your ABS from OMSAS, but more on this later) · Letters of evaluation (standard)* · Medical schools (where you choose your schools list)* · Essays (your personal statement – more on this later) · Standardized tests (MCAT scores and such) This is the information that you want to complete and press submit by early June. Upon pressing submit on AMCAS in early June, you are unable to alter or change anything except for the starred items (letters of evaluations, medical schools). You are always able to add more letters of references and add more medical schools to your list, even after you have submitted. Technically, you can submit your application with no letters of references initially, but make sure you have them in as soon as you can. If you make any changes to the starred items, all you do is resubmit your application – and there are no disadvantages to doing this once your application has been processed by AMCAS. New schools you add or new letters you add can be received pretty quickly if you do ever resubmit, as long as you’re already processed by AMCAS MCAT scores can also be added to your application. AMCAS will ask you if you have an upcoming MCAT date, and you can put that date in so the admissions committee is aware that you are still taking the MCAT. However, know that if you apply in June, and mention that you are taking the MCAT in August, you may not necessarily be seen by the admissions committee until they have your new MCAT score. It varies based on school, but generally speaking in an ideal case you would already have an MCAT score that you're happy with when you submit your primary, However, if you need to rewrite over the summer, that's fine, just make sure you indicate that on your application and understand that you'll most likely be evaluated when your new score is released. Secondary Application: Once your primary application has been sent out (hopefully by early June), it will take 3-4 weeks to process by AMCAS. Once it is done processing, every school you applied to will receive your application, and you will receive a secondary application from each school (usually in July, if you submit your primary app in early June). In the US, almost every school has a ‘secondary application’. This application is essentially a series of essays with word limits that you need to submit. Pretty much every single school in the US has a secondary application, so unfortunately there’s no escaping it. Now, some schools will actually pre-screen you before they send you a secondary application (so there is a chance you may not get a secondary if you don’t qualify) – however in my experience, it seems like a majority of schools don’t do this and will send you a secondary application nonetheless (lowkey it costs $$ to submit a secondary application, sooooo I get it ☹ ). Once you receive your secondary application, you want to submit that as soon as you can – only then is your job done! You can be very efficient and submit your primary in June, BUT if you receive your secondary in July and don’t submit it until August/September, you’ve basically lost your advantage. By the time you complete your secondary application, you also want to try to have all your references in by then as well (not necessary, but definitely a good idea). Once your secondary application is complete, the school has everything they need to open up your file and start the process. It is at this point where the waiting game begins for you… Regarding the content of secondary applications, there is generally a theme. Every school differs in the kinds of questions they ask but generally speaking you’ll see a lot of ‘Why do you want to attend school X’, ‘What makes you special/unique?’, ‘Describe a time where you displayed X’, and so on. To save time, a lot of applicants pre-write their secondaries even before they receive them. This is because secondary applications generally don’t tend to change from year to year. A database online actually lists the secondary questions from every school based on the year before, and for the most part, you can count on it not changing. Here is the website: https://www.prospectivedoctor.com/medical-school-secondary-essay-prompts-database/. However, with that being said, given the status of the world currently, and an ongoing pandemic, questions might be evolving over time. I personally never had the time to pre-write secondaries, BUT it can be very useful. In an ideal situation, you could submit your primary by early June, take the next 3-4 weeks to pre-write all of your secondary applications, and then when they arrive in early July, you can simply copy and paste and submit them ASAP to save time. It’s definitely easier said than done lol, but an option that I’ve seen people do.
GPA + MCAT
If you’re used to the cut-throat GPA culture that exists at a majority of Ontario medical schools, then you’ll be happy to know that in the US, GPA is a little more flexible than it is in Ontario. Unless you want to attend an IVY league, generally speaking, the GPA ranges are not as intense as they are here. You don’t necessarily need a 3.9+ to get an interview, the ranges vary on a scale and I found it a lot more accommodating. In terms of MCAT, it honestly varies from school to school. From what I’ve seen though, they tend to use the MCAT holistically and as a total score vs. requiring specific scores in certain sections like ahem some of our Canadian schools. The US is also a lot more holistic when it comes to assessing an applicant. From my experience and after speaking to some people as well, I’ve learned that your stats (GPA+MCAT) will get you the interview, and the foot in the door. For you to seal the deal and get accepted, your experiences, activities, personality, goals, and such come into play during the interview. This is obviously not the case for every school in the US, but generally speaking, that is the case. The US also cares about the number of times you’ve taken the MCAT. Generally speaking, if you have an upwards MCAT trend, then that’s great. If you’re showcasing considerable improvement every time, that’s good. However, at some point, there is a limit and 3+ or 4+ attempts could be frowned upon. Also, if you happen to have a downwards trend, that also doesn’t help unless you are able to recover it and increase it again (like me). Most schools look at the most recent MCAT scores, but some will take the highest, and others will super-score the MCAT scores (highest from every section across all attempts). Every school is different, so make sure you do your research. This link has a great table with every school in the US and how they treat the MCAT, very useful if you have multiple attempts: http://manoa.hawaii.edu/undergrad/pac/health/allopathic-medical-school-multiple-mcat-scores/?fbclid=IwAR2DBlRUZtv8YSW7lIdeo9emax0DMz4YeGjKPsjbSifXlZORJgoU9VDqMp0 My advice – based on your GPA and MCAT, filter through all of the schools in the US to see where you might have a shot. A great tool for applying to MD schools is MSAR (https://apps.aamc.org/msar-ui/#/landing). I’d recommend buying a subscription and it will inform you about all of the MCAT and GPA requirements, averages, and a TON more information specific to each school, in an organized fashion. You can also filter based on what schools accept Internationals, which helps us Canadians! The DO equivalent is called Choose DO Explorer (https://choosedo.org/choose-do-explorer-registration/). If you’re ever confused about something on the MSACDE, I’d recommend emailing the admission committee directly for the school you’re inquiring about as sometimes MSACDE might capture general information while the school can give you specifics. One last thing – unfortunately as Internationals applying to American medical schools, we need to present stronger stats than in-state applicants. When I was rejected from schools in the 2019-2020 cycle, I scheduled an appointment with some of the schools to gain feedback on my application. The admissions committee from one of the schools mentioned to me that although their MCAT average at that particular school is 508, a lot of the Canadians/Internationals they accept tend to have 510-511+ MCATs. Unfortunately, it is what it is, and having stronger stats than the average is helpful to get ahead of the competition. This is not an overarching statement for all schools in the US, but this is what I’ve been told so keep that in mind when you compile your school list. EDIT: I forgot to mention that AMCAS/AACOMAS actually evaluate you as an applicant based on two different types of GPAs.
An overall cumulative GPA (cGPA)
A science GPA, known as the BCPM GPA (including all biology, chemistry, physics, and math courses).
A lot of people assume that when you apply to US MD, you absolutely need shadowing as a requirement. This is not true. I’m sure there are schools out there that do require shadowing, but from my experience, I haven’t come across any in the 3 years I’ve applied. You will definitely see shadowing as a recommended activity/experience, but I haven’t seen it as being a necessity. In Ontario, it is very difficult to land any shadowing opportunities, so that is just the fact of the matter. Don't avoid applying to the US for the sole reason of not having shadowing experience because it is a holistic process. For what it’s worth, I didn’t have any shadowing experience and I wasn’t asked about it either for the MD interviews. D.O. however, is slightly different. A lot of DO schools will require applicants to have shadowing experience with a DO. As Canadians, this is really hard because it’s not as accessible to find DO’s that practice in Canada to shadow in comparison to the US. I’ve read on threads that people have traveled to the US for this shadowing experience (which is crazy lol the dedication is impressive). My advice would be to choose your schools list wisely and clarify with the school in particular if they require shadowing with a DO, or if it’s just recommended. With all of that being said, I hear this shadowing requirement/recommendation has been changing over the past year given that it’s not really possible to do in a pandemic – so that may actually work out better for a lot of people. Just do your research about this! As a side note, shadowing is a pretty passive experience. If you don’t have it but have other clinical experiences that are more active in nature, definitely play those up – they will see value in it.
Prerequisites
This is likely going to be the largest hurdle for a lot of Canadians applying to the US. Unlike applying to Canadian schools which generally do not have many prerequisites, the US is very different. With the help of MSAR and checking every school’s particular requirement on their admissions sites, do your research before applying. I know you don’t want to hear this, but yes many schools do require a full year of physics and a full year of organic chemistry. Not all of them do, but a good chunk do. I know this poses a challenge for a lot of Canadians applying to US schools, but unfortunately, it is what it is. In my opinion, you have three options really. If you’re still in school, just take the courses! You can also email some schools to ask if they are willing to take it as Pass/Fail (many will likely not give you a straight answer, but it’s worth a shot). If you’re no longer in school, you can definitely still take physics/organic chemistry as a non-degree student at any institution. I’m not sure how this works when it comes to your GPA calculation, but I’ve heard it’s an option some people pursue. If none of those work for you, you can filter your list based on what prerequisites you do have, and apply to those schools with strong faith. NOTE: Prerequisites need to be fulfilled before matriculation, not before the submission of primary/secondary applications - so this buys you some time. At least this is the case with most schools.
References
Unlike OMSAS where you are free to have any 3 letters of reference from your professional networks, the US is very different. Firstly, unlike OMSAS where every school gets the same 3 references, in the US every school has a different requirement. On the AMCAS portal, you request a certain number of letters based on who you contact, and then select which references you want to send to which schools. The reason it is this way is because the requirements at every school vary. The biggest obstacle I faced, and I think many people feel this way, is the academic reference requirements. Many schools in the US will require 3 academic references. This would include professors from your university who have taught you, supervised you, or know about you in some shape or form. Some schools will specify if they want 2 science professors and 1 non-science professor. Besides that, some schools will require a letter from an MD/DO physician (based on shadowing OR other research-related experiences). In my experience, the MD schools I’ve applied to in years past didn’t have a physician requirement BUT many of the DO schools either required a reference letter from a DO or strongly recommended that you have one. The specific information for what schools require what kinds of references can be found on MSAR as well as supplemented with the institution’s admissions website. As mentioned before, you can always add or remove references even after you have submitted your primary application. A lot of applicants have this misconception that they need to have their references in before they press submit on their primary and hence delay their submission – but this is not true! You can upload them afterward and it’s fine, just make sure to do it in a timely manner or at least by the time you submit your secondary application. Many schools will have limitations as to how many references you can send – ex. some schools will want 3 academic references and nothing else, while others will have some required ones and some that are up to your choice. I believe AMCAS lets you request up to 10 letters on your profile, and then you can select which schools will receive which ones. However, for AACOMAS, you cannot assign which letters go to which schools, all of your letters go to all the schools (like OMSAS). My advice – contact your professors soon and have a couple in mind from now on so you’re not frantically searching for professors in June. Personally speaking, I submitted 3 academic references, 2 research references, and 1 volunteer reference for my US MD applications.
Work/Activities Section on AMCAS
This section of the application is very similar to OMSAS, except that you have more breathing room in terms of character limitations. You have 700 characters to describe an activity, and you can add up to 15 activities on AMCAS. You then choose 3 activities that are most meaningful and have an additional 1325 characters to elaborate. Just like OMSAS, you will also need verifiers. The activities section for AACOMAS is slightly different, and it has some differing classification of activities, but overall it is pretty similar in function. From my experience with applying to the US, it seems like clinical experience (voluntary & paid) is valued higher than research experience when it comes to your activities. I can say this based on my experiences as I had a decent amount of both however at the interviews, I wasn’t really ever asked about my research experience, and the focus was on my clinical experiences. I know this varies though based on every school you apply to, and maybe IVY league schools have a larger emphasis on research, but this is what I experienced.
Personal Statement
This is the additional component of the primary application for US schools that OMSAS does not have. It is one essay that is sent to every single school you apply to. The question is the same pretty much every year: Use the space provided to explain why you want to go to medical school in 5300 characters or less. From what I’ve heard, this essay is valued pretty highly when it comes to evaluating you as an applicant. Many schools will look at your GPA, MCAT, and personal statement, so make sure you work hard on it! This essay can take a while to write, and it’s a good idea to get it reviewed by several people (even people not in medicine) before you submit it. If you start now, you can have it all good to go by the time May comes around! You will likely go through several drafts of this essay before you are happy with it (I had about 21 lol). AACOMAS also has the same question with the same character length. There is debate about whether one should change it based on whether you are applying to MD vs. DO, but that is up to you. I think in an ideal case, you would customize your DO personal statement to focus on certain parameters that are more relevant to osteopathic medicine. I personally didn’t have time and kept it the same for both portals – however, if I did have the time, I likely would have changed the DO one slightly. You can find my personal advice on how to write a good personal statement at the end of my previous Reddit post: [https://www.reddit.com/premedcanada/comments/kunf98/504_502_512_accepted_canadian_at_us_md/]. Furthermore, in my 3rd cycle applying to the US, I decided to seek out some professional help for my personal statement. I used a service provided by "@premed_plus" on Instagram, and I found it incredibly useful. Their team was able to comprehensively review my personal statement many times and provided insightful feedback and rigorous edits. Compared to other services out there, I found it relatively affordable as well. I would definitely recommend it if you decide to seek out professional help for your personal statement. As a side note, you can also do really well independently, but for me personally, after 2 unsuccessful cycles, I wanted to give it my all the 3rd time around so I decided to use this resource. Check them out on Facebook too: https://www.facebook.com/PreMedPlus115
Finances
There is no surprise here. Applying to the US is going to be more expensive than applying to OMSAS or other Canadian schools. I think it goes without saying that the actual tuition is pretty insane (anywhere between $60K-100K/year). Before you decide to apply to the US, have a conversation with your family and establish a plan for how you are going to go about financing it, if you got accepted. Unfortunately, as a non-US citizen, you aren’t eligible for financial aid in the US, so you need to find some way to finance it (loans, LoC, assets, investments, private donors, etc.). Besides tuition, here are the application costs for the US: AMCAS – primary application costs $170 for the first school and $41 for each additional school you add. The secondary application fees differ for every school but I would approximate it to be $70-$110, per school. AACOMAS – primary application costs $196 for the first school and $46 for each additional school you add. The secondary application fees differ for every school but I would approximate it to be $50-$100, per school. Fee Assistance Programs exist for both AMCAS and AACOMAS.Yes, all of these prices are in USD ☹ (I know, this part makes it so much worse as a Canadian)
Early Decisions Program (EDP)
The US has something called EDP, which can also be an option for some applicants. Not every school in the US has this program, but several US schools do have it. When you are applying to an American medical school, it may ask you if you would like to enroll in the early decisions program. This means that you are ONLY allowed to apply to one MD school in the US. The reward you may ask? If you are selected to be interviewed, you will be interviewed in the very first round of interviews for your school (before anybody in the regular pool of applicants are interviewed), and you will be given a decision by October 1 (the year before your matriculate). In terms of timelines, you may submit primary in June, submit secondary in July, interview in Aug-Sep, and by Oct 1, you will have a decision from that school. It is an all eggs in a basket kind of approach – high-risk, high reward. Pros – you save a lot of money, as you only end up applying to one school. You only have to write one secondary application. You could potentially even tailor your personal statement to the mission statement of that school in particular, as it only goes to them. Some schools tend to have stronger acceptance rates through EDP vs. the general pool. You can be accepted a solid 10-12 months before you start medical school, having a stress-free year. Cons – you really spread yourself very thin. You limit your opportunities to one school and have all your hopes and dreams rely on it. If you don’t get accepted on Oct 1, then you are now eligible to apply to any other school in the US – however, it is late in the cycle. Nothing is stopping you from applying to other schools if you are rejected/waitlisted on October 1, but understand that you are at a disadvantage of applying to new schools on Oct 1 due to the rolling admissions nature of US schools. If it is your first time applying to the US, it may not be the most ideal situation to go with because you are limiting the number of schools can apply to. However, if you notice that you meet the qualifications for a certain school to apply EDP, and you absolutely love that school and could see yourself going there, it’s not a bad option, as long as you understand the consequences if you are not accepted. Personally speaking, after two unsuccessful ventures applying to the US as a general applicant, I eventually applied through EDP and was accepted. However, that was just my experience, so please make informed decisions about your process.
Closing Remarks
Wow, that was ultra-long. I hope this overview was useful to you! Just a reminder to always do your own research. A lot of the opinions I’ve formed over the course of this post are based on my experience, and I may be wrong, so definitely look into it yourself as well. As you can see, applying to the US requires a lot of time, money, and resources. You may do all of this and land nowhere despite having great stats, a fantastic story, and unique activities – unfortunately, that’s just the way medical school admissions is like with the insane competition we’re all experiencing. If you want to look beyond the US, I hear Ireland and Australia also have great programs with decent match rates (always inquire about this though, some of these schools boast some skeptical statistics aha). As always, if you have any questions feel free to holler below or DM me for any personal questions. Based on my last post, I anticipate the volume of responses to be pretty high lol, but just know that I will make an effort to respond to all of your comments/DMs in due time. Good luck on your journey, fellow pre-med!
A beginner's guide to investing in the bond market (and debt mutual funds).
2020 has been a wild ride for investors in the financial markets. All over the world, stock markets crashed in March, central banks started to print money (out of thin air) at an unprecedented rate and the markets bounced back to new all-time-highs even though the global economy haven't fully recovered from the pandemic. A lot of investors have been reminded about the importance of managing the risk & protecting the downside of the investment portfolio. As a follow-up to my earlier post about stock market investing, let's look at how investing in bonds can benefit investors. Compared to stocks, bonds are a low-risk stable investment. Holding bonds in an investment portfolio reduces the risk & volatility of the overall portfolio, while ensuring decent returns for the investor.
What is a bond ?
Most of us are familiar with a traditional Fixed Deposit. To create an FD offline, we'll go to a bank and give our money to them for a specific period of time at a specific interest. They give us a 'receipt' as a representation of the FD. The receipt will have the FD owner's name, principal, interest rate and maturity date. We can't transfer the FD to someone else. During the duration of the FD, we don't care about how & where the bank uses our money. We merely want the money to be kept safe, and we want to continue receiving/accumulating interest. Once the FD duration is over, we go to the bank to return the receipt and they'll give us the money along with the interest. As long as the bank stays afloat, it's a risk-free way of earning returns on our money. Essentially, we have lent our money to the bank, and the bank repays the money at a later date with some interest. This is the simplified version of how a bond works. A bond is a fixed-income debt instrument that represents a loan given by the investor to the borrower (a.k.a bond issuer). In the case of an FD, the borrower is the bank and we are the investor. Bonds are known as fixed-income instruments because they provide a fixed 'income' to the investor via the regular interest payments. Unlike FDs, bonds are actively traded in the secondary market. Bonds come in all shapes and sizes, and it can be tough for a new investor to choose the fixed-income investment that's suitable for their needs. To understand things better, let's look at the basic attributes of a bond.
Bond Attributes
Face Value : Also known as Par Value. It's the price of the bond when it's first issued. It is also the amount of money the bondholder will get once the bond matures.
Coupon Rate : It's the interest paid by the bond. It's represented as a percentage of the bond's face value. For most bonds, the coupon payments are paid once or twice a year.
Term to Maturity : Simply known as Maturity, it's the lifetime/tenure of the bond. The time period after which investors will be paid back the money.
The above attributes are constant/fixed for most bonds. Apart from these, there are other dynamic attributes :
Price : This is the market value of the bond after it has been issued. Since all bonds are marked-to-market, the bond's price will fluctuate in relation to the price of other bonds. When a bond is freshly issued, the price will be equal to the face value. But, soon after, the price will vary depending on market conditions
Credit rating : This indicates the bond issuer's ability to repay the debt. The credit rating of a bond can change during the lifetime of a bond. A bond's credit rating is often used as a measure of how much risk an investor takes by investing in such bonds.
Yield-to-maturity (YTM) : YTM is the expected return an investor can get by holding a bond till maturity. It depends on the current market price & the remaining years till maturity. YTM is considered as the XIRR of the bond, since it considers the 'time value' of the future coupon payments.
Modified Duration : It is a measure of how much the bond prices can change when the interest rates change in the market. For example, if the modified duration of bond is 5, it means that the bond's price can increase/decrease by ~5% when the interest rate changes by 1%. Long-term bonds have higher Modified Duration, because they're more sensitive to interest rate changes.
Macaulay Duration : Simply known as Duration, it's a measure of how long it takes for an investor to earn back the money they invested. (ie) It's the duration needed for investors to be paid back the bond's price. Duration shouldn't be confused with Maturity, although both are measures in years.
Bond categories
On a broader level, there are two categories of bonds :
Government bonds
These are bonds issued by the government - Central govt, state govt or municipal govt. Government entities issue bonds to raise money from the public for various purposes. Bonds issued by the government are virtually risk-free since they have a Sovereign Guarantee (ie) The government always repays its debt. Government bonds have a maturity of a few weeks to a few decades. Treasury Bills are short-term bonds issued by the Central Government with maturity of 3 months, 6 months or 12 months. G-Sec (also called as 'dated G-Sec') are long-term bonds issued by Central & State Governments with maturity of several years. Although government bonds are risk-free for a domestic investor, it's not the same for foreign investors. Each country is assigned a sovereign credit rating based on the country's economic stability. India's international credit rating is BBB- . International bond investors use the country's sovereign credit rating to assess the risk of investing in the government bonds of a particular country. In the domestic bond market, government bonds are the most actively traded & they have high liquidity (ie) A government bond can be easily sold at a fair price, whenever we want. Moreover, financial institutions like banks are required to hold a certain percent of their assets in short-term government bonds. So, it's guaranteed that there'll be a lot of buyers & sellers of govt bonds. If there's a mismatch between the supply and demand in the govt bond market, RBI will buy/sell government bonds (via Open Market Operations) to restore the balance of liquidity in the bond market. If we look at the list of Outstanding Government Securities, we can see that bonds issued at different times have different interest rates. The interest rate of government bonds depend on the economic conditions & the demand/supply in the bond market. When there's high demand, the govt can afford to issue bonds at lower interest rates. Conversely, when the govt needs to raise money quickly, they'll have to issue bonds with high interest rates to lure investors.
Corporate bonds
Any bond issued by a non-government entity comes under this broad category. More specifically, any bond without a sovereign guarantee can be considered as corporate bonds. The issuer can be a PSU, private bank, private corporation. The different types of corporate debt include Commercial Paper, Certificate of Deposit, Secured/Unsecured Debentures etc. Corporate bonds' interest rates depend on the issuing corporate entity and the economic condition. Each corporation is assigned a Credit Rating to indicate its 'credit-worthiness' (ie) Its ability to pay back the debt. The credit rating of an organisation and its bonds can change based on the corporate's finances, its total debt and its future economic prospects. Credit rating upgrades & downgrades are a very common occurrence in the bond market. The credit rating for the issuer is given by several rating agencies like Standard and Poor's, Moody's, Fitch. The S&P credit ratings for long-term bonds, in the order of highest rating to lowest rating, are AAA, AA+, AA, AA-, A+, A, A-,BBB+, BBB, BBB-,BB+, BB, BB-, B+, B, B-, CCC+, CCC, CCC-, CC, C, D. The bonds with credit rating AAA to BBB- are termed as investment grade bonds. All companies strive to become investment-grade so that more investors will buy their bonds. Naturally, well-established & financially-stable companies tend to have a higher credit rating than emerging companies. Since the repaying capacity of emerging companies is questionable, they have to issue bonds with a higher interest rate to entice investors into buying the bonds.
Types of bonds
The most common type of bond is called a Straight Bond. The list of attributes (in the 'Bond Attributes' section) applies to Straight bonds. However, there are some special types of bonds in which the attributes vary.
Floating-Rate Bond : The coupon/interest rate of these bonds varies on a regular basis. The interest rate is usually tied to a short-term interest rate benchmark. When the benchmark rate changes as a result of economic conditions, the interest rates of these bonds are also changed.
Zero Coupon Bond : These bonds have no coupon payments. Instead, the bonds are sold at a price that's discounted from the face value. For example, if the face value of the bond is ₹100, the bonds are sold to investors at ₹95. The 'returns' from the bond is the difference between face value and discounted price (ie) ₹5. Short-term bonds, like Treasury Bills, tend to be zero-coupon bonds.
Callable Bond : Some bonds have a 'callable' option. (ie) The bond issuer can call back the bond before it reaches maturity & give back the money to the investor. Generally, the bond issuer uses the call option to buy back the bond if the current interest rate in the market is lower than the bond's interest rate. 'Callability' is one of the extra attributes that a bond can have.
Convertible Bond : Companies sometimes issue these special bonds that can be converted to stocks of that company. These bonds offer dual benefits to the investor - If the company's stock performs well, the investor can convert the bond to stocks & reap the benefits of the stock's growth. If the stock performs badly, the investor can still earn a fixed return by keeping the bonds. Investor's downside is protected, while letting them benefit from the company's potential upside.
Perpetual Bond : These bonds have no maturity date. Investors receive coupon payments forever (unless they sell the bond in the secondary market or the bond issuer buys back the bond). Since there's no maturity, perpetual bonds are often compared to dividend stocks. However, perpetual bonds are more risky than normal bonds. The bond issuer can choose not to make the coupon payments. Also, the bonds can easily be 'written down' if the bond issuer is in severe financial trouble. (Eg: Yes Bank, Lakshmi Vilas Bank)
Inflation-Indexed Bond : A special type of bond where the face value and coupon payments vary depending on the inflation. These bonds serve as a 'hedge agains inflation' by preserving the value of the bond by indexing it with respect of inflation. In US, it's known as Treasury Inflation-Protected Security (TIPS). In India, the bonds aren't as popular. Although it seems like a great investment, the inflation-adjusted price of the bond is taxed. So, it can diminish the investor's returns.
Sovereign Gold Bond : A unique bond issued by the RBI (on behalf of the Government) where the face value is pegged to the price of gold. Investors choose how many 'grams of gold' they want to buy, which will determine the face value of the bond. The returns fluctuate based on the movement of gold price. The bond maturity is 8 years. The coupon rate is 2.5% and the coupon payment is done twice a year. From the investor's perspective, it's a risky-free way to 'invest' in gold. From the government's perspective, it's a way to reduce the demand for imports of physical gold.
Debt mutual funds
Retail investor can buy bonds directly through portals like NSE goBID, The Fixed Income, Golden PI, Zerodha Coin, Fincues. However, investors would benefit by investing in debt mutual funds instead of buying bonds directly. Debt mutual funds invest in bonds of all varieties and all durations. There are several types of debt mutual funds, and each of them can be used for specific purposes. Investing in debt mutual funds has two key benefits :
Diversification : Instead of putting our capital in a single bond, we'll be investing our capital in a diversified portfolio of bonds. So, the risk of loss is significantly reduced. Sometimes, the face value of some bonds can be large enough that the average investor couldn't afford it. Examples : #1 , #2, #3. If investors want exposure to such high-yield bonds, investing in debt mutual funds might be the only way.
Taxation : When we buy a bond directly, we'll get regular coupon payments. Those payments will be taxed as per the investor's income slab, which'll diminish the overall return from the investment. In a debt mutual fund, the coupon payments are reinvested (in Growth plan). So, investors are taxed only when we redeem from the fund. For young investors, buying bonds directly is disadvantageous from a taxation standpoint. They won't need the coupon payments as a source of income, since they'll most likely have a job that provides regular income.
Types of Debt mutual funds
Debt mutual funds are classified based on two different criteria : The maturity/duration of the bonds and the type of bonds. A debt fund's Macauley Duration will be slightly lower than (or equal to) the fund's Average Maturity - The weighted average of the time taken for all the bonds in the portfolio to mature. So, a fund's Macauley Duration can be seen as a rough estimate of the time taken for all the bonds to mature.
Categories based on bond maturity and Macaulay duration
Atleast 80% of the portfolio is bonds issued by banks, PSUs, public financial institutions
Gilt fund
Atleast 80% of portfolio is government bonds of all maturities.
Gilt fund - 10 year Constant Maturity
Atleast 80% of portfolio is government bonds, and the portfolio's Macauley Duration is 10 years
Floating rate fund
Atleast 65% of the portfolio is floating-rate bonds.
FMP fund
Closed-ended fund with a fixed maturity period.
Risks of Debt mutual funds
With so many types of debt mutual funds, it can be overwhelming for an investor to choose the right debt fund for their requirement. It's important to consider the risks (and not the returns) while choosing a debt fund. Here are the different risks that investors face in debt mutual funds :
Credit Risk
This is the biggest risk in debt mutual funds (and bonds), and it can cause a permanent loss of capital. Credit risk occurs when the 'creditworthiness' of the bond issuer is in question & the bond issuer is unable to repay the interest (or principal) to the bond holder. When it happens, the bond's credit rating will be downgraded to D (for default), and the bond holder suffers a loss. When a bond issuer is unable to repay the debt, it's called as a credit event. In debt mutual funds, credit event has happened time and time again. Any fund that holds non-government bonds is subject to credit risk. Even liquid funds are not safe from credit risk. Ballarpur bond default has caused Taurus Liquid fund's NAV to fall by 7.22% in one day. Investors who used liquid funds as an 'alternative to Savings Account' would have been shocked when the reality set in. Over the years, bond defaults have spooked debt fund investors many times - IL&FS bond default, DHFL bond default causing debt fund NAVs to fall upto 9%, Jindal Steel bond default, Essel bond default in Kotak AMC's FMP funds(2018) & Franklin debt funds(2020). Note that even PSUs bonds have credit risk. Even if the PSUs are owned & operated by the government, PSUs don't have a Sovereign credit rating. When there's a default, the bond's market price plummets and effectively becomes zero. So, investors' capital will be lost because the money invested in those bonds can never be recovered. Even if there's no default, investors can face a mild loss when a bond's rating is downgraded. The credit rating downgrade causes the bond's price to fall, which causes the debt fund NAVs to fall. How to mitigate credit risk : Avoid funds with low AUM. If the fund has a huge AUM (several thousands of crores), it will have a massive & well-diversified portfolio. Even if there's a bond default, the investor will be affected to a lesser extent. Also, avoid funds that exclusively invest in low-quality bonds. Always look at the fund's portfolio and scheme mandate before investing. If a fund gives better returns than all of its peers, that fund will most likely invest in risky bonds. If you want to avoid credit risk altogether, invest only in gilt funds. But, gilts have their own risks !
Interest rate risk
If investors choose gilt funds to avoid credit risk, they'll have to deal with this risk. Interest rate risk arises because of the change in interest rates in the bond market, which will adversely affect the prices of long-term bonds. Let's say the government issues a 10-year bond with 5% coupon/interest rate. Debt mutual funds will buy these bonds and hold it in their portfolio. Next year, the govt issues 10-year bonds with 6% interest rate. Now, the newer bonds (with 6% interest) will be preferred by everyone because they offer higher returns. The price of the older bonds (with 5% interest) will fall (because they're less valuable now), which will cause the debt fund NAV to gradually fall. Note that this fall is often temporarily and it won't result in a significant loss of capital. Eventually, the NAV will recover, but the recovery depends on the debt fund's modified duration. Interest rate risks affect long-term bonds the most. The longer the average maturity of the debt fund, the more sensitive it is to interest rate changes. So, Gilt funds & Constant Maturity Gilt finds have the most risk. Conversely, if the newly issued bonds have lower interest rates, the older bonds will be more valuable and so the debt fund's NAV will rise rapidly. To witness interest rate risk in action, observe the historical NAV of an Ultra-Short-Term debt fund (or Liquid fund) and compare it with the historical NAV of a Gilt fund. While the former will have a smoothly increasing NAV, the latter will have a more volatile and irregular NAV. As a result, it's possible for Gilt funds to give negative returns for a particular time period (like 2009). Whenever there's a sudden change in the interest rates, bond prices are affected which causes debt fund NAVs to plummet or soar. Even liquid funds are not safe from interest rate risk. When RBI suddenly increased the interest rate in 2013, liquid funds 'fell'. Although they'll recover in a few weeks, investors will be at a loss if they redeem the money before the NAV recovers. How to mitigate interest rate risk : Invest in debt funds with lower Modified Duration (like UST funds, Short Term funds). Those funds will have lower NAV fluctuation because of interest rate changes. To completely avoid interest rate risk, invest in Overnight funds.
Liquidity Risk
Liquidity is the ability to easily buy/sell an asset at a fair price in the market. Liquidity risk arises in debt funds when the bonds of the fund can't be sold. Or, they'd have to be sold at a lower price. If there's a mismatch in the demand & supply (more supply & less demand), the bonds have to be sold at a discount because there are less buyers. Bonds with low credit ratings can't be sold easily, if at all. No investor would be willing to buy the bond at market price, so selling such a bond would result in a loss. Government bonds have the highest liquidity in the bond market because they're risk-free. Liquidity risk is the reason for the closure of Franklin debt funds. The funds had significant exposure to low-rated bonds. When the pandemic started, a lot of investors started to redeem. So, the fund manager has to sell the bonds to give back the money to investors. But, those bonds aren't meant to be sold because they're low-rated bonds. No one will buy it at a fair price. If the fund managers sells the bonds at a lower price, the NAV will fall and other investors will be affected. In an effort to prevent such liquidity problems, debt funds are mandated (from Feb 2021) to hold atleast 10% of their portfolio in liquid assets like cash, cash equivalent, money market instruments, treasury bills and short-term government securities. Even if the mandate is enforced, the funds can face liquidity problems if there are mass redemptions.
Reinvestment Risk
When compared to the other three risks, reinvestment risk is moderate. There is no loss of capital, but there'll be a reduction in returns. Reinvestment risk refers to the risk an investor faces when the capital is reinvested in lower-yielding bonds, which results in overall lower returns for the investor. Reinvestment risk can be observed in PPF. As the PPF interest rates gradually start to fall, the investor's returns would also fall because the interest rate of a particular year determines the investor's return. If someone opened a PPF account in 1995, they'd have witnessed interest rates go from 12% to 8% in 2010. The risk is also easily observed in Liquid fund returns throughout the years. Considering HDFC Liquid Fund as an example, the returns for the fund went from 9% in 2014 to 7% in 2016 to 6% in 2017 to 4% in 2020. The gradual decline in returns is a result of the gradual decline in the yield of Treasury Bills. Anyone who invested in liquid funds by thinking of it as an 'alternate to Fixed Deposit' would have been disappointed.
Which debt fund(s) should an investor choose ?
The availability of so many types of debt funds can make it tough for investors to choose the proper fund. While choosing a fund, there's one important point to keep in mind : "Never choose a debt fund only based on returns. Always choose a debt fund based on the investment horizon". Being hungry for high returns & investing in random funds (without understanding the risks) is the worst thing a debt fund investor can do. Debt funds are not a 'simple alternative to Fixed deposit' because the risk profile of Debt Funds and Fixed Deposit are completely different. Debt funds ought to be used for adding stability to our overall investment portfolio, not to get 'high returns at low risk'. Investing & redeeming in funds randomly, in the quest for high returns, is also futile. Choosing a fund based on investment time horizon : Decide on how many years you're going to invest the money. Divide the time horizon (in years) by 3 or 5, and you'll get a number. Select debt funds whose Average Maturity is (approximately) equal to that number. That's the simplest to do it. If you don't know the investment horizon, stick to Overnight funds or Liquid funds (Arbitrage funds can be considered for short durations, because they have better taxation. Be aware of the risks, though). When parking money for a handful of months, don't expect great returns. Keeping the money safe is more important than maximising returns. To park money indefinitely (as a part of the Emergency Fund), choose quality Liquid funds. Liquidity is the most important aspect for an emergency fund. Keeping emergency fund in random debt funds can be problematic if we don't have immediate access to our money. Other things to consider while choosing debt funds :
Check out the fund's scheme document before investing. Ensure that the fund doesn't have the leeway to invest in risky bonds.
Funds with larger AUMs (thousand crores or more) are preferable. Large AUM allows the fund to diversify better. Generally, it's better to invest in debt funds of big AMCs like HDFC, ICICI, SBI, Axis, ABSL.
Avoid funds that invest in risky bonds. Debt funds are not the place to take high risks. Even when equity mutual funds crash, it usually happens over a series of days/weeks. Debt mutual funds can crash overnight.
PROVIDER NETWORKS. Below you can find links for each of the provider networks we are partnered with. To access the resources for a specific provider, please click the provider to be redirected to their site. QUICK LINKS. HOME MEMBER AGENTS PROVIDER NETWORKS LOG IN MEDICAL PLANS CONTACT. CONTACT US. Phone: 469-791-5900 Toll Free: 1-800-969-5238 Fax: 469-513-8522 Located at: 15455 Dallas Pkwy Corporate Benefits Service, Inc., founded in 1947, is a health care benefit plan asset manager for self-funded employer plan sponsors. CBS employs a fully integrated, comprehensive medical risk management program that improves health care outcomes for plan participants and significantly reduces claim costs for employer clients. Both utilization of healthcare services and cost per clinical If you are interested in becoming a Signature Care provider, please complete our provider nomination. Partner with a growing network that cares about quality and integrity - Signature Care. Call today for more information. (260) 266-5520 or email us at [email protected]. MeridianTotal (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the MeridianTotal Member Create Account: Register now for a secure account. Once signed up and approved, you’ll be able to: Check Member Eligibility; Check Claim Status; Check Your Panel That’s why Arkansas Total Care operates from your neighborhood. We partner with local services and providers. Our team brings over 20 years of healthcare experience. We look forward to continuing that dedication. Every individual should live with respect and dignity. We will help our members to maximize their independence. We will also help and maintain members quality of life in their Find out about: the role of providers, using the NDIS price guide, quality and safeguards, market Total Plan Services Provider Portal; ENTRUST. Resource Center; Contact Us; About Entrust . Entrust was established as a benefit administrator in 1975 and is uniquely positioned in the healthcare industry. Our technical expertise spans a compilation of legal, analytical, actuarial, and experiential areas related to health benefit plan design, implementation, and operation. As a proven CONTACT US. Phone: 469-791-5900 Toll Free: 1-800-969-5238 Fax: 469-513-8522 Located at: 15455 Dallas Pkwy # 450, Addison, TX 75001 Total Vision Services offers a variety of non-insured healthcare benefits. Whether you are seeking benefits for yourself, your family, your business, or association, Total Vision Services has a program that will provide the benefits that best fit your needs. Locate a Provider near you. History of Total Vision Services. Originally established in 1988 as Total Vision Services, we began marketing
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