Background: There has been an increased need to develop social connectedness, well-being, and resiliency. With the COVID-19 pandemic resulting in isolation, grief, and loss, and an increased awareness of social injustices – we have been in a historic public health crisis. Many in-person services came to a halt in March 2020 across VHA hospitals. While telehealth has been used by VHA for decades, there has been an exponential growth in virtual delivery of complementary and integrative health (CIH) and Whole Health (WH) services. To help address social isolation, the #LiveWholeHealth (#LWH) blog series was launched to provide experiential self-care resources that can be accessed at home, such as video sessions for yoga and meditation. VHA has a workforce of over 400,000 employees, and concerted efforts began to increase virtual delivery of similar resources to support employee self-care including creation of an Employee Whole Health (EWH) webpage with relaxation/ mindfulness exercises, resilience tools, and CIH videos. At local facility and regional levels, similar efforts resulted in innovative use of online platforms for Veterans and employees to participate in live-streamed or on-demand self-care offerings.

Methods: WH encounters and unique data were extracted for WH/CIH, including tele-health data, from the VA Corporate Data Warehouse. For #LWH and EWH offerings, website and platform analytics were collected to evaluate use over time.

Results: In fiscal year (FY) 2020, there was a 10-fold increase (n = 130,741) in WH/CIH encounters delivered via telehealth compared to a 3-fold increase in FY2019. Similarly, in FY2020 there was an 8-fold increase (n = 29,873) in unique Veterans receiving WH/CIH services via telehealth compared to a 4-fold increase in FY2019.

In the first month of #LWH, we reached approximately 1.1 million people with 60,000 post clicks on Facebook alone, 230 retweets on Twitter, and 67,000 views on YouTube. Through October 2020, we reached an additional 3 million people with an additional 112,000 post clicks on Facebook, 625 retweets on Twitter, and 101,000 views on YouTube.

Through February 2021, there have been a total of 50,556 EWH pageviews (monthly pageviews were highest in May 2020 (n = 9,025)). Over 1,000 employees have participated in over 4,700 live-streamed classes in a single region, while at another local facility, creation of an on-demand video library platform has resulted in use by 400 employees at over 12 locations.

Discussion/Conclusion: Since March 2020, local VA WH staff transformed care delivery using virtual care platforms and delivered over 130,000 WH encounters, and additional CIH and WH encounters via telephone, blog, and mobile app interaction. Virtual care platforms and telehealth technology have enabled us to support the well-being of the VA patient and employee population, with continued access to WH services.

This session includes lessons learned and best practices for expanding access to CIH through virtual platforms and telehealth technology to strengthen social connectedness and resiliency of the VA patient and employee population. A discussion will be included on strategies to maintain virtual access as we move into a hybrid of in-person and virtual care delivery.

Background : Since early in the Covid-19 epidemic, it has been obvious that there are wide differences in risk based upon race and age. In the face of an emerging epidemic, it becomes important to differentiate modifiable and non-modifiable risk. Taking a Preventive Medicine approach, the racial and age-based differential in risk can be seen in primary, secondary and tertiary prevention. Sadly, the remedy for historic prejudicial and socio-economic factors underlying this differential risk in primary prevention and tertiary prevention is a long-term ongoing issue. However, the area of secondary prevention is one where short-term intervention is possible. Race and age are not, in and of themselves, the true reasons that Covid-19 is deadlier for Black Americans and those of increasing age. Instead, this clear statistical association has an underlying physiologic basis. The underlying risk factors are ones that can be objectively measured and the at-risk individual can reverse.

Methods: Covid-19 physiologically is a hyper-inflammatory disease. It is known to attack many different organs systems. Pre-existing inflammatory states give the virus an advantage in causing more severe cases of disease. One cause of pre-existing inflammation is insulin resistance. The likelihood of having insulin resistance is greater with increasing age, increasing weight, and being a Black American. Although this can be expected in those with diagnosed diabetes and prediabetes, it is actually present much earlier in life, on the pathway to diabetes or prediabetes. It is rarely tested for in asymptomatic individuals. Another common cause of inflammatory disease is an inappropriately low Vitamin D level. Vitamin D is important endocrine messenger within the immune system. Although known for a century, its importance in this role is a more recent discovery. In addition, low Vitamin D also produces a weakened immune response demonstrated earlier for other pulmonary diseases. Although testing is easily available, the official levels of deficiency and insufficiency are currently well below levels indicated as appropriate by more recent research. Taken together, these two areas of concern clearly heighten the risk for Black Americans and those of advancing age.

Results: A protocol has been developed using objective and readily available laboratory testing to identify these conditions. The additional use of an algorithm developed by the Oxford University Diabetes Research Unit (available at no charge) further enhances the sensitivity of this commonly available testing. Once identified, individuals can be given instruction in nutritional and lifestyle changes that will modify these risks. Efficacy can then be demonstrated with follow-up testing.

Conclusions: Physicians, mid-level practitioners, and alternative medicine practitioners with the ability to order diagnostic testing all can identify risks for more severe cases of Covid-19. Once identified, teaching, motivating, and monitoring can be done by many members of the integrative health team. Although we cannot modify a person’s race nor their age, the healthcare team can help achieve equity regarding susceptibility to severe disease. Additionally, actions taken also holds promise to reduce other chronic diseases the individual may face in the future.

Background: The traditional model of mindfulness interventions has been associated with positive health outcomes. A low-intensity (1 hour/week for 4 weeks) mindful walking (MW) intervention has been found to be feasible among physically inactive adults, which could mean that a shorter duration of intervention may be more helpful in easing the dissemination challenges associated with traditional mindfulness programs (at least 2.5 hour/week for 8 weeks duration). Therefore, we developed a moderate-intensity (1 hour/session, twice-a-week for 4 weeks) MW intervention for adults whose physical activity did not meet the recommended level of 150 minutes/week, with the purpose of assessing whether a shorter intervention with increased dosage could have added benefit as compared to the low-intensity MW intervention. This study focuses on our qualitative findings from our program implementation during the Covid-19 pandemic, as we switched from in-person sessions to online delivery.

Method: Our on-going MW intervention study uses a waitlist-control evaluation method. We recruited 29 participants in the Jan 2020–Jan 2021 period. For every 10-12 participants enrolled, we randomized them to either the intervention group or the waitlist control group (who would receive the intervention later). After we delivered the first two MW sessions using the traditional in-person format, our delivery was switched to the online Zoom platform in March 2020 due to the COVID-19 pandemic. We provided assistance to those having difficulty using or accessing the online therapist-led sessions. Qualitative feedback about our intervention was collected when participants were surveyed at the end of their intervention wave, using an online survey or telephone interview method.

Results: The online delivery mode posed challenges for attendance and affected participants’ experience with the intervention. Only 10 participants attended more than 50% of the sessions. Although the online intervention had an audio-video interface, most participants were able to experience the audio component only due to lesser or complete lack of access to the Internet or smartphone. Thirteen participants responded to the survey. Reasons for absenteeism at intervention sessions included health issues (including surgery, and not being able to walk for 10 mins anymore), technical issues with online connectivity to sessions, difficulties using the online platform, and other commitments. One participant wrote: “hated that our time to be together physically was disrupted by corona...The time together in person helped me to bond with the group.” One participant suggested that offering classes thrice a week might be better. Eight participants responded positively to the question about engagement in self-practice of mindfulness meditation in the past month, and six out of these eight participants mentioned having incorporated the physical activity component of the MW intervention in their self-practice of mindfulness meditation.

Conclusion: While the online delivery allowed us to continue the MW intervention and some participants maintained good attendance and adherence, the participants’ challenges with using the online platform and their indicated strong preference for the in-person mode imply that the in-person delivery mode is still the preferred approach. The online mode’s disadvantages include the lack of social bonding effect and participants’ technical challenges with the platform.