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COVID-19 Update: Newswise Live Expert Panel
As the COVID crisis continues to test the capacity of the healthcare system, what interventions are necessary to turn the tide of new infections, will the relief package have an impact, and how will a prolonged shutdown affect our economy?
This Newswise Live Virtual Press Conference invites media to ask our Expert Panel their questions about the COVID-19 pandemic and the effects on all aspects of daily life around the world. Panelists include experts from institutions such as Stanford University, the American Association of Nurse Practitioners, and the University at Albany.
- Samantha Penta, Ph.D - Assistant Professor of Emergency Preparedness in the College of Emergency Preparedness, Homeland Security and Cybersecurity - University at Albany.
- Dr. Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP - President - the American Association of Nurse Practitioners (AANP)
- JonathanB.Berk - A.P. Giannini Professor of Finance - Stanford Graduate School of Business (GSB)
- Dr. Robert A. Salata - Professor of Medicine, Epidemiology and International Health - Case Western Reserve University
- Bernard Weinstein - Associate Director of the Maguire Energy Institute - Southern Methodist University
When: April 9, 2:00PM EDT
Where: Newswise Live event space on Zoom - https://newswiselive.zoom.us/j/7459578068
This live event will also be recorded and transcribed for use by media and communicators after it is concluded.
The transcript of this expert panel is available below.
THOM: Welcome to this Newswise live virtual press conference, we have today an expert panel to talk about topics related to the current COVID-19 crisis affecting the United States as well as the entire world. We have with us five different experts in a couple different related areas. We have Dr. Samantha Penta from the University at Albany, she’s an assistant professor of emergency preparedness in the College of Emergency Preparedness and Homeland Security. We also have Dr. Sophia Thomas; she is the president of the American Association of Nurse Practitioners. We also have Dr. Jonathan Berk; he is professor of finance at the Stanford Graduate School of Business. We have Dr. Robert Salata, professor of medicine, epidemiology and international health at Case Western Reserve University. We have Dr. Bernard Weinstein, associate director of the McGuire Energy Institute at Southern Methodist University. Thank you to all the experts for joining us. For the media here, I want to remind everyone that we are going to open up the floor to questions from media and if you can chat us your questions, I or one of my colleagues co-hosting the meeting, Craig Jones and Jessica Johnson will reply to you and ask if you want to ask the question yourself on video and camera and audio, if not, we can just ask the question for you, that’s certainly fine but we want to invite media to get involved here. We have a couple questions prepared for each expert to start things off. We’ll start with Dr. Salata in moment and go around the room with each expert with one or two questions while we invite the media to also provide their question. Without further delay, I want to get right to it.
Dr. Salata, thank you for joining us. Dr. Salara there are Case Western Reserve, working in epidemiology and other topics related to that. What do you make of the current models and statistics regarding the disease and the spread? Are we seeing some areas of the US successfully flatten the curve?
SALATA: We are. I can speak to first my own state of Ohio, where many of you know there was an aggressive and early response to this outbreak with regard to sheltering in place, closing schools and a number of other things, including social or physical distancing, etc. Whereas about 10 days ago our rates were increasing, numbers of cases on the order of about 30 percent per day in Ohio, over the weekend it went to seven percent. There are some models, including from the University of Washington which mainly uses death rates to predict the peak, etc., that predicted our peak was going to be yesterday, that’s great news. We also know that from the major epicenter right now in New York City, that it does appear that although the number of deaths is increasing, they are seeing few hospitalizations and I think that’s a good sign, at least of our colleagues that are really struggling with this in New York, that that seems to be flattening as well. There have been a lot of discussions about the effect that physical distancing has made on the epidemic, but I’m a firm believer that it has made a difference. Estimates across the country range from as little as 20 percent decreases in cases of deaths to as much as 67 percent. I think that although some viewed these measures as draconian, on the other hand I think they are making a difference to answer your question.
THOM: Thank you, sir. With regard to the response that some of these measures are draconian, I’ve seen a lot of coverage about places like Ohio, California, New York, doing a good job and even though some of these measures a little bit draconian to some people, they’re affective. Can you tell us what’s happening in areas where people are defying these kinds of stay at home orders and how does that compare to the ones where we’re doing more successful interventions and what are your thoughts on that?
SALATA: Several states have not put into place these measures yet and I think many of those are places where there have been relatively few numbers and the population density is not as great, so that’s understandable to an extent. But like my colleague Dr. Tony Fauci at the National Institutes of Health, I’m astounded that other governors have not put these into places as yet. We also hear of increasing reports of people defying the orders to stay in place, including in New York where this is the biggest epicenter as I said and that’s astounding to me and people have chalked this up to independence and so and so forth. I think where we have clear evidence that this making a difference, even though there are significant hardships all along and our economic experts will speak to that issue among other things, I think it is making a difference and despite everything that’s been done there are still people defying it.
THOM: Thank you, Dr. Salata. If any of the media in attendance have questions for Dr. Salata please do chat those to us, we’ll invite you to ask the question yourself or we can relay the question to him for you. I want to you ahead to our next expert and we’ll come back to Dr. Salata with more questions. Next, I want to go to Dr. Sophia Thomas from the American Association of Nurse Practitioners. Dr. Thomas, we have a couple of questions actually from the chat that really actually coincided very well with some of the questions I had prepared already for you, so I want to ask you that. Jenelle Miller, one of our reporters in the meeting and like I said, one that we planned to ask you as well. More deaths among minorities and hotspot communities where some of these health disparities among racial minorities and other socioeconomic groups we’re seeing big numbers and that exposes the threat of these health disparities. What can you say about how that’s effecting your area in Louisiana, as well as nationally and what we should understand about that?
THOMAS: Absolutely, the numbers are correct. Here in Louisiana, the New Orleans area is definitely a hot spot. We’re seeing that 70 percent of the deaths are in African American individuals and coincidentally this is population in Louisiana that has the highest rates of kidney disease, diabetes, hypertension. Before this crisis Louisiana was in a perpetual crisis, our healthcare numbers were some of the worst in the nation, we’re one of the most unhealthy states. This crisis right now has really highlighted the true problem with the health disparities here in Louisiana and it’s quite unfortunate. This population’s been hit with the most number deaths, hospitalizations. Here in Louisiana our numbers are still on the rise as far deaths and new infections. We do still have room in the inn if you will, in the hospital there are still some ICU beds. We were thought to have peaked a couple days ago was supposed to be our peak, we were supposed to run out of hospital beds ago if you will and we still have room in the inn. Going back to your question about the social distancing, it’s really been working here in Louisiana. Now, having said that, we have pockets of population that don’t realize how important this is and I don’t think it’s their want for independence as much as it is their ignorance unfortunately and so we’re seeing still more cases.
THOM: Another question for you from Deb Wood at Nurse Zone, she wants to ask about the surge staffing in some of these hard-hit areas and how nurses are being asked to step up in the ICU. Nurse practitioners can play a big role in supporting the need for surge staffing, I wanted to invite you to tell us your thoughts about that and how your association is working to make that more possible and what are we seeing as an impact there that nurse practitioners can have?
THOMAS: Absolutely. Prior to this crisis, 22 states plus the District of Columbia and the VA Health System have what we call Full Practice Authority, which means nurse practitioners can practice to the full extent of the education and training without and regulatory restrictions. In those other states they’re required to have a written agreement with a physician which is called a Collaborative Practice Agreement, that simply says this is the physician I’ll collaborate with. We know that nurse practitioners collaborate with healthcare providers of all specialties everyday without a written agreement. What’s happened through this crisis is a couple of things. In states where nurse practitioners are required to have a Collaborative Practice Agreement, if they’ve been laid off because their clinics were slow of if their physician is unable to practice because of COVID-19 or other reasons, those nurse practitioners are therefore unable to practice as well because that written agreement is not there. The National Governor’s Association, we sent a letter to them and several governors have since taken action to remove that requirement of the Collaborative Practice Agreement, so far, we’ve got about five states. Governor Andrew Como was the first governor to do that and since last week when he removed that requirement, we’ve had 4000 nurse practitioners volunteer, just in the New York area, to help with this crisis and help on the frontlines. We know that we’ve got a workforce there that wants to work and wants to help and once these regulatory red tape problems are removed, we really step up to help.
THOM: Thank you, Dr. Thomas. For any of the media in the meeting, please let us know if you have questions for Dr. Thomas or any of the other experts, you can chat those to me or chat them to the whole chat room and we’ll invite you if you want to get on video and audio to ask the question yourself or I can just relay them for the expert for you. I want to move on next to Dr. Samantha Penta from University at Albany. Dr. Penta is an expert on emergency preparedness and disaster response and other topics related to that. I want to ask you Dr. Penta, some hot spots in the US may already be in the process of or need to soon set up things like field hospitals or healthcare facilities in unused spaces like convention centers. What are some of the decision-making processes and logistical concerns for this about when is the right time to start setting these things up and what your background in emergency preparedness tells us to understand about that?
PENTA: There are a few things that people really have to think carefully about as they start thinking about what spaces they want to repurpose in this way, how they want these operations to function and the logistical elements of that. One of the really important things is actually thinking about the nature of that space in terms of the physical layout, not all spaces are created equal. If you think of the special aspects of a hospital environment, whether that’s elevators being big enough to transport patients that are not able to walk themselves in some way or thinking about space for equipment room, whether or not it’s an air-conditioned space, all of those things matter. It’s not just a matter of finding a physical place to put a person, there’s a whole host of facts involved and whether you can actually provide the appropriate care for whatever health issue it is that you’re trying to serve. Also making sure you can get the equipment and all those things, all of that support service and network into that physical location. Something else that’s really important to keep in mind is a long-term view of how long do to think this facility is going to be functioning as whatever that makeshift healthcare purpose is? Will you need that building for its original purpose as a part of the recovery? This is something for instance that we run into in our disaster circumstances if you have a hurricane where people have to go to shelter. For example, if a local high school becomes a shelter, if part of your recovery and transition to normalcy is kids going back to school, you cannot do that as long as that building is being used a shelter. I image that’s a similar debate that’s going on now, where there might be buildings that are going unused currently because people are working remotely but if we think about how we transition as this epidemic and this pandemic unfolds and then hopefully slows down, thinking about what role does that building then play in our recovery and transition back to normalcy and does that timeline mess with the timeline for what you need for the medial purpose of that repurposed space?
THOM: We had a question earlier about surge staffing and repurposing of healthcare professionals into different areas, what also can you tell us about, in the emergency response vein, of increases in volunteerism? What are we seeing with things like donations and partnerships with non-profits or NGO’s and things like that? What’s happening in those areas to help support communities that are hardest hit here?
PENTA: Again, drawing parallels to other kinds of disasters we see or we experience, usually we see what we call pro social behavior and that’s basically helping behavior, helping your friends and neighbors, engaging in that donation behavior and volunteerism and we’re really seeing that in this event as well. One of the previous panelists noted nurse practitioners were standing up to take on a role and there are other personnel who are standing up to take on a role. Thinking about volunteers in formal capacity but also thinking about that informal behavior where maybe you’re going grocery shopping for someone who’s immunosuppressed and feels uncomfortable and going in that environment. Also seeing a lot of donation behavior, a lot of that I’ve noticed particularly is around food, supporting things like food banks. Locally in this area there was an initiative partnered with the local food bank to help provide meals for restaurant personnel who had been laid off or furloughed or simply couldn’t work even if they didn’t lose their positions, that’s something we’re seeing. Also, the donation of PPE, personal protective equipment. Universities have been sending out surveys among their professors saying, “Do you have relevant PPE? Is that something you can donate?” The University of Albany did that and I’ve heard of other universities doing that as well. I think we’re seeing a consistency in that prosocial behavior in this event.
THOM: Thank you, Dr. Penta. If any of the media have questions for Dr. Penta, please chat those to us. I want to turn briefly to our two experts who have backgrounds in the economics and the financial aspects of this crisis and then we’ll come back around the room to Dr. Salata and others with some questions that I’ve gotten in the chat in the just the last couple minute. Next to Dr. Berk at Stanford. Thanks for joining is Dr. Berk, I want to ask you about your analysis of the big relief bill. It was signed by President Trump I think a little over a week ago. What are some areas that you think this bill got right? Some areas maybe you think it got wrong, where it’s not doing enough? What are your thoughts?
BERK: I think the relief bill from my perspective is hugely problematic. Much of this crisis I think we’ve done the wrong thing at the wrong time. It’s hard for me to think of any way of handling worse than what the government is doing on the relief bill. As far as I see it, what the government is doing is basically transferring wealth from poor people to rich people in the relief bill. There is a part of the relief bill where there is direct payments to people and that is the one part of the relief that’s a good idea, that is actually a small part of the relief bill. The major part of the relief bill involves bailouts of every organization that has any political power in Washington as far as I can tell. The current situation, let me just be clear what I mean by this. If you go in and you bailout a corporation and there are many ways corporations are being bailed out, Boeing for example, the government is actually making payment directly to Boeing from what I can see or if instead the Fed buys up the debt of these corporations. Just this morning I heard that the Fed is going to buy junk debt as its asset buying program. All of those things are transferring wealth to investors, that’s what happens if you buy debt, if in the market debt is trading at 70 cents and you buy for it one dollar, that 30 cents is 30 cents going from the government to the investors, which essentially from tax payers to investors. I think it’s fundamentally unfair but I don’t think it’s in anyway going to address what the real issues are with this crisis. In many ways people are approach this crisis as if it were a normal crisis. A lot of times when we go into recession, nobody knows why we go into recession, each economist has their own theory of why we’re going into recession and there is a lot disagreement. In this case, there is no disagreement why we’re going into a recession. The government tells a huge part of the population to go home, stop working, then of course we’re going to go into a recession. The inability of people to come to grips with this fact I found astonishing. I actually think it’s part of the political economy because it’s not in the interest of the people who are being bailed out to come to terms with this fact. We see it all the time. We see it all the time, we see very large unemployment numbers. I don’t know why people are in anyway surprised, if you tell people to go home and stop working, unemployment will go up. There is nothing to be surprised about. In fact, I think the numbers are way low. It’s got to be around like 50 million at least because you say what fraction of the economy is not working right now? It’s a large fraction and so those people are unemployed. Businesses aren’t necessarily going to keep paying, I don’t see any reason why they would. Those people definitely need government help or I think they need government help but I don’t think investors need government help.
THOM: With comments today from the Fed Chairman Jay Pal, pledging aggressive action, what are your thoughts about how much more the Fed can actually do with interest rates already so low?
BERK: I think it’s the other way around. I don’t understand where the Fed thinks the money is coming from. Two trillion dollars, everybody thinks billions, trillions, two trillion dollars is a lot of money, it is an unprecedently large amount of money. As you say, interest rates are zero, presumably the Fed is go out, the government is going to out and borrow two trillion dollars and maybe interest rate will stay at zero but I think we can say for certain that there will one day be a limit, there will one day be a time when the rest of the world or the people buying treasuries will say, “Maybe these treasuries are not risk free. Not if you issue and extra two trillion dollars of it.” I don’t know when that time will come but if we hit that limit, that could be a long term, hugely negative impact on us because currently, we live off the fact that the rest of the world is willing to lend us money at very low interest rates because they believe our treasuries are risk free. If that belief, it doesn’t matter if they are or they’re not but if the rest of the world or the people buying treasuries just began to think that maybe they’re not risk free, our ability to borrow at zero percent goes away. The long-term impact of that on our economy is huge.
THOM: If any of the media have questions for Dr. Berk, please chat them to us. I want to go next to professor Weinstein at Southern Methodist for a few more questions about economics and financial question. Dr. Weinstein, what’s your prediction about the US economies ability to recovery in the light of the fact that the whole world is facing the same crisis that we are? Does that potentially put the US in a good position relative to the rest of the world? What else do you see in regard to the world’s major economic powers?
WEINSTEIN: I think it’s going to be a long period of economic recovery. Things are going to get worse before they get better. We’re probably going to see unemployment, measured unemployment as high as 1 percent in the US over the next couple of months. Real unemployment is probably much higher. There have been some forecasts that we could see the gross domestic product contract by as much as 25 percent in the second quarter and that’s unprecedented, at least it’s unprecedented since 1930. Other prognosticators think that year over year, assuming that we pick up some speed in the second half the year and start to reopen the economy, we’re still going to look at year to year contraction on the order of five to seven percent. Pursuant to your question, it’s not just us, it’s the rest of the world. China maybe a little bit ahead of the curve, there is some evidence that their economy is starting to open up but already we’re seeing that the recovery process in China is very slow, number one because Chinese consumers are being very cautious and number two because the rest of the world isn’t buying the stuff that China produces. If you’re asking me, what’s going to happen long term? Is there going to be some type of a reorientation of global economic power or global trading patterns? I think the answer is yes but I’m not sure what it’s going to look like. We see more and more politicians and even corporations saying, “We need to change our supply chains. We need to be less reliant of China.” The next six to 12 months will have some evidence but I really think it’s going to be a pretty long and hard slog, it’s not like we can flip on a switch and get the economy reeved up quickly. I think we’re looking at what you might call a U-shaped recovery, as opposed to a V shaped recovery but I do think that will happen, probably starting in the middle of the summer, assuming we get this virus under control.
THOM: Now, with your focus on the energy industry, I want to ask you about what are the impacts in particular of the fossil fuel industry and how connected that is with so many other industries that drive the economy? The number of people employed in the industry and other kinds of concerns. If you can explain some that and also and news or thoughts about OPEC’s meeting and the G20 meetings brining about any policy with some positive change to them?
WEINSTEIN: You want a 25-word answer to a multi part questions. Here’s the deal, the oil and gas industry has been hit very, very hard, particularly the oil sector. We’ve seen prices the lowest prices that we’ve seen in 20 years and I think everybody understands what’s happening. There is huge excess of supply relative to demand. We’ve had demand destruction because of the Coronavirus and the fact that economies all over the world have shut down and then we see supply continuing to increase or at least until very, very recently because of the nature of shale production in the US that has made us the number one producer in the world. There has a been a little war going on between Saudi Arabia and Russia, they’ve been increasing output, trying to drive the shale guys out of business and increased their market share. I think everybody is starting to realize that this is a negative sum game, nobody is winning and that is why there is a meeting today, it’s called OPEC Plus because it’s got Canada, it’s got Russia, the US is probably listening in and then tomorrow there is a G20 meeting. I think by the weekend we will see some type of agreement to reduce global production by maybe 15 million barrels per day and that would be significant. If we could sustain a reduction of that level for some period of time, I believe it would bring supply and demand into balance but of course, there is always the opportunity to cheat even if there is an agreement.
THOM: Thank you, Dr. Weinstein. If anyone else has questions for Dr. Weinstein, please chat those to us. I want to go back to Dr. Salata, we have a question for you from the chat. Jessie Hicks from Vice News I think had this question. It looks like some companies are looking to introduce an at home saliva test for the coronavirus, do we know how accurate such a test might be and any other thoughts you have about the prospect of that?
SALATA: So, there is no question that one of the major challenges in the United States has been the lack of adequate testing. We are still triaging in our institution and many others, the types of individuals that we do tests on. We’re focused here in our own stand up planform testing wise on those that are hospitalized, coming from the emergency departments and also our healthcare workers. We haven’t been able to test everyone and that’s been one of the major issues here. Take in comparison what happened in South Korea where at in one moment in time, they were able to test every single individual in that country and they showed that 98 percent of people were infection free and only two percent were infected. We don’t have that kind of information in the United States yet. Having said that, the more we expand our capacity for testing will be really important to understand how broad this problem is in the United States. We could talk about those confirmed cases and the death rates related to that, which in the US is about 2.5 percent but we don’t really know the denominator here because there are many people that are either asymptomatic, we know about that now or have what is called pre-symptomatic symptoms which are very mild in nature. Still, 80 percent of people who develop this infection can stay out of the hospitals for the most part and recover from this without specific treatment. Having testing capability broadened will be very important. The closest we have for diagnosing acute infection right now, is with a molecular based test called a PCR Pulmonary Chain Reaction Test and the shortest timeframe for performing individual tests right now comes from a recently released test from Abit and this is 15 minutes. Let’s take us back to the emergency department where you have to make a decision about who is or who is not positive and having that testing capability within 15 minutes is really an outstanding advancement in terms of where we’re at. What I can say is there have been different specimens with regard to testing in terms of what is called sensitivity, that is how often is it positive when it really is. The current platform for PCR that are being used around the country are about 80 to 92 percent sensitive, so they’re not perfect and there are some cases where we’re convinced clinically that people may have COVID-19 infection and sometimes we retest or treat them as if they have it. Aside from that, there was one study out of Hong Kong where they looked at different sources for testing and the standard right now is what is called a deep nasopharyngeal swab but we have done that for the most part as has been the case in the United States. The problem is, we don’t have enough swabs and interestingly enough, most of those had been manufactured in Italy and we know the devastation that they’ve seen there, so that really has been another issue of supply. There was a study, as I said from Hong Kong that looked at saliva as a potential test and it’s sensitivity, that is how many times compared to nasopharyngeal swam it was positive was pretty good and this is called a convince sample, you don’t need a swab and it can be collected and then tested accordingly. We’re not there yet but something like that could be useful in the future. The other thing, just over the weekend there was approval by the FDA of an antibody-based test. Antibodies are something that we develop ourselves in the context of either a vaccination or an infection. The problem with antibody testing in most reports so far, is these can take as much as seven to 10 days to develop. In our view right now, this is not helpful as much and useful for acute diagnosis. But from a population-based study analysis, to see how much infection there is out there or in redeploying people to go back to work, having a positive antibody test would be reassuring, assuming again, this is the protective immune response that we think it, as with other viral infections. I expect that to rollout very aggressively soon and I think we’re going to be utilizing it more. As an example, in our state they’re going to do an initial study of 100 individuals, that’s not very high but in the Boston area they’re studying 1000. As we get more idea of what is prevalence, that is how wide spread this infection is, that will really help shape our approaches in the future, including redeployment, making decisions about lifting some of the current restrictions on staying home, etc., especially in the healthcare sector as I mentioned. I think many things are coming about. I would just end by saying, in my career, I’ve never seen such rapid development of technology, both for testing and also for treatment and vaccine strategies. Within two weeks of the first reports of this virus coming from China, we had the virus fully genetically characterized and that really has helped us move this forward in terms of our approaches these days. I think in that home test, like a pregnancy test, etc. may come about. Right now, there is some indication that saliva might be a suitable specimen, which is a convenience specimen as I said and then we’ll go from there.
THOM: Thank you, Dr. Salata, a lot of interesting developments there that will clearly have a major impact in the coming weeks. I have another question from the chat for Dr. Thomas and this converges well with another question we had planned to ask out. Telemedicine and telehealth, from Pam Baker at Tech Target, how well is telemedicine performing during this COVID-19 crisis? Is it doing a good job at relieving pressure on healthcare providers treating patients with non-COVID medical issues? Tell us what you can about that Dr. Thomas.
THOMAS: Absolutely, that’s a great question. Telemedicine has been around for a long time but we’ve really been utilizing it over these last few weeks. CMS loosened the guidelines on that, it used to be that only Medicare patients that were rural areas could have telemedicine but now anybody can have telemedicine anywhere. Any patient in any city at anytime, most insurers are covering which is really nice. It’s a great technology. A lot of providers offices, the outpatient clinics – first of all we’re seeing COVID-19 patients in these outpatient clinics and having to test them as well, it’s not just the hospitals. We’re trying to limit at the same time in our outpatient clinics, we’re trying to limit the number of people to get out to go to the office for social distancing, we want to keep these patients at home. Telemedicine has been a great tool with that. There are two parts of this. First of all, some places it’s been slow on the uptake because patients have to get use to this new way of receiving healthcare and providers have to get use to the new of providing healthcare. We’re use to putting our hands-on people, we’re use to touching them. It’s been a completely different model that I think is our new normal. I think going forward this is going to be a new shift in healthcare, the way we provide healthcare in this country. I think we’re going to be able to do more over telemedicine. We can do telemedicine visits for things like diabetes and high blood pressure management, especially if a patient has a high blood pressure monitor or a diabetes monitor at home. Asthma checkups, allergies, thyroid disorders, even infections, urinary track infections, skin infections, rashes, all types of diseases and diagnosis can really be managed over telemedicine, to really keep the patients at home and keep them social isolated. A lot of offices have EMR’s now and in the EMR technology is embedded telehealth services but for some offices that don’t have that, there have been some great apps that we’ve been using Docsmity and Doc See Me are just a couple but CMS even allows us to do Face Time now. Really any technology means that we need use to deploy to provide care to the patients is what we’ve been using and it’s been working really, really well, at least in my practice it has.
THOM: Thank you, Dr. Thomas. I want to go next again to Dr. Penta. Dr. Penta, what can you tell us about communication during national emergencies? Does the way of communication is put out, can help or hurt people’s ability to make the right decisions about their own personal behavior and what else do you think that the public needs to understand about the difference between maybe misinformation and conspiracy theories verses information changing as the crisis unfolds?
PENTA: There is a lot of stuff in there. The short version is that yes, communication absolutely matters, both in the content of the message and how that message is conveyed. When think about the people who are managing this crisis, it’s incredibly important to have clear, very frank messaging that not only informs people about the nature of the risk that they face but very clearly what they can to do to address. Understanding the nature of that risk is and what people can do about it. Making sure that it’s communicated in a variety of channels and a variety of mechanisms. People have their different communication channel preferences. From an individual standpoint, as a receiver of information, it’s incredibly important for people to be critical consumers of information. On social media in particular, I’ve heard that there is a lot of different conspiracy theories out there on this pandemic or what’s going on and how people are interpreting that. It’s important for people to be thinking very carefully about where they’re getting their information, what that information is. Another element you referred to in your question, this is not a static situation by and stretch of the imagination, this is a novel virus that we are still learning about, the extent of it’s spread is very dynamic and it changes as we increasing our testing or we decrease our testing. The responses to it are constantly changing, so as people are also weighing the validity or whether or not they feel like they can rely on or believe the information that they’re receiving from these sources, it’s also important for people to keep in mind that this is changing. Just because information has changed, it doesn’t necessarily mean that that source is no longer reliable or valid, it’s just that the situation has changed. I think the conversation around masks are a good example of that. Initially the conversation was, don’t buy masks, we need the supplies for our healthcare providers and the only time you should be wearing a mask is if you’re sick yourself, now the recommendation is that people wear cloth masks to keep from spreading the virus. There is a change fundamentally in the logic behind those decisions but it doesn’t mean that the people who are making those decisions are no longer trustworthy, all it means is that there are changing their response and that change in information needs to be considered by the individuals consuming it.
PENTA: Thank you, very important distinction there between misinformation and changing information. I want to go again to Dr. Berk. Dr. Berk, we have a question from the chat from Jessie Hicks at Vice News, I’d be interested to hear what a better relief bill would have looked like in your opinion? More money directly to workers for example? European countries seem to have figured this out before we did as far as a need for an open-ended commitment to people, rather than funneling money to corporations. What are your thoughts about that and what can you tell Jessie about what you think a better relief bill would have looked like?
BERK: I think a better relief bill would have absolutely prioritized the workers who are currently being laid off in industries because they can’t work. There were ways to do that and I don’t understand why they were not used, I don’t understand. We already have unemployment insurance system and I don’t understand why we just didn’t use that system, funnel money directly to people who are unemployed. I also think that there should have been a means test. The extent to which we’re money from poor people to rich people is astonishing to me. For example, there is a huge issue about small business, which I agree in an issue but let’s be honest, the business owner is richer than the employee in the small business, so I don’t understand how we’re prioritizing the owner of the business over the employee. Maybe we should do both, there may be a lot of cases where using a means test where we need to help small businesses but the idea of let’s just help every business, doesn’t seem to make much sense to me. The other thing is, there is all this concern about the finance system and about supply of credit, which I’m always very suspicious about because it’s one easy way to get a government hand out, is to say, if you don’t give me a government hand out, the whole economy is going to come to a crash, so you have to give me a government hand out. Again, I’m not suggesting that there isn’t a role for government in this but I am suggesting we need to justify that role. It seems unjustified right now. We just hand out money without any real justification. Assuming that there is a role, one obvious way of doing it, is for the government just to guarantee dead end financing. For people who don’t know what dead end financing is, when a company files for bankruptcy it still needs cash, they get financing called dead financing, the way that works is, any financing they get after the bankruptcy declaration is highest priority, that way banks continue to lend and the corporation can continue to work, that’s called dead end position financing. By just guarantying it would allow companies that were in trouble to continue operating but as well that, it would have a very, very good incentive effect because if you do declare bankruptcy and you do take this dead end position financing, the people who get screwed are the investors because of course, if I have a debt outstanding it’s highest priority, that debt gets paid back first, which means it reduces the claims of all the other investors, which makes it not in the investors interest to use that financing if they can help it. That sets the incentives for investors not to go to bankruptcy and find other ways to keep the corporation going. Those are just two examples of what I would consider a much more measured and intelligent approach to solving a problem that clearly does need to be solved.
THOM: Thank you, Dr. Berk. To Dr. Weinstein again. I want to ask about energy prices and how you think low fossil fuel prices during this crisis will affect the adoption of renewable energy?
WEINSTEIN: There was a piece in the New York Times yesterday, telling the fact that right now we’re using more renewable energy than ever before on the power grid. Just over the past year the number of electrons generated has jumped from about 15 percent to 20 percent, well that sounds great but I don’t think you can draw the conclusion that that necessarily bods well for the outlook for renewables because we’re talking about a lower level of consumption. In other words, we’re using a larger share of renewable energy today while domestic consumption of power is probably down, I would guess, 10 or 15 percent as America’s factories have shut down. What’s more the increase in the demand for renewable energy is being driven in large part by something called the Production Tax Credit, which means that wind generators can offer fed and tariffs that are very, very low, sometimes they offer tariffs to the power grids at negative rates but they can still realize a positive cash flow because they get this 2.3 cent per kilowatt hour tax credit from the government. I’m not saying that the outlook for renewables has worsened, I think long term outlook for renewables remains positive but right now, we’ve got a very strange conapt nation of circumstances, so you can say, “Oh, look, we’re using a lot more renewables.” That’s only because we’re using less energy overall.
THOM: Very interesting, thank you Dr. Weinstein. I think we have time enough probably for one more question for each expert. Any of the media in the meeting please do chat your questions to us, we’ll invite if you want to ash them yourself or we can ask them for you. I would love to go back to Dr. Salata to talk about other drug trials that you’re familiar with, any studies in progress, especially about already approved drugs that may be potential for repurposing here to threat COVID?
SALATA: And you’re probably discussing Chiloquin or Hydroxy Chiloquin in the later.
THOM: That’s definitely the one getting the most coverage.
SALATA: There are clearly studies, primarily by Gilead right now with the drug called [INAUDIBLE – 0:46:31.9] this particular drug us being studied where it’s given to all comers with moderate or sever COVID-19 infection, either five days or 10 days. In the laboratory this have exquisite activity against not only this virus but other coronaviruses, namely SARS-1 as well as MERS, which came out of the Middle East. It also has activity in part against Ebola and was tried there but did not really pain out in that respect. We should have some results from this treatment initiative probably within the next month or so. At our institution we’ve enrolled over 30 individuals in these studies so far. We would like in the end to be able to treat earlier in the course of disease, to stop the progression to serious disease and death of course. Paramount in that regard has been all the fanfare around Chiloquin, Hydroxy Chiloquin and Z Pack. Chiloquin which had been primary used in the past for both prevention of Malaria, has not been used very much in that regard because most of the Malaria around the world has become resistant to it and therefore the supplies have relatively low and that drug is not without its side effects. In the context of coronavirus infection, it’s being used daily as opposed to weekly and we gave it for prevention of Malaria. In that respect, it has activity in the laboratory again, it changes the PH or acid-based context so that there is less binding of the virus to the susceptible host or human cells and therefore this should be operative. Hydroxy Chiloquin, which is a kissing cousin of Chiloquin has been utilized primarily in individuals with [INAUDIBLE – 0:48:42.4] particularly things like rheumatoid arthritis and lupus and is used daily and quite successfully as an anti inflammatory with the same mechanism of action to prevent viral infection and spread. Neither of these drugs as without their side effects, including a process called [INAUDIBLE – 0:49:04.1] where the red cells burst if one is predisposed to that genetically and also, there have been visual problems reported. The caution is not to do these unless we know for sure about the cost in terms of side effects and the benefits regarding that. Because of the shortage of both of these products, they now are in the national stockpile and they’re being distributed to the states and then individual hospitals now have to garner some from the states and really would require one of two things for them to be used in treatment. One is that the patient is COVID-19 positive by testing and the other they have a chronic condition that requires these drugs to be maintained. Now, the data regarding the combination of Hydroxy Chiloquin and Z Pack came initially from the French, where they studied this in patients without a control group and they found initially that it did decrease the amount of shedding of the virus from respiratory secretions, that was in a relatively small number of individuals. Subsequently, they released a study that was larger, 80- individuals, where not only did it impact on viral shedding from the respiratory secretions, it also had a favorable impact on fever as well as respiratory symptoms. There was last Friday, the first randomized controlled trial of Hydroxy Chloroquine plus Z Pack plus placebo from the Chinese experience and it did have benefits but it was again in only 62 individuals. Right there are standing up studies to look at the benefit of these in a larger randomized control trial and then we’ll know for sure, especially balancing the side effects. Chiloquin phosphate, which is the first drug we talked about, is available in non medicinal concentration’s and ways for instance, cleaning fish tanks. There have been a couple serious side effects, including one death from that and two more deaths in Nigeria where this was taken as very large doses for this purpose. The other studies include trying to dampen the very sever immune response that occurs especially once there is lung involvement and it’s associated with a condition called a pro inflammatory store, where our own white blood cells are releasing androgenesis products that really drive the situation and actually contribute in a harmful way to the host defense measures otherwise. These are drugs that would called [INAUDIBLE – 0:52:11.3] they are given to try and dampen that and there has been some success with that with a study through Roche. The other major thing that’s being tried right now is that in people that have successfully convulsed from this infection, they can take blood from these individuals and purify out the antibodies, again we talked about that before with antibody testing and then these could be administered to people that are in the throws of acute infection, to try to change the course and stop them from going on to sever infection and death. In that regard, this approach called hyper immune plasma has been used previously in the Ebola outbreak in West Africa, as well as the pandemic H1N1 setting some years ago with some success. I think that ultimately however, that’s giving someone passively somebody else’s antibodies but it is a strategy for those that really are at risk or moving progressively to develop sever infection. The other thing is the vaccine, I wasn’t asked that specifically but as most have heard, again it’s astonishing to me in my career to see this development happen so quickly. Trials are going on in China, two of them right now and one in the US conducted through the National Institutes of Health. These all start initially with otherwise normal individuals to mainly assess safety and tolerance and then it proceeds to what is called phase two testing and that is you’ll take some suspectable venerable populations and see whether or not it’s also safe and tolerated. The largest studies are so called phase three trials, that will really look at efficacy and those will take a while until all of that goes through that process. The best guesstimates are that this will be at least year if not 18 months before these become available. Lastly, if this virus cycles again and many have this opinion that this will be the case, perhaps in the next cycle we’ll have some vaccine to offer and really establish whether that’s affective or not.
THOM: Thank you, Dr. Salata. To Dr. Thomas, a lot of this crisis, in fact most of this crisis is unprecedented, how in your opinion are healthcare professionals coming up with innovative solutions and workarounds when there is really no roadmap about how to handle this?
THOMAS: Like I said yesterday, I feel like this has been one big work around from the get go but that’s what healthcare providers do so well. Whether you’re a nurse practitioner, physician, respiratory therapist, you’re a scientist inventing vaccine, we figure things out to get things done in the best interest of our patients. The begging of this crisis we were told N95 respirator is the only thing you can use, the CDC has had to loosen up their guidance as we’ve been running out of PPE and I’m still hearing from people, “Where is the PPE?” I hear from my colleagues all over the country, we’re still having that problem along with the testing. People are having to be very inventive. I talked to my colleagues who are in the hospital right now who are running IV poles out into the hall so they don’t have to [INAUDIBLE – 0:55:46.3] all their PPE and they can save PPE to care for the IV pole in the hall. People are figuring out how to use ventilators for more than one patient, so healthcare providers are innovative, we do whatever it takes to get the job done on the best interests of the patients and we’ll always continue to do that through this crisis and beyond.
THOM: Sorry to interrupt but I want to ask about this IV poles in the hall. Are you saying that they’re running the line maybe under the door and into the patient’s room so that they can administer a drug or whatever else with the IV pole in the hall without having to go into the room and be exposed to the patient?
THOMAS: Yes, it takes a lot of time if you have a beeping IV in a patient’s room, you have to put your gown, mask on, put everything on before you can actually enter that patients room and it’s a process and it takes time to do that. They figured out how to run everything out in the hall and just extend the tubing because this not only helps facilitates the time caring for the IV pump itself but it also saves PPE because you’re not having to soil your PPE everything you go in a patient’s room. Ideally, we’re supposed to be using onset of gloves, one gown, one mask, in a perfect world, per patient and not reusing this disposable PPE but we’re having to reuse it right now and that’s okay because that’s our new normal right now but ideally, in a perfect world, you’d be changing it out each time you go in a room.
THOM: Fascinating. One of these little workarounds just involves some extra long tubing to make the process go a little smoother logistically, that’s really quite an interesting little tidbit Dr. Thomas, thank you so much. I want to go to Dr. Penta again and as Dr. Penta, from the crisis so far, what do you feel like we may have learned about preparing and planning for pandemics before they happen?
PENTA: I think something is really emerging out of this COVID-19 experience is for us to really appreciate how much we can apply many of the concepts, practices, tools, personnel that are engaged in preparing for disasters to this pandemic, to an epidemic crisis. I’ll give a couple examples of that. There has been pandemic planning on in the States for a while but when we think about emergency management planning a lot of times we talk about the importance of the planning process more so then a plan that goes in a binder on a shelf because it’s about building those networks, identifying who you go to when you need a certain kind of supply or when you need your surge personnel of those kinds of things. I think this event illustrates that those networks, that problem solving, the identifying where those resources are, it’s showing that that’s parallel. Likewise, we see at the Federal level that the Federal Emergency Management Agency is taking a leading role in organizing this and facilitating this response. Emergency management activity is fundamentally about coordination and collaboration. Where are the needs? Who has the resources? What can we do to connect those two things? That has been much of what this response has been about. We also know from emergency management a lot of important things about the messaging that we need to make or how we need to craft those messages, what some of the obstacles are to participation. I think one of the big takeaways from this experience is realizing how much we can really transfer over and blend in from what we’re already doing with emergency management and applying to this response.
THOM: Dr. Berk, when this crisis is under control and the virus outbreak is halted finally, what is your opinion about the most important way to restart the economy?
BERK: I would say actually this is one of the most important questions right now. All through this crisis, we’ve always reacted instead of prepared. Right now, I see no attention being given to what happens when we switch the economy on. I don’t subscribe to this belief that people seem to take for granted that there is going to be huge long-term effect of this. In a very simplistic way, we switched the economy off in a day, we can’t we switch the economy on in a day? Now, I’m not suggesting that that’s a simple process but I am suggesting that if we get that wrong it will be a long [INAUDIBLE – 1:00:32.7] the question is, can we thing of ways of switching the economy on? One proposal that our group in finance at Stanford have thought about, would be for the government to induce firms to hire back all their workers, every last one. One way of doing that would be tell firms, if you hire everyone of your workers back for at least two months, then for two months you do not have to make any social security payments or unemployment insurance payments on behave of those workers. You induce the firms to hire those employees back. Why I think that is so important is, it gets us to where we want to be, which is why don’t we just think of this as a vacation? We switched the economy off, now we’re going to switch it on and let’s just go back to where we were. That is probably unrealistic to go exactly back to where we were, the closest back to where we were in my mind, leaves us with the least long-term implications of this process. I guess I’m just depressed when I think about the fact that nobody’s paying much attention to this, we’re back in the old, let’s just react when it happens, much less try and think about it ahead of time.
THOM: Very interesting Dr. Berk, thank you. Dr. Weinstein for one final question. Globalization, you mentioned about our dependence on China for so many goods and the interconnectedness of all of our economies being part of the reason why this crisis unfolded the way that it did. What is your thinking about that as generally a positive but also with some potentially some limitation or vulnerabilities? What may be coming out of this crisis will we have learned about that interconnectedness and globalization of our economies?
WEINSTEIN: We’ve certainly learned from the quick spread of this virus that we are an integrated, global society and to a large extent, we’ve become a globally integrated economy and on balance I think it’s been a plus for everybody. Yes, people have lost jobs, businesses have closed, comparative advantages have shifted but until three or four weeks ago the consensus was that globalization was a pretty good deal and yes, we have a president right now who likes to slap tariffs on countries who he believes are stealing jobs from us or playing unfairly but I’m hopeful that the so called liberal economic structure that evolved after the second world war will continue into the future because I think it’s been good for a consumer welfare and human development. There is one point I’d like to make, you didn’t ask me the question but I think it’s a question that we’re not really focused on and we don’t really understand what the implications are going to be and that’s the huge amount of unfunded liabilities that are going to follow this coronavirus in public pension funds and also in state and local government finances. That’s going to be a real difficulty going forward. With the economy shut down, states are collecting a lot less sales tax revenue, a lot less income tax, localities are collecting a lot less property tax, particularly here in Texas, where we have many communities that rely on evaluation of oil field equipment and reserves, help support schools and public services. I’ve seen very little attention being paid to the outlook for state and local government finances and particularly, public pension funds.
THOM: Very interesting. Bond ratings for state to be able to borrow may be a concern in the future and other aspects like that?
WEINSTEIN: Oh yes, absolutely. I think along the lines of what might be another round of support from the Federal government or from the Fed would be to focus on keeping these pension funds if not statistically sound at least financially viable so they can payout benefits.
THOM: Very good. Thank you so much, Dr. Weinstein. With that, I think we’ll move toward a close. For all the medial in attendance, we’re going to share a video of this, we’re also going to get a transcript and we’ll send that to you by email. If you have any other questions, we’re going to also provide you with the contact information to the communication offices at each of our expert’s different institutions so you can get in touch with them for any other follow ups or interviewers that you want to. Thank you all so much for joining and media for asking your questions. I want to just tap my colleague Jessica for any final thoughts before we close thing up,
JESSICA: Again, I love hearing these conversations. Thank you, Dr. Berk, I hope we can jump start the economy after this and it will be a great vacation. I look forward to you and your colleagues working on that and hearing more about that. Dr. Thomas, thank you and Dr. Salata for your work in everything and with patients or the work that you’re doing to resolve the pressure and Dr. Penta to support people in the emergency response right now. Dr. Weinstein, your comments were very interesting and I appreciated them. Thank you all.
THOM: Thank you everyone. Dr. Weinstein, Dr. Berk, Dr. Salata, Dr. Thomas and Dr. Penta, this has been an excellent discussion and like I said to our media, we’ll make sure that you have all the means necessary to get in touch with these experts for any further questions. With that, thank you all very much. Stay safe, stay healthy and good luck.