COVID-19 Update: Newswise Live Expert Panel
Newswise Live Expert Panel discussion of unique angles to the COVID-19 pandemic and the effects on all aspects of daily life around the world.
Experts from institutions including University of Oxford, Michigan Technological University, and AANA, will participate in an expert panel covering a wide variety of topics, with questions prepared by Newswise editors and submissions from media attendees.
- Professor Doyne Farmer - Professor in the Mathematical Institute at the University of Oxford, and an External Professor at the Santa Fe Institute. Farmer will discuss depression-level unemployment due to the pandamic.
- Randall Moore DNP, MBA, CRNA - CEO of the AANA. Moore can discuss PPE in the clinical environment, drug-shortages, and the critical role of nurses.
- Dr. Andrew Barnard, Ph.D.- director of the Great Lakes Research Center and an associate professor of Mechanical Engineering-Engineering Mechanics at Michigan Technological University. Banard can discuss rapid innovations in the times of crises.
- John Wilczynski - Executive Director of America Makes. Wylczynski can speak about new innovations for healthcare.
- Shandy Dearth - Lecturer, Director of Undergraduate Epidemiology Education- Indiana University. Dearth can speak on why we do not have more testing and tracing. How can testing be used to restart the economy.
When: April 30th, 2020 at 2:00 PM EDT
Where: Newswise Live event space on Zoom - https://newswiselive.zoom.us/j/7459578068
Registration for media, as well as colleagues from participating Newswise member institutions
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 Press Event, we have an expert panel today with five participants from different universities and other organizations who can talk about the current COVID-19 pandemic and different aspects of that and how it affects daily life around the world. We have Doyne Farmer, he’s a professor at the Mathematical Institute at the University of Oxford and he’s also an external professor at the Santa Fe Institute. We also have Randy Moore; he is the CEO of the American Association of Nurse Anesthetists. We also have Dr. Andrew Barnard, he is from Michigan Tech University, he’s the director of the Great Lakes Research Center and he’s also an associate professor of mechanical engineering and engineering mechanics. We have John Wilczynski, who is the executive director of America Makes and he’s also affiliated with the American Society of Mechanical Engineers. We also have Shandy Dearth, lecturer and director of undergraduate epidemiology education at Indiana University. Thank you very much for all the experts who have joined today and for media in attendance. Let’s start with you professor Death at Indiana, as an epidemiologist, I think that’s an important place to start as we talk about the pandemic. What’s your assessment of the current level of testing and contact tracking? This is the most important issue I think as we’ve begun to kind of debate nationally whether or not and how to reopen the economy and I think that that will help to kind of set the framework of how we’ll kind of continue talking about that. Tell me, what are we doing with testing and is it sufficient or not?
DEARTH: Great question. It is improving, I don’t think we’re there yet. I just saw today that LA announced that they have enough testing now to test anyone, symptomatic or not, so kudos to them, that’s great. But unfortunately, many parts of the country are not there yet, so we still need to ramp up available testing so it’s not just for the symptomatic people, it could also be for household contacts and others.
THOM: What else needs to be improved about that situation and why? What’s the basis for example, testing people who are not currently sick or maybe were sick and couldn’t get tested before but they want to find out if they did in fact the Coronavirus, why is this important and what else needs to be done?
DEARTH: That’s helpful for a couple of reasons. One is, it would give us a better idea of just how far the disease had spread before we even knew it was thing here. As we’ve seen, we’ve now gone back and found that the disease was here in the US earlier than we original thought because of some of those coroner reports where they were able to go back and do additional testing and verify it was there. The second piece is just to know how many people have been exposed and hopeful immune going forward, if we were to have a second wave, we all are assuming we will have a second wave, we have not yet verified that having those antibodies means we will be immune but typically with these kind of diseases you are, so we are hoping that’s the case, we n…eed more data coming in to see that. Again, it would help us plan that next wave. There is a big difference if we have 20 percent of the country already affected and immune verses 80 percent of the country and we just don’t have enough testing yet to say which way we are.
THOM: And presumably the higher level of people that have been exposed and developed antibody the better, the safer it is go back out in public?
DEARTH: Correct, it kind of creates that heard immunity that we aim for when we do vaccinations.
THOM: And what’s the current understanding as far as you know of whether those antibodies do mean that a patient is unlikely to get infected again? This was something that was unclear early on, whether a patient could indeed get infected by the virus a second time, do we know more about that yet?
DEARTH: Well, we’re waiting for some results from South Korea because they had mentioned a couple of weeks ago, they were starting to see some people who were possibly re-infected but they weren’t sure if those people were truly negative or they just happened to test negative. These tests are not 100 percent on accuracy. Additional studies need to follow people, not just in one country we would like to see that replicated in several areas, just to make sure antibodies really do lead to immunity.
THOM: With all this in mind, what’s your perspective on how we safely begin to reopen parts of the economy without risking new hot spots emerging and a spike of infections in new areas? What do you think is the right process and policy to follow there?
DEARTH: I think we need to follow the data and follow the science once we really start to see a decline in cases, that’s when we can start to move forward. I think we should do that step by step, wait two or three weeks between each set of opening to see if we are seeing increases. A big think I’m hearing right now is as these businesses are starting to open, they’re not able to secure masks and PPE that they might need. We need to do some education also around what kind of cleaning might need to be done in public places because we didn’t have a chance to do a lot of that yet before we went ahead and started shutting things down across the country.
THOM: Thank you, professor Death. I want to go ahead to professor Farmer and talk a little bit more about this possibility of reopening the economy and professor Farmer you’ve done some study about the current numbers and made some projections for how bad or how sever the recession may be. What does your study predict? Are we looking at a few quarters of recession potentially or something longer and a more full-on year or more depression?
FARMER: I think the thing that’s clear is for a couple of quarters thing are quite bad, so that’s deep. We’re predicting and our predictions are pretty much worn out, the order of 25 percent of workers in the economy are in danger of losing their jobs, even if they don’t lose them, they’re not able to work productively during the lock down. The big question is what happens when you let the lock down off? It’s not very clear because the US unfortunately is following the strategy of firing people and letting people get fired and then giving them support. This frightening statistic is that the great depression, which had levels that if you analyze stuff, match what we’re going to get in the first two quarters, the great depression lasted for a decade. Why did it last for a decade? Because supply depends on demand and demand depends on supply, you’ve got to have people with money to buy stuff, to make stuff to employ people to have people with money. The question is, how long will it take to rehire everybody and realign the economy as we come out? Already there is problems just coordinating the supply chains as you try and come out of a lock down. The worry is that -- I guess the way we think about it, there is going to be some mixture of a V shaped recovery, where we come out, we go down really hard and then we come back up. An L shaped recovery we would go down and we don’t come back up. The big question is, what fraction of those two scenarios are we going to see? I’d be very surprised if we don’t see a couple of years of reduced output afterwards but that’s the part frankly that’s the hardest to predict and we can’t really say and I don’t think anybody else can right now.
THOM: Digging a little bit further on that, are there certain sectors of the economy that may be able to experience a more V shaped recovery while others looks more L or U shaped?
FARMER: Yeah, it’s pretty clear that some sectors like manufacturing should be able to come back fairly quickly, particularly with revised procedures and mask and cleaning and all that kind of stuff. The bigger challenges are consumer facing industries. One of the questions is, when you come out, how different will the slope be than it was when we were going in? In the early days of the epidemic, the doubling time was about three days. On the other hand, if you look at Japan, the doubling time was much slower, why? Presumably because Japanese don’t shake hands, don’t hug, they wear masks if they get sick and so it was a long steady exponential decrease but in a much slower slope. Let’s hope that we can at least achieve Japan coming out and particularly if we selectively open manufacturing and other industries that don’t involve a lot of face to face contact or don’t involve interactions with consumers and then hold off on the more consumer-oriented industries.
THOM: You compared the current crisis a little bit to the great depression which has some good historical analogs, although it was different time, with different technology and different levels international integration, globalization. What can we learn from the great depression that does apply well to this current crisis? And maybe a more recent example, the 2008 housing crash and resulting economic crisis at that time, that’s much more fresh in our memories. How do both of these examples give us a clue about what to expect now?
FARMER: I don’t think the difference in technology makes that much difference because the great depression at the very basic economics as Kane’s originally intuited this feedback loop between supply and demand, getting stuck in a low level because if you have a lot of unemployed people they don’t spend much, if they don’t spend much people don’t make much, which means they don’t hire much which means they don’t spend much and we just got stuck for decade in that kind of trap. One big difference this time, because people get that, is that at least a lot of money is being pumped back into the economy. I don’t think it’s being pumped back in in the most efficient way. I think a lot of European countries are doing a better job in the way they’re delivering the funds. At least everybody understands that, they realize you really have to re-prime the pump once you shut it down otherwise the pump never pumps well again. That’s the most important lessor. Before the depression the world was surprisingly international actually and one of the things that happened during the depression is that changed international trade went, we way down during the depression. Some people worry that that was one of the reasons that it sustained for so long. What finally got us out of it was World War II and let’s hope we don’t have to go there this time.
THOM: And what can we learn about the recovery from the 2008 crisis, this is only maybe four or five years that we’ve gotten back to the levels that we dropped from?
FARMER: The 2008 crisis was different in two key ways. One is that the 2008 crisis was what we call and indigenous event to the economy. We got way over leveraged, people didn’t understand mortgage backed securities, their positions were all way too big, was driven by the financial system and it was driven by the financial system acting on itself. This one is coming from outside; we have a pandemic. The pandemic hits the real economy, then the real economy is going to transmit back to the financial system. Whereas in the 2008 crisis it started with the financial system and then reverberated back to the real economy, it’s going the other direction this time. That’s actually kind of unusual. The good news is historically depressions or recessions that are driven by the real economy are not as bad as the ones that are driven by the financial system. The financial system there is a different loop we get stuck in. We’re way over leveraged, everybody’s borrowed too much money and then they go, “Oh my god, things are dangerous.” And everybody sells and then there is not enough leverage and businesses can’t operate because they can’t borrow money anymore. Then you get stuck in some mode like that for a long time. I think one of the main lessons is, I think everybody agrees in hindsight, that again if it hadn’t been for the really aggressive actions that the government took, we have Ben Bernanke as head of the Federal Reserve, he was a depressions scholar, he knew we really have to go after this one and while I think again, they could have delivered the stimulus more effectively, from the bottom instead of the top, we might have a lot fewer problems with dissatisfaction about the system that they given the money to householders instead of banks. Nonetheless, everybody pretty much agrees that big stimulus was essentially and that message is coming through this time and so that’s probably the most important thing.
THOM: Great, thank you, Professor Farmer. I want to next to Randal Moore at AANA, your members, your constituents are front line medical worker, nurse anesthetists are being redeployed to work in ICU’s and all kinds of other task. Tell us about the strain of the healthcare system and what’s your sense of that, while both the pandemic and the pressures of dealing with that but also, the closing or the halting of other types of routine medical care? You members are kind of caught in a little bit of bind there. Tell us what we need to understand about that?
MOORE: When you think about the impact of COVID-19 on the healthcare system it’s especially cruel phenomenon because you’re looking at a precipitous decline in elective care and you’re seeing hospitals and health systems realizing right now 75 to 8- percent decline in their revenue and many of those hospitals, particular in the rural areas of this country were already in a very epicurious financial position. Many of them were in the red or just barely in the black and then you add a precipitous decline in their revenue, we’re seeing some really scaring things happen. We’re seeing hospitals close, some of which will not reopen. That’s coupled with a profound increase in patients, COVID-19 patients in metropolitan areas in particular but now it’s starting to move out into the rural, in the community-based hospitals and that’s resulting in an increase demand in care. It really is a particularly cruel crisis in that revenue stream has been almost completely eliminated and then the demand has increased precipitately in some areas and it’s created an enormous strain on the financial stability of healthcare in this country.
THOM: Tell us about the status currently of PPE and other types of equipment shortages and how that’s been handled? Are health systems finding ways to source the equipment they need and what else do you think needs to be done?
MOORE: The challenge is it’s highly variable, it depends on how you talk to. When get hopefully get on the other end of the crisis and we do in Military what we call an After Action Review, we’ll identify some opportunities here, particularly around supply chain constraints. Right now still, we’re six, almost seven weeks into this crisis and we still have areas of this country, hospitals and clinics and nursing homes competing with each other for PPE and competing with states for PPE and then the states are competing with the Federal government and it goes on and on and on. You can see the challenges, there right? I can give you an example of what this means in real life, for a clinician in the trenches right now. Just last week I spoke to a nurse anesthetist in a well-known health system in this country who’s been using the same N95 mask for a month. Those masks are manufactured to be single use only, you use it, you throw it away. She’s been using the same one for a month. She’s not an anomaly. There are healthcare providers all across this country having to make do with an inadequate supply. Some health systems and hospitals and clinics are just fine, many are not and many of them are just fine right now but if they experience a surge and we’ll probably talk about this a little bit later on, if there are subsequent surges or waves, they could be in a lot of trouble. Still today, six, seven weeks into this crisis we still have some very serious issues with supply chain.
THOM: Thank you for shedding some light on that. I want to go ahead to John with American Makes, as they are working really hard with the team of engineers to work together with healthcare leaders to figure out ways of improving that supply chain. John Wilczynski, what can you tell us about how American Works and the ASME are working together to bring these kind of tech experts into the fight?
WILCZYNSKI: Absolutely. Randal very clearly just documented where we’re at with things. It’s really why we got engaged going on seven weeks ago. We represent at community of manufactures, the additive manufacturing 3D printed space. There is a belief that there is opportunity for that technology to supplement or potential bridge supply chain gaps. That’s how we got involved. One thing we found immediately was there is a tremendous interest in supporting those front-line workers but there wasn’t a lot of organization around how to do that effectively. Many of the folks in our community aren’t familiar with working underneath regulatory requirements of the FDA and healthcare system. There was a lot of information and knowledge sharing required in order for folks to be able to support the needs. We teamed up very early on with a group of Federal organizations from the FDA, VA and NIH to build a process or a workflow where those that had ideas for how they could supplement the supply chain in some way could produce designs that would ultimately would be vetted such that manufactures would know where to go to produce and item that could be delivered to the front line and that all obviously depends a lot on criticality of use and where it’s going to be used and what type of item it is. It’s somewhere where we’ve seen the technology step up and play a key role. In some cases, just re-tooling a line, which is very important. We’ve seen many manufactures in injecting moulding lines and more conventional manufacturing processes re-tool such that they could produce these parts. In some cases, we used additive or 3D printing to bridge a gap and maybe now we’re over some of those hurdles, although as just documented, we’re hearing some of those same stories. The demand signal has difficult to understand. Day to day it would change so dramatically and then when you talk to some front-line workers you realize some of that’s because they’re being forced to use PPE items for weeks, whereas normally they would replace those multiple times per day. It’s really hard to predict a demand signal with ultimately makes it difficult for the supply chain to understand whether a small manufacture or a Fortune 50 manufacture, to know where they can step. We’ve dealt with the entire spectrum there. Ultimately, we’re in the position where we’re trying to build a more resilient supply chain, that’s what we all understand we need to have. There has been a lot of progress made. We’re seeing a lot of conventional manufacturing e repurposed or retrofitted right now, you’ve seen a lot of those stories. That is reassuring and hopefully that is now starting to get to the point where some of the PPE is making its way to the front lines so that we stop hearing those stories of reuse over lengthy mounts of time.
THOM: With a lot of these engineers and the industry partners being from other industries, not necessarily having experience in medical device manufacturing, how are you guys helping to translate these kind of complicated issues and getting these new participants up to speed with important things like following the right procedures, testing, safety and getting FDA approval and things like that?
WILCZYNSKI: Absolutely. We’ve learned a lot really quickly. We’ve talked to a lot of folks and experts in these spaces who deal with these types of scenarios. We’ve come out and through some of the work we’ve done with NIH, created a porthole where folks can access designs but it’s really about information sharing. We’ve built something that internally we call the Rosetta Stone but it’s really about how does a manufacturer come to a place to understand -- they all want to get engaged but in some cases they don’t know what they can and cannot do, so we’re trying to lower those barriers to entry, make sure they understand any regulatory concerns. Do they need to have GMP? A term I didn’t even know what that meant a couple of months ago, around different quality systems that they need to have in place. We’re trying to make that as transparent as possible, so someone can very quickly can come to a location, determine where they can get involved and then go do good. I think that’s proven to be successful. We heard some stories of where material wasn’t able to be utilized because people weren’t following the right process. There is little details like that were even in times of dire need, you have to make sure you’re checking the right boxes because we don’t want to and most importantly, we want to deliver safe, affective products, that’s what this all should be about. We’re trying to help the community come together. There’s a number of organizations, I’ve been involved in many different get togethers through ASME and other standards organizations to get the manufacturing community to understand what they can do and where they should be involved.
THOM: Thank you, John. I want to turn next to an example from a engineer with professor Barnard at Michigan Tech. Andrew, you worked on developing something here, I’m going to share an imagine of it so people can get an idea. Repurposing an old shipping container and equipping it with the means, I hope that picture is showing for everyone, equipping it with them means to sanitize equipment through exposing it to high heat. Tell us about this project, how it originated and any more info about what this kind of innovation means for bringing engineers into the fight as John has described?
BARNARD: Thank you. We really set out to try to address the need that both Randal and John have mentioned in PPE shortages. One way to help our front-line health workers is to provide some semblance of decontamination between reuses of PPE, even though the PPE is not made for that. Can we do something that’s better than hanging your PPE overnight in a paper bag, which is what’s currently going on. The idea started really with a call between my cousin and I, he’s an organic farmer, we were chatting about box trucks and insulated containers and started thinking about can we convert rapidly available materials like insulated trucks, into something very quickly that can be used in the fight to help our front-line healthcare workers? We came up with the idea for our mobile thermal utility sanitizer. There is lots of different sanitizing for decontaminating methods out there. We chose to go with thermal because it’s very rapid to manufacture, it’s relatively inexpensive and the parts are available. You don’t have to have a PHD or MD to design and make these units. You’ve to be good at HVAC and have an electrician onboard. We also wanted to make something that was scalable and large enough that could really help in emergency situations. Something bigger than say just using your kitchen oven is what we were after. It turns out a 40-foot shipping container works really well for this. We can sanitize about 5,000 N95 masks in a two-hour period, so 60,000 to 80,000 masks a day. We designed and built that unit, our first unit in eight days. I think it goes to show what engineers and universities can bring to the table in an event like this were time is of the essence.
THOM: You built this and conceived of it deliberately as a plan that could easily be replicated and shared with health systems and states agencies and even I believe you told me that you’ve got the prototype now with the National Guard Tell me about how that as a kind of a format or template for this project, of wanting it to be something that you achieve the prototype but then share the design freely and hope that it can be utilized?
BARNARD: That’s exactly where we started on this project. We wanted to make something if the plans were available, any small manufacturing house in any part of the country could make it in a matter of days and that’s a real challenge because usually engineers make these complicated systems that require specialized manufacturing in order to build. We intentionally went after things that could be bought on basically residential, do it yourself can have access to with one or two day shipping in order to build this. For those of you that aren’t familiar with Michigan Tech is, Holtan Michigan is the upper peninsula and we like to say, if we can get in Holtan in two days, you can get it anywhere else in the country in one because we are about as far as you’re going to get. We really, really intentionally worked with available residential grade parts to try to make an inexpensive but safe system that can be used for our healthcare workers.
THOM: Thank you, professor. I want to go back to professor Dearth for some more about the progress of this pandemic and especially on the debate about reopening the economy and I want to ask you if you think that there is any concern about there being a false sense of security in some parts of the country, in less densely populated areas or more rural states because they’ve not yet seen these high levels of infections that we’re seeing in New York being the epicenter but that doesn’t mean it won’t come to those places, correct?
DEARTH: That’s correct. It’s possible that we shut down the county early enough that it had not spread to those very rural areas in a serious situation. The more we test the more we’re finding it obviously. Another concern and another way where these areas are hit again, maybe we don’t have as many people who already had a past exposure and may have built immunity but also as noted earlier, a lot of rural residents rely on those larger city urban hospitals who have already the first big hit and so we really want to contain that and make sure that we don’t have that second hit until we have more PPE available, it sounds like it’s still very much a problem even in many healthcare settings around the country.
THOM: What concerns do you have about this notion of reopening, easing restrictions and then that resulting in new hot spots and that false start leading to a second wave? We’ve talked a lot about that with some of our economic experts that have been on recent panels and the cost of that to the economy. How would that impact the healthcare system in general and as a epidemiologist why is that a concern?
DEARTH: Obviously that surge just means we have fewer people available to treat people for other issues going on. We’re getting to that point in this pandemic now that some things that may have not been so urgent six, seven, eight weeks ago are becoming urgent for some of these patients, not related to Coronavirus. We need a safe way to get those patients into medical care when needed while still protecting the PPE supply.
THOM: Thank you, professor. I want to Randy, what lessons do you that there have been in this crisis so far as it’s unfolded about preparation and leadership? With this being something that there was a lot of unclear info early on and maybe contradictory statements and advice coming out of different places, it’s been confusing, it’s been challenging. Looking back, what maybe could have been done better and what did we learn for the next time?
MOORE: A few things that come to mind. One is, clearly the leaders in this country, the state and local and even the federal level, who moved decisively early made the right call and that’s one of the challenges, is when you have incomplete data set and you’re having to make difficult decisions. It appears now at least, that those who moved aggressively probably saved a lot of people’s lives. The other piece about this that is really important and hopefully again, another lesson that’s learned is, the inadequate infrastructure, healthcare infrastructure in this country to deal with the public healthcare crisis is I think abundantly clear to me at least. We already talked about the supply chain issues, the centralized nature of healthcare in this country, the competition between facilities and all of those things indicate to me that this pandemic has uncovered and we already knew that we had challenges in healthcare delivery in this country, I think this pandemic has uncovered a lot more and that those challenges are probably a lot worse than what we thought they were. Certainly, we were not prepared. I don’t think any country ever fully prepared to do deal with a novel virus pandemic, but if you look at how we responded, there is some things we did well and there is certainly some things that we didn’t do particularly well.
THOM: You called out some states that did decisive action early on and that’s been effective, I think parts of California have been held up as examples for that. We’ve got cases where other states are in some people’s minds, rushing to reopen and that has its own risks, so that’s kind of the flip side of that. What are your concerns about a state by state process for this and kind of laze a fair attitude of the federal government of allowing the states to make us their minds about this themselves, why does that concern you?
MOORE: We’re currently embarking on a high stakes experiment right now in terms of how states individually and in some cases collectively are approaching reopening the economies within their states. Georgia is obviously the example that many people point to where they close [INAUDIBLE -- 0:32:48.1] and they appear to be by many people’s definition opening early. Even if you look at the criteria that were established by the White House in terms of how you reopen, Georgia meets none of those criteria. Now we’re opening up and we’re going to see what the consequences of that are going to be from an economic perspective but more importantly, for a public health perspective. My fear is that they open up, that they experience a significant surge in patients who are COVID-19 positive, it creates a profound strain on the healthcare facilities in that state, people die that probably should not have died because of the strain on resources and those facilities in that state is unprepared for what’s coming it’s way potentially.
THOM: Thank you, Randy. To professor Farmer, as we talk more about what factors go into and what policy goes into the idea of reopening the economy. What are your thoughts economically speaking on these kinds of state by state decisions and even internationally, nation by nation different cases? We’ve heard a lot, South Korea has done a good job, they’re back to a certain level that maybe other areas are not ready for. What are your thoughts about that and how that affects the global economy?
FARMER: I think the best way to get the economy going is to deal with the epidemic quickly and effectively. We see that most of these eastern countries have done a pretty good job in that regard. In contrast, Europe has done a fairly good job, they started too late. UK in particular started about two or three weeks after everybody thought they should have but at least they all have coordinated lock down policies and minimal flow now across national borders. The US, you can drive from anywhere to anywhere anytime you feel like and you open some states up and you close other parts down, it’s going to ciaos and it’s going to prolong the epidemic in my opinion, for a long time because in the end it’s going to be economically unproductive. My prediction is that when the dust settles, US is going to be hit harder both in terms of number of deaths and in terms of economics than any of the other developed countries because of the incoherent public health policies that we’ve implemented.
THOM: Thank you, professor Farmer. John, I’d like to ask you about some of the projects that American Works is collaborating on and do you have examples or some more ideas that you share about the kinds of designs and prototypes that you’ve helped --say take a design that wasn’t quite ready and helped to improve it or fast tracking ones that had promise, what can you share with us about those other kinds of novel challenges as well beside just PPE that’s been one that the public largely I think grasps, masks and face shields but there might be other things too that you’ve come across and that you could share with us.
WILCZYNSKI: You actually kind of hit on it when you asked Randy a question a second ago. Early on there was a lot of bad information out there. We worked together to try to get that information organized and we have a progress as I mentioned for submitting designs into a system, they get flagged as prototypes and then they get reviewed, evaluated and then they ultimately can be released per our collection of organizations, the VAFDA and NIAH as okay for community use or okay for use in a clinical setting. We have almost 500 designs submitted to the site, the NIH site, the 3D print exchange right now and many of those, a lot of those folks that are designing these items aren’t typically designing items for use in the healthcare setting. There has been iteration, there has been feedback and back and forth between those evaluating. Early on we focused on face shields, it’s something that you can very quickly and easily get out but it was also a critical need. We’ve moved past that to face masks; they are certainly a big need right now and as more folks are going back to work that becomes an even greater need. We’re tying to make sure N95’s are available where they’re needed and then use other means for portions of the population that don’t ultimately need that same protection. Additive manufacturing has potential to play a role, we’re actually finding though in the 100 plus or almost 200 different designs that we have, there is still a problem with fit, so they don’t seal. Even if it’s a great design, if you have big gaps around it, it’s not doing its job ultimately. We just launched something called the Fit to Face Challenge with the VA and we’re currently reviewing and down selecting designs, ultimately trying to fit as large a portion of the population as possible. A couple of other interesting things going on and this is all really about getting the community, I’ve mentioned it, others have mentioned it, everyone wants to help, we need to make sure they’re focused. One way we’re trying to focus people is to not make the 50th version of something that’s already been viewed as acceptable but to move on and focus to something else. We teamed up with a group called Challenge America, we’re currently in the midst of a active challenge with them, they’re actually having something called a Hack or Make-a-thon this weekend, where they are getting virtual teams together to address a challenge space. The challenge space for this weekend is that of first responders. We recognize there is specific needs of that community, that COVID is now presenting, that we’re not really very well aware of, so we want to make sure that we’re addressing it. This weekend, on Saturday and Sunday there will be groups of people coming together to try to address those challenges and then we’re planning on, through this relationship with the VA and Challenge America, continuing to do this every few weeks on the new a challenge space. The next one that we’re focusing on, that was identified was the role of sanitation worker, recognizing that as more and more people get back to work, there is going to be an extreme focus on that job description that maybe there hasn’t been in the past. What are the things that sanitation community can benefit from by coming up with new designs? Again, all about focusing on how can we help and just not spinning our wheels doing the same thing we’ve already figured out.
THOM: Thank you, John. I want to ask professor Barnard, again talking about a very specific example of the decontamination unit that you created, what’s next for your project in terms of approval by the FDA? What’s happening with the prototype that you’ve created? How are you navigating this environment that John’s described where engineers need to follow the right protocols?
BARNARD: That’s been a big learning experience for us. I’m a mechanical engineer who runs the Great Lakes Research Center, I’ve never done anything in the healthcare sector. Trying to understand FDA approval is a whole new world for me and for many on our team. We’re currently going through the FDA emergency use authorization process, which is an iterative process with the FDA. They send us questions, we answer those questions, they send us more questions, we answer those questions, back and forth until eventually they tell us yes or no, we’re still in that process. Our unit is deployed with the Michigan Army National Guard. We were lucky enough to have the governor agree that it was important enough technology that the National Guard should be running it. We given a contingent of nine solider who were able to train here on campus and then they took the unit down to Taylor Armory, which is just north of Detroit and they are awaiting an opportunity to go and use that unit. We have several healthcare facilities interested but not willing to start using it until the FDA EUA is issued. That’s really the step we’re at right now, is waiting for that EUA.
THOM: Very good. Tell me also what plans if you have any, to continue to develop this prototype and make further enhancements to it for a second generation of it?
BARNARD: That’s a great question. Our device is a dry heat device, which is really the least effective of the decontamination methods but the easiest to access, which is why we started there. Our second generation device, which we just completed a couple of days ago by our industrial partner, is a moist heat device, so it actually has humidity control as well as temperature, which allows us to more effectively kill things beyond viruses, like bacterial spores and other things that are also a risk of spreading around in hospitals. We are really excited about that technology as well. We’re looking at based on feedback from the FDA, how we develop our procedures and our protocols so that our devices can be used safely in a hospital environment.
THOM: Thank you, professor. If any of the media in attendance have any questions, please do chat them to us, you can see the chat bubble at the bottom of the screen, you can chat to me, we’ll invited you if you’d like to ask your question live to the panel or I will relay the question for you. Back to professor Dearth again for some more about the medical and epidemiology questions. Can you explain to us what the federal guidance really says about state policy for reopening and lifting these restrictions?
DEARTH: They’ve outlined a few guidelines; one says that you have to have good contact tracing in place. It says that you have to have good testing in place. There aren’t a lot of very specific elements around those items though. You have to have a decline in percent of cases that are positive. As we do more testing, we’re going to find more cases, so in many areas the case counts continue to go up but that’s probably a factor of just having better testing, not that we are necessarily having more transmission go on but that’s where they’re focusing on that percentage. I can’t say lots of places have seen that leveled off, we’re not seeing a big decline yet, so we’re not there quite yet. As you said earlier, most places have not reached those federal guidelines that they’ve set.
THOM: I’m curious about one point you made there, about more thorough testing, not necessarily meaning that there has been a change in the number of transmissions. This feels like something that’s been really at the heart of this whole crisis, whether we test people who are symptomatic and when they come to hospital verses contact tracing and more wide spread testing for people who might have been at risk or might have already been sick and gotten over it. Why is this so complicated? Why is this difficult to understand? Does it have a lot to do with the fact that there are asymptomatic cases or why else, from your perspective, can we not truly pin down what’s the transmissibility rate?
DEARTH: That’s a big piece of it and early on as you know we had very limited testing so we had to reserve those very precious tests that we did for the healthcare workers because we know we don’t want a healthcare worker sick working, infecting other people in a hospital where you’ve got the most venerable populations going. Then, as the testing has improved, we’re seeing the numbers of how many people are truly asymptomatic, so we’re doing those questionnaires. If you were positive but you didn’t report and symptoms in the past, then we know that’s been a problem.
THOM: Thank you so much for clarifying that for us. With the possibility of testing for antibodies, this is post infection, what does that tell us that’s worthwhile and why does that matter?
DEARTH: Again, it goes back to two factors. One is how well was the disease transmitted earlier on, how long was this really in the country, how far was the geographic spread? Then for the second future possible wave, how many people might have immunity?
THOM: Got yeah. Not to share too much personal information but I had a really terrible cold in January, late January and I’ve been suspicious maybe it was the disease and I’d like to get tested to know or not, especially since I have a family member who’s got some high risk issues and would know whether it was safe to go visit or not. Do you see that this will be something that is more accessible in the near future or is that still something facing a lot of complications?
DEARTH: We’re getting there. I know a lot of the larger cities are offering more of the antibody testing. A lot of universities have stepped up and been able to develop that test themselves. All of that work is not put on the CDC labs and the state public health labs.
THOM: If any of the media have further questions for any of our panelists, please do share them. I’d like to go back to Randy Moore, Randy beyond PPE, what are other kind of equipment shortages or other resources that are facing risks looming on the horizon? Is there issues wither certain kinds of medicine for example, running low?
MOORE: We’re certainly very concern about drug shortages, we’re starting to experience that already. As you know the drug supply chain is pretty inflexible. We’re seeing a high utilization of drugs associated with treating critically ill patients. We also know that COVID-19 patients, the one’s that become really, really sick are on ventilators for prolonged periods of time. You are talking about medications like narcotics and sedatives, muscle relaxants, we think there is a very real possibility that we’re going to be experiencing some pretty significant shortages moving forward. We’re working very closely with the FDA and with facilities and other agencies to try to understand how we can conserve these medications in a way so we don’t deplete them prematurely. Certainly, that’s something that we should all -- that’s the next issue that’s going to drop in terms of, okay now what are we going to do with this new sub-crisis associated with the pandemic. Weeks ago I was very concerned about ventilators and that was one of those things that was keeping me up at night, based on some of the modeling that I was seeing and the utilization that was occurring and the lack of supply that appeared to be unavailable at that time. I’m becoming less concerned now but again, if we experience another wave, if in the fall, in the winter or certain areas of this country can experience surges, there is still a very real possibility that we could have challenges with ventilators moving forward. The third resource that is not getting a lot of attention is really the providers, the people who are in the facilities taking care of these patients’ day in and day out. The clinicians, the housekeepers, they’re experiencing immense strain, psychological, physical strain as a result of taking care of these critically ill patients for a long period of time. I would like to see more conversations about the psychological trauma associated with that and what are we going to do in this country to address that? Because I think that’s going to be another element in the coming weeks and months, it is going to be really difficult to deal with.
THOM: Thanks for raising that and that’s a topic that we’ve had panelists on in recent weeks to talk about some of those mental issues and we’re currently talking with another of our members about having more of that. That’s well noted, thank you. I want to ask real quick if you could tell us a little bit more about what your AANA members are doing in terms of being redeployed to other areas and especially if there is policy that could be improved to make redeploying CRNA’s more effective to solve some of these problems that have been highlighted by this crisis?
MOORE: If you look at the background and the education and training of a nurse anesthetist, it’s almost as if there were ideally positioned to be involved in responding to this crisis. One is, we’ve had a background as critical care nurses before we go to anesthesia school for critical care nurse and then anesthesia school and we’re advanced practice nurses that have deep expertise in managing patients airways. We know that 12 to 13 percent of COVID-19 patients require tracheal intubation, putting a breathing tube in and mechanical ventilation. We are experts, airway experts and we’re highly involved in taking care of patients who require mechanical ventilation, we manage critical ill patients with nasal active drugs and a variety of other clinical interventions that occur in the critical care space. What’s been remarkable is, that’s not the role that we traditionally play, nurse anesthetists and anthologists usually are not in critical care units taking care of pandemic patients but we’ve been redeployed in those areas in many cases and there is all kinds of stories of how we’ve stepped up and contributed. There is again, in this country there still remains a lot of challenges relative to advance practice providers that are not physicians, I’m talking about inadequate state laws, rules, regulations that really prohibit nurse anesthetists, there is practitioners, physician assistants who practice into the top of their education and training and what’s been interesting to see is at both the state a federal level, all of a sudden those rules are gone. There is a crisis and all of sudden we’ve become a lot smarter and a lot more capable and we’ve stepped up and we’ve been able to make major contributions. The work we’re doing at both the state and national level, let’s get rid of these barriers now during pandemic and let’s get rid of the barriers permanently because we know pre-COVID there was a huge access to care and cost issue with healthcare in this country. That’s not going to go away, in fact it’s going to be worse after COVID-19.
THOM: After COVID-19, a question from the chat on this topic, how might emergency care change? Randy, what can you tell us about your thoughts on that?
MOORE: Emergency care, one I’d call out, this disease has only been in existence for a few months, so we will still know very little about it, which is scary and which makes it particularly dangerous. I think some of the things that we’ve learned is, one you need to move decisively. Two, you need to make sure that you have the resources available within your facilities. Just in time supply chain has not worked when it comes to a pandemic where you’re using -- the burn rate for PPE is through the roof. We now know that the national stockpile didn’t work in terms of the number of ventilators and PPE. We need to be very serious about making sure that we have adequate supply. I think that’s one of the things that’s particularly illuminating for me, we need to be very cognoscente of the supplies that we need in order to respond to these kinds of health crisis which we did not see coming right? In November, December this was not on radar, at least not in a real way. I think those are some of the lessons that I’ve learned.
THOM: Thank you, Randy. That question from Deb Wood with Nurse Zone. I want to go to Professor Farmer for a few final questions about some economic topics. Again, after COVID-19, as we had the last question, what do you see as obstacles to this economic recovery, that will make the difference between part of the economy that might be more V shaped verses or L or U shaped? What are some of those obstacles? What industries might be in the mix for that quicker recovery verses a longer one and why?
FARMER: Manufacturing type industries will get back to work soon, will be able to make stuff fairly soon but restaurants, airlines, vacations, those kind of industries are going to probably take a long time before they get back to normal because until we have a vaccine and really wipe the disease out, it could be a year or two before people are comfortable going. I think common sense kind of tells you the most, the key part in that.
THOM: What myths or misinformation have you seen about the economic effects that you’d like to address?
FARMER: There are a couple of things that people don’t realize, like getting sick isn’t just about getting sick yourself, it’s about keeping the virus alive to make other people sick. It’s really a matter of citizen duty to not get sick. I think a lot of young people have been irresponsible about that or in some states where people don’t understand those kinds of issues. Obviously, there has been huge amounts of misinformation in various parts of the media and social networks about conspiracy theories, about the virus being the result of a leakage from the lab or stuff like that, there is just a lot of silly stories floating around.
THOM: Thank you, Professor Farmer. We have a couple questions from some of the media in attendance that I think are best for professor Dearth. We’ll try to wrap up with a couple questions here as we are about at an hour. First, we have Yasim who has a question, go ahead, Yasim.
YASIM: I would like to like to ask about how effective the lock down is in decreasing the COVID-19 infection rates? That some of the countries imposed lock down fully like Italy, Spain or maybe partial like Singapore and how effective is lock down in lowering or flattening the curve? The economic impact, what do you think governments can do to mitigate the economic impact of a lock down and which countries are more venerable to recession? If I’m not mistaken, I read in Singapore recessions are worse than estimated and how sever is the recession compared to Asian financial crisis in 1987/88 global financial crisis 2008? Thank you.
THOM: Thank you, Yasim. First, Professor Dearth on the lock down and the infection rates and then professor Farmer for the economic questions.
DEARTH: I think had we not locked down it would have been catastrophic. I think locking down was the right to do. Knowing that people show symptoms sometimes up to 14 days after exposure, we were able to look at when things were locked down and we were able to see the cases start to decrease coming into the hospital emergency departments. I think it’s been very effective and we’ll need to do it again in a second wave if we do have that.
THOM: Professor Farmer on the economic questions about which countries polices have been most effective and which are maybe at most risk for a sever recessions?
FARMER: I’ll boost what Randy says, just look across the countries and it’s very clear, the countries that imposed early strong lock downs got rid of it quickly and their economies are functioning just fine. Vietnam, no deaths, New Zealand reopened they’re having few infections per day. Most of the eastern countries have done far better. India being an unfortunate example in the other direction. No, I think it’s very clear that economically locking down early and hard is far and away the best way to go from a death and an economic point of view. Somehow, it’s like politicians weren’t paying close enough attention because by the time we got to the US there was plenty or warning, all you had to do is compare what’s happened in the countries across the world. It just seemed like a no brainer.
THOM: Thank you, professor. Another question from Carlen Hultgren who is with the Porch Press, she’s the east Atlanta editor. Carlen, would you like to ask your question?
CARLEN: Sorry, I lost you there.
THOM: Your audio is live Carlen if you want to go ahead and ask your question?
CARLEN: I’d taken off my picture while I was eating lunch. I’m in Georgia, there is not a lot of wide spread testing, once we get to that point where there is wide spread testing does that mean for everyone? Does it mean just for venerable populations still? How does that manifest itself to what end if you will? What’s the best-case scenario, let’s put it that way?
THOM: Thank you. I think professor Dearth is best to answer this one.
DEARTH: That’s a great question. I’ve got to say, we are so far away from having enough wide spread testing I’ve not even heard that question asked yet, so that’s a great one. I would say we might get to the point where we’ve got a vaccine before we have enough tests for everyone and even if you’ve already had it, if you were to be vaccinated, there is not harm in being vaccinated for a disease that you’ve already had in the past. I would think that they’ll just not give up on testing but they won’t necessarily recommend testing before you get a vaccine would be my guess but again, I have not been a part of those conversations.
THOM: Thank you for your question Carlen. Professor Dearth, what if any misinformation or myths have you seen recently that you think are especially important to address?
DEARTH: I don’t know so much about myth but one piece of education we need to get out there is that in March, when we first started shutting down things, the US Poison Control Center’s announced through CDC that they’d seen an uptick in the number of people with problems mixing chlorine, ammonia, other chemicals that should not be mixed. My concern, I know some cities were reporting an uptick again last week after some information got into the news. My concern is that as things start to reopen over this next month and businesses are trying to do their best to clean and sanitize areas, that we’re going to see some more of those accidents happen and actually HHS I believe just gave an allotment of money to the US Poison Control Center and CDC to do some additional public education around that topic.
THOM: Thank you, professor Dearth. I want to thank John Wilczynski from American Makes, not America Works, sorry about that John, America Makes. We also have Randal Moore from the American Association of Nurse Anesthetists. Shandy Dearth from Indiana University. Andrew Barnard from Michigan Technological University and Doyne Farmer from Oxford University Santa Fe Institute. Thank you so much again to the panelists and for the media attending. Stay safe everyone. Stay healthy and good luck.