Topic: It’s the summer of COVID and experts will discuss four major news stories converging together during the global pandemic. First, what’s the latest on infection rates and the likelihood of a ‘2nd wave’? Then, how is the pandemic affecting the economy, Black Lives Matter protests, and the looming 2020 election?
Media are invited to participate and ask questions in this Zoom meeting, either on camera or by chat.
When: June 25, 2020. 2PM-3PM EDT
Where: Newswise Live Zoom Room
- Anne Bailey Ph.D - Professor - Binghamton University.
- Eli Rosenberg Ph.D - Associate Professor in the Department of Epidemiology and Biostatistics - University at Albany.
- Kevin Smith, MD, FACP,FAAP - Chief Medical Officer at Loyola University Medical Center
This live event will also be recorded and transcribed for use by media and communicators after it is concluded.
Thom: Okay, welcome to this Newswise Live expert panel. We have three experts today to talk about two very important topics that are going on in the news, the Covid-19 pandemic as well as the Black Lives Matter protests and movements for police reform.
I want to give a couple of instructions and introductions and then we’ll get started with questions for each panellist and we want to invite media who are on the call to give us your questions. You are welcome to use any of the quotes during today’s discussion in coverage that you’re writing about these topics and we will also provide a recording and a transcript of today’s panel afterwards that you're welcome to use for any of that content. We also welcome that you could contact the experts to ask them further questions yourself and arrange your own interview if that’s something that you'd like to do. The contact information for the communications offices at their home institution will be part of the materials that we send around with the video and transcript. We’ll go ahead and get started with a couple of introductions.
We have Doctor Anne Bailey from Binghamton University. She's here to talk with us about the black Lives Matter protests and calls for police reform and the history behind those issues.
We also have Doctor Eli Rosenberg, he's the associate professor in the department of epidemiology and bio statistics at the University at Albany and we also have Doctor Kevin Smith, he's the chief medical officer at Loyola University Medical Centre.
Thank you very much to the panellists for joining. One thing that we’re going to try this week as well – we did this for the first-time last week is to do a quick poll and since we’re talking about two big questions here about the pandemic as well as about Black Lives Matter, we have one question for each topic. I'm going to go ahead and launch that poll and we’d love it if all of you in the audience would respond. So, first about the pandemic – do you believe that the recent rise in Covid cases is due to increased testing or increased transmission of the disease? Please indicate whether you think it’s because of increased testing or increased transmission. And also on the second topic, with a lot of news in recent weeks about the removal of confederate statues around the country, both by officials as well as those done by protestors in the act of protest, we want to ask this question – is the removal of confederate statues an important step towards healing racial division or is it a slippery slope towards erasing history, and we’ll go ahead and leave that poll open for a few minutes so that as many of you all can answer as possible.
I want to go and start first with Dr. Rosenburg. Doctor Rosenburg is an expert in epidemiology and we want to talk a little bit about this recent uptick in cases. Dr. Rosenburg big news just in the last couple of days, the governors of New York, New Jersey and Connecticut have implemented a 14-day quarantine for visitors from out of state, specifically states that are currently surging in Covid cases – Texas, Florida and others. Is it your opinion that those states reopened too soon and how else can we explain these rising case numbers?
Dr. Rosenburg: Great question, so I’ll start just by saying that it’s really hard to make a blanket statement. The truth is our national epidemic – there's really a collection of many epidemics at the state level or smaller, so it’s really hard to make a single statement that applies to all states that aggressively reopened – did so too quickly. That being said, at the same time many of the states – at the time that many of the states that are currently surging had reopened and many which were in the lead up to memorial day, the epidemiologic data were not in favour of them reopening to such a liberal and broad degree. Reopening seemed to be more driven by political, economic and public pressures and frankly fatigue. I think part of that is – maybe in the way that we shut down, which is that many states shut down in a very short time frame, even though the epidemic was not surging in all of those places, so it increased the amount of fatigue that everyone has. I will say though at the time many epidemiologists, myself included thought that we would see a resurgence after such drastic reopening about a month later and here it is. So, I think yeah – speaks for itself.
Thom: And do you think the move to issue a quarantine like this was warranted and would we likely see further interventions needed?
Dr. Rosenburg: That’s really hard to say, I work very closely with officials here in New York, I won’t comment or criticize frankly at this point. I think vigilance – and first of all these are all – some of these measures are compulsory but they're very hard to enforce, so we’re really relying on a lot of cooperation, which is actually going to limit any such measure. I think these are sort of potential stop gap measures, what we really need is national coordination that for states to unilaterally act is a very difficult position to be in.
Thom: Thank you Dr. Rosenburg. To Dr. Smith, as leadership at a major hospital in the Chicago area, we wanted to ask you about the issue of ICU capacity. There have been reports of hospitals in several states, I saw headlines today about Houston for example – all kind of getting close to reaching some level of ICU capacity, somewhere in the high 70’s to 80% capacity. What can you tell us to explain what that means when an ICU is full when dealing with a pandemic of this nature and why it’s such a concern?
Dr. Smith: Yeah absolutely. So, surging to a level where ICU capacity is full is really a scary time and I think to truly understand what that actually means it’s important to understand what goes into ICU level of care. So, it is somewhat the physical plant of it, so it’s having a bed – but it also is having the connections for medical gases, to have a room that’s large enough to have all of the different equipment’s that’s required to manage these critically ill patients. So not every area can take on the role of being an ICU unit. Additionally, there's ICU staff that has to care for these patients and those are people that have additional training in critical care and are able to take care of the sickest of the sick. So when you talk about getting to a level where you have your actual capacity, that really means that there's not a lot of good options of where you can put these patients and deliver really high levels of care and in some of these cases the patients who have Covid, they are sick – and for some of these patients they are far and away the sickest patients in our hospital and so not just anybody could come in and care for them. So, you have to have really that collection of space and skills to be able to care for that patients and if you don't have that, then you're really providing I think in some ways sub-standard care.
Thom: Thank you Dr. Smith. So, Dr. bailey on the other major topic in the news of late, the Black Lives Matter protests, news just coming out yesterday afternoon that senate democrats have blocked the progress on the republican majority police reform bill on the grounds that it was toothless with promises of studies and things like that but little actual policy change. Do you think they made the right move and what in your opinion should meaningful legislation include?
Dr. Bailey: Well I do think in many ways this is a historic opportunity. This window of opportunity that we have for police reforms and other reforms, with respect to race and other issues – related issues, this is the time to be bold and so I think to the extent to which the democrats are saying very clearly that a chokehold or just advising that we end chokeholds and other more – bodycams that we absolutely require bodycams, which in many places are required anyway – that doesn’t go far enough. I think they really are after the qualified immunity that policemen enjoy and there are many cases in which qualified immunity is appropriate but the fact is that there's an abuse of that, and we know that from the many cases in which there's too few – not only indictments, but too few – people are actually held into account for killing people because of abusive – excessive force. So, I think the democrats have a really strong case here to make, that we need to do something much more bold.
Thom: And that’s likely to come in the form of a bill working its way through the house currently – are you familiar with the proposals in that and would you explain any of that for us?
Dr. Bailey: Well some of what I think is necessary quite frankly – I do think that the democrats want to go to an extent that probably is going to need a little bit more community support and I think that’s something that they have not – you know the republicans are saying that we want to do more studies and so forth, and I'm not really in favour of a lot of studies but there are situations in which if you go too far without community support, you're just going to get a backlash and that’s what we see as a historian, that’s what I've seen over and over and over again that if you go too far without getting community support, what you're going to get is a backlash and in that what you're going to get is the same policy that shape shifted into another version of the same thing. So, you will still find police brutality in the streets.
Thom: Thank you Dr. Bailey – we’ll come back to Dr. Bailey on a couple more questions about the Black Lives Matter protests and police reform but I want to spend a little bit more time with Dr. Smith and Dr. Rosenburg to talk about the pandemic. Before we get to that I’ll share the poll results, thank you all for responding. We had 13 out of the audience respond and I think there is a pretty wide agreement that the answer of the first question is increased transmission with 92% agreeing with that and on the topic of the confederate statues, a little bit closer to split with 62% saying it was necessary for healing division and 38% saying it’s a concern about erasing history. So, thank you all for your response to that, very interesting and informative.
We have a couple of questions from members of the audience and I want to turn it over to Charlotte Libov for her question and I think Charlotte – this would be best directed to Dr. Rosenburg.
Charlotte Libov: Right, and first of all Thom, thank you for doing this wonderful session and hope they continue because I think they're great.
Yeah, I live in Florida and there's a lot of concern about the accuracy of the state’s numbers that they give us every day, in particular sometimes they tend to vary. If you're looking back a day, somehow some of the cases seem to go down from the ones that were announced and so continue but the reduction in numbers is never fully explained and the state says well there's a normal variation in numbers. So, I was just wondering if you would address that.
Dr. Rosenburg: Sure I mean, so it's hard to specifically comment, but I'll say in general with data like this with surveillance data on case reporting, there is always a little bit of data cleaning and data delays that usually occur in the days leading up to –like looking back a few days from today. And then when we look back a week from now, and what was said about today, the numbers should be more stable. So, there's always this sort of data cleaning and lagging and fixing process that will occur that can cause some of this. However, the typical direction would generally be in the direction of up so that more - there'll be a delay in reporting for today, but in a few days, the reports will come in from laboratories and hospitals and so forth that would increase the number of cases. To have a systematic decline over time like this –you're saying that the numbers seem to always go down later - It's a little, I don't know, I can't explain that. But in general, we expect always a little bit of wiggle, but once we're - particularly with Covid tests. Once you're a week out, it should be stable. If you have a system that's working.
Thom: Thank you, Dr. Rosenberg. I want to go next to Deb Wood from nurse zone. And she has a question for Dr. Smith. Go ahead, Deb.
Deb: During a Florida Governor's press conference this week, one of the Orlando doctors on the call said because we know so much more about how to care for Covid patients, fewer are needing ICU level care. They're being treated on med surge units. Is this true nationally or in other communities? Or don't you – or just tell me about Chicago?
Dr. Smith: Yeah. Deb, that's a really great question. It's a really great point. So, I agree with you is that we do know tremendously more about Covid and the pathophysiology of Covid now than we did when New York was hit, or even when Chicago was hit, and I think there is some truth in that. I think we do know that if you're pruning patients and that's where you basically put them face down in a hospital bed and you're using oxygen - those patients it does seem like are recovering a little bit faster or not progressing quite in the same way. Additionally, medications like remdesivir, which has shown benefits, at least in some of the earlier studies, does look like that might help people who are not quite at that intubation level, but sort of before intubation when you're on mechanical ventilation. So, I think we are in a better place overall, when it comes to Covid. That being said, I don't think that all of these interventions are the turnaround where we're not going to see any ICU level patients. I mean, even looking at the data, not all patients respond to remdesivir, and I know anecdotally, not all patients respond to proning. Now, what percentage we might be able to see a decrease in ICU utilization because of these techniques - I don't know - I think best guess for anybody - so I still worry about ICU surging and ICU capacity, but I'm sure there's going to be some patients that aren't going to need it because of these newer interventions that we have.
Thom: Thanks for your question, Deb.
Dr. Smith during early phases of the pandemic, especially in the high density, urban areas on the coasts, and then moving toward Detroit and Chicago and other major metropolitan areas, hospitals were reported to be surging their capacity. I wonder if you could help us to understand what that surging term means. And are hospitals in more rural areas in smaller cities able to do that quite at the same level as hospitals in Manhattan, for example.
Dr. Smith: Yeah, that's a good question. So, the surging basically just means that you're seeing a large increase in the number of patients that are coming into the hospital that can either be through the emergency department as hospital transfers, admissions from clinic, etc. And so, it's just seeing a large number. You know, this also happened at the time when we were shutting down elective surgeries and procedures and patients were scared to come into clinic. So, we were seeing decreases in those types of patients, but we were seeing increases in the number of patients who either had Covid or suspected to have Covid and we were waiting to see if the test would come back positive. And when you surge in that circumstance, you're really filling beds. And also, importantly - as I talked about before is really pulling staff in a coverage model that maybe they're not used to working in.
In urban areas, even though we have a higher density of patients, we are a little bit in a better place when it comes to surging. One is we tend to have more beds in general, because we expect that we need them for our larger population, and there also can be some coordination between the different hospitals in urban areas as well - I know in Chicago we had the benefit of having - actually, in some ways depending on if you look at it, maybe more beds than we actually need for our population. So, there is a way to move patients around in urban areas a little bit more. If you're talking about rural areas, especially critical access hospitals, you are potentially talking about a small number of beds both on the floor as well as the ICU, as well as maybe a hospital that you're going to transfer to, that could be hours away from that hospital - And I think the other piece of a rural hospital is they tend to have less number of staff as well.
So if you are talking about somebody who may have caught Covid, either in the community or from a healthcare interaction, and they go down or need to be a quarantined, that could be a potential significant amount of your staff that then goes down and is not able to take care of those patients.
And so, you know, I feel for some of these rural areas that are really seeing a surge because they just don't have the same level of resources that many of urban areas have.
Thom: Thank you, Dr. Smith.
Dr. Rosenberg, I'm hoping you can help us to understand a little bit about how the pandemic is kind of moving throughout the country, and while we may see a number of new cases dropping in New York, it's rising in Florida, in Texas and other states. In your opinion, is this, what we would call that second wave that's been discussed? Or is this really part of the first wave as it spreads throughout the country and that first wave just hasn't dropped as low nationally as we'd like it to?
Dr. Rosenberg: Yeah. That's a great question. So I think, again, as I sort of alluded to earlier, I think it's really important that to wrap around, that there really isn't a national epidemic that this is playing out locally across the US and it's hard to give single labels like first wave or second wave to the nation at large.
I think to have a second wave means you've successfully fought a first wave. I think that's the really important piece to – that’s my starting definition. And I think in some places like Seattle, like here in New York State, we are to a large extent on the other side of the mountain as it were - not fully there, I would say, but we're really - we've made it very far on the other side of that mountain, and that was due to massive public health efforts. And so now if we saw a resurgence after being all the way on that other side of the mountain, you might say - Yeah, we'll call that a second wave. And it probably happened some time from now. It would have to happen sometime from now.
I think in many of the places that we're talking about in the past few weeks to pick on Florida since that's come up already. Texas, Arizona - those places that we’re seeing these massive increases did not have that big decline that we've seen in Seattle or New York. They were still on the way up or levelled out, but there was sort of not – there was not that first conquering of a mountain. And I think it's really, this is really better characterized as really a period of acceleration and that first wave from not really having fully controlled the initial outbreak.
Thom: Thank you, Dr. Rosenberg. Also, on kind of that idea about the acceleration, one of the things that it seems like a lot of people were counting on was for this disease to have a seasonal fluctuation, lower risk of transmission in the summer months, which comparing to the flu, standard influenza, right? What was wrong with this assumption?
Dr. Rosenberg: Yeah, I don't know if it's necessarily a wrong assumption still, I think it just may not be a full assumption. So, what I mean by that is - a number of studies have shown looking at weather patterns, that transmission does seem to track with temperature, precipitation, humidity and the ways that you might expect from experience with seasonal influenza. However, it's not a full effect that it does - It may be - the weather may have some impact, but it's not enough to outright halter - greatly diminish transmission during the warmer months, right? We're seeing its summer and we have large scale transmission in Houston. Right. That's counterintuitive.
So, we're still seeing transmission despite some modest weather and seasonal effects. And it may be suggests that what we're seeing across the nation now may yet have been worse if this was the middle of the winter.
We're seeing obviously a very troubling pattern and it could have been worse then - so it's, I would say that the assumption wasn't wrong, but it was insufficient. There wasn't enough to remove the transmission that we're seeing now.
Thom: Thank you, Dr. Rosenberg.
Back to Dr. Smith for one more question and then we'll bring Dr. Bailey in to talk a little bit more about Black Lives Matter. On the subject of those ICU beds and in these kinds of more rural areas, smaller hospitals, less staff, fewer beds to increase their capacity –what happens with those patients - a Covid patient in a waiting room, or in an exam room or somewhere that's not as fully functional to protect staff and other patients from contact with them. Are those patients while they're waiting for a bed or a transfer to another hospital - are they likely to come into contact with others and potentially spread the virus in those conditions?
Dr. Smith: I think you know, theoretically, yes. I mean, prolonged contact, it appears with somebody who has Covid - it definitely can increase your risk of transmission. And so theoretically, being stuck in a waiting room could do that. However, hospitals have tried to do different interventions to try to reduce the risk of transmission - I can't say eliminate, but definitely have tried to reduce it. I mean, we've gone to really universal masking for anybody in a healthcare setting. We try to - also when people come into the hospital, we're screening them right away, performing temperature checks - and that's at least one way that we can say, okay, well, could this person have Covid based on reported history as well as whether they have a fever, and then you do your best to try to separate those people from people who don't screen positive for that. And so those are sort of the techniques that different hospitals have used. I think you mentioned about the rural hospitals and if you are trying to transfer to another hospital, inherently there's always delays in the transfers, no matter how good of a health system you are, when it comes to coordinating a transfer, a patient from one bed to another bed - it's just natural delays, whether that's waiting for the transport - the ambulance transport or helicopter transport or whatever it is that you're going to use, and so I can imagine is, when other hospitals have a very full ICU and you're waiting for a bed to open up, those delays could get longer and therefore could put that patient at risk of deterioration even if they do have Covid.
Thom: It seems like the more pressure the hospital is under the more vigilant they have to be about adherence to those practices, right?
Dr. Smith: Absolutely. Absolutely. I mean, that's why things like PPE were such a big deal and why there was such worry in places like New York when we were seeing there are shortages in PPE, is that's the way you protect your staff and that's the way you protect your other patients - so making sure either the patients are using PPE, when it comes to a mask or making sure your colleagues have PPE, that's one of the ways to really prevent transmission.
Thom: Thank you, Dr. Smith. For a question for Dr. Bailey about the Black Lives Matter protests I want to go to a Freelancer in the audience – Yasmin Rasidi, please go ahead and ask your question about the George Floyd case.
Yasmin Rasidi: Okay, thank you for the opportunity. I would like to ask Dr. Bailey that - this is not the first case police violence but why did George Floyd incident trigger a nationwide protests, and how the protests could affect the US election and each candidate's electability, and about the destruction of Confederate state statues - what are you saying about it - that why they are people doing that? Thank you.
Dr Bailey: Sure. Great, great questions, and they're related. So, you're absolutely right that the George Floyd case - of course is not the first case of excessive force, which leads to the murder of yet another unarmed black man, right.
There are probably a couple of reasons - on one level, frankly -it was so unequivocal - in several other cases, even though effectively, it was unequivocal there were things that people could say - well, he tried to resist or he moved this way or he did that - you know, there were always these interesting excuses as to why the police were justified in killing someone who's unarmed, already handcuffed, etc., etc.
I think the fact that it was unequivocal, there were four people on top of him, the officer, the main person who is killing him has his hand in his pocket. It's so nonchalant. I mean, the whole - the fact that there's a multiracial group of people who are around them saying, what are you doing? Please stop. You know, they're witnesses, if you will, I think that had an enormous impact. The fact that George Floyd called for his mother. His mother died two years. ago, and in his dying breath he's calling for his mother. I mean, there's just - there's something - I mean, others have said this - he narrated his own death. There's something beyond just moving, but profound. I'm a mother of a black son, he's 17 years old. Who could not be moved by that? So, I think that, to me, that's part of what makes this not only a national issue, but a worldwide call to action.
That said, I'm concerned that it's not just something that we're concerned about because emotionally we're drawn to it, but that there really is an end result that these men are not acquitted, which is what's happened in most of the cases like this. And so, I think we have to be really concerned that it's not just kind of - a lot of interest in the case right now, but then we don't follow this up and for the media, we really hope that you follow it all the way to the end, because we have seen this happen over and over and over again, where it starts with protests. It starts with a lot of interest, but it doesn't end with a desired result and the justice - a result that really is based on justice.
Is there time for me to say something about Confederates?
Thom: Absolutely, absolutely. And Yasmin also was asking kind of about the impact that the pandemic has had on this and what you what you see it doing to influence the 2020 election.
Dr. Bailey: Okay, so, let me just say that coming also, at a time when people of African descent are disproportionately being affected by the pandemic, for a number of different complex reasons, that also impacts the way in which we looked at this George Floyd murder, and having to see it happen in plain daylight and so forth.
What's the impact on the election? We don't know - I think we really - I personally hope that the protesters, advocates, media, others, we continue to keep the pressure on for some kind of change in terms of race relations. I hope that the issue of reparations is on the table. The New York Times magazine is coming up with a big article on this this weekend. There are lots of advocates for Reparations - long standing - for the last 155 years. And we'd like to see that be an election issue. It's time for that to be an election issue.
As far as the Confederate statues are concerned, let me just say that I am not in any way an advocate of people illegally taking down property on public property on public grounds. I have advocated for these Confederate statues to come down like many others, and I think that public officials - it would be in their interest, as it was in the interest of New Orleans a couple years back to actually take these things out themselves or Charleston did this just yesterday, I think, with Calhoun, actually removed the statutes so that they don't become symbols of hate and they don't become a place for the protesters to gather and then consider doing illegal things.
So, I hope that that is an election issue - that people do talk about the fact that these symbols of hate need to come down. But more than that systemic racism needs to be something that we attack full on.
Thom: Thank you, Dr. Bailey, and thank you for your questions Yasmin.
I would note about the Confederate statues we have some very close experience with this here in Charlottesville, where many of our staff are at Newswise -and the city of Charlottesville tried to address this through the democratic process. The citizens voted for a city council that then tried to do this, but unfortunately, state law is written as such that those kinds of things can only be done at the state level and a judge issued an injunction for that. So Dr. Bailey, when the citizens of a city themselves cannot decide about the placement of these monuments, what are we to do?
Dr. Bailey: What are we to do? I know - not only that, but then you know, there are states like Alabama, right that put in a new state law that said you can't remove any statue that was built and put in erected before you know 1940.
So yes, what are you to do?
We are we are to continue to protest. We are continuing to petition. We are to continue to appeal to state officials, we are to continue to appeal to federal officials. I mean, a lot of this really comes down to though, how do we convince the hearts and minds of people of America that we are people of the present and the future. We do not want to live in the past, in which we were engaged in the big lie about a hierarchy of races, that we had one race on top and other races in between and then one race on the bottom. This is not the way we want to live now. So, somebody like a, like a Calhoun, who said that slavery was a positive good. Why would you want him towering over the beautiful city of Charleston? He doesn't represent who Charleston is today. It's a beautiful city. It's a multiracial city. It's a place that's trying to move away from its past.
So, I think you just have to keep advocating. I think that advocacy is the key and keeping the fire burning on this issue and not just taking it up when it's popular or it's trendy or what have you. So that's what's that's what I would say to Charlottesville keep on doing it.
Thom: We have another question from Benita Zhhan with WNYT. Benita - I'm unmuting your audio so you can ask your question. Okay, I'm not able to make Benita’s audio live - her question is - the messages - Oh, go ahead, Benita. Thank you,
Benita Zhhan: Hi, we've been working on this issue of racism in health care and at this juncture, how do you recommend - what are you seeing ways to help the black community be cared for better during the Covid outbreak because of the concerns they may have about seeing a physician because of the colour differences and barriers, language, understanding barriers, help us as reporters help the black community access the care the best they can in this time?
Dr. Bailey: Well, first of all, you have to acknowledge that these are some of these issues as you really alluded to in your excellent question are long standing issues, and the reason that we want to be addressing root causes - which is my commitment - is the root causes - because when you have an emergency like this, you just can't attack those root causes and actually fix those root causes in a short period of time, that's just the reality of it.
If you have communities which have been denied access to health care, along with other communities, not only black communities, obviously, but poor communities elsewhere across the country, because we don't have a commitment as you know to federal health care for all - universal health care for all, this is going to happen during an emergency.
So the first thing I would say is that even though we're trying to address the short term problem, let's at the same time, put the pressure on the long term problem because once this emergency is over, eventually there will be another and there will still be situations exactly the way they were before. At the same time - I know personally - I work a lot - a lot of my research work is in Georgia and there are excellent NGOs that work - grassroots organizations that work to help facilitate and bridge that gap between regular healthcare institutions and the people. And they have a relationship and can have a relationship with both. And so, they're perhaps one of the best, I think, kind of modes through which we can try to deliver that health care both preventative and immediately to some of the people who really need it. But other than that, I say we have to address those root problems. And once again, it goes back to issues of universal healthcare, it goes back to issues of reparations for people of African descent. There's no question that if you look at the question of reparations that healthcare would have to be one of the top things on the list. I hope we put it on the top on the top of the list.
Thom: Thank you for that question, Benita. And I want to let our other panellists weigh in on this too. Dr. Smith, what have you seen and observed in terms of racial disparities at your hospital and how the Covid pandemic has affected black and brown communities?
Dr. Smith: Yeah. I think it's such a great question because - and Dr. Bailey, you couldn't have said it any better than what you said - I mean, this is the reality is that we've seen increased illness in many of our communities of colour, especially when it comes to looking at the patients who are in the hospital who require an ICU level of care. And a lot of it does get back to those health disparities that are in place, and you're right - during this time, this was not necessarily a time that we could fix those health disparities. But we were seeing the consequences of these health disparities. The way that we tried to address it was, try to give the best level of care in the hospital - that was what we could possibly do. But then, when it came to times of discharge, it was challenging. We took care of a lot of patients who either were under insured or uninsured, and setting up a safe discharge plan was always a challenge. But what I also found really interesting was, one of our things we talked about is - okay, so do you have anybody in your family who has been exposed to Covid? Because if you don't you have to self-isolate yourself so that you're not spreading to your family? Well, inevitably many of these families of colour, they'd say, Oh, yeah, I had it. Everybody else in my family had it. And you really were seeing that it was spreading in these communities within families. And that does change the way you think about this illness.
I think the other piece is - we tried to use more telehealth to be able to get to some of our patients of colour who may not have trusted coming into the health system, but we were able to connect with them in that manner.
I can't say that it was perfect. But we did try to do some more innovative techniques to make sure we weren't losing those patients and having them fall through the cracks.
Thom: Thank you, Dr. Smith.
Dr. Rosenberg, what does the data show about these racial disparities, and what else would you like to add about this?
Dr. Rosenberg: Sure, yeah, I'll just add on to everything with just a really sweeping sort of population level view, that when we look at Covid-19 outcomes, by race, ethnicity, and really focusing on the black community versus let's say, the white, non-Hispanic populations, that the disparities are truly multi layered, and go back to community level factors, just like Dr. Bailey has shared. So, we have some results coming out next week, that really show along a continuum of processes where the disparities might sit. We have already published on the - with New York State Department of Health results from the SERA study across New York State showing very large racial disparities and simply being infected to start with literally points to community level origins. It could be, many, many social and structural factors that simply expose minority groups disproportionately compared to other groups. And that's a real thing - as was just alluded to by Dr. Smith's remarks that we see differences in the likelihood of needing hospitalization, by race, ethnicity, again, with African Americans needing that intensive level of care, precisely likely for some of the reasons that have been discussed - co-morbidities, other historic access to care issues. I’d say maybe the only silver lining that's emerging in some of the data is that once patients hit the hospital and controlling for some of those co-morbidities, that some of that - the mortality rates, and some of the outcomes - given that you're receiving quality care don't seem to matter that much, don't seem to differ that much by race, which I think, points to a good - or at least points to the quality of care that patients are receiving in our hospitals. I think really, the roots of this are more upstream and they have to do with community factors, comorbidities and the access to care issues that have been described. Obviously, in the midst of the pandemic, we can't fix all of it. but it's truly the upstream issues that we're seeing play out in a very rapid pace. And I'll just comment just for context, a lot of my work historically has been in HIV, where we see the same magnitude of disparities, but they took a far longer time to emerge. HIV moves slower. Here in a respiratory infection and a pandemic, we're seeing the same disparities occur in weeks. And that is just an experiment that I don't like to see played out.
Thom: Thank you Dr. Rosenberg.
Dr. Bailey I want to ask another question about the Black Lives Matter issues. There have been major developments in two cases of the murders of black men in the United States – I'm sorry, I'm getting a little off-track. One case with the murder – the case of Ahmaud Arbery in Georgia, the grand jury indictment was just passed down yesterday, charging these men. The other case – not an actual murder but another case just hit the news last night about three Wilmington, North Carolina police officers that were fired over a recording, catching them talking about some very racist attitudes and even one of these officers wishing for a race war and threatening to go out and shoot people. These officers have now been fired. Both of these situations developing in the last 24 hours. What does this signal in the case of the indictment for the Arbery murder which took more than three months to happen, and then now this case with the North Carolina police officers, the police chief dismissing these officers very quickly – what does that signal to you and what does this reveal about police culture and how is this maybe hopefully changing?
Dr. Bailey: Well first I'm going to start with – I like the word “silver lining” from Dr. Rosenberg – I'm going to start with the silver lining on all these matters. Certainly – cause as a historian I could start with the early history and keep going all the way up in terms of the history of not just police brutality, but in the Arbery case, really a vigilante justice right – in this case white vigilante justice. But – what's the silver lining? That at least we are finding a certain amount of public outrage – which I think is very important, and it’s not just within the black community, it is multi-racial. It’s multi-generational also. This is a huge factor. It’s very, very important. We’re also seeing that these cases are not being swept under the rug – they may not – in the Arbery case I think maybe they wanted action a little bit sooner, but nonetheless we have some charges that – we have an indictment, we have charges – I think one of the charges was malice murder charge – which I mean I could take a whole day just to break that down, but the fact is that we are seeing some progress and at least movement towards justice.
That said, I think that we have to understand that this history that we have, we need to reckon with it. Those three men that essentially entrapped Arbery on the street, they were playing out a long-standing tradition of vigilante justice. They can decide with themselves – they can be judge and jury as to the life and the death of any black person, and in this case somebody who is just jogging down the street, and I think – we have to deal with once again – we have to deal with why is it that we’re in a society which allows- which gives them permission if you will, to think about a person of African descent in this way. How do we create a society that does not give permission, that creates boundaries, that even if you have that intent or you have that random thought, you cannot play it out, because it’s clear that Black Lives Matter?
Black Lives Matter in healthcare, Black Lives Matter in education, Black Lives Matter in the economy – right. If you create a mind-set and a social climate, and a political climate in which this kind of behaviour is just unacceptable, it will stop happening, and I really do believe that.
Thom: Thank you Dr. Bailey – it’s particularly disturbing as it’s so akin to lynching and there have been I think six or more cases of unsolved hangings that appear to be lynching’s in recent weeks. Thank you, Dr. Bailey.
So, Dr. Smith on the pandemic again – lots of reports about the ICU limits and especially some reports of children’s hospitals now needing to open things up to adult Covid patients. What are some of the logistics and breakdowns of the healthcare system, transferring patients around to facilities and who coordinates these efforts and how can we be assured that this is being done properly and effectively?
Dr. Smith: Yeah it’s an interesting time when you're seeing children’s hospitals being used to take care of adult patients and we have always seen in medicine is that kids are not just little adults and its vica versa as well – so, the way that a paediatric hospital is set up, may not necessarily be set up in a way that it’s always conducive to adult level of care. So, whether that’s dependant on again the physical plant, whether it’s the staff that are there and how they're trained and how they're taking care of adult patients, but during desperate times, desperate measures are taken. The way the transfers generally work is – there is a hospital realises that they need help, and so they request another hospital to help them and then there's an aspect of accepting that patient based on bed availability and then there is transportation that occurs between the different hospitals, and there might even be times where patients are too unstable to actually be transferred. We do see that at times and so as I mentioned earlier – there's just always going to be an inherent delay in transfers and any time you're talking about delays there's always the chance that that patients status changes and therefore you may even lose your window to be able to get them to another hospital that can care for that patient. And so – the question of how do we manage this and how do we coordinate it it’s a really interesting one, because generally it’s up to the institutions to coordinate things. So, it’s really the role of one institution asking for help and another institution saying yes – I’ll take that patient and then setting up that transportation. So, we’re just not used to having one group or one body that manages that. I can see in Illinois is that we separate our different areas – different hospitals into regions and the region has some ability to coordinate things based on the hospitals in their area, but I can say just from the standpoint of Chicago – we’re very close to university of Illinois Chicago, not too far away from North Western university of Chicago, but all of us are in different regions, so we’re in a very different region than the rest of Chicago and so there's not a lot of coordination between different regions. So, we don’t really have a great coordinated process.
During this time we understood that we were all in this together and so I think – different hospitals reached out to us for help and we were willing to help them as best as we were able to because we knew that we were all responsible for caring for our communities and so, there's not a great regulatory way to do this, but I think fortunately in medicine, most of us are in this for altruistic reasons and we realise we have to help each other because there's a good chance that other place is going to help us at some point down the road as well – and that’s how most of this has happened.
Thom: Dr. Rosenberg – why is it so important for a coherent national strategy versus leaving so many of these decisions and logistics up to the states?
Dr. Rosenberg: No that’s critical. I can't overstate the importance of national coordination at times like this. Although the federal government is not officially charged with running public health response to Covid-19, public health is traditionally a state role and has a large potential to play in providing critical advice, scientific data and logistical support and really conveying a coherent coordinate national plan, so that the coordination is really the piece. The federal government doesn't have to command, but it can coordinate. I think the department of health and human services and some of its agencies like NIH and CDC have done this well in prior outbreaks and national health crisis and they can do it again. I think the challenge here is that we’re right now - with the current level of federal leadership, the US will continue to be a checkerboard of state responses and that’s not good. We’re going to have different epidemics, and as people travel state to state – one states victory in getting over that mountain can be compromised by another states lack of progress and we’ll going in cycles. So that’s really on the epidemic side tragedy. I think on the other sides of this – a federal coordination and stock piling in distribution and negotiating – which has become very important – negotiation prices for vital resources like personal protective equipment – PPE and testing supplies, can really hamper and frankly make impossible local efforts. So, if you have different states outbidding each other on ventilators costs, no state can afford something – it just doesn’t make sense – so the federal government – that’s why we have a federal government, to step in and help resolve those issues, it’s really important and just critical.
Thom: Thank you Dr. Rosenberg. We have just enough time for one final comment from Dr. Bailey on the Black Lives Matter issue and I want to give you a chance to tell us a little bit more about what we should understand about Juneteenth. Last Friday was Juneteenth celebration of the word reaching slaves in Galveston, Texas – enslaved people in Galveston, Texas about the emancipation proclamation – two full years after it had been announced. Why is Juneteenth so important and what should we understand about it?
Dr. Bailey: That’s a great question to end with because its two years after the emancipation proclamation in 1863 and effectively Texans then were denied their freedom. There was a delay in them receiving their freedom and it says so much – it’s such a fitting metaphor isn’t it? To what's happening now, today – and why people are protesting today and why a multiracial group of young and old alike are outside saying it’s been too long, it’s been 400 years more or less since some of the first people of African descent made this – this became their home effectively. Because of the slave trade they were forced to migrate here and yet were still seeing justice denied, were still seeing freedom denied – the freedom to job or the freedom to lie in your own home, in your own bed and not have a no knock warrant be the reason that you are killed in your bed, and Breonna Taylors name I hope we won’t forget – cause justice has not come there yet. So Juneteenth and the fact that freedom was not denied but delayed, really is a fitting metaphor for where we are today and I want to say that when we get to the point when Black Lives Matter is not just a phrase or slogan, or even just a movement, when we get to the place where we really have equality in healthcare, in education, in the economy, in all these important things, that’s going to make the work of people – amazing work just listening to my colleagues here, like Dr. Smith, Dr. Rosenberg – it’s going to make their jobs that much easier because we’re going to see those disparities start to close and we’re going to see that we can look at new challenges as a nation, not just the same old story for 400 years of racial disparities which break out every now and again into a big storm, but are never really solved.
I'm looking forward to that, I hope that the celebration of Juneteenth in at least a number of the states – including my state New York becomes a federal issue and that that becomes a federal holiday. Many people have fought for that for years, I hope- many people on the grassroots level have fought for that for years – I’d like to see that happen, and may it issue in a new day. A new day, new challenges, new innovations, as opposed to the old story of – we still haven’t found a way to work together, to live together and to dream together.
Thom: Thank you very much Dr. Bailey for closing on that note of optimism. We are going to wrap this up because we do have another panel scheduled for 3 o'clock. If you're interested, we’re going to be talking to three cancer researchers who are turning their efforts to fight the Covid pandemic and talking about trails and new therapies that they're investigating. So if you're interested in that, please do stick around and join us for the 3 o'clock panel, we’re going to close this one down and just take a short break while we get set up for that and before we go, I do want to say thank you to Dr. Smith at Loyola University, Dr. Rosenberg at the University at Albany and Dr. Bailey at Binghamton University, for all of the media – we’re going to make sure to get you the recording and the transcript as soon as that’s available – if you're on the list and registered for this event you're going to get that, if you didn't register and you just clicked the link to join today’s meeting without registering and you want that info, send us an email at [email protected] and we’ll make sure to get you on that list.
Stick around for the next panel and if you're going to leave us, I’ll say – stay safe, stay healthy and good luck.