March 31 Tele-Briefing: Three Expert Physicians Offer Unique COVID-19 Perspectives to Capitol Hill

Background

United States of Care (USofCare) has shifted priorities in order to respond to the historic and unprecedented COVID-19 pandemic. While our overall focus remains on our mission – ensuring every single American has access to quality, affordable health care, regardless of health status, social need or income – we are directing our full efforts towards supporting policymakers at the local, state and federal levels and serving as an information clearinghouse for decision makers.

Our team is available to anyone who would like to access our organization’s expertise and our Board of Directors and Founder’s Council members (please click!) are ready to help, offer advice and provide access to their relevant networks and experience. We have also created a COVID-19 Rapid Response Hub as a resource for those combating the pandemic.

March 31, 2020 Telebriefing

*Summary has been edited for clarity On March 31,

USofCare held a tele-briefing for top U.S. House and Senate health care staffers, along with officials from executive departments and the White House. We also invited members of the United States of Care’s Entrepreneurs Council.

The call featured the Following United States of Care Founders Council Members:

• Dr. Mark McClellan, MD, PhD, former CMS and FDA administrator under President George W. Bush and current Professor of Business, Medicine, and Policy at Duke University
• Dr. Lisa Fitzpatrick, MD, MPH, CDC-trained medical epidemiologist, board-certified infectious diseases physician and Founder of Grapevine Health.
• Dr. Joshua Sharfstein, MD, former Secretary of the Maryland Department of Health and Mental Hygiene, Principal Deputy Commissioner of the U.S. FDA, Commissioner of Health for Baltimore City and current Vice Dean for Public Health Practice & Community Engagement at Johns Hopkins University.

Dr. Mark McClellan shared the following macro points:

• Described his work, and that of his collaborators, on a new report: National coronavirus response: A road map to reopening. This is a guide to what happens next beyond initial social distancing and also future steps for states and the federal government.
• Right now, the most important thing to do to combat the surge is to get capacity up and continue extreme physical isolation measures until we see sustained reductions in cases and hospitalizations.
• When these conditions have been met for a few weeks and additional state and local capacity has been built up, it is reasonable to take steps towards reducing some of the extreme physical isolation. These steps include:
  • More surveillance capacity including special ways of conducting and sharing the tests in the community.
  • Rapid development of therapeutics and vaccines
  • This doesn’t mean we would get back to normal in Phase 2 but it does mean that some of the current physical isolation steps may be relaxed while a possible new normal emerges such as people wearing masks plus physical distancing steps and deep cleaning of public areas.
• This will take significant, concerted steps by local governments, states and the health care community because this is the type of surveillance capacity we haven’t seen in this country.
• These steps may not be able to be completely lifted until vaccines become available (expected 2021) but we can ease into people going out, maybe not to crowded bars and stadiums, but going out to socialize in some way and for business activity to take place.
• But we also don’t want this to happen again and, if we do things right in the short and medium term, we can become better prepared for future pandemic risks.
• For the long run, we can lay the foundation for a system much more oriented to meeting people where they are and promoting population care and delivering care outside of hospitals in a more person-centered way.

Dr. Lisa Fitzpatrick shared an extreme local view from her experience in underserved communities:

• Underserved communities are experiencing the pandemic differently than mainstream communities/what we’re seeing on social media.
• Misinformation thrives in underserved communities. Even basic questions are still being asked:
  • How is it spread?
  • Who is at risk?
  • How do I know if I have it?
  • Should I get tested?
• Skepticism is high because of general mistrust of the health care system and government. People are confused because, in the beginning, athletes and famous people got tested without having symptoms; that now runs counter to what we are telling people.
  • Conspiracy theories and inaccurate information about cures and vaccines are running rampant.
• We take it for granted that information is out there but it’s not that simple; If you really listen to people you realize we’re all getting different information from vastly different sources.
• The impact to underserved communities is dire and tangible.
  • “Our community partners that focus on food – one of our partners usually feeds 100 people per session but that is now up to 300 – and the increased demand for food is coming via the natural economic impact of the pandemic and people are concerned about how they will make ends meet.”
  • “While we’re talking about Coronavirus and disease transmission and how to interrupt spread these are not the conversations I’m hearing. The folks I talk with are more concerned about whether or not they can feed their families.”
  • “A woman I spoke to last week said “you know, this neighborhood is more dangerous than Coronavirus,” so there is so much trauma built in here that things like this come along and it doesn’t rise to the level of concern for people and this has been very eye opening for me. “
• There needs to be better ways to connect with/build trust/improve health literacy in these communities.

Dr. Josh Sharfstein shared a public health view of the current situation, the country’s response and steps we need to take to move forward:

• We have an enormous challenge with the supply chain for PPE and ventilators.
• States and cities and health systems are pitted against each other; “strange” businesses and middle people/brokers trying to sell things to people equals chaos.
• Hospitals, mayors and governors are angry over what’s going on. All of this is unnecessary.
• If the federal government took over the supply chain, we would see more transparency in delivery of PPE and ventilators to the front lines. Dealing with an infectious disease requires robust testing; while hospital care is important, it doesn’t stop the spread of COVID-19. To stop the spread, you must test, isolate cases and trace their contacts. We have almost no capacity to implement this protocol. Most health departments have one or two people to do this tracing work; we don’t have capacity for this work at this scale.
• So what does this mean?
  • It means tests plus follow up.
  • For some, it will mean isolation.
  • Presents challenges for others i.e. homeless. Where do they go to isolate themselves?
• Need to figure out a robust public health response for those who need to be isolated/quarantined. In Taiwan they pay people to quarantine and in other places they open hotels to do this.
• These issues are core to stopping the spread of the disease and if one person spreads it, everyone else suffers.
• For Congress: it’s partly more resources for public health departments but also how do you pay for the infrastructure for public/private partnership on this? How do you use hotels to scale this up and manage food delivery?
• There are roles to be played by schools of public health to train a public health workforce that gets out and does this work.
• This is the capacity the country needs in order to reopen because you only feel as confident reopening as you feel confident you won’t have to close back down the next day.