Coronavirus: Canceling Conferences, Changing Life

Healthcare conferences like HiMSS, Rise, NAACOS, etc. are crucial to the continued evolution of population health as ideas and best practices are often shared by attendees. New relationships form and new technologies or partnerships cultivate as people get together. Many of the clients I currently serve were introduced to me via a conference that I attended. I have always preferred to do as much business in person as I can. Unfortunately, every healthcare conference has either been canceled or postponed due to the outbreak of COVID-19. I’ve already felt the change, as many of us have, and not just in our travel schedules. This affects every industry across the country as COVID-19 is impacting life and business across the world in a myriad of unfortunate ways.

But here’s the thing…how warranted is this “slamming on the brakes?” I’ve heard a lot of different information out there about how the Coronavirus doesn’t affect children, it can severely affect the elderly, and if you’re healthy then, should you contract the virus, symptoms would be mostly mild. Are we really doing the right thing based on the fact that the symptoms are not as bad as the flu? Yes, because apples-to-apples comparison shows that COVID-19 is actually more deadly. Even though there is still a lot of debate out there about the economy vs. public health, the right decision is always to side with public health.

Outside of linking to all these news articles that shed more light on what’s going on, I wanted to talk to people that I know and trust in the industry. I reached out to them to get their opinions on COVID-19, how it impacts those they come in contact with, and if they think whether-or-not this harsh reaction is valid. Here are their thoughts and opinions.


Pediatrics

Peter D. Murray, MD

Everything I say here is my own opinion and not a reflection of the opinion of my employer. That business out of the way…as a baby ICU doctor, I am quite good at saving very sick newborns (with a team, of course, no doctor functions alone, on an island)…Early data from other countries suggests that COVID-19 infection in children is milder when compared to disease in older adults. To be clear, there are reports of poor outcomes in children. To that child with an unfortunate result and to that child’s parents, earlier data is moot. What matters is the outcome of their child. Pediatricians across the country have mobilized and responded to this crisis along with our brethren who will face this beast head-on, adult physicians in emergency medicine, internal medicine, intensive care, anesthesia, and surgery. While I am very rusty when it comes to treating adults, I am happy to live in a city that has a highly ranked hospital, and brilliant healthcare workers prepared to meet this challenge head-on….

Discussions of preparedness aside, the degree of pandemic fueled news reports have turned everyone into amateur virologists. This transition to amateur virologist has two consequences. One, those with the aim of social distancing promulgate its potential effect of the Gaussian curve (flattening the curve). Still, others use their new fund of knowledge to compare COVID-19 to the flu and use such comparisons to suggest COVID-19 is simply a “bad flu.” The latter group is dangerous as COVID-19 appears deadlier than the flu, though, hopefully, less harmful in the US when compared to other localities. The former have inundated social media platforms with pleas to flatten the curve to spare healthcare providers from having to make tough choices of who lives and dies based on the rationing of scarce resources. 

I find myself more on the flattening the curve side, of course. It is true, decreasing the spread will allow the healthcare industry to provide care and, ideally, avoid rationing. As an intensivist, I am familiar with arguments for rationing, especially when one of my 23 weeks’ gestation infants may cost the general public hundreds of thousands of dollars. As an ethicist, I am familiar with rationing. I have taught my trainees that rationing should not be performed at the bedside but, instead, discussed at higher levels such that societal values inform the decision to ration. Honestly, avoidance of such situations is of paramount importance, thus the importance of social distancing and acknowledging the Gaussian curve.

To be clear, COVID-19 does scare me. I have mild asthma and, honestly, have been sick for months with gifts from my daughter and her preschool. My dad has COPD, and my mom has the sugars; both diseases lend themselves to higher mortality from infection. I fear for my good friends and confidants truly on the frontlines in the emergency departments and MICUs; my beloved sister-in-law included who is an ED physician assistant. My wife and I, while both healthcare providers are somewhat insulated being in pediatrics but not immune from the effects of COVID-19. It is unclear how the disease impacts newborns, but, in the absence of them coughing directly in my mouth, babies really cannot cough forcefully enough to spread droplets that far. My wife’s patients could infect her as she sees big kids, but I pray this doesn’t happen. Sometimes, all you can do is pray, social distance, and put faith in those who are a hell of a lot smarter than me. Stay safe and separate but somehow together.

Peter D. Murray, MD
Neonatologist & Assistant Professor of Pediatrics at University of Virginia Health System
Charlottesville, VA

Emergency Department

Sean A. Mackman, MD

Everything I say here is my own opinion and not a reflection of the opinion of Froedtert or the Medical College of Wisconsin. Starting now, a lot of people are coming to the Emergency Department (ED) with concerns of COVID-19. For the majority of people, this is unneeded, and it will only put you, and others, at far more risk – Based on South Korean data, which is a healthier dataset than the United States, they still had a near 10% fatality rate among patients over 70 years old. It was increased in smokers, those who are obese, and patients who are immunocompromised. If you feel sick, and you have flu-like symptoms, you should self-quarantine for two weeks. If you have a high fever, shortness of breath, and/or confusion, you should come to the ED. That being said, anyone in the ED is at higher risk due to exposure. The ED is designed for the sickest of sick patients. For those who are not sick: Wash your hands, stay in your house, and do not go outside unless absolutely needed for now! Eat healthy and clean, drink plenty of water, and stay away from soda and processed foods. You can supplement with Vitamin C and Honey.

Sean A. Mackman, MD
Emergency Medicine Resident at Froedtert Hospital
Milwaukee, WI

Elderly and Family

Yauna Williams, ARNP

The Coronavirus pandemic is very serious. Social distancing is important to prevent the spread of this virus. Currently, our primary care practice has reduced the number of staff working. Patients are being triaged by phone and we are only seeing urgent patient visits. We currently do not have access to test our patients for Coronavirus, and we have had to direct a few patients to the local hospital.

Yauna Williams, ARNP
Advanced Registered Nurse Practitioner at Cold Harbor Family Medicine
Richmond, VA

Alexandra Lewis, MPAS, PA-C

As providers, we have to change our focus, temporarily, from preventative medicine to just dealing with acute issues that require immediate attention. Patients really need to take into consideration whether their condition requires urgent care attention or if it’s a minor issue that can wait. Providers don’t have enough protection (PPE), and we need to really lean on technology such as telehealth. Problem-focused medicine that takes care of the patient while minimizes risk to the staff is key otherwise you risk not having anyone to take care of our population later on.

Alexandra Lewis, MPAS, PA-C
Physician Assistant at Premier Family Health & Wellness
West Palm Beach, FL

Are we doing the right thing?

Leslie Bell-Harper, RN, BSN

COVID–19 (Coronavirus) has impacted our country, as a whole. When COVID-19 was seen in China at the end of December increased safety measures to decrease transmission should have been implemented nationwide. However, we went on about our daily lives and many are still doing just that despite what is currently happening around them. People need to take precautions as transmission of COVID-19 is via droplets. This means when you cough, sneeze, or your respiratory secretions come into direct contact with a person’s mucous membranes there is a risk of infection. If you come into contact with a known infected, or possibly infected person, the incubation period is 14 days, with most persons showing symptoms within five days.

What are we seeing here in Georgia? 197 confirmed positive cases with one death. Hospitals canceling elective surgeries/procedures in an effort to free up PPE for those caring for patients on the frontlines. Designating/converting hospital wards/floors to COVID-19 units. Increasing the amount of airborne isolation rooms in facilities. Limiting the number of visitors to one family member or halting all visitation within facilities.

As staff members we are seeing stocks of PPE running low, charge nurses are micromanaging the disbursement of goggles, face shields, N95 and surgical masks so hopefully, supplies will last longer. Disposable goggles are now not disposable and must be cleaned between patients, N95 masks are not being worn to care for these patients unless you are doing a treatment that changes the transmission from droplet to airborne. This is per the updated Centers for Disease (CDC) guidelines.

Healthcare providers (HCP) are caring for these patients with every changing guideline as more is learned about the transmission and management of these patients. We are relying on the World Health Organization (WHO), CDC, and our facilities to help keep us safe. Unfortunately, the reality is HCPs are getting sick despite implementation of these guidelines. Some people ask, “How warranted is this ‘slamming on the brakes’?” In my opinion from the statistics presented from other countries such as China and Italy; and data provided from our own states Washington, California, New York, etc. slamming on the brakes is 100% warranted. The curve of transmission needs to be decreased nationwide or I fear we will be facing the same overrun of our healthcare capabilities as that of Italy. Social distancing is required to lessen the transmission. By implementing such drastic measures as is required such as the closing of restaurants, bars, nightclubs, counties implementing curfews, no gatherings of more than 10 presents its own set of consequences. But, in the long run, this is needed to slow transmission so we as HCP’s are not faced with those decisions that Italy is making of who lives and who dies because there aren’t enough hospital beds, ventilators, etc. for patients. This is a decision that no HCP wants to be faced with. So, with that being said, Americans need to accept this as reality stay home and please only take the supplies you need for your family for about 2-3 weeks at a time.

Leslie Bell-Harper, RN, BSN
Nurse at Northside Hospital
Greater Atlanta, GA

Justin Rubin, BSN, RN, CCRN

The general public is panicking. We had H1N1, SARS, Zika, West Nile Virus, etc., and we were fine. If you aren’t immunocompromised, then it is in your best interest to stay home if you think you have the flu. Otherwise, you run the risk of subjecting yourself, and others including doctors and nurses, to even more illness.

Justin Rubin, BSN, RN, CCRN
Intensive Care Unit Nurse at Sinai Hospital of Baltimore
Baltimore, MD

Healthcare’s Future After COVID-19

After speaking with each of these excellent providers, there appears to be a few common threads:

  • Lack of personal protective equipment is going to contribute to more provider infections
  • Less providers available means the healthcare system is going to be strained further
  • Improper use of the Emergency Room is going to both strain the healthcare system and put non-infected patients at risk of becoming infected
  • Children don’t show symptoms, but they’re carriers that can lead to further health system strain
  • Strain on the health system jeopardizes care for even those patients who don’t have COVID-19 (think heart attack victims who can’t be seen)
  • Social distancing and shutting down are more about thinking of others and indirectly assisting our healthcare providers

Regardless of what the end result of the Coronavirus pandemic is, our healthcare system is going to have to learn from this and make changes. Looking towards the future, I think the first modification you’ll see is greater adoption of telehealth across the entire country. Think of COVID-19 as a forced test drive, but the positive result of this is that providers are going to quickly become more comfortable with telehealth options. Comfort breeds quicker adoption, and we’ll find out how effective treatments are over online visits. Just like more people are going to continue to work from home, more people are going to see their provider from home, too. Chances are you’ll see that same online/remote trend carry over into other industries like education, even more into shopping, and likely also into religious sectors where holiday services will be more commonly held online.

I hope provider safety moves even further to the forefront. With a current lack of PPE, you’re going to see companies like GE, 3M, etc. begin to produce a surplus of equipment that facilities will keep in storage “just in case.” Here in Florida, we’re always ready for the next hurricane. Now across the country, we have to be ready for the next pandemic. Nobody will be burying their heads in the sand thinking, “lightning can’t strike twice.” The penalty for unpreparedness is just too great.

For ACOs, it’s the patients with chronic conditions and comorbidities that are most likely to be affected. In turn, this means a significant increase in cost, and a very low chance that many ACOs receive shared savings from the 2020 performance year. In fact, for those taking on two-sided risk, there’s an excellent chance that they’ll be paying a penalty which is why the National Association of ACOs (NAACOS) is trying to push their members to write Congress asking not to require ACOs to pay shared losses during the 2020 performance year.

Getting to the macro level of healthcare, there’s no doubt that the cost in care for 2020 is going to skyrocket. As a country, we weren’t prepared for a pandemic, and we were already battling a broken system, to begin with. As other industries suffer, layoffs will likely send the United States into a recession. Those layoffs are going to strip a lot of Americans of health insurance. That’s going to put a greater burden on Medicaid and/or you’ll see the overall health of the country start to decline. That’s not including the mental health toll of losing jobs, losing loved ones, general anxiety, and stress, etc. It’s our job to figure out how to put family care/primary care squarely in front of whatever solution we come up with. If we don’t, we’re only going to fall back into the same broken pattern we were in before COVID-19.

Another important piece to consider is our country’s medical schools. A major event like COVID-19 will have a ripple effect on who wants to be a provider. It can galvanize people into wanting to care for others. However, it can also scare people away, left to thin out already thinning numbers of providers. It’s too early to tell which way we’ll go at this point.

There is no doubt that it’s a scary time, and there’s no doubt that unforeseen changes are going to occur. In the end, we can’t stop the changes, but we can save lives. It’s our job to continue to practice social distancing, to wash our hands, to take care of ourselves, and to take care of our loved ones. We need to handle this pandemic swiftly but thoughtfully. We have to think of the community, of others, of our frontline healthcare workers, and all of our providers. I look forward to the day we can return to “business as usual,” but know that just because business will never be usual again, it doesn’t have to be all bad.

Disclaimer: The opinions reflected within this piece do not represent the opinions of Salient Management Company.

RESOURCES

Ryan Mackman

About the Author


Ryan Mackman, MBA, MHA - Business Consultant

Ryan Mackman has been an ACO business consultant team member with Salient since March 2018. In this role, he acts as a solution trainer, marketing and sales consultant, as well as Value Based Payment strategist. His skillset helps augment Salient’s efforts at the ACO and physician practice level. Prior to joining Salient, Mr. Mackman spent four years as the Business Administrator and Project Manager for Premier Family Health, a Level 3 Patient Centered Medical Home near West Palm Beach, FL. Mr. Mackman holds a Master’s in Business Administration and a Master’s in Health Administration from Florida Atlantic University. He received his Bachelor’s degree from the University of Florida. He currently holds a Six Sigma Green Belt Certification and is a member of the American College of Healthcare Executives.

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