COVID-19 strategy: The outlook, action and impact on the industry

Will the novel coronavirus COVID-19 lead to greater trust and a better healthcare system? Or will we see a breakdown in the system?

Today we recorded a conversation between our CEO David Jarrard and Emily Evans, the Managing Director for Healthcare Policy at Hedgeye Risk Management. In it, they discuss the questions above and look at what the COVID-19 virus could mean – for hospitals, public health, the markets, the election, and much more.

It was a long conversation so we’re running it in three parts – you’ll want to listen to them all. Find each part below along with key takeaways from the conversation.

Be sure to share it with your colleagues and subscribe to High Stakes on Apple Podcasts or your favorite podcast platform.

Part 1 Highlights:

  • Yes, it’s going to get worse before it gets better. The next few weeks are going to be very uncomfortable.
  • COVID19 is an opportunity for healthcare systems and political systems to work together to build trust amongst the public—but we do not know how that will play out.
  • This is a pressure test for the healthcare system: How will health systems in hot spot areas handle overcrowding and strain on infrastructure and staff?
  • Outpatient and telemedicine healthcare services were already accelerating; they’re likely to accelerate even more amidst COVID-19.

Part 2 Highlights:

  • There are concerns that a focus on testing could fuel the outbreak and that the US healthcare system should switch its focus to mitigation.
  • The idea of “public health” has changed over the years, in large part because of individual behavior.
  • This is a moment for hospitals, health systems and traditional providers to step into the situation, be a voice of trust and reason, and reinforce their mission of caring for our community.
  • COVID-19 could provide telemedicine it’s breakthrough moment.

Part 3 Highlights:

  • Many analysts have been expecting a slowdown or recession sometime this year regardless. COVID-19 looks to have just poured some fuel on it.
  • The worst case scenario for hospitals – especially small systems and/or independent community facilities – is that loss of revenue from delayed/canceled elective procedures puts too much pressure on their revenue.
  • What should a hospital CEO do? Speak directly to the community about what’s happening and what the organization is doing to prepare.

Read the transcript

David Jarrard: Well Emily, I’m glad you’re here.

Emily Evans: Thanks for having me, David.

DJ: And I’m glad we’re not hugging.

EE: Or handshaking.

DJ: Or hand shaking, because we don’t want to be that person.

Would you start by telling us just a little bit about yourself and what you do and what you’re watching?

EE: Okay, so I am the managing director responsible for health policy at Hedgeye Risk Management. We are an independent research group and we serve largely the investor community –those are investors in nonprofit health systems, for-profit health systems, health care providers of all types— and we provide them with guidance about health policy, and I think of myself as a translator and a tour guide.

DJ: Translator tour guide—that’s excellent. So, in providing guidance, what kind of guidance are you giving your clients today?

EE: Generally, or specifically related to the current crisis?

DJ: Well, generally and specifically seems to be the same thing right now cause it’s all encompassing—But we’re talking about COVID.

EE: So COVID-19 is, I think, an accelerant to a disruptive trend that’s been with us probably three or four years. The move to outpatient services was well underway before COVID-19. It’s probably just going to be accelerated by that. The move to disruptive technologies like telemedicine, it’s probably going to be accelerated by that. So the pieces were already there, it’s just a question of them being—the gasoline being pushed—

DJ: So COVID is kind of the tipping point. It’s like a test of the system that’s been fragile and this might be the thing that would actually accelerate directions that have already been happening.

EE: Right, and more globally— you know, we’ve seen over the last, maybe decade or so, just this breakdown in trust for community institutions.

A lot of that, my theory is a lot of that has to do with we don’t know what the community institution is doing because we no longer really have community connections with our— like we did before—with our newspaper, local newspaper was the most common.

DJ: The whole breakdown of the idea of community itself.

EE: The whole breakdown of the idea of community itself and public health is based, almost entirely on trust, you know. There’s some medicine in there for sure, and there’s some science in there, absolutely. But it is— It’s about trusting your government. It’s about trusting your government to tell you the truth.

And with that, I would say your healthcare provider system— telling you the truth, telling you what you need to know, when you need to know it, so that you can act appropriately. Because what do you do if you, if you aren’t getting good information? You go to the worst-case scenario immediately and you start behaving in a way to protect yourself and your family.

DJ: I wonder what that would look like.

EE: Well, it looked a lot like China. It looks— I don’t know if you saw when they decided to close the North in Italy? The pictures of people running to the train?

DJ: Fleeing? The head of the quarantine? Yeah, good strategy.

EE: Yeah, great— thank you! If you live in Southern Italy, that probably was not what you wanted to see.

So the more–this is an opportunity. And we don’t know which way it’s going to go, either it’s going to tip away from trust, meaning the healthcare system and the political, the political system that controls and manages it, they are, their credibility will be reduced or it will be increased. And if you look at the Washington state press conferences, that is trust building. They’re straight out. The public health directors’ telling it like it is, telling you— this is what I know, this is what I don’t know, this is what I think is going to happen. Here’s the problems, here’s—all of that. Just laying it right out there.

DJ: How would you compare Washington state’s engagement with the public on this and Washington DC’s engagement?

EE: Well, it’s been messy, right? We had— first of all, I don’t, you know, we can argue all day long on was there is a deep state or not. I would tell you that in the public health world, real true public health, and especially in infectious medicine, there probably isn’t. But there’s just such distrust in the white house for career people. Even if they’re career scientists or career medical people, but there is just a lot of distrust. So that, that made the messaging really messy. And you saw this early on with the president say, ‘oh, 15 cases, it’ll be zero,’ which was just unrealistic if you know anything about how disease moves around.

DJ: Anything at all

EE: Yeah, but in the last few days, Tony Fauci has been moving to the forefront and doing a really great job. He is the infectious disease— Allergy and Infectious Disease Institute—he heads that up at NIH. He has refused to take over NIH on a number of occasions, he really likes his infectious diseases, and he’s doing a really, really great job of messaging. Very consistent

DJ: Very credible

EE: Very credible. He is very credible.

DJ: Which is so important in this moment.

So in the past, I don’t know, 48 hours, we’ve seen national guards called out in Washington and Massachusetts. We’ve seen stock market doing what it’s doing with the Saudis and the Russians— What kind of guidance are you offering your investor group about what to expect? How to think about this moment?

EE: So we had a great discussion yesterday with an infectious disease specialist who started a few companies and on diagnostics and, you know, we told him a few things: one, the next few weeks will be really rough— very uncomfortable, especially in hotspot areas. I’m very focused on Washington, Boston, Santa Clara County or San Francisco, but mostly the East Bay area. And then Washington DC to a lesser—and of course, New York city.

DJ: Of course. And when you say rough and tough, how does that translate?

EE: First of all, an explosion of cases because every day the capacity grows for testing. So we had this, and I think this misled the White House initially is we had this very low rate that just wasn’t really growing it was the test—

DJ: Because we weren’t testing for it.

EE: We couldn’t, yeah, we didn’t have the test capacity. Now we’re constrained by reagents. We have some shortages that are, that are constraining that. That led to a certain amount of complacency amongst the population that contributed to the growth. So that means that there are lot of people running around this country with coronavirus who didn’t know it and were infecting other people.

And so the next few weeks, I’d say two, maybe three, are going to be characterized by a huge explosion of cases. Maybe if we get to 10,000, we’d be on kind of par with what China experienced. Yeah. If we get 50,000, that’d be more like Italy. I think we’re going to be more like China than Italy, but we’ll see.

And then we’ll probably see the taper around May. We might catch a break with some sunny hot weather. You’ll notice there are not very many cases in the Southern parts of the United States. They are there, but they’re not proliferating like they are in the upper North, the Pacific Northwest, where you don’t have as much sunshine, and you certainly don’t have the high temperatures that viruses hate.

DJ: And so the impact of that is crowded ERs, overworked hospitals,

EE: That is one outcome. And we’re actually looking at that. What is the ER capacity in those hotspots? What is the bed capacity in those hotspots and what— one of the things that’s gonna be really important is the level of cooperation amongst health systems and their cooperation with the public. And that’s gonna vary a lot from, from region to region and from within a region, hospital to hospital I would think.

DJ: So this is a time for some of the private equity back, non-acute care players, to step into this, that are already there

EE: Right.

DJ: What counsel do you have for them?

EE: So they’re going to see, you know, a lot of ERs in this country are staffed by EmCare, which of course is owned by Envision, which—I think they’re still called Envision. And so they’re— That’s actually a good thing, not just from the private equity perspective, but if you have a concentrated caseload in, say, the Pacific Northwest, you’re able, with a company like EmCare to pull docs out for temporary gigs in the Pacific Northwest to staff up hospitals

DJ: So they can flex the workforce.

EE: You’ve sort of created a flexible workforce, which is ironic, the way EmCare and so forth have been beat up here in the last few months over surprise billing. It’s true also of AMN, the nurse staffing company. You know, they could draw from this pool of nurses all over the country in affected areas, unaffected areas, and really provide some flexibility to the workforce that, you know, wouldn’t be the case if we were required, if we were relying solely on local markets. So, this is probably a good thing for those—

DJ: And a good test, right? For these organizations and their structures. Does it work like it’s supposed to work?

EE: Does it work? Yeah. And I think another question I have is, you know, emergency preparedness, pandemic preparedness, is part of the public health system. You know, this city gets loads of money from the federal government every year to be prepared and drill and hospitals drill. And this’ll be a test of whether or not they did what they were supposed to do. Are they ready? You know, are they able to convert the step-down unit into an isolation ward? You know, are they, do they have the skills and the wherewithal and the foresight, to stop people at the front door who might need a test but also might be carrying disease and divert them in, you know— like we do, we do chicken pox. You know, when kids go to the pediatrician, you know, that sign on the door.

DJ: Wherewithal is the right word for this.

EE: Why do you say that?

DJ: Whether they know what to do and then have the ability to do it and then can sort of have the command and control to make sure it happens. That’s a whole series of issues there.

EE: And I think— you can correct me if I’m wrong. I think we’re going to see a better— we’re going to see the research universities; the more sophisticated hospitals respond very favorably. Less sure about some of the community hospitals. The good news there is if you look at the disease spread, it’s in concentrated, very sophisticated healthcare markets which is nice, which helps, I think.

DJ: So I’ve thought a little bit about this as a test of the system itself, particularly given the Medicare for all conversations that have been happening. This is a significant access question. We’ve seen some policy makers either through their state or through their, I don’t know, influence, tried to make testing free, access free. How’s that playing out? What do you think some consequences are of this?

EE: You know, I think one of the negatives about the current political environment where we are so focused on health. You know, it is such a big priority because the people in power typically are at an age where their friends are getting sick and dying, they’ve encountered a health crisis

DJ: It’s very personal.

EE: It’s very, very personal and compare that to the 1980s, where we were just transfixed by national security. I mean, it was all about, you know, the Cold War and the post Cold War, and the personal experience of the people that set the agenda really is informing a lot of it.

But one of the bad things about that is that we’re now really focused on testing, when we should be really focused on mitigation. You know, you’re testing, when you test somebody, you’re sending them to the doctor, where other sick people are.

DJ: But isn’t that classic healthcare? Cause that’s what we can do, and that’s what we can measure, and that’s what we can pay for, so that’s what we’re going to do. Whether it’s effective or not is really secondary to the checklist that we can create.

EE: Then think about, you know, I’m old enough to have a mother who, you know, was raised during the pre-vaccine era. So there was no smallpox, or no chickenpox vaccine. There was no measles vaccine, there was no polio vaccine and so, you know, you never touched your face, you wear gloves when you went out

DJ: Well, public health was really public health. Everybody was responsible.

EE: That’s a great way of putting it. Everybody was responsible. Well now back to this breakdown in institutions, people who are walking around, feeling pretty good and healthy – ‘I’m not sick. You’re not sick. You don’t look sick. Let me shake your hand.’ And which I’m sure is what happened at the Biogen conference and…

EE: …instead, what you’re supposed to do is, take responsibility for yourself. Wash your hands. Don’t shake hands. Stay home when you’re sick. All of these things have a huge impact. Forget about testing. Just act like you’re sick, and then we’ll all get well together. But yeah, we’re not there.

DJ: I have read with interest, the phenomenon of people wearing masks…

EE: Oh gosh, yeah.

DJ: …particularly in China and some other countries, and it’s helped my understanding to recognize that for some, they see it as protection, but for others, it’s a signal that I take public health seriously.

EE: I know that people in China, when they see somebody without a mask, they get very uncomfortable. Which we aren’t at that point. One of the concerns that public health officials have in the United States is, you put that mask on, and you just drop all your public health behaviors.

One head of our public health department here in town, he said, “Yeah, it’s great. When you cough it into your mask, it goes that way. So, people who don’t know you’re going to start coughing, get hit.” He’s like, “It’s not smart.” But yes, it does indicate that you’re serious about it, I suppose.

DJ:  want to go back to the access question, because it has been such a big part of the national conversation and now everyone wants to be sure they have access. Maybe in ways they didn’t before. It feels urgent. Or maybe just for a few weeks, but it feels urgent right now. Do you think that will sort of rekindle this conversation at a policy level?

EE: For like Medicare for all types?

DJ: Yeah.

EE: I really don’t. I think my conclusion turns on my belief that the healthcare system will function as it’s trained to function through this crisis. And that the trust that people have in that system will be either restored or affirmed.

That’s what I think will happen. If that does not happen, then yeah, there will be punishment in spades. And that may likely be Medicare for all.

DJ: So it’s an opportunity—we talk about opportunities and moments in time—this is a moment for hospitals, health systems and traditional providers to step into this and be who they are and to reflect their mission.

 EE: Yes—to lead!

We’ve heard from a lot of politicians on this, except for Washington state. I have not seen any press conferences out of Santa Clara County yet, and they’ve been pretty proactive, but not as good as Washington state. But what I have not seen, is the healthcare system talking about this.

And if your doctor sends you a note that says, ‘You’re over 60. You’re at risk. Here are the things I want you to do.’What does do? That just affirms your belief that this is the right doctor for you, right? He’s thinking about me. Don’t go out—you’re over 60, and you’ve got emphysema, or you’ve got asthma.

DJ: Don’t take a cruise.

EE: Yeah, don’t take a cruise. Don’t go to the mahjong tables. Just don’t do those things. It’ll only be a couple of weeks, I promise, and you can go back to your normal life. But we haven’t seen that yet, so we’ll see how it pans out. It’s a huge opportunity though.

DJ: We’ve talked about the doc and nurse staffing companies and how they could play a really vital role here. Got to talk about Telemedicine.

EE: Oh, yes. Of course.

DJ: Everybody is being urged to work at home or anticipating doing that. So, medicine at home?

EE: Medicine at home.

The centers for Medicare and Medicaid have made moves to relax the reimbursement of telemedicine. One of the reasons telemedicine is so behind the curve is because of the Medicare rules. And because of Medicare rules, that’s how docs get trained, and when docs get trained that way, that’s how we practice medicine. That’s the way it works. And if they’ve relaxed those rules, and I think that if it goes smoothly, we’ll see them repealed entirely. For people who don’t know Medicare, it says if you want to have a telemedicine visit, you have to be in a nursing home or in a psychiatric institute and you have to call your doctor from there, which really makes no sense.

Really crazy rules, and it’s all created by the fraud, waste and abuse crowd. So, if it goes well, then we should see an explosion of that. And a company like Teladoc, is by far and away the leader in that industry. And who really needs to make the investment is doctor practices. Physician’s practices make the investment and have a Telemedicine platform within their practice area.

DJ: You mean local physicians who already have the credibility and some sort of patient base?

EE: Right, exactly. So, we’re old enough to remember Telebanking.

DJ: Oh yeah. Very exciting!

EE: Do we call it Telebanking anymore?

No, we call it banking. Remember that was so neat? You log in, and you could see everything in your bag. It was very cool. I think the Telemedicine effort is going to be augmented, supported and expanded by the interoperability rules that were released two days ago. Seems like a lifetime. But I think that’s going to be an accelerate on that as well.

DJ:  So let’s go back to D.C. Medicare for all—maybe, maybe not based on all of this—will there be any repercussions or consequences or fallout in D.C. because of all of this? Too early to tell?

EE: Donald Trump may lose. He was on a pretty clear path to victory, especially at the electoral college level. Not at the general election, and a couple of things happened. One, something I expected would happen, the Democratic party establishment rallied around Joe Biden, the former vice president.

DJ: It’s remarkable—what has happened, I think.

EE: It really was. I wasn’t sure that all those young candidates would bail like they did. But I’ve had that conversation. I’ve heard that conversation. And it goes something like this: for the good of the party, it’s not quite your turn. Think about where you’ll be in four years or eight years.

DJ: I bet it was a discipline that wasn’t shown by the Republican party four years ago.

EE: They’ve never had the—here in Tennessee, we call it the unit control. They’ve never had the unit control over their party that the Democrats have. And Democrats have always had a much stronger establishment. Within the Republican party, there are like five parties. Within the Democratic party, there are probably two.

So, Joe Biden, for all his flaws as a candidate, and they are considerable, he will come across as competent, experienced and able to talk about government and what it’s here for in times like these. Donald Trump took a completely different—”Oh, it’s no big deal. Don’t worry about it”—which is absolutely the wrong thing to do at a public health crisis. It’s what gave us the Spanish flu. If you studied that, you wouldn’t remember it, but that we had it was right after World War I, and the Sedition Act had just been passed and there were controls on the press.

DJ: You weren’t able to tell the truth and talk about what was important.

EE: Right, and a lot of people died as a result. They got sick and died because they didn’t know what was going on. People still don’t know what’s going on, but now the one person who is doing the talking and the cameras are on him, is not developing any kind of trust.

Tony Fauci is doing a great job. Scott Gottlieb who left the FDA, he’s doing a pretty good job talking about it even though he’s not part of the government anymore. The CDC is doing a decent enough job. I think the breakdown has been, Alec Azar and Seema Verma, and his conflict with her and the White House.

DJ: And you’ve mentioned several times, this is a moment for trusted voices to speak. For hospitals and health systems and others who would naturally carry that. And they can either be silent and allow others to fill that vacuum or advance themselves.

EE: Right. And I think if you’ve seen a credible person sitting there in front of that microphone, like you’re seeing in Washington state, although I will caveat that by saying Washington state has some explaining to do about the nursing home infection which caused problems throughout the country. And I suspect we could draw a line from the measles outbreak in the Pacific Northwest to where we are today in Washington state, which is just a rejection of…

DJ: Are we getting into any anti-vaxxers? Are we going to go there?

EE: I don’t think it’s unreasonable to ask why people are so distrustful of traditional public health efforts. And we now have two crises centered in a general geographic area of the U.S., so I think that in those communities where you don’t have that credible public voice, it’s a great opportunity for a healthcare system to step out and say, ‘Here’s how many patients we have. Here’s their ages. Here’s the condition area, and here’s what we, as your public health provider, recommend that you do.’

DJ: Here’s what we know to be true, and here’s what we know to not be true.

EE: Right. Don’t come to our emergency room if you just want a test. Because you’re going to encounter people who want a test because they need a test and you’re going to get sick.

DJ: Which goes back to your thought about true public health.

We’re all in a sense, healthcare providers. What if we allow ourselves to get infected? We’re a disservice to others who may be vulnerable.

EE: The reason that the governor of New York put this containment zone around poor New Rochelle, New York, is because people were not doing what they were told.

They weren’t self-isolating, they weren’t doing the things that we all depend on them to do in order for the rest of this to skew. So, he’s like, okay, fine. Welcome to the national guard. It’s a little extreme and kind of might create a little panic. I’m not sure. I think Washington King County Washington has five stages that they have identified, and when they get to each of those stages, they’ll take additional incrementally stronger measures.

They’re at stage two. Right now. A stage five is actually shutting down roads and limiting travel. And you know, like everybody stays in their house kind of thing, which has not happened in this country in a hundred years.

DJ: Dramatic for a whole bunch of reasons.

EE: The reason, you know, we have four cases in Williamson County.

Do you know why we have four cases in Williamson County instead of one? Because the young man, apparently this is, you know, at least this is the rumor. A young man apparently who contracted on overseas travel, decided he wanted to go with his buddies, and he didn’t want to be courted. So again, you know, behavior, be public, it personal responsibility.

DJ: Alright, so let’s talk about stock market. It’s been crazy, healthcare socks affect maybe less so. Tell us a little about this.

EE: So one thing, you know there’s a new friend in politics who referred to it as the law of the little thing.

Where all these bad things are happening, all these negatives and it just takes this one little thing to crack it open and for everybody to look at it for what it is. And that’s what’s happening here. The S and P earnings, the, the economy growth, all of the fundamental metrics had been slowing for a while.

We are and continue to expect a slowdown slash recession sometime this year. Anyway. Now we’ve just poured a little gasoline on it.

DJ: So to be clear, are you looking at or even predicting a recession this calendar year?

EE: It could, yeah. It seems likely to be barring any.

DJ: You’re the only one I’ve heard that from, but it’s interesting.

EE: Yeah. Well, it was already headed that way.

If you look at all the data points. You know, we, we look at earnings reported earnings, which were down fairly significant on a, on a quarter, over quarter and year over year basis. We look at, growth, GDP which was okay but a lot of it was government spending, you know, not a lot of private sector spending.

You know, we would get about 35 things our macro team looks at and, and it was all pointing one direction before this happened. So what you are seeing is a lot of people use this, a lot of companies use this opportunity to go changing guidance, you know, and just bring that, that stock market down a good, it probably has another 15% or so to go.

I would say another 15% or 20%. Yeah. I haven’t looked at it in a couple hours. Yeah. I haven’t looked at the last hour is down 3%.

DJ: Right. And how our healthcare industry stocks playing?

EE: Healthcare industry stocks, it’s, it’s varied. Teledoc’s doing great, AMN, which is the nurse staffing that, that, that seems to be doing well. Real concerns about, for example.

Tenant’s debt, which is heavy. And if you get into a global slowdown, you have a liquidity issue, debt becomes a real liability. So that’s a, that’s a big, big concern. As far as some of the, technology players there, you know, I think they’re, they’ll be fine.

I think the worst-case scenario though, for the healthcare system is, and we haven’t seen this yet, but we’re watching for very closely. It is if the patient, the caseload of hospitalizations as a result of the coronavirus do not exceed the suspended or delayed elective procedures. If you’re, you know, you’re getting your knee replaced.

Your doc, you’re going to talk to your doc, you’re going to express concern. He’s like, why don’t you wait? So, you’re not going to be that extra bit of margin for your local hospital. All that revenue is lost, and you’re replaced with a $200,000 ICU patient probably on Medicare. That’s not super great for margins.

Or you’re not replaced by a COVID patient because it doesn’t come to your community.

DJ: And that could happen because someone’s afraid to go to the hospital because there’s COVID there, or the stock market is hitting the bottom, and I don’t know if I’m going to have money to pay for this.

EE: Or I just don’t want to take a chance.

I can do this later. I’ve been putting it off already for, you know, a year, so I’ll just do this later.

DJ: I can do, I can do another couple of months.

EE: Right now. We still have people taking cruises right now, so I’m sure we’re going to.

I’m sure we’re still going to have people who are going to go and get their surgery. But that’s the worst-case scenario is that those hospitals empty in expectation of COVID patients and they just don’t come.

Because there aren’t enough of them.

DJ: If you’re leading a hospital or health system, you’re a CEO of an integrated delivery network. What do you do?

EE: I think first of all, you speak directly to your community, because if there are cases in your community or ILI influenza like illness, which is how coronavirus is being classified until a test is produced.

You can see the city of New York actually produces on a two-day lag. All of their influence activity so you can pull it up and you could see that yesterday I had 503 cases of influenza liked it. Now it went through their ERs, and now they have 702, that’s up close to seasonal highs for influenza.

That number keeps going up. That’s when there is an opportunity for the hospital system in a community to say, here’s what we’re seeing, here’s what we want you to do, you know. Hit the airwaves, you know, go get in front of every broadcast media, Facebook post and talk about it honestly and forthrightly.

And you may get less revenue because of it in the near term, but you’re going to build that trust with the community.

DJ: You’ve protected, your reputation, your credibility on the backend.

EE: Right, exactly.

DJ: When things burn out and the world starts over.

EE: Right, exactly.

DJ: And we can shake hands again.

EE: In May.

DJ: May.

EE: Or June.

DJ: Thank you for this. I really enjoyed this conversation even though the topic is a little troubling.

EE: A little morbid. What are you hearing out of hospitals as far as caseloads, volumes or anything like that?

DJ: There’s all, there’s a lot of work in being prepared and being ready.

EE: What does that look like?

DJ: There’s the work internally, of communicating to your staff the procedures and the protocols.

This is how it’s going to work, which they all need to know. But also, let me assure you, as a healthcare system that we’ve taken care of you, the caregiver. Where we’re protecting you. And then to the community. Here’s how we want you to act. Here’s how we want you to, perform. If you feel like you have this.

Williamson Medical Center, I think they have,

EE: They have four of the six Tennessee’s cases.

DJ: And I think they met one of these, one of the patients in the parking lot, right. Anticipating that they were coming in and didn’t want them to come into the hospital to infect the hospital or create that, even the impression that it was. Which I thought was an interesting response.

EE: Yeah, that’s what, I think Brigham and Women’s who did that in Boston, they set up a pop-up tent outside to test the biogeny.

DJ: To keep it separated.

EE: To keep that out of the hospital.

DJ: You know, until, two or three days ago, we had many more of our, our hospital clients didn’t have a coronavirus patient then than do. And every hour it’s changing. Right? One thing we do expect to happen is it, it’ll go from being a unique event, sort of a seismic event that shakes an entire community to everyone having some experience with someone with a coronavirus patient.

EE: And assuming responsibility for public health.

DJ: And beginning to assume responsibility.

But we’re at this moment where it’s big. It’s tipping from being a unique outlier event that’s particularly scary because it’s unknown. In addition to being troubling to being something that we’re all dealing with. We’re living through what may be the next 72 hours because it’s moving so fast of transition, psychologically from somebody else.

And it’s scary too. It’s everybody and I know how to live in this world.

EE: Right. We’ve been hearing a lot of talk about shortages and we’ve seen this with the lab testing reagents.

How are hospitals addressing that issue?

DJ: They’re equipping up. I mean, not unlike a hospital that’s preparing for a hurricane, right?

Right. They step up their blood supplies, they step up the materials. But in, in addition to what we’re finding is they’re being much more deliberate about how those supplies are distributed.

EE: I have heard stories that, that some of those gowns and masks are disappearing, not for medical use within the hospital.

DJ: Right? So, we have some hospitals that are, that are putting in, like agents.

EE: Agents.

DJ: Just like you wouldn’t have stockroom, you know, one mask per person, one mask per patient to be as judicious as they can with the, with supply.

EE: Washington state as part of their presentation, which I think is super helpful for the community is they include, we have adequate supplies, we did use a lot of our ventilators in our stockpile, the federal government is replenishing those. You know, when you talk about those things, people go, oh gosh, they’ve thought about this. Because the really scary thing is people overtake the system and there isn’t enough stuff and there aren’t enough people.

DJ: And you’ve seen the pictures like a Costco, right?

The shelves are empty because people are doing just what you’re saying. They’re taking care of themselves and making sure that they and their family. Have all the toilet paper and, baby wipes and disinfectant that they need

EE: I did that, but I did it about two weeks ago.

DJ: See!?

EE: Nobody was in Costco. Nobody was in Costco when I was there, and everybody laughed at me.

DJ: And, and to your point about, being a voice of authority and being credible. We think it’s so important that hospitals and health systems speak to their nurses and to their physicians because those folks with the white coats are extremely credible in the community.

Where that, where those conversations are actually happening.

EE: And you saw a little bit of a breakdown in that with, the California Nurses Association is just very active politically and from a labor perspective.

You saw them really making, a lot of statements about how they felt like their nurses, were in danger.  I think Vacaville has had some, some issues with, with nurses too. So, the keeping that staff healthy, you know, as your capacity to be, what it needs to be.

DJ: Keeping the capacity, right, so you can fulfill your mission. But it’s also a tug of war over who owns that mission? Who is, who is really in charge of public health?

Who is the voice of authority on making sure that nurses and patients are taken care of? Some will see it as an opportunity to own that space. We believe hospitals and health systems naturally own this space, but they conceit it if they don’t speak.

EE: That is the message. And, and it speaks like people like Tony Fauci, who’s 79 years old, you know, and is on every single televised appearance. You know, if he can do that, everybody can too.

David Jarrard