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A deep-dive look at the healthcare industry

Hosted at Kiln coworking space in downtown Salt Lake City and livestreamed online, Utah Business editor Elle Griffin moderated a deep-dive discussion with Utah healthcare executives about the intricacies of navigating a global pandemic. In partnership with Roseman University, they discussed how our panelists responded to the crisis, what steps their organizations took to pivot to a new normal, and what innovations were made that will set us up for a more sustainable future. Read the transcript from our event below.

Panelists

Elle Griffin | Editor-In-Chief | Utah Business

Utah Business editor-in-chief Elle Griffin will be moderating this deep-dive discussion on the state of the healthcare industry. In addition to covering the businesses at the forefront of Utah’s economy, she moderates discussions with industry leaders at utahbusiness.com/live.

Dr. Frank W. Licari | Dean & Professor | Roseman College of Dental Medicine

Dr. Licari has over 30 years of experience as an educator and  administrator. Previously, he served as associate dean for academic  affairs and professor at Midwestern University College of Dental Medicine  in Downers Grove, Illinois, and has also held several leadership positions  at the University of Illinois at Chicago (UIC) College of Dentistry, Marquette  University School of Dentistry and the Commission on Dental Accreditation (CODA). He is an internationally known speaker, author and consultant.

Edward Stenehjem, MD, MSc | Medical director of antimicrobial stewardship | Intermountain Healthcare

Dr. Stenehjem is Intermountain Healthcare’s Medical Director of Antimicrobial Stewardship, overseeing antimicrobial stewardship programs across 23 hospitals and over 185 outpatient clinics throughout Utah and Idaho.  His leadership and research are focused on improving the quality of infectious diseases care delivered to patients with an emphasis on developing, implementing, and measuring methods of improving antimicrobial prescribing practices across the continuum of care. 

Christine C. Ginocchio, PhD MT | VP of science and medical affairs | BioFire Diagnostics

Christine C. Ginocchio, PhD MT(ASCP)  is VP, Medical Affairs, bioMérieux, VP, Scientific and Medical Affairs, BioFire Diagnostics, and Professor Emerita of Medicine, Zucker School of Medicine at Hofstra Northwell, NY. Previously, she was Senior Medical Director, Division of Infectious Disease Diagnostics, Department of Pathology and Laboratory Medicine, North Shore-LIJ Health System and Research Professor, Feinstein Institute for Medical Research, NY. She has 40 years’ experience in all phases of laboratory management and clinical diagnostics.

Gary Edwards | Executive Director | Salt Lake County Health Department

Gary Edwards is the Executive Director of the Salt Lake County Health Department, a  post he has held for 15 years. His public health career spans 39 years at both state and local agencies. During his career, Gary has been involved in investigating and managing numerous disease outbreaks. He was responsible for some of the initial work in the nation addressing smokeless tobacco. He has served on numerous state and national boards and committees, and currently serves as the Chair of the state Health Advisory  Committee.

Stephen Foxley | Government Affairs Director | Regence Blue Cross Blue Shield

Stephen Foxley is the Government Affairs Director for Regence BlueCross BlueShield of Utah, where he oversees legislative and regulatory activity. Prior to joining Regence, he was an associate at Foxley & Pignanelli, Utah’s premier government relations firm. Stephen is on the boards of the Utah Health Insurance Association, the Utah Life & Health Insurance Guaranty Association, and the Utah Department of Health’s Health Data Committee. He is also involved with several non-profits and the Utah State Bar.

Elle Griffin: Today we are going to be talking about healthcare with some of our state’s top health experts: Edward Stenehjem, the infectious disease physician for Intermountain Healthcare; Stephen Foxley, the government affairs director at Regence BlueCross BlueShield of Utah; Christine Ginocchio, VP of Scientific and Medical Affairs at BioFire and a professor of medicine at Zucker School of Medicine in New York;  Dr. Frank Lickeri Dean at Roseman University; and Gary Edwards, the executive director for Salt Lake County Health.

We’ve had a very interesting year to say the least, and I’m very excited to talk about this with all of you. Gary will you take us through a little bit what went down at the public health level in the county and state?

Gary Edwards: When we started learning about this novel coronavirus in China [at the end of 2019], and then watched it spread. Our staff has been actively involved since back in December, working closely with the state health department and the other local health departments across Utah. In March, we had our first case and that really put things in motion. After that point as everyone knows we had school closures and we closed down venues that were not essential for us to continue living. We asked individuals to stay home and those efforts were successful. We weren’t able to flatten the curve. If we look at the epidemic curve, it was successful. 

With these efforts, we made it through the summer fairly well but people are tired. This has been going on for a long time. People are tired of restrictions. They’re tired of testing. They’re tired of the whole message and then getting our universities and our public schools, private schools back in session. We saw the spike that we’re currently dealing with now, the surge take off to where we are today. We are in very deliberate and serious preparations for receiving vaccine and having mass vaccination clinics. And hopefully we’ll see that begin rolling out over the next 60 to 90 days.

Elle Griffin: A lot of you are in healthcare, where a lot of things played out a little bit differently than from what the public saw. So Eddie, do you want to take us through what went down at Intermountain Healthcare? What have you been seeing?

Edward Stenehjem, MD, MSc: I think first was getting our testing platforms up and working with our central labs with companies, like BioFire and ARUP and really figuring out how to test a lot of people. And we initially started testing in early March, and then we had 24 testing sites set up before the end of the month. And now we’ve done over 300,000 tests here in Utah. And then it was that transition to telehealth. And so turning on our telehealth platform across the entire state and really ramping that up, getting all of our providers comfortable with it, and also the patients comfortable with it. 

We’ve definitely refined our practices with the communities in terms of making masks and emotional health relief hotlines. And now we’re in a phase where it’s, how do we manage the ever increasing numbers of hospitalizations? We are now in this critical phase and it’s unfortunate to be happening this far into the pandemic because people are tired of the pandemic, but now is when we need critical, bold, aggressive action to actually stop this tide. And we haven’t ever had hospitalizations this high across our facilities, and we’re having to do things in our healthcare network that we’ve never done before.

I mean, for the first time in the past two weeks, we’ve had to open up a new ICU down at St. George because we couldn’t accommodate all the ICU patients. We are now transferring our pediatric patients from Riverton Hospitals to primary children’s hospital. So we can put COVID patients in those pediatric beds. We’ve opened up medical and surgical unit at Tosh orthopedic spine hospital. So we can take care of medicine patients.

Elle Griffin: What does that look like internally? Have you had to hire new people?

Edward Stenehjem, MD, MSc: We are all taking on new roles and we’re getting very comfortable in those roles. And it’s all about working together as a team and trusting in your colleagues that they will set up the system that you’re going to need. And then we’ve also developed multiple new communication lines, starting at the top and going through all of our providers, whether it be ambulatory care or the providers that work in the hospitals. And so it’s setting up the teams, having faith in our teams and then being able to communicate effectively to all of our staff and we have 40,000 caregivers across the state of Utah. And so we’ve really had to be a cohesive unit to be able to pull these things off.

Elle Griffin: Yeah. I think the organizational power behind this has been really fascinating, and that’s why I want to talk to you next Christine, because at BioFire, you were doing something totally different until COVID came along and then you had some massive changes at your company. So will you walk us through exactly what you did this year?

Christine C. Ginocchio, PhD MT: So one of our primary scopes of diagnostic testing has always been respiratory tract infections. And we have many panels that deal with viruses, atypical bacteria, we deal with lower respiratory tract pneumonia. So that has been a main focus, but the company also deals with a lot of other infectious diseases like meningitis encephalitis, gastrointestinal infections, bone, and joint infections. And we’ve really grown to expand that. So when we started watching [COVID] in December and we had a lot of discussions about what’s going to happen if COVID really becomes significant. But when you think back to the first outbreak of COVID-1 that happened in 2003 and globally, there were only 8,000 cases. So we had to watch that very closely in the very beginning.

 BioFire Defense developed one of the first COVID assays, where the department of defense, we took on a lot of their production to help support them. But then as we watched the pandemic grow, then we got the feeling it was time that we should step into it. So the first things that we did was to take a look at our panels. We don’t make individual tests, we make broader syndromic patents. So if you come in with the respiratory infection, we can look at 15 different viruses. We can look at a number of bacteria, all in a single test. So for us, it was having the ability to now add SARS, COVID-2 panels that were already established. And they’re very, very complicated panels. And from the time we started development of the panel through emergency use authorization with the FDA was only 40 days, which would be something that would normally take years.

Elle Griffin: I’m amazed at how a lot of these Utah companies were able to assemble these things so quickly. And when you talk about supply chain and getting these things done and in 40 days, I mean, are you competing nationally or internationally for those resources?

Christine C. Ginocchio, PhD MT: Yes we are. Just simple things like to isolate the nucleic acids that we detect in the test. Those reagents, many big companies have had one or two of the same suppliers. So we want to make a million tests. Roche wants to make a billion test. BD wants to make a million tests. So everybody’s juggling for the same resources. So it was something when you bring up something from scratch, no one could have expected the amount of people globally that would be infected with the coronavirus by now. We don’t serve just the US we don’t serve just Utah. We serve the entire world. So we have to think about all our external customers also.

Elle Griffin: So what made the difference between a company that was able to get the resources nationally and internationally versus a company that didn’t?

Christine C. Ginocchio, PhD MT: Well as an international company? I think that was very beneficial because as you know, BioFire Diagnostic started as I-double technology, a small startup company, they became BioFire. And then they were bought by Biomerieux, which is a huge global company. And they have a lot of global resources. So having our parent have that ability was really very, very helpful to try to get us the resources we needed. 

Elle Griffin: I’m curious, Stephen, how did this play out in terms of that as a healthcare provider BlueCross BlueShield? What kind of changes did you have to make to be able to make sure everyone’s care was taken care of?

Stephen Foxley: We’re in a unique position. We’ve been here in the state for 75 years and people count on us to be there to make sure that their claims are getting paid and to finance and protect their healthcare and were in a different position from some of the people here where we don’t provide direct care. But we want to make sure that our members are protected and we operate in four States and early on saw COVID in Washington and Oregon, two of the states where we operate, and we did a stress test of our IT systems and stuff and said, lets send everybody home and make sure that if this does really become something bigger then we’re prepared to handle that.

We are also making sure that our members have access to the treatment they need. I have our nurses calling, make sure they have access to food, seeing the kind of challenges in the nonprofit community, making sure that we’re supporting our nonprofit partners, especially in areas like food scarcity and then businesses. I mean, two thirds of Utahns get their insurance through their employer. And we wanted to make sure that that businesses were doing all they could to stay safely open and we help them with education and then also supporting them and making sure that they had the benefits they needed for their employees and giving them the flexibility that they needed to be able to offer those throughout the year.

Elle Griffin: That’s really interesting because in Utah, we had a lot of layoffs, a big round of layoffs and then a big round of hiring almost immediately after, so you must’ve been seeing plans fluctuating as people get off, get on, how were you making sure all those people were cared for during transition?

Stephen Foxley: We were lucky all of our plans had options for people as there were furloughed so that employers could keep those furloughed employees on and many employees, even when you did have those hours cut back at we’re working to make sure that their employees stayed covered. 

Elle Griffin: Did you also make any policy changes in terms of health care coverage?

Stephen Foxley: Like most carriers, we were very early, even before federal and state policy, on making sure that everybody had access to no cost testing for diagnostic purposes and then waving cost sharing for COVID testing and treatment. We’ll be doing that at least until the end of the year. 

Elle Griffin: That’s interesting. Right. I mean, I feel as an end user that we didn’t see a lot of what you saw. We were just getting our mask for free in the mail, working from home, and you must have seen extreme costs to pivot so quickly. Was that ever a factor for any of you where you had to take on a lot of costs unexpectedly? Eddie?

Edward Stenehjem, MD, MSc: I mean, clearly. I mean, if you look at what just happened in terms of our volumes, whether it be an urgent care, family medicine or internal medicine, they essentially plummeted. And not to mention the fact that early in this pandemic, we stopped elective surgeries. And so people weren’t getting the hip replacements, the back surgeries that they needed. We don’t like to use the word elective because there’s nothing elective about the pain you’re having from a severe osteoarthritis in the knee, for example, but they were non-emergent surgeries. Fortunately Intermountain came from a place of strength financially, and we were able to weather that and we have a large proportion of our lives protected and a fee for value type service. 

But it was a big deal. And you could probably see across the US healthcare providers getting laid off and getting furloughed. And fortunately within our system, we didn’t necessarily need to furlough people, but we did have to redeploy them. And so we took operating room nurses and redeploy them to our testing tents. And we taught them how to do our triage line for the COVID hotline or staff, the emotional relief hotline. And so being able to pivot a lot of those employees into different positions and allowing them to have that flexibility allowed us to continue to keep them getting paid.

Elle Griffin: This is making me think of Roseman because you’re in education. You’re having to teach medicine semi-remotely or non-remotely. You’ll have to tell me how you’re doing that. And you’re also maybe having teachers doing things differently where you have to readjusting teachers, tell me what that’s like at a teaching institution during all of this.

Dr. Frank W. Licari: We are a health professions university exclusively and we run a large clinic too. So we had two elements we were running at the same time and getting the online was tricky. We closed out on a Friday, we were up and running in three days. And so our faculty pivoted pretty well with that environment, and so did our students. 

Elle Griffin: Did any of you really have cases happen internally at your organization where you maybe had to lose some employees for a bit and it became harder maybe you losing teachers, some doctors and you’re kind of having to deal with the staff and making sure everyone’s taken care of, was that a factor or is it a factor right now? Stephen?

Stephen Foxley: About 99 percent of our workforce is currently at home but of course given the amount of community spread, we do see employees who are forced to quarantine or take time off. I’ve been amazed at how well everybody’s been able to pick up work and make sure that we don’t miss a beat.

Christine C. Ginocchio, PhD MT: So, I don’t think there’s any institution or business that has not been impacted. I mean, this is part of life. People go home to their families and they could be exposured. So, the nonessential people, the people that could work from home, all of those people were sent home to work remotely. But we have this whole group of essential people, we have a thousand people in manufacturing, we have hundreds of people in instrument manufacturing, the R&D scientists that need to come in. So, very early on, we had teams that met, it could have been daily, weekly, to set up our own infection control practices and facilities where we limited people coming in. 

Every table and chair in the cafeteria went away one day because you couldn’t sit in groups. We had to teach them about masks and social distancing. A lot of people that had never done that before. People in manufacturing were a little bit more conscious of that because they do wear a lot of protective gear to protect not only themselves, but we have to protect the products we make too. So, in the beginning it was changing every single day. Every day new guidelines came out from the Department of Health or the CDC or the WHO. So, we had to be really quite flexible. And even on our side to get PPE was really, really difficult. But yet we had to put people in PPE also. So, of course we’ve had cases. I think they’ve been minimal considering the large volume of people that physically have to come to BioFire and it’s unavoidable. And we keep a lot of people in quarantine, anybody that has any type of respiratory symptom can’t show up for work no matter what.

Edward Stenehjem, MD, MSc:  Within Intermountain, yes, we’ve had employees turn positive, we’ve had employees have severe disease. Fortunately, very few of them have been linked back to caring for patients within the hospital or in the clinic. And the vast majority of the cases that we see within Intermountain from our own employees are contracted outside, they’re in community circles and social circles or in their families which is what’s really driving the spread right now.

And when you look at where are we going, 2,100 cases recorded today, 32 percent test positivity which is just a mind-blowingly high number, we’re going to need to be adaptive to be able to say that this is going to happen more and more as we go into this winter season and how are we going to adapt to that. And we really need to take this mentality of like Christine said, if you are sick, you would do not go to work. You do not go out. Even if it feels like the common cold, that could be coronavirus. And so it’s going to be this really changing a mentality of like this, isn’t a personal decision where I can go to work or school and be effective or learn, this is I can’t go to those places because I need to protect our community. And we’re really going to need to focus that as we move into this winter season because our cases are just out of controll.

Elle Griffin: I’m curious what you think because a lot of businesses have put rules into place saying if you test positive for COVID, you get two weeks off, take care of yourself, don’t come into work. What happens if you get a negative test? Have we started to see people say, “Oh, well, I don’t want to get a test because I need to be able to work and if it’s negative, then I’m still going to have to go in.” Or is that a factor, Gary?

Gary Edwards: Well, even if somebody has got a negative test, they were tested because they were in close contact with a positive case, they still have a 14-day quarantine that they need to comply with. So, the test just tells you, “Here’s where you are right now but you’ve got a 14-day period where you could convert on any one of those days.”

Elle Griffin: Would you recommend people coming back in and getting a test if they get sick after a negative test?

Gary Edwards: Yes. Because we want to know of all of the positive cases so that we can do contact tracing, identify where they may have been. And hopefully they’ve been home. So, we can talk to them about their family and what their family needs to be doing because their family members have now been exposed. So, yes, it’s really important.

Elle Griffin: How has contact tracing been going? 

Gary Edwards: Well, it’s very challenging. Each case has multiple contacts and our goal is to try and make contact with each one of those individuals. I’m sure all of us on our cell phones, it rings, it’s a number we don’t recognize, we don’t answer it. And so that is a lot of what we’re dealing with. Many people are good about listening to the voicemail that’s left and following through and so we are able to still make contact with most individuals.

However, that just delays it that much further. We have the delay from the test being reported and then the delay in contact. And if that person is positive because of that contact they’ve had, they’re unknowingly out in the community within their family spreading the disease.

Elle Griffin:

Yeah. What are you seeing as being the number one reason why somebody would test positive? Is it public events? Is it being at work? Is it just family members? Where are these cases congregating?

Gary Edwards: Family and friend contacts. When we go out, if we’re out just doing some shopping, we know stores are expecting us to wear masks, to be social distanced. Even when we go into a restaurant, we’re expected to wear a mask unless we are actively eating or drinking. When we’re home though, we let our guard down. Home is a safe place. We invite people in who are safe. We let our guard down, they let their guard down because they’re coming to a safe place. They’re not thinking that they might be in the early stages of an illness and expose somebody. That’s where we’re seeing a lot of this surge that was taking place.

Elle Griffin: How has your job changed this year compared to past years? I imagine it’s changed quite a bit.

Gary Edwards: I do nothing but COVID-related activities. One of the things I’ve loved about being in public health is, it’s so broad and diverse. I can deal with immunizations in the morning and a policy issue around septic systems in the afternoon, just incredibly broad, but every day, all day long, all night long is COVID.

Elle Griffin: So, Christine, are you all in the same boat on that? 

Christine C. Ginocchio, PhD MT:  Certainly COVID was a huge tremendous focus for everybody but in our field we have to still continue to supply. Like I said, previously diagnostics for all the other infectious diseases and we can’t stop development on new projects. So, COVID is a huge part of our day but we still have that other full day on top of our COVID day. So, it’s quite a challenge but rewarding because we’re helping public health and keeping people safe. But I think everybody is looking forward to some day of downtime.

Elle Griffin: We have made some changes this year. What are some of the changes we’ve made that maybe might stick around even after this?

Edward Stenehjem, MD, MSc: I mean, I think when you look at healthcare, so many changes have happened. The focus on telehealth is not going to go away. We’ve found that to be such an effective tool to communicate with our patients whether it be through their MyChat or through a true teleconsultation where they’re their home and we’re seeing them virtually. We’ve gotten very good in adept with that from our Connect Care clinic which does that all day long and that’s all they do, to our primary care clinics that do that intermittently throughout the day.

Gary Edwards: One of the things that has been really obvious to us in public health, and I know that Intermountain has been working in this for a while, is the concept of social determinants of health that we see individuals, lower income and ethnic and minority groups that have higher rates of poor health from a number of different things. It’s not because physiologically they are more susceptible to those infectious or chronic diseases, it has to do with these social determinants that are part of their life. And we’re seeing that play out right before our eyes with COVID-19 as we have much higher rates in our ethnic minority populations, our lower income populations because they’re not able to stay home and work. Their job requires they’re there serving a customer and that puts them at greater risk. They go home, they live in a smaller home. They might have extended family living with them in a smaller home. And so there’s greater opportunity for spread within that household. Individual goes to work, they have to work, they bring it home and it spreads to that household.

Elle Griffin: Are you making changes in public health to try to affect that now going forward?

Gary Edwards: We’ve implemented changes prior but this is helping us help the community realize that there is a need to have additional focus in certain areas of our population. We have services that are available to everybody but we need to focus some services specifically and target other populations to make sure that these situations can be addressed before they become a problem.

Elle Griffin: So, we’ve sped up innovation in healthcare in a lot of ways. Is that what you’re all seeing? Were there any challenges that maybe this did away with some things you didn’t like before or?

Edward Stenehjem, MD, MSc: Just the thinking about research within Intermountain Healthcare, we weren’t a big trial list center and that wasn’t our focus of research but we had to make it our focus of research. And so now within a month we stood up to large community-based trials in conjunction with University of Utah to study multiple different medications including the controversial hydroxy flow and now we’ve got multiple NIH-sponsored studies in both inpatient and outpatient and we didn’t have that platform to begin with. And so we had to spin that up, create it and now we’ve got a mechanism to provide access to these new drugs to patients that come in, whether you’ve come in and down in Utah County or in Salt Lake. And it’s something that was new and challenging for us but now we have that platform built to be able to offer access.

Stephen Foxley: One other challenge here, I bet I think you know, there are systems and groups that do a good job with our fragmented healthcare system but ultimately it still remains very fragmented and it doesn’t pay for value in the ways that it should. And I do think that this year has brought up some of those challenges but I would really say that there’s a lot more opportunities. And I think that any of the healthcare systems and payers and providers, I think there’ll be a new found interest in working together in a more collaborative fashion.

Elle Griffin: How about in healthcare education? I’d imagine you probably found some hurdles with going remote teaching in some ways but maybe even some strengths there.

Dr. Frank W. Licari: One of the things we found out and the minute we went online, we noticed that there were more students in lectures than there usually were and we were all pretty shocked by that. But they participated, they did it, they took it seriously. The question part of it, they’d like the technology of being able to chat and ask questions and they worked on other issues that go with that. We also then were worried we had our examinations and assessments online too. We wondered was there any impropriety happened? We reviewed all those things. We noticed that there was none with that. So, that was another thing that we could look at. The possibility then of looking at going forward I think from our university is, what can we do online? How can we utilize it? We took a totally in-class courses and went online with them. And now we’re trying to sort out what can we look at and have as online courses going forward with it. So, it’s been a good experience for us to do that part.

Elle Griffin:  What have we learned that we think maybe we’ll do differently next year? Or is it just going to be still fly by the seat of our pants? 

Gary Edwards: We are preparing for mass vaccination and we have learned a lot from doing mass testing that can carry over to mass vaccination, how to handle crowds, how to anticipate, not anticipate, but prepare for an anticipated changes in weather to repair for, or to anticipate. Our anticipation is that COVID is going to be around for a while. We’re going to have a vaccine that will help us to a certain extent, but this is still a novel disease. We’re nine months, 10 months into it. We still have a lot to learn about this. How effective is the vaccine going to be? Is it going to provide three months worth of immunity, three years worth of immunity? Three decades worth of immunity? We don’t know that yet.

Edward Stenehjem, MD, MSc: I think it’s really hard for us to look forward to next year. And the reason that it’s hard for me to look forward to next year is because of what we’re facing right now. I mean, we are at a healthcare crisis right now at the rate of hospitalizations.  And so it’s really challenging for me to be looking forward to next year because we haven’t addressed the crisis in front of us. And so, something needs to change now, and it needs to change in a big way for us to alter the course of this.

 This isn’t just recommending mask use. That’s not going to get us out of this current situation. And so, I think it’s a little bit challenging for us to look forward to what will happen with vaccines or routine testing or how healthcare is going to look when I think everybody is so anxious and scared.

We’re not going to have a vaccine available to us to be able to mass vaccinate by December. We may have some vaccine that we’re going to be able to give to critical workers and people that need it most, but it’s not going to be a vaccine we can distribute to everybody before Christmas. That’s just not going to happen. And so I think we can’t forget the fact that we’re going to be in this situation through this winter and really have to abide by a really strict, good public health measures, which means reducing our close contact, wearing our masks, washing our hands and not getting ourselves in situations where we’re going to have high rates of transmission.

Dr. Frank W. Licari: Well I do think there’s some positives that are going to come out of this. One is I think we’re going to continue to see less people in the waiting room. The way that you’d go to the doctor and everybody waiting in the waiting room and could be now with the way it is, we’ll call you when we are ready and I think that’s going to continue. I think that’s a good thing. I think we’ve figured out ways in which we can do things digital with the digital technology in terms of treatment. That we don’t have to do is invasive procedures with them and that’ll continue with looking at it. 

Elle Griffin: I know before when we all got here, there was some conversation off camera about how many hours you’ve been working and they were a lot, you guys are probably tired. Your staff is probably tired. How are you seeing that coming into play here?

Christine C. Ginocchio, PhD MT: I think it’s been a great benefit working from home for those of us that could, because I think it played a large part and not in an exposure and it keeping people safe, but when you’re home and all of the time when you’re on complete lockdown working from home is stressful. You find that you’re working from 5:00 or 6:00 in the morning until 11 or 12 o’clock every single night, there is no break. You’re home, you’re stuck and you work. So I think there’s a lot of that mental fatigue that goes on. And I think that’s part of why people just want to get out and have a normal life again. And we’ve been doing this seven days a week, but it did work. And I commute back and forth between Salt Lake and New York. And when I went back to New York for the first time in June, after being here for what, four or five months, because I couldn’t get back to New York, nobody questioned anything. Everybody wore a mask. Nobody gave you a hard time if you went into a shop, nobody had to ask to do it.

Edward Stenehjem, MD, MSc: Yeah. We talk about the fatigue that we have. If you want to see fatigue, go to our ICU. Go to the hospital, the units where we round and talk to those nurses, the respiratory techs. That’s the fatigue you see. And it goes so far beyond just the physical fatigue, asking them to take more shifts or work longer hours, or more often. It’s also the mental fatigue that our caregivers are under when these people are in the hospital, dying from COVID and they can’t have visitors. And so now you’re asking a caregiver to have a Skype conversation with their loved ones to talk about end of life care. Now that’s not something you leave at the doors when you go home, right? That’s something you take with you as you go home. And unfortunately, we’re getting very good at it.

But we’re now confronted with this misinformation campaign, or we see it in our communities when people just push back against wearing a simple mask, or we tell somebody, “No, you shouldn’t congregate in thousands of people for a Halloween party. That shouldn’t happen.” That is so hard for caregivers and that’s one of our biggest challenges is, how do you impact the misinformation and get people to actually listen to their leaders who are knowledgeable?

Elle Griffin: Based on what you said, some of what you said about politicizing this, do you think that there should be more lockdowns, that there should be more controls? I know this is, like you said, it’s become a very political issue, but to some of your points, the lockdown has really worked. People are not adhering to guidelines, and that’s some of what we’re having the rush about. What is your take on that? What should be done here?

Edward Stenehjem, MD, MSc: I’ve got a very clear opinion on this but I’d love to hear what everybody else thinks. Our rate of a community transmission is so high right now and our test positivity rate is so high that we need aggressive measures and we need them now. And so this isn’t asking more people to wear masks or asking people not to gather and politely asking, “Don’t gather for these thousand person parties for Halloween.” We need aggressive measures. And I think, we think of this as all or nothing, right? But we can’t think of that like all or nothing or a light switch we can think about gradations of an intervention.

 And so, yeah, I think we all need to go home. I think we need to take at least two weeks of time where we just go out for essential activities. Maybe we say, “Okay, kids go to school, but there’s absolutely no extracurricular activities.” And if we do that and do it effectively, we can bring our community transmission up to zero, it’ll still be present. We’ll still see transmission. And then we may have to do that again in two months time and take a two week pause, but we have to do something now to control the current pandemic, we’re at rates that are not sustainable.

Christine C. Ginocchio, PhD MT: The young people don’t feel it you know. They don’t get sick as the older people do, but they spread the virus among other family members. So what type of lockdown do we need to go to a hundred percent for a two week, just to say, “Okay, time out, we need a break.” Everybody criticize Cuomo when he shut down New York state, I mean, really criticized. And it was devastating on the economy. It really, really was, but that was almost a four month lockdown,

But we would have had millions of people in New York City die if he hadn’t done that. So, you don’t want to get to that point. If we could take maybe a two week break, that’s a sustainable for businesses, but for a month, which is something that it could lead into, is really not sustainable. So, maybe that timeout, we need to time out, is something that needs to be considered, but it has to be mandated and enforced by the government of the state. 

Elle Griffin: Is this even a possibility, or Gary, you’re in all the conversations, what’s happening?

Gary Edwards: Well, there are always discussions on, what do we need to do, because where we are doesn’t seem to be working. I’m accused by my kids of having been the pioneer of social distance. They say, well, this just fits right with you. It hasn’t been a challenge for me. If I have something that I need, essential, I go to the store, I get it, I wear my mask, I stay away from people. I don’t have a lot of people that come and visit me, and I don’t go and visit a lot of people. So, it hasn’t been hard for me, but I know that I’m different that way. A lot of our public struggles with not being able to have that social contact, which has surprised me somewhat, because so many of our young people are so tight to the electronic way of communicating. But I’ve learned that no, they also really need that social interaction that’s not electronic. I think we can individually take that two week pause if we will be disciplined enough to do it. To say, okay, I will go out for the essential things, but I’m not going to just go out to eat out.

Elle Griffin: But you’re saying that probably won’t be forced from the city, from the state. We probably won’t go back to that again?

Gary Edwards: I’m not saying it won’t be, but I don’t know that it’s on anybody’s immediate plan to do that. I would just, again, say, and these are things that many of our elected officials have said, we all have a personal responsibility for our neighbors, for our families, and even though it’s not as comfortable as we would like, it’s not as loving perhaps as we would like it to be, we want to go and take that meal to our neighbor who had surgery. We need to figure out different ways to do that. If we will continue this for, I would like to say a little bit longer, it’s probably longer than we all want it to be, we will see progress with the surge that we’re in right now. But we all have to assume that responsibility, it’s not just your responsibility, it’s my responsibility.

Edward Stenehjem, MD, MSc: Yeah, I mean, I think that’s challenging because that’s the call we’ve been making since the Mask Up Utah Campaign this summer, and you hear pleas from healthcare workers at the governor’s press conference on Thursdays. The pessimists in me says, well, what’s going to change now. We need something to help us change. Maybe that is getting a groundswell of support from our business leaders, from the Chamber of Commerce, from the Utah businesses, to say, hey, there’s a really critical point coming up for us in this business season, and that’s the holiday season, maybe we can develop a groundswell of support to get our elected officials to move in this direction. Maybe it’s relying on some large churches or members of faith in this community, to push in this direction. We need to look at what levers can we pull to change behavior and maybe that starts with our business leaders. 

Elle Griffin: So, Stephen, at your organization, do you imagine all of your employees coming back to the office when there’s a vaccine?

Stephen Foxley: We’ve taken a slow approach to that, and one other thing is, we operate in multiple States that are in different positions and have different political realities about reopening. We wanted to communicate to employees with multiple months of advanced warning. So, I don’t know if a vaccine, but it will be a scenario where the pandemic is under control, where schools are open, and recognizing the burdens that are on our employees and their families right now. I think that that’s not a decision that we’re going to rush into. I don’t expect it will happen too soon.

Christine C. Ginocchio, PhD MT: Just to note about vaccination, I think if people think that this is the way COVID is going to end, I think they’re putting a lot of faith in something that we don’t know a lot about right now. We have no idea on the protective nature of the vaccines, how well will the elderly do with the vaccines, they don’t even do well with influenza. You get a double strain shot for influenza in the elderly, how long will it be protective? There’s this whole movement in this country against vaccination. We had huge measles outbreaks in New York this year because we have whole populations that refuse to vaccinate their children.

We can’t get people to get a flu vaccine. Maybe they’ll be a little bit more scared this year because it’s COVID and they’ll think about it, but COVID is a two dose vaccine. You can’t even get people in for a first dose, let alone, how do you schedule, make sure they come back in three weeks for their second dose? You’re going have a whole huge part of the population that will refuse to be vaccinated. I will get my vaccination, believe me, the minute it’s available, but a lot of people are very unhappy about vaccination. You can’t mandate people get vaccinated, not even for the schools, not even in the private business sector either. 

Elle Griffin: Frank, did you have something you wanted to add?

Dr. Frank W. Licari: I did, one of the things that we haven’t discussed, that I think would help all of us as an employer and as a educator with the numbers of students in these populations that aren’t complying, is rapid testing. We really haven’t employed those things, which would be easy, something that we can do within 10 to 15 minutes, that is inexpensive for us to do. Doing large scale rapid testing would help us know and segregate those individuals would do it. We’re frustrated, compliance is very difficult, but testing would at least be able for us to identify and segregate those individuals very quickly. I think that’s something that we’re looking at as we go forward as we do this that would help us be able to do it, get past those that don’t want vaccination, get past those that don’t want to comply. We can still keep everybody safe from [COVID].

Edward Stenehjem, MD, MSc: Yeah, I completely agree. I think as we look forward, vaccination will have a role, hopefully. Most vaccines that go through trials fail. We’ve got a lot in phase three trial, would hope that, based on phase one, phase two study, they look promising, but we haven’t seen any data yet to say whether or not it’s effective. The first data we get isn’t going to be the data we want. We want to know, does it reduce hospitalizations, does it reduce deaths? That’s not data we’re probably going to have initially. Given the vaccine hesitancy in our communities, and also across the US, this isn’t going to be a magic bullet. It’s most likely not going to be a vaccine that’s as equivalent and as good as the measles vaccine, hepatitis B vaccine, excellent vaccines, 95 percent efficacy. This is most likely going to be like a flu vaccine in terms of how well it is effective. So, that’s going to be, I think, one arm of the way we approach this.

Elle Griffin: Can you tell me more about the antibodies? How does that work?

Edward Stenehjem, MD, MSc: Sure, when people are infected with SARS-CoV-2, we develop antibodies. That’s a way that our body essentially identifies the virus and takes it out of circulation, is a way to think about it. That’s how we identify people that have gotten sick. What we’ve done now is, we haven’t done this, the greater scientific we, have identified specific antibodies and manufactured them. So, then if somebody gets sick, then we can give them that antibody. Ideally, it would prevent hospitalization and death. So, it’s therapeutic that would be given, and it’s a monoclonal antibody, but that also brings in a lot of operational challenges in terms of somebody getting diagnosed, finding out 24 hours later they’re infectious, where they go to get this infused, there’s transfusion reaction, who’s going to pay for this probably very expensive antibody that the government will probably pay for for the first little bit, but then it’s going to be put on payers. So, the ripple effect of this type of therapy is going to be really challenging for all of us to figure out in healthcare.

Elle Griffin: Are we preparing for some kind of future in which we’ll have rapid testing, we’ll be able to do this where we have these antibodies, are these things we’re actively preparing for?

Gary Edwards:

There are rapid tests available now, they’re not necessarily available on the over-the-counter market but rapid testing technology is there, there are new reports almost every day of a new rapid test that is under development. We are employing rapid tests right now, primarily with the school-age population to help with some of the policy that the state has adopted called test and return. Students are quarantined, again, after a period of time, get a test, and if they’re negative, and there’s the concern because they could still turn positive, but if they’re negative, they could return to school because we want to get the kids back in school. So, that technology is there continuing to be developed. I’m sure, before long, it will be available, so you can go and purchase tests over the counter and use in home.

Elle Griffin: Is there anything we can really leave this on a positive note and say that we’re really looking forward to in 2021?

Edward Stenehjem, MD, MSc: I think, as we look forward, we have learned so much about this virus. So, is next year, 2021 will be better than 2020, yeah, no doubt about it. So, I think we can look forward to that and the fact that we know how to manage this from a public health standpoint. We have therapeutics now that work, we have testing and testing capabilities that are coming on board for mass testing, and we have vaccination that is actually probably right around the corner in a number of weeks, potentially for coming to some parts of our communities. So, yeah, it’s going to be better, but it’s not going to be back to normal. It’s going to be our next normal of what we can expect with this virus. You’re right, the innovation that has come through education and how we train our medical residents, and medical students, pharmacists, and dentists has just been phenomenal.

Those innovations are going to continue. Telehealth is going to continue to push forward, and we’re going to have a more friendly healthcare environment that I’m hoping is simpler, and easier, and cheaper to navigate. So, I think 2021 is going to look better than 2020. I’m hoping that the stress on our healthcare networks is going to be a lot less because of all of these multifaceted interventions we’re going to implement, but it’s not going to be 2018, it’s going to be 2021. It’s going to have its uniqueness, but it will be better than 2020.

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