Friday, March 27, 2020

Stopping the Spread of COVID-19

In times of crisis, people become more concerned about each other. Over the past few weeks, many people have stopped me in the hallway to ask me how I am doing. I can honestly tell them that I am doing fine. I am fine because we have a great team at GBMC - experts in their fields who work very hard and who are focused on our vision.

The community needs us, now more than ever, to remain focused on our vision. Many people are scared, and they are hoping that we will be there for them if they get sick with the coronavirus (COVID-19). We are doing everything we can to manage what is in our control and we are actively creating plans for scenarios that we cannot control.

As a physician, I was trained to look for evidence to make a diagnosis - to use data to decide what to do. One of my frustrations as we deal with the pandemic is the degree of uncertainty that we are experiencing. Will we have a surge of patients and if so, when will they come? So far, we have not had a surge, but has it simply not happened yet?

I have been reviewing the epidemiology of infectious disease outbreaks. There is a statistic called the basic reproduction number (R0) or R naught. A common definition of R0 is the number of secondary cases that one case would produce in a completely susceptible population (i.e. How fast is this disease likely to spread?). Since there is no immunization for COVID-19, we believe that everyone who has not yet been infected is susceptible. An outbreak of a disease will continue if R0 is >1 and it will end if R0 is <1.

There are three primary factors that determine the contagiousness or transmissibility of infectious agents and therefore the R0. They are: 1. The duration of contagiousness of the agent (early data shows that this is about 10 days from the onset of symptoms in COVID-19); 2. The likelihood of infection per contact between a susceptible person and an infected person; and 3. The contact rate between infected and non-infected persons.

We obviously can’t do anything to change the duration of contagiousness, at least until there is a cure. We wear personal protective equipment (PPE) like face shields and N95 masks to reduce the likelihood of getting infected when we are in contact with an infected patient. These are precautions we must take, but the best way to reduce R0 to <1 is to reduce the contact rate. This is why our schools are closed, why most people have been sent home from work, and why the GBMC Fitness Center and all my favorite restaurants are closed. We have essentially shut down our economy and put large burdens on our citizens to stop the spread of this disease.

Is it working? There are some hopeful signs. The number of Emergency Department visits are down, and we have not seen a surge in cases, yet. We can’t really tell what the actual R0 is, in part because we don’t have enough test kits to test a large enough segment of our community to see who has been infected. But we must stay the course. We will overcome the coronavirus if we stay together and stick with the science. If you have questions, our Infoweb is the official source of institutional information for the COVID-19 outbreak and it is updated frequently. Please check it at regular intervals to keep yourself in the know.

Thanks to all of you for your hard work!

Friday, March 13, 2020

Keeping yourself and those around you safe

The GBMC HealthCare System is focused on the COVID-19 pandemic and preparing for a possible surge in cases. What can the individual do to protect himself or herself? There are two things that we should all do: 1.Wash our hands.  The virus is generally spread through droplets that occur when someone with the virus coughs or sneezes. If you touch a surface that has a droplet and then you rub your eyes, you will contaminate yourself. So, wash your hands frequently and avoid touching your face. 2. Keep yourself at a distance from those who may be sick and could spread the disease to you by coughing or sneezing.

Two tents are now located outside the Emergency Department. They will be fully operational beginning Monday, March 16, at 11 a.m. We will use them to respond to an evolving situation as needed.

Currently, we are well stocked with personal protective equipment and our Incident Command Team, led by our Chief Medical Officer, Harold Tucker MD and our Chief Nursing Officer, Dr. JoAnn Ioannou, has a plan in place to deal with a potential surge in infected patients. Beginning Monday, March 16, we will begin screening visitors to our hospital and limiting visitation to patients to protect both the patients and our staff. It is critical that we protect our staff so that we will have enough people to care for the sick when they come. I am very grateful for all the work that has been done to prepare us for what might come. The Team is assessing the situation hour by hour and will adapt as necessary.

New Method for Measuring Hand Hygiene Compliance
Speaking of proper hand hygiene, starting on Wednesday, April 1st, we will no longer be using secret shoppers to measure our compliance with hand hygiene. This will now be handled by observers who are not only counting, but who will also intervene and provide real time feedback and coaching. This will help us “hardwire” washing in and out of rooms to get us closer to 100% reliability in this practice.

The Centers for Disease Control and Prevention (CDC) says that “on average, healthcare providers clean their hands less than half of the times they should.” Our Chief of Infectious Diseases, Dr. Ted Bailey, stressed multiple times, during a recent interview, that the best way to protect yourself and your loved ones from getting COVID-19 is with proper handwashing.

Thanks very much to all my GBMC colleagues for their efforts in combating the COVID-19 pandemic.

Friday, March 6, 2020

What if your loved one couldn’t pay their healthcare bills?

If you read my blog, you know I believe that the United States has the best doctors and nurses in the world; however, they work in a system that spends at least 40 percent more per capita on healthcare than all other countries. So, when an individual gets sick in our country, depending on his or her health insurance, it is very easy to end up with significant out-of-pocket expenses.

There are several groups of patients who are covered by programs that have little or no out-of-pocket expenses. This is often called “first dollar coverage.” Medicaid, a federal and state program, covers low-income patients and disabled patients and Kaiser Permanente offers a similar program. Veterans’ medical expenses are covered through the Veterans Administration (VA). The technical definition of “socialized medicine” is healthcare provided by the government. Like the National Health Service (NHS) in England, the doctors, nurses and other clinicians serving the VA are all federal government employees.

Medicare, the U.S. program that covers citizens over the age of 65 (and a few other groups, like those with end-stage renal disease), has out-of-pocket expenses, so Medicare beneficiaries can opt for Medicare Advantage (HMO) plans where they have limited out-of-pocket expenses but fewer choices of providers. Medicare does not employ doctors or nurses so, by the definition above, this is not socialized medicine. The only thing that Medicare does is pay the actual medical bills. By the way, by this definition, the Canadian system is not socialized medicine either, because the Canadian government does not provide care, it only covers medical costs. There is actually more socialized medicine presently in the U.S. through the VA than there is in Canada. Canada is one of the countries that pays about 40 percent less per capita on care than the U.S. and their average life-expectancy is longer than ours. There is no appreciable difference in healthcare quality between the U.S. and Canada.

The majority of working Americans have employer-based health insurance (like me and my 4,000 or so GBMC HealthCare System colleagues). These plans vary significantly from employer to employer. At GBMC, if you take our platinum plan and use GBMC medical staff members and GBMC facilities, you can run up large bills with no out-of-pocket expense. But, many employers have been dealing with the rising cost of healthcare by pushing more and more of the cost onto employees through deductibles and co-pays. We now have many Americans who have insurance through their employer but cannot afford care because they cannot afford the out-of-pocket expense. This is a real problem for many.

I know someone who is currently facing this dilemma. This person is a graduate of a prestigious college and a hard worker, with a good job and is making a reasonable wage. The person recently needed to have a medical procedure and the amount this person had to pay out-of-pocket was much more than the person could afford. I know that this story is not unique.

Middle class Americans are paying a greater percentage of their earnings than ever before for healthcare, according to this report, from The Commonwealth Fund, which says rising premiums have outstripped wage growth over the past decade. Medical debt is the most common cause of people filing for personal bankruptcy (65%). So, last week’s news about hospitals’ bill collection practices should not come as a shock. The number of people who can’t pay their bills is growing significantly and hospital margins are very slim, so they are trying to capture the reimbursement. We at GBMC make sure that we treat patient fairly by offering financial assistance for those patients in need and creating reasonable payment plans for those who have the ability to pay their medical bills.

The real question is: Do we believe that healthcare is a right or a privilege? If we believe that healthcare is a right, then we should learn from other countries where all people are covered, and the total cost is less to create a smarter insurance system. What do you think?

Thank You to Our Social Workers!
March is Professional Social Work Month and I would like to thank the devoted group of social workers who serve GBMC. Our social workers help inpatients and outpatients navigate the complexity of the medical care world and prepare them for discharge along with our care managers. Please thank our social workers for all that they do to move us closer to our vision.