I Miss Seeing Our Volunteers

As we celebrate National Volunteer Week (April 19-25) and Volunteer Appreciation Day (April 20), I want to thank our volunteers who have selflessly donated their time and talent to our healthcare system.

Our volunteers have not been onsite because of the coronavirus (COVID-19) crisis and we are getting by without them only because we are serving fewer patients in the hospital. On a typical day they are directing patients to where they need to go, serving people with a smile in the gift shop, and helping throughout the campus and at Gilchrist.

Each of our volunteers has their own special talents that they use freely to help us deliver health, healing and hope to their community. I want them all to know how much we value their efforts and how much we miss them. I look forward to seeing them again, hopefully soon.

This week is also Medical Laboratory Professionals Week (April 18-25) and for over a month now, our medical laboratory professionals and pathologists have focused on preparing samples, running tests, and helping identify COVID-19 cases. Our laboratory is full of unsung heroes. Their work is critical to our mission, but often forgotten. We are so fortunate to have the most highly reliable laboratory that I have ever seen, and I want to thank its leaders, Robert Palermo, MD, and Janis Smith. We are blessed with outstanding pathologists, technologists, technicians, phlebotomists, managers, administrative personnel, and others on the team. I want to extend my sincere thanks and appreciation for the work they do behind the scenes to drive us towards our vision.

April is Sexual Assault Awareness Month. GBMC’s Sexual Assault Forensic Examination (SAFE) and Domestic Violence (DV) Program does so much for our community, especially during the current pandemic.

Sexual assault and domestic violence patients not only get quality medical-forensic treatment but also receive much needed crisis intervention and safety planning. Under the leadership of, Laura Clary, BSN, RN, FNE-A/P, SANE-A, our SAFE & DV program is expanding in new directions as additional needs are identified. The pandemic has increased the risk of abuse as the crisis has created more stress and less opportunity for the victims to distance themselves from their abusers.
We want the community to know that our SAFE & DV Program is always available – 24 hours a day, 7 days a week, 365 days a year – and our doors are open to those in need even during the COVID-19 pandemic.

To learn more on how our program continues to serve survivors of sexual assault and domestic violence, even during these times, please check out this video here that our marketing team put together.

Preparing for the Next Steps: Case Finding and Contact Tracing

Many people are asking me “When do you think that life will go back to normal?” They are getting tired of social distancing and not being able to do most of the things they enjoy. We must still be vigilant, wash our hands, and keep a safe distance from others, but it appears that the steps taken to control the coronavirus (COVID-19) have had a positive effect and the peak of the outbreak may not be as bad as was once thought. If this is the case, since our economy is suffering from these restrictions, the pressure will be on the Governor to let people go back to work.

However, lessening the restrictions is potentially dangerous unless we are prepared for the next steps. A few months ago, when COVID-19 first came to the United States, 100% of the population was susceptible to contracting the disease. Now, some have had the disease and survived and carry antibodies against the virus and are immune. Others have not been exposed and are still susceptible.

Since we have not had enough test kits available to test directly for the virus or to do blood testing for its antibodies, we really don’t know what percentage of the population is still susceptible. Since there still is no treatment or vaccine, lifting the restrictions could allow the virus to spread rapidly once again. We must be able to find each new case, quarantine the patient, and then identify his or her contacts and quarantine them as well.

This case finding and contact tracing is already done for other diseases by our local health departments. If a patient is identified as having syphilis, for example, they are reported to the health department, which then interviews the patient, identifies anyone who the patient may have transmitted the disease to, and contacts them as well. The contacts are tested and treated if they come back positive. This process will be more difficult with COVID-19 because it is very contagious and can be transmitted to a larger number of people.

Experts at the Johns Hopkins Bloomberg School of Public Health released a paper entitled “A National Plan To Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the U.S.” You may want to read this paper. It identifies the steps needed to create a system of case finding and contact tracing for the country and it gives an estimate of the costs associated with building such a system.

Over the next few weeks, the conversation will turn from the medical care of COVID-19 patients and the work of hospitals, to the next phase: the work of a revitalized public health system. Stay tuned.

Creating More Wellness in this Time of Sickness

After I got home from work last night, I went for a run and I was really impressed with the number of people who were out walking or running in my neighborhood. I started to think that this might be another good thing to come out of the COVID-19 pandemic – a new push towards better overall health.

Behind frail elders, those with chronic diseases are at the second highest risk for death related to COVID-19. Unhealthy habits like smoking, overeating, and not exercising can cause conditions like chronic obstructive pulmonary disease (COPD), obesity, and diabetes – now, more than ever, it’s critical to reduce these habits. Wouldn’t it be great if people took this as an opportunity to focus on their health as a whole?

Our “Virtual” Walk for a Great Cause
I want to thank everyone who participated in our fifth annual Walk a Mile in Their Shoes event. We had over 300 participants, who walked or ran 2,501.76 miles (three times our goal of 725 miles!), helping us to raise more than $67,500 for our Sexual Assault Forensic Examination (SAFE) and Domestic Violence program.

In response to the pandemic, we created a VIRTUAL version of this annual event. It is great to see that the support and participation from our community was even stronger than with the previous in-person events. COVID-19 did not deter people from shedding light on the extremely important issues of sexual assault and domestic violence in our community. I am grateful for their commitment to the cause even through this crisis. Walk a Mile in Their Shoes allows GBMC to provide the necessary services 24 hours a day, 7 days a week at no cost to our patients.

I want to thank the GBMC Foundation, our Volunteer Auxiliary, and all parties who virtually walked with us to make this year’s event a major success!

Thank you to our social workers
I want to extend my appreciation to our social workers who are doing so much during these challenging times. As COVID-19 continues to impact more individuals and communities, our social workers are working on the frontlines side-by-side with our clinicians to maintain preventative and treatment services for all of our patients. I have always been impressed by the resourcefulness and fortitude of this group and we are truly fortunate to have such a talented and hard-working group of social workers on our team.

Give a much-needed morale boost to your colleagues
Over the last several weeks, many members of the community have shared encouraging messages for our nurses, doctors and other members of our workforce on social media. I’m very appreciative of the community’s efforts to encourage our dedicated healthcare workers.

I want to extend the same opportunity to all the GBMC family who might be interested in sending along positive thoughts to their coworkers.

Remember we are all in this together! I hope you take advantage of this opportunity and click here to offer your words of encouragement to a colleague.

Happy Passover and Easter
As we learn to live with the challenges of sheltering in place and social distancing, I hope that many of you will still be able to maintain a part of your holiday traditions amid the COVID-19 pandemic. For those staff members working during their spring holiday, a special thank you for taking care of those who are ill during this time. I grateful for all of you. I want to offer my best wishes to everyone celebrating Passover and Easter.

Meeting the Needs of those with Chronic Disease During the Pandemic

It’s clear that people are heeding the call not to come to Emergency Departments (ED) with non-emergent needs during the COVID-19 pandemic. GBMC and the other ED’s in our area have seen around a 40% reduction in visits. Since people are also staying away from physician offices, we should be concerned that those with chronic disease may have needs that are currently not being met. GBMC Health Partners has made fabulous progress in improving the health of patients with diabetes, for example. How can we assure that these gains are not lost? Our nurse care managers and care coordinators have been reaching out to those with chronic disease on the phone and our providers have done more than 2,600 video visits over the last three weeks! What a great testament to our core competency of redesigning care to meet the needs of those we serve regardless of what comes our way.

Earlier this week, our Marketing Department coordinated three Facebook Live interviews, one of which included our Chief of Endocrinology, Dr. Ruth Horowitz. Dr. Horowitz provided some very important information for those with diabetes about why it’s important to take extra precautions during the COVID-19 outbreak. If you are interested, click here.

Walking for A Great Cause!

To follow social distancing guidelines and avoid bringing a large group of walkers together, we decided to do this year’s Walk a Mile in Their Shoes event VIRTUALLY.

Walk a Mile in Their Shoes, hosted by the GBMC Foundation and presented by the GBMC Volunteer Auxiliary, financially supports our Sexual Assault Forensic Examination (SAFE) and Domestic Violence (DV) Program. This event has continued to grow over the years and I am hopeful that, despite these unprecedented times, this year will be no different.

So, I ask everyone to walk or run a mile (or more) and to encourage their friends to do the same, anytime between now and Saturday, April 4, for victims of sexual assault and domestic violence. Our goal is to reach 725 virtual miles in recognition of the 725 patients who received help from the SAFE and DV Program in 2019. There are three simple steps to take:

1. Take a photo or video of yourself walking or running a mile (or more!)
2. Post the photo or video on any social media platform (Facebook, Twitter, Instagram) - use hashtag #GBMCWalkaMile, tag GBMC HealthCare, or email socialmedia@gbmc.org so we can feature you!
3. Complete this form to let us know how many miles you walked/run so we can meet our goal of 725 miles. (And we’ll mail you a T-Shirt!)

We are so proud of our SAFE and DV program, and with your help, we can continue to be a leader in this area by serving those in need and educating the community.

If you’re interested in participating in our virtual walk or want to donate to our SAFE and DV program, it’s not too late. Please visit www.gbmc.org/WalkaMile for further details.Thank you!

Doctor’s Day 2020

March 30th (this past Monday) was the annual Doctor’s Day. On this day we thank physicians for their commitment to serving those in need. I’m honored to recognize our doctors who, despite the risks that they face, continue to serve on the front lines to care for people and help to contain the spread of the coronavirus. The pandemic is taking an emotional toll on all, and that includes physicians. Healthcare workers across the country are sacrificing for others. If you are looking for ways to make a difference, please consider a donation to our HealthCare Workers Fund to support those on the front lines who are making these sacrifices to keep us safe. Thank you!

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!

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.

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.