A Year in Review: America’s Fight Against COVID-19

(This is an unedited transcript. For accurate quotes and presentations, please refer to the full-event video.)

0:03
Hello, everyone, and welcome.

0:05
Thank you for joining today’s webinar, A Year in Review: America’s Fight Against COVID-19.

0:12
I’m Sarah Dash, president and CEO of the Alliance for Health Policy, and I can tell you that a year ago, I never thought I would be doing dozens of webinars from my bedroom living room, and neither to any of the rest of us. And yet, here we are.

0:28
For those who are not familiar with the Alliance, welcome. We’re a non partisan resource for the policy community, dedicated to advancing knowledge and understanding of health policy issues. And we gratefully acknowledge the National Institute for Health Care Management Foundation for supporting today’s important event.

0:44
You can join our conversation on Twitter at #AllHealthLive and our community @AllHealthPolicy as well on Facebook and LinkedIn. Couple quick housekeeping notes to ask your questions, Please use the speech bubble icon in the right hand side of your console. You can submit questions anytime. We’ll address them during the broadcast, and you can chat any technical issues. You might be experiencing also check out our website. I’ll have policy dot org to find background materials for today’s briefing and a recording of today’s webinar which will be made available.

1:16
So, to say that this has been a momentous year, would be an understatement.

1:21
It’s a really somber anniversary as we’ve lost over 529,000 of our fellow Americans, which is more than one for every minute in the last year.

1:32
And it’s also an opportunity for hope as we look towards the future as vaccines begin to come online and as our friends and colleagues and neighbors begin to get vaccinated.

1:45
And there there are other causes for for somber Reflection, and for hopeful, looking towards the future, and that’s what we’re going to do today.

1:55
one other note that I want to make is we seen in a time when our country was already divided unprecedented division politically over the course of this pandemic.

2:07
As a bipartisan organization the Alliance hopes for opportunities for future bipartisan collaboration.

2:16
And I think personally that’s something we can all agree on, is that we want our economy to be strong and resilient. And we want our people to be strong and healthy and resilient and so today to help us talk through the implications of this.

2:30
Last year of this pandemic are some phenomenal panelists and they are going to be led in conversation by the incomparable Julie Rovner.

2:43
Julie Rovner is the chief Washington correspondent for Kaiser Health News, the host of Kaiser Health News, what the Health Podcast. She joined …

2:51
and after 16 years as a health policy correspondent for NPR, where she helped to lead the Network’s coverage of the passage and implementation of the Affordable Care Act in 2005. She was awarded the National Press Foundations, Everett Mackinlay Dirksen Award for Distinguished Reporting of Congress. And, really, she needs no introduction.

3:08
Julie, thank you so much for joining us today, and for introducing our distinguished panelists. Thank you all for joining us today for a day of reflection and to our audience.

3:18
Thank you. And I’m going to sign off and turn it over to you.

3:22
Thank you so much, Sarah. That was great. Welcome, everyone. Today, we’re going to reflect on the past year and discuss how the covert 19 pandemic has shaped and will inform, going forward, clinical care, state preparedness, and the individual consumer experience. Today, I’m honored to be joined by an esteemed group of experts to have this conversation.

3:42
First, we have Frederick Isasi, he’s Executive Director of Families, USA, a leading national, non partisan voice for health care consumers for coming to families. Mr. Isasi worked at the National Governors Association and the Advisory Board Company. He’s an expert on Medicaid, state innovation, health System transformation, behavioral health, and social determinants of health, as well as health care quality payment, and equity issues. Frederick, thanks for joining us.

4:09
Next, we have Dr. George Diaz. He’s the medical director and section chief of Infectious Diseases at Providence Regional Medical Center in Everett and Washington State. Dr. Diaz successfully treated the first confirmed covered 19 patients hospitalized on US. Soil and pioneered at first in the worldviews of remdesivir to prevent respiratory failure and COVID-19 patients. Yes, Thank you for joining us.

4:34
And last, but not least, we have Adriane Casalotti, she is Chief of Government and Public Affairs at the National Association of County and City Health Officials where she leads the Association’s Efforts on Policy Development, Communication, and Federal Advocacy. She previously worked at the Food and Drug Administration, where she led the agency’s work with Congress on a wide range of policy topics and high profile issue. Spent seven years on Capitol Hill, serving as Deputy Chief of Staff, Legislative Director, and Health Policy Advisor for Senior Member of the House Energy and Commerce Committee. Adrian, thanks for being here.

5:09
We have a lot to cover, and not much time to cover it, so we’re going to dive straight into questions and answers to maximize the hour. Remember, you can use the questions panel of the audience interface to submit your questions at any time. I’ll try to get to as many as I can. I’m going to start with an opening question to each of the panelist, Frederick, let’s begin with you. Last year, it’s provided an opportunity to reflect on how inter-connected our health System actually is with other aspects of our daily lives.

5:38
However, individual and family attitudes change towards how people seek care and who they trust for health communications. I understand Families USA has conducted some polling on this.

5:49
We sure have. Yeah, thank you so much for the question, and it’s a joy to be here.

5:52
We’re big fans of the alliance. We think it’s really important work.

5:57
It’s so critical that we can engage in bipartisan communications and knowledge learning to move the country forward. So it’s a joy to be here. We’re big fans.

6:06
So what we know is that we’ve gone through a really profound experience as a community, as a country, and no, it doesn’t matter. your wealth, your geography, your race, your gender. This has been a shared experience, not and, frankly, not just in United States, but across the world.

6:24
And one of the things that’s happened, we went into the field about a month ago to really understand what has happened, four, to the American understanding consciousness around health and health care.

6:38
We discovered a few things.

6:40
…, to your question, really the most profound thing we discovered was a deeper and more a deeper understanding. And commitment to the notion of the social determinants of health.

6:51
That people can see the ways in which the extrinsic factors in your life, Not just the physician that you might see or the clinic that you might go to for your primary care.

7:04
But all the other factors, things like the job that you have, the environment in which you live, your access to things like clean air and your proclivity towards asthma, a lot of really profound more public health and social determined oriented issues that have arisen in the conscious of the American people. And a lot of policymakers around the country.

7:28
George, you’ve been at the forefront of covered 1900 Treatment in the US. What can you tell us about the communication infrastructure and partnerships necessary for safe and efficient covert response and can you speak to how the pandemic is reshaping clinical practice?

7:45
Yeah, it’s it has reshaped clinical practice quite a bit. The greatest I think change that occurred in clinical practice with respect to covert but is applicable to really anything, any disease state, is the use of telehealth.

7:59
When we were first seeing our surge of patients in February, we had done a lot of work in the weeks before that to stand up the infrastructure, to be able to manage the disease in the outpatient setting.

8:14
We wanted to be able to identify patients who were safe for home.

8:19
That said, we could also keep track of them safely at home, and then bring them back to the hospital, when they got sick.

8:26
And we needed to be able to move patients who were coven positive from the ED setting to the home setting in a safe way.

8:34
Thereby reducing our use of PPE by being able to have a safe place for patients to wait for the results.

8:44
Early the pandemic we had serious delays in testing results.

8:49
And by employing Telehealth and scaling them across our, our enterprise and we have 50 hospitals on the west coast, we were able to move thousands of patients from the ED to home and keep them home safely and then identify those patients who were at highest risk for decomposition and get them back into the hospital.

9:09
That’s the right time.

9:11
And we know the system works.

9:13
And so telehealth has allowed us really to at least in the state that I work in, preserves the hospital beds and resources that are so critically needed, and allow us to manage the high volumes that we had early the pandemic.

9:28
We know that this this use of telehealth has been beneficial, and the rules around telehealth were relaxed, I think, by the federal government, and allowed us to provide that service to our patients.

9:44
We also know that within our telehealth system, we were able to address inequities in our population.

9:50
We had translating services available for people that were non english speaking, and those patients were equally as engaged as the rest of the population with our Telehealth program.

10:03
So we know addressing communities that are that have inequalities can be addressed through Telehealth.

10:09
And so that’s, I think, Ben, really a game changer for the way that we manage Covid.
10:16
We also know that these services are uniformly applied everywhere.

10:21
And even within our county, there are patients with outside of our health system that do provide care within community health clinics, or other minority clinic systems.

10:32
They don’t have access to this.

10:33
And what we see is those patients delay of care, And I engagement is care and more likelihood of having test results take much longer. And so, the morbidity is much higher in those populations even locally.

10:47
where we have a footprint, that they have worse outcomes. So while we’re able to design these systems to improve the outcomes, they are limited to our health system, and they’re not uniform across the country, or even within my county.

11:03
I think that has really been the biggest game changer for the measurement of patients, and it really should continue.

11:10
It’s very difficult to build brick and mortar buildings for healthcare and then want to move it outside of those settings safely.

11:19
The better, or how small our health care system will be.

11:22
I definitely wanna circle back to Telehealth, but, first, Adrienne. What are some of the opportunities and challenges and the interaction between states and localities and a public health emergency? Now that President Biden has signed the American Rescue plan, how can we leverage covert response dollars, and there are a lot of them coming to build and maintain sustainable systems of care?

11:43
Just a small question.

11:46
So, we have our, our public health system really is a partnership across the federal government, State, public health and local health departments. And really that partnership that is not resourced and coordinated and communicating up and down the chain.

12:04
Back again, that’s where that’s, that’s where we have challenges. And so, throughout the entire pandemic and I have a cat who’s clearly coming to join us and we have, you had to work together across that.

12:17
That has meant that, you know, when we’re all together and on message and working together, things are, can be good. There tends to be challenges. everyone’s moving at, 100 miles an hour. The local health departments I, that I work with, have literally been on the front lines of this for over a year. They were raising the alarm before there was even the name of Coping. 19. And so the, the challenges are immense.

12:39
The dollars that are coming from the American Rescue Plan are absolutely critical. We need funding for the work that’s being done right now. We certainly need more funding for how we’re gonna get through this and you know to the next phase, you know, post pandemic but it’s been a real challenge across the past year. So, the way that the federal government has really engaged, especially last year, was pretty hands off.

13:04
It really said, Here, states, Here’s the money, Give us your plans. And then in each state, the state determines if, how much, when, what other strings may be attached, if local health departments will be included in either that planning or those funds. And again, everything is being done on really short timelines. What ends up happening is that there’s a real varied response depending on what state you live. So it’s not even necessarily what’s happening in Iowa in your county in Iowa versus a county in Missouri. So what we ended up having are kind of patchwork of different plans of different states.

13:41
Different levels of funding in different in different localities and not really that clear national plan. This is where we’re all going.

13:49
We saw this a lot with the early vaccine rollout where every state’s prioritization and plan was a little bit different. That involves watching national news. We listen to fantastic national public radio. We hear what’s going on in other places, and want to understand how that applies to us, and why it doesn’t. And so that, that national level planning, has been, certainly a challenge.

14:12
And then, obviously, now, with the vaccine, we are, the federal government’s play a key role in making sure that those vaccines get sent out, but the localities and states and to be working together to make sure they actually get in arms.

14:25
Yeah. And states seem to be in very different places, in terms of, I mean, presumably, every state is getting a similar percentage of vaccine for their population, yet.

14:35
Some states are, you know, are way far ahead, and some states, including mine, are way far behind.

14:41
Yeah. I mean, that’s the very nature. We really haven’t had that national, like, this is how we’re doing it. It’s really been, you know, each state, and we have 57 plans when you add in the territories, right? And then local health departments, even in the majority of states where they aren’t, necessarily a function of state government, they’re trying to work within whatever the Feds are telling them to do, whatever the states are telling them to do. And then the reality on the ground, what’s going on in their locality?

15:06
All right.

15:06
Well, I want to back up a little bit and ask each of you the same question, which is What’s the most important lesson that you have learned from this past year and we’ll go back in the same order. so Frederick, you start.

15:18
I think probably one of the most profound lessons that we’ve learned that really I think is going to influence the direction of health policy and public policy And in the years to come is the interconnectedness of our health and our economic vitality.

15:34
I think that there’s been a real awakening to the notion that health, if we don’t have a healthy population, we don’t have our population Health protected. We cannot drive as a country economically, I think that’s a very powerful lesson. I think it has a lot to say about where we’re headed in the next couple of years.

15:53
And, you know, we’re excited at families to think about the ways in which Congress and administration can really activate to better protect and ensure that all Americans have access to health.

16:05
And the other, you know, some of the other key findings that we’re about to release then the the thing that’s most interesting is after the pandemic, after everything we’ve lived through, we talked a little bit about this, the renewed understanding of the social determinants of health, the interconnectedness of our health, all those things. All those themes are coming out and the research we’re doing.

16:22
But the number one issue that American families are bringing forward.

16:27
And one of their top 2 or 3 issues consistently, this is Republicans, Democrats, Independents, rural, urban, it doesn’t matter, There’s a real consistency, is they are very, very concerned about being able to afford health care, right?

16:43
So, when you take that concern about affordability and you link it into the lesson of our economic vitality being closely tied into the ability of our American, the American population to be healthy, it really puts a lot of pressure on the New Biden Administration and Congress to take some really bold steps to address the affordability of healthcare. Fundamentally.

17:06
George, what’s the single most important lesson that you’ve learned from this past year?

17:13
For me, I would say it’s the value of information.

17:18
Really just to give you an example within my health system we felt pretty prepared for the pandemic. We did a lot of work to prepare our hospitals to receive patients with ….

17:29
We optimized our supply chain of PPE to be able to move people from one hospital to another, so no one run out.

17:37
We worked on testing capacity.

17:42
We worked on clinical algorithms to triage patients from home to hospitals, ICU, or wherever. we stood up clinical trials across our health system. So, we were enrolling patients to study disease. And we did that all quite rapidly.

18:00
We had good collaboration with state or state health departments. We have good collaboration with the CDC.

18:07
If you think about, the fact that first patient diagnosed with covered in the US was also treated with a novel experimental therapy against coven, which is now the standard of Care in the US.

18:19
It’s, it’s mind boggling the resources that we have to deal with this disease.

18:24
On the back end, there are still people that don’t believe that covert exists.

18:30
In Idaho, for example, the health administrators from a local hospital were begging their counsel to make them ask mandate.

18:42
And one of the Council members said she didn’t believe that koval existed, that it was completely made up.

18:50
And the result is obvious.

18:53
If you, if you do not believe in the same facts, no matter, the resources you have, technology to the right, doctors, health systems, is going to fail.

19:07
And we have a large proportion of our population that simply believes in this information.

19:13
They don’t believe it exists, they don’t believe masks work, they don’t believe in, in vaccinations.

19:20
And this makes what we do on the ground so much harder.

19:24
And we are directly affected by, for example, in Eastern Washington.

19:30
one of our Hospitals Sacred Heart Hospital in Spokane was being inundated by patients come across the border from Idaho, because they ran out of hospital beds.

19:41
You know, and this was true of many friends in the center part of the country.

19:45
In Oklahoma, where they were shipping patients to Texas and Kansas trying to find beds, And that is a direct result of disinformation that’s occurring within our society.

19:56
So the lesson that I think I’ve learned, is that, unless we’re on the same page page nationally, to deal with the problem before us, we’re gonna fail.

20:06
And that is in large part, responsible for the outcomes we’ve seen in the US.

20:11
Adriane, what’s your biggest lesson?

20:13
Well, I definitely agree with what I’ve heard from the other panelists. I think.

20:17
You know, one of the things we, we in public health kind of talk about that I don’t think we really need to wrap our heads around, is, you know, public health and healthcare are sisters, but they are different. And what we saw in the beginning of the pandemic, especially when you have no treatments, when you have no vaccine, when you don’t have enough hospital, that’s the only thing we have are to fall back on our public health tools, which are pretty ancient ways. But, we, as a nation don’t value public health the same way. We value healthcare. And, so, for every dollar we spend on health, 97 other sense is going to healthcare, and three of those census going to public health, but that’s all we had. And that’s all we had for awhile.

20:57
And that’s all we continue to focus on here, because that’s how we preserve our health care resources.

21:02
I think that has been incredibly important.

21:06
You know, re solidifying for those of us who are all like, public health, is the best, but also have the community, understand, better, you know, what are those health departments doing? Or not just doing restaurant inspections? And telling you how many people are allowed to the public pool, there’s a lot that’s going on beneath the surface, everyday. So that we don’t have these types of headlines.

21:24
And so, having that connection between public health, health care, and then also, as was mentioned earlier, how public health impacts all facets of daily life.

21:36
And when we don’t have that, we really can’t have a functioning society. Those pieces, I think, and I hope are the things that we have learned and also will using going forward.

21:45
I feel like public health is kind of a disadvantage because it’s public. We have the private health care system that, you know, has ads and billboards and you know, huge communication staff so we know exactly what they do. We know all the modern miracles. We see the commercials on TV all the time.

22:01
But public health, people don’t know what public health doesn’t. They don’t even know we have public health. Until there’s a public health crisis. Is there some way to fix that?

22:09
Well, the whole point of public health, is that you don’t know what we’ve prevented.

22:13
That’s kind of the point do you like, oh, wow. It today. I didn’t get measles again. That’s great. You’re welcome. But that’s not something that people are thinking about a day in and day out, so that there isn’t and visibility crisis with public health. And that has been a significant challenge historically, as we’ve tried to actually fund this work to continue to keep these problems down. I know it seems like years ago now, but it was just a few years ago. We almost lost or measles elimination status in this country, because we took, we didn’t have enough focus on all these different areas. We have to triage, and we had pockets of under vaccination that allowed us to have these outbreaks. So Public health is with us all the time. We don’t talk about a lot. And frankly, what we’re finding now is, as people learn about public health and know how important it is, there is a backlash.

23:02
We see in some states, bills being introduced to try and take away public health authority, trying to make this false dichotomy of open society versus public health, whereas all these public health tools and efforts are being done to keep us functioning as best we can through, hopefully, once in a lifetime crisis.

23:21
Frederick and, George, I’d love for you to, to weigh on the sort of public health nurses that there are medical care system.

23:28
Yeah. This is a huge point, and I think that this is something that I think has been lost over the past 20 or 30 years. So, you know, I’ve had patients where they have tuberculosis.

23:42
The refusing their treatment is clearly a danger to society and, you know, they get brought into the hospital and the public health officer can get a court order to have that patient stay in the hospital receive treatment.

23:58
I don’t think people are standard that public health, they are officers, and like police officers. They’re there to keep us safe.

24:06
So for example, if someone runs around with a gun shooting it, a police officer will probably track them down and, You know, put them in jail or somewhere safe.

24:17
People that walk around with crowbars infection that aren’t wearing masks that aren’t social distancing, are also putting the population at risk.

24:26
And at some point, you know, public health has lost that authority to say, you know, what you’re doing is wrong.

24:33
No, this, these measures, which have been known since antiquity, including a 1993 Spanish flu, um, work and it keeps the public safe.

24:46
And I think that’s been lost.

24:48
And, I think that people believe that there. no, right. To, to freedom.

24:55
Know, we live in a free society, which is wonderful.

24:57
I mean, you know, we’re all blessed to live in the US with the freedoms that we have, but they’re not unlimited.

25:04
And there are rules that we should follow in public health.

25:07
Is a subset of that?

25:08
Those rules that work to keep us safe, and I think that is something that needs a lot more support.

25:15
Those ideas, that what they’re doing is working to keep us all safe.

25:19
It needs a lot more support from the federal government to ensure the rightful place amongst the rest of the, you know, police officers, courts, and everybody else. That also does the same thing to keep us all safe.

25:32
Frederick? Yeah. Julie, I would make two observations about this at first, is, you know, fundamentally, going back to doctor …

25:38
earlier, comments, the public health is a science, And it’s rooted in understanding things like epidemiology, or Maternal Child Health, you know, behavioral health.

25:50
And at its core, particularly when we have crises, there’s really important principles in a public health response. And those are things like, let Science guide our reactions.

26:01
Make sure that information is provided, free of bias, or political, politicalization People have to trust that the impression they’re getting is accurate.

26:11
Describe what you know and what you don’t know.

26:14
Keep people in a very centered, very direct form of communication.

26:19
And, and, fundamentally, I think, what we’ve lived through, as a country, I mean, it’s important to say this out loud, and say it over and over again, you know, We have had five times more infection as a nation.

26:33
Then, we showed it five times more, not twice.

26:38
five times, we’ve had four times more, grandmothers and grandfathers and moms and dads and brothers and sisters, and friends, and neighbors die in this country, four times more than we should have.

26:54
Right?

26:54
And that’s because we decided as a country either passively or overtly that we were going to fight the science. We were going to fight knowledge and we’re going to make this very political.

27:04
Right. And I think that the first principle here around our public health responses, we’ve got to put the interest of the country first and our, our, our reactions in these crises have to be rooted in science and knowledge and honest communication.

27:18
All right. That’s the first thing.

27:20
Secondly, I would say, isn’t it in a much bigger sense? What we know is up to three point five trillion dollars?

27:25
Whatever the dollar amount is today that we spend on health care in this nation, just pennies.

27:31
Pennies are going to things like public health or social determinants. Our behavioral health resources are vastly under resourced as well, our social services, right.

27:40
And as a result, what we do is we have very, very expensive, very costly, very high price specialty care.

27:48
And we’ve really allowed all the other systems that we have to atrophy.

27:54
Alright, and so, one of the questions we have to really struggle with is, if we do have a renewed understanding, that health is foundational to us as a country thriving, being able to be an economic engine, being able to be a dominant force in the world economy. If we know that is true, All right.

28:10
How do we address this terrible disparity between the way in which we approach, say, for example, a useless knee surgery that’s going to cost you tens of thousands of dollars versus the pennies at cost for the vaccination? Or the Obesity Prevention Program or the Asthma Prevention Program, we have to recalibrate those things and I think that’s the big question. I think it is not a foregone conclusion. I think it’s most likely that’s not gonna happen. I think you and Adrian have hit on some of the reasons. Remember that public health is funded for all the congressional staffers out there. It’s a discretionary program. It’s funded.

28:49
Hannah Mount year over year, right, is not funded through Social Security Act, It doesn’t automatically get funded. And as long as that’s the case, we know the systems in this country that are funded through discretionary spending. Indian Health Service, VA and public health are terribly underfunded.

29:05
And on the other side equation, we see that the programs that are funded through entitlement or through Social Security Act.

29:13
In those instances, the healthcare sector has just hammered away on price. They’ve created, you know, and terribly abuse of pricing 3 4 times every year If prices are going up for no good reason, right? So we’ve we’ve ended up in this very lopsided environment, and we have to fight hard to recalibrate that.

29:33
So Adrian, here’s a question for you. one of the big issues that hindered both officials and public has been a lack of timely trustworthy data. Have we made any progress over the past year and what do we need to do going forward to make sure that data can be shared in a way that it will become more useful?

29:52
So this is absolutely huge. We have public health. Let me put it in perspective.

29:58
Free coven: We are getting research out of CDC, saying, like, STD rates of two years ago. That’s how long it can take for us to get some of our data and finalize it. Some of our fastest systems might give you reports like a month after that seems like Real Speedy public health has not had the investments in data and infrastructure, the way that pretty much every other sector has had.

30:26
And it shows, we have, far to me, I’m gonna make the very typical joke that all of us make, sure we’re keeping the factory scenes in business. But for some people, it’s really just like keeping pen and paper in business and data entry clerks in business, because that is what it can take and that this is a problem up and down the stream. So, we know that this is a problem, CDC systems don’t talk to each other.

30:52
We know that there is a challenge with state systems. And then local health department systems are also facing these challenges.

30:58
And oftentimes, even an information they put in, they can’t get anything back down.

31:02
And so, having data and being able use data, are two different things.

31:10
The virus has shown, again, because it puts a magnifying glass on everything, how problematic that is, when every second of every day, we need to have a firm finger on the pulse. So we know where to go, and how to address what the challenges as they keep shifting.

31:26
So, um, there have been significant investments over the past year, from Congress in Data Modernization, how that is actually going to play out, given the amount of need, up and down the system, I think is still to be seen. And we know that a lot of that needs to be used at CDC, so their systems can talk to each other. But if that money doesn’t reach down back into local health departments, through And through state health departments were Never actually going to have the information that we need.

31:54
We’ve also seen a real challenge in data reporting.

31:57
So Let’s say all of our systems were perfect. We still don’t have people asking the questions and getting the answers to put in there so that we can actually figure out without more clarity, you know.

32:09
How are responses working in the big win Springs Springtime? When we were looking at our testing data, there’s this question of, Well, what, how are our testing weight rating based on vulnerable populations and minority communities. When you look at it, so many of the forms just are blank.

32:29
And so in regular public health times, you get a blank form. Say for something like an HIV test.

32:35
And you go and call them back and say, hey, you forgot to fill this out. What is it?

32:39
You can’t do that when you’re processing thousands, and thousands, and thousands of pieces of data a day.

32:44
Um, so that’s a huge challenge.

32:46
Having the data is really important, and then being able to access it and implement it is also a second piece.

32:53
one of the challenge we have local health departments, is our data systems at the federal, and state levels are used together. But local health departments do not have access to those data systems despite the fact that we think they do.

33:03
And that’s a problem right now with vaccines.

33:05
So local health departments don’t necessarily know where the retail pharmacy program is within their boundaries. They don’t necessarily know which community health centers have vaccine within their own boundaries, because they don’t have access to those data.

33:19
These are challenges that we had during testing. We had during contact tracing, we continue to have touring vaccine. And if we don’t start thinking about this differently, we’re gonna continue to have the same blinders on that make this response even harder than it already is. A good example, though, that, because I’m usually negative, Nancy, is that when you do have data and you can act upon it, you can make changes.

33:41
So, in vaccine distribution, city of Chicago, which gets is one of the few directly funded cities, and gets their own vaccine allocation, so they can do this, noticed that they had a significant disparity in there.

33:55
In indexing people of color, they were then able to say, OK, so what populations, what neighborhoods? What housing blocks are we missing?

34:03
Partner with community organizations there. Work around some, you know, city challenges of, can you use a school, can you not use a school, and come together, call out to people, go knock on their doors, versus waiting for them to register and call you. And we’re able to make significant impacts. And improving the rates of vaccination need to have the data, first of all to do that. You need to have the flexibility to then act on those data. And then, and then you have to have the people to do it. And those are all things that are inter-connected when we’re thinking about this data challenge.

34:33
So, I get related, question from the audience an audience. Please feel free to submit your questions, and I’ll try to ask some of them. And then I’m going to ask the other two panelists to weigh in on the data issues. Here’s a question, says, I’m sure I’m not alone as a person who has entered personal information on several sites, including various Facebook vaccine hunter pages, hoping to find a vaccine for myself and family. That’s how policy person I’m beginning to wonder about privacy issues and what will happen with that personal data, what special protections for this data should we be thinking about? Or is it already too late?

35:06
I feel like this could be another whole hour and change of conversation. You know, HIPAA does apply for, for these issues. But, I don’t know, is, you know, what are the systems you’re putting your data into? I’m sure that there are people trying to take advantage of this as they do all things I’m trying to scam people. Unfortunately, one of the challenges we had that leads to having all these different registration points and all of them not necessarily communicating and working together, is. If you remember back, we had as a nation put billions of dollars into vaccine development knowing that this is going to be what we need to get to in the future, and we will invest in the science.

35:43
We had been asking calmer since the spring to also put some investments in vaccine deployment infrastructure.

35:49
So we could build those systems in advance Congress, that would have been nice.

35:55
I worked there. We love you. Also, the money did not come until December 28th, which was weeks after vaccines were already being sent out the door.

36:06
Then, we, the ACIP had recommended what stages we were going to open up vaccination of different people and that kinda got tossed up into the air. While people were working on given plans. Meaning, more community members were able to access vaccines, which is a good thing, but those systems weren’t necessarily built out yet.

36:24
So, we are building the plane while flying it, which is the story of this pandemic.

36:29
And it’s really difficult because as I mentioned before, we don’t have that centralized focus of where vaccines are coming through.

36:36
So you have these different places to register, it’s not great. We’re all working through it together. The hope is, you know, everyday we learn from it, and we can actually put it together to have something a little bit better. But, you know, HIPAA does apply, and there are probably lots of other conversations have around that as well. And, you know, I’m sure you have feelings about data and the, and the lack thereof or the inability to access it there.

37:01
Yep, you’re on mute.

37:05
Yeah, this is a big issue in the US. to give you an example.

37:09
In the UK, they can generate clinical trials and enroll thousands of patients over a few months period, and generate no, really robust results.

37:21
You know, if you look at COVID studies, you can look at the studies for steroids, and other treatments, they’re rolling thousands of patients across their health system rapidly.

37:32
You know, our clinical trials in the US are hundreds with a lot of effort.

37:36
And that’s really a result of our disparate EMRs that we have in the US.

37:42
So, the current model for a vendor or for an EMR, they have an out of the box product.

37:48
They sell to their health system. in my, you know, in my case, if we have 51 hospitals, what they’re selling us doesn’t meet our needs.

37:56
So, we hire a lot of analysts, and doctors to customize it the way that we can make it usable for whatever data that we need.

38:07
When there are requirements for testing, you know, someone wants to know, how long this person had symptoms, or were they, you know, a health care worker that we’re testing.

38:18
We’re building those rules at our EMR, on the local level, or system level, with a lot of work.

38:25
That doesn’t, that doesn’t mean that another health system or hospital is doing it the same way we are.

38:31
Right.

38:31
So, you’re getting disparate datasets that are very difficult to repair, where the requests for data shouldn’t be going to other vendors of these EMRs.

38:41
Because, for example, in the US, there’s two very large vendors that account for probably 80% of the health records across the US.

38:51
The burden of generating the data is to health system of hospitals, and not the vendors of the electronic work record.

38:59
This is something that could be developed centrally within the vendor’s office and pushed to every single hospital. If they sell the EMR, too.

39:08
And you’ll be able to generate and report on standardize data discretely across millions of patients across numerous states with much more ease.

39:18
And I think that burden of data acquisition needs to move from the local health system hospital level to the people that are actually designing these EMRs. Because we are wasting a huge amount of resources, trying to do this data generation from hospital to hospital.

39:38
When the vendors are able to do this on their own, for their, their entire population of folks, they’re selling these tools, too.

39:47
And that’s the difference, which, honestly, UK, you know, they can generate their data very quickly with thousands of patients because they have the platform, this unified in a way that they can generate this data, validate it and report it quickly.

40:01
For us in the US, when we were starting to clinical trial, we can get a study up amongst, you know, 5, 2 hospitals over a couple of months and we can generate data on a few hundred patients.

40:13
That’s simply not fast enough to make a difference in the care of these patients.

40:17
We have to build leverage the size of our country and our EMRs to be able to generate the data necessary to improve the lives of patients.

40:24
That is there it just sitting there, but it kept in mind it’s not standardized.

40:29
I think that’s good from an advocacy point of view. What does it mean to sort of not have access to tend to literally know what’s going on?

40:37
Yeah, Juliana, this is such an important sheets when we’re very active on at at films USA, and for that, I’m sure, for the staff out there the Congressional staffer listing. It’s the issue that you convince your boss and their eyes just glaze over and they will just doze off because it sounds it sounds so boring but fundamentally, it’s readily important. And it just to kinda tie these things together.

40:56
I think, agents are describing the very complex and difficult data environment in which public health exists.

41:04
There’s a much larger data ecosystem that we’re talking about, which is really the all of the different healthcare systems that are running, including physical health and medical care. As doctor Diaz is describing, but then we have behavioral health and social services, and on and on, right? We’ve done a bunch of looking into this, a bunch of research into it.

41:23
I’ve done it in previous slides when I worked with the governor’s, when I looked at advisory board, here’s what we know for sure, And I want to say this really clearly, first and foremost, it’s really important understand, in an environment, a fee for service economics, where health systems, corporate physician groups, insurers are being held responsible for units of care.

41:44
No, I need to get my appendix out.

41:47
I need to get my hip replaced. Whatever it might be, Alright?

41:50
It is in no one’s interest, at all, to be sharing data.

41:55
In fact, it’s against their business interests, to share data, right?

41:59
A hospital does not have any financial incentives, and it doesn’t make sense for them to let other hospitals have access to their patient records, what they’re doing with patients, et cetera.

42:09
That’s the first thing to say, it’s really important, is, we’ve had, we did qualitative and quantitative research with hospital executives. And they also told us, told us this, right?

42:19
Second thing is, remember, that, fundamentally, these data, to me, they might be the most exciting, disruptive innovation that we could achieve as a country in health care, if we can allow these data to flow.

42:32
So, that we can actually analyze two things, cost versus outcomes and quality.

42:39
And we can actually see where is value occurring in our system, Which hospitals are getting it right, which physicians are keeping their patients healthy. And then when it gets there, getting them, getting them better quickly, and in most effectively right, when we actually know the answers questions, we can start holding our system accountable for their gross inefficiencies.

42:57
But right now, it is against the interests of the health care sector, and every step of the way, we just went through this at the end of the year, with the end of year package, we got the state all payer claims database enacted, It’s happening now.

43:11
Every single provider group that we worked with that we heard from was against this, they were against this.

43:20
And the last thing I wanted to say was also understand that from the insurer perspective, Insurers have most of the claims data out there.

43:29
And for insurers, there’s an enormous economic opportunity for them to two quantities that to say, if you want to access to that little, you know, to find out what that person is doing, pay us a penny, right, And then you can make a lot of money. And so, we also have that, there’s a couple things we need to settle as a country. The first is, our data are our data.

43:47
When I go to a doctor, no one owns that data. They can use it, but it should be in my service and to make me healthier, not to make a penny you know, for the insurers and make a penny for that for the vendors.

43:59
The second thing to say is we have got to establish interoperability, standards to say whatever data system this is, if it’s public health, behavioral health, social services, medical care, whatever it is.

44:13
Here are the basic contours of an interoperable system that everybody has to need and then allow people to innovate with those standards.

44:23
And I think the best analogy here is global positioning satellites back. I think it was in the fifties.

44:31
The military finally allowed GPS satellites to be used for commercial purposes. That’s when it all started very slowly to evolve.

44:38
Think of all of the innovations that we have today from our i-phones, to Google to to to Uber, to go I mean it is, it is hard to understand the way in which access GPS is change your life. That’s what interoperable standards are for us.

44:55
If we can create a level playing field, say here’s what, you have to get the plugin and communicate this way, think about the incredible innovations that could happen in health care in our country.

45:04
But what’s stopping right now is that the business interests of healthcare don’t want that to happen.

45:09
So we need policy because you step up and say, Nope, we’re going to create this level, playing field. Create interoperable standards and then let’s don’t innovate.

45:16
Let’s go find the ways that we can save people’s health, get them healthy, Make things more efficient.

45:23
I’ve been hearing about this into the Bush administration, possibly the first Bush administration but definitely the second, which is Why it’s really and that’s a great point to make It’s utterly bipartisan.

45:31
Know.

45:32
The Bush nutrition was the first administration it really started to innovate with this, right? It should be utterly bipartisan.

45:40
Well, I want it I don’t want to spend the whole rest of the time on data although it is super important. George here’s one for you. Covered 19 has shined a very bright light on just how fragile our medical care system is. What’s been done to make it more resilient? and while some of these lessons, you know, push forward into the future.

46:03
Yeah, you know, I think it’s a really good question and difficult to answer.

46:10
The hospitals that our health system is the smallest are the ones that generally struggles the most.

46:16
They’re the ones who don’t have access to additional resources internally.

46:21
Even within my health system, for example, which is large. We’ve got 50 hospitals on the West Coast, You know, we had issues with supply chain, You know, we were in order to cabinet PPE.

46:31
We were collaborating with businesses locally to change from being producers of furniture to be producers of PPE.

46:42
So, you know, this was on the Ground innovation to improve our supply chain, we ran out of swabs, you know, for code testing at sites. And, so, we’re having to do alternate methods or, you know, other things to try to get people tested correctly.

47:02
And so, even a large health system, as well funded on the West Coast, still has issues with supply chain.

47:11
This is, this is a larger issue, then the largest health systems in the country. In the supply chain, issues have to be addressed at the national level.

47:21
When, you know, covert was first being pound on the West Coast, the University of Washington took it upon themselves to group two, modify their lab to be able to do higher throughput, cover tested.

47:34
And at least locally, for me, that saved us, we were able to ship our samples two years in Washington, rather than two, use the State of Washington Department Health Lab in that helped us enroll patients that helped us diagnose them and treat them correctly. We have so many labs in the Puget Sound to do genetic testing or DNA based testing.

47:55
That it wouldn’t have been hard to convert many of those labs from what they were doing a basic research to coma testing labs for a short period of time, to allow us to, to really raise our ability to get the throughput necessary on a at least, multi-state level scale. But it didn’t happen.

48:16
In, in that sort of delay in testing really harmed us, across the West Coast and I think that has to occur at the federal level.

48:28
There has to be, a federal response to supply chain, whether it be PPE, whether it be testing, or whatever it is, because even the large houses can’t manage this on their own, right? I mean, there’s only so much we can PPB. We can create our own.

48:44
For example, those supply chains and other critical resources have to be secured very early on by the federal government in a digital currency that made our jobs much much harder.

48:54
So I would say that we’re extremely vulnerable as a nation to another pandemic.

49:00
I don’t think we’re, at a point where if COVID-21 came, that we would be in a great position to manage that either, right? These issues haven’t been solved, even though.

49:12
So, so I think this this whole, how we address the next pandemic, is on the federal government.

49:21
It can’t be on the state, it can’t be on the health system, or the hospital, we will be overrun.

49:29
Either Frederick, you want to address this winter, we move on. OK, I have another question from the audience. What do we say to people who believe that conspiracy theories, they are still people? They are our neighbors. Sometimes they are. Relatives. How should public health and science engage George? You sort of touched on this in the, in the idea that there are a lot of people out there who don’t believe it, but how do we How do we sort of regain their trust that scientists and medical professionals actually have more information than the general public?

50:03
We have to have unified messaging across our country. It has to be from your doctor SV from your public health official. It has to be from the year old Governor. It has to be President.

50:14
It has to be everybody in the US on the same page, to deal with this.

50:18
Imagine if we went to World War two with a divided country. No, we wouldn’t probably succeeded.

50:29
You know, you saw what happened with the outcomes with when the US is divided on the opinion, in places like Vietnam.

50:36
And so, anytime our country is divided, we’re not going to do very well.

50:41
And this pandemic showed the same thing that if we’re divided in our opinion, or divided on the basic facts that we believe we’re not going to do well. And it said, because we have amazing resources, innovation. We have companies that are generating new therapies.

50:57
We were, we’ve got the best vaccines in the world being made here.

51:02
And yet we still have this kind of outcome, and it’s directly related to people’s beliefs.

51:08
There are people that believe in false information, and we have to have everyone saying the same thing that’s based on science and truth, and that’s where our problem is.

51:19
Adriane.

51:22
Everything that the doctor has said.

51:24
I think one of the challenges, what we haven’t had over the course of the year necessarily was saying what we know and what we don’t know.

51:31
There was a lot of we’ll get to the summer. We will get here very short-term thinking. And when doctor Messenger, a little bit over a year ago now said, Hey, guys, you know, things are going to change and this is how they’re going to change. She was yanked off the airwaves. She was not she’s not permitted to do those those media engagement again.

51:51
That’s a huge challenge.

51:54
While all of the it’s clear that we need to have the same consistent messaging from the Federal level, from the State level, from the local level, it’s also important that we actually invest in this effort.

52:03
You can’t build trust in 20 minutes.

52:06
And so, when you have, a system that we expect, is only going to pop up, when you need it, but then just gonna kind of go hibernate in the meantime. You’re not building those relationships and doing that outreach. That’s necessary, so that you can, then, have tough conversations. We know that there’s been a lot of research done around, especially vaccine competence and how you how you work with that. And a lot of it is, you know, that that what your provider recommends, you see anyone else in your family who has gotten, who has gotten vaccinated, what are those close connections, mean to you?

52:41
Um, there are people for whom, you know. Sometimes you’re just saying, whether or not you believe it, can you just act this way to, like, let’s just so that we can all kind of move move through it.

52:51
I think things are getting better. There’s more of that more consistent messaging, more clarity.

52:58
But it is a challenge that will continue to challenge. And frankly, public health tends to not want to like get in the fray. Sometimes the fray and social media is where a lot of this, you know, hibernates and lives and then pops up again.

53:10
And so sometimes we need to be thinking not just as scientists and as public health people, but as just communicators and how do you know, how do we market that everyone all of a sudden thinks that, like, genes that go up to your armpits or again in style. I don’t know how you market that. But, apparently. And if you can start thinking like that, you’re probably going to get your messages through a little bit better than being like, Well, in science, we never say, this is 100%.

53:38
So it seems to be that we will have an increased ability of not getting, really, really, really sick. If you, please. And thank you, go get a vaccine. Like, there has to be a happy medium between these two.

53:53
Fredrick, That was, I mean, Adriane just props to you for being on the bring high Waisted genes in this conversation as a reference, the very best.

54:02
Yeah. Definitely will remember that, for sure. So some really important say here. I think we, we actually, we had, we did, we went to the field to talk about messaging in the middle of the pandemic with one of the leading kind of strategic messenger. Message goes out there, doctor Drew Westen. We have messaging guide on this that’s available on our website. We really encourage folks reach out, if you’d like to take a look at it. But we learned a lot of really important things. There’s two things I wanted to say to this. It’s a very important set of questions. The first one is this.

54:34
We, I think we have to understand, for everyone out there that we have as a, as a people and as a world, undergone a very significant change in technology. And that’s really rooted in social media.

54:47
The way that social media works.

54:49
And we know and we’re hearing members of Congress start to talk about this. We know that we’ve created very powerful algorithms that are built on machine learning that are aimed at us.

54:58
And their entire purpose is to activate our reptilian brains and get us to click and look at things, Right?

55:04
That is happening. And that’s happening to conservatives, and it’s happening to progressives. This is not a, you know, one side or other. Right? In that environment, where we are so highly activated.

55:15
It creates a terrible opportunity, for, as doctor Diaz and Adrian has have said, for, for the very foundational facts, to be called, into question.

55:24
Alright, we lose our anchoring in facts.

55:28
And so, I think, first and foremost, there’s a fundamental policy question for Congress to really think about how do we operate a democracy.

55:41
one of the oldest and most mature democracy in the environment of this social media revolution, because, what’s currently happening, isn’t allowing us to have meaningful public policy debates. That can move us forward. All right, I just want to get that out there. I think it’s going to be one of the biggest issues in the next decade for us to start with as a country. And there’s a lot to think about there.

56:01
There’s a lot of ways that we can create guardrails and make sure that we can operate a vibrant democracy in that environment, but the beneath that, what I wanted to say was it’s also time for us, all of us. We all come from different perspectives, different political ideologies, different life experiences right.

56:17
To stop, arguing about what that, what our beliefs are, and just really speak from, well, what we’re trying to achieve, and this is what our messaging research shows, time and time again, so I think progress is need to stop talking to the world as if everyone was progressive. It’s exhausting. They’re not and therefore, you know, when you say to people, Healthcare is right, there’s a lot of people who don’t believe health goes, right, Why are we argue about whether I healthcare’s? Alright?

56:45
It’s a It’s a waste of time, but we do know however, is and we’ve pulled we went into the field, and we message tested this right across the political spectrum, Republicans, Conservatives, and everyone in between.

56:57
Almost all of them agree.

56:59
When a family in this country gets sick, and needs to see a doctor, they should be able to see a doctor, and they shouldn’t go bankrupt.

57:05
Most Americans, almost all of them, believe that.

57:08
So let us start with that. How do we get there?

57:11
Right. Second thing is most people agree that, right.

57:14
Not the health care system in this country is working too much for the benefit of health insurers and hospitals and pharmaceutical companies and not enough for all of us as vamped, right?

57:25
Let’s start there, and let’s build from there.

57:28
And so I do think I hope coming out of this that the response to the incredible division and demagoguery that we’ve seen in the last few years, instead of that, we see, is, let’s start talking to each other about the things that we can agree on and move forward. And if anyone out there who’s interested in this work, we’re working right now on getting it out there.

57:48
But it’s a really beautiful messaging guide that kind of lays out how we can build these messages that bring us together at unite us to achieve these really fundamental fundamental improvements that we all need.

58:01
All right, well, on that hopeful note, that is all the time that we have. Thank you all for your insights on this really important topic. Please, audience out there, take time to complete the brief evaluation survey that you’ll receive immediately after the broadcast. And as well as by e-mail later today, a recording of this webinar and additional materials are available on the Alliance’s website. Frederick, George, Adrian, thank you for joining us, and that’s it.

58:30
It was a joy to be here.

58:33
Thank you.