Dr. Arjun Srinivasan, Centers for Disease Control and Prevention

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Mark Masselli: This is conversations on healthcare. I am Mark Masselli.

Margaret Flinter: A nd I am Margaret Flinte r.

Mark Masselli: Well , Margaret as the Ebola story continues to dominate the headlines
we have to remind our listeners of the eminent and annual threat of flu . Millions of
Americans who don’t get vaccinated are going to come down with flu this season , and
it’s estimated that 200,000 Americans will seek medical care in hospitals in emergency
rooms due to flu complications.

Margar et Flinter: Well , while the threat of Ebola is a one that’s primarily in the public
consciousness right now , we are still only looking at a very small number of cases in
this country . But we know Mark , as frontline providers we will be kept quite busy wi th
the flu this winter due to people still persistently not getting that flu vaccine as is
suggested.

Mark Masselli: The flu is expected to kill close to 50,000 Americans this year. We must
encourage a vigilant approach to vaccinations that can prevent s o much suffering. It’s
also important to remind folks that flu vaccines are completely covered under the
Affordable Care Act.

Margaret Flinter: And the other deadly pathogen that’s killing tens of thousands of
Americans is antibiotic resistant bacteria. An estimated 75,000 Americans die each
year from such infections. Medicare starting to crack down on hospitals with the highest
infection rates which often leads to costly re - hospitalizatio n for patients , as well of
course as poor out comes for these vulnerable patients.

Mark Masselli: Medicare has cited some 700 hospitals across the country for poor
infection control. It’s part of an effort to improve outcomes for patients , as well as , bri ng
down cost. Finding of these facilities will provide more incentives to better protect their
patients with more targeted preventions.

Margaret Flinter: Well , all of this is something that our guest today is very well versed
in. Dr. Arjun Srinivasan is an internist in Epidemiology specializing in infectious
disease , as well as , in Hospital Acquired Infection at the Centers for Disease Control
Prevention. He is also acting as a spokesperson for the CDC during this Ebola crisis.

Mark Masselli: He has be en studying evidence based practices on prevention of
hospital infections. And will have the latest information on the government’s protocol for
Ebola , as well as , other infection pathogens that may pose a threat to public health.

Margaret Flinter: Well , there is still so much information out there Mark , that’s being
stoked by fear . So, we look forward to hearing a voice of knowledge , and expertise on
the topic.

Mark Masselli: Lori Robertson looks into more of false claim spoken about health policy
in th e public domain , but no matter what the topic you can hear all of our shows by
going to CHCradio.com.

Margaret Flinter: And as always if you have comments please email us at
[email protected] or find us on Facebook or at CHCradio on Twitter , because we
would love to hear from you. We will get to our interview with Dr. Arjun Srinivasan in
just a moment.

Mark Masselli: But first here is our producer Marianne O’Hare with this week’s headline
ne ws.

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Marianne O’Hare: I am Marianne O’Hare with these healthcare headlines. Forget
Ebola , the flu is most likely to be a lethal agent in this country wherein estimated
thousands die each year due to flu . In the US t ens of millions are expected to get
influenza. More than 200,000 of them will be hospitalized, 49,000 will likely die from flu
according to figures from the Centers for Disease Control. Flu shots are recommended
for just about everyone over 6 months of age , but less than half of the p eople actually
get vaccinated each year. We have more definitive guidelines on the books for Ebola
coming from the Centers for Disease Control and Prevention, and outbreaks limited to a
small handful. The attention is turning once again to ground zero . The need for aid
workers far outstrips the actual number of booths on the ground in certain parts of
hardest - hit West Africa . Cases mounting daily in Liberia , World Health Organization
r eport warns the virus could lead to economic collapse in certain parts of West Africa , if
continued unchecked. Our love and chocolate, a new study shows that Flavanol riches
found in dark chocolate that darker , the better, the better a ffected as on your brain ;
especially , your aging memory challenged brain. A study fo und those who are given a
regular dose of dark chocolate over 3 months did better on standard memory test . The
study led by Columbia University Scientist, D r. Scott Small showed that after three
months on a liquid chocolate compound , brain function and me mory improved 25% .
But you would have to eat the equivalent of about 7 bars a day. Chocolate
manufacturers are hot on the dark coco trail to develop a product that would do the trick
more efficiently. I am Marianne O’Hare with these healthcare headlines .

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Mark Masselli: We are speaking today with Dr. Arjun Srinivasan, a spokesman for the
Centre for Disease Control and Prevention , an d an associate director for healthcare
associated infection prevention programs in the division of healthcare quality at the
National Center for Emerging and Zoonotic infectious disease at the CDC. Dr.
Srinivasan is also a captain in the US Public Health Services . Has served as a
response team leader in medical epidemiologist at the National Center for Infectiou s
Disease, a Board Certified Internist and infectious disease specialist. He earned his
medical degree from Vanderbilt University , and conducted his residency at John
Hopkins School of Medicine. Dr. Srinivasan welcome to Conversations on Health Care .

Dr. Arjun Srivnisan: Thank you so much for having me.

Mark Masselli: Yeah. Obviously we are at a terrible intersection , and terrible health
crisis in West Africa with the spread of Ebola, this deadly virus that can be quite lethal if
left unchecked. Thous ands of residence in several West African countries have
contracted Ebola , and more than half of them have died and well there have not been
many cases in the United States. There is a tremendous amount of fear percolating
throughout the countryside. Wha t our folks in this country, what should they be most
concerned about?

Dr. Arjun Srinivasan: Well Ebola has long been known to be a very deadly viral
infection. We have experience with Ebola outbreaks over literally decades , that CDC
has participated in efforts to control those outbreaks along with a number of different
organizations . And if you look historically , the experience has been largely consistent
with what we are saying now with a very, very high infection rates . The infection
spreads readily , and it’s very lethal. The difference of course is that this outbreak is
without any pre cedent in terms of its scope and its scale. We continue to emphasize at
CDC that all of us in the United States need to be concerned about the outbreak in
Africa. We do really believe that the best way to protect the United States , and all other
countries from Ebola is to support the African Africa to control Ebola . So, it is important
to us to be aware of what’s going on in Africa , and to support the efforts that ar e
underway in Africa to control this outbreak.

Margaret Flinter: Well , Dr. Srinivasan we are obviously keeping our eye very closely on
the evolving information and the Ebola protocols coming out of the CDC. It seems that
those regulations for identifying and isolating , and treating suspected Ebola cases
continue to evolve a bit and to be refined. Now the CDC recently amended the
requirements for health professionals who work directly with Ebola patients here in the
US , much more stringent guidelines for downing , and discarding a personal protection
equipment or PPE’s. Perhaps for our listeners you could outline these stricter
guidelines , and talk a little bit about the chain of command that’s recommended should
a patient present with Ebola like symptoms and risk factors to health care facility?

Dr. Arjun Srinivasan: There are kind of three overarching principles that are outlined in
the n ew guidance. The first is that healthcare workers need to have training on the
protective equipment that they are going to be using for caring for a patient with Ebola.
It’s I think clear that this is an equipment that we don’t use every day in patient c are ,
and so we have to be trained on it ., so that we know how to put it on and take it off
carefully. The second overarching principle is that we shouldn’t have exposed skin
that’s present while we are providing care for hospitalized patients . And I shou ld
emphasize that these are guidance or guidelines for personal protective equipment for
caring for patients who are hospitalized with Ebola virus disease in the United States .
So, this is guidance for car ing for hospitalized patients . And the third princ iple is that
there needs to be an observer . Someone who watches every step of putting on and
taking off the protective equipment to ensure that it’s been done properly. A couple of
other important changes that we made is to be more descriptive about exac tly the types
of protective equipment, to provide fewer options for what people could use . And to be
a little more specific about what those options are , and to provide a suggested protocol,
a methodology for putting on the equipment , and taking off the e quipment . But we
wanted to provide some suggestions , and guidance on how that could be done. The
other big change is the recommendation that healthcare workers who are entering the
room to provide hospital care for a patient with Ebola virus disease , where respiratory
protections, and actual respirator . So, either in N95 respirator or a powered air purifying
respirator. We change that guidance not because we think that Ebola is spread via an
airborne route , but we changed it because discussions wit h folks who have firsthand
experience with caring for patients with Ebola virus disease in this country , and that’s a
new experience obviously, we’ve never had a person cared for in a US hospital with
Ebola . So, we are learning about how to safely care fo r these patients . And one of the
things that they have told us is that the level of care might change very suddenly. There
might be a need for folks to do an aerosol generating procedure that could create
aerosol that might pose some risk . And so , what they said that its safest for healthcare
workers who were entering the room to be ready for whatever might need to be done ,
because we don’t want people to have to leave the room suddenly , and put on
something else or to rush in putting on the equipment , and so that’s why that
recommendation is based.

Mark Masselli: You know , Americans have obviously become quite concerned about
the outbreak once it hit our shores . And there has really been a firestorm of criticism
about the quarantine protocols. I thi nk the public really needs to understand how the
CDC arrived at its guidelines for handling healthcare workers.

Dr. Arjun Srinivasan: CDC is actively engaged with a number of different professional
organizations. We are working with emergency department groups in order to work with
them on the protocols and guidance for emergency departments where c onnecting with

the groups of ambulatory physicians about guidance for ambulatory physicians , which
were working on. I do want to emphasize , one of the things that we touched on a little
bit earlier the idea of chain of command of patients who might be identified in
emergency department or a clinician ’ s office , and there is guidance for emergency
departments . And the key for those centers really is something th at we call the Three
I’s, it’s identify, isolate and inform. We have those questions that are out there for folks
to ask about travel history and symptoms . You know , not that many people have travel
histories or symptoms . And so , in the overwhelming maj ority of cases how you proceed
as you would to deliver high quality patient care . But if patients do answer yes , to those
questions where they have a travel or exposure history , and have symptoms . Then we
do have a recommendation that . you know , the patient would be isolated and you inform
public health. We know that public health jurisdictions around the country are working
very hard on developing plans for what to do with someone who might need to be
evaluated for possible Ebola infection . An d this is again , this is a collaboration between
healthcare and public health , and so the health departments are your point of contact to
help you talk through that process of whether the patient needs to be more thoroughly
evaluated for Ebola, are they at risk , and then how can that be done.

Margaret Flinter: So , Dr. Srinivasan I also want you to just ask you to comment on your
incredible responsibility of trying to teach the entire country how to come into
compliance or to be trained on these latest reco mmendations . And certainly all across
the country people are following your advice to practice, practice, practice, the
procedure so that our nurses , and physicians , and other frontline healthcare workers will
be safe. Maybe you could talk a little bit h ow is the CDC facilitating this effort across the
country on something that’s really new ? What are sort of the tools , and maybe
technologies helping us get this message out by video, by social media ? Talk to us
about how that effort is proceeding at CDC?

Dr. Arjun Srinivasan: Yeah , absolutely , and it’s an all of the above approach . And so ,
what’s been key and is always key for CDC when it comes to working to provide
information to the healthcare community , and this instance to the public as well is
partnership. CDC is actively engaged with a number of different professional
organizations . So, we really rely on these partnerships with these groups who can
reach their members. You know , we want to provide them the information that we have ,
and we want to hear from them what types of information do you need, what questions
are you hearing? Yeah , absolutely technology is key . The Internet is such a gift for
being able to provide this information to folks. Social media is certainly something that
CDC has gotten a re very good at using . And also trying to work with partners who can
make videos , because I think when you are talking about something that is so very
visual like putting on , and taking off persona l protective equipment , I think people really
find , you know , training videos to be very, very helpful . And so , CDC recently partnered

with the Armstrong Institute at John Hopkins Hospital to try and produce some good
training videos that show people , you know , suggested ways to put on and take off
protective equipments . And we are always receptive to input if people have ideas for
better ways to reach out and connect with people.

Mark Masselli: We are speaking with Dr. Arjun Srinivasan , Spokesman for the Center
for Disease Control and Prevention, and associate director of healthcare associated
infection prevention program at the National Center for Emerging in Zo onotic infectious
disease at CDC. He is also captain with the US Public Health Service s under the
Surgeon General. And I think many of our listeners know about the great work the US
public health service does . So, thank you for your service. It’s campaign season , and
we are without a Surgeon General though one has been since February wit h the
appointment of Dr. Vivek Murthy. Could you describe just as a physician who works for
public health services what the impact has had in the week of the Ebola crisis ? I know
we have had surgeon general’s on our show over the years , and their ability to
communicate to the nation is very important . And just take a few minutes and talk to us
a little bit about the work , and the valuable role that the US Public Health Services play ?

Dr. Arjun Srinivasan: We would point out , I think , t here is certainly an acting Surgeon
General Boris Lushniak who has a lot of experience in public health. The public health
service has of course a long history of working to serve and promote the health of
Americans. We are thousands of healthcare profes sionals working in a number of
different professional organizations, government agencies on a variety of issues both
providing frontline healthcare , and of course working like either with CDC on working on
guidance , and issues to improve the delivery of he althcare.

Margaret Flinter: So Dr. Srinivasan , I am intrigued by the name of the division that you
head in director of the division of healthcare quality at the National Center for Emerging
and Zoonotic Infectious Diseases at the CDC . And Ebola is just o ne example of the
many infectious diseases , and deadly pathogens that your division is test with
monitoring. Tell us about the scope of infectious diseases that you and your team are
concerned with beyond the Ebola virus?

Dr. Arjun Srinivasan: You know , one of the major issues that we are confronting on a
daily basis is the threat of antibiotic resistant organisms . And this is not just an issue in
the United States, it is a global problem , and it is a huge threat to public health. The
CDC estimates that every year in these county more than two million patients will suffer
on infection for which the first line antibiotic is ineffective . So, more than two million of
these resistant infections every year , and thousands of patients actually die from these
infections. One particular type that’s really in some ways the poster child of this
problem is a bacteria called the carbapenem - resistant Enterobacteriaceae , ACH, really
a family of bacteria . And this is a gr oup of organisms that has now in some instances

become resistant to every single antibiotic that we have available to us . So, there are
patients in hospitals in the United States who are getting infections that we can’t treat
with antibiotics , and that is really certainly a very stunning development and something
that requires a great deal of urgent action.

Mark Masselli: You know , we have been fortunate to have the heads of Save the
Children and doctors without borders on the show recently , and also we h ave been
following the World Health Organizations estimate that the rate of infection could jump
to 10,000 new cases per week. What more needs to be done to attack all this epidemic
at ground zero?

Dr . Arjun Srinivasan: You know I think it’s going to tak e nothing short of a global
response of the type that I think , we are beginning to see developing. It’s going to take
the global community coming together to support those countries in West Africa in their
efforts to control this epidemic.

Margaret Flinte r: While we are responding on the ground , we are also trying to really
control and really support really the public’s need for knowledge , and education , we
always say knowledge is power in public health as in everything else , and especially
where there has been so much new information coming at people . We are still looking
at CDC as providing the go al standard for up - to - date information that certainly what we
are using to communicate with folks . But where do you recommend th at interested
clinicians , and providers , as well as , consumers go for the most up - to - date information?

Dr. Arjun Srinivasan: So , there is a wealth of information on the CDC website. There is
a separate section of that website now but dedicated to Ebola. You get there from our
home page, cdc.gov or you can get there directly at cdc.gov/ebola , and there are
separate sections there that pertain to healthcare providers to the public . But also a
host of scientific information, frequently asked questions , so information that’s relevant
both to the healthcare community , and to the public is found on cdc.gov/ebola.

Margaret Flinter: We have been speaking today with Dr. Arjun Srinivasan,
Spokesperson for the Centers for Disease Control and Prevention and associa te
director for healthcare associated infection prevention programs in the division of
healthcare quality. You can get the latest updates and learn more about their work by
going to cdc.gov. Dr. Srinivasan , thank you so much for taking the time to join u s on
Conversation on Healthcare today , and thank you for your service to the country during
this very challenging time.

Dr. Arjun Srinivasan: Thank you so much.

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Mark Masselli: At Conversations on Healthcare we want our audience to be truly be
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award winning journalist , and managing director editor of FactCheck.Org , a non -
producing, non - profit consumer advocate for voters that aim to reduce the level of
d eception in US politics. Lori what have you got for us this week?

Lori Robertson: We have seen instances of Republicans mischaracterizing the impact
of the Affordable Care Act on student loans . For instance in the Arkansas Senate race,
Republican Repres entative, Tom Cotton claimed that the ACA nationalized the student
loan industry , and implied students can’t get private loans from their local banks
anymore , not exactly. Plenty of banks offer private education loans , and the federal
student loan program always has been a government progr am. Cotton was also
attacked in an ad from the National Education Association Advocacy Fund , which said
that he quote , ’Voted to end low interest student loans ’ , he didn’t. The vote in question
was on a Republican budget that called for ending federal subsidies for need based
Stafford loans. The subsidies cover the cost of interest payments while students are in
school. The Republican budget didn’t call for ending the loan program , which includes
unsubsidized Staf ford loans at the same interest rate. The federal government got into
the student loan business in 1965 with the passage of the Higher Education Act. First
the loans originated with private banks , but were backed by the government and offered
at low inte rest rates. By 2010 55% of the federal loans originated with banks , and the
rest with the government. The ACA or more specifically , the reconciliation bill , included
student aid provisions to cut out the middlemen, the private lenders. Now the
governmen t is both the lender and the guarantor for all federal loans. The move saved
$61 billion over 10 years according to the congressional budget office . And the
government does still contract with private banks meaning some students may still send
their gove rnment loan payments to private banks , and that’s my FactCheck for this
week. I am Lori Robertson managing editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players , and is a proj ect of the Ann enberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you would like checked email us at
CHCradio.com. We will have FactCheck.org ’s Lori Robertson check it out for you here
on Conversations on Health Care .

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Margaret Flinter: Each week conversations highlight ’s a bright idea about how to make
wellness a part of our communities in everyday lives. The flu doesn’t just exact a toll on
public health. It pack a meaningful punch on the economy every year as well.
Comprehensive vaccination programs have had an imp act on curtailing flu outbreaks,
but there is still a lot of room from improvement. In 2011 an estimated 100 million work

days and close to $7 billion and l o st wages were attributed to the flu , l argely because
many employs without paid sick leave were more inclined to work while sick. An
estimated 80% of those who come down with flu like symptoms ignore doctor’s orders
and go to work leading to more widespread co - infections. In the first of its kind study
researchers at the University of Pittsburgh School Public Health decide d to analyze the
impact on flu outbreaks in the workplace , and to ask what would the difference be if
there universal access to paid sick leave. Lead Researcher Dr. Supriya Kumar says
their study showed a pretty dramatic link between access to paid sick leave , and a
reduction in flu outbreak in the workplace. They also created another option. What if
there were a new sick leave category focusing just on flu days? Their mod el showed
that if those workers specifically diagnosed with flu were guaranteed just one payday off
to recuperate . There would be a 25% reduction in the spread of flu . And when workers
were guaranteed two pay days up , the numbers went up to a 40% reducti on in co -
infection. A universal paid leave program for all workers that has a potential to greatly
reduce flu co - infection in the workplace positively impacting both public health while
saving billions of dollars in the overall economy now that’s a bright idea.

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Margaret Flinter: This is Conversations on Health Care . I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli. Peace in health.

Narrator: Conversations on Healthcare broadcast from the campus of WESU at
Wesleyan University , s trea ming live at wesufm.org and brought to you by the
community health center.

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