Pandemic Expert Dr. Sheri Fink on Reducing Harm From Coronavirus in US

Dr. Sheri Fink

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Moderator : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the hea lthcare of the future.

This week Mark and Margaret speak with Dr. Sheri Fink, Pulitzer Prize
winning author of Five Days at Memorial on the devastating
aftermath of Hurricane Katrina, and one of the producers of
Pandemic : How to Prevent an Outbreak, now out on Netfl ix . Dr. Fink
talks about the outbreak of the Coronav irus, what governments,
health systems and individuals need to do as the disease spreads
across the U.S.

Lori Robertson also checks in, the Managing Editor of F act C heck.org
looks at misstatements spoken about health policy in the public
domain, separating the fake from the facts . We end with a bright idea
t hat's improving health and well being in everyday lives.

If you have comments, please e - mail us at chcradio@ch c1.com or find
us on Facebook , Twitter , or wherever you listen to podcast s . You can
also hear us by asking Alexa to play the program Conversations on
Health Care. Now stay tuned for our interview with Dr. Sheri Fink here
on Conversations on Health Care.

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Mark Masselli: We are speaking today with Dr. Sheri Fink, Pulitzer Prize winning New
York Times correspondent and author of Five Days at Memorial : Life
and Deat h in the Storm - Ravaged Hospital, harrowing account of chaos
in hospital after Hurricane K atrina. Dr. Fink is also Executive Producer
of the documentary series Pandemic: How to Prevent an Outbreak
now airing on Netflix.

Margaret Flinter: She has worked extensively as a re lief worker in disaster and war torn
regions. She has earned multiple writ ing awards for her coverage of
the Ebola epidemic, of the genocid e during the conflict in Bosnia, and
Herzegovina and the aftermath of Hurricane Katrina. She earned her
PhD and MD degrees at Stanford University. Sheri , welcome to
Conversations on Health Ca re.

Dr. Sheri Fink: Hi, thank you for having me.

Mark Masselli: You know, you just published a very powerful piece in The New York
Times that asked really a very simple question – Is America ready to
handle a new pandemic? – and you have noted that our hea lth
system while it's robust, has a series of deficiencies and something

Dr. Sheri Fink

you examine closely in your book about hospital failures post Katrina.
I'm wondering based on your experiences and your research, wh at
should our hospitals and public health officials be doing to better
prepare for an epidemic like COVID - 19 and is there enough time?

Dr. Sheri Fink: Well, deficiencies are one thing and then also just the very fact that
it's hard to be perfectly prepared for an extreme crisis. There's a
triage that goes on every day there are everyday health needs, but
this certainly is one of those rare but very foreseeable and potentially
quite severe types of disaster scenarios. Certainly, these kinds of
scenarios that we're seeing now have been on the planning books f or
a long time. There should be some level of preparedness, but what we
know from those planning exercises is that we do have vulnerabilities .

I just was listening to the World Health Organization leaders speak
today , and they said every country should be looking at its capacity to
provide critical care and ventilators. The Coronavirus, of course, in
most people is a mild illness, 80% in China have not needed
health care. However, there are those more severe cases that can turn
into pneumonia where you do n eed to be on a ventilator and have
that kind of critical care life support for a while before you get better .
That is really where our healt hcare system, one of the places, and I'll
talk about one other, but obviously hopefully most of our hospitals
that d o have critical care facilities are really thinking hard now,
looking at how they can provide that care with the surge in patients
and being creative.

I spoke with some hospital executives last week that were thinking,
could we provide critical care on a regular unit by staffing it
differently? How can we block off areas of the hospital if we don't
have enough negative pressure rooms, which is sort of like that extra
set of airborne precautions, even though they're not really sure that
Coronavirus can spre ad through the airborne ro ute versus droplet and
contact . Those are the kinds of creative thinking , looking at stocks
that's one thing that's the extreme sick people, and I just listened to a
press conference with Seattle health officials, and they said th at some
of their hospitals are already feeling a strain , are already overtaxed.
They actually asked people with mild illness to not flood into hospitals
so this is already happening. We've seen it in China where some
hospitals were overwhelmed , and we may be seeing that very soon in
parts of the U.S.

Then the other big thing, of course, is detecting people keeping the
health work for safe from the first person at the door, whether it's a
guard or a registration official having the ability to put a mask on
somebody and protect them protect others at the hospital. So those
infection control and prevention types of steps are very important.
There should be good communication from hospitals to the staff. I've

Dr. Sheri Fink

spoken with many regular frontline staff at hospital s, both medically
trained, nursing trained as well as just regular folks, and not all of
them have had great communication on this yet, so the leadership
might be preparing but that word needs to get out to the health
workforce.

Margaret Flinter: Well Sher i, I think you are so right . We certainly are aware of a lot of
fear and confusion at the community level and of course we want to
do everything possible at the community level to reduce the burden
on the hospital so they can take care of the people that c an only be
treated in an inpatient setting. I think people generally do better
when they have some sense of power and control over what they can
do to prepare and protect their family. Your recent New York Times
article offered, I thought, some great infor mation about COVID - 19,
what it is, how it spreads, and most importantly what every day
people can do about it . You offered some simple precautions on how
people can protect themselves and their family, so share those with
our listeners, if you would.

Dr. S heri Fink: Yeah, so simple and so important, and I think it's – I am really sad to
see how much panic and fear and confusion is out there. That's
unfortunate because there are steps that people can take to prepare
to protect themselves and their families. Again, that reminder that in
mo st cases this is a mild illness but for certain populations if you're
older they say over 60 - 65 that's not considered older to a lot of
people these days, and as well as if you have like many people chronic
health conditions, you're going to want to be even more careful.

Okay, so what are those steps and I would say before I get into the
actual steps, number one step is turn to good sources of information,
keep your eye if you're a social media type on the local health
depart ment, what they're recommending, because that's what's
happening in your area and that can change. And then of course the
federal healt h officials in the U.S. the CDC, www.cdc.gov Coronavirus
site and the World Health Organization as well
www.who.int/coronavirus . So go to trusted sources for information.
What are they all saying? They're saying the same things. Wash your
hands. If you are out in the public and you touch some things you're
going to not want to be touching your face.

It's something humans do we touch our faces a lot , but this is how this
virus is already known to spread. There are things we don't know yet
but there are things we do know. Touching your eyes, your nose, your
mouth, you don't want to do that. Start practicing now. It's very hard.
You'll catch yourself touching your face many times. And then of
course to protect others. If you've got a fever and cough, signs of
illness, you want to stay home and cover your cough like that. Use a
tiss ue, wash your hands , again that han d hygiene is so very important.

Dr. Sheri Fink

Those are some of the really simple but what people say are very
effective things and actually washing your hands a bit longer than
most of us do, and you can go on the web and get some vid eos for
how to do that. I think, I can't remember how many seconds we're
supposed to –

Mark Masselli: 20

Dr. Sheri Fink: I thought it was around 20, yeah, which again, feels long.

Mark Masselli: I think there are some songs you can sing along that are shor t to the –

Dr. Sheri Fink: Oh that’s right.

Mark Masselli: I think you make a good point that governments are playing such a
critical important role in addressing fear and confusion. We had Dr.
Anthony Fauci on the show the other day, just as the epidemic was
spreading beyond China, and he certainly has had decades of fighting
pandemics. We've sort of noticed a shift in the past week or so in how
the messaging is now getting out to the public, which may be leading
to some confusion. You talk nicely and dire ctly about going to the
local government , but in general, how should the larger government
address the fears informing public and making sure the threat is being
properly addressed by experts well versed in evidence based science?

Dr. Sheri Fink: I mean, I think you just said it yourself, which is that, obviously,
sometimes public officials who are not trained in science have to
make some of these really tough decisions about major measures to
try to counter an epidemic and those are hard choices. Those are
choices like things that can disrupt our lives , shutting schools or
sporting events or whatnot. Those are tough questions that officials
have to make government officials and I don't envy them. But it's
certainly, certainly important that when they make t hose choices that
they rely on the experts who know this best and of course there are
things we don't know yet but there are some things we do .

One of the very interesting and important aspects of this outbreak is
that a lot of science is being done very quickly. If you go to the major
medical journals they're constantly putting up papers, and more and
more information is coming out of China where they've had
thousands of cases. It's important that we have the experts weighing
in on what the measures shoul d be and that the public be able to
access that information.

Margaret Flinter: Well Sheri, you're one of the executive producers on the new
documentary Pandemic on Netflix, and that is the most unbelievably
prescient thing I've ever seen in terms of ---

Mar k Masselli: Timing, timing, timing ---

Dr. Sheri Fink

Margaret Flinter: Timeliness . You r experts in the documentary examine what can
happen in a very short order when a pandemic takes hold and
infrastructure breaks down, and you've alluded to some of this . We've
certainly through the media watch ed the shutdown of everyday life in
Wuhan as the virus rapidly spread there. We've seen quarantines,
travel restriction s, huge disruptions, and travel, and it's starting to
filter down to the local level. I think when the Louvre clo sed in Paris,
that really kind of shook us all when we think about just what we
expect to always be there and available . Help us better understand
what large scale disruption might look like in the United States and
just your opinion on what kind of prepar ation for that might be
prudent?

Dr. Sheri Fink: Sure, well, I should say that so the docu series Pandemic which is on
Netflix , you said it's prescient, but in some way the whole or one way
to look at it it's the whole reason we made a series about pandemi cs
is because that risk is all the time here with humanity.

Margaret Flinter: Sure

Dr. Sheri Fink: We hope that when people watch that they see we have a variety of
people on the frontlines that are there all the time kind of trying to
prevent these new vi ruses from jumping from the animal kingdom to
the human animal. Then from there on what we do, and sort of the
commonalities all around the world, but the challenges and the
benefits the wonderful ways that people work together to try to limit
the sufferin g and the damage. In terms of the disruption, again, those
are difficult choices when do you shut a school , when do you shut a
workplace .

I think what I hear public officials saying now is that we need to start
thinking even if the virus is not currently circulating in your local area,
you should start thinking about stocks of food at home in case you
have to stay home for a while, not major amounts. I've heard a couple
weeks perhaps just having dry goods and it's always a good thing
anyways to have that. If you're somebody who relies on medications,
making sure you have an extra amount of that just in case that could
just be supply chain disruptions, other reasons why it might be
difficult to get medications, for example , just kind of important things
to d o.

Thinking about what you'll do if you have kids and their school is
canceled. Thinking about how you might be able to telecommute, if
you can, and I know some of these things are very hard for people
who might have jobs where they're working paycheck to paycheck
where they have to be present. Those are definitely concerns but
definitely something to start thinking about. It's just going to be area
by area. Some of the measures taken in China was discussed today
with the World Health Organization. Those w ere very, very extreme

Dr. Sheri Fink

measures in Wuhan . They said that somewhat less severe measures,
also aimed at containing the virus in China have also been effective. I
think that everybody is trying to figure it out and there's no 100% -
there are benefits and ris ks of these different approaches.

Mark Masselli: We're speaking today with Dr. Sheri Fink, Pulitzer Prize winning New
York Times correspondent, author of Five Days at Memorial : Life and
Death in the Storm - Ravaged Hospital. Dr. Fink is also Executive
Produc er of the documentary series Pandemic : How to Prevent an
Outbreak, now airing on Netflix. I want to pull the thread on the
statement about the supply chain because we're seeing now in China
where they're running out of protective equipment, mask, protectiv e
clothing and the like, and just trying to think a little bit about maybe
the redesign that's going to happen in the health system. I know,
we've been advocating the use of Telehealth . If people are self -
quaranti ned, we have to figure out ways, there's go ing to be an
enormous amount of anxiety that's going on in people and to the
extent that we can leverage technology I think we want to – so we
have both sides. One people who are going to go out and start
hopefully not hoarding but certainly appropriately getting supplies,
supplies are running out , and then we've got a health system you
talked about earlier, that may be strained and how we can re - imagine
the delivery system people . Any sort of general thoughts on those?

Dr. Sheri Fink: Sure, absolutely , I s poke for the story that we did that came out this
weekend about is our society prepared, our hospitals, health sector
prepared. I spoke with a lot of hospital executives and emergency
folks, and they are already experiencing shortages and difficulties
gett ing some protective equipment, particularly those N - 95 masks the
higher filtration mas k s that are really mostly only needed by health
professionals who are going to be really close to patients. That is
already a concern here and you saw over the weekend, a gain, some
plans that the U.S. has to help ramp up some production there. That's
very important, and I forgot the rest of the question, I am sorry , I’ve
not been sleeping much .

Margaret Flinter: You have a lot on your mind, and one thing that is on the min ds of
healthcare people and I think this is translating to the consumer and
the patients in the community as well , is the whole area of testing .
People are used to, there's a issue in the community go and get a test,
you think you have flu, your provider w ill often do a flu test. The CDC
had been doing targeted testing for the presence of COVID - 19 in a
handful of cities but not widespread or extensive testing. Most
facilities do not have the necessary testing kits is at least our
understanding so far. There 's been some questions back and forth I'm
not sure where that's landed about the adequacy of the test
themselves, and perhaps most importantly the criteria for testing ,
who should we use one of these test kits on? What are your thoughts

Dr. Sheri Fink

on how we address t he need for better testing and the infrastructure
to meet that demand b ecause that is going to be something that
really bubbles up I think very quickly from the community.

Dr. Sheri Fink: Yeah, I mean, that's already been an issue. Certainly , the limited
t esting that the U.S. has been able to do has limited the ability to
detect the virus and certainly that's very clear in Washington and the
officials that are talking about how the fact that they couldn't test and
that the criteria were so stringent for so long, really until last week.
We were supposed to only test if somebody had been to China within
the last 14 days or had been exposed to a known case. They said that
that definitely hampered their ability to understand that the virus was
already circulatin g in the community, which we now know. That is an
issue w hat we've seen as of late last week is that state health
laboratories now are able to test and they're ramping up and there is
also there are many plans to allow hospital laboratories that have the
c apacity to do this test . Of course, there are frontline clinicians are
saying we want to be able to do rapid tests right here in our clinics
and so on. I know that technology or I've heard it is being worked on. I
don't know what the timeframe for that is, but it's certainly, certainly
a recognized need . As long as we can't test widely or just do wider
surveillance we don't have a sense because you have a lot of mild
cases of how big the issue is and w h ere the outbreaks exactly are.

Mark Masselli: And, you know, we're certainly looking at the rapid test . We run a
large health system entirely focused in on uninsured and
underinsured people who live in poverty, and this is a real anxiety and
we talked a little earlier about supply chains limitations and hopefu lly
leveraging some Telehealth. But you actually ---

Dr. Sheri Fink: Oh yeah, that was what I was going to tell you.

Mark Masselli: Do that but also talk a little bit about your own experience in Bosnia,
in Africa with the Ebola outbreak. What did you exper ience there and
certainly in Katrina is some of that so maybe supply chain and just
touch on some of your on the ground experience?

Dr. Sheri Fink: Well, I thought what you said about Telehealth was a really good
point and I feel like we've been talking ab out Telehealth and medicine
for so, so long and it hasn't quite. I mean, it's just starting perhaps to
really get to that place that many people had envisioned. I was
speaking with one hospital executive of a very large hospital health
system in the New Yo rk area , Northwell Health and they already have
EIC Us . I hope I am getting that right but where they do some even
remote monitoring of their ICU patients and can sort of, of course
multiply, keep eyes on things when clinicians in the unit mig ht be
busy, co mputer algor ithms to pick up issues that patients might be
having . They were envisioning a role for that perhaps to be helpful in
a surge standpoint .

Dr. Sheri Fink

You're absolutely right Telehealth you know, right now I just heard
officials in Seattle just pleading wi th the public to not run into
hospitals if they have a mild illness. If there was a system whereby
those people could get good advice by calling a phone number, that
would be terrific . Certainly this morning in New York City a phone
number was distributed by the Mayor for people to call. If those are
linked up in a good way then you could imagine that could be very
helpful because of course you want to reserve that hospital capacity
for the people who really need it. But you also want to make sure that
peop le who might have the illness know what to do to pro tect
themselves, their families, and can get care if their cases worsen.

This sort of fear and panic and the human sort of reaction to extreme
situations by being afraid, I think it just highlights the i mportance for
people who are in leadership roles to keep that communication going
to try to – our people in our healthcare i ndustry work really hard they
are very passionate. But we also have to pace ourselves because this
could be a long haul to get that fleet, make good decisions,
communicate regularly, tell people if you don't know, and I think that
trust with the public when it breaks down is really tough and we do
see that whether it's domestically in other countries whatever the
emergency. Those are o ur common themes. We also see really, really
great examples of people coming together and wanting to help out
and that's sort of where the beautiful side of humanity comes out and
we do show that in the Netflix series. I think it's a scary prospect, a
new virus emerging that could be deadly and cause suffering , but we
do have our human sort of our humanity and our skills and our
resources to help to counter that threat.

Margaret Flinter: We've been speaking today with Dr. Sheri Fink, Pulitzer Prize winning
author of Five Days at Memorial : Life and Death in a Storm - Ravaged
Hospital. She's a New York Times correspondent and the executive
producer of the documentary series Pandemic : How to Prevent an
Outbreak now airing on Netflix. Learn more about her impressi ve
body of work by going to www.sherifink.net or
www.facebook.com/sherifinkbooks and please follow her on Twitter
@SheriFink. We want to thank you for your wi llingness to walk
straight towards all the crises in the world that you've walk ed towards
over these decades so that we can all have better insight, better
understanding and hopefully better preparation for what is to come.

Mark Masselli: And just also a s hout out to the Times coverage, which has just been
really comprehensive and very informative I think across the board , so
thanks to all ---

Dr. Sheri Fink: I've been working very hard here so thank you for saying that.

Mark Masselli: Yeah

Dr. Sheri Fink

Margaret Flinter: All right, thanks so much.

Mark Masselli: Thank you.

Margaret Flinter: Bye , bye

Dr. Sheri Fink: It's my pleasure. Thank you.

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Mark Masselli: At Conversations on Health Care we want our audience to be truly in
the know when it comes to the facts abo ut healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. Politics.
Lori, what have you got f or us this week?

Lori Robertson: Through a TV ad and Twitter, Democratic Presidential Candidate Mike
Bloomberg and President Donald Trump are arguing about Trump's
actions on preexisting medical conditions. Bloomberg charged in an
ad that Trump had broken a promise to protect those with preexisting
conditions. Trump fired back on Twitter, “I was the person who saved
preexisting conditions.” In fact, Trump back ed Republican plans that
would have weakened the protections in the Affordable Care Act.
Under the ACA , insurers can't deny coverage or charge more based on
health status. Those provisions of the law have primarily affected the
individual market where those without insurance through an
employer or a government programs such as Medicaid buy their own
pol icies. Before the ACA , premiums on the individual market were
often set based on health status and coverage could be denied
entirely.

The Republican Repeal and Replace bills debated in 2017 did incl ude
some of the ACA protections but not all of them. In p articular, the
GOP plans could have caused some with medical conditions to pay
higher premiums. The Trump administration also has backed a court
case arguing the ACA is unconstitutional. In a 2018 letter, then
Atto rney General Jeff Sessions said if the cas e were successful ACA
provisions regarding preexisting condition protections would need t o
be eliminated.

That's my fact check for this week. I'm Lori Robertson, Managing
Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual acc uracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked e - mail us at www.chcradio.com , w e'll have
FactCheck.org's Lori Robertson check it out for you here on
Conversations on Health Care.

Dr. Sheri Fink

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Mark Masselli: Each week , Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Students o f
public health are often tasked with devising interventions for
addressing some of health's biggest challenges. For Harvard T . H . Chan
School of Public Health s tudents Dan Wexler and Priya Patel, their
idea netted an award and launched a business idea at t he same time.
The students were tasked with addressing food insecurity in
underserved parts of the world, including in neighborhoods in their
own backyard, families living in high poverty, low resource area and
finding fresh affordable healthy food in neig hborhoods with no
grocery stores or food markets. They thought of the current trend of
healthy meal or meal services like Blu e Apron and wondered what if
we modified that business model to serve the needs of those living in
food deserts.

Wexler and his pa rtner sourced food delivery companies that could
provide pre - packaged meal kits, with all ingredients included even
spices, dressings , and recipes and instead of home delivery approach
they designed refrigerated kiosks that could easily be placed in local
neighborhoods. Wexler says they wanted to make the idea of healthy
eating and meal preparation as simple as possible.

Dan Wexler: I think the biggest change is that there is no delivery system door to
door per se, and that by going and setting up these kio sks in the
community you can have a very lean design, you can have – you don't
need a storefront. You don't need to pay for shipping. You don't need
to have inbox refrigeration, and you are very much addressing the
needs of access by physically saying, hey here is healthy food. It's
convenient because everything you need is in the box. The directions
are simple and very picture bas ed as there’s a lot of literacy issues ,
and so just really thinking about how can we take all those lean design
principles to fa cilitate access that really I think mak e it a solution that
has the potential for impact.

Mark Masselli: They also conducted research with local ethnic groups to create
recipes that would resonate with their families.

Dan Wexler: Then we just went down to the community and did taste testing at
the Farmers Market and talked to people and said, do you like this ,
what do you want to be able to eat for dinner , how do you want to
cook – so b asically we have some dishes that have similar textures
similar spices. One thing that we found is there's a little bit of
contention between parents who want to eat more traditional foods
and kids who want to eat more American foods, and we tried to
alleviate that and bridge those gaps to one of our recipes, for
instance, is a chicken pot pie pasta. So it's kind of American it is fun
sounding, but also we use a lot of traditional seasonings and spices.

Dr. Sheri Fink

Mark Masselli: Customers can simply walk to the kiosk and purchase their meal kits
with the SNAP cards or cash, and the added benefits. The Kiosk will be
run by the residents of the neighborhood giving them an opportunity
to purchase the kiosk and run them like a franchise offering an
economic benefit to the community as well. Their idea earned them
the Rabobank - MIT Food & Agr ib u siness Innovation Prize, and $15,000
in startup money to launch their enterprise. A low cost portable
healthy meal service placed in portable kiosk and food desert
neighborhoods, offering families a simple solution to address the
problem of poor nutrition providing an economic opportunity at the
same time. Now that's a bright idea.

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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health

Marga ret Flinter: Conversations on Health Care is recorded at WESU at Wesleyan
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