COVID Variant and Delayed Vaccines: Dr. Megan Ranney on Pandemic Perils

Dr. Megan Ranney

Female : 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 health care of the future. This week Mark and
Margaret speak with Dr. Megan Ra nney , Emergency Medicine
Physician and Director of the Brown - Lifespan Center for Digital
Health, a frequent contributor on the COVID - 19 pandemic to multiple
new s programs across the cable landscape. She is the founder of Get
Us PP E n ational c oalition to get much needed personal protective
equipment to frontline providers. Also MyCOVIDRisk is a free app she
helped develop where anyone can calculate their activities with
COVID risk .

Lori Robertson also checks in , the Managing Editor of FactCheck.org,
and we end with a bright idea that’s improving health and well - being
in everyday lives. If you have comments please e - mail us at
[email protected] or find us on Facebook or Twitter , or wherever
you listen to p odcast and you can also ask Alexa to play the program.
Now stay tuned for our interview with Dr. Megan Ranney here on
Conversations on Health Care .

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Mark Masselli: We're speaking today with Dr. Megan Ranney , Emer gency Medicine
Physician and Director of the Brown - Lifespan Center for Digital
Health . She is the Assistant Dean of the Brown Institute for
Translational Sciences and Associate Professor of Emergency
Medicine at Brown University.

Margaret Flinter: Dr. Ran n ey is also the co - founder of Get Us PP E , a n ational c oalition
that seeks to get the necessary personal protective equipment to
frontline clini cians battling COVID - 19. She co - developed the app
MyCOVIDRisk , a free tool to help anyone assess their risk of exp osure.
She's the co - founder of the American Foundation for Firearm Injury
Reduction in Medicine , AFFIRM, and that seeks to empower health
professionals to reduce preventable harm from gun violence. Dr.
Ran ney , we welcome you a nd thank you for joining us on
Conversations on Health Care.

Dr. Megan Ranney : Thank you it is an absolute honor to join you both.

Mark Masselli: You know, as a frontline ER clinician, and thank you for the work that
you do and your colleagues do. You're located in one of the many
COVI D - 19 hotspots right now and i t's pretty safe to say that we're in
that phase that Dr. Fauci has warned us the darkest days are ahead. I
think he's also said it's a -- we're having a surge on a surge . M any
hospitals are reporting they're at this breaking po int from the millions
who are traveling , came back during Thanksgiving . I think we're going
to perhaps start to see another surge as folks are returning from their

Dr. Megan Ranney

Christmas travels , and the death toll is rising exponentially. I think
today the re are repor ted 3700 deaths. I ’ m wonder ing if you could
help our listeners and put this pandemic surge into perspective right
now.

Dr. Megan Ranney: W here we are right now is honestly the worst we have ever been. Our
current death rate is more than 150% higher than ou r highest in April.
Our hospitalizations are approximately 300% higher. Th e thing that's
really different about now is compared to the spring is that our surges
are not just in your state and my state in New York and
Massachusetts, but literally spread acr oss all 50 states. What that
means is two things. First, every health care system is strained.
S econd, every health care worker is strained. There's just no more
space to give . We’re having trouble getting traveling nurses . W e’re
having trouble getting som e basic supplies. My colleagues th at are in
LA are reporting that they're running out of oxygen. W e don't see this
stopping anytime soon.

As you mentioned, the travel numbers during the Christmas and New
Year's holiday have dwarfed the number of folks that traveled over
Thanksgiving. I'll tell you as a frontline provider, I have seen patient
after patient over the last week who got sick over Christmas. They got
together with family for just one day. They said I've done everything
right. I thought I could ge t together for one evening , a nd that was
enough to get multiple members of their family sick. I'm quite scared
about the weeks ahead.

I think we have the resilience still in our system to make it through.
But I worry about getting into those kind of crisis standards where we
have to start rationing care or once again, canceling elective
procedures which aren't always elective , right , that sometimes help
put off other emergencies down the road.

Margaret Flinter: W ell , Dr. Ranney there's so much to talk about , but let's talk about
vaccines for a couple of minutes. We have two vaccines now w ith
emergency authorizations from Pfizer and M oderna . We all
remember Dr. Fauci telling us that we are not going to get to vaccine
herd immunity till 80 % to 85% of the Ameri can public has been
vaccinated. This HHS Secretary Azar promise d that we see a 100
million vaccines distributed by the end of the year. But maybe we're
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at a 10 of that , a nd I understand maybe about 2 million doses
administered a nd that, of course, is the first of what is still required of
the two doses.

F rom your understanding, where have we fallen short in the vaccine
distribution chain ? I say that with full appreciation and admiration for
what it took to develop these two vaccines, but we've got to
dist ribute them . W hat is going to be required to catch up at this
point?

Dr. Megan Ranney

Dr. Megan Ranney: Yeah, absolutely. The science is amazing a nd the investment that we
put into developing these novel vaccines for the novel coronavirus is
really nothing short of remarka ble. I agree, I don't want to diminish
incredible accomplishment of scientists across the world that have
already created two vaccines that have made it through our
emergency use authorization process, and with more vaccines
seemingly on the way. But where we failed is that at the same time
that we were investing money into developing the vaccines, we
should have simultaneously been investing money into that last miles .

W e've already seen our country fail at getting and distributing
personal protective equi pment. We've already seen our country fail at
rolling out adequate testing, both getting the supplies, setting up the
centers to test people and then setting up the IT system to accurately
track test results. I don't know why we thought that vaccines would
be any different. It's the same sort of logistic system both in terms of
distribution and of course, with these Pfizer and M oderna vaccines,
the need for that special cold storage. I n terms of that last mile boots
on the ground, having the workers to put vaccines in arms, having the
vaccine clinics in places where people can easily get to, and having of
course that data system, the data infrastructure to track who's gotten
vaccinated and when a second dose is due. None of that's been
established . W e're rel ying on already overstretched local public health
departments.

This late st stimulus bill is supposedly going to give some money on to
state health departments to set up vaccine infrastructure. But my
goodness, this is too little too late. It should have bee n done nine
months ago at the same time that we started Operation Warp Speed .

Mark Masselli: You know, and you both obviously lauded our scientist and the
research they did. I think we have pretty good data on the efficacy of
the vaccines, probably less so on the effectiveness which will come
over time, right , when the general population is being vaccinated.
We'll learn more about how it operates in the general public. But now
we have a concern with a new variant of the c oronavirus originally
emerged in bot h South Africa and the United Kingdom , i t was recently
identified here in the country , I think in Colorado . I t seems like it's a
more contagious variant. But it doesn't appear to be more lethal at
this point. But I'm wondering, talk about how scientists ar e tracking it
and what public health officials should be concerned most about with
this variant .

Dr. Megan Ranney: Yeah, so a couple of things. One is, is that the first reported detection
of this new strain was in late September in the UK. W e didn't know
until today that it had been discovered in the United States. But even
before that revelation of the Colorado man who did does have the UK
-- is infected with a UK variant, it would have been foolhardy to think

Dr. Megan Ranney

that the virus wasn't already in the United S tates . We have traveled
between the two countries, right , t here's just no way it isn't here.
W e're just not sequencing genomes of the virus in the United States
the way that Britain is, which is probably why we haven't picked it up
yet , so t hat's the first thing.

The second thing is , is that the data so far from the UK suggests that
what's different about this mutation is that it makes the virus more
transmissible, it means it's easier to transmit from person to person . I t
doesn't seem to change the pathoge nicity . I t doesn't seem to change
the course of the illness. But what we worry is that it's going to lead
to more of those super spreader events . I t's going to make it the virus
more on the level of measles which spreads really easily th a n on the
level of , say , flu . T hat's, of course, going to change the number of
people that we have to get vaccinated.

So far, it seems that the vaccines that we've already developed will
work against this novel strain , b ut the j ury i s still a little bit out on
that. I think the thing that worries many of us more is that most of the
vaccines that have been developed are against this spike protein. If
we get significant mutations in the spike d protein, we don't have
anything else right now. W e're all super excited about the mRN A
vaccines and the fact that they can be super targeted. But as opposed
to a full viral vaccine, it means that those other elements that can
drive an antibody or an immune response may not be fully
represented. W e just don't have a lot in our armamentarium if this
mutation does end up causing resistance to the vaccine.

Margaret Flinter: Well , Dr. Ranney we're fighting this on so many fronts. I think back to
what now seems like ancient history, but very real and present to us
in March when all of this starte d. Dr. Frank Gabri n was the first ER
clinician that we know to die from COVID in the United States while
on the front lines, treating patients . Y ou warned at that time that
there would be more deaths to follow if we didn't do a better job of
getting the pe rsonal protective equipment or PP E that we needed to
our health care workers on the front line. That's when you launched
Get Us PP E the National Alliance to help fill that gap by collecting and
sourcing and distributing PP E to those most in need.

I'd like t o say that that was something that we solved completely. But
it still feels like there's big needs out there a nd there's challenges
getting all the PP E that's needed, where we need it when we need it.
What's your sense of how we're doing with that? W hat's the status of
your project t hat you started to address this?

Dr. Megan Ranney: W hen we started Get Us PP E , we really imagined that we were going
to be in existence for a couple of weeks, and that FEMA or HHS would
step in and take over . W e thought the Defe nse Production Act would
be activated, that we would grow domestic manufacturing, and that

Dr. Megan Ranney

someone else would make sure that PP E was being sourced and
distributed in an equitable fashion. Here we are more than nine
months later, and the requests for PP E co ntinue to come in to our
organization .

We have seen shifts in the need over the last nine months . W e can
actually watch as COVID spikes occur in different parts of the country,
we'll see spikes in demand for PP E in those regions. The other thing
that we've seen is that the larger hospital systems that have a little
more funding and a little bit more robust of a supply chain have
managed to stabilize their PPE supply to a large extent. Many of them
are also fitting out their workers with things like elastome ric
respirators instead of depending on disposable N 95 s .

But what we're finding is that it's t he smaller clinics, home health care
aides, nursing homes, school nurses, who are still in desperate need,
they can't afford it, they can't source it. T hey , of cou rse, are the true
frontline, right. We know that the first outbreaks of COVID that we
found in our country were in those nursing homes in Washington
State. I t's just unconscionable to me that these same folks are still
going without protection.

I love that my fellow ER d ocs are for the most part protected, with
some exceptions. But the fact that we've left this whole segment of
our frontline healthcare workers unprotected just astounds me . I'm
hoping that with the new administration that w e’ ll both have
act ivation of the Defense Production Act, that domestic
manufacturing is incentivized, and we ’ ll have increased attention
towards equitable distribution a t G et U s PPE.

When we are distributing on the personal protective equipment
donations that we get, we try to account for both logistical efficiency,
getting it to the closest place possible, but also for the prevalence of
COVID - 19 a nd for the social vulnerability index . K nowing that there
are going to be certain types of facilities that are just aren't going to
have the financial resources to get it, and who are going to be treating
the populations that are at highest risk for infection.

Mark Masselli: We're speaking today with Dr. Megan Ranney , Director of the Brown -
Lifespan Center for Digital Health . You kno w, I think we've heard from
so many of our guests this year that actionable data and consistent
public health messaging have been lacking in this pandemic. B ut you
and your colleagues developed an app called MyCOVIDRisk , which
really allows anyone to deter mine their risk of becoming infected with
COVID - 19.

I think it's fair to say the pandemic has spawned a wave of new digital
tools to track outbreaks , to empower the citizenry, and really to help
inform public health officials. I'm wondering how do you feel such

Dr. Megan Ranney

tools are forming a more effective public health response , and w hat's
new and encouraging about all the digital and data development that
you see on the horizon?

Dr. Megan Ranney: T his has been a really exciting time for those of us in digital health ,
partly because there i s no alternative, right? The in - person visits are
really tough to do right now for many folks , a nd so it has given a wind
beneath the sails of what many of us have been pushing for , for a long
time. There also, of course, has been s ome relaxation of regulations
around telehealth that allow us to use things like FaceTime or Skype
in order to interact with patients synchronously in ways that weren't
allowed prior. There are still a lot of concerns, though.

T here has been this massive s urge of new digital health products, not
a lot of them have been validated. I n fact, there was a systematic
review in by Cochrane showing that these digital contact tracing apps
may not actually do much both because they aren't adequately
penetrating into the population , a nd because they may not work as
well as they're touted to. The other thing that's consistently ignored
by many are considerations of both privacy and ethics and equity.

At the Center for Digital Health , we try to develop tools that are
pri vate and ethical, and that are developed with an eye towards being
available to those who are most in need. That's why we developed
MyCOVIDRisk app without collecting PHI , it's one of the concerns
about some of the contact tracing apps that are out there. Although
we initially developed it just in English, because of funding limitations,
we tried hard to make it graphically easy so that for folks with low
health literacy it was easy to interpret, and are currently translating it
into other languages.

I thin k there's tremendous promise, I'm seeing some s urges , for
instance, in digital health for substance use treatment and mental
health that I think will be durable. But in order for us to achieve long
lasting change we have to keep an eye on efficacy and that eye on
privacy ethics and equity as well.

Margaret Flinter: Dr. Ranney , there were big problems we were facing before COVID.
O ne of the areas that you were doing very important work in was
addressing gun violence in this country, and you created A F FIRM th e
American Foundation for Firearm Injury Reduction in Medicine. E ven
with all that you're doing around COVID you're still directing research
on ways to address the American predilection for gun freedoms as a
direct threat to public health. W e can't help bu t notice some of the
analogies may be in the response to the pandemic in resisting the
science behind the public health protocols developed to keep people
safe from harm.

Really curious how your research and work on gun violence maybe is

Dr. Megan Ranney

informing the work you're doing now as we watched some of the
harm being done by resistance to proven safety protocols. W e had Dr.
Hotez on the show . H e said he felt like we might have lost the war on
the internet around vaccines , f or instance . I t's just an example of how
c hallenging this is and wonder if you could commen t on that .

Dr. Megan Ranney: A couple of things one is , is that I'll sometimes kind of joke that I cut
my teeth with the firearm injury work on kind of politicization of
public health. It is an issue that is absolutely a public health issue b ut
that had been ignored as such for well over two decades. Over the
last seven years or so, I've had the privilege of helping to lead and be
part of a much larger group of healthcare professionals who really
have succeed ed in restarting the science of firearm injury prevention
and are working on a community by community basis to redefine the
conversation about firearm injury prevention to not be political, but
rather to be focused on the health effects of firearm injury t o identify
risk behaviors and to talk about the ripple effects of not preventing
firearm injuries and deaths.

We've done that in collaboration with firearm owner groups with 4 H
as well as some of the more typical public health players. I think I
learned a lot about how to create collaboration, how to depoliticize
public health, and how to move the science forward in a way that
allows everybody to come to the table. I think our failure in COVID - 19
which may not be entirely on the public health community, cer tainly
partly on our federal leadership, but is that this virus did get
politicized and that those internet bots did dominate the conversation
for a while. W e were unable to kind of pull that back. I think it's one of
the things that has motivated me to be involved in the national
media, right , t hat's not my day job . I still do my research . I still work as
an ER doc . I t is, I think , an essential thing for us to do right now for us
to be out there as science communicators.

It ’ s why I've been on Twitter for a decade is because I kind of will say
st
that it's the public agora of the 21 century . Our democracy is created
right now, online, that's where the debates are happening. I f we're
not part of them then we see the discussion to others. Just as with
firearm i njury, there are going to be the extremists on either side who
are not going to be able to kind of come together into a nuanced
middle ground . There are the people that think that we should be
purely shut down forever. T hen there are the people that think that
we should do nothing. That's also ridiculous. But when you reframe
the issue in ways that make sense , when you approach people with
respect and when you are willing to engage, I find that much of the
time for kind of that middle 70 % or 80% we can come together. Again,
I'm hopeful that as we move forward into 2021, that our messaging
will be a little more consistent and clear a nd that we'll be able to kind
of move past the horrors that 2020 has brought.

Dr. Megan Ranney

The last thing I'll say, though, is that this is n ot new. I actually was a
student of the history of science as an undergraduate. My entire
undergraduate major was about the ways in which society and politics
influence interpretations and implementation of science , r ight. This is
something that goes back to Galileo and Copernicus and certainly to
the smallpox vaccine. I don't know why we would expect that
somehow we're special and different and that politics isn't going to
effect public health. It's a question of using it effectively, and kind of
channelin g people's fears and desire to keep themselves and their
family healthy into something that also helps the larger community
and respects the evidence.

Mark Masselli: L et me just pull the thread on the whole issue of messaging, and it's
starting at the top . Y ou just wrote a powerful op - ed for CNN urging
public health and policy leaders really to model their behavior that
they're demanding of their constituents. R eally, there's no question
that the American public has been sent many mixed messages during
the course of the pandemic, especially from the White House , a nd
that will soon change . The Biden team has really , I think , assembled
really an impressive array of influential voices, including Dr. Fauci
really quite a remarkable COVID - 19 taskforce . What are y ou hoping to
see in the next coming weeks in terms of ne w messaging about this
pandemic?

Dr. Megan Ranney: T he biggest thing I'm hoping is to move beyond this like Marie
Antoinette like, let them eat cake kind of attitude that we've seen for
the last nine months, I'm hoping to see a few things. The first is, like
you said, consistent messaging about how this virus is spread, about
how to protect ourselves and about how to get back to normal. The
second thing is that I'm hoping to see improved emphasis on th e
logistics of testing , of PPE and of course of vaccine distribution . We
need to put funding into it, we need to have consistent messaging and
we need to support our on - the - ground public health workers in all 50
states and in Puerto Rico.

The third thing t hat I'm hoping to see is continued emphasis on and
funding of science going forwards . W e still don't know what we don't
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know about COVID - 19. I t's not like on January 20 we a re going to flip
a switch and this virus is going to magically disappear. Moreove r, it's
going to continue to mutate . I t is going to be part of our society for a
long time to come. I'm hoping to see from Biden an awareness of that
and an awareness of all of the knock on effects of the virus . The CDC
just released today, new data around opioid overdoses. We're talking
about mental health crises among kids. We're of course seeing rising
numbers of gun injuries across the country. W e need to focus on
those after effects of COVID as well as the virus itself.

Margaret Flinter: We've been spe aking today with Dr. Megan Ranney , Emergency

Dr. Megan Ranney

Medicine Physician and Director of the Brown - Lifespan Center for
Digital Health . She's the co founder of Get Us PPE , the co - developer of
the app MyCOVIDRisk , and you can learn more about her impressive
work by g oing to www.digitalhealth.brown.edu , or follow her on
Twitter @ megan ranney . Dr. Ranney , thank you for all that you're
doing for the dispatches from the ER frontlines of this pandemic , for
the digital heal th innovations you're bringing to the public and for
taking the time to join us today on Conversations on Health Care .

Dr. Megan Ranney: Thank you. It's been a pleasure to join you both.

[Music]

Mark Masselli: At Conversations on Health Care, we want our a udience to be truly in
the know when it comes to the facts about 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 US politics. Lori,
what have you got for us this week?

Lori Robertson : Late in the presidential campaign, President Donald Trump claimed
that state COVID - 19 restrictions are a partisan ploy with Democratic
governors purposely keeping their states closed while Republican
governors are opening them. But that doesn't square with the facts.
For instance, in Bullhead City, Arizona, just across the border from
Nevada, Trump wrongly contrasted the reopening actions of both
states.
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In that spe ech on October 28 , the President said “ In Arizona you've
opened up , but Nevada get your governor to open up your state
please. ” B y Trump's telling Arizona, which is run by a Republican
Governor Doug D ucey is opened up but Nevada run by D emocratic
G overno r Steve Sisolak is not . But the reality is both states have very
similar restrictions. In late October , in both Arizona and Nevada bars,
restaurants, movie theaters and gyms were all open , but use was
capped at 50% of capacity.

Jennifer Tolbert, Director o f State Health Reform at the Kaiser Family
Foundation which has been tracking policy actions taken in states in
response to the pandemic confirmed to us that the two states were in
similar phases of reopening. In fact, Arizona has slightly tighter
restrict ions in some areas. For example, large gatherings are limited
to 50 people in Arizona, but it is 250 in Nevada, Nevada is stricter than
Arizona in one respect. Nevada has a statewide facemask mandate
requiring people to wear them in public spaces when they come into
close contact with others, such as on public transportation or in a
business . Arizona does not have such a mandate and leaves it up to
local governments to impose them if they want. T hat's my fact check
for this week. I'm Lori Robertson, Managin g Editor of FactCheck.org.

Dr. Megan Ranney

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Margaret Flinter: F act C heck.org is committed to factual accuracy 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.

[ Music ]

Margaret Flinter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Daniela Tudor
had a revelation A few years ago, waking up on the cold floor of a jail
cell . S he could ask for help for her drug and alcohol addiction or she
could die. She chose the former . T udor th e n launched not only on her
own recovery journey, but on a broader quest to develop tools that
c ould help all people grappling with addiction recovery to avoid
relapse, which is so common, especially in the early days of sobriety .
She realized that there needed to be more readily accessible tools for
those in recovery to stay connected to their treatment goals b eyond
the 12 - step meetings and the talk therapy sessions .

Daniela Tudor: I am in long term recovery. I went through a fou r - week inpatient
treatment program where at the end of that four week program, all I
received was a piece of paper that listed an enormous amount of
things I'm supposed to do on a daily and weekly basis for the rest of
my life to stay in recovery. I knew t hat building something on our cell
phones that are with us 24 /7 regardless of where you're from and
who you are, would be a way to bridge that gap and keep people
accountable through an app to those activities.

Margaret Flinter: She founded WEconnect a rel apse prevention on the go mobile
application that can be downloaded on a smartphone. The platform is
designed to keep people engaged in their recovery plan u sing daily
reminders and a reward system for when you perform the tasks that
are essential to recov ery.

Daniela Tudor: The individual along with the support of our certified peer recovery
support specialists are able to input those activities into the app , a nd
when it comes time for that activity to start, you simply check into it.
You see at the top of the app how you're earning your incentives. By
the way, this incentive program is based on evidence based research
called contingency management. I t's actually proven to show that it
keeps people accountable to their recovery plans or their care plans .
Th e way that we've digitized it a nd the immediacy of that incentive
keeps people accountable to checking into those activities on the go.

Margaret Flinter: T he digital platform also allows everyone who's connected to the

Dr. Megan Ranney

person's healthcare ecosystem to see in real time activities that are
enhancing recovery , a nd also when one might be at higher risk for
relapse .

Daniela Tudor: We have trained peer recovery support specialists all across the
country , a nd they get to a leverage tool that we developed called th e
data dashboard, where they can see in an instance if someone needs
additional support or outreach . T hat is built through the app with
keeping them accountable to those activities and the peer having
insights on how they're staying accountable to those ac tivities in real
time. I t really allows for this connection of support 24 /7 and visibility
so that when someone needs that added support not days or weeks
go by which is without this program is what happens, but rather gives
insight and gives the option fo r connection in real time.

Margaret Flinter: Since the pandemic hit Tu d or says the WEconnect platform has been
a lifeline for those in recovery. Those now oft en cut off from meetings
and in - pers on sessions during the shutdown.

Daniela Tudor: Actually , when the pandemic hit, immediately, my heart went out for ,
wow , none of us have support meetings to go to any more in person.
W e immediately stood up with a set of partners these mutual aid
meetings that are online that are led by certified peers. W ithin just a
couple months over 200,000 people joined from all states and several
countries .

Margaret Flinter: WEconnect a downloadable app designed by people in recovery for
people in recovery, to help maintain sobriety with a support system in
the palm of their han d, keeping them on track with health goals,
staying connected to a care team and avoiding relapse. Now that's a
bright idea.

[ Music ]

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.

Female : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to p odcasts. If you have comments, please e - mail us at
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