1
00:00:00,400 --> 00:00:03,480
Speaker 1: Hey, before we start the show, we have a quick

2
00:00:03,520 --> 00:00:07,400
Speaker 1: favor to ask you. As many places in America enter

3
00:00:07,480 --> 00:00:11,160
Speaker 1: their second month of social distancing, questions are coming up

4
00:00:11,200 --> 00:00:14,920
Speaker 1: about what's okay? Can you drive to another town to

5
00:00:14,960 --> 00:00:17,520
Speaker 1: see your mom from a distance if you never get

6
00:00:17,560 --> 00:00:20,520
Speaker 1: out of the car. What about taking a bike ride

7
00:00:20,520 --> 00:00:24,360
Speaker 1: with a friend two days six ft away? Daily life

8
00:00:24,400 --> 00:00:28,600
Speaker 1: now involves a lot of confusing risk calculations. So what

9
00:00:28,840 --> 00:00:33,000
Speaker 1: social distancing ethics and etiquette argue you wondering about? We

10
00:00:33,040 --> 00:00:36,519
Speaker 1: want to know. Leave us a voicemail with your question

11
00:00:36,720 --> 00:00:40,920
Speaker 1: at six four six three two four three four zero.

12
00:00:41,800 --> 00:00:44,720
Speaker 1: We'll answer some of your questions and we may use

13
00:00:44,760 --> 00:00:54,200
Speaker 1: your voice on a future show. And now today's show,

14
00:00:55,520 --> 00:00:59,920
Speaker 1: it's day forty two since coronavirus was declared a global pandemic.

15
00:01:00,920 --> 00:01:05,200
Speaker 1: Our main story, patients who are seriously ill from diseases

16
00:01:05,440 --> 00:01:10,200
Speaker 1: besides COVID nineteen are finding themselves in a strange limbo.

17
00:01:11,440 --> 00:01:15,560
Speaker 1: Getting treatment in hospitals is riskier than ever, and doctors

18
00:01:15,560 --> 00:01:20,199
Speaker 1: are forced to delay procedures without knowing for sure whether

19
00:01:20,280 --> 00:01:25,679
Speaker 1: patients will suffer long term harm. But first, here's what

20
00:01:25,800 --> 00:01:39,560
Speaker 1: happened today. New York is building a tracing Army to

21
00:01:39,600 --> 00:01:43,640
Speaker 1: attract the origin of individual coronavirus cases, according to Governor

22
00:01:43,720 --> 00:01:47,720
Speaker 1: Andrew Cuomo at his daily press conference today, the governor

23
00:01:47,760 --> 00:01:51,080
Speaker 1: said that doing this kind of so called contact tracing

24
00:01:51,320 --> 00:01:54,320
Speaker 1: will reduce the spread and let the state focus on

25
00:01:54,440 --> 00:02:00,320
Speaker 1: reopening UH. And we've been talking about testing, tracing and

26
00:02:00,360 --> 00:02:04,080
Speaker 1: then isolating UH and that is going to be the

27
00:02:04,200 --> 00:02:07,840
Speaker 1: key going forward. That's how you are educated and have

28
00:02:08,040 --> 00:02:11,440
Speaker 1: some data points as you're working your way through this

29
00:02:11,520 --> 00:02:15,480
Speaker 1: reopening calibration. And we set as a goal yesterday to

30
00:02:15,639 --> 00:02:19,520
Speaker 1: double the number of state tests, to go from twenty

31
00:02:19,560 --> 00:02:23,640
Speaker 1: thousand on average to that almost at the state would

32
00:02:23,639 --> 00:02:27,720
Speaker 1: work with Connecticut and New Jersey on the initiative. Former

33
00:02:27,760 --> 00:02:30,920
Speaker 1: New York City Mayor Michael Bloomberg volunteered to help the

34
00:02:30,960 --> 00:02:34,760
Speaker 1: state implement the program and will donate ten million dollars

35
00:02:34,919 --> 00:02:38,800
Speaker 1: to the effort. Michael Bloomberg is the founder and majority

36
00:02:38,840 --> 00:02:42,880
Speaker 1: owner of Bloomberg LP, the parent company of Bloomberg News.

37
00:02:45,040 --> 00:02:48,680
Speaker 1: New evidence suggests the new coronavirus may have been spreading

38
00:02:48,720 --> 00:02:53,160
Speaker 1: in the US earlier than previously thought. In California, to

39
00:02:53,360 --> 00:02:57,239
Speaker 1: Santa Clara, residents who died in early February were infected

40
00:02:57,240 --> 00:03:01,000
Speaker 1: with the virus. According to the Counties Public Health Department,

41
00:03:02,160 --> 00:03:06,160
Speaker 1: the first death on February six was twenty days earlier

42
00:03:06,240 --> 00:03:09,880
Speaker 1: than what was previously believed to be the first US fatality,

43
00:03:10,400 --> 00:03:14,120
Speaker 1: and it came three weeks before health officials identified the

44
00:03:14,120 --> 00:03:18,000
Speaker 1: first infection that didn't have a known tie to other cases.

45
00:03:19,080 --> 00:03:22,640
Speaker 1: The deaths were also weeks before cities and states started

46
00:03:22,680 --> 00:03:28,040
Speaker 1: implementing widespread social distancing measures. At the time, US attempts

47
00:03:28,080 --> 00:03:31,520
Speaker 1: to track the virus were limited, Tests were scarce, and

48
00:03:31,560 --> 00:03:34,960
Speaker 1: the criteria for who could be tested was tightly limited.

49
00:03:35,960 --> 00:03:38,200
Speaker 1: It's not the only thing the US may have gotten

50
00:03:38,240 --> 00:03:42,120
Speaker 1: wrong about the spread of the virus. The Trump administration's

51
00:03:42,160 --> 00:03:45,120
Speaker 1: projections for how many in the country will die from

52
00:03:45,160 --> 00:03:49,920
Speaker 1: the coronavirus maybe short by about a hundred thousand. According

53
00:03:49,960 --> 00:03:54,280
Speaker 1: to the American Civil Liberties Union, that's because it hasn't

54
00:03:54,360 --> 00:03:58,400
Speaker 1: fully accounted for the high prison population in the country.

55
00:03:58,880 --> 00:04:02,080
Speaker 1: Models that account for the hundreds of thousands of incarcerated

56
00:04:02,160 --> 00:04:05,960
Speaker 1: people suggest there will be many more deaths than projected

57
00:04:06,440 --> 00:04:10,400
Speaker 1: unless inmate populations are rapidly reduced. The A C. L.

58
00:04:10,520 --> 00:04:14,880
Speaker 1: You said, and how Speaker Nancy Pelosi said, the House

59
00:04:14,880 --> 00:04:18,159
Speaker 1: will pass the emergency four hundred and eighty four billion

60
00:04:18,200 --> 00:04:23,359
Speaker 1: dollar relief package tomorrow, giving small companies quick access to

61
00:04:23,440 --> 00:04:28,440
Speaker 1: additional loans. Pelosi also said on Bloomberg Television that a

62
00:04:28,520 --> 00:04:31,520
Speaker 1: major package of aid for state and local government will

63
00:04:31,560 --> 00:04:36,400
Speaker 1: be in the next stimulus legislation considered by Congress. That

64
00:04:36,480 --> 00:04:40,200
Speaker 1: sets up a conflict with Senate Majority Leader Mitch McConnell,

65
00:04:40,600 --> 00:04:44,200
Speaker 1: who was urging a slowdown in dolling out federal help.

66
00:04:49,040 --> 00:04:54,640
Speaker 1: And now our main story, the waves of coronavirus patients

67
00:04:54,839 --> 00:04:59,120
Speaker 1: flooding hospitals across the country have put an unprecedented strain

68
00:04:59,279 --> 00:05:03,440
Speaker 1: on our healthcare system. But it doesn't mean other diseases

69
00:05:03,520 --> 00:05:07,160
Speaker 1: just go away. The crisis is putting care on hold

70
00:05:07,480 --> 00:05:10,520
Speaker 1: for a lot of people with other serious health conditions

71
00:05:11,120 --> 00:05:16,400
Speaker 1: like cancer. Doctors are delaying procedures and surgeries in order

72
00:05:16,440 --> 00:05:20,240
Speaker 1: to save resources like hospital beds and ventilators for COVID

73
00:05:20,320 --> 00:05:25,920
Speaker 1: nineteen patients and prevent the infection from spreading. But as

74
00:05:25,920 --> 00:05:30,279
Speaker 1: Bloomberg News reporter and Accord explains, doctors are forced to

75
00:05:30,360 --> 00:05:34,920
Speaker 1: make often difficult choices about what constitutes an urgent procedure,

76
00:05:36,279 --> 00:05:40,080
Speaker 1: and experts worry that we're feeding another kind of healthcare

77
00:05:40,160 --> 00:05:48,120
Speaker 1: crisis one with consequences we're only beginning to see. Jenny

78
00:05:48,200 --> 00:05:53,040
Speaker 1: Alstrom has had a type of blood cancer since. Jenny

79
00:05:53,160 --> 00:05:55,760
Speaker 1: is fifty two and lives in Salt Lake City with

80
00:05:55,839 --> 00:05:59,440
Speaker 1: her family. In early April, she needed to see the

81
00:05:59,520 --> 00:06:02,560
Speaker 1: doctor for some tests that would help her understand the

82
00:06:02,640 --> 00:06:07,000
Speaker 1: status of her cancer, but she was worried. I had

83
00:06:07,040 --> 00:06:11,200
Speaker 1: to make this risk benefit analysis. Is it worse for

84
00:06:11,240 --> 00:06:13,480
Speaker 1: me to wait and then how my numbers go up

85
00:06:13,520 --> 00:06:16,240
Speaker 1: and not know what I could be doing about it,

86
00:06:16,480 --> 00:06:19,839
Speaker 1: even if I had to start treatment, or do I

87
00:06:19,920 --> 00:06:24,800
Speaker 1: wait and maybe have a disease that's growing more out

88
00:06:24,800 --> 00:06:28,240
Speaker 1: of control. So I was really holding off on doing

89
00:06:28,279 --> 00:06:31,480
Speaker 1: that just because I didn't want to put myself at risk.

90
00:06:35,560 --> 00:06:38,800
Speaker 1: Jenny did decide to go to the hospital. Her doctor

91
00:06:38,839 --> 00:06:42,359
Speaker 1: recommended a seven am appointment as the safest time to

92
00:06:42,440 --> 00:06:46,880
Speaker 1: go in. She didn't sleep well the night before. I

93
00:06:46,920 --> 00:06:49,839
Speaker 1: woke up really early and I had an in ninety

94
00:06:49,839 --> 00:06:53,080
Speaker 1: five mask, put that on, put my gloves on, and

95
00:06:53,240 --> 00:06:57,000
Speaker 1: went in And the streets are pretty quiet. There was

96
00:06:57,040 --> 00:06:59,679
Speaker 1: no traffic going up to the university, which there usually

97
00:06:59,760 --> 00:07:03,559
Speaker 1: is even at that time of the morning. Jenny says. Now,

98
00:07:03,839 --> 00:07:07,719
Speaker 1: even getting into the hospital to receive care is different

99
00:07:08,080 --> 00:07:10,520
Speaker 1: going into the facility. You know, I walked in, they

100
00:07:10,560 --> 00:07:13,320
Speaker 1: took my temperature. They were taking everyone's temperature that was

101
00:07:13,320 --> 00:07:17,600
Speaker 1: walking in the facility. There were signs everywhere that basically

102
00:07:18,120 --> 00:07:22,000
Speaker 1: there are no visitors or very few visitors, a single visitor.

103
00:07:22,760 --> 00:07:25,040
Speaker 1: And I went up to the floor and I was

104
00:07:25,080 --> 00:07:27,960
Speaker 1: the only patient that I saw on the entire floor.

105
00:07:28,360 --> 00:07:31,440
Speaker 1: No one's getting routine testing right now, no mamograms, no

106
00:07:32,360 --> 00:07:36,240
Speaker 1: stuff you would normally schedule for primitive care or even

107
00:07:36,400 --> 00:07:39,480
Speaker 1: just part of your regular care. They were cleaning off

108
00:07:39,520 --> 00:07:44,400
Speaker 1: all the chairs and surfaces when I got in, and

109
00:07:44,680 --> 00:07:48,520
Speaker 1: there were very few people working in the lab. So

110
00:07:48,720 --> 00:07:54,520
Speaker 1: it's truly changing normal cancer care, and I think that's

111
00:07:54,560 --> 00:07:58,960
Speaker 1: the case for every other disease to Jenny says she's

112
00:07:59,040 --> 00:08:02,600
Speaker 1: glad she went in for the tests. The doctor told

113
00:08:02,600 --> 00:08:06,400
Speaker 1: her she won't have to start treatment immediately, but it's

114
00:08:06,400 --> 00:08:09,920
Speaker 1: not always up to the patient. Hospitals are still doing

115
00:08:09,960 --> 00:08:13,720
Speaker 1: surgeries that are considered emergencies, but in many cases are

116
00:08:13,760 --> 00:08:19,080
Speaker 1: pushing off other kinds of procedures. Those procedures include lots

117
00:08:19,080 --> 00:08:23,360
Speaker 1: of things the average patient wouldn't consider optional, like cancer

118
00:08:23,400 --> 00:08:28,000
Speaker 1: surgeries or a knee replacement. John Hick is an emergency

119
00:08:28,040 --> 00:08:33,600
Speaker 1: medicine doctor in Minneapolis, Minnesota. He says doctors often make

120
00:08:33,679 --> 00:08:36,720
Speaker 1: the decision to delay this kind of care based on

121
00:08:36,880 --> 00:08:40,560
Speaker 1: three things. How much time it will take, how much

122
00:08:40,600 --> 00:08:45,480
Speaker 1: expertise is needed, and what the treatment involves. You know,

123
00:08:45,600 --> 00:08:49,640
Speaker 1: if we needed to take those resources altogether, what's the

124
00:08:49,679 --> 00:08:52,240
Speaker 1: overall investment that we're going to have to make, you know,

125
00:08:52,360 --> 00:08:55,040
Speaker 1: in the patient, And then what are we investing in,

126
00:08:55,240 --> 00:08:58,840
Speaker 1: you know, so kind of cold hard economic terms, what's

127
00:08:58,880 --> 00:09:02,080
Speaker 1: the return on investment here for this particular patient. So

128
00:09:02,200 --> 00:09:04,280
Speaker 1: we have to try to bring the best evidence that

129
00:09:04,360 --> 00:09:07,640
Speaker 1: we can to bear on the situation. But nothing's perfect,

130
00:09:08,080 --> 00:09:09,720
Speaker 1: you know. And I think that's the thing with medicine

131
00:09:09,800 --> 00:09:13,440
Speaker 1: is I used to tell people who wanted a firm answer,

132
00:09:13,440 --> 00:09:15,000
Speaker 1: and I get that all the time. Doctor, you have

133
00:09:15,080 --> 00:09:17,200
Speaker 1: to tell me, you know, I need to know, I

134
00:09:17,240 --> 00:09:19,360
Speaker 1: need to know a hundred percent. And I always say,

135
00:09:19,400 --> 00:09:23,640
Speaker 1: there's nothing that's in medicine. Doctors in the US are

136
00:09:23,679 --> 00:09:27,480
Speaker 1: delaying care for some in order to avoid what happened

137
00:09:27,559 --> 00:09:32,800
Speaker 1: in China and Italy. Hospitals there were overwhelmed by COVID

138
00:09:32,920 --> 00:09:37,600
Speaker 1: nineteen patients. This led doctors to have to make agonizing

139
00:09:37,720 --> 00:09:41,800
Speaker 1: decisions about who to treat and where to put resources.

140
00:09:43,120 --> 00:09:47,679
Speaker 1: Matthew Winnia is a bioethicist at the University of Colorado.

141
00:09:48,520 --> 00:09:53,920
Speaker 1: He says the situation presents major ethical questions. We're almost

142
00:09:54,000 --> 00:09:57,760
Speaker 1: certainly going to have some people with non COVID disease

143
00:09:58,040 --> 00:10:01,800
Speaker 1: who are harmed as result of delays in the care

144
00:10:01,880 --> 00:10:04,720
Speaker 1: that they receive. There's no perfect way to do this,

145
00:10:04,760 --> 00:10:08,559
Speaker 1: because no matter how you slice up that pie, someone's

146
00:10:08,559 --> 00:10:12,120
Speaker 1: not gonna like how much they got. Many doctors are

147
00:10:12,200 --> 00:10:15,959
Speaker 1: turning to virtual visits with their patients to fill the gap,

148
00:10:16,640 --> 00:10:20,560
Speaker 1: but not everything can be done that way. Jason Fung

149
00:10:20,920 --> 00:10:25,240
Speaker 1: is a kidney specialist based in Toronto, Canada. He says

150
00:10:25,280 --> 00:10:28,400
Speaker 1: he worries that people are staying home even when it

151
00:10:28,440 --> 00:10:33,600
Speaker 1: poses health risks. Many of Fung's patients are elderly and

152
00:10:33,640 --> 00:10:37,920
Speaker 1: have other health problems. They're more vulnerable to COVID nineteen

153
00:10:38,280 --> 00:10:41,080
Speaker 1: and they're afraid of getting it. The other day, I

154
00:10:41,120 --> 00:10:45,040
Speaker 1: admitted a patient who was so scared about COVID that

155
00:10:45,120 --> 00:10:47,400
Speaker 1: they didn't get their blood pressures checked, they didn't get

156
00:10:47,400 --> 00:10:50,440
Speaker 1: it taken care of, and I admitted that patient with

157
00:10:50,480 --> 00:10:54,400
Speaker 1: a stroke. That's not reversible, like they will suffer from that.

158
00:10:54,440 --> 00:10:57,200
Speaker 1: They can't see properly, so they will suffer from that

159
00:10:57,280 --> 00:11:06,319
Speaker 1: for the rest of their life. M bioethicist Matthew Whinia

160
00:11:06,559 --> 00:11:10,000
Speaker 1: says access to medical care has always been an issue

161
00:11:10,120 --> 00:11:13,679
Speaker 1: in our health system. The pandemic has just thrust these

162
00:11:13,679 --> 00:11:17,720
Speaker 1: subjects into even clearer view. But he does see a

163
00:11:17,760 --> 00:11:21,960
Speaker 1: silver lining here. Things like virtual visits are becoming much

164
00:11:22,040 --> 00:11:26,160
Speaker 1: more used and accepted. So there are ways in which

165
00:11:26,440 --> 00:11:30,920
Speaker 1: because of a disaster you develop new ways of thinking

166
00:11:30,960 --> 00:11:33,720
Speaker 1: and new ways of doing things that will then carry

167
00:11:33,720 --> 00:11:37,080
Speaker 1: on afterwards. You know, they're saying that necessity is the

168
00:11:37,120 --> 00:11:40,760
Speaker 1: mother of invention. We're having to invent a lot of

169
00:11:40,760 --> 00:11:44,280
Speaker 1: things right now because we have to, and some of

170
00:11:44,320 --> 00:11:47,920
Speaker 1: those will lead to long term improvements, I hope in

171
00:11:48,040 --> 00:11:51,679
Speaker 1: the health care system. The US is starting to talk

172
00:11:51,720 --> 00:11:57,680
Speaker 1: about reopening states that would include non COVID procedures, but

173
00:11:57,800 --> 00:12:01,840
Speaker 1: until then, patients and doctor will still have to make

174
00:12:02,200 --> 00:12:07,640
Speaker 1: the difficult choices about when and where care happens. And

175
00:12:15,240 --> 00:12:18,560
Speaker 1: that was Emma Court and that's it for our show today.

176
00:12:19,320 --> 00:12:22,000
Speaker 1: For more on the outbreak from one and twenty bureaus

177
00:12:22,040 --> 00:12:27,720
Speaker 1: around the world, visit Bloomberg Dot com slash Coronavirus, and

178
00:12:27,840 --> 00:12:31,839
Speaker 1: one small favor. If you appreciate the show, please leave

179
00:12:31,920 --> 00:12:35,559
Speaker 1: us a review and a rating on Apple Podcasts or Spotify.

180
00:12:36,400 --> 00:12:39,079
Speaker 1: It's the best way to help more listeners find our

181
00:12:39,080 --> 00:12:43,560
Speaker 1: global reporting. The Prognosis Daily edition is hosted by Me

182
00:12:44,160 --> 00:12:48,280
Speaker 1: Laura Carlson. The show was produced by Me, top foreheads

183
00:12:48,440 --> 00:12:53,760
Speaker 1: Jordan Gospore and Magnus Henriksen. Today's main story was reported

184
00:12:53,760 --> 00:12:57,760
Speaker 1: by Emma Court. Original music by Leo Sidrin, and our

185
00:12:57,920 --> 00:13:02,120
Speaker 1: editors are Francesco Leady and Rick sh Francesco Levi is

186
00:13:02,120 --> 00:13:10,439
Speaker 1: Bloomberg's head of Podcasts. Thanks for listening. H