WEBVTT - How Stanford is Fighting COVID-19 0:00:00.120 --> 0:00:03.680 You're listening to Bloomberg Business Week with Carol Masser and 0:00:03.800 --> 0:00:08.320 Jason Kelly on Bloomberg Radio. Certainly, what's on investors minds 0:00:08.520 --> 0:00:12.040 and again many around the country is the increased numbers 0:00:12.520 --> 0:00:16.280 in virus cases and hospitalizations. And there's a lot of stories. 0:00:16.280 --> 0:00:17.800 If you look at the most right on the Bloomberg 0:00:17.880 --> 0:00:20.520 almost all of the top ten have something to do 0:00:20.560 --> 0:00:22.800 with the virus. So let's get into it and talk 0:00:22.840 --> 0:00:25.720 about the virus how the health community is continuing to 0:00:25.800 --> 0:00:28.920 deal with it. Lloyd Minor is a scientist, surgeon, and 0:00:28.960 --> 0:00:31.920 academic leader. He's also dean of the Stanford University School 0:00:31.920 --> 0:00:34.440 of Medicine. It's a position he has held since December. 0:00:35.560 --> 0:00:39.280 Also with us is David Entwistle, presiden CEO of Stanford Healthcare, 0:00:39.320 --> 0:00:43.000 which in November opened its new eight hundred twenty four 0:00:43.040 --> 0:00:45.960 thousand square foot state of the art hospital. It's total 0:00:46.000 --> 0:00:48.839 bedcount is now six oh five, total operating rooms to 0:00:49.000 --> 0:00:52.519 eight seven, so a huge facility. Both joining us on 0:00:52.560 --> 0:00:55.760 the phone from Stanford, California, gentlemen, so nice to have 0:00:55.880 --> 0:00:59.200 you here with us. So I gotta just ask you first, 0:00:59.240 --> 0:01:02.400 because of the virus surges, should some states and cities 0:01:02.400 --> 0:01:07.279 be considering slowing or reversing reopening plans. And Dr Minod 0:01:07.319 --> 0:01:08.840 let me start with you. How do you see it? 0:01:10.520 --> 0:01:13.360 Thank you very much, it's good to be with you today. Certainly, 0:01:13.360 --> 0:01:16.679 we are seeing an increase in the number of COVID 0:01:16.800 --> 0:01:20.840 cases in many cities and locations across the United States, 0:01:20.959 --> 0:01:23.360 and I think that indicates that we need to continue 0:01:23.400 --> 0:01:28.720 to observe social distancing. The masking guidelines that have been 0:01:29.000 --> 0:01:32.280 rolled out in many communities. There's good evidence that masking 0:01:32.760 --> 0:01:36.680 helps to prevent the infection. It's gonna be I think 0:01:36.720 --> 0:01:41.440 a location by location decision as to what additional measures 0:01:41.440 --> 0:01:43.800 are put in place. That is, whether or not we 0:01:43.920 --> 0:01:48.520 roll back from stage two where many places are today 0:01:48.760 --> 0:01:52.080 to earlier stages. But the main thing is we've we've 0:01:52.120 --> 0:01:56.640 got to be more prudent about UM as we resume activities, 0:01:56.880 --> 0:02:02.880 as businesses, restaurants, uh, department stores start to open. We've 0:02:02.880 --> 0:02:05.840 got to observe social distancing, we've got to use mass 0:02:06.440 --> 0:02:08.880 um and do things that less than the spread of 0:02:08.880 --> 0:02:13.480 the infection. Well and David, largely because all of this 0:02:13.639 --> 0:02:15.839 comes down to or so much of this comes down 0:02:15.840 --> 0:02:19.560 to essentially hospital capacity, So help us understand from the 0:02:19.600 --> 0:02:23.240 perspective of someone running a hospital, what you worry about 0:02:23.320 --> 0:02:27.680 with this spike and what hospitals like yours are doing. 0:02:27.880 --> 0:02:31.399 And obviously you're not facing at the moment any sort 0:02:31.400 --> 0:02:34.600 of surge, But in your shoes or in the shoes 0:02:34.680 --> 0:02:38.519 of others running hospitals, what are they thinking about. Well, no, 0:02:38.600 --> 0:02:40.600 I appreciate that opportunity. One of the things that we 0:02:40.680 --> 0:02:43.360 wanted to do, and certainly with any slowdown, which we 0:02:43.440 --> 0:02:47.000 did as the initial pandemic came on, as we started 0:02:47.040 --> 0:02:49.440 to see the numbers diffendit, what we were most concerned 0:02:49.440 --> 0:02:51.840 about then is getting some of the folks back into 0:02:52.400 --> 0:02:54.720 the queue that actually needed some of the delayed surgeries 0:02:54.720 --> 0:02:57.480 and other things that were going on. We started with, 0:02:57.760 --> 0:03:00.400 which I think is a bit of a model, building 0:03:00.400 --> 0:03:03.400 on what Dean Miner said, actually doing testing, so making 0:03:03.440 --> 0:03:07.720 sure that the population that we had within the hospital itself, 0:03:07.880 --> 0:03:11.120 our employees, our physicians, uh that we were free of 0:03:11.120 --> 0:03:15.120 the virus. And we actually tested over twelve thou employees 0:03:15.120 --> 0:03:18.400 and staff and saw less than a point three percent 0:03:19.120 --> 0:03:21.560 of those staff actually had the virus, And so we 0:03:21.639 --> 0:03:24.280 knew that we were creating a safe environment. But I 0:03:24.280 --> 0:03:27.040 think it's important. Despite being able to be there and 0:03:27.080 --> 0:03:29.720 be a resource for the community, we do also have 0:03:29.800 --> 0:03:32.399 to have capacity. And one of the things that we've done, 0:03:32.400 --> 0:03:37.360 despite opening back up doing our elective surgeries, is creating 0:03:37.400 --> 0:03:40.880 still a capacity within the organization that's there and always available, 0:03:41.240 --> 0:03:43.839 because that really is the concern is if we get 0:03:43.840 --> 0:03:47.160 another significant spike, well, we have the capacity to be 0:03:47.200 --> 0:03:48.480 able to treat and we want to make sure that 0:03:48.480 --> 0:03:50.840 we're ready for that this time without having to shut 0:03:50.880 --> 0:03:53.760 everything down. Well, Dean Minor, you know what have we learned? 0:03:53.840 --> 0:03:55.920 You know, here we are, Jason and I have been 0:03:55.960 --> 0:03:58.080 working from home essentially. Jason went into the office a 0:03:58.120 --> 0:04:00.280 little bit this week, but he's back home. But here 0:04:00.280 --> 0:04:03.800 we are, and I think week fourteen, week fifteen, Um, 0:04:03.840 --> 0:04:07.720 what have we learned from the medical perspective about how 0:04:07.760 --> 0:04:09.480 to treat with the how to treat the virus, how 0:04:09.520 --> 0:04:12.400 to stay ahead of it, how to watch for either 0:04:12.440 --> 0:04:16.839 another spike? I mean, tell us what we've learned? Thank you. 0:04:17.000 --> 0:04:19.560 I think we've learned several things. First is that this 0:04:19.720 --> 0:04:23.359 is a respiratory virus. The principal mode of transmission is 0:04:23.360 --> 0:04:26.960 from one person to the next through secretions through mucus, 0:04:27.000 --> 0:04:30.960 through a cough, um and and there may be other 0:04:31.600 --> 0:04:35.800 modes of transmission as well, but the main danger is 0:04:36.240 --> 0:04:40.360 through direct contact with secretions of someone who is infected, 0:04:40.600 --> 0:04:44.520 and it is a highly infectious virus. We've certainly improved 0:04:44.560 --> 0:04:48.520 our ability to treat people who become ill in the 0:04:48.560 --> 0:04:53.280 hospital our own hospital, Stanford Hospital UH we have been 0:04:53.320 --> 0:04:58.200 a pioneer in the studies of brindissevere that has been 0:04:58.240 --> 0:05:02.920 shown to be effective and in improving the recovery rate 0:05:03.320 --> 0:05:07.279 uh and and perhaps also in lowering the risk of 0:05:07.440 --> 0:05:11.560 mortality from the virus. We've been a part of those studies. 0:05:11.640 --> 0:05:14.880 We now have studies going on in the outpatient setting 0:05:15.240 --> 0:05:19.359 using anti virals at the time someone is diagnosed with 0:05:19.400 --> 0:05:25.120 the infection, before they become severely ill, using antivirals in 0:05:25.240 --> 0:05:28.600 a clinical trial setting in order to determine if there 0:05:28.600 --> 0:05:32.000 are therapies we can give to outpatients that reduce the 0:05:32.040 --> 0:05:35.200 severity of the disease and reduce the likelihood that people 0:05:35.200 --> 0:05:37.920 will need to be admitted to the hospital. We know 0:05:38.080 --> 0:05:42.280 that the tragedy in New York and in other places 0:05:42.400 --> 0:05:47.120 where hospitals and health healthcare delivery systems became overwhelmed. The 0:05:47.200 --> 0:05:51.000 tragedy was that we as health care professionals, were not 0:05:51.120 --> 0:05:54.520 able to provide the care we're capable of providing to 0:05:54.720 --> 0:05:58.920 patients who come to us because our facilities were overwhelmed. 0:05:59.240 --> 0:06:01.880 As long as we're not overwhelmed, as long as we're 0:06:01.880 --> 0:06:06.000 able to provide the type of high quality, intensive care 0:06:06.400 --> 0:06:09.080 that our hospital and so many others across the country 0:06:09.240 --> 0:06:12.720 are able to provide, As long as we don't become overwhelmed, 0:06:12.920 --> 0:06:15.400 I think we'll be able to take care of people 0:06:15.800 --> 0:06:18.919 throughout the course of this pandemic. But it's important to 0:06:18.920 --> 0:06:23.279 remember this is a serious infection in many people. Um 0:06:23.279 --> 0:06:26.039 in young people it tends to be less severe, but 0:06:26.160 --> 0:06:30.080 in older people or people who have underlying medical conditions 0:06:30.320 --> 0:06:34.320 like high blood pressure, diabetes, the infection can be very seriously. 0:06:34.600 --> 0:06:37.000 So we have to continue to take it seriously and 0:06:37.120 --> 0:06:41.520 to respond accordingly. So, David, it feels like as a 0:06:41.640 --> 0:06:44.760 society we're faced with a few big moments right here. 0:06:45.120 --> 0:06:48.080 You know, we're faced with this moment around racial justice, 0:06:48.200 --> 0:06:51.320 and we're talking a lot about that every day on 0:06:51.400 --> 0:06:53.440 this program, and I'm sure you guys are talking about 0:06:53.440 --> 0:06:56.080 it as well. It also seems like a moment where 0:06:56.120 --> 0:07:01.880 we are thinking about healthcare very pun intended holistically and 0:07:01.960 --> 0:07:05.919 really rethinking it in terms of if we were to 0:07:05.960 --> 0:07:08.719 sort of design this from the ground up, how can 0:07:08.800 --> 0:07:12.960 we create a healthier community? How can we create a 0:07:12.960 --> 0:07:16.160 healthier society Because we're going to be living with things 0:07:16.200 --> 0:07:19.120 like COVID nineteen for a long time, you have the 0:07:19.160 --> 0:07:23.760 responsibility of building a health care system in that image, 0:07:23.800 --> 0:07:27.040 how do you do it for everyone? Because equality is 0:07:27.080 --> 0:07:30.680 one of those big big topics right now. Obviously well, 0:07:30.680 --> 0:07:33.360 and I'm granting brought inequality because we know that there's 0:07:33.400 --> 0:07:35.600 disparities in the way that health is delivered, and we 0:07:35.680 --> 0:07:38.280 know that there's more that needs to be done and 0:07:38.440 --> 0:07:41.280 that perspective, and that's something certainly we're working on here 0:07:41.280 --> 0:07:43.920 at Stanford. There's a lot in that question that you 0:07:44.000 --> 0:07:45.920 just ask. I have to say because if you think 0:07:45.960 --> 0:07:48.760 about um, we have been trying for years to think 0:07:48.800 --> 0:07:52.640 about population health. How do we take care of populations? 0:07:53.520 --> 0:07:57.280 If we were doing this right, we hopefully we'll keep 0:07:57.320 --> 0:07:59.240 them out of the hospital to begin with, because we'll 0:07:59.280 --> 0:08:01.560 be able to keep them healthy and keep them in 0:08:01.640 --> 0:08:04.480 a venue where they won't need to come here. Oftentimes, 0:08:04.520 --> 0:08:07.160 within hospitals, we think about the care that we deliver 0:08:07.360 --> 0:08:09.720 is when there's a failure and when they need to 0:08:10.000 --> 0:08:14.200 receive treatment beyond what their own health will sustain. I 0:08:14.240 --> 0:08:17.320 think we have some real opportunities with this pandemic, which 0:08:17.400 --> 0:08:19.600 is certainly the first in my lifetime and I hope 0:08:19.640 --> 0:08:22.280 the last. But I think as we rethink the way 0:08:22.360 --> 0:08:26.240 that we deliver healthcare, one is that we are we 0:08:26.320 --> 0:08:29.240 actually have individual stewardship and responsibility for our own healthcare, 0:08:29.280 --> 0:08:31.920 and I hope that we're taking advantage of those opportunities. 0:08:32.280 --> 0:08:34.240 But at the same time, we can re envision the 0:08:34.280 --> 0:08:36.240 way that we provide care. And I'll just give you 0:08:36.240 --> 0:08:39.080 one example that I know you've heard of before, but 0:08:39.160 --> 0:08:41.960 it's transitioned here at Stanford, and that's just the use 0:08:42.000 --> 0:08:46.200 of our digital technology both to look at data in 0:08:46.280 --> 0:08:49.200 predictive ways, but also digital technology in the way that 0:08:49.240 --> 0:08:51.760 we provide the care and a lot of times being 0:08:51.760 --> 0:08:54.240 able to provide care to individuals at a place that's 0:08:54.280 --> 0:08:57.320 comfortable for them and also avoiding, you know, having to 0:08:57.360 --> 0:09:00.120 go out and have in this case, potential access to 0:09:00.200 --> 0:09:02.520 other parts of the virus. And so there's so many 0:09:02.559 --> 0:09:04.320 things that I think that we can do now to 0:09:04.400 --> 0:09:08.439 re envision the way that is we're using digital technology internally, 0:09:08.480 --> 0:09:13.880 both predictive modeling, but also telehealth. One quick example, we've 0:09:13.920 --> 0:09:17.560 gone from roughly two and we do a couple million 0:09:17.600 --> 0:09:20.360 clinic visits a year, two percent of those being done digitally, 0:09:20.760 --> 0:09:24.160 two at the height of the pandemic, those being delivered vidually. 0:09:24.200 --> 0:09:27.920 And so think about how we can not only mitigate 0:09:28.000 --> 0:09:29.920 some of the cost of health care but also be 0:09:29.920 --> 0:09:32.720 able to provide care to individuals at their own sites. 0:09:32.800 --> 0:09:34.679 And so there's so much that we can do and 0:09:34.720 --> 0:09:38.680 think about, but certainly data will have a big place 0:09:38.720 --> 0:09:40.800 in that. We want to use that data to actually 0:09:40.920 --> 0:09:43.080 drive our decisions. And I have to say to both 0:09:43.080 --> 0:09:44.320 of you, you know, Jason and I have spent a 0:09:44.320 --> 0:09:47.679 lot of time at Stanford UM. We've done several broadcasts 0:09:47.720 --> 0:09:50.360 for TV and radio at the Business School. You know, 0:09:50.400 --> 0:09:52.480 you guys are smack in the middle of so much 0:09:52.520 --> 0:09:56.239 innovation in terms of Silicon Valley and just the conversations 0:09:56.240 --> 0:09:59.120 about kind of where does the world go? Always forward looking? 0:09:59.400 --> 0:10:01.880 So dr My, I do wonder. I do feel like 0:10:01.920 --> 0:10:05.400 the medical community, and maybe not yours specifically, but just overall, 0:10:05.480 --> 0:10:08.720 has been slower to innovate. I think it's a hard 0:10:09.040 --> 0:10:11.920 it's a hard beast to move right, So what will 0:10:12.000 --> 0:10:14.320 be kind of the innovative trends that maybe come out 0:10:14.360 --> 0:10:17.120 of the virus and then just others that are going 0:10:17.160 --> 0:10:19.120 to come in the future that really will be part 0:10:19.160 --> 0:10:22.880 of the medical world. Well, I'm please you brought it up, 0:10:22.920 --> 0:10:26.440 because if we look at the digital transformation of of 0:10:26.480 --> 0:10:31.160 our lives, every sector of society and of the economy 0:10:31.480 --> 0:10:36.840 has been radically transformed by digital technologies, except for healthcare. 0:10:37.240 --> 0:10:40.160 I mean, think about the way we order goods and services, 0:10:40.200 --> 0:10:43.720 the way we perform financial transactions. They're radically different than 0:10:43.760 --> 0:10:46.920 they worked ten years ago. And yet healthcare, at least 0:10:47.040 --> 0:10:51.080 prior to four months ago, um, we were still using 0:10:51.080 --> 0:10:53.520 fax machines and still calling up on the phone to 0:10:53.600 --> 0:10:57.480 make an appointment in far too many cases. David mentioned 0:10:57.760 --> 0:11:02.200 this transformation that we've seen over an incredibly fast period 0:11:02.200 --> 0:11:04.920 of time towards telehealth, and I really have to do 0:11:04.960 --> 0:11:08.439 a big shout out to our i T team here 0:11:08.559 --> 0:11:12.679 that very rapidly scaled up for the type of transformation 0:11:12.720 --> 0:11:15.280 that David described to have us do at one point 0:11:16.920 --> 0:11:21.120 of our visits is virtual online visits. We we should 0:11:21.120 --> 0:11:24.960 not lose the momentum that that we've had to obtain 0:11:25.400 --> 0:11:28.680 during this crisis, because there is so much more we 0:11:28.840 --> 0:11:33.080 can do leveraging technology, not in a way that separates 0:11:33.160 --> 0:11:36.120 us as healthcare providers from our patients, but in ways 0:11:36.200 --> 0:11:39.240 that connects us in more meaningful ways with our patients 0:11:39.559 --> 0:11:42.679 and also helps us to address some of the disparities 0:11:42.720 --> 0:11:44.880 that you brought up and that are so troubling to 0:11:44.920 --> 0:11:48.000 all of us. Yeah, it's a really important conversation right now, 0:11:48.000 --> 0:11:49.800 and I'm so glad Jason and I are both so 0:11:49.840 --> 0:11:52.000 glad that we had some time, um to catch up 0:11:52.040 --> 0:11:53.920 with both of you, and hopefully we can get to 0:11:53.960 --> 0:11:56.880 back soon again in the future. Dr Lloyd Minor, he's 0:11:56.920 --> 0:11:59.480 Dean of the Stanford University School of Medicine, joining us 0:11:59.480 --> 0:12:02.520 on the phone for Stanford, California. Although with David Entwistle, 0:12:02.600 --> 0:12:05.679 president and CEO at the Stanford Healthcare Uh, and I 0:12:05.679 --> 0:12:08.640 feel like, um, we could talk to them forever because 0:12:09.400 --> 0:12:11.600 with everything that's going on, Jason, and we're hearing lots 0:12:11.600 --> 0:12:13.640 of conversations we hear, you know, we talk with so 0:12:13.679 --> 0:12:16.160 many different members of the medical community. You know, everyone 0:12:16.200 --> 0:12:19.280 agrees it's been slow to change, um, but these guys, 0:12:19.400 --> 0:12:22.160 they're certainly involved in what's to come. It's also a 0:12:22.160 --> 0:12:25.040 reminder that there are multiple constituencies here, right, you know, 0:12:25.080 --> 0:12:27.160 we think about it just as patients and doctors, but 0:12:27.200 --> 0:12:29.560 it's much more complicated than that. And you alluded to 0:12:29.679 --> 0:12:32.040 that when you talk about slow to change, and you 0:12:32.080 --> 0:12:34.959 have the pharmaceutical industry, and you have the medical device industry, 0:12:34.960 --> 0:12:36.960 and you have you know, all these elements of it. 0:12:37.360 --> 0:12:41.680 There's an academic and research uh community embedded in there 0:12:41.720 --> 0:12:44.640 as well, so important to remember all those aspects. Yeah, 0:12:44.640 --> 0:12:46.120 and a reminder that I think we're going to see 0:12:46.160 --> 0:12:50.160 a lot more technology working alongside humans to better situations, 0:12:50.240 --> 0:12:51.520 especially when it comes to healthcare.