COMMENTARY

Mar 13, 2020 This Week in Cardiology Podcast

John M. Mandrola, MD

Disclosures

March 13, 2020

Please note that the text below is not a full transcript and has not been copyedited. For more insight and commentary, subscribe to the This Week in Cardiology podcast.

In This Week’s Podcast

For the week ending March 13, 2020 John Mandrola, MD comments on the following cardiology news [and features] stories.

COVID-19

The exponential spread of coronavirus through Europe and the United States has given our time a post-911 feel. I follow about 1500 people on Twitter. 1495 of them are Tweeting about COVID19. This is a cardiology podcast, but it seems tone deaf to discuss anything else.

A UCSF expert panel did the rounds on social media. Among other things, their ID experts predicted that 40%-70% of the US population will be infected over the next 12-18 months. Containment is hopeless. Now it’s all about mitigation to flatten the curve or take away the peak of people getting sick at the same time.

In this podcast, I discuss several themes.

First Theme: Societal: The exponential spread of the virus was predicted. It was ignored. But it is now happening. Perhaps it was all the cancellations, perhaps it was Joe Rogan’s podcast in which an infectious diseases doctor from University of Minnesota spoke the reality, or the reports of National Guard blocking off a suburb of New York City, or stories on social media of sick people not being able to be tested. People have started to get serious about social distancing. At my hospital, we are talking about cancelling elective cases, doing remote checks of pacers, and virtual visits with stable out-patients.

Second Theme: Administrative-heavy Healthcare System: The COVID19 crisis will expose the problem with bureaucratic bloat in our system. Testing is the obvious example. I learned that a real-time PCR test was approved in South Korea in February but CDC and FDA are documented as having blocked or delayed this.

Another example is the slowness of stopping routine care in order to prepare. In our private system, virtual visits are discouraged because no one can get paid.

Third Theme: Leadership: We haven’t seen anything like this in my lifetime. When sick people come to the hospital and begin to overwhelm the system, we will need clinicians to lead. ICU doctors and nurses first, but then others may have to step in.

Doctors will make it clear that policies that punish workers for staying home when ill are harmful to patient safety. It’s always been this way, but COVID makes clear the difference between the façade of patient safety and real patient safety.

Fourth Theme: Changing of Norms: Some states are streamlining licensure requirements, to get more workers. Virtual visits should become reimbursable and encouraged.

Fifth Theme: Social Media: While some mainstream media is doing great work, the place to be to follow news on COVID is social media – primarily Twitter and blogs and podcasts. The thing with podcasts and Twitter threads, is that they allow for longer form information. Given the uncertainty of COVID-19, people want more, not less discussion.

Sixth Theme: Treatment: The preprint servers and Twitter case reports are coming on treatments of COVID-19. There is a push to get compassionate use anti-virals.

References

  1. Notes from UCSF Expert panel - March 10

  2. Will the Coronavirus Pandemic Trim the Nonsense in U.S. Healthcare?

Comments

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