[MUSIC PLAYING]

DANIEL KRAFT: Welcome to Healthy Conversations, an open discussion amongst health care professionals about what we've learned from the frontlines of the pandemic and how it's transforming our industry in real time. I'm Dr. Daniel Kraft. We're here to share the latest insights around our collective response to COVID-19. Let's dive in.

SCOTT GOTTLIEB: So we're going to see all this technology come into the market. All these new point-of-care-based tests, energy-based tests. PCR is going to continue to expand, and so the back end, the platforms for running the tests, are going to be widely available. What I worry about in the fall is the front end. Where do you go to get tested?

And I worry about a sort of a fall where if you call up your doctor and you say, I think I have the flu, the first thing the doctor will tell you is, don't come in. Go to a special COVID only testing site. So we need to make test a really ubiquitous and widely available at the settings where people are. So it's not a really encumbrance to go get tested. That's the only way we're going to turn over the mildly symptomatic and asymptomatic cases.

DANIEL KRAFT: That was Dr. Scott Gottlieb, former FDA commissioner discussing one of the most urgent continuing needs expanded testing. Dr. Sree Chaguturu and Sharon Vitti have been coordinating the rapid testing ramp up at CVS sites across the country. They're on the front lines of this pandemic in America's cities and towns, and here's what they had to say.

SHARON VITTI: To be impactful we needed to have a high level of testing volume, and multiple access points. And so we moved from having five sites that were doing about 1,000 tests per day, to having over 1,400 sites. I think we're going to have to evolve one more time as the fall comes along and there's a higher incidence of both ILI influenza like illness, and CLI, which I think are somewhat mixed together.

DANIEL KRAFT: I'm sort of interested to know what you've learned in the big picture. Triage is always an element for clinicians for health care systems.

SHARON VITTI: There has to be bi-directional communication because there's a whole ecosystem. Patients are either, one, trying to navigate that ecosystem, or two, receiving care by multiple providers in an ecosystem, whether it be primary care provider, the pharmacist, the minute clinic, nurse practitioner, whatever it needs to be. Making sure that patient feels like all of their providers are all on the same page and working together. So I think that's really important.

DANIEL KRAFT: What are the trade offs and what are the needs for testing to improve in the future.

SREE CHAGUTURU: We need to use a central laboratory, or are you able to bring the laboratory technology out into the field, into a doctor's office or to a point of care on a worksite.

DANIEL KRAFT: It might depend on if you're testing someone who's symptomatic versus a more public health screening.

SREE CHAGUTURU: For each solution needs to be customized and configured for the continuity needs of that university, or for that employer. So if you think about universities. A university might be a regional university, it might be a university that has people coming from all over. It might be a commuter university or might be hybrid or all on dorms. So just listening to that, you can imagine each university would have-- and college-- would have a different need.

But employers, they think about testing. People who might become symptomatic at work. And so they screen for a fever as they're walking in, and so you want to rapidly assess is this COVID-19. And then the last port is reporting and analytics. And so that reporting and analytics is reporting that's out back to public health authorities around tests that come back positive, a dashboard in analytics that help employers understand what are the number of tests that have occurred, what the positivity rate, what's the geo-mapping.

SHARON VITTI: To have a level of interoperability so that what we're doing is not on an island. No matter how quickly we want to stand this up, no matter how large the demand is, it's very important to make sure you've got that foundation.

SREE CHAGUTURU: The unfortunate reality is that we have a health care system that has been rife with racial inequity and disparities, and this pandemic has only accentuated and enlarged those disparities.

DANIEL KRAFT: With that in mind, I'd like to hand it over to Dr. Dela Taghipour and Dr. Garth Graham to discuss this complicated issue and what we as health care professionals can do to mitigate its impact moving forward.

DELA TAGHIPOUR: A disease or an illness leveling the playing field and making everyone aware of their vulnerability, but of course, we saw that even in this virus that we didn't think should show bias actually did. Why do you think that was?

GARTH GRAHAM: A couple of key factors. One, underlying issue around on social determinants of health. And then the overrepresentation of African-American and Hispanic populations in frontline essential jobs. People who we need to power our country, but by doing that they're putting themselves continuously at risk.

A lot of folks have also alluded to the disproportionate impact of underlying disease from diabetes, hypertension, asthma et cetera. One of the things that used to always kind of get me down is when I'd see patients who thought that whatever their drastically bad hypertensive number was, was what it was always supposed to be. So the blood pressure 190 over 100. And a lot of times we'd be like, wait, that's not acceptable. Oh, it's always been that high. So that they've kind of reset themselves to a new normal that is actually not normal. And I think for a long time as a country, we've been in a not normal state for a lot of those folks in our community.

DELA TAGHIPOUR: How do you think implicit bias plays out in our industry in health care?

GARTH GRAHAM: One of the more troubling things Dr. Taghipour that I've seen is even the data on pain, and how clinicians treating the same patients with the same pain syndrome disproportionately feel like African-Americans, among other minorities may be tougher and need less pain medications. As you know, some of this data filters on to trainees, meaning the next generations are coming behind us.

DELA TAGHIPOUR: This really is an opportunity to take a look deeply at what's going on systemically in the system that not only has impacted the outcomes in this pandemic, but really, as you said, in every aspect of health.

DANIEL KRAFT: This is the kind of analysis that can help us deliver better care to those who need it most. I'll leave you with one more thought from our experts.

SCOTT GOTTLIEB: What we should learn from the initial response is the importance of having a coordinated strategy. That the country really is subject to what each state is doing, and if one state isn't doing a good job turning over cases, or is slow to implement mitigation, that can put the entire country at risk.

SREE CHAGUTURU: As unsettling as it is, it has been an era of unbridled creativity, collaboration, and speed. And so if I look at my clinical scientist colleagues, the amount of sharing that's occurring around scientific discovery, what might have been a meeting that you scheduled a week in advance is now pick up the phone and let's figure this out right now. And time is of the essence.

GARTH GRAHAM: I once heard somebody say never let a good crisis go to waste. And so let's take advantage of the moment to make sure that we leave it better than we found it.

DANIEL KRAFT: Thank you for watching Healthy Conversations. It's our mission to reveal the frontlines of the health care profession and educate everyone as to the challenges and potential opportunities of a world changed by corona. Next time we'll look at COVID recovery efforts, how we're using data and modeling to our advantage as we continue to tackle COVID, and the role that digital health tools play in recovery efforts.