Episode 69- Covid-19 A New Deadly Wave
Welcome to Richard Helppie’s Common Bridge. The fiercely nonpartisan discussion that seeks policy solutions to issues of the day. Rich is a successful entrepreneur in the technology, health and finance space. He and his wife, Leslie, are also philanthropists with interest in civic and artistic endeavors with a primary focus on medically and educationally under-served children.
Rich Helppie:
We’ve got a special edition episode of the Common Bridge today. And it’s about COVID-19, there’s been new information about the corona virus case counts are up. There’s been a lot of reporting on this, and I know it’s confusing to hear terms tossed about and different interpretations of the data. But one of the things that we do on the Common Bridge is we get experts in the field who can tell us what’s happening from the seat that they sit in. And today we’re very fortunate to have Robert Casalou. Lou Rob has been a long time healthcare executive. His full biography is on the website, RichardHelppie.com. Rob, welcome to the Common Bridge.
Robert Casalouu:
Thank you Rich. It’s really good to be with you.
Rich Helppie:
Rob, tell us just a quick snapshot of your career, or academic preparation and what’s the job you’re doing today?
Robert Casalou:
Well, starting with academics, cause tomorrow’s a big day for us with the Michigan-Michigan State football game, Rich, but I went to the University of Michigan for both my undergraduate and graduate work. I did economics as an undergrad and then an MBA and an MHA as a graduate student.
Rich Helppie:
An MHA is a master’s of healthcare administration.
Robert Casalou:
Correct. And I actually started my career in the auto industry. I was about 10 years in the auto industry on the supply side working for one of the major suppliers to the OEMs, traveled the world. It was a great experience, but I had always wanted to be in healthcare. So I went back to school, ended up as a student intern at Providence Hospital in Southfield, Michigan working for a Catholic health system. And now 30 plus years later, I’m still in Catholic healthcare. My current role though is now at Trinity Health and I’m the CEO of Trinity Health, Michigan and Georgia and Florida. Trinity is one of the largest national systems in the country in 22 States, and I work as the regional CEO in three of those States.
Rich Helppie:
And how many hospital facilities, employees, physicians are in that area of responsibility for you?
Robert Casalou
Well, overall there’s 12 hospitals and 35,000, employees-colleagues as we refer to them. In Michigan specifically, we have seven hospitals. We have 25,000 colleagues across the state of Michigan.
Rich Helppie:
So Rob Casalou is coming to us as someone that’s had to deal firsthand with the COVID-19 pandemic. So today I am expecting we’re going to have some education on what’s behind the COVID numbers. We’ve heard this news about new highs in corona virus cases and corona virus deaths. Look, six or seven months ago healthcare providers were overwhelmed. Today we hear about the front line heroics and hopefully we’ll get an update and see if we’re better prepared for what could be a second wave. So I’m expecting a real educational session. So Rob, from the front lines, you’re taking care of corona virus patients, you’re restarting all the other health care services and taking care of the caregivers on the front line. We’ve heard about the rising COVID-19 cases. What’s causing this?
Robert Casalou:
Well currently, yes, you’re right. We hit our surge, obviously, back in April in the state of Michigan and it was primarily centered in Southeast Michigan where the density of population is in the state. We went off the charts back then, the numbers were high in the hospitals. We were concerned about enough capacity, enough protective equipment. We didn’t know a lot about the virus. I mean, we’re learning every day about this virus. And so it was really a fire drill Rich, to to be honest about it. This time around-then we got things under control and Michigan actually was one of the states that has had it under control the longest and most consistently. And what I mean by that is our numbers. We got them down in the hospitals, we got them down in the communities. And for the months of roughly starting in June, June, July, August, we were doing really well. And then all of a sudden now the last particularly two to three weeks, even yet today, we hit our high mark now, that we haven’t seen since early in may. And it’s a little different this time. One it’s in different parts of the state, primarily in West Michigan. So we’re seeing a spiking now of hospitalizations and cases in the western part of the state and the northern part of the state. When you look at the current surge that’s going on, it’s actually less in Wayne County, city of Detroit, although it’s still picking up there, but nothing like the rest of the state. The other differences, a little bit of a different demographic. The deaths and infections still infect elderly and what I mean by elderly-and I always have to be careful not to put myself in this category-but 60 and older is defined as the risk area. The predominant deaths and problems with this virus still reside in nursing homes and things like that. But now we’ve seen college campuses surge. We’ve seen some people kind of get pandemic fatigue, so there’s more gatherings, more parties, more bar kind of stuff. And that has really fueled this increase. And also to be honest, the fatigue around the pandemic, and also our personal views. We don’t have consistent use of the guidelines around masks, social distancing, and the like, so the combination of all that is putting us back on a trend to go right back where we were in April, if we don’t put a stop to it.
Rich Helppie:
So Rob, that is very much one of those multifaceted causes, non-compliance with health practices, so unguarded gatherings would be a great example, college students going back to school. And I think we should come back to that because I think that’s a little different aspect. But we’ve heard allegations that no, we we’ve just doing more testing, therefore we’re finding more cases. So is it just the result of more testing or changes in the reporting in some way?
Robert Casalou:
The part of that statement that is absolutely true Rich, is that there is more testing. So, right now we’re hitting about 60,000 tests a day in the state of Michigan. That’s far more than we were doing daily back in April. And that was partially because we didn’t even have the availability of tests. So, this line that you hear around, well, if you do more tests, you find more cases. We’ll actually, that’s true. However, that’s not the metric to watch, it’s not even the case count that you really should watch, which you should watch is the positivity rate, because what it tells you is regardless of the number of tests you are doing, how many of those tests are actually finding positive cases of COVID. And the guidelines around this are pretty tight in terms of-and pretty prescriptive-in terms of where you start to become worried. Now what’s considered manageable and low is anywhere from obviously under 3%. That’s where you want to be on positivity rate. If you’re at 3% or less, that tells you there’s not a lot of spread. If you start to see increasing amounts, as we are now in the state of Michigan, we start to reach other levels. And so we have like three counties in the state of Michigan right now that are 10 to 15% positivity rate. So you can imagine if the testing volume’s going up as is the positivity rate, this virus is spreading. There’s no debate about that. So it’s unfortunate that some people only focus on well we’re doing, more testing and now we’re going to have more cases when the fact is it’s the conversion of the numbers of tests to positive that we’re most worried about. We have 16 counties that are at seven to 10%. Now, mind you, the whole state of Michigan was around two and a half percent back in the middle of the summer. And now the state of Michigan on average is over six and a half percent. So this virus is spreading.
Rich Helppie:
And isn’t that one of the greatest threats from this virus is the asymptomatic spread in that, like surveillance on a college campus and they’re finding students who may have mild symptoms, or may not be aware even that they have been infected that would raise the positive case count, but is there the next data on the stream? Would it be treatments? Would it be hospital occupancy? What would-clearly there’s a risk because more people infected means more spread, even if some of the people that get it in that arc, are not going to be personally affected.
Robert Casalou:
Sure. Well, you raise a few issues I want to touch on because they’re all really, really good points that get discussed-usually in silos. One is let’s talk about the students for a minute, the younger population who’s getting infected right now. There’s a school of thought with some, well, they’re younger, they’re healthier, the mortality rates are really low. So why are we worrying so much about that? I’ve heard that. Now what they don’t talk about is the vectoring of that virus through those young individuals, back to their homes, back to their grandparents and their parents and bringing that virus and being the carrier of that virus, to those who are vulnerable and not healthy and would be at risk. So it doesn’t give me any comfort to hear well, the population’s younger. Okay.
Now number two, hospitalizations are a lagging indicator. When you see hospitalizations going up, your problem started two to three weeks ago, and we are seeing hospitalizations rise, not just in my seven hospitals in Michigan, but across the health systems. We confer with each other continuously. And we report our data every day to the state of Michigan, and we keep track of this and the trends are going in the wrong direction, which tells you that these infections started occurring at an increasing rate two to three weeks ago just because of the evolution of the disease, by the time people get sick enough to come to the hospital and our hospitalizations are much higher. Now, the demographic is still largely older people, although some younger in the hospital. And we don’t have as many on ventilators in the ICU as we did before. And it isn’t because, necessarily that the virus has changed or even that the demographic has changed. But we’ve learned about this virus a little bit. So we have treatments available that we didn’t have in April that we have now that are helping treat these patients. We know better to hold off on ventilators as long as possible, because once you put a person on a ventilator, the mortality rate goes way up. I mean, all along the way we’ve learned. And that’s why at least the good news is that we’re having a better experience in the hospitals. But the death rate is still very high with this disease. And we can’t be faked out by my comment that the people aren’t all in the ICU, because the death rate back in April was probably 5-6%. The death rate of nursing home patients is 38%. I mean, it’s huge. And so now that the death rate is around 3%, nobody should feel good about that.
Rich Helppie:
How prepared are our hospitals right now? And what have we done in terms of capacities for personnel supplies, beds and such?
Robert Casalou:
Well, we were scrambling in April, right? And we were doing everything we could to just keep our head above water and we canceled all kinds of care. And we just focused on the disease. A lot of our PPE that we received was coming from, actually coming from China, the irony is our masks and all that were being made, the raw materials for the gowns that we use came from Wuhan, China-true story. So what we’ve done over the course of the summer, when we’ve had a very manageable amount of this disease in our community and our hospitals, we created other avenues for supply chain. We have filled the supply chain with adequate days of supply. We’ve gone to reusable masks, we’ve gone to reusable gowns, we’ve done some things creatively to make sure that PPE wise we’re okay. We reconfigured our hospital and outpatient and office clinics so that we can separate the patients who either have this disease or suspected of having it to make sure we don’t co-mingle populations. So we’ve been able to bring all of our work back, the non COVID work, in a very safe environment. Now, if you were to ask me if we get back to the levels of surge that we had in early April, I can’t answer whether or not we’d be able to hold on to all of our elective work. Right now I’ll give you an example. Our peak day on April 7th for Trinity Michigan, we had roughly 600 inpatients with COVID in our hospitals, largely in three of them, located in Southeast Michigan. Today, we hit a number of 172 compared to that 600. So we are nowhere near where we were, but I will tell you, we were at 30, just about four weeks ago. So you can see the trajectory.
Rich Helppie:
I see. And my understanding is when you talk about elective surgery or elective care, we’re talking about serious things, your colonoscopies, your cancer screenings, management of chronic disease, diabetes, and such. And we’ve seen this manifest itself in more acuity or more sicker patients. And you’re trying to balance the needs of both of those within the constraints that you have in terms of facilities, supplies, and personnel.
Robert Casalou:
Very true. I mean, it’s a little bit of a balancing act. Now, when you were in a situation like us Rich, where we have multiple hospitals that are co-located and also working very cooperatively. I should mention the cooperation amongst the health systems has been incredible. And we’re able to load balance both not only with patients, but also with resources. So if we have somebody who’s being overwhelmed, we have the ability to work together, to try to spread that load and also help each other out. And so we perfected that during the initial surge in April, we did a very nice job of that. And so we’re already gearing up in advance now, even though we’re not near where we were in April, we’re already working together with the other health systems and our incident command. So that we’re ahead of this game, if this trend continues.
Rich Helppie:
And I think all of our listeners should take comfort in knowing that we have really good people at all levels within the healthcare system. And at a later date, I do want to come back to some of the changes that we need to make in our health system, paying for keeping people well versus the number of things we do to fix them after they’ve become injured. I was actually looking at the CDC website and looking at obesity rates, which according to CDC, Merit, 42% of Americans today are considered obese. And then I went through the health impacts of obesity, which is of course, heart disease and diabetes and cancers, and many other things. And then they’ve started going into the demographics of the people that develop acute illnesses based on obesity, and it tracks where the worst impacts of COVID have hit. So clearly we need to start making sure that we’re taking better care of ourselves before these pandemics hit. And maybe our immune systems might be a little better. Probably a bigger topic for another day I would think.
Robert Casalou:
Well, it is, but you’re pointing to the issue that we’ve been now really spending time with and that is how this pandemic really put a spotlight on health disparities within our communities and how it hits certain communities harder because those communities exhibit a lot of the risk factors that you just mentioned: obesity, diabetes, heart disease, and this virus preys on weakness. This virus gets in some bodies and it kind of just acts like a mild flu. And then it gets in some people’s bodies and it’s senses weakness, and it takes over. It’s amazing to watch what can happen to some people in a very short period of time with this virus, where another person just feels bad for a couple of days. And that’s kind of the, I think, some of the misunderstanding that occurs is that some who have experienced it and had a mild experience, are like what’s the big deal, or these are young people-what’s the big deal? What they don’t realize is what we’ve seen in our hospitals, what we’ve seen in our clinics and the devastation that this virus can do to a body is unbelievable.
Rich Helppie:
Rob, we’ll definitely be looking at the structure of our healthcare system. I know on the Common Bridge we’ve had now, well you would be our sixth expert on healthcare. And interestingly, we’ve all come to a very similar conclusion, although very different starting points. Let me just jump into a quick lightning round here. So really short answers, or you can pass. Rapid fire. How effective are masks?
Robert Casalou:
Very effective. I, there’s no debate on this one. The, I don’t even know why there is a debate.
Rich Helppie:
Look if you look over at Taiwan, Hong Kong, other Asian countries that have dealt with other outbreaks, SARS, for example, you don’t have to convince them. You tell them there’s a virus out there. Everybody masks up practices social distancing, and if you look at the numbers, they have very, very low infection rates and very few fatalities.
Robert Casalou:
Think about one thing, Rich, we don’t even need science on this one. We know one thing for a fact that nobody’s argued about-that this is an airborne virus. It transmits in the air by our breath and by our spit and anything that comes out of our nose and mouth. So if you know that as a fact, then why would you argue about a mask?
Rich Helppie:
Well, I know it makes perfect sense to me. How about hand hygiene is that the only cleaning practice we need? I know at the beginning of this, that people were washing their groceries and that type of thing. And I guess that perhaps the idea that this transmitted on surfaces is gone down, but hand hygiene that remains important, yes?
Robert Casalou:
Absolutely. And anything, your hands touch. There’s been guidelines out that you don’t have to necessarily wash your groceries and all that thing, but your hands go to your face. And that’s why as many times, if people touch their face that’s why we want to keep the hands clean. But the hands touch your cell phones, the hands-even the outside, some people make a mistake with their masks. They can have that virus on the outside of their mask, and then they put their hand on the front of their mask, they take their mask off, they take their hand to their face. Oh my gosh, they just defeated the whole purpose of the mask. So keeping the hands clean, because it is the number one transmitter of bacteria and virus, that we know.
Rich Helppie:
Rob, looking at the data back in April. The idea of the day that based on where we saw the data about who was affected in such that if you’re under 45, you don’t have any symptoms, you’re not near an aged or a health compromised person, probably okay to get back to work or school-true, false, some of both?
Robert Casalou:
If you’ve been exposed or you think you’ve been exposed, there are very specific recommendations and guidelines on what you should do regardless of your age. And that is to quarantine yourself. And it depends, I have seen the guidelines from 10 to 14 days because you can develop an asymptomatic spread of this virus. So it’s not age specific when you’ve got to be cautious and not be cautious, you should quarantine.
Rich Helppie:
I’m going to jump into quick lightning round, relative to schools and where I’ve personally witnessed the economic disparities between affluent areas and disadvantaged areas. When kids can’t get to school, they’re missing out on years of development and often the only safe place they can get to. France and Germany, and now Ireland have issued new lock-downs, but this time they’re excluding schools. And we had judge Milton Mack on episode 38, he is an expert in public health. And then episode 67, we had Dr. Martin Kulldorf, who talked about the impacts on public health, from the continued stay at home orders, not only delayed treatments, but especially around school children. Do we know enough now to safely open schools and keep everything else restricted?
Robert Casalou:
Well, as you know, there’s been schools that have gone completely virtual, and then there are schools that are using a hybrid model or are having students come in. And if you notice the current surge that we’re going through right now, no one’s pointing to the schools, and particularly the K through 12 as the source of these of this surge. I have personally witnessed schools that are following some excellent guidelines and able to bring kids into school safely. And I think when we talk about the colleges, and I know of a couple of examples where the colleges have gone through great pains to make it safe, it isn’t the school itself that’s creating the problem, it’s the gatherings, the parties, and the things of that kind of behavior. So when we look at what’s going on now, Rich, I think personally, I think a lot of people describe that you can safely open your schools, but you have to marry that with very diligent discipline around the things we’re seeing now that are causing an increase in our cases.
Rich Helppie:
Rob, what did we not cover today that we maybe should have discussed?
Robert Casalou:
I think Rich, I will tell you that I’m watching the dialogue right now and the fatigue factor, and I get it. And this hope of a vaccine right around the corner, which we know is coming. We’re going to run a course on this. And the nursing homes right now are still a huge, huge concern. They’re not getting a lot of air time right now, but they are a huge concern. And I think what we really have to do is emphasize with your listeners, emphasize with everybody, that from a healthcare perspective, and I’m speaking now on behalf of intensivists, nurses, infectious disease experts, who are sleeping very little these days, taking care of patients, they’re begging and asking everyone to buckle down for the next few months and get through this. There are so many avoidable deaths right now it breaks our heart. That we could have avoided a lot of the 7,500 plus deaths we’ve had in the state of Michigan, 600 of those in my own hospitals. And these individuals die alone. Okay. They die alone. And so I know that unless a person feels like they’ve had this personal experience, they may not believe this. I am telling you without any kind of agenda, other than care, that we need to really buckle down and work together to beat the thing and get through to that vaccine. So that’s, I wanted to at least say that at the end, because it’s a very deep seated belief on my part.
Rich Helppie:
I don’t think we can add anything to that. We’ve been listening to healthcare, senior executive and leader, Robert Casalou of the Trinity health system on this special edition of the Common Bridge, relative to COVID-19 and the numbers. Everyone, please stay safe. Whatever you’re doing, however active you are, wear your mask, keep social distance, wash your hands and look out for your fellow human beings. This is Rich Helppie signing off on the Common Bridge.
You have been listening to Richard Helppie’s Common Bridge podcast. Recording, and post production provided by Stunt Three Multimedia. All rights are reserved by Richard Helppie. For more information, visit Richard Helppie.com.
