In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. 

About Dt. Tista Ghosh:

Dr. Tista Ghosh, MD, MPH, is a medical director at Grand Rounds. She has specialized training in epidemiology and disease control and previously oversaw all outbreak response and preparedness activities for the state of Colorado. She has also consulted for the World Health Organization.

HLTH Team: What are your future projections on how COVID19 will continue to spread throughout the US? 

Dr. Tista Ghosh: I think that will depend on where you live. Typically, a novel virus that nobody has any immunity to will tear through an area and cause a fast spike in illness, unless we truly practice social distancing. So for example, the Bay Area, which was a couple weeks ahead in implementing social distancing policy, may see lower numbers of cases than New York City, which also has a much more dense population. I predict we will see spikes in cases throughout the country over the next few weeks, but they will be worse in places where social distancing policies were delayed or not implemented. And as a result, I think healthcare resources will become overwhelmed in many parts of the country, and virtual care options will become increasingly important.

HLTH Team: What states and metro areas are of a particular concern for you?

Dr. Tista Ghosh: We’re obviously seeing New York and New Jersey getting hit very hard with this virus. We’re also seeing spikes in Louisiana and Michigan. I think a great indicator to keep an eye on is the Outpatient Influenza-Like-Illness (ILI) monitoring system that the CDC has in place across the country. What that tells you is how many people are seeking outpatient care for flu-like symptoms (which in this case could be COVID-related). As those numbers surge in a certain location, it’s a pretty good indicator that we will start to see a surge in inpatient hospitalizations and deaths in those areas relatively soon. I also think those places that have been less stringent with their social distancing policies will be hardest hit. The Kaiser Family Foundation has a great resource summarizing policy actions taken in each state. In addition, I think parts of our country with the oldest populations may see the highest death rates.

HLTH Team: Looking at NY, why do you think the virus spread so rapidly here and what lessons can other states learn from what happened in NY?

Dr. Tista Ghosh: I think New York didn’t implement strong social distancing policies early enough. It was days behind other major metropolitan areas like San Francisco. Given that and how densely packed the population is, it’s not surprising to see such high numbers of cases and deaths. Other states can learn from this by acting quickly with regards to social distancing.

HLTH Team: When do you predict the shelter-in-place and other self-quarantine orders will begin to relax?

Dr. Tista Ghosh: I’m assuming it will be location-dependent, and will depend on how ravaged the healthcare system is in each place. Shelter-in-place is hard on everyone, but the longer we can maintain it, the less likely we’ll see a resurgence in cases.

HLTH Team: Many experts are saying that those who have had COVID19 and recovered are now immune, is this certain and what evidence is backing this up?

Dr. Tista Ghosh: We don’t know yet if infection with the novel coronavirus results in long-lasting immunity. A recent study in rhesus monkeys did see some short-term immunity. However, other studies of common coronaviruses in humans have been shown to result in only partial, short-term immunity. Whether natural infection with this novel coronavirus will result in short-term or long-term immunity in humans is still not clear.

HLTH Team: Do you predict that the warmer weather will slow the spread and if so, will there be another wave come the Fall?

Dr. Tista Ghosh: We don’t know yet. We’ve seen that type of pattern with other viruses, but we are also seeing this virus in countries with warmer climates, like Costa Rica or Australia (where it is summer right now). That said, if we do see a decrease during warmer months, we may see another wave in the fall.

HLTH Team: Switching to the front lines of the crisis, where do you think we failed to support our healthcare workers and what can we do to better support them as the coronavirus continues to spread?

Dr. Tista Ghosh: We have really failed healthcare workers with regards to Personal Protective Equipment. We are asking them to put themselves at risk, without appropriate masks or other equipment. And as those healthcare workers get sick themselves, clinicians will become a limited resource as well. It’s shocking to see this happening in America. We should have been ramping up production of masks and other medical equipment weeks ago. While I feel hopeful because many companies are voluntarily stepping up to producef masks and ventilators now, I still worry that this will be too late in some parts of the country.

HLTH Team: What can leaders across the health system, and perhaps executives outside of healthcare, do to contribute to the solution?

Dr. Tista Ghosh: I think access to virtual health services will be key in offloading the traditional, in-person healthcare setting. Health systems should consider expanding virtual methods to answer questions for the worried well or those with mild symptoms, and to serve people with chronic conditions like high blood pressure, asthma, or diabetes who may have difficulty getting their medications refilled or getting their regular checkups during this time.

If you are an employer in any industry, augmenting virtual health options could be the best thing to offer your employees. Consider making virtual guidance available through telephone support lines, clinician chat services, or other digital methods. In many cases, this will help offload the worried well from the overstretched healthcare system, and help those who are really ill get the healthcare they need. 

For those employees who are having difficulty getting into their doctor for routine visits or regular medication refills, consider what telehealth options or mail-order/delivery pharmacy solutions you might offer. And think about tele-psych or virtual behavioral health support options that you might offer your employees through this intense and difficult period. Another way to support employees is by offering virtual town halls or webinars with experts in infectious disease or epidemiology to help address questions and quell panic.

HLTH Team: Keeping in mind that things will rapidly change over the next few months, what do you feel have been the three biggest lessons learned so far stemming from this pandemic?

Dr. Tista Ghosh: 

1. More social distancing early on is incredibly important in lowering the impact of a novel virus.
2. We need to prepare better for the potential next wave of this virus, by increasing production of masks and ventilators in advance. We should not be caught flat-footed next time. And we need to better support our healthcare workers.
3. We, as a country, need to invest more time, effort and capacity-building in the telehealth space to better respond to emergencies.