Biotechs around the world are sprinting to develop a viable coronavirus vaccine. But which will get to the finish line first? In this episode, Business Insider’s healthcare reporter Andrew Dunn takes us through the myriad of concurrent trials taking place and what this all means for potentially changing the course of the pandemic.

TRANSCRIPT

Jeffrey Freedman: Hello, and welcome to the RP HealthCast by RooneyPartners. I am your host Jeffrey Freedman. It seems like every day now we hear of promising new discoveries or potential cures for the novel coronavirus. Just last week, there was a study that came out of the UK out of Oxford University, about an older, inexpensive steroid that had preliminarily been shown to help patients on respirators, but it has not been shown to have any effect for people with milder symptoms. In fact just the opposite, it could potentially be harmful to those people with milder symptoms. The much-touted remdesiver, it’s been shown to have the opposite effect actually. It’s been shown to help people with milder symptoms recover quicker, but it has not been shown to help severely ill patients. The one thing we know for sure is that we just do not know enough about the disease and because of that we cannot find a potential cure right now. To make sense of all this, our guest this week is Andrew Dunn. Andrew is a healthcare reporter at Business Insider, covering the pharmaceutical and biotechnology industries. For the past several months, Andy has been reporting exclusively on the current coronavirus pandemic. His stories have taken an in-depth look at vaccine discovery and clinical trials for potential new therapies. Andy, it is a pleasure to have you with us here today. 

Andrew: Yes, thanks for having me. Happy to do it. 

Jeffrey: Great. Now before we get started on your in-depth novel coronavirus reporting. I want to take a step back and discuss how you got here. You join Business Insider from a solely healthcare-focused organization. A great organization called BioPharma Dive, was this a tough or weird transition being able to carve out a healthcare niche at Business Insider which covers everything? 

Andrew: Yes, it’s been an interesting transition. BioPharma Dive is more on the trade publication side for business news. At Business Insider, one thing that was helpful as far as making a smoother transition was that I am still covering the same industry, so I am still covering the drug industry, pharmaceutical biotech companies, just the audience has changed. 

Jeffrey: You joined Business Insider at a crazy time, I mean, it was a pivotal time. It was right before the coronavirus reached our shores here in the US and I think your first article or one of your first articles was back on January 23rd. It was entitled and I quote, “A vaccine for Wuhan Coronavirus could take years to develop based on our experience trying to fight Zika and Ebola.” Now, what were your thoughts back then? Starting with a new publication and then stepping into this global issue. At the time of that reporting, they are only six hundred thirteen people infected. Did you think it was a global issue back then?

Andrew: You mentioned that article, January 23rd that was my first week on the job. So I was going through a lot of the orientation stuff, what you typically know when you start up at a new company and basically between those moments I reported out that story. Basically that the gist of it was we were hearing some level of discussion about some vaccine efforts for this novel coronavirus and basically I was saying based on how Ebola went, Zika went if you look at other infectious diseases, vaccine development takes multiple years and many billion dollars usually to get something over the finish line. Sometimes it does not happen like Zika. There is no approved vaccine for that yet. Ebola there is one now, but I mean as far as the global issue in realizing how big of a new story this would turn out to be, I definitely did not realize that in late January early February. I think I was aware of the potential but it was hard for me to imagine how widespread it would become.  

Jeffrey: Yes, and it really hits corona all the time in the news cycle and it has to be, but I think that experience you have or that interest you had in gene therapy, in gene-drug development probably led you into discovering and following Moderna who is working on that, right? 

Andrew: Yes. 

Jeffrey: Also you started early on, first reporting on Gilead and they were repurposing their experimental drug, which is now Remdesivir. So how do you get dialed into following these companies? You mentioned the gene therapy, what about Gilead and Remdesivir back in January?

 Andrew: Yes, I mean I think that these were on my radar really early on. I think both those companies before this virus happened are just particularly fascinating companies. Moderna has been one of the buzz startups and biotech for the last decade and they have just raised these massive funding rounds to off of this vision really for a new modality of medicines. MRNA is the name of their platform, which is still an unproven technology, but they have raised these mask evaluations and just record funding rounds over the last ten years based on the potential for its platforms. So, that was a really interesting story before that COVID vaccine effort even began that I was interested in. Gilead likewise is one of the biggest biotechs in the industry. I think their market value is something like ninety billion dollars and they obviously have a really interesting business story. Again before coronavirus, they develop these transformative medicines for HIV and hepatitis C and are now sort of at a crossroads where a lot of their focus has shifted to immuno-oncology, some cell therapy medicines for cancer. I was really curious in a business story how do you transition from one of these focus areas to another and then obviously with remdesivir they are antiviral here. It is playing a fundamental role and immediate response to coronavirus. So that quickly became the focus too. 

Jeffrey: All right, so let us fast forward almost five months or six months later to today. Now in these short few months, we went from as you said January six hundred and thirty confirmed cases worldwide and eighteen deaths to approximately eight million confirmed cases and half a million deaths worldwide over a quarter that number coming from the United States alone. Now, aside from face masks and social listening, I hope we are further along, for protecting ourselves from this. Now, where do we stand with these, it was back in January, promising medical discoveries and I would love to be able to unpack them one at a time. Now first, can you define the difference between a vaccine and a treatment?

Andrew: Yes, so vaccine and treatment, it might be helpful, there are three big buckets that at least I think through as far as distinctly different when you think about the pharmaceutical industries response to this virus. So first you have repurposed treatments, which are basically medicines that already exist. We already know their safety profile. They are used in other indications. So, this is something like remdesivir would fit in this group. It was tested against the Ebola virus in humans several years ago. It did not work on Ebola very well, but it did show that it was safe which was valuable and being able to quickly test this in COVID. The second bucket is sort of these therapeutics where you are crafting drugs to fight this virus. That is kind of a middle ground approach of repurposed drugs you are going to have available immediately and we could start testing in January, February and March. Therapeutics are just now entering the clinic. So we are seeing some antibody-based drugs. Some drugs are based on the blood of COVID-19 survivors. These medicines are now sort of entering human testing in June, July, August with the goal of some of the earlier efforts being available this fall or later this year. The third major bucket is obviously vaccines ideally will prevent infections, massive administer vaccines to healthy groups of people. It gives them the immune response or prepares them with an immune response if they are exposed to the virus, their bodies can fight it off and not become infected and even a partially effective vaccine would be massively helpful and a partially effective vaccine will be something that reduces the severity of the disease. So taking that vaccine you might still be infected but there is a much lower chance that you will end up in the hospital and hopefully that can weigh down to mortality rates with this virus. So those are kind of the three main buckets and I am happy to go into more detail on each of those if you want and we could start with repurpose treatments and kind of go lay the land there. 

Jeffrey: Yes, that is great. So, I mean we spoke about your initial reporting back in January on Remdesivir, right? So especially in light of this week’s announcement of the dexamethasone trial and the FDA’s decision to discontinue testing hydroxychloroquine. Where does Remdesivir stand? 

Andrew: Yes, so Remdesivir, again the antiviral developed by Gilead Sciences. That showed in late April a positive result, a modest benefit for hospitalized COVID patients. That was a massive deal, it showed that this virus is druggable to some extent. It gave doctors something in their tool kit that they could use to try to help some of the sickest patients and it is shown some level of antiviral activity so actually fighting the virus itself instead of getting the other repurposed drug that just showed a clinical benefit. The other day, a UK ran study came out and said dexamethasone which is a type of steroid, which is a cheap generic pretty widely available medicine that showed a mortality benefit. That kind of went a step beyond remdesivir as showing for a specific group of patients specifically COVID patients who need oxygen support, it lowered the risk of death for them. So that seems to be potentially a very effective treatment for very late stage critically ill patients. One caveat that is very important with dexamethasone is this was all from a press release from these researchers. We have not seen any peer-reviewed published data, but even with that said, the UK’s National Health Services already approved the drug for use in the UK at least for COVID patients. So, science is moving from remarkably quick at times on stuff like that but when you look at the landscape overall, these are not game-changing medicines, remdesivir and dexamethasone. There is a lot of talk about hydroxychloroquine, which is a malaria pill that was first approved in the 1950s and a lot of people with arthritis or lupus use it, that is gotten a lot of attention because President Trump has brought it up time and again throughout March and parts of April I believe. Many studies now have shown that to not be effective in treating COVID-19. There’s also been some research that suggests. It is not effective in preventing COVID-19. So there are still a lot of studies going on for each of these medicines. That is kind of the lay of the land and I think doctors are now kind of trying to figure out the best way to use these. If remdesivir and dexamethasone are both in the toolkit, does that lend itself to a combination of the two? Or, would it be better to treat earlier with remdesivir? If they progress to a later stage then start using dexamethasone? So these decisions of sort of clinical decisions are being worked out in real time just as sort of the clinical research is coming in, which is completely unusual. Normally you have the clinical research happen, the findings are published in a journal, doctors have the time to really study those results, chew them over to bait them internally at medical conferences and among themselves and then they make clinical practice decisions. We have really seen that process eliminated. We see stuff published in a press release now and then the same exact day, it is pressed released, the UK government approves the medicine and says they are going to treat all patients in clinical practice with this new medicine. It’s been fascinating to watch. It is a very fast-moving space and I expect that will only continue over the next months. 

Jeffrey: Yes. Now you mentioned you did not think any of these were game-changers. Have you seen anything out there that has caught your eye that might be?

Andrew: I think this is kind of that second bucket. I think the repurposed treatments have a vital role here as their immediate options. Remdesivir, dexamethasone, some of the other treatment theories around IL 6 Inhibitors or Jak Inhibitors. These are immediately available and I think anyone with realistic expectations was hoping for something that could slightly help patients. I think the game changers are going to come from some of these therapeutics that are crafted against the virus based on several months of research, really understanding how the coronavirus works with the spike protein. We have a much better understanding now of antibodies, these virus fighting proteins as far as which ones really help fight the virus, which ones do not do as much. So, these therapeutics are now starting human testing and I think if some of them are successful, they are aiming to be ready this fall, which I think those are kind of the game changers, so you look at antibody therapeutics. These are companies like Regeneron, Eli Lilly, Vir Biotechnology, kind of leading the way with these and starting clinical testing. 

Jeffrey: So on one hand, you have some fantastic vaccines. So like polio, mumps, rubella, things that have pretty much wiped out diseases as we know them and then, on the other hand, you have like influenza, which you need the vaccine every year because you get a different strain of flu every year and then you have other diseases like HIV that after twenty years of trying to create an HIV vaccine were unsuccessful. Why are we so sure we can create a successful vaccine for the coronavirus? 

Andrew: That is a question I ask a lot of the vaccinologists that I talked with on kind of a daily regular basis and that it is an open question. I mean, I think there is a growing level of optimism the more we learn about this virus, that we will be able to vaccinate against it, that this is not HIV or Hepatitis C which are also RNA-based viruses like the coronavirus. But, something like HIV has some really complicated, this kind of goes above my pay grade, these mechanisms that it uses to kind of adapt to whatever situation it is in. At least from talking with a lot of researchers in the labs with these coronavirus vaccines, they are hopeful and they are not seeing signs like that. They are not seeing these red flags that suggest these efforts just would not work at all. So with that said then the question kind of becomes what level of effectiveness can we get with these vaccines. Are we going to end up with something like the flu market for vaccines where we have a lot of partially effective influenza vaccines and you already see most Americans are well aware of that and I think the vaccination rates for flu are fifty-sixty percent something like that. About half the country does not get flu shots anyways, and if they do it, they are usually partially effective but that kind of has some unique elements too as far as how the flu changes year-to-year and so on. The complicated thing is we do not know. This is a new virus. We will see how it plays out. It is hard to think too much ahead but there are a lot of reasons for optimism as far as there’s one hundred twenty-five plus vaccine research programs ongoing. I think about twelve right now are already in human testing. So this is moving remarkably quick and some really big pharmaceutical companies that have done this before have put forward pretty aggressive timelines as far as saying that they think they could have effectiveness data for a vaccine by maybe as early as this fall, if not early 2021. 

Jeffrey: Okay, so if they have effectiveness data, that means that they came out with the trial at the end of this year. They are saying it could be effective, now they have to make it for a billion people or three hundred fifty million in the United States. How is that going to be distributed? Is it going to be a priority list? Is it going to be staggered? Is there any indication of this yet?

 Andrew: Well, so recently at least for the US Government standpoint, some Senior Administration officials working on operation warp speed which is the Trump administration’s ambition to get three hundred million doses ready by January 2021, which is a timeline without precedent and vaccine development. It would just be historically quick, but with that said that these administration officials have said that they are planning to use a tiered distribution approach. So, you are looking at vaccinating the elderly people with pre-existing conditions, health care workers, people in roles like that would have a higher tier. 

Jeffrey: Thank you so much for joining us today. This has been great.

Andrew: Well, thanks for having me, Jeff. I really appreciate it. 

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you , enjoyed the RPHealthCast.

In this week’s episode we speak with Bailey Lipschultz of Bloomberg to discuss the outlook for the biotech industry and the industry’s recent winners and losers in these turbulent markets.

TRANSCRIPT

Jeffrey Friedman: Hello, and welcome to the RP HealthCast by RooneyPartners. I am your host, Jeffrey Friedman.

Investing in the stock market these days takes a strong stomach, especially with these thousand points swings we’re seeing both up and down, and investing in healthcare stocks takes a keen understanding of both healthcare technology and market dynamics.

To break all of this down for us, our guest this week is Bailey Lipschultz. Bailey is a journalist for Bloomberg News focusing on healthcare equities. He reports on breaking news across the healthcare industry from small medical device manufacturers to big pharma. Bailey it is great to have you here with us today.

Bailey Lipschultz: Yeah, of course. Thanks for having me.

Jeffrey: So Bailey, as a graduate of Syracuse University’s Newhouse School of Public Communications, you certainly have the right pedigree for journalism. But, how did you get into covering healthcare for Bloomberg? How did you get up to speed so quickly on all the science?

Bailey: Well, I had always been interested in either covering healthcare or tech just rapidly advancing Industries. And a role opened up on our equity’s team covering healthcare, and I was able to slide over and get caught up to speed on everything around the science. You just read as much material as you can, as many sell-side notes or journal submissions as you can to try to get a real good grasp on it.

I talked to a lot of people all day and just try to better understand the entire landscape from the perspective of people like bankers and analysts all the way to patients and the doctors that are treating patients in the real world.

Jeffrey: Yeah, that is great. But healthcare investing, it is not for the faint of heart, right? Along with a million other market dynamic issues, you need to really understand the clinical trial process and what it takes to bring a product to market, or what a deal structure could look like if a company is going to partner that product with another company.

Now, just a couple weeks ago, you wrote an article. It is titled, “Analyst Pitch Up to 1,000% Returns in Biotech Beyond Covid-19.” And in the article, you said that Wall Street Analysts expect a hundred and five of the two hundred nine members of the NASDAQ Biotechnology Index to double over the next twelve months. Now, in normal market conditions, these are unprecedented returns. But with the markets so upside down right now, how can these analysts justify these predictions?

Bailey: Well, there are really big swings within the Biotech Sector in particular. A lot of these companies are built on one or two drugs, or even a broader platform. So, some of those returns and some of those big calls for these massive swings in the stocks, can be as little as a smaller dataset reading out positively or a positive patent update for these drug makers. While they do seem kind of unprecedented and crazy, as much as the Biotech Sector is exposed to the broader market, these smaller names are more insulated and protected and have their own fundamentals that will drive these potential returns that these analysts are really playing up.

Jeffrey: Alright. So that is the index. A lot of people do not understand indexes too well. Can investors buy the index instead of individual stocks? And if stocks are supposed to have 1,000% returns, what is the projection for the index over all over the next twelve months?

Bailey: We do not necessarily track the index per se, but investors certainly can invest in things like ETFs that track the index. So you look at something well-known like the iShares, NASDAQ, Biotech, ETF, it’s tickers IBB. It is well-known because it follows the bellwether of investor sentiment, which is the NASDAQ Biotech Index.

Another play that investors can get into is something called the XBI, which is a SPDR ETF that is an equal-weighted index. The difference between the two is the IBB is exposed to larger companies on a greater scale. Whereas, the XBI is an equal-weighted index. So when a small stock like Moderna, who is developing a vaccine for the Covid-19, that ETF will see a greater swing as opposed to the IBB given how it is weighted towards individual stocks.

Jeffrey: So, that one is a little more conservative in nature because of the heavy weighting to the bigger pharma.

Bailey: Exactly. You will see it is more drawn towards the bigger companies, the Gileads of the world, the Regenerons of the world. Whereas, these smaller stocks, they can see more volatile swings on make or break binary data who have a larger read-across two things like the XBI. Exactly.

Jeffrey: Got it, okay. That is the index. Can you give us some examples of some of the top picks that these analysts were talking about on the individual basis?

Bailey: A lot of these companies are big calls, but when you want to look at things that are more consensus plays or examples that the broader Wall Street is swooning over. The first one that comes to mind is a gene therapy company known as Sarepta Therapeutics. A couple others looked at a drug maker, a cancer focus name like ALAgene, or even smaller names like Arcus Therapeutics and Compugen. It is really a broad range just given how widespread Biopharma is. So some of these names are very small, microcap stocks. Now, there is a bigger place like Disreptor, which is well into billions in terms of market value.

Jeffrey. Okay, so I guess you really have to know what you are doing there. Switching topics slightly, two thousand and nineteen was the largest year ever for Biotech M&A. But today is twenty-twenty and we know the world is a very different place. You recently wrote an article titled, “Biotech Packs, Leave Wall Street Salivating for M&A.” Great title. So what is the current state of Biopharma Partnerships and activity now, here in twenty-twenty?

Bailey: Well, we have been seeing, given the unknown with the pandemic, we have been seeing more and more of a push towards things like partnerships. So you are seeing less outright M&A where a large drug maker will go ahead and buy a smaller drug maker for its platform or its pipeline at a marketed premium. You are seeing companies go ahead and team up.

Even announced earlier today, AbbVie is in partnership with Genmab to focus on a broad cancer R&D pack that could bring well over three billion dollars. So we are seeing companies like Gilead Sciences, we are seeing companies like AbbVie shift more towards partnerships in a way from the M&A that really was the keystone over a year ago when we saw AbbVie buy Allergan, the maker of Botox, we saw Bristol-Myers go out and buy Celgene at the beginning of the year. So we are seeing a shift towards more partnerships and being able to walk in step, as opposed to some of the riskier and bigger BioBucks deals.

Jeffrey: Right, with the Amgen and the Celgene.

Bailey: Right.

Jeffrey: So with the market being crazy, you would think investors may shy off a little bit with these big swings. But I am seeing a lot of fundraising, right? There is a lot of cash going into the Biopharma industry right now. Are these companies building war chest right now for these M&A programs?

Bailey: Well, a lot of the fundraising you are seeing is for smaller companies because of how euphoric and how high the stock market in Biotech, in particular, has been running as of late. So these smaller companies are able to raise cash and issue equity, so that they can continue to fund their pipelines, which actually would draw away from a need to strike a deal.

In that sense, these smaller companies are able to fund their research and not have to worry about selling in a weakened position to a larger company looking to take advantage, if that makes sense.

Jeffrey: It does make sense. But as we know, the smaller companies are even more speculative. So I guess investors have a stomach for this sector as opposed to certainly retail right now.

Bailey: Yeah.

Jeffrey: There is not a flight to safety, but a flight to change the sector and what the future may hold. In terms of Biopharma, do you see any sectors in particular that are seeing more activity or specific areas?

Bailey: We are seeing a lot of excitement in terms of cancer research for Next Generation Technologies, like gene therapy or things like CRISPR gene editing. Those are areas that we have seen a lot of investors rush to. We have seen so many of these IPOs take off compared to what has been a rocky market landscape, because investors want to be on the cutting edge of science and be looking at what is next, what can be the next blockbuster drug, or the next billion dollar therapy and opportunity.

And a lot of that is coming from cutting edge sciences and things like cancer research or other areas looking at things like gene editing and gene therapies that were only an idea many years ago, and then now are really quickly being brought to the forefront.

Jeffrey: Interesting. Now, you mentioned cancer. In our last topic, a couple weeks ago at ASCO’s American Society of Clinical Oncology’s Annual Meeting, it’s the Super Bowl of cancer research meetings, right? So all of Biotech’s elite met to talk about their advancements in cancer research and talk about their clinical trials, the good, the bad, and the ugly of it. You wrote an article entitled, “Traders Sift Through Virtual Cancer Meeting’s Winners and Losers.” And in this article you talked about how investors view data coming out of ASCO. Can you tell us about some of these winners, and why did the Wall Street analysts favor these companies?

Bailey: Yeah. As you have said, ASCO is very much the Super Bowl of cancer research in this year with the ongoing pandemic. It was pretty interesting to see it shift to a fully virtual experience. But looking at some of the winners adapting to immune therapeutics, is this small cap that we saw more than double in the trading after unveiling some data and that company, in particular, had early stage results from a group of trials and a range of cancers in showing that its technology, it can work. And that comes back to the point that a small patient group seeing a benefit can really drive some wild swings.

Other companies that were really crowned winners by Wall Street, one was a company named Trillium Therapeutics, which is an originally Canadian company that is loved by hedge funds. It showed its cancer treatment was also shrinking patients with lymphoma, and that could lead to potential upside and other indications. And another company that was a big winner was AstraZeneca, which is a global pharmaceutical giant based in London. It had a terrific conference where it unveiled updates for a trio of its drugs and its blockbuster TIGRIS, a cut risk of small cell lung cancer or lung cancer death, and then, another couple of other cancer studies showcase some pretty strong benefits. So analysts were really key on those three among a couple others.

Jeffrey: Now, there were also some darlings that put out some inconsistent data. Subsequently, they got punished a little bit by Wall Street. Can you talk about any of those?

Bailey: Yeah. Two of them that really come to mind, one is Arvinas, Inc. ASCO for this company, in particular. It is based out of New Haven, Connecticut. ASCO was a big stage for the company to showcase its potential cancer platform in prostate cancer. Obviously, prostate is a very tough cancer to treat. But the benefits it saw in the first twenty patients that were treated, failed to meet the bar that sell side analysts had set. Another company that comes to mind is MacroGenics, Inc. It did not really meet some of the updates that Wall Street really had been looking for. But stock has been on an absolute tear this year, in particular. We have seen their stock price well more than double at some point this year. So it really was one of those that the company was running red hot into the meeting, and maybe it did not meet the high bar that investors were looking for.

Jeffrey: Well, the virtual meeting was certainly different. They did a great job, ASCO. But I have been attending for the past ten years in my annual trip to Chicago to attend the meetings and they will be missed. Hopefully, we will be able to get there again next year.

Bailey: Yeah. I am looking forward to that. I know IHA, which is based in San Diego, they are trying to march forward towards being able to have that conference in person in San Diego. So hopefully, we will be back to some form of normal as soon as possible.

Jeffrey: Yeah. I think that will be a combo. I think it will be a hybrid of that as well. Bailey, thank you so much for your time today. And as I said earlier, healthcare investing is not for the faint of heart, but I guess that is what makes your job so interesting.

Bailey: Every day is certainly a new day. It is what keeps me going and keeps me coming back to work.

Jeffrey: That is great. Bailey, thank you.

Bailey: Thank you.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP HealthCast.

In this week’s interview we speak with Shawn Tully, Senior Editor At Large for Fortune Magazine, where we discuss the intersection of public policy, public health and government spending as it relates to the coronavirus and the huge cost we are shouldering by keeping the economy closed.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP HealthCast by RooneyPartners. I am your host, Jeffrey Freedman.


The intersection of public policy, public health and government spending as it relates to the coronavirus is the subject of this week’s interview with Shawn Tully, Senior Editor at Large for Fortune Magazine. This topic is almost tailor-made for Shawn given his career and his education. you see, Shawn joined fortune in 1979 and in 1983, became the magazine’s first Paris Bureau Chief. Shawn was also an on-air reporter for CNBC from 1996 to 1998 when he returned to Fortune and he is now approaching his fortieth year with Fortune. Shawn received an MBA from the University of Chicago, a Masters in Applied Economics from the Université Catholique de Louvain in Belgium and holds a Bachelor of Arts degree from Princeton University

Shawn, it is a pleasure to have you join us today to share your thoughts and insights and discuss some of your recent coverage about the policy and financial implications of the US federal and state governments response to the Coronavirus.

Shawn Tully: Sure, my pleasure.

Jeffrey: Great. Now before we dive into this extraordinarily important topic though, I would like to post a couple of career track questions if I may. At first, your decision to dedicate your life to journalism. Now, if I were only studying your education pedigree, the logical conclusion is this is someone destined for the C-suite or Wall Street? Why the noble path of journalism, Shawn?

Shawn: Actually, I started at what was then called First National City Bank. So I was an MBA student and had also gone to graduate school in Belgium in economics and right after I finished in Belgium, I went to work for First National City, which is now Citigroup and they were in the building on Park Avenue. I think it is 390 Park Avenue and I was in the real estate lending division and I was there for about a year, but I did not love it. And then, I just started freelance writing and I work for New Jersey Monthly and then, the editor there said, “You really should concentrate on business writing. Your stock will go up.” And it was the best advice that I ever got because I had kind of the technical background to understand business subjects, but I also like writing so when you put the two together, I was able to succeed as a freelancer, initially. And then, go do more and more business stories and then go on to get hired by Fortune and then, work with some great writers as their reporter; the likes of Carol Loomis, who recently retired in early 80s and is a legend in the business. I worked under her, learned a lot from her. Roy Rowan, covering the Hunt Brothers trying to corner the silver market back in the 1980.

So just working for these greats even though I was not writing at the time. I was just taking notes for them and doing reporting for them really prepared me and then, I was promoted to being a writer within a couple of years and had been at Fortune the entire time, except for a year and a half when I worked at CNBC as a TV reporter. But I spend the entire career as a business writer and trying to do as many types of stories as possible. Some about drama personalities takeovers. It is kind of yarn style stories. Others that are much more about the markets and numbers based, but the good thing is business reporting gives you the ability to use all of those skills and tell a variety of stories.

Jeffrey: Yeah, but I think you have interviewed more Fortune 500 CEOs over your almost forty years span of Fortune than any other business journalists. When you are conducting an interview with a captain of industry, you know, based on your pedigree, do you ever think that could have been your job. I mean, let me put it another way. What goes through your mind when you are sitting face-to-face with a CEO subject.

Shawn: Well, no, I would never want to run a company or to have wave or be qualified to run a company, but normally I am… You cannot fake it. When I interview for CEO, I have read up on the company. I have done a lot of homework. I am intensely interested in how he manages and deals with a crisis which, of course, has been a big subject recently. So my interest is strictly from a journalistic standpoint and trying to take a lot of what is often highly technical information or covered up with lots of cliches and explanations. You cannot understand which is often what the companies put out and make it understandable and colorful for readers. And therefore, the background, the personalities, the styles of these CEOs become very important to getting people to read the more serious stuff because the more fun you can make it, the broader the audience becomes.


Jeffrey: Right. That is a great insight. Thank you. This is a healthcare podcast. So if you do not mind, well let us turn to coronavirus. In late April, the Fortune published the story under your byline. It was entitled “Pandemic economics. The U.S. is learning why limiting hospital beds carries a steep cost.”

Shawn: Right.

Jeffrey: All right. As New Yorkers, recalling the erection of the field hospitals in Central Park at the arrival of the USNS comfort and other measures to boost bed capacity, the issue of hospital shortage remains an open wound. Sorry, forgive the expression. But you identified an arcane government regulation as responsible for effectively blocking the construction of new hospitals. Now, can you explain the certificate of need laws and its role in capping hospital bed capacity?

Shawn: Yes. These are state laws. These are not federal laws, but they are very widespread. You have them in over half the states. These laws force hospital companies or companies that want to get into the hospital business or expand to go to the state authorities, which are often controlled by the existing industry in order to get permission and get the permits to add beds, which would involve either adding more beds to an existing facility or building new facilities. Now, the industry, obviously, the existing players want to have all their beds full all the time. So they resist construction of new hospitals, which would add to the surge capacity that we need to fight this virus. And that was the rationale for most of the lockdowns, was that we were going to swap our hospital capacity and not being able to treat the people who were in serious need of respirators and hospitalization due to the virus.

So, what really worked was the suspension of the certificate of need laws in many states, then enabled hospitals to add beds and to move beds between hospitals. Under most of these certificate of need laws, hospitals are not able even to move beds from one part of a hospital chain to another part of the hospital chain, if you can believe it. So, they are extremely restrictive and they prevent the market from determining how many hospital beds you really need and they leave it in the hands of the industry and the entrenched players who want to shrink the supply to keep the prices higher and keep the capacity lower. It is not unusual. You see it in OPEC or any cartel and it is not healthy, right? So, my objection to it was that first of all, it is never a good thing because it just simply raises prices and does not allow hospital beds. There is a view that you cannot have more beds in rural areas. That is not true. It simply caps the total number of hospital beds. You have fewer beds everywhere than you really need and this was brought into bright relief by the virus where we needed a lot more capacity and we are only able to get it because these laws were suspended.

Jeffrey: Okay, so I get the concept of permitting the free market to dictate need. But as I understand that the CEO and programs help distribute care to disadvantaged populations or geographic areas that new and existing medical centers may not serve, right? So, according to some policy experts, the removal of CON well actually favor for profit hospitals because they may be less willing to provide indigent care. So, given the disproportionate impact of the coronavirus on communities of color, are you not concerned that the dreadful death data we have experienced would have been even worse without the CON laws.

Shawn: No, and the proof is that they were suspended. In other words, if you have a shortage of capacity in a crisis as what we had and it were a good thing, why did they not shrink the number of beds and strengthen this thick certificate of need laws? Not at all. In other words, what… The reason they were able to serve underprivileged populations was that they got rid of the laws. If you are in a densely populated urban area and you cannot move beds from one facility to another or add more beds in an existing facility. What is the good of a Certificate of Need law? It freezes and place the number of beds. So it was the suspension of these laws that opened up the capacity needed to serve underserved populations and to take care of the surge. They should be suspended indefinitely. And one of the mysteries of the entire crisis is why this is not a major topic of discussion and of a policy point that would be extremely helpful in solving this surge problem that we have. 

Jeffrey: Okay. Thank you. Switching topics a little bit, still staying in our home state though. Last week, Fortune posted another thought-provoking article by you entitled “New York City’s lockdown is costing $173 million per day. Is it still worth it?” All right. That is quite interesting. Now, clearly the trade-off of public health and economic health, it is a Hopson choice. But what struck me was your estimate that New York City shutdown has cost the economy a staggering sixty-three billion dollars. Now, I am having a census taker shot. That is a big number. So, walk me through those numbers.

Shawn: Yes. So the hit too… Well, okay what the… You have to start with how big is New York’s economy to figure out how big the hit is. This is not an easy task because you never see a number for New York City’s GDP or gross urban products. There is a couple of names for it, but essentially, it is the output of goods and services annually that the city itself of 8.4 million people produces. But you can find the number. Interestingly, it is usually referred to only by how much it is going to grow or shrink every year and they never tell you how big the dollar number is. But I was able to get it by going through the websites from the US Commerce Department that do give that number by county so you can add it up. So it is nine hundred billion dollars approximately. The projections of the shrinkage in GDP this year from Boston Consulting which did a study for the state of New York for the city is seven percent, which is much higher than for the country as a whole. Because the country as a whole is a 5.6 percent according to the Congressional Budget Office. So the sixty-three billion is an annualized number based on the seven percent of shrinkage in GDP that we are going to experience because of the coronavirus outbreak and the lockdown that is is brought on by the outbreak.

Now, that is an annualized number. The daily amount is actually much bigger because the shrinkage and GDP in the middle of the year is more like ten percent or eleven percent , but I use the annualized number. Now, what we do not know is how much of that would be restored if New York were opening much more quickly. Part of it would, but that number is impossible to come up with accurately. But we do know it is a lot of money and given that eleven percent of GDP in this crisis period is more like ninety billion a year. Would that be fifty billion? Would you save… Sorry, a million per year. It is ninety billion per year. Would you, with the daily amount drop by thirty million from one hundred seventy-five to one hundred forty-five? We do not know that number, but we do know that it is a big number. And my point in the story was that, again, there is a… Definitely, New York has been very successful in getting these numbers down as Dr. Scott Gottlieb, the former FDA commissioner, cites it has got the best track record in the country. Yesterday, they were three hundred and forty cases that tested positive in the entire city. That is a one percent positive rating. It is one quarter of the national average. We are way below the national average at this point, and we have been getting closer to fantastic results for several weeks. But the lockdown has been very severe and remains very severe.

So, the question becomes you are getting extremely small incremental improvements in the various metrics that the state has been using and the city has added to those metrics. There is ten altogether, three from the city and seven from the state. You know, if you are within one percentage point of reaching some of these metrics and you have acing almost all the other ones, question is what is the objective? Where do you want to get to before you open up? Because staying locked down is not getting you a lot of progress on the margin, but the costs on the margin are extremely high. So, I would like to see more discussion of what does it really costing and are there ways of dealing with the virus that would be less damaging to the economy and at the same time, protect the health of these few people now, who are getting the virus where at levels that are extremely small by national standards. Now, the virus is very contagious and I leave it to the experts to find ways that you can find hot spots and do tracking and treat the virus in tailored ways that do not lock down the entire economy. So the question I was raising is not to say that it has not been worth it, or even that it is not worth it now, but to point out what is really costing which is a subject that I had never seen addressed. 


Jeffrey: Right. So your argument, you know, is that we have already met most of the arguments set by Governor Cuomo and which perhaps we are taking too cautious in approach by delaying the restart. The numbers that you mention are staggering. So, yes, economic impact is significant. But New York has been victim number one, right? Seventy percent of total New York State coronavirus deaths are in Manhattan. I am sorry, New York City. And you know, we have had almost seventeen thousand New York City residents passed away due to COVID-19 so that equates to about fifteen percent of nationwide fatalities. So, you know, I think it might be understandable why New York is taking a more prudent approach to the reopening and you do not feel that way or you are…?

Shawn: I think there is going to be [crosstalk]. I think there are going to be some very interesting studies on this subject. The debate is really a little different. Clearly, New York was the hardest hit, but it clearly New York is the quickest to come out or the most successful in coming out. So, the question is how much do you want to spend to get to instead of three hundred and forty people yesterday testing positive; one percent to get to three hundred and twenty people. In other words, at what point do you want to… Have you reached all of the metrics that would justify a reopening. Now, you have reached them, the issue is that there are very long delays between the different phases of reopening that can be pushed back and there is not even any guidelines now for reopening restaurants, which do not even possibly open until Phase 3, which would be mid-July and that could be pushed back. So, the question is where do you need to get to to open up? And are you are you that much better off if there are three hundred people instead of three hundred and forty people getting it if you open that. Right? You are at such low levels that for whatever that improvements to come are going to be tiny. There is no other way because you are already at such excellent, excellent levels. So the cost per metric of improvement or unit of improvement is very high. That was the point that I was making, not that I think that the state has made a huge mistake or is taking the wrong course.

Jeffrey: Got it. Got it. I mean, at this point, what you are saying is it is not a health debate. It is not an economic debate. It may be more of a philosophical debate and I would love to actually have that in a future episode. All right, let us conclude where we began a little bit and by more of a personal look. Now, you live in New York City. And since the death of George Floyd in late May, the streets your neighborhood have been teaming with protesters and the medical community has voiced concern that these crowds are going to lead to another bout of coronavirus cases and, like you mentioned before, we may have to delay opening. Do you think that the results will lead to a further delay in the reopening in New York?

Shawn: Well, there is a lag in the statistics between when you have a dangerous signal such as people congregating in the streets and not respecting social distancing and when you get a spike in positive cases. Certainly, there has been no spike. The opposite, we have gone from four percent positive results to one percent in the last several days. Now, that does not mean it is not going to spike back up. I think it is going to take another week or so before we know. So it is possible. There is two dangers. One is that you get an additional spike which would lead to possibly to more delays, which is disastrous. Because from an economic standpoint, because as I said, you are probably looking at ten percentage points shrinkage in GDP during this crisis period that would have been counter balanced by coming out of it when we open up. So if you delay the opening up, the depth of the damage becomes much worse, the economic damage.

And the other problem is that these demonstrations tend to shut down clinics that are doing a lot of testing and New York state is doing a tremendous amount of testing. We were testing around between fifty and eighty thousand people per day. They are testing half a million people per week. It is tremendous and it has really helped and the great news is that despite much higher testing, the number of daily cases is dropping which means that the positivity rate is going way down. So, if those things are reversed, if you cannot test as much and more people have it, that is a bad situation. So you have a double hit, potentially coming in the form of people not respecting social distancing in these demonstrations and also the possibility that some of the testing clinics will have to close down.

Jeffrey: Now, if we do not see a increase, would it not warrant or do you think it would warrant a moving forward of the reopening of the different phases?

Shawn: Again, I think the city and the state have decided to stick to a preordained plan that sets a timetable so I do not think that Mayor de Blasio or Governor Cuomo are going to try to to accelerate the reopening schedule, which is I say pushes restaurants back to around July 8th. And then we do not have any guidelines on what the capacity would be in restaurants and that is assuming that there is no pushback in that fourteen-day difference between Phase 2 and Phase 3. So I do not anticipate that they would move it up. They seem to be determined to stick to the schedule that was settled long time ago. I do not know that that is from the economy standpoint. That stretches this out a very long time when you have very, very good metrics. So it definitely stretches the damage to the economy much longer which may or may very well be justified. It is just a fact. It just does. But I think the question then becomes more will they stretch out these interim periods between the phases and pushback the reopening? For example, theaters do not even reopen until Phase 4, which would be back getting close to August and that is if everything goes great. And as you said, you may be in a situation where the protests led to a spike, which given the extremely cautious stance that New York state and city are taking would conceivably push it back more.


Jeffrey: All right. Shawn, this has been a very enlightening and interesting conversation. So, I want to thank you so much for joining us today, and good luck in New York City. And we hope that everything comes back on board very quickly. So , thank you.

Shawn: Great, my pleasure. Thank you.


Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP Healthcast.

In this week’s episode, we speak with Sara Harrison of Wired.  Sara discusses the issues our senior population have with the coronavirus and why they are more at risk for serious health complications than the rest of us.

TRANSCRIPT

Jeffrey Friedman: Hello and welcome to the RP Health Cast by RooneyPartners. I am your host, Jeffrey Friedman.


Jeffrey: As her country begins to move forward from the pause we took due to the pandemic. We must try to find a balance between safety and normalcy as we open up our economy. We still have a large highly vulnerable population. That is at high risk of serious illness if they get infected and this includes her senior citizens.


Jeffrey: To talk more about this is our guest this week, Sara Harrison. Sara’s a healthcare reporter for Wired and has been covering health and technology-related stories there for the past four years.

Jeffrey: Sara recently wrote a fantastic piece about the serious risk issues our elderly have and why they are so vulnerable and more at risk than the rest of us.


Jeffrey: Sara, it is great to have you with us today.

Sara Harrison: Thank you so much. I am happy to be here.


Jeffrey: So your recent story for Wired about COVID-19 severe impact on seniors was a fantastic piece but before we dive into this. Let us talk a little bit about how you got here, and how you started covering health care.

Jeffrey: In the past, you have written about many different topics. What is it like refocusing your coverage almost exclusively on health care during the pandemic?

Sara: Yes. It has been really interesting. I do not have a science background. I was an English major in college but I love writing about science. I love learning about it.

Sara: It has been really challenging. I think especially during the pandemic because the information is coming so quickly and it has been really challenging to weed out, what is important. What is a big discovery and what is maybe just a theory?

Sara: So I think especially for people who are non-scientists like me, it feels very challenging and that is one of the things I try to focus on. My coverage is providing some actionable easy-to-understand information for people who are not trained in the sciences but really need to understand what is going on around us.

Sara: That is something that I tried to do in all my reporting but I think it is particularly important now.

Jeffrey: Yeah, absolutely and you bring an almost humanistic, if I will, humanistic approach to the writing and if we could turn now to the article you wrote about the COVID-19’s overwhelming impact on seniors.

Jeffrey: Now, it is a topic that hits home for everyone with elderly loved ones. The subhead to your story really summarizes the issue and I quote, “It is not one thing. It is everything. Older people are more likely to catch the disease to suffer from it more severely and to have a tougher recovery.”


Jeffrey: Now, let us take all that in smaller bites by having you start with why seniors are more at risk of contracting COVID-19.

Sara: Yeah. Seniors are at risk for two reasons: One is biological, and one has more to do with their social living situations. The first is that they are just more physically vulnerable. Many seniors who are more likely to have comorbidities like hypertension or diabetes, which have been linked to increase susceptibility to coronavirus.

Sara: They also generally have weaker immune systems which we can go into more depth later but they are not as able to mount a really strong immune response to this virus. They are also, you know, carrying around all these other physical ailments that make them more at risk.

Sara: The other issue is that not only are they more physically vulnerable but they are also more likely to live in congregate living settings like a nursing home or an assisted living facility.

Sara: So that means that they are just around more people. Many of them, even if they live at home, they need physical help with basic tasks like feeding themselves; going to the bathroom; taking a bath; walking around, and none of that care can be delivered through a Telehealth call.

Sara: It all has to be done, you know, physically by someone else and so it is really hard for them to physically isolate or socially distance. It is basically impossible and so that makes it more likely that they will contract the virus just because of where they are living and what kinds of health needs they have.

Jeffrey: You use a term and I hope I am pronouncing it correctly, Immunosenescence. What is that? What is its role in contributing to the vulnerability of the seniors?

Sara: Yeah. So Immunosenescence is a natural part of the aging process. It happens for different people at different times. So I should specify that being like more talking about seniors. It does not necessarily mean somebody in their eighties or nineties. It really depends on what you are sort of physical well-being is. This could be true of people in their seventies

Sara: Immunosenescence is basically the slow deterioration of the immune system. So when the immune system sort of grows in three phases. When we are young, you know small children. We are full of T and B cells. These are the frontliner of our immune defense there. They recognize foreign pathogens and viruses and bacteria and they gobble them up and they protect us from them.

Sara: And when you are young, you have a huge reservoir of what are called naive T and B cells. Basically, they have not specified to a specific pathogen or infection. So you may get more sick; more colds; imminent infections; things like that but you are able to ammount an immune response and yourselves learn.

Sara: So by the time you are in your twenties and thirties, you have this full healthy and immune system. That is ready to fight off lots of imminent infections and also still has lots of naive cells that are ready to learn and adjust to new pathogens.

Sara: But starting in your fifties or sixties, generally, there starts to be this decline where you run out of naive cells and you just cannot adapt as quickly as you might have. So the older you get the fewer cells you have basically, to pull on and it is harder to adapt.

Sara: So for seniors, that means that they are just much slower to mount an immune response and their immune response will be much weaker.

Sara: It also means that their symptoms will look very very different because the virus will be reacting to their immune system in different ways.

Sara: So instead of, say, having a very high fever. Most seniors do not get high fevers in general. They might present as being like, very confused or delirious, or eating more and eating less, and sleeping more.

Sara: And so, it can be very difficult to diagnose coronavirus in those patients because they have these very atypical symptoms.

Jeffrey: Well, now besides the immune response. I know that chronic low-grade inflammation is another health condition found predominantly in seniors, and use a term called, Inflamm-aging. Explain how that affects the body.

Sara: Yeah. This is another sort of part of the dysregulation of the immune system as people age. Again, it is not true for all people and it can happen at different times in their life for different people but essentially, inflamm-aging is a condition under which you stop being able to control or there is a dysregulation in the control of cytokines, which are these very small things and among other tasks that they perform. They help regulate the immune system.

Sara: That means that basically, you are always sort of releasing cytokines and you are always at the sort of like chronic low level inflammation. That can potentially and I should specify that there is still a lot we do not know about coronavirus.

Sara: And so I do not want to say that this is like an absolutely proven fact. One of the thoughts, is that these cytokines have also been associated with some very severe COVID infections where patient’s immune systems will sort of spiral out of control. And they will have these very big overreactions in the immune system will start attacking healthy organs.

Sara: At that point the body is not just fighting off the infection, it sort of attacking itself. And so, if you are a senior and you have more cytokines already in your system that may make you more susceptible to these cytokines storms.


Jeffrey: Got it. Now, in the news we hear about the coronavirus and the need for respiratory and respirators respiratory equipment, but it is not just a respiratory disease. It is a lot more complicated you write about.

Jeffrey: So, you want to talk about how it can affect the vascular system or other organs and different ways that the COVID-19 can attack?

Sara: Yes. Yes. The more that we learn about this virus, the more complicated it becomes. I think. There have been reports, you know, in addition to all of the respiratory problems. 

Sara: There have been reports of like very young people who have mild infections or may not even know they have infections suddenly having a stroke.

Sara: There have also been these reports of something called COVID Toe which is like where your toes become very swollen and red. It looks kind of like chilblains and the thought is that the virus, in addition to attacking the respiratory system. It is also getting into the vascular system and attacking your blood vessels.

Sara: They have also found and there have been quite a few papers and autopsies showing lots of blood clots in COVID patients. So that means that the virus is affecting so many other parts of your body. It is not just your lungs. This is pressing cause problems in your toes; in your brain; in your heart.

Sara: There are lots of lots of scary scenarios, and this can be especially dangerous for seniors because many seniors already have wear-and-tear on their blood vessels. They may already have hypertension or other vascular issues. And so this is just like yet another way in which the virus could affect them or severely than younger populations. 

Jeffrey: Yeah, I guess it just shows how little we still know about this disease and how it affects us.

Sara: Yeah. It is pretty incredible like given how much it has changed our lives. How little we understand about what it is doing inside our bodies.

Jeffrey: Yeah. Now, you touched upon this a little bit earlier. Public health officials have been requiring social distancing as part of the regime to protect us from contracting the coronavirus but seniors as you said, they need caregivers, some.

Jeffrey: They may be residents in nursing homes, or they have family members that are needed to be able to check in on them and help take care of them.

Jeffrey: This does not work with social distancing, right? The elderly, they cannot do this. So, how do we square the circle here?

Sara: Yes. This is a very very complicated question and that I should specify that I do not have a clear answer and I do not think that many people do.

Sara: I think there are some basic things, you know, like we need to make sure there is enough PPE in nursing homes and assisted living facilities. Enough so that all the staff and residents can wear their in a mask so that they do not have to worry about, you know, when to put on a full kit to protect themselves.

Sara: So that is one big thing. Another thing is that in long-term care facilities. They have started in some cities, universal testing where they will test the staff and the residents whether or not they show symptoms and this is potentially another way that we could sort of make sure that nobody in that setting is infected and that they can touch each other and provide the care that people need without this constant fear of getting infected.

Sara: Commonly, with something like the flu for example. They will often, you know, nursing home vaccinate the entire staff and so whenever there is a vaccine, that would be a great way to protect people as vaccinating caregivers. Vaccinating the seniors in the facility but also like all of the staff.

Sara: Anyone who helps out, family members if they are caregivers. But honestly, I do not think that there is a very simple solution to this, and when I talked to geriatricians, especially people who work in long-term care facilities. They are very very scared and they are very worried about reopening their facility to the public because it is hard.

Sara: It is virtually impossible to sort of keep a distance and provide good quality of care and make sure that everyone is safe.


Jeffrey: It is scary. It really is. You mentioned vaccines and about vaccinating the staff and we are all waiting the day when a vaccine is available. It is considered probably the optimal way to reach herd mentality in the community but your reporting reminds us that seniors are not apt to benefit substantially from the development of a vaccine.

Jeffrey: Now, from the seniors that are patients but why is that the case?

Sara: It goes back to this, if you would reduced immune response because seniors do not melt this like big immune response and do not have like lots of cells that are ready to learn this new disease.

Sara: They sometimes do not respond to vaccines in the same way that younger populations do. That is not to say that we could not create a vaccine that would work for older people.

Sara: They have created, you know, food doses that have a higher dose of the actual flu that sort of elicits a greater immune response. Older adults also respond very well to the shingles vaccine but the big issue is that.

Sara: In order to create those specialized vaccines for older populations. We need to include older people in clinical trials and that often does not happen and I will quote one of the doctors I talked to.

Sara: He’s a geriatrician at UCSF. His name is Eric Widera, and he said that one of their big worries is that we will be looking at potential treatments and vaccines but not actually testing them on the people who are most at risk of developing this disease.

Sara: So that is all to say that, he is not that they could not benefit but we have to be mindful about making sure that they do benefit and including them in the research that we do now.


Jeffrey: Yes. Well, then let us talk about recovery and you report that despite high mortality rates, many seniors do recover but their recovery is going to take a lot longer and it is much more difficult than younger or healthier people.

Jeffrey: Why is that? Is that the immuno suppression issue?

Sara: It is a little different. I mean, I think in general like seniors just have, they are less resilient than younger populations. So, yes. Many do recover.

Sara: I think we have all seen like heartwarming videos of hundred-year-old people who survived and it is great to see but you know? The longer that they are in the hospital, the longer that they are stuck in bed and are not able to move around. That reduces their overall health.

Sara: So people who spend a lot of time in the hospital usually if they are seniors, they will be weaker. They will lose muscle mass more quickly and they need a lot of time and rehab to regain the skills that they had before they started their hospitalization.

Sara: And as one person I talk to, you mentioned like that can be really challenging in the hospital setting right now because you know, the hospital gyms are closed. The physical therapy centers might be closed. Some long-term care facilities which is where someone who has been in the hospital for a long time and need some rehab might go.

Sara: They are afraid to take COVID positive patients because they do not want to bring an infection into their facility. So that can make it really, really hard for someone to make the transition from the hospital to home safely.

Jeffrey: Now, the issue you talked about with their being in the hospital or in bed or isolated so long. I mean that is part of what we are told, right? As citizens, be socially distant, you know? Be isolate. Keep isolated. Reduce your activity. Stay inside but that is so bad for seniors, right?

Sara: Yes. It is really, really hard for them. I mean, if I take a day and I lie down in bed. My muscles will be fine but for a senior though, their muscles will deteriorate faster. And so, they really need to be active.

Sara: The other issue is that you know, whether you are in a nursing facility or not. I should phrase this a different way. In nursing homes, a lot of nursing homes have sort of reduced the amount of mobility that people have because they are trying so hard to reduce the spread of the virus.

Sara: So that means that people are spending more time in their rooms and less time walking around which obviously is not great for their physical health but for also, for people who live at home, like most of the places they would go to socialize or exercise like a senior center or a library or like a church or temple or synagogue. They are all closed.

Sara: So not only are they losing like the sort of fit impetus to get up and go out and be out in the community, but they are also very isolated.

Sara: Isolation and depression are, I mean, they are bad for everyone but they are very very bad for seniors and they are linked to a host of very big health problems including worst cognitive function, higher blood pressure, higher risk of heart disease.

Sara: So even though it seems like kind of a nicety but it is actually very much part of their physical health that seniors are able to get out. To be active. To be intellectually simulated and connected to people around them and not stuck in home alone.

Jeffrey: Right. Well, as we all start to come out of this quarantine and emerging to society. We all have to bear in mind that they are our most vulnerable and we do need to always keep guard against that.

Jeffrey: Sarah, this has been very educational, very thought-provoking. Thank you so much for taking the time to be with us today.

Sara: Thank you for having me.


Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions. Please reach out to us on social media.

Jeffrey: Thank you, and we hope you enjoyed the RP HealthCast.

In this week’s episode, we speak with Maria Aspan, senior writer for Fortune, where we discuss the risks and sometimes fatal results stemming from breast augmentation surgery, and we explore where the responsibilities lie for protecting the millions of woman who have had this surgery and educating those women who are exploring the surgery for the first time.

Click here to read more about Maria’s eye-opening article in Fortune

TRANSCRIPT

Jeffrey Friedman: Hello and welcome to the RP Healthcast by RooneyPartners. I am your host Jeffrey Friedman. 

Jeffrey: Our guest this week is Maria Aspan. Maria is a senior writer for Fortune Magazine, and prior to coming to Fortune she is written for Inc. Magazine, Reuters, and American Banker. Maria just wrote an incredibly interesting investigative feature in Fortune Magazine’s June-July issue about the decades of problems with breast implants and there sometimes fatal health problems for women. Now to give some context and to place some scope on this issue as to why it is so serious. More than eight million American women have undergone breast related plastic surgeries since 2000, and in 2018 alone more than four hundred thousand women had breast surgery for either cosmetic or reconstructive reasons. Breast augmentation is the most popular cosmetic procedure in the United States, and that is tracked by the American Society of Plastic Surgeons. Maria will discuss her article with us and talk about the big business behind the surgical procedure. We will talk about the potential danger it poses and what options women have if they are considering breast augmentation surgery.

Jeffrey: Maria, thank you for joining us today.

Maria: Hi, Jeffrey. Thanks so much for having me.

Jeffrey: Well first let me say, you know, I read your article and it is very thorough. It is an incredibly interesting piece on the issues surrounding breast surgery. I personally I did not realize how large an industry this is. So can we start out by framing this for our listeners? It is not just the manufacturers that are making money here.

Maria: Absolutely. It is not just the manufacturers who are making money and whatever sort of image you might have in your head about the sort of person or patient who might go for breast plastic surgery, it is probably not only devoted to that sort of woman neither. This is an industry that has served some eight million women since 2000. There are in 2018, which is the latest figures that were available, there were about 400,000 women who had a breast related plastic surgery. A hundred thousand of those women were getting reconstructive surgery, which is most often done after someone has a mastectomy for cancer related reasons. In terms of financial impact, we can say from a manufacturing side of things, it is probably under a billion dollars annually, but from an overall, including doctor fees and health insurance costs we are talking a multi billion dollar industry. Breast augmentations can cost up to twelve thousand dollars according to the American Society of Plastic Surgeons and there were three hundred thousand of them alone last year which which we are talking like three point six billion dollars from that alone.

Jeffrey: It is I mean that is mind-boggling because especially because the history and the risk behind breast implants and augmentations history. Augmentation surgery, the risk has been known for decades, and it is always been deemed as controversial right? For example in 1995 Dow Corning had over twenty thousand separate lawsuits related to the implants. What happened there? What was the outcome?

Maria: Yeah, highly controversial and also highly litigated in all senses of the word. So breast implants have been on the market since the 1960’s. They have been regulated to some extent since the 1970s. And by the 1980s women were starting to complain about about pains and illness and other side effects of their implants. Dow Corning which was a joint venture of Dow Chemical and Corning, was one of the biggest makers of silicone breast implants and by 1995 had filed for chapter 11, because it was the subject of so many complaints. Of those twenty thousand lawsuits that you mentioned, ultimately there  were more than four hundred thousand women with complaints against the manufacturer. By 1998 it had agreed to set it up a thre point two billion dollar settlement fund. Meanwhile, there were three other big manufacturers of silicone implants, Bristol-Myers Squibb, Baxter Healthcare and 3M, that set up a separate multi billion dollar settlement fund. And incidentally the Dow Corning settlement fund, that only just expired last year. Women were able to file claims for it up until June 2019. But the outcome of all of this was muddy and again controversial, but even the controversy was controversial. The science was highly disputed. The FDA had in 1992 asked for a moratorium on the sale of most silicone breast implants and lessen in certain cases, especially again for for cancer patients. So most implants were becoming saline. 

Maria: There was a highly influential study or a panel rather, that in 1999 a panel of scientists that was convened by The Institute of Medicine concluded that silicone implants did not cause any major disease, even though the panel did not really do their own research. They relied on a lot of research submitted by other entities including manufacturers and surgeons who are involved in this industry. And public health advocates pointed out at the time and still point out that some of those findings were obviously conflicted. And there was also some legitimate criticism of the sort of Gold Rush of lawsuits against the manufacturers. The idea that plaintiffs attorneys saw that breast implant makers were ripe for the plucking, were a good target of personal injury lawsuits, and that raised some concerns about the legitimacy of perhaps of all of the claims. So you have all of that and there is a lot of bad feeling all around, a lot of awareness that breast implants might not be safe, but little direct conclusion and into this in 2006, the FDA grants approval again to manufacturers, Allergan and Mentor to start selling silicone breast implants again. However, it demands as a condition of these sales that the manufacturers continue to study the impact and the health effects of their implants on patients, and neither one has to the FDA’s satisfaction. We are now 14 years after those approvals were given and the FDA has sent warning letters to all of the manufacturers of silicone breast implants saying, “You have not done what we told you, you had to do in order to sell these things.”

Jeffrey: There is so much going on here. And then it is tough to unpack it all. That is why the article is so good. It is just history has a way of repeating itself. I mean in 2017 Allergan sold about four hundred million dollars worth of implants before they were taken off the market and you mentioned that the FDA still asking them for information. What happened with Allergan? Why was not more done to them about this and are there fines? So what is going on now?

Maria: It is a good question. And again, it is hard to explain briefly, but I will try not to get too into the weeds. So I think it is first of all important to point out that Allergan is still selling some breast implants. But what started to happen actually in the late 90s, but what the FDA became fully aware of and started to warn people about in 2011 is that breast implants were being linked to a new complication, a type of cancer of the immune system that is called Breast Implant-Associated Anaplastic Large Cell Lymphoma, otherwise known as BIA-ALCL. Now these implants– This cancer has been linked to textured implants. So all the manufacturers make either smooth implants or implants that are covered in this more roughly textured silicone shell. There are a couple of reasons why it might be preferred. It allows tissue to grow onto the implant more easily. There is some doctors and patients say that it looks more natural but textured implants were not super popular in the United States. They were very popular in Europe and by the end of 2018, European Regulators were seeing a big surge in cases of BIA-ALCL and starting to get worried about the sale of textured implants and this disease that it seemed like that they were linked to and then it seems like they might be responsible for. So at the end of 2018, European Regulators stopped the sales of Allergan textured implants and later banned them entirely. The FDA in March 2019 convenes a hearing to look into– Two-day hearings actually to look into BIA-ALCL. Some of the other side effects that women are increasingly reporting- have increasingly been reporting of their breast implants, but it is not until last July 2019 that the FDA says alright five hundred seventy three women worldwide have been diagnosed with this cancer, 33 women have died from it. Women with Allergan textured implants, even though all of the manufacturers with textured implants have been linked to the disease, women with Allergan textured implants are six times as likely to contract BIA-ALCL. So Allergan, we are asking you to take your textured implants off the market, which the company did. The FDA later increased that recall to a class one designation, meaning that use of these devices could cause serious injury or death. So, it was a very– It seemed from the outside perhaps if you were not paying attention to these issues, like a very sudden withdrawal, but the awareness of these issues, the awareness of this disease had been around for years by then, and the FDA was taking action several months after Europe did.

Jeffrey: All right. Well, it is just with all the controversy, with all the awareness, it is still a billion dollar industry. All right. So let us move away for right now. Let us not talk about the economics. But let us talk about the humanistic side and in particular in your story you feature many women that have been affected by issues related to their implants and in particularly the story of Paulette Par you wrote about, she was very moving and her husband the work that he was doing. Can you share a little bit about Paulette’s story with us?

Maria: Absolutely. This was a really difficult story to tell and a very sad one. And I do have to say I am so grateful to all of the women who did talk to me or their families, in Paulette’s case, her husband because this is maybe from the outside seen as kind of a niche and taboo subject, you know, this is breast implants. This is feminine sexuality and kind of shallow plastic surgery. This is lady business, and kind of gross, and kind of silly, and not that serious. And a lot of the women that I talked to said that they had to kind of get over their own feelings of shame or the external judgement of you know, “Oh you got these things for vanity and now they gave you cancer. Are you happy?” You know, “You deserve this.” is what more than one woman told me that she had been told by family members or friends after after developing BIA-ALCL. In Paulette’s case, her story really kind of follows the history of breast implants. She lived in Missouri. She was a young mother of two children in the 1980s when she got her first set of breast implants, you know, as she wanted to feel better about her body after childbirth and nursing. And they were mostly okay. They were silicone. She was worried about the health impact when all of the news about lawsuits and the FDA moratorium on silicon implants came out, but you know, they were fine until around 2000-2001 she noticed that they were leaking and so she got– Her plastic surgeon did replace them with the first set of implants made by a company that Allergan later required. These were the textured bio cell implants that were eventually recalled due to their linkages to this cancer of the immune system. Paulette had one set of these biocell textured implants until 2010. Then there was another leak and she had them replaced with another set of biocell textured implants, and she was you know, in 2018, she was she was 67. She had just retired. She had worked in the administrative offices of her local hospital for decades. She and her husband were restarting– Her husband had retired a couple of years. before, and they were looking forward to traveling some more together and just you know, enjoying the start of their retirement together. And in the fall of 2018, Paulette noticed that she had a small pimple sized growth and she went and got it checked out and eventually was told, “Oh, you have this new rare cancer that has been linked to your type of breast implants.” A few sessions of chemo and you will be fine. And unfortunately the really, the just horrible and sad story is that over the course of the next year, she had her chemo during the Spring, as the FDA was holding hearings on breast implants, as Europe had banned the textured implants from their market, and the chemo did not work and her cancer metastasized and she wound up being hospitalized and growing weaker and weaker. And 29 days after the FDA banned her implants or asked Allergan to recall them, she passed away. 

Jeffrey: Now, the implants are deemed medical devices. So, what type of testing is done? And is the oversight just on the- you know by the FDA over these manufacturers? And how much oversight is done? It seems to be a recurring theme.

Maria: It is a really good question. It is. It is a recurring question. Medical devices in general have come under all sorts of scrutiny for the sort of lack of testing and regulation that they are subject to. I have to give a shout out to the International Consortium of Independent Journalists, which did an amazing series of articles called the Implant Files, that looked into- starting in 2018 it looked into some of the failures of regulation and study of all types of medical devices. Whether we are talking pacemakers or artificial hips or ventilators, which have been in the news so much with COVID-19. So breast implants are a specific subset, but by no means the only sort of medical device that is subject to some of these questions about the regulation and testing. For breast implants specifically the FDA now does regulate them as class 3 devices, meaning that they are the highest category of risk. And so they are subject to what is known as pre-market approval processes. They have to undergo clinical testing done by the manufacturer. But again, there is still some question about the adequacy of that testing and the data submitted. For example with Mentor, which is now owned by Johnson & Johnson, and Allergan which is now owned by AbbVie, when the FDA in 2006 gave them both approval to start selling silicone implants again, they base that improval on three or four years each of study and then required the additional study that the manufacturers have not fully complied with. 

Jeffrey: So as we said history does repeat itself. Unbelievable! All right, before we go, is there anything else you would like to warn or discuss with someone that is considering the surgery

Maria: So I think one thing that is important to point out and in that maybe does not come across in all of the discussion of the negative side effects and very serious and sometimes fatal consequences is that, I did speak to many women who are grateful to have implants as an option, including it has to be said, a lot of women who have been affected by cancer. Whether they are women who are cancer victims themselves who have undergone mastectomies to treat cancer or women who are the children of people who have been affected by breast or ovarian cancer, who have undergone preventative mastectomies and remove their breasts to remove their high risk of developing cancer. Many of these women say that they are grateful for the options, that the choice to have breast implants have given them. So I would not necessarily want somebody to come away from this thinking that all breast implants are absolutely bad, but I would conclude from all of my reporting that the breast implants that are on the market just have not been adequately tested or studied and that for women to have options they deserve to have fully studied, vetted choices that have- and to be clearly informed about the risks which many women said they had not been, whether it was the fault of their doctors, or the fault of the manufacturers not adequately communicating the risk to their doctors, or in some cases even hiding or not fully reporting the adverse events in the malfunctions of their devices. It is just there is been a lack of clear information given to women who might want to consider these medical devices.

Jeffrey: That is great advice and research and research and research is key. So Maria, thank you so much for your time today. This was incredibly interesting and enlightening and informative. Thank you.

Maria: Jeffrey, thank you so much. It was my pleasure.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media. Thank you, and we hope you enjoyed the RP Healthcast.

In this week’s episode we speak with Brian Bremner, Executive Editor, Global Business at Bloomberg, where we talk about the global aspects of the Covid-19 pandemic and the politics behind finding a cure, creating a vaccine and ultimately could government policy effect the global distribution of that vaccine.

TRANSCRIPT

Jeffrey Friedman: Hello and welcome to the RP Health Cast by Rooney Partners. I am your host Jeffrey Friedman. Despite its worldwide spread, the global pandemic is not being met with global cooperation. At a time of trade wars between the US and China, and at a moment in time when the US has dramatically scaled back its commitment to the European Alliance and scaled back its commitment to the World Health Organization, and at a juncture in history when nationalistic forces have been on the rise, the environment conducive to a coordinated global effort to defeat the coronavirus is simply absent. To help us understand how we got to this place in world history and what we should expect the geopolitical state of play to be in in the age of the coronavirus, we are very fortunate to have with us today, Brian Bremner. Brian, good afternoon and thank you for joining us today. 

Brian Bremner: It is terrific to be here.

Jeffrey: Brian, your role for Bloomberg News includes overseeing the global coverage of the coronavirus. You are based in London, now. You were a journalist in the US for many years. Right before coming to London, you were the executive editor for Bloomberg in Asia. It would seem your career and background were tailor-made for this assignment now.

Brian: Yeah, in some ways it is. I spent about 20 years in Asia for Business Week Magazine and then Bloomberg. I lived through the SARS epidemic which you might recall happened in the early 2000s, which in many ways kind of foreshadowed what is going on right now, although the current pandemic is bigger in scale. It is wreaking more economic damage. But in a weird way, this is kind of closing a circle for me at that journalistically. 

Jeffrey: Yeah, I bet. What comes around goes around. It is a circle. Now, at Bloomberg, you and your colleagues have done extraordinary reporting on the coronavirus. Before we turn to geopolitics, I want to start with the beginning, with Wuhan, China, which is generally viewed as the source of the SARS-CoV-2 virus. Suspicions about the coronavirus leaked from a bioresearch lab. What is your take on that Brian?


Brian: Well, you know from the very beginning, I think a number of people in the intelligence world, particularly in the US did notice that there was a biosecurity lab in Wuhan which turned out to be the first epicenter of the coronavirus epidemic. A lot has happened in the intervening months since this broke in late December. In the last several weeks, particularly as the epidemic is deepened in the United States, there have been some theories about the origin of the virus being tied to the biosecurity lab. There are basically two competing theories. One, that the virus was man-made, in other words, it was designed in the lab intentionally. The other theory is that the virus may have started in the wilds of Central China. But a sample was taken into the lab and then was accidentally released and set off this chain reaction that we are all living with today. I think the scientific consensus is that the first theory is pretty much unfounded. If you look at the genetic sequencing of the virus, there are telltale signs that one would find that it was kind of splice together. There seems to be no evidence that took the case. Even I think the China Hawks, the most intense critics do not give terribly much credence to that theory. Whether it was accidentally released is plausible. However, there is no hard evidence that actually occurred, so that is a bit of a mystery still. I do think the US is kind of backed off some of the rhetoric that you heard a few weeks ago with Secretary of State Pompeo basically saying that there was overwhelming evidence that this had taken place. I think he is backed off of that. If you talk to professional virologists and people who do this for a living, the reputation of the Wuhan facilities is pretty good. They have done some landmark work in coronavirus research. Yeah, there have been accidents that have happened over the decades all over the world with virus samples. But I think the reputation is pretty good and it is far from proven or even a strong case has been pulled together that that is what happened, that there was an accidental release.


Jeffrey: There is still a sense of mystery around this. China said international experts are not going to be allowed into China to investigate the origins until the world secures an unspecified final victory against the virus. Those are their words, final victory. What is that about? Is final victory even possible with something like this?


Brian: Well, let us put that apart. I mean, the first issue is the access on the ground to finding out the virus origins. So there was a World Health Organization scientific mission that went in in February. Now, this was in the darkest moments of China’s own experience with the epidemic. The hospitals were flat out, people were getting sick at massive levels. So they were not able to do a tremendous amount of forensic work, I mean the kind of disease analysis to go back to the origins of it and therefore protect us, you know, going forward. They were not able to do that at that time. They want to go back to what the World Health Organization does and just this week, China seemed to indicate that they were open to that. Now, what the ground rules are going to be and how deeply they can go into China and re-interview patients, look at virus samples, really do a lot of fieldwork, that remains to be seen. The question of what will the end looks like, it is really hard to say. This coronavirus which had its origin in the bat populations of China, the genetic sequencing seems to show that it kind of started in that population. It is somehow, and you know, the world does not know the answer to this, made that leap from rural China into a megacity like Wuhan, and then took off around the world from there. So the big unknown is whether there was a secondary animal host. If you look at previous outbreaks in this family of viruses, the SARS virus and its cousin, the MERS virus which is the Middle East Respiratory Syndrome. They both had kind of intermediary animal hosts. MERS had camels and the SARS epidemic back in the early 2000ss. Although they do not know this conclusively, they are pretty sure that there was an animal called a civet cat, which is this mammal that is used in wild exotic dishes in China was the carrier into the human population. There is also a big concern about wet markets in China but also in other parts of the world where you have wildlife trade, kind of co-mingling meats. Depending on the quality of the wet market, these scenes can become very unsanitary and breeding grounds for pathogens. So yeah, these are all unanswered questions that another scientific mission, another group of experts from all around the world are going to have to piece together. It may be quite sometime before we know the exact origin of the story. So the other question that you ask is what does success looks like? So we do not know whether we have an effective vaccine yet. There are a lot of very interesting crash programs in the United States, in Europe, in China, in the UK, the Oxford Group. These vaccines are in various stages of development and have to go through human trials. If we get really lucky and there is an effective vaccine that can be ramped up commercially, I mean in terms of production and distributed to big chunks of the human population, that could be one path to protection. Then the question is, is this going to be one of those viruses that linger from year to year and that we need some kind of additional protection from in vaccine form. The other path to the end of this is what is sometimes called herd immunity. This is the idea that sometimes viruses are pathogens. If they reach enough of the population, it is usually around 60%, then you have got enough people who have survived it and have natural immunity and the viral dynamics change. It becomes less, you know, something that will race through the population and it can be more isolated and dealt with. So that is another scenario that we may be living with for a while. So those are the broad diameters of where this might go. 

Jeffrey: So I guess the bottom line is we do not know enough and it is way too early at this point. 

Brian: That is right. There is a lot of really important infectious disease detective work that needs to be done. It probably has to be done in China. That is why you are seeing this kind of international pressure on China and on the World Health Organization to get in there. Because if we do not know which animal species is that secondary carrier, then we are vulnerable to second and third waves. You are already seeing kind of a mini outbreak in northeastern China which is worrisome. Even though Wuhan and the central part of the country have calmed down and are opening up, the Chinese authorities are already having to deal with the secondary outbreak. That is obviously a big issue in the West, in Europe and in the United States which start to open up again.

Jeffrey: So Brian, Europe has been the site of some very terrible hot spots with where you are in the UK and Italy having the most fatalities in Europe. What is your assessment? Why? Why those two countries?

Brian: Well, I think in the case of Italy, unfortunately, the Chinese experience with the epidemic coincided with their lunar holidays, the Chinese New Year holidays which were in late January, early February. China, because of the size of its population has an enormous impact on global tourism and that series of holidays is actually the biggest human annual migration every year. Unfortunately for Italy, a lot of Chinese tourists, probably infected, may be asymptomatic, gather in a place, they went to Venice and they went to Milan during their holidays and completely blindsided the Italian health care system. People just were not aware at that point in time, late January, early February just how stealthy this virus is. What is unique about this coronavirus as supposed to SARS is that when you get SARS or MERS, you get sick right away. There is just nothing nuanced about it. In a weird way, although the fatality rates are higher for these other diseases, they are actually easier to manage because it is obvious to everyone that someone is sick. Then you are more likely to quarantine them, more likely to get medical help. This virus, you can walk around for weeks and not really feel it all differently but be very contagious. So it hit Italy really, really hard and then kind of took off from there. The British experience is interesting because there might have been compounded by a policy error. I think early on, the scientific consensus was very much in that herd immunity mentality that I talked about a few minutes ago. Maybe the best way to handle this since it is not terribly lethal is to keep things going as normal and then we will deal with the older patients who get sick. But a lot of people are going to experience this as a flu or something, slightly worse than that. They will be fine, they will get immune, and then gradually, the society will build up as collective immunity and it did not work out that way. It got really bad, really fast. Because again, we started to learn that this virus, although it is not as lethal as Ebola or SARS, it is pretty lethal. If you infect enough people, the vulnerable parts of the population are going to get seriously ill. The big irony is that Prime Minister Boris Johnson became seriously ill and had to be put in intensive care because of this. So then, that experience led to a rethinking that you had a more proper lockdown in the UK and you are starting to that the curve bend. Now things are starting to slowly reopen.

Jeffrey: So Brian the economic pain caused by this virus has been staggering. So in the US for instance, over 30 million workers have filed unemployment claims in the past six weeks. I think that represents about 15% of the workforce. So developed countries like the US and those in the EU are using fiscal stimulus plans to provide a measure of relief for its citizens. If this is the case in developed countries, can you talk about what is happening in emerging market countries? It must be unbearable. 

Brian: Well, this is going to be a kind of global experience, unfortunately. I mean, no one doubts that we are heading into a pretty meaningful global recession. When you have that kind of set up, the emerging markets in Asia, Latin America, Eastern Europe are going to feel the full brunt of it and you are right. They do not necessarily have the fiscal and monetary cushion to unload big stimulus packages to hold things together. So it is probably going to be a very, very difficult economic experience for emerging markets. It is not going to be much fun for developing markets. Basically, people have made the analogy to medically-induced coma, as we have kind of put the global economy into because of the public health concerns. It is going to take a while for the patient to get back up to fighting speed. There are all sorts of negative feedback loops that can become embedded and prevent you from that sharp recovery. I mean, one hopes that that happens but I think most economists view that this is going to be a very, very long kind of convalescence. Certainly well into 2021, the unemployment rate really starts to come back down meaningfully and the economy really starts to rub up again.

Jeffrey: Okay. So before I ask why we do not have a global response to support each other, I would like you to compare the macro-political climate today with that of the last crisis, the Great Recession of 2008 and 2009. I mean, the world was a different place then. Can you please remind us how the world’s leaders responded to that financial threat?

Brian: Well, I think what is interesting about the financial crisis is that it did not take long to understand exactly the source of it and then the dimension of it. It was pretty obvious that there was a structural imbalance in the housing market in the US, and to a lesser degree Europe and that you know, through a number of events, some of the biggest banks in the world had made very highly risky bets on mortgage-back securities when the housing market went down. Those went down and then you had this cascading effect around the financial world that was very scary. It was very economically destructive. But at least you could kind of get your mind around the nature of the problem. So I think the policy response, although even to this day, there is a debate about whether enough was done to this sting, it was pretty clear what needed to be done by the major central banks and the US, UK, EU governments, and China as well. So even though that was a long recovery back, this different because first of all, this fully global in scope. The virus raced around all around the world to every economy and the requirement is like a full-blown stoppage of economic activity. So that is different. The nature of the problem and then the time it took to fully get your mind around the problem. Early on, when it looked like it was just China and maybe possibly other parts of Asia, the US Stock Market was bounding from strength to strength because it did not seem like it was a systemic risk around the world. Then when this thing went into Europe and then started to flare up in the US in a serious way, all the financial markets reacted. I think what else is different is the intensity of the US-China rivalry. I mean it certainly existed back in 2008. But I think it has been heightened and it has intensified and the economic and geopolitical rivalry is so much more intense these days. So that is complicating the international policy response to the virus because everything, well, the science is getting politicized. There is a lot of you blaming each other. It is a kind of a toxic political environment and that makes smart decisive policy action a lot more difficult. 

Jeffrey: Do you think that this economic crisis similar to back in 2008, is a bump in the road? Do you think that this is going to be business, as usual, back when we come out of this in 2021? Or do you think the world is going to learn a little bit, there is going to be massive changes because of this?


Brian: Well, I think a couple of things are pretty clear and some of these trends pre-existed the virus, the pandemic and it just been intensified by other trends seem newer and are unexpected. But once they getting grained or going to be hard to reverse, I mean an obvious one is just the state intervention in economic life. If you look at the scale of the Central Bank interventions and lending, and then also the fiscal side of it where you are seeing governments lend big amounts of money and maybe even taking equity stakes in the airline industry, in the small business sector, in hospitality and leisure, anything with a strategic national interest like a Boeing or an Airbus. There is just going to be far more government interaction in our economic life than anyone probably would have predicted a year ago. Other trends about telemedicine, telecommuting, these things were kind of out there but I think a lot of companies are waking up to the idea that this does not happen in every instance. But some companies have been able to function at a pretty high level with most of their workforce at home. What is that going to mean for the way we organize ourselves in our corporate working lives but also the commercial real estate markets. If companies start to rethink their commitments to long-term expensive leases in the major business centers of the world what is that going to look like? Who is going to win? Who is going to lose? There are going to be big changes I think in consumer behavior. Are we going to bu much more mindful of the microbe world? Are we going to you know change the way we consume and entertain ourselves as a result of this experience of the lockdown? The very real possibility that in a highly globalized world where human populations are growing and encroaching on wildlife, we could be facing more of these kinds of breakouts in the future. How we are going to prepare ourselves for that? Then finally, I have to think that this epidemic has been so destructive to people’s lives certainly. The economic toll has been so high that there will be a very serious rethink about how can we organize ourselves internationally so if there is an outbreak, we are much faster on the scene and getting the right resources in place to manage these crises and maybe even avoid them. One area that is really interesting is vaccine development. That was a very sleepy part of the big pharma world until this crisis. Now, you have got all these crash programs and of course, a lot of money flowing in. But that is because you a gun is on our head. Should we rethink that after this crisis is past, do we have to think about vaccine development like we do weapons programs? In other words, they are heavily subsidized. You do not use them right away but can we start to think about full-spectrum vaccine development that would get us close to the mark if a new virus came on the scene. At least we would be better prepared to speed up that vaccine, turn around time, and put us in a much better place than we are right now.

Jeffrey: Brian, Bloomberg took about vaccines. Bloomberg reported a couple of days ago that the US moderne side, US was likely to obtain the vaccine from the French company Sanofi. So in a world of rising nationalism, one would have thought that France would have had the first rights to this vaccine. So we talk about global coordination, can you explain what is going on and why would the US State claim there?

Brian: Well, right now you have got this outbreak of vaccine nationalism, right? I mean all the countries, they want to protect their own people. Some of them have major global pharmaceutical companies operating within their borders, some do not. A lot of money is, you know, emergency funding is being spent to place bets on various crash programs around the world. In the case of Sanofi, they are getting a fair amount of US funding and the CEO of the company said that means that the US will get some preferential treatment which upset the French very much. The question also becomes, what if the Chinese, what if their crash program finds the price first, how would that work. Xi Jinping this week at the World Health Organization governing assembly said that if the Chinese do find a vaccine that works, it will be a public utility. In other words, it would be available to the rest of the world. So it is a bit of a mess, but it kind of speaks to a point I just made is that you know, this is a very chaotic way to approach a pandemic. In theory, you would have fought through these things, you know, war game, get out. So these viruses come along and they come along pretty regularly particularly in this century. It is not a secret that this could happen. We have agreements, we have understandings about how we would finance a pandemic shot and distribute it around the world. How you scale it up. It is clear that we are not there and that is why there are all these friction points and name-calling that is going on in the political world. Instead of pointing fingers, we need to work on that global coordination.

Jeffrey: Brian, thank you so much for your insights today. Your thoughts and experience on the global stage are certainly fascinating and thought-provoking. I would love to have you back on our podcast in the near future to discuss this global coordination, and hopefully, that will happen, the global coordination very soon. Thank you again and stay safe. 

Brian: Thank you.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media or email us at rphealthcast@rooneyco.com, or visit us on our website at rphealthcast.com. Additionally, if you like what you hear, please follow us, review us and share us with your friends and colleagues. Thank you and we hope you enjoyed the RP Health Cast.

In this week’s episode, we speak with Tiernan Ray, a freelance journalist who writes for ZDnet, the Street.com and other publications, about healthcare technology innovation including the power of artificial intelligence – its pace of development and where it may lead us in the 21st century and beyond.

TRANSCRIPT

Jeffrey Friedman: Hello, and welcome to the RP health cast by Rooney Partners. I am your host Jeffrey Friedman. Our guest this week is Tiernan Ray. Tiernan’s been covering emerging technology and business for almost twenty-five years. He was most recently the technology editor for Barrens where he wrote The Daily Market coverage for the Tech Trader blog as well as feature stories, cover stories, and a weekly print column. Prior to that, Tiernan was a reporter for both Bloomberg and for Smart Money today. We will be talking to Tiernan about some of the recent stories he has written on healthcare technology both in medical technology and in artificial intelligence.

Jeffrey: Tiernan, welcome and thank you for joining us today. 

Tiernan Ray: Thanks for having me Jeffrey. 

Jeffrey: Right. Now, you are a veteran technology reporter. And in Baron’s you wrote daily market coverage for the Tech Trader blog for nearly a decade, while at the same time, you were writing their feature stories, their cover stories, in a weekly column all on Tech for the print magazine. Now, will you continue to write about tech your increasingly — we noticed, more focused on healthcare technology. So, what is that transition been like?

Tiernan: I had to really go back and try and reinvent my skills Jeffrey, because I spent so much time focusing on semiconductors in networking and I was talking to public companies and I noticed that when I left Barons in twenty-eighteen, I really needed to go back into areas of research and challenge myself to figure out what are things that are going on and say artificial intelligence in life sciences and to dig into basic research going on and to school myself, really. So, it was kind of job retraining of a sort, for me. 

Jeffrey: Now, it is interesting because as you started with semiconductors and they were doubling, you know, capacity every couple of days, right. Technologies always move fast. Developments now in healthcare technologies is kind of similar. It is related right now, especially COVID related once. 

Tiernan: Yes. 

Jeffrey: So, they are moving even faster, you know, every moment. Can you lend a little insight into what it is like to keep up with everything as you are talking about retraining? How do you identify what you are going to cover in such a crowded and fast-moving health tech news environment? 

Tiernan: Yes. I felt I was in a position Jeffrey at Barons for years where public companies came to me and wanted to tell me stuff. And when I decided I would have to broaden my knowledge and find out about areas of life sciences. For example, that I did not know about I started to dig in places where I had previously looked and one of the things that astounded me was this whole field of preprint publications. So, the process is, you know, you go on Twitter and you see somebody says, hey, we just released our paper on archive, which is the Cornell-operated preprint server. Anyone can go and download the PDF and there is just tons as hundreds of papers on a daily basis that show up from researchers. These are things that have not been peer-reviewed. They are the kind of thing that will eventually show up in nature magazine or science magazine. 

But some of them are amazing kinds of discoveries in all fields in artificial intelligence, in physics, in life sciences. And so I discovered this, I had no idea while I was at Barons with this whole phenomenon had popped up in the preceding decade or so where you just go to this server and there are tons of stuff and it is just like kid in a candy store, if you like to research. And so, it is also to use another metaphor drinking from the fire hose. So, I had to have — kind of a learning curve, where I just started reading stuff I found on artificial intelligence, in genetics, on the archive preprint server and got into this rhythm of constantly checking. And it is the kind of thing that I continue to do for the last year and a half since Baron’s — just every single day. I will go and check out what new research has been posted and it is not just me Jeffrey, you see stuff in the New York Times, from the post in the Boston Globe and Financial Times that is pulled from a preprint server where basically every journalist is trying to get ahead of the curve in what is the latest COVID research. 

And so they are going on archive or versions of it called bio-archive or meta archive and they are pulling down the latest report from Harvard that is not yet in publication, that just been thrown up there and it is kind of amazing, front kind of moving wave, you know, leading edge of research from these labs. 

Jeffrey: That is really interesting. So, is it like one of those old school bulletin board servers that people are just posting?

Tiernan: It does not have the social interaction yet, Jeffrey. The social interaction component appears to happen to an extent on Twitter where a scientist will post something, there will be a thread of discussion about it. These are really bare bones. I compare it more to FTP, file transfer protocol, in the early days where you just cannot believe that there is a resource. You have broken into some folder, and there is just stuff there and it is like, oh my God, this is amazing.

Jeffrey: Wow. So, as an example, I think when one of your stores, last month in New York, right. Now, New York last month — we were like in Dire Straits, right. Our healthcare leaders were looking to source as many ventilators from around the world as we could.

Tiernan: Right.

Jeffrey: And you wrote a story about a team of a hundred astrophysicists who were working together from quarantine to develop a super simple cheap ventilator that they hope to make in order to help patients with COVID-19. You know, is this the type of things that you were finding? 

Tiernan: Yes. Amazing. Just amazing. I stumbled upon this report and I just saw, they have a name, Mechanical Ventilator Milano. And so that is the kind of thing where you see that in an article on a preprint server and you say that is fascinating, wonder what that is because they already have some kind of branding. I do not know if it means anything. And I dug into it and as I read it, I saw, “Oh, my God, this is kind of incredible”. These are people who are — you know, start to follow the author citation. So, the lead author is a gentleman named Christian Galbiati who is a physicist at Princeton University. And full disclosure, I went to Princeton. So, I am kind of intrigued as soon as I see a Princeton reference. So, I started tracking it down and I said, “Okay. He has been working on something called Dark Side, which is this detector to try and pick up traces of dark matter in the universe that is built in a tunnel several miles underground under the Gran Sasso mountain range”, which is a kind of a belt across the middle of Italy. He has been working on this for years with a huge team of physicists. 

And so, suddenly he is popping up here with over a hundred authors, on a paper about a ventilator and second reading it started digging into it, and I reached out to him and they were kind enough to respond to me. And this is just sort of one of those gems that shows up where you are just sort of kind of wandering through the preprint server and you stumble upon, “Oh, my God, there is like just an incredible piece of fully-developed research an incredible team of people and it’s right there”. And you feel that, “Wow! I am the first person”. I know Jeff, seamless. 

Jeffrey: And I mean, it is such rabbit hole that you may have been, absolutely. But — so, like a story like that, the news is moving so fast and in New York, the infection rate curve has peaked. It is declining. Our need for additional ventilators has gone down. Now, looking back. How did it all turn out? Did they make the ventilators? Is the story still relevant? 

Tiernan: Bill very relevant. I spoke yesterday with Cristiano Galbiati and he said this, “We, all in the physicist at Princeton”. And it was very moving Jeffrey because he told me in sweeping detail about the technical aspects, but he also gave me a perspective on how it came together. You know, they went into lockdown in Italy, in early March. And he said to me we were really kind of feeling at a low point, because in Italy we felt it was just Italy. For a while, you may recall in an early — late February, most of the say, “Oh, it will leave the hot spot”. And it was before things have been implemented even how. And so, they felt alone and he was talking with a friend who runs a gas company that he partners with to develop these dark metal detectors and they said, you know, we since we have no labs to go to at the moment, because we are in lockdown, couldn’t we do something about what is going on? 

And so, he and this friend brainstormed about, you know, building these large detectors for antimatter is — you know, kind of a really complex version of moving air in and out of a chamber. Kind of like what you would do with a ventilator. And so, they just got underway and he and Cristiano sent messages to collaborators at Fermilab in the US and Illinois, and other facilities around the world, and got some of his top people to kind of quickly throw together the diagrams, the technical specifications, and within days they had gotten what was basically shown in this paper that I found on archive just by brainstorming. And he said, you know, this was a way to move beyond feeling frozen. He said I was just four days when the lockdown happened in Italy. I was just frozen. I did not know what I was doing. I could not function. And so, gradually by going back to what he knew how to do and bringing together a team of people and seeing that there were connections around the world, that they were not completely isolated. That there was partnership and friendship. This was something that kind of lifted everyone out of this. 

And so, it was an incredible, been an incredible effort. They are now under, starting volume production, and they hope to get to thousands of units per day. They have a sort of initial run of fifty units if it tests them. They got FDA emergency approval for this ventilator. And so they are kind of on their way now and he does the basic science. He was not in charge of manufacturing runs, but he did indicate that this is still a current need. And one of the things he is concerned about is, there could be as many people say a second wave and the fall. And so, as far as he is concerned, building ventilators is still a critical thing to do.

Jeffrey: Well, what started out as a cathartic exercise is lifesaving. 

Tiernan: And could be — yes. And could be something you really still want again depending on the shapes of these curves in many nations of the world. 

Jeffrey: Yes. That is great. One of the topics — another topic you have been reporting on as a contributor for ZDNet has been the significance of healthcare modeling. And you recently wrote about the concept of super spreaders, and that’s really been in the news lately, especially with that nightclub guy. Maybe got to talk to a paddock, but in terms of healthcare modeling, do these one-off super spreaders, you know, can you talk about how that may affect the modeling and what is modeling being used for to track the virus? 

Tiernan: Yes. Everyone is trying to figure out how can we do better than what has been the — known as the susceptible infectious recovered model, which has been around for over a century. That is the main model that you hear about from Oxford and from up in Seattle, from Bill Gates’ group. All of these models that are used by public policy experts and by governors to decide what do we think is the shape of the curve and how can we flatten the curve? The problem with them is a very generic and they are very abstract. And so they do not capture a lot of real-world data. There are people doing what is called Curve-fitting, where they take some parameters to try and guess what they think will happen with the spread of the infection, with the doubling of cases. 

And so, everyone has been trying to get — do better than this and one of questions now becomes — that is tied to these models is, how do you do testing to fill in real-world data as opposed to simply mathematical exercises? And so, one of the things again that showed up in just amazingly preprint, is a bunch of authors from Google. One of whom is a off your right, who is a data scientist at Google. He had a couple of colleagues with help from Tel Aviv University. They put out this paper and they said, “You know, everyone’s talking about testing now. You do not want to go out and mass test everyone because it is just not practical”. What you should do is you should follow the super spreaders, and the super spreaders are maybe index patients, first patients, who appear to have been able to, for whatever reason, spread the disease to more people than what is the average transmission rate of a disease. And these are again statistical terms because we do not know the mechanism. 

But it does seem to be that in any kind of epidemic or pandemic, you can actually find individuals who, if you trace all their contacts, have led to more infections than what you mathematically model. And so, as being the average — and so, they are saying, “Go and do contact tracing”. And this could be something you can imagine as the Google or Apple kind of Bluetooth tracing system on a smartphone. It could be using GPS signals. There are no people talking about using GPS signals. And it could be plain old-fashioned contact tracing where there is a kind of like the intake interviews on a hospital, someone in hospital, who after someone test positive, you say, “Okay. Who have you been in contact with?”. 

So, there’s all kinds of forms of this, but it shows you that we are still trying to fill in the blanks with these very abstract kind of rigid models that have been around for a hundred years that are statistical that do not reflect the details of spread of disease. And two, we are trying to decide how we are going to use testing when we are in a testing constrained environment? We do not have the number of tests. We should have, we have stumbled in the US in getting testing rolling. It is because we have to make these choices, decisions about how to use resources and what is going to be most effective.

Jeffrey: Yes. I guess it is fascinating and so important and that brings us to another topic of artificial intelligence, which I know you have been covering for more than a decade. So, what are you seeing now that you find particularly interesting as it relates to AI in healthcare?

Tiernan: I think that combining AI right now with the work of human experts is pretty interesting. I took a look at — there is a lot of attempts, Jeffrey, that you may have seen to try to use AI to look at chest x-rays or CT scans as a basic way to look for COVID and there has been a lot of struggle in this area. I spoke to scientists who worked on this and the problem is that you do not have enough data. It takes time to train AI. And so, in this rush to try and implement AI, I think we are seeing people saying we need — we are realizing the gap — one of the gaps — the big gaps is implementing AI and machine learning and deep learning with human processes, with human systems, where experts are working. The model, when things were, you know, kind of casual, before the world change was to say, you know, we are really impressed with what the machine does. 

And we are just writing everyday about what the machine does. And I think, when systems suddenly are stressed and you see human beings rushing into the breach with their skills, be they radiologists, who can look at an x-ray or first responders. You say, “Oh, okay. This is what it means to really be able to handle situations”. And maybe you need to take these machine learning models if you have been building and have them actually integrate with human expertise because human expertise makes quantum leaps. That is what happens in times of stress and you cannot spend the next decade, sort of leisurely training a system. You might want to add in some of this expertise.

Jeffrey: Yes. I mean, I think last year or two years ago, IBM’s Big Blue did that experiment on breast cancer? 

Tiernan: Right.

Jeffrey: Right. And they — you want to talk about that?

Tiernan: Yes. So, the IBM Big Blue experiment with breast cancer, and similar experiments with radiology, Jeffrey, always come down to a kind of obsessed highly abstracted model of diagnosis where you know a probability after a fact, just by virtue of how things you train that this diagnosis would have been something that would have led to — you know, the correct procedure for the patient, it is all after the fact. And so, the consistent flaw and these kinds of you know, AI does better than a human expert kind of thing is, they are always looking retrospectively at what has been gleaned and they are not true to the actual scenario, which is you are a female patient, you come to your doctor and you get a certain diagnosis and there is a level of uncertainty. And this human being in front of the doctor has to actually be given advice and it has to be a procedure pursued. And this is the moment of decision and you can be helped by statistical tools, which is what machine learning is generally. But there is still a choice about a person and what is the proper standard of care for that person? 

And so, I think this is actually another instance where all of these models, despite being kind of remarkable science, have to be — they have to be integrated into the work of human experts and people in fields. And we have seen this across the healthcare landscape. We saw it with DeepMind working in British hospital system in diagnosis as well. That there was only — there was a limit about what could be achieved with these AI models because at some point, you sort of have a connect with actual clinical practice. And so there is this big challenge of how do you get these systems to work with the reality of a clinician and what they have to do with uncertainty, rather than simply statistically modeling what you know long after the fact by looking at case series.

Jeffrey: All right. So clearly, you feel we are not there. There needs to be human interaction. All right. So, for the tough question then, if you were to pull out your crystal ball, where do you see AI taking us in five to ten years from now? You know — also do you think it is a good place for mankind or will it be a scary one? 

Tiernan: It is going to focus; I think it is going to focus on language principally because it is the area we have seen the most progress and that progress is still unfolding Jeffrey. The Transformer, which is a seminal breakthrough in two thousand seventeen from Google that has informed all of natural language processing and language translation by machine learning has continued to pay dividends and some of the things that are happening with just even chat Bots and with natural language translation between French and Spanish and Hindi and Yiddish and Chinese and being whose giant capabilities are incredible and there is a kind of, you can see there is an industry within AI of just the language stuff. 

And so, I think that you are going to see, for a while, a concentration of achievement and breakthroughs in the area of language and that is no small thing, because if you have increasingly sophisticated models of using language, they can flow through to lots of other tasks that have to do with describing things seen in pictures. Tests that have to do with how you respond to speech online, writing social. And there is a qualifier, which is that more and more these large companies that dominate AI like Facebook and Google, will combine language capabilities with other kinds of signals, be the images with a sound, to do what is called multimodal learning and that will enhance, I think, the language part. But I feel like the language part is going to be pretty profound revolution as it flows into the world because text writing can travel so quickly and we have yet to see the full impact of that because we have yet to see all of the technological breakthroughs that will happen in that area of AI.

Jeffrey: Well, as the speed of technology changes, I am sure we will see it pretty quickly. Tiernan, thank you so much for your time today, especially with everything out there. 

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Business Insider’s Lydia Ramsey shares how she covers the pandemic while living in one of its epicenters, the way hospital systems are handling the crisis, and new forms of doctor/patient communication.

TRANSCRIPT

Jeffrey Freedman: Hello and welcome to the RP Healthcast by RooneyPartners. I’m your host, Jeffrey Friedman.

Jeffrey: Certainly, the biggest health care story we have is the continuing pandemic. We now have over a million and a quarter American sick with the virus and over 72,000 that have died from it. While the news for the most part has been grim, there have been several stories of hope and perseverance that have been coming to light, especially here in New York, which has been through so much these past few months. To talk a little bit about this, our guest this week is Lydia Ramsey. Lydia is the senior health care reporter for Business Insider. She joined BI in 2015 and covers everything from science to healthcare mergers to drug pricing and to healthcare startups. She’s also in charge of a great weekly health care newsletter called Dispensed.

Jeffrey: Today, we’ll be talking with Lydia about her recent coverage on the coronavirus and her coverage on how hospital systems are faring in the face of the pandemic. We’ll also talk about other ways patients are communicating with their doctors outside of hospitals.

Jeffrey: Hi, Lydia. Thank you for joining us today and actually for taking time away from arguably the biggest health care story of our lifetime, so thank you.

Lydia Ramsey: Of course, happy to be here.

Jeffrey: To start, why don’t you talk about your personal experience covering the pandemic? What’s it like being a journalist covering the business of healthcare at this time, especially living in New York? You live in New York City, Brooklyn. How are you choosing which stories to report on?

Lydia: Yeah, it’s been an interesting ride. I think we all had our world’s turned upside down in March when we started to realize that this was going to be a reality we were all going to be living through, and in my case, reporting through as well. It kind of took a few weeks to figure out where I best fit in. It’s one of those things where I have a pretty broad health reporting background both from a scientific perspective and from a business perspective. In those early days, I tried my best to figure out what stories I could best tell based on my skills. A lot of that was looking at the inside of the hospitals on the front lines here in Brooklyn. I was hearing ambulance sirens all the time. I’m sure everyone else in Manhattan and elsewhere in the city of New York was hearing the same thing for a lot of March and the early April. That kind of drove a lot of my reaching out to hospitals around the city, nurses, doctors, other caregivers. I really tried my best to get a sense of what was going on inside. As a reporter, I wanted to make sure I was getting the full story but I wasn’t myself going to be able to get inside the hospital without freaking out my family, so I tried my best to figure that out, and it has been really interesting. It’s one of those stories where before this, I could cover a health topic and it would be really in the abstract. It’d be talking about an experience and having to think about some condition. That was something that had never affected me.

Lydia: In the case of COVID-19, this is a very real disease and it’s something that’s affecting practically everyone around the globe and social demographic wise be damned. Young, old, everyone is involved. Some of our reporters even seem to have gotten it, things like that. It was really a new experience for me to see like, “Oh, wow, this is something that personally affects me and it’s something I’m covering professionally.” That took a few weeks to figure out how exactly to handle that because it is a bit of a adjustment.

Jeffrey: Lydia, in healthcare business, hospitals and healthcare systems are among the hardest hit. Both because the flood of COVID-19 patients they have to treat but also because of the hits they’re taking at the revenues which you wrote about one of your recent stories. Can you talk about what you’re seeing here? Are these hospitals really expected to recover revenue once their broader operations are back up?

Lydia: Yeah, that’s going to be the big question. I think a lot of hospitals are understanding that that initial wave of patients we saw that that led to elective procedures being postponed and delayed across the country, that first wave seems to be hitting, we’re past that here in New York. We’re seeing that hit elsewhere in the country right now. Beyond that, it’s not like there’s going to be a magical point at which there’s not a single COVID patient in a hospital. Hospitals have to really figure out, “How do I go back to some semblance of normal and bring those procedures back online?” Because really I was talking to one health system and and the vibe I got was if these kind of money-making procedures, this normal business operation doesn’t come back online within the course of May, a lot of hospitals won’t be around to keep caring for COVID patients, which is kind of frightening to think about. These are pillars of our communities. They’re there to serve the communities. If financially they can’t make it work, they’re in a tough spot. That’s unfortunately the case for a lot of folks.

Lydia: To your point, it’s one of those things where you think about hospitals as nonprofit organizations. That’s typically how they’re structured, but they really are huge business operations. If that money dries up either from procedures or from people just deciding they don’t want to come back to the hospital just yet because they’re worried they might get COVID-19, that’s a really big issue. That’s not going to go away anytime soon.

Jeffrey: At the same time, you have other business verticals like telehealth really taking hold. A lot of people have never had a remote doctor’s visit and now it’s becoming a norm. Where do you see this settling for the telehealth players? Are there particular features that are expected to determine the winners or is it all about first-mover advantage?

Lydia: Yeah. It’s one of those things that I’m curious to get the answer to that and I think only time will really tell. It’s been really interesting for me to speak with some of the big telehealth companies. Last week, I was hosting a webinar with the CEO of Amwell and we were talking about just the types of visits that are happening right now. At first, it was a lot of COVID. I’m really nervous I might have the novel coronavirus but I don’t want to go to the ER. What should I do? Those kind of visits were happening virtually first, but now we’re seeing a lot more visits, more chronic care, and hey, I might have a lung condition that I want checked out but I can’t go in person. It would just be a bad idea. I can do it remotely. We’re seeing a lot more of those visits take hold. I’m going to be really curious if we see how something like Zoom really took over and became the video conferencing platform of record. I’m going to be really curious to see if there is a telemedicine winner here. We’ve seen a lot of places basically overnight set up video services either for their own practice or epic [inaudible] a bunch of other big IT players are doing it. I’m really curious to see if someone can crack the code on this and do it really well because I think it’s quite easy to set up a video system. I think it’s harder to set up an entire functioning, you’re basically trying to replicate what goes on inside the four walls of a hospital or a doctor’s office online to some degree. We’re talking billing. We’re talking about waiting rooms, things like that. I’ll be curious to see if someone can come in and and sweep the world, but right now, where I sit, it’s pretty fragmented. It’s based on who you were working with before, what they’re very good at, what kind of pain points do you have right now, what kind of patients do you need to be seeing?

Jeffrey: Yeah. It’s an interesting business story. I mean, WebEx was around forever, but it took a pandemic to really come out with Zoom and a real leader. I have to imagine as well that from a telehealth point of view, that should be around the corner, but with everything we know in healthcare in formal marketing, it takes a little bit longer. That’s your business hat. We’re going to ask you to take that off and maybe put your science hat on for a second. There’s a lot of discussion about how to treat COVID-19 and a lot of talk about existing drugs being repositioned as a treatment, Gilead’s remdesivir – it’s getting the most attention as a drug – just received emergency approval. There are other drugs though; 40, 50 drugs that are getting approval for initial testing. You wrote about a heartburn drug that’s being considered as a treatment. There’s a company I work with out of Florida using amniotic fluid. As part of a treatment, Pfizer just made an announcement about a new program yesterday that’s getting a lot of attention as well. Do you think there is ultimately going to be multiple treatments for the condition or is the industry thinking, “We’re going to have one treatment of standard of care?” Are these just band-aids until we come up with some sort of vaccine program which could be years away?

Lydia: Yeah. They’re all good questions. I think that the shortened [inaudible] of it is nobody quite knows. I think a lot of it will depend on how prolonged this virus kind of sticks around. I think we saw a lot of drugs get kind of shelved as pandemics or epidemic started to recede. We saw that with SARS and MERS to a degree, but I think one of the big things I’m learning a lot about as I cover COVID-19 is just how many different ways it can affect people. We’re seeing everything from symptoms like COVID toes, which is just like a frostbite-type symptom showing up in otherwise asymptomatic younger adults, often teens, and then you’re seeing blood clotting showing up in either severe cases of COVID or people who were sick enough to go to the hospital but got sent home after a couple of days but were not in a ventilator but they still got really sick. We’re just seeing so much showing up that I can’t imagine a world where there’s going to be one cookie cutter, great solution out there for everyone. Maybe there will be. Maybe there’ll be some great antibody out there that really works.

Lydia: I had a doctor at a hospital here in Brooklyn kind of really explain it to me really clearly that I thought was a really interesting theory. He basically bucketed out the disease into three groups. You’ve got the viral infection and that’s where something like an antiviral like remdesivir might come in handy, then you’ve got the clotting issue and luckily we’ve got a lot of stuff already out there to treat that. We’ve got blood thinners. We’ve got some clot-busting medications that are being developed, things like that. They already exist but they’re being explored for their use in COVID-19. Then, you’ve got this immune response that seems to be really wreaking havoc on people, especially those who have been sick for quite some time or are on a ventilator in the ICU. For those patients, something like an antibody treatment which a bunch of pharmaceutical companies are developing, and then there’s instances like convalescent plasma and some other ways of kind of triggering the immune system to mount a response to the virus in a different way. Those are where we might be able to see those work. It’s really interesting to me. I’ll be curious to see if his theory holds out. Those are ultimately the three buckets of disease areas where we’re worried about and kind of symptoms we need to treat, but I think everyone’s holding out hope for some kind of vaccine. Maybe the whole populations here in New York got it. That’s what some of the antibody surveys are suggesting that about a fifth of people got it here in the city. For someone who hasn’t felt symptomatic from COVID yet, I would be really optimistic and really happy to see a vaccine come online.

Jeffrey: Absolutely. I’m in the same boat. I’m not ready to walk down the middle of Times Square yet. I think every day we’re learning more about this disease. To think that there is this one silver bullet, I think it’s way too early. I agree with you to think that. All right. Shifting gears just a little bit. Back to business. Are you seeing an impact on the fundraising environment for healthcare or biotech companies? Some are benefiting, right? They’re saying they’re going down the COVID path but other’s clinical trials are drawing up because patients aren’t coming in. How have investors changed the way they evaluate new opportunities either public or private? What are you seeing?

Lydia: Yeah. It’s been one of those things where I think that we saw this hit a lot of other industries early into the pandemic. Retail was clearly an instance where there’s going to be a lot of issues and those showed up almost immediately. We saw a lot of layoffs. Same with the technology industry as we saw a lot of layoffs happening there and we’re still seeing it with companies like Airbnb. I think for the most part, the impact to biotech and and healthcare in general has been a little delayed with the exception of the hospitals because their financials are really taking an early hit. To your point, it is a really curious question. This question of what is going to happen now that clinical trials are put on hold. I really wouldn’t be surprised to see a number of fledgling biotechs who are in their early days and have the funding runway for one set of clinical trials over a set period of months. How does someone stay afloat like that? It’s a big question for me. I think a lot of people are trying their best to figure out how to be useful at a time like this. I think about the healthcare industry as a whole as either being sidelined or on the front lines. If you can find a way to be on the front lines, I think you’re going to find a way to be an integral piece of this and you’re going to find ways to get funding and things like that. The fundamentals of the business haven’t really changed. It’s just that we threw a pandemic into everything. It’s going to be interesting. I think it’ll depend almost entirely on who your backers are to some degree, how they did on their other investments. I’m going to be curious if we’re talking a year from now and realize there wasn’t that much of an impact on biotech actually because it’s been weird. I’ve been seeing in the health insurer space especially, they’re having a pretty good year so far. It’s a little jarring to hear.

Jeffrey: Right. Well, tying into that, last question. What do you see bubbling up to the top in the stories that you’re covering? Something that might grab everyone’s attention once we have a bit more normalcy in our lives. I mean, you put out a weekly newsletter, Dispensed, which I love and and you write every day, but once we have more normalcy in our lives, what do you think is going to be there?

Lydia: Yeah. I think personally, I have this beat before the pandemic hit that I was covering, the changing way you go to your doctor’s office. That was everything from urgent care to online visits to what CVS is doing, with the health hubs, what Walmart’s doing, things like that. I think in a lot of ways, my beat has completely changed on its head. Maybe health hubs are still an important piece of that but maybe they are a lot more virtual, things like that. I think figuring out the fallout is going to be the big health care story of the year. Who are the winners and losers? Who was able to come out of this stronger than ever? Who completely faltered? I think we’re noticing that in a lot of other companies. Taking Airbnb, for example, it does seem like laying off 25% of the company is almost exclusively connected to the fact that nobody is traveling at the moment and probably won’t be for quite some time. In other cases, I think the pandemic really exposed a lot of where things were going wrong. You see some parts of the pharmacy model already being in jeopardy; that kind of front store part of the store, that hasn’t been a good business for a while and I think something like this, a pandemic, only exacerbates that. I think it’ll be really interesting to see where people land. Can you survive this moment? Can you not?

Jeffrey: Unfortunately, you’re absolutely right, it is. I hope that in a few months when all this is a bit more normal and we get to see some of the shakeout and some winners, we can have you back and we could discuss this a little bit more and do a retrospective as to what occurred.

Lydia: Absolutely. That’d be great.

Jeffrey: Thank you so much for your time. We hope you enjoyed this week’s podcast. If you have any questions, comments, or future story suggestions, please reach out to us on social media or email us at RP Healthcast at rooneyco.com or visit us on our website at rphealthcast.com. Additionally, if you like what you hear, please follow us, review us, and share us with your friends and colleagues. Thank you. We hope you enjoyed the RP Healthcast.

In this episode, we speak with Edward Baig, a veteran technology journalist and former USA Today columnist about new technology, Contact Tracing, that will enable America to get back to work as we come out of the grips of this pandemic.

TRANSCRIPT

Jeffrey Friedman: Hello and welcome to the RP Health Cast by Rooney Partners. I’m your host Jeffrey Friedman.

As certain parts of our country have reached a plateau in terms of their infection rates from the coronavirus. We’re turning our eyes towards returning to work and achieving some sort of normalcy in our daily lives. But how can we do this? How could we return to work without having a vaccine or without faith that when we emerge from our homes that we’re going to be safe or that we won’t harm the most vulnerable in our society.

Our Guest this week is Edward Baig. Ed was the National Tech Journalist for USA Today for over twenty years and prior to that wrote for business week, U.S news and World Report and Fortune Magazine. Today we’re going to be talking to Ed about ways in which the country can get back to work. We’ll talk about the intersection of healthcare and technology and new applications being developed for contact tracing and we’ll discuss what contact tracing is all about.

We’ll also talk about what sort of privacy concerns are there with this new technology concerns between the public and private sectors and what are employers responsibilities and rights. It’s all very fascinating. New questions and issues that we’re going to have to deal with that we never thought we’d have to deal with.

Ed, welcome and thank you for joining us today. 

Edward Baig: Good to be with you.

Jeffrey: Great. Now before we get started with today’s topic, which I’m really fascinated about. I want to talk about you for a second. Now, you’ve been a business journalist for I say forty years, right? And if–

Edward: Yeah, I started when I was seven.

Jeffrey: But for thirty years of that you’ve been covering technology and the developments and over the past thirty years it’s incredible. You’ve witnessed up close and reported on really the technology Revolution. I mean what a career. Now who among like the technology Business Leaders? I’m such a geek about technology here. So I love this stuff. Who have you interviewed and watched and written about that you admire the most and why?

Edward: Well there’s, it’s probably the obvious list of the biggest names that are out there. I’ve talked to Steve Jobs. I’ve talked to Bill Gates. I’ve talked to Jeff Bezos, you know, I’ve talked to people like Richard Branson a lot, you know, a lot of well-known people who I’ve interacted with through the years. You know, it’s not going to surprise anybody that these probably in their names because since in working certainly at USA Today for twenty years and being a personal Tech columnist and reviewer, you know, I was among the initial four people who got the iPhone ahead of everybody else back when it was first introduced. So I’ve interacted with all those leaders, you know, I remember talking to Jeff Bezos when their Kindle came out, the first Kindle. Certainly through the years in talking to Bill Gates about lots of things Microsoft did before he moved on and others as well. Sure, I’m forgetting people but you know, they’re the big names for a reason and their companies have obviously made a huge impact for a reason. Not always good but a lot of.

Jeffrey: I would have loved to have been a fly on the wall with that. And now that we’re on like iPhone 11, 12, 13 that was a while ago. 

Edward: Yeah. It’s amazing time flies. But I mean I certainly you know, I was well like a lot of people were by the initial iPhone, but you know, I would be lying if I knew it would have the impact that it ended up having you know.

Jeffrey: Well technology has changed and it’s the adaptation and what’s interesting. So we’re Healthcare podcast. I head up medical communications so that the ability to combine this technology and healthcare technology is a professional passion. So I love what I do. And obviously this is a very timely topic the convergence of healthcare and technology. So given the efforts underway right now to harness a credible digital process for surveilling against the coronavirus. I’d like to develop our time that we have to explore some of the technological solutions being developed and deployed to identify either identify people with Covid-19 or to identify hot spots in different areas. Now last month Google and Apple they announced plans to develop an API for contact tracing. 

Edward: Yep.

Jeffrey: Big word right now, contact tracing. I guess that’s two big words. Can you explain what this is and how it works? 

Edward: Yeah. Well, I should probably say right off the bat that both Apple and Google would rather you talk about it as exposure notification because contact tracing sounds kind of scary and you know, big brother-ish and all that. But basically what’s going on here is these two big rivals are teaming up Apple and Google and they’re developing as you mentioned solution that is trying to determine basically who has the virus and who might have been exposed by it. Basically, what it’s doing is it’s using Bluetooth wireless technology that were most of us are familiar with to sent nearby smartphones. So if you happen to come in contact with anyone else who might have been exposed to the virus over the past two weeks, you’ll get a push notification that you know you or they’ve been potentially exposed. Now, this is completely voluntary and I’m sure we’ll get into this but you know, there’s all sorts of privacy security questions raised not only about what Apple and Google are doing but about what everybody else is doing here because there are other Solutions, but basically that’s what’s going on here. It’s using Bluetooth to sense nearby smartphones to see you know, if you may have test, you know, if you test positive you enter the results. Hopefully the person other people you come in contact with have done the same and you may get a notification that you potentially been exposed. 

Jeffrey: So, there starting out with an app right now. If you download for the phone and it’s obviously completely voluntary that if you download it. But I understand that they’re building into the iPhones and the Google Android phones basically into the operating system. This technology. So, you know, you said they didn’t want to talk about it said it sounded you know in a certain way because it sounded big brotherly. But at the end of the day it is Big brotherly, right? I mean the data privacy protection. That’s yucky stuff. Right? 

Edward: It’s very tricky. I mean this is going to raise all sorts of trade-offs. Let’s face it. You know, we’re fighting obviously a devastating virus and people can have to make that decision for themselves. Am I willing to give up some privacy potentially or not? And again Apple and Google have been very good about this in terms of talking about privacy and insisting this privacy encryption and is involved here. We mentioned its voluntary, but you know, there are questions and certainly around the world, you know, we’re seeing efforts in China and elsewhere where the government’s asking people to you know download these apps or what have you so you know back in February and New York Times reported that China began requiring residents in two hundred cities to download this healthcare code app that automatically would tell the locals whether they needed to quarantine or not. Now you can argue both sides of that. Okay, it helps tame potentially the spread of the virus, but what are you giving up? So those questions are always going to be their sort of right, you know, it’s right there. It’s a trade-off.

Jeffrey: Well, it’s a trade-off of the public need versus an individual need.

Edward: Correct. Right? So it’s you know a definitely a public health situation. 

Jeffrey: Now, what about even private to private? So if you are a large employer, can you man that mandate this for employee safety concerns? 

Edward: That’s another tricky one. I know, you know price Waterhouse has been beta testing, you know an enterprise great system that they’re adding to corporate apps uses Bluetooth as well as Wi-Fi to determine sort of as I understand it, you know literally where employees would be within a building in terms of proximity to other employees. That’s a tricky one. You know, I can only imagine that there’s potentially a backlash here again, I think everybody’s sort of in this boat, right? We’re all concerned about this. So I think most people probably will be willing to I don’t want to say give up their privacy, but at least maybe a little bit more wiggle room on some of this stuff. But also at the same time where you know, do you want your boss? Do you want your bosses to know your health history? I don’t think so, you know or are people going to get you know, put in different groups. There’s been efforts about you know different tiers. Well, you’re at risk because you’re above a certain age or you’re at risk because you have some underlying health condition. Do you want your bosses to know all that? You want your colleagues to know all that and then what happens when you leave the building, you know, there’s all sorts of okay, it’s great. You can track me and he’ll corporate headquarters or wherever you are what happens on the subway on the way to work or when you’re out of the building, you know are you know, I don’t think they’re going to trace you there. But you know, it’s just a big can of worms here with a lot of this stuff. 

Jeffrey: Yeah, I think you know in terms of baby steps right for we have these electronic key cards that we open our door with that tells management where we are and what doors we went through and so we’ve already given up I guess a little bit of that privacy in terms of the location aspect, but this certainly takes it to the next level.

Edward: Yeah, and that’s you know, what happened after 9/11 things changed, you know, you now have to show your ID when you go into a corporate setting or walk, you know, go through one of these with your key card as you mention or whatever so, you know, that changed our lives and for the most part we’ve all gotten accustomed to that. My question, let’s say some of these, you know enterprise systems are implemented in some way or another what happens when we finally get past the pandemic? Is this going to be permanent, you know, do we go back to the way it used to be or some combination? I suspect we don’t go back to whatever was quote unquote normal before if I’m the full way.

Jeffrey: If the technology is built into the operating system to the phone so we’re not going to take it out. 

Edward: Oh, they’re not going to take it out. And your employer is probably going to show you know what, I like knowing where someone so is during the day is he or she really working? I don’t know again. I don’t want to you know, assume the worst here. But again, I think people will be on edge and I think privacy Watchdogs in particular will be keeping a close eye on the stuff.

Jeffrey: Definitely an interesting discussion and debate about your rights as an individual versus the rights of the society. And even take it one step further. You know, I know that there’s a company in Israel called Wave Guard and they’ve taken this privacy or knowing where you are even to the next level. So if you are determined to have the coronavirus you are then supposed to be you know, quarantined. So what they’re doing is they’re tracking kind of correct me if I’m wrong, but they are tracking these quarantine people and real time to ensure that they’re quarantined and they’re not leaving their space.

Edward: That is my understanding anyway, and again I don’t know not close enough to it to know what’s going on in terms of the reaction from from the locals there about this stuff again comes back to this core discussion that we’re having about how much freedom people have or are willing to give up and again, you know, I think people will self-quarantine if they’re in a situation where they need to. But you know, there’s a difference between I guess self-quarantining and being told you better do this. It’s just tricky stuff.

Jeffrey: All for the better good of society. I assume.

Edward: That’s the goal. I mean, we all want to do what we can to keep safe keep our family safe and obviously defeat this thing. 

Jeffrey: Absolutely. Now, moving away from contact tracing apps a little bit based on your experience and your recent research and just being in the field. What else is out there in terms of technology or health tech that you find interesting right now? 

Edward: Well, I think a lot of the efforts, you know, one of you know, we keep talking about the cell phone and Apple for example has done a lot with the built-in health capabilities of not only the cell phone but the Smartwatch, their Apple watch, you know, they’ve done some interesting heart studies the app. The watch has an ECG or EKG depending upon how you refer to it that can detect a fib, you know, which is basically an irregular heartbeat. It’s got limitations, but they’ve done studies with Stanford as I believe and certainly with Johnson & Johnson. So we’re seeing now this, you know, the stuff that a lot of us wear everyday certainly the phone in our pocket, wearables and such you’ve seen more and more of a link there in terms of health, you know.

So that’s one thing. The other thing that’s going on with the coronavirus in this is not going to come to surprise with anybody is all the Telehealth stuff. You know that people are doing now because you can’t visit the doctor and person unless it’s a real dire situation. So everybody’s doing telemedicine and so we’re relying more and more on technology and personal technology for a variety of health reasons and it’s interesting that it’s being actually coordinated with the studies, with universities and with companies like Johnson & Johnson and others. 

Jeffrey: Now being that you’ve been there from the beginning, you know certain apple and the iPhone not the beginning of time.

Edward: Yeah. I was going to say, it wasn’t there with Adam and Eve. I don’t think they have an iPhone then.

Jeffrey:  All right. How about Apple and Eve? [crosstalk] You were there for the first iPhone. The acceleration in, I guess the technological advancements have been astounding right so you know that we used to make the analogy of chip sizes shrinking, you know and half every few months type of thing. Can you make any bold predictions of anything that we’re going to see in the future, near future? 

Edward: Oh gosh. Well, there’s a lot of certainly interesting efforts being done with everything from artificial intelligence to you know, something called Quantum Computing and all of this. Making predictions only gets you in trouble. So, you know, I will say this I think that you know, I had a story called now a couple of years ago, Pew Agenda Big Study on AI and would the human race basically be better off through artificial intelligence by the year. I think it was 20-30 which isn’t as far away as it once sounded now that we’re 2020. So ten years out would we be better off or not based on you know advances in AI  and they asked all these experts, you know from business and Academia and what have you and basically two thirds of the people thought we would be better off but a good solid one-third were concerned. And actually, it ties back into our earlier discussion. They’re concerned about some of the things we’re talking about privacy and security and what are we giving up if anything along those lines so but I think the benefits if I was if they ask me to take that survey, I would probably lean more on the positive side of it as well. I think for the most part we have ways we will work these things out as a society as long as we’re careful and I think you know certainly health and health care will be a big area. It’s already benefiting from advances in AI and some of these other technologies machine learning and whatever and I think that’s only going to accelerate and continue in the future. So and you know, one of the questions that I had asked even talking to IBM about this technology called Quantum Computing, which is basically it’s kind of hard to explain but the shorthand is it’s you know, exponential advances in computing. Could this have somehow help solve Covid-19 kind of before it got to this point. I don’t know that it could but you do question or question in a good way can some of these advances in technology help deal with the future pandemics. And I think there’s real potential there for breakthroughs. But again, there’s no Panacea unfortunately either with technology.

Jeffrey: That’s very true. And I’d love to actually, you know, have you back in a few months and we’ll talk about more of the convergence between technology and healthcare and hopefully before the computers take over.

Edward: Sure and hopefully by then we’ll be in a better state with covid-19 in this situation. We’re all in right now. 

Jeffrey: Yeah from your lips. I hope so. So thank you so much for your time. This has been so informative and interesting. So thank you very much.

Edward: Absolutely.

Jeffrey: We hope you enjoyed this week’s podcast. If you have any questions comments, or a future story suggestions, please reach out to us on social media or email us at RP health cast at rooneyco.com, or visit us on our website at rphealthcast.com. Additionally if you like what you hear please follow us, review us and share us with your friends and colleagues. Thank you and we hope you enjoyed the RP health cast.