How Stanford is Fighting COVID-19

deal with it. Lloyd Minor is a scientist, surgeon, and academic leader. He's also dean of the Stanford University School of Medicine. It's a position he has held since December. Also with us is David Entwistle, presiden CEO of Stanford Healthcare, which in November opened its new eight hundred twenty four thousand square foot state of the art hospital. It's total bedcount is now six oh five, total operating rooms to

eight seven, so a huge facility. Both joining us on the phone from Stanford, California, gentlemen, so nice to have you here with us. So I gotta just ask you first, because of the virus surges, should some states and cities be considering slowing or reversing reopening plans. And Dr Minod let me start with you. How do you see it?

Thank you very much, it's good to be with you today. Certainly, we are seeing an increase in the number of COVID cases in many cities and locations across the United States, and I think that indicates that we need to continue to observe social distancing. The masking guidelines that have been rolled out in many communities. There's good evidence that masking helps to prevent the infection. It's gonna be I think a location by location decision as to what additional measures

are put in place. That is, whether or not we roll back from stage two where many places are today to earlier stages. But the main thing is we've we've got to be more prudent about UM as we resume activities, as businesses, restaurants, uh, department stores start to open. We've got to observe social distancing, we've got to use mass um and do things that less than the spread of

the infection. Well and David, largely because all of this comes down to or so much of this comes down to essentially hospital capacity, So help us understand from the perspective of someone running a hospital, what you worry about with this spike and what hospitals like yours are doing. And obviously you're not facing at the moment any sort of surge, But in your shoes or in the shoes of others running hospitals, what are they thinking about. Well, no,

I appreciate that opportunity. One of the things that we wanted to do, and certainly with any slowdown, which we did as the initial pandemic came on, as we started to see the numbers diffendit, what we were most concerned about then is getting some of the folks back into the queue that actually needed some of the delayed surgeries

and other things that were going on. We started with, which I think is a bit of a model, building on what Dean Miner said, actually doing testing, so making sure that the population that we had within the hospital itself, our employees, our physicians, uh that we were free of the virus. And we actually tested over twelve thou employees and staff and saw less than a point three percent of those staff actually had the virus, And so we knew that we were creating a safe environment. But I

think it's important. Despite being able to be there and be a resource for the community, we do also have

to have capacity. And one of the things that we've done, despite opening back up doing our elective surgeries, is creating still a capacity within the organization that's there and always available, because that really is the concern is if we get another significant spike, well, we have the capacity to be able to treat and we want to make sure that we're ready for that this time without having to shut everything down. Well, Dean Minor, you know what have we learned?

You know, here we are, Jason and I have been working from home essentially. Jason went into the office a little bit this week, but he's back home. But here we are, and I think week fourteen, week fifteen, Um, what have we learned from the medical perspective about how to treat with the how to treat the virus, how to stay ahead of it, how to watch for either another spike? I mean, tell us what we've learned? Thank you. I think we've learned several things. First is that this

is a respiratory virus. The principal mode of transmission is from one person to the next through secretions through mucus, through a cough, um and and there may be other modes of transmission as well, but the main danger is through direct contact with secretions of someone who is infected,

and it is a highly infectious virus. We've certainly improved our ability to treat people who become ill in the hospital our own hospital, Stanford Hospital UH we have been a pioneer in the studies of brindissevere that has been shown to be effective and in improving the recovery rate uh and and perhaps also in lowering the risk of mortality from the virus. We've been a part of those studies.

We now have studies going on in the outpatient setting using anti virals at the time someone is diagnosed with the infection, before they become severely ill, using antivirals in a clinical trial setting in order to determine if there are therapies we can give to outpatients that reduce the severity of the disease and reduce the likelihood that people will need to be admitted to the hospital. We know that the tragedy in New York and in other places

where hospitals and health healthcare delivery systems became overwhelmed. The tragedy was that we as health care professionals, were not able to provide the care we're capable of providing to patients who come to us because our facilities were overwhelmed.

As long as we're not overwhelmed, as long as we're able to provide the type of high quality, intensive care that our hospital and so many others across the country are able to provide, As long as we don't become overwhelmed, I think we'll be able to take care of people throughout the course of this pandemic. But it's important to

remember this is a serious infection in many people. Um in young people it tends to be less severe, but in older people or people who have underlying medical conditions like high blood pressure, diabetes, the infection can be very seriously. So we have to continue to take it seriously and to respond accordingly. So, David, it feels like as a society we're faced with a few big moments right here.

You know, we're faced with this moment around racial justice, and we're talking a lot about that every day on this program, and I'm sure you guys are talking about it as well. It also seems like a moment where we are thinking about healthcare very pun intended holistically and really rethinking it in terms of if we were to sort of design this from the ground up, how can

we create a healthier community? How can we create a healthier society Because we're going to be living with things like COVID nineteen for a long time, you have the responsibility of building a health care system in that image, how do you do it for everyone? Because equality is

one of those big big topics right now. Obviously well, and I'm granting brought inequality because we know that there's disparities in the way that health is delivered, and we know that there's more that needs to be done and that perspective, and that's something certainly we're working on here at Stanford. There's a lot in that question that you just ask. I have to say because if you think about um, we have been trying for years to think

about population health. How do we take care of populations? If we were doing this right, we hopefully we'll keep them out of the hospital to begin with, because we'll be able to keep them healthy and keep them in a venue where they won't need to come here. Oftentimes, within hospitals, we think about the care that we deliver is when there's a failure and when they need to

receive treatment beyond what their own health will sustain. I think we have some real opportunities with this pandemic, which is certainly the first in my lifetime and I hope the last. But I think as we rethink the way that we deliver healthcare, one is that we are we actually have individual stewardship and responsibility for our own healthcare, and I hope that we're taking advantage of those opportunities. But at the same time, we can re envision the

way that we provide care. And I'll just give you one example that I know you've heard of before, but it's transitioned here at Stanford, and that's just the use of our digital technology both to look at data in predictive ways, but also digital technology in the way that we provide the care and a lot of times being able to provide care to individuals at a place that's comfortable for them and also avoiding, you know, having to go out and have in this case, potential access to

other parts of the virus. And so there's so many things that I think that we can do now to re envision the way that is we're using digital technology internally, both predictive modeling, but also telehealth. One quick example, we've gone from roughly two and we do a couple million clinic visits a year, two percent of those being done digitally, two at the height of the pandemic, those being delivered vidually.

And so think about how we can not only mitigate some of the cost of health care but also be able to provide care to individuals at their own sites. And so there's so much that we can do and think about, but certainly data will have a big place in that. We want to use that data to actually drive our decisions. And I have to say to both of you, you know, Jason and I have spent a lot of time at Stanford UM. We've done several broadcasts

for TV and radio at the Business School. You know, you guys are smack in the middle of so much innovation in terms of Silicon Valley and just the conversations about kind of where does the world go? Always forward looking? So dr My, I do wonder. I do feel like the medical community, and maybe not yours specifically, but just overall,

has been slower to innovate. I think it's a hard it's a hard beast to move right, So what will be kind of the innovative trends that maybe come out of the virus and then just others that are going to come in the future that really will be part of the medical world. Well, I'm please you brought it up, because if we look at the digital transformation of of our lives, every sector of society and of the economy has been radically transformed by digital technologies, except for healthcare.

I mean, think about the way we order goods and services, the way we perform financial transactions. They're radically different than they worked ten years ago. And yet healthcare, at least prior to four months ago, um, we were still using fax machines and still calling up on the phone to

make an appointment in far too many cases. David mentioned this transformation that we've seen over an incredibly fast period of time towards telehealth, and I really have to do a big shout out to our i T team here that very rapidly scaled up for the type of transformation that David described to have us do at one point

of our visits is virtual online visits. We we should not lose the momentum that that we've had to obtain during this crisis, because there is so much more we can do leveraging technology, not in a way that separates us as healthcare providers from our patients, but in ways that connects us in more meaningful ways with our patients and also helps us to address some of the disparities that you brought up and that are so troubling to

all of us. Yeah, it's a really important conversation right now, and I'm so glad Jason and I are both so glad that we had some time, um to catch up with both of you, and hopefully we can get to back soon again in the future. Dr Lloyd Minor, he's Dean of the Stanford University School of Medicine, joining us

on the phone for Stanford, California. Although with David Entwistle, president and CEO at the Stanford Healthcare Uh, and I feel like, um, we could talk to them forever because with everything that's going on, Jason, and we're hearing lots of conversations we hear, you know, we talk with so many different members of the medical community. You know, everyone agrees it's been slow to change, um, but these guys,

they're certainly involved in what's to come. It's also a reminder that there are multiple constituencies here, right, you know, we think about it just as patients and doctors, but it's much more complicated than that. And you alluded to that when you talk about slow to change, and you have the pharmaceutical industry, and you have the medical device industry, and you have you know, all these elements of it. There's an academic and research uh community embedded in there

as well, so important to remember all those aspects. Yeah, and a reminder that I think we're going to see a lot more technology working alongside humans to better situations, especially when it comes to healthcare.