Coronavirus in Context: How COVID-19 Transforms Our Relationship With Healthcare

Welcome to Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. My guest today is Dr. Richard Isaacs. He is the Executive Director and CEO of the Permanente Medical Group. Dr. Isaacs, thanks for joining me.

Thank you, John, and thanks so much for having me. I really appreciate it.

Now, you're based in northern California. Let's start off with telling our viewers what's going on in the Bay Area right now.

Well, in the Bay Area I oversee the health care delivery for Kaiser Permanente here in northern California. We have 21 hospitals that span from Fresno all the way to Auburn. And we were one of the early sites for COVID penetration into our community. It started right after February 16 when the Diamond Princess ship was disembarked in Oakland. And we were working with the Department of Defense and the Secretary of Health and Human Services to develop a plan for mitigation of COVID-19. So we were very early on in this picture in February.

Currently we are seeing a flattening of the curve because we've been sheltering in place. We are now about to start our fifth week of sheltering in place. And we have some very good data to indicate that we're seeing a slowing of the doubling of COVID-19 in our communities and a flattening of the curve by social isolation. Physical isolation is actually working.

Now, you're head of the Permanente Medical Group. You represent physicians. What are you hearing from your physician colleagues?

RICHARD ISAACS: So the physicians are doing an amazing job. We have risen to this occasion like I can't even believe. The stories that I'm hearing from the care delivery are amazing. Our physicians are courageous. They're brave. They're taking care of these patients.

The issue is, as you know, 80% of folks that are COVID-positive don't require hospitalization. But the ones that do deteriorate pretty rapidly upon presentation. And some of them require intubation and intensive care. So they're seeing that section of this disease that requires hospitalization. And I know in the community there's a fair amount of kind of benign disease that just feels like a cold or a flu and then it passes. But the patients who go on to have deterioration really get sick. And then they present to the hospital or the centers. And we've been hearing in New York about this lack of personal protective equipment. What's happening in the plans that you're involved with in northern and southern California?

So we tried to get ahead of this. We started procuring PPE, personal protective equipment, from wherever we could find it. A lot coming from overseas, a lot coming internally. But early on, there was a supply chain challenge. So we started partnering with local community businesses who are now sheltered in place who are helping us develop the PPE equipment.

So the distilleries in our neighborhood -- we're in wine country -- they're helping us produce bottles of hand sanitizer that are supplying all of our offices and hospitals across northern California. We've partnered with Levi Strauss and the Gap. And they're making gowns for us that we can use for that aspect of personal protective equipment. And then we're building surgical masks using those same factories with materials to help develop the masks to help provide security for our folks.

Now, we've been hearing around the country, a lot in New York, from the physicians who are saying they're gagged, that they're not allowed to talk about what they're seeing on the front line. And they're actually being threatened with being fired. It's the same for nurses as well. What are you hearing in the Permanente Medical Group?

Well, I think that currently there is a challenge between HIPAA, personal privacy and security of personal health information, and then the overall experience of what we're facing. So in northern California, we have been sharing the disease penetration with all of our physicians and staff. They understand what the volume of disease penetration is and what percentage are actually in the hospital, and from that segment, who's requiring more invasive intervention.

Do you have policies that prohibit physicians and other providers from talking to the press?

Well, it's evolving. So our policies are evolving. I think that over the last four weeks, there's been challenges for every organization. And we want to be true about what this disease actually is. Because I feel if there's a void, people will start to make things up.

They see things on the national media. Is this New York City and we're just covering things up? But I can tell you that the disease penetration in northern California is extremely low. And the volume of patients that require extreme intervention is also extremely low.

I want to get your thoughts on a couple policies that we're hearing about if I can. In some hospitals, we're hearing that partners, spouses aren't allowed at childbirth. There's been some loosening.

But we're still hearing about some hospitals that don't allow that. And then at end of life where loved ones are not able to come in to say goodbye. As a physician, and then as a leader, what are your thoughts on those policies?

So I understand why the policies were originated at the beginning of shelter in place and social isolation. So the government in California recommended against hospital visitation right. And that created the extremes of the challenge of loneliness in our hospitals. We promote a visitor at the time of childbirth. It's really life-changing activities that think is really important that people are with a loved one, end of life and also beginning of life.

So you promote a policy of someone at end of life as well?

Yes.

Now, you've always been very involved and interested in advocacy for homeless, the disadvantaged. How does COVID-19 exacerbate those conditions? And what are all of you doing to help fight that?

Well, homelessness is a challenge in this country. And it's likely worsening as the unemployment is increasing. So we are, as an organization, promoting investments with local partnership communities to create shelter for folks to help promote health. As far as COVID-19, I believe that in the communities where we have inability to get social distancing, you're going to see a provocation of this disease. There's been some reports in Chicago and elsewhere where in the homeless community we're seeing more spread of this viral illness.

Now, you've always been a leader in telehealth. How has COVID-19 revolutionized telehealth and telemedicine?

Well, we went to a virtual first philosophy four weeks ago. So our pediatricians, adult and family medicine doctors, OB/GYN, and mental health went to a pure telehealth strategy using video first, except for obviously where face-to-face is required. We're doing over 80% telehealth today, which has completely transformed -- the silver lining of all of this is COVID is moving health care in the direction that we were trying to go. But we're going quicker.

80%, but did you want to be at 80%?

I love the fact that we're at 80%. Well, it changes your mindset. As you think about the way this rolled out in every community across this country, when you first heard, oh, the school district is going to be closing until further notice, it sounded kind of crazy.

And I remember when the NBA shut down the league in the middle of March. People were thinking, this is a movie. This can't be reality. But over the next 72 hours, the next week, you start to realize there's a massive change in mindset in this country right now.

Now, I saw some patients on telehealth a couple weeks ago at a Kaiser. But I also think some degree of patients need to get used to this as well. Don't you think? Because there is a subset that are very used to coming in. And they're not quite sure how to manage their interaction with a physician or other health provider by video. Would you agree with that?

It's definitely a change in mindset for the patients as well. We need to make sure that there's a platform that's user friendly so that when the physician is requesting a video visit, it's as easy as picking up the phone and having a video visit with your physician. The patients are loving this. They get to see their doctor in the comfort of their own home.

And we've also created ancillary support, pharmacy delivery to the home, which is helping round out that whole experience. It's amazing what's happened in four weeks, John. It's just unbelievable.

Has the physician community embraced it, or do you have a couple old timers out there?

The physicians are actually loving this. They actually are enjoying it. But we've created the infrastructure that makes it easy for the user and also for the receiver to use the technology.

How do you think things will look six months from now? Will it still be a very large percentage of telehealth? Will we still be social distancing? Put on your crystal ball and tell us, what are we going to see six months from now?

So my team is looking at what is the best way to deliver care in the future. And we're going to identify which scenarios are better utilized with telehealth and which ones require face-to-face so that when we emerge from COVID-19, we'll have a whole new paradigm about the way that we deliver care. And my goal is to ensure that we don't slip back into the kind of fragmented approach that we've had in the past and ensure that what's working best we use moving forward. Because as you know, it's our obligation to create value to the health care delivery system in this country. And I think telehealth and technology will be a huge component of that.

I'm going to push you, though, on it. What's going to be the biggest change? And you can't say telehealth. So what else will it be, in your mind, in terms of how the health care system has been changed as a result of COVID?

Well, I think that we have to think about what is it doing to all industries. And I think that the health care industry is not going to be immune. I just read an article in the New York Times about how Bob Iger and Disney are struggling for survival.

How is Disney going to come back with more robotics, less staff, using technology to help drive their product? I think it'll be the same thing in health care where we've got to find the best way to deliver value and lower costs. And having a lot of human resources may be not the future.

And how are you going to get those patients that do need to come back that can't do telehealth? That the virus may dissipate, but their fear may not? So how are you going to get those patients to come back in to see the doctor face-to-face when the circumstances require that?

I think it's really developing trust that the health care organization is the most trusted resource for your health. And it will have safeguards in place to ensure that we have COVID-free centers, that we have a change in the way that we interact to eliminate the spread of disease.

And you've talked about trust in the physician community and the health community. Is this epidemic and the way that we're handling it restoring trust in the health system and in providers?

I think it depends on the community and the circumstances. If the community feels that there are not enough resources to provide the care that they need, there could be an erosion of trust. But if the health care system is there and providing what's required, it's an opportunity to actually demonstrate extreme trust.

Well, I want to thank you, Dr. Isaacs, for showing the leadership and taking time today to talk to us how COVID-19 is changing our interaction with the health community.

Well, thank you, John. I really appreciate your time and look forward to seeing you soon.

And I want to thank you for watching Coronavirus in Context I'm Dr. John Whyte.