What We’ve Learned About this Pandemic After Six Months

Next week will mark the 6-month anniversary of the World Health Organization’s (WHO) first meeting to discuss what was becoming multi-country spread of a new coronavirus. That same day, we began communicating about the preparations we were taking to be ready, and to keep our patients and employees safe. 

Little did we know that just over one month later, we would be treating the first COVID-19 community spread patient in this country and highlighting testing deficiencies which continue to this day. Since that first day, every person at UC Davis Health has played a vital role as we confronted this unprecedented crisis, showing the utmost grace under pressure, while serving our patients and collaborating with our community partners in the interest of public health for everyone.

UC Davis Health was then, and remains now, at the forefront of our nation’s experience with the virus. We are helping to develop treatments for the disease the virus causes, and we are helping to lead the research that will find a vaccine to prevent it. 

So, the question is, what have we learned in these last 6 months?

Let’s start with the fact that in an unfolding pandemic it’s critical to take a scientific approach, follow the evidence, innovate in research, and share your findings and expertise with your community. Regarding that first case of COVID-19, we took what we learned and published it to help other physicians and front-line health care workers. What we discovered in those early days led to the Centers for Disease Control changing its testing protocols, UC Davis Health becoming one of the first rapid testing hubs designated by the State of California, and helped remdesivir to become one of the first emergency use drugs to treat the disease. Now we’re pushing research forward to find more effective patient treatments and ultimately, a vaccine.

We’ve also learned that to manage this disease through the next 6 months, we need to focus on four key things: 

1. Strategic use of testing (with rapid results),
2. Virtual health care (whenever possible)
3. More use of AI (to analyze mountains of data)
4. Community Collaboration (we’re all in this together)

Here’s more on each of these key areas:

1.    Strategic testing

We don’t need to test everyone, but we do need to better focus our testing capabilities on those at the highest risk – family members of those who are infected, front line health care workers, older adults, and people living and working in nursing homes and senior living facilities. Group home living is clearly a risk factor as more than 40% of all US deaths have been people living in nursing homes. Being older is very clearly high risk, as more than 92% of all deaths in the U.S. have been people aged 55 or over. We also know the older the person, the higher the risk, as fully one-third of all deaths have been people aged 85 years or older. A focus on preventing disease spread among these two groups alone – confined living groups and the elderly – could dramatically reduce the overall U.S. death rate of COVID-19.

Beyond this, strategic testing should pinpoint other high-risk people – those with symptoms or who are identified by contact tracing with a high risk exposure; those with underlying health conditions; people who work in close quarters with others, especially first responders, transit workers, grocery store employees, and patients in hospitals or who are about to undergo medical procedures.

Rapid results are also important. Patients should see results of their test back within 12-24 hours. Waiting 6-8 days leaves far too much time to potentially infect dozens of other people. It’s unrealistic to expect hourly workers to take 6-8 days off work while they wait for test results to see if they should isolate themselves, especially those with fewer economic resources living in underserved communities.

This week, Governor Newsom adopted the testing priorities for California that Brad Pollock and I wrote about back in May. These will help, especially with limited testing supplies. Through more efficient testing, the early identification of the disease will lead to early isolation of these cases, and that will help to dramatically reduce the virus spread. We should be proud that UC Davis Health will continue to do its part, together with the county, testing whole nursing homes at one point in time and providing testing in community clinics for underserved communities.

2.    Virtual health care

This pandemic has rapidly accelerated health care’s move toward virtual appointments and care – “telehealth” or “video visits” – essentially remote health care services.

On this front, our numbers have been amazing. On March 4, UC Davis Health had just 23 telehealth visits between providers and patients. Four weeks later, on April 1, we conducted 1,054 visits via video, and for the entire month we averaged nearly 1,100 video visits each day.

And that’s just the beginning, as we have already noticed that a number of UC Davis Health groups successfully shifted at least 75% of their appointments to video visits, including dermatology, pain management, the Spine Center and the MIND Institute. Psychiatry went from 2% to 100% in three business days.

It’s not just us. We’re part of a UC systemwide effort aiming to have about a quarter or 25 percent of ambulatory appointments done through video as a permanent feature of our care going forward.

We must provide care where patients want it, when they want it, how they want it – with or without a pandemic, it just makes good sense for our patients. It is patient centric – reducing the need to drive, eliminating transportation barriers to seeking care, and supporting those patients least able to afford a day off from work to see the doctor. And during a pandemic, it also reduces the opportunities for exposure, and helps conserve PPE for better uses.

3.    Artificial intelligence

I think most people don’t understand how artificial intelligence (AI) is going to transform the post-COVID-19 world. AI will be a game-changer, and it’s happening now. It is not a fad – AI will revolutionize how we practice medicine and care for patients beyond this black swan event of a pandemic. We all recognize patterns – for example we know women with a history of breast cancer in their family are at higher risk. AI though can look thousands of such factors in combination, across a population suffering from a particular cancer, and come up with associations we might have never considered before, allowing earlier and better identification of people at high risk. And all of this is done at the super speed of a computer. 

AI technology can crunch huge amounts of data to improve the patient experience, increase personalization, empower patient choice and expand access to medical experts – just as it does for consumers in other industries. Perhaps even better for us, it reduces low-value work for health care workers while producing better and more accurate outcomes for patients. Through Internet-enabled AI, we can monitor patients after surgery to determine if they are on a good course of recovery, and intervene early if treatments are likely to be required for a blood clot or wound infection. AI is already being employed by Silicon Valley firms (mostly using iPhone location services) to determine the risk of exposure to COVID, with the computer learning by itself and refining the likely impact of your particular exposure, allowing you to make good decisions about quarantine or testing.

Understanding how all of these issues yield a risk profile of exposure can only be done with a computer running AI – was the exposure inside or outside, if inside how big a space, how far away from the infected person were you, for how long were you exposed, were you involved in direct conversation or not, were you exposed to a symptomatic or asymptomatic person, how old was the person who had COVID, and how far along in their disease process were they, etc. Combining all of these factors into a whole, with understanding of which factors are critical in combination, is not something humans do well – but at which computers excel.

AI will help us to analyze mountains of data from tens of thousands of patient cases – something the University of California’s five medical campuses are uniquely positioned to do and this research is already getting underway.

4.    Collaboration with the community counts

We want to complete, not compete with, other health care providers, in everything we do. In the true spirit of public health and in the interests of patients – we have ramped up collaborations with our local partners and health systems, and the results are highly positive.

I’m pleased to report we’re now able to, once again, help support Sacramento County’s community testing clinics. And we’re partnering with the county to test group living facilities whenever needed. We’re also partnering with Yolo County, home to our main university campus, to help lead their public health response.

UC Davis Health also joined with all the other Sacramento area hospitals and public health agencies on a campaign to encourage people not to delay their health care – “For Today and For Every Tomorrow.” Together, we are explaining how we’re working collaboratively to ensure peoples’ safety as they return to seek health care in the region. Our valued partners in this effort include Dignity Health, Kaiser Permanente, Sutter Health, and the public health departments of Sacramento, Yolo and Placer Counties.  We are also part of a Northern California medical leadership group (including all four regional health systems along with the California Medical Association, California Hospital Association, and the California Health and Human Services agency) which is monitoring and reviewing data from the current surge, planning for the fall, and working out how we can load balance if one system gets overwhelmed by patients.

We know so much more about how this virus spread and how to treat it more effectively. And really, we can each make a difference and go back to containing this outbreak just by wearing our masks indoors with other people, and if we are not 6 feet apart, and outside without being too paranoid (passing by someone walking in the opposite direction is not a likely way to contract the disease, but being outside and conversing with someone, please wear a mask.

Looking ahead

We are all unified by the shared value of preserving life, and it’s this shared sense of humanity that gives us the knowledge and the collegial mindsets to overcome the difficult months ahead, before we get to the final stages of this crisis.

Finally, I am thankful to everyone at UC Davis Health, our patients, physicians, nurses and staff – and all of our community partners – who have helped us meet this challenge with confidence and compassion every day.