How health workers are responding to the COVID19 pandemic Esther Choo

hi dr. chu hey Whitney how are you thank

you for being with us today I’m good

thank you so much for having me on you

know I I’m store that you’re working

around the clock these days so it really

it means a lot that you took some time

to be with us and you know I think I I

asked how you are but I would love to

hear you know truly like how are our

things going how are you making out in

these times yeah I mean I personally

can’t complain you know Oregon is not

New York right now we’ve actually taken

a lot of early public health measures

and are being pretty successful at

flattening the curve so certainly I mean

we’re seeing cases it is a time like no

other in healthcare I mean really

experienced nothing like this it is you

know I’m part of this kind of big

community of frontline health care

workers and talking to my friends around

the country and around the world really

who are in the emergency room or or are

working in the intensive care units and

it it is an incredibly stressful time as

a whole but but here in Oregon we’re

lucky to still be waiting for the wave

to hit us and and you you know mention

this at Oregon is not has not been hit

as hard as some other states but I guess

could you talk a little bit more about

what you were saying there with Oregon

flattening the curve and tell us a

little bit more about what the situation

looks like there and then also in your

hospital specifically yeah I mean the

the first case in the United States of

course came to Seattle which is just

three and a half hours up the road as it

happened it came the first case that was

detected was someone who works at the

school were my that my kids attend which

is one block from my house so when it

came to Oregon it started feeling real

very quickly and then early on we saw

the pattern that we were seeing across

the United States I mean the doubling

times here were every two and a half to

three days

and I think between watching what was

happening in Seattle where the case has

really exploded we we took our

stay-at-home order very seriously you

know so schools were shut down pretty

early on people have really been trying

to abide by stay-at-home recommendations

and and we we watched that doubling time

start to stretch out and the progressed

the projections for what our hospitals

would see for our needs for bed space

for intensive care unit base and for

ventilators started going down until

until you could see that probably we

will be within the resources that we

have in our state

which is wonderful and earlier this week

you know Oregon was able to to clench to

send 140 ventilators to New York City

there try to help them meet the need in

this time of crisis so it’s you know

we’re still at the stage where it’s very

very different from state to state I

mean the cat is kind of out of the bag

in certain states in Washington and in

New York but many other states still

have the opportunity to change their

fate so it’s really a day-to-day battle

to make sure that we stay in the game

and that we we continue to be really

vigilant with all of our public health

measures or even escalate efforts so

that we can get over that hump and get

to the other side of this thing I mean

and that’s it’s amazing to hear that

things seem to be going really well or

going or doing much better and and you

know I’m curious I’m talking about those

other states that you mentioned that

maybe aren’t faring as well I know

you’re in touch with a lot of colleagues

in other parts of the country you know

what are you hearing from folks who are

maybe in some of those harder hit areas

yeah it’s really unlike anything you’ve

seen I mean the thing to understand

about emergency care and disaster

response systems is this is what we do

you know it’s not like we run on the

assumption of of normality you know we

we are always planning for the

worst-case scenario and so we’re we’re

prepared for disasters but but normal

quote-unquote normal disasters are

they’re so much more contained than this

so you know we’re ready for earthquakes

hurricanes other national natural

disasters or maybe a single mass

casualty all these things that have so

much more so many more sort of borders

to them you know these discrete events

maybe they affect a single city or a

region or you know you’re in a position

where other states or regions can can

chip in I mean you’ve seen after some of

our largest disasters things like 9/11

other countries were so willing to sort

of lend a hand in terms of our our of

addressing our aftermath and and this is

one of those things where where should

the help be coming because we’re all

dealing with this at the same time and

so everybody is either in full in it you

know like they are in New York City

either they’re they’re in there just

trying to deal with a huge caseload of

patients and then very sick patients and

just scrambling to be really creative

around these these limited resources

that we have everything from personal

protective equipment to the medications

and space and ventilators and healthcare

workers to just being in full-on

preparation mode and that’s kind of

where we are right now in Oregon because

our our peak is expected to hit at the

end of April or early May and so we’re

using that precious time to try to

figure out in every eventualities our

are we going to to handle this surge so

no matter what whether the wave has hit

or whether it’s about to hit everyone is

really working 24/7 around this pandemic

and you know when I think about

emergency workers even before this time

you know I always think about them in

general just like a you know sort of

chaotic frantic space and you know I

have mentioned that that may change have

changed a little bit in the recent weeks

and so could you talk a little bit about

what your day-to-day experiences are

like now as compared to what they would

have been like what they were like

pre-pandemic yeah totally and again I’ll

speak to the experiences of health care

workers that I’m hearing from everywhere

you know rather than just mine

individual er but there there’s kind of

two parts to this one is in normal times

we run hospitals pretty lean you know so

we don’t we don’t run it so that you

walk into a shift and you’re relaxing

for half of it you know or or so that we

have a bunch of empty beds just in case

I mean you run it to be pretty close to

maxed out all the time because we really

run it for financial efficiency you know

so hospitals more and more are very full

we’re not expanding hospital wards we’re

really running them as pretty close to

peak and in the emergency department I’m

on a regular day let’s say a weekend

evening shift when when an ER doctor

walks in or an ER nurse walks in you

kind of stop and take this deep breath

because you know you’re going to be

running non-stop basically all-out for

your entire shift eight to twelve hours

or whatever it is and so in normal

circumstances we are I mean you feel

pretty close to max capacity and then

add on to that a pandemic and you kind

of think of your worst regular day and

and in places where they’ve already hit

search it’s twice regular or three times

or five times or ten times that and so

you went from it never was a relaxing

job I mean it was always a stressful job

where there’s only so much one person

can do and yet you’re doing more than

that all the time and just trying to

keep people safe - really - really you

know some order of magnitude higher than

that so places that are hit hard really

impossibly busy and then and then on the

flip side we are we have really done a

lot of work in terms of public messaging

and messaging through a health system

that if you are not very sick you should

stay away because first of all we need

to care for these kovat 19 patients and

also you don’t want to get sick by

coming here because this is where the

Cova 19 patients are coming so for your

own safety and your family’s safety

please stay away and so people even

people with very serious health

conditions are are staying away

and our caseload in the emergency room

is actually very different and so we’re

disproportionately seeing patients who

have fever

you know respiratory illnesses symptoms

that are likely cope at 19 but almost

everything else has gone away or gone

down I think what else has contributed

to that is that with all of this social

distancing so people are staying at home

they’re not going to parties or bars or

restaurants or places where you might

drink a lot and get into trouble

afterwards so a lot of that Friday night

Saturday night trauma that we would

normally normally see car accidents from

drunk driving or just from high traffic

conditions I mean all the things that

happen when you throw a whole bunch of

humans together in close quarters though

that is kind of our bread and butter in

the emergency room and we’re not seeing

that whole chunk as much the puzzling

thing is actually why we’re not seeing

things that have no relationship to Cove

in nineteen imeem heart attacks strokes

those diseases have not gotten any

notice that they should wait until kovat

is over you know and so where are those

diseases I mean there was an op-ed in

The New York Times the other day

wondering if people who have very

legitimate reasons to come into the

hospitals are also avoiding avoiding the

house but not that other things aren’t

legitimate but you know things that that

are true emergencies that we should be

seen immediately otherwise can lead the

very poor outcomes or even death in a

short period of time what you know what

kind of collateral damage are we seeing

because people are afraid to come in so

but all of that adds up to a very

strange environment in the hospital

right now yeah I mean and that’s and

that’s so interesting to hear it sounds

like in some ways people are being

really more thoughtful about how when

they actually do need to seek out care

and when they can handle something

themselves and I and I imagine it

probably remains to be seen whether

that’s better that people are dealing

with some things on their own at home or

or whether that’s worse what is your

take on that probably a mix of both I

mean I think the truth is right in the

middle I think when we go back to normal

it’s hard to imagine a time they’ll come

back to normal but probably when we go

back to nor

we’ll see some things we’ve learned can

stay out of the emergency room or you

know I think we’re being very creative

about telehealth right now and I’m

getting people to get health care

through their computers or their phones

and I think we’ll probably find that

that that we continue to have expanded

use of telemedicine after this because

it worked so well I bet people actually

be very happy and surprised by the

number of things that you can do at home

for some common health conditions but I

also think that when the surge is over

for every state we will get an influx of

those delayed care cases that will kind

of be the second surge of stress on the

healthcare system not directly rated

related to code 19 but what we’re kind

of calling the collateral damage I’m

deferred health problems that really

could have benefited from an earlier

visit to the hospital emergency room or

and in-person visit to your doc to your

doctor or nurse practitioner or whoever

and you know as the months have gone on

and you know we’ve been dealing with

this as a country as a world you know

for these past few months in emergency

rooms in your emergency room how have

you seen the situation change or worsen

you know how are things different now

than they were say back in early

February I mean now we are in it I mean

all of us to some extent I mean it’s hit

all 50 states and so it went from this

anticipation to really needing to make

those hard decisions and I mean this is

so challenging always but in this

disease we’re not familiar with it and

so we are learning on the fly so we’re

learning from China from Italy from

South Korea and then from our own early

States but that decision making changes

so fast that that really there are some

days where I feel like the hospital I

walk out of at the end of my shift is

different than the hospital I walk into

at the beginning of my shift and I’m

hearing this from colleagues all over

the place it’s not just at my

institution where people are sitting you

know we’ve created these these COBIT

emergency task force or committees that

make decisions for for every health

system

and people are sitting and receiving

data as it rolls in and then using that

data to enrich the response in their own

institution so whether it’s I’m trying

to think of a good example like even

just what we decide to do around brown

face masks or around how we manage

certain types of patients what

medications were looking at as potential

therapies I mean this is how wild and

and quick it is a few weeks ago earlier

in this pandemic we were concerned about

a certain class of blood pressure

medication called AR B’s angiotensin

receptor blockers and the rumor was that

these were harmful that these would

actually lead to more severe disease and

there was a question about whether we

should be taking patients off of those

medications who are using them for blood

pressure control 3 weeks later that

medication is being used in the hospital

as a potential therapy I mean that is

how fast a science is changing it was it

was bad

now it’s potentially really good I mean

I it’s a constant process of keeping up

with what the best evidence is telling

us is right to do and I mean I’ll just

tell you you’re always wondering am I

getting it wrong right now as I feel

like it’s gonna be different in about 24

hours and you just do the best that you

can with with current information well I

mean - you’ve been documenting your

experiences and uh sort of talking about

what how you’ve been going through this

pandemic and your new podcast doctor’s

log and you know you’ve talked about

some of the unique challenges that

health workers are facing one of those

being heightened exposure to the virus

and so I’d love to talk about that a

little bit just you know what are some

of the physical ways what does the

physical toll that this pandemic is

having on health workers yeah this is

this is so stressful I mean we are used

to working under conditions where your

risk is some nonzero number above that

of the general population you know we

see dangerous infections all the time

there is violence in the health care

works the workplace because of the

volatility of what we see all the time

and so there’s a little bit of you know

adrenaline there that’s that’s always

present and that we we’re used to over

time you actually become completely a

nerd to some of these things that aren’t

a part of other people’s day-to-day

existence but with this we have a you

know a disease that’s highly

transmissible and also is is leads to

very severe disease and so you know and

then you throw in there the shortage of

this one simple resource which is this

personal protective equipment and when

you put those three things together and

we’re seeing a high volume of patients

it’s you know it’s it really becomes

stressful on a different level because

it’s rare that we see something in the

hospital where we have to worry what am

i bringing home to my family member

because I wasn’t perfectly protected

against this very dangerous disease and

I think when you add on that layer of

personal stress all the time am i right

by doing this thing that I love to do

care for patients am I putting my family

at risk

am i putting other patients at risk my

colleagues at risk I think that has been

one of the most emotionally draining

things of this of this whole pandemic is

just not just not being free to kind of

go in and just do your clinical duty to

the top of your potential but having

this added layer of of constant stress

about how much you’re able to do it

safely yeah I mean it’s seeing these

headlines really across the world about

the number of health workers who

contract the virus and you know that

sort of thing is is is really upsetting

and you know thank you doctor true for

all you do and I think another thing

that you talk about you know and also

thinking about you mentioned not having

PPE but also other equipment that we’ve

seen a lot in the headlines that are

we’re lacking in the hospitals are

shortage of our ventilators

you’ve talked about this and how it’s

not just enough to think about the

ventilators themselves but you know what

are some other factors that we need to

consider when we’re thinking about the

need for ventilators in in medical

centers and hospitals yeah the the needs

are so great and it’s really everything

that you know it’s everything that

surrounds the ventilator you know it’s

it none of these things live in

isolation you know and so when I think

of just the issue of the ventilator um

that we’re running out of it’s like well

you you actually need highly trained

staff to use a ventilator it’s not like

you can just take anybody and just put

them next to a ventilator and they can

start programming it in this super fancy

you know with with all skill and

confidence you know we we rely on the

fact that there’s a highly trained

workforce including respiratory

therapists intensive care unit trained

specifically trained physicians nurses

who are really experienced in ICU care

even to put somebody on a ventilator you

need a number of common medications just

a date and paralyze them so that they

can tolerate the insertion of a pretty

rigid plastic tube down their throat and

then to keep them in a state that’s

comfortable so that they can stay on

that tube for many many days which is a

very uncomfortable thing actually and so

you know and so we need all of those

medications and we need them in pretty

large quantities and then of course you

know ventilators need to go into

intensive care units those intensive

care units require a lot of maintenance

I mean the cleaning staff to to clean a

intensive care unit where there’s been a

kovat positive patient in these our

larger rooms they have a lot of

equipment in it often the cleaning after

a Koba 19 patient to do it right and

disinfect that space so it’s safe for

the next patient that’s an hour and

twenty to thirty minute process or more

depending on the facility so or that

that room is just out of use and so I

mean there really is a complex team that

it takes in order to maintain an

intensive care unit around a single

machine it’s really hard to to convey

that all the time you know it’s a lot

easier to say we need the single

resource let’s manufacture it and get it

there and I will say to just this this

whole thing is really such an education

on public health messaging and how we

get ordinary people and policymakers to

kind of get galvanized around some of

these issues that are buried deep within

a hospital it’s like the deeper you get

into a hospital and the further you get

from outside of it the harder it is to

communicate these needs and so you know

testing was something that was very

relatable to people and that we were

really able to raise public outrage

about because everybody suddenly wanted

to get tested right I mean you had a

virus the the the the Cova 19 disease

was in the country you wanted to know

whether you had it and so if you didn’t

then something you knew really wanted

that test PPE the personal protective

equipment that was a little harder

that’s the first step into the hospital

what do you need if you’re working on

copa90 and you need some PPE and so and

there was something so visual about it

right we saw pictures of healthcare

workers with their masks and their

goggles and their gowns and and we saw

those images from other countries where

they were wearing them or not wearing

them you see the pictures on one of the

most vivid pictures I think that will

remain in people’s memories after this

is the pictures of the health care

workers with the bruises around their

faces for wearing these masks non-stop

because normally we don’t always wear

personal protective equipment for every

single patient but having to wear it for

patient after patient for hundreds of

patients over a shift people started to

get bruising on their faces and there

was something so visual and visceral and

relatable about that and so we got

people really excited about PPE and I’m

so glad because I think we won’t get

relief in those in that resource soon

after that our ability to kind of

communicate our needs are as critical as

they are they may be as critical as PPE

and as testing once you get downstream

to a stage of disease where you need to

be treated in the hospital it’s very

hard to communicate how badly we need

these things and get the kind of you

know the public interest and an outrage

and energy around it but really every

single thing that we need in the

hospital is is we’re starting to strain

the supply I’d love to

I fell in here yeah yeah please Helen so

many questions pouring into Facebook so

I’ll just share a couple and then I’ll

jump back off but I think overwhelming

made the number one question that people

have is how can they help alright I’m

sorry that question just kind of kills

me it kills me every time and you think

I’d be ready for it because how many

people are asking me so Oh give me a

second first of all everyone who asked

that question thank you I mean we feel

feel the outpouring of goodwill and and

I mean that is honestly what keeps us

going to work every single day and gives

us energy to do this and it actually it

makes me feel like how can I do more so

thank you and I will say there there are

a million ways to help I’ll throw it a

couple of simple things the first of all

whatever you do to help your own

community helps us so even if you’re not

out there I mean a lot of people are

selling face masks and things are

contributing to you know to the to

increasing the supply of PPE and that’s

wonderful but but it doesn’t have to be

that literal so when you contribute to

your local food bank your local homeless

or domestic violence shelter your local

diaper bank in any way contributing to

the needs of the community around here

you are helping us and I will tell you

even in times of pandemic we are seeing

people come to the hospital because they

are lacking food and they are lacking

shelter because those needs are still

paramount for people and so when you

help in those ways that is healthcare

that you are giving directly and you are

helping us every single day keep people

healthy so those things are so valuable

I think the second thing is to come into

the healthcare mentality which is that

this is not going to be short it is

going to be prolonged and there is no

single campaign that will win this thing

they’re going to be many campaigns after

campaigns and I always feel like I’m

giving bad news but I want people to

kind of spread the word that this needs

to be a really sustained effort we don’t

have an end date we may even have a

second surge of disease on particularly

if you don’t get this right we don’t

have a timing for things like vaccines

and effective treatments those things

simply take time so I would say take the

little breaks that you need to from

you’re helping roll help when you have

the energy and you know and the

resources to do so but also take time

for yourself but understand that this is

not going to be short and then the last

thing I would say is remember that

sometimes what we don’t do is as

important as what we do do and so people

are always worried that they haven’t

done enough but remember that restraint

is so important here and one example

I’ll give is every time there’s a whiff

of promise around a medication people

are going out and they are they are

trying to get people to prescribe it to

them they’re they’re filling these

prescriptions and in quantities that are

much higher than than anybody needs and

really there’s some medication hoarding

that’s going on so I would ask people

you know wait for the evidence and the

recommendations please let health

professionals guide how we use these

resources and and please don’t do the

toilet-paper thing for any resource in

healthcare we need to we need to have

enough restraint that the limited

resources we have yet to those who

really need them that goes for a number

of things also those you know hi Phil

tration facemasks some people in the

public do not need to be wearing those

and those should go directly to health

care workers one of the question and

then I’ll jump back into the comments

but even there’s a question around the

risk of using a drug for something it

wasn’t intended and I guess this is a

reference to Cora Queen which has become

a kind of a word that non-medical

professionals are now using liberally

but what do you make of the kind of the

sudden resurgence of people’s awareness

and knowledge of chloroquine and what

should we actually think about it yeah

there you know every time there is a

pandemic there are a number of

medications that have the

radical benefit because they have in

vitro action against against the virus

and there have been many disappointments

I mean all all these medications that

we’re talking about hydrochloric win and

as if through Meissen and antivirals

that are effective against different

viruses we wonder can it work against

this virus maybe the excitement about

these medications hydroxychloroquine i

think is the one that’s been mentioned

the most I mean really through the roof

I’m excited too it would be nice to know

if it works we have very little data on

these we have not been able to do these

randomized control trials that will

allow us to know not only are they

effective but is the is the good that

they’re doing does it exceed the harms

because all these medications have

potential toxicity on you know they have

psychiatric side effects they have

cardio toxicity particularly in

combination with other medications that

affect your heart they can cause very

serious illness seizures and even death

and we’ve seen we’ve seen an early death

from from the use of chloroquine so so a

lot of caution here in every sense there

is no indication for people to go out

and start using these medications as

either prophylaxis or treatment I’m

really worried about how people can hurt

themselves and advertently particularly

if they’re taking these outside the

recommendation of a health professional

I mean that’s just a nightmare waiting

to happen and I’ll also say I mean this

goes in line with with the issue of

medication shortages but I mean the the

treatment for hydroxychloroquine or

chloroquine overdoses is is generally

benzodiazepines which is another

medication that we’re in very short

supply of we need critically for

intensive care unit patients and so you

know everything has consequences that we

will then have to grapple with so not

you know unsupported you so these

medications this really has the

potential to be another disaster buried

within this disaster we do not want that

okay I’m jumping off thank you so much

back to you Whitney

Helen you know it’s so you talked about

sort of how you’ve been advocating for

PPE and our need for that and you

advocate for a lot of things in this

public health space that I think are

just really critically important at this

time and one of those things is the work

that you’re doing with chip health and

I’d love to talk a little bit about that

as far as looking at building emergency

health centers and creating these spaces

at this time and as we’re seeing that

hospitals are overcrowded throughout the

country the world you know I guess how

how long before we get to a point where

where we really are beyond capacity and

and need to seek out alternative

measures yeah we’re already seeing it in

New York and I think we will actually

see this space shortage in every major

city and then a different kind of space

shortage actually in rural and critical

access areas so you know in large cities

we’re running out of space in every

single cup you know if every single kind

so yes it is the intensive care units

and it’s the hospital wards and it’s a

space in the emergency department and

you’ve seen these I think you’ve seen

these pictures in in emergency medicine

triage where people packed in there like

sardines no doubt transmitting disease

while they’re waiting you know and so

some hospitals are bumping out to large

tents places where they can enforce try

to enforce social distancing while

people are waiting to be seen some of

them very sick but there’s also housing

needs around health care so increasingly

as we’re seeing many many very static

Ovid patients and particularly when you

add in that layer of inadequate PPE our

personal protective equipment um health

care workers are not wanting to go home

and that’s a very reasonable thing to

watch because we we want to we want to

shield our families as we do this I mean

a number of many many health care

workers I know are sick and have to go

into quarantine away from their families

and so where do we do that I mean

hospitals are only equipped to handle a

very small handful of health care

workers spending the night you know so

you go into any hospital in a regular

time in the

they’re empty at night and you just have

a tiny handful of physicians who are

required to stay in house overnight this

is to sleep there you know between

between daytime hours and so you’ll have

a couple of call rooms and now we have

this this situation where a large

portion of our healthcare staff does not

want to go home in between and so we’re

getting really generous offers I mean in

the in New York City for example the

Four Seasons offered its hotel rooms up

to up to health care workers who wanted

to stay there to keep their families

safe or to avoid the commute between

shifts and that’s great but you know

most hospitals aren’t lucky enough to be

next door to a luxury hotel where they

can spend a month and so how are we

pumping out housing in addition to all

the health care space we need and and so

that’s why I started working with this

amazing team it’s a project called Joop

health and we’re building three kinds of

units as fast as we can so this this

expanded housing for health care workers

and actually for other people who have

covin 19 or likely have codon koba 19

and cannot go back to their their living

situation for whatever reasons so you

think of people living in homeless

shelters domestic violence shelters

group homes nursing homes correctional

facilities psychiatric units basically

all these places that we’re calling

coronavirus traps because people are

held in there there is no option for

social distancing and the infection is

spreading like wildfire fire unless we

take known cases and actually pull them

out so expanded housing can be used for

any of those populations and then basic

hospital beds and then and then actually

these these mobile intensive care units

that are being designed with

architecture design teams engineering

teams and a whole bunch of health

professionals and also patients and

patient advocates and we’re trying to

make a very functional space that can be

shipped anywhere in the United States

very quickly there are hospitals in

remote areas that don’t have hundreds of

ICU beds that they can mobilize they

might have two ICU

but all of a sudden they’re not able to

transfer all the kovat patients that

they need to take care of and so we want

to see that their needs as well as we

see that the needs of people and very

densely populated areas that simply

don’t have room I mean I think the

reality is we can’t you know we can’t

run hospitals that have have endless

capacity for surge I mean that’s just

not something that you can build and

maintain so what are creative ways we

can we can do this we can create very

deployable extra space not just for this

crisis but but for every single other

one that we face moving forward and you

know when you think about these needs

for health workers and and just for the

broader community you know how much of

this is on the government and I you know

and I’m curious to hear I guess what you

feel like in thinking about this crisis

what the government has getting right

both on the federal state level and then

what are some of the areas that really

still need more attention yeah I mean I

I think it’s pretty fair to say that the

government response as a whole has been

disappointing

the biggest tragedy is that when that’s

those first cases came in the United

States that we didn’t get on top of the

testing that day not even that day the

month before when we knew that this was

starting to spread and it was clear this

was going to be a global pandemic it

really I find it hard to even think

about because I it’s so upsetting that

we didn’t just roll out testing encase

and contact identification very

assertively from the beginning I mean

that was the difference between what

will ultimately be hundreds of thousands

of lives lost and and and having saved

all those lives will be that early thing

and you know you’re psychologically it’s

so bad to dwell I’m trying not to dwell

on that first mistake but and really

just kind of move forward and say okay

how do we avoid that that that

and that’s kind of been where I’m trying

to push the conversation like okay

what’s the next thing you know it’s like

okay we’re kind of got behind testing we

still aren’t where we need to be with

testing but then then what you know what

are the other containment measures and

then when we get to the you know

downstream to the treatment everything’s

really about containment and then

treatment capacity and I I think

containment is where I really wanted to

focus and then it was like okay well we

because we failed in containment we

better shift quickly and think about

here escalation so how do we expand our

care capacity and it’s sad to me that’s

that’s where I need to be but since

we’re going to be doing large-scale care

what are all the little gaps that we

need to fill so and I think the really

hard thing I mean I’ve been involved in

in these organizations to try to improve

our PPE supply and the and I can you

know we’re all so many hundreds of

thousands of people are involved in this

and and I think we’re able to boost

supply here and there and and have have

some successes but what we can’t do what

is very hard to do on the grassroots

level is to centralize our understanding

of the problem I mean there should be in

an ideal world a national command center

that has its fingers on the pulse across

all 50 states that knows where are all

of our hospitals and health systems and

clinics what are their patient caseloads

like and what do they need of every

single resource whether it’s human

resources or or these concrete sees

these recent these supply resources and

then understands the national supply and

can divert resources exactly where they

need to go at the exact right time

including identifying places that are

getting over the you know the surge and

are able to reallocate to other places

where they’re just entering their surge

so that kind of centralized national

coordinating role is something that

we’re really missing here

and I think not only does it make it

hard for all of us to get the resources

we need but there’s real equity issues

here I

worried all the time about who is

getting the limited resources it’s

probably they’re really enriched out

systems that have a lot of political

power in their communities and you know

have already we’re kind of well

resourced going in they’re likely to get

more and smaller and less resource

places are simply not going to get the

attention the political will the the

voice do to get what they need and that

affects their their communities and so

there’s there’s huge inequities that are

going to be doubled down because we

don’t have a coordinated system that

that has some you know some structure in

place to make sure these decisions and

resources are equitably made Helen has

some got some more questions from online

I do I have overweening love for you and

gratitude but everything that you’re

doing and I have some questions too so

one is someone has five and ninety five

masks they want to donate them but

they’re not quite sure how to do that

how how can how can they help how can

they get those masks to you or to your

colleagues thank you

so most hospitals have listed drop-off

locations for n95 and ours and actually

have built methods for people to be able

to drive by not get out of your car and

risk yourself by coming into a health

care center but to be able to do it on

the outside with minimal contact and so

I would encourage you to to either call

your local hospital or health system

almost everybody has a kovat hotline set

up or the hospital operator can divert

you to it also if you go on some of

these coordinating websites the one I’m

involved with is called get us PPE org

we have by state a sorted list of

hospitals that are accepting PPE

donations including the address and

hours of drop-off so you can go right

there and hopefully find one that’s

close to you and then this is arguably a