Coronavirus (COVID-19): Press Conference with Paul Biddinger, 09/11/20

You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Paul Biddinger, the director of the Emergency Preparedness Research, Evaluation and Practice Program. Also vice chairman for emergency preparedness in the Department of Emergency Medicine at Mass General Hospital, and the medical director for Emergency Preparedness at Mass General and at Partners Healthcare. This call was recorded at 11:30 a.m. Eastern Time on Friday, September 11th. 


PAUL BIDDINGER: So good morning to everyone. As Nicole said, my name is Paul Biddinger and it’s a pleasure to join you. I’ll be speaking mostly from the perspective of the Mass General Brigham Hospitals and what we’re up to right now with respect to COVID and the topics that she mentioned. Across our hospitals, across our system, I think it’s important to point out that in some ways we are still in a version of recovery mode, despite all the preparations and all the other planning that we’re doing. There are still a lot of efforts to consolidate lessons learned from the spring experience from the first wave in terms of what our patients went through, from an access to care perspective, from our staff, and how we can support them, and how we can incorporate those lessons into our plans going forward. It’s really important to acknowledge still, I think, the burden and the stress on our health care staff, that our nurses, therapists, physicians, I think, are still tired. They’re still working very, very hard. And there’s been a lot of effort to resume care and to take on the care that was deferred during the first wave. And so even though, thankfully, our COVID-19 numbers are much lower now than they were in the spring, there is still quite a bit of stress within the health care system. And really important acknowledge that for the workers within our system, we are absolutely preparing for the possibility of a second surge. Obviously, I know you know a lot about the second surge events. And historically in pandemics, we have traditionally seen second surges. Now that comes with the caveat that most pandemics have been related to influenza, which is, of course, a different disease. And so how much the lessons of what a second surge could look like or how it will play out in COVID-19 as opposed to influenza? We really don’t know. But our system and our hospitals are looking very much at all of the other countries around the world that are experiencing recurrent waves of COVID-19. We’re looking at when those waves occur, how big they are, what patients are affected. We do note that there are sometimes differing patterns of hospitalization in terms of how many patients are hospitalized, how many patients require the ICU, what are the demographics of those patient groups, whether the age or other factors are changing, and we’re using that data to inform our own planning in terms of our own planning. 

We are following what we call the four S’s of surge planning, so that’s staff, supplies, space, and system. And I would say that staffing is probably still the hardest of those S’s in terms of what we’re planning for with any second surges. It’s our hope that we will be able to continue more ongoing routine medical care than we had in the first wave. As you all know, in the first wave, hospitals had to cancel essentially all non-essential care and while there were very good reasons for for doing that, that is hard. Primary care, routine medical care, procedural care is important, obviously, and there are consequences to deferring that care. So we are looking at how much we are able to sustain primary care, ambulatory care, procedural care and patient care while making sure that we are always able to accommodate patients with COVID that need hospitalization or intensive care. And the challenge, of course, planning is that our staff are not able to do all of those activities at once, at some point we have to redistribute. So we’re looking very closely at how we best use our staffing and acknowledge, again, the stresses of what they’ve been through. In terms of the supplies, we have been working very hard to build up our cash of personal protective equipment. Our supply chain leaders have been trying to garner new supplies of N95 respirators, surgical masks, gowns, gloves. And while our system went into the COVID pandemic with a target cache of supplies that was meant to get us through the worst two weeks of supply chain interruption or a pandemic, our new revised planning target is actually a four month cache supply, so substantially larger. And I’m pleased to say that we are well on our way to making progress towards that goal. In terms of system, what I am referring to is really how we manage patient flow and patient volumes. We learned an awful lot about how to manage patient volumes during COVID, both in the outpatient and inpatient world. And I think, again, we are working with our health care systems engineers, our admitting office, our capacity management leadership to try and figure out how best to manage patient volume both across our own system at Mass General Brigham and how to work with the other hospitals in our region to successfully live with what we call load balance hospitals so that all hospitals are able to care for the patients that they care for, and accommodate COVID patients. 

We’ve been participating in discussions with the Massachusetts Hospital Association on this effort and really I think we’ve made some great progress based on lessons learned. And the last thing I would say we’re up to in addition to recovery. In addition, the planning is really watching. Like all of you, and like so many people around the Commonwealth, we are really watching the data to try and understand what’s happening and what might give us a signal that there could be a second wave of COVID. We look at community data, we look at state data, we look at our own system data on a daily basis and look at it in many different ways by community, by race and ethnicity and language, by age group, by others, so that we understand as best we can what’s happening in the community, what we can anticipate. We want to continue to be able to to assist hotspot communities that we provide care in so that we can help them to minimize prevalence as much as we possibly can. Those efforts are ongoing. We’re distributing supplies. We’re working in language, appropriate communications mechanisms, so many other ways which we’re trying to support municipal leaders. And then we are also trying to identify what data points would help us know when we think we would see a surge in hospitalizations, changes in some of the community prevalence rates that have been reported in the last two months have not always translated into increases in emergency department or hospitalization rates. And so our modeling experts and our health care systems engineers have tried to identify what data points we think would indicate changes in health care system stress. And one of the data points I guess I’d share that we think is most indicative of a likely second wave in terms of overall numbers of patients, would be changes in emergency department presentation rates and hospital admissions. As I said, we look at this every day across the Mass General Brigham system. We are not seeing any increases yet. And we have confidence in our models looking about two weeks in the future. So, so far, for what we’re seeing today, what we anticipate in the next two weeks, we believe that the emergency department visits and the hospitalization rates should stay essentially flat, should stay about where we are right now. So I’ll stop there. I hope that was helpful, but I’m eager to answer questions or let you know what I can share. 

MODERATOR: Great, thank you Dr. Biddinger. First question. 

Q: Hi, how are you? Thanks for taking the time to take our questions today. Might come from left field, but basically a report from the latest Morbidity and Mortality Weekly Report by the CDC found that adults with COVID were twice as likely to report dining out in the 14 days before getting sick. What are your first impressions of that? Should we not be dining out even with a mask or social distancing or other precautions? 

PAUL BIDDINGER: So I have heard of the report. I have to say I have not seen the details of it. I think we do know from other epidemiology that we’ve been seeing that eating is one of the higher risk activities depending on how it’s done. Of course, you have to take off your mask in order to eat, and that changes the protection that we’ve been recommending now for so many months with always wearing the mask and always wear the mask appropriately to cover both nose and mouth. So I think there really are two categories of risk when people are dining out. There are the people with whom they’re sharing a table, and often those are people that are within six feet of you. And so there’s an increased level of risk based on that proximity. And then there’s the risk of the broader environment about who else is sharing the airspace with you, particularly inside versus outside. So I’d say there’s more data to be garnered, no question. I think people should be extraordinarily thoughtful in how they decide to go out. And if they are sharing a table with people that are not part of their household, part of their close environment, they should actually be discussing risk factors, recognizing still that we think that 30 to 60 percent of people can transmit COVID when they have minimal or no symptoms. And I think people just have to be cautious. We will learn more from epidemiology about the risks of dining indoors. We definitely believe that there is a different risk profile with dining indoors as opposed to dining outdoors, and I absolutely understand why people are eager to get together with friends. We certainly want to be able to support the restaurant community, and people have to be exceptionally cautious in their dining choices and very much at work. I think people have to understand that conference rooms, break rooms at work can be at risk if people take down their masks and don’t maintain that six foot distance when they’re eating together. 

Q: Thanks. And I have a quick follow up on that, I mean, with the study, especially because now with studies, we’re always questioning the sample size because we just can’t get enough people for COVID studies to meet the gold standard. But this is a study of more than 300 adults and I believe about one hundred and fifty tested positive for COVID. Is that sample size too small to trust these study results? What do you think? 

PAUL BIDDINGER: Yeah, so that’s that’s a great question. I think sample size always relates to other factors as well, which is what’s your control group and what’s the prevalence of the thing that you’re looking for. So the description we often use as power, does the study have adequate power to really detect a difference? Or if you see a difference, is it statistically significant? Again, without knowing a little bit more about the variables, I can’t say that particularly that sample size either does or doesn’t prove what’s going on. I think, you know, the limitations always are what other factors, but other variables are involved in a study meeting? Are these all small indoor spaces versus outdoor spaces? And again, forgive me, because I haven’t looked closely at that data, but I think we need to make sure that we generalize lessons appropriately. And I think there is an important question that if indeed we find that there is an increased risk of COVID infection with people who have dined out, that tells us there are more questions we have to be asking about, again, with whom they sat, what symptoms people may have had. Were they indoors? Were they outdoors? How long were they together? So I think it certainly prompts further study and it should prompt people to be cautious. I don’t think it automatically says that all dining events are risky. 

Q: Totally fair. Thank you. 

MODERATOR: Next question. 

Q: I’m trying to get a clearer picture of the treatments that patients are getting. Is there sort of a standard? Somebody comes in with COVID, we do this or is it really per patient? Are we becoming more more standardized with the treatment now? 

PAUL BIDDINGER: It’s a great question. With everything with COVID, it’s a slightly complex answer. It’s important to note that there are still no FDA approved therapies for COVID, meaning that none of the therapies that we have in front of us has gone through full approval. There are therapies that have received emergency use authorization, and there are other therapies that have evidence behind them. They apply to different patient populations and say the two therapies that have the strongest evidence so far are dexamethasone, which is a steroid, and that is useful in a population of severely ill patients with COVID, and Remdesivir, which is the investigational drug that received emergency use authorization for a subset of patients with COVID, with low oxygen levels at a certain point in their disease. It’s thought probably that the way in which those two different drugs are helpful, differ in terms of the both the patient population and the timing of illness. And so it’s certainly not the case that if you have COVID, you should definitely get both of those drugs. That’s not true. And there are patients who are more appropriate for one or the other and sometimes both. So right now, I would say those really are the two leading therapeutics that we have. The guidelines about which patients are appropriate and when patients are appropriate are changing a little bit. The Remdesivir guideline did change recently. But I think what we’re showing is that Remdesivir has evidence showing that the people who do need supplemental oxygen, extra oxygen, relatively early in their course plays a role in keeping a certain number of patients from progressing to more severe disease. And for patients with severe disease that have significant inflammation and lung injury, the dexamethasone plays a good role in protecting them and improving outcomes. So we hope, of course, that there will be more therapeutics coming on line, there’s a lot still ongoing in terms of research trials, but those are the two leading candidates.

Q: Are you surprised? I remember back in March, people were saying we’ll have therapeutics galore within a few months or six months. We’re now at the six month point today, I think, for the pandemic declaration. Is there an explanation for why we don’t have more or is this the practice of science? 

PAUL BIDDINGER: Yeah, I don’t want to be glib. I don’t know that I ever heard at least people saying we were gonna have therapeutics galore. I think we are hoping for effective therapeutics. I think we’re certainly hoping for more therapeutics and really a bigger benefit of the therapeutics. You know, there’s ongoing trials of many medicines, including the two I mentioned, Remdesivir, which has been proved to shorten hospital stays, still has not been proved to decrease mortality. And I think, you know, we are really hoping for drugs that prove a decrease in mortality. I think it is probably about expected, I would say, for where we are with therapeutics, that it’s really hard to develop a therapeutic, that it really does change the most important endpoints that we care about, which obviously death first and foremost, but progression of severe illness to either prevent ICU stays or intubations or shorten hospitalizations. So I would say I’m not surprised, but I am cautiously optimistic that we will identify more. But I think it will probably take many months, not unfortunately, many weeks before we see our next round of effective therapeutics. 

Q: Sorry, one more. Do you think, I mean, we’ve heard about blood clot, blood thinners and anti inflammation fighting the cytokine storm. Are any of those getting closer?

PAUL BIDDINGER: Yes. As some of the candidates looking at the cytokine storm have not yet proved to be effective. And so there may be more. I think the blood clot question is a really interesting one. There’s more research that’s just been even published this week. Early on in COVID, there was a lot of attention given to the blood clots that we’re seeing in patients with COVID. And a number of patients were given blood thinners. As we’ve gathered more data, there’s some studies that suggest it’s not clear that patients with COVID make more clots in their lungs, for example, then other patients with similar kinds of critical illness. And so it absolutely happens. COVID infection is, in fact, a risk factor for making more clots. But whether it’s substantially different than other kinds of similar critical illnesses, it is not clear. And it’s actually, it underscores the importance of doing good, high quality, high volume clinical research across the nation that we need lots of patients in the clinical trials to give us the data to know that our therapeutics are effective. We can see hints. We can see suggestions in small studies. But as actually I think we’ve seen in COVID, sometimes those hints don’t turn out to be the truth when you look at larger populations. And I think people’s approach to anticoagulation to blood thinners has been a good example of that, that, you know. Well, a lot of what we’ve been doing previously to treat blood clots and critical illness probably looks like it’s the right thing to do with COVID. 

MODERATOR: Next question. 

Q: Good morning. Thank you for your time this morning. Is there a concern as kids go back to school and we enter cold and flu season that every symptom that could be linked to COVID but might actually be allergies or the common cold or flu will concern people so much that people without COVID are overwhelming the hospital systems and bogging down testing turnaround time?

PAUL BIDDINGER: So I think we’re absolutely worried about the confluence of what’s called cold and flu season, or we sometimes call respiratory virus season with COVID. Thankfully, we hope that the allergies will become less of a factor as we head more into the significantly colder months. I think it’s a really good question about how much the confluence of respiratory viruses and and COVID will interrupt school activities, will force people to seek care frequently, I think there’s a little bit of good news in that, which is we want people to seek care when they have symptoms. And as we bring more and more and more testing online, which we do expect in the coming months, we’ll have more tests and more different kinds of tests, especially rapid tests that people will quickly go get tested. And if it’s not COVID, be able to resume schooling or work or other activities. So we think that certainly my own health care system, we are working to identify non emergency department, non primary care ways of expediting testing so people can reach out to their doctor, describe the symptoms they have and get tested quickly. And again, we hope to be able to expand that capacity even more through the fall that will let people go back to school sooner, let people go back to work sooner. There is a bit of an upside. Again, I don’t want to be excessively optimistic in this, but we’ve been looking, as I said, constantly and all the data available to us related to COVID and other illnesses. And what we’ve seen in the Southern Hemisphere is a dramatic decrease in influenza cases in a number of other risk viral cases. So, you know that southern hemisphere is coming out of their winter, their flu season. And the number that we’ve seen, especially from Australia but from other Southern Hemisphere countries, suggests that wearing masks, keeping your distance, doing good hand hygiene dramatically affects the overall prevalence of risk by viruses. And so hopefully, we hope we don’t know yet, but we hope that we’ll see a significant decrease in those numbers, which will lighten the burden on, of course, the population, but also on the medical system for when people need to seek care. 

Q: Thank you. That’s it. Thanks. 

MODERATOR: Next question. 

Q: Hi. Can you hear me? 

PAUL BIDDINGER: It’s a little quiet, I’ll turn up my speaker. 

Q: I apologize if this is repetitive, I had difficulties during your opening remarks. I’m wondering what kind of lessons you’ve learned in terms of preparedness or, you know, maybe changing your approach as you anticipate a second wave this fall. And then maybe your approach for longer term planning for something bigger or worse in the future? 

PAUL BIDDINGER: Great questions. So I think there are definitely lessons we’ve learned from the first wave, from  from last six months that we’re incorporating in all of our planning. I think we have a lot of assurance about the safety of hospital environment overall, that the personal protective equipment that we are using when we’re using it, how we’re using it, keeps our staff safe and keeps our patient safe. We still look at every single case of COVID in our patients and in our staff, and we do an investigation to see if there’s any chance that the illness is acquired or transmitted in the hospital setting. And our data’s very, very reassuring. And so how we screen our staff. How is screen our patients and visitors, how we again wear masks. Both our staff and all of our patients and visitors. How we set up our spaces, that’s been awfully reassuring and I think gives us a lot of confidence in our ability both to provide really high quality care to patients with COVID, but to all the other patients across the medical system. I think we’ve been trying very hard to listen to our medical staff about their experiences from the first wave as everyone is aware, we had to redeploy a lot of staff, move nurses, physicians, physician assistants, others out of the common settings, whether it’s in an inpatient or an outpatient or other setting, to be able to support care delivery during COVID. And there were a lot of successes and there was really just extraordinary effort by so many people across the healthcare system. People have learned lessons about what kinds of redeployments work well, what people are comfortable with, where they’re more uncomfortable and what they need for support. And so when we look at our staffing plans, when we look at our surge plans, if we have to, again, create intensive care units outside of our existing normal intensive care units, I think we’re really refining our plans for which physical units are best suited for that kind of care, which staff are really best redeploy able and really enthusiastic about that care and what else we need to support them. So I think those are some of our most important lessons in how we use our staff, our space, as well as how we feel confident in our ability to deliver good care. 

In terms of longer term issues, I think there are probably a couple of categories. COVID again, is something we’re learning a lot more about the transmission of in lots and lots of different ways, and there’s been a lot of discussion about airborne COVID and how far it can be transmitted. But the vast majority of events of COVID transmission that we see epidemiologically in the country and in the world are relatively closer to one another, meaning within that six foot radius, relatively more prolonged a period of time between folks. And again, there’s a lot of science still emerging and there definitely are cases of exceptions or other concerns that we pay very, very close attention to. But there are diseases that may be more transmissible at a longer distance through the air. And so we continue to look at our air handling and our facilities. We look at all the new construction that we may do in the coming years, new hospital buildings or facilities. And we’re trying to anticipate what kinds of modifications we would make or how we adjust those facilities, if needed, for an even different kind of virus there. You know, we obviously five years ago, we’re very worried about Ebola, which was transmitted in a very different way through body fluids, and the care of those patients and the management of their waste was very, very challenging for hospitals. So we don’t want to presume that all of the infectious disease threats that we might face in the future will be transmitted exactly the way COVID is. So we’re really revisiting our facilities, learning the lessons of what we’ve needed to do, what works well for COVID, but then trying to factor in diseases again that can travel over a longer distance or longer in the air, like a measles kind of transmission or have a different route of transmission, different infectivity like Ebola as an example, and kind of fold that into our facility and our space planning for what we’re looking to do going forward. 

MODERATOR: Do you have a follow up? 

Q: Yeah. What kind of help do we need from federal and state governments? 

PAUL BIDDINGER: I think certainly the financial impact of COVID-19 on hospitals has been well described and the financial support has been extremely helpful, certainly has not covered all of the costs, all of the losses that the hospitals have incurred, but I think the financial support has been a great life line to many health care organizations and is really important to help hospitals continue care. I think for the hospitals, data reporting has been a huge problem. And so data that’s shared among hospitals really helps to do that. I think the Commonwealth has done a good job of that, working with our state health department and the command center here. But I think there’s still room across the whole country, but certainly room everywhere to improve how we can streamline and share that. 

MODERATOR: Are you all set? 

Q: Yes. Thank you. 

MODERATOR: Next question. 

Q: Hi there. Thank you for taking my questions. So you mentioned that we’re seeing lighter flu seasons internationally and some of that is because of how they’re kind of taking precautions against the coronavirus. And we mentioned Australia specifically, but how similar is the United States to Australia in that sense? So what we see over there, how likely is that to carry over here? 

PAUL BIDDINGER: Yeah, great question. I think two things, I think and forgive me if I didn’t say clearly the first time, I think we think that their lighter flu seasons have to do with the masking and the hand washing and physical distancing, et cetera. But we don’t know. Many of the countries in the southern hemisphere have very good rates of influenza vaccination. And so I think there are key differences between some of the countries that we’ve taken hopeful signals from and the United States. I think still in the United States, our population, influenza vaccination rates are not as high as many people would like them to be, myself very much included. And so I think, you know, countries like Australia that actually have very high influenza vaccination rates serve as a model and I think potentially serve hopefully as inspiration for us to achieve similar vaccination rates. And then I think, you know, there’s variability around the world. There’s clearly variability in the United States about adherence to the public health recommendations, about mask wearing constantly, about vigilance, about gathering’s and about physical distancing. I think, you know, to me, the really important lesson to to draw from this is that we think what this means are the measures we recommend are effective not just for COVID, but for public health. And until COVID is much, much less prevalent in the community. These are measures we still need. I know there are people that are concerned that this may at some point become the permanent recommendation, and I definitely do not see it that way. I think hopefully when we have a vaccine, when we get to much lower rates of COVID transmission, we will be able to get back closer to normal. But I think we’re not there yet. We definitely have a fair amount of COVID in the community, depending on where you are in the United States. There are higher and lower rates. But I think for all of us anywhere within the United States, the risk of COVID transmission is high enough. We absolutely need masks, we need hand hygiene, we need physical distancing, and we need really careful attention to the size of gathering’s. And again, I would just say that the lessons of the southern hemisphere should hopefully bear out how successful that can be and how much that’s needed. 

Q: And my follow up question would be, I know there’s a lot of data about hesitancy regarding a coronavirus vaccine. But is there any data out there in the likeliness of Americans getting the flu shot this year compared to previous ones? 

PAUL BIDDINGER: So I expect there is data, unfortunately I’m not aware of it. I think certainly all of the major health care organizations and national groups that talk about vaccination have stressed that this is perhaps the most important year for Influenza vaccination that we’ve ever had. Influenza vaccination is always important. I would remind people that, again, in the typical flu season in the United States, that flu can kill between 20 and 60 thousand people, which is on par with the number of people that die in car accidents. So influenza is, in fact, still a significant threat. It’s why every single year we try to get as many people to get their flu vaccine that possibly can. But I think this year, for people’s own safety, to minimize the burden on the health care system, to minimize, frankly, the chance that they have symptoms themselves and have to go get tested and have to have to receive medical care. There are just so many reasons that we that we want to encourage flu vaccinations. So all of us are trying to encourage it. We’re trying to make it as easy as possible. There’s nothing about influenza vaccination that should be affected by the COVID situation in terms of it’s not riskier, it’s not less safe. And there are lots and lots of ways people can get a flu shot without going to the hospital if they don’t want to go to the hospital. The hospitals are definitely ramping up their flu vaccination. So I don’t know about data, about whether people are more hesitant, but they certainly shouldn’t be. And in fact, I hope that people are inspired that this is really the most important year for them to get their flu vaccine. 

MODERATOR: Next question. 

Q: Hi, thanks for taking the call. I just wanted to know if the Abbott test kind of preempts all the other tests on the market and in particular Quidel test. Does that just plan to dominate now and all the other companies, their tests are now irrelevant? Like, what’s your assessment of that? 

PAUL BIDDINGER: Yeah, I certainly wouldn’t say any test is irrelevant. I think for lots of reasons, for the foreseeable future, we are going to need lots of different kinds of tests. I think there are tests that fall in the bucket of really important for diagnostic purposes. And those are the tests that really have a very high sensitivity and specificity, meaning when they’re positive, we trust it. When they’re negative, we trust it, and we need a subset of those diagnostic tests to be available rapidly for Real-Time clinical decision making, specifically when we are admitting people to the hospital from the emergency departments. Those are what we call the nucleic acid amplification tests. Those are the ones that look at basically the genetic material of the of the virus in our study in a lab controlled way to to to give us high confidence. Just really, really important. We get the diagnosis right. When people have symptoms now, there’s a whole host of other tests, the antigen tests and others that are much more useful in the population screening. And again, there’s a wide variety of those. I think right now, whether it’s Abbott or whether it’s other manufacturers, there’s no test that is being produced in significant quantity to meet all of our needs. And I think there are lots of reasons why we want to maintain the lab based tests for, again, clinical diagnosis. But there’s lots of reasons we want tests that don’t require hospital lab for ease of use, for quick turnaround for others. So I would say there’s no single test that’s crowding others out of the market at this point, but that we do need not just the variety tests that we currently have, but we actually just need more of them because we need to really continue to improve our screening of the population to get transmission rates down. We need to be able to have fast turnarounds in the hospitals to protect hospital flow and keep the emergency departments from being overcrowded. 

Q: Are you still using the Quidel test? And is it generally being used? 

PAUL BIDDINGER: So I can’t speak to who is using it right now. But I think, you know, we are always changing our testing regimen based on what’s currently available and in what quantities, because in many cases we need to use the tests that we have access to. 

Q: Got it. Thank you. 

MODERATOR: Next question. 

Q: Hi, sorry to come back at you. I wanted to get back to this idea of treatment of patients, are patients objectively better off today or are you better off being in a hospital today than you were, say, in March? And if so, why? I’ve heard people say, well, we’re not throwing the kitchen sink at people anymore, and that’s helping. But what would you say made the most profound, and not ventilating, things like that? 

PAUL BIDDINGER: Yeah. I’d say a couple of things. I think patients absolutely are better off now because we have more data. We have more science. And so as is the case with with everything in medicine, the more data we get, the better we do. And we continue to see articles published, obviously on a weekly basis about ventilation, management strategies. any coagulation, blood thinning strategies, others. And so the more data we get on larger populations, the more confidence we have in the therapeutic decisions we’re making. You mentioned ventilation. I think there had been a significant debate about when to intubate patients, when to put them on a ventilator and not. I think that debate is somewhat dying down. I think we’re getting more science that really supports a lot of what we have been doing for people with acute respiratory distress syndrome. And so that is definitely better. And I think more sites have access to that data. And so, again, I think overall, just as scientific knowledge grows, we get better. Specifically to the therapeutic question, we have therapeutics we didn’t have before and there’s data saying that they are effective. So I think those are definitely, definitely helping anecdotally. Also, I talked to some of my colleagues in the intensive care units, and they believe they are seeing the improvements related to those therapeutics with their own eyes. You know, I would caution that that’s why we have science is all of us can be misled by what we see. Sometimes we see what we want to see. Clearly, we all want to have patients doing better. But so far, the data’s actually been supporting that, which is encouraging. 

Q: The New York Times magazine had a huge piece maybe a month ago, six weeks ago now, about kind of the tension between delivering medical care and doing research and needing to do both I guess at the same time. Are you seeing that play out and what does that say? 

PAUL BIDDINGER: So I would say I’m not seeing it play out in the way that it was described in the magazine, but I absolutely appreciate it. I think, you know, in a newly emerging disease like COVID, everyone is anxious to know what is the right thing to do. And there’s so much that we have to learn this, so much that we’ve learned in the last six to nine months about COVID overall. I think we, I, personally, strongly, strongly believe in the need to do research in the middle of pandemics, in the middle of emergencies. If we don’t, we won’t learn lessons. And the longer we wait to do research, the longer we’re in the dark and we don’t know what those best therapies are. So I would say for our hospitals, we’ve not really seen that tension play out. I think there’s actually been an extraordinary enthusiasm to participate in carefully designed, randomized controlled trials, because that’s how we learn things like about dexamethasone and its effectiveness. So, you know, there can be a tension with how many trials there are. Ultimately we have the patients we have in the hospital and not every patient can be part of every trial. And so trying to figure out which are the most promising trials, which are the most well-designed trials that are answering the most important questions. We do have to trials which studies we do, and we have a group of scientific leaders that are very, very good at that. But in terms of our clinical staff, I think they very much understand how important it is that we generate that knowledge and they’re eager to follow the recommendations that come from those studies. But I think there’s a particular emphasis within our system of using the knowledge we already have to treat patients well, meaning when we see patients with ARDS that we use our tried and true principles. And we think so far that’s really been validated with the outcomes that we’ve seen in our patients. 

Q: Thank you.

MODERATOR: We’ll just wait for a while to get any final questions. 

Q: Hi, circling back here. Thank you. I guess this might have been asked already, I got fooled, I thought this started at noon, so I missed the big chunk of this. But I’m just curious. Any predictions you have on how bad the flu season will be in terms of COVID itself? And then the duality, or I guess maybe there might even be two other main influences circulating. Thank you. 

PAUL BIDDINGER: Yeah, no, no worries. We did talk about a little bit that maybe we’ll see how consistent my answer is. I think we’ve seen some encouraging data from the Southern Hemisphere, from a couple of different countries that have had a much, much lighter flu season than before. And we think but we don’t know, that that may be related to all the other things we’re doing for COVID with masking, with physical distancing, with attention to hand hygiene, et cetera. It is, I think, likely that it also is in part due to some of those countries vaccination rates as well. And so we don’t have data that lets us tease it out, but it gives us a reason for optimism that the things we are trying to do to prevent the spread of COVID, it may help keep the influenza burden light. You know, it’s a truism in infectious disease management that anyone who tries to predict a flu season is extremely likely to be wrong. So I’m cautious in trying to predict the flu season. But I think there are two important factors. The confluence of influenza and COVID, it definitely stands to potentially or in other respiratory viruses, I should say, stands to be a significant disruptor for schools and for workplaces, that as people have any kind of febrile or respiratory symptom, they should be staying away from school. They should be staying away from work, they should be getting tested. And I definitely appreciate that that is an inconvenience and a significant disruption. But we’re worried about what impact that will have on the population. We on the medical side are working really, really hard to make sure we mobilize as much testing capacity as possible so that even if people have mild symptoms, they can get tested. And if it turns out it’s not coded, then fantastic, they can return to their activities. The area where we’re most worried about influenza overlapping with COVID, I would say, well there are two areas. One is just in the medical system capacity realm that every year in the wintertime, the medical system sees a surge of influenza patients. And if we were to be experiencing a surge of COVID patients and a surge of influenza patients, that obviously is just a significant challenge in terms of trying to make sure we have enough care resources available. The second relates to vaccination. I know a vaccine has been talked about a lot in the news recently, and there are both storage and administration challenges, depending on how two vaccination programs might or might not overlap. Right now, most of the United States is really robustly in its vaccination campaign. And so we are storing and we are administering vaccine across the whole health care system. And as we get deeper and deeper into the winter, we never say even in February or March, we never say it’s too late to get your vaccine. But hopefully we will have administered most of our vaccine at that point. And at some point in the coming months or later, when we have a vaccine, then that will free up space for storage and for administration. But if the two overlap, to a degree, it’s just a contingency we have to plan for. 

Q: And just real quick, does Southern Hemisphere countries and also you mentioned vaccines as one of the reasons maybe, that’s curious to me. Are you suggesting that vaccines for other viruses help prevent it? So I see Australia just on the countries, I see Australia has a really low death per million rate. Was there another one? And then there’s the question of vaccines. Thank you. 

PAUL BIDDINGER: Yeah, so you know, yes, Australia’s one that we looked at. Brazil is another one that we’ve looked at. And so there are a couple. And yes. Well, let me answer carefully. The the influenza vaccination, we believe is affecting influenza cases. I know there have been studies suggesting an association between previous vaccinations overall, specifically influenza vaccine and COVID susceptibility or at least COVID’s severe illness. I don’t think we have any idea whether that’s a real association or not. 

Q: Thank you. 

MODERATOR: Next question. 

Q: Yes. A quick question related to also the flu, but pertaining to children, the American Academy of Pediatrics just came out recommending that it get the flu vaccine by the end of October. How do you think that will play out when it comes to COVID and fighting that virus? 

PAUL BIDDINGER: Well, I think it’s a fantastic recommendation is, you know, all of the major national medical societies and specialty societies always recommend a flu vaccine for everyone who’s eligible, which is basically everyone aged six months and older without a medical contraindication. I think the sooner the better, for lots of the reasons we’ve been talking about. We do know that school aged children are a particular vector of transmitting influenza, that they are one of the ways which influenza moves around most efficiently in society. And so I think particularly emphasizing vaccination for school age children is not just good for the children, which it is, but it’s good for for all of society potentially shutting down influenza transmission. And again, given the concerns for the effects of influenza on COVID, on health care demand, on symptoms, others. I think the sooner the better. 

MODERATOR: Do you have a follow up? 

Q: I’m good. Thank you. 

MODERATOR: Doctor Biddinger, do you have any final thoughts before we go? 

PAUL BIDDINGER: I don’t think I really have more beyond the point that I probably make too many times. Forgive me. As you know, we are we are not out of the woods yet here, especially in New England, where I practice, where I live. We are very pleased to see lower rates of COVID transmission. But we all really need to keep our vigilance up and we have to recognize how interdependent we still are, everyone’s ability to wear a mask appropriately over their nose and mouth to physically distance to follow the other public health guidance affects the health care of all of us in our neighborhoods, in our states and across the country. And even though it’s been an extraordinarily challenging half year and everyone would like to come out on the other side of this COVID pandemic, we are not yet ready to give up on any of the things that have been so effective. So just encourage people to please be vigilant. Please keep up the behaviors that have been so helpful. It will continue to pay off in terms of fewer deaths, fewer hospitalizations, and it will get us through until the time that we have a vaccine and then we finally can start getting closer to normal. 

This concludes the September 11th press conference. 

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