Coronavirus (COVID-19): Press Conference with Thomas Tsai, 12/03/20

You’re listening to a press conference from the Harvard School of Public Health with Thomas Tsai, assistant professor in the Department of Health Policy and Management and a faculty member in the Harvard Global Health Institute. This call was recorded at 11 a.m. Eastern Time on Thursday, December 3rd.


MODERATOR: Dr. Tsai, do you have any opening comments?

THOMAS TSAI: Thanks, Nicole. I’ll just say a few words and then take the questions. Unfortunately, we’re hitting some new milestones with the current phase of the pandemic with over 200,000 new COVID cases, over 100,000 hospitalizations and almost 3,000 deaths per day. So the surge that we’re seeing from the last few weeks is now translating into the clinical consequences of higher hospitalizations and, unfortunately, deaths. To put that number in context, that’s over two deaths per minute over the course of the day. So we are really entering a phase where the pandemic really requires bold public health and policy action. And there’s the opportunity for ramping up our testing strategy, continue our efforts at non pharmacologic interventions like social distancing, and obviously on everybody’s minds is the role the vaccines are coming around the corner, hopefully in the next few weeks. But again, like I’ve always said in the past, you know, despite the grim numbers, the course of the pandemic is not out of our hands, and urgent action can help avert sort of worsening consequences for the pandemic. I’ll stop there and happy to take any questions.

MODERATOR: Thank you. All right, first question.

Q: Hi there, thank you so much, Doctor. I guess I would just like to ask you about this, looking at the at the data following Thanksgiving, you know, there’s a lot of questions about will we see this surge? How will it show up? How will we know it’s happening? I’d love to get any thoughts you have on that.

THOMAS TSAI: I think that’s a great question. And that’s been a concern over the course of the pandemic. After any of the major holidays, we saw small peaks and cases at large peak cases after Memorial Day, coinciding with some of the reopening’s, small peaks after July 4th. We saw this continued surge after Labor Day. And I think there is a growing concern that there may be a rise in cases from Thanksgiving travel. It’s still, I think, too soon to see the data reflected from the consequences of the traveling in on Thanksgiving. So I think over the next several weeks, we may see another continued rise in cases partially as a result of the background of the current third surge, but also because of the increased travel and potentially household exposure over Thanksgiving.

Q: Just one quick follow up, if you have time. Are you talking about hospitalizations in particular, like how will we see this manifest? And there’s so much virus out there already, right? What will you be able to tell what Thanksgiving did or didn’t do?

THOMAS TSAI: Yeah, I think that’s a great question. I mean, let me clarify a little bit. The surging hospitalizations and deaths we’re seeing now reflect the exposures for hospitalizations from one to two weeks ago. The rising death numbers are some of the exposures from three to four weeks ago. So I don’t think we’ve seen the consequences clinically yet of the potential transmission of cases from Thanksgiving. My worry is that we’re basically seeing small peaks stacked on top of small peaks. And it’s just, you know, being evident as a exponential trend in the growth of cases. If you homed in within this rapid growth in cases over the last several weeks, you’ll see smaller peaks in it. And my fear is that because of the increase in travel over Thanksgiving and increased exposure of transmission from around the country into households, that we may see a rising number of continue to rise in cases in the next couple of weeks. But then that may manifest as a higher hospitalization rates and potentially mortality over the next month. Now, the hospitalizations is actually there’s a bit of nuance to that, even though the absolute number of hospitalizations has been increasing.

With over one hundred thousand people hospitalized in the most recent data, the actual proportion of individuals that are hospitalized has actually decreased. So we’ve decreased from about three point five percent of positive cases being hospitalized and seen that decrease over the last several weeks. And the growing concern among medical professionals and public health researchers is that as hospitals become fuller, that may translate to different thresholds for admitting patients to the hospital. We just don’t know what the consequences of that will be. So it’s important to really keep focus on the data over the next weeks to be able to observe and hopefully react to these trends.

Q: Great, thank you.

MODERATOR: Next question.

Q: Hi, thanks. I wanted to ask about what we’ve been seeing from the federal government. We saw the CDC director, Redfield, yesterday saying, you know, this could be the most difficult stretch in public health history. And the White House task force has some dire warnings about people over 65 should basically try to stay home as much as possible. But then I guess, President Trump himself has not really been echoing those warnings. Do you think the government’s health agencies are becoming more vocal than they were in the past? And would it be helpful if the president himself was echoing those messages in terms of getting his supporters especially to wear masks and to take precautions and that sort of thing?

THOMAS TSAI: I think it has been a refreshing trend over the last several weeks and since the election, with our public health agencies taking the forefront and updating and releasing guidance. And I think there’s been a shift back towards evidence-based guidelines and scientific communication from our scientific experts nationally and not just from political perspectives. So I think that’s been a refreshing and important development from a public health communication standpoint over the last several weeks. And it’s incredibly important as we approach the possible distribution of vaccines in the coming weeks, so reinsuring the integrity of our scientific information and communicating that and earning the trust of the public is incredibly important. And I’m seeing more of that over the last several weeks, which has been a very positive development. I think what we think we’ve learned from the pandemic is that it’s best if there’s a consistent and clear message flowing from a clear and consistent strategy. And ideally, the White House, the president, the task force, you know, would be a way to amplify the science that’s being developed by our scientists at the CDC, at the NIH, the FDA. So I think that would be the the role of some of our political leaders is to amplify the best scientific guidelines. Now, the scientific guidelines may change, and they will change as we learn more and more about the virus, the best ways to manage it as new therapeutics come on board, as vaccines come on board.

But it’s important to be transparent about that and also remind the public that science is a process. It’s not a philosophical belief system, that it is a mode of inquiry. So the reliance on data. And while the information may change in the next couple of weeks, the process is very important. I think it’s an important development that we’ve returned to a credible and trustworthy process. And I think our vaccine development is a good example of that. The FDA advisory bodies are taking the right approach by examining the raw data with objective eyes before authorizing an express approval. So as a public health researcher, it’s good that we’ve moved beyond talking about bleach and UV lights and Hydroxychloroquine and are starting to focus really on the best data to guide our policy making.

Q: Got it, thank you.

MODERATOR: Next question.

Q: Hi, doctor, thanks for taking questions. Appreciate it. As we begin looking to 2021 and a transition to a new presidential administration, you know, a lot of people are talking about what are we going to get a new strategy, particularly around testing. I want to ask you what your view is on that. And just to play devil’s advocate a little bit, perhaps, if you do go to the CDC website, for instance, there’s a lot of guidance information up there about testing. As you know, HHS has been sourcing a number of supplies to the states for swabs, rapid tests. So if we do need this new testing strategy, I’d love if you could just talk about it in concrete terms. What is it that needs to happen that’s not happening now that would go into a new testing strategy?

THOMAS TSAI: I think that’s an incredibly important question, because even when the vaccine becomes more widely available, the role of testing and non-pharmacologic interventions still remains paramount. So a lot of the modeling studies suggest that the vaccine is actually most effective while we still continue a background of mitigation and suppression strategies around the pandemic. So essentially, in some ways, controlling a pandemic so we can actually develop the immunity that comes from buying time for a wide scale rollout of the vaccines. So testing is still a very important part of our toolkit over the next several weeks to months. What that strategy looks like means more wide scale screening of asymptomatic individuals. And there’s a growing awareness of the role of asymptomatic transmission, with some estimates of up to 60 percent of transmissions maybe due to asymptomatic carriers.

Through our work at the Harvard School of Public Health, in collaboration with the Harvard Safra Center and the Brown University School of Public Health at our website, about a month ago we released a testing calculator. So not just testing targets that are for each individual state and for the country, but it’s a policy tool that lets the policymakers and the general public look at what different testing scenarios could look like in terms of the number of tests. So by prioritizing K through 12 students versus staff, do we test them once a week versus twice a week, prioritizing nursing home residents and staff, health care workers, first responders, even adding in additional screening, testing capability and capacity for essential workers or for food service retail workers? Our Policy Tool estimates a number of tests that’s needed for that state’s specific population demographic profile as a way to translate these priorities into actual targets that the states then can use the BinaxNOW tests from HHS, for example, or through additional testing that may come online with the new administration and actually implement a strategy into a tactical approach and hopefully get the tests out to the communities and to individuals.

Q: Thank you. One follow up, if I could, you know, you mentioned the importance of asymptomatic screening, and I agree. I mean, it seems like that has to be a big part of this. One thing you hear sometimes from some people in the laboratory world or others as well, we don’t have a lot of experience with mass asymptomatic screening, especially for respiratory viruses. Is that right? I mean, would this be something new or have other countries really done a lot of mass asymptomatic screening and what are your thoughts on that?

THOMAS TSAI: Yeah, it has been implemented in other countries. And even if it’s new, by definition, everything we’re doing is new. This is a novel pandemic that most of us have not seen in our lifetimes. But I think that’s why it requires bold action. We’ve seen the failure of a very limited and diagnostic focused approach to testing of just symptomatic individuals. That was what we lived with for the first part of the pandemic, and that was too little too late to be able to have testing be enough to suppress a pandemic. And we’ve seen the multiple surges across the country. Testing is an incredible part of it, but we have to actually implement that strategy at scale. So, yes, you know, it is a newer approach to do more wide scale screening of asymptomatic individuals for upper respiratory infection like the coronavirus. But we’ve seen the consequences of not doing that in terms of the rising number of cases, hospitalizations and deaths. So this is the time for a paradigm shift. Now, we’ve you know, in some ways the pandemic has been a natural experiment gone awry across 50 states and across our country. We’ve seen successful approaches in some states, and we’ve seen very unsuccessful approaches in other states. And the states have had very successful approaches. You know, think about New York and Massachusetts that have made significant improvements in terms of ramping up testing and availability of testing, given the severity of the pandemic in March, April and May in those states. And those states are able to reach test positive rates of about one percent over the course of the summer before seeing some increased cases in the last several weeks. So we’ve seen what a successful approach involving testing, contact tracing in conjunction with physical distancing, looks like, and masking. So we just need to implement that more broadly. I think the challenges that individuals along that spectrum of care or interventions focus within their own silo. But it’s important to take a step back to coordinate the approach across those silos of interventions. And I think that’s where a coordinated federal strategy is incredibly helpful. And some of the proposed mechanisms, including a pandemic testing board authorizing the Defense Production Act to scale up capacity, can all be effective interventions along the way to make this strategy actually possible.

MODERATOR: Next question.

Q: A question about vaccines, so we have two vaccines right now going through the FDA authorization process, what would happen if the other candidate vaccines came out and they were just not as efficacious? We have to highly efficacious vaccines right now, why would the FDA accept anything less or I mean, I know we had that preliminary benchmark when we didn’t know where we would land at 50 percent. But do you think that the FDA would still authorize something like 70 or even 60 percent?

THOMAS TSAI: Yeah, that’s an incredibly important question. And I don’t have a crystal ball, so I can’t speak for the FDA or its advisory committees. But I think what’s helpful is to think about what a successful vaccine strategy looks like. And it’s not a single vaccine. And what’s just as important in a series of papers have been published recently. We’re also working in collaboration with the Google Cloud and with our forecasting model to model different vaccination scenarios. And what emerges is that the efficacy of the vaccine is important. But the other important components include what the background growth rate of the pandemic is. The effect of r with the rt, as well as the ability to have wide scale coverage. That means the coverage from the sense of the proportionally population that ultimately gets vaccinated in terms of being able to translate to broader population level herd immunity. But also, just as important is the pace. So what proportion of population per day are being vaccinated? All those things matter. And in fact, the implementation of the vaccines may even matter more depending on the efficacy of the vaccine itself. So to put that into perspective, a vaccine that’s 25 percent efficacious on a background of transmission of rt of about 1.5 is actually more effective than 75 percent efficacious vaccine on a background of exponential growth with an rt of two point one. So this suggests that, yes, the efficacy of the vaccine is important, but only one piece of the puzzle. The other important puzzle pieces include what we’re doing in the background in terms of controlling the growth of the pandemic. So that’s the testing, the supported isolation, the non-pharmacologic interventions like masking and distancing to bring the art level down to a level where the vaccines to buy time, flu vaccines to make a difference. And then in addition to that is how well we are doing in terms of rolling out the vaccine, in terms of both the pace of the rollout, as well as ultimately what proportion of the population now trust the vaccines and will ultimately get vaccinated. So all those pieces are important. So I don’t want to lose the forest for the trees. I know there’s been a lot of focus and excitement about the press releases from the vaccine manufacturers about the efficacy of vaccines. They’ve been a pleasant surprise. But that’s not even the most important piece of these of the overall strategy.

Q: And a follow up question to that, so I would love to try to explain that to readers. I don’t know, I might be able to. I feel like, you know, most of the public would be like, well, you know, my neighbor got the Moderna vaccine and that’s highly efficacious. And so I’m going to my provider and I’m getting this vaccine that’s less so and my less protected, basically. So how can we explain that?

THOMAS TSAI: You know, it’s really hard. And I wish there was an easy and short answer to that. Let me think about that, because I think, you know, we need to come up with a really good analogy to be able to communicate that to the public. You know, that the vaccine, I think it’s important, the efficacy comes from a population from the trials. It’s not about an individual efficacy. So I think it often gets interpreted that way as this vaccine is 90 percent or 94 percent efficacious for this specific individual. It’s actually a number that comes from the overall sample of trial participants that either received a placebo or the vaccine, a proportion of that population that ends up developing COVID-19 while on vaccine or placebo. So this is really a population efficacy. So I think then that’s not the same as your individual risk after receiving the vaccine. Let me think of a good analogy for that. I don’t have one off the top of my head, but I agree that’s incredibly important to be able to communicate that. Also, just one point, I’m using the term efficacy and efficacious. I’m not using effectiveness as the adjective for efficacy because efficacy is often in epidemiologic terms, the reporting or the results of a clinical trials or under ideal conditions. Effectiveness is the real-world application or the real world results of that vaccine or intervention. So in epidemiology, we do differentiate between how efficacious the intervention or vaccine is under ideal conditions versus how effective it is under real world conditions.

Q: Thank you.

MODERATOR: Next question.

Q: All right, Doctor, thanks for taking my question here. I wanted to ask you, this might be a little bit out of the scope of the conversation so far, but I want to ask about the CDC’s new quarantine guidance that came out yesterday. I think it was a little more complex than people were expecting. I was expecting it to just go to the 7-day quarantine with the negative test. That’s under quarantine. But they decided to stick with the 14-day quarantine and then kind of supplementally advise that these other options are available. I’ve heard from some public health specialists concerned that this could cause some confusion in the public and also perhaps that the CDC would have been better suited to, rather than adjust the quarantine period to provide more services that help people actually carry out the safest option, which the CDC says the 14-day quarantine. I was hoping you could maybe speak to that if you have any concerns or you think that was a solid policy update?

THOMAS TSAI: You know, I’ll be honest, I’m personally confused myself. And it’s been the conversation over the last several weeks, 14 days versus 10. Maybe they’ll move to seven. You know, it is very confusing. And I’m speaking both not just from a health policy researcher and public health researcher, but I’m also a clinician. I’m a surgeon. And this has real world ramifications for our patients. I literally operated on a patient on Monday who had an occupational exposure 14 days ago. She tested negative. But, you know, the hospital policy was still 14 days, but it was unclear if the CDC policy applied. You know, should she count as a 10-day limitation and erring on the side of caution, despite two negative COVID tests and 12 days after an exposure we all wore N95s and full PPE in order to perform the operation safely. So these guidelines have real world ramifications for patients, for clinicians trying to provide care. But even out of the health care context, in our everyday context, what this means for schools, for daycares, for people returning to work. So I think clarity and consistency is important. And I’ll be honest, I’m just as confused as everybody else. And I do agree that, you know, this is where clear communication and guidance is clearly important. The data can point in different directions. And I think there’s nuances to how we interpret the scientific data that’s emerging. But I think that’s the role of a public health agency, the CDC, to synthesize that data, weigh the risks and benefits of the data in either direction and come out with a guideline, but also be clear about what the guidelines are and aren’t. And no guideline is going to be perfect. But I think, again, we’re in this phase of pandemic as everything is about tradeoffs. It’s not that clear cut flattening the curve. Everybody stay home is how do we navigate this phase of pandemic safely. But that does mean being very clear about what the tradeoffs are.

Q: Right. Thank you, Dr. Tsai.

MODERATOR: Next question.

Q: Hi, thanks, Dr. Tsai, appreciate it. You touched on this a little bit earlier, but can you break down what the federal government needs to be doing to support suppression of the virus that we’re not seeing?

THOMAS TSAI: Yes, it needs to be a multipronged strategy. So starting from testing, we need to move to a wide scale screening of asymptomatic individuals. But that means having an actual strategy to implement that. So there’s multiple prongs, but we need an implementation plan for each of those prongs. So for the testing, that means ramping up the capacity, distributing the tests in an equitable way to the states and local jurisdictions, really changing the focus on testing from a supply to a demand. Right now, individuals are sometimes still paying out of pocket for screening tests because they may not be covered by insurance. So rethinking about how we pay for the tests and really making them free or at least affordable and widely available is incredibly important. So that’s thinking about not just the technology, which really has been the focus for the last several months, but really about the implementation that the technology can decrease the time a test takes to run. But really, how do we think about getting to the noses, the swabs and the swabs of the noses and getting the results back to the people? And just as importantly, using that information to guide the next set of actions. And this relates to the earlier question from Will, what those actions are, to clear guidelines about what it means to have supported isolation for exposed contacts versus quarantine for positive cases. And then the other prongs of that include clear guidance on masking. We’re still on a state-to-state level, seeing variations in terms of the communication around masking. I think it’s very clear now that masking is an important part of the strategy. So continuing that communication is incredibly important.

The third part is also supporting the ability to implement some of these social distancing or physical distancing policies in an equitable way. And a lot of businesses have been shut down over the last several months. I think it’s an important investment in order to keep bars and restaurants closed to decrease the risk of communicable transmission is to provide financial support for some of these sectors of the economy that have been very severely impacted. So a conservative stimulus package and relief bill basically to align the incentives of the economy along with suppressing the pandemic so we can align those incentives to make sure that we create sort of a safe public health environment within a city that has safe public health and thrive.

And ultimately, what it’s going to create is the economic growth on the other side of the pandemic. But we can’t keep limping along like we’ve been doing, trying to have the best of both worlds. And clearly, it’s not working. And then that comes to the vaccine is having the clear guidance about we’re seeing that from the CDC, about the different priority groups, starting with residents and staff of skilled nursing facilities, long term care facilities, health care workers, and then actually implementing that in an equitable way and making sure that the vaccine is rolled out safely over the next weeks to months. So it’s multiple pieces, you know, that have to also be coordinated into a game plan. And I think the analogy I’ve been using is it feels like a flu pandemic over the last several months that they’ve been individual plays have been called using a football analogy. But there hasn’t been a clear sort of playbook or game plan is sort of you know, there’s been some reactions on what to do on first down or second down, a third down. And oftentimes those play calls have been really linked in with the prior play calls or the future play calls. I think this is a time where we need to implement a game plan for the for the next few months.

Q: Thank you.

MODERATOR: Looks like that’s our last question for right now, which is very strange. So if you have a question, go ahead.

Q: Thanks. Thanks so much for doing this. I was hoping this is a little artificial because I’m looking for a quote, but I need sort of a sweeping quote, never in the history of medicine that we pulled off something like this before, what would you say sort of from a broad brush about what we’re about to do?

THOMAS TSAI: Never in the history of medicine have we ever pulled this off before. No. I guess to be helpful, this isn’t to vaccines, to testing?

Q: To all of the above and vaccine distribution.

THOMAS TSAI: Gotcha. So, you know, even with the rapid vaccine development, you know, we’ve seen really a historical result in the rapidity of the development of a vaccine. And we’ve never seen the scale of sharing of scientific information, collaboration, to get to the point that where we are. So even the scientific process has been historic. And we’ve never seen this in prior examples before. But thinking about the vaccine itself, you know, this really is a historic moment that we’ve been planning for since the start of this year. But I think the pieces are in play. You know, it’s not just I think we’ve been focusing on state plans or national plans, but this is truly a pandemic across the world and across multiple countries, international agencies, as well as individual national agencies across countries. And this is just a a breathtaking scientific and public health effort that’s been in place over the last few months. But I think the foundations have been laid for a truly historic rollout of a vaccine, not just on the state level or national level, but on an international level. But more importantly is that, you know, COVID-19 won’t be the only pandemic in our lifetimes. What can we learn from this to make sure that we’ve gotten here in some ways sort of by fits and starts is how do we take the lessons from this pandemic in order to prepare for the future one so we can roll out the plan and the more efficient way.

Q: Thanks. And one more follow up on that, I presume you don’t think we have or do we have adequate public health funding to try to meet this historic moment or are we in need of more? And why have we been underfunding this?

THOMAS TSAI: Yeah. So I feel very strongly that the pandemic has shown the importance of public health and all of our lives and the need to have a strong public health infrastructure because, you know, public health crises like the COVID-19 pandemic, they can touch everyone’s lives and touch every sector of our lives, from the economy to the social aspect to education. And the core solution is both medical innovation as well as public health innovation. So I think one of the most important takeaways we can from this pandemic is that, you know, is to reinvigorate and reinvest in our public health system because we want to be able to prevent or at least mitigate the consequences of any future pandemic.

Q: Thanks so much, really appreciate it.

MODERATOR: And while we’re waiting to see if anybody else has any questions, I have one for you. I know back in March and April, there was restrictions put in place for operations that were I’m sorry, I’m blanking on words, but they’re were not necessary. So do you see that coming down the pike or do you think it’s going to be more as long as the patient tests negative that you’re going to go ahead with procedures?

THOMAS TSAI: Yeah, I think that’s a really important question, Nicole. You know, part of our strategy for creating hospital capacity in March and April was to cancel elective surgery that created the capacity or the headroom to be able to focus on our COVID-19 patients. There is sort of two challenges with this current phase of the pandemic. One is the first phase was really a lack of capacity of material. So beds, masks, respirators, ventilators. But what’s been shown in this phase of pandemic is that the lack has really been in human resources. So nurses and physicians and we can manufacture our way out of swab shortages and gown shortages and ventilators even. We can manufacture our way out of a shortage of front-line respiratory therapist and nurses and clinicians. And that supply has not increased. And if anything, it’s just decreased over the last few months with attrition and burnout of some of our clinical staff, as well. As, you know, the clinicians and frontline staff are also part of the community and many have been affected by COVID-19 themselves. So I think we need to refocus our efforts on shoring up the medical system, but also from a from a human capacity standpoint.

And what that has looked like this phase is that there’s been more nuanced plans for creating capacity. There’s been a significant amount of pent-up demand for health care utilization from the first phase of the pandemic. The elective operation in March, you know, became nonurgent in the summer. But right now, in the fall, is that not an urgent operation? We can’t delay. So that very necessary care for cancer surgery, for example, or care for heart attack and stroke. So the challenge in this phase is balancing the continued demand for health care that’s not related to COVID while being able to create the capacity to address the current surge of COVID-19 hospitalizations. I think, you know, a blanket sort of cancelation of elective procedures may be challenging, given that there’s a very large demand for medical care. That’s absolutely necessary. But I think hospitals have made tremendous progress in implementing more nuanced pathways and more flexible capacity. But, you know, we’re seeing field hospitals now pop up across the country again with a field hospital in Massachusetts. And there’s increasing chorus of hospitals being overwhelmed, especially in rural areas and smaller community hospitals. So I think that’s an incredibly important part of the story that we still need to focus on.

MODERATOR: Thank you. Next question.

Q: Hi doctor, actually, on that point you just brought up, because I’m doing a story on this in terms of deciding when to stop doing other kinds of medical procedures. I mean, I’ve seen, again, a number of places, a lot of hospitals now canceling elective procedures. And I know there’s, like you said, an effort not to just do that across the board. But when we have so many hospitalizations, how do you balance that or is there a threshold where you have to where a place has to say, you know, we can only take over patients or we have to stop taking COVID patients because we need to keep room?

THOMAS TSAI: Right, and so I sort of have three comments to that. First of all, I think we’ve made tremendous progress over the course pandemic and understanding and prioritizing the types of medical care that’s necessary versus that’s more elective. You know, as a surgeon, well, as per my practice, we actually have a priority list of four groups of different types of procedures or conditions to help us think through, you know, if we ever need to come to that again in my hospital, how to prioritize care for non-COVID patients because of the demand for COVID care. The broader comment, though, and I was talking to a reporter about this yesterday, is that there isn’t really a margin of safety in U.S. health care systems anymore. Right? And the bridges are built to withstand not just the weight that they’re rated for, but there is a two or two and a half X capacity above and beyond what it’s designed for to accommodate for a margin of safety. But the U.S. health care system over the last several years, the pendulum has shifted to being to lean. You know, supply chains are all about Just-In-Time delivery. Hospitals run at near 100 percent or sometimes even more than 100 percent capacity. And I think the pandemic has shown that we need to develop a margin of safety and lead to more resilient health care systems so that it’s not about wholesale canceling of non-COVID conditions. But how do we actually do this in a more nuanced way, like an electrical grid system to better load balance across health care systems so that we end up with more resilient health care systems. So that’s an area of research that we’re actually actively working on now is developing strategies to measure margin of safety and health care systems and then strategies and developing policy incentives that incentivize hospitals to maintain that flexibility. And because we’ve seen a failure of approach that that is to lean.

It’s not about adding more waste to the system. That’s not what I’m saying. It’s about adding more resiliency to a system. And the third part of that is, greater coordination and collaboration, not just within hospitals in the health care system, but also across health care systems. So in Massachusetts, the governor has launched a task force of daily meetings with hospital leaders across health care systems within regions of the state to coordinate some of the transfers so hospitals can share their capacity data. And \one hospital system can let us know, you know, are they at capacity and unable to accept transfers versus a hospital that may have little extra headroom and be able to accept transfers? I think that’s really the phase of coordination that we need to establish a margin of safety in our health care systems. I think that’s another important takeaway of the pandemic, is that on the delivery of health care is rethinking our model. And a lot of the health policy interventions have been not even just doing less, doing more with less that sort of doing less with less. And I think we need to shift to doing from just thinking about value in a very narrow context of decreasing costs but thinking about how we develop that capacity for resiliency and flexibility and create that margin of safety.

MODERATOR: It looks like there may be no other questions for today, Dr. Tsai. Do you have any other comments that you’d like to close with today?

THOMAS TSAI: No, I think we covered all the other key points.

This concludes the December 3rd press conference.

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