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Transcription:

Richard: Hello, and welcome to Avalere’s third episode in a series of podcast focused on COVID-19. My name is Richard Hughes, and I am a managing director, leading our vaccine team. I am joined today by my colleagues Nick Diamond, who is a consultant on our vaccine team, and Dr. Angela Shen, who is a senior advisor to our team. In today’s episode, we will discuss the COVID-19 pandemic and how the response compares to other outbreaks. I am interested in hearing your perspectives on this outbreak and how the public health response compares to other outbreaks. Why don’t we start with Dr. Shen and then move to Nick?

Angela: Great. Thanks so much, Richard. Coronavirus does not resemble other experiences that we have had, most notably SARS, MERS, or Ebola, all of which can be contained. We do have an example and experience with pandemic H1N1 and how we responded to that. For H1N1, we had a vaccine and we knew how to make one. We knew it was relatively safe and we had a treatment, not just a supportive treatment but an anti-viral that has also worked against flu. Here, with COVID-19, we have rapid spread, and we cannot say we will have certain pharmaceutical treatments in a certain number of months, even after we have mobilized the public health infrastructure to get one. We are having to rely heavily on non-pharmaceutical interventions. We do have a commonality though, in that public health mobilized very quickly. But we are dealing with a different situation here, and because we do not have a vaccine, it has become a different issue. Governments are limiting travel to contain the COVID-19 virus, but once the virus has been established it’s difficult to stop. This is very different from the experiences we’ve had in the past.

We have had a lot of experience with walking carriers—those who may be minimally impacted because they are not feeling symptoms—who may be infecting others. In short, this pandemic is very different. It is difficult to diagnose who has it. We do not have a vaccine treatment, and there is a great level of uncertainty around this outbreak, so we do not know how long it’ll last.

Richard: Thank you for that context, Angela. Nick, governors and states are taking public health action in response to the outbreak. The President has declared a national emergency. We have activated the national stockpile. Tell us about the response from the perspective of the public health system and healthcare system, as well as any interactions between the two of them.

Nick: That’s right. We have had a much broader and significant reaction to COVID-19 than other similar viruses in the past. As you mentioned, we have 2 concurrent presidential national emergency declarations, one under the Stafford Act and one under the National Emergency Act. We also have an emergency declaration by the United States Department of Health and Human Services—section 3-19—as an emergency declaration.

All these together give certain flexibilities that are very tactful in care delivery in Medicare and Medicaid populations. And again, as you mentioned, we have emergency declarations that are very applicable and incredibly relevant in a pandemic situation, at the state and local level. By now, we have emergency declarations in all 50 states plus DC and several localities, such as cities like New York City and San Francisco.

Richard: Okay, great! Can each of you touch on what is going well in response to this outbreak? And where do you see the system grappling to keep up with it?

Angela: I think that is a really good question. And I think the most important lessons that we have learned from previous emergencies, like the H1N1, is about trust and communicating what [are the] public health actions or what [actions] need to be done. It’s part of federal plans and state and local pandemic response plans, and at the core of the response is the trust. Relatively, we are doing better than some cases in the past, but we are also struggling because the response to COVID-19 looks different than others. We have not had to manage the magnitude and type of holds on the systems in the past—where the response has had to relay to the supply chain for not just pharmaceutical purposes, but [for] how we live. I think, with my experience, the important lessons we have learned in order for the response to go well, relative to other response, is the importance of trust in government and public health officials. And that needs to flow down from the federal to state levels. It’s the frontline and local levels where people will turn to look for guidance and action to respond and answer questions.

Nick: I would also underscore what Dr. Shen said about trust and communication. One thing that makes this situation different from what we’ve seen in the past is the degree of public and private partnerships. In the past few weeks, in terms of vaccine development, we are seeing several manufacturers participating in creating a vaccine for COVID-19. We’re also seeing public and private partnerships in relationship to testing for COVID-19. This past Friday [March 13, 2020], during the presidential announcement, we saw stakeholders—ranging from pharmacy to large retail stores—providing or pledging access to their parking lots for purposes of increasing testing sites. We are also seeing private entities making the test to voluntarily contribute to overall testing and identification efforts of potential COVID-19 patients, compared to prior events.

Richard: Great. As we look at these actions of government, private sectors, and stakeholders and think back to our experiences with SARS, H1N1, Ebola, etc., what does this mean going forward for the public health system and our healthcare system? What are some lessons and implications we can take for the future?

Angela: Like all our past lessons, it is about people and plans. It is the iteration of capacity and capability building. In the healthcare delivery system, different from the development of vaccine and pharmaceutical products and medical devices, we learn from each of our epidemics through each of our emergency responses.

In terms of preparedness, it is really about a process [more] than an outcome. As we move forward, the gaps in our local communities—the town I live in does not have a public health department in our township—preparedness plans will [help us to] learn from this experience. In the vaccine development space, we have several examples from previous development attempts, that after the virus has passed and crisis has waned, these vaccine candidates aren’t always taken across the finish line. In reaction to what we have now, we have a lot to build on especially in reference to what Nick alluded to in terms of companies getting into the game. In advancement to an outbreak, one potential thought is to follow through with the current vaccine candidates instead of reactive responses.

Nick: As Dr. Shen said, planning before outcomes and process before outcomes is spot on. I think we will see a range of stakeholders, whether it is government or others, focusing on the pandemic preparedness efforts moving forward. I also think, in terms of the care delivery lessons that will come from the current pandemic attention:

• We’ve seen a light shown on the built-in issues for the care delivery system from several stakeholders.
• We will see more [of] the value of telehealth to augment care delivery for different populations.
• We are also seeing an emphasis on the different roles of providers and the practice considerations that go with the provider’s role in supporting response efforts.

And I think we will also see focus on the classic cost-sharing issues related to treatment and testing, as well as general access for patients moving forward. This pandemic will give us a new lens to view these issues.

Richard: Great. Thank you! This has been incredibly insightful, and I know our listeners will agree. We appreciate your time. Tune into more podcasts in the series as we talk about the impact of the current outbreak on our current health system, the future implications of telehealth, and additional interesting topics. Thank you for listening!

Listen to Other Podcasts in This Series

E1– Get the Facts on COVID-19: Vaccination Affordability and Access

E2 – Get the Facts on COVID-19: Patient Out-of-Pocket Costs