Responding to the Coronavirus Pandemic: A Virtual Town Hall

Responding to the Coronavirus Pandemic: A Virtual Town Hall


– Good evening everybody,
my name is Gregg Gonsalves. I am an Assistant Professor at the Yale School of Public Health. Welcome this evening
to our second town hall on the coronavirus pandemic. As you’ll see I’m standing
in an empty studio at the Yale Broadcast Center. And all the panelists you’ll meet tonight are at home in their own apartment and in their own houses. In order to maintain social distancing which you’ll hear a lot
about, spoken about tonight. I’m gonna introduce our panelists. They’re each gonna speak
for five minutes or so. Afterwards, we’ll go to
a series of questions. We asked you to send in
questions until 4:30 p.m. today and you sent in over 400 questions. So, we tried to pull a
representative sample in order to give you a
wide breadth of answers to the things that you’ve
all been thinking about. So, without further ado
I’m just gonna introduce our panelists who you’ll
see on the screen here. I’m going to introduce them
in order of their appearance. First is Ellen Foxman who’s
an Assistant Professor of Laboratory Medicine and Immunobiology at the Yale School of Medicine. She’s going to talk about
what is Coronavirus? Is it like the flu? What are its symptoms? It’s prognosis for different risk groups. Sten Vermund is the Dean
and the Anna M.R. Lauder Professor of Public Health at the Yale
School of Public Health. And he’s gonna talk about
the possible scenarios that could play out over the
next few weeks and months. How bad might it get? What are the population level expectations for this pandemic? Next, we’ll hear from
Ann Kurth who’s the Dean and the Linda Lorimer Professor at
the Yale School of Nursing and she’s gonna talk about what we can do to protect ourselves, our
families and our communities. Next we’ll here from Rajita Sinha, who’s a Foundation Funds
Professor of Psychiatry at the Yale School of Medicine. And she’s gonna talk about how we cope with the changes in our lives. The dramatic one for being
asked to make right now. Next we have Amy
Kapczynski, Professor at the Yale School of Law. And she will talk about
what we can do to ensure rights are being respected and the larger social justice issues that
are raised by this pandemic. The last three speakers
are gonna talk about what’s happening locally. Paul Genecin, who’s the
Chief Executive Office of Yale Health is gonna talk
about what is Yale doing. What is Yale Health doing? Mehul Dalal who’s a
Community Services Director of the City of New Haven
is gonna talk about what the City of New
Haven that we all live in is doing right now. And finally we have Sanil Parikh, who’s an Associate
Professor of Epidemiology at the Yale School of Public Health. Is going to talk about what
Yale New Haven Hospital, our local hospital, is doing. So, I’m gonna ask Ellen to start us off. Then we’ll go to Sten and Rajita, Amy, Paul, Mehul and Sanil with
five minute of opening remarks. We’ll go directly in
order, one to the next. And then in about 45 minutes
we’ll turn to questions, Ellen. – Thank you Gregg. Well, hello everybody. It’s nice to be with you
virtually as we’re all in our different locations. But I want to tell you a little bit about this new Coronavirus and how it’s similar and different to the viruses
that you’re familiar with. As you may know, viruses are
tiny germs that when they get into your body they make
more copies of themselves. And in the process of doing
that create collateral damage which gives you symptoms. So, if that process is
happening in your nose you might get a stuffy nose of runny nose. If that’s happening in your throat you might have a sore throat. And if that’s happening in your lungs you might have shortness of breath. Now, we have a lot of viruses
we’re all familiar with that do this every year. Such as common cold virus, the flu virus. And we’ve all experienced these symptoms to different degrees. So, the question is what’s different about this new Coronavirus? Why we should be taking
all these extra precautions about it and be extra worried about it and it comes down to this. The reason why this virus is so concerning is it’s a new virus in
the human population. So, the other viruses we’re familiar with like common cold virus and flu. Those come every year which means that our bodies that have seen the virus before have built some immune
defenses against those viruses. And that means the
virus can spread as well and don’t cause as much illness
as they otherwise would. The thing about the novel Coronavirus is it wasn’t in the human population before. It recently came into humans just a few months ago from another animal. And a few months ago there’s nobody in the human population who had built up immune defenses against this virus. So, what that means it that the virus can spread more easily
from person to person. And also has potential to
cause more serious illness in a given person then it
would have if it was a virus that many individuals
had experienced before and had built up defenses against. So, again just like the
common cold and the flu. It can infect the same parts of the body in the airway and in the lungs. But unlike those viruses
it has a lot more potential to spread from person to person and cause serious illness in certain populations. And just to answer the question. The other question that Gregg posed. Those populations appear
to be people of older age. So, people over the age of
70 have been hardest hit in getting severe symptoms by this virus. Younger people, especially
people under the age of 20 can still get the virus
and transmit the virus but don’t appear to have
very serious symptoms. In general, another important factor is if you’re somebody who has
other long term health condition such as breathing problems or diabetes, those kinds of things. It’s important to be extra
cautious with this virus. – That’s Ellen Foxman talking about the pathogenesis of Coronavirus infection. We’re gonna move to Sten
Vermund who’s gonna talk about the populations level
impact of the disease. Sten, are you there? – Thank you very much Gregg. The phenomenon of influenza
every year is something that washes over the globe quite predictably. And is a severe burden on the human race. We have a high degree of mutation. So, there tends to be
a new strain each year. And therefore, we have to have new vaccine development each year. Every year we’re guessing
what the new strain will be in the subsequent year. This is why we are very keen
for people to be vaccinated against influenza every year. To reduce the global burden of infection and also of disease and death. The death rate for flu is
about one in a thousand. And the death rate for the new Coronavirus which seems to be about
as infectious as flu as Professor Foxman just said. The new Coronavirus, the death rate may be one in a hundred. So, 10 times greater than influenza. Since this has been introduced to mankind or humankind recently. We would be very pleased
to rid it from humankind the way that the 2004 original SARS Coronavirus was eliminated. And we are not sure how to do that because this particular Coronavirus
is more infectious than that 2003, 2004
version of Coronavirus was. But it’s worth a try
because we cannot afford to add another flu like respiratory virus that recurs and plaques
humankind year after year. It is worth a try to see
if we can suppress it sufficiently to reduce the
burden on our hospitals. To reduce the death rates in
our vulnerable populations, mostly the elderly. And persons who have
underlying medical conditions. And it’s critical really that we do this with a sense of urgency
because if we fail to reduce viral transmission adequately. When the new winter respiratory
pathogen season comes about we could see Coronavirus
added to influenza as a major global threat. So, not only do we want to
so called flatten the curve to reduce the pace at which our hospitals are faced with this
very serious condition. Not only do we want to reduce mortality. But we also want to
see if we can eliminate this virus in this transmission season. And if we can do that it
may be that the summer time is our friend with warmer
and more moist air. We don’t know if that will be
enough to get rid of the virus because it’s possible that
herd immunity plays a role in why respiratory viruses are seasonal. And if we have very little heard immunity perhaps that will work against us. But we’re in unchartered territory. We’ve never confronted a
pandemic threat of this nature. Unless you go back to the Spanish
influenza of 1918 to 1919. So, at this point we
see a fairly rapid rise. The epidemic curve in the United States. It resembles China and Italy and Korea more than it resembles Hong Kong and Singapore for example. Where they were successful
at containing viral spread. So, we don’t seem to have
gotten a handle on this yet. For example, there were a
thousand new cases reported from New York City just
in the past 24 hours. So, we are seeing the uptick
in the Connecticut curve as well as the uptick in curves in many countries and states. And we’re going to have to
practice social distancing. Shutdown our economy for a while. See if we can control this
virus for the long term benefit. – Thanks Sten. Our next speaker is Ann Kurth who’s the Dean of the Yale School
of Nursing as I said. She’s gonna talk about what we
can do to protect ourselves, our families and our communities, Anne. – Great, thank you for joining. You’re taking the time
to educate yourself. To plug into a community of
people who are also thinking and working on this current crisis. And so, I applaud you for doing that. And I just want to acknowledge
that this is in fact extremely stressful for everyone. We’ve emphasized the fact
that this is a new pathogen. It’s having an effect on our economies and our emotions in a way that
feels almost unprecedented. And so, I think we can go
ahead and acknowledge that. And think about the things
that we actually can do. So, what are some of the
things that we can control? And there are some common sense guidances that are things that
you can do for yourself to reduce risks and for your family. And that will help in
your community as well. I’d say for some of these things is just to try to keep yourself in as good mental and physical shape as possible. One way to perhaps do
that is to try to shutdown some of the constant noise
and the borage of news. So, find one trustable source, like the Centers for Disease Control,
that you can listen to maybe once or twice a day. Not every hour, not every 15 minutes. Just to control and stay up
to date with trustable news and information and science. You’ve heard about social distancing. We’re all trying to practice that now. I like to say we’re all standing
together six feet apart. Because that is really
the perimeter in which this pathogen is spread by droplets when someone sneezes or coughs falls. So, you want to keep that perimeter. We also want to ensure that we
are not gathering in groups. And there have been many
guidances around this. As you see businesses, places of the arts. Even hospitals restricting the
number of people who come in. All of this is towards that common goal that we’re working for to
reduce the transmission of this Coronavirus from
one person to another. Hand washing, everyone
should know it by heart. You’re singing Happy
Birthday twice in your head as you wash with soap
and water for 20 seconds multiple times a day. This is gonna be good for
the health of everyone, including our small children. So, make sure that they are
also getting their hands washed and managing our sneezes and coughs. Again, to reduce the respiratory
drop of transmission. Speaking with your
children or young people that you’re taking care of. You’ll just want to give them
information that’s factual. That it acknowledges their concerns and that’s age appropriate. And again, keep your own trusted sources of communication going. Getting ready for taking care of yourself and others at home is
something to think about. So, if we should all be
sort of monitoring ourselves and if we start to have a
fever, dry cough and fatigue. Ideally we would not
bring that to a workplace or to a group setting
where we might encounter other people if, in fact, we are infected. We are concerned about some
of our folks more than others. Who are at higher risk
of more severe morbidity and mortality with COVID-19. This includes people over age 70 and people who are immune compromised. Have heart and other conditions
who would be more at risk. So, we want to take care of, particularly, our more vulnerable
members of the population. We want to ensure that if we are working in the workplace as I said. That we hopefully are getting the message that we can work from home. Or that we will continue
to have the opportunity for our pay and our
entitlements to keep coming. And the US government has been looking at injecting money into the
economy in order to do that. So that we don’t, in the midst of having our economy shutdown and
having to be more home bound. Really run into trouble for keeping our own families going economically. So, we do also need to know our rights and advocate for those good policies. Care at home, again. Schools and daycares
are often shutting down. So, just be able to cover child care. We are looking into, for example here, ways to try to get childcare coverage for our health workers. But we do need to go
into the health system to take care of patients. Both COVID patients
and non COVID patients. So, if we become sick or
exposed with a fever, stay home. If you do get COVID-19
because many of us will actually become infected. And have a relatively
mild case of COVID-19. Please stay home until you’ve recovered. And just take care of your mental health and of each other, thank you. – Thanks Ann. Our next speaker is Rajita Sinha. And she’s gonna talk about how we can cope with the changes we’re being asked to make in our lives which are
pretty extraordinary. Even for many events
that we’re experienced over the course of our lifetimes. – Thank you Gregg. It’s a pleasure to be with you all even though these are
difficult circumstances. And to get a chance to talk about this. Indeed we have been asked
to make some rapid changes in our lives in a short period of time. And you’ve already begun
to hear about some of them. The first one you just heard
about was social distancing. Really a number of
recommendations like that to reduce the risk and to
prevent getting exposed. The psychological side
of social distancing and pulling back from your net community and your social network can be difficult. Particularly in the context of having to and not actually connect socially, physically with loved ones. And so, one of the things that we want to remind people to do is
to still stay connected using FaceTime, using other
technology and social media. And really stay connected with the family, with your friends. To get social support
because social support is a really important aspect of offering under stressful conditions. The second thing that
you heard about already is that workplaces are
changing and asking people to stay home or not come in. And there are lots of challenging and difficult fallout from that. Either loosing pay which
you’ve heard about. But also suddenly finding
yourself being in isolation if the workplace is a place where you are, in fact, connecting with others. So, feeling a sense of disconnectedness. On the one hand it can be
rejuvenating in terms of time and you could get more work done. On the other hand it can be disconnecting. And so, it’s really important to really develop a schedule to list the
kinds of things you can do. And again, connect with others. The final thing that I want to talk about which I think is a big one. Which is when you don’t
know who is going to get it, whether you’re going to get it. Whether your family’s gonna get infected. When it will be here. That really increases our fear and anxiety and a sense of panic. And so those emotions are
difficult to cope with. They increase our stress levels. And it’s important to acknowledge that. To start by really accepting
that this is a difficult time and there’s a lot of
things that we don’t know. And so, it’s important to pay
attention to recommendations. But also not overwhelm ourselves
with news and information. Sometimes you might get
involved in a lot of conflicting pieces of information. And that can create confusion
about what to listen to. And so, as you already
heard, you want to focus on the things, reliable sources of news. So, in the spirit of
that let me just give you a couple of points of resources. So, the Centers for Disease
Control actually has how to manage life and the
changes during this period. And has a section on
managing stress and anxiety. So, I urge you to go there. The American Psychological Association has lots of resources posted on their website. The Yale Stress Center here right at Yale will be offering a free class
starting next Wednesday. For 30 minutes every week
for the next number of weeks and that’s on the
YaleStressCenter.org website. And so, there are a
number of resources that can provide you with
information on how to cope. As well as tools, skills and
strategies on the best ways that you can cope that would match your particular skills and
abilities, thank you. – Thank you. Next is Amy Kapczynski who’s
gonna talk about the sort of, the human rights aspect. And the social justice
aspect of this pandemic and what’s facing us, Amy. – Thanks, it’s nice to
be here with all of you. So Gregg and I have been
working together actually with many others on broader rights and justice implications of the pandemic. Wanted to say a couple of things. First, there’s a number
of places where we’ve tried to specify how to protect rights in the context of COVID. And really what that means
is that our government has to step up and provide
protections for people. And really create a
surge of social support. So, some of this is
detailed in an expert letter that Gregg and many others
and I contributed to. I’m gonna provide links to
that and a few other things along side this video. So that people can access in
more details on some of this. But just to say a couple of things about what’s important to think about. So, we really have been
concerned for a long time now that not enough is being
done to protect our rights and to protect people. That we need a major
infusion of public support. Now, that’s under discussion now. We really are starting to see
some action in that regard, both nationally and locally. We need, obviously, to
think about how to increase our capacities with respect to hospitals. How to protect healthcare workers. And how to protect everybody
who’s going to seek healthcare. For example, by ensuring that nobody fears immigration enforcement if
they’re seeking healthcare. Or fears that contact with
public health officials put them at risk. So, we also need to be able to
have science based responses. So, there’s a lot of, of
course, action going on. And things are changing very, very quickly with respect to what the states are doing. What localities are
doing and, more slowly, the federal government is
doing to try to respond. So, broadly speaking the
state has pretty broad public health powers to
require things like quarantine or other social distancing measures. So, people are probably
wondering what can the state do? How far can it go? What are our rights in that regard? So, let me say a little bit about that. So, every state has it’s own laws about powers like quarantine for example. But many of them have broad statutes that allow them to take measures that are necessary for health and safety. Many states are asking for cooperation and that’s a good thing. About where they can do things voluntarily and not issue orders,
that’s a good practice. But there are also places now. We see what’s happening in San Francisco with respect in the
shelter-in-place order. And many other states
with respect, for example, bars, restaurants and schools
are ordering closures. And the state does have
broad powers to do that. So, if it is the case though
that social distancing measures restricts rights. Then they have to be
especially well justified. So, both the state and
federal constitutions protect our rights in various ways. One thing to know generally
about US law though is that the kinds of rights
that we protect are limited. So, we protect liberty
very strongly for example. But we don’t have a right
to food or healthcare in our state or federal constitution. So, if the state does do
things that restrict liberty. For example, ordering
somebody into quarantine. There are protections that do exist. The law is not, there
have not been that many cases about these kinds of things. So, it’s sort of challenging to set out what the legal requirements are. But just as a general,
very broad standard. If the state’s restricting
liberty one of the things. Our view of their legal
requirements is that the quarantine. If it’s a quarantine for
example has to be necessary. Justified by science and the least intrusive means of achieving an end. Even if a measure is
justified the state does also need to follow certain
rules when enacting it. For example, you have to
provide clear justifications. People need notice of
what’s expected of them. They need information about how to challenge any restrictions. So you can be allowed some
kind of independent review. If you’re being, for example,
ordered to stay home. Then the state has to give
you adequate care and food. So, it’s important to
know that those kinds of legal supports have to be taken care of if the state does do things
that restrict your liberty. So, broadly speaking,
another emphasis that we have been all trying to pay attention to and call for is more social support to allow people to follow
public health advice. So, broadly speaking there
are all kinds of things that we need to do to
be able to get people in position to do the
social distancing that, of course, we all need to do right now. And some of that has to do with providing resources directly to effected people. And to providing resources to those who are hard hit in the community. So, a couple things about
that and I’ll just speak more specifically here about Connecticut. Because I know there’ll
be a lot of local people who are interested in how to think about the benefits that are available to them. So, I’m mostly gonna summarize
here from some excellent information that was provided
to me by Alex Rosenthal who works for the Center
for Children’s Advocacy. And global partnership and Shelley Geballe who is Assistant Professor of Clinical Public Health at Yale. So, many other states will
be doing similar things but this is specific to Connecticut now. So, unemployment, for example, may be available for some people. And Connecticut has relaxed
the rules for who is eligible. So, right now this state
is encouraging everyone who is currently out of
work due to the pandemic to file for unemployment ASAP. Any worker who receives health insurance through their employer
and becomes unemployed. And loses minimal essential coverage or whose COBRA expires. Whether because of COVID-19 or otherwise. It’s gonna qualify all year
long for open enrollment to access Health CT. Which is the states health
insurance marketplace. There’s actually a new
special enrollment period that was just announced. So that people who are uninsured can now from March 19 to April 2nd. If you are uninsured you
can enroll now, again, through Access CT, Health
CT for health insurance. So, there’s also financial help available for those who are in need. With respect to housing. Of course, many people
face housing issues. And housing is gonna be
critical to being able to engage in social distancing
and protect people’s health. Here there’s advocacy going on. So far what we know is that there’s been a suspension of hearings
and defaults in executions in Connecticut’s Housing
Court until April 1st, 2020. So, that means that those facing evictions may have some relief. It’s also been steps taken
to order utility providers to suspend shut-offs for the duration of the public health emergency. Regardless of people’s ability to pay. Schools are providing meals for children who attend their schools. And for further details on all of these issues as well as how people can apply for things like cash
assistance and food stamps. Follow the links that I’ll provide associated with this video. The last thing I just
wanted to say here is that all of this is going to
be evolving very quickly. Many of these things may be
out of date in just a few days. The last thing I’d urge
you to do is to contact your local state and
federal representatives to tell them what you need. To make yourself heard about
the hardships to your families, to your business and to your loved ones. And many of our state
legislators are also providing useful updates on these daily
changes that are now happening to try to provide support
for these in this context. – Thanks Amy. Next we’re gonna have Paul
Genecin from Yale Health to talk about what the
health plan is doing for staff, faculty and
students at Yale, Paul. – Thank you Gregg. Hello to everyone. I’m Paul Genecin, I’m
Director of Yale Health. Several weeks ago Yale
President Peter Salovey appointed the COVID-19 or
Coronavirus Advisory Committee. This 12 member group has quickly become a multi disciplinary task
force meeting daily by Zoom. We have Yale public health experts. Representatives from
Yale New Haven Hospital as well as Yale Health. And leadership from our
schools of public health, nursing and medicine. In fact, two of our
members are Dean Ann Kurth and Sten Vermund. We found many opportunities
to work together to track the Coronavirus epidemic and prove our responses in university as healthcare providers and members of the New Haven Community. We’ve recommended public health actions to our university leadership to reduce the risk of contagion. And examples include defining criteria for isolating and monitoring individuals. And whom the diagnosis of COVID infection is suspected or confirmed. And developing ways to
care for them at home while protecting the community while these patients are contagious. We’ve developed ways to
register, isolate, monitor returning travelers from high risk areas. Examples are China, South Korea,
Iran and now all of Europe. We’ve made recommendations
to reduce gatherings to minimize the spread of infection. And transition to Zoom
and other technology for teaching and meetings and gatherings. We’ve also recommended reducing activity across the university to
protect our workforce, our students and our community. We’re working to ensure clear
and reliable communications with our community. For example, with email
messages online content that we update frequently
providing answers to frequently asked questions. Also advice for people
on how to stay healthy. We have instructions for people
with symptoms and concerns. Guidance and resource for travelers and links to reliable online resources. Our group is fostering
communication and collaboration between Yale University,
Yale New Haven Hospital, our state and local health departments and government leaders. And we’ve worked to adapt and
expand patient care capacity to respond effectively
to the COVID pandemic. One example is opening telephone access through a hotline and
call centers to deal with many COVID related concerns. We’ve initiated telephone screening instructing patients to call first before entering healthcare facilities. And this allows us to avoid transmitting respiratory infection. But still allowing us to see patients who may have COVID safely. We avoid accidental spread of this disease to other patients and to staff. We’ve also worked on ways to scale back nonessential care encounters. And to transition to
telephone, telemedicine and in some cases postponing
care that can safely wait. And this is maximizing
our access to patients with concerns about COVID. And is also making sure
that we have time to take care of patients with other non-COVID related immediate health concerns. Our group has focused on
increasing the workforce of physicians, nurses and other essential healthcare personnel. To take care of people,
whether they’re at home or in outpatient settings such as offices or also in the hospital of course. Now, you may know that
our country has been slow to roll out testing for Coronavirus. And so our work group has
put a lot of work into diagnostic testing capacity
and testing criteria for patients are hospitalized
with acute illness as well as others. We’re also concentrating
on ways to protect healthcare providers and their patients from the spread of COVID
infection in healthcare settings. This of course includes face
masks and other environmental and personal protective equipment. But also ways to deal effectively
with healthcare providers who may have been exposed to infection. To make sure that they do not spread the infection to others. And then last but not
least we are collaborating with the health department
and with our colleagues at the Yale School of Public Health on the important task of concentration. To identify and council those exposed to non-Coronavirus patients. We give these people that
we identify information to keep themselves and the community safe. And we advice them on how and when to seek medical care if they need it. I look forward to your questions. I hope that everyone stays
safe and well, Gregg. – Thanks Paul. Next we’re gonna hear from Dr. Dalal at the City of New Haven about what the city is doing, Dr. Dalal. – Thank you Gregg. I want to start by saying
a word of gratitude to all the staff at the city who have been putting in immense amount
of hours in relation to the response to this epidemic. It’s a privilege to work under our mayor, Mayor Justin Elicker. Along side with our Director
of Health in New Haven, Dr. Maritza Bond. This has been a time of
unprecedented activity in response to this crisis. And I’d like to say from
the city perspective. I break it out into kind of three phases. The first phase is when we saw the tsunami coming from far away. And our main concern at
that point was putting out clear communication about
infection precautions. While we ramped up a number
of messaging campaigns around, focused around flu. At the time flu was the main concern with respect to public health. We knew the messaging around
flu would apply to Coronavirus when it hit Connecticut. However, the general
public was not as in tune with the threat of Coronavirus as the public health officials
and the public health community was at the time. So, we thought that
focusing our message on flu in the early phase of the
pandemic was the way to go. The second phase hit us pretty hard. The second phase I think
I mark by the event at Yale that needed to
be canceled because of a suspicious case of Coronavirus
in a visiting student that turned out not to be a positive case. But it heightened the
communities awareness and the fact that this
virus was going to hit, eventually, our community. In that ramp up phase we
escalated the frequency of our meetings. Both internally with
city staff and externally with our partners. Continue to ramp up the
education and messaging around preventive precautions
that one could take everyday that were discussed
previously on this video. Then we also started in
the background planning what we would do for city operations when the Coronavirus would
appear in Connecticut. Of course, third phase
right now is the one that I would describe
ourselves in right now. This is a period of and
it’s marked by the fact that we do have Coronavirus
in Connecticut escalating exponentially just over the last few days. This is a period of
intense operational work. There’s a multi prong
strategy being coordinated through the city. In coordination with the state, in coordination with
Yale New Haven Hospital. In coordination with Yale
Health which includes not just a traditional
public health response. But also standing up a community health and well-being strategy. Standing up a intense public
communication strategy as well. We had our site go live
that dedicated to COVID for New Haven just in the last 24 hours. That focuses on local level information that our community needs to know about with respect to COVID-19. Our operations, there
are many aspects to it. But I would say there’s
three major buckets to it. The first is a community
well-being strategy which focuses on outreach and protection of our older adults. Including intense outreach
and technical support to facilities that house older adults, such as nursing homes. But also multi unit dwellings
where a lot of adults live potentially in subsidized
housing or in NORCs, naturally occurring
retirement communities. We are standing a community
wide food distribution strategy. The New Haven Public
Schools had led the way with respect to making sure that the kids who are no longer in
school are receiving meals or have the opportunity
to receiving meals. We understand that when we talk about older adults and even more
or less the entire population advising you to stay home and not gather. Not everybody’s gonna have
the opportunity to eat. They rely on food pantries or other food distribution services. So, we’re working on
standing up a community wide food distribution strategy. We have a specific
strategy that’s targeted towards homeless individuals. They are in a very unique
and difficult circumstance that if they are told
that they have COVID-19 or they are suspected have COVID- 19 but do not meet acuity
level for hospitalization. They do not have a place to self isolate. So, we are looking to
stand up a quarantine facility for that purpose. And finally, we have an
emerging mental health and well-being strategy headed
by a partner organization. That will be looking at the
mental health well-being aspects of our unprecedented
situation where we are asking individuals to stay at home. Whether through recommendation
by a medical professional or public health professional. Whether through public health order or whether just a general recommendation to not gather into groups. The second bucket is our
public health response. This is the piece of the bread and butter. What public health trained
for with respect to identifying positive cases. Doing the contact, tracing
those positive cases. Advising and counseling
those who may not be exposed. Assessing the exposure risks
and counseling accordingly. In this bucket includes our on-going daily or more than daily. I would say on-going
everyday communication with our health systems partners. That includes Yale Health
and Yale New Haven Hospital. That collaboration has
been very much appreciated. And we need to have this
on-going collaboration in order to respond effectively. And finally, if you are
local and you’re watching and you are in the New Haven community. You know that over the
last week we have put forth an escalating set of policies
that compliment the state escalation with respecting to
promoting social distancing. Not just through messaging
but through actual policies. Some of that includes the school closures. The recommendation to close,
actually the requirement to close larger daycare
systems and other orders that will be forthcoming. And finally we have the third bucket is a public communication strategy. Where we have daily press briefings to provide the public
updates on the most recent information and education around COVID-19. And it’s cascading
impacts in our community. And it also includes a
component to special populations and segmented populations
regarding what they need to know. This includes faith leaders,
non-English speakers communicating that stigmatization around this disease is not acceptable. And particular outreach to our businesses and our small business community to understand their impacts, thank you. – Thank you and finally we
have Sanil who’s going to talk about what’s going
on at our hospital, Yale New Haven Hospital
here in New Haven, Sanil. You’re on mute Sanil. – Hi, can you hear me? – Yep. – Excellent, so I will be
probably repeating a bit of what Dr. Genecin and Dr. Dalal had said in their statements. I’m an infections disease physician but an Epidemiologist at
the School of Public Health. But also see patients at
Yale New Haven Hospital. And first of all, I just
want to really give credit to the amazing leadership. The nurses, the physicians
and the staff at Yale New Haven Hospital. This has been an extremely
rapidly evolving situation. A lot of pieces to the
puzzle and I’ve just been really amazed by the work and dedication and passion that everyone’s
putting into this. And really the empathy that everyone has for everyone around them. So, I’m really speaking on behalf of many, many other people. I also want to really reassure the public that folks really at the hospital system are doing everything that they can to really curve this epidemic and take the best care of those effected. I know there’s a lot of worry out there and appropriately so. With not having tried and true treatments available for this disease. But folks are really doing
their best for supportive care. And again, it’s a very
rapidly evolving situation. Just to kind of highlight that. We had really our first positive case. It began this weekend really
with our first positive case at Yale New Haven Hospital. And at this point we have, I believe, about eight in-patients
now at the hospital. So again, things changing very rapidly. I want to, again, let
folks know that those entering the hospital system. They are really making a lot
of changes on a daily basis. You know, has really
established or in the process of establishing a floor that all patients with COVID will be sent to. And that really has the effect that we see in the community as well. The social distancing so that within the hospital system itself we can really limit exposure of other patients who
are there for other reasons. And I think that’s something that I think can provide some comfort to
those outside the system. Knowing that at least
patients with COVID will be really not spread throughout
the hospital system. Other measures I think that Dr. Genecin also mentioned is that
visitation to patients has been limited and restricted. With certain floors having a little bit more of a liberal policy. Such as pediatrics where
interaction with patients are necessary of course. Again, that is really
focused on us being able to limit the spread of the disease. They’re making adjustments to the Smilow, the cancer hospital. Surgical floors in terms of
outpatient elective surgeries and whether they should be pursued. And really all different
aspects of medical and surgical care being
readdressed on literally an hour by hour basis. I’m sure many are worried about the workforce situation as we are. You know, for many of these epidemics the healthcare workers are the ones that end up getting effected early on and over the course of the disease. But, a workforce plan has
really been developed to mitigate the risk of staff
shortages through this epidemic. I think Dr. Genecin also
mentioned the telehealth visits. And I think that’s gonna
be another powerful way to really limit patient
exposure into the hospitals. In terms of those I don’t
want to spend too much time on just the clinical aspects of things. ‘Cause I think this has
been covered in the news and other sources and
maybe raised in question. But I think just to
reiterate that the primary point of contact should be your physician. And that is the person that could really help direct where you should go for. Whether or not you should go for testing and how to proceed from that point on. But we’re really urging folks not to enter the medical system
without first contacting their primary physicians. Again, to limit exposure. One of the most, I think,
helpful things was the establishment of a call center. And that was really established very early on in this process. It’s being staffed by other individuals. Yale Infectious Disease
physicians, trained physicians. Early on with the limited
availability of testing. They had a very important
role in determining or helping to determine
who should be tested. But now, I’m happy to
say that Yale New Haven, the lab, has been
fantastic and they are now able to run testing for inpatients within the Yale New Haven system. For folks getting tested in the outpatient ambulatory system. Those are being sent to
a different location. But, we now have a significantly
increasing capacity for testing throughout the system. It’s not yet where we’d like it to be but it’s significantly better than it was early on in this pandemic. I’d also like to let people
know that we are kind of sharing information between one another on the clinical services. I think almost every department
is having, if not daily, multiple times per week. Having department wide calls
to share what we’re learning on an hourly basis, daily basis. So that we can provide
good care for those around, those presenting. And I learned today that this is not just occurring even within departments. There are folks reaching
out to physicians in China and Europe to learn the most
we can from other experiences and other places that
have had the epidemic hit earlier than we have. So, I think we’re
learning things in a real global way through this epidemic. And I’d say kind of the last thing I think has been on the mind of
individuals certainly is the treatment issue. And while there is no
proven treatment for COVID. The Yale system has put together both. There’s individuals as well as groups that have been put together to try to look into investigational therapies. And see if Yale can become
part of clinical trials that are gonna be unfolding
in the coming weeks. So, I hope that answers some
folks questions, thank you. – Thanks everybody. It was miraculously on time. We should do this online more often. So, we opened an email box for questions around 9:30 am this morning. And by 4:30 pm there were
close to 400 questions from all around the world. I don’t think we have time to
go through all 400 questions. So, I pulled out a
representative sampling of them that we’re gonna try to
go through between now and the next 45 minutes that we have left. I will read the question then
I’m gonna turn to our panel. And if you would like
to answer the question, raise your hand. If there are two of you we’ll go in turn. The first question is from
Mura Vangrove from the UK. It’s one of our more distant questions. She said and this is representative of several questions that came
in locally in New Haven all the way across the country. I’m a very healthy 73 year old. Why am I being told to self isolate? Who would like to take this question? Ellen, you have to unmute yourself. You’re muted, go ahead. – Okay, so that is a great question. I think what it is is this is a new virus in the human population and
we’re just learning about it. We don’t know all the details. But one thing we do know
is how different age groups have done with this virus. And one very interesting thing is young people, especially children. Even though they get
the virus, do not appear to get very sick in general. And we also know that the highest risk age group is elderly people. And people with other health problems. So, if you’re in the age
category, over the age of 70. You’re at significantly higher risk of having a serious disease. Now, as we learn more about the virus maybe we could break that down into a healthy 73 year old versus a 73 year old with this health condition. But we don’t know that yet. All we know is that
people over the age of 70 are in a very high risk category. So, it’s a very good idea
to try to not get the virus. And the most tried and
true way of doing this, even though it seems rather
dull, is to just avoid exposure. – Thanks Ellen. The next question we have– – Can I add to that? – Go ahead, go ahead Stan. – Mortality rates in
early data for Wuhan China were less than a fraction
of 1% in young people. But 15% in persons over 70. Similar data from Korea. Were not as alarming but still death rates were over 6% in Koreans. And we’re seeing some
data in Italy that also suggests what Professor
Foxman was highlighting. So, yes, some of those people have underlined medical conditions. But as someone who’s over
the age of 65 myself. I can tell you that the
evidence is that we do lose immune vigor just as a
natural part of senescence, as a natural part of aging. That’s why we recommend
things like pneumococcal vaccine in people over 65. And other vaccines that are,
like the shingles vaccine that are going to afflict you more often if you’re a little older. And just age can be associated with the less robust immune system. – Thanks. – I think– – Sanil. – Just a second here. Piggy backing on that, I think we have examples even from the United States with the unfortunate situation in Seattle with the nursing homes. So, you know, largely elderly population. And that had a mortality
much higher than we had seen really in any other situation. – Thanks, I’m gonna go
into the next question from Chris George who is a New Havener and happens to be the
Executive Director of IRIS. The Integrated Refugee
and Immigrant Services organization here. He has a question, I’m just gonna read it. Thank you for your heroic efforts to deal with the COVID-19 outbreak. Having worked in partnership
with Yale New Haven Hospital for more than 15 years to serve the needs of immigrant communities,
particularly refugees. IRIS is grateful for your commitment in high quality services. Although we don’t have anyone from Yale New Haven Hospital here. It says there’s some
confusion about provision of free services for
COVID-19 related issues to uninsured patients. I’m sure I don’t need to remind
you how important this is to remove barriers to
healthcare at this time. What’s the best way to get
priority on this issue? Does anyone here have a sense about the status of the uninsured
and seeking care in the city? Does anyone know? – Well, I think it’s fair to say that if Yale New Haven Hospital is contacted with a potential Coronavirus case. That case will be
triaged like anyone else, regardless of insurance status. And that would go for a
trauma victim or anybody else. So, I acknowledge that
getting a bill from a hospital at the end of a day is
immensely burdensome for people without health insurance. One of the fatal flaws of
our American health system. That we have so many
people without insurance. But, nobody’s going to
be turned away for care because of lack if insurance. – I do also want to add
that I believe that now the state has assured us that DSS will cover the cost of testing for people on Medicaid and HUSKY and also for those who are undocumented. And that’s just testing. But as Sten said, it’s
important for people to know that they can get care. And we are seeing a lot
that’s on the table now at the federal level. If the federal government
provides more support, the states will be able
to provide more support. But I do hope we can also get
somebody from the hospital to speak directly to sort
of what their policies are with respect to these communities. – [Gregg] I think I saw
Dr. Dalal’s hand up. – Yeah, I just wanted to notify
for the New Haven community. Both our community health centers are online with testing as well. So, if there’s trouble
accessing the testing at Yale New Haven Hospital. And they can access the
community health centers, they are also doing testing. – Okay, so the next question
is from Molly Connelly who’s asking what daily changes should pregnant people be making? This came up, the question of
the risk to pregnant women. It was 5% or more of the
questions that came in over the past days. So, can anybody offer some guidance here? Sten. – The evidence from China and Korea is they have not seen untoward
events in pregnant women. It does not seem to be more
severe in pregnant woman, nor is it less severe. So, clearly being younger is an advantage for pregnant women. Compared to being over the
age of 70, for example. Now, we do not have good data on someone who is infected in the first
trimester of pregnancy, those first three months after conception. So, that remains an open question. However, pregnancy
management has been the same for infected individuals. I can tell you as a
pediatrician we don’t want pregnant women getting
infected with anything. So, cautious approaches
to pregnancy and exposure are in order as they are for all of us. But pregnant women should
be especially careful with social distancing. – [Gregg] Anybody else
want to respond to that? – I would say in addition
to that the only other information we have. There’s not great information
on what to do with breastfeeding and I know that’s
come up with individuals. But I’d say, again, probably contacting your obstetrician in that
situation or pediatrician. At the moment there’s been
no evidence or no data to suggest that it can be
transmitted by breastfeeding. However, there’s really
limited data on that. So, we are encouraging
people to reach out to their obstetricians and pediatricians
if they are breastfeeding. And they have come down
with symptoms of COVID. And to get further guidance at that point. – This is Ann just jumping in. To also work with their midwives if that’s who they’re delivering with. We do want women to have
support throughout pregnancy as well as their birth
plan and postpartum. Knowing that with the
current hospital restrictions around the number of people
who can be in the room. There may be some alterations in that. But again, to protect
oneself as much as possible. To stay healthy during the
pregnancy outside of COVID. – So, move on to the next
question which is about the effects of isolation
on very young children and their caregivers by Faren Tang. She asks what might we
expect to see in terms of potential effects on the
socio emotional development of very young children,
toddlers, preschoolers? Of complete physical
isolation from other children for potentially prolonged period of time. Does anybody have any thoughts on that? Dr. Sinha perhaps. – So, I can say that
it’s actually not good to have children be isolated. But very young children
are with their parents in terms of being at risk. If you’re isolating, you
have to take the precaution of social distancing. But that, again, does not prevent you from engaging with the children. Talking with them,
communicating with them. Really expressing a lot
of emotion in other ways. And that’s very important in these times. So, I would say that to
keep up the communication, both nonverbal and verbal communication. And warmth and love
and belonging is really critical in these times. – Thank you, anybody else? – We’re looking for closed units. Network theories suggests that the greater the outreach that you have the more risk you have of getting infected. So, if there were next
door neighbors who were staying at home, not going out. Those two children played
and those families interacted preferably with a six
foot social distance. That would be highly
preferably compared to say a babysitter who’s going from house to house with different calls. So, the notion of a
highly restricted network is a very superior idea
than a larger daycare with many children from many families. So, when we’re talking about children and their inevitability of running next door to their friend. What we’d like to do
is have those networks be very small and very contained. And that will be a much better situation than say an alternative to close schools where parents who have to go to work put their children in
some days, not other days, other children come in. That sort of thing is
much much more risky. So, one has to perhaps limit
the child’s friendship group to a very, very limited pool
if that’s absolutely necessary. – Okay, thank you Sten. The next question is fairly specific and I know who’s probably gonna answer it. It’s from Kate Nyhan who’s our Research and Education Librarian for public health here at Yale University. And she asked great to hear
about what legal strategies are available to avoid or mitigate delays in vaccine development or manufacturing with respect to patents and licensing. I think that might be for Amy. – I worked a lot on these questions about patents and so forth. And how they can interfere
with both access to medicines at the end of the day and also at the development of medicines. So, one thing to know is that patents are granted by the government. And what they do is they prevent
anybody who holds a patent. So, anybody who holds a patent is allowed to prevent others from
using that invention. And so, they can get in the way of both the kind of free exchange
of scientific information. And of people being able to access broadly something like a new vaccine. There’s gonna be a lot going on. There is already a lot going on in the vaccine development space and in the development of therapeutics. We’ve all been hearing the same account and it’s what I believe to be the case that we’re talking at least a year for any kind of vaccine. Perhaps therapeutics could happen faster. But one of the things
that it’s useful to know is that the government
does have the authority if patents are getting in the way with respect to the access. At the end of the day
when something’s developed or with respect to
developing new technology, a vaccine or a treatment. They have the ability to say that people have to collaborate. And that we can override patents and provide royalties effectively. And so that’s not a right
that the US government has used very much. But one example which
seems very salient now is maybe you may remember back to 911 when there was concern about Anthrax. And because Anthrax, to be treated you needed a drug called Cipro which is owned by a company called Bayer. They were the ones that held the patent. They couldn’t supply sufficient amount to the federal government
and prices were very high. This was obviously sort of an opportune moment for price gouging. And government threatened
to use this power which I’ve written a lot about. Called the Government Patent Use Power to say we’re gonna override your patent. And we’re just gonna buy generic
drugs from somewhere else. And the company immediately
lowered the price in half and made much more
available to the government. So, the government does have these powers and it’ll be important
for our policy makers to be thinking ahead if
we’re going to be funding, as we are now, a lot of
the development efforts. To be ensuring that those
come along with guarantees. So there’ll be access
at the end of the day, the taxpayers aren’t paying twice. Both to fund the treatment
and to then afterwards paying exorbitant prices for it. It’s also important to be paying attention to once we do get these
kinds of things developed. That the access through these tools like government patent use. – Thank Amy. Gonna move on to our next question is from Jason Mento who’s a student at
the Yale Student of Nursing. Jason asks what services
and efforts exist right now for the elderly, the poor
and the recently unemployed as a result of the stay at home measures? Have we accessed the
needs of these populations and can we meet that need? And what services exist
to meet those needs in the city of New Haven? Dr. Dalal, do you want to take that? – Yep, just unmuting here. Yeah, I’m happy to take that question. So, it’s important to
remember this type of. This has come so fast that providing the services requires an entire retooling of our current social services network. This is happening pretty rapidly. But it takes some good times in terms of ensuring the logistics will work. And not only the logistics
work but the logistics are now under the auspicious
of a public health framework. So, I’ll just start with one example. Food distribution would
typically as long as it passed a standard set of
public health requirements, of sanitary precautions. We would sign off on
that as an appropriate food distribution program
or food delivery program. In this scenario we have to consider the social distancing
aspects of food delivery. Which means that if we
were to distribute food from a certain location. Are there the logistic
and aspects planned out to the fact that many people don’t rush to that single site in order
to pick up their meals? We also have to think
about the precautions that the food delivery
personnel or food distribution need to take and educating
them about distance. So, there is a ramp up period with respect to the availability of these services. I mentioned earlier in
my remarks that we have a strategy to outreach to
every single facility that maybe housing elderly. Either in a nursing home
or a congregate setting. My hope is that we would,
by congregate setting I mean multi unit housing places. And my hope is that we would be able to muster volunteers to make contact with every single senior in
New Haven to understand what kind of support they need. And if we’re assessing their supports. To be able to deliver on those supports. – [Gregg] Thank you. – Gregg, I can add to that. Just to remind folks that
there’s the Connecticut Mental Health Center coping with this risk and the worry about it can
be very anxiety provoking. And the Connecticut Mental Health Center is state supported. And available for mental health needs but also providing information,
helping people cope and also to get to their right services. So, that would be an additional resource. – Thank you, next question is
also from a nursing student. Kelsey Jug, she’s saying I’m
a first year student at YSN. I’m a babysitter and also a volunteer for search capacity in the hospital. I’ve had people tell me I
shouldn’t be babysitting if I’m gonna be stepping
foot on the floors of the hospital at this time. Should healthcare workers and hospitals give up all social interaction, even small groups with social distancing? Or should we simply continue
with other responsibilities with the necessary
precautions of distancing and hand washing, et cetera? This is in the context of a bunch of other questions about is there
a role for volunteering for people who want to do
services for the elderly or people who can’t otherwise go out? This is a very specific one in healthcare but you could take this
as a more general question or a may specific one about people in the healthcare industry,
in the healthcare fields. Who would like to answer that, Ann? – So, our healthcare workers
are a really precious resource. And people talk a lot right
now when we’re thinking about the potential implications
and more patients in the hospital with
acute healthcare needs about ICU beds and ventilators. Let’s not forget the staff who actually have to be there 24/7 with patients. And so, we are really
thinking quite carefully about all of our workforce needs. Nurses tend to be, as
with all other pandemics, on the frontline spending the most time is really in the hospital
settings with patients. So, many schools of nursing in Connecticut and around the country are
really trying to ensure that we can continue the
education of our students safely and fairly. While also thinking ahead
to some workforce needs. Including the opportunity for
students who are licensed, who are RNs for example,
not pre-licensure. To be able to engage in
some what will be likely to be some surge activities. The thinking there is that there may be different levels of care. No patient contact as with phone banks and phone triage for example. Lower level patient care activities and then higher level
acute care activities that may involve aerosolizing procedure. For all of the care in the hospitals and health systems, it just must be said. One of the other failings as we dissect the lessons from this epidemic. Is going to be around
persona protective equipment and the constraints and
supply of that equipment, PVE that we’re calling. There really is, that’s
really extremely problematic. So, we do want to protect
our health workforce as they are engaged in
care in the hospital or in volunteer activities
in the community. And so following standard procedures around trying to social distance. And stay home if ill, get
treated and recuperate at home with a mild case of COVID. So that you could even go
back into the health workforce because we will be needed. Health workforce will
be needed for some time. – So, I just want to pivot to a question which related from Julien Mortan who’s from the Yale College class of 2020. He says, for those who are able bodied relatively young and healthy. What can we do to help more vulnerable individuals in New Haven
without putting ourselves or the larger community
at unnecessary risk? So, it’s another volunteering question. Ellen. Unmute. – Yes, so I mean one thing
that young people that age can do is take the precautions
that we’re recommending. It’s hard, especially at
that age group sometimes to have the more social distancing
and to take head of that. Especially you hear sometimes young people talking about the fact that they don’t feel as vulnerable to it. But I think that sort of
realizing that young people can still get infected and
can still spread the virus. It’s something important. It’s a self sacrifice
for the broader community to try to still practice the
social distancing measures. – Anyone else want to speak
to the volunteering question? – Yeah, I would say that
probably the very first principle and any volunteer engagement that you may involve yourself in is to ensure that there’s a social distancing aspects. In terms of needs, I
think we’re going to have many individuals who are
at home that may not have the typical social supports. We want to support them to stay at home. As I said, whether they are
under medical recommendations to stay at home because if COVID. Or we are recommending globally
for people to stay at home. I think creative ways to be
in touch with individuals who are at home. Whether that’s a telephonic
or video capabilities would be excellent
opportunities for volunteering for a younger healthy population. – [Gregg] Thanks. – Could I put a pitch in for tutoring. Our children are out of school. And you’re talking about
kindergarten through 12th grade. And tutoring can be very
easily done for families who have a computer and internet access or even a smart phone and internet access. And you can even do tutoring, believe it or not, by telephone. So, there’s a huge need and the
Yale School of Public Health is working with the United Way. And there is a new website
that the United Way has opened up which is
going to permit people to make those kinds of
contributions back to the community and still maintain social distance. – Thanks Sten. The next question also
comes from somebody at Yale, Victoria Ellison. She says why aren’t international
domestic flight bans being instituted and enforced? Should airports enforce
this by shutting down? Anybody want to take this? Sten. – This is a complex issue. Let’s just first point out that flights have been cut radically. On some routes they’ve been
cut from 40 a day to one. And there’s almost no route domestically or globally that has not
been substantially effected. You’re going to see the
airlines making more and more cancellations and adjustments. We’re hearing stories
of people flying planes with 150 passengers and three
seats are being occupied, 147 vacancies. So, there is almost a natural with the social isolation recommendations, people’s concern about
exposure in close spaces. People are walking with their feet and they’re not traveling. So, how could I defend
somebody who actually does have to travel? Some of them are trying to get home. Some of them have to leave where they are. For example, our diplomats internationally are coming home in very large numbers. The entire Peace Corps
is being brought home. So, there is a global shift
in where people are going. I think that routine business
travel, holiday travel. Things that can be deferred
should be deferred. And I think you’ll see
that there is considerable social distancing even on airplanes and even in airports at the present time. – Okay, thanks Sten. Next question is from Prashant Emani. She says my name is Prashant and I’m an Associate Research Scientist at Yale. My question is the following. What are the protective measures in place for New Haven significant
population of homeless people? What are Yale and New Haven contributing towards the provision of services for vulnerable populations? Dr. Dalal, you want to take that first? – I can start and then
others can weigh in. So, one of the strategies
that we have in place that we’re close to implementing
in terms of logistics is a decompression of
the homeless shelters. Our homeless shelters were
not equipped to do the six feet social distancing. And they were also working
at or near capacity. So, we realized very
quickly that we needed to decompress the shelters
in order to maintain the social distance recommendation
within the shelters. So, we are about to
bring online hotel rooms that will actually house
up to 50 individuals that are not known to be COVID
positive into hotel rooms. And then for the protection of that population in that sense. We are also working to stand up a separate isolation facility for
homeless individuals that do happen to test COVID positive. But do not need the acuity
standards for hospitalization. We have multiple outreach
efforts that I eluded to earlier which includes insuring that
homeless service providers know the protocols in respect
to screening individuals. And are implementing them to
the best of their ability. – Anyone else know Yale’s
role in any of this? Sten. – There’s been activity
in our Yale faculty working for the VA. The VA has done, David
Rosenthal and colleagues have done a marvelous
job housing veterans. But, sometimes there can there
can be housing and security and they’ve been very
aggressive in following up each and every veteran. Many of whom are struggling
with chronic medical conditions including substance use or
mental health conditions or chronic diabetes and the like. The Divinity School is
actually getting involved. Ms. Cunningham, all the
faculty there used to be the Executive Director of Columbus House. And she’s gotten extremely involved with the pragmatics of homeless
housing and mitigation. That I think Dr. Sinha
may want to comment. We do have a challenge in our city in that nexus of homelessness,
poverty, substance use, mental health which is
an independent challenge. Whether we have Coronavirus or not. But I do feel like the Yale community is stepping up to the plate. I just saw guidelines from
our Addiction Medicine Group guiding us exactly how
we would like to tackle folks who are struggling
with addiction issues. But may be in harms way with Coronavirus and strategies to mitigate that harm. – Thanks Sten. This is a question from Michael Lawler who’s a Yale College grad from 1970. He says given that the symptoms
for all but the elderly, which I am. And or infirm seem to be trending towards mild to moderate symptoms
with high recovery rates. And past viral epidemics, swine flu, H1N1. In fact, even killed
more people than COVID. Please explain why these global actions are a rational response to the situation and not the greatest case of mass hysteria in recent history? I think there are a
lot of people who think this is all overblown. Anybody want to weigh in here? – I tried to address that
in my opening comments. I really feel like we
should not underestimate the risk of a new influenza like disease with 10 to 20 times the mortality rates being introduced to the human race. And it taking hold and
being with us forever. That is catastrophic. This virus is far better
adapted to human to human spread than either the prior
Coronavirus’, either SARS or MERS. And because we now know
that it’s just as good at spreading human to human as flu. It is worth this effort to try to see if we can run into the
summer with extremely low levels of ongoing transmission. And see if the summer
dynamics will essentially scrub it out of the human populations the way that we saw SARS in 2004. So, that’s why I think
it’s not mass hysteria and I don’t think it’s an overreaction. – Anyone else? Ellen. – Oh there we go, so yeah. I would agree. I think this is a
appropriate reaction in that also if you look at
what happened in China. In the epicenter of the epidemic where everyone got sick all at once. The mortality rate was much higher than in other parts of China. And you might wonder why that is. It has to do with the fact
that a significant number of people do get quite ill with this. And it’s not only people over 70. Just FYI, there are younger people who have gotten quite ill. Have been in the ICU and even died. And one of the factors, it’s not just a property of the virus. It’s a property of the healthcare system and its ability to cope with
the number of sick people. If you have that number of sick people who need that intensive care. That matches or is less than
the number of ventilators and the number of doctors available. The mortality rate is gonna be much lower and people are gonna do much better. So it’s not necessarily
just intrinsic to the virus, what the mortality rate is. It’s how fast the virus
spreads and how long the healthcare system has to
build up to deal with this. So, in the epicenter of
this epidemic in China. That happened so fast
everything, it was overwhelmed. Whereas in other places the
social distancing measures that are being proposed. The point is to slow that down. To stay below the threshold of what the healthcare system can handle. And that’s gonna make a huge difference in the outcomes that people have and the mortality rate of the virus. – Thanks Ellen. – I just add to both of those
statements by Sten and Ellen. Although MERS and SARS were not long ago. Just the exponential growth in our travel is really, I think, year by year going to increase the risk of spread to every remote corner of the world. And I think we can also
view this really in a larger global context. I think as Ellen was saying,
I was on the call earlier with collaborators in an
African country where I worked. They have five ventilators
in the capital city, period. So, I think we have a
larger global responsibility to limit this epidemic. Because places that don’t
have the resources like we do. They’re gonna be really
potentially devastated by the spread of the virus. So, I think there’s
another aspect to this. And as Ellen said, the experience in China shows that areas where there was not a lot of great infrastructure. Mortality, again, was
really high and that was as good an example of that
impact we’ve seen so far. Africa’s hopefully not
going to reach the point where Europe and the rest
of the world has reached. But we just don’t know that at this point. And I think we need to take
this incredibly seriously. – Thanks, so we have a few more minutes and a few more questions
I think we can go through. The question from a Grace
Parisi in Brooklyn New York. She says my son’s college
has suspended classes and asking everyone to leave. If there’s a shelter in place
policy for New York City will I be able to pick
my son up at the airport? The question I think can
broadly be abstracted to think about how do
you understand all these public health regulations
that are coming down? They’re telling us we can’t
do this and we can’t do that. What are our obligations and what are? Can we get in trouble
for doing certain things like picking up our
children at the airport or things like that? Anybody want to jump in? Amy, Amy then Paul. – Well, you know in general. If you look at some of
the strongest measures that have been taken. Like the measures in San Francisco where there’s a shelter
in place, order in place. They have exceptions for
essential and necessary activity. And so there are exceptions
for necessary work, necessary travel with
respect to healthcare. And broadly speaking I think what people who are writing those orders
are trying to accomplish is communicating the
message that everybody needs to socially distance
and take this seriously. But not to prevent them from doing things that are really necessary to be able to take care of their families. And so, you have to look at any
specific order that came out to see how it would impact any
particular place or activity. But, my expectation would be
that these are gonna be written with the intent and
enforced with the intent to allow them to take
care of their families and take care of what’s necessary to do. And they do have
flexibility built into them for essential activities. And so, I think that hopefully that will be the case with ones
going forward as well. – Thank you. Paul, do you want to weigh in? – Just to say that the
principle of doing the things that you have to do is to
them as safely as possible. And with the social
distancing measures in place that are practical to take. So for example, picking up
your son at the airport. It makes more sense to do that in a way that you can get him
home without the crowd of public transportation
if it were possible. If it’s not possible,
then you have to do that. We need to do the essential
things that we need to do. But minimize the number
of times that we have unnecessary exposures or
nonessential activities outside the home. – So, a little bit of time for
maybe one or two questions. This is from Kyle Trantina who’s in the Yale Systems Biology Institute. I know several post docs and grad students who intend on doing nonessential research throughout the shutdown and I’m concerned. There is a notice from the
President of the university about nonessential research. A bunch of different post
doc and grad students are worried about having
to go into the lab either by encouragement by their PI or on their own sort of
willingness to do that. What is going on in terms of research that’s nonessential at
the university right now? Ellen and then Sten. – Sten may know more than I do about this. But I guess as a researcher,
the head of a research lab. Actually, these policies
are evolving very fast. It seems like every half
day we have a new guideline. But I think that the way
that things are going is to shutdown nonessential research. There are certain things to
maintain the infrastructure. Such as, you know. Crucial things for research like stored very important samples
and things like that which we’ll try to maintain
through this hiatus to not destroy those resources. But I think everyday
we’re seeing more and more from the administration of the idea that nonessential research. Which is research that’s
not directly related to trying to curve this
epidemic is be curtailed. Of course, as a research
institution one of our reasons for being is to be
able to apply our knowledge to try to help in situations like this. So, in that case we don’t want
to shut those efforts down. – Ellen got it exactly right. I’ll just add one thing
and that is animals. The animals have to be taken care of. The insectarium has to be maintained. So, that’s an essential function. – [Gregg] Okay. – I would just add in addition I think there are folks involved
in clinical trials at the university that are being followed. That are also in experimental therapies. That is not being shutdown. So, just want to reassure the public that those are considered essential of course. So, those distinctions are being made. – So, I think we have time
for one more question. It’s from Risa Sodi
who’s an Assistant Dean of Academic Affairs in the
Yale College Dean’s Office. She’s asking about is
it safe to play tennis or pickleball, which I don’t
even know what this is, outdoors in light of the
guidelines for social distancing. I think the question is
what kind of an exercise can people get safely during a pandemic? Sten. – There are sports that are contact sports that are very close quarters. The extremes would be things
like football and rugby but also soccer, volleyball. These are not advisable. This is a great opportunity for you to breathe on each other,
to cough on each other, to spit on each other
accidentally of course. And that’s why the NBA
has suspended its season. Now, the tennis players have
also suspended their season but it’s not so much
because one tennis player is going to infect the other. It’s because there are large crowds that go to tennis matches
and watch these matches and mingle and socialize. So, in theory the further
apart you are with exercise. For example, I’m still going running and I’m giving wide brief to anyone that I have to pass on my run. And that would be still social distancing. So, one has to use I think common sense. The specifics of tennis and pickleball. The reality is you might go
and chat with your partner and be close to that partner,
that would be the risk. Not being at the other
end of the tennis courts. So, I think one has to
really think this through and be very cautious. – [Gregg] Okay. – [Sanil] I think these are– – [Gregg] Ann, go ahead. – I think it’s worth
noting that to maintain a healthy lifestyle with
exercise and good diet. Being able to sleep well and taking care of your mental health. And reducing the stress
level will all help with building your immunity. And so that’s really
important to reduce the risk of getting the infection. – [Gregg] Thank you. – I think it’s a really important point. I do very much worry
about public’s ability to, you know, for the elderly. For many folks, it’s really
the way that they get out is getting to the gym or getting outside. And folks should still have their kids playing in the backyard. Maybe not in large groups or not with the neighbors necessarily. But some of this network
theory that Dr. Vermund, Dr. Vermund talked about. We might have to do
more collective thinking about how to make this happen. There’s also challenges in the inner city where folks don’t have
the backyard necessarily. I think we have to put our heads together and think about ways that we can let individuals get out
there and get some exercise. Or relief, mental
anxiety and I think being in front of the TV like we are for a lot of the time is not healthy. So, maybe for the person who asked about what you can do as a youngster is maybe help us brainstorm about ways that we can have people get out a little bit more yet still maintain social distancing. – Thanks Sanil. I want to thank all our panelist for being with us this evening from their various homes and
apartments across the city. Stay safe, stay healthy and we may have another one of these down the line. But hopefully you learned a lot tonight from our wonderful panelist,
thank you very much. Goodnight everybody. (music)

Leave a Reply

Your email address will not be published. Required fields are marked *