Heroes of Healthcare
Heroes of Healthcare

Episode · 1 year ago

COVID-19, NYC: Lessons in Preparedness

ABOUT THIS EPISODE

In healthcare, things don’t always go as planned.

So, it’s important to talk about the things no one talks about.

And COVID-19 is proof.

In our latest episode, Dr. Marc Napp, Senior Vice President, Medical Affairs & Deputy Chief Medical Officer at Mount Sinai Health System, explains how healthcare leaders prepare for the most unlikely events through emergency management.

Marc discusses:

  • The events that led to his focus on emergency management
  • How he and other healthcare leaders approached the pandemic
  • The tension between civic responsibility and civil liberties in the COVID era

Heroes of Healthcare is hosted by Ted Weyn.

You're listening to heroes of healthcare, the podcast that highlights bold, selfless professionals in the healthcare industry focused on transforming lives in their communities. Let's get into the show. Welcome to the heroes of healthcare podcast. I'm your host, Ted Wayne. I'm excited to kick off the next episode with Dr Mark Nap. Good morning, Mark. How are you? I'm very well, Ted, and yourself. I'm great. Thanks, excited to have you here. Real quick, let me tell the listeners a little bit about you. I understand your senior vice president of Medical Affairs and deputy chief medical officer with Mount Sinei health systems in New York City. You were integral and mount signize ability to manage the influx of covid nineteen patients, and you assisted in the system's emergency management response, where you recruited and deployed over three hundred and sixty physicians, nurse Practitioners and physician assistants from outside the health system to manage the crisis. Amazing. Thank you for joining us, Dr Nap. Nice to be here. I appreciate the opportunity. So, mark, before you jump in, could you tell us where you hail from? What got you to Mount Sini and about your background. Sure, so it's a little bit of a circle actually, because I began my career as a physician amounts and I did my training in general surgery there back in the nineteen late S. so, as you as I just mentioned, I'm a general surgeon. I had practice General Sir Dury in Connecticut for little under ten years and while I was there I really became very interested in healthcare operations and in what makes healthcare run well and, more importantly, what makes healthcare run not so well, and started to dig into some of those issues and decide to get some advanced training and got a master's at administrative medicine from the University Wisconsin and transition to actually from full time clinical practice to full time administrative work in being hospitals, the senior physician executive in hospitals and and ultimately in health systems. So I've worked at a small community hospital in Northern Westchester, just northern New York City. I've worked in the heart of New York City at Lenox Hill Hospital, which many of your listeners may know of because it's now actually a series that was on one of the major streaming sites and then at North Shrowlan on Jewish, which now is called North well, and now I'm at the Mount Sawney health system in in right the heart of New York City, and my role in those places has been to be as a physician leader and to as a physician leader, my responsibilities to try and create processes and create opportunities for physicians to do their best work so that patients receive the best care. That's probably a very that's by a fiftyzero foot view of what it is. With regard to what you mentioned the start of the podcast, I initiated the emergency response at Mount Sni for Covid, and that's an unusual arrangement, but it's some thing that I've really valued over the last seven years while I've been a Mount Sinai and building its emergency management capabilities. It's incredibly rewarding to be able to ensure that your health system is able to respond to crises, and that's what covid is. HMM, yeah, sure, here you just mentioned a little bit that that's unusual. Can you explain that a little bit more when you say that emergency management fell under your per view, and how is that a little unique to maybe other health systems. Sure, I mean typically emergency management reports up through the operations line of an organization, ultimately up to the chief operating officer, for example. At least that's what I've observed in number of other organizations, and Mount Sawney, which is a physician led organization, it was, I think, relatively unique. When the health system formed seven years ago by the merger of Mount Sawney Medical Center with continuum health partners, there really was no grand plan for how emergency management would be run, and so when I got there I had just basically led part of the response for North Sorlan on Jewish for Hurricane Sandy and hurricane Irene, and got a real taste for emergency...

...management. And so when I got to mount sine and we were confronted by some early events that needed response and saw that we really had didn't have a system approach to it that would account for seven separate hospitals set up across the Greater New York City area, it seemed that somebody needs to take ownership of it, and so I I did. We there was a gas explosion on Hundred Sixteen Street and Park Avenue. People are not from the New York City area will know that area, but that's only about twenty blocks away from the Mount Signy hospital and so we got a number of patients from that. Now mounts on a hospital was very good at accepting those patients, but other patients might have ended up at more at Mount Sidney morning side, which is on the west side of Manhattan, and there was no plan for coordinating the response between Mount Sanny Hospital and Mount Signi morning side. Wow, and that's sort of what led to say, Hey, we've got to think about this more broadly. HMM. And then, you know, then it took it from there. So that's great. I'man interesting so how in retrospect, and I want to talk more about, you know, this year with you from your and the facilities perspective. But how do you think that were that you just talked about organizing and seeing that gap that existed? Howard did that help you, do you think, or these did you see ways that helped you when the pandemic broke in, things in New York all just started going, you know, going crazy. Well, I think it helped tremendously because over the past seven years Mount Signey has built and grown its capability around emergency preparedness. If you think back to nine hundred and eleven. Prior to eleven, hospitals were expected to be able to manage a disaster within their facility. So if there were a power outage, you had plans for managing that, if there were a fire, you had plans for managing that. But there really was no expectation, at least to my understanding and my looking back at the history, there was really no plan for a major external event that hospitals would have to respond to. And I remember I lived through one hundred and eleven. I remember waiting in in the hospital I worked in at the time, waiting for patients to come. And, as every healthcare provider in the New York area will tell you, everybody was waiting for patients to come and they never came. Had they come, had we had three thousand patients show up in our emergency departments within the New York Metropolitan area, we would have been swamped. We wouldn't have been able to manage them. We didn't have plans in place for that. And so cms, a joint commission and you know, our public officials said Hey, we've got to fix this. Yeah, we've got to have plans, we've got to build resiliency, and emergency management, as a hospital function, grew up and suddenly game important. Subsequent to eleven, we had Joblin, Missouri, where Frnado hit a hospital. Yeah, I remember that took it out right. You had Hurricane Katrina, where memorial hospital ended up actually being unable to take care of the patients that had had. I mean, these were devastating scenarios that health systems were just still grappling with and I didn't want to see that happen to the health system that I was responsible for. Now, as far as being involved as a physician, I think that's what's unusual, but I think it added a flavor to to the approach so that we could bring in the expertise. Emergency Management is now a real profession. I mean it isn't a profession that we should all know more about and really embrace, but it's a convener, it's a convener of resources, it's a convener of expertise and it's a structured way of thinking that needs to then pull in the resources it needs to actually solve the cute problem having a medical infrastructure that's fully aware of what those plans are and how that works. I think that's what made our response unique. Yeah, it's really that preparedness, right, it's just that it let's think about the things that we don't think about, right, what could happen and how do we be ready for that? You know that. That is exactly at it goes to...

...a principle that we're learning about more and more in healthcare called high reliability and being preoccupied with failure, being preoccupied with the with the reality of something's going to go wrong. Yeah, are you ready to manage it? Yeah, for sure, you know, and I think we see that in lots of ways. We see that with the CDC, we see that with all sorts of different things that are popping up now, which is and it's always easy when you're in the middle of the crisis to say why didn't we and who didn't we and to point the fingers and at that's not the time to be doing that. But certainly being prepared and doing those things for sure are important. It's funny you talked about the hundred and eleven experience. I remember my dad, who I just actually had on our first episode. He was getting ready to go in for bypass surgery on N and eleven that morning and he was in a New York hospital out it at the time it was winthro up hospital university and now it think it's part of the nyu system. And he was getting ready to be wheeled in and nine hundred and eleven the card and they wheeled them back out and they said we have to be ready because we're in the epicenter or regional area. We have to be ready for this influx of this catastrophe that happened in pss story, saying like you, unfortunately nobody came right. So take me back to January February this year and then to march in April and tell me what were you working on in January February and what were you looking at? When did you guys first get wind that this might be coming? And I've heard reports that there were signs earlier than what sometimes is reported. And then what did March in April look like for Mount Sina? So you know, January and Fripoly, we were aware of the coronavirus outbreak in China, that this was a novel virus and the first time I remember ever hearing the term novel virus was when I was the chief medical officer at Lenox Hill Hospital and and n one appeared. HMM, and my director of infection prevention, Dr Michael Tapper, came to me and he said this is this is a big deal. You know, this could be really be a very big deal, and I had no idea really what he meant. I just didn't have a perspective on it. Now, Mike was an extremely seasoned, knowledgeable infection prevention, fecialist, epidemiologist and as and as you recall, each when anyone really didn't cause a big deal. I mean, there are people who got sick, but it wasn't a lethal infection and it came and it went and it caused a hiccup that summer where kids got sick and but that was it. Yeah, and then there was stars and there was mirrors. Those were novel viruses as well, but for whatever reason they didn't you know, they didn't track all over the world. There were outbreaks their pockets, but as novel viruses go, they weren't causing tremendous problems for us, at least not in our region. And even Ebola back in like two thousand and fifteen. I think of two thousand and fourteen even. There was a worldwide panic about it, right, but it never materialized into anything really significant outside of Africa. I mean there was there was a patient in New York City and we had a patient. We thought we were had a patient when when a patient showed up in our emergency room with the right story. So I think to some degree, hearing about this novel virus and China, having lived through those four episodes, it was almost like the boy had cried wolf four times in the past and it just didn't generate a lot of panic. A lot of you know this is going to be really significant, although I would say our epidemiologists were saying this is important, we got to pay attention. It just didn't seem like it was going to be as I don't think that's maybe maybe that was my own personal response. Sure. Well, I think, like you said, it's it is you know, when you it's in human nature for us to as you said, the boy who cried wolf. We've heard it before. We've heard it before and it never mounted, which reads me a question and you know not to get to technical because I won't understand it, but not to get too technical, but do you have any sense what is it about corona that made it different than the others? Is it just the ability for its transference, its ability to stay alive and stay active and hyper? You know what made those others die off...

...and this one just sweep the world? You know, I probably am not the right person to comments on that. I defer the answer to an epidemiologists, but I think it's a it's probably a number of factors. Yeah, one is every organism that causes infection has a an infectivity rate called the are not. You know, if somebody has it, how likely or other people to then get it, and I think the are not for this virus is relatively high compared to other types of infections, I believe, and again this is not my air expertise. Sure. And then I think that in the beginning, at least as I'm understanding it, in China, they did not clamp down on it, and so there was there were really no attempts at containment early on. Okay, there was denial, and so when you if you take a major urban center, from what I understand, the province where this occurred, the center is is massive, hugely populated very densely populated. If you take that sort of situation and you do not try to put in place any containment and or mitigation strategies and you don't limit travel, you are going to very rapidly disseminate the virus very long distance. So I think it's a combination of the infectivity of this virus, the social circumstances of when it was first came up and whether or not the public response was appropriate, that the infection prevention response was appropriate. Again, when you think of Ebola, he bola scares everybody as soon as people talk about it and there are tremendous resources that are brought to bear to contain it. Area where it's endemic is not nearly as populated and doesn't have as much travel in and out as that part of China. So it's a very different set of circumstances. Interesting at least that's that's my understanding. Okay, well, fair enough. We thanks and you may need to do another podcast or correct everything I just said. You're giving me content. I love it. So let's jump back to January. February talked about you're getting somewhen from your colleague saying, you know, heads up. This is we got to we got to take this seriously. So please keep continue walk us through that. So we started, when I say we don boys. WHO's our VP from emergency management, who, if you have an opportunity, you should probably interview him as well done. Is extremely seasoned. We recruited him out of the government. He literally was taking care of survivors of Hurricane Maria when I when I reached out to him. So he and I started talking about, you know, what do we need to do to start preparing, and this would we started up relatively slowly. was in late January. We started having weekly phone calls amongst some of the key areas that we thought would be involved if something were to happen, so engineering, infection prevention, supply chain, you know, some of the light of the infrastructure elements of the health system, and we increase that, the frequency of those meetings and we grew the meeting larger and larger. Those meetings larger and larger through mid February and then by late February we actually pulled together and in person meeting. Remember those? Those? We you antally all go into one room and you say, I can't look at each other. You actually had a meeting where which we focused entirely really on communications, because we were getting the sense that communication was going to be one of the biggest challenges, as it is in any emergency, but it was going to be a huge challenge because of the combination of panic, a lot of disinformation and a lot of things that we still didn't know. So we started to plan our approach to communicating when I left the New York City area to go visit my daughter in Atlanta, not far from where you are sitting right now, right, and this was the last week in a February. On that Friday, I get a phone call from one of the staff saying we think we have our first patient with covid it was a woman who had just returned from Iran and her husband who had also returned from Iran, and she presented to the Emergency Department and amountside a hospital with symptoms that sounded like covid bad cough, high fever, recent travel. You know this the triad right, pause for a minute, just at this point, though. It did hospital have any way to test for it? So No, the testing was only being done...

...by state departments of health. Got It. So in New York's Department of Health. The Epidemiology said action is actually really pretty strong and we have a great relationship with them. And again we've been through this with them for measles recently, because the measles was back in two thousand and nineteen. We'd been through this with we BOWLA. Every time there's a TV case we bring them in. So there's a very collaborate relationship with the Department of Health for Epidemiology Group. But when we have a patient who's got a strong history, you immediately pick up the phone. You call it apartment of health. They then listen to the story. They determined as a somebody who's high likelihood of having, you know, whatever disease it is that we're concerned about and it's so you do the specimen, you draw the specimens and you get it to the Deparma to health and at that point I believe the Deparma health was since sending them to the CDC. I think they were developing their own testing. So they tested, but it also went to the CEC for confirmation. Anyway, the turnaround time was was two days. So that was on a Friday. On Sunday I'm in the Atlanta airport flying home and I get a call that there's an emergency meeting because we had just gotten word the test was positive. Wow, and this was the first case in New York City. And you said that. Then you said this is end of February. This is well, this was March first, actually first happen, and as soon as that happened, all of a sudden all the questions, right, you wish you had worked on beforehand. HMM, start coming forward, like, okay, where does this woman live? Okay, she lives in one of our apartment buildings. All right, meaning where our residents live. Okay, how do we deal with that? Do we have to alert all the other residents that live in that building? Do we have to do special things about cleaning the building? Do is she have to stay quarantined, and if so, what does that mean? Can what about her husband, who tested negative? You know what should how did they function right? How do we provide her with care? And so all these questions started coming very quickly. Policy decisions had to be made, and so that's when we really ramped up our emergency response and we started virtually because, again, initially we had no idea how widespread this was going to be the notion of community spread hadn't happened yet. We thought that she got it because she had just gotten back from Iran. In Iran already had an outbreak. So it wasn't community spread meeting somebody within the community New York giving to somebody else within the community of New York City. This was somebody who traveled right Brian Without knowing how infectious it is. We had no idea. Okay, so she's traveled, she's come through the airport, she's taken an Uber to get to our apartment, she's walked across the street, she's been to the emergency department. Certain people were exposed there. You know how many people has she been a contact with? Sure, and so the Department of Health now comes in and starts doing all the contact tracing for that. But this was again, this was early. Yeah, an interesting that you said that, because I was I was going to ask that, but you just said that. So they started that. That whole contact tracing process happened right and right, immediate, correct. Now, shortly after that case a case that got much more attention, and that was a man who took the train to work every day from New Rochelle which is a suburb north of New York City, and I believe he, I think he's in banking. WHO ended up getting really sick? Now, this woman that we that I mentioned, she wasn't really sick. She got better in her apartment. But this other this other gentleman got sick and ended up being admitted to another hospital in New York City. He took a cab to get to the hospital. The cab driver got sick. HMM. Several other people in new Rochelle got sick because he had been part of this community, right. And so we had a hot spot in new Rochelle that got a lot of attention. That was the first major outbreak in the New York City area. I you know, I remember that and you know, again, being from New York, I know the area and I remember scratching my head saying why new Rochelle Right, you know, out of here. If you said to me, and obviously it had been eventually got to New York City with everybody on the subways and all the different things, that would make sense. But I remember saying new Rochelle, and what happened in New Rochelle? That made that happen right, and I don't recall if it was ever determined where he had gotten it, but he had was I don't believe he had had any recent travel. HMM. And so that was evidence of likely I believe, and...

I may be spending wild rumors here, but I listen. There's plenty of people out there right now who were struggling with these issues, but I believe that was considered community spread and that was huge concern from an epidemiological perspective. Yeah, that now it's just in the community and people are not necessarily going to know that they have it and will be seeing other people. And if you think back to those days, you know information coming from the CDC wasn't all that clear, and I'm not pinning anything on the CDC. When you ever you have some new organism that in you don't know what its behavior is like. I don't believe that masking was being strongly recommended at the time. Right hand hygiene is always recommended, but I don't think masking was. And so people weren't masking because I don't think people thought it was particularly infectious or that it would be something that you would catch just by being in proximity with somebody else. Yeah, I recall we middle of marchers on a family vacation and things were really starting, you know, shut down. They were talking about borders closing and things like that, and we did, we did travel back, but I remembered, you know, unlike three months ago and I traveled, there was no mask, you know, we got on the plane, we packed in with everybody and we were heading home, but there was there wasn't any. So I wouldn't be surprised if there was no you know, none of that cautionary messaging was coming out. So I remember specifically attending a press conference that governor Cuomo had done. That was before the first case showed up and it was all about preparation and we had matts and I had just sent, or was in the midst of sending, a few mental health workers down to Puerto Rico because, to tell provide some relief, resilience, relief, and so he done a press conference thanking e Veroy for doing it, and immediately after that press conference he did an update on what was going on with the coronavirus preparations. So this was all around the same time. But I I went to the airport with those people being deployed to Puerto Rico and I remember walking the long distance to the jet blue terminal at JFK and passing about three people wearing masks. Nobody else was wearing a mask. You know, that was just something that wasn't being considered. You know right was. It wasn't happening. So we've learned that we have to do things there. Filly. Yeah, well, we learned that, Matt. You know, in even in the early days there was all the social things going back and forth about in masks, don't help, masks do help. Don't make me wear mask, make me, you know, all those sorts of things. And you know, now we're certainly understanding that it is. It is not the silver bullet by any mechanism, but it certainly is a preventive action right up there with washing hands and sanitizing and doing all those sorts of things. So yeah, I know, but we've come a long way. So now we're about mid March, it sounds like. And when do you really realize that this thing is this is the tornado coming. So you know, at this point the World Health Organization did not declare a pandemic. I don't remember what the definition of pandemic is from from WHO? But it wasn't a pandemic yet. But we were now really activating. We were meeting on a regular basis. We admitted our first patient with covid on the seventh to amounts on my west which is on the west side of Manhattan, hence its name. And even then the numbers of patients in the hospital were not that high. But so the first patient diagnosed on the first, the first admission to one of our hospitals was on the seven. By the twenty three. So only twenty two days after that first patient in New York City, half of our beds were filled with covid patients and all our iceuse were full. Well, wow. So now when I say all our I se user full. We run an average census of about a hundred, ninety two hundred, I seeu patients across the health system. So all those beds were full. Now by then the governor has already made an announcement that he wants the hospitals to identify fifty percent additional beds, meaning you've got to create space for all those patients. You also have to have physical beds to put them in right.

So you have to order beds we had to get beds in from outside the organization and then you have to staff those beds. You have to figure out how you're going to do that and that's where we pivoted our planning a bit and I took over leading the response with regard to making sure we had enough healthcare practitioners, physicians, PA's and P's in various specialties to make sure we could take care of all those patients. Our particular modeling a week later said that we were going to have tenzero covid patients by the end of April. And at that point, what did you think? You're even your pivoted, if that's such a word. You know, Retro Fitting Your Facility to manage that. How did that compare to the numbers you felt you could take? So we figured out very quickly. I have to give tremendous credit to the leadership in each of the hospitals where they identified how they could ramp up significant volume in order to make space for additional patients. Don Boys, who I mentioned earlier, reached out to an organization who came in and they are fully self sufficient organization. They sent up at ten hospital across the street from ount Sinai in Central Park. That gave us another seventy eight beds, mounts on a hospital itself. Started building patient rooms in the Atrium that we have. We have a very large atrium that was part of a hospital and we're talking about like thirty beds that we were able to put in their dirty isolation rooms to be able to accommodate those patients. But it's not just the space, it's also, again, the staff. We were able to create the fifty percent increase that the governor had asked us to do that we were able to identify those spaces, we were able to get the equipment build the beds. Nursing, our our human resources department worked on getting additional nurses from outside the organization, as well as training up our existing nurses and redeploying them, and I worked with my team on ensuring that we had sufficient physicians, and the first thing we did was reassign our physician workforce. One of the things that the governor had done on the twenty two he implemented something called New York pause and all elective surgeries were ceased. Yeah, well, immediately you have all your nathesiologists or ail your nurse and esthetists and all your surgeons are now essentially available, so to speak, to do other things and a thesiologists, they can with relative ease, transition into doing in critical care medicine. You know, being a Nassiologist, you have a lot of the skills that that intensivists have. Okay, our medical surgical nurses, the regular nurses that are on the you know, our floors, the ones who are used to take higher acuity patients, they were trained up to do critical care and that was a huge that was a huge growth requirement for them. Suddenly you're taking care of patients who are on multiple different intravenous medication simultaneously, with side effects that they're not familiar dealing with, monitoring them and a much more aggressive basis. Patients who are on respirators, are breathing machines. It was it was a huge, huge challenge to do that and I attribute that to all the steps the governor took in terms of implementing the New York pause, the social distancing that people adhered to, the masking, the hand hygiene, cutting visitors and we weren't letting visitors into the hospital. Tremendous. You know, there's a lot of behavioral stuff that we that we implemented that cause those numbers to come down. So by then people got a sigh of relief. But then we started talking about, well, there's probably being a going to be a second way. You know, if you look at history previous pandemics, there is a second wave. Sure. And then we started really focusing on resilience and mental health. I mean we had had been doing it, but we foot all of our attention in the mental health. For you. Let's just take a moment and let's talk about those folks who, in your eyes, staying with the team of our show. Who are the heroes? I mean, when I hear you talk, I say they're all heroes, you know, when I hear you talk about them and esenthasiologists and all these people changing their roles and willingness to do it. And you know, on the thing that I also always really want to always be reminded about is superheroes that we think of in the comic books have super powers, right. These are humans doing superhuman...

...things, doing hero type things, and I think that that's always important thing for us to understand. Some of the other conversations I've had that's what people are saying. These are regular people just doing heroic things. But I know that there are certain folks that you mentioned, you know, Don and heather and some of the others, who just really kind of stepped up and rallied and and not only did they rally from an effort and an energy, but really got creative and got innovative in the time of that. It was needed and I'd love to see it loved you take a moment and just shout out some of those people and that you recognized who really just came to the call. So I personally do not feel like I was a hero. I mean, and you and I talked about this in preparing for today, and that I mean I was not on the front line, meaning I was not sitting there operating on a patient or starting an intravenous line or doing chest compressions on somebody who's arresting or assisting an innovation. To me, the people who did that, those are the people who are the heroes. Yes, it does take leadership to get a hell system organized to be able to do what we did. So Don boys from burdency management, Heather Solo, who leads our PA services, and we have close to nine hundred physician assistance across the hell system. Billbow Decker, who did the same thing for the nurse practitioners, Sabina Limb, Jonathan Rip and other people, Dan Hughes, who led a lot of the work we did regarding resilience and mental health, Brendan Carr and his emergency departments. These people, that the leaders, are essential because you can't really get everybody to work in a certain way. But our head of critical care, a young physician named Adam out and mounts on. I'de Brooklyn. Who I mean? I he's really just recently out of training and he's a bright, energetic, very hard working, dedicated physician and I remember roughly about, I guess it was before the twenty three of March, was probably about the seventeen or so, getting a phone call from him one evening and he was literally crying on the phone, just overwhelmed with the numbers of patients that we had. I went out and visited him at Brooklyn and made rounds there and he was obviously much better by them. This was this was later. This was, I thinking, probably in May. The numbers had come back down. I mean he had grown tremendously through that, but I just remember being on the phone and trying to figure out how I could help him and how I could get him resources, because they're just too many patients to take care of. Yeah, one of the nurses that I spoke with when I was visiting, who was a regular medical surgical nurse, meaning that she took care of, you know, your typical patients on a medical floor and not an intensive care in. Her nurse had been pushed into serving as intensive care in. Her nurse is one of one of the instances I mentioned earlier and she was single, young, probably early S, maybe late S, and she was going to be off for the next three days and I said to what are you going to do with your weekend, and she lived alone in an apartment in Brooklyn, and she said what can I do? You know? I mean, I can't visit my family and my friends right. You know, what do you know? So what do you do when you're off? It was it was almost worse for her to be off than it was for her to be at work. Sure, because the risk of exposure and then exposing others, but you're also sitting, you sitting in your apartment and emotionally isolated and thinking about what you've just gone through and thinking about going back to it. It was just such you know, I mean what besides picking up some solitary hobby? That would just you. But you know, you can't get out of your own head. Sure, and we're social and we're social creatures by nature. So, you know, seeing them, those, those are the heroes to me and I understand. You know, I've had this conversation with Don a number of times. He really doesn't like being called a hero. I mean it's his very strong feelings about not calling other healthcare workers heroes, that they actually really reject the concept. Sure if what they chose to do, it's their job and it's almost as if, no matter how hard you do it, it's never enough. Yeah, now, and I can appreciate that and it was actually one of the things when we decided to name the podcast, it was one of the things we struggled with because we recognize that true heroes don't see themselves as being heroes and I appreciate...

...it. And you know, and I love the fact that you shouted out, you know, those folks that in the leadership mode and things like that, but it goes without say everybody was on the front lines at Mount Sinai during this crisis, where heroes. They all were. You know, there were the leaders, but, as you said, those people who were receiving and those people who were taking temperatures out in the tents and out in central park, and I mean all of them were, all of them were heroes. So thank you. If they don't want to tell their stories, I'm appreciate that you're telling their story because it needs to be told and it needs to be heard. So, with some of the time that we have left, a couple of the questions. So we go through the you just talked about everything declining and we're kind of getting down to something that we feel like it's more manageable. And here we are in November and it's coming around the horn again. What are you seeing with the new spike, the second wave that you mentioned earlier, that it's starting to come? How are you guys managing that? Maybe better? What are you seeing? What are the observations as where as they say, Oh, here come, it's coming around again, so to speak. Well, before I just sort of jump right into the whole notion of second wave of planning, I'd be remiss if I didn't mention all of the civil unrest that we've, you know, witnessed in the wake of the George Floyd murder because, and the reason I raised that is we were laser focused on resilience and mental health for our step, for our staff, in recovering from the first wave when George Floyd died. And New York City is about as diverse an area as you could possibly imagine. I mean, from what I understand, Queens, that borrow of Queens in New York City is the most diverse geographic area and in the country of not the world, and diversity something that's very important amount at Mount Sinai something that we really value, but it's also something that we could always do better at, and we started to think, look at ourselves and say, well, you know, did we do enough as healthcare providers, because in our own backyard we did have different outcomes from this virus. We had black and Brown patients who didn't do as well as the white patients did, and I think that's been everybody's experience, frankly, and so now it's sort of married this sort of, you know, value of diversity and inclusion to clinical care and our responsibilities healthcare providers. HMM. And we couldn't ignore this because you know what had happened to George Floyd and what's happened over and over again across our country and in our history. It's been there, but now in our faces was this reality that we actually we contributed to. We whatever we did, it was somehow connected in terms of our ability to provide care for our communities. And so we now would really distracted because we were planning on really focusing on our resilience and our mental health, when we knew, for our people's sake and our patients sake, that we had to acknowledge in a really meaningful way that we had to fix the embedded racist behaviors that exist in our society. And I don't want to hijack the podcast and take it away, but the reason I'm mentioning it is we realized we could. You can't just say we don't have time to discuss that right now. Right, you're dealing with a pandemic, right, you really can't, because, you know what, there's plenty of stuff out there that's calling racism a pandemic. And and look, this is my political view. I agree with them and I will tell you that dial back five months, I wouldn't have probably said that. And the reason I bring this up is my youngest daughter, who graduated from from Bucknell a year and a half ago, has been living with us since March because she works for Deloit and Deloit's working remotely and so she's not living in an apartment in Arlington, Virginia anymore. She's living in our bedroom at our house. And when this came up, when George Floyd was killed, one day she said to me at dinner and I could have dinner with her every night, which is rare. That did never happen in my lifetime. That's a benefit of covid yeah, that's me. So, Dad, what are you saying to your to your staff about George Floyd? What are you doing about that? And I said to her, what am I saying about it?...

We're not talking about it. I mean, that's not that's not appropriate to talk about a work. I mean, you know, it's that's a that's a private issues. People have feelings about it. She let me said, Dad, you gotta talk about this. This is like really important to people. They want to know you're a leader. What's your feeling about it? You know, where do you come down on this issue? Because they all have feelings about it and so to not address it, it's just sort of the elephant in the room. And I said, come on, Sydney, you're not right. No, that's just not appropriate. I appreciate your youthful exuberance, it is not right, but I was really troubled by it. So I started talking about it with a couple of other very senior people at Mount sign and I and we pulled in the person who leads, who's very high up in our office at diversity and inclusion, and we asked her to talk to us about this and it was literally like opening a floodgate. She but she went on a rant about how, you know this. She's in this office on officer, on the officer adversity inclusion, and she comes to our leadership meetings and she's there, she's educating us. But you know, where is it really tangible? Is it really reaching? And we really understood that for some my daughter was right. We need to talk about it and, frankly, we needed to take our leadership and educate them. So we started a book club and we had done this summer before, for another purpose, we used our leadership meetings as a book club and we read White Fragility, which that is what really opened my eyes. I mean it's so well laid out, it's written by a white person and it really does lay out what it means to be racist and and what it means to be white in the U, in the US, and what it means to be not white. And the reason I'm saying that is because now we had to focus on that and on wave two. Wow, but I think it has. At least my feeling is I feel like a much more genuine leader, knowing that I have now had conversations with people in my organization that I never would have had before about what it's been like for them to work in an environment that, you know, to work in our society when they are an art so, first off, thank you for for pausing us and going there, because I appreciate that and I think that that would be is such a big part of the story of what you all were going through. And I think you're right. We get so focused on the pandemic. I know I do that sometimes we forget about the other part, things that are going on in the world that are equally as important and equally impactful. You know, and I think it was can't remember who told me, but somebody I spoke to recently said that the George Floyd event was a bit of a breaking point for a lot of the healthcare workers, especially in New York in the middle like that was the point where they were like, I just can't do this anymore, like the George Floyd event, on top of, as you said, they were doing all this hard work to try to save lives, was a bit crippling for a lot of them. That that was the part that they felt that that was a burden now they couldn't take on in addition to everything that they were doing. So I had forgotten about that and so I'm so glad you paused us and said let's not forget that that was going on in the in the middle and I love your vulnerability and I love you just to be opened about it and to talk about that. That was I appreciate that very much. I have learned. This has been the two thousand and twenty s been a lot of things. I'm probably learned more in this year that I learned in the last five years before it combined, about myself, about what an organization can do and about what our society needs to address. I know that this has been incredibly painful. I guess it's one of those things, you know, that that that which does and kill you makes you stronger. I think that my daughter got married in the middle of all this, and a micro wedding, not the wedding she had intended. Right, there's a lot that's different. Yeah, yeah, for sure, this has been awesome. I think the as we start as again, as we as we start to wrap up here, they'll ask you questions that I kind of had for you. One was we started to talk about the second wave and what do you say and kind of what are your thoughts are? And then the other thought is, with the second wave coming, how is Mount Sion Eyes Preparedness,...

...which is now even different, getting, you know, making you feel more confident, less confident, you know, in terms of this coming around again, as I had mentioned? So I would say the way that we're approaching a second wave, or whatever wave you call this, because you know, there's ripples all along. When we look at our numbers, this is clearly you know, we haven't hit the second wave yet. We're starting to see things inch up. Yeah, one thing is we have much better data than we had back in March. In March there was no tracking of infection rates, testing was even available. Now we can keep very close eye on how much activity is there in the community, so we'll have a more of a warning if things start to ramp up. That's one. The second, though, is we're really trying to thread the needle. We took a very blunt instrument in order to save lives last time, meeting New York pause, stopping all elective surgery, diverting all of your resources toward managing the pandemic, bringing in three hundred sixty or so people from outside the organization at extremely high cost, because you know, they don't could. They didn't volunteer to come. They got paid. While I think some may have volunteered, we did pay them all. You know, we can't afford that again. The financial hit we took was on the orders of hundreds of millions of ballots. Yeah, we haven't even touched on that. Yeah, we can't afford to do that again. That will you know. I mean, look, I was just driving around this morning and I saw a bunch of store fronts that are all now have, you know, for rent signs in them, businesses that have been there for years. I know that people have been crushed by this from an economic perspective and people probably think healthcare is doing okay because we're taking all the care of all these patients. The reality is no, right now it is we took a financial hit that we may not recover from and all across the country health systems are laying people off or finding other ways to shed expense. So we don't want to do that again. As I said, we're trying to thread the needle and not have to do that, meaning that we don't want to have to stop elective surgeries, which we did last time, because we needed the resources meeting the people and we also needed the space. We need the pack use the recovery rooms, as I see you, spaces. Sure, we needed the doctors and nurses that were doing surgery to do other things. We're going to try not to do that and we don't want to bring in people from outside the organization. HMM. You know, we don't want to have to spend that extra money for that. So we are trying very hard to thread that needle and it may not be achievable, right, but that's how that so our plans are all predicated on that and hopefully with really responsible civic duty on the part of the community. You know, they shut down the New York City schools today, right, because the numbers started to inchop yeah, I saw, I saw they were going to watch and consider that. Yeah, well, they did it. So and I sense your approval of that. That's the way. You know, I'm struggling with the whole idea about closing school. I mean it's the likelihood of children getting very sick is low. M teachers, on the other hand, art risk. Previously, they're older and there's a real cost to not sending your children to school, for sure, huge coss. I mean their own development, as well as the fact that, well, now somebody's got to stay home with them, right, parents now, or you know, it's there's a huge societal cost of this that we will we will not be able to calculate for private generation. Sure, yeah, no, and not every parent can work from home. Right. Yeah, no, it does, it does, it does reach, it does reach bar and so I keep saying one more thing, one last thing. So if we're hearing stuff coming out of fiser. We hearing stuff coming out of because some other areas. I know you're not an infectious disease. You know background. But what's your thoughts? I mean, in my view is, even if the vaccines are good and they're ready to deploy them at the speed and they're saying we're still twelve months before we're starting to feel that, you know, maybe we're feeling safe again, if not more. What's your view on that? I think that what this country needs, and this is getting just one man's opinion, is somebody taking charge arge and making a statement about how people should approach this.

We really need to be much more responsible and less divisive about how people should be protecting themselves and actually protecting each other. Yeah, there are going to be people who refuse to take the vaccine. There are people who refuse to take vaccines now. I mean that's not unusual. Sure, and I think with a new vaccine, I think the numbers of people who are afraid to take it until there's more history with it is going to be significant. Sure, nobody want. Nobody wants to take the vaccine to find out twelve months later you probably shouldn't have done that correct and I think the projections are like right now, fully fifty percent of people will take the vaccine. Hmmm. Fifty percent will not get us to herd immunity, which means that we are still going to have infections, you know, hot spots. And then it comes down again, if you're of a certain mindset that this is not a big deal and that stuff happens and if you get it, you get it, and you're not going to take away my civil liberties and I'm not going to get a vaccine and I'm not going to wear a mask, then the consequence, I think, is really in this again, I'm healthcare worker. The consequence is that our healthcare infrastructure can't handle that. We're not built to manage taking care of, you know, additional thousands of patients. HMM. So I do believe we have to have a national conversation about civic responsibility and balancing that against civil libertarianism, you know, personal freedoms versus your responsibility to your neighbor, and that's again, this is highly personal. Sure. I do think, though, that, and I just heard anythink, if out you speak, that he's very confident and I got if anybody, if anybody has a voice that's trusted in the US right now, I would say it's him that corners were not cut in developing the virus and so therefore, if sufficient numbers of tested individuals are there and that the virus has been checked shown to be safe, that it is safe and that it is effective. So I think that, you know, we it's going to take time for people to come to grips with that and decide to get start getting vaccinated. But until we have significant amount of immunity we're not going to be to take our masks off, we're not going to be able to have life as we used to know it. Yeah, now I great. So again, thank you so much for your time. This has been amazing. Really appreciate every time you kind of walk into these things, you're you don't know where it's going to go, and this has been really special to have you on and to have you share your heart with us and give us some ideas of what's been going on. I think for our listeners, I think you'll be excited because I think we're going to try to get some of the heroes that Dr Nap has shared with us on to some of our other episodes. So you can continue to hear the story from New York and the Mount Sineid view of things, and I just again thank you very much for your time, thank you for your service or candor, your heart, and thanks for being part of the heroes of healthcare. But before I leave I've got to ask you the my famous end question. If you had to pick who your hero is, the Abbey Hero, I'd have to say that, well, I really don't have a single hero. I mean my family and what they do, and you know their heroes to me. But I think I know what you mean and I think overall, if I were to identify a specific hero, that would be negating the things that others have done that have been important to me. So I guess in the moment, while we're, you know, thinking back past about covid and what we went through and getting ready for a next wave of Covid, clearly I think the people who've been putting themselves out on the front line, the doctors, the nurses, housekeepers, dietary workers, pharmacy workers, all of those are heroes to me. They are the ones that are running into the proverbial fire to to help and they've got. All they have is something they could lose, but they're still they're still doing it. So again, thank you, Dr Napping, your time. Thank you for your insights. It's been amazing and we just continue to wish you good health and continue to do the great work. Thanks for being a part...

...of heroes of healthcare and thanks for the invitation to participate. It was it was great to do this. I've I really enjoyed it. You've been listening to heroes of healthcare. For more, subscribe to the show in your favorite podcast player or visit us at heroes of healthcare podcastcom.

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