Andy Slavitt Tweet Thread

numbersjunkie

This is a must read:
Threader
Note: This thread is related to #Coronavirus #COVID19
Andy Slavitt @ 🏡
@ASlavitt
Ex-Obama health care head. Helper. Founded @usofcare & @townhallvntrs. www.stayhomesavelives.us/. Insta: @andyslavitt. Listen: smarturl.it/inthebubble
Apr. 04, 2020 5 min read
COVID Upate April 4: Spent the day talking to hospitals at ground 0. Learned about new problems that will emerge everywhere.
And on a program for vulnerable populations rolling out in NY that can be done everywhere.
Amazing stuff. In about an hour. Follow if interested. 1/
3 of the next major hot spots in are NYC, New Orleans & Detroit. I decided to talk to all 3 today— hospitals, Congresspeople, health commissioners. To figure out how to help and to send the early warning signals to everyone else.
It’s like talking to civilians fighting a war.2/
The NY Public hospitals have 3500 beds & are right in the middle of the war zone. I heard from the WH that they had the biggest challenge on vents & vents were sent there.
They in fact told me that vents r not their biggest problem. What he told me are not in the news as much.3/
Number one issue by far is labor: they are desperate for RNs, nurse practitioners & especially respiratory therapists.
So short in fact that they will fly people, put them up at a hotel, and pay them big sums. They also have sufficient PPE for people willing to do it. 3/
I don’t want to list what they would be paid here because shortages drive bidding wars, but I looked up starting salaries & the weekly payments are 6-8x traditional salaries. 4/
If anyone is interested here is an intake form: https://covid.nychealthandhospitals.org/Volunteer
Or contact @AndrewSchwabDC at @USofCare
So I decided to call the American Nursing Association & the equivalent for Resp Therapists....5/
Andrew at the @USofCare team found them and got them both on the phone within the hour.
Here’s why: in MSP, Denver & other locations, nurses are getting furloughed & laid off as they eliminated elective procedures. 5/
Casual conversations indicate that these folks need money. And some would gladly go to NY.
To their credit, both organizations are putting out a call to find staff. 6/
I suggested that they organize a nurses and therapists brigade to go from place to place.
(I know I’m a great marketer.) 7/
Yes, there are staffing companies. And they are fully engaged in this. But we need greater reserves (and not clear we need to add profits to anyone).8/
The second issue is the lack of social services. I’m going to cover a great new program shortly but this covers everything from food to medications to social work. Every city should get ready. 9/
NY is also having real issues at the Javits Center. There are vents, staff & machines ready to go. But like the hospital ship, the rules are too tight & we have packed hospitals & empty field hospitals. 10/
Yes I let FEMA know although I’m sure they already did. Detroit having similar issues starting up its field hospitals. States start working on this now. 11/
The other issue was new to me and I can’t urge other cities enough to start focusing on this TODAY.
Reengineer rooms to pipe in Oxygen. The amount of oxygen to it takes to keep a COVID-19 patient alive is absolutely startling. 12/
Apparently 8 or more of those massive oxygen cylinders/day to keep someone alive.
I don’t know who the oxygen suppliers are & what kind of engineering is required to create walled oxygen rooms but look into it. 13/
Time out here: one thing I learned leading a major turnaround is until you go all the way through a complete cycle of something you don’t really know where the bottlenecks are. 14/
I wanted to talk to these 3 cities for the simple reason that today’s N-95 and ventilator problem tomorrow will be some other problem.
I wanted to learn what those problems are. 15/
Why we set up a rapid response unit. To capture challenges and best practices and get them to states as real time as possible.
Just because the federal government doesn’t do something doesn’t mean it can’t be done. 16/
https://unitedstatesofcare.org/resources/united-states-care-covid-19-policy-agenda/
Before I move on I have to mention something that one of the hospital leaders said. He said their no show rate had skyrocketed in COVID wings. I asked if it was because of PPE? No. Illness? No.
The answer...27/
“No one is supposed to see that much death.”
18/
Now I want to tell you about something that could be a game-changer.
The death rate will be disproportionate in low-income, older populations with chronic conditions.
So in New York, a group formed— The New York City Rapid Response Coalition to serve & save at risk people. 19/
They pulled 40 organizations together across NY to serve people & created a process & simple SMS based technology to reach out people to get them services. 20/
Who’s involved: hospitals, Medicaid plans, social service organizations, pharmacies, transportation companies, translators, telemedicine, & technology companies.
I did none of this work, but along with others agreed to serve on the board. The people who did this did it in weeks.
They did it without a penny. They are now approaching foundations now for funding. 21/
And @USofCare built a playbook following each step so this could be replicated in any city in America.
If we keep our seniors, sick & low-income neighbors safe, comfortable and well fed, we will dramatically kick down the death toll. We can do this.22/
https://bit.ly/3aDKYcp
I’m going to say what I learned today:
-Help the hot spot cities while you can. They will help you.
-Prepare for all the bottlenecks that can come up. There are more than meet the eye.
-Protect the people who need it.
-If we #StayHome we can help the most. 23/
I’m guessing many of you may have lost someone close to you in the past few weeks. I did today. One of the first people I ever knew. Not from COVID-19 actually but for the second time in 10 days, it’s a loss without a funeral.
Strangely it makes the loss not seem as real. 24/
Governor @PhilMurphyNJ decided to fly all flags at half-staff until further notice. Look at the flag or whatever fills you wih hope or solace ahead. Phil is going to be on #inthebubble this week as he deals with massive tragedy. You can subscribe./end
https://podcasts.apple.com/us/podcast/in-the-bubble-with-andy-slavitt/id1504128553

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Comments (8)
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foodonastump

Before I move on I have to mention something that one of the hospital leaders said. He said their no show rate had skyrocketed in COVID wings. I asked if it was because of PPE? No. Illness? No. The answer... “No one is supposed to see that much death.”

This one has been on my mind a lot. We’re early into this thing, and our healthcare workers are already drained, emotionally and physically. How long can they keep on going?

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barncatz

Wow - interesting numbersjunkie!

Just as to the last point, it reminds me of an article about Germany's approach. They have teams visiting identified patients, those who aren't yet hospitalized, to keep checking on them. They're getting them to hospitals at the sweet spot - before they crash out but if they can be maintained at home, they get that help to recover at home.

I didn't realize hospitals had furloughed or laid off nurses!


Edited - as to FOAS' point: there is a really interesting article by a doctor in new york over at The Atlantic. They've removed the paywall for coronavirus articles. It was really worth reading, inspiring and thoughtful.

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Izzy Mn(4)

That's the type of professional that needs to replace Jared.

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petalique

Don’t you think that the sustained high effort, high danger, high adrenaline, high death and suffering for so many weeks is going to cause a lot of PTSD? “Was Neurosis,” Shell Shock, “Soldier’s Heart.”

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terezosa / terriks

"as to FOAS' point: there is a really interesting article by a doctor in new york over at The Atlantic. They've removed the paywall for coronavirus articles. It was really worth reading, inspiring and thoughtful."

------------------------------------------------

Is it this article? There are several coronavirus articles written by doctors in The Atlantic

https://www.theatlantic.com/ideas/archive/2020/03/were-failing-doctors/608662/

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carolb_w_fl_coastal_9b(zone 9/10)

FWIW, Slavitt is the guy who volunteered and fixed the ACA website and then ran Medicare & Medicaid services for President Obama.

He's a Minnesotan and has been on Al Franken's podcast more than once, most recently discussing the pandemic.

A very smart and compassionate man. United States Of Care is his organization.

https://unitedstatesofcare.org/about-us/


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foodonastump

Thanks, t/t, I was looking and didn’t see that one. His predictions are exactly what I’m afraid of.

Before that I was reading an article about Long Island. Cuomo put some focus on us yesterday. Though early in the game, rescue calls are already doubled and maxed out. For the first time, calls for additional manpower are unanswered. Our hospitals are less equipped to handle this than NYC’s.

https://www.washingtonpost.com/national/coronavirus-long-island-nassau-suffolk-new-york/2020/04/03/af37f090-75db-11ea-85cb-8670579b863d_story.html?outputType=amp

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Nana H

FOAS, my heart goes out to you and your family as it does for all of you in hot zones coping with the stress of the disease and the terrible toll on your healthcare workers.

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