MAG members weigh in on the COVID-19 pandemic from A to Z

Adam Bressler, M.D. Shamie Das, M.D. Thomas E. Bat, M.D. W. Scott Bohlke, M.D.

Fonda A. Mitchell, M.D. Rob Schreiner, M.D. John J. Marshall, M.D.

MAG members weigh in on the COVID-19 pandemic from A to Z

The Journal of the Medical Association of Georgia asked a diverse mix of MAG members to weigh in on the COVID-19 pandemic from a number of perspectives, including how it has affected the profession, the economic implications, the biggest challenges they have faced, the steps that their practice or system have taken to protect their patients and their staff, how much support they have (or have not) received from the state and federal government, how MAG and other advocacy organizations have assisted them, and whether the state is prepared for a “second wave.” The MAG members who were asked to participate in this process included (in alphabetical order)…

Thomas E. Bat, M.D. – Family Medicine

CEO, North Atlanta Primary Care, PC

W. Scott Bohlke, M.D. – Family Medicine

Bohler Family Practice, Statesboro

Adam Bressler, M.D. – Infectious Diseases

Partner, Infectious Disease Specialists of Atlanta

Shamie Das, M.D. – Emergency Medicine

Emory University Hospital, Atlanta

John J. Marshall, M.D. – Cardiology

Chief, Northside Hospital Cardiovascular Institute & Governor, Georgia Chapter of the American College of Cardiology

Fonda A. Mitchell, M.D. – OB-GYN

Southeast Permanente Medical Group, Duluth

Rob Schreiner, M.D. – Pulmonary Medicine

President, Wellstar Medical Group, Wellstar Health System

How prepared/unprepared were we for COVID-19?

Dr. Bat: Fortunately, our practice recognized that some of the patients we were seeing that had traveled to Asia in January had COVID symptoms – and we started submitting persons under investigation (PUI) forms. However, the government’s response to the pandemic was, on every level, too slow and poorly 8 MAG Journal coordinated. From testing to public service communications, we lost valuable time and let this virus spread. Having reviewed the U.S. National Influenza Pandemic Handbook for the last 20 years, I believe that we should have collectively responded better than we did. Our failures will be analyzed for decades to come. Dr. Bohlke: I would say average. We have dealt with the flu for years, and we have undergone proper precautions over the years. I do believe that the speed with which virus spread made it very difficult to be completely prepared, and our health system is not set up to handle this type of situation. Dr. Bressler: We were prepared on some level due to previous threats (H1N1 and Ebola), as well as some lead time relative to other parts of the country, but there was simply no way to be totally prepared for the pace and degree of disruption. Dr. Das: Unfortunately, as a country we were unprepared for the COVID-19 pandemic on multiple levels. The pandemic further stressed an already stained health care system. While we have experienced “bad” flu seasons that have pushed our systems to the limit in terms of capacity, the pandemic exacerbated those weaknesses. In terms of the pathophysiology, COVID-19 manifests with a broad symptomatology that is comparable to many respiratory viruses, making it difficult to distinguish (other than the loss of smell and taste, which appears to be somewhat unique). Donning and doffing PPE is another area where we had not practiced enough prior to the pandemic, and we still are not 100 percent sure what level of PPE we really need (e.g., goggles vs. face shields). In terms of a systemic response, we did not learn from other pandemics like SARS, MERS, or the swine flu. Health care systems did not have procedures in place to account for the shift in volumes, the need for isolation, or testing a large cohort of patients. If a mass casualty event had occurred, many hospitals would have been overwhelmed and unable to meet the demands. Dr. Marshall: We were very well prepared. We had lots of PPE, etc.

Dr. Mitchell: The resource that really stood out at our practice during the early stages of the pandemic was our EMR. It allowed us to contact our patients on a remote basis, which enabled us to divert our resources to the more critically ill patients. Dr. Schreiner: On one hand, “we” – the U.S., the state, my health system, and our industry – were as prepared as possible. For example, we had a national entity charged with preparing for and responding to such events (i.e., the CDC), all health systems are required to have emergency preparedness and HICS infrastructures with discrete communicable disease plans, and we have more health care infrastructure (hospital beds, physicians, nurses, drugs, etc.) than nearly every other country. But on the other hand, the White House administration behaved in ways that diminished the effectiveness of the CDC’s response and the national response.

What are the short- and long-term financial implications for your practice?

Dr. Bat: We estimate that short-term losses for our practice were in the seven-figure range. It is always hard to make up for income that has not been realized. The long-term losses, such as further shutdowns and the increased prevalence and deaths, are harder to predict. Primary care continues to be at the front line of the COVID response, and we need to grow and strengthen our primary care practices if we hope to defeat this disease. One of the real priorities is increased reimbursement for our frontline physicians. Dr. Bohlke: The loss of revenue in the short- and long-term remains to be seen. A lot will hinge on payments for telehealth services. Dr. Bressler: Fortunately, we have remained busy and able to weather the storm as an infectious diseases practice. Our office/ clinic suffered a significant loss of patient volume early on, but we quickly adopted telemedicine – which helped offset some of those losses. Long term, I suspect telemedicine will remain a part of what we do. With the resurgence of COVID in the summer, after regular hospital activities resumed, we have been busier than ever managing both COVID and our usual ID work. And I think hospitals will further recognize the need for ID services, so I expect that trend to continue. Dr. Das: As a hospital-based physician, our practice has suspended CME funds (other than necessary for recertification) and retirement contributions. The decrease in volumes during the shutdown of elective procedures (and associated complications) has resulted in compensation cuts of 10 percent, and much more for those who are paid on a pure productivity model. The hospital sustained losses in the hundreds of millions of dollars by throttling back elective cases which generate most of the operating margins. Dr. Marshall: None so far. Dr. Mitchell: The biggest impact we saw was the loss of patient volume due to patients’ losing their jobs and, in turn, losing their health insurance. The loss of revenue associated with not being able to bill for remote care (telehealth, video) has been significant. Dr. Schreiner: My medical group shifted from a positive one percent margin to a negative 10 percent margin overnight. And that negative margin will carry over into the first or second quarter of next year at least – with cumulative losses that have only been offset by about 50 percent by the CARES Act relief funds. The remainder of the losses had to be accounted for with a combination of pay reductions, furloughs, delayed hiring, and delayed projects.

What are the biggest challenges your practice/facility faced (e.g., PPE shortage, testing, capacity, furloughs, employee wellness, other)?

Dr. Bat: The lack of leadership at the state and national levels of government remains the biggest challenge. There is no unified plans or messaging, the response time was slow, and there were a lot of mixed signals. Testing failures caused by poor leadership led to an exponential spread of the virus. Staff and physician anxiety nearly paralyzed the delivery system, as more than 80 percent of practices shuttered in March. In Georgia, we never surged past capacity and our health systems took the lead and managed this crisis well. PPE was in the news just about every day – and yet we experienced no shortages. Our masks and gloves protected us, we never closed, we never refused to see a COVID patient, and we began COVID testing as soon as soon as it was clinically available. Employee anxiety surrounding COVID, finances, and job loss are still top-of-mind, but our support systems at our practice have allowed us to excel and perform. Dr. Bohlke: The availability of PPE and testing capacity. We were able to avoid staff furloughs because of federal ‘Paycheck Protection Program.’ Dr. Bressler: We faced some real challenges on several important fronts, including PPE, testing, and employee illness. We also had to deal with furloughs that occurred at the wrong time when things were opening back up and patient volume was increasing. Overall, our hospital and the Emory system has done a very good job of navigating through these issues. Again, as things opened-up and the recurrent COVID wave hit over the summer, we were again strapped to near capacity trying to manage both. Daily, multidisciplinary coordination within our hospitals and the Emory system were critical to navigating those challenges. We have also had to work hard in our practice to maintain momentum and morale and manage staffing concerns and burn out and the like. Dr. Das: We had to contend with a multitude of issues. We had a stockpile of PPE, but we were also asked to re-use PPE that was intended to be used once. Hand sanitizer and disinfectant wipes were rationed. Early on, our hospital system suspended elective cases, freeing up much-needed bed capacity in preparation for the surge of patients – but the timing was a mismatch given the surge of cases that followed the reopening of businesses and as elective cases resumed…we once again saw boarding and issues with nursing resources as the system elected to furlough staff to stem the losses that were related to the shut-down. Dr. Marshall: Our health care system did not have to resort to these measures. Dr. Mitchell: We dealt with an array of challenges, including a shortage of masks and reagent for testing and a physician backlog of surgical cases. Dr. Schreiner: PCR testing capacity was a real issue in the March-April timeframe, as we had about 10 percent of what we needed. We now have 100 percent of the PCR tests we need www.mag.org 9

on hand, but the highly-variable turnaround time (TAT) for results – from hours for point-of-care testing to many days for send-outs – have impaired our ability to optimally manage the health care workforce, contact investigation, and meet basic customer expectations. The quick turnaround antigen test platforms offer hope. Having enough hospital and office staff (especially RNs) to handle the COVID and non-COVID load has also now become a problem.

What unique safeguards/processes did you develop/ employ to ensure patient safety?

Dr. Bat: In January, our practice developed protocols to deal with patients who were presenting from Asia. We sourced and used PPE at the onset of the crisis. We developed a COVID task force in March, and we educated our staff and our patients. We joined COVID education groups at our health systems and partnered with them to improve patient care. Our COVID treatment teams were able to keep 95 percent of our COVID patients at home. We continue to improve our COVID care plans, office protocols, and increased testing with same-day results. We have not had any office personnel convert, and we have not lost a single patient to COVID since the onset of the pandemic. We continue to strive to institute best practices and update our protocols – following Georgia DPH and CDC guidelines. Dr. Bohlke: Proper spacing in our exam rooms. We also asked patients to call before they arrived so they could be tested in their cars. Dr. Bressler: We have COVID-specific units. We have extensive isolation and PPE policies and robust testing throughout the Emory system. We also clinically evaluate all PUIs for clearance. Very early on, we started daily multi-disciplinary COVID rounds with ID, hospitalists, nursing, PT, infection prevention, and case management in our hospitals. This has been critical in developing and effective response. Like most places, we have instituted symptom screening and temperature checks. Dr. Das: Our ED implemented a split flow model to isolate patients who have respiratory illness. This created a strain on resources, as we have a duplicated our efforts of triage and work up (labs, imaging, EKGs, etc.) We mandated that everyone, including patients, wear masks to further prevent the spread within the facility and from patients to clinicians. Dr. Marshall: Flyte suit modification for cardiac catheterization procedures. Dr. Mitchell: We established a single-entry point into our building, where we asked screening questions, took temperatures, and distributed face masks and hand sanitizer. Dr. Schreiner: We were highly successful in preventing health care-associated transmission. We only had one patient who was hospitalized who clearly became infected in the health care setting. We followed the evolving CDC and WHO guidelines. So, nothing “unique” – we just followed the prescriptive guidelines (PPE, social distancing, etc.).

How would you rate the support/relief you received from state and federal lawmakers and regulators?

Dr. Bat: At both the state and national levels, the flow of information was slow and confusing. We also did not get enough help. We missed a window of opportunity in the January/ February timeframe to make a difference. By late March, the government did take some steps that helped – but it was too little and too late. CMS’ decision to loosen the telehealth regulations with private payers was a tremendous success. Let’s hope that government has learned from its failures. Dr. Bohlke: A B-minus. Their response was delayed, but once the scope of the problem was revealed it was appropriate enough to keep the health care system viable and not let it crash and cause more issues for patient care. Dr. Bressler: I was not directly involved in our interactions with the government, but some of the regulatory relief that made a difference were related to lab issues, payment for COVID care, and coverage for telehealth. These were positives. In terms of messaging, guidance, coordination, there has been a vacuum. I also think a much more rapid and extensive system for convalescent care would have helped. Dr. Das: It was non-existent. The lack of centralized, coordinated care and a lack of resources left every entity from private clinics to large safety-net hospitals to compete with one another and the federal government for scarce PPE and life support systems. The expansion of telemedicine was the one saving grace for patients who could no longer access the health system. We were able to innovate and triage the “well” patients from those who needed more urgent medical attention. This also enabled us to allocate our resources to more ill patients. A lot of patients who lacked access – for a variety of reasons – simply deferred their care. We are starting to see more of these patients, some of which have suffered morbidity due to the delay in care. Dr. Marshall: A 10 out of 10. Dr. Mitchell: I would grade them a five on a scale of 10 because they took too long to act on some important fronts, including extending the Good Samaritan Law to inpatient and outpatient care and reimbursing physicians for some virtual care visits. Dr. Schreiner: I believe that our state-level government – including GEMA and the governor’s office – was terrific. They expressed a genuine interest in listening to physicians and learning from us and helping us as opposed to dictating to us.

How well do you believe the state has handled the pandemic – and what changes would you have liked to have seen?

Dr. Bat: The state of Georgia took too long to acknowledge the epidemic in a public way (i.e., until it was necessary to “shelter in place”). But behind the scenes, DPH, the governors’ task force, and health system leaders were taking important action that helped to reduce a surge that would have crippled the state’s health care system. That said, we should not have relaxed the mitigation steps that we had in place until our numbers

were significantly lower. Re-opening the state as early as we did was a mistake. We still are not conducting enough tests, and it is still nearly impossible to conduct a same-day test. Dr. Bohlke: This was a very difficult situation for the governor. Close too late and risk peoples’ health or close too early and risk a significant loss for the economy. Georgia is required to balance its budget every year. With a significant loss of income, necessary and vital services that are provided by the state would have to be cut and people/services would have been affected. Dr. Bressler: I think our public health response has been poor. Testing, tracing, treating, quarantining, housing, etc. has been slow and inadequate and inefficient. If not for the monumental efforts of our health systems and private industry, it would have been beyond-belief worse. To me, the need to build a better public health infrastructure and response system is a key lesson. Dr. Das: In a pandemic, systems of care from social services to ambulatory services to acute care must be coordinated to ensure that the right resources are allocated to meet the needs of the community. With the politicization of something simple as wearing a face mask, the government has contributed to the spread of the disease. The fine balance (or imbalance) between supporting commerce and the public health demands to reduce transmission has proven challenging for the current administration to navigate. Again, the lack of coordination at the state level early on contributed to “hot spots.” The lack of timely testing and testing supplies further confounds our ability to contain the virus’ spread. The governor has made some good decisions, including encouraging the use of face coverings. However, his decision to not require people to wear face coverings has placed others’ health at risk and was unfortunate. Dr. Mitchell: The state took too long to close, and we reopened with industries that simply should not have qualified as “essential.” It was ridiculous to suggest that Georgia could host the Republican National Convention. Dr. Schreiner: I think our state handled it well (e.g., the use of the National Guard, mobilizing the MAG Medical Reserve Corps, and daily and weekly conversations with the major health systems to find out what we needed the most and when). I know that the governor has been criticized for “opening the state too soon” to business, but bankruptcy and poverty can destroy families just like the coronavirus. He was caught between a rock and a hard place (i.e., the public health conundrum of ‘death by viral pneumonia’ vs. ‘death by financial catastrophe’).

Do you foresee any permanent changes as result of the pandemic? (e.g., increased use of telehealth)

Dr. Bat: Let us hope so. Pandemic funding for research, testing, vaccine and therapeutics development, and population health need to become a much higher national priority. Primary care funding should also be expanded, and we need to place a bigger emphasis on technology and telehealth. We need leaders who will stand up and do the right thing. Leadership is about making the right decisions even when it is difficult. Dr. Bohlke: Yes, I believe that we are going to see an increase in telehealth use. I believe that people will be more focused on good hygiene practices, including washing their hands on a regular basis and using hand sanitizers. Dr. Bressler: We need to increase the use of telehealth, for sure. I think this is now ingrained in our society. Hopefully, public health and preparedness will finally become a greater priority – and I suspect it will. In terms of human and societal behavior, who knows? Maybe, but memories are short. Dr. Das: The lack of adequate reimbursement has historically stifled the growth of the provision of care via telemedicine except in the most progressive health systems. I cannot see the expansion of telemedicine regressing much once the pandemic is under control. Much like 9/11 changed how we fly, this pandemic will no doubt have a lasting effect on how we deliver health care and respond to these kinds of outbreaks. It might take some time, but I am hopeful that this experience will translate into lessons that will result in change – keeping in mind that a lot of the lessons we learned during SARS nearly a decade ago could have significantly improved our response to this pandemic, especially in the area of surveillance, testing, and containment. Dr. Marshall: Yes, I believe we are going to see an increase in telemedicine use and an increase in the telemedicine options that are available. Dr. Mitchell: The pandemic has forced the health care system delivery into the 21st century. We have newfound resources that will help expand care to underserved parts of Georgia. The Georgia Composite Medical Board needs to ensure that health care policy is aligned with the needs of the people. Dr. Schreiner: Telehealth in general – and video visits in particular – are here to stay. The rapid deployment and use of video visits are among the pandemic’s silver-linings. A lot of patients, and especially those with chronic conditions, are going to benefit from more frequent video visits (and fewer inperson visits) by physicians and allied health care professionals.

Has any good come out of the pandemic (e.g., changed the way physicians, health systems and hospitals interact and cooperate)?

Dr. Bat: Only time will tell if the lessons that we are learning are going to result in any permanent changes. Most physicians went home at the peak of the crisis. The front-line physicians – including primary care, ED, intensive care, pulmonary care, and others – are all heroes. Will the system recognize and reward them? I am not sure. Our health system leaders need to make some hard choices...better care or bigger profits? Dr. Bohlke: Better communications and coordination across the health care system. Dr. Bressler: I do think some good has emerged. There has been an incredible sense of cooperation and camaraderie among the health care workforce. Society also has a greater appreciation for physicians and allied health care professionals and everyone who works at a medical practice or health care facility – at least for now. At the hospital and system level, I have seen a

genuine sense of teamwork and cooperation flourish, which is something I hope continues going forward. Dr. Das: I think it is too soon to know if any of the recent changes in telemedicine and mutual aid transform into lasting change. History does repeat itself, so hopefully we can continue to appreciate the importance of communication and relationships from health systems to individual interactions. Dr. Marshall: Better cooperation and a recognition that we need to be willing to improvise. Dr. Mitchell: The expansion of care delivery options, including face-to-face options and virtual options (e.g., telehealth and video). Dr. Schreiner: I love the way that the physician leaders of health systems from across the state collaborated and cooperated. That never would have happened with non-physician leaders. The video visits proved to be an excellent adjunct to the in-person visits (i.e., from theory to proof).

How did MAG/organized medicine create value for you during the pandemic (e.g., coordination, advocacy, information)?

Dr. Bat: As news of the pandemic broke in March, organized medicine was jolted to attention. I was glad to have the help, but the overall response was too reactive. A lot of organizations channeled information from CMS and payers. They attempted to sway the conversation about the need to educate providers, staff, and patients. They attempted to influence lawmakers and other decision makers. Our government made some bold financial moves that helped. Yet there has not been enough of an emphasis on the front line health care responders who continue to put their lives on the line every day. Our practice today is still contending with COVID-19 daily, but we still are not seeing enough assistance with PPE, testing, and supply costs. Dr. Bohlke: MAG created value by providing great and timely information and by being involved with the governor’s task force. MAG represented physicians across the spectrum of specialties and practice settings. Dr. Bressler: I believe that most physicians were focused on patient care and/or keeping their practice afloat. I know that MAG distributed a lot of good information that helped practices deal key issues like telemedicine, HR, office policies, and reimbursement – which allowed me to focus on my job. Dr. Das: Organized medicine helped to create a unified voice for physicians. The #GetUsPPE movement and various town halls have helped to bring awareness to the challenges we face in the trenches. The MAG Medical Reserve Corps helped meet the needs of underserved areas. More than anything, organized medicine helped by disseminating timely information on patient care and practice management. I can lean on MAG to help educate lawmakers and the governor to implement measures to stem the spread of COVID-19. I expect MAG to be a voice for physicians and support those measures that may not be popular but are the right thing to do – such as suspending elective cases and wearing face coverings to prevent the spread. Dr. Marshall: Advocacy. Dr. Mitchell: MAG enabled physicians in the state to have an open line of communications with the governor’s office, the governor’s COVID-19 task force, the General Assembly, and other key stakeholders. MAG also went to bat for physicians on some key issues – including reimbursement. Dr. Schreiner: MAG – and Donald Palmisano and Ryan Larosa, in particular – organized and facilitated weekly calls with physician leaders. And MAG’s Government relations team (i.e., Derek Norton and Bethany Sherrer) did great work resolving some important telehealth issues with the Georgia Composite Medical Board.

Are we prepared for a “second wave”?

Dr. Bat: A second wave is months away, and we still need to survive this ongoing current surge. The administration’s COVID task force has gone into hiding. States are being forced to re-open for the wellbeing of the economy. Physician leadership is needed to guide these decisions, but there is not a lot of dialogue taking place. More testing is desperately needed – though I would add that our practice can now do up to 2,000 same-day COVID tests per month, and we hope to double that capability in the next month. We should be building our stockpile of PPE, but that is not occurring. I am confident that our medical scientists will develop therapeutics and vaccines by the end of the year. Our physicians, nurses, and first responders are heroes – and they will always be ready to serve our patients. The American Academy of Family Physicians is proposing new funding and payment methodologies to ensure the availability of primary care to meet the needs of our population. The successful primary care practices have become adept at delivering virtual care (e.g., telehealth, telephone, remote patient monitoring). COVID care plans allowed primary care physicians to keep 95 percent of COVID patients at home, monitoring their vitals, oxygen saturation, and admission into and out of ERs and hospitals. Being able to conduct COVID testing at primary care offices will help as society learns to safely return to work and school. Primary care practices must also get ready for the flu season, increased viral testing, developing treatment protocols, and developing immunization programs. Dr. Bohlke: I do not feel that there will be a second wave per se, but rather an ongoing pandemic. So far, it has not turned out to be a seasonal virus and not affected by the change of season. I believe that we will need to continue to be prepared every day until vaccinations are available plus a proven medication is available for the virus. Dr. Bressler: We essentially have just come through one. It was difficult to manage the COVID-19 epidemic and the rest of our health care needs at the same time, but it may no longer possible or even desirable to focus exclusively on COVID. Moving forward, I think we have at least learned enough to navigate both. How well we are truly prepared depends on how big that wave ultimately gets and what metrics are used to determine success. Dr. Das: We saw a lull in May, and I think we have already

crested the second wave. So many of the interventions that were taken early on have been abandoned, and the public is now so weary of isolation that I believe things are going to get worse before they get better. We are doing better in terms of PPE, but testing has proven to be a real challenge. I think the real challenge will be the coming flu season. Some have speculated that increased hygiene and social distancing might mitigate any summative impact, but only time will tell. Given the rate at which guidance was being provided and data published, the American College of Emergency Physicians (ACEP) created a clearinghouse web page. Getting guidance on how to obtain personal protective equipment was challenging and confusing given the lack of studies related to efficacy and supply chain issues. ACEP supported the #GetMePPE initiative, which was founded by an EM physician and continues to work to address supply chain issues. Shut downs in many communities and health systems strained emergency departments in other ways, including subsequent staff furloughs and lost revenue to creating new patient care pathways and split flow models of care delivery for patients suspected of being infected with COVID-19 and those presenting with other symptoms. Finally, ACEP has continued to advocate for addressing the psychological and social impacts of health care workers’ morbidity and mortality due to COVID-19 exposure. ACEP has been actively engaged on all these issues and the subsequent expansion of telemedicine resulting from CMS reforms. As emergency physicians, we continue to serve as the safety net of our health care system and rely on the tools and training necessary to serve our communities 24/7/365. Dr. Marshall: According to the American College of Cardiology, clinicians and researchers have documented significant cardiovascular sequelae in association with the infection since the earliest published clinical reports on COVID-19. Examples of this include elevated cardiac biomarkers, myocardial infarction, acute cardiomyopathy, myocarditis, and proarrhythmic and prothrombotic effects. Most cardiovascular interventions remain supportive, with biomarker and rhythm monitoring and standard prophylactic anticoagulation as indicated. We will be more prepared for a second wave than we were for the first one, for sure. Dr. Mitchell: No, but we do need more capacity for testing and screening symptomatic patients. We also need better contact tracing to stop the spread of the COVID-19 virus. Dr. Schreiner: We better be, because it is something that we are going to have to contend with for the foreseeable future.

Are there any other key takeaway points that you would like to make?

Dr. Bat: We are at the beginning of a process. Let us hope that we do better in the future, but hope is not a plan. We need to keep the conversation going, and we need to continue to serve the people we are trained to help. God bless America’s health care workforce! Dr. Bressler: The pandemic has highlighted the crucial need for our health care providers, including infectious diseases, hospitalists, critical care, nursing, allied health, RT, PT, laboratorians, case managers…everybody who plays a role in our health care system that may not always get recognized. They have all played a vital role during the COVID-19 epidemic. Dr. Das: Given the limited information and lack of coordinated government efforts, most health systems were left to fill the void with whatever information and guidance they could obtain. We are in uncharted territory, due the scale of the pandemic, in the modern era of medicine. When one examines health systems around the world that were successful in mitigating the effects of the pandemic, there are common themes, such as centralized coordination of care, including public health interventions and testing strategies, that aided in getting the outbreak under control. The U.S. is different in many ways to other countries who lack the geographic and cultural diversity that defines our country, but we need to really understand the shortcomings of our private, for-profit, decentralized health system. Yes, we get blockbuster drugs and other technologies – but we are abysmally bad at population health. We need to start becoming more intentional about how we deliver care and ensure equitable access and humanistic end-of-life care. Technology cannot solve all of society’s problems. We are all in this together. Hopefully, the current crisis has made that more apparent. I am hopeful that we will come out of this better than when it began.

COVID-19 Resources

American Academy of Family Physicians www.aafp.org/patient-care/emergency/2019-coronavirus.html American College of Cardiology www.acc.org/latest-in-cardiology/features/accs-coronavirusdisease-2019-covid-19-hub American College of Chest Physicians www.chestnet.org/Guidelines-and-Resources/COVID-19/ Resource-Center American College of Emergency Physicians www.acep.org/corona/covid-19-Main American College of Obstetricians and Gynecologists www.acog.org/en/Topics/COVID-19 American Thoracic Society www.thoracic.org/covid/index.php Centers for Disease Control and Prevention www.cdc.gov/coronavirus/2019-ncov/index.html Georgia Department of Public Health dph.georgia.gov/health-topics/coronavirus-covid-19 Infectious Diseases Society of America www.idsociety.org/public-health/COVID-19-Resource-Center/ MAG COVID-19 Resources Center www.mag.org/covid19 Pediatrics Pediatric Infectious Diseases Society www.pids.org/resources/covid-19.html PPE Clearinghouse www.projectn95.org