Responding to COVID-19: U.S., International, and What’s Next

May 13, 2020

Challenges in areas ranging from education to the environment, gender to governance, health to housing don’t exist in a vacuum. Each month, Abt experts from two disciplines explore ideas for tackling these challenges in our monthly podcast, The Intersect. Sign up for monthly e-mail notifications here. Catch up with previous episodes here.

Data collection. Analysis. Communication. Collaboration. As the coronavirus response continues to unfold, what’s working in the U.S. and around the world, and what’s next? Domestic health expert Ann Loeffler and international health expert Bob Fryatt compare notes and look ahead in this episode.

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Read the Transcript

Eric Tischler: Hi, and welcome to The Intersect. I'm Eric Tischler. Abt Global tackles complex challenges around the world, ranging from improving health and education to assessing the impact of environmental changes. For any given problem, we bring multiple perspectives to the table. We thought it would be enlightening and maybe even fun to pair colleagues from different disciplines so they can share their ideas and perhaps spark new thinking about how we solve these challenges. Today I'm joined by two of those colleagues, Ann Loeffler and Bob Fryatt.

Ann has two decades of experience working with healthcare safety net service delivery providers in the U.S. Trained in epidemiology and biomedical policy, she has worked with health center leaders in frontier, rural and urban areas.

Bob is a public health and health financing expert with over 30 years of experience working in public health and social policy in low, middle and high income countries. That experience spans NGO, government and multilateral settings.

Welcome.

Ann Loeffler: Thank you.

Bob Fryatt: Nice to be here.

Eric: COVID-19 is stressing health systems around the world, so I want to talk about the experience and possible solutions in the U.S. and internationally. Ann, what can you tell us about the U.S.'s response?

Ann: I think as far as the response, it's really been exacerbated by problems that already have existed in the U.S. healthcare system for decades. Things like fragmentation, lack of care coordination—general regional as well as local collaboration—that our healthcare system has suffered from all along. So it's kind of amplified those problems. Right now, we're seeing issues related to getting equipment and supplies like PPE (personal protective equipment).

We're seeing the healthcare system financially in distress because of lost revenue. They can't serve patients that they normally would under these conditions. They're concerned about keeping their staff safe and protected and well, and not just physically, but also emotionally. They're also struggling with the variety of information that's pervasive across the country, whether it's through social media or email chains that folks are sharing. There's a lot of misinformation out there.

Eric: So, Bob, when you hear about the challenges in the U.S. … I know that we're working with other countries on COVID-19. How are we helping to address some of those challenges elsewhere?

Bob: Well, one of the big things that happened in the last few months, which hasn't happened so much in the past, is a phenomenal level of collaboration and sharing of technology and information about what works and what hasn't. We've all seen what happened in China: within weeks, the technologies to develop tests was being shared. It was being published. The data was out there. They stumbled at first, but they initially put on a good response, and the rest of the world has learned from that. So I think that one of the first big changes is actually just collaboration about what works and what doesn't.

We're also, with U.S. government support, working in various countries to help bring them up to scratch. Some countries had their pandemic preparedness plans pretty well developed and prepared, but many were just simply not ready. So even getting the basics ready around how to prepare and contain very early outbreaks weren't in place, and so that know-how is being shared together with the latest evidence of what works.

Eric: So, Ann, how does that reflect with what we're seeing in the US in terms of our response? Are we seeing sort of the same trends, or are you seeing different trends?

Ann: I think it's very similar. I think, for example, in New York state you're seeing kind of a de-regionalization or localization of the healthcare system where you've got some communities contributing supplies and equipment to hotspots in their state. You're also seeing more collaboration between public and private providers so that there is sort of a shared capacity and offloading higher demand areas in hospitals where you need it. You also see, nationally, different states and governors looking to each other for interventions and policies that tend to flatten the curve, so they speak, so that people can learn from each other and see what's working in areas and trying them out in their own places. So more of that collaboration, I think, is happening.

Eric: So, speaking of flattening the curve, if we're seeing that collaboration where people are coming together, what are some of the next steps that we can be taking or that governments are taking to get things under control more quickly?

Ann: Well, I think these measures, we're starting to see that they do matter, that physical distancing is having an impact on the number of new cases that we're seeing. I think where we could do more is having more of a cohesive and consistent strategy across states. Because, for example, I'm in Colorado, and we have a lot of physical distancing, mask wearing, all kinds of policies in place here in Colorado to keep everyone safe and keep the curve flat, and we're surrounded by states that don't have those policies. But that doesn't mean that people who live in those states aren't coming to Colorado. It just means that the policies are different. So there are risks associated with that, when you don't have that level of consistency.

Eric: Right. So, Bob, obviously we do a lot of health system strengthening internationally. What could the states maybe be doing to help get a more consistent response?

Bob: Well, there's an amazing amount of learning and innovation going on across the world, and one of our roles really is to pick up on that innovation and learning and spread it more widely. It is remarkable, when there's a crisis, what can happen. Often it's not easy to detect that when you're in the States or in Geneva. So you need to have links to the field and find out what's going on and how they're coping, get that documented and get that shared. So that's one thing.

The other is actually is getting the science in place. I mean, getting good data and analysis and research. There's been a huge call for research to take place in the social sciences and the basic sciences. The response to that is great, but that knowledge has to be synthesized and disseminated, and that's another major role that we're finding ourselves taking.

Eric: How so?

Bob: Well, a lot of it comes to just basic things. So in some of the countries we're working in, a lot of that is actually just working with the policymakers and the managers, getting some of the basics understood and disseminated using all sorts of local media and using local experts and local groups to sort of disseminate the messages.

The other area that we're getting brought into is around procurement of essential supplies such as tests and such like. There, because the technology has been moving so quickly, we have to keep up with the latest technology about what's the best test and then the best sources and then plug that into national needs. That's occupying a lot of our time at the moment.

Eric: Got you. Ann, what are you seeing in terms of having to get those resources in place in the States? Are we making progress?

Ann: I think one innovative thing that has actually become more important than ever is the nation's primary care safety net, the federally-qualified health centers. Right now they serve almost 30 million people across the country through 12,000 primary care locations, and we've really seen them step up and offload the hospital burden in terms of their surge capacity, and they're doing that through triage and treatment. They're doing tests. I think 75 percent of health centers are doing tests, that testing right now. They have pharmacies. They are a trusted source of information, and I think down the road they will be an important source of vaccinations and immunizations and also surveillance. They have state and regional electronic health records data that could potentially serve as surveillance of any further outbreaks as we look down the road.

Eric: Is that something we can help coordinate, like through dashboards or clearinghouses? How do we bring all that together?

Ann: Yeah, I definitely think Abt's ability to do data visualization and dashboarding would be something where we could play a role. I also think our capacity with predictive analytics—so even if there isn't a positive COVID-19 test but there are these other health indicators, respiratory issues, things like that that might flag or predict potential outbreaks in the community—I think there are a lot of options where Abt could play a role in anticipating epidemics or second waves, third waves. We've heard people talk about those are the types of things that we could do with that data.

Eric: Yeah, great; we even talked about it on a previous podcast. That segues into my next question, which is: we've talked a little bit [about how] there was a learning curve, people are coming together, we're adapting in the response. How can we help countries—the U.S. and others—learn from this for the future? What can we do to help make sure the next pandemic can be managed more efficiently and more effectively?

Bob: Right. Well, that's a big one, I mean, the big question. This had started after some of the previous outbreaks, but there's going to have to be a lot of thinking around how this all started, the viruses, where they come from and how we can get better at surveillance, picking them up as they jump from animals to humans. This has happened in the past. It's going to happen again. It's not just about the public health response, it's also about the economic response, which is going to be absolutely vast. I think a lot of people are going to be scratching their head and learning about how can we do this better and not have such an impact on our economy, on our society. How can we do it in a less disruptive way?

Eric: How about you, Ann? What do you think for lessons we want to learn for the future here?

Ann: I think we've learned a lot about the barriers to really just getting services out to people, and that's been reflected in loosening the regulations and policies that prevent access to care. We've seen changes in restrictions around telehealth services, for example, data exchange, being able to share information, those types of rules that prevent things like collaboration and multi-sector involvement, I think has been successful. I think, in general, the work that Abt does to strengthen health systems is really going to strengthen the foundation of our healthcare system overall.

So whether it's our work with the centers for Medicare and Medicaid services on quality payment for quality, different payment models for bundling services and things like that, I think those are things that kind of strengthen your healthcare system so that when these types of epidemics come along, the healthcare system is able to be more responsive.

Bob: One of the lessons that we see in COVID, but this is the same for virtually all infectious diseases, about many diseases, is that often those groups, certain groups who are more vulnerable are at higher risk of getting a serious disease or even a lethal disease. We're certainly seeing that with COVID-19. Everyone knows about how the elderly is really prone to getting a nasty illness and the death rates are much, much higher, those that are immuno-suppressed, the people that have preexisting cardiac and restrictive diseases, the overweight. I think we do need to quickly pick up on that.

Eric: So what are some things that we could be doing?

Bob: It can be some little things. I mean, in some countries you find simple things like just making sure things are translated to the groups. Some groups are more marginalized in other countries that have multiple languages and making sure there's good communication to all groups.

In the UK, around the groups that were actually more at risk, they had a special initiative where they identified all the immuno-suppressed and people that had sort of preexisting diseases, and they gave them a special package of services—health services—but also in the community. So they didn't have to go out. They weren't exposed so much. I think having those carefully-designed initiatives to protect certain high-risk groups, I think, no matter what the outbreak, is always going to be important.

Eric: Right, right. Ann, anything to add to that about what we're thinking about as we're looking at the at-risk populations here in the US?

Ann: Well, I think that it's aligned with Abt's mission to serve people who are disenfranchised by our healthcare system. I mean, there is data now that's showing that African-Americans account for over half of the positive cases in Chicago. So if you look at the South in particular, that's where you see the biggest health disparities as far as what would be considered at-risk because of an underlying condition.

So you couple that sort of risk status already with the lack of jobs that are more work-from-home. So, more blue collar jobs that you have to show up for so you can't practice physical distancing as easily—and the unemployment and poverty and all of that with the state policies that aren't requiring people to shelter in place—so it's almost like a perfect storm of how both policies and structural racism and other factors come into play to really create what will probably be a high level of mortality in the barrios.

I think Abt's projects across the country, whether it's related to evaluating projects that are designed to prevent recidivism in the justice system or looking at the factors associated with why cities like LA have such a major housing problem, all of those projects, I think, will help lead to maybe mitigating some of those issues. But I think what this country has seen so far in mortality, I think it's only the beginning when you think about in those other states where you've got all of those kind of factors coming into full force.

Eric: Yeah, I'm nodding soberly. So, it sounds like, as you're pointing out, it's a really a holistic issue. In this case health system strengthening goes back to the whole social structure strengthening, right? In terms of workforce and housing. It's a good thing we work on those things. To sum up, we're talking about: we need to monitor data, continue to strengthen health systems, and there is some research to be done. That sounds like the trifecta of intersects, which is why this podcast is called The Intersect. Thank you both for joining me.

Ann: Thank you, Eric.

Bob: Thank you.

Eric: Thank you for joining us at The Intersect.

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