Tele-Town Hall with Richard Gordon and Bob Riney

Well. Good morning everyone. My name is Brad Williams. I’m the vice president of government relations here at the Detroit regional chamber. Thank you for joining us again in our series of tele town hall meetings that the chamber has been hosting, uh, throughout the covid-19, uh, crisis. Uh, just a few minutes of housekeeping and then we’ll get into this important discussion. This morning first of all, you can find, uh, later today this conversation and every conversation we’ve had throughout this series on the Chamber’s website, uh, detroitchamber.com/covid19. Also, if you have a question, uh, for Director Gordon or Bob Riney, our moderator, you can enter that in your chat box, uh, which is on the right hand side of your screen. For those of you who have, who have logged in via the computer. Uh, with that, we’ve changed up the format a little bit today. Uh, our guest is the director of the state department of health and human services, uh, Director Robert Gordon. Uh, but we’ve brought in a moderator, um, outside of the chamber staff. Uh, and we brought in, Bob Riney, who is the president of healthcare operations and the chief operating officer at Henry Ford Health Systems and we’re going to start by Bob giving, uh, Bob is going to give us a little bit of an update of what has been going on at Henry Ford. Uh, we know that the stress placed on our healthcare systems has been tremendous. Uh, and then Bob is going to lead the conversation with Director Gordon. So with that, Bob, I will hand it off to you and thank you for joining us today.

Bob Riney:

Thank you and good morning everybody. Um, I just wanted to start off with a little bit of an overview of what’s going on at Henry Ford Health System, which in many ways mirrors what’s going on in some of the other Southeast Michigan, uh, health systems. But, uh, I wake up every morning early and I look at what has transpired overnight in terms of overall volumes and what I will tell you is that we’re still continuing to see an increase in the number of covid patients that require hospitalization. We are seeing, um, uh, what I hope is smaller spikes as opposed to larger spikes over the last few days, but it’s way too early to certainly tell whether there is any kind of a flattening of the curve that we’re starting to see at. In fact, our predictive modeling, which suggests that we’re a little ways away from that. What we are seeing though are patients that are presenting themselves quite ill. So, as I wake up this morning and look at our data, we have a 915 patients that are in isolation with, ah, the vast, vast majority of those patients being covid, positive or presumed positive, uh, pending tests. So, you know, as we look at that, every day we assess three different things, our physical capacity, our human talent capacity and our supply capacity. And with physical capacity, we have been doing okay by putting a kind of Detroit ingenuity to work on a daily basis and so we’ve converted what used to be general practice units to intensive care units because that is where we see the significant crunch in terms of bed needs. We’ve also taken some of our clinic space both in ambulatory surgery sites as well as attached to our hospitals and opened up, if you would, ‘mini hospital units’. So we’re doing a number of things to expand the physical capacity. The supply capacity is a daily battle. We have been so fortunate by the Southeast Michigan business community who has kind of raided their closets and gone through everything they can in terms of their supply chain connections to help us and I might add the State of Michigan has done a terrific job in that regard as well, but it’s not a comforting way to build your supply capacity as you can imagine, because these are such vital supplies. So every day we are working 24/seven to make sure that we are finding ways to uh, getting into new avenues for supply procurement and we chase a lot of dead ends to be honest with you, the things that look promising, but either there’s a price war going on or it just leads to something that is embargoed somewhere in another country and can’t be shipped or all sorts of different situations, but we are having certainly some success. One thing I would like to share with you on supplies just to put in perspective is these patients, um, require a lot of PPE for all of our caregivers to wear and so when you see things like “a shipment of 500,000 X”, you might think, “Oh my gosh, that’s a great number. That’s huge”, but just to put a little perspective, isolation gowns, which is something that we’re currently really struggling to build our supply on. Just Henry Ford alone, it’s going through a burn rate of 15,000 a day. So just to give you perspective of the magnitude and the quantity of supplies that you need as we go through, uh, fighting this covid-19 battle. And then last, but most important to me is our human talent capacity. Do we have the staff to increasingly support expanded ICU is expanded ventilator use. I’ve said before, “hero” is too short of a word in my mind to describe healthcare workers today because they are just doing extraordinary things under extraordinary circumstances. But we are worried if this volume continues and I know all the other health systems are as well about that talent. So we are seeking talent from other states, other parts of the country that have not been hit with the kind of a covid-19 surge that Detroit has. We have redeployed, and continue to redeploy clinical talent that might not have been working in a hospital setting, uh, but can come and support. And, uh, we’re also looking at how we can get creative with our scheduling and our staffing so that the team members have a chance to rest, so that they don’t burn out in this, uh, struggle because it’s not likely to end anytime soon. Uh, so the human talent capacity, we’re also calling on retirees to see if they’re willing to come back into the fold for an interim period of time. We’re getting a lot of positivity, um, but it’s a, it’s a significant strength. Um, so let me stop there and turn it over to Robert Gordon, who’s our state’s leader of health and human services for the state of Michigan. And who along with Governor Whitmer have been constant, um, partners with the healthcare organizations in this challenge. Robert,

Director Robert Gordon:

Thanks Bob. Thanks for having me, and Bob, thanks for all that Henry Ford is doing. You really are a ground zero of this whole thing. And, and you know, when I read the stories in particular of your frontline staff and the contributions they are making it’s always very moving. I will talk a little bit about the strategies we are pursuing. Obviously I’ll just start with the raw numbers, which continued to be, um, uh, jarring with each day. We had as of yesterday, 17,221 cases and 727 deaths. I think we do see glimmers of hope along the lines that Bob described that at least the, the rate of growth has slowed down, but there is still growth every day. And I think we share the understanding that not just at Henry Ford, but at a lot of hospitals, the, the admissions continue to exceed the discharges and that is a very precarious place to be and one we’re trying to address. The first aspect of our strategy is reinforcing social distancing. That remains critical even at this late hour. Um, uh huh. People being rigorous about going outside only when they have to obviously with a big exception for health care providers who have to that is going to save lives. Uh, every day that it happens and that remains the governor’s perspective and medical professionals perspective. We are investing in a media campaign to get that word out. It’s got traditional channels like PSA is, it’s got nontraditional channels like cell phone dialing people. We have a new “my mask challenge” around encouraging people to wear masks that will be going up with soon. So, so promoting social distancing is, is job one. I think number two is building out our testing capacity. We have had an increase, significant increase in the number of tests that we are able to do daily. But we also remain in a position where we are not testing at anywhere near the levels that we should be in order to, um, to diagnose and also to support the kind of tracking and tracing that would begin to enable us to return to more normal life. But we are doing everything we can. The governor, uh, almost every day is talking to some other source of testing, testing supplies to see what we can do to increase our capacity. We have increased and we continue to do so to and Detroit has been a leader here. Number three is building out our surge capacity, which Bob talked about quite a bit. The hospitals have added thousands of, we’ve granted thousands of CONs and have supported the hospitals to add thousands of beds, which is the front line of, of expanded capacity. And I’m appreciative of the steps that Bob described around changing the way the hospital works, but still enabling it, provide high quality care. We are, as you know, also creating additional facilities. So we are moving ahead at the TCF center, uh, with a FEMA designated site that will be for non-acute covid patients and we’re looking to start having people actual patients there in a few days, that has been a Herculean effort on the physical side and on the people side, which I’ll talk more about in a minute, we’re also building a facility. We have approval and are moving forward with suburban showcase in Novi that will be additional beds, in the Detroit region. And we’re looking at other sites beyond the sites. As Bob said, the people remains a huge challenge and uh, we will be getting some help from DOD around staffing the TCF site, but we need more people. The governor has put out a call for volunteers. It’s been, uh, it’s been aired nationally. She’s talked about it when she’s done national TV and uh, we have gotten thousands of people volunteering. We continue to be interested in growing that pool in every way possible. Traditional limits around practice and certification have been relaxed. Traditional rules around medical malpractice have been relaxed. We’re doing everything we can to enable people to come and encourage them to come and to create pipelines for them to come. I think if I had to name what will be the, the biggest gating factor in our ability to provide quality care through all this, I think it is as much and maybe more those people issues rather than the physical space. The last bucket of our, our, our strategic response I would describe as as how we are serving vulnerable populations. Obviously that’s at this point a huge sheriff of Michiganders in total for the agent. Um, we are working, uh, with our aging administration to support food delivery to support, um, ongoing home visits for folks who have in home care in a way that is that the minimum necessary to sustain the huge challenge around keeping people on the job right now for obvious reasons. With respect to mental health, we’re doing all we can to support the CMHS and support frontline mental health providers. Um, with respect to the, the, the broader low income population, we have worked hard to keep UI benefits flowing. Obviously it has been a massive crush on our UI system to be able to provide benefits at a level that nobody anticipated.

There have been some, some something breaks in service which just arise for a system that wasn’t built in this and that here and nationally didn’t get the level of investment than it needed. Nonetheless, we had been extremely aggressive about expanding access to UI benefits and I think that as aggressive as any state in the country and trying to lower income thresholds, extended periods of eligibility, uh, and, and ease the application process at MDHHS, we’ve done taking similar steps with the SNAP program and with state relief and we are managing much, much higher volumes and more generous benefits. We were one of the first States to push out the money in the first federal relief package. We pushed out $66 million to 380,000 families within a week after that package became law. So we are doing all we can to support getting resources out. Um, but, uh, but obviously the scope of the challenge is such that it’s hard to keep up. So I think, um, with that I’ll just say thanks to all of you. Thanks. Bob. Uh, texted the chamber for setting this up and I realized what an unbelievably great challenge this is for everyone. We are working, uh, really around the clock to do our part and to help Michigan get through this as best as we possibly can. Thanks.

Sandy K. Baruah:

[Bob Riney]: Thank you Robert. And I will turn it over to you, Sandy, so we can get into some Q and. A. [Sandy K. Baruah]: Great, thank you so much. Uh, director Gordon, uh, Bob Riney, thank you for the incredible work that you and your team are doing at this, at this critical time. So, uh, we have several questions. Uh, let’s start with a question for both of you. Uh, how can we quantify how effective social distancing has been in Michigan? So can we compare, uh, the rate of the infection rate kind of pre and post, uh, the governor’s executive order? Bob, why don’t we start with you?

Bob Riney:

Well, I can tell you that one of the things that we’re looking at is what’s happening outside of the Southeast Michigan. And so our epidemiologists and our public health officials are studying, um, the other markets and we’re studying those markets because, um, there’s two theories, right? One theory is that the other markets are going to get hit, get hit potentially as hard as Southeast Michigan, but there’s a delay factor. But the other theory is that if the social distancing was put in effect at an early enough stage for those areas outside of Southeast Michigan, that the number of individuals with the virus was a smaller number that we might see less spread, which would be a great problem to have because we obviously know that the virus was present in a significant numbers in Southeast Michigan before we were in a position to put the social distancing, uh, requirements into place. Um, so we’re looking and right now, you know, many of the areas outside of Southeast Michigan are holding their own. Again, I cannot draw a conclusion to that, but we’re hoping and then certainly in Southeast Michigan, the fact that the spikes aren’t as large as they were. And again, we don’t know exactly what that means but could very well be connected to. We’re now seeing, you know, 10 days, we’re seeing some time where the social distancing has been, um, uh, allowed to take, you know, full effect and I will, last thing I will say is we’re looking at, you know, kind of micro zones of hot zones within zip codes and looking at whether there are other conditions in those, um, particular areas that make social distancing even more difficult or where it just hasn’t been adhered to as diligently as it should be. And if we can tie back the, the increase into those hot zones relative to that, in many ways it will prove the theory of social distancing. But Robert, you may have some other things add, cause you’re very a schooled in this area.

Director Robert Gordon:

Yeah, no, I thought that was a great summary. And I think it’s very consistent with what we are observing that, that um, there is, uh, the growth rates, the doubling rates are slowing around the state. It’s just that they are slowing off of a much, much higher base in Southeast than anywhere else. And so we need them to slow even more to be able to say, yeah, about the situation there is, is under control. And I think the slot on the other hand, the slowing as to the rest of this day at off of a much lower base is good news because it signals that the period at which you would get to a problematic peak has pushed much further out. That could change tomorrow, every day, the day to look different. Um, and uh, and so we do observe day to, but, but I agree with the points about how we are seeing a bifurcation. We should hope that it continues and, and there’s every reason to think that the bifurcation is about social distancing. The reality is that this thing was in Detroit before it was elsewhere and so by the time the order came in, there was already a significant community spread. But I don’t think that’s true for the rest of the state. The last thing I’ll say on this point just is that we do also look at cell phone data and you know,there’s noncompliance everywhere to some degree and it’s different kinds in different places. But if you look at the cell phone data

um, it’s important to say that in the aggregate Detroit is doing quite well on social distancing. It has clamped down actually more than other parts of the state. That’s not to say that there aren’t individuals in Detroit who are ignoring the order and causing huge problems, but in the aggregate, the data showed that people in Detroit are taking this very seriously. And that’s an important to say and it’s confirmed by survey data that we’ve looked at. Um, and uh, I think I’ll just stop there.

Sandy K. Baruah:

Thanks. Okay, great. Thank you. Thank you. Uh, director, uh, you mentioned contact tracing. Uh, we have a couple of questions in the chat room about, uh, how is the state doing that and what level of confidence do we have that we have a good idea of how people are moving around the state or not?

Director Robert Gordon:

Yeah, so the level, yeah. Uh, I’m having to take that, um, we are stepping up tracing and, uh, we have gotten a lot of volunteers to engage in tracing folks with public health background. It does take a little bit of background or significant training and so we have greatly increased the amount of tracing that we are doing. We are also using technology tools. We’ve, we have a sort of, um, we’ve been using a dialing tool that reaches out to folks who we have reason to think had I, lots of contacts and, uh, it’s, it’s HIPAA compliant, but it also reaches those folks and, and provides them with additional information about the spread. And we’re going to build an additional tool. Uh, we’re working with a major technology company to build an additional tool that will deploy to automate contact tracing in a more formalized way. Um, I will say that, uh, for Detroit with the level of community spread that we have. It is, it is hard for contact racing to have, how would the level of testing we have in the level of community spread we have, it is hard for contact tracing to have a significant impact because there’s so many people that have it. I think it is a more meaningful strategy at this point elsewhere in the state where, uh, the disease where the virus is more contained and actually there is less community spread and so if we, there is a smaller manageable number of people who can be rundown, uh, and their contacts can be traced and they can engage, they can do isolation or quarantine. So there is a little bit of a difference in what is appropriate at this point given where we are, I think, and in Southeast because of the limits of, of testing and tracing. It’s another reason that social distancing remains the core strategy that we have to follow. Thanks.

Sandy K. Baruah:

Great. Thank you for that. Uh, uh, Bob Riney, question for you. Actually it’s a two part question. Uh, part a is other than PPE. What are the key needs that our healthcare delivery systems need right now? And secondly, if we have a staffing firm or a, our firm that has access to approved PPE. How does a firm like that get in touch with Henry Ford health system to, uh, offer their services or products? Two part question.

Bob Riney:

Sure. Well, in the, um, first part, in addition to PPE, you know what our healthcare workers, um, really want and need, um, are a few things. One, not to kind of go back to a point that we’ve raised, but they really want the community to take the social distancing very seriously cause they’re out there on the front lines doing everything they can to get people to return to health. And so they’re, you know, they, they drive home back and forth and they’re overjoyed when they see great adherence to social distance thing and they’re really demoralized when they see the examples where it’s not being adhered to. So I would say just first and foremost that in addition though to PPE, if you think about our caregivers, which by the way, when I say caregivers, I’m including environmental services, housekeepers, people that are preparing the food for patients. Um, the security officers and everyone else that is a, you know, a first responder in every sense. But they are struggling because they are working long shifts for all of our health systems. And they are also facing the same realities that everyone else is. And that having kids at home with all of a sudden no daycare or childcare support, many of them relied on bus services to get to work. And those bus services have been extremely reduced. And so all of those challenges and so Henry Ford health system has set up a covid-19 relief fund for our own employees to help them through all of the, you know, just really, really challenging things in their lives that they’re doing well. They are helping this community so hard. I would assume other health systems have, um, uh, some similar support programs. And you could go to Henry ford.com our website to get information on how you can promote, uh, and, and support this fund in. We have a well wishes campaign both for patients because if you think about, you know, one of the biggest and most sobering challenges is that our caregivers are not only working under incredibly stressful conditions, but because no visitors can be allowed in. They are also serving as that conduit between the patient and their family. So they’re passing on messages. They are, you know, holding that patient’s hand, doing everything they can to create a connection that normally is there with a visitor sitting by the bedside. And so this well wishes campaign, which there’s information on the website as well, allows the community to send messages of hope to our patients and messages of gratitude to our staff. And we are showing them on regular basis through all of our, communication process through the organization. And our staff is really deeply appreciative of it. So there’s some small ways in some big ways that, uh, people can help, uh, in terms of the staffing and PPE. Um, again, if you go to our website, there is a link which will directly connect you to one of our individuals that is, um, working the problems every day and looking for a PPE sources as well as, um, you know, staffing sources for especially for clinical areas.

Sandy K. Baruah:

And Bob, did you want to mention how a firm, either a staffing firm or a firm that’s offering PPE products can connect with the Henry Ford system?

Bob Riney:

I’m sorry. If you go to our website, there is a link. You can also contact our supply chain area and they’ve got people working 24/seven to get information and connect you to the right individuals for the particular supply or the particular staffing opportunities that you may, I have a connection to. And we certainly appreciate all of that.

Sandy K. Baruah:

Great. Thank you Bob. Director Gordon, we have, uh, a couple of comments here, a noting, you know, when such and such a firm has announced that they will go back, uh, go back into operation. How will, uh, the rest of us know when when we can kind of come out of our homes and start emerging, what would the green light look like?

Director Robert Gordon:

Well, the Governor’s stay home stay safe order that is in place now expires on April 13th, but I would expect another order that is, um, not identical but substantially similar to be coming soon. And, uh, I don’t know the precise period on that. I think unfortunately we’re going to be in a position of, of living with stay safe, stay at home until we are that we kind of have reduced social distancing and not re-introduce surges in the levels of disease. And I think as Bob said, we would want to be in a different place in terms of the admissions trajectory and hospital capacity and the number of infections and the number of daily. And so I don’t think it’s not, I don’t think it’s going to be forever. I don’t at all mean to be, you know, delivering a hopeless message. But I also think it’s, it’s not imminent when that moment comes.

Sandy K. Baruah:

Great. Uh, another question for you, director Gordon. Um, uh, what can the state do or what is the state doing to help county based public health organizations that, uh, seem to be cutting staff or don’t have the resources they need at the county level to respond to the crisis?

Director Robert Gordon:

Yeah, I mean God bless the local public health folks who I think had been under-invested in for years and now are the front line and being asked to do everything with levels of investment that just are not sufficient. We are doing everything we can to help them. I talked a little bit about the volunteers from around the state that we are sending including to Southeast Michigan and Detroit. Um, we continue to look at ways to provide more financial support for front end providers across an array of functions. And so there, there is some money that the legislature provided that we will be providers, uh, that are in need. I think the federal relief that has come in will be helpful. I believe there there’s definitely money for, for FQHC in the federal package and there may be other dollars as well. It’s huge amount, huge and complex laws that have passed. But the last thing I just want to say, and, and again, not to be negative, but just acknowledging our reality is that the state’s budget, because of the, the loss in economic activity, there’s going to be a huge revenue fall off. There’s some relief coming from the feds. It’s not really at the level that’s going to be needed to fill that hole. So it will be a very difficult period financially for us. I think we’ll find a way through the state outside of surge activities is basically stopping much of what we normally do in order to focus on response. And we’ll keep doing things like that so we can get as much money as we possibly can to the folks on the front line.

Sandy K. Baruah:

Great. Now we’re coming to the end of our time, uh, with Director Gordon and Bob Riney of the Henry Ford health system. I just want to ask a couple of quick questions. Uh, I’ll last question for director Gordon. A lot of discussion about, uh, the general public wearing masks, uh, when they’re outside out and about, uh, does the state have a recommendation regarding public wearing masks homemade masks or whatever?

Director Robert Gordon:

Yes, we’re supportive of the public wearing homemade masks when you’re in a setting that is public and where you will come within six feet of other people. We don’t, if you’re going jogging by yourself, you don’t need to wear a mask or going for a walk. But, um, but if you’re going to Meijer, uh, or Kroger, yes, we think wearing a mask is appropriate and it can be homemade. It is protective. The core reason is that Coronavirus is asymptomatic in a large and a significantly larger share of people than we realized. And, and there’s every reason to think that it can be transmitted in that period, even if that’s not the main method of transmission. And then wearing masks can reduce the rate of transmission in the circumstances. So the simple version is you can have coronavirus and not know it. And by wearing that mask you can protect others.

Sandy K. Baruah:

Great. Thank you. Director Gordon. Uh, Bob actually a related question for you. Uh, do you have a sense from the healthcare delivery standpoint, what percentage of Michiganders are out there walking around with the virus but are asymptomatic and just don’t know it. They’re not, you know, they haven’t been tested, uh, that they’re not under a doctor’s care but they are asymptomatic walking around. Do you have a sense for what that percentage might be?

Bob Riney:

I could not really give you a percentage. What we do know is that, um, the general population can be asymptomatic for several days and still be able to transmit the virus to others. And so, you know, the importance of social distancing has nothing to do with whether you’re feeling well or not. It has to do with the requirements. I would say the obligation of all of us to make sure that we’re doing everything we can to stop the ability for this virus to spread. And whether you’re feeling good or not is not an indication of that. It shouldn’t be used in any way. Um, and I do want to end just in a little bit of a, uh, a positive note. Um, one is that, you know, our team members are working so hard, are looking to celebrate small victories and there are small victories that are very encouraging. There are a lot of individuals that are very sick with this virus who get hospitalized, who are successfully being, uh, treated and are recovering and being discharged to homes that are doing well. So it’s important to keep that in perspective. And then secondly, our ICU teams have a small victory on nights where they have actually removed more individuals from being on a ventilator than the number of new patients that they put on ventilators. And well, that doesn’t happen every night. Those nights where that ratio is in the way I just described gives them energy. And I think it’s important for context. And then my last comment is Henry Ford hospital in particular has been around for over a hundred years. So we pulled the newsletter out of the archives from Henry Ford hospital in 1919 and 1920 where we were treating and played an incredible role in the last pandemic. And there’s a sentence at the end of the article that I think we all would hope because history could repeat itself and it says the epidemic ended worldwide as abruptly as it began. And I just think it’s good to end on that note.

Sandy K. Baruah:

Well that is a perfect, a perfect way to end. Um, I know a director Gordon had a hard stop at at 11:30, and so he has a, he has signed off the line. So what I will do, Bob, is thank you for your incredible, uh, service to this community. Uh, for those of you who don’t know Bob Riney, uh, this is not the only time that Bob has risen to the occasion, uh, here in Southeast Michigan. So thanks for all that you do in normal times, Bob, but especially during this crisis. Want to thank, you. Want to thank all your teammates at the Henry Ford health system for, uh, seeing us through this crisis. So, Bob, thank you very, very much.

Bob Riney:

It’s our pleasure and it’s really our caregivers that deserve all the praise. So thank you to them.

Sandy K. Baruah:

All right. And to our folks joining us on the phone. Thank you for staying with us for this, these extra five minutes. I’m sorry we didn’t get to all your questions. We literally have pages and pages and pages of questions, so we did our very best. Please know that this recording will be archived on the Chamber’s website. It’s Detroit chamber.com/covid19. And you can listen to this podcast, uh, later on today or in future days. Thank you all for joining us. Bob, Thank you again for your time. Hope everyone has a good day. Stay safe and stay indoors. Take care.