Three Duke scholars discussed issues related to medical supply shortages, the benefits of the $2 trillion federal bailout, and various health care challenges related to the COVID-19 pandemic Friday in a call with journalists.
Here are snippets from that conversation:
On the single best thing people can do right now
Dr. Mark McClellan: “It’s hard to do just one thing. But right now … follow the advice, the requirements from state and local government to physically isolate. That’s the best thing we can do right now. You’re going to see more cases and more hospitalizations in North Carolina over the next couple weeks.”
“What we do now is the most important thing to slow the spread over the next few weeks. Once we get past that surge, hopefully we can build out more capacity for the surge, for treatment. Isolation right now is really critical to help us get past the surge that’s coming in North Carolina.”
Dr. Peter Ubel: “We also have to take care of our mental health. We need to get creative about how to keep connecting to people in our lives, even as we stay physically distant from them.”
"On new interest in drugs like chloroquine and others for treatment of COVID-19."
Dr. Mark McCLellan: “There isn’t definitive clinical evidence that hydroxychloroquine or chloroquine are actually effective in the case of COVID-19. It’s premature for people to be using it. Right now the best evidence is that those drugs should be preserved for patients for whom there is clear evidence.”
Dr. Peter Ubel: “There are trials ongoing right now to see if it is effective against the virus. But there’s been so much hype and enthusiasm for the drug you worry about there being shortages for people who do need them.”
“Individual physicians need to show restraint in prescribing these medications.”
On the role and power of states during this crisis
Arti Rai: “Local authorities have a lot of power. (Locally) Durham has put in very significant restrictions. That’s certainly completely legal. If we were to go beyond that to talk about mandatory enforcement of those restrictions, some of the concerns that might arise are liberty issues. But the Supreme Court in a series of cases … made it clear states have a huge amount of power. To the point of even mandatory vaccination and the like. We probably wouldn’t go there, but if we needed to, that would be possible.”
On the $2 trillion federal bailout to stimulate the economy
Arti Rai: “The $2 trillion does give a lot of money to relevant agencies, which I think is very good. One of the issues that has received a lot of attention in the media, and rightly so, is whether all that money can be prioritized quickly and effectively without the president involving the Defense Production Act.”
“There are challenges up ahead in terms of the balance that has to be struck … between incentivizing industry to come up with interesting new antivirals and vaccines … and then figuring out how to get access.”
On how to deal with surge capacity and the urgent, immediate need for supplies
Dr. Mark McClellan: “A lot of that is bringing together a publicly led but private collaboration on matching up demand and supply for the most needed resources in the short term. For us for the next couple of weeks, that’s all about surge capacity for an increasing number of cases especially those that need hospital care and ventilator care. Beyond that there is a great need to develop greater diagnostics and capacity to detect when exposure occurs and when illness occurs out in the community.”
“Vaccines take a while but there are therapies in the works right now that can be accelerated. We need to be thoughtful about supporting fast work and showing these treatments are safe and effective.”
On the decisions doctors make when ventilators are scarce
Dr. Peter Ubel: “When there aren’t enough ventilators to go around, the primary thing people are going to do is try to figure out how to save the most lives with the ventilators we have. And there are scoring systems that measure how sick people are, that help you set priorities about who should receive ventilators and who should receive comfort care.”
“So that’s the primary thing people are doing. And in addition, giving priority to health care workers, to get them back in working with patients.”
On finding a rare bright spot in this mess
Arti Rai: “There has been a remarkable coming together of the scientific community with respect to sharing of data, and putting drugs into trials, particularly drugs that have already been tested for safety and so forth, to try to speed them towards some sort of marketability.”
“That’s a remarkable commitment on the part of the public sector and the private sector.”
Meet the faculty:
Dr. Mark McClellan is an economist and former commissioner of the U.S. Food and Drug Administration whose work has addressed a wide range of strategies and policy reforms to improve health care. He is also a former administrator of the Centers for Medicare & Medicaid Services. McClellan now directs the Duke-Margolis Center for Health Policy. He can address questions regarding how to scale up U.S. health infrastructure in response to the pandemic.
Arti Rai is a law professor and faculty director of The Center for Innovation Policy at Duke Law. She can discuss scaling-up testing as well as pricing and research and development issues surrounding development of a vaccine. Rai can also address R&D and pricing issues surrounding potential COVID-19 treatments.
Dr. Peter Ubel is a physician and professor of business, public policy and medicine at Duke University. Ubel specializes in behavioral science and how health care decisions are made at the bedside and the policy level. Ubel, who writes a regular column on health care for Forbes, can discuss the federal role in ramping up response to COVID-19.
Duke experts on a variety of other topics related the coronavirus pandemic can be found here.