Balance Lacking in the COVID-19 Response

Brent James, M.D., M.Stat., doesn’t want to be misunderstood. COVID-19 is a big deal. But…

“How do I nuance this? Covid is a very important disease, it has had a major impact,” James said in video interview with Managed Healthcare Executive® this week. “But not to the extent that some of the news media and some of our political leaders have pumped it. This is well within our scale as it turns out.”

James, an international leader in quality improvement and patient safety who became well known for his work at Intermountain Healthcare in Salt Lake City, said the initial reaction was understandable: “People are trying to make decisions in the face of poor data.” 

And he noted that some health systems were hit hard by COVID-19, citing as example Northwell Health, the 23-hospital system in Long Island and New York City. James said he has been working with Michael Dowling, the Northwell president and CEO, and that Dowling did, indeed, have a “true crisis.”

But James, who is a clinical research professor at Stanford but still lives in Utah, says there is “night and day” difference between what happened at Northwell and where he lives. He said he had been told about a steep drop in the number of stroke and heart attack patients being seen in the emergency departments of Utah hospitals.  

“It is not because those diseases aren’t happening. They most definitely are still happening. No question about it. The difference is that [patients] aren’t coming into system.”

James said a certain proportion of the current excess mortality in the country — he said he wasn’t sure how much — is coming indirectly from Covid-19 and the lack of care for life-threatening illnesses.

“Did Covid cause it [indirectly]? Yes. But it is because people didn’t come in for care for treatable disease that are life threatening. Like heart attacks, like strokes.“

James talked about the need to take a balanced approach to the outbreak. 

“I am trained not just as a statistician. I am also a surgeon. I was trained in surgical triage; as a statistician I would call it proportional hazards. You realize it is never just one thing. It is a whole array of things. You are trying to balance this new challenge against the array of other things that human beings continue to face.”

“Some people have been ‘professionally disappointing’ in terms of taking a careful, thoughtful balanced approach,” said James, without naming anyone. “They tend to be screamers, their hair caught on fire. The news media, to some degree, that is their business.” 

James said he expects monoclonal antibodies to lead to successful treatment and effective vaccines, although the traditional, protein-based vaccines will take longer.

“We’ll get on top of it. When we get on top of it, we’ll be looking back. I am really interested in seeing how fast it drops out of consciousness, how fast we get back to normal life after it is gone.”