00:00 Kurt Baker: You’re listening to a podcast of Master Your Finances with me, Kurt Baker, a certified financial planner professional, Sunday mornings at 9:00 AM on 1077thebronc.com.
00:09 Kurt Baker: Good morning and welcome back to another edition of Master Your Finances, presented by Certified Wealth Management and Investment. I am Kurt Baker, a certified financial planner professional, located in Princeton, New Jersey. I can be reached through our website, which is www.cwmi.us or you can call me directly at 609-716-4700. This week, very pleased to have with us, Keith Hovey who is a licensed nurse and attorney. He works as an attorney for the Capital Health Medical Group, a division of Capital Health. He is also the chair of the Political Action Committee for the New Jersey State Nurses Association, and the litigation section of the American Association of Nurse Attorneys. Keith has experience handling litigation of healthcare and employment disputes, licensure issues before professional licensure boards, contract negotiations and hospital policies. He has testified on several occasion before various legislative committees on healthcare-related legislation and issues.
01:16 Kurt Baker: Keith, I appreciate you coming on. We’ve had a lot going on in the last few months, and I know you’ve been on before, I thought it was a great time to come back since you have a unique perspective from a medical perspective as well as the legal perspective, and there’s so much happening right now that impacts both of those, I thought it’d be interesting to see what your perspective is on what’s going on. So I guess we’ll start off with, when this started to develop, what were some of the thoughts that were going through your mind as far as an attorney and a medical expert, and then as we’ve phased into this, did you have any kind of process? ‘Cause I know when I first heard about what was happening, initially, it was like, “Okay, there’s a flu, be careful,” and then it got more serious, more serious and you’re like, “Okay, they want us to stay home,” and then they shut the gyms and I’m like, “Alright, I guess this is pretty serious.” So then I went the other way around like really cautious, right? Now, I think I’m somewhere in the middle. I think I have a little bit of understanding about what’s going on, but I’m still pretty cautious. So, I’m just curious about your perspective on what was happening, given your exposure to these different… The medical as well as the legal field.
02:25 Keith Hovey: Well, Kurt, great to be back. Thanks for having me on. I do have to just let everyone know that what information I’m providing is for informational purposes only, it’s not for the purposes of legal advice, and that the opinions that I’ll be expressing today are mine, they’re not the opinions of Capital Health or the New Jersey State Nurses Association.
02:46 Kurt Baker: Okay.
02:48 Keith Hovey: So with that…
02:49 Kurt Baker: I would expect, as a good attorney, you would say that.
[laughter]
02:55 Keith Hovey: Right. I will throw the disclaimers out of the way.
02:56 Kurt Baker: Gotcha.
02:57 Keith Hovey: You now, we were I think, like a lot of other states and healthcare providers is, we were getting the information as it was coming in both through media outlets as well as eventually the CDC. And what happened, at least very quickly for us, particularly in the New York-New Jersey area, is because we were hit so hard and hit so early on that it became almost like flipping a switch, and at that point in time, we went into, I would say, in the medical field, the term we use is of triage mode. We then started to prioritize, “Okay, what is it we need to do immediately to reduce the potential transmission, to get acclimated as to what we need to know, both from a healthcare delivery as well as a disaster preparedness standpoint to help ensure that we can deliver the care that we need as quickly as possible, and to make sure that we minimize the exposure to the providers.” To make sure that we’re taking care of the people who are gonna take care of the people who are getting sick.
04:26 Keith Hovey: One of the fundamental issues you have in healthcare, particularly when you’re dealing with whether it’s the coronavirus, whether it’s Ebola or other conditions, is if your primary care providers go down, there’s no one left to take care of everyone else who get sick.
04:46 Kurt Baker: I do remember we did… Early on, I know that we lost some pretty prominent doctors and things like that, I believe it was New York. I think that’s when it really became real, right? These people were out, and I know you can maybe talk about a little bit of this, I know there was concerns about the PPE, there was concerns about protecting them, was there enough supply, what was going on in the hospitals, were they actually functioning without necessarily being protected. And we weren’t even sure exactly fully how to protect is my understanding, like, how cautious did you have to be?
05:19 Kurt Baker: I’m just curious about how… ’cause I know that was a big topic initially was like, “How do we do this?” And I guess the ventilators came next, but I think we started off with the actual profession. First, you have to, as you point out, you’ve gotta maintain the structure to take care of the rest of us, if that’s not in place, then we’re all in serious trouble; if you don’t have that expertise out there. So what was going through their minds about how do we make sure we have what we need, if we don’t have it, how do we get it? What was that process like?
05:44 Keith Hovey: Right. Any institution that’s dealing with a new virus, new medical condition, the first thing you need to do is make sure that your individual, your staff, your providers are protected. So the easiest thing to do at that point in time is provide them the most protection possible. So it’s face masks, shields, gowning up and then abiding by the strictest precautions as provided by the CDC. In that regard, healthcare institutions and even institutions like New Jersey State Nurses Association, which is a membership-based organization, is looking to those people who have the most resources and greatest access to information. So that in our case, in the United States is the CDC. This is what they do all the time, but our job then as an institution that provides care based on their recommendations is to form a committee to make sure that the information gets disseminated to the people who need it. It may be things like drafting policies, it’s doing instructional videos, ’cause in this situation, what we need to do is, we need to educate everyone who’s gonna be providing direct patient care as to how to appropriately protect themselves and minimize transmission to other individuals.
07:14 Kurt Baker: Now, I think that brings up a lot of great points in there. I just remember when I was… And not that it’s… It’s the same but not the same. I remember as a merchant marine we went through this holy process. If you had a catastrophic event on the ship or catastrophic event, you went through all these drills and processes and things like that, and you’re always checking to make sure you have certain things in place so if things happen, you can respond to it. I guess some of the things that came up initially that I was wondering how this worked out, like if… ‘Cause there’s a lot of hospitals out there, and I assume that there is somewhat of a disaster preparation policy, like we have certain things, right? We know that there’s ebbs and flows with different things, whether it’s PPE or something else, and I know that was a topic initially. Well, we didn’t appear to have enough and there seemed to be some kind of sharing that went on. So if New York was being hit hard, maybe if I’m not getting hit hard in the Midwest, maybe they’re sending stuff out this way. So was this all communicated? Or was this something already in place? Or did it have to be done on the fly? Do you remember how all that worked?
08:12 Keith Hovey: Yeah, it’s a bit of combination of both. So you’re essentially pursuing two tracks at the same time. One is you’re doing an internal assessment as to what do you have and what are your immediate needs, and then doing some initial projections as to where you think you’re going to be and toward the near future. How far out those projections have to go is also based then on logistics, which is purchasing, acquiring to then supplement and backfill what your current needs are. So the difficulty in the New York-New Jersey area was that we didn’t have a real model other than some of what we were seeing in Europe and in China, and again, that information and how quickly and hard they were hit, the lag was not that great. We’re talking about a month, two months at most, and at that point in time, there’s not really enough data out there to analyze as to what your overall needs are, how the virus is gonna behave.
09:26 Keith Hovey: And also you’re trying to compare China, which has a billion people, and then you’re looking at Europe, which is a little bit different from its layout in a way, its people move and behave versus the United States. It’s not a pure apples to apples comparison and we’re doing that. At the same time, we’re trying to even assess where in the United States the virus is landing. So the logistics for us to get PPE, say, from California to New York or even if it’s somewhere in the Midwest to somewhere in New York, we’re trying to assess both where it needs to go, but we only can do that once we know where the virus is, and we’re a country where people are traveling across state lines all the time. So there was a lot of assessing at various levels of goals from the logistics side, the healthcare provider side, and then trying to project out based on what limited information we had.
10:30 Kurt Baker: And I remember as part of that, that we had this 14-day lag, which I think they realized early on there was a lag. I don’t remember if we knew it was 14 days or not, but I know they knew that just because you seem like you’re fine doesn’t necessarily mean you’re not contagious, and I think that was a big concern of a lot of us was like, “Oh, wow! We have people literally going around spreading the virus and not even realizing they’re spreading the virus,” which of course, is really dangerous because then they’re not self protecting at that point. They’re like, “Oh, I’m fine. I’m not gonna hurt anybody.” Which we learned is not the case, right?
11:02 Keith Hovey: Correct.
11:02 Kurt Baker: Necessarily.
11:03 Keith Hovey: Right. And if you look at the lag time, and even from when we started to have our first initial cases until all of a sudden, then even in New Jersey when the mask mandate came down. If you think about having a month and then even as we look back, it’s possible that even some cases were here in New Jersey as early as January, even possibly December. But during that entire time we have people interacting who are asymptomatic, potentially transmitting the virus. So by the time we had an appreciation, we were already at the point in time where infections were much higher than we had an appreciation for, and then once you have the infection rate is going up then you have the lag of the rate of death.
11:53 Keith Hovey: And then that’s when the death rate started to follow the infection rate is when we had a greater appreciation as to how transmitted the disease had become, how prevalent it had in our communities, and then that became the concern, because that’s what you’re dealing with from a treatment standpoint, is you’re trying to prevent the death. And now we’ve got all these healthcare providers who have never encountered the condition trying to address how to minimize hospitalization, keep people out of the ICUs and then keep the mortality rate down, and everybody is learning about the disease at the same time. So there are lots of interventions we now do in the hospital and preventative measures we take that we just didn’t have that knowledge of back in March and in April.
12:44 Kurt Baker: Yeah. Yeah, I’m gonna take a quick break here. You’re listening to Master Finances. We’re gonna be right back.
13:06 Kurt Baker: Welcome back, you’re listening to Master Your Finances. I’m Kurt Baker here with Keith Hovey, and we’re talking about how some of this information developed over the initial phases of the pandemic hitting the United States, and you mentioned that we really knew very little at the time. We had a little bit of information out of China, some information out of Europe, and then New York got hit really hard. And I just remember back then, we really didn’t have any idea what was gonna happen. At one point we thought, “Well, this is gonna be not much,” and then next minute we’re like, “Oh, this is gonna be really serious. We’re gonna lose a significant part of the population,” and we’re, of course, somewhere in-between now.
13:41 Kurt Baker: One of the things that I remember that… And of course, this is a hot topic now, it’s like this whole mask idea. So at one point they said, “Don’t worry about wearing a mask,” and now we’re back to the point where, “Definitely wear one if you can’t social distance.” Kind of my understanding, if you’re outside you’re probably okay as long as you’re not close to people. If you’re close to people definitely wear it. Indoors, some companies are saying, “Definitely wear it.” I mean some of the large chains. Other chains are like, “We’re not gonna enforce it depending on… ” What about your perspective on all this? Why initially they said don’t worry about a mask and then all of a sudden they said definitely worry about it, and under certain circumstances? Do you wanna walk through all that, why there’s so many different pieces of information on that?
14:24 Keith Hovey: Right. The first is follow the CDC guideline, which is wear a mask. There are some things that we know that we can do to drastically reduce the transmission of the coronavirus, it’s wear a mask, wash your hands regularly and socially distance. If we’re doing those things, if everyone is doing that, we will tremendously reduce the transmission rate of the virus. The issue in large part comes, I think as far as what the recommendations are as they were coming out, is that we were trying to understand the virus and the way the virus moves. When I say moves means how it’s transmitted from one person to another. When a person is infected, how does then that person transmit it to other people? The only way we get that information is when the virus has been in existence. We are constantly playing catch-up. You don’t ever get ahead, you simply follow the bread crumbs, and as we’re going through the forest here, we didn’t have the luxury of time to sit and analyze the data.
15:49 Keith Hovey: Remember the same people who are gonna be analyzing the data in part are waiting for the people who are providing the information because they’re the frontline healthcare providers, are collecting it based on their experiences and what they’re documenting, that then information gets relayed to people at the CDC and other academic institutions who are analyzing it. So we have to collect it before it can then be analyzed, and that process just takes time. And if you’re dealing with a hospital that has no capacity for future patients simply because everyone is taking care of coronavirus patients, your resources are limited and directed towards caring for the people who have the illness, rather than doing the data analysis and collecting it. That becomes secondary to the primary goal of saving lives. And that’s what initially we were doing, we were saving lives and then letting other people come behind us to analyze the data as it became available, knowing again, that the priority was first is, how do we treat these people and try to just keep them alive?
17:04 Kurt Baker: Do you wanna talk a little bit about how the hospital system had to make major adjustments? I know that things like a lot of the elective surgeries were stopped, and in some cases, I hear about people talk about elective surgeries. To some people, that’s been not necessarily be elective. It’s kind of like they have a heart condition or if they have something fairly serious, but it’s not an emergency. I know that ’cause there was concerns out there that, well, some things that might be an inconvenience, like maybe if your knee’s bad, it’s gonna be very painful for a while, which is not great, obviously, but other people may have a heart condition where it’s not an emergency, but we really don’t want you coming in. And you had to re-setup the hospital and you have to segregate places and things like that. Do you wanna maybe talk a little bit about that? How that impacted you from a procedural as well as from a financial standpoint, how that affected the hospital system?
17:54 Keith Hovey: Right. So once we understood and had better appreciation as to transmission then within our hospitals, not just Capital Health, but across the state, and particularly saw this in nursing homes with the idea of creating COVID-based units, that we were trying to minimize the transmission from people who we had confirmed COVID cases to people who did not have or already tested negatively for COVID. ‘Cause the idea is we gotta minimize transmission, and at the same time you’re a healthcare provider knowing that in some situations and settings, for example, rehab facilities and nursing homes, those people can’t go anywhere else. They’re socially distanced only to the extent that you have them. So it’s then a matter of, “Okay, well, we’ve got healthcare providers who are treating COVID patients, we’re gonna keep them treating COVID patients.” And then you’re going to have non-COVID or people who have tested negatively on different units, and then their providers will only be providing care for non-COVID patients.
19:13 Keith Hovey: So there became socially distancing within the healthcare facility settings to minimize transmission, but that became a reconfiguration. Another would be, for example, units that have the ability to treat ventilator-dependent patients. For example, a unit called like a PACU, a post-anesthesia care unit, that would then become almost like a hybrid or essentially, a pseudo-intensive care unit. It would become a place where someone could be on a ventilator. Whereas, you couldn’t have that on, say, other areas of the hospital. So you need to be a place where you could treat or have additional intensive care unit patients and have them treated by providers who are specialized in treating patients who are in the intensive care units. In other words, you don’t want a nurse who’s spent their entire life in pediatric oncology all of a sudden now trying to figure out how to work a ventilator and taking care of a COVID patient. You need people with some specialised training.
20:28 Keith Hovey: If you’ve got a heart condition, you don’t go to your gastroenterologist, you go to a cardiologist. Well, the same is true in nursing. So the nurses who are taking care of these patients, need to be taking care of patients when they’ve got the skill set for it. So then there’s also a shortage, how do you make sure that you have enough intensive care unit trained nurses to care for this influx of patients? So it’s not just a matter of do you have the beds? It’s do you have the requisite staff? And remember, intensive care units, you now have a nurse who typically takes care of sometimes two to three intensive care unit patients is now gowned up in one room all day with one patient. So then you’ve got a staffing issue as to making sure you have the people with the requisite skills and enough of them to take care of the people who are really sick.
21:17 Keith Hovey: So there’s a lot going on to make sure that we’re providing the best possible care and we’re minimizing transmission within a facility, knowing that we’re going to have to have COVID and non-COVID patients. Imagine being a family of four and trying to keep separated, half the people have COVID and half don’t, and you’re trying to keep those two groups separated within one household.
21:43 Kurt Baker: Yeah, that sounds really difficult. A couple things you brought up, two things I remember, I guess, there were people coming in from outside of the state is my understanding, and now aren’t they… We’ll go to the attorney side of this. Aren’t they licensed? If I’m a California nurse, isn’t that where I’m licensed to practice? So if I’m coming to New Jersey or New York, I’m technically not licensed in the state, right? So how were they able to bring these people in to work? Obviously, we needed them, so how did that all work as far as bringing people in from outside of the area?
22:13 Keith Hovey: So that process is still ongoing. What happened is that on a state-by-state basis… Mind you, every nurse, every physician, every physician assistant, nurse practitioner, everyone who has a healthcare license is licensed within the state in which they originate. There are some exceptions, but that gets a bit esoteric, but let’s say for the purposes, everyone is simply licensed in the state in which they live, then therefore, to practice in another state, you have to have one of two things: You either have to have a license in that state, or there has to be some sort of a waiver provided to you.
22:47 Keith Hovey: And what New Jersey did, and many other states did, is we provided during the pandemic, the state of emergency as declared by the Governor, to allow people with out-of-state licenses to practice in New Jersey. In other words, to help with the need for additional staffing, bring in nurses, bring in physicians and other licensed healthcare providers to help in the hospital setting. The other thing that we did is by removing elective surgeries, we also expanded telemedicine. So there’s been an incredible increase in healthcare being provided to patients by way of electronic devices, whether it’s the phone, whether it’s over the computer by way of a portal, or even as easy as FaceTime, Zoom and Google Meet, depending on what the patient has access to.
23:47 Keith Hovey: Now typically what happens in telemedicine is, the physician has to be licensed at the state where the patient is located. So if I’m a New Jersey provider and my patient’s out in Nebraska… Well, if I’m the provider, I have to make sure that I’m licensed in Nebraska, and that I can provide telemedicine both from a billing standpoint, but even just the ability to be licensed and practice in that state.
24:14 Keith Hovey: So what happened to us and one of the things that we, and a lot of other providers, had to do quickly, which is, when we had found that patients were quarantined in other states, is we had to make sure and still have to make sure that our providers were licensed in those states when they’re providing that care. So if you’re a patient and you’re not in New Jersey and your contacting your New Jersey-based provider, you’re gonna make sure your provider knows that you’re out of state before you have your telehealth visit. Because there’s a legal department behind there that has to make sure that for all 50 states, ’cause it’s not uniform, every state is different. The requirements are different for every state, some states don’t have waivers, some waivers have expired, their telehealth rules are different, their licensure rules are different. So every time that a patient is out-of-state, there’s a process that has to be gone through from the legal standpoint to make sure that we can even provide the care.
25:13 Kurt Baker: Right. Excellent points, Keith. You’re listening to Master Your Finances, we’re gonna be right back.
25:18 Kurt Baker: Welcome back, you’re listening to Master Your Finances, I’m Kurt Baker here with Keith. At the end we’ve been talking a little bit about telemedicine just before we broke, and he was talking about the different licensing and the fact that it’s different in different states so you have to be really careful about when you’re doing the telemedicine is everything in place structurally, legally in order to have that relationship. I’ve heard from several people that three or four months ago would never have dreamed of doing a telemedicine call. Even some professionals who did it on a limited basis, they tell me like, “My whole afternoon is all telemedicine type stuff.” It’s much more utilized than it had been in the past, and I was wondering from your perspective, what do we learn from the professional side of the screen as well as from the patient side of the screen? Maybe some things that we weren’t aware of or now that maybe we’re doing a little bit better than we would have been doing three or four months ago even.
26:11 Keith Hovey: Yeah. Great point. I think one of the things that we have benefited from as a result of the pandemic is that in a very short period of time, people have become very comfortable and have acclimated to the idea of telemedicine. People have had become very comfortable with both the technology, even on the provider side. Providers have had to get comfortable very quickly with providing telemedicine and familiarity with. And with that practice, their medical practice improves. Through experience, we get more experienced and we get better at it. I think also what we’re gonna have then is a greater data sample at some point in time in the future, to then be able to go back and analyze what was the quality of care, and that analysis is gonna come much later down the road, but we’re gonna have a much larger sample, particularly in New Jersey and New York, and then now as you see other states spiking and their telehealth medicine practices increase, they’re gonna have data samples as well that we’re gonna be able to analyze quality of care.
27:26 Keith Hovey: I think on the flip side, from the patient’s standpoint, what we’ve learned is that some patients really like it. There’s a convenience factor and now there’s a comfort level with it. I think early on also, one of the things is that people who would never have thought to use telemedicine said, “You know what, I’ve got a condition, I just can’t wait but I’m too scared or I’m immunocompromised, or I’ve got someone at home who’s in need of… I have to use it.” They were forced into using telemedicine, and as a result, after the experience, they said, “Jeez, that was a lot easier than I thought,” or “That didn’t go as poorly as I thought it might,” or “I just really liked the convenience because my kids were at home ’cause they’re out of school, and I only had to take a half an hour rather than two hours to go see my doctor.”
28:21 Kurt Baker: Yeah, with it too, convenience is really huge, but I’m assuming that you can’t do everything through telemedicine, so if I have a condition is my first response to try that and then they’ll say, “Here’s what we can do, and well, maybe you need to still come in,” right? Depending on what the situation is, but I’m assuming a number of things can be screened, especially I’m just thinking when I had young children it’s like, there’s a lot of stuff where as a young parent, you’re like, “Oh, my gosh, what’s going on? So you bring your kid over, put him in front of the screen, explain what’s goin on,” and it’s, “Oh, no, you’re fine or maybe you not fine,” but I would suspect… And we found out as you became a parent longer that many of these things were just us being concerned as a parent, but they could differentiate that fairly quickly and then only come in if you really need to, right?
29:02 Keith Hovey: Right. And I think this goes to on both sides, so physicians now are getting a little bit more adept and saying, “Okay, well, I don’t just need them sitting there, you’re having some concerns with your gait, just step back and walk, take a couple of steps.” And then their ability to do an assessment expands because they’re getting more familiar. The flip side with the parents is, well, what things do parents have at home? Well, jeez, they’ve got a thermometer. So like, “Okay, let me take your temperature right now,” or “Let me look at the child,” or “Let me look at you. Hey, can you open your mouth for me?” There are certain things you can do, but then also, there’s always the benefit that the standard of care is still the same.
29:45 Keith Hovey: In other words, you don’t get less quality care or a physician doesn’t get to, or a healthcare provider doesn’t escape any sort of liability because they’re providing telemedicine. They don’t get to provide you less care, what they have to do is say, “Well, jeez, you know what? I have some questions about this. I don’t feel like I can provide you the full care necessary for what I’m seeing, there are other things I need to know, and I can only do that in person, so I’m gonna need you to come in.” And they schedule that visit, and that could be anything from, “Hey, you might be having a heart attack, you gotta go to the ER right now.” Or, “I have an opening this afternoon,” to, “It doesn’t look that serious so why don’t we see what you got later on in the week, as far as you coming in.” But the standard, the care that is being provided, that level is still the same, whether it’s telemedicine or in person.
30:45 Kurt Baker: I can actually see where it might actually improve because somebody might be more likely to set up a phone call because it’s more convenient. I know many people are busy and they’re like, “Oh,” they put it off, put it off, put it off, and then they don’t ever see their physician ’cause it’s just too inconvenient. But if you can actually get on the phone and talk to somebody, then at least you can clear it up one way or the other and move on. Right?
31:02 Keith Hovey: Right. And that ties right back into the concern that we have with the coronavirus and people being afraid to come in and see and make an appointment with their providers, ’cause the one concern that we had early on with the coronavirus is that people were having conditions that they were then willing to dismiss and say, “You know what? I’ll just put it off. I’ll see how I feel later on.” And that what we know and there are a lot of instances whether it’s your heart or it’s potential stroke, there are certain conditions that we need you to come to us, we need to shorten and truncate that time for the healthcare delivering interventions. And our concern is that people aren’t getting those because they’re too afraid of the coronavirus.
31:56 Kurt Baker: And I can see where it ties into. They even said even if you had the coronavirus, if you were able to manage it at home and there was no other conditions that were gonna put you in serious danger, they were actually recommending we stay home because then you’re less contagious, you’re not gonna infect other people so there is actually this balancing act. So even if you had the virus… And I can see where telemedicine might come into play like, “Okay, I think I may have it,” they can do an analysis and say, “Well, you look okay now, why don’t you just stay home? We’ll manage it from home then if it gets more serious, we’ll bring you in.” Then you’re only bringing in the patients that probably really need the full care at the hospital, is what it sounds like.
32:36 Keith Hovey: Right. And with that, we don’t wanna lose the trees through the forest in the sense that if you’re having chest pain, it’s appropriate to have concerns about the coronavirus, but if you’re having chest pain, you’re sweaty or diaphoretic, and you have numbness down your left arm, you need to go to a hospital. Don’t delay those treatments because you’re afraid of the coronavirus. If you’re having symptoms that you would otherwise go to a doctor, that’s a perfect time for a telehealth visit or if it’s more urgent, to be reaching out and still go to your emergency room.
33:17 Kurt Baker: And that kind of bring… I mean you bring up the fear a couple of times, and I think that is a very, very big part of this entire thing. It’s good to be concerned at an appropriate level. So I think that’s having a large impact. Of course, we have all the shutdowns, the partial shutdowns, do you wanna talk a little bit about how concerned we should be in the different aspects of the economy that have been closed down literally. Like I can go swimming in the pool outside of my gym but I can’t go in the gym and have a class. There’s some things I can do and some things I can’t do. But I know people that are like, “I’m not going out regardless,” and other people are like, “I don’t really care it’s no big deal.” Now, the answer’s probably somewhere really in the middle, I would assume. So how do we address this large variation between different people? Where do we really fit in here? ‘Cause we have to run the economy, we can’t just completely stop. We have to move ahead at some pace, correct?
34:14 Keith Hovey: Right. You know, Governor Murphy has said data determines dates. And we’ve heard that almost ad nauseam, and I think in a positive way. That the information’s gonna tell us what things we can do. And again, back to my prior analogy, we are following breadcrumbs. In other words, as we start to ease restrictions, we then get information, but then that information has to be collected, it has to be analyzed, and then once we get the results, it’s not linear. We don’t simply do one research study and say, “Okay, we’re done, we’re all set, this is what we’re gonna do,” you have to replicate that research, you have to replicate or you’re gonna slightly change some variables, do some additional research and see if the outcome from the prior research is accurate or is correct.
35:07 Keith Hovey: I’ll give you an example. Several months ago, there was a research study coming out of Norway saying that gyms were fine, no problems. But that was a small sample, it was one study. And now we have a different study out of China where you have, because of air conditioner flow, you have people on one side of the restaurant getting infected, and yet the people on the other side of the restaurant did not. But again, those are very small samples, we can’t simply take one research study and say, “Okay, we’re just gonna do for an entire state of millions of people,” and just say, “This is what we’re going with.” So we need to replicate the research, but that data only comes in as we ease the restrictions.
35:48 Keith Hovey: One of the concerns that we have as a hospital and across the board as healthcare system providers is knowing that healthcare facilities are the second largest employer in the State of New Jersey, you know? If we’re not doing elective procedures, if we’re only taking care of COVID-related patients, then that creates a financial strain on healthcare institutions as employers, not just as healthcare providers. The state has decreased revenue because people aren’t working and unemployment is up. So the economic realities are real, and we have to be cognizant of them. But again, also recognizing that if we have another surge, then everything goes back to phase one, we’re then shutting everything down, because then we have to reassess as to where we went wrong. And then we’ve got to do all that data collection and re-evaluation and reassessment again, and that took us several months even to get where we are now.
36:46 Keith Hovey: So, the progress in reopening has to be incremental. The data just is not clear right now and I think a lot of people are thinking about, “What about schools and reopening?” Well, we’ve got a couple of major events coming up with respect to potential surge events. If you look at the calendar, you’ve got people going back to school, you have Labor Day weekend, then you’ve got Halloween, Thanksgiving, and Christmas. So you have events. And remember that one of the issues that’s real when you’re dealing with social distancing and isolation is you get quarantine fatigue. The longer people are in it, the longer they get tired of complying, the more likely they are to become noncompliant.
37:37 Kurt Baker: That’s really critical. And I would definitely wanna get into that. We’re gonna come up on a break here real quick. Keith, we’ll be right back. You’re listening to Master Your Finances.
37:47 Kurt Baker: Welcome back, you’re listening to Master Your Finances, I’m Kurt Baker here with Keith Hovey. But just before the break, I think a couple things that are important. One is you mentioned how we may have a resurgence as some of the normal things start to happen in the fall, and one of these thing I’ve heard about is whether or not the public is gonna respond. I mean, how are they gonna respond to that if we say, “Oh, wow, we really have to lock everything down.”? I’m a little concerned about what might happen if that literally is the conversation. And another big event going on as you pointed out was this going back to school, some parents are like, “I want my kids back five days a week.” And you have other people saying, “We’re gonna do this remotely.”
38:25 Kurt Baker: And obviously, it’s hard to do both of those. So the system has to somehow adjust to that. I think Princeton is doing every other week, four days a week, for like four or five hours a day or something like that. So it’s some kind of chunk with the rest being done by a video conference type thing. In those who can’t necessarily work from home for the next four or five months. So you add all these complicated issues into this thing too. So, what are your thoughts about how we’d try to manage this as best we can?
38:52 Keith Hovey: I think about this thing is to sort of point out how reliant our system is on our children being in a school setting, five days a week. And if you think about some of the social programs, and the well-being of children, it is really dependent upon their interacting, not only with other children, but also with professionals: Guidance counselors, teachers, school nurses. Think about how many kids, abuse and neglect cases get reported because those kids are in school. Issues of mental health, suicide prevention are diagnosed and screened because those kids are in an environment… Because they’re having conversations with friends, they’re able to talk to a guidance counselor. How many kids get meals, square meals because they’re in a school on-site five days a week. Or just the fact that they’re escaping whatever potential domestic violence issues and abuses going on at home, even if they’re not directly the recipient of it, they’re still exposed to it. And all of those opportunities for those kids to communicate is removed when they are isolated at home.
40:16 Keith Hovey: There’s also the flip side though, which is then we don’t have a tremendous amount of data yet as to how different age groups transmit the disease. And that’s a legitimate concern, because what we don’t want is we don’t want high transmitters getting the disease, getting the coronavirus, and then bring it home to people who are immunocompromised, or depending on where you are socioeconomically, what your living situation is. Are you in a multi-family dwelling unit? Are you living with someone who is an essential worker and has a high risk of exposure to it, and then you’re bringing it to school and then giving it to other kids to then bring to their houses? So then you have… Are you increasing the potential for transmission? So there’s a really difficult balancing, not to mention the potential exposure to school administrators, teachers, custodial workers, cafeteria workers. There’s a lot that needs to be balanced, and it’s a very complicated issue. And we need both the CDC recommendations, we need the input of teachers’ unions, we need the input of school boards as well as government officials at the county and state and local levels. And we’ve got a month to do it. [laughter]
41:43 Kurt Baker: Not a lot of time, right?
41:44 Keith Hovey: And then also on top of it, there’s the economic structure, which is parents who have to go to work. Essential workers need a child’s care. There’s a child care component to school. So there’s a lot at play as we go through this. And then the last thing that I haven’t mentioned before is viruses… I’ve heard comparisons of coronavirus to the flu, and maybe five and 10 years from now, we’ll be able to say that more definitively. But viruses, this is a novel one, as Dr. Fauci has said repeatedly. And what that means when we say novel is we don’t know how it interacts with the body over the long term. We’re still learning about how it even interacts with bodies in the short term based on young people, healthy people, immunocompromised, people with pre-existing conditions that didn’t initially seem related to the virus.
42:43 Keith Hovey: So for example, is there gonna be some element of the virus that’s similar to chickenpox? Where you get chickenpox as a child, you don’t get the vaccine, you got chickenpox, and then 20, 30 years later you develop shingles, which can be very painful and cause other exacerbations and issues with other pre-existing medical conditions. So it’s not a single entity like the flu where you just get sick one winter and then you’re fine after that, that there may be some long-term. Maybe it’s like HIV/AIDS, where you have the virus and then there’s some sort of conversion component that could go on later on. And I don’t say this to be an alarmist, but merely just point out that we haven’t had enough time with the virus to be able to study it, to know what the long-term effects are. And some of it maybe not come to fruition at all. It may actually be some components are more like the flu, but we don’t know that yet.
43:45 Kurt Baker: And I remember back when we first started this whole exercise of shutting down is that we had to “flatten the curve.” Flatten the curve, flatten the curve, flatten the curve. And then once we started to flatten it, then some people started saying, “Well, now we have to have a vaccine.” And I remember the response from some people was like, “Well, we don’t have a vaccine for HIV yet. We have therapeutics, but we haven’t… Some things we just haven’t solved.” So you still have to balance all those, ’cause again, you have to function at some level and still be cautious. So given that we don’t really know a whole lot about this yet, and every week and month we’re learning more and more about how to better manage that, so any thoughts about what our target should be, at least over the next few months so that we can operate? And I know you mentioned the basics were wear a mask and wash your hands and socially distance. And those seem really basic, but they seem extremely effective. So why don’t we just do the easy stuff? To me, that sounds like a no-brainer, right? And let’s hope that the rest of it works out if we can organize our businesses and our schools and things that at least comply with those aspects, I think we have a huge chance of mitigating some kind of huge jump in the fall. ‘Cause that’s what everybody talks about now, that second wave, it’s gonna be a big jump, right? And then what’s gonna happen?
44:54 Keith Hovey: Right.
44:55 Kurt Baker: So what are your thoughts about that?
44:57 Keith Hovey: So I think one of the really important things is, as we continue to work towards and are successful in reducing transmission, what that allows us to do is when we do our testing, is to be able to do contact tracing. Which means we’ll then have a better understanding because as we’re able to isolate individuals, we’ll be able to dedicate what resources we do have to the fewer number of cases that are being identified and trace them back to the source, and to do that faster. And then that gives us a better idea as to how a virus is behaving. That’s really crucial ’cause that’s data and that’s closer to real-time data, the fewer cases we get as we’re able to test more effectively, and then trace it back to the source, or the point of contact or origin. So I think that that’s one major component that we’re looking at as we’re flattening the curve or reducing it.
46:00 Kurt Baker: And you mentioned something that’s interesting. I think right now United States is way ahead of everybody else as far as testing per capita at this point, which I think is a great thing. And so I’m assuming that’s gonna help if we know whether or not there’s an issue… I went down to Florida to visit my father who was high-risk and things like that. And so I ended up getting tested just… We wanna be sure, negative, no problem, but that wouldn’t have been available two or three months ago, I wouldn’t have been able to do that. And now I think there’s more stuff coming out. So what are your thoughts about the testing and how that’s gonna help us and impact things moving ahead?
46:36 Keith Hovey: So I think it’s important. One term people have used is herd immunity, this idea that if enough people get infected, then what will happen is then that will help for the purposes of future vaccines, that enough people will have been infected and that they will have the antibodies, and then they will be able to reopen because enough people will have reached a critical mass. The one concern we have with that is, in order to identify the success of herd immunity, we need to know how effective having antibodies is against future infections and exposures. And we don’t have enough of that data yet. Because if you think about when infection was at its highest in New Jersey, it was around mid-April, and we’re not even four months out from that, so to be able to get enough of a sample as to whether or not those people do have potential for re-infection, how successful is their antigens against re-infection? So really what we need again, is back to the basic point, which is wear a mask, wash your hands, socially distance.
47:52 Keith Hovey: We can be hopeful for a vaccine, but realize that a vaccine, again, is a matter of developing it, and then testing it, evaluating the results to see if it’s effective, and if not, then we start over… We’re going to a different… We’re not restarting, but essentially we’re not pursuing that avenue, or at least where that promising “results” were from. We gotta go and look at a different option. And that’s why we’ve got multiple options at the same time. But just realizing that not only do we need to identify and create and test a vaccine as to how successful it is, but once it is, then we have to mass produce it and disseminate it. Because then we’re back to the healthcare providers, which is we need enough of them trained, and then there also has to be enough materials for the purposes of glass vials, syringes. And these are all logistics issues. So when we talk about a vaccine, it’s not simply having a successful vaccine, it’s that we need to have the providers to deliver it, and we need to have the materials to transport it. So it’s everything from the guy making the glass vials to the truck driver driving it across country, to the nurse giving it in a school or a CVS or an urgent care center, to make sure that enough people get it.
49:28 Kurt Baker: No, it’s a great point. I remember that’s similar to what was going on when they actually started doing the testing where we had different tests and different… Once they figured it out, they had to get the machines out and everything to do it with. Another thing you brought up there, I just wanna talk about it quickly, is the antigen test or antibody test type things to see if you actually do have a potential immunity, which we don’t really know what that means right now. You might get it again next year, we don’t know. Is that test out there yet at any level? ‘Cause I don’t really hear a whole lot of discussion about an antibody test.
49:57 Keith Hovey: Right, so there are three different types of tests as of right now. There’s the drive-through test that people know, which is the nasal swab test. That’s the standard one. That’s the one that confirms whether or not you have active virus in the respiratory system. Then there’s the antibody test. The antibody test has also been referred to as the serum test. That’s drawing blood to see whether or not you have antibodies that have been developed as a result of having exposure to the coronavirus. And then there’s antigen tests. The antigen tests were initially, by the CDC, not approved and recommended. I don’t know if that has been changed, because predominantly what people have been directed to has been either the respiratory, the nasal swab tests or… And some people have been… Sought the antigen… I mean sorry, the antibody test.
51:05 Keith Hovey: When we talk about whether or not there’s immunity to future exposure, we don’t have all the data enough to know. We’re starting to collect that, meaning the CDC, because of enough lapse in time as to whether or not what we do know, and CDC has put out information, is that some people who have been testing positive on subsequent nasal swabs don’t actually have an active communicable virus. So even though you might test positive based on a nasal swab, you may not actually have an active virus. But there’s still the presence because you’re still shedding it. Again, the data is still coming in and we’re still trying to identify best practices based on what we’re learning.
52:00 Kurt Baker: Well, Keith, this has been amazing. We gotta wrap it up here, but that’s an excellent job of going through all of that for us. Do you have any last thoughts before we go?
52:09 Keith Hovey: The simplest thing to do is wear a mask, wash your hands, and socially distance.
52:17 Kurt Baker: Yeah, great advice, Keith. Again, thank you very much. You’re listening to Master Your Finances. You can subscribe to the podcast and listen to all of them at masteryourfinances.us. Remember, together we can master your finances so you can enjoy financial peace of mind.
