ADITI MODY: Good morning
to all joining from the US,
and good evening to all
that are joining from Asia.
My name is Aditi Mody, and
I am the executive director
at the University of
Chicago Center in India.
I hope all of you are
keeping safe and healthy
in this turbulent time.
It is heartening and amazing
to see such a great now
for today's topical
webinar, COVID-19 and Health
Disparities--
Protecting Our Most
Vulnerable Populations.
Today's webinar will
feature medical faculty
at the University of
Chicago's Bucksbaum Institute
for Clinical Excellence and
is being held in partnership
with the University of
Chicago Center in Beijing
and the University
of Chicago Francis
and Rose Yuen
Campus in Hong Kong.
The University of Chicago, as
many of you might be aware,
has a long history of
eminence in the sciences.
And this has been
furthered in recent years
by significant growth
in faculty and research,
especially in the
medical sciences.
And the Bucksbaum Institute
for Clinical Excellence
is one such example.
The Institute's mission is
to improve patient care,
strengthen doctor-patient
relationships,
and enhance communication
and decision-making
through research and
education programs
and reduce health
care disparities.
Our centers in Beijing,
Delhi, and the Francis
and Rose Yuen
Campus in Hong Kong
have become a hub
for the University
of Chicago's community in Asia.
And their presence has allowed
the University of Chicago
faculty to establish long-term
relationships with partners
in the region, resulting in
a constant stream of contact
and collaboration.
The format of
today's webinar will
be that each of our
eminent panelists
will speak for a few
minutes, and then this
will be followed by a
panel discussion that
will be moderated by
my colleague, Mark
Barnekow, the Executive Director
at our Hong Kong campus.
A brief introduction
to our eminent
panelists before I invite
them on the screen.
Our first speaker
is Marshall Chin.
He is a Richard Parrillo
Family Professor
of Healthcare Ethics at
the Department of Medicine
and the Associate Chief
and Director of Research
[INAUDIBLE] of Internal
Medicine and Associate
Director at the McLean Center
for Clinical Medical Ethics
at the University of Chicago.
Dr. Chin has been
working to ensure equity
across all areas of
the health system
and currently is part
of a few coalition
efforts by foundations,
agencies, and patient consumer
advocacy groups to influence
the short- and long-term health
and social policies
impacted by COVID-19.
And today he will
speak on the health
care systems and
policies and how
they are and are not addressing
the vulnerable populations
of COVID-19.
Elbert Huang is our next
speaker after Dr. Chin,
and he is a Professor
of Medicine Director
of the Center for Chronic
Disease Research and Policy
and Associate Director of the
Chicago Center for Diabetes
Translational Research at
the University of Chicago.
Dr. Huang is a
former senior advisor
in the Office of the
Assistant Secretary
for Planning and Evaluation,
Department of Health and Human
Services and over the past
decade has established
one of the most active research
programs in geriatric diabetes
in the US.
And today, he will speak
on the implications
of COVID-19 for older patients.
He will be followed by
Dr. Monica Peek, who
is the Associate
Professor for Medicine
and Associate Director at the
Chicago Center for Diabetes
Translational
Research and Associate
Director at the McLean Center
for Clinical Medical Ethics
at the University of Chicago.
She will address on
issues that are related
to racial and
ethical minorities,
as she has been studying
racial health disparities even
before the outbreak
of the coronavirus,
and her research is now
very important than ever.
Dr. Peek has advised both
the University of Chicago
and the state of Illinois
on the allocation
of scarce resources--
for example,
ventilators-- and has also
been appointed to the city of
Chicago's Racial Equity Rapid
Response Workforce to address
racial disparities in COVID-19
mortality.
Our final speaker will
be Satendra Singh,
who is Associate Professor for
Physiology at the University
College of Medical Sciences,
University of Delhi,
and an Executive Member of the
Ethics Committee of the Delhi
Medical Council.
Dr. Singh is a noted
disability rights activist,
and he recently
spearheaded the filming
of disability competencies in
India for health professions
to improve doctor-patient
relationships.
He is also working on
supporting decision-making
among marginalized
populations, especially people
with disabilities.
And today, you
will hear from him
on issues related to disabled
patients and COVID-19.
Thank you all again for joining
us this evening and morning.
And with that, I will request
our first speaker, Dr. Chin
to provide his opening remarks.
MARSHALL CHIN: Thank
you very much, Aditi.
I'm going to cover how the
US has addressed the COVID-19
situation, covering
both successes
and challenges with
lessons and issues
that are generalizable
to other countries.
I'm going to divide
my remarks into four
stages of the pandemic.
First is what I would call
the public health stage,
where we try to identify cases
of COVID-19 and then contain
the virus using the principles
of good infectious disease
public health--
identifying cases,
isolating that individual,
contacting the people
who have been in contact
with that particular
person, and then
isolating those who
have also been infected.
In the US, the first case was
found in the middle of January
on the west coast of the
country in the state Washington.
And the US has had
two major problems
around that particular issue.
First is that the
national government
was slow to take the
pandemic seriously.
President Trump had
previously eliminated
a global pandemic office
in his national security
office, which was designed
to plan for pandemics.
He also was slow to take
the concerns of his advisors
seriously about the pandemic.
And then finally, it took
until March 13, two months
into the issue in the US,
before President Trump declared
a national emergency.
Second, there was early
on an inadequate supply
of COVID-19 testing materials.
The Centers for Disease Control
had created the initial test,
and it was faulty.
The Food and Drug
Administration,
which is the part of the
federal government that
oversees and regulates
private laboratories,
was overly restrictive
and bureaucratic
in its initial dealings with
the private laboratories.
And the federal government
was unwilling to step in
to address and fix the problems
with the supply of materials
for COVID-19 testing.
The end result was that,
because of few tests available,
there was overly restrictive
criteria on who would
be able to receive a test.
I remember, for example, at
the University of Chicago,
like many different hospitals,
the initial criteria
were that you had to have
really been in China or in Wuhan
as a major risk factor.
Other people were not tested.
The result is that because
not enough people were tested,
COVID-19 spread rapidly
throughout the country.
And so the initial
public health methods
of being able to do
case identification
and contact tracing
really were not possible,
because the virus
had spread too far.
And therefore, the country
entered a mitigation strategy
phase--
social distancing, six
feet between people.
The second phase
of the pandemic I
would call the stress
to the health care
system, where
COVID-19 patients are
going to clinics and hospitals.
And here you might
think of multiple levels
of key stakeholders.
You have the front
line, the health
care providers at
clinics and hospitals.
You have cities, you
have the 50 states,
and you have the
federal government.
The front line has been heroic.
The doctors, nurses,
frontline responders
have done an outstanding job.
At the level of large cities,
many of the large city mayors,
such as the city
of New York City,
have also been aggressive with
their public health measures--
doing the social
distancing, trying
to find adequate
supplies like ventilators
and protective
equipment for personnel.
The level of 50 states
have seen great variability
among the response
among the governors.
And also among the
federal government,
there has been a
variable response.
The third level I would call
the current evolving situation
for the pandemic, where
one of the key issues
has been tensions between
science and medicine
and then the interests
of the economy
and businesses and
political considerations.
From a scientific
perspective, the concern
is spreading the virus.
And so still, a major push
for social distancing.
On the other hand,
shutting down the economy
has caused great harm to
people also, economically
as well as spillover
effects into health.
And there's a great push
then from the business
and economic community
to open up the country.
We're also in a
complicated situation
where this is an election
year in the United States.
So there are additional
political considerations.
And so we then have
then the situation
where we are trying to
balance then issues of science
and issues of politics.
The fourth issue I would mention
is then the emergency relief
phase, where we have in general
been funding the status quo as
opposed to trying
to address some
of the more fundamental
social drivers of inequities.
Much of the direct funding
has gone immediately
to health care institutions
like hospitals,
to businesses, and to the
public, as opposed to doing
a more fundamental
reform of the system,
such as expanding
health insurance
coverage for different
parts of the country.
So overall, I would mention that
we have five overall lessons
to share.
First, that honesty and
transparency with the public
are incredibly
important if we're
going to have
faith in the system
and a unified national response.
Second is that it's critical
to ensure that there's
an adequate public health
infrastructure for doing things
like identification cases
and contact tracing,
as well as it's critical
to have an adequate safety
net for the overall population.
Third, there's a role for
both central control--
so for example, in
the United States
there should be a role then
for the national government
ensuring that there's an
adequate supply of COVID-19
tests or an inadequate supply of
ventilators or adequate supply
of personal protective equipment
for health care workers.
At the same time, there is
a role for decentralization.
So for example, the issue of
when to open up businesses
so that the economy can
start flourishing again--
that might need to be
done at a local level.
So for example, some
rural areas of the country
have relatively less cases of
COVID-19 than the urban areas.
Fourth is that science
and evidence matter,
that of course there are
economic considerations.
There are political
considerations.
But you can't fool
mother nature.
So ultimately, what is good
for the health of the public
and what's good
for the economy is
controlling this coronavirus.
Then finally, fifth,
leadership matters.
The United States,
we've had many examples
of both outstanding leadership
as well as poor leadership.
And it matters in any
situation, particularly
in our current
situation of COVID-19.
So thank you very much, and
I'll come back for discussion.
ELBERT HUANG: Hello.
I'm Dr. Elbert Huang.
Thank you, Marshall,
for that overview
of the history and policies
related to COVID-19.
I'm going to be talking to you
about a particular vulnerable
population that has been deeply
affected by the pandemic, which
are people that are older.
So throughout the
world in every country,
the oldest in every
country has unfortunately
been the subgroup
that has suffered
the most from COVID-19.
In particular, older adults who
are dependent on others living
in long-term care facilities
have experienced tragic levels
of morbidity and mortality.
In some parts of the
world, 50% of deaths
have happened among older
people living in long-term care.
And this is not
limited to one country.
As Dr. Chin mentioned, the first
outbreak in the United States
was actually in
long-term care facilities
in and outside of Seattle.
But we've had recurring
and ongoing reports
of high rates of death
in long-term care
in Spain, the United Kingdom.
There are ongoing tragic reports
of people finding dead bodies
in long-term care facilities.
And what the
pandemic has done is
it's revealed some
of the deficiencies
of the social safety net that
is related to long-term care
throughout the world
in different countries,
even in countries where
long-term care systems are
fairly robust and well funded.
And so I'll talk about the
problems and challenges--
why that death rate has been so
high, why this population has
been so vulnerable, and talk
about some immediate short-term
actions that
countries could take,
and then what it means
long-term for the social safety
net for older people.
So the complex issue
around care of older people
is that many are not
fully independent.
And so many rely
on a social network
of individuals to support
help with daily tasks
of daily living, such
as shopping and driving,
even more basic tasks such
as bathing and dressing.
And so in normal times,
these individuals
need the support of this
network to remain healthy.
But this very network is also
what creates the vulnerability
to pandemic infection.
So if one is dependent on others
and anybody in the support
network develops
an infection, this
can lead to rapid
spread of infection
among people that are cared for.
If a key member of
the support network
becomes sick or must
go into quarantine,
the older adult will
then have to find
alternative forms of support
for the care that they received.
And so this duality
of the network--
the network is both supportive,
but it's also a risk.
And that illustrates
the twin risks
that are associated with this
vulnerable older population.
So this risk related to
the need for a network
is really encapsulated within
long-term care facilities,
where really, the most frail
and vulnerable of older adults
reside in concentrated
populations.
Long-term care
throughout the world
is at different
stages of development.
Some countries are
just developing
long-term care systems of
insurance and long-term care
industries.
Others are much
more mature, with
well-established long-term care
facilities and different levels
of regulation around
the quality of care
delivered in these facilities.
Historically-- I'll just
give the story of the United
States--
these facilities have
been understaffed.
And this situation has
worsened during the pandemic,
as sometimes nurses
and other staff
have been deployed to
other clinical settings.
And long-term care
includes everything
from assisted living,
where people are relatively
independent, to acute
rehabilitation to actually
long-term care nursing, which
is what is provided for people
with conditions like dementia.
The outcome that
is typically used
to think about staffing
support within facilities
is the staff-to-patient ratio.
And in general, there
have been complaints
about these ratios being
out of balance, where
there are just not
enough staff to care
for individual patients.
The lower this
ratio is, the higher
risk of a single
staff member who
is infected to spread the
infection to multiple patients.
So what's happened
with the COVID-19
pandemic in routine
care is that staff,
if they are following
social distancing policies
and have to wear
protective gear,
are slower to respond
to the concerns
and needs of their patients.
So for example, if a
patient has diabetes,
the frequency of glucose
monitoring may go down.
And there is an increased
risk of missing side effects
of diabetes, such
as hypoglycemia.
So I would also add that
long-term care facilities that
are attempting to
enforce social distancing
have also had to
do things that may
have affected the
long-term mental health
of their patients.
So many patients
have now been forced
to go into individual rooms.
They have been barred from
seeing their family members.
And so this raises concerns
about whether or not
the reaction to the pandemic
may lead to deterioration
in mental health, where we lose
the benefits of social contact
with friends and family.
So in addition to concerns
about potentially under-managing
chronic conditions that
we cared for before,
there is concern about
creating new forms of harm
through social
isolation-- which we
know is harmful from prior
research, much of it done
at the University of Chicago.
So
I will just talk
about a few things
that can be done
in the short-term
and what we think needs to
be done in the long-term.
So in the short-term,
there's no doubt,
if countries have
limited resources
for testing for COVID-19 and
limited resources in terms
of PPE, the long-term
care setting
is probably the
place where he would
want to devote those
limited resources.
In long-term care is where
many states and municipalities
are devoting routine testing for
COVID-19 among staff certainly,
and among patients.
This is where you want to
catch an outbreak early
and to quarantine
individuals who are infected
as quickly as possible.
This is the location
where staff need
to be taught and need to
be provided PPE in order
to continue providing
care for patients.
And there are also creative
ways of potentially reorganizing
the space of long-term
care facilities
where those who are infected
are allocated to a special ward
from those who are
not, just as people
are doing within hospitals.
So these are some
short-term maneuvers
that likely are
happening already
but need to be strengthened in
order to prevent more outbreaks
in long-term care facilities.
Unfortunately, I think
every day we continue
to hear about these outbreaks.
For the future, I mean, I'll
just go to the main point.
We know that overall, long-term
care has been systematically
underfunded.
In the United States, through
a complex system of insurance,
a lot of health care
in long-term care
is actually paid for
through our Medicaid system.
And our Medicaid system provides
low rates and reimbursement
for long-term care.
This is probably at the
root of why staffing
is low in these facilities.
And so it may be that
because of this pandemic,
there is a revisiting
of the amount
of resources that go to
long-term care via Medicaid.
And it's clear
that going forward,
there's going to be an increased
emphasis on infection control
and strengthening regulations
around infection control.
Under different
administrations, there
has been more intense focus
on infection control--
for example, under
Obama administration
versus the Trump administration.
And those will likely
need to change.
And there is likely also
going to be a movement
to see if we can take care
of people more at home
and not in long-term
care facilities.
Are there ways that we can
increase funding and support
for home care, which is the
way we took care of older
people for generations before?
We may also be using, though,
telehealth and technology
that in ways that we
did not in the past.
So with that, I look forward to
the discussion after the talks.
MONICA PEEK: Great.
Thank you so much,
Dr. Huang and Dr.
Chin for setting
the stage of talking
not only about our
health care system
but about vulnerable
populations.
So I'm going to
talk specifically
about the case of
African-American disparities
in the United States,
recognizing that this is a case
study for a type of
marginalized population
that represents a population
that has been exposed
to structural inequities.
And that this case
study can be generalized
to other populations
within the United States
and other populations
across the globe.
So it was about six weeks
ago that we first heard data
around some of the racial
disparities in the United
States around the coronavirus.
And so in Chicago, where we
have about a 30% composition
in our city of
African-Americans,
we learned that 72% of the
deaths from coronavirus
were among African-Americans.
And we were seeing
similar numbers
in New Orleans and Milwaukee.
And that started
a national debate,
and it triggered other
cities and municipalities
and states to begin
releasing data.
And so we've seen a national
trend of these disparities
between blacks and whites in
not only coronavirus cases,
but also coronavirus deaths
throughout the country.
And so what we have
learned is that it's not
a biological construct.
There initially were
concerns about differences
in ARB receptors and other
things, but a lot of that
has been put to rest.
What we're finding is that
it's the structural inequities
that African-Americans
are disproportionately
exposed to that appears to be
driving a lot of the increased
COVID mortality.
And so there was a
recent national analysis
of county-level data
that came out last week
that looked at different
counties in the United States
and found that the higher the
proportion of African-Americans
in the county, the higher the
number of cases and the higher
the number of deaths, and
that these counties were more
likely to be very
crowded, physically
crowded, to have lower scores
for being able to socially
isolate, to have
higher unemployment,
to have less health
insurance, and to have
other factors that we would
have otherwise predicted
to be associated with
communities that have been
historically marginalized.
And so I think what
we can think about,
some of the take-home
messages, is
we can separate this into
two different brackets.
One is the impact of
structural inequities
on access to health
care, and then
non-health care mechanisms.
And so for
coronavirus, what that
means for marginalized
populations
like African-Americans
is that there
is an increased challenges
with physically distancing.
At the same time, there's
a decreased ability
to have physical barriers.
So people have increased
exposure but less protection.
And so this is a
double challenge.
And so the sort
of classic example
that we've been discussing
here in the United States
is the challenge that we
see for essential workers.
So these are people
who are allowing
the rest of the country to
safely shelter-in-place.
They're the ones that are
keeping the pharmacies
and grocery stores open,
keeping public transit working,
staffing our power plants so
that the lights can stay on--
all the critical
functions that we need
as a society to be
able to stay at home.
Those are
disproportionately serviced
by low-income racial
and ethnic minorities.
So for example, in New York--
which has been the
city that has been hit
most hard by the coronavirus--
70% of essential workers
are persons of color.
And in that group of
minorities, the largest subgroup
is African-Americans.
And the essential
workers are not
being protected like
health care workers.
So even though they are
working in crowded conditions,
being exposed to
the public, they
don't have personal
protective equipment.
And this gets back to what
Dr. Chin was saying in
that we missed
the ball early on,
and we did not have
enough supplies
for personal equipment.
We didn't have enough
supplies for testing.
And so we have had to
triage all of our equipment
that we do have.
And so we've had to,
understandably so,
prioritize our
health care workers.
But we have a whole
separate workforce
who's being exposed to
the coronavirus who's
not being protected.
And as a result, those
workers are disproportionately
black and brown,
disproportionately
African-American, and they're
getting sick at a higher rate.
And so that is a
significant contributor
to the increased cases and
increased mortality seen
within the African-American
population.
The other kinds of
structural inequities
have to do with decreased
health insurance.
Again, Dr. Chin had
mentioned the need
for us to sort of reopen
the health insurance
exchange within
the United States
with the Affordable Care Act
and increase people's access
to be able to have
health insurance
and for people to have just
physical access to hospital
systems.
Some people are
living in communities
where there's not
a nearby hospital
or where their hospital is a
community hospital that is not
prepared to take on heavy
cases for severe COVID,
where people need
to be in the ICU.
There may not be enough
ventilators to adequately staff
the demand that's coming
from the community of people
who are really sick
with the coronavirus.
And so we see that there are,
in some of the communities that
have the highest need,
shortages of testing supplies.
There are different
kinds of testing
where there may be delays
of five to seven days
in getting their test
results compared to,
for example, at the University
of Chicago, where we can get
our test results within hours.
There are differences
in the kinds of care
that large academic
hospitals can
provide that can't be provided
in community hospitals,
because that is not what
they're designed to do.
And so the differential access
of low-income communities
to these kinds of care also
impacts the mortality and sort
of the disease course once
people become infected.
And so there are
a range of inputs
that lead to a
culmination of disparities
that we see amongst
marginalized populations who
have historically and
contemporarily been exposed
to a range of
structural inequities.
And so that's what we're
seeing across the country,
the combination of
historical injustice
being played out with the
current system of injustice
sort of layered on top of that.
And so what we're seeing is
a number of cities and states
standing up and trying
to address these issues.
Again, Dr. Chin had
mentioned in his last comment
about the importance
of leadership,
and that we've seen some
excellent outstanding
leadership and we've seen
some leaders that have not
stepped up to the plate.
And we've been lucky in
that in New York, which
has been a hotspot, we've seen
some outstanding leadership.
And in Chicago, which is
one of the first cities
to note the significant
disparities in coronavirus
between blacks and whites,
we've had outstanding leadership
as well.
And so some of the things
that we've been doing here
in the city have been to
try and reverse or address
many of the things that
I was just mentioning--
so to try and not
just screen people
who make their way
into a hospital system
with algorithms
about comorbidities,
but to try and begin
screening in hotspot areas
so that we're trying to
do more public health
prevention screening
that we would like
to have been able to do from the
beginning with contact tracing.
So we've identified
certain community areas
where there's a significantly
higher prevalence
of COVID cases and
deaths, and trying
to do more universal
screening in homeless shelters
and congregant living, like
Dr. Huang was mentioning,
where there's a lot of elderly
and cases of mortality,
and trying to universally
screen in those areas.
We're using community
health workers
to be out in the community.
Our academic centers are sharing
equipment, sharing testing
supplies, PPE, and
other things with
our lower-resourced hospitals.
We have developed a triage
protocol, like a lot of cities
do for trauma, so that our
safety net systems can directly
go to some of the larger
hospitals, many of whom
are academic
hospitals, and bring
their cases of coronavirus
directly to those hospitals
so that we're better
able to meet the needs,
to balance the needs of patient
type and severity of illness
with the capacity
and skill set--
the clinical skill set,
the infrastructure,
and the human capital
of the hospital itself.
So there are a
number of things that
are happening to
try and rebalance
the policy infrastructure
that's in place to reduce
the disparities that
we're seeing in Chicago.
And so the city releases daily
statistics around mortality.
And so six weeks ago, 72% of the
cases for African-Americans--
72% of the cases
of COVID mortality
were African-Americans.
And a few days ago, it was 49%.
And so we've made significant
strides in a very short period
of time being able to implement
real-world things that we
can do today on the ground they
don't require federal action.
And so those are just some
examples of recommendations
that we're doing
here in Chicago.
But I underscore the
underlying root causes
of the problems for
African-Americans
and the universality of these
issues across the globe.
So that's all I have to
say for now about that,
and I look forward to further
discussion during the panel.
SATENDRA SINGH:
Thank you, Dr. Peek.
Good morning and good
evening, depending
on which part of the
world you are in.
Thanks to the University
of Chicago Global Centers
and Bucksbaum Institute
for this opportunity.
I am Dr. Satendra
Singh, and I will
be focusing on
health disparities
among disabled population.
So disclosures up front, I'm
a doctor with a disability.
Around 15% of the
world's population
live with some
form of disability,
as per World Health
Organization.
In that way, we are the
world's largest minority.
So how is this largest
minority faring
with the COVID-19 impact?
The 1.3 billion living
with disabilities
globally, which is equivalent to
the current Indian population,
they are no stranger to the
kind of exclusion or lockdown
imposed by the coronavirus on
the rest of the population.
Many of us living
with a disability
will not be able to go back
to quote unquote business as
usual once the pandemic
is over, because 80%
of disabled worldwide live
in developing countries.
And 60% to 75% of these
live in rural areas
where they face
multiple barriers.
As of today, India has
around 50,000 active cases
and around 2,400 deaths.
But we don't have any
data on the number
of disabled people affected
or dying because of COVID-19.
Most of the time when
reporters talk about COVID-19
preparedness,
inadvertently the focus
is on how the elderly and the
disabled are more vulnerable.
Despite our best attempts, it
sends an unreasonable message
that a few people's prosperity
is more significant,
and it in a way
devalues the lives
of elderly and the disabled.
However, we all know that
viruses don't discriminate
based on ageism or ableism.
And everybody, whether a
person with a disability
or not, can acquire
this infection.
In the state of Kerala in
India, an elderly couple
aged 93 and 88
years were infected,
and now they're
completely recovered.
A 106-year-old gentleman
recovered from COVID
in the super speciality
hospital which is
next to my workplace in Delhi.
It is this inherent bias in the
conventional health setup which
exacerbates health iniquity
and uses quote unquote
quality of life and social
worth as indicators in triage
protocols in the pandemic.
There was some
disturbing reports
from the four states
in the United States
suggesting that medical
rationing programs were
discriminating about people
with intellectual disabilities
advanced neuromuscular
disease, cystic fibrosis,
and traumatic brain injury.
This was termed
as "ICU eugenics"
by a disability
activist in the US,
who got united under the
hashtag #NobodyIsDisposable.
Accordingly, Office for Civil
Rights of the United States
Department of Health had to
give a release on 20th March
citing very clearly that
Americans with Disabilities Act
prohibits discrimination
on the basis of disability.
We must not forget that
anti-discriminatory legislation
applies to all medical
health care decisions
even in crisis
standards of care.
In India, section
3.3 of the Rights
of Persons with Disabilities
Act warns against discrimination
based on disability.
It is true that those having
thoracic disability or those
were elderly have decreased
lung compliance, decrease
vital capacity.
But we do not have
any studies which
have proven a direct
association between these
and poor prognosis when
mechanical ventilation is
required--
for example, in ICUs or
in ventilated patients.
The triage policies
should be based
on individualized assessment
based on equity and justice.
So the reason why disabled
people become more vulnerable
is because of attitudinal,
environmental,
and institutional barriers
that are reproduced
in COVID-19 response.
For example, many blind
people, deaf and blind people
who rely on touch--
for them physical distancing is
inherently harder to practice.
And the same is
true for those who
are dependent on caregivers.
Moreover, the word
"social distancing"
has a different connotation in
a geographically diverse country
as wide as India, which has
had its share of grappling
with untouchability amidst
socially outcast dalit
and tribal communities,
segregation forcing people
affected by leprosy to
live in leprosoriums,
and people with intellectual
and psychosocial disabilities
who were locked in institutions.
I personally prefer
"physical distancing"
over "social
distancing" to mitigate
the attitudinal barrier and to
respect cultural differences.
We need to be socially connected
but physically distant.
We need to ensure that
health advisories are
accessible through sign language
interpretation, captioning,
and easy-to-read format.
We need to engage in
equitable practices that
leave no one behind
and provide help
for all, including rural areas.
India spends only
1.29% of GDP on health.
India is a low medium income
country, where 69% of disabled
live in rural areas.
Around 2 million families
have more than a person
with a disability
in the household,
as per the government
of India data.
Disabled people are less
likely to be employed.
And when employed,
they are likely to be
in informal sector.
Lockdown has further ensured
the loss of work and income.
Stigma has perpetuated hunger,
starvation, and deaths.
Social protection
measures for disabled
are inadequately
resourced at 0.03% of GDP.
The value of the
emergency cash transfer,
which was initiated by
the government of India,
works out to be less
than $5 US per month,
which is grossly inadequate.
Even this amount covers only
8% of working-age adults
with disabilities.
And this does not include
children with disabilities.
It should be, as per
the International Labor
Organization's recommendations,
$2 per day or $66 per month,
which comes out to be 5,000
Indian rupees per month.
Pandemics are a period of
greater uncertainties that
require equally swift
action to embed ethics
in all decision-making
processes.
The principle of
solidarity justifies
efforts to overcome
health inequities
by protecting the rights
of the most marginalized.
The emerging field
of disability ethics
can help policymakers
in employing
anti-discriminatory approaches
to value disabled lives
and triage decisions.
So that's all I have
to say at the moment.
MARK BARNEKOW: Good evening.
My name's Mark Barnekow, and
I'm the executive director
of the Francis and Rose Yuen
Campus here in Hong Kong.
And it's an
interesting foundation
setting that the
doctor panelists have
provided for us tonight.
We have many questions
from the audience.
And what I wanted to do
next was kind of drill
into a couple areas.
But I didn't want to leave
many of the questions unasked,
so I'm going to kind of go
back and forth between drilling
down and asking questions.
And we'll probably have more
questions pop up on the screen.
The questions that I'm going
to be asking the doctors
had already been sent
to us in advance.
So I'm going to
start with Dr. Chin.
And Dr. Chin, what amazes
me is this whole idea
that we had these
initial faulty tests.
And I'm wondering to
myself, how did this happen?
How did the US, the richest
country in the world,
end up so unprepared for
a situation like this?
As the health care systems and
policy expert on our panel,
I was wondering if you
could address that, please.
MARSHALL CHIN: Thanks, Mark.
They were the four
main causes that I
mentioned a bit
earlier, that first,
the Centers for
Disease Control--
which is a great organization
and historically has
done a great job of creating
tests when they are needed--
ended up using a
contaminated laboratory
to develop their initial tests.
So the initial
tests didn't work.
And so we lost three
weeks right there.
The private industry, the
private laboratories--
many were eager to
jump in and help out.
But the Food and
Drug Administration,
which regulates the
private laboratories,
had overly restrictive
bureaucratic rules
that were a great disincentive
for the private laboratories
to enter the space.
And then third,
here's an issue where
the federal government, you
need to have a national response
for the supply chain.
You can't rely upon each of the
50 states to solve the problem
or for the private marketplace
to be able to rapidly figure
out how to fix the supply
chain and where to give
the tests where they're needed.
And so the federal
government should
have come in in terms of--
they actually have the ability
to enact a regulation that
allows them to issue direct
industries to make more
ventilators, make
more masks, make
more of the supplies needed
for COVID-19 testing.
And the administration
has been reluctant to use
that particular power.
Then also, earlier, in
President Obama's administration
there was an office within
the National Security Council
whose job was to think all
the time about how to prepare
for a global pandemic.
And that office was
dismantled early
in the Trump administration.
MARK BARNEKOW:
Thank you very much.
Dr. Huang, you mentioned that
there are some creative ways
that you've seen that some of
the patient care facilities
are reorganizing
themselves to be more
effective to combat this virus.
Do you have any examples of
things that you're seeing,
best practices that you could
share with our global audience
tonight?
ELBERT HUANG: Yes.
I think I alluded to one
of the strategies, which
is to basically reorganize
the space of long-term care
facilities to
basically create areas
where there are known people
with the infection and those
without.
This allows for,
basically, staff
that are going in to take care
of people who are infected
with COVID-19 to
be better prepared,
to be dedicated
to those patients,
and to separate that
staff from start taking
care of non-infected patients.
So that creates this sort of
physical spatial separation
of infected people.
The other kind of novel
things that you've
seen that people are
certainly introducing
is the use of technology
to reach patients that have
to be isolated in their rooms.
So many older patients
have been forced
to use their iPad
for the first time,
to use different technology to
communicate with family members
and with staff of
the facilities.
And I'll end with actually
another novel approach
to caring for people
in these facilities,
is to actually start to rely on
some of the individual patients
to monitor themselves.
This actually carries over
into the community as well.
So for example, in the case
of blood pressure control,
having patients measure
their own blood pressure.
For diabetes management,
actually using technologies
like glucometers or
continuous glucose
monitors to actually have the
patient themselves collect
the data, thus reducing the
number of times the staff
interacts with them and
reducing the use of PPE.
So those are sort
of novel things
that are being
deployed right now.
MARK BARNEKOW: Thank
you, Dr. Huang.
Dr. Peek, one of the
questions from the audience
is a question about
the ongoing effects
of the sufferers
of loved ones who
die during this period of time.
I'm just wondering if you
could speak to our audience
about the suffering
that's going on
across families across
communities and the stress
that it's causing.
There's another question
that's related to stress
and whether that's causing a
higher incidence of strokes
and heart attacks.
And I was wondering,
since there's
a preponderance of that in the
African-American community,
whether there's more of
it now during COVID-19.
MONICA PEEK: That's a
really interesting question.
So there's a lot of
embedded questions in there.
I'll take the first part just
about the impact on loved ones.
I think that the loss of loved
ones is always challenging.
I think the coronavirus has
compounded that in the fact
that the restrictive
visiting policies
during the hospitalization makes
that much more challenging.
So families are really,
for the most part,
allowed to visit right
near the end of life.
And the funeral policies
are more restrictive,
so like 10 people
can go in at a time.
And some people just are
forgoing funerals altogether
and waiting for a
memorial service later.
And I think all off the
social cultural rituals
that we as a
society put in place
to help us deal with the
grieving process around death
have been altered
during the pandemic.
And I think that that weighs
on our collective ability
to maintain our mental health
during these extra burdens.
I think all of
our panelists have
alluded to different ways
in which the coronavirus is
impacting seniors' mental
health or our mental health just
in our day-to-day functioning.
And certainly, with the
death of a loved one,
it's certainly impacting the
family's mental health in ways
that it ordinarily wouldn't be.
We have seen an increase
in cardiovascular outcomes
recently.
And we're not exactly sure for
all of the reasons that is.
One of the hypotheses is that
with the shift in ambulatory--
the ambulatory setting has
primarily, for the most part,
been shut down.
So we're not doing as
much in-person care.
And there's a
study that came out
of UCSF that was saying that
racial and ethnic minorities,
only 36% of them are
utilizing telehealth.
And so for those racial
and ethnic minorities
who are more likely to have
cardiovascular disease,
hypertension,
diabetes, they're less
likely to be using telehealth.
And so those chronic diseases
may not be monitored as well
and may be putting people at
increased risk for strokes
and heart attacks.
The other thing is that
we're not seeing them as much
in the hospital setting.
So people may be having
symptoms and staying at home
for fear of not wanting
to go into the hospital.
I'd rather stay at
home with chest pain
than go in the hospital
and die of coronavirus.
And so I think there may
be multiple causes why
we're seeing an uptick.
And then last, we do know that
chronic stress is associated
with cardiac inflammation and
other kinds of markers that
put people like
African-Americans at increased
risk for cardiovascular disease.
I think the time period for the
coronavirus has been too short.
It's only been a
couple of months.
But certainly, that
can be additive.
We do know, for example,
that only a 10-point increase
in blood pressure can
increase your risk
for cardiovascular
outcomes by 50%.
And when we looked
at the associations,
for example, of community
violence and health,
we saw a 10-point increase
in blood pressure.
So I think there's a
lot of data out there
to support, a lot of
hypotheses for why
we might be seeing some
increased cardiovascular
outcomes now.
MARK BARNEKOW: Great, thank you.
I might come back to the
mental health in a bit.
But Dr. Singh, there was a New
York Times article yesterday
that talked about
the fear of the virus
being greater than the
impact of the virus itself
on vulnerable populations.
Do you agree with that?
Is that something that
you could comment on?
You alluded to it a bit.
SATENDRA SINGH: Yeah, in
fact, about three days ago
I was watching a documentary
on FDR, President Franklin
Roosevelt, which is titled
The Wheelchair President.
And in that speech,
President Roosevelt
said that the only thing we
have to fear is fear itself.
And it is very
true, because there
are many deaths which are
being caused not only because
of the COVID-19 itself,
but also because
of non-virus factors, which
include suicide, which includes
deaths due to lockdown
in India, [INAUDIBLE]
happening in some
places within India,
hunger, which is a
very common cause,
and the migration, et cetera.
So that is, I think, a
very important factor
which we need to consider,
that there are multiple issues
to this particular problem.
And remaining calm
holds the key,
because for people
with disabilities,
specifically like those
who are having autism
or those who are having
psychosocial disabilities
or intellectual disabilities,
it is very difficult
to implement the strict
lockdown measures
for this particular
category of disabled people.
There was one incident
in [INAUDIBLE] in India
where there was an autistic
person who went outside,
and he was beaten by
the police because they
said, why are you violating
the norms of the lockdown,
without understanding that
he is a person with autism.
Similarly, there was a person
in Dehradun who went outside.
She bought a few groceries.
But he came empty-handed.
And the reason for that was
that he was a deaf person,
and he was unable
to understand or lip
read the police official was
standing outside the grocery,
because the common
problem with the mask
is that many deaf
people who can lip read
are unable to lip read
because of these masks.
So there are
various issues which
can create more fear among
the vulnerable population,
specifically among the
disabled population.
Because as I said earlier,
there are many disabled people
who rely on caregivers.
And there are many
caregivers-- for example,
in Delhi-- who are staying in
the nearby bordering areas,
suburbs of Delhi.
And they find it very
difficult to commute,
because they have to get
those electronic passes, which
are not easy to get.
So there are so many pros
and cons of this whole issue.
And that is why
there is definitely
fear about the whole issues.
But we need to
keep our composure
and identify ways by
interacting with the community--
for example, disabled community
in this particular case.
And then we need to sort
out these possible avenues
to ease all these tensions.
MARK BARNEKOW: I'd like to
stay on the topic of caregivers
and actually go to Dr. Huang
on caregivers, because you do
specialize in older patients.
And you know, being
situated here in Asia,
we see a lot of
elderly patients,
elderly people who are
taken care of by caregivers.
And they're surrounded
by their family, which is
kind of a cultural norm here.
We don't have that same cultural
infrastructure, if you will,
to support elderly people.
And I was wondering if Dr.
Huang, you could comment on,
what are we going to do?
We're keeping people
out of our country.
We're keeping them from
coming into our country.
Some of the those jobs that
are available for people
to take care of our
elderly people, you know,
we're not letting people
come in to take them.
So I was just
wondering, Dr. Huang,
if you could comment
on that point.
ELBERT HUANG: Right.
So Mark, you're alluding to the
fact that in some countries,
many caregivers are
actually immigrants.
And because of immigration
policies related to COVID-19,
some of them cannot
enter into countries.
Frankly, in the United
States, many of our nurses
actually come from
the Philippines.
So it's important
to say that those
who are nursing, providing
caregiving right now,
many of them are under
incredible stress.
So if they are doing caregiving,
their jobs are stressful
because they're concerned
about getting the infection--
some of them have died
from the infection--
while caregiving is also
already quite difficult.
So yeah, I think--
I'm going to segue a little bit.
I think a lot of these questions
we're asking about which relate
to policy and decision-making,
they're about the greater
tension between the immediate
effects of the harms
of the pandemic and,
at the same time,
the side effects of any
policy decision that we make--
the side effects
related to people
not getting the caregiving
they need, right?
So if we have a
policy for immigration
that prevents people
from traveling,
we then have fewer people
to take care of some
of our vulnerable populations.
And the calculus and the
balance of the immediate risks
of the pandemic and
then the side effects
of the policies,
the challenge is
that we are gathering
the data about what's
happening while we're
living with the pandemic
and dealing with its acute
effects at the same time.
So it's hard to be dispassionate
and objective about what
the best policy should be
and to make sound decisions
in that kind of environment.
We are probably going to
learn a lot from variation
across countries
and across states
and how people responded to
how we deal with caregivers
and how we deal with the
most vulnerable populations.
I think a really fascinating,
really social experiment,
has really been
the one in Sweden,
where they actually did
purposely physically distance
the oldest people in their
population while allowing
people to interact
among those who were not
older and more vulnerable.
What's sort of
disheartening, though,
is that the long-term
care experience
is basically consistent
across every country.
So that means that that
particular population--
the oldest, the sickest,
those with dementia--
there is something about
those settings that--
and that has occurred
in Sweden as well.
So I don't know if I've
answered your question, Mark.
But it's difficult.
We somehow need to provide care.
We need to care for
people, somehow maintain
physical distancing,
as Dr. Singh said.
And we have to do
it in creative ways.
I think that we can probably
go back and re-litigate what
happened in the early
period of the pandemic.
But we have to probably come
up with new solutions for how
to take care of
people going forward.
And I think it's going to be
some mixture of technology,
protective equipment.
And that's the best
I can do right now.
MARK BARNEKOW: OK.
Thank you.
National policy is something
that one of our audience
members had asked about.
And I was wondering--
we'll start with Dr. Chin.
If you had one wish
for a national policy
that the US government
could institute
to help rectify this
situation now or prevent
further pandemics in the
future, what would that be?
And I'm going to go to
each one of the panelists
and ask them their
number one policy change.
MARSHALL CHIN: My
number one wish
would be for an adequate medical
and social service safety net
so that no matter who you
are, if the worst happens
like COVID-19, there is that
financial and social safety net
so you don't decline, as
many people have done.
MARK BARNEKOW: Great.
Dr. Huang?
ELBERT HUANG: I mean,
I may be boring,
but what Dr. Chin
described is on my wishlist
as well, a safety net
for health insurance
that is frankly separated
from your employment.
So what we've seen now is that
people in the United States,
the majority-- over 50%--
have health insurance
through their work.
Well, the job issue is
a separate discussion.
But to lose health insurance
in the middle of the pandemic
because you've lost your
job because of the pandemic
has been a double whammy,
I think as Dr. Chin
has said in prior news reports.
And unfortunately, the safety
net system that we rely on,
many of them are federally
qualified health centers
or rural hospitals.
These have been under
threats basically
for at least a decade or so.
Rural hospitals are closing.
So the safety net is very
frayed in the United States.
So strengthening it, sort of
disconnecting health insurance
from employment-- these
are on the wishlist.
MARK BARNEKOW: Great, thank you.
Dr. Peek, insurance?
Or do you have
any other policies
that you'd like to see enacted?
MONICA PEEK:
Definitely insurance.
But since that's
already on the table,
I would say
reinstating the office
for global pandemic planning.
The lack of planning that got us
here in the first place cannot
be understated.
Even if everyone had insurance,
we would be short on supplies.
And everything has--
the way that we've
been able to respond to the
pandemic in this country
compared to other countries has
been limited by those factors.
And so we have not
been as successful--
like you're saying, how did this
happen in the United States--
because of that
critical lack of insight
in planning on the front end.
And so when it seems to
some like a good idea
to slash the
government, it never
is a good idea to
think that we don't
need to plan for emergencies
and to shore up our ability
to protect our country
in time of need,
because those times are going
to be coming faster and more
severely.
And so we've got to have
these things back in place,
because the next
pandemic is on its way.
MARK BARNEKOW: Thank you.
Dr. Singh, can we
do that globally?
Can we get our
global act together
or is everybody
retrenched and gone back
into their own nationalist ways?
How do you view things from
your vantage point in India?
SATENDRA SINGH: Yeah, I
think from a perspective
from the global south,
I personally believe
that true universal health
coverage will be achieved only
when people in the
rural areas of the world
have equitable access.
And that is why my primary
wishlist with the government
of India would be that we need
to spend more on the health
and more GDP on the health,
and specifically strengthening
the primary health care
system in the rural areas.
Because in India,
villages contribute
a much larger population
than the urban population.
MARK BARNEKOW: Thank you.
One of the questions that--
actually, this is
a question I have,
because I've been following the
news in the US, I know this.
There are many
instances of racism
against Asian populations
in the United States.
And I was wondering
if that is impacting
that group of
people's vulnerability
during this COVID-19 crisis.
And I know a lot of
people in our audience
who are from Asia actually
are interested in this topic
as well.
So I'll open it up to the
panel, whoever would like to.
I know Dr. Peek, you kind
of specialize in this area.
Anybody who'd like to
take that question?
MARSHALL CHIN: I'll start off.
And please, everyone
join in here.
In the US, as in probably
every other country,
there is an unfortunate
history of scapegoating
and sometimes blaming the
other when there's a problem.
We talked about
racism, for example.
Xenophobia.
In the US, in
Asian-American history
there is a history of
viewing Asian-Americans
as not American, having
exclusionary immigration laws,
treating Asian-Americans as
less than human at times.
And at times of great
stress, such as a recession
economically or something
like the pandemic,
it's a high-risk time for
all vulnerable populations,
all minorities.
And so initially,
there was the referring
of the coronavirus as the
"Chinese virus" by some
in the government.
And that was dangerous.
You had then some incidents
of verbal or physical
discrimination or violence
against Asian-Americans,
fear of coming out, as
you mentioned, Mark.
To the person's
credit, he then later
on at one of the
press conferences
did say, we don't have
discrimination against anyone,
and specifically called out
not having discrimination
against Asian-Americans.
However, actions speak
louder than words.
And just most recently--
I think two days
ago, for example,
at the press
conference-- there was
a Chinese-American journalist
who was asking a question which
the president did not like.
And he basically told that
Chinese-American journalist,
well, maybe you should
ask the Chinese government
or the Asian
governments about that.
The reason was, why
did he single her
out for making that remark?
So I think there is a
very sharp awareness
we have to have of how
important words are,
terms are in shaping
public opinion,
public actions, because it
has concrete results in terms
of either implicitly in terms
of discrimination or outright
physical violence--
so something we
have to have strong safeguards
against and speak out against.
MARK BARNEKOW:
Thank you so much.
Would anybody else on the panel
like to speak to that issue?
MONICA PEEK: No, I totally
agree with Dr. Chin.
Particularly now, when
we have a heightened
sense of racial violence
and a sense that--
a higher tolerance, I
think, in this country
that's been purposely cultivated
within our national discourse--
that we have to
be vigilant, extra
vigilant when we see
new opportunities
for scapegoating arising.
When people want to
pretend that these are,
you know, misspeaks or
jokes or unintended,
that that's not acceptable,
that we understand the deeper
meaning.
We see the results.
We see Charlotte.
We see the violence
that happens when people
feel empowered to
take what they see
on TV coming from our
president or others
as a mandate for action.
And so I feel like we should
have an extremely low tolerance
for hate speech that turns
directly into hate crimes.
MARK BARNEKOW: There's this
really terrible confluence
that's going on with the virus
in the US, and around the world
really, the virus
and the economies.
Basically, the bottoms falling
out of all these economies,
and the fact that most of
the vulnerable populations
are these low-income
essential workers.
I know, Dr. Peek, you
did talk about this.
But is there anything we can
do to protect these people?
Because these people
are on the frontlines
saving us, the rest of
us at the end of the day?
MONICA PEEK: Yes.
I would respond to
that in two ways.
One, I think there's the
physical protection as far
as making sure that they
are as safely protected
as our health care workers.
And you're starting to see now
when you go into grocery stores
or pharmacies the plexiglass,
the this is six feet,
I'm wearing a mask--
so some additional
things like that
are in place, even though they
may not be the kind of PPE
that I'm wearing when
I go to the hospital,
but at least some recognition
that the workers need
to be more protected.
And then there's the
economic protection.
I see a chat
message from someone
whose dad is a lawyer
working with employees.
And what we've
heard on the news is
that a lot of the money that's
been channeling to sort of help
boost the economy is
not going, as you might
imagine, to the right places.
So large checks
going to Ruth's Chris
when it should be going
to smaller businesses
to help the most vulnerable.
Some of the food workers
are specifically not
getting some of the funding.
And so the plans for
helping the economy
are not necessarily
helping those
who are most vulnerable
in the economy.
And so that's just
a double insult.
And so we need to make sure
the devil's in the details,
that we're protecting-- that
we're economically protecting
as well as physically
protecting--
those who are protecting us.
It's in our self-interest to
protect essential workers.
There's a reason that we're
calling them essential.
And if we cannot recognize
that essential role for them,
we need to at least recognize
that essential role for us.
MARK BARNEKOW: Thank you.
We have a couple
other questions.
You mentioned-- one of the
questions that's just come in
is, how has private medical
sector risen to COVID-19?
Does anybody have any experience
with the private sector?
MARSHALL CHIN: I'll
start with some comments.
So on one hand, I think the
frontline health organizations
have by and large done
an excellent job--
that in some ways,
the closer you
get to the people
in the front line,
there's no sort of
room for politics
and for abstract
hand-waving, because you
have to deal with the
immediate situation.
So I think a lot of the
hospitals, private hospitals
and clinics, have done a great
job of organizing and planning.
On another hand,
I think there are
situations where the
private marketplace has not
worked well.
So one example would
be the supply chain,
where there's got to be
an adequate incentive
for private industry
to invest in,
for example, retooling
a factory to make masks
with a guarantee
of adequate supply
to justify the
upfront investment in,
for example, creating that
type of manufacturing capacity.
This is where, for example,
the role of government
would be to then overcome
these areas of market failures
where, because of the
lack of incentives,
something's got to be done then
to ensure that there's a supply
chain adequately.
So that's one example where,
again, there's a balance,
I think, in the US between--
a general belief in the power
of free market and industry.
There's a lot of
great strength there.
But at the same time, there
are specific situations
or externalities where
markets don't work well where
the government has to come in.
Otherwise, you have
then great equities
and the vulnerable suffering.
MARK BARNEKOW: Great, thank you.
We have a bunch of
questions coming in,
and I've been asked to kind of
address a couple of questions
that we had before
the webinar started.
One of the questions
is around suicide rates
and whether we're
seeing a greater
preponderance of suicide rates
in the vulnerable population
itself.
Is there any particular
segment of vulnerable people
that are experiencing that more
or are more susceptible to it?
MONICA PEEK: You
know, I don't have--
I don't know.
But I would imagine so.
Everyone-- go ahead.
ELBERT HUANG: Sorry, Monica.
I think the answer is--
actually, I think
we don't know yet.
I mean, there's
certainly anecdotes
about suicides in the time of--
and actually, there are
these high-profile anecdotes
about murder and suicide in
the time of the shutdown.
But I don't know
how much of that
is attributable to the
pandemic in that we don't know
the sub-populations
of people who,
if there is an increase,
which populations
have experienced it more.
We are actually
in the middle of--
I think in prior webinars you
heard about the National Social
Life Health and Aging
Project, which is based
at the University of Chicago.
And so we are in the middle
of designing data collection
around death and morbidity
in the COVID-19 experience
for this national sample.
And so we'll know more
about the health effects
of some of the pandemic and
the side effects and policies
from those sort of studies.
But I don't know
right now if we can
answer your question directly.
MARK BARNEKOW: OK, great.
SATENDRA SINGH: Can
I add to that, Mark?
MARK BARNEKOW: Yes, please.
SATENDRA SINGH: Yes, we have
some sort of data in India.
There was a public interest
technologist in Bangalore
by the name of [INAUDIBLE].
So he has curated data
coming out from the media
reports published in India.
And based on that, he has
published an open access data
directory where they have
reported the non-virus deaths
from 30th January to till now.
So from 30th January
to 25th March,
when the lockdown
started in India,
there were 11 non-virus deaths.
And from the beginning
of the lockdown-- that
is 25th March-- to as of
today, that total number
of non-virus deaths
have been 418.
And in that data set, you
can actually categorize that
based on the type of deaths
in the section of the society.
And there has been 168
suicides among the 418 deaths.
So that says it all.
I think we are on the verge
of a mental pandemic as well.
And the next large
cause of death
were death of the
migrant workers,
because in India
there has been reports
that they have to travel
miles and miles to reach
their respective states.
There has been many a
death, many accidents
attributed to migrants.
So that is the
second largest data
set in that Indian database.
I will be sharing the link
of that in the Q&A section
so that people
who are interested
can have a look at that.
MARK BARNEKOW: Great,
thank you very much.
I'd like to stay
with you, Dr. Singh,
and talk a little bit
about collaboration
with other institutions.
We know you have a
strong affiliation
with the University of Chicago.
But with other institutions in
Asia, what are you learning?
What are you experiencing?
How are you sharing?
Can you give us a little bit
of your experience from that?
SATENDRA SINGH: Well, yes.
One of my reasons to visit
University of Chicago
was to gain knowledge in
the clinical medical ethics.
And University of
Chicago is the pioneer
in the case of clinical
medical ethics is concerned.
And I was the first Indian
to do that fellowship.
In addition, there were a few
of my colleagues from China
were there.
What we believe is that the
ethics committees are very
robust in the United States.
On the contrary, what we
need in Asia-- specifically
in India and China-- is that
more of these ethics committees
become a part of normal
routine consultations, which
are not there.
We usually discuss these issues
once there has been a death.
What we need right
now, for example,
in a situation like this,
the current pandemic,
when there is so much moral
injury on the physicians--
what to do, what is the
right decision regarding use
of ventilators, whom to
give, whom not to give--
what is the ideal scenario?
So these are the situations
where these ethics committees
can help.
So I learned a lot from the
clinical medical ethics.
And the second
was my association
with the Bucksbaum Institute.
With a grant from the
Bucksbaum Institute,
I was able to frame disability
competencies for health
professions educations.
I shared so many examples
where inadvertently, doctors
don't even know.
But there are few subtle biases
in their decision-making,
which comes up not because they
are not educated about that.
The main issue is
that many of them
had no interaction with various
types of disabilities or people
having those disabilities.
And that is why, with the help
of the Bucksbaum Institute,
we framed disability
competencies in which we cover
a very historically
neglected sector, which
is the voices of the
doctors with disabilities.
And I think that is important
in bridging the health
disparities, because you
need to have the voices from
the various vulnerable
populations,
people from the elderly,
people of color,
people who are from
the poverty background,
[INAUDIBLE] doctors
with disabilities,
people from the
LGBTQI+ community.
When you hear those voices,
when these will come up
in your medical decision-making
as your colleagues,
then I believe you will
start to see changes
happening at the ground level.
MARK BARNEKOW:
Thank you so much.
As a university-- and this is
one of the questions that did
come from the audience--
I'd like to ask two
related questions.
One is, as the
University of Chicago,
have we done enough during
the pandemic period?
Could we do more?
What could we do?
And then the second
part of that question
is, what do we see the
role of the university
during a period like the
one we're experiencing now?
I'll start with Dr. Chin.
MARSHALL CHIN: That's
a great question.
I think there are multiple
roles for a university.
And I think on
whole, I have been
impressed overall with what
the university has done.
One is thought leadership.
And so I think it's
wonderful you've
been sponsoring this
particular webinar,
and thank you for
the opportunity.
And I know you've had
other opportunities
for other webinars.
And so on these
different issues ranging
from medical care,
basic science discovery,
these policy issues,
cure the vulnerable--
these are important to discuss
these different issues.
A second would be the
direct medical care.
And again, I think within the
limitations of the US health
care system, the University
of Chicago, I think,
has done an outstanding job
of taking care of its patients
and organizing its care.
I think the caveat there
is that ultimately,
for us to do the best job
caring for the safety net,
the underlying
health policy system
needs to change so that
we have a financial case
to basically sustain the
types of care and investments
that allow the best care for
all particular populations.
The last thing I'll
mention is that there's
a critical role for being what
we call an anchor institution.
In other words, on the
South Side of Chicago,
the University of Chicago is the
biggest employer and dominant.
And so besides the academics and
the resource and direct patient
care is how we either model
or don't model our actions
as an institution-- which
again, I think overall
we've done a good job with.
So things, for example,
of creating food delivery
programs.
Monica has been--
Dr. Peek has been
one of the leaders
in creating a partnership
with the Greater Chicago Food
Depository, then to
work with the university
to supply foods for some
of the South Side folks
who are food insecure.
Or things like hiring in
the community, and community
outreach programs and all--
these are all important,
specific, concrete ways.
Or the rules and
regulations we have
for employees in terms of
trying to preserve jobs
and not furloughing in all--
which again, I think
overall so far,
the university has done
an excellent job with.
MARK BARNEKOW:
Thank you so much.
Dr. Huang, would you
like to comment on that?
ELBERT HUANG: Yeah,
I mean, I think
Dr. Chin summarized the
kind of the top line
categories in which university
can play a big role.
And I agree with him that
I've been quite impressed
with the university's response.
I would just amplify
that I think what's
exciting is, you know, really,
the solution to the problem
partially is going to be
in science and in medicine
and making discoveries
around testing or treatment.
And in both of
those cases, we have
scientists that are on the
frontlines of, for example,
developing antibody tests.
We were enrolled in some of
the earliest trials of some
of the treatments for COVID-19.
And so that's, I think, the
proper role for the University
of Chicago as well.
Kind of another thing that's
happening, as it were--
I think if we can shape
policy and make policy
more empiric and evidence-based
in either opening the country
or keeping things shut down,
those are critical decisions.
And so our economists
and our policymakers
have all actually gathered
together, actually
with epidemiologists as well.
There's some really
novel studies
around cell phone data
about what businesses
have highest levels of
contact, where people have
a lot of contact
with each other,
led by our dean of the
public policy school.
Those are kind of objective
data that could be used to help
decide what parts of the economy
can open and what cannot.
So the university
is definitely--
oh, the other thing
that's been impressive
is how much everything's
been shifted
to thinking about
COVID-19, because it's
such a historic and
devastating event.
And so we're doing
everything we can
to try to reverse
this or mitigate this.
MARK BARNEKOW: Great.
Dr. Peek?
MONICA PEEK: Yes.
I would say because
of the location
of the University of Chicago--
we're on the South
Side, where we
are surrounded by communities
that are greater than 95%
African-American,
low-income working class
communities that we as
an anchor institution
have a moral obligation
to serve our community.
And so we have been
doing so clinically.
But we also have an
obligation to help and to rise
to the challenge of
helping to support,
as Marshall was saying, as an
anchor institution in times
of great economic crisis to
help support our neighbors.
And so one of the things that
the institution has been doing
is really leaning heavily
into the city's racial equity
rapid response team
to try and help
the city think about how
we can reduce disparities
in the coronavirus
epidemic within our city.
Three of the communities
that are suffering
most significantly from
the coronavirus epidemic
are communities that
are primarily black.
And two of those are
on the South side.
And so the University
of Chicago has
been partnering with
community-based organizations,
community clinics, and
community hospitals
to try to do a lot of things
to work in those communities
and decrease cases
and prevalence.
And so that, I think, is part
of our responsibility as well.
MARK BARNEKOW: All
right, thank you.
Dr. Singh, I'm going to give
you the last word on what
do you think universities
could be doing more.
SATENDRA SINGH: I think
yes, because there
is a very great role for
medical universities,
specifically in
India, because there
is no country with more
TB patients than in India.
And there has been this
buzz about the availability
of vaccination offering
protection for people
in the global south
against COVID.
But unfortunately, we don't
have any evidence yet.
What is reported in media is a
handful of ecological studies,
which are not peer-reviewed.
They are just [INAUDIBLE] with
serious methodological flaws.
So already, I believe Australia,
Netherlands, and I think also
US, they have already
started conducting trials
to test this hypothesis.
And I think there lies a greater
opportunity in medical journals
within India,
because we need to do
more of these randomized
controlled trials
within India, because here
we have maximum amount
of tuberculosis patients.
There is a tuberculosis program
running down over there.
In India, TB kills more
people than COVID-19.
So there is a role for
medical universities.
MARK BARNEKOW:
Thank you so much.
You know, when you're
running a panel
with medical doctors
as contributors,
you have to be
sensitive to time.
And I know it's early there,
and your phones and your texts
are probably going off.
So I want to make
sure that we try
to stay on schedule with
closing the program.
But one thing that
I would like to say
is that in preparing
for this webinar,
I've learned about so
many different vulnerable
populations that COVID-19
really drew to the forefront.
So if there's really any
kind of silver lining,
it's putting more
attention on these classes
of people, these
groups of people
so that we're more aware.
And I think that hopefully, our
institutions and our government
policymakers are going to be
listening to programs like this
and be more aware when
they're actually making policy
to help not only
deal with COVID-19,
but also to help us
become more informed
and I think more civil as a
society when we're dealing
with vulnerable populations.
So I really want to
thank the entire panel
tonight for your contributions.
It's been fantastic.
I wish we had more time.
And maybe we'll take
more time in the future.
I also want to thank
the Bucksbaum Institute
of Clinical
Excellence in Chicago,
as well as Aditi and her team
in the Delhi Center, [INAUDIBLE]
and his team in
the Beijing center,
and of course, our
team here who's
been kind of the backbone
of the program in terms
of delivering this program
here at the Yuen Campus in Hong
Kong.
So I want to thank
everybody for participating.
And one last thing
I'd like to do
is mention that if you
haven't registered,
we have another program.
And it is in the
form of a series.
It's called One Hundred
Year Lives in Asia.
And actually, episode
two is tomorrow night.
This is hosted with our
chairperson, Professor Kate
Cagney.
And tomorrow's episode will be
discussing health care and life
expectancy.
This is tomorrow night
8:30 PM Hong Kong time.
We adjusted our time
for most of our programs
so people in the US and
Europe and throughout Asia
could be participating in them.
If you'd like to know
more about our programs,
you can find us at
www.uchicago.hongkong/events.
And the Delhi Center
events are at uchicago.in.
The Beijing Center events are
at uchicago.cn.beijingcenter.
And you can always
follow us here
in Hong Kong on the University
of Chicago Yuen Campus Facebook
page.
Have a wonderful evening.
Thank you so much from
wherever you dialed in from.
Hope to see you again,
and please stay safe.
Goodnight.
