Cspan. Org, or listen on the free cspan radio app. Next, ceos from the Cleveland Clinic and metrohealth system on how the coronavirus will change Health Care Delivery, public confidence, and telemedicine. The city club of cleveland hosted this event. Hello and welcome to the city club of cleveland. I am the chief executive of the city club and proud member. As we take the steps to reopening the state, your city club is continuing with our virtual forums and still presenting here our friday forms from the studios. We are very grateful for their partnership and support. We all know the coronavirus pandemic has put an incredible amount of pressure on the American Health care system. A shortage of supply and Health Care Workers, declining revenues from the cancellation of a lecture of procedures and Massive Health insurance losses due to unemployment has shaken the foundation of our countrys health care infrastructure. As states begin to reopen and the number of coronavirus deaths and cases is expected to plateau, we have the chance to examine what is working, and more importantly, what is not working when it comes to the ways in which we deliver health care. Today, we will talk to two local hospital ceos who are physicians about the pandemic, changes their hospitals needed to make and what the future of Health Care Delivery might entail. Before i introduce our speakers, i want to thank our generous generous donors who support these virtual forums. For a list, visit us at cityclub. Org thank you and support their work when you make a contribution online or become a member. Now to our speakers. Ceo of thent and metrohealth system arrived at metro in 2013 and has worked through vitalize to revitalize the campus including the construction of new hospital and improving Economic Conditions in the surrounding westside neighborhood. Cleveland, heto was a consultant for hospital turnarounds and administrator at st. Francis in new york. The president and ceo of Cleveland Clinic. As a surgeon 2004 specializing in minimally invasive and robotically surgeries. Rdiac prior to being appointed ceo in 2018, he served as ceo of klingler Cleveland Clinic abu overseeing strategy and operations as the first u. S. Multi Specialty Hospital to be replicated outside of north america. You canevery forum, participate with your questions. Text them 2330541, 57 91 and we will put them into the second half of the forum. 5315794. Thank you for the vital work you have been leading. I want to start with you. As the stayathome orders have transformed into strong recommendations, businesses are reopening, commercial activity is coming back, your hospital put out a model suggesting to us all that we expect a sharp increase in cases. Can you talk a little about that . Sure, in early march during the First City Club interview on the coronavirus, i said the health is donec if people dont die in great numbers. Some people are going to think you are overreacting. You did a tremendous job. We responded in a very responsible way and we crushed the curve. It was expected to be 60,000 cases and came down to 10,000 cases a day. To 2000 cases and now we are hovering around 500 to 700 new cases. As more people interact, we are going to see that number increase. It could be 900 to 1500, but it will come back down again. In our model. Cases are almost guaranteed to increase, given the reopening of the economy, what is different at the Cleveland Clinic today than the situation three months ago when you anticipated the first surge . A lot has changed over the past several months. First and foremost, the Public Awareness about the disease has changed tremendously. The information that we have gathered, new knowledge, i think all of our listeners today here have a good understanding of the pandemic but also understand how to behave in a new environment. Distancing, hygiene, and separation, measures i believe are going to significantly improve the safety of work environments. On the hospital front, a lot has changed. Over the last three months, we have jointly worked to ramp up capacity to take care of covid patients. Fortunately for us in ohio, we have not seen a large wave that our colleagues in new york and detroit have experienced. Also the hospital environment has changed in many ways. Announced temperature screenings at entry points in the hospital, all of our employees are caregivers, wear masks, and hospital environment, we strongly encourage visitors and patients to do the same. Social distancing is prevalent and our ability to test has increased exponentially from the beginning of the pandemic. We have been able to create a safe environment for care. It is really important to emphasize hospitals are a safe environment for care and in the case of Cleveland Clinic, fewer than 1 of our caregivers have shown signs of infection. Most likely, infected in their own environment and currently, out of 60,000 caregivers, only five of them are hospitalized and being treated for covid infections. Interviewer you said we didnt get the wave detroit encountered, apart from luck. Why is that . Dr. Mihaljevic i think the earliest recognition of the importance of Public Safety measures by our government was the decisive step. I would like to think that also the coordination, unprecedented collaboration and coordination among Health Care Providers and government has resulted in an exceptional outcome for the state of ohio. Interviewer go ahead. Dr. Boutros two things. One is if you look at the difference between michigan and beo, one critical issue will the election day, where ohio didnt have postponed it and michigan did not. That contact of that number of people is going to demonstrate that it is the single biggest change between ohio and michigan. The second thing i would say is regarding safety in hospitals, safety is our priority every day, but because of the additional measures he described, our facilities have never been safer, so i would say hospitals are safer than they were before the pandemic. Oferviewer i know that part the reason that message is so important to both of you and for both of you to get out of the community is because so many people have delayed elective procedures and also Necessary Health care because of fear of and going to the hospital would put them at risk. Do you want to talk a little about the dangers of delaying necessary medical care . Dr. Boutros well, i would say people toly told limit contact with the Health Care System, Hospital Systems and the like because we wanted to limit unnecessary exposure for vulnerable patients and Health Care Workers and that has worked. Where the largest numbers of Electronic Medical records is showing data that for over 3 million patients, that we have seen an abrupt drop between 86 86 and 94 for cervical cancer, cancer, breast cancer, prepared compared to prior years. Admissions for heart attacks have decreased 45 , strokes by 38 , and childhood immunizations are also decreased by 44 . Neglect thee cant proven medical interventions of preventive care. Because weoncerned are likely to have a far worse secondary Health Crisis due to coronavirus may have an impact on us. Interviewer dr. Boutros is ceo of the metro system. Also here is dr. Mihaljevic. , with respect to elective procedures, that is worth hospitals like the Cleveland Clinic make a lot of the money that supports the overall operations. This is a National Story that Healthcare Systems are finding revenue to operate has decreased significantly. How much of a problem is this for the future of health care . Dr. Mihaljevic it is a tremendous problem for the future of health care because the Financial Impact on health has been tremendous. 1. 2 million Healthcare Workers lost their jobs in the midst of the Largest Health care crisis u. S. History, which at a time when our communities need our help and support more are ever, all hospitals struggling due to this unprecedented loss, so that is a real issue because the demand for Health Care Services will not disappear. Industriesany other where demand to our services is here to stay and is most likely going to be increased for the reasons we just mentioned, deferment of care has created a lot of pentup demand and i believe this is going to be to healthcarege industries to meet the needs of people who we care for. Dan what about the challenge to the Business Model . Does this point to some other solutions, who pays for hospitals . Run on a veryls so that youty model are running i dont know what figure, 70 , 90 capacity so every room and everybody can in aate revenue, but capacity situation like that, you may not have the ability to manage a surge. Dr. Mihaljevic absolutely, so we have created a lot of additional capacity in the meantime but when it comes to differences in the business , the way we care for Industry Health care as a whole has reacted in a way that it always does. There is a lot of innovation taking place at an accelerated pace. We are now delivering more and more care used in digital means, Telehealth Services have exploded in popularity and have been embraced by patients as well as providers. The clinics example, before the pandemic, we were providing about 5000 healthcare visits using telehealth a month. Currently that number is up to 200,000, so more than half of all of our outpatient visits are being provided on a digital platform and i do believe that this is a significant usrovement and will allow also in the future to provide services at much more acceptable and much more affordable way. Dan dr. Boutros, have you seen a similar increase in telemedicine . Dr. Boutros dr. Mihaljevic and the Cleveland Clinic were using telehealth more than we were. Ofwere at about. 5 outpatient visits being delivered by telemedicine. We went up to 85 and we are now hovering around 50 of our services being provided through telephone and video. You asked a question about the andncial hit the hospitals the Hospital Association has calculated we are losing 1. 2 andion of revenue a month talked about over a million Healthcare Workers losing their jobs. This pandemic has really uncovered for us at metrohealth the fragile Financial Health of many of our workers. Weve seen it manifest in different ways. Everybody working i am really proud. Yesterday, the Metrohealth Foundation has given us a grant to provide frontline workers a 2. 25 raise this year so that they can continue to care for their families and juggle all the stresses at home and as dr. Mihaljevic said, we will need every Healthcare Worker to be available for the future. Dan i want to ask you both about the Minority Health task force strikeforce that governor dewine convened, which was the report out was included as part of the press conference yesterday. The disproportionate impact of covid19 on africanamericans and other communities of color has been a huge piece of the learnings of the last three months, but for people in health care, it wasnt much of a surprise. Whatou both talk about your institutions are doing to address the underlying causes, the systemic racism, structural racism, and implicit bias that is involved in creating the conditions under which africanamericans find a disproportionate impact of events like covid19 . Dr. Boutros . Dr. Boutros if you remember, last june, i spoke about social racism and in terms of how it negatively impacts racial and ethnic minorities. We then put together the institutes for hope, which has been highly active in dealing with underlying social determinants of health. Everything from Food Insecurity jobs and the like. Things wevef the done is we have a at our own coronavirus testing and covid cases and what we found is was icuhousehold admissions represented disparities and due to the Health Conditions and age of the patients who were coming in. For us, this is another wakeup call. Going forward, we has a community and nation must commit ourselves to addressing these disparities, and we have begun by working with the county by goingpartment to different localities to test high risk populations. A churchust at yesterday and tested a couple hundred people to make sure that they are getting the testing necessary. Dan dr. Mihaljevic . Dr. Mihaljevic that is certainly a phenomenon that comes as no surprise for us who are in the Health Care Profession, unfortunately. Both our organizations as well as the Broader HealthCare Community in cleveland and ohio have been working together. This has been an unprecedented joint effort to address the disparities in Health Care Delivery during the pandemic. Clevelande on the clinic site in collaboration with the University Hospitals and as a nextdoor neighbor, we opened the first drivethrough testing site that was available for all patients that are being treated by our caregivers and since then, since we opened our , we have opened five or six additional sites. There are additional sites that will be available for the testing and they are going to be dispersed through the communities all the way from akron to cleveland. Theresting capacities, are additional efforts. We are focused on education as well as provision of not only educational materials, but lifes necessities. Everything from sanitation materials to food to direct outreach, and we have also ramped up our capacity to knowingcare at home, that very many of our patients are concerned and scared about coming to the hospitals, we have decided to come to their homes to deliver the care they need and that has been warmly welcomed and i think it has been an effective measure. Dan dr. Mihaljevic, i want to ask you about what happened early in the crisis, early in this pandemic, there was a shortage of ppe, personal protective equipment, shortage of ventilators, and a lot of concerns that as a nation, we did not have a Public Health system that was and supply and logistics system that was ready for such a crisis as we were experiencing. The Cleveland Clinic delivers care both in the United States and internationally, and is a worldrenowned hospital, you are part of the conversations that go well beyond our borders and i just wanted ask you to comment on the relative level of preparation that our nation had, and what you think to be different in the future ought to be different in the future. Probably thec most important thing is to provide context about this pandemic. Myre is no nation to knowledge that was well prepared to meet a pandemic of this proportion. This is a phenomenon we have never encountered in the past, and certainly a phenomenon that has taught us and continues to teach us very many lessons, but speaking about the system and briefly about nationwide efforts. Haveleveland clinic, we a presence in the United Arab Emirates and that is how we learned about the complexity of the care for patients with covid19 because they had experiences in taking care of these patients before the pandemic arrived in the United States. Daily contactn with our colleagues in upper darby, we started in january to prepare our system for covid, but did not have the most resources at our disposal. What we have seen in ohio and nationally, the collaborative efforts are something we can be very proud of. Very many of us have participated. All of us have participated in ohio in sharing resources and knowledge, as well as analytical capability. We have collaborated very closely with our governor and his office and i believe that the success of the collaboration is evident. At the federal level, if you take a look at the ability to get the personal protective to different parts of the country, i think this has not been perfect, but in many instances has been better than other countries that were struck with the Covid Plandemic pandemic. Where manylator bank large providers have committed to being a part for centers that were hit hard such as new york and detroit and lastly, i would like to say we have also seen very many caregivers and Health Care Professionals stepping up to the task and go into the areas that needed help most. Have very many people from Cleveland Clinic who volunteered and spent months in new york city. We had a large contingency that is just about to come back from Henry Ford Hospital in detroit, taking care of covid patience and this past saturday, 45 caregivers flew to the United Arab Emirates to help combat a pandemic in the uae. The result of solidarity and a lot of effort, and i think there is inspired it is inspirational for those of us who had a chance to participate. Undoubtedly, onal but i assume at some point in the next year, there will be a number of reports with recommendations about what the federal government ought to do differently in preparation for a future pandemic. What kind of recommendations would you add to that list . Dr. Mihaljevic several are obvious. One is that we have to have a greater reliance on Domestic Production of critical equipment for Health Care Delivery. In this case, it is personal protective equipment. We should never be in a position the safety of our citizens is dependent on availability of a relatively that welowcost item know how to produce which is downs, gloves, and fay shields. Facewns, gloves, and shields. That production will have to tick up at home and we will have to have a Strategic Reserve and coordination in detection as well as in treatment has to be i would say lastly, that if we think about the measures that worldwide we have implemented to combat the essentially used the tools from the 14th century to combat the biggest Health Care Crisis of the 21st century. The quarantine is seven centuries old method of combating infectious disease. We have yet to use on a larger school they tools scale the tools from the 21st century, such as our analytic capacity to produce, accelerate new knowledge, to use Digital Technology, and i believe there is going to be a lot of thought and a lot of thought is being put in about how to leverage those capacities and our ability to address new and yet unknown pandemics. Dan dr. Boutros, what recommendations would you have . Dr. Boutros i would echo dr. Mihaljevics comments. I would also say i would add to that, many of the pharmaceuticals need to be Domestic Production capacity here. One of the things that will need to happen, the integration of our data across the entire nation of all Health Care System so we can share information quickly. Career and my health care and my life, this is the largest and steepest learning curve, our knowledge we have gained from one another is remarkable and as dr. Mihaljevic and you and i were talking before the program, we havent been able we have been just reading about this coronavirus and the implications and we havent been able to read anything else because of the increase of knowledge and information that we have had, so we have to have a better way of sharing that information and we do today. And have a little bit more coordination, and i think we have developed some muscle memory here on how to do that and that shouldnt go to waste. I would also say, i have never of the u. S. Oud response to this. Graduallyle to shift and were able to create Different Solutions for obstacles. We did not suffer what other countries had to go through like italy. Im really proud of our overall response of our citizens and our nation and our state and our Health Care Providers. Dan is there something more you wouldve liked to see from the federal government . Dr. Boutros theres always something more that you can do. I think they did the best with the information they had. Something we would not have done as well as they would have. We had our visceral reaction to this that we were sore afraid that we are going to have millions of people are going to be millions of americans were nothing e, that literally nothing could have been done that would have been sufficient to ease our fear. That our, did we see measures are impactful and we could get back to a sense that we can manage this. For a while, it was fear, panic, throughout the country and they did the best they can. Dan i want to ask you, though, how should then listeners understand the news out of Columbia University this week that had the federal government acted a week earlier, tens of thousands of lives would have been saved . Would say to you that had they acted two weeks would more than that had they closed the borders before the current first case, we would have never had to close we would never have had to shelter in place. Hindsight is 2020. Live dataaling with and decisions like dr. Do all the time with incomplete information and have to make decisions on it. As long as you act responsibly and according to your guidelines that have helped care for decisionou make the and make the best decision you can, and it is never going to be ideal, so i would say to you that some people think governors should have closed the state earlier. Some people think they should have closed later and they will have arguments. Is with Akram Boutros us and so is dr. Mihaljevic tomislav, the president and ceo of Cleveland Clinic. You can text your question to 33 3305315794. Pediatricians are worried about dropping immunization rates among children. What are you hearing from parents worried about bringing children to the hospital or their own local clinic . Dr. Mihaljevic all parents are worried about returning to school. They are worried about bringing children to the hospital out of fear of immunization and my message, our message, im sure with dr. Boutros, is that hospitals are safe. They are safe environments. We have to be very, very cognizant of the fact we have to be aware that chronic conditions and conditions in general that need treatment need treatment even during the covid pandemic. Immunizations of children should not be stopped. It is really important that we do not lose sight of this. Forconsequences can be dropped communications can be very severe, so i would encourage parents to bring their children for regular immunizations. Dan dr. Boutros . Dr. Boutros again, the only thing i would add is that we are looking into ways into immunizing our patients at home. What we want to do is reach out and if they are going to postpone it just because they are afraid of coming in and we cant convince them to do that, we have to look at different ways to provide the vaccination to these children. The consequences for under youth isd infants and really substantial. Dan are we going to see a rebirth of the house call . Dr. Boutros we are already. Metrohealth is doing the same. We are providing hospital at telehealth are like housecalls. We are also sending nurses and doctors into peoples homes instead of them coming to the hospital. We are literally taking care of patients who would normally be hospitalized at metrohealth at home today. Dan a couple of questions have come in about how health. How we keep telemedicine accessible as it currently is due to relaxed regulations. While also protecting both patient and provider privacy and security, and also a positive outcome of the greater use of telehealth opportunities for treatment and provider engagement, but ensuring billing for mobile and online visit cap appropriately happen appropriately . Dr. Boutros it is a rapidly moving topic and health care. I would like to say that the prevalence and the greater use of telemedicine has been enabled by one of the immediate actions of federal government, when they have reacted on our recommendations as a Health Care Provider that local restrictions of the availability of Telehealth Services should be lifted so we as providers conserve any patient in the United States without the need that we used to have in the past where physicians had to be licensed in different states to provide services for states that had to reside in different state. This is important because many patients who live outside the accessf ohio wanted to our physicians but couldnt in the past but now it is possible. Are obviously many things we need to do in the future to ensure telemedicine continues to be an important and effective way and safe way to deliver care. One is to protect the privacy and that is something i believe we have already made significant strides in through the in digitalon platforms and i believe reimbursement will continue to evolve. So far, reimbursement has been very good, but i do believe we as a nation, the entire world has to embrace Digital Technology in Health Care Delivery to a larger extent and this is a journey that has begun, but there is a lot of work ahead of us. The idea oftros, increased use of telemedicine assumes increased access to broadband internet, which is currently the city of cleveland is ranked i think fourth worst in the nation of cities of this size. We spoke about this a few weeks ago. How concerned are you with regard to the growth of telemedicine in the absence of real access to Digital Infrastructure . Dr. Boutros we very much art. With the help of several are. Of others, we are toing broadband ability homes in the neighborhood but also doing the training possible to do that. We are doing this to demonstrate this is a better utilization of funds to keep people healthy by providing them this digital connection. It is the first of its kind in the nation and we will see if 1000 homes is enough to demonstrate the excellent use of health for funds and be able to both insurers and cms cover that cost in the future. Dan with regard to switching to a Public Health question specific to the pandemic and how we approach it, both your institutions have had to integrate. Who is going to lead the initiative . Will it be hospitals or Public Health, and how important a role is that going to play . Are we compared to do that prepared to do that work . Dr. Mihaljevic Contact Tracing is typically done unless there is an outbreak in the organization, done by ehealth. We worked with the city of cleveland to look at these things. Clinic is constant and testing Public Health is very much involved in doing the tracing for positive cases. I would say to you, it is i donthat people think recognize how good our Public Health system is in cuyahoga county. We have some of the most dedicated, knowledgeable individuals that have been able to increase the ranks significantly and they are continuing to do so, so i feel very confident in their leadership and capacity to do the tracing. , is there aaljevic Silver Lining to this pandemic at all . Dr. Mihaljevic i do believe there is a Silver Lining to the pandemic. I think we have made a lot of strides in the way we deliver health care and the way that we share knowledge and resources and the ways that we always wanted to do in the past that couldnt. This pandemic has served as a catalyst, accelerator for a lot of good medicine and i would highlight a few things we have touched upon that reflect that i think first and foremost the adoption of the Digital Technology has sky rocketed and that is a good trend, a trend that we always wanted to see but had difficulties putting in place. The second part when it comes to our own Health Care Professionals i do believe society as a whole has been reminded about the importance of the work that Health Care Professionals do, that care givers do. As something that has been lost on many over the past several decades. And that rest ration of faith in our Health Care Profession is something that is very dear to our hearts and something that i think this pandemic has really accentuated in the best possible way. Integration of our Health Care Efforts among various providers i truly hope that it is here to stay. I think the value of integrated Health Care Delivery systems is demonstrated its effectiveness in the treatment of this pandemic. And lastly, efforts in the community and understanding are much deeper that we will not be able to have a Healthy Society until we have our healthy communities. That every community has to be healthy in order for our society to be healthy. The importance of Public Health care efforts and Community Care efforts has never been clearer to the general public than it is today. Can you talk about vaccine. The Vaccine Research in the past used to be very slow because we used to use different methodology to deliver the vaccines. Development of potential vaccines in coronavirus has been nothing short than astounding. International collaboration is progressing at a fast pace and currently we have several dozen different vaccines that are under investigation. Some of them are already in clinical use and theyre in clinical trials. That has he one gathered most attention is the vaccine coming from mod earna and is an gathered most attention innovat deliver vack since. We believe through the production of vaccines we chose is going to be accelerated. With all of that taken into account, if and when we get a vaccine the distribution is certainly going to need to follow the indications for medical need and the distribution will have to first address the most vulnerable populations who are the highest risk of covid infections and those elderly with chronic conditions as well as the Health Care Workers and Health Care Providers. Having said all of this, it is important to remind all of us that having a vaccine is by no means a certainty. We do not know when the vaccine, effective vaccine, is going to come. We do not know if it is going to come. Because coronaviruses have been around for a really long time. The common cold that each of us has experienced is caused by a coronavirus just not this type of coronavirus yet we do not have a vaccine for the common cold. So this is not an easy task. We have to be patient. By the e encouraged pace of discovery. Can you shed some more light on the timeline that i think dr. Fauci said yesterday he believes it could be here by december or january. I was nk that the speaking about the acceleration of development of the vaccine. That 21st century tool that were using today to be able to develop a vaccine. Because this is such a worldwide phenomena, everybodys working with each other on collaborating. A vaccine production, no one company is going to be able to produce enough vaccine for the entire world. So what i think you will see is that the First Company that finds it is going to be able to lease out its technology to other companies to produce it. So thats why well have mass ploducks of the vaccine. So you will see collaborations as you saw with Hospital Systems, also pharmaceuticals which typically is not collaborative at all. And then while were on the topic of collaboration, i want teams for hank the working together with all of us during this time and in the most exceptional way of caring about the Community First and making sure were all doing the right thing. This experience has been nothing but stellar. Another question for you about Health Service pross vided to the county jail. These conggat care situations and places where its almost impossible to do social distancing causing a lot of concern. Weve seen a spike in cases as well at the Marion Correctional Institution in ohio. Can you talk a little bit about care being provided to vulnerable inmates . I honestly could not be more proud than the care that was provided at the cuyahoga jail, our first model shows that up be bout 1400 people would infected so we went to the judges and worked with the administration and the courts and the Prosecutors Office and the defense attorneys, and we were able to reduce the population to permit us to put people in single cells to create social distancing and the like. So then the number came down as we did that there were less people in the jail and the models showed that we could get up to 600 to 800. We started doing some very innovative things of isolating people as theyre coming in and doing observations. And today the number of about rus inmates is 170 over the past twoandahalf months and we have had only one visit to the hospital, no major illnesses, and no deaths. So im very proud of what weve done. Weve put the information together and have shared it Ohio Department of corrections. But jails are not the only conggat living facilities at risk. Nursing homes account for 250 of the deaths. Thats why we are working to make sure people are tested, and homeless shelters and other locations, also the staff torks make sure we keep it under control. The n you speak to how Cleveland Clinic and metro health how youre both working to share data and the coordination of referrals to social Service Agencies . So we have been sharing our data in particular during this covid pandemic better than we ever have in the past. Ll providers here in northeast ohio, and numerous others in the state, we have all been sharing data about the covid pandemic on a daily basis, and that has really been one of the most important determine nants of our success so far. And probably being one of the best prepared states in the country to meet this new challenge i do believe that data sharing and the integration of data is just going to get better over time as our understanding as well as our digital sophistication and Data Collection sharing analysis and Data Protection which is a really important piece of it gets more and more sophisticated. Heres another question from the audience. You seem reluctant for both of you. You seem reluctant to criticize the federal response to the pandemic. Isnt it true that the u. S. Has not fared we will in the crisis . Statistics show we have one third of the worlds cases, that we didnt have adequate testing or ppe and President Trump denied covid was anything to worry about. When i compare our responses we dont look so good. Please respond. Honestly im not trying not to criticize anybody. My point is to focus on what we were able to do and how we met the challenges. There are going to be plenty analyses of what we could have done better and those will take place and well have lessons learned. I can tell you that we assess our response metro health and at the county and collectively every day, and we learn from mistakes that weve made and continue to improve. I am very, very proud of how the Health Care Systems, ohioans in general, helped reduce the curve. Actually, as i said before, crush the curve. How our governor has worked with us and listened to us and worked to make sure everyone is safe. Increasted Testing Capacity. I know the clinic increased Testing Capacity significantly. Maybe that ability to do 9,000 tests a day were going to get up to 2,000 tests a day. So im focusing on how quickly were responding to this and doing better. Do i wish that we didnt have a single case in the u. S. . Absolutely life would be much simpler than it is today. And more and more people would be alive today. Are there specific lessons we can draw from korea and germany . This is far from over. I dont think we can really responsibly tally up the effectiveness of individual countries in combating epidemic. But what we have learned frm there is orean model, a lot of regional variability in the way that this pandemic has been addressed. There is lot this speaks to a certain degree about cultural and social norms and government ability to influence Public Health. To speak about korea, social distancing, wearing a mask in public, has been a norm, a social norm in south korea for a really long time. Actually a relative amount of testing that it has done was relatively high but not exorbitantly high. And they have been very good in being able to combat an pandemic without shutting the economy down. They. Germany had a different trajectory and the trajectory is also reflective of their cultural norms. And an interesting thing about germany, they didnt have more hospital beds per capita than any country in the world for which they used to be criticized in the past by being over by having too many hospital beds. In this particular circumstance , that turned out to be an advantage. Lastly, i would say its really important to keep a perspective about a pandemic. Nobody has really been prepared to address it. As dr. Buteross said folks have done the best with the information they had in hand. From our interactions with government officials both in the state and federal level, we have found them to be responsive to our suggestions and they have implemented the measures we suggested swiftly. I will say that our collaboration in the state of ohio has been unprecedented. In the two visits and two conversations with federal government lets say for example the lifting of the f. D. A. Restrictions for testing so that the testing can be done in individual hospitals is something that we brought forward. And the loosening of the f. D. A. Restrictions was lifted literally in the following week. That has allowed individual hospitals to develop Testing Capacity and help more people in need. Another good example is that weve asked to lift for the restrictions on the adoption of telemedicine to be lifted and i have to say that their response was positive and immediate, and that has allowed us to serve many more patients across our entire country. Excellent. I thank you both for your time today and for joining us for the friday forium. We are going to leave it there. Im shocked that neither doctor mention it had importance of hand washing and wearing a mask and keeping your distance. So having done that were going to close it out. I thank our sponsors who sponsor our Health Care Innovation series. City club virtual forums are sponsored by cleaved foundation nd others and pnc with additional support. There are many more member sponsors and donors you can find at city club. Org. Thank you. Were going to leave it there. Stay close in your hearts if you cant stay close in person. Have a great memorial day weekend. Thank you