I am chief executive of the city club and a proud member. May 22. As we take these steps towards reopening the economy and state, the city club is continuing with virtual forms and still presenting from the studios of 90. 3 idf stream our public media partner. We are very grateful for the partnership and support. We all know that the coronavirus pandemic has put an incredible amount of pressure on the American Healthcare system. A shortage of supplies and Healthcare Workers, sharply declining revenues and Massive Health insurance losses due to unemployment. Shaking the foundation of our countrys infrastructure. As states began to reopen end as the number of coronavirus deficit in cases is expected to plateau, we have the chance to talk about what is working and what is not working when it comes to the ways in which we deliver healthcare. We talk with two local ceos who are also physicians about the pandemic, the changes are hospitals needed to make a what the future of Healthcare Delivery might entail. Before i introduce our speakers, i would like to take a quick moment to thank our generous sponsors, workers and donors. For a full list please visit us online. You can join them in supporting our work when you make a contribution online or you become a member at city club. Org now to our speakers. President and ceo of the metroHealth System. He arrived at metro in 2013. His work to revitalize, a new hospitalized building and improving Economic Conditions in the westside neighborhood. Before coming to cleveland he was a consultant for hospital turnaround in an administrator in new york. Also with us is doctor tom. President and ceo of Cleveland Clinic. Joining in 2004 is a cardiothoracic surgeon specializing in minimally invasive cardiac surgeries. Prior to being appointed ceo in 2013 he served as ceo of Cleveland Clinic abu dhabi for three years overseeing the strategy and operations as the first u. S. Specialty hospital to be replicated outside of north america. As with any form you can participate with your questions. Just text them. We will put them into the second half of the program. Text your questions. If you are on twitter, tweet them at city club and we will work them in. We are so glad to have you both back beard welcome to come again, the city club of cleveland. Thank you for having us. I want to start with you. The stayathome orders have been lifted and transformed into strong recommendations. Businesses are reopening. Commercial activity 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 bit about that . Sure. How we march during that city Club Interview over coronavirus, the Public Health, if you do your job well and people do not get sick or die, some people are going to think you are just overreacting. How you did a tremendous job. We responded in a very responsible way. We crushed the curb. 60,000 cases came down to 10,000 cases. 2000 cases and now we are hovering around 500 to 700 new cases. As more people react, you see that number increased. 9001500. Dock there, as cases are almost guaranteed to increase given the reopening of the economy, what difference at the Cleveland Clinic today than the situation three months ago when you are anticipating the first surge. The locals change over the past several months. Public awareness about the disease has changed. Tremendously. The information that we have gathered, i think that all of the listeners today have a very good understanding of the pandemic, but also understand how to behave in a new environment. The social distancing, hygiene, sanitary measures have really, i believe, significantly improved the safety of work environments in the overall Safety Environment there in our communities. On a hospital front, a lot has changed. We have worked to ramp up our capacity to take care of covid patients. Fortunately for us here in ohio, we have not been a lot of ways where our colleagues in new york and detroit have experience. Changing in many ways. We announce cleaning all of our two temperature screening. All of our employees are caregivers where masks and we strongly encourage visitors and patients to do the same social distancing that is prevalent. Our ability to test his 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 the safe environment for care. The Cleveland Clinic, fewer than 1 of our caregivers have shown signs of inspection. Becoming infected. Most likely being infected in their own environments. 60,000 caregivers, only five of them are hospitalized and being treated for covid infection. You said we did not get the wave that detroit encountered. Apart from lock, why is that . Recognition of the importance of Public Safety measures by our government was a decisive step. Unprecedented. A call operation among Healthcare Providers and the government. It has resulted in exceptional outcomes. Doctor, go ahead. If you look at the difference between michigan and ohio, one critical issue of the election day. They had responded that michigan had not. That content will demonstrate that. The single biggest change between ohio and michigan. The second thing that i would say is regarding safety, safety is our priority every day. Because of the additional measures he described, our facility has never been safer. I would say that hospital facilities today are safer than they were before the pandemic. I know that part of the reason that that message is so important to both of you and for both of you to get out to the community is because so many people have delayed elective procedures, but also medically necessary healthcare because of fear of covid and going to the hospital would put them at risk. Do you want to talk adetermiadetermi ner little bit about the dangers of delaying necessary medical care . I would say, you know, we initially told people to limit their contact with the Healthcare System. Residency and the like. We wanted to limit. It absolutely has worked. But now, at the corporation which has the largest number they have just shown data that for over 3 million patients that we have seen an abrupt drop between 86 and 94 of preventive cancer screenings for cervical cancer, colon cancer and Breast Cancer compared to private prior years. Decreasing by 45 . Strokes by 38 . Child immunizations are also decreased by 44 . So, for me, we cannot neglect the proven medical intervention of preventive care. I am very concerned. We are likely to have a far worse secondary Health Crisis due to delays than though coronavirus may have an impact. Ceo of metroHealth System. Also here with city club friday tom. With respect to elected procedures and other not covid related medical care, that is where hospitals like the Cleveland Clinic make a lot of money that support the overall operations. This is a National Story that Healthcare Systems are finding their revenue that they relied on to operate has decreased significantly. How much of a problem is this for the future of healthcare. A tremendous problem for the future of healthcare. The Financial Impact of healthcare has been tremendous. 1. 2 million Healthcare Workers lost their jobs in the midst of the largest healthcare crisis in u. S. History. At the time when our communities need our help and support more than ever, very many hospitals, all hospitals struggled due to this unprecedented financial loss. That is a real issue. The amount for Healthcare Services will not disappear. Contracting many other industries. Demand for our services is here to stay. And most likely going to be increased for the reasons that we just mentioned. The care has created a lot of demand. I believe that this will be another challenge to meet the needs of people who we care for. What about the challenge to the Business Model . Is this point to some other solutions . Regarding who pays for hospitals i know that hospitals run on a very tight sort of Capacity Model so that they, i dont know what figure it is, 7080 capacity so every bed can generate capacity. A capacity situation like that, you may not have the ability to manage a surge. Absolutely. We have created a lot of additional capacity in the meantime. When it comes to differences in a Business Model, i would rather use the time to waste that we provide care and care for patients. Healthcare industry as a whole has react did in a way that it always does. A lot of innovation taking place at an accelerated pace. Now delivering more and more care using digital means, Telehealth Services has exploded in this popularity. They have been embraced warmly by patients as well as providers Cleveland Clinics example, right before covid pandemic, we were providing about 5000 healthcare visits using telehealth and digital platform a month. That number is up to 200,000. More than half of all of our outpatient visit with the new platform. It will allow us in the future to provide services that are much more acceptable and much more affordable way. A similar increase in the cellular medicine . Using telehealth more than we were. Outpatients being delivered. We went up to 85 . We are now hovering around 50 of our service being provided through telephone and video. You asked a question about the financial. The hotspot association. Calculating losing revenue a month for the higher hospitals. Mohammed talked about the millions, over a million Healthcare Workers. This pandemic has really uncovered for us the Mental Health fragile Financial Health of many of our workers. We have seen it manifest in different ways. That is why we have not furloughed anybody. We have kept everybody working. You know, it comes to different areas. I am really proud yesterday for the Mental Health foundation. Giving us a grant to provide frontline workers at 2. 2 raise this year so that they can continue to care for their families and juggle all the stresses that harm. We will need every Healthcare Worker to be available for the future. I want to ask you both about the Minority Health task force tries force. Included in the report out as part of the press conference yesterday. Disproportionate in acts of covid19 on africanamericans an other communities of colors has been a huge piece of the learnings of the last three months. But for people in healthcare, it was not much of a surprise. Can you both talk about what your institutions are doing to address the underlying causes . It is involved in creating condition under which africanamericans find a disproportionate impact of events like covid19. Yeah, so, i spoke about Structural Racism and negatively impacting racial and ethnic minorities. We then put together highly act give in dealing with underlying social determinants of how Food Insecurity to housing to jobs and the like. For us, one of the things we have done is looking at our coronavirus testing and covid cases. They are reflect the above the population. Demographics, i see omissions that really demonstrated the disparities. That is really due to the Health Conditions in the age of them coming in. For us, this is another week. Going forward we as a Community Must commit and start addressing these disparities. Weve been gone by working with the Health Department by going to different localities to test highrisk population. We were at the church yesterday and tested a couple of hundreds people to make sure that they are getting the testing necessary. I think that that is certainly a phenomenon that comes as no surprise to us in the healthcare profession. Both of our organizations, as well as the broader Healthcare Community here in cleveland in northeast ohio have been working together. It would be an on precedented joint effort to address, do despair Healthcare Delivery during a pandemic. They are here on Cleveland Clinic sighed in cooperation with the university hospitals. Next door neighbor we opened the first drive through testing site that was available for all patients that are being treated by our caregivers. Since then, since we opened our first site here, we have open five or six additional sites. Additional sites that will be available for testing. The testing capacities there, additional effort where they were focused on education as well as provision off of not only educational materials, but the lights and necessities. Everything from sanitation materials to food to direct outreach. We have also ramped up our capacity to deliver care at home knowing that very many of our patients are concerned and scared about coming to the hospitals we have decided to come to their own homes to deliver the care that they need. That has been warmly welcomed in a very effective measure. The Cleveland Clinic delivers care both in the United States and internationally and as a worldrenowned hospital you are a part of the conversation that go far beyond our borders. I just wanted to ask you to comment on the relative level of preparation that our nation had and what you think ought to be different in the future . I think it is probably most important thing is to broaden the contexts of this pandemic and estates implement there is no nation to my knowledge that was well prepared to meet a pandemic of this proportion. This is a phenomenon that we never encountered in the past and surely a phenomenon that is continuing to teach us many lessons but speaking about first of all the system and briefly about the National Wide effort, Cleveland Clinic, as you mentioned, we have Cleveland Clinic of the United Arab Emirates and that is how we learned about the complex city of the care for patients with cova 19 because of they had experienced in taking care of the patients before the pandemic arrived to the United States. Since we are in a daily dialogues with our colleagues in abu dhabi we started immediately and generate prepare for the covid pandemic and to make sure we have an appropriate resource in particular personal protective equipment at our disposal. As the pandemic unraveled by think what we have seen and not only here in ohio but also federal, nationally the collaborative efforts i believe the something we can be very proud of. Very many of us have participated in all of us have participated here in ohio ensuring our resources and knowledge as well as on the capability and we have collaborated very closely with our governor and his office and i believe that the success of that collaboration is evident. At the federal level it is just great if you take a look at the ability to get the personal protective equipment and the different parts of the country and i think this has not been perfect but in very many instances have been far, far better than in some other countries that have the covid pandemic. And other resources like a virtual ventilator bank where very many providers that are committed a part of their inventory for centers that were hit hard, such as new york and detroit. Lastly i would just say that we have also seen very many caregivers and Healthcare Professionals stepping up to the task and going to the areas that needed their help most. Here we have very many people from the Cleveland Clinic who volunteered and spent a month in new york presbyterian in new york city and we had a large contingency that is just about to come back from Henry Ford Hospital in detroit where this pandemic they were taking care of patients and this past saturday 45 caregivers flew to the United Arab Emirates to help combat a pandemic in the uae. There is a lot of solidarity and effort and i think it is inspirational for those of us who had a chance to participate. Inspirational undoubtedly, excuse me, but i assume at some point in the next year there will be a number of reports with films with recommendations about what the federal government ought to do differently in preparation for future pandemic. What recommendations would you add to that list . There are several. One is that we have to have a greater reliance in Domestic Production of critical equipment for Healthcare Delivery. In this case it is personal protective equipment. We should never be in a position again when this safety of our citizens is dependent upon availability of a relatively simple, lowcost items that we know how to produce, such as gowns, gloves and face shields. That production will have to be home and we have a strategic reserve. The coordination of the efforts in detection as well as in treatment has to be greater and lastly, i would say that if we think about the measures that worldwide that we have implemented in combat and pandemic we essentially use the tools from 14th century to combat the biggest tucker crisis of the 21st century grid the quarantine is seven centuries old. We have yet to use and a larger scale to pull from the 21st century such as our analytic capacity, capacity to produce, to accelerate new knowledge, to use Digital Technology and i believe there will be a lot of thought and a lot of thought is being put in on how to leverage those capacities and ability to address new and unknown pandemics. Dr. Boutros, what recommendations would you have . I would echo dr. Mihaljevic his comments. I would also add to that, many of the pharmaceuticals need to be helped Domestic Production capacity here. One of the things that will need to happen is the integration of our data across the entire nation of all Healthcare Systems where we can share information quickly. In my career and in healthcare and my life this is the largest and steepest learning curve our knowledge that we have gained from one another that is remarkable and that somehow you and i talked before the program that we have not been able or we have been just reading about this coronavirus and the implications and i have not read anything else because of the increase in knowledge and information that we have had. We have to have a better way of sharing that information than we do today. And have a little bit more coordination. I think that we have developed some muscle memory here on how to do that and that shouldnt go to waste but i would also say here that i have never been more proud of the u. S. Response to this. We were able to shift add chili and so obstacles and were able to create Different Solutions for them and we did not suffer what other countries had to go through like heavily. Im really proud of our overall response of our citizens and our nation and our state and Healthcare Providers. Is there something more you wouldve liked to seen from the federal government . You know, dan, there is always something more that you can do. I think they did the best with the information that they had. I certainly would not have would have but we had our visceral reaction to this that we were so afraid that we would have millions of people that would be or millions of americans were going to die that nothing, literally nothing, could have been taught that would have been as efficient or ease our fear. Only time did we see our measures are impactful and that we can get back to the sounds of that we can manage this but for a while there was sheer panic and throughout our country and this, they did the best they can. I want to ask you 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 . I would say to you that had they acted two weeks earlier, more than that, had they closed the borders before the first case we would have never had to close, you know, and he would have had to shelter in place. In hindsight, thats 2020. Were dealing with like data and decisions and we deal with that all the time with incomplete information and we have to make decisions on it. As long as you add act responsibly and according to your guidelines that has helped care for people, you make the decision and you make the best decision you can. It is never going to be ideal so i would say to you that some people think that the governor should have quote, close the state earlier and something they shouldve closed the state later they will have arguments. Dr. Boutros, president and ceo of the and dr. Mihaljevic of the Cleveland Clinic. You can join our conversation when you text your question 2 330 5415794, that is 330 5415794, tweet the question at the city club and we will work them in. Joining the City Club Friday Forum from the studios of 90. Three idea stream in cleveland. Getting two questions now, dr. Mihaljevic, pediatricians are dropping among immunization rates in the later outbreak of vaccine preventable diseases. What are you hearing from parents worried about bringing children to the hospital or their own local clinic . Parents and all parents are worried about return to school and worrying about bringing children to the hospitals out of the fear of immunization and my message, our message im sure with dr. Mihaljevic will like this is hospitals are safe. They are safe environments. We have to be very, very cognizant of the fact that we have to be aware that chronic conditions and the conditions in general that need treatment need treatment during the covid pandemic. Immunizations should for children should not be stopped and it is important that we do not lose sight of it and the consequences can be for immunizations and can be very severe so with we encourage parents to bring their children for regular immunization. Dr. Boutros. Again, the only thing i would add is we are looking into ways and into immunizing our patients at home and what we want to do is reach out to everybody and if they are going to postpone it just because theyre afraid of coming in and we cant convince them to do that we have to look at different ways to provide that vaccination to these children because the consequences for under vaccinated infants and youth is really substantial. Will we see a rebirth of the house call . We already are. I think they alluded to it and metrohealth has done the same thing that we are providing hospital at home and telehealth visits which are like hospitals through the videoconferencing but we are spending nurses and doctors into peoples homes instead of them coming to the hospital. We are literally taking care of patients who normally would be hospitalized at metrohealth at home today. Couple of questions a comment about telehealth. How do we keep telemedicine as accessible as it currently is due to relaxed regulations and perhaps one of you can explain a revelation is that we are relaxed 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 provide Patient Engagement but how are hospitals insuring the bubble billing for online and mobile visits have been appropriately . That is a rapidly moving topic. I would like to say that the greater prevalence in the greater use of telemedicine has been enabled by one of the immediate actions of federal government and when they have reacted on our recommendations as a Healthcare Provider, instead local restrictions bought the availability of Telehealth Services should be lifted so that we now as a Healthcare Provider can serve any patient in the United States without the need that we used to have in the past when our physicians had to be licensed. This is really important because very many of our patients who live outside of the state of ohio wanted to access our physicians and couldnt in the past been out that it is possible. They are obviously very many things we need to do in the future in order to ensure that telemedicine continues to be really important and effective way and a safe way to deliver care. One of that is obviously to protect the privacy and that is something that i believe we have already made significant strides in through the collaboration with a number of digital medicine platforms, such as american. I believe that a reimbursement will continue to evolve so farther enforcement has been very good but i do believe that we as a nation in the entire world has to embrace Digital Technology and the Healthcare Delivery to the larger extent in this is a journey that is begun but there is a lot of work ahead of us. Turn dr. Boutros, the use of telemedicine assumes increased access to Broadband Internet which is currently the city of cleveland is being ranked i think, fourth worst in the nation of cities of this size was spoke about this a few weeks ago with the ceo and how concerned are you with regard to the growth of telemedicine in the absence of real access to Digital Infrastructure . We very much are. That is why with the help of several funders including [inaudible] we are making available both digital broadband available to homes in our neighborhood but also during the training possible to do that. We are doing this to demonstrate that the better utilization of funds to keep people healthy by providing this digital commencement, its the first of the kind in its nation and we will see a thousand homes is enough to demonstrate that this is excellent use of healthcare and to make sure that both insurers and cms cover that cost in the future. With regard to this is switching to a Public Health question, specific to that pandemic and how we approach it, both your institutions have had to integrate well with existing Public Health infrastructure and with respect to Contact Tracing in cleveland and tioga county, who will lead that initiative . Will it be hospitals or Public Health and how important a role will that play and are we prepared to do that work . Contact tracing is always done typically unless theres an outbreak in your organization. It is always done by Public Health and we work with the city of cleveland and Cuyahoga County and the boards of health to look at these things. Terry allen and Cleveland Clinic and metrohealth and university confidently contact everyday and i think we announced were doing these testing at the Public Health and its very much involved in doing the tracing for positive cases after that. I would say to you that it is something that people, i dont think they recognize how good our Public Health has been. We have some of the most dedicated knowledgeable and capable individuals that have been able to increase the ranks significantly and continue to do so. I feel very confident in the leadership and capacity to the tracings. Dr. Mihaljevic, is there a Silver Lining to this pandemic at all . I do believe that there is a Silver Lining for this pandemic. I think we have made a lot of strides in the way that we deliver healthcare and the way we share knowledge and resources and the way that we always wanted to do in the past but couldnt. You have this pandemic has served as the capitalist and accelerator and i will just highlight the few things that we have touched upon that reflect that change. First and foremost the adoption of Digital Technology as an effective means of Healthcare Delivery has skyrocketed and that is a really good trend. A trend we always wanted to see and but had difficulty those putting in place for the second part is when it comes to the caregivers with Healthcare Professionals i do believe that the society as a whole has been reminded about the importance of the work that Healthcare Professionals do that caregivers do. Something that has been lost on many over the past several decades and that restoration of faith in the healthcare 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 and integration of our healthcare efforts among various providers, i certainly hope it is here to stay and i think the value of integrated Healthcare Delivery systems is demonstrated and it is effective in the treatment of this pandemic and lastly, our efforts in the community and understanding a much deeper societal understanding that we will not be able to have a Healthy Society until we have a healthy communities. That every community has to be healthy in order for our society to be healthy. The importance of Public Healthcare efforts and immunity care efforts has never been clearer to the general public than it is today. Another audience question. Can you talk about the state of the research on vaccines and how and what plan is being done now to ensure that any vaccine that is discovered and manufactured can be distributed en masse without chaos . The Vaccine Research used to be very slow and used to be slow because we used to use different methodologies to deliver the vaccines and development of potential vaccines in coronavirus has been nothing short and its been systemic. International collaboration as progressing at a fast pace and currently we have several dozen different vaccines that are under investigation and some of them are already in clinical use and in clinical trials. Probably the one that is gathered most attention is the vaccine that is coming from the Company Called maternal aunt this is a very in every way to deliver a vaccine. We believe that through new technologies that the production of vaccines which also has been used a limited step if you will be accelerated and with all of that taking into account, if and when we get a vaccine the distribution is certainly going to need to follow the indications for medical needs and that distribution will have to first address the most vulnerable populations for the highest risk of covid infections in those elderly with chronic conditions as well as a Healthcare Workers and Healthcare 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 will come and we do not know if it will come because coronavirus has been around for a really, really long time. Common cold that each of us is experienced several times is caused by coronavirus, just not this type of coronavirus yet we do not have a vaccine for the common cold. This is not an easy task and we have to be patient but we also are encouraged by the case that we have discovered so far. Dr. Boutros, could you shed light on the timeline that i think doctor prouty and doctor Anthony Fauci said yesterday that he believes it could be here by december or january. I think dr. Fauci, i was speaking about the involvement of the vaccine and that 21st century tool that we are using today to be able to put on the vaccine and because of this is such a worldwide phenomenon everybody is working with each other on collaborating and im finally will say to you this that a vaccine production, no one company will be able to produce enough vaccine for the entire world. What i thank you will see is that the First Company that finds its will be able to lease out its geology to other companies to produce it and thats why we have mask production of the vaccine. You will see collaborations, as he saw with Hospital Systems and you will see pharmaceuticals which typically there is not collaborative at all. Dan, while we are on the topic of collaboration i want to really personally thank how [inaudible] and their teams for working together with all of us during this time and in the most exceptional way of carrying about the communities first and making sure we are all doing the right thing. This experience has been nothing but stellar. Dr. Boutros, another question for you about health and Services Provided at the county jail but these congregate care situations and places where it is almost impossible to do social distancing are causing concern. Weve seen a spike in cases as well at the Marion Correctional Institute here in ohio and can you talk about the care being provided to vulnerable inmates . I cannot be more proud of the care provided to the county jail, our first model showed that up to about 1400 people would be infected so we went to the judges and we 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. Then the number came down as we did and there were less than a thousand people in the jail and the model showed that we could get up to 600800 and we saw during some very innovative things coming in and doing observations and today the number of coronavirus positives inmates are about 170 over the past 2. 5 months and we have had only one visit to the hospital, no major illnesses and no deaths. Im very proud of what we have done. We have put the information together and help shared it with Ohio Department of corrections to implement similar protocols but jails are not the only congregate living facilities in which there are risks. As you sought Nursing Homes account for 50 of the deaths and that is why we are working to make sure the people are tested in the Nursing Homes and homeless shelters and other locations in the staff to make sure that we keep it under control. Another question for you dr. Mihaljevic, regarding healthcare integration. Could you speak to how the Cleveland Clinic and dr. Mihaljevic, you and dr. Boutros are working to determine the referrals to social Service Agencies and dr. Mihaljevic. Yes, we have been sharing data particularly during this covid pandemic better than weve ever had in the past and all providers, Cleveland Clinic here in northeast ohio and numerous others in the states have all been sharing data by the covid pandemic on a daily basis. Data is really been one of the most important determinants of our success so far and probably be one of the best prepared states in the country to meet this new challenge. I do believe that that data sharing and the integration of data is just going to get better over time as our understanding and as well as our digital sophistication and Data Collection sharing analysis and Data Protection which is really important piece of it and it gets more sophisticated. Heres another question from the audience. You seem reluctant and this is for both of you but dr. Boutros we will start with you, you seem reluctant to criticize the federal response to the pandemic writ isnt it true that the u. S. Has not fared well in this crisis statistics show we have one third of the worlds cases that we did not have adequate testing or ppe when it was needed and that the President Trump denied covid with anything to worry about . Compare our response to south korea and germany we dont look good but please respond. Honestly i am trying to not criticize anybody. My point is to focus on what we were able to do and how we met the challenges. There will be plenty of analyses of what we couldve done better and those will take place and we will have lessons that are learned. I can tell you we assess our response at metrohealth and the county and collectively every day and we learn from the mistakes we have learned and continue to improve. I am very, very proud of how Healthcare System and ohio, and how they helped reduce the curve. We crushed the curve and how the our governor had worked with us and listened to us and want to make sure everyone is safe and we increased testing. I know we increased our testing capacities significantly and they are developing new 9000 tests a day and we will get up to 2000 tests a day. We are all and im focusing on how quickly we are responding to this and doing better. Do i wish that we did not have a single case in the u. S. . Absolutely. Life would be much simpler than it is today and more people would be alive today. Dr. Mihaljevic, they refer to germany and south korea and are there specific lessons we can learn from them . I was eight when we take a look first of all this pandemic is far from over. I dont think that we can really responsibly tally up the effectiveness of individual countries in combating a pandemic but what we have learned from the korean model is what we have learned is we look at the pandemic as a whole that there is a lot of regional variability in the way that this pandemic has been addressed. This really speaks about the degree about a cultural behavioral norms as well as an ability for governments and regulators to influence Public Health. I think about korea for a moment, social distancing and wearing a mask in public has been a norm, a social norm in south korea for a really long time. The relative amounts of testing that is done over there was relatively high but it was not exorbitantly high. They had been very good and being able to combat up endemic without shutting their entire economy down in a closed the schools about the jobs have stayed open. Germany had a complete different trajectory and the trajectory that is also reflective of their cultural norms and an interesting thing about germany is they had more deaths beds per per capita that almost any other country in the world for which they used to be criticized in the past by being or having too many hospital beds. In this particular circumstances that turned out to be a advantage and lastly i would say its important to keep a perspective about a pandemic. Nobody has been prepared to address it as dr. Boutros said, folks have done, i think, the best they could with information they had in hand. From our interactions with government officials, both in the state as well as in the federal level we have found them to be responsive to our to our suggestions and they have implemented the measure that we have implemented swiftly and we will say that our collaboration in the state of ohio is been unprecedentedly productive at the federal level and in the two visits with federal government lets say for example, the listing of the fda restrictions for testing so that the testings can be done in individual hospitals is something we brought forward and the loosening of the fda restrictions was lifted literally on the following week and that is allowed individual hospitals to develop Testing Capacity to help more people in need. They are not another good example is that we have asked for the restrictions on the adoption of telemedicine to be lifted and i have to say that the response was positive and immediate. That has allowed us to serve many more patients across our entire country and telemedicine. Excellent. Dr. Mihaljevic is the president and ceo of Cleveland Clinic. Dr. Boutros is the president and ceo of the metrohealth clinic. Thank you for joining us for the City Club Friday Forum. Well going to leave it there and im shocked that neither doctor mentioned the importance of handwashing and wearing a mask and keeping the distance of having done that we will close it out. I want to thank our sponsors, medical mutual and Health System in our Community Partner is a Better Health partnership. The city club virtual forums are sponsored by cleveland foundation, georgetown foundation, keybank north and northeast ohio river sewer district with pnc and the Family Foundation print many more sponsors and donors and you can find city club. Org thank you. We will leave it there and im dan, stay strong, stay healthy, stay close in your hearts and stay close in person if you can read our forum is adjourned for it have a great memorial day weekend. Thank you. U. S. Senate meets this afternoon at 3 00 p. M. Eastern. Senators will resume work on judicial nominations. Later this week they will turn their attention to the nomination of white house senior associate counsel brian miller to be the First SpecialInspector General for the pandemic recovery. They may work on legislation providing greater flexibility to Small Businesses to receive Paycheck Protection Program loans. And possibly more debate on the pfizer reauthorization bill. Watch the senate live on cspan2. Tonight on the communicators. Former sec commissioner susan asked talks about ways to reduce hate speech and extremism online. Companies when they find content they will attack so that others dont copy us and there is now is much greater cooperation that we had even two years ago but there is still a systematic things that needs to done. Watched the committee caters tonight at 8 00 p. M. Eastern on cspan2. On wednesday former Deputy Attorney general Rod Rosenstein testifies before the Senate Judiciary committee on the pfizer application process used during the fbi investigation into possible ties between the Trump Campaign and russian officials. The fbis investigation was eventually taken over by special Counsel Robert Mueller who rosenstein appointed in 2017. Watch live coverage of the hearing beginning at 10 00 a. M. Eastern on cspan, ondemand cspan. Org or listen live wherever you are on the free cspan radio app. President trump won wisconsin by less than 1 in the 2016 election. We interviewed craig gilbert, Washington Bureau chief for the Milwaukee Journal Sentinel about this years race in that state, including the impact of the coronavirus and how voters there will cast their ballots. Milwaukee is due to hold the Democratic National convention in august