You very much, and welcome to our 13th virtual signature events of our 35th season. I wanted to thank all of you for joining us, we have with this today and number of special guests that i would like to mention the investor from singapore, we also have members of economic members of detroit, we also have members of economic of new york, and we also have a number of people who are members and our members guest. Thank you all for joining us. Today were going to have a Congressional Panel that are going to have medical panel. Our congressional pana, i will talk about us number of subjects including the recent attacks on the us capital, the political environment, security measures, and the way for to national unity. The two members that we have are very honored that are joining us today Debbie Debbie dingell brooks in the 12 district of michigan and shes a democrat and tom reed representing the 23rd district of new york hes republican. And i will give them a more formal introduction in a moment. Then the second segment i will interview three leading healthcare experts who also went to discuss the current search and covid19 cases, the vaccination situation, and also the overall healthcare situation that they observed now and for the hospitals. Those are on this panel arc and billy horn, who was executive Vice President and Group President of markets outside of california with pfizer firm and other hospitals and of california with the pfizer firm. Doctor stephen jones, is the president and ceo of the nova Health System and sin sam at the president ceo of sin health i would think all of them for joining us today. I would like to make it knowledge of her Title Sponsor of america, larry divina and thank you very much. I would like to thank our emerging leader sponsor, pwc senior partner at pwc. And ceo of the seamen usa and take our virtual sponsor johnson johnson, and us federal government bears, and i would also like to recognize our Corporate Partners who were on the screen now. Upcoming events on february 10th , at 4 00 p. M. Will be hosting an executive conversation featuring symphony german nada who will be as the president cofounder of born this way foundation. Hubie interviewed the Economic Club vendor club member mika of the Greater Washington manager partner delights and board member of his foundation. The foundation is cofounded by the lady gaga and Whose Mission was to make the kind the school and eliminate stigma around mental health. Two Upcoming Events that i would like to mention. Wednesday for pre 17th at 12 00 p. M. I will interview ken fraser he was the chairman of the board and the chief executive officer of merck. In a march 17th at 12 00 p. M. Ill intro mike roman who was the chairman and chief executive officer of 3m. And almost certainly will have an event on april 7th at 1230 where we will probably announce that in the day or so, maybe later today. And who will be our guest then. I would also like to announce he was the winner of our election ballot, some of you may know we had our little election ballot in late october and we invited all members to tell us who is going to the next president and who is gonna control a health news and a control the senate and whos going to win some the major races. One pleased to announce tableware. It took a while because he had a the final decisions in georgia but the winner is thomas president of ceo freedom bank he will get an 12 pro as his prize. Congratulations to joe thomas. We also would like to think and acknowledge some cuts really l of the delayed for analyzing the data and confirming a winner. So let me get on with this enemy introduce our crewmembers more formally. Debbie dingell is well known in washington for and she was in washington and washington for many years and a native of michigan but in washington for many years heading up the General Motors foundation and doing work for General Motors. She was first elected to the congress of, i would say 2014 she was elected to congress and was now serving since that time. As a member of congress from michigan. She was an active member of the Democratic Party and she has us are most important accomplishments, a member of our board before she joined the congress and went to thank you very much debbie for joining us and giving us your insights. Thank you debbie. Okay, those like to think read. Rate is a member of the house and he was elected first in 2010 and he is a person who was a graduate of Alfred University where he was an allamerican swimmer and a graduate of ohio northern law school. In his bio he pointed out something to me that i had not known he was the youngest of 12 children and was raised by a single mother his father a military hero passed away when he was only two years old welcome tom and welcome debbie. The mages kickoff at the beginning and ask both of you what to do you was going through your head during the time of the invasion of congress . Did you know what was going on and did you think it was going to be as bad as it turned out to be . Where were you when you first were told something was happening . Debbie where were you . I was actually in the house floor. When this began and i began to notice some of our security was becoming a bit intense because of the sheer noise but i really did not realize that anything was knots without her out of the ordinary. I did others would be protesters that day then suddenly i saw somebody taking the floor but then candidly at the same time steph a comment me and said to me we need you to help people, and tell you what to say. We want to keep things normal. Shortly after that they came in and said that the we need to be ready to get onto the floor very quickly because there were many of the members who pump publicans and democrats that there werent them in their room that day. To help Law Enforcement turned barricade the door. But i still so if they were saying inside the chamber. Began to hear grassley and we heard him evacuated and we heard the gunshots which unfortunately resulted in the death of someone. And then we were taken to and under disclosed location. But if you have ever been a target of the donald trump attack, you dont understand what its like. I have been in his hate funnel for a couple of years life had some militia in my house where my antenna is now always up. No way silica i will survive its and makes my life and comfortable but i dont think any of us really realize how serious this was and that they wanted to kidnap us or kill us until it was over. And we began to see the aftermath of it. You are on the house floor as well. What did you think you was going on when you heard the noise . Actually day but i just left the health for about 15 minutes before this all went down. And so i was walking outside as i always do and i was outside when the mob was coming up around and at that. That. Time they locked the buildings down. You knew it was different, you knew that it wasnt just a protest he knew that it was just something and we were not expecting it that day but this was going to be a different situation. But i worked my way into its inch of my duty and then got back into it with a secured us. For the duration of that offense. They will just tell you, i watched on tv and is texting my colleagues from the bring this country back together we checked in on each other and we were safe and i watched on tv with tears in my eyes. It was something that i never could see in my lifetime and i was disheartened, but i also left that evening to the floor in the chamber and completed the end of democracy by the task at hand and theres a lot of folks that voted us to go offsite and what it is to complete the process about on the chamber of the son of the house. But the credit of the democrats and publicans that david they said no. Were going back to the chamber and rock of the mob win. And i would across the aisle and josh and give a speech i spoke from the heart and five minutes notice and said you know what im a proud republican and i know that josh and debbie are proud to democrats forward in the stand together and not the mob win and stand going forward. Were not going to do it through violence were going to not litter the ballot box determinant. Glad to see us complete it and i was energized to the. That we debbie made bring our country is broken. Ive had Death Threats and they had one here in october with a brick and a dead rat left in my front soother my wife and covered with the names of my children that were left on democratic socialist on the left that we are now going to be left arresting here shortly. Because of this event they came out and got bold nor chattering on websites so the bottom line is extremism is not the future of america and i think leadership is going to see us through hopefully we can move through this and i stood the inauguration on both sides of the house and said times have been moved on and time for us to unite as a country. In hindsight, was the fault some extent of the congressional Capital Police or was it not having more security, or the National Guard but who do you think failed to provide adequate security. And im also curious if youve all thought about if those who invaded the capital were more i would say professional in terms of their abilities to harm people within norms in odessa occurred. I am someone that basically is very strongly believes that we need independent panel to see what could happen. If you come from michigan which been living with this with a government that they have tried to kidnap and potentially hank. We know what some of these people are capable of. I dont know who the people were that did not want to have a military presence on the hill that day, the National Guard shouldve been stationed at a place just because of the crowd that could possibly get out of control. I dont know how to go in the dark web, but i even know that reading my social media and reading when i read of the newspaper none of this was going to be easy day. Ive asked a lot of questions and every time i ask a question somebody gives me a different answer i dont mind gh security. I should be living by the same rules. This is a very serious issue and we need to make this a top to bottom operation. What is your view who was at fault and do you think there should be a commission or what will be to improve the security . I agree we can always learn from these events. The tension that we always face on the hill when people come to the capital what we pride ourselves in is the 1993 and weve gone through 9 11 and the rationing of security is always on the back of remember we are a free and democratic capital and thats where we wrestle with this and i know talking to Law Enforcement you wrestle with that mission like we want to keep that openness. There is a functioning democracy you never know who you are going to see so you have that need with security and freedom that is represented and i think with an independent commission we can find that and make sure this event never happens again. I applaud the capitol police. Some members were like they should have opened up their weapons and things like that. Think of that imagery as to what happened. We are the leaders of the world of democracy. I think we can do this in a way that recognizes we need to be that beacon of hope and democracy going forward. Secure the capital and make sure that its still free. I didnt see any of the clips until after four in the morning and i had a lot of people say this person did this, we wouldnt hear today were it not for the men and womens courage that day. Things are taken out of context and not understood. They defended the capital and im grateful for the Law Enforcement that kept so many people safe that day. There is been clips like that and in conspiracy those were tactical decisions. They went to a position of higher position controlling some of these people to take them away from the mob. Each one of these actions be careful to judge what you see in the picture. We have to make sure we give the ability to explain what they were doing in each of those moments because they were trying to do the best they could with the situation and it was a dire situation that got out of hand real quick. I think every democrat supported that and if you think that did you get a lot of feedback from the district . We were part of a group that held a lot of discussions about what was the right thing to do and how should one proceed. I raised issues i do believe President Trump needed to be held accountable. I think its important that even as we go forward now that he not contribute further to the division. As more and more video came out, people began to feel stronger about it. There are people with very strong feelings on both sides of this issue and a lot of the members are hearing from people on both sides. You voted against it and your reasoning was what . It is a constitutional tool you have to look at the full picture and what i saw was a snap impeachment, people demanding and emotional response and i understand but when i look at impeachment and the due process that needs to be included and i saw the president was leaving and what that would do to further divide the country and what i saw with issues of constitutional freespeech that needed to be debated, even though i saw some issues that caused great concern and i came out to support President Trump in regards to the activity that occurred on the mall that day in the speech i watched and witnessed myself i recognized the accountability and i thought that it was a more measured and appropriate response to respond to the situation and its not a slap on the wrist. Its not like its a nonexistent penalty. I was concerned about why pursuing impeachment that quick with that many days left in the administration so the votes that were kept in 2016, that would President Trump in place and if you are going to overturn it you still have to take all of the consideration into effect. So i was against impeachment for all those reasons. Its going to further divided the nation and its going to play into this gasoline that those folks do not believe that it was legitimate. There are millions of americans not just because President Trump said it but they do believe it and ive heard it. We have to heal this nation and listen to the frustration and anger of the 74 Million People and make sure their concerns are heard. If there is no conviction in the senate and it looks like it may be difficult will either pay house pass a center or will that end this whole matter will there be an approval in the house later . My hope is that we move forward and i think President Biden has an opportunity to heal the nation and that will be the road he takes to bring the country together and move forward and a further picking at this division i think it isnt going to serve anyone well, but we will see. That is something the Political Office will want to divide and hopefully we just move forward for the sake of the country. Let me ask you lets go forward and talk about legislation. The president has proposed 1. 9 trillion stimulus bill. You think that the democrats will support that bill the way he wants it or there will be a lot of give and take and he will not be able to get all of what he wants or even most of it . The general outline for the bill will be there. We are already in discussion with others trying to find a way we can all agree and move forward. Its clear what he is asking for we all need. We have to increase the production of the vaccines and increase the protection. We have to do more testing and help people that are in danger of being evicted from their homes. Its the same group that we faced since the beginning of the pandemic that yet, when the president walked in it was worse than he thought that it was and we cannot rebuild the economy until we have a National Strategy and get it under control. I think we need to unite. I am tired of partisan bickering and i think a lot of people in america are tired of partisan bickering and we need to figure out a way to get this done. Do you think republicans are likely to support the legislative agenda we have seen so far in the stimulus proposal or is that unlikely . We are engaging in good faith and i appreciate this in the 56 56member group and with a majory in the house. Hopefully we can get there and there are a number of things we can agree to readily easily. Covid vaccine and the distributionmoney. That should get people together in the house and senate and get it taken care of. But when you talk about 900 billion working with our group and the senate and that Common Sense Coalition got to the president s desk we see the impact of the 900 billion, so i think in the conversations ive had with bipartisan concerns, is it monopoly money, lets see where the money is out and whats going on with the economy. May be a little bit down the road what is needed after the 1. 9 trillion we can come to a common ground. There are things like taking care of that liability. We will have to deal with that issue. State and local aid with the liability reforms because we are starting to see the disclaim as well as the liability that started to stack up so you will get individuals and this will ripen as we go forward but i think we are in the position to see what we can do to come to an agreement on that 1. 9 trillion. Since you dont control the house or the senate and is nobody the leader . That is a great question. Right now a great amount of leadership and inspiration january 6th and elsewhere mitch mcconnell, mike pence did what i think was needed and that period of time. They looked to the constitution and stood for the constitution and i think they gained a lot of respect by a lot of numbers and i would say mike pence in particular who i served with and i think is rising in the ranks. I will tell you President Trump isnt gone. Hes got a tremendous amount of influence and if you think of the folks that went to the floor of the house and senate they will be removed and likely so so the trump leadership that you are referring to i dont think thats going to be part of the Republican Party in the future. For the last four years, the democrats in the house more or less were the leaders of the Democratic Party and to some extent opposition to what was going on at the white house but now you have a democratic president. Is it hard to listen to someone at the white house and you cant just say this is what the democrats stand for because we are the democrats in the house, how do you adjust to the way you operate . No matter what party it is always a challenge and both parties have found very kindly after, what happens to the United States house of representatives. Those who dont study history are bound to repeat it and you have a lot of people who do not want to repeat modern history. You also deal with people who know each other. One of the things i want to say its not the younger, newer members that have been but its a Seasoned Group of people. They have relationships. People dont trust each other. Thats how a lot of things shift. You can totally disagree on an issue but you go have a drink at night and talk or play paddle ball in the gym. The good thing for democrats right now is this leadership has known each other for a long time. They trust each other. They know when they want to go after somebody but i think they are going to Work Together and help the new members understand it and be there as well and have a voice. Youve been in the house for a number of years now. What is the pleasure of being in the house when people criticize you and you have to go back every weekend to your district, people are threatening you with things. Is it not as much fun as you thought it was going to be and you say maybe this isnt worth the aggravation factor . I would be totally lying if i didnt say there are days i quite frankly wonder if i was more effective in the private sector than i am in the public sector. Weve started to demonize the public sector. Our government is the strong people willing to serve and fight for it. I say what i think and theres not enough people that just say it as it is. I love this country. Its worth fighting for and i wont use the word i want to but i wont let people attack it in any way. What is the pleasure in being in the minority because arguably the minority isnt that pleasurable but the minority is really not that pleasurable i assume. What is the pleasure that you get out of being a member of the house of representatives getting to be the minority, what is the pleasure of that . We change the rules of the house for example. To get things done is very rewarding. As i said before i got mentors and they said early on identify people across the aisle that are good people and become good friends with them. There are people who come to the table and are committed and love the institution and the institution is filled with those folks. Im not going to sugarcoat it. Theres a lot of division and polarization and people looking for their five minutes of fame. I dont associate with those people on a regular basis. I associate myself with good people and try to get things done for the sake of the institution of the country. I want to say something. You think of the washington side of this, but they dont know the good we do back home, the people we serve, the difference that you can make. I got a steel plant taken down that sat idle. We do it to help the people counting on us. Let me ask in your case you think congress will have the highest priority on the stimulus bill but after that what do you think the house is most likely to focus its attention on . We have needed one for a very long time and it will be a broad infrastructure bill to fix the roads and bridges but we need broadband. Congress has shined the light on urban and rural areas and we need to fix the broken pipes and infrastructure and there are many. We have to rebuild our schools. I think the infrastructure bill would most likely be. I dont know, what do you think, john . I wholeheartedly agree. I think that its crying out for us to demonstrate that we can Work Together on an infrastructure bill. Im not supposed to do this as an official that i said the trillion dollar infrastructure builders broad bipartisan support not only on what we need to do, but financing it, doing it with zero Interest Rates now is the time to seize the moment and learn from republicans. We lead with healthcare, wrong path to take. Infrastructure brings the country together and the roadmap is already there. Bipartisan support for what needs to be done and the money can be there and the country needs that in my opinion and we are ready to do it. For some of the stimulus and other things, some people have been increasing taxes. Do you expect a tax increase this year or next . I think theres an appetite on the left for the fair share argument and raising revenue, so thats going to be part of the conversation. Youve got to pick infrastructure over the horizon and the whole electronic vehicle. There is some legitimate conversations going on on how to take care of that revenue. Final question for you. You are the youngest of 12 children. What is it like to grow up with 11 siblings . I had none. How many nieces and nephews did you have and can you remember their names . Its tough to keep track of the number but i guess its a little bit like being in congress. I was always told when you you guys fight, figure it out and get the job done. So we got together i always loving each other and that is what made us work and you never knew any different. It was a happy household. Debbie, final question for you, in a locked down visitors cannot come in. How can the congress survive without lobbyists on capitol hill how are you able to pass legislation without lobbyists coming around and lobbying . I dont want to insult the members of the club bit its been kind of nice and quiet but the fact of the matter is we are working on bills. I think of them as sources of information that we all study to get the background information. I miss seeing people. I like to dig in. I miss people on the hill but i want us to be safe on the hill as well. So its good to see everybody virtually and im always available on zoom. Thank you for your time and service. Thanks, everybody from detroit. Thank you. Okay so now we have three medical experts. Let me introduce them again. Kim, the executive Vice President and markets outside of california for Kaiser Permanente finishing up her first year in that position but previously had of the midatlantic region for kaiser and then we have Kenneth Samet whos been the president and ceo in this region and then steve jones who has for the last three years been the president and ceo so why dont we just start. Are the hospitals being inundated today with covid19 patients and are they at capacity, how bad is it if you come into the hospital today to get the First Priority treatment if you have it . It varies across the country in terms of the infection and hospitalization rate. Arguably the largest in the country outside of new york and Southern California most recently. And where the views are way past capacity its remarkable how the Healthcare Industry and workers responded to that. Day in and day out, working in credible shifts and that sort of thing. So, thankfully knock on wood we are seeing a little bit of a decline in the surge that is occurring particularly in Southern California, but we are seeing high hospitalization rates in places like atlanta and even in the midatlantic and virginia and maryland in particular but its been interesting how its impacted different parts of the country at different times. In the beginning of the pandemic there was a shortage of ventilators and ppe. Is that still the case, do you have the need and other equipment . In the beginning you are absolutely right it was all about first of all understanding what kind of masks were effective and having ventilators and that sort of thing so weve got that under control. Now it is the staff in so many people have been impacted by covid. We are not even allowed to get healthcare traveler so that is a major issue and so right now, not just with the surge taking care of the patients but even as we think about the vaccination, this is hopefully the final stage, preparing for the mass vaccination and to be able to do that is why it is so important that we Work Together with Public Health and the private sector and Healthcare Industry to really get organized around that mass vaccination. Do you have enough equipment to deal with the patients that come in and is it going up or down in terms of coming into the hospital now. The last two weeks we have seen a bit of a downturn which is good coming out of the christmas holiday. We did see a surge and it went up to about 650 patients from two weeks ago. We are down to about 40 today so thats really good. And if i put that back to the spring when we had that initial surge, we were at about 725 which is interesting in the spring montgomery and Prince George county were 50 of all of the covid hospitalizations in the state of maryland. That was the epicenter we saw a more significant. Its been spread across the state differently this time which has helped in our immediate area, but the big difference right now connecting to the point on staffing, all of those issues are not for the big star systems here. To kims point, we are not able to get travelers from across the country. But also, we are not canceling elective cases and we will talk about that. It is a big definition so lets make that non covert cases, cancer, cardiac, a host of cases that were canceled in the spring. That actually let us have more staff internally. But its a bad decision relative to trying to take care of our patients that need care. Today we are fighting very hard to take care of covid and non Covid Patients which stresses the staff even more. Let me ask you a question. How are they doing in terms of too many patients coming in for treatment and let me ask you if you got covid nine months ago and came into your hospital would you get better treatment of them were now because we know more . Unequivocally better at this point. We know a lot more. To the question on ventilators, initially we had patients that we learned subsequently across the country, across the world were using ventilators to early because that was the traditional way you took care of patients with serious respiratory disease. Now we do everything we can to keep them off of ventilators so we have hundreds of extra around but it goes to even pulmonary care and the positioning of the patients and we have therapeutics both inpatient and outpatient therapeutics. So now its exponentially better than it would have been nine months ago and his mortality rates have dropped dramatically as a result of that. What about the therapeutic President Trump dot when he went to walter reed that seems to be like a miracle drug maybe with some side effects, is that something you can readily give people or is it experimental still . Even if we dont keep them out of the hospital then the disease course seems to be less severe than it would be otherwise we are very enthusiastic at this point we will continue to study them but we are being active. This morning i had my tenth test for covid all ten have been negative to put the stick up to your brain now its not quite as bad. But it turned out positive should i wish to the hospital and say for me in the icu . What should i do if they have a positive rating from a test . Unless they are acutely ill they should stay home and quarantine. If they live in a house with sometimes they cant. But not repeating the is critical. Only if if you have breathing whether difficult issue to go to hospital for evaluation. But apparently the intentions need to be in the early days you cannot be two weeks and i think youll have impact. How do i get vaccinated in this area . And the private equity said on position is not the top of the list goes on how easy is it to get vaccinated to have enough supplies and who gets it . Start with the supply first of all. All of those locations across the country we have been very proactive to identify based upon the jurisdiction guidelines we have given 29000 vaccine so far in this region of Kaiser Permanente and it is just a fraction of what the rest of would entail. With that availability is critically important and once we have it then given the numbers of people that have a vaccination is what we really need to work on i believe mastiff nationstates one and strategies they were being very plan for about the number of people that we need to vaccinate locations we need to think about space and have enough for social distancing and people need to stay around for a while literally millions of people that need to get vaccinated. So now we dont have enough. We optimistic and assuming we get it theres never a vaccine that is a store put with the vaccination supplies and a huge opportunity in this region and within jurisdictions to Work Together and on those strategies. Based on what you have heard if i have a choice between pfizer or moderna does it make a difference or are they the same . There is no difference at all. Just make sure you get the vaccine one is not more effective than the other. So the first vaccine make sure it is consistent for those i get people back in with their subsequent vaccine whether or moderna or pfizer. I think what is behind your question one of the biggest frustrations absolutely the Biggest Issue for us it is the lack of understanding of that predictable level of supply if he understood the schedule it is about leadership because this is what it looks like and how it will out. Is a mass equation and to have distribution at hospital levels to make it work within the guidelines can get a vaccine because there is a full set of expectations with a lot of communication and conversation over time, fd 15 year old friend i have cant believe they have a vaccine on january 27. But we need a reset in a predictable way with kaiser and then whether private equity are not to actually tell them registered, this is you can get a vaccine investigated until then that starts with wearing a mask. People say they have a healthcare emergency the have to get it even if not qualified. Are they coming in with fake ideas about their age or cheating . There is always examples and we see them at times in the news some try to cheat the system that is not the overwhelming issue. They are getting tens of thousands of people reaching out asking how they can get a vaccine but as it relates to our associates, 60 percent have all been offered they have taken the vaccine at this point and as my colleagues can talk about the part of the story the variability that happens with the diversity of the associates and people of color taking a much lower percentage than the general population that also plays out in the region if you look at Prince Georges county be different than Montgomery County thats not a good thing that the trusted voice issue and we all have to do the best we can. What about your organization . Do have enough supplies have you been vaccinated. I have been practicing physicians ipad vaccination on the first day we see disproportionate among many members are black and brown communities we took this on before the vaccine even arrived to address legitimate concerns on vaccine safety and effectiveness and now we see that breakdown were nowhere near as fast as it should. You been vaccinated have you had any side effects . Zero. Ive spoken with others who have had side effects put when i got my shot for shingles i had a significant reaction and bad 36 hours Public Interest subject of the rest of my life as individuals who are responding to these current vaccines with those responses they should for very good about the fact they have 95 percent protection against one of the most perfect diseases that has come along in a lifetime. So you have the side effects it is worth it. s capital. So it will get the second one so is the first one useless at that point . We do know the answer to that. We been very diligent focusing on the science indicates that both doses with the timetable the study show. We may find out in the future but so far we found 95 percent of folks do come back in that window interestingly if they dont at least a short period of time approved to come back so about 5 percent may not come back and we dont know why we continue to look into up that is unfortunate. I would like to make a contribution to the Hospital System here so many by the way can i get a vaccine quicker . Does that work . It absolutely will not work when building across the country is we have seen extreme few instances of that people say everybody wants to be next i call my own life and ask her because shes not eligible the first time she is she will be in mind but right now weve done a good job as a country largely avoiding the skipping in line concept. Delivery away from approved and a great job across the country. In your case, who pays for all this . If i walk into Kaiser Permanente and is a guess what im a member, im 65 or older or 70, they just stand in line . How do you decide will get and who pays for it . First of all it is free to the public members of kaiser permanent a and approved provider and in our case nonmembers are members but we ask we actually do reach out we know that age and comorbidity make them in a standby list with that jurisdiction but if they are not coming in or reaching out or calling to get them scheduled what is really frustrating is this is high anxiety some weeks we get 60000 doses so you have to schedule ahead and then the next week your people scheduled of the new find out you have a fraction of that. So soon as you get the vaccine and to make a standby list. So then if they say what afraid of claiming to put the needle in your arm to have to be a nurse or can you train non nurses or do i worry they put the needle in the wrong place . Its important we address that. Because right now and the intensive care unit or in the Emergency Department where the Vaccination Centers at least during the current emergency advocate we allow physical therapist occupational therapist that are totally capable of doing that and the clarification of the federal and state level would be helpful to expand the people could do that. Is a hard disk reporting the needle in the arm or take training to do that . I cant do that but how long does it take . I could teach you four minutes. You ever seen my physical capabilities. [laughter] to davids point we developed a quick training model literally six minutes the introduction because nursing students and medical students and ultimately the National Guard. This is not complex and were getting people ready for that because the staff does need to be taken care of with covid and on Covid Patients in the hospitals. What about the new strain we hear about coming from south africa and england and brazil . You see evidence of a new strain of covid19 or not yet . The only science we havent seen South African but i think it would be silly as you hear from National Leaders they will have implications for us i dont think we should go to the panic stage dont get a vaccine because they will not be worthwhile or beneficial it will be beneficial. We find about the efficacy on that but even if it somehow took the efficacy from 70 percent down from 90 but with the variance is they transmit quicker so we have to do Everything Possible not to let that happen. Take the vaccine when you can and bleeding the drama for a mask and social distance and be smart. We can control this now it has become a political issue but its not that Simple Science we will save lives well we get to some immunity it is so important. For some reason it still seems to be debate for some people. Let me ask a medical question to stephen. If i had covid19 and some members of my family have, do i get the vaccine are still needed because i have a relative antibodies . At least 90 days your protection the number of people who had covid and then again is very low to my knowledge no one has had severe covid after initial case there is a lot of protection there. Recommendations people away from the 90 day window then get the vaccination. All the hospitals you are involved in the country is there an advantage to living in wednesday versus another to get treatment or the vaccine . And five different homes kelly is one of those is the place to get the vaccine . Are doing matters there an advantage to that . I have heard people contemplate that the first thing i would say is if you are eligible there are a lot of different providers vaccines we are encouraging people to get vaccinated whatever they can if they are eligible. Interestingly enough across the country the allocations are not consistent per capita. We are hoping that changes. We are finding some places in the country, none of them have enough. Let me say that there is no place that i am aware that would say we have the about us but there are varying degrees of allocations by state we are already hopeful now to have a more concerted plan with the Covid Response the allocation will be predictable and then the methodology will have taken into account the numbers people that are eligible. The question is important for those sitting in this region because obviously we have in the tristate area. As it relates to can get a vaccine zero three different sets of rules for certain place maryland is in a different place relative to age and other conditions and if they can be considered but yet way take care of patients who live in a play jurisdictions. So this gets back to the need to ultimately have a federal plan because its so hard to tell the patient that was in virginia we cannot take it yet because of jurisdictional issue the same and true in reverse for a patient in marilyns im hoping we can get that complication out of the way and ties those patients with the limited vaccines that we have. If we could do that it will alleviate so much anxiety and angst and resources its taking within the Healthcare System to sort that out we have members and patients in all three jurisdictions. And then methodology we have to use, and it changes how we notify them is important. Something we dont get at the federal level but give them the metropolitan. Since covid has started did it cost a lot of money . Did you make more money than you file did you break even on the stipulation because of federal reimbursement for you lost money how to calibrate the impact on your organization . I think it cost all of the economy not just healthcare. But i would say different parts of the country has been impacted differently but overall it has been a huge economic drain on all of our organizations preparing for the search and taking care of patients. And then we didnt know food have enough beds. So those things that could be delayed or put off if not urgent. Then we had to get enough staff and run a greater capacity and with the testing we are paying for the vaccine before the distribution and administration and scheduling and many other kinds of things it has been taxing on the Healthcare Industry no doubt about it. I have all the body parts that im planning to get but if i wanted to get the official hip because my friends have and i want one so is now a bad time to get one because i may be afraid i would get covid is a risk somebody comes into elective surgery if they come down with covid because you cannot adequately protect . Thats a great question originally when we saw the terrible things that happened in new york and italy were there werent objections there was no doubt there was significant transmission of covid to those members providing care and potentially to the patience now we know how to prevent transmission of this disease its not Rocket Science but the science support that they protect us so for example we have 10 percent of our employees who had covid that sounds like a big number until you see the cdc says in november 15 percent of all americans have had covid. There is a concern hospitals a place where covid is but thats the one place that is adequately protecting ourselves. So you should get the necessary medical care. In fact we saw tragedies across the country where people with healthcare because industry is forced to hold the back and we know the number of actual deaths have been highest than one higher than covid deaths the last two months that is due to delaying necessary medical care you would feel very strongly you are safe at least as safe and the hospital in a healthcare setting is anywhere else that you go. I think its important because communities have to see hospitals as safe zones and it has been in the numbers of the percentage of those that have become positive similar across the region i know its true with midst of the transmission rate between patients and associates is less than 1 percent that are getting sick their positive from the community we are not seeing transmission because of all objections everyone is conscious of creating that space in the hospital so needed care absolutely you should be doing that. That is a really Important Message that nobody should hear differently relative to seeking care in a Physicians Office or whatever it may be. What is the impact on your organization financially . Have you lost money . Yes. Significantly. Part of the mission to do the right things is the single biggest financial crisis and to do the things the community expects us to do so and q2 the spring of 2020 medstar took a bunch of management interventions at the expense and revenue side that was a 200 million a number in q4. Looking at this school year for us and now into two quarters of that, another 100 million from the expenses are taken care of with the issues related to covid even though he stopped doing on covid cases but not back to non historical levels. That is a 300 milliondollar number before what might come from the government in support. Anybody who said anybody who wants a test can get a test. What do i do . Like to stop by and say give me a test . I think testing is the issue. If you have a symptom and you were symptomatic you can show up at the urgent care with the primary care physicians if you want to test there are sites over the region getting a test is not an issue. If i get positive on my covid test and he said i can quarantine at home where do i do to drink a lot of water . Do i drink a lot of diet coke . Go to mcdonalds and get things delivered what should i eat to make me recover more quickly . At this point nothing other than the normal good care of yourself and staying away from others during that period of time we were potentially transmitting we still understand why so many cases are mild and some are severe or fatal sustainably from other people is the only advice i could give you in that window. Had a vacation since covid started you plan on having one ever . We went to the cabin on the water and mean the weekend im scheduled to go skiing in six weeks i am vaccinated and also what happens between now and then fortunately the cases are going down significantly. But its always easy to predict the past and not the future so if actually go to the slope i have not bought my ticket yes. Whats more dangerous going there with you are vaccinated of just skiing . [laughter] i will place a skier. The Vaccine Availability one of the things that happens and discussed nationally as we are throwing away a lot of vaccines in the bottom of the bottle and we need to look seriously at that and the pharmacists of which at that they could get eight or 10 percent more doses out of the bottles and were not allowed to do that but my understanding it is being looked at me could do that if you think. In the bottom no matter but if you do get 5 percent more that is pretty significant of those in need to be vaccinated and i hope that would be taken under consideration as well. I know that is being looked at. Have you ever talked to doctor fauci about this . Is he feeling better today than he was a couple months ago . I have not spoken specifically with him on that topic but i did have the opportunity during this i always appreciate his leadership. I think they are out of time. Thank you to our guests kim and stephen and ken, thank you for giving us this information is so if anybody has Health Questions they should go to one of the three organizations and no others . Exactly. [laughter] thank you for participating. Thank you. Thank you to our viewers for watching. And tune into the next program shortly. This will be on the website in a few minutes as a repeat of what we heard today. Thank you. Do you solemnly swear that all things pertaining to the trial of impeachment of donald john trump, former president of the United States now pending according to the constitution and laws of god . I do this is an hour. Well, hello, everyone. Im bhan behalf of georgetown law, i want to welcome you hello everyone. On behalf of georgetown law welcome to our conversation on constitutional priorities the first 100 days