Detroit Regional Chamber > Tele-Town Hall with John Fox and Susan Grant of Beaumont Health System

Tele-Town Hall with John Fox and Susan Grant of Beaumont Health System

April 2, 2020
Sandy Baruah (00:00):

Good afternoon, everyone. Thank you for joining us. This is Sandy Baruah of the Detroit Regional Chamber. Thank you for joining us for our latest Tele-Town Hall. We appreciate the value of your time and we promise to be judicious with it. We are very pleased today to have our first healthcare leaders to join us on the Chamber’s Tele-Town Hall Series. I’m pleased to be joined by John Fox, the CEO of the Beaumont Health System and Susan Grant, the chief nursing officer for the Beaumont Health System. Susan, John, thank you so much for joining us. We know the incredible work that you and your healthcare colleagues are doing at this critical time. On behalf of all of us, we thank you all for everything you and your colleagues are doing, and frankly, the risk that you’re putting yourselves and your teams at to take care of the rest of us. Thank you. Let’s talk about the real health risk out there. There’s a lot of confusion. Are we overreacting to this COVID-19 virus? Can you talk about the real health risk that is out there?

John Fox (01:11):

Sure. One, let’s face it, the risk is quite real. This is a very serious, highly contagious pathogen. It’s exactly the pathway that many suspected for years. In the wet markets of China or Asia, where animals are juxtaposed to each other in very much unnatural ways, pathogens would jump from species A to species B, and then to the humans because we put them together in this unnatural way while they’re butchered. That’s how humans get infected. Often that ends it because it doesn’t transfer from human to human, but this version of the coronavirus is very serious.
It attacks the lungs, and in its most advanced stage precipitates a condition known as ARDSM or Acute Respiratory Distress Syndrome. It’s a very serious disorder. That, with some other conditions, is probably the one that drives the mortality associated with the disease.

John Fox (cont.) (02:30):

To give you some facts about Beaumont Health: We probably got our first inpatient for COVID-19 two weeks ago. This morning, we broke through 500 inpatients. At this point we’re probably at 540 already today and we will, I’m sure, be at 600 shortly. So, we’re growing by a hundred patients a day in our inpatient census. They’re cohorted on medical units, where they’re kept together, or they’re in our ICUs. So, in two weeks we’ve eliminated 80% of our elective surgeries, a lot of other procedural areas, and we converted a large part of the system to a screening, diagnostic and treatment operation for COVID-19. It’s been a lightning speed endeavor for all of us [with] all sorts of consequences. One key item is [that] we have to stay available to our patient populations who come to us for emergency services, for heart attacks, normal deliveries, ongoing cancer treatment, and everything else. So, it’s very much a high wire act. There’s no way to convert the whole system to COVID-19 treatment. If you’d like us to talk about the curbside testing, I’ll let Susan Grant walk the group through that. Would that be a good next step, Sandy?

Sandy Baruah (04:06):

Sure. Susan, let’s talk about the curbside SAS type testing.

Susan Grant (04:11):

So, with the curbside testing, just some background, first: What we’ve done thus far to expand the testing, and to help people better understand what they should do if they have COVID-19 systems. Beaumont was the first health system in the state to launch these emergency center curbside screenings at all eight of our sites. As of March 24, as of yesterday, we have seen more than 8,000 people through these curbside screening sites. We also, in addition to that, have launched about two weeks ago, a coronavirus hotline that has been staffed by Beaumont nurses and employees to help evaluate their symptoms over the phone and to determine whether or not they need to go to curbside or if they need to seek other medical attention. Since we’ve launched that on March 12, we have answered over 36,000 calls on that line.

Susan Grant (cont.) (05:20):
We also implemented a virtual screen on our website, too so that people can – If they don’t want to call the line and they have questions – they can go to our website and do a virtual screen on the website to see whether or not they need to take any further action. We have had over 100,000 hits on that site as well. So, people have been utilizing all of those resources and appropriately so to better understand what they need to do and whether or not they need to take further medical action. And then – last, but not least – we began testing here at Beaumont in its labs on March 16. We currently run about 400 tests per day. So, those are some of the things that we’ve been able to do.

Susan Grant (cont.) (06:19):

But given the limited amount of test kits that we’ve had available, we’ve had to prioritize who gets tested and which of those tests can be processed at the Beaumont labs. The people who are getting first priority are those who are showing severe symptoms and need to be cared for in the hospital. That provides us a better sense and information on how to care for them and direction on those who are not infected. So, those are the things that we’ve put in place thus far to respond to the needs of our community.

Sandy Baruah (07:00):

Susan, regarding the testing, how much testing do you think is available state-wide to meet the need? How underwater are we as a state? Do you have a sense for that?

Susan Grant (07:14):

I know John will want to comment on this as well, but it’s very limited state-wide. And as I said, we’ve only been able to run 400 a day, and given the other numbers that I’ve shared with you on the number of people seeking testing curbside and those in the hospital, it’s far exceeding our capacity. I don’t think we’re unlike anyone else statewide.

John Fox (07:40):

The same lab in Lansing will only do it for an inpatient who’s been admitted. So, you can’t get an outpatient screening done through that lab. We’re pretty rigorous in our screening. We won’t give you the test unless you’ve indicated symptoms and we’ve already screened you for Influenza A and other viruses. It was only given as the last resort. We’re way behind South Korea and other industrialized countries who were able to pull this together. We have the ability to do more tests, we just can’t get the kits that go with it. We have all the primer solutions: the motto nucleotides, the other ingredients needed. A COVID-19 test takes about two hours because it runs off of PCR polymerase chain-reaction technology, where you have to heat and cool the sample 40 times – they’re cold cycles – that allow the RNA to replicate so you get enough volume of RNA that the diagnostic equipment can recognize and say, yeah, that’s COVID-19 or no, it’s something else.

Sandy Baruah (09:03):

Okay. Can the two of you comment on what should people who need to be out – either they’re working in a critical industry or they have to just go to the grocery store – What are the things that people who have to be out and about in these days can do, should do to protect themselves and others? What are the most effective things?

Susan Grant (09:28):

Number one: Hand-washing, good hand-washing, good and frequent hand-washing. Making sure that they’re very attuned to that. And then we’ve heard a lot about social distancing. Maintain about a six-foot distance from others and to be attuned to that as well, but the number one is around hand-washing. Then also, using good hygiene etiquette. If you have to cough, cough into your elbow or sneeze and to make sure that you’re doing that and maintaining your distance from other people.

Sandy Baruah (10:07):

Right. For people who just need to go to the grocery store, things like that, should they feel relatively comfortable doing that on the occasions that they need to do that?

Susan Grant (10:17):

For the most part, I think that that the guidance that we’ve all received is that to avoid larger crowds and groups of people standing in close proximity to each other. Also, many of the grocery stores have the wipes where you can wipe down the carts where the handles are. If they don’t have them, it’s a good idea to take those and keep them yourself to be able to wipe down any surfaces that you’re touching.

John Fox (10:47):

I talked to somebody at the CDC two days ago about this – someone I’ve known for a long time. They’ve done some analysis around it. [With the] grocery store issue, some strike cleaners and other things are now closed. They’re recommending as an infectious disease physician that you go early in the morning because a lot of the stores do their sanitizing and cleaning overnight and use antimicrobial agents in that cycle and do it lesser in the day. Also, they recommend not going frequently. When you go buy everything you need, if you need to get a little extra and stock up, and but don’t go to the store frequently. And they say that early in the morning, there’s probably got some advantage over later in the day before more people are in there and with them, potentially more, more microbes.

Susan Grant (11:46):

And, I’ll just add to John’s point: I have elderly parents and many of the stores have created hours for the elderly to shop in the grocery stores very early in the morning. So we encourage our elderly citizens to be doing that and to take advantage of those store hours so that they can minimize their exposure as well.

Sandy Baruah (12:12):

Right. It’s the whole balance John of, of stocking up so you don’t have to go frequently, but we don’t want people to hoard either. So everyone’s got to strike that balance.

John Fox (12:22):


Sandy Baruah (12:24):

John, I want to go back to the numbers you were expressing. You’re up to 540 COVID-19 patients today; soon to get to 600 possibly by the end of the day. We were initially led to believe – now it seems erroneously – that this was a condition or virus that was only a risk to elderly people or people with a preexisting medical condition or a compromised immune system. Obviously, we don’t want you to share anything confidential, but what are you seeing in your patient mix? How true is that? Is that view that it’s really an elderly person’s issue?

John Fox (cont.) (13:12):

Generally, that that is a higher risk group, but we have plenty of 40 and 50-year-olds also succumbing to the virus. If somebody has been a smoker or have other issues, in many way,s they can become more vulnerable. At Beaumont, we’ve only had two pediatric patients out of what is now 540. Just for a point of clarity, we have 540 as of an hour ago that tested positive [with a] confirmed diagnosis. We have about another 200 that are pending where we suspect it’s COVID-19, but either from test availability or just the timing of the test, we’ve not gotten a confirming diagnosis from the lab.

Sandy Baruah (14:09):

Are the conditions being presented differently in different age groups or is it really just this kind of incapacity to breathe? The affection of the lungs that is causing the most problem with the patients who are diagnosed with this?

Susan Grant (14:27):

What we’ve observed is that, for the most part, there’s similar symptoms: severe shortness of breath, cough, fever – and we’re also learning, too, that many of these patients cannot smell anything or taste anything.

Sandy Baruah (14:47):

Susan, obviously for people we’re still hoping, that that a vast majority of the people who have this are able to recover safely being isolated at home. Is that still the case that you’re seeing?

Susan Grant (15:07):

Yes, absolutely. Out of our patients who have been confirmed positive, our total number is close t0 1,000, and about half of those are hospitalized. So, you know, we have the rest of them who have been sent home to recover.

Sandy Baruah (15:30):

Okay, great. A final question before I turn it over to Brad Williams, who’s looking at the typed questions that are coming through our system, what recommendations do you both have for businesses that are still operating, that need to operate? Obviously as a healthcare organization you are in the best position since you’re operating not just at your normal rate, but at an exponential rate. What can businesses do to keep their, their employees safe, their clients safe? What are some of the best practices that you are seeing out there for the business community to mirror?

John Fox (16:08):

I think the key item is adjusting to all the public health guidance that goes with this pathogen. That goes to what Susan covered – hand hygiene and the extent of business can facilitate that and social distancing is critical. Teleconferences like this are a lot better than all of us being together somewhere. And picking up on that risk, it’s not easy. Businesses are being hit in multiple ways in terms of how to protect their own people. But conversely, in a hospital industry that is potentially ground zero for this, is that we’re all dealing with massive revenue declines that are going to be very difficult to sustain as we are in this suppression phase rather than the mitigation phase of managing the pathogen.

Sandy Baruah (17:13):

All right, Brad, questions from our audience.

Brad Williams (17:18):

John and Susan, thank you both and thank you to your teams at Beaumont for being on the front lines of this crisis. There are a number of questions in that regard about your teams and the people on the front lines, about what can be done to serve them, what can be done for healthcare workers particularly around donations. There’s been some talk in the news regarding the shortage of masks and gowns and those sorts of things. Are there things that people in the business community, in the general public can and should be doing to help you as far as donations to do your job?

John Fox (18:08):

Yeah, any, the donations are very much appreciated. There’s another side to that. It’s got to be material that’s usable. An example is, as Susan was educating me on this morning, we’ve gotten N 95 masks and other PPE or personal protective equipment from the national stockpile, but it’s also versions of the N95 mask that a lot of our employees has never seen, used worked with, so, there’s an orientation issue. You start to have different supplies coming in and no one has ever used before or has got variation in how they’ve used. We’ve potentially added complexity on top of hopefully providing some protection. And there’s a trade-off there. Susan, did you have another comment?

Susan Grant (19:01):

As John said, we’re receiving and we’re very grateful for the donations we’ve received around N95 masks and disposable gowns. We have a number of community resources and companies who have offered to work with us on designing a different PPE. We had a group in here this morning helping us sort through and designing disposable gowns and masks, so that is very much appreciated. But as John said, we are working through kind of the challenges of using different equipment that our staff has not always used, but they are stepping up every day and being just our courageous, devoted healthcare professionals who want to meet the needs of our community doing it every minute of every day the best that they can. And as I said, they’re very devoted to meeting these needs and making sure that we help people get healthy and that we get through this.

Brad Williams (20:11):

How real is the threat of airborne transmission and should people who are healthy be wearing masks when they have to go out? Say to the grocery store or [after] the governor has said that people can go outside, those sorts of things. Should people be wearing masks in those situations?

Susan Grant (20:35):

The evidence does not indicate that we have to be wearing masks when we’re out and when we’d go outside. Unless, of course, it falls within the guidelines we’ve received around maintaining distance from other people three to six feet and using those hygiene techniques that we just talked about with hand hygiene. But you know, there isn’t any evidence and the CDC guidelines do not indicate that everybody should be wearing a mask. However, having said that, I think that there’s a lot of anxiety and a lot of concern and we do know that it may make somebody feel better to wear a mask. And, of course, if that makes someone feel better than they should do that.

Brad Williams (21:29):

How is the health of your supply chain, overall? I know we’ve talked about masks and gowns, but what about the rest of your supply chain?

John Fox (21:40):

The way I describe it is as this: You can draw a line across, which is our normal consumption of functional supplies and our normal suppliers are doing fine. We’re getting our normal allotment. What has happened is the consumption function jumps when you have so many more medical patients or particularly treating infectious disease – so, just COVID-19 – so that is a stress. We are buying additional supplies wherever we can find them. I mean all of America unfortunately is competing with each other on this and it’s definitely the struggle. We’ve not stocked out yet on any a key item and we think we’ll do reasonably well overall. But all of this is predicated on how the infection rate moves through the pandemic and the shape of that curve. And if it’s a flat curve – the bad news of a flat curve is if will be more tolerable from a supply chain, bed availability and everything else.

John Fox (cont.) (23:03):

The bad news about it is that it will last longer. And because you’re going to push it out over time, because this pathogen is going to find a big percentage of our population to infect ultimately. And so there’s no way to beat that out. Right now, there’s only two ways to control this, the end of one is a vaccine, and the other one is, if enough of us get it, we’ll create what they call herd immunity. And so if 80% of us have had the disease, the other 20% are substantially protected and they do special calculations of the CDC and modeling to determine when you start to get the word immunity. Otherwise, it’s out there. And if you’ve not built up the antibiotics to fight it, you’re vulnerable.

Brad Williams (24:02):

So there you, you mentioned herd immunity and there’s a couple of questions in the chat room about that. Are we sure that once someone gets the virus and recovers that they will not be susceptible to getting the virus again? That seems to be the consensus from what I’ve seen reported, but I have not seen that that is confirmed. Is that right?

John Fox (24:27):

Yeah. Magic word. This is a new pathogen. The science is not caught up with it completely in terms of definitive research around things like that. We know it produces antibodies. And we believe those antibodies as with other viruses ultimately kick in. Nobody ever had a cure for Ebola. The only thing that mattered was keeping the patient healthy enough with fluid management and other things until their immune system kicked in with antibodies that would kill the virus. So it was a foot race. and so viral attacks typically would build up antibiotics in the [unclear]. But because it’s viral, the antibiotics don’t work. And so it’s really our own immune system. People are believing that it’s likely that this Corona virus version well create immunities that are similar to other Corona viruses. Again, Corona virus is a big class of viruses and that seems to be what they’re seeing in Asia right now. But a lot of scientific evidence around that has yet to appear from everything we know.

Brad Williams (25:56):

Okay. The last question from me in the chat room and then I’ll give it back to Sandy. You know, I think many of us saw in the news in the last 24 hours that you have Beaumont are getting close to reaching capacity. How close are you to reaching capacity and then what is next when and if you do reach that point?

John Fox (26:22):

Yeah, I know Gretchen Whitmer made that comment. I talked to her this morning to give her some additional information. We’re not at capacity yet. We are doing all sorts of things to create capacity. Last night, we converted again two units of Royal Oak to COVID units and that hospital now has nine dedicated to COVID- 19 patients. We will be converting our ORs to ICU. One of our rate limiters that we’re concerned about is vents – Mechanical ventilators – that these patients need if they can track pneumonia or worse ARDS and we are moving ventilators around between and amongst the eight hospitals. Again, a point of emphasis I made to the governor today was, we, we’d have to get load balancing implemented across the system. We can’t have people drive by a hospital that may have 10% capacity more for ventilators or other things

John Fox (cont.) (27:34):

Some of the patients need, and then pull up into an ER of a hospital that’s super saturated. We really need to do that. And that means invoking, the medical coordination center powers the state as across the eight regions that they’ve defined in Michigan. Beaumont hospitals are in region one and two. And so, that coordination is critical. It exists in many other industrialized countries that have their, their healthcare more under government control, good or bad, but in the U.K, and in China, they have immediate control over that and distribute the load so that everybody gets the most effective care possible and they don’t have supersaturated set location compared to one that’s got 20% capacity that’s being under-utilized.

Sandy Baruah (28:37):

Great. John, Thank you. I know we’re reaching our half hour limit. I’m going to ask just a handful of speed round closing questions to you and Susan. Number one, if people do have or companies do have PPE to donate where do they go? Who do they contact if they want to donate it to Beaumont?

Susan Grant (28:56):

Our donations where we’re taking them through Saturdays the 28th and they should be sent to the Beaumont Service Center, 26901 Beaumont Boulevard, Southfield.

Sandy Baruah (29:14):

Great. Thank you. Next question. As I sit here in my kitchen in, in Grosse Pointe, Michigan, the number of people who are out walking about in groups has quadrupled over the last several days. The safety of that?

John Fox (29:31):

A lot of conversation around that. I mean, somebody walking out alone or a park is a obviously not a problem. I think married couples are doing it. My RN wife of 40 years and I have not practiced social distancing yet, although she may think that’s a good idea of some days. So, it’s judgment. I think if you’re walking around [as] a group of five people, arm in arm, being an outside doesn’t do anything for you. That’s that would not be recommended.

Sandy Baruah (30:11):

Okay. If we have some companies on the line that are expressing some interest or potentially capability of producing a PPE, where would a company go to get the specs to produce ice shields or masks or gowns or such?

John Fox (30:33):

What I would recommend – because it will speed it up – is a lot of these specifications are in the public domain and simply go to manufacturers or other sources you can find on the web. So if it describes the face shield, the dimensions, the thickness of it. So, you know, as the first test that’s a pretty good sanity check as to whether their production capability is a potential solution. So augment the supply chain for that particular item.

Sandy Baruah (31:09):

Okay, great. Thank you John. Given the steepness of this curve, are you anticipating opening up new facilities or repurposing existing facilities for this?

John Fox (31:22):

We are playing with scenarios and some use that where we are basically are planning around scenarios where we could potentially access. For example, we’ve talked to Oakland university who could potentially open up 500 dorm rooms that it may have the ability to provide foods, laundry. We’ve got beds in them. The tricky part is providing patient care in those spaces. Our patient care teams are spread to the max right now. And you know, Susan directs 12,000 RNs across Beaumont Health and there’s a limited number of them that could go staff these other locations. And then you’ve got all the equipment issues. And again, it’s being in a dorm or a hotel when your acuity spikes, without the availability of lab and pharmacy and other things that you may need, it can get complicated very quickly.

John Fox (cont.) (32:28):

So that’s going to be the challenge. I think that, you know, you read it in the media, American healthcare has a downsize on bed availability over the last several decades for all sorts of reasons. Like a lot of supply chains, you know, you will pull health care supply chain problem or issue – everything is tightened up, which is great to run a very tight supply chain until your source is interrupted. And I think a lot of businesses saw that, you know, with all the disruption out of China and we can see it locally on the healthcare side.

Sandy  Baruah (33:10):

Okay. And a final question. I don’t know if you or Susan can even answer this question: Do you have any guess as to what the percentage of people who have COVID-19 are presenting themselves as asymptomatic?

John Fox (33:36):

Susan, what would be your comment on that?

Susan Grant

I don’t, I don’t have a number or percentage. I can say that initially, two weeks ago when all of this started, that people who were seeking advice as to whether or not they had a COVID were presenting without symptoms initially. And I think since over the last two weeks is there’s been more information shared. We have fewer people presenting without symptoms who are needing to be evaluated. And I think that is partially due to the screening tools that we’ve put on, on our website and our hotline. I don’t have an I an estimate of how many are presenting asymptomatic at this point.

John Fox

In that regard, it’s really important that people use all the screening tools out there.

John Fox (cont.) (34:35):

And that’s how you as individuals, all of us can take control of the situation. Are they asking you to tell your pros, align your employees? Cause this always generates fear, doubt and uncertainty. And there’s nothing like people getting engaged with it. Frankly going through a process. And I think the, the science around the screening is fairly rigorous. And have you passed the screens? Your odds are very strong, you’re in good shape. If you trip a wire and don’t pass the screens, it’ll give you direction on where to go the next step.

Susan Grant

And we encourage people that if, if they do not have symptoms and they pass the screen, they do not need to come to the emergency department or the curb sides or call. They’re okay. So to really encourage people to pay attention to that. And you know, as we have people present who are asymptomatic…

Susan Grant (cont.) (35:38):

And really do not need to be evaluated, that that fills our emergency departments and our curved sides and it prevents those who need it from getting what they need.

Sandy Baruah (35:50):

Susan, thank you so much for that answer. As we wrap up, I want to remind all of the people who are on the phone that this teleconference is being captured and you’ll be able to download it and listen to it again, should you wish to, that’ll be available on the Chamber’s website, And with that I want to thank John Fox, CEO of the Beaumont Health System, Susan Grant, the chief nursing officer for the Beaumont Health System for sharing this wonderful, useful information at this very important time. Thank you to you and to all your colleagues in the Beaumont system for being on the front lines of this crisis. I thank you for the service that you’re providing.

John Fox (36:32):

Well, thank you. We appreciate the opportunity.

Susan Grant (36:43):

The same. Thank you.

Sandy Baruah (36:45):

Great. Thank you. All right, everyone. Have a good afternoon. Be safe. Thank you very much.