Lori Walsh: As the coronavirus spreads across the US, doctors and healthcare workers stand on the front lines of prevention, testing and treatment. They do this work without knowing the nature of the novel coronavirus fully. They do this amidst uncertainty about the availability of supplies. Dr. Jerome Freeman is a neurologist and professor in medicine at the Sanford School of Medicine at the University of South Dakota. He's joining us today to talk about caring for those who care for us, and about kindness and empathy for patients who are frightened, even panicked in a pandemic and have that as part of their training for South Dakota doctors all along. Dr. Freeman, thanks for being here.
Dr. Jerome Freeman: You're welcome.
Lori Walsh: I feel like you're the voice we particularly need to hear from now on a number of levels of medical ethics and training our doctors and protecting them. But I want to start with this idea of protective equipment for doctors and healthcare workers, the things that we're learning about how they can be effected by their exposure. How do you approach a pandemic like this from that viewpoint as far as keeping healthcare workers safe but also working?
Dr. Jerome Freeman: Well, it's very important to have adequate equipment and to know how to use it. Oftentimes if people, if students or physicians aren't regularly using the equipment, they might need a refresher on the order you put the equipment on, how you establish that it's safe. But unfortunately, in many areas of the country, there is an inadequate supply of the equipment and that's causing a lot of concern.
Lori Walsh: What's caused that inadequate supply? Is this something that everyone was just ill prepared for?
Dr. Jerome Freeman: Well, I think in part many people didn't envision a global pandemic like this. So the stores of the equipment just aren't sufficient to meet what seems to be the demand.
Lori Walsh: What do we know about in, in South Dakota, how that is being coordinated now? Is there a plan for getting more?
Dr. Jerome Freeman: Well, in South Dakota, I think right now we are in very good shape. Our health systems and smaller hospitals as well have been trying to forecast what they're going to need. They've been looking at their supplies. There's been good collaboration. For instance, in Sioux Falls, Avera and Sanford had been actively working together to coordinate their testing efforts, and I think in South Dakota, we are in a much better situation than in other places around the country.
Lori Walsh: Just that collaboration alone might somewhat unprecedented in the sense that these are not necessarily organizations that work together often.
Dr. Jerome Freeman: But they certainly are capable of it when cooperation is needed, and I've been very impressed with the collaboration that's taken place. This morning, I received a email from a former student. She's a resident now in the Western part of the country and it was so evident how alarmed she was. She and her husband have a six month old baby and she indicated they're feeling unprotected by their employer. They don't really feel their concerns are being listened to. They feel there is a mentality of putting their work as resident positions ahead of their family and their little baby. So it just gives a flavor of the stresses and concerns that many people are feeling at this point.
Lori Walsh: What's your advice to someone like that who is in this highly stressful job, but is also thinking about spouses and children and parents and grandparents at home?
Dr. Jerome Freeman: Right. I think having a notion that we need to collaborate and to share and to really look out for each other is very, very important. Healthcare providers have always understood that there are risks with doing the job correctly. In order to care for our patients with any infectious diseases, there is always some risk undertaken of contracting and infection. With the coronavirus unfortunately, it appears to be very contagious and so precautions need to be heightened.
Lori Walsh: Do you feel like in South Dakota, that the healthcare organizations are taking their employee concerns seriously? I know you're not listening to every closed door conversation, but in general, how is that baked into what we do at Sanford and Avera and Monument and some of the South Dakota providers?
Dr. Jerome Freeman: I think all of the institutions are taking a proactive approach. For instance, at Sanford, there are regular, often twice daily communications with the physicians and staff. Yesterday, they conducted what they call the town hall for employees in the region. I believe over a thousand people were in attendance, virtually in attendance, not in person. Understandably, nurses, doctors, other healthcare workers have a lot of questions, and I think the institutions have been very forthright in terms trying to provide accurate and helpful answers.
Lori Walsh: We just heard from the White House at the coronavirus task force talking about prioritization of testing and processing those tests to areas where the need is the highest. That has a lot of people in South Dakota asking about whether or not we are a priority and where we fall in the prioritization of testing. When we've heard so much about the importance of testing, to getting ahead of this and flattening the curve, so people who know they're sick can stay home and self isolate. Talk a little bit about what that looks like in South Dakota as hospitals struggle to get tests, struggle to find the place to process them, whether they're processing them in house or are contracting with a private lab. Unpack that for us a little bit please, Dr. Freeman.
Dr. Jerome Freeman: Well, I think around the country, there has been a scramble really to get testing up to the levels we need it. Ideally, we would have the tests available to check millions of people because persons who become infected are asymptomatic for a number of days, five days or so, and can spread the virus. So what we really need ultimately is sufficient tests to screen large numbers of people. The most urgent need right now is in areas that are hardest hit. One precept that's always used in medicine is one of triaging, where you direct the resources to where they're needed the most. So in places like Washington state or in Los Angeles and certainly in New York City, their need right now is way more pressing than our need in South Dakota.
Fortunately right now, we still have a very limited number of cases, 11, I last heard, 11 or 12, and I think all of these have been from outside contacts. So we want the testing available as soon as possible, but I think our need, our urgency is somewhat less than around the country. One other point to make is I received a communication earlier this morning indicating that Avera and a Sanford will be working together and expect to have a lot more testing available this week even, so we're making good strides I think.
Lori Walsh: All right, and that number is 11 for the state of South Dakota. We'll get the new numbers here within the next 20 minutes, is what the plan is. We'll update you here on in the moment as soon as those numbers come in. Dr. Freeman, for medical students who are studying to become doctors and the various layers of how that works, how does this impact them? Are we a year behind in getting them into the field because of the closures of universities?
Dr. Jerome Freeman: Well, there are some accommodations being made. Currently the organizations that accredit medical schools have recommended that students throughout the country avoid any patient contact for two weeks. So at our school and schools across the country, students will be doing online learning but not be in the clinic or the hospital seeing patients. A second concern is that since protective equipment is limited, probably in dealing with infectious patients right now, patients right now with the coronavirus are suspect of having it. Students would not be engaged in that, not only to protect the students, but also because of the limitations of the protective equipment. One thing we do want to do however is to educate our students very thoroughly in terms of how to respond to this type of pandemic, how to respond to the challenges of infectious diseases, and that'll be an important part of our curriculum.
Lori Walsh: Let's talk a little bit about that response, and I know kindness and empathy and ethical considerations and a more thoughtful way of doing medicine are so important to you. It's just infused in everything that you do through USD. This is an incredibly stressful time for healthcare workers because patients ... their phones are ringing off the hook. Patients are upset, demanding maybe, suffering and not being able to get help. Talk a little bit about how to approach that very human aspect of this.
Dr. Jerome Freeman: Well, one fundamental that we are emphasizing at our medical school is kindness. We emphasize that kindness is so important, not only from physicians to patients, but colleagues, students to professors, to kindness to staff. We feel that kindness is an imperative that we are making. Well, it's part of our new strategic plan at the medical school. We define kindness as what we do and how we do it, so the how is acting in ways that are perceived to be helpful and kind. But kindness also demands that we use evidence based medicine, that we take ... in the case of the corona infection, we take adequate measures to protect our healthcare people. So kindness is really important, I think, right now, especially as you mentioned Lori, when people are stressed or anxious or they get angry because of delays. I think in that setting in particular, to have an attitude of kindness and empathy is crucially important.
Lori Walsh: There are people who are learning now that if they can't get to their doctor, how much they really rely on them for this kind of emergency, or urgent care, to regular daily care. I'm wondering if you think, at this point ... This is hypothetical, but do you think that it's possible for us to avoid these things that we see happening that we're being warned about? Is it unavoidable at this point? They were going to have community spread. Is it unavoidable that we will have equipment shortages? Is it unavoidable that doctors here will have to triage people and make choices about who receives emergency care intensive care and who doesn't? Are those things unavoidable at this point?
Dr. Jerome Freeman: I wouldn't say Lori, that they're unavoidable, but the prospect of this pandemic getting worse regionally and nationally is very good. I mean there have been some people who have wondered if the discussions were overblown. I've had patients ask me, is this really as bad as is being reported? I would say emphatically it is bad. It's bad. It's a very contagious virus and it's going to spread. I think we can do a lot here locally and, it's been implemented already in our state. I mean closing schools, closing businesses, restaurants and bars and big gatherings of people, I think is very, very important. Good hand sanitation and social isolation really make a difference. Sometimes it's hard for people to understand and believe how important it is, but I would say these measures are crucial.
Lori Walsh: President Donald Trump also talked about the response and mentioned progress on a vaccine and an expansion of testing. Are you hearing things from the federal government that, whether it's the president himself, or whether it's just Dr. Deborah Birx or Anthony Fauci, are you hearing things from the public health officials through the administration that encourage you that they understand the severity of this?
Dr. Jerome Freeman: I think there is a national understanding at this point. I don't think that was always the case. I mean we can always look back and think we should have been responding more quickly. There are some things that are beyond our control. Realistically, I don't think we are going to have an effective vaccine for maybe a year and a half. It just cannot be developed more rapidly than that. Right now though, antiviral treatments for people, in fact are being looked at vigorously, and there is some hope that we may come up with some ways to lessen the severity of bad infections in terms of drugs, but a lot is being done for that. I think there is a part of all of society that has difficulty grappling with how severe something may be in the future when it isn't immediately in your region. We're so fortunate that there are not a lot of cases in South Dakota, but I would not minimize the risk to us at all. This is a serious infection and pandemic and we need to be very vigorous in terms of our preparation.
Lori Walsh: What's your advice to patients who are listening about the days ahead and how they can treat themselves at home? How they should really navigate their relationship with their doctor? What's your advice for patients who are worried and who may be sick?
Dr. Jerome Freeman: Well, the worry alone, not even being sick, but the worry alone can be very hard to cope with and incapacitating. But the standard advice that has been given makes sense. If a person thinks she or he actually has a corona infection, they should call and learn where to go to get tested. If a patient's symptoms are mild, self isolation is very important. One of the most frightening things about the infection, I think again, is the fact that people can be infected and walk around in the community and spread it unknowingly. So I think the measures that have been taken make good sense. Restaurants, I know, in Sioux Falls and other places have been closed, bars have been closed, big community events have been canceled. All of these things, although they're hard, I think are worthwhile and ultimately are going to help us.
Lori Walsh: Dr. Jerome Freeman, professor of medicine at the Sanford School of Medicine, University of South Dakota, we thank you so much for your time. We appreciate it.
Dr. Jerome Freeman: You're welcome.
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