Stanford’s Top Doctor: Coronavirus Will Reshape Digital Health Care Forever
WHY YOU SHOULD CARE
Because you might be having your blood pressure taken over video chat before long.
As the world grapples with the fallout from the coronavirus pandemic, OZY CEO Carlos Watson sat down (remotely) with Dr. Lloyd Minor, dean of Stanford University School of Medicine, to take stock of where we are and where we’re going.
This interview has been edited and condensed. The full audio is available at the bottom.
What was the difference in California from other places in handling the pandemic?
Dr. Lloyd Minor: I think the reason that we didn’t experience the type of surge that New York has experienced is we went to shelter in place here very early, and that’s to the credit of our local government officials and state officials that put into place the restrictions at a time when many across the country were still skeptical. That coupled with the fact that we don’t have the same sort of mass transit systems that New York and the East Coast cities have, that may have also contributed to reducing the spread of the virus.
Were there any novel or particularly effective medicines you tried?
We participated in a number of clinical trials — the remdesivir trials that you’ve read about. We’re also bringing early-stage trials to the benefit of our patients. Still, as you know, there is not a therapy that has been shown objectively to really be effective. There are a number of therapies that in the early stages of the evaluation seem promising, but there’s a lot more work needing to be done in therapeutics. Of course, ultimately we need to develop a vaccine, and that work is underway here and at many other places.
Is it true that a vaccine is going to take 18 months, or is there an opportunity to fast-track this?
People are certainly trying to fast-track the development of a vaccine. I have to say all things considered, yes, I do think it’s going to take about 18 months. I’d love to be wrong about that, as would all of us. There are just lots of steps involved in vaccine development, and while there are some early-stage trials going on right now, those are mostly at the so-called phase one level, that’s establishing that the vaccine is safe. But showing that it’s effective and improving it based on the efficacy studies, those are all steps that have to be followed before a vaccine is rolled out broadly to millions of people.
As a physician, what has surprised you the most about this?
This is a really bad virus. It has a relatively long incubation period, up to two weeks. It makes people ill. For many people that illness is similar to other types of upper respiratory illnesses, but for some — and in an unpredictable way sometimes — that illness is quite severe. And the fact that it has a long incubation period, that we do have evidence it’s transmissible even before it makes people really ill, that’s what has led to this virus spreading as rapidly as it has.
In comparing it to its neighbor, the SARS virus caused greater illness in the people it infected and caused people to become quite ill quickly, so they were in the hospital — they weren’t circulating in the community. And that may be one of the reason the SARS virus in itself did not spread widely. And we’re still not sure why SARS as an epidemic, when it occurred back in 2002, 2003, why it went away.
How will your hospital and the practice of medicine change as a result of all this?
During the month of February we did about 1,000 virtual visits in our adult health care delivery system. One day a week now, we do more than 3,000 — so about a 50-fold increase. And thanks to our amazing IT team who’s enabled us to scale up in that way.
What we’re discovering is that we can do a lot more through a virtual visit than we thought we could in the past. And yet I’m also sure we are only scratching the surface. The revolution in digital health, which had begun long before COVID-19, is going to increase and become more meaningful now. Whereas you and I can have a virtual visit, a conversation like we’re doing today, wouldn’t it be great if we could also interface into that a blood pressure measurement, a measurement of glucose, a variety of other things? We have the technology to roll that out and do it, but we haven’t had the driving force that would lead to those sorts of changes.
Well, the world has changed, and I think it’s going to be a good transformation in health care delivery. And yes, of course some people are going to need to come in. But by doing more virtually, it’s going to open up more opportunities for in-person care. I think the waiting period for those types of on-site visits are going to be shorter because we’re more effective in the virtual realm.
Have there been any interesting transformations in your life personally?
Well, I don’t go to the gym now, because the gym is closed, but I still try to exercise every day. My job before COVID-19 involved something almost every evening: interacting with the wonderful people who support Stanford University, honoring our faculty. Of course those events aren’t occurring. Now actually I have dinner at home every evening, which is nice for my wife and me. And then I’m able to get some more work done at home.