Dr. Emily Landon talks COVID-19 with David Axelrod


AXELROD: Good afternoon, and welcome to our first event of the spring quarter at the Institute of Politics. It is not exactly how we expected to be getting together, which is exactly why we have the guest we have today. Dr. Emily Landon, who is the Executive Medical Director of Infection, Prevention, and Control at the University of Chicago Medical Center. Dr. Landon, you, first of all, welcome.

LANDON: Thanks.

AXELROD: And I should ask before we even get into the, and we have many great questions from students. And by the way, a little later in the program we're gonna go to live questions. If you have them, you should be signed in on Zoom, there should be a box underneath the, at the bottom of your screen. Just type your question in. If your question is selected, the staff will then give you instructions about how we will advance you to this conversation. Tell me how you're doing.

LANDON: I'm okay. It's a lot the same as everybody else. We are working really hard to make sure that everybody in the hospital is safe. And now I have to do that in a really different way, from my living room, and doing a lot of these Zoom calls, and then only sometimes going into the hospital for necessary reasons. But I'm okay, I hope you're doing okay. Nobody in my house is sick. We're staying home and staying safe. But it sure is different than how I ever thought life would be.

AXELROD: And yet you gave an admonition to all of us. I wanna just play a little bit of tape from what you said that actually went viral in a good way on, I think it was March 21st.

LANDON: Yeah. Is this the part where I said the young and healthy among us will doom the vulnerable?

AXELROD: Yes, no, but you also said that it didn't seem like we were doing much to help by sitting on our couch and watching Netflix. But the goal is for nothing to happen. And if nothing happens, that means your family is well. It was your admonition to stay at home. I will say I've done my part. I feel patriotic. I have been sitting on my couch watching Netflix. I did the whole "Tiger King" because of you.

LANDON: Well, good--

AXELROD: But tell me what you've learned. How does the picture look to you now? Now 18 days later?

LANDON: It's still pretty bad. I think that we've done a really good job in Illinois, especially, of sort of getting the curve to be more manageable for healthcare. So the real problem here is not that a lot of people are gonna get sick and have a cold for a week. That's not the problem. That's the sort of low-level undercurrent that we can handle anywhere, anytime. It's the 20% that need to be in the hospital. And everybody is susceptible to this disease. And so when everyone is susceptible and it is so, like, I think I said it in the speech that the virus is unforgiving. And it is, it just, it makes you contagious before you even know that you're sick, it makes you spread it for a long time before you get so sick that you end up in the hospital. And once you're in the hospital, you're isolated, and we're gonna take care of you and make sure it doesn't spread any further. But there's such a long time before that. And so so many people get sick at the same time that you have situations like we saw in Italy, and what we're unfortunately seeing happen in New York. In Illinois, yeah, we're a little better.

AXELROD: But you feel like that social distancing and the stay-at-home orders are having an impact?

LANDON: I think they are. I think it takes a couple of weeks to see that. And we did see things stabilize out a little bit. We stayed steady at about 80 in-patients with COVID at the University of Chicago for a good week. We're up again from yesterday. We're up to 100, about 100. And so it went up a lot yesterday, and it'll, probably will see more. Certainly we're expecting it to come up. But even having a week or five days at 80 patients gives us time to get more ventilators, to get more masks in, to find places to be able to open up McCormick Place, so that we can move patients there so that they can have a safe place to go so that we have more beds in the hospital. All of these little one day here, one day there that we can spread things out matters a lot.

AXELROD: You mentioned the supplies. How significant, we're heard about it. We're heard conflicting accounts. Obviously we hear one account from the White House. But what is the, from the ground up, what has your experience been in terms of equipment?

LANDON: It's like nothing I've ever seen before. I mean, we're, like, living shipment-to-shipment. Like, we don't know, we have had enough masks and enough PPE to get us through each day. But not because we have, we like to keep five days of supply on hand. Five days, that's not that much. But we're not really ahead of the curve here. We're not sure we're gonna be okay later. We think that now the supply chains are starting to be a little bit easier, but we're ordering, I mean, we ordered huge shipments of KN95s for China, and they don't fit anybody. And some of them just don't work well. And so that's just supply, I don't know what we're gonna do with.

It's just not what I expected. I thought there would be some sort of, we did all these tabletop, in my job, you do all these tabletop meetings where you go through, like, a pretend pandemic, and you sorta figure out where the weaknesses are and where the strengths are. And in every one of those, there's a centralized governmental, organized facility for distributing supplies, distributing resources, and like, a couple weeks in, the Defense Production Act kicks in, and everybody starts getting their stuff, and we're just not seeing that. And I don't understand why the cries from the front line of, this is not enough, I don't have enough, there are a lot of places that are re-using N95s, which is, I don't think, a great idea. And I don't understand why those are not being heard in a way that has resulted in mobilizing America like America can mobilize. I just don't get it.

AXELROD: How much time did we lose from the beginning of this outbreak as it occurred in China, to this point? There was a period of time when we were getting messages out of Washington about the severity of this. And when there was a flub of testing, apparently, by the CDC, and there was an absence of testing like the testing that they were doing in South Korea. How much of a difference did those six weeks make?

LANDON: Well, I think there's two questions in there, and I'm gonna answer them a little bit separately. One is we lost time as a nation for our preparedness, probably two months worth because of this situation. But I think the situation was just not accepting or acknowledging what was actually happening. Now, I think hospitals and public health didn't really lose that time the same way, because many of us are plugged into the situation in China and have friends, and colleagues, and scientific counterparts, and we knew that this was not gonna be good. And we've been having that message at the University of Chicago for some time. We stood up our emergency operation in mid-January and have been preparing since then. What we expected was that we would have some more support from our external counterparts, like, sort of getting supplies in, testing, that sort of thing. So then the testing piece is the second thing that you mentioned, and I think it's important.

So it's normal to really, sort of, limit testing in the beginning, because when you have tests like the ones that we're using, you can have a problem with false positives. And you need to make sure. And they are difficult to make, especially in the beginning. And so in the beginning, I'm not surprised that it was very limited testing only through CDC. That's how it always is with new infections. But it didn't ramp up the way I expected. I don't, I still don't know why that didn't happen. But I do know that the virology and the epidemiology that's coming out of places now, it's very clear that there was circulating disease in the community that was missed because of our lack of testing, and that's why we failed to be able to, the main reason why we failed to be able to contain this virus.

AXELROD: And where would you rate the testing now? President said we've done a million and a half, or whatever tests, but where is the testing now? What do you, as a specialist in this field, think is needed now in order to know how to, how to cycle out of this stay-at-home order that we're under?

LANDON: Yeah, we need testing like they have in South Korea and in Singapore and a really comprehensive plan for being able to do the containment that we couldn't do in the beginning in order to get out of this. And I say our testing is probably about halfway to where it needs to be. One of the biggest problems is that the swab that you need, even when the reagents are more available, the swab that you use in the back of the nose to gather the sample for this test is made in northern Italy. And it was really a very limited supply, and so there wasn't a major worldwide supply chain except for this northern Italy. Now we're finding ways of using different swabs. Other people are opening up new, like, they're making new things, but they're still not easy to come by. We're still short on them and we're still limiting our testing. We've opened it up quite a bit in the last week, but we're still not seeing, it's still not what we want it to be.

And people are now, like, I think it's important that people stay home, but there's also this concern about leaving your house to go to a hospital to get tested at this time, which I don't, I think is reasonable. I mean, if you're well enough to stay home, you should probably stay home until we have a good system for getting you tested, getting you isolated, a place for you to stay if you need to stay somewhere else. Otherwise, you should probably just stay in the bedroom, or the place in your house where you're isolated. We need a better, we need a better funded, and stronger, and more robust health system to be able to get out of this. And that's something I'd like to see happen. 'Cause we will need to contain it. It's not gonna go away.

AXELROD: Yeah, let me ask you a few questions that incorporate some of the concerns that were raised in the questions here. First of all, when, we have an order that lasts 'til April 30th. Is it your expectation that come April 30th the stay-at-home order will or should be rescinded? Or can we look forward to a longer period?

LANDON: I think it will need to be longer. I've been working with some colleagues at the University of Chicago. John List and Kate Baker from the Policy School and the Economics School opposite of the direction I gave their names. And we are trying to figure out a model that will help us understand how to be more precise about what needs to stay closed and what needs to happen, what places shouldn't be open and what places should be open in order to maximize the benefit for the economy wile minimizing the health impact. And I think we need a better tool than just a sledgehammer to, like, close everything all at once. I think that's really obvious. But we also need more epidemiologic data in order to inform those models. And we don't have it without widespread testing and without sort of a better understanding of the mortality in the US and what happens, and how much, what really does overwhelm our health system. And then being able to rationally distribute ventilators and supplies so that they're where they need to be, and healthcare workers so that they're where they need to be at the right time to enhance our ability to take care of these patients.

AXELROD: The pace of testing is an integral part of how we can phase out of this. And unless testing is done on a much more massive scale, and is more available to you, that makes it very hard.

LANDON: Yeah, we need two pieces of testing now, because you also need to know who was sick before and you never tested them when they were sick. So serology, so that's a way of using blood to tell us whether or not you have antibodies to the virus, and it tells physicians, and epidemiologists, and healthcare workers that you did have it before and you've made antibodies to it. And that is coming online, actually. We're validating a test that we should be able to use at University of Chicago soon. We're doing a lot of work with Patrick Wilson about what kind of immunity that it's actually producing, and how long it's going to last, and how well it's going to work. But when we know that, we can tell where in communities there was this asymptomatic or low symptom spread, and give us a better idea of how dangerous different contacts are, and different industries, different places that are currently still functioning as essential workers. I also think more availability of things like masks and protective equipment will allow even other workplaces to be able to function better.

AXELROD: You talked about the public health system. We've got a number of questions about that, and about what this says about our overall health system, and what changes might be required to deal with these kinds of issues in the future. But also, a lot of concern about these numbers that we've seen. And you're sort of at the epicenter of this, about racial disparities, and the fact that as much as 70% of the people who are being treated for COVID in Chicago are African-American. And it speaks to the sort of socio-economic divergence that courses through so much of our public life. But here, it's a tragic, tragic outcome.

LANDON: There's a lot of work that can be done to better understand what actually is happening here. But I think that we can be pretty certain that the fact that we haven't provided good access to some of, to African-Americans, people of lower socio-economic background. Obamacare is amazing, but we haven't had it for long enough and not enough people have been able to have the access that they need to make sure that their asthma is not out of control, and their COPD is good, and their diabetes is under great control. And so you've got a lot of more privileged white people working in white collar jobs who can stay home and work from home and don't have as many exposures, and their hypertension and their diabetes is under better control. And this is, like, years, and years, and years of insult, and now throwing injury on top of it.

It's not fair. Nothing about this is fair. But that's really not fair. But we will provide, look, we provide, this is what I can say. We're providing world-class care at the University of Chicago, and at many other academic medical centers with research, and investigational drugs, with amazing therapies. We're gonna probably announce in the next coming couple days, I'm really, really hoping that we get everything done to announce that we're gonna do convalescence serum treatments and testing for our people that are our patients, or that come to our emergency room. And we're gonna do, we're gonna have our top experts in hypoxemic respiratory failure, or this kind of respiratory failure who have been, they're world leaders, they're gonna take care of every one of these patients. And so when you come to the hospital with this, you're gonna get the best, the best care we can provide.

AXELROD: So the underlying point, though, is that if you have poor health conditions in the first place you're obviously gonna be more subject to hospitalization and mortal threat from this virus. You mentioned that you're testing a bunch of treatments. Where do you come down in this whole discussion of hydroxychloroquine and all of American is learning how to say that.

LANDON: Yeah, I was gonna say, nobody knew that drug before

AXELROD: But I mean, and some of the other drugs that have been mentioned. Are you guys testing these? And are you seeing impacts of these different potential alternative treatments?

LANDON: So there's, like, a new vision about these drugs every week as we learn more. At first it was Kaletra, a medication used to treat patients with HIV. And that was tried a lot in China and Italy without as much success as people had hoped there would be. Then there was remdesivir, which we are using. And remdesivir actually looks pretty good. And we're part of the remdesivir trial, and many of our patients are being put onto that trial and are getting remdesivir if they qualify for it, if they qualify for the trial--

AXELROD: What was that developed for in the first place?

LANDON: Ebola. Small molecule anti-viral works, it seems to be working. There's also medicines that we use to help balance or control the immune system and the immune response. Some of the younger people who get sick, who get very sick, do so because their immune system is so, it disregulates, it becomes overly active, like a massive autoimmune disease kind of thing, making everything worse. And so we use some medications that are, they're not, like, typical, like, just steroids. But they are things that are really fancy. Monocolloidal antibodies that can inhibit specific parts of the immune system to sort of tailor that response and make it a little safer. We're also using hydroxychloroquine. So hydroxychloroquine has not been particularly successful when it's used later on. But we know that with this drug, you need to give it, you can't just give people a big bunch of it at once to load them up on it, they have to slowly build up. And it may be that we're using it too late. So we are trialing it as part of, well, we're participating in a trial of using it in higher-risk individuals when they first get diagnosed. 'Cause there's that week long lag between when you first get, when you first have symptoms, and when you get sick enough to need the hospital. And so we want to try and use it early on to try and convert some of those people from ending up in a ventilator to being able to get over it like everybody else. That would be a game changer. If that worked, that would change how we did everything. Because it would allow us to get out of this home quarantine for all of us much faster.

AXELROD: Do you have any concerns about the hyping of these things in advance of the testing? Or that just--

LANDON: There's no way to know if it's going to work or not. The thing is, I think it'd be awesome if it did. But just because it would be awesome if it did, doesn't mean it's going to. And that's where, as a scientist and as a researcher, we go into things hoping stuff's gonna work, but it doesn't always work. And I can look at that and say, we definitely have to try this. But there's a lot of side effects with that medication. It's not always easy to take. Certainly you have to be watching the heart rhythm specifically. And heart rhythm abnormalities can be very deadly very quickly. And so there's a lot of, like, you wanna have a lot of bumpers around the way that you try these things. A little safety. You need a life vest to be able to pull people back from the brink if it doesn't go as well as you think. And so widespread use of something that has not been proven is not a good idea. It needs to be studied and then we can know if it's going to work. And then we can roll it out more widely. But we don't know yet. So it's just, as nice as it would be, we all want this to work. We all want everything to work. Actually, I can't really blame the President for wanting it to work. But I do not think that it's wise to tell people to go out and just take it. We have to wait and see if it does.

AXELROD: There's a lot of, obviously none of the students who ae listening to you today, or any of us want to be communicating in this fashion, and they've lost the spring quarter, at least, the ability to be on campus in the spring quarter. Lot of concern about the seasonality of a virus like this, absent a vaccine. So let me ask you, as best as you can, and I understand that this is a very hard question, how concerned should we be that we're gonna face this again in the fall? How will we be better prepared for that in the fall? And what is the prognosis, do you think, in terms of the development of a vaccine, which obviously everyone is working on feverishly right now?

LANDON: So I think that expecting this to get better when the weather is warmer is probably not, that's not realistic. Because there are just too many people that are sick. So the way that this weather stuff probably works for influenza is because there's like this sort of low-level immunity in the community because there's influenza every year, and then the influenza sort of spreads more that are not that sort of spread number. If you spread it to more than one person on average, then you'll have increasing cases. If it's less than one, then you'll have decreasing cases. And the spreading out outside is probably enough to tip influenza down below one. This is nowhere near that. This is not just one sunny day away from getting us below an R naught of three, right? And so you can't expect that the sunny weather is gonna solve the problem. I mean, it's just not. And I'm more concerned that we're still going to be facing this in the fall, not that we're gonna be having another wave, that we're just not gonna be done.

The only way to safely do this is to spread it out. And if we need to get 30 to 40, until we get a vaccine, we need something like, I think the estimates are 40 to 70% of the population has to get sick. And we need to do that in, sadly, an orderly fashion so that we have room for everybody that needs to have care in a hospital. And that means we gotta stay home and limit our contact so that we keep it running at about a 1.5 instead of at a two or a three. And that the area under the curve, for those of you who are studying, is the same whether you have a big high peak or whether you have a low peak that goes on. And so as high as that curve would have been without any intervention, it has to be at least that long. And so it may be that we don't have a second wave, we just don't ever finish this wave.

AXELROD: And what does that mean?

LANDON: Until we get a vaccine.

AXELROD: What does that mean for the ability to gather in groups for the foreseeable future?

LANDON: I think there's a lot of work that needs to be done and known about which medications we can use. Because if you can change people from, if you could change that number of people that need to be hospitalized to a much smaller number, then it's much safer for us to get out and about, right? So there's a number of ways that we can get out of this. But they are not known whether or not they're gonna be effective yet. And so I think right now, I think Dr. Fauci is saying this is gonna go on longer than you want it to go on. It may be going on through the summer. I would say probably most of the summer's gonna be spent really being careful. Maybe there'll be ways in which we can get out of the house a little bit more. If we can use some of those models to help us understand what activities are safe and how to do them.

There is gonna be a lot of restrictions on crowding. Tim Frieden's NGO, I think, came out with some recommendations last week about how to tighten and loosen the levers on, or the faucet on social isolation measures. And I think those can give people a really good idea of what happens. As you loosen them, maybe the cases come back, and then you gotta tighten 'em up again. And you need really robust public health to be able to do the on-the-ground work of containing those cases and making sure that we're testing people a lot so that you don't get this silent curve happening that you can't see, like what happened to us in February, and January, and March.

AXELROD: A student asked about the, and I was getting at this earlier, the decentralization of our public health system. And is that a problem in an environment like this?

LANDON: I love our local public health officials. And you've gotta have powerful local public health officials that can do the ground work of tracking these people down. You don't want to have the CDC be responsible for figuring out who you had lunch with last week when you get sick, right? But I think you also have to have a messaging and a strategy that comes from above that says you are gonna contain this. We're gonna get you whatever resources you need so that you can do this. I want you to be doing. Look at what Singapore does. They have, like, really robust contact tracing and really great isolation. So when you get put into quarantine or isolation in Singapore, they bring you food, they check on you multiple times a day, they ensure that you have what you need so that you cannot leave and get anybody else infected. They make it possible to follow everything that they're saying. But that's, like, an army of people that we don't have. We don't have, like, a big reserve corp of public health officials.

AXELROD: In terms of a vaccine, what's your--

LANDON: Oh, I'm hoping it'll come sooner than later. But I think a year is really short for a vaccine. Flu, I know H1N1 in 2009 had a vaccine sooner, but that's because it's just another kind of flu, and we have a system, it's a whole, like, method set up and ready to run every year for influenza vaccines so you can just harness it and make another flu vaccine. And you know how to do it. But that's not true for this. And so we'll probably have a vaccine to try in the late winter, maybe, I heard maybe a little earlier. I don't know. I think it's not for certain that that vaccine's gonna work. There's gonna be a lot of candidate vaccines out there.

AXELROD: We just don't know.

LANDON: We'll have to wait and see. Yeah, I just don't know.

AXELROD: So before we go to these student, live student questions, we got a number of questions just about basic lifestyle things, decisions that people have to make. One student's family owns a restaurant, and they're still doing takeout. And she said, "Should we be? "Should we just be closing down?" And I guess by the same token, should people feel safe going and getting takeout food?

LANDON: I think it's probably good for the economy and good for people. Sometimes people get sick and they can't take, they can't make themselves lots of food. Or they just don't usually do that. And so I think having some source of restaurant food available, especially if there's delivery or takeout, is probably necessary. I mean, I think it is actually essential for the economy. Now, the real thing that I think is a big deal that we need to talk more about is how to do better social distancing at work.

So in the hospital, it was really, it became really clear to me really quickly that were gonna have real problems if we let everybody just keep coming to work and doing their jobs the way they normally would. And so we needed to create a whole new way of running a hospital, of taking care of patients without being right next to each other all the time. We're very team-based care, there's all these people on the team, we work together really close. We can't do that that same way. So now rounds are done over Zoom, like what we're doing here. So the doctors will meet over Zoom and talk about the patients. Only one doctor on each team is examining the patient. Some of the consultation teams don't ever even go into the hospital. They have the one person from the primary team will do the examination and then report back, because these are objective findings that they should be able to share, instead of everybody doing it. There are, we took away a bunch of workstations from all of the work rooms so that people couldn't be too close together. One of our first issues was in one of the clinical areas, somebody got sick with COVID from a community exposure, and then gave it to, like, five other people in the area because they all shared the same workroom still. Because they hadn't moved all their displays. So we just had to move all these things so that just spread everybody out. And we switched to only takeout from the restaurants that are operating, or the food areas that are operating in the hospital. There's just so many, put everybody in fabric masks.

So there's ways that restaurants and other places can be creative. And believe me, it was a lot of just creative thinking to figure out how to do the work in a way, like, can you have the people that are the sous chefs come in and prepare earlier so that they're out by the time the next people. Whatever it takes to make it work.

AXELROD: And it's safe, in your view, to eat takeout food?

LANDON: I think as long as the restaurants are being careful and not allowing sick people to work, I think that's a key piece. You gotta make sure that people are not sick. I think using fabric masks like the CDC is now recommending is actually really important for that because it helps keep your respiratory secretions, your droplets that you make every time you talk and breathe, off of whatever you're doing, like the computer that's in front of me, or the shared workspace if you're going to an essential workplace. And so that's the sort of thing that will help protect people and make food safe. Hot food is, heat is deadly to coronavirus. And so hot food, I think, is actually pretty safe.

AXELROD: Last question from me, a student from South Dakota asked about the policy of these states that have not been profoundly affected yet, and have not enforced stay-at-home orders. And we know today, that in Wisconsin where there is a stay-at-home order, they're moving forward with an election today. Should that be a concern?

LANDON: The states that don't have a bunch of cases yet, now is the time, do it now. Put your stay-at-home order in place now, use your public health to get everybody, to, like, get everything contained, don't quit, don't give up, please don't pretend like this is not a big deal, and maybe you can get through this faster than the rest of us. Like, maybe you can get past it. Maybe you can prevent it from taking hold in your communities. Especially in your communities of color, where people have had lack of access to care that's left them with worse co-morbidities. Like, do it now, do what you can to protect them. You have the best hope of saving lives.

AXELROD: Yeah, public health in rural areas has not been stellar, either. So if it should start to spread there, you could find some of the same problems where people have medical conditions that were untended, and now face greater vulnerability. But your message is, just because you don't have it now, doesn't mean you're not gonna have it.

LANDON: No, now is the time that you can do something really good. You can make a much better impact because you're not that affected yet. Don't look at it and say, wait until it's a problem. That's not the right plan.

AXELROD: Dr. Landon, let me go to questions from students who are standing by. The first one will come from Michael Gorman. Michael, tell us where you are in the university, how you're doing, and then ask your question of Dr. Landon.

Michael Gorman: Sure. So I am a student at the Harris School of Public Policy. I'm getting through this like everyone else. So my question is, I'm a gay man. I was happy last week to hear that the FDA reduced the restriction of men who have sex with men giving blood from 12 months to three months. And I'm actually gonna, I've already signed up to donate blood here in a couple of weeks. I'm curious, though, long-term, it doesn't really seem like restricting based on sexual orientation is maybe the best approach. Do you have thoughts on maybe what better science-based, data-based policies would be that really address risky sexual behavior in general rather than sexual orientation?

LANDON: Yeah, I think your question is a good one. We've been talking about this in infectious diseases circles for a long time about whether or not we really should be doing those deferrals based on that, or whether we should be using more rapid testing, or what we can be doing to make it more or less safe for people to be able to do more in the way of donating blood. And I think that conversation has to continue. And I think it's really good that the FDA is reducing that limit now, and I think it shows that it's on the mind of everyone, and that it's heading in that direction. So I think there's like many things in our lives are gonna change because of the way that we're doing things in the pandemic, this may be a good change that comes out of this as well.

AXELROD: Thank you, Michael. The next question is from Maggie Shope. Is it pronounced Shope? Maggie?

Maggie Shope: Hi, sorry, my computer was stressed out.

AXELROD: It's okay.

Maggie Shope: So hi, I'm Maggie Shope, I'm a first year medical student. I actually got to hear Dr. Landon speak over a month ago when this was all kind of just getting started in the US. And I was so grateful for the rude awakening, 'cause it kind of has helped me cope. My question, you touched on this with talking about restaurant workers. My question is about the, like, changing recommendations for mask wearing for lay people. And, like, making makeshift masks, or just, like, basically putting anything on your face. What is your opinion on that? What do you think we should really be doing there?

LANDON: It's super confusing, right? And I think it's a good question. But I'm gonna give you the mask story now. So medical masks have gotta be saved for medical people doing medical care. They need the extra protection of these fancy filtering masks, either surgical masks or N95 masks when they're taking care of, close contact with people that have known positive COVID status, or other infections that are still happening in the hospital. And so those masks have gotta be saved.

But the real benefit of those fabric masks is that they help hold your droplets in the mask. They're actually much better at that than they are at filtering out other people's droplets. But if everybody is wearing one, then it's not so much about protecting me. I'm not wearing the mask to protect me. It does provide about 50 to 70% of the protection of a traditional surgical mask, so it's not nothing. But it's really I'm wearing it about to protect other people. So when I put that mask on my face, if I get sick in two days because, I don't think I'm gonna get sick in two days, but what if I do? And I go to the grocery store today and I'm picking out which produce I want, and some of my respiratory droplets are landing on that produce. If I'm wearing my fabric mask, that's not gonna happen. And so no one's going to be able to pick up a few viruens from my produce that I've picked over in a couple of days.

Now, I don't think I'm gonna get sick, but that's the point. No one knows when they're gonna get sick. And this virus is nasty. It will spread even before you get sick. But wearing those masks is a way that we can work together as a society to show that we wanna protect other people just in case we're getting sick. And I think it might make a big difference if we're really able to get everybody to do that and it shows in the statistics and the epidemiology that it's making a difference, it might allow us to be able to relax some of those social distancing measures. I think it's, right now we have to treat it as an adjunct to those. As an add on top, not as a replacement for. And if we learn more, and as the situation gets under better control, maybe we can pull back on some of the other things and let the masks stick around. But it's not an either/or. It's an and and it has to be there because there still is spread even with the social distancing measures.

AXELROD: We have, thanks, Maggie. We have a question from Aviva Waldman. Aviva?

Aviva:  Hi, thank you so much. My video isn't quite working right now. But I have a question about, I'm a second year undergraduate in the college, and I'm actually here on behalf of the "Chicago Maroon". And I have a question about the pay structure for medical care for coronavirus. So I know that some insurance companies have waived fees, there's been some mixed messaging from the government officials about how exactly that it's going to happen. And I know that Chicago Medicine, as a research hospital often has higher fees for services. So for the people who are being treated for coronavirus right now or who might be in the near future, what's gonna be the financial impact for them? How is their care going to be paid for?

LANDON: This is a really tough question. We are addressing the best ways that we know how. I will tell you this. As a physician, it is mindbogglingly confusing. I don't actually understand very well what patients are charged for anything. Because there is no transparency about fees, about, I don't see any, I have no idea what it costs to get anything done in the hospital because we don't tell people. And it's not just that we don't tell people. No one tells people. There are some new laws that are requiring more transparency about the pricing in hospitals. And you're right, academic medical centers do charge more, but they also provide a lot more free care, and care to underinsured individuals, that ends up just getting absorbed into their bottom line. So it's not that they're the big bad wolf, it's that they're trying to figure out how to, they're just trying to meet their own needs. It's also more expensive to provide care in the academic medical centers.

But that aside, how do you figure out how much it's gonna cost for you? I don't have a good answer for that. We are working with insurers. And I know the hospital, this is not part of my main role, but the hospital's working with insurers and with the government to try and get good guarantees for people that this kind of care is going to be subsidized in some way. This is just one more reason why we need adequate healthcare coverage in America. Whatever reason, whatever method we're gonna choose. There are good ones, there are bad ones, we've gotta make it so that people are not penalized for becoming healthy. There's not a cost to people for coming in and preventing spread to other people. This is a major part of why we need good quality, and less expensive, and comprehensive care for everybody in the United States. I'm 100% behind that. And I don't have a great answer for your question because we don't have that. And I wanna have that. I want good care for everyone.

AXELROD: Thanks, Aviva. Now we have a question from Meredith Mewer. And there she is.

Meredith Mewer: Hi, there. My name is Meredith Mewer. I'm a first year at the Harris School for Public Policy. And I know that the healthcare community is carrying a lot of the burden right now of caring for people, but my concern is around the essential workers who are carrying on working at places like grocery stores, pharmacies, other places like that, even cleaning. How do we prevent the burden of this crisis from falling on low-wage workers who don't necessarily have a choice to work or not right now?

LANDON: Meredith, I am worried about them, too. I agree with you. I saw first hand what happens when we don't have social distancing in our hospital. When we're not doing it very well. And so I know that these workers are at risk, too. And so I am really pushing in all of my messaging and in working with the governor, with my contacts at the City, with public health, with our outreach to help people to understand what it means, how we can safely put social distancing in the context of these essential workforces. Providing them, as soon as we have enough masks for our healthcare workers, the next place we should be sending medical grade masks is to essential workers, and to people who are taking care of patients in their home, the other people in their home and people who are high risk that are living in homes with people who have to go and be essential workers or healthcare workers. So this has to be part of that whole coordinated distribution system of how we use our resources wisely. A family would distribute resources within that family to make sure that everyone's needs are met. 

And we need to treat, I mean, I'm not suggesting that we need to have communism in the United States. I'm suggesting that for this crisis, the things that are in the shortest supply, we need to do a better job of distributing them where they're needed, when they're needed, to whom they're needed. And I think that includes essential workers. In the meantime, the best they can do, wear fabric masks. They should require fabric masks or face coverings of some kind. The less stretchy the fabric, the less you can see through it, the better.

And we should lower the number of people on their shifts. The Trader Joe's down the street from me does a great job. And the Jewel doesn't do anything. I have nothing against The Jewel. I'm not impuning Jewel. But the Trader Joe's does great. They've got marked spots on the sidewalk where you stand in line six feet apart. They only let 30 people into the store at a time. They only have a certain number of, you have to stand on spots for lines. And they have protection for the people that are checking you out, protection for you and for them, in order to help make them safer while they're doing their jobs. And I think those are the kinds of things that every business can do. And so when we are out shopping, we should be favoring places that protect their workers better. That's my recommendation. Meredith, I think you got it right. I think that's the next thing we gotta watch out for.

AXELROD: And how much, Dr. Landon, we talked earlier about the disparities, and racial disparities, socio-economic disparities. And you said a lot of it has to do with just poorer health conditions in poorer communities. But how much, also, has to do with the fact that if people are living from paycheck-to-paycheck, that they don't have the option to shelter in place and not go out, and not expose themselves?

LANDON: That's right. That's exactly the situation. I mean, it's like doubly bad to be in a lower socio-economic group. You can't get the care that you need, you also have to go out and expose yourself. It's just not right, it's not fair. But there are ways that we can help protect these essential workers, and we need to do so, especially when these essential workers are the people that most need to be able to keep working. And so we just need to find a way.

So if you don't need to be on public transportation, don't. Because that is for the people that need to get to their essential jobs. And they need to be able to sit six feet apart on that public transportation. And if you don't need to buy up all the Purell and the wipes because you're not going out of your house, then don't buy them up. Leave them for the people that need them so that they can safely get to and from work. We have to think about everybody together. We have to come together. No matter how much we disagree about things. The only way we're gonna get through this, and I think probably that is a silver lining, albeit a thin one, it is important that we have to come together and see our community as our community, not just as separate people living in little sheltered lives.

AXELROD: Let me ask you a related question about sort of mental health, just on the last point you were making. And how much of a concern is long-term sort of isolation in terms of mental health and potential for suicides, drug overdoses, and so on, and are you seeing any of that yet?

LANDON: I'm not seeing it. But my sister is a, she's a counselor, a therapist for children, and she's seeing a lot of it. And I know that other mental health professionals that I know are saying that it's tough on people. But these are people that are plugged into mental health services. What we don't know are about all the people that don't have adequate access to begin with to mental health services. The mental health professionals that I know are working overtime to be able to try and connect with people and help them get through this using all of the methods that are available. Including Zoom meetings like this one, and having phone calls, and outreach, and exercises, and you can see tons of YouTube videos about meditation, and yoga, and exercising in your home. These are all great things that you can do. And the city has a great mental health hotline for people who are feeling really down, or who really need help. And I'm glad they've stepped up that service, because it really is important, especially at this time. But I think that there's a really, there's a silent minority out there that we're even less likely to see because of this.

And if any of you are watching, please reach out for help, if you are feeling like this is too much. It absolutely might be too much, and that's okay. We can get you help and there are services available, even if it feels like you just don't know where to turn. The City does have some numbers. And I suspect some of the people that are your helpers will be able to help get us those phone numbers, or I can get them. I can get it after this call and make sure that it goes out to the people that joined. Because I do think that reaching out to those emergency mental health numbers could be helpful, and they could help you find sources that you need.

AXELROD: I don't wanna keep you from your appointed rounds much longer here, but I do wanna, there are a couple things I wanted to close on. One is, you said earlier that you have about 80 to 100 patients right now. And you made very clear that the great, the great fear is that we get an apex that overwhelms the healthcare system. What is your level of confidence as you sit here today that the UC medical center will be able to handle the patient load that is coming as a result of COVID, and how much will this McCormick Place facility that's being set up be used and necessary? Just what is the picture in the near term, do you think, of capacity?

LANDON: Well, we are gonna move heaven and Earth. Pull out all the stops. You can use any sort of wording that you want to to make sure that we can meet the need as much as we can. And we think we can probably almost double our bed capacity in order to, in an emergency situation. We can use our procedure recovery areas as ICUs, we can double up patients in rooms if we have to, as long as they both have COVID, of course. We can use outpatient areas as inpatient areas. We can do all kinds of things. 

We don't wanna have to do any of that, right, 'cause it's different, and it's weird, and it's not exactly the way we usually do it. And we wanna be able to keep providing as many, the untold story are all the people that need to keep getting their chemo, and keep coming in for their other medical problems. I went in and got my allergy shots, like, last week, and I was really impressed and thrilled with how things are going with being able to continue to provide that kind of care. But we are ready. We are as ready as we possibly can be. I think that we are ready for more than what it looks like we're gonna see. That's the good news. 

But that number, that's a today answer. Everyday it looks a little different. And so, sure, there is a chance that there could be something that could overwhelm us. But we're gonna work with our colleagues and our peer institutions, and we're gonna make sure that we're helping each other out. If they're overwhelmed, we're gonna help them, if we're overwhelmed, they're gonna help us as best they can. 

And the McCormick Place, I really hope it's, I don't know what they're gonna be able to do and not be able to do changes day-by-day. I'm really hoping that they can provide some oxygen, because that's what we really need. That's keeping people in the hospital, the need to continue on oxygen, and there's a shortage, as you might imagine, on oxygen concentrators and oxygen tanks across the country. And so it's sort of hard to get people home on oxygen right now. We're working on figuring that out. We're working on doing everything that's being done that's worked successful in New York. We're gonna do everything that we possibly can. We are going to find a way to meet the need. But it may not be pretty. It may not be what you want it to be. It may not be acceptable. I mean, if we have to split ventilators, we'll try and split ventilators.

AXELROD: Mm-hmm, yeah. Well, we appreciate the gravity of the moment that you are all dealing with, and the sobriety of the message that you've delivered here, which is that this is not, okay, April's done and we're finished with this. And until we get that herd immunity, or and, I guess, an adequate vaccine, we're gonna be grappling with this.

LANDON: I'm sad to say that I think it will be awhile. Longer than any of us want it to be. But it is what it is. It's the life that we get right now. We're living through a historic time. And we're gonna learn a lot from it. Our lives are gonna change. And some things are gonna be different. Maybe different for the better. And a lot of things are gonna be different for the worse, but we'll get through it. And we will find a way to go on and be Americans, and Chicagoans, and Illinoians going forward. And we're gonna try and keep that mortality as low as possible. That promise of the low mortality. That's what we really need to deliver on. I think it's what we're all focused on. And that's what I want, too.

AXELROD: Well, Dr. Landon, we're all incredibly grateful for this hour of your time now, but much more so for all the efforts that you're putting into this, and for being such a wise voice at a difficult time. And let me just say to those of you who have joined, we will send an email to participants on this Zoom, information with mental health services that are available for students. So please, as the Dr. said, if you feel the need, don't hesitate to take advantage of those resources. This is a difficult time and we need to help each other to get through it. So Dr. Landon, thank you for your message. Thank you for all this useful information. Thank you, everyone, for joining. And we will see you at our next event.

LANDON: Thank you.