We’re All in This Together Against COVID-19

How the Coronavirus has brought together a normally fragmented healthcare system

By Abbas Mooraj, Managing Director, Health and Life Sciences

As the number of COVID-19 cases escalates with each passing day and we work toward flattening the curve to slow the spread, many of us are following shelter-in-place directives to physically distance ourselves from others. I’ve specifically chosen the term physical distancing vs. social distancing as this is something that the World Health Organization has adopted because the goal is to strengthen our social ties but maintain physical distance in this battle. Each of us has a role to play in this unfolding pandemic, and in this story, I’d like to highlight how healthcare providers, biopharmaceutical, health plans, lab services, and medical device organizations have sprung to action to work together, the challenges they face, and how regulatory agencies are responding. Most of all, I want to recognize that this pandemic has brought together a normally fragmented healthcare world to work together and come up with creative solutions to a worldwide problem.

Frontline Provider Battles

Hospitals and healthcare providers clearly are at the forefront of this pandemic and are asking critical questions as demand for care ramps up, including:

• How many test kits do we have on hand and how quickly can they be processed?
• How many ICU beds do we have and when will we reach capacity?
• Do we have enough Personal Protective Equipment (PPEs) to protect our staff?
• Do we have enough ventilators and when will we hit capacity?
• Will we have enough staff to care for the influx of patients and how many of them will contract the coronavirus?

Hospitals already struggling with overwhelming costs associated with caring for COVID-19 patients — estimated to be between $362 billion and $1.45 trillion — saw some relief in sight with the passage of a $2 trillion stimulus bill, and could receive as much as $150 billion to help meet skyrocketing costs. Here’s a partial breakout of how funds will be allocated:

• $16 billion to the national stockpile of medical supplies
• $11 billion to fund the development of vaccines, therapeutics, diagnostics, and other medical needs
• $100 million to help providers offering telehealth
• $275 million to expand services and capacity for rural hospitals, telehealth, poison control centers, and the Ryan White HIV/AIDS Program
• $4 million to the HHS’s Office of the Inspector General for oversight activities

Additional provisions include:

• Medicare Part D and Medicare Advantage members can get refills and fills on prescriptions for three months.
• Programs that were expected to run out of money by May 23, 2020, have been extended to November.
• Waiver of the 50% rule during the emergency period (cutting payments where fewer than 50% of Medicare patients get a standard payment).
• Medicare rule for sequester is eliminated and Medicare payments for COVID-19 get a boost.
• Health plans will be required to cover hospital-made tests.
• Hospitals must publish the cost of COVID-19 diagnostic tests.

The Centers for Medicare and Medicaid Services announced that it will accelerate payments to Medicare providers that are treating COVID-19 patients.

There are also powerful initiatives from Cloudera’s provider customers who are seeking ways to use big data and technology to help hospitals predict the number of potential patient admissions and determine ICU bed, medical equipment, and PPE capacity during the pandemic.

One is Yale School of Medicine, which is using a data science platform to support real-time data acquisition and agile analytics that are helping determine how many people have been infected, how many beds are available to handle inpatient and ICU care, ventilator capacity, number of healthcare providers exposed to COVID-19, and how it affects the organization’s ability to respond to increasing numbers of coronavirus patients.

Another of our customers, Rush University Medical Center, is using a variety of big data tools and has developed a hospital resource calculator for COVID-19. This is a web-based tool that helps hospitals project needed resources. The calculator is designed to help hospitals gain a better understanding about the use of inpatient and ICU beds, ventilators, and PPEs.

These are real-world initiatives, and I know many more healthcare providers are taking new measures to keep operations running as elective surgeries get canceled or postponed, and determining how to pay for the 27.5 million individuals with no insurance — and possibly more due to job loss. While no healthcare organization is turning people away for screening and treatment if they are exhibiting severe symptoms, the best recourse at this time is instructing individuals to seek guidance from their respective health departments.

Health Plans Responding to the Battle

Health plans also face challenges in covering the millions of Americans — both those who are insured and the growing number who may lose their jobs and their health insurance in the coming months and years. Here’s how health plans are taking action.

• Some states are looking at ways to expand Medicaid eligibility so they can temporarily insure more people during the pandemic, and open enrollment for state-run exchanges has also been expanded in 11 states and the District of Columbia, while insurance organizations have asked Congress to open up enrollment on the federal exchange as well.
• Aetna plans to waive copayments and cost-sharing for COVID-19 inpatient admissions for commercial members through June 1.
• UnitedHealth Group conducted a study that found self-administered COVID-19 tests were just as effective as clinician-conducted tests, with a 90% positive rate for tested subjects. As a result, the Food and Drug Administration has updated guidance to allow healthcare organizations to use self-administered tests. The organization also committed an initial $50 million investment to fight the pandemic and help healthcare workers, hard-hit seniors, homeless individuals and those with food insecurities.
• Blue Shield of California is offering to its network hospitals the “COVID-19 Screener and Emergency Response Assistant” (COVID-19 SERA), an online tool where patients answer questions to help direct them to the appropriate level of care to help hospitals better manage patient flow.
• Cigna and Humana are waiving deductibles, copayments, and coinsurance for the treatment of COVID-19.

Here are some additional actions health plans have taken:

• Testing will be covered at no cost to members
• Treatment is covered at the plan level the member selected
• Prior authorizations have been waived for testing and treatment
• Telehealth will be covered, and costs waived to expand telemedicine programs

Additional challenges faced now and in the future by health plans include how to manage premiums — projected to spike 4%-40% or $151 billion next year, according to one analysis from the California Affordable Act exchange — pay claims, engage members to keep them safe and healthy, and care for complex care members who require case management.

Health plans are also banding together to come up with creative solutions and are putting emergency plans in place to make sure Americans have access to the prevention, testing, and treatment needed right now.

The Biopharmaceutical Focus to Speed Delivery of Treatments and Vaccines

Pandemics are not new to the biopharmaceutical industry, which has a track record of developing solutions for similar viruses such as MERS, SARS, and influenza. Two organizations coordinate activities for biopharma organizations and regularly post COVID-19 updates, including PhRMA (Pharmaceutical Research and Manufacturers Association) and BIO (Biotechnology Innovation Organization). These two groups are working together and have laid out a campaign called “Our Commitment to Beat Coronavirus” that includes six steps to combat COVID-19, including:

• Screening existing medicines for use
• Getting top scientists working together
• Sharing information with each other and government agencies
• Expanding manufacturing capabilities
• Working to ensure new treatments or vaccines are accessible and affordable

Hundreds of biopharma organizations participate in this initiative, and here is what some are doing:

• Regeneron is conducting phase 2/3 clinical trials for Kevzara® to treat patients in the hospital who are in critical condition for COVID-19.
• Roche started testing arthritis drug Actemra for treating COVID-19 patients with pneumonia.
• Gilead is supporting phase 2 and 3 clinical trials in the US, China, and other countries to rapidly evaluate its investigational compound remdesivir as a potential treatment.
• Johnson & Johnson was ahead of the curve and began to search for vaccines and therapies in early January 2020, and is leveraging technologies that provide the ability to ramp up production of the optimal vaccine candidate.
• Sanofi Pasteur is leveraging previous work on a SARS vaccine that may offer a fast path forward for developing a COVID-19 vaccine.
• Abbvie has partnered with the US Food and Drug Administration, Centers for Disease Control and Prevention, National Institutes of Health, and Biomedical Research and Development Authority to support using HIV medications to treat COVID-19 patients.
• Genentech initiated a phase 3 clinical trial of Actemra in hospitalized patients with severe COVID-19 pneumonia.
• Abbott announced FDA approval of a test that can deliver positive COVID-19 test results in as little as 5 minutes using a device that can be deployed in physicians’ offices, urgent care clinics, and hospital emergency departments.

In addition, Novartis, Mylan, Teva, and Bayer plan to deliver tens of millions of tablets of malaria drug chloroquine and hydroxychloroquine. The FDA has approved the use of these drugs to treat patients as healthcare workers deem appropriate.

A consortium of pharmaceutical organizations — including Novartis and Pfizer―have joined with the Bill & Melinda Gates Foundation to share their proprietary compound libraries. Working with the COVID-19 Therapeutics Accelerator the Gates Foundation set up with Wellcome and Mastercard, the plan is to screen for compounds that may work against the coronavirus.

Another consideration for biotech and pharmaceutical companies is disrupted clinical trials as they focus more resources on the coronavirus. According to the BioMed tracker, there are currently 120 phase 3 clinical trials with top-line data readouts expected by the end of the year. This will ultimately mean delays in drug filings and a longer time for needed drugs to get on the market.

Gene and cell therapies also are affected, with disruptions to clinical trials (acquisition and retention of patients) and therapies certain to be put in a holding pattern as healthcare systems devote resources to care for COVID-19 patients

Each of these organizations has its individual initiatives, but they also have united in ways never seen before — with new partners emerging — to come together and work toward solutions.

Ramping Up Lab Services Testing Capacity

Two of the largest lab testing services in the US — LabCorp and Quest Diagnostics — were ramping up capacity to test up to 300,000 COVID-19 cases by the end of last week, with LapCorp’s capacity at 100,000 tests a week and Quest’s soon to be 200,000 a week. Both organizations also stress the importance of looking at all the different entities conducting tests, including other national, regional, and local labs, and academic medical centers, hospitals, and state labs. Right now, it’s all hands on deck to increase testing capacity.

Increasing the Manufacture and Delivery of Medical Equipment and Supplies

Traditional makers of ventilators are ramping up production, including Philips, which plans to double hospital ventilator production from 1,000 a week to 2,000, and Medtronic, which plans to double production this year.

Other organizations are looking at ways to increase medical equipment production and PPEs, including:

• A partnership with GE, Ford, and 3M to produce medical equipment and protective gear for healthcare workers.
• Tesla, which is repurposing a manufacturing plant in New York to build ventilators and already has donated purchased ventilators from China.
• Dyson and Gtech have committed to creating ventilators as well, with Dyson planning to donate 5,000 globally, and produce 15,000 total, and Gtech making its ventilator designs available for free to speed production.

New York approved using two patients per ventilator, not an ideal solution, but something being tested as it faces a projected need for 30,000. The FDA has also authorized the use of modified devices as emergency ventilators, including anesthesia gas hardware and positive-pressure breathing devices, as well as positive airway pressure machines (CPAP) used for sleep apnea, just to name a couple.

Again, we are seeing the traditional medical device manufacturers work independently and together, with non-traditional organizations emerging to speed production of much-needed supplies and equipment in this battle — and the FDA is loosening guidelines to accommodate the urgent need for more supplies and equipment.

Physically Separated Yet Together in the Fight Against COVID-19

Cloudera, just like every other organization in the world, feels the impact of COVID-19 as well, and has closed our offices and has employees working remotely. We remain committed to fully supporting all of our customers, and also are working with a variety of non-profit organizations “to identify ways to contribute Cloudera’s data expertise where it can make a difference,” as our CEO Rob Beardon said.

This is a global crisis, and we — the healthcare community — are all in this together. I encourage you to reach out to me with your questions, to brainstorm, or to share what your organization is doing to make a difference.