As Chief Medical Officer of VNSNY CHOICE Health Plans, Dr. Jay Dobkin brings four decades of medical experience to our organization. He is an infectious disease specialist and associate professor of clinical medicine at the Columbia University Medical Center and served as director of Columbia’s AIDS program from 1988 to 2009. Most recently, he has drawn on his infectious disease expertise to advise VNSNY’s leadership on their response to the COVID-19 crisis. As a key member of VNSNY’s Emergency Response Team, Dr. Dobkin provides important insights into the coronavirus and the illness it causes, as well as the challenges that health care providers are facing.
My 40-year career as a physician started in the 1980s, just when the AIDS crisis was occurring. I’ve been around long enough to see a number of other crises, including drug-resistant tuberculosis and serious flu outbreaks, but there’s been nothing quite like this. The speed with which COVID-19 has spread and the sheer number of cases dwarfs anything the U.S. has experienced since the 1918 influenza pandemic. Also, this is a new organism which has similarities, but also obvious differences, compared to the other coronaviruses that caused the SARS and MERS outbreaks in recent years. That means that studies need to be done on many levels—and in a hurry—to understand the basic biology of the virus, including how it’s transmitted as well as diagnostic testing, treatment and prevention. I’m confident that major scientific advances will be forthcoming, but the urgency is enormous.
If we’re peaking now, it means we are peaking at a lower number of cases than projected, which is a good thing. The immediate issue is availability of hospital ICU beds and ventilators, and the demand for these seems to be flattening out. Hospital discharge numbers have also gone up recently, so it appears that our hospitals are able to handle the volume at this point. Whether this is a plateau or we’re actually going to see a decline in demand remains a big question—because it’s clear that this level of effort can’t be sustained over a long period without doing tremendous damage to the way our hospitals and other health care facilities operate.
We have a real crisis on our hands in New York, and VNSNY staff can play a huge role in helping with that crisis. Hospitals need to be able to send people home who don’t need to be hospitalized, freeing up desperately-needed beds. A lot of these people will need home care, and that’s what we do.
To minimize overall exposure risk to our staff, patients, and members, we’re now doing virtual visits in place of in-home visits whenever possible. We’ve also developed evidence-based protocols for determining what staff should do if they think they may have been exposed to the coronavirus, as well as protocols for the appropriate use of PPE, including specific protocols and Care Kits for treating COVID-19 positive patients. Fortunately, we’ve recently been able to secure additional PPE supplies despite the shortages. But even with proper PPE, nothing is risk-free. People need to balance their responsibility as health care workers against the risk of possible exposure to the virus. In the end, it’s an individual judgment everyone has to make.
I don’t think there’s any guarantee that’s going to happen. The flu really does disappear in the warmer weather, but coronaviruses may be different. The MERS outbreak started in Saudi Arabia, for example, so no cold weather was involved in that setting. It would be nice if the COVID-19 virus did subside in warmer weather, because it would buy us more time. But the answer is, we really don’t know yet.
I’m confident we’ll have more weapons fairly soon, including much more accessible coronavirus tests as well as antibody testing, which will let us know who has had COVID-19 and therefore may be protected against it. Also, this particular coronavirus appears to be fairly stable genetically. That means it’s probably not going to get less virulent anytime soon, but it also means that any vaccine we develop should retain its effectiveness over time.