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Brian Lehrer: It's' the Brian Lehrer show on WNYC. Good morning everyone. As New York City plans for a reopening of schools this month, as gym's re-opened yesterday against governor Cuomo's better judgment, but under threat of a lawsuit and as a similar suit is now being filed on behalf of restaurants for indoor dining. Remember that every individual is at risk from Coronavirus exposure, but some communities are more at risk than others. The highest case and death rate per capita in New York City has been in the Bronx.

Can all of these reopenings take place without a second deadly wave and if it comes, can the savage disparities we saw in wave one be avoided? With me now to talk about that question and more, we're happy to welcome the president and CEO of the Montefiore Medical Center in the Bronx, Dr. Phillip Ozuah, with a medical degree earned in his country of origin, Nigeria, then an additional master's and doctoral degree in education from the University of Southern California and the University of Nebraska, and even a postdoc in medical education from USC.

Dr. Ozuah has also been the pediatrics chair at the Albert Einstein College of Medicine, physician and chief of the children's hospital at Montefiore and more, so he cares about kids. He cares about paying it forward. He cares about equity and he cares about COVID and he is Montefiore CEO. Dr. Ozuah. Thanks for joining us. Welcome to WNYC.

Dr. Ozuah: Thank you very much for having me.

Brian: Based on what you see at Montefiore, what's the current state of the COVID pandemic in the Bronx?

Dr. Ozuah: Thank you, Brian. Things in the Bronx are better, but I think it's important to underscore what you said earlier about the Bronx because better is relative. I think when one looks at the latest data, if you look at the infection rates for COVID, per 100,000 New York State average is about 2,100. New York City average is 2,700. The Bronx is at 3,500. When one looks at the mortality rates, New York State per 100,000 is 162 people per 100,000 New York City is 283, and the Bronx is 343. I know that you understand these numbers, Brian because you obviously have a master's degree in public health. It might be important for some [crosstalk]

Brian: You did your homework on me, go ahead.

Dr. Ozuah: [laughs] Yes I did. As you did on me I can tell, but I think it might be helpful for some members of your audience to understand what these data mean because when-- I'll explain this. When you look at New York State, what's called the case fatality rate, which is over 1,000 people that get that disease COVID, how many died of 1,000 that get it? New York State overall is 78. When you look at New York City, Brooklyn is 117 per 1,000. Manhattan is 109. Queens is 206. The Bronx is the lowest at 97.

That suggests that it is not the medical care in the Bronx that is the issue because of 1,000 people forget the disease, fewer are dying, about the same or fewer than elsewhere, but many more people are getting the disease and many more people are dying. Disease is a cruel teacher and Coronavirus, frankly, is all the cruelest that I have encountered. What it's done is exposed an underlying public health crisis. Call it disaster if you will. [crosstalk]

Brian: If there is a second wave, how ready with PPE and other equipment and staffing, are you compared to the first wave?

Dr. Ozuah: We're certainly more ready than we were Brian for the first wave. Justin gave you an example with PPE, we're required by the state to have a 90-day supply of all the items of PPE at the maximum consumption rate that we had during the pandemic. I was supposed to have that by the end of this month, we already have 90 days’ supply for all of those items but even with that, any supply can be exhausted if the demand exceeds what is there and all of these things, there's only so many of them that exists in the world and that are manufactured at any one time.

The hope is that the demand does not exceed the supply that's available, but there are many more things in terms of being ready for a second wave and there are about seven items that we look at PPE being one of them, space is other staffing is important, testing is important, tracing and isolation is important, treatment is important and then, of course, the administrative management of the institution.

Brian: Given the case, fatality rate disparities, and those other numbers that you were laying out that describe to people numerically, how bad things were in the Bronx compared to other places. Do you have an opinion about opening schools in-person or indoor dining in that context?

Dr. Ozuah: Yes. I'm aware of some of the back and forth on this. I'll answer this. I've heard it said, Brian, that democracy is not perfect and it can be messy and contentious, it's still the best system of self-governance. I'm not a politician, but I'm a physician and a scientist and I believe that decisions around public health should be based on science and data.

I hesitate to speculate on absolutes without facts because these are complex evolving public health issues. I think they require a rigorous [unintelligible 00:07:19], for example, when you talk about schools, I think the factors to look at include the physical layout of each school. Is it even possible to have social distancing, other students, how many are at risk versus not? The teachers, how many are at risk?

That competency of teachers to do distance learning with technology, tablets, broadband for students, particularly in underserved areas. I haven't studied these issues because it's not in my purview to make these calls, but if I were to be making these decisions, those are the things that I would look at it I will say, we will go wherever the data take us and where the facts go.

Brian: I'll ask one follow-up on this, which might be more policy-oriented than what you think about as the head of a hospital system, but the policy argument for reopening’s is sometimes framed like this. The only reason for the government to keep things closed is to prevent the hospitals from being overrun, beyond that it's just about getting safety protocols for reopenings, and then it's up to individuals to make decisions about their risk tolerance. Now that we know better how to prevent the really big outbreaks, like in nursing homes, the hospitals like yours are not likely to be overrun so the government should have a light hand. As a hospital administrator, do you have an opinion about that argument?

Dr. Ozuah: Oh, I think that we're definitely more experienced, more sophisticated, although we're still learning about this disease, we're better armed than we were before. I do think that public policy should factor that in. The first time around we used a blunt instrument because that was all that we had. I think if there's moving forward such measures should be more targeted swifter, faster, smarter, shorter in duration where need be, and so on.

I see the merits of people who are arguing for opening but also having gone through the reality of seeing thousands of deaths and fearing being overrun and your staff at the point of exhaustion, I can also understand the hesitancy of, "We don't want to go back, we don't want to do anything that might take us back there."

Brian: Listeners, if you just joining us. my guest is Phillip Ozuah, he's president and CEO of Montefiore Medicine, which includes Montefiore Medical Center and the Bronx, and some affiliated satellite hospitals, as well as the Albert Einstein College of medicine. We could take a phone call for him from you.

If you have any questions for Dr. Ozuah 646-435-7280, 646-435-7280. What are you finding at Montefiore or the state of the art treatments for COVID to prevent the worst outcomes for those who have the virus? It's so much about politics in the media these days regarding convalescent plasma or some of the specific medications or supplements. I've heard something about steroids for some patients. What's the real medical state of the art?

Dr. Ozuah: Sure. Well, thank you. This is something that we monitor all the time. The fact is the rigorous empirical scientific evidence at the moment shows that Remdesivir which is an antiviral drug for patients in the early part of the disease who require oxygen, that improves mortality and it reduces the duration of symptoms. There are other clinical trials going on with that. There's the recent paper in the general of the American Medical Association, which is probably the more eminent medical journals. That's what's called a Meta-analysis, they looked at seven clinical trials of steroids, prednisone as well as dexamethasone, seven clinical trials, five continents, a dozen countries.

It showed empirically and definitively that steroids used later in the disease on patients who also require oxygen reduced death and mortality from the disease. Remdesivir an antiviral agent and steroids both have been shown to be helpful in this disease. That's scientifically. Unfortunately, at the moment, hydroxychloroquine and Azithromycin haven't been proven by randomized clinical trials to be effective, vitamin C, zinc same thing, not shown at the moment, immune modulators are being tested. Those results are not in yet. Those include things like, Tocilizumab, sarilumab those are immune modulators being tested.

All the antivirals are also being tested and have not been shown to have any effect so far. So far, scientifically, Remdesivir, and steroids. Obviously, we've become better with the use of oxygen with the use of high flow nasal cannula, deciding who should go on a ventilator versus not. We are better at treating the disease and there are a lot of the over 1,300 clinical trials going on. This is the state of therapeutics.

Now, there are vaccine trials also going on and a seven in the US are part of the warp speed, the two what are called MRA vaccines from Moderna and Pfizer to Adenovirus vaccines and the Oxford Zeneca, and Johnson Johnson. Oxford AstraZeneca, there is a recombinant vaccine from Merck and there are two recombinant proteins vaccine I believe from Sanofi and Novavax. All of these trials some are in phase three, some are about to go into phase three which requires tens of thousands of patients to demonstrate both efficacy as well as safety, but that's the state of affairs, Brian, medically,

Brian: Since you brought up the vaccines, what was your reaction when you heard yesterday that the federal government says it's possible that there will be a vaccine approved by the end of next month? Of course, that would be the end of October. They're talking about before November 1st.

The first thing that comes to mind to me is, "October surprise," in the context of the presidential race and that this might be getting directed politically rather than medically for someone like you as a hospital administrator and medical professional when you hear the government say during the presidential campaign that a vaccine might be ready that quickly just before election day, they said just before November 1st, does it make you shudder or does it make you think, "Wow, warp speed is really warp speed. This could be great."

Dr. Ozuah: Well, there've been lots of things that have been announced and perhaps hyped that haven't necessarily panned out during this pandemic in terms of treatments, and so on. Now, one, I have to hope, and I believe in the integrity of the scientists that are doing these experiments. Generally, these are very serious ethical, rigorous experts who are totally focused on safety and efficacy of populations and who understand that if one introduces a vaccine, that's not-- Which efficacy has not, or even safety has not been fully understood. The damage goes far beyond that particular vaccine and the damage from that vaccine can be more than we could bear.

I've also had comments from some of the scientists and some of the leaders of the various organizations reaffirming their commitment to science and to excellence and rigor. Now, I must make a distinction, Brian, between a vaccine being approved and a vaccine being available for the general public because even after a vaccine has met all of those standards and is approved to produce the hundreds of millions of doses that are needed just in the US alone and the billions of doses that are needed worldwide, will still take some time.

I think sometimes people are talking about different things and those of us would say that to have a vaccine available for me means that you Brian can go to your doctor and get it. I think that will take a while. I don't believe that would happen by October.

Brian: Yes, we want to have that. We may just have a big unveiling. Let's get in a few phone calls for you. My guest, Dr. Phillip Ozuah, who's the president and CEO of Montefiore Medicine, Montefiore Hospital System, and the Albert Einstein College of Medicine. Kay in Westchester, you're on WNYC with Dr. Ozuah. Hi, Kay.

Kay: Hi, good morning. How are you both? Thank you so much for being with us. I have a question regarding symptoms of a number of things that are happening as well with regard to seasonal allergies, things that has to do with the flu vaccine and taking that, and then being subjected to the flu, and then all of those COVID symptoms. How is one person to know how to treat, whom to seek help from, and how not to panic? Thank you. I'll take my answer off the air.

Brian: Thank you so much, Kay. Certainly, it is going to be complicated for doctors as well as patients when people get symptoms, when flu season comes around, again, that seem at first that they could either be a flu or COVID or something else.

Dr. Ozuah: That's true. Kay, you raise a very important issue that most people are wondering about not just you. I think the answer lies for us as medical experts in surveillance. We track and New York state tracks, New York City tracks, the CDC tracks because every hospital, every doctor's office has to report these patients with these symptoms anonymized, but also positive tests. If we know that let's say 80% of everybody who has flu-like symptoms is testing positive in November for the H1N1 then I think then you approach in the community is to say, "If you've got these symptoms, the overwhelming likelihood is that you have H1N1 or it could be COVID-19 or both."

The surveillance will help us determine what's going on, but my advice would be to get the flu vaccine. For one thing, the flu is still out there and will come back. Two, we don't know yet what the impacts and the morbidity will be if one gets the flu and then subsequently gets COVID-19 or gets both at the same time. That’s a risk that I would hope most people would not be willing to take. The other is that the flu alone in the winter sometimes stretches hospitals to their limit. If we have the flu season going on a COVID surge, we may hypothetically be worse than we were earlier this year in line with what Brian was talking about earlier. [crosstalk]

Brian: You had another reason for people to get their flu shots this year not just to protect themselves, but as a population measure so there won't be as much severe flu that would wind up with more pressure on hospital beds. Dan in Brooklyn, you're in WNYC with Dr. Ozuah. Hi, Dan.

Dan: Yes, can you hear me?

Brian: I can hear you fine.

Dan: Okay. As a physician in the field, as opposed to an administration would be like logistics versus combat, my concern is that this is a virus, unlike a bacteria that needs ourselves to be reproduced, it cannot reproduce itself. One of the things it does is cause the cytokine storm that by the time it causes it we really have a little more to work with now but not much more than we had before. It would seem to me that the ability to find the presence of that virus inside a patient is the most critical component. I don't understand how you could quote any statistics until we have frequent universal testing. UCLA just found that two tests within 24 hours gives you a 91% chance of no false negativity, which is a big problem.

Brian: Dan, I'm going to leave it there for time, but he's right. When you talk about the flu and separating what people have. I had a respiratory thing last winter, I went to a doctor, they gave me a flu test and a strep test, and a few minutes I knew I didn't have the flu and didn't have strep. Right now, we can't do that with COVID.

Dr. Ozuah: There's no doubt. I completely empathize with Dan. I was a doctor for 18 years in the South Bronx. I think ultimately rapid testing is the solution and I'm not a test that you have to wait a day to get the results. During those 24 hours or 48 hours, you could be infecting a whole bunch of other people. There are efforts going on to develop such a test, which I think would be absolutely critical in our management going forward. At the moment, we have to battle this disease with what we have, but there are tremendous efforts going on to develop rapid testing that are reliable. Some of the rapid tests out there now have been, shall I say problematic. The PCR, the test with a swab from your nose is definitely sensitive and reliable.

Brian: Well, we're going to have to leave it here for today. I just want to say before you go that the caller brought up you as an administrator and he as a combat frontline troop as a doctor out there whatever. You pointed out that you worked as a community physician for all those years in the Bronx. I just want to say you are in a category of people in the world who I admire the most. That's MDs who don't just use their medical degrees to practice and make a good living but also get additional degrees that are more policy or public service focused.

I know some MPHs that is doctors who got masters of Public Health degrees who I admire so much and they have not just a private practice, but also work in public health. You with your MD degree then went on for additional higher education degrees in education. I really admire that. You want to just give us 30 seconds on how that all fit together for you? After you were already a doctor you went back for a doctorate in education.

Dr. Ozuah: Thank you. I did because I thought that first of all medicine and being a doctor, it is a lot about education and educating yourself and educating your patients and families. My mother was a school principal her whole life and that showed me the power of education and so teachers are some of my heroes. It was a pleasure for me and about self-actualization to go on and get a Doctorate in Education as well.

Brian: Now you're training and in charge of training the next generation of medical professionals at the Albert Einstein College of Medicine, part of Montefiore medicine that whole system of which Phillip Ozuah is president and CEO. Dr. Ozuah, thank you so much for joining us.

Dr. Ozuah: Thank you very much Brian for having me on.

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