Health Care Expert Atul Gawande Suggests Looking To Hospitals For Our 'Regimen For Re-entry'

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Some Massachusetts hospitals have proven particularly effective at avoiding the spread of COVID-19. So what can we learn from them as we approach our statewide reopening?

Dr. Atul Gawande says quite a bit. He's a surgeon at Brigham and Women’s Hospital and a professor at Harvard T.H. Chan School of Public Health and Harvard Medical School. He is also the former CEO of Haven Health Care and now chairman of Haven's board, and a staff writer for the New Yorker.

He recently wrote about how our reentry can be modeled after what's being done in hospitals, and talks with us about that approach.

Interview Highlights

On hygiene and social distancing at the hospital:

"So first when I arrive, right away we have a dispenser for hand sanitizer. And, you know, that's important. One thing about just hand washing that people may not recognize: more is better."

"Studies have shown that when you wash 10 times or more per day, that's when you get ... half of the infection rate. Now, what does that mean? That means anytime you're going to enter into a high-traffic environment or exit a high-traffic environment, then you want to wash hands or sanitize. You also, every two to three hours when you're in that environment with people ... you want to be washing your hands and then, of course, disinfecting the surfaces. Now, just about 5 to 10% of spread is from surfaces and your hands. Most is airborne. That's where distancing comes in. And we have a 6-foot distancing at work on the escalators, elevators, all of those things. We also know it's not enough."

"...We have hundreds of thousands of people right now who are infected and most have no symptoms yet. And that's why lockdown works, as we're just avoiding those people at work. We can't avoid them. And it's actually less about the patients. It's about us. The patients are isolated. They're in their rooms. They're not coming and going. We, the workers, are coming and going."

On the different level of compliance and expectations of health care workers through the coronavirus pandemic: 

"...Our culture has been that you go to work no matter what. It's embarrassing, but it's true. Like we've traditionally seen it as a sign of weakness if you take a sick day. And here is a complete change in our culture that's been required, so that if you even have the hint of a cold that, you know, your job is not to infect other people ... your job is to stay home."

"And that's been hard, right? Over the last five weeks, out of all of the 50,000 [Brigham and Women's hospital workers] ... 11,000 people have had symptoms, stayed home and got tested. [Of those workers], 1,400 of them turned out to be positive. And if we hadn't caught those, they wouldn't have stayed home and then they would have been at risk of infecting others."

On what will work with the greater public to change some of our behaviors, such as wearing a mask:

"It's critically about 'I protect you, you protect me.' Our discussion in our culture right now is only about two values: safety and freedom. Keep me safe. Leave me alone."

"The culture of the hospital that we've had to create. ... [is] about never wanting to be the one to infect someone else. Never wanting to be the one to put somebody in the morgue. And we're not vigilantes about it. That doesn't work. It doesn't work to scream at people."

"Our discussion in our culture right now is only about two values: safety and freedom. Keep me safe. Leave me alone."

Dr. Atul Gawande

"It's about the idea that we're in this together and that you can then say, 'Hey, dude, your mask is down.' And then they say, 'thanks.' Or that you say to yourself, 'I got a cold coming on. I really don't want to be that person who could hurt somebody at work.' We have to work at that. You have to find leaders and we have to communicated it, and we have to communicate at the top level. It does not help that we have a president who's embarrassed to wear a mask, who does not want to communicate that, you know, we're in this together and that you can do this. So it's up to the rest of us."

On opportunities to address gaps in the healthcare infrastructure:

"Without question. This is a big opportunity. We have all experienced now moving 70 to 80% of practice into a virtual environment. We have to have a sustainable way to maintain that, and I think that's a big opportunity. We have to be able to use it so that it actually improves people's outcomes and care and ... it's not clear we're yet progressing to the place where we know how to do that."

"And then lastly, we have big parts of our specialty infrastructure that are in real danger. You have 70 to 80% of ophthalmologists and ear, nose and throat clinicians..., who their practices have been completely shut down. And we need to have ways that [their practices] can continue."

This segment aired on May 15, 2020.

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Tiziana Dearing Host, Radio Boston
Tiziana Dearing is the host of Radio Boston.


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Paris Alston Host, Consider This
Paris Alston was WBUR's host of the Consider This podcast and a former producer for Radio Boston.



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