Episode 24: How to Adapt to the COVID-19 Crisis with Dr. Vik Sengupta, MD in NYC

Transcript: How to adapt to the COVID-19 crisis with Dr. Vik Sengupta

Dylan McCabe: WeInfuse Podcast, episode number 24. Welcome to the WeInfuse Podcast, my name is Dylan McCabe and in every episode we give you a behind the scenes look at the infusion suite, whether it’s a provider office or a standalone infusion center and in this podcast, I’m interviewing Dr. Vikram Sengupta, he’s the Chief Medical Officer at Thrive Well Infusion in New York and he’s right in the middle of everything with the Corona virus happening right there in New York City. So I’m excited to do this interview with you. He brings a lot of insight to the table and I’m not going to spoil any of it. Let’s jump right in. All right. As I stated, I’ve got Dr. Vik Sengupta on the show today and like I said, in the introduction, the reason I’m really excited is because he is right at the center of everything in the New York City area and he’s going to share a little bit about what they’re going through and the precautionary measures they’re taking to make sure they navigate this COVID-19 challenging situation well. So Vik, thank you for being on the show.

Dr. Vikram Sengupta: Yeah. Thank you. Yeah, basically I guess a little bit about myself I’m the chief medical officer of Live Well Infusion. We were founded in 2017 and we have currently three ambulatory infusion centers, two located in Brooklyn in Crown Heights and one in Borough Park and another in Manhasset, New York, which is in Long Island. All of these have been impacted by the COVID-19 crisis and as many of the listeners will know we are really at the epicenter of this with 32,000 cases confirmed as of this morning and greater than a thousand deaths were nationwide already. So basically I guess we’re going to discuss our response to the COVID-19 situation has been to, I think basically what it really highlights about ambulatory infusion is the importance of site of care optimization for the safety of patients and that’s the sort of angle that I have taken because as the person responsible for managing and ensuring that these patients received the highest standard of care and the safest settings possible, and to that end, we have implemented many of the broader measures that have been recommended both by NICA and by the CDC and Johns Hopkins and other authorities on this matter and as far as screening and ensuring that we minimize risk of exposure, I’ve sent all of my administrative staff home and they’re working remotely and it’s the only clinical people on the ground. We make sure that people are two meters apart if they are basically at the center at the same time and we try to prevent having more than one patient actually in our centers at the same time right now, which is not always possible, but the good news for us is that we have our model is centered around predominantly private rooms. So that’s allowed us to segregate patients and avoid cross contamination and we’ve basically just stopped using our semi private infusion suites, which have about one or two chairs typically.

Dylan McCabe: Well, tell us quickly, I think a lot of people listening to this, especially if they’re providers, are people running standalone infusion centers, they’re thinking how do I know which risk mitigation strategies to take with my patients? Where are you getting your information? I know you mentioned NICA, the National Infusion Center Association, which we can find an infusioncenter.org. What’s your main source for protocol for navigating the situation?

Dr. Vikram Sengupta: Well, I don’t use a single source. I think it’s important to be aware of all of the major sources and also to be directly in touch with primary sources on the ground. So I’m in communication with infectious disease docs and the hospital is and ED docs on the ground at NYU where I’m on faculty every day and I’m communicating with other people in other parts of the country who have started a COVID-19 task force and basically trying to synthesize all of that with a set of other clinicians into something that applies more specifically to the ambulatory infusion setting. I think that the NICA standards really distilled it quite nicely, for our purposes in terms of personal protective equipment, it’s really gotten gloves, goggles, face shield, and 95 masks or less substantial in our setting because we are not really involved in aerosol generating procedures, but we have those and make sure that everybody is trained and that people are repeatedly trained on that and to make sure that everyone is up to date and we’re making sure that we decontaminate all of our surfaces before and after a patient encounters with EPA approved medications or rather cleaning products, including cavalry wipes, alcohol greater than 60 to 70%, diluted bleach, Windex, water or sunlight. We’re not using sunlight, but those are the modalities that have been shown to be effective and we’re considering the half-life involved in the dissipation of COVID-19 from physical surfaces, et cetera. Some other measures that we’ve taken is that we’re screening the patients remotely via phone, fever, cough, traveled to high risk countries, which has expanded substantially now and then we are not really allowing visitors into the centers and we are checking patient’s vital signs and screening them when they do come onsite outside of the center before we allow them in. The policy is that if we suspect someone of having something; somehow a patient enters and we begin our encounter, if there is a suspicion, for example that maybe suddenly they expect a fever, the plan is to immediately mask them, put them in a private room, which they probably will be in already and then basically send them for contact infection control and go from there.

Dylan McCabe: Now let’s talk about the big elephant in the room, I think as you are located in the New York City area, what is it like there? Because all of us, I mean, I’m in Dallas, Texas, we’ve got listeners all over the US and I just saw a video, I mentioned to you before we started recording the video, put out by this emergency room doc in New York City and she’s talking about how they refute receive five new ventilators, but really they need like a hundred. I mean, what’s the situation like out there?

Dr. Vikram Sengupta: The situation is pretty grim. The hospitals are straining and we sort of anticipated this at Thrive Well and have reached out to the CMOs of all the major systems and making them aware that we’re available here to help offload their autoimmune patients who need infusions right now, because there is a convergence of people with transmissible illness upon all of the major academic medical centers and there are words afterward that are opening that are dedicated only to those infected with COVID-19. There’s a very high mortality rate and resources need to be dedicated to that. There is a shortage of vents and PPE at various and every institution is a little bit different in terms of their access to resources. But the hospitals are definitely over-strained and the executives who I’ve been in touch with over the course of the past few weeks, they’re rising to the occasion and I just have to really express my respect and appreciation for all of my colleagues in medicine and the administrators and the advanced staff, advanced practitioners and physicians, and everybody there that are just handling this on the front lines every single day because they’re really working hard and hopefully we’ll be able to contain it. But it’s over-strained right now and there is a need that is emerging right now as it pertains to ambulatory infusion, there’s an emerging need that for patients who are immunocompromised, at risk, to be transferred to sites of care that are safer for them, namely ambulatory infusion centers like ours that have been able to remain in perturbed and unexposed at least so far as much as possible and can contain and prevent transmission and detect. We’re not trying to detect at all. We haven’t taken that tack. We are basically trying to serve as a haven for that and certain kinds of patients on biologics really are more susceptible than others. Most of them tend to be immunocompromised, but MS patients, for example, those on Tysabri are at higher risk and increasingly we’re seeing an influx of these kinds of patients because of that and we’re open to that. We’ve basically, hopefully can offload the hospital resources while making sure that these folks don’t get cross contaminated because their risk of critical illness in the setting of a COVID-19 exposure is about 20%, as opposed to the general population, which would be more about 5%. Then that’s another vent occupied that was totally avoidable. It’s another hospital bed that was totally avoidable for a non-elective procedure that has to be done on a regular basis and often biweekly or even monthly.

Dylan McCabe: No, that’s a great point is that you can actually relieve some of the strain on the hospital system by saying, hey, we have room for patients that are on these biologics, and we can take care of that need and free up space for others. I mean, I haven’t heard anybody talk about that.

Dr. Vikram Sengupta: Yeah. I mean, to me, that was the first thought really. I mean, how can we help? We’ve also extended our resources to hospital leadership across the city in any way that they might see fit and are open to any other thing. But that is the most natural extension of the notion of site of care optimization from this standpoint and so to that end, also, we are working to set up new centers acutely in zones that are at very high risk for very rapid propagation. There were some new studies out of MIT that came out this week that certain parts of the city, certain boroughs are going to be very difficult to control transmission in and the hospital systems that are very overwhelmed and so we’re trying to create basically pop-up infusion centers that allow us to handle those patients. It’s taking some time and energy and then the other option being mobile infusion units that we’re trying to explore as well because we have refined the ambulatory model and now basically I think that if you just take, for those who can’t get a straight home infusion and require a higher level of monitoring and have to get their infusions, sometimes it may make sense in order to enforce social distancing, which is really the core of controlling this epidemic by utilizing mobile units. So we’re talking to people and trying to do something favorable while also serving our existing patient population and making sure that they get the best care that they can, that we can give them.

Dylan McCabe: That’s so interesting. I think about situations like this that are so challenging, it really forces people to think more creatively and kind of think like an entrepreneur and come up with solutions and it’s great because you just voiced a few solutions that I think other people may not even be thinking of, or maybe they did think of it, but they didn’t pull the trigger on it and it’s really neat to see how you can try to lend that helping hand and be creative about it. And so as we talk about, I mean, we’ve talked about protecting your patients, a question comes to my mind is how are you guys managing the communication flow to all of your patients? I’m sure your patients have lots of questions like what do we do? Can we come in and get our infusion? How are you guys navigating that and managing that information transfer to your patients back and forth?

Dr. Vikram Sengupta: That is a big issue and I think that, again, this pandemic epidemic has really brought that into bold relief, which is the important of bi-directional communication in real time to patients on mass basically and which as far as outgoing information, and then also in the way of surveys, et cetera and also collecting information from the real time directly. But right now we have a pretty straightforward system is that we’re just calling every single patient and making sure that they’re okay and it’s not a technologically the most advanced approach, but it’s exhaustive and it’s thorough and we’re making sure that everybody’s okay, that they haven’t been exposed, that they’re not having symptoms and if they are, we’re helping formulate alternative plans for them to get their care and helping them come up with not just solutions for their health, but also trying to extend some form of something that can help them cope with the stress and just the general personal disorder that originates from being basically suddenly in lockdown, in a city where people are so accustomed to being out and about all the time. So that’s what we’re doing in terms of our patient communication, we’re giving them information about and we’re screening them via phone. So those are the essential elements of that.

Dylan McCabe: That’s great and I know at the time of the recording of this podcast, I know WeInfuse released some updates in their software that allows for appointment reminders and alerts and stuff like that and some of our customers are tweaking that to kind of tailor it to this outbreak and they’re communicating to their patient population in that way and I know it’s been very helpful, but like I said, at the time of the recording of this podcast is a brand new feature that was just released and so I think we’ll see more people use that moving forward just to help with communication. Well let’s switch gears here, let’s talk about your team. I mean, you mentioned that some of your admin staff, you sent them home. I looked at the video I saw earlier, it showed a lot of the healthcare providers, nurses, all kinds of staff, the hospital, everybody looked like they were in the operating room. So what are you guys doing to protect your staff? Because that’s a lot of news articles that we read talk about that like, oh my gosh, what if the nurses start getting sick?

Dr. Vikram Sengupta: Yeah, that’s a huge deal because first of all, we had a death yesterday there was a nurse at one of the major hospitals who passed away as a result of the Corona virus infection and it’s really tragic because he was there out on the ground trying to help him and I don’t know the details, I won’t presume to know them but it seems that there may have been a lack of availability of personal protective equipment there. So one thing that we’re doing, as I said before, is that we’re ensuring that nobody who doesn’t need to be there is onsite and that’s all of our administrative side, billing, front desk people, prior auth, none of those people are onsite. We’re all operating remotely and the only people who go to the center are the clinicians to handle the patients and handle their infusions and in order to protect them, we’re giving them education, we’re using educational flyers, some of which have originated from NICA, which by the way, we’re also giving to our patients, the patient education flowers produced by WeInfuse and NICA were really good too and teaching hygiene and forcing diligent hygiene, ensuring that they are aware of proper donning and doffing techniques, ensuring that there’s copious amounts of sanitizer everywhere and making sure that we risk screen them and make it clear to them that they don’t need to engage in presenteeism. Namely showing up for work, even though you’re feeling sick because you feel somehow obligated to do so as a clinician, which everyone who’s a clinician knows is that there’s a pressure for that and we’ve made it very clear that there, if you need to call out, you call out, there’ll be no retaliatory responsible figured out and just take care of yourself and quarantine yourself for the appropriate for the two 14 day period. The other thing we’re doing to protect them as we’re extending our clinic again, extending our clinic patient hours, so that there’s minimal exposure to the fewest number of people in the clinic per unit time.

Dylan McCabe: That’s great and you think about all the things that you have to do to provide for the safety for the patients, for yourself and it sounds like you guys are thinking creatively, you’re making sure you can navigate this well, you’re communicating well with other healthcare providers in your area and you guys are navigating it well. So what’s been a big takeaway or kind of a key learning point that you’ve gleaned from all this that you didn’t have before?

Dr. Vikram Sengupta: I think that emergency preparedness for a broad, widespread infectious disease epidemic, it just was not a really at the top of my mind, it’s been a long time since we’ve really had something like this happen and although we did respond quickly I think that I would have preferred to have like a stockpile of PPE. We have enough, and maybe even some of the novel therapies which are being utilized for the treatment or being evaluated as potential therapies for COVID-19 maintaining those are basically unavoidable, I couldn’t have predicted those, but I think in the future, if something like this happens and wouldn’t it be much more aggressive. I waited a week probably before I started to explore and really see what kind of infusible medications might be utilized in order to help patients either as a preventative measure or a therapeutic measure, examples being Rendezevere, Tocilizumab, which is being explored for its ability to diminish interleukin six activity and therefore the cytokine storm that reeks to death in these patients and some hospitals are actually also using things like high dose vitamin C and we’re capable of doing all these things and I think just having the supply chain there and prepared and ready to spring into action for emergencies of this nature, I think will be essential moving forward. Then also really, I think we’re going to enter a new world with a totally different paradigm after this, because how could we not? Where our attention to infection and infection control will be much higher and we will be enforcing and paying a lot more attention to ensuring that we have habits that prevent transmission, that we are all looking for, signs of infection, that we are looking to protect those who are at greatest risk, even more than we already have been. So those are a few takeaways, I would say, because those are; it’s really this social distancing is essential, I really have come to appreciate that because in the Spanish flu of 1918, there’s the story of St. Louis versus Philadelphia, which St. Louis chose to not have their World War I parade in Philadelphia to choose to have that and St Louis had a 700 mortalities as a result and Philadelphia had 12,000 and there were 40 to 50 million mortalities in that case and that situation, and this sort of is starting to look like it could become something on that scale. Hopefully we can use modern medicine and modern epidemiology to really contain this as rapidly as possible.

Dylan McCabe: Well, it’s so interesting that you say that, with the social distancing, it’s been interesting being in Dallas, Texas and seeing things happen from afar and now it’s come to Texas, a lot of people are, I feel like just now starting to practice social distancing, of course, all the restaurants, all the stores, everybody’s shut down, just like everywhere else. I mean, that’s spreading rapidly, but just kind of a question of opinion, obviously this isn’t medical advice or anything like that, but just for people out there that are thinking, or even saying like, oh, this is no big deal, this is going to pass in a few weeks and there’s been a very small amount of deaths so far where everybody’s overreacting basically, and therefore social distancing is not that important. What’s your response to that?

Dr. Vikram Sengupta: I just don’t think it’s true and one of the biggest reasons is that 81% of those with the disease are simply carriers, asymptomatic carriers and so transmission can be occurring without anyone’s knowledge, not only because of that, but also because of the latent period while the virus is incubating during which someone that is virulent can be spreading this everywhere and when those folks get into the circulation that’s what causes the explosion among those who are susceptible those 14% who become, these are based on Chinese statistics, 14% of those who become severely ill, 5% who become critically ill with a 2.3 case mark fatality rate, these numbers are astronomical, that’s number one. The number two thing is that if you look at New York and you look at the number of cases, there are 32,000 cases, the numbers don’t lie at this point. I have to admit that initially one of the first hints of COVID-19 emerged long before it really came to us, I didn’t have the same level of concern and I was concerned that maybe an overreaction and the economic consequences and contractions that originate from things like mandatory shutdowns might be might be of a greater consequence than the healthcare consequences of the COVID-19 epidemic and the transmission of it. But I just don’t believe that anymore, based on the fear that I am hearing from the physicians on the ground, that I’ve never heard from anyone before and based on seeing it with my own two eyes and then looking at the numbers, which just don’t lie, 32,000 more than a thousand dead. It’s more in New York of course, it’s the most, I think a third of the cases are in New York right now, but it has the potential to affect us everywhere and in different ways and we just need to contain it.

Dylan McCabe: Right, better, safe than sorry.

Dr. Vikram Sengupta: Because we can’t really flatten the curve. If we have a lockdown that lasts two weeks, it’s not going to sufficiently fill out in the curve and we open up the lockdown. Based on my discussions with epidemiologists and their readings and their communications with other people that sort of evaluate these things at a higher and at a much greater depth than I am capable of evaluating from a statistical standpoint. Their impression is that if you do a two week or three-week quarantine and then stop it and you open things up, this is going to extend further in time. First of all, you’re not going to control the number of cases as a much and the rate it’s going to spike again in a few months, and you’re going to have to quarantine again for two weeks, and it’s going to a spike again a few weeks later, and this might go on for a very long time causing an ongoing strain on this system. It’s just a very hard thing to take care of and when those cases spike at that rate, it’s not just; flattening the curve is not about just reducing the total mortality. It’s also about reducing the acute strain on the healthcare system that originates from having an explosion of cases that converge upon cities at a hospital centers in a very short period of time, which is what we’re seeing right now and hopefully next time, we’re more prepared for that.

Dylan McCabe: All right. So for anybody listening, who’s doubting the severity and the needed measures that has the ring of truth and I wanted to ask, because look, I mean, you’re a sharp guy, you got a medical degree from the Yale school of medicine, you’re definitely well-studied, you’ve received several awards, you’re published in multiple articles and so I kind of want to get your feedback, especially because like you said, you are networking with all these other specialists and it’s just really interesting to hear your perspective and how you guys are navigating this storm. So before we part ways, I guess what’s for people listening in who are dealing with this, what’s one parting piece of advice?

Dr. Vikram Sengupta: People stay safe, enforce social separation and keep your spirits up and try to take care of each other. I think we’re all going to get through this.

Dylan McCabe: That’s great and that’s something we talk a lot about at home. Yes, this is putting our stressors on these different areas of our lives. Yes, this is affecting our friends and family these ways, but how can you be solution minded and how can you focus on the positive? And they’re obviously long-term, there will be a lot of positives that come out of this, but it is definitely a trying time. So we really appreciate you joining the show. We’re going to release this show immediately so that people going through this now can get tapped into resources now. So Dr. Sengupta, thank you for joining us.

Dr. Vikram Sengupta: Thank you so much for having me.

Dylan McCabe: All right. I hope you took a lot from that interview with Dr. Sengupta, especially about communication with patients, specific safety protocols, and he’s doing a lot of things similar that we’ve heard from others to just do everything he can to be educated, everything they can to be educated. One thing you did not hear in this podcast that he mentioned when I stopped the recording and hit the button to end the recording, as he said, I really just want to thank my team and we took the time to go through all of his team members he wanted to thank, and he wanted them to know how grateful he is and he mentioned his nursing staff, Olga, Rochelle, Lisa, Christina, Janice, Este and Sandra. He mentioned his administrative staff, Brenda, Ibiza, Theresa and Dalia. He mentioned his partner’s Ben and Ira Newburgh, his associate medical director and a wife. He also mentioned his medical advisory board the physicians who trust them with referrals, his corporate partners, and last but not least his patients and he wanted to thank of course above all just team Thrive Well, it’s a team effort and of course you heard on the interview, he’s collaborating with other physicians in the New York City area. If you’re curious about what else WeInfuse can do to equip you, if you’re thinking about starting an infusion center, we offer consulting and we offer software. The consulting is to help you start and grow a successful infusion practice and the software is a tailor designed product to manage the practice, just go over to weinfuse.com and you can schedule a time with an account executive to learn more, especially now that people are working remotely. The software platform has really never been more powerful because it’s got all kinds of systems in place to keep everybody the same page for every part of the process from initial intake to scheduling, to nurses’ charting, to patient follow-up and alerts and reminders, the software like none other tool that exists puts everybody in the same system on the same page and completely streamlines the process. So do not hesitate to call one of the account executives at WeInfuse today. Just go to the website, you can schedule through the, through the site, or you can call the main number. You will be glad you did. All right, guys, this is Dylan McCabe with a WeInfuse Podcast, and I will catch you in the next episode.

Guest Speaker: Vik Sengupta, Chief Medical Officer at Thrivewell Infusion and Direct Biologics, received his MD from the Yale University School of Medicine. He has prior experience as a physician, and currently serves as a professor at the NYU School of Medicine.