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Steve Edwards warns hospital bottom lines are under severe stress.
SBJ file photo
Steve Edwards warns hospital bottom lines are under severe stress.

Why CoxHealth CEO called for ‘stay-at-home’ edict

Posted online

In a Springfield Business Journal exclusive, CoxHealth President and CEO Steve Edwards addresses his call for swift action on stay-at-home policies to lessen the COVID-19 impact on hospitals. A few days later, it happened. A statewide edict should be next, he says.

Here are excerpts from a March 24 interview with SBJ Features Editor Christine Temple.

On Saturday, you called for local and state leadership to mandate shelter-in-place restrictions, saying in an epidemic, we're making decisions two weeks behind. Days later, city and county officials announced an ordinance of just that, effective for 30 days beginning 12:01 a.m. Thursday. What's behind that call and what will it look like for businesses and residents?
We've got to be planning for what the world's going to look like in two weeks, not what it looks like today. We took the data from the Imperial College report, and applied it to our community and it became readily apparent that if we did nothing, we would quickly outstrip our community resources, hospital resources. Springfield has already been moving to do those things, so any of that data that shows worst-case scenario isn't likely to occur because we've already started this. I'm really grateful for that.

But if you look at the data, (a) shelter-at-home approach is the most important measure. As long as restaurants and businesses and grocery stores have lots of people in them, there's a high risk. And there's employees that feel like they need to stay at home, but maybe they're not in a position to stay at home because their work setting still requires them to be in. We hope there will be access through some of these federal bills to help people that are temporarily out of work to seek unemployment.

All those things are in my mind. I'm looking at the world through the lens of do we have enough (personal protective equipment) and enough ventilators to take care of our patients. Forcing this in Missouri and our city and county is the only way I feel like we could be prepared because our capabilities at Cox and Mercy, even though we're doubling some of these things getting ready for this, could have been outstripped. I am really grateful for city and county leaders. They heard us.

If we move so quickly that we don't understand the repercussions, you could shut down the supply chain, for example. They've got to think of what businesses make sense to be open. 3M manufactures the adhesive that is then sent to Nebraska that makes the N95 masks that we need. As a community when we do this, I want us to be careful. The call to action, I honestly intended it to be jarring because it needed to be. Our state is one of the few states that has not acted as a state and that's dangerous.

What about the businesses that need to be operational to survive? How do you balance public health and economic health?
If you act quickly, businesses may have a better chance of surviving. If you're a business, would you rather be in northern Italy right now or in South Korea? I look at both an economic advantage and, maybe more importantly, a community health advantage to act quickly. We're not going to avoid this. It's here. It's probably endemic in our community now. If we had massive testing, we would know that.

You said hospitals' bottom lines are suffering. Are you considering layoffs or furloughs?
Not layoffs at this point, but it's a worry. We're trying to keep our community strong and keep our employees working. For example, we shut down our fitness centers. We asked those staff, would you be willing to help us man our front doors as we check visitors and employees in? If we suppress this thing successfully and we get back to business sooner, our finances will be better for it. If we don't, hospital finances will struggle. I was on a call two days ago with hospital leaders and there are many hospitals, smaller hospitals, are saying we're not sure we'll make payroll in two weeks. The profit work hospitals do are the elective surgeries, so when we canceled those to protect our community, protect PPE, etc., we also devastate our bottom line.

Have you furloughed any employees to date?
We've sent employees home due to normal productivity. We have policies when our volume goes down, we send employees home, they can use (earned time off). We put in an extra $2.7 million into our ETO bank to help employees that might have COVID. And then we created a $1 million fund that employees in crisis can access based on criteria. Then we have about 400 workers that we set up, starting today, we'll be working from home.

SBJ interviewed you 15 days ago regarding COVID-19. At the time, you also said we were surrounded by the virus. Did we act fast enough?
I think Springfield, Greene County has acted fast. By surrounded, (we started) to see it in Washington state and now we're seeing it in New York. At that point, it was just starting to pop up. As a nation and as a state, there will be pockets that will be clear we did not act fast enough. There's also things beyond our control where you can have an outbreak that occurred despite taking all the social measures. Kirkland, Washington, kind of the early U.S. epicenter, it really started there from a nursing home outbreak. Those are things that worry us as a nation. Would I be more aggressive than our president? Absolutely. I have the deepest respect for our governor – he's called, he's been helpful, he's been offering resources and assistance. We don't agree on the shelter home rule for the state, but he's been supportive otherwise.

What's stopping government leaders from taking a more aggressive approach?
I look at the world through: do we have enough capability to take care of our community? There's probably a broader lens that others are looking to. I am surrounded by absolute experts, and they have educated me so rapidly that I have a better understanding than I think others will. Part of the problem in Missouri there's probably 90 or so counties that have not had a COVID case. There's a sense of invincibility until you have that first case. When you (do), then you're mad at your government for not acting fast enough. I try to remind all the politicians we work with, in a pandemic, no one gets chastised for acting too fast. History will judge us by the speed we act today. Two-thirds of our patients come from outside of Greene County, which means if we don't take those provisions outside of Greene County, we could still find ourselves in a position that we don't bend that curve back.

When we spoke two weeks ago, you suspected that COVID-19 would not cause near the amount of deaths as the flu and that it would not pose as great of a risk for those who are younger and healthy. Has the science changed on that?
Science is evolving quickly. Our initial data was really coming out of China and I think even epidemiologists doubted their data because it's a closed society. The data we're seeing out of Italy, which is more transparent, gives us more insight. It is still true that younger people are at less risk of fatality. It's also true now that we've found out that 40% of the admissions come from people under the age of 40. They are not impervious to this. If you take the Imperial College analysis and apply it to the United States, if we did nothing, the expected deaths would be 2 million. If we suppressed it successfully, it could be less than the flu. I don't think it will be less than a routine flu for sure. The flu fatality rates tend to be around 0.15%. I think when it's all said and done (the COVID-19 mortality rate) might be 1%.

This week the hospital system purchased 420,000 PPEs that will arrive in the coming weeks. How did you find that equipment amidst the shortage and how did pricing compare?
We've got a chief supply chain officer. We also have a man that used to work in supply chain who we freed up just to source those from all over the country. The pricing, it's in my mind clearly price gouging. A mask that costs 62 cents apiece, people are proposing $6, so a hundredfold markup. We'll be working with the attorney general on any of those cases. What we've found out is that the markup across the nation for these masks tends to be a fivefold increase.

In addition to purchasing equipment, you're also 3D printing some of these masks in partnership with Missouri State University's Jordan Valley Innovation Center. Tell me about that process.
We're learning from other hospitals. Jordan Valley just happened to have a roll of about 5,000 feet of the proper plastic that could be used. Then we looked at how we could 3D print it. We have been doing trials on it and it looks like it's ready to go. We have been sharing those plans for free online. We're having hospitals all over the country reaching out asking how can we get hold of those. There are also manufacturers that reached out to us to say we want to help. There are also parts like vent pieces that Italy ran out of, little plastic parts that are required in a vent, and we're prepared to 3D print.

Do you have other examples of how businesses have shown ingenuity in this crisis to support local hospitals?
Last week, Texas Roadhouse dropped off 100 dinners for our employees. Great Southern [Bank]'s Joe Turner reached out to me and said, "Can you use N95 masks? We have 4,000 of them." Hal Higdon at OTC said, "Hey, before we inventory all this stock, how about you come over and just grab it?" They brought ventilators and PPE and all kinds of monitors and all kinds of equipment. College of the Ozarks has done the same, Evangel has done the same, MSU has offered. A good friend of mine, Charles Taylor, who's on our school board, he texted me and said, "My dad was a woodworker. He's got N95 masks. I know that he would have wanted them put to good use." The [Springfield] Contractors Association is trying to rally getting resources for us. Harbor Freight nationwide said we're just going to give (masks) all away.

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