>>BOB ZALTSBERG: This is Noon Edition on WFIU. I'm Bob Zaltsberg. We're doing the show remotely today to avoid the risk of spreading infection. We're spread over six different locations, coasting with Sara Wittmeyer, the WFIU news director. And we're gonna be getting updates from hospital officials on what their facilities have been doing in the last few weeks to prepare. We have three guests with us. Two are going to be joining us the first of the show. We'll have a third later on in the program. Dr. Dan Handel is back with us again. He's the chief medical officer IU Health South Central region. And Brenda Reetz is the CEO of Greene County General Hospital. If you want to follow us on Twitter, the handle is at Noon Edition. You can also send us questions there. Or you can send us questions for the show at news at Indiana Public Media dot org. We're not able to take your phone calls today because we are spread all over the place. Thanks for joining us though. So Dr. Handel I wanted to touch base with you first because you've been on the program a couple times already. Where are we in this pandemic? What are you seeing at IU Health facilities? 

>>DAN HANDEL: Well thanks for having me back. I - you know I kind of would describe this as kind of the calm before the storm. We're holding steady right now in terms of the numbers and the daily numbers. Not only at that Bloomington Hospital, but across IU Health. I think we're doing well in terms of our resources and our staff and our supplies. We're just kind of waiting for for the next the next steps and the surge that we're anticipating in the next one to two weeks. 

>>BOB ZALTSBERG: So can I follow up and ask how does that sort of equate to what Sir Whitmire just said on the news that the state saw fifty five more deaths and now it's at three hundred? It seems like the death rate is certainly going up fairly rapidly and has been this week. 

>>DAN HANDEL: Well you know I think one - I encourage anyone if they haven't looked at it already to look at the Indiana State Department of Health website. I think there's two numbers to look at. There's that the total amounts but also the daily amounts. And one of the things I'm looking at day to day are the total number of positive cases, new positive cases increasing or holding steady. And actually if you look over the past week or so the number of new cases on a daily basis is held relatively steady across the state. And that goes for deaths as well. So you know we've done a lot of work across the state from social distancing ourselves. I think the challenge for us over the next one to two weeks is really staying intentional about it. And I know it's hard particularly as the weather gets warmer for people. But you know the hardest days are ahead of us. And I think it's just maintaining that discipline to keep this up for the next few weeks. 

>>BOB ZALTSBERG: All right. So Brenda Reetz is joining us. She's the CEO of Green County General Hospital. So you know we've heard a lot about how rural communities - and Green County is certainly more rural than a lot of the IU Health Communities, although IU Health has some facilities in smaller communities as well. But you know what - how are you doing just in general like Greene County General Hospital? 

>>BRENDA REETZ: I don't think we're doing much different than Dr. Handel just talked about. I mean it's - we are - we've prepared as much as we can. We're doing OK right now on resources as well. And really for the rural communities, it's kind of proportionate to - we have a proportionate number of patients to the size of our facilities and the resources that we have. I think our community has done a good job with social distancing here that - doing the best that we can. And we are seeing positive cases. And we have right now the resources to take care of those. And like - just like IU health, we are prepared for that surge as well, waiting for it to happen here in the next couple of weeks. It's hard to tell when it's really going to happen. And when our community does the social distancing really well I, think we continue to delay and flatten that surge that we will have which is a good thing. But one of the challenges we have here is preparing for that surge to - kind of the difference with rural is that there's not a lot of depth to our resources. So right now our resources are OK. And we've - part of our preparation has been to try to add depth to those resources. But it's - you know if we have very many employees get sick, we don't have a lot of - a huge staff to kind of fall back on. So those are the challenges that we have that I think are somewhat different here in the rural communities. 

>>BOB ZALTSBERG: Yeah. So I want to follow up on that and dig a little deeper. Both of you and Dr. Handel said, you know, preparing for the surge - I mean, what's that mean? Are you just getting as many PPE's and as many ventilators and as many masks as you can and get them put aside so that you have the equipment when and if the surge hits? 

>>BRENDA REETZ: Yes. So a lot of it has been just trying to build up our current stock of - you know when we're talking about PPE it's building up what we have available. And then the other part of preparing with that PPE is making sure that we are properly using it now and conserving what we have so that it lasts as long as possible. We don't know how much more we're going to be able to get. We don't know if we're gonna be able to replenish the stock that we have. So we're trying to just get our stock as big as we can and then conserve what we have and properly use it. So in terms of PPE that's the preparation we've gone through. And then ventilators - we have been able to basically double the number of ventilators that we have here in house by renting from some different places and acquiring some from organizations that have them but won't necessarily need them. So ventilator - you know increasing that. The other is just increasing the number of beds that we have in the hospital as a critical access hospital. By CMS regulations we can only have 25 beds. But that regulation has been waived during a situation like this. So we're able to increase the number of beds. And we've increased our surge capacity to be 40 beds. And we've actually been able to - because we have one unit that is typically our medical surgical unit. We've been able to open an additional unit. So we are able to separate the infectious and non-infectious patients from each other, which has been a benefit. And then that also - because it doubled our volume of patients that we can handle. So that's a lot of the surge prep that we have done. 

>>BOB ZALTSBERG: So when you say you've doubled the number of ventilators, how many did you have before? And how many have you added? 

>>BRENDA REETZ: We have eight now. 

>>BOB ZALTSBERG: OK. All right. Dr. Handel can you go through the same kind of preparation for us? 

>>DAN HANDEL: Absolutely. I mean it parallels exactly what Brenda was talking about. And what we're doing is we've done a lot of drills about our search planning saying OK. If we're at this volume of patients what do we need for that? When we get to the next level what do we need? So it's not only the ventilators and the beds but also our staffing. You know we're also anticipating if people get sick during this process, what is our backup plan? And you know one of the things we've done is we significantly curtailed our outpatient visits which gives us a workforce of people who normally work in the clinic setting. And we're retraining them up to do inpatient hospital work as well. That includes our operating rooms as well, teams that normally work in the OR. And how do we pull them into our inpatient staffing? So as with any situation like this you can't prepare too much. And so we have a Plan A, a Plan B, a Plan C, etc.. And we've worked through every possible scenario we can think of based on best case and worst case scenarios in terms of how we would address it. So that - when the moment arises, we know exactly what we want to do based on our previous plans and drills. 

>>BOB ZALTSBERG: How have you kept your staffing levels? Have you had people who've fallen ill? 

>>DAN HANDEL: Very, very few. I think you know probably about two weeks ago we implemented universal masking of all of our staff at any patient care area. And I think that's gone long way in addition to universal universal masking of patients who present to our emergency departments. I mean we learned early on - we thought that the typical symptoms for this were primarily respiratory nature. But we realized there were a myriad of other symptoms as well. So out of an abundance of caution, as patients show up to our emergency departments, we've been much more intentional about masking. That protects the patients when they show up but also our team members as well. So you know it's a very small percentage of our team members who are out. And you know we're trying - and we're doing everything we can to make sure that we keep them as healthy as possible for a multitude of reasons. 

>>BOB ZALTSBERG: You're listening to noon edition on WFIU. And we have some health experts with us today. So if you have questions about the coronavirus and what's going on at this point, what to expect, how to protect yourself, anything like that, please give us - don't give us call but please send us an email. News at Indiana Public Media dot org. You can also follow us on Twitter at Noon Edition. So what about testing? How - you know we've been through - Dr. Handel, we've been through times when there were no tests available to what's the status now? 

>>DAN HANDEL: We're trying to - you know initially the state was the sole testing source. And that's been shared with facilities around the state. So IU Health is trying to expand their capacity as fast as they can. So as our internal testing capabilities expand we've obviously expanded our ability to test different populations. We started out testing just health care workers and people who were sick enough to get - admitted to the hospital. We've expanded that to our patients who are at high risk in the outpatient setting as well and working in certain markets with first responders and so forth and also non IU health health care workers. So as quickly as we can scale up our testing capabilities we are expanding that to larger and larger cohorts of our population to meet their needs. 

>>BOB ZALTSBERG: How about in Green County? 

>>BRENDA REETZ: We follow the same guidance. And we have been able to - we were fortunately already partnered with lab corps as a reference lab. And so very early on we were able to start sending our swabs or testing to lab corps. So we've been working with the states as well either doing state testing or sending to lab corps. And I think the frustration with the testing very initially on was the turnaround time for us to get the results back. That's - we're seeing a lot of improvement with that, particularly with the state test. And it's it's the same as we were very restrictive I think in the beginning on testing because, one, supplies were very limited and resources were limited. And now as we are getting more supplies and ability to test how we are - we're really ramping that up and testing a lot more people than we were. 

>>BOB ZALTSBERG: OK. Sara. 

>>SARA WITTMEYER: How are you handling contact tracing then in those cases if somebody does return with a positive test. 

>>BRENDA REETZ: For us here in Green County that's all handled by our local health department. 

>>DAN HANDEL: What we're doing from an IU health perspective - we work with are our infection prevention teams that are employee health so that we're following the CDC criteria. If people - if team members do test positive in terms of first of all making sure that they are doing well from a health perspective but also appropriate according to cautions and following those so that we're very intentional in minimizing their risk of spreading to others but also making sure that when they are better that they're safe to return to work. 

>>BOB ZALTSBERG: So both of you work with a lot of health care professionals. And we've seen a lot of news reports about the stress that they're under. How can people help the health care professionals in Green County or in any of the areas where IU Health has facilities? Brenda could you answer that first? 

>>BRENDA REETZ: Yeah. I think here we've had a lot of community support coming in with you know even ordering pizzas for our staff, all kind of things like that plus sending in just kind of comfort items is what we call them for our employees. And I think just the staff knowing that the community is really looking at them as heroes and that they're on the front lines and there's that acknowledgement in the community has been huge for our staff. It just gives them the sense that people care and they know why we're here. And then in here at the hospital too we tried to do as much as we can to reduce the stress of coming to work and whether that's making sure that everyone has has a warm meal or even if we can send food homeless people because they can't cook dinner for the families or they can't go to the grocery store. So having food here that they can get instead of running to the grocery store - those kind of things that we're trying to do - provide scrubs for them and provide laundry services for them. Those are the kind of things that we've received some community support to be able to do some of that, whether donations are coming into the hospital or otherwise. It's just that I think general sense of knowing that the community cares and the community appreciates what they're doing helps a lot. 

>>BOB ZALTSBERG: I know Dr. Handel you provided for us an email address or a web address before. So it's IU Health dot org slash donate hyphen COVID hyphen 19. We can put down on our Web site. But what are you hoping? Or what can people donate? What can people provide for you? 

>>DAN HANDEL: I think it's anything - that's to our IU health foundation, anything from money to food to medical equipment. Anything is greatly appreciated. And I mean I echo Brenda. I couldn't be more touched by the support we've gotten not only in our region but across the state. You know it really is. It's really kind of emotional when you see these local businesses who are hurting themselves. But they're not thinking of themselves. And they're thinking of how they can support the community. So I mean I think it's nothing short of amazing in terms of the outpouring of support. You know the other thing too is if people are making homemade masks. And if you're in the Bloomington area, our IU Health Community Center on 3 3 3 Miller Drive is accepting masks and everything from things that people are making at home. And then they'll make sure it gets out to the people who need it most. So there's no shortage of opportunities. And I think more importantly really appreciative of all the support we've gotten. 

>>BOB ZALTSBERG: All right. Sara? 

>>SARA WITTMEYER: We got a question from Joan. And here's what she says. It seems like we won't be able to come out of social isolation until we get the testing situation under control. Why is the US so far behind other countries in testing? What needs to be done to get this problem solved? And I should say Indiana - we did a study this week that Indiana is doing less testing per capita than all the neighboring states as well. So Dr. Handel do you want to - can you talk a little bit more about testing? 

>>DAN HANDEL: Yeah. I think it's an interesting experiment to look at the different countries around the world and those who have more or less robust community health or public health infrastructures. I mean, I think one thing - not only us as a state but as a nation as we come out of this, I think it's a big wakeup call that I think we need to look at how we better invest from a public health perspective. And it's not only just a conversation for this but also kind of as we look at how we provide our cost effective and higher value care down the road. So yeah. I mean I think we are - I think both Brenda and I you know as many people as we could test we would. It's just we're limited by the amount of tests that we can do at this time. 

>>BOB ZALTSBERG: All right. We're being joined now by Dr. Aaron Ermel. He's the IU School of Medicine clinical service line leader for the Division of Infectious Diseases. Thanks for being with us. 

>>AARON ERMEL: Thank you. 

>>BOB ZALTSBERG: So I guess I want to ask you first about what we're seeing. Has social distancing then really help us get this under control? 

>>AARON ERMEL: Well it's a little early to tell. Though if we've looked over the last few days in our systems, at least downtown's admissions, we've seen a gradual decrease over the last four to five days. I think this trend statewide is also being seen. Clearly in certain areas we will see pockets although we continue to covid related admissions. But overall as we follow the metrics - and kind of one of the more important ones to follow is new cases - that trend is starting to flatten out over time. So we think that the major reason for this is partly the social distancing measures that actually Indiana started a little bit earlier than some other states. 

>>BOB ZALTSBERG: So as an infectious disease expert I mean what advice would you give people you know as we go into these next weeks which a lot of leaders have said are particularly critical to stopping the spread of the disease. 

>>AARON ERMEL: Well to continue to practice the social distancing measures that we've been trying to counsel people on - I mean this is kind of one of our best I guess weapons against this disease if you look at something the community can actually do. So if the community wants to participate I think trying to continue to follow these measures as well will continue to flatten out what we're seeing as far as new cases and allow us to spread that out over time. It's really hard I think from the public to see that - to make an intervention. Sometimes there's that feeling of being helpless. But I think following these measures and following the guidance is probably one of the best things they can do. 

>>BOB ZALTSBERG: All right. Let me give our phone - or the way to contact us again at Noon Edition is our Twitter handle. If you have a question or comment you can send it there. Or you can send it to news at Indiana Public Media dot org. Dr. Ermel are there particular areas of Indiana that - where people should pay particular attention. I mean we know that Indianapolis has been very hard hit. There are other areas that have been maybe harder hit in terms of just population. 

>>AARON ERMEL: Right. So I would say that actually - you know right behind if you just look at the county level - right behind in Minneapolis if you look at Lake County and then also Hamilton County we've seen more cases. Now there's a lot that goes into seeing cases because you know the number of tests and things that people run. But if you also think of where those counties are located they're located next to other major population centers. So Lake County being right next to Chicago and then Hamilton County being just north of Indianapolis and where you know some of the first cases were - so those are kind of some of our higher areas. Again some of this reflects like - there are lots of testing or lack of testing. But those are the two areas that have seen the greatest increase. 

>>BOB ZALTSBERG: This is question for any of you really that actually came in through our city limits project. But people want to know should they be wearing a mask and should they be wearing gloves when they go out in public? 

>>AARON ERMEL: Well... 

>>BOB ZALTSBERG: Brenda. 

>>BRENDA REETZ: Yeah. So we talked about this yesterday. I think the CDC guidance now is that if you can wear a mask in public it is best. But it's the fabric homemade masks don't use the medical grade surgical masks or N95s. Those need to be reserved for health care workers and working directly in facilities. So community members are advised to wear a fabric mask when they're out in public. And the glove topic - it comes out just because the gloves won't protect the general community from cross contamination. And cross contamination is a real problem. That's whenever - you walk into a store. And you touch a grocery cart. And the person right before you had covid. And they sneezed all over the grocery cart. Now you touch that. And it's on your hands. And it's going to be on your hands whether you have gloves or don't have gloves. It's all about sanitizing after touching surfaces that could be contaminated and that the gloves don't change that situation. So that's where - the gloves aren't necessarily that beneficial in the community. It's more about sanitization of your hands and avoiding contact with surfaces that could be contaminated. 

>>DAN HANDEL: But I think the mask also is really important if people are in situations where they can't separate themselves by 6 feet. The State Department of Health did put out some guidelines a couple days ago about that as well. So now I completely agree. And I think the biggest risk to also with people touching things whether they're gloves or not is our natural propensity for touching our faces. And that's really kind of how this virus spreads if someone touches a contaminated surface and then touches their face. So that's - I think a hand hygiene is still central whether people wearing gloves or not. 

>>BOB ZALTSBERG: Sara. 

>>SARA WITTMEYER: We've got a question from Lily wanting to know do you anticipate the need to use either retired nurses and physicians or new grads to help with staffing during the surge? Do you want to start Dr. Handel? 

>>DAN HANDEL: You know we talk about our contingency plans. I think one of the nice things about IU health being as big as is that we've not only talked through surge plans within our hospitals and our regions but across the system. So for example if Indianapolis hits the surge before the rest of this state then we have opportunities to pull people from different parts of the state to support them and then vice versa. I do appreciate the school nurse nursing through IU Ivy Tech and other nursing schools did graduate. They're nursing students early to school Medicine graduate students early as well. So there - I think as people are getting trained up in the workforce they're going to do so. And you know we've had a strong outpouring from our local medical societies as well. That's one of our contingency plans. But it's not at the top of the list. But we do have it in as another tool, a tool in our toolbelt if we need to use it. 

>>SARA WITTMEYER: And what about in Green County? 

>>BRENDA REETZ: Yeah. I think we don't have that ability to pull from other locations. We're kind of self-sustaining here. So we have looked at that as an option. I think one of our first line defenses though is if we have those surges - we've talked about implementing team care to try to just extend the nursing abilities there and partnering a nurse with maybe other staff that can kind of expand the abilities of what the nurse can do in terms of providing patient care and really reserving the nurses for the care that has to be performed by a nurse. So I think what we will see before we actually start bringing in retired staff is going to be more of that that team approach to care and pulling from the areas just like Dr. Handel said of where we've closed outpatient procedure areas where we can pull that staff in for a team approach. But we definitely - we've received a list from the Indiana State Department of Health for the volunteer workers that would be willing to come in. And we have that available. We've also talked to our staff about expanding their hours, working kind of typical shifts that they wouldn't necessarily work. And those are the things that we are doing first before we would implement something like that. But it's by no means off the table. 

>>SARA WITTMEYER: We got a follow up question as well. I'm not quite sure if you'd be able to answer it. But the question is are doctors, nurses, health care workers - are they allowed to talk freely just about how things are operating in hospitals and then what the person calls the terrible lack of testing? 

>>DAN HANDEL: I guess I'll start. I mean I think it's always it's a fine balance. It's important that we maintain patient privacy. And so I think that's - obviously I'm a practicing emergency physician myself. So you know what I can tell you when I worked three shifts in three of our emergency departments over the last week you know it's a intense environment to be in there. And I think that I want to respect people's ability to kind of debrief from that. But we just also have to be mindful that we are still taking care of patients and maintaining their privacy. So I think it's fine for people to talk. We just got to make sure that the privacy of our patients is of the utmost importance. 

>>BRENDA REETZ: Well I can address as well if you're talking about some of the operations of how we are changing operations in the facilities and what our plans are and talking about those. I think that's one really good thing that has come of all of this is that the facilities and all our talking - I've probably communicated more with other health care facilities throughout the state more than I typically would. And it's really that we are all collaborating to make sure that the whole state is taking care of and that there's nothing proprietary during this time. And so in terms of operations and tips and tricks that we found and how we get through it and sharing of resources - there's there's more of that going on than I've ever seen on health care which I think is phenomenal. 

>>BOB ZALTSBERG: All right. Dr. Ermel I wanted to ask - we have one question. And I know there there's been I guess hope that warmer weather might have some impact on this virus. Is there any evidence to show? 

>>AARON ERMEL: Yeah. I mean not as of yet. You know we've seen some increase in our local temperatures. And our case rates have been relatively the same. I think you can't - it's even actually hard to look across the US where there's pockets in the south that aren't as affected but yet other states like Florida and Louisiana that are suffering even more than we are. Whether this was due to other social movement or population density it's really unclear. Other countries that are right now experiencing their summers or warmer weather than we are are still seeing a pretty large number of cases. And unfortunately some of those countries aren't really even testing. So it's still difficult to pull the numbers. So I'm not too I guess too confident in warmer weather helping at this point. I'm just - maybe it will be more seasonal. But I think with such a new virus and the way it's moving to the population I won't be counting on the weather too much. 

>>BOB ZALTSBERG: We had Dr. Tom Rosmallis. o a couple of weeks ago. And I think there had just been some studies out about how long the virus could last just in the open air. There've been things floating around on social media about runners and bicyclists and not getting too close to another runner and other cyclists. What's the latest science on whether you could get the virus just through contact in the air? 

>>AARON ERMEL: Right. So most of the studies there's kind of a nice paper that came out in nature medicine just within the last four or five days. They actually tried to quantify this and to see how long it would last. I mean clearly the longest duration is with aerosolized particles. So when they tried to stimulate this in the lab that was how they got those - the few hour duration. I think outside contamination is a little hard simply because that's - that environment's very different where you have different air movement. It's not quite our laboratory models. So yes. I've seen some of those studies where they're trying to replicate this though I don't know that that's the mode of transmission now that we're worried about. And I think this has been mentioned before. I mean some of this - we're already trying to distance people. But it was really like stationary distance maintaining kind of those close contacts. I don't know that running and biking are going to be as problematic though we're still recommending that people space themselves out. 

>>BOB ZALTSBERG: All right. So if you have a question you can give us an e-mail, news that Indiana Public Media dot org. You can also follow us on Twitter and send questions out way at noon edition. We remind you of who we have lined up today to talk to you, three experts in the area. Dr. Dan Handel, chief medical officer for IU Health South Central region, Brenda Reetz, who's the CEO of Green County General Hospital and Aaron Ermel who is an M.D. He's with the IU School of Medicine, clinical service line leader for the Division of Infectious Diseases. So again let me ask about about data that you may or may not have. But when all the people who have tested positive and then - and the 300 people who now died in Indiana. When when you look at them as a group, what specific things come out to you? I mean the - with the deaths I know the age and underlying conditions have been considered the biggest things. Are you seeing anything different from that? Or is it just sticking to the form? 

>>AARON ERMEL: Well you know so when we look at the deaths - actually over time as we look at our trends we're pretty much matching the age considerations that were taken you know very early on in the disease. So if you look at people 16 above this is the vast majority of our deaths. But what I think has really over the last couple of weeks as we've accrued more data come out over time is that males are disproportionately affected. So we're seeing - right now if you just look at our State Department of Health Web site we males are sixty two percent of the deaths in this state. And it was a little bit closer to 50 50 a couple of weeks ago. And now we've seen that spread. So that's been the trends the whole time. So age is held up. And then now our disparity in gender is starting to appear. 

>>BOB ZALTSBERG: OK. Anything just about contact and about getting the disease, testing positive? Any data about that? 

>>AARON ERMEL: Right. So I think this one thing that has made something of the contact tracing those things difficult has been lack of testing and this has been very hard to do out in the community which we're just now starting to do because the majority of our testing really comes from hospital based testing which doesn't allow you quite the detailed epidemiologic investigation. So outside of at least in Indiana we have yet to report some of our larger like the assisted living facility type outbreaks even though there may be some but not quite those events like we've had in other areas. So - and we are starting to screen our jails and things as well so other areas where people are I guess in high density living situation. So we're still - we still haven't seen quite those yet and we're just now starting to get a feel as to disease in the community. 

>>BOB ZALTSBERG: Sara. 

>>SARA WITTMEYER: With testing we had a question about whether that is something that is going to be covered by insurance or if somebody has had contact with somebody who tests positive. And then it's recommended they get tested? Is that something they're going to have to pay for potentially out of pocket. 

>>DAN HANDEL: I've seen - I mean, I - for example, our own health insurance plan for IU health that we've been very - IU health plans - we've been very intentional saying there's no out-of-pocket cost to our team members and those on IU health plans. I've seen other insurers like United and others who have taken similar stances for - covered from an insurance standpoint. I don't know if there's universal mandate at this point in terms of how it's covered by insurance plans. But I'm sure that will quickly materialize in the next couple of weeks. 

>>BOB ZALTSBERG: We had a follow up to the question about whether people can speak freely. And I'm just gonna be blunt because the questioner was. And the questioner asked are doctors, physicians being muzzled about what's actually going on in the hospitals? 

>>DAN HANDEL: I don't - I can tell you not from our perspective as I said. I mean I think we are very intentional in terms of how we communicate not only with our physicians and our other team members in being very proactive at making sure that they have the appropriate amount of personal protective equipment or PPE. You know I have seen those reports around the country. And it's a little concerning to me not only as a hospital leader but also as a physician. You know as I said I think we should be mindful that we strike the balance of hearing people's concerns but at the same time making sure that are our patients privacies are maintained. And you'll know that we don't we don't comment on specific patients. We comment on what's reported through the State Department of Health. And that's very intentional to make sure we maintain patient privacy. 

>>BOB ZALTSBERG: So let me ask you this question because you know every physician I think I've ever come in contact with had a pretty good sense of confidence about them. So I would think it would be kind of difficult if a physician wanted to speak out to whoever he want to speak out to her she wanted to speak out too. I think it would be difficult to muzzle a whole group. 

>>DAN HANDEL: Oh yeah. You know one of the things we do within our region. So every evening I get on a call with all our medical staff members across the region. We have an open forum and open dialogue. So not only do I connect with them daily to make sure they have the latest information because this is such a rapidly evolving process. But it's an open forum for them to reach - to give me feedback in saying OK Dan. This is what's working from our perspective. This is what we can do better. And we've been doing this for probably two or three weeks now. And having that dialogue has been essential to really connect - connect with all our medical staff across the region. You're right. They're not shy people at all. 

>>BOB ZALTSBERG: All right. Well again if you have a question - our listeners if you have a question, we have three health experts with us. News at Indiana Public Media dot org and Twitter at noon edition. We can't take your phone calls today. So Brenda I wanted to ask you - Brenda Reetz is CEO of Green County General Hospital. Again we've heard a lot about rural health care in rural communities. What kind of a financial - longterm financial impact might this have on your health care facility. 

>>BRENDA REETZ: That's yet to be determined of course. But initially that was one of our big concerns, especially when you're talking about canceling outpatient procedures and elective surgeries and even your nonessential outpatient visits. It's - that took away when I'm looking back at our revenue for last month, we were down by about 25 percent. And so if you equate, we were only working to this process about half the month. And we're taking it personally 50 percent revenue loss right now. And that's not something that we can afford. I don't think there's any hospital in the country that can afford a 50 percent revenue loss. So it's - it is challenging. I have been very impressed with the federal government's responsiveness to all of this and to get funding available and to us. We were - we've actually received just today - in our direct deposit from Medicare we did receive our first payment from the stimulus fund that the care acts that I'm sure most of you would be aware of. So we've received our first payment from that. And it's definitely going to help. It's not going to be something that definitely secures our future. There's still a lot to be mitigated through all of this. And even I think the unwinding of all of this, when we get on the other side of this pandemic, that properly unwinding is what's going to be the challenging part and to be very strategic about that so that it doesn't have an even greater financial impact on us. But there's still a lot to work through. But there's a - I have been impressed with the support that we've gotten from all of our federal and state support on that. 

>>BOB ZALTSBERG: Dr. Handel, how about with your hospitals and the IU system? 

>>DAN HANDEL: It's the exact same thing. I mean I think we have the benefit of being able to lean - our small hospitals are able to lean on the system at large about, how do we make sure that we make ends meet? And we just talk down - we have a daily incident command call we just talked about this morning about the similar stimulus. But I mean I just think not only for my health and from a larger state perspective I worry about our smaller hospitals or independent hospitals because they serve a vital role to meet the needs of our citizens across the state and making sure that we support them through this to make sure that they're still able to do so after we get past this. 

>>BOB ZALTSBERG: All right. So Dr. Ermel, what - with the all the religious holidays coming up, I mean, how difficult does that - or what what's that add to the you know the degree of difficulty for social distancing issue? 

>>AARON ERMEL: Right. So I think that's what it does is it adds kind of that other layer of kind of temptation to wanting to return to normalcy? So you know all of us getting - who celebrate Easter would normally gather with our families and larger groups, families who normally are not together that are separated. And you will want to get together as you've done every other year. And for some people they might look to this as the first opportunity to get back to our usual lives. And I think that's what the challenge is as it's going to be trying to maintain that separation during a time that is so so celebrated, that people enjoy. So I think it's trying to make the best of it. But that really right now understanding that's in the long term probably not celebrating that holiday or not gathering will be the better option. 

>>BOB ZALTSBERG: In a sort of a related way you know nursing homes are really getting hit pretty hard with this. And that would be a time when a lot of family would would be going to visit with their older relatives around the holidays. So can you talk a little bit about the state of Indiana's long term care facilities and nursing homes and what they can do to make sure and protect the people that live there? 

>>AARON ERMEL: Right. I mean you know a lot of the earlier outbreaks can partially be traced back to maybe sick individuals who had entered the long term care facility before we really understood how covid was transmitted or that we knew there were so many cases here in the US. And I think trying to maintain that separation and not expose is probably the best thing you can do for your loved ones in that care facility. You know I mean because that would actually be much more harm than I think even the benefit of visiting them would provide. So it really - again it's trying to maintain that trying to maintain contact in other ways. I think we've all had to adapt in trying to find other ways to make contact with loved ones. I know Zoom has become popular and not necessarily the substitute that we all wanted. But I mean it's trying to do that - I mean those things so that people you don't forget about people. But again trying to understand their safety is important in staying out of those. And that's only reflected in the you know the ages that we see most affected by this disease. You know who develops a severe disease? And that's those elderly individuals that we would go visit. 

>>BOB ZALTSBERG: Brenda have you seen anything that's different in a rural communities? One thing that I think about is how the schools are such a focal point in rural communities. 

>>BRENDA REETZ: Yeah. Fortunately, all of our schools in Green County have the ability for e-learning. And so that was a pretty quick and easy decision, I shouldn't say easy. But it was operationally it worked because all the pieces were in place to move to e-learning fairly quick. And in kind of talking about the schools in the nursing home, a relation that we have there is that we have school based telehealth units in all of our schools throughout Green County. And that's where we can see the students from the school-nurse compliment. And it's a diagnostic unit so the kids can be seen from the school. What we've done now that the schools are closed is that we have moved those telehealth units to be - sorry my phone's ringing. We've moved those telehealth units to now be in the nursing homes. So our - we have a sniff allergist. She's a physician that only sees patients in a nursing home. They've been able to - he's been able to see those patients without entering the facility. So trying to limit the exposure. So it's been nice to be able to move that out of the school, put it in the nursing homes and have that diagnostic telehealth available. 

>>SARA WITTMEYER: Doctor Handel how is the coronavirus affecting other operations within the hospital? For example if someone comes in to deliver a baby, are they allowed to bring their spouse with them or are there restrictions on those kinds of things? 

>>DAN HANDEL: Well we've across the board - we've implemented visitor restrictions. So we people still have babies. And people have other medical issues that we need to address that still we've been restricted where we allow one significant other with a laboring mom. So yeah. So but the important thing is we're being intentional about it. We're screening everyone when they come through the front door to make sure they're not exhibiting symptoms. I think one of the other things we've done to kind of follow up on Brenda's point is that technology is a good tool. On our patient experience team it's been very deliberate about deploying iPads throughout our inpatient settings so that when patients are hospitalized and they can't have visitors we still have that connection by video and by audio with their loved ones on a daily basis so that they can still connect even if they physically can't be there in person. 

>>SARA WITTMEYER: I'm sorry. I think we think we may have lost Bob for just a minute. I know New York State and some other hospitals have issued restrictions about if you are pregnant your spouse can't come. But that's not the case right now. I just wanna make sure. 

>>DAN HANDEL: Yeah. I can say for IU health that is not the case. We do allow one significant other at this time based on our guidelines and that's consistent across our system. And Brenda perhaps you can start. Just I would like to get a better understanding of how this is different in terms of how your staff is treating folks who have this virus as compared to other illnesses that you all are used to dealing with? 

>>BRENDA REETZ: Yeah. I don't know that we treat it any different from a kind of a social perspective. It's - I think one of the challenges that our nurses are seeing in caring for these patients is these are members of our community in a small town. We know a lot of our patients. But they can't recognize us. And it makes it even more frightening for the patients because we have so much PPE on. And so you're not seeing familiar faces. And so some of that has been a challenge of helping the patients understand. So we're implementing where we can have pictures that we can hand the patients to show them this is who's is caring for you. And I think it's a challenge. Nurses are very, very hands on. And you can't be as hands on as you typically would in this scenario. And so I think that just disconnect that we are forced to have somewhat from a physical standpoint is a little bit hard on our staff. But otherwise you know we're gonna be at the bedside when they need us to be there. And we're providing that same level of care from a compassionate standpoint even though it doesn't feel as touchy feely I guess as a nurse would typically experience. 

>>SARA WITTMEYER: And the same thing is at IU? 

>>DAN HANDEL: Absolutely. And I - it's trying to strike a balance of making sure we're keeping people safe but still having that personal connection. You know, it's interesting when I've been taking care of patients over the last week you know how much you can emote your your feelings through kind of eye gestures but you know when you're your face is otherwise covered. So I think we have to be even more intentional how we communicate with people because people can't otherwise see our typical body language. 

>>SARA WITTMEYER: Dr. Ermel we got a question that I think is for you. Just someone is saying, how safe is it to go visit someone if you do practice social distancing? 

>>AARON ERMEL: Well I'm not sure. Well that question is kind of complicated because if you're practicing social distancing you're probably not visiting someone. But if you're going to someone who is actually trying to maintain a group of like one on one and someone who is hopefully not in common contact. I mean right now unfortunately trying to determine how safe that is is still quite difficult since we're still measuring new cases. But we've kind of suggested that people outside their immediate family with whom they live do not - like do not congregate and that in that way. So it's - I can't say it's entirely unsafe. But it does raise your risk of potential exposure. 

>>SARA WITTMEYER: Well even if you are no more than six feet apart or something, you just still shouldn't do it. 

>>AARON ERMEL: Yeah. You probably shouldn't. I mean there's been groups who have tried to I guess form small social gatherings and then maintain that six feet. But I think, one, it might be a little hard to maintain that over time or at least trying to limit that contact time there as well because not only is it distance. It's also time with that person. So that would increase your risk as well. So I think it's trying to maintain that six feet. But really I think it's still - it's hard to always maintain that six feet. And that's something. 

>>SARA WITTMEYER: We only have a couple of minutes left here and a few more questions to get to. This one is also for you Doctor - says we live in a farm - we live on a farm in Hancock County. And then it looks like they also own a place in South Carolina. Is it OK for them to go there in May? 

>>DAN HANDEL: Yeah. So when we placed all the travel restrictions in the country even though they were - there are no I guess formal restrictions as far as no one's going to stop you going from state to state, we still were kind of discouraging transport even by car, not because you'll be infected in the car with the people that you know. But it's actually moving to another community to another level of exposure or potentially bringing something with you. So we're still discouraging kind of the interstate travel by any means right now. Hopefully that will be one of the first things that are lifted as we see - as we see cases decrease over time. But that's still the recommendation. 

>>BOB ZALTSBERG: Well I think I'm back after a slight glitch. So I did want to ask about Whether there could be - I mean the idea of a second wave coming. I mean we've seen a lot about that now too. 

>>AARON ERMEL: Well I guess we are trying to plan. So as Dr Handel and Reetz have actually been explaining, our surge plans and even here downtown - I mean we're actually planning on subsequent waves just in case we've set up these I guess our workforce plans so that we have backups and we have that capacity. We've done various things that we've all discussed before. Whether we'll see a very very large second wave. I don't really know. I think what - and I haven't seen the latest models. But I think the biggest concern that I would have are actually just resurgent pockets, not necessarily a wave across the country but in areas where we'll see kind of micro outbreaks that will occur and that this will be something that we'll have to deal with. And even if it isn't until next season you know if this truly is a seasonal thing I think we will see that and have to be prepared for it. But I don't know that we'll see the same large wave as an outbreak. 

>>BOB ZALTSBERG: All right. I think - does somebody have a last comment because we're running out time? 

>>DAN HANDEL: I'll just - want to say I can't be more proud of our team members who have just to a T have stepped up to meet the needs of our communities. And I think this really kind of shows how invested people are in taking care of their neighbors and the population at large. It's been just nothing short of heartwarming and fantastic to see how people really stepped up to meet the challenge. 

>>BOB ZALTSBERG: All right. Thank you very much. That was Dr. Dan Handel from IU Health South Central region. We've also had Brenda Reetz CEO of Green County General Hospital and Aaron Ermel who's with the IU School of Medicine, the clinical service line leader for the Division of Infectious Diseases. Thank you all for joining us. It's been very very helpful. For our producers Ben DaButtie and John Bailey, for co-host Sara Wittmeyer, also for Matt Stonecipher for his health to the help today and engineer matt Paschcash. I'm Bob Zaltsberg. Thanks for listening.