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March 31, 2020 - Rudy Giuliani
26:02
BATTLE Against COVID-19 in Rural America, Interview with CEO of New Hampshire Hospital | PART 1
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It's our purpose to bring to bear the principle of common sense and rational discussion to the issues of our day.
America was created at a time of great turmoil, tremendous disagreements, anger, hatred.
There was a book written in 1776 that guided much of the discipline of thinking that brought us to the discovery of our freedoms, of our God-given freedoms.
It was Thomas Paine's Common Sense, written in 1776, one of the first American bestsellers in which Thomas Paine explained by rational principles the reason why these small colonies felt the necessity to separate from the powerful Kingdom of England and the King of England.
He explained their inherent desire for liberty, freedom, freedom of religion, freedom of speech, and he explained it in ways that were understandable to the people, to all of the people.
A great deal of the reason for America's constant ability to self-improve is because we are able to reason, we're able to talk to each other, we're able to listen to each other, and we're able to analyze.
We are able to apply our God-given common sense.
So let's do it.
It's Rudy Giuliani again, uh, back.
And we're going to have an interview with Dr. Maria Ryan, who is the CEO of Cottage Hospital in Woodsville, New Hampshire.
So this is a different kind of look at it.
We talked to Dr. Zelenko, who's treating a community of 35,000 people, very large, very densely populated.
So now we go to the experience that rural hospitals will have with this illness, because all the predictions are it's going to affect all of America.
So, Dr. Ryan is and has been the CEO of Cottage Hospital for about eight years and she has already had ten days of intense experience with this terrible illness.
So, let's see how she's doing it.
Have her tell us about herself.
Doctor, how are you?
Very well.
How are you, Mr. Giuliani?
I'm fine.
I'm fine.
I think I'll call you Maria, though, because you are a good friend.
So, Maria, are you doing well?
I am doing well, Rudy.
It is a unique situation in a rural area.
We're going to be the last one that gets support, per se, from the National Guard or the government, because we're not a densely populated area.
It doesn't mean we have to slack on regulatory issues or anything else.
And if we see sick, sick, sick COVID patients, we could easily get overwhelmed in our small size hospital.
But Cottage Hospital is unique in a number of ways.
Tell us where Cottage Hospital is geographically, so people get a sense of where we're talking about.
Yes, we are in New Hampshire.
We border Vermont.
We're in the northwest part of the state.
Very rural.
I serve 26 towns between New Hampshire and Vermont.
We're physically located in Woodsville, but we serve, like I said, about 50% of our volume is from Vermont.
Very unique population that we serve.
Hardy is all get out.
These people are hard workers.
Older population most of them have two and three jobs very self-sufficient
They don't seek health care until they're like These are these are these are quintessential Americans yes
quintessential what they call Yankees They call us good old Yankees.
Yeah, I know.
I always wondered how that Yankees is up there in New England and we have the team here in New York, but that's another matter.
Yeah, that's another conversation on another day.
But I'd like to tell you a little bit about Cottage.
So usually small rural hospitals depend on larger hospitals for everything.
They send a lot of cases to the larger hospitals.
They don't have sophisticated equipment because they can't afford it.
Let's face it, if the volume is that low, you can't afford a $2 million CAT scan.
But Cottage is a little bit different.
We are a designated trauma center.
And so we train and prepare for mass casualties all the time.
We also have a dedicated unit for bioterrorism, whether it's chemical or drug like anthrax or other sarin gas.
We took advantage of FEMA funding after 9-11 and during the 2009 H1N1.
So we drill, we have a decon unit, we have a place set up just for decontamination.
And we also, one of the things that we did really well is we stockpiled a lot of this protective personal equipment just for situations like this.
Now, why did you stockpile so much of it in a small, relatively small community?
And how much is so much?
Yeah, well, you go through it pretty quickly.
So we're theorizing, because we've got to remember, novel coronavirus means new.
The coronavirus family itself has been around for a long time, but this is a new strain, per se.
So we don't know a lot about it, haven't had time to analyze everything.
But one of the things that is coming out is that it is more contagious than, say, influenza virus.
Right.
You go through protective equipment very quickly.
Say you had one case that's hospitalized that suspected COVID-19.
You don't have the test results back, or even if you got the test results back, you have to use specific protective equipment whenever you go around that patient.
So you can, that's for one patient 24-7, so you can burn through stockpiles pretty darn quickly.
So in knowing how the community depends on this hospital for survival, not just health-wise, but economic survival, I need to do everything in my power to make sure we're ready for whatever comes our way.
And back in 2009, when we had the H1N1 pandemic, heck, that was a perfect time to prepare, get ready, and knowing we're going to have other pandemics that come.
Or chemical attacks or bioterrorism.
I wanted to make sure we had the right equipment right off the bat because as you can see in America right now, we've depended on China and India and we didn't have anybody manufacturing this stuff or very little people manufacturing this stuff in the United States and people are really suffering.
The New York hospitals are crying out for additional PPE.
So what is it?
Tell us the critical equipment that'd be involved here for the layman that they wouldn't know really.
There's different levels.
So if you're actually going to be in a patient room and do anything that that will cause the patient maybe to cough or do anything that's auralized, you have to use what's called a papper.
It's a powered air purifying respirator.
It's the big hoods you see in those science fiction movies.
You mean you have to have this on you as the health provider?
Correct.
If you're doing anything aerialized with that patient.
At the same time, that patient all the time when they're in their room should have a mask on.
Because they pass it by coughing, sneezing, or talking, and then it enters your mucous membranes through your mouth, nose, or eyes.
So, say you're done with any kind of aerialized, you know, treatment.
Right.
The regular get-up for a nurse or a doctor going into the room is an N95 mask.
It's a particular mask that fits to your face.
We actually fit test people.
It fits to your face so nothing gets in and around it.
You have to wear goggles or some kind of eye protection.
Wow!
My staff do the eye shield.
So the shield goes over your face.
A gown and gloves.
Now the least I'm concerned of if we were out of is a gown because you could just wash your clothes immediately leaving the patient room and put on new scrubs.
But really you need that mask, eye protection, gloves more than anything.
Now how, when you say running out of it, how many How many do you go through in a day?
One for each patient, or I guess one for each examination of the patient, right?
Well, pre-pandemic, the guidance was if you use an N95 on one patient, you would throw it away after you used it.
Now the CDC says you can reuse it for the entire day.
And then so you can use it for multiple patients now.
Can't use, obviously, gloves for multiple patients.
The minute you come out of the room, you gotta take off your gloves, wash your hands, put on new gloves.
So you're talking about the hood.
What you're saying now is... No, no, no.
This is not even the hood.
This is just a regular, what's called an N95 respirator.
It just goes over your nose, in your mouth, and it's fitted, so nothing comes in around it.
So you can use that for the entire day?
Now, and then you have to have another one the next day.
Yeah, so loosening these guidelines, and hopefully through research, that it's okay to do that, it's definitely helped.
So you can use one mask a day.
And is that okay?
Is that hygienic?
Does it present a risk?
You know, as long as it's not soiled or the patient, this might sound gross, but didn't vomit on you.
Obviously, anything soiled, everything comes off, gets discarded if it's disposable and you get all new stuff.
But if you're going in giving medications to the patient, the patient wasn't actively coughing, no, it's fine.
As long as you keep washing your hands and that N95 mask.
So the Big Papper one is only for very specific Things that, you know, you might need an aeralized treatment or anything.
Then going down, regular contact with a COVID-19 patient, N95 mask, goggles, gloves, gown, and that's really it.
What we're telling the public, when they come into the hospital, now this is in a hospital setting, The minute they come through the door, they're being greeted by a staff member.
They take their temperature.
They put on a surgical mask to that patient.
They may be coming in for an x-ray, and it couldn't wait.
Anybody that doesn't have anything critical or urgent, everybody got rescheduled.
But some people, you know, if they, you know, really twisted their ankle, it might be broke.
They need to come in.
They may not know they're sick or not, so that's why we're extra cautious and we put a mask on them.
So that you avoid their picking up something, right?
Or transmitting something.
Yeah, or them transmitting something.
So tell me the experience now of what you've seen.
What is this illness like?
How bad is it?
What are the first things you have to look for if you're worried about having it?
Just from a medical point of view.
Right.
We've been telling people if you have a cough, fever or any respiratory symptoms, To stay at home, to isolate.
I believe every state is doing this.
So this is important to understand numbers because people are looking at confirmed tests.
Yes, that's nice when we have confirmed ones, but we don't test everybody.
So it's important to know that there's a whole bunch of people that could be COVID-19 positive out there.
But we tell them if they have mild symptoms, don't even come into your doctor's office.
You call your doctor.
Your doctor gives you, you know, does an assessment over the phone, realizes you haven't traveled in any country.
You haven't been exposed to somebody with positive COVID-19.
You sound pretty good.
You're breathing good.
You stay home and you isolate for 14 days.
And they teach you how to stay home and isolate.
Like if you have a second bathroom, you're the only one that uses that bathroom.
You know, washing your hands.
Wearing a mask if you can when you're around your family members.
So there's a whole thing.
But we don't test everybody.
What do you consider mild?
What are mild symptoms?
You know, you have a cough.
A cough?
You have a low-grade fever that you can treat with Tylenol.
Certainly when you start getting in the realm of very high fevers and shortness of breath, And when do you go to the next stage?
So now the person has a cough, the person has a low-grade fever.
When does the person go to the next stage that you're more concerned about?
What's the next thing that they would have to look for?
We're definitely much more concerned if fever cannot come down with Tylenol or Motrin, but especially if you're having difficulty breathing.
That can become a medical emergency.
You call your doctor, they alert everyone you're coming in.
We prepare a negative pressure room.
We bring you immediately into the emergency department and start examining you, and we go from there.
The chest x-ray is very, very interesting, actually.
People who have severe cases of COVID-19 disease are showing a particular pattern in their chest x-rays, usually bilateral, both sides of the lungs, and it's glass-like.
The lungs look glass-like, is that what you're saying?
Yeah, yeah, on x-ray.
So even before you get the test, you're highly suspicious just on the chest x-ray.
So then you admit them to the hospital and take the regular treatment as you would for pneumonia.
But we also have protocols now because we want to avoid people Really getting really, really sick that they need a ventilator.
So there's great protocols that I know there's not been a lot of research on, but I've talked to a lot of doctors in the field who have treated mass numbers of COVID-19 patients, and they've had great success with hydroxychloroquine, azithromycin, Some are adding zinc and vitamin C to those cocktails.
So what you're saying is when these symptoms now show, the more severe ones, the fever can't come down, particularly trouble breathing.
Yeah.
I wouldn't want people to think, oh, I'm supposed to stay home and I can't breathe.
No, no, no.
You're going to the next phase.
We need to see you.
When do you start treating it as pneumonia?
Well, when they come in and their chest x-rays look like that, it is a type of viral pneumonia.
So these chest x-rays would determine whether you treat it like pneumonia?
Yeah, and there's two types of pneumonia.
There's viral and bacterial.
Right.
So bacterial, obviously, we treat with antibiotics.
The viral ones, we're treating with some of the antiviral medications in some of these label anti-malarial drugs.
But looking at... Go ahead.
Yeah, go ahead, I'm sorry.
Go ahead, dear doctor.
No, I was just going to start going into some of the numbers and some of the interesting things.
Actually, what I was interested in is when you checked around with doctors that are dealing with far larger numbers, they gave you some advice on treatments that seem to be working.
Yes, their treatments contain hydroxychloroquine, azithromycin, which is an antibiotic, And vitamin C and zinc.
And some are different.
I've talked to a number of doctors.
Some aren't adding in the zinc.
Some aren't adding in the vitamin C. But what seems to be consistent in the field from field doctors is hydroxychloroquine over the chloroquine and azithromycin.
And I really would like to see President Trump have some of these doctors who've been in the field Help share that information in the medical community.
Because their successes can help us.
Because as you notice, the way the virus spreads, right?
We know some places that are really fine right now, through travel, will start to get infected.
And we certainly can learn from the Seattles, from the New York City.
So it's important we share information.
Now in your hospital and then your state, tell us what the numbers are.
Yeah, in my hospital we've had to test a number of our community members, a number of our staff, and so far they've been negative.
But again, some people do not get tested.
They're presumed positive and we tell them to isolate.
In New Hampshire overall, remember we're a pretty small state, about 1.3 million people in the whole entire state.
We have 137 confirmed positives.
Again, knowing there's more positives out there.
137,000 confirmed?
No, no.
137.
Yeah, yeah.
Hospitalizations, 19.
And we've had one death from a COVID-related pneumonia.
Now, if I recall correctly, weren't there projections a week ago that these numbers would be significantly higher?
Yes, we did hear from one of our medical facilities that was doing some modeling at the time that it was going to hit now that between now and the next, you know, four or five days that we were going to have massive amounts of surges, which we haven't seen yet.
The state has some different modeling and they still think we're a week to two weeks out.
But this makes me very curious to look around me in all of New England, the six New England states, but I also have to pay attention to New York City.
Because we're a travel destination, especially in the north country of New Hampshire, you wouldn't believe it.
It's like we have lines of New York and Massachusetts people coming to the north country in droves with their trailers, you know, trying to flee the infected area.
So I have to keep an eye on, you know, how bad it is, what county they're from, as much as I can.
So what you're saying is that people from New York, which is the epicenter at this point, right?
Yes.
And let's say Boston and other parts of New England, where there are fairly large numbers.
So they're coming up, they're coming into New Hampshire with their recreational vehicles and trailers and like going to a trail park?
Or they're camping.
A large number own second homes here.
Now the thing I'm concerned is they have to remember they're supposed to self-isolate.
And I know everybody feels such great freedom when they come into the North Country of New Hampshire.
The woods, the mountains, the beauty, the sparseness.
You don't have dense populations.
But they are still going into Farmway.
They're still going to Walmart.
They're still going into places.
And they've got to remember they're supposed to self-isolate for 14 days.
Now, if you think of this logically, they're coming up here.
They don't have any food or any supplies.
They're going to go into the stores.
If they're responsible, they'll go into those stores wearing a mask.
Or they'll bring the supplies with them.
Yeah, or bring the supplies with them.
Yes, correct.
So, right now, if you... Right now, the protocol, I mean, it's recommended rather than enforced, is that if you leave New York and you go somewhere else, almost anywhere else, right?
You have to self-isolate for 14 days.
Because I guess it...
The numbers here are so large in New York that it's just presumed that you're going to be a carrier.
Of course.
Of course.
And this is what we say about the young people.
We don't want people to panic.
And if you get it and you're young and you're healthy, it'll feel like a typical flu.
So, yes, OK, we're not worried about you.
And actually, in some ways, it's good to get it over with because you're going to build antibodies to it and you won't get it again.
But the problem is, who are you going to give it to?
And that's when we're very scared of the elderly immunocompromised.
Gotcha.
But I wanted to tell you of your beloved city, New York.
Very interesting stats.
I love your public health department because they put out some good numbers.
Oh, I think, you know, I have to tell you, the New York City Public Health Department is one of the best in the world.
I would kind of argue it's equivalent to the CDC.
I know the CDC would get upset.
When I say that, but we have one great victory over them.
We discovered West Nile virus before them.
And I think I know the mayor at the time.
The mayor at the time stuck with his CDC, I mean, stuck with his health department and was very, very criticized for spraying because there was no, CDC didn't agree that it was West Nile virus only to find out 10 days later that it was.
So I have great respect for that health department because they work with 12 acute care hospitals, 17 hospitals overall, so in some ways they have more practical experience and they're more like the doctors in your hospital than, you know, complete academics.
But in any event, tell me.
Well, looking at their data, because it's public data, it's on the New York City Health website, I can tell The tests that they've done that are positive, how old they are, what age group, what sex they are, what borough they're from.
But I want to know, I'm not so concerned with people at home per se, because they're going to get over it.
They're going to do fine.
I'm really curious about those severe cases that are in the hospital.
Right.
So I can tell in New York City, the hospitalizations, again, age group, sex, where they're from.
The only thing that I can tell is if they require ICU admission.
And if they're in the ICU, do they require mechanical ventilator assistance?
So that I can't tell.
But boy, oh boy, with the death, the 281 deaths that the New York City has had, number one is from Queens.
33% of that 281, 92 deaths from Queens.
And then Brooklyn.
Yep.
Good.
81, 92 deaths from Queens.
Yeah.
And then Brooklyn.
Yep.
Yeah, and then Bronx and Staten Island, or excuse me, Manhattan, and then lastly, Staten Island.
So and I can show that see that data too with trouble in New York City.
Yeah, yeah.
Well, I mean, there is a shortage of ventilators here, no question about that, and a shortage of equipment.
The governor has made a request of anyone that has it to help.
And right now, you know, we're in the middle of it.
Hopefully, this will surge and start moving in the other direction.
But, Doctor, I have to tell you, it's been very Illuminating, finding out what's going on in a small, smaller setting where
We are warned and told that this is going to spread to all of America.
Secondly, congratulations on having been prepared because you didn't mention it, but I know that you helped other hospitals with equipment that they needed because you had the foresight to store it in advance.
And I hope you avoid the worst.
I mean, you've had it pretty bad so far.
I hope it isn't the projections they're saying, but at least if it is, they're in very good hands.
So we'll be checking back with you, Dr. Ryan, okay?
Okay, very good.
And making sure that everything is going right there.
Thank you for your good work.
God bless.
All right.
Thank you.
So that was a very interesting interview from another part of the world, from Upper New Hampshire, where everybody loves to go skiing.
Upper Vermont, kind of a playland, and now Hundreds, if not thousands, of people worried about what they have.
Some of them sick, some of them not.
Some of them self-isolated.
And then I thought it was very interesting that we have large numbers of New Yorkers and New Englanders fleeing to New Hampshire, which is kind of like just bringing it in there.
So everybody's got a different issue here to deal with, and it's important that we focus on it.
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