What Does a Successful Vaccine Rollout Look Like?

-----An interview with Dr. David Roye, Chief Medical Officer of JuniperMD, by Hugo Wang

Vaccination has been on everyone's mind. With the fight against COVID-19 at its final stretch, the vaccination rollout in different countries becomes the key to the successful containment of this vicious virus. Dr. David Roye is with us today to discuss his views on what a successful and considerate vaccine rollout looks like.

Living in China, but also keeping close eyes on the movement of vaccination in the U.S., Dr. Roye was able to offer us some insights on the reasons why cases in China have been drastically declining even though vaccination there is not as rapid and extensive as it is in the States.

"Not to be unpatriotic, but they handled COVID-19 so much better here. The system here is rational and public health-oriented." Dr. Roye then told us about his personal experience with China's contact tracing strategy. "It would be considered by half of Americans an invasion of privacy. When I am traveling, I have two health account on my phone. When I enter two different provinces, I need to present my information about COVID-19 on those accounts to a public health official. These checkpoints are set up before plane rides, later at package pick-ups, and even in train stations."

"I even got a knock on my door after my last Beijing trip, where they had couple hundred cases and a few hospitalizations." An even more personal encounter surprised Dr. Roye. "The neighborhood public health worker told me that they know I was in Beijing and asked me what neighborhoods I was in." This was part of China's subsequent contact tracing following the recent cases in Beijing that have caused alarm from public health professionals all over the country.

While public health strategy in China was praised by Dr. Roye, he also cast doubts on China's vaccine rollout's future outlook. In terms of vaccine, China has discreetly rolled out its domestically produced batch. "The efficacy of these vaccines is not yet clear. There are no data on the effect for people over 60." With China's past scandal of fake vaccines, the unclarity may cause doubt and distrust of the new vaccines, leading to an unideal vaccination rate.

In the U.S., the problem is different. Health disparity remains a large issue that hinders vaccine rollout. "Rural areas and countryside rarely have access to healthcare and vaccines." Dr. Roye describes the problem as such.

"A truly effective vaccine program would target one's antibody load. If you have the antibody but are staying in line for the vaccine, valuable resources are being wasted." Dr. Roye further gave his suggestion of what an ideal vaccination plan should look like. "Each state should not be able to do its own thing. This is a national problem and a global problem."

Looking forward, both countries have room to improve and more lives to save. The essence of Dr. Roye's message is to administer a public health-oriented strategy with transparency and collective effort.

Photo by Artem Podrez from Pexels

Why on Earth do People Believe COVID Conspiracy Theories?

---An interview with Dr. David Roye, by Hugo Wang, Writing Fellow at International Healthcare Leadership

Have you ever believed in a conspiracy theory? I’m sure everyone has once in their lifetime heard of ideas like the moon landing wasn’t real, or that aliens are being held captive in Area 51. Most of the time, these theories are rather harmless; but recently, conspiracy theories regarding COVID-19 have gained a larger and larger audience in the United States. The US constitutes only 4% of the world's population but has produced 20% of the total death due to COVID-19. Misinformation claiming that COVID-19 is planned or simply isn't real can have and have had severe implications for the public's health. Certain groups of our population have been refusing to cooperate with any public health measures to contain the virus. 

It might be challenging and near impossible for most of our readers to fathom the idea that someone would believe baseless claims over scientific facts. How are people willing to choose to blame Bill Gates for the pandemic rather than listening to doctors, public health workers, and other health professionals? Dr. David Roye, Chief Medical Officer of JuniperMD might have a possible answer for you.

Referring to a study done on potential neurological mechanisms of believing in COVID conspiracy theories, Dr. Roye said: "It is comforting to know that there's a neurological basis for this." Dr. Roye endorses the potential explanation that neural pathways and how people's brains are wired to think to have a lot to do with science denials we've witnessed throughout the pandemic. "If you don't have adequate pathways to support processing a lot of evidence for your beliefs, you're going to believe all kinds of silly stuff."

"The scientific rationale that the neuroscientists gave in this article are based on disease models, which is a little bit unfortunate." Addressing the study's approach of drawing inference from neurodegenerative disorders, Dr. Roye said: "But when you look at the way that neuroscience works through an Oliver Sacks approach, isolated disabilities and the inability of someone to remember the recent past or the inability of people to interpret environmental information can be linked to known anatomical or metabolic conditions. You're then better able to explain normal human behaviors like distinguishing truth and conspiracy theories."

But if the way you process information is determined by your brain functions, does that mean we are predisposed to think a certain way? The good news is, no! Specializing in treating cerebral palsy in children, Dr. Roye is an expert on the subject of brain redevelopment. Using his experiences, he explains: "The message of the study is hopeful. Because the brain has a lot of neuroplasticity, which exists right until we reach senescence. New connections of pathways can be made and the connections that are missing in people who are unable to interpret data can be formed, with the right exposure."

Reflecting on the takeaways of the study, Dr. Roye shared with us some final thoughts: "This particular framework kind of allows me to rationalize and accepted why people believe in conspiracies in a way that makes them more comfortable. And I think the reasons I like that is that it allows me to become less and less angry. I can now understand the process behind the irrationality of COVID-19 deniers and better able to suggest solutions rather than just become polemic."

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Biden Won, Trump Lost: Why is that Important to Chinese Doctors?

I have been a global man since elementary school. I was born in the reddest of red states, Oklahoma but my family moved to France when I was five years old. I started elementary school just south of Orleans, France in a school that was close to the Loire River. Sister number 2 was born in a French village close to our home. Middle school was in Japan. Number three and four sisters were born there. I continued to travel as a young man; I was drafted into the US Army and I spent time in South Korea and in Vietnam. At the University of Oklahoma I was a History major – ironically I took a number of Chinese History courses. Once I became an academic surgeon and settled into my position at Columbia University, I wanted to enhance my training. I spent many months over several years as a visiting fellow at University Hospitals in Germany, France and Italy studying spine surgery. Starting in 1983, just three years after my appointment at Columbia I began volunteering with not for profit organizations providing medical care in other countries. That work took me to Africa, Eastern Europe and to South America. Of course, 1997 marked the beginning of my dedication to China – China has been my home away from home ever since. 

My vision is that the bilateral relationship between China and the US is the most important bilateral relationship in the world and more than that it will be hard, if not impossible for the world to continue to prosper, continue to bring populations out of poverty, continue to improve global health, continue to improve the human condition if the Sino-American bilateral relationship does not work. That does not mean there is not competition and hard talk, but it does mean predictability, communication and yes even cooperation. That is basically the history of the relationship since rapprochement.

So why should I care? I’m living in China and I’m well accepted here – except, the atmosphere created by the current US government has not just impacted high level international relationships. The fruits of this toxic environment have drifted down through even the medical establishment. I find Chinese hospitals reluctant to cooperate with my not for profit organization founded to help disabled orphans and indigent children. The Chinese organizations we have worked with in the past few decades to raise funds for the care of these children have been increasingly reluctant to work with us as the bilateral relationship continues to deteriorate. The International Healthcare Leadership clinical fellowships had to be suspended because of the corona virus, but before that, the harsh attitude of the US government on legal Chinese travel to the States for educational purposes was making it more and more difficult for Chinese physicians and surgeons to take advantage of the opportunities we were offering.  Currently I am working with a cadre of highly intelligent, hardworking Chinese medical students who started their journey intent on augmenting training in the US – they are finding it increasingly difficult to obtain the necessary visas – even though they are desperately needed.

Hopefully America’s change of administrations will potentiate a renewal of the professional international governance that the United States has fostered for generations and will allow a slow build towards a new globalism. I will no longer worry that my Chinese fellows will not be granted Visas, that the leadership of Chinese hospitals will again welcome American teaching/operating teams into their institutions, that the free flow of academicians between the two countries with resume and that perhaps I will no longer have to constantly apologize for my country as I speak to my Chinese friends and colleagues. Here’s hoping!

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GOLDEN WEEK IN CHINA; POLARIZATION IN WISCONSIN: A Tale of Two Cities

My perspective on the pandemic derives from the fact that I’m an American physician living and working in China since February of this year. On 29th September 2020, I set out with a friend from Guangzhou to visit Chengdu, Sichuan. We were warned by friends and colleagues that this was a horrible week to travel as we would be part of a Chinese holiday diaspora and we would be overwhelmed by crowds. 637 million Chinese people travelled that week (I think 100 million of them were in Chengdu!). The airport was packed, the trains were packed and we were shoulder to shoulder with other tourists at all the sites we visited. It was beautiful – empowering – and for me another lesson in how to manage a public health crisis. No new clusters were reported as a result of the tourism, there were no public health emergencies. We had a glorious time in Chengdu.

The constant drumbeat of bad news about the COVID-19 pandemic from my country has numbed me. I don’t understand why the USA has not learned from multiple other countries what basic public health measures they could institute to ameliorate the epidemic, save lives, save the economy, but I just try to avoid thinking about it. But for some reason the news from the State of Wisconsin this week overcame my ennui and inspired me to comment. Back in the spring the Governor of Wisconsin Tony Evers, issued a stay at home mandate. Republican opponents went to court and had it overturned. On October 16th, 4,039 new cases were reported in the state, there were 19 deaths representing a 25% and 59% increase respectively over the preceding 14 days. Despite these appalling numbers opponents of public health measures continue efforts in the courts to overturn the governors mask mandate and orders limiting crowds and occupancy in bars and restaurants.

By contrast, Qingdao City, China was in our news this week. There was an “outbreak” there. Two dock workers, likely not community transmission, followed by some hospital transmission for a total of 13 cases. The population of Wisconsin is about 5.86 million. The population of Qingdao is about 9.4 million with another 1.5 million non-residents in the city. The response of the Ministry of Health in Qingdao was contact tracing, to test the entire city (yes, 10 million tests in 5 days!) and restrict some local activity. Those measures produced no protests – In China there is a feeling that compliance is a matter of patriotism and family values. The basic economic and social fabric of the city was not seriously disrupted and there are no more cases.

I recognize that my title is wrong, Wisconsin is a Province not a City, but there are fewer people there than in Qingdao – measures applied there could be applied in Wisconsin. The original 'lock down' in the late winter early spring that the citizens of Qingdao tolerated could have been tolerated by my countrymen.

More concern about the human toll and less about the economic toll would have led to a better human and economic outcome.

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Cash

My third encounter with the Chinese medical system since my arrival in February occurred this week and it was another reminder of how much technology has changed our lives. I realized it had been more than a year since my last eye examination and I was concerned about my vision and so wanted to be examined and refracted. I made an appointment in an eye hospital here in Beijing and went with my young colleague to help me negotiate the language problem I have (I don't speak mandarin) and of course the hospital logistics. There are typically more steps in registration in the Chinese system than in the outpatient setting in the United States. The registration in the Chinese hospital is in addition way more automated than in the US. I register at an ATM like kiosk and the ticket I receive after paying tells me exactly where to go. I still find it amazing. To me as a consumer (as opposed to a provider) the extra steps to complete registration is related to the fact that the outpatient facility that I am attending is in a hospital, so I must register my presence in the hospital and then in the clinic. I paid for being there, then to have a screening vision test then to see the doctor and after seeing her (a very pleasant efficient English speaking professor) I needed to register for visiting another provider to get refracted. Of course I’m talking as if I was doing the registering, but the reality is that my Chinese colleague was doing all the work. It turned out that I could not pay with my WeChat as it is associated with a credit card and the hospital would not accept that. So, my associate was paying for me with his phone. By the time we reached the final necessary payment, he no longer had enough money in his WeChat account to pay! We both stood there in front of the cashier trying to think of what to do. We texted and called a couple of colleagues to send us money, to refresh his WeChat but no one answered. We didn’t want to leave the hospital without completing the consultation. We easily spent several minutes trying to think of something to do to pay the 49 RMB fee – and then – my friend’s face lite up. He said “I have some cash!” I responded, “I have cash as well!” Between us we had 500 RMB, 10 times what was needed to pay the fee. It was a great irony that the 73 year old American who grew up using only cash and when he is in the US still has to use cash for some transactions did not remember that he had a usable method of payment in his pocket that did not need technology. I had totally forgotten that I could exchange those paper bills for services. The Gen Z Chinese man who never uses cash was the one who came up with the solution. But perhaps the greater irony was that both of us stood there dumb founded for five minutes before we thought of an alternative to our phones and handed over that 100 RMB bill to the cashier! My action step was to make sure that between my two phones, I possess every possible form of payment available globally. With a little luck I'll never have to use cash again.

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Photo by Darío Martínez-Batlle on Unsplash

A Shocking Injury to My Knee

I moved to Beijing in February after retiring from a 40 year career in academic orthopedic surgery at Columbia in New York City. I moved to work full time for my team at JuniperMD a medical startup and International Healthcare Leadership a not for profit organization dedicated to healthcare management and clinical education in China.

It is the end of my first month in Beijing and Saturday was a perfectly beautiful spring day. The sky was blue and clear – I could see the West Mountains from my window when I got up Saturday Morning. Beijing is starting to open up as the Covid19 crisis ends. There is more traffic, there are more pedestrians. Restaurants and stores are opening – appropriate and timely for spring, the flower that is Beijing is reopening after the quarantine. I was on my way to meet my entire Beijing JuniperMD team at the subway stop for the Summer Palace. Our plan was to have a team building event on the grounds of the Summer Palace and to see the cherry trees, plum trees, peach trees all in bloom. We had a great day with team competitions and a marvelous lunch at the tea house adjacent to the Summer Palace sitting outdoors around the fish pond. Once the day was finished, we took a few more group photos then headed for the subway once again. That’s when things went wrong. After a long day of hiking, racing up and down stairs, scrambling up rocks, I was pretty tired. I was still keeping up with my Gen Z crew, but at the point where we changed subway lines, walking down stairs surrounded by my teammates, I fell on my right knee striking the proximal tibia hard. I saw stars. There was lancinating pain, a vasovagal reaction. I knew I had done something not good to that 73 year old knee. But, I wasn’t going to lose face with my young colleagues. I got up and kept walking to the subway. For a moment I thought it would be OK but not so lucky. I said farewell to my colleagues a few stops later and went to dinner with the family of my young CEO. I examined myself (what any orthopedic surgeon would do!) and found some tenderness but very little swelling. We applied Chinese Traditional Medicine patches and ice. By the time we left dinner I really couldn’t walk so we borrowed grandmother’s wheelchair to get downstairs to the car. At this point it’s late Saturday night and I am not about to go to an emergency room. I called a friend at Chao Yang Hospital here in Beijing and made an appointment with one of his colleagues for Sunday afternoon. I didn’t know what to expect. I have spent years working her on an intermittent basis but I have never been a patient in a Chinese 3A hospital. Beijing hospitals are opening for the spring as well – as of this week, elective patients are being seen and surgery performed. Despite this the hospital was really quiet. Very few people in the hallways and no one in the waiting rooms, no lines. The hospital was very clean. The clinic staff was professional, courteous and efficient. There were two doctors in the orthopedic clinic and there and a constant flow of patients, but no one waiting – really efficient. I saw the doctor, he examined me and he and I decide that I needed an x-ray. My first shocking event. As a “Self-Pay” patient I had to pay 50 RMB. That is approximately 7 USD. If the doctor friend who referred me to his clinic were in New York and I referred him to one of our sports medicine doctors for care he would have had to pay 500 USD! I went to x-ray. It took me less than a minute to register and pay (with my phone of course, my WeChat platform something I can’t do in the USA) and the computer directed me to a room (no people) where x-rays were completed in minutes. The x-ray was the second shock – 120 RMB or about 17 USD. In New York City it would be about 300 USD with two components, the technical component (taking the x-ray) and the “professional” component which is the reading of the x-ray by the radiologist.  I walked back to my doctor and he and I decided there was a minor fracture and we discussed the treatment which consists of pain management, exercise and activity modification. I felt much relieved that I knew what it was. And to reassure my friends I am already much better and back in the trenches today.  I was so impressed by the care I received and how professional efficient and reasonable it was, how technologically advanced it was – amazing value.

The Chao Yang Hospital charged me 170 RMB. My Chinese orthopedic friend being seen in New York would have paid 5600 RMB (800 USD). That is 33X more! That is 3300 % more! You can see why this injury was shocking. I can add this to the list of reasons for being happy that I moved to China.

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The Summer Palace.

Just In Time: Arriving in Beijing

The People's Republic of China Ministry of Foreign Affairs National immigration authority issued an announcement on March 26, 2020 that China has decided to temporarily suspend entry of foreigners with currently valid visas and residence permits in China from 00:00 on March 28, 2020. My first comment is that I totally get this policy implementation. China has eliminated community transmission of Covid19 from almost the entire country. The new cases have come from returning Chinese nationals and foreigners. As much as I understood the rationale I did have an emotional response. First, I am thrilled that I chose to come in the middle of February and was able to use my 10 year visitor’s visa with no problem. Now I realize that I arrived just in time. Imagine if I had decided to listen to the advice of friends who told me it was too dangerous to work in China.

The second reason for my emotional response is that I was hoping to visit family and friends and to attend academic meetings in the US starting in May but after hearing this announcement ( and watching CNN) these activities seem faraway and the timing indistinct, totally unpredictable. When will it be practical to return? Both countries must have relaxed travel restrictions and requirements for quarantine and for that to happen the virus must be under control. It is impossible to predict when it will be practical to return. It was easy to contemplate coming to China for the long term to work in the healthcare sector since I have been doing that short term for 20 years. I’m comfortable and happy when I am working here – but in previous days there was a sure knowledge that after a couple of weeks I would be heading back to family, kids, grand kids, friends, colleagues – that has changed. 

If I were able to travel to New York I would likely be required to quarantine (not sure why given I am coming from Beijing where there is no community transmission) adding two weeks to any journey. The worst part is that given the way things are now I would not be able to return to China. It’s made me think about immigrants and travelers of yore. In the 18th century when you left New York for Europe (much less the Orient) you were gone for months and there was no FaceTime! Letters could take months to transit by sailing ship. If someone died there was no getting back for the funeral, if a friend decided to get married you missed it, your baby who was 2 years old when you left would not remember you when you returned.  It points to how resilient humans are and how much we need to challenge ourselves by putting ourselves in a different environment.

So I must take this situational affliction in stride. As oppose to my ancestors I do have FaceTime, Zoom, WhatsApp, WeChat, LinkedIn, SMS, email (yes, my friends email really exists and really works and is a better work platform than Chat platforms). I have amazing coworkers, colleagues, friends here in China. I am excited and challenged by my work every day, work that is making a difference to patients and to providers. Today I hosted a Gen Z live stream Webinar. I enlisted my 26 year old youngest daughter, my 22 year old granddaughter and my 19 year old granddaughter as part of the mixed Chinese and American group. There I was on a sunny Sunday morning in Beijing having an existential conversation with 15 young smart ambitious men and women including three of my family! What could be better? It is hard to imagine that anything could be better. Here is the link the Gen Z webinar.

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