Medical College of Wisconsin CEO on science, academic medicine during COVID

Dr. John Raymond Sr. has served as president and CEO of the Milwaukee-based Medical College of Wisconsin since July 2010. It’s the nation’s third-largest private medical school, and its more than 1,600 faculty physicians constitute one of the largest medical groups in a state where COVID-19 cases have surged in recent weeks. Raymond talked with Assistant Managing Editor David May about lessons learned during the pandemic and priorities for the months ahead. The following is an edited transcript.

MH: Can you talk about Wisconsin’s COVID-19 caseload? It’s recently been one of the nation’s hot spots for surges in new cases.

Raymond: Like many parts of the Midwest, Wisconsin is experiencing rapid community spread of COVID-19, especially in the north central and northeastern regions of the state. In addition to a surge of new cases, the positivity rates and the reproductive numbers and measures of contagiousness are very unfavorable. So this indicates a large and growing burden of disease. Data posted (on Sept. 30) by the Wisconsin Department of Health Services showed that every county of the state had either a high or very high burden of disease. And more than half of the counties had a trajectory that was unfavorable.

And this has also been exacerbated by the need to quarantine healthcare staff, who either have active infections or who have confirmed exposure. In many cases, especially in rural parts of states, the staff is the bottleneck. You can create surge capacity for ventilators, ICU beds and hospital beds, but if you don’t have enough staff to take care of the patients, that’s a real problem.

MH: Initial reporting was that the universities were a part the problem, but what about the rural areas? Is there a general theory about what’s happening?

Raymond: We had well over 100,000 students, returning to school; most of the universities in Wisconsin had some form of in-person classroom activity that began in early September and late August. So for the first week in September, when the surge really was beginning to be apparent in Wisconsin, most of the cases were associated with young people in the 18-24 range. There was a very, very significant spike in cases. What was interesting though, is the spike wasn’t limited just to counties that had a large university; we were seeing community spread in addition to the return of thousands of students. And we believe that was in part due to long-term (pandemic) fatigue, some skepticism about the utility of wearing a masks and a lot of gatherings and relaxation of social distancing around the Labor Day holidays.

MH: Given all that’s transpired, what have your doctors and affiliated hospitals learned during this pandemic?

Raymond: Like other parts of the country, we now know much better how to triage and provide supportive care for patients with COVID-19. And there are some moderately effective therapeutics that we can strategically deploy to help us. Just the level of comfort in taking care of novel coronavirus has increased significantly.

We’ve been blessed in Wisconsin with a pretty significant capacity to provide all forms of testing throughout the pandemic. That’s allowed us to stay on top of the pandemic and standard public health practices. Our public health infrastructure is better coordinated now than it was early in the pandemic. Plus systems know how to work well with each other, in ways that I think are unprecedented, and all of us have surge capacity plans that we’ve activated and know how to implement fairly rapidly.

MH: Looking at the medical education component amid the pandemic, what has changed in the curriculum? Has COVID played a significant role?

Raymond: It has been quite dramatic. First, we were challenged in the early months of the pandemic by not being able to have our students participate in clinical care in any meaningful way. But that challenge, I suppose, was in terms of their individual academic progression, so they can graduate on time and also our institutional accreditation. Students were largely excluded from front-line care, primarily because we didn’t want to complicate the healthcare environment, but also to protect the students and our PPE supply.

But we were able to create virtual nights-on-call where students would rally, so to speak, with front-line healthcare providers and participate in care remotely. And I think that innovation will help us. One of the things we’ve learned is we need to invest more proactively in preventing burnout, dealing with the mental health issues, not just of our community and our patients, but healthcare workers and our learners.

MH: How do you view the conflict over mask policies, social distancing guidelines and the science of fighting the pandemic? It’s often called an “infodemic.” Do you think science is winning?

Raymond: Well, I don’t think science is winning enough in the United States. I’ll just start by saying that we have suffered more from the side effects of the infodemic than most of the countries in the world.

Academic medicine has tried very hard, and we certainly have here at MCW, to be an apolitical source of science. In fact, that’s what we’re all about. Social media politicization of data, science and pseudoscience, disinformation, and misinformation, and a torrent of poorly curated information from many sources, have posed a very significant and unprecedented challenge for us. And it is frustrating that we know that some simple nonpharmacological interventions such as wearing cloth face coverings in public, staying at home as much as possible, maintaining a physical distance of six feet and washing hands really do help.

MH: Where do you think we stand in the vaccine development process?

Raymond: First of all, what we’re trying to do is compress a process that normally takes 12 years on average in the U.S. and develop a vaccine in 12 months. And so we’re going to be expediting many, many components of this, including the regulatory component.

We’re also going to be challenged by trying to build up the capacity of manufacturer and distribute vaccines before they’ve been proven to be fully effective and always safe, and so we’re taking a bit of a leap of faith. I’m very confident that with one or more of the four major vaccine makers that are in phase 3 trials, we’ll have a vaccine available by the end of the year. It will be in a limited basis, probably for front-line healthcare providers and possibly for high-risk populations, but we won’t have a year’s worth of safety data.