A Healthcare Lobbyist’s Insight to COVID-19

by Hadley Boston '21

Dan Boston is the father of Hadley Boston, who is conducting the interview, and Griffin Boston. In college for his undergraduate degree he studied public policy and political science with an Econ minor. He received his masters degree in Journalism and English, and his minor in History and Political Science. He’s been a healthcare advisor and lobbyist for twenty years working for and with institutional, physician providers, and state and federal agencies. He has also worked during other healthcare crises besides COVID-19 , such as the medicare solvency crisis of 1997 leading to BBA 97, the 9/11 response from CMS, and market stabilization in 2009.


1. What is your role as a lobbyist in healthcare during the current situation?


Right now it depends on the organization. It’s more business operations to try and help them. Whether it is cash flow issues and how to maintain services when the federal government has essentially told most people to shut down except for emergency services. Or in the case of state and federal work, it is more helping them manage through the response, whether it be from call centers, to processing claims, to helping them engage with the private sector.


2. What is your opinion on the package that was recently passed?


The Cares Act was 2.3 trillion dollars. It was the largest package ever passed outside of an annual federal budget. It was ginormous. I think it did a lot of good things. I think it did some things that were completely unnecessary.There are going to be some things they build off of in probably the next 2-3 relief packages that congress will pass, maybe between now and September/October.


3. How would a large quarantine be implemented and enforced?


I don’t believe a quarantine is feasible. It might be commonly thought that we are under a quarantine, but are just participating in voluntary social distancing. A quarantine would be a diagnosis directing isolation. 


4. How is this virus different from the flu?


People need to know that this is not a flu, first of all. It has flu-like symptoms, but it is not a flu. It is contagious like a flu, but it is also five times more contagious than the normal flu. It’s also at least ten times, if not fifteen times, more fatal than the normal flu. So you can compare it to the flu for purposes of making sure folks understand it, but in terms of what it does to the body. Those types of diseases, you’re talking about SARS, MERS, H1N1, and now obviously COVID-19, are all such that basically the flu itself will not kill you, it causes the lungs to shut down so then in fact you can’t breathe which leads to respiratory distress or what is called acute respiratory distress syndrome and therefore it feels like you are drowning.


5. How do you believe this virus will come to an end? Will it be quick or dragged out?


I think it will be dragged out. I think we’ve still got two more waves. This is either the strongest in terms of lethality or it’ll be two equal waves between now and the fall. And then we will have another blip or reoccurance in spring next year or late spring next year. It all depends on what we do in the intervening period, relative to developing therapies and working on building up herd immunity and hopefully working towards some type of vaccine of some sort, but that’s probably at least eight months away if not longer.


6. How long do you predict the virus will last?


I think it’s here forever. I don’t think it ever fully goes away. The only way it goes away is if countries do what they did in the 50s and 60s where you had the massive national polio-type vaccine programs, where literally kids line up along the school wall gym to get their polio vaccine, every single year. And just build up generation after generation after generation of tolerance to it.


7. Is there anything the U.S. could have done better to prepare for the spread? Have we acted too slowly?


I think there are some things we could’ve done differently, but it would’ve required substantial resources by both state and federal governments. I think the country is prepared as any country in the developed world for what you would consider the normal pandemic, but this moves so fast and you have a society that is so mobile that things move very rapidly. Plus you have a generation that is very used to, not so much the Baby boomers or Gen x, but the Gen Zs that are used to going on spring break, mardi gras, and New York, just being very mobile. That can exacerbate things and the fact that they didn’t express this as an imminent issue soon enough, just led to a faster spread. And that’s why you saw the United States and Europe blossom faster than everybody else.That doesn’t mean that Africa, South America, the Southern Hemisphere is not going to blow up this summer, which is their winter. It was more of a communication and generational problem in the U.S.


8. How will the drastic costs affect future generations like ours? Or ones that come after?


Do we really care about costs in the future when people are dying now? I think that glass is already broken and we can’t worry about that right now. They’ll cross that bridge when we get to it.


9. Will this change the way we treat pandemics in the future? 


I would like to think we learn our lesson, but remember this all happened a hundred years ago. Now granted a lot of things have changed since then in terms of mobility, medical developments and such, but I think what’s probably going to change is a greater degree of preparedness. So instead of preparing for like a one or two or three city pandemic where we have the national stockpile which really isn't one big warehouse, it’s about fifteen separate warehouses all over the country in secure locations, underground, but the more likely is not just that it gets built up like the national strategic plumbing reserve, but more probably repatriate a lot of production of some of the drugs and therapies once we figure out what those are as well as some of the personal protective equipment so we don’t rely on the cheapest foreign labor we can get for them. I think it’s going to come back to the country.


10. What do we know about where it came from (not just the country of origin)?


We know it came from China, obviously. There is debate about where it came from in China. There are a number of papers out of India, Hong Kong, and Australia that suggest it was a developed disease vs an organic disease, but it honestly doesn’t matter. I think whether it is developed or organic is irrelevant because the disease is here to stay. The bigger issue was more China made it sound like this emerged in January, it actually emerged in the second week of November. So that would’ve given us at least a month if not a month and a half head start in terms of sealing borders or developing therapies or getting PPE on hand, things of that nature. It’s more the lost value of time issue.


11. Any suggestions for how people can stay safe during social distancing? 


Take social distancing seriously. If you go through the normal conduct course of your life you come in contact with roughly fifteen to twenty people, in terms of physically touching them. If you stay at home the odds of you getting it go down because you are obviously just touching the people in your house so it more importantly lowers the exponential increase. Does it get rid of it? No, but most of the time you are confined to transmision just within your own house and if it gets into a house, that whole house will probably get sick to some degree, maybe not all going to the hospital sick, but they’re going to get sick, but hopefully this will get things to a level where the healthcare system system can sustain the surge of cases. So that as they present when the country is back up probably in late May or early June so that our healthcare system can handle it. If anybody needs to go to the grocery store, please wear a mask and if you have them surgical gloves. I know both of my children participate in spring sports, I make them wear a mask if they go on a run. If you are in your backyard or front yard, that’s when you might not need to. If you need to get exercise, my best suggestion is do it indoors, in a garage, on a treadmill or peloton. 


12. When do you believe Washington D.C. could become a potential hotspot?


It already is. While there are some outlier cases, there is a big socioeconomic presentation of this disease. Either it’s those that can have the ability to stay and work from home are in fact staying and working from home, but those that can’t typically those that are less economically well off or are a person of color, are not. So that’s why you see a disportion in numbers, that’s why the CDC is not completely updating all that information. More people are going to stay at home in Northern Virginia than Southern Virginia. The biggest hotspot in Virginia is around Norfolk and Richmond, not so much Northern Virginia. Although there may be more numerically, if you look at the density relative to the population, it is denser than those two other areas.


13. If someone believed they had the virus should they go to the hospital to get tested or should they self quarantine because hospitals could more easily expose someone to the virus?


They should call their doctor’s office. They should try and shelter at home and only present at the hospital if their doctor tells them to or they are having trouble breathing, something that is life threatening or an emergency because odds are when you go to the emergency room even if you are hurt or bleeding, unless it is head or breathing related, they don’t see you right away. Well 99 percent of the people at the emergency room right now are having breathing related issues and if there is only between nine and twenty ICU vets for the triage in an ER. You can see how those can get overrun pretty fast. So you don’t want to put yourself at risk or in a situation where you can make the disease worse by being near other sick people and eighty to eighty-five percent of people who get this will be fine. They will weather it like the normal flu, but those that have non-seasonal asthma, that have more like COPD, emphysema, diabetes of one degree or the other, but primarily type one, that have breathing or immune deficiency issues, will have problems and they are the ones that you have to look out for. This lockdown isn't about the bulk of the country, but about protecting those that are most vulnerable.


14. What comment do you have on there being more interest in SSSAS due to our distance learning plan? Is it more effective?


I’m glad they keep you all busy. I’m happy they are doing something to make at least the most of your school year. It’s a hard thing, you want the kids to keep learning because it is still the school year, but by the same token, I think it is hard to accurately assess grades incurred now to grades that were incurred during school. I hope that SSSAS takes into account that everybody is going through one of the most stressful environments in the last three generations. I am glad to know some teachers are switching to a more educational plan rather than a grades based focus.