ARTIST CREDIT “Dyad” by Stuart Davis

Dear Member,

We need your help.

As we attempt to make sense of both the global and local impact of COVID19 and grapple to understand what it means for our nation and planet, on Friday we crossed two staggering milestones:

The first is that the US is now leading the world in number of cases, surpassing even China*. The second is that Friday marked the largest number of deaths in a single day in one country: Italy over lost 900 lives just yesterday.

What this tells us is that this won’t all be resolved by Easter, despite what our president is wishfully broadcasting. We are about a month behind Italy in the spread of this virus. And the way it hurts our society the most is that it can actually break entire healthcare systems. As healthcare systems breakdown, the repercussions upon the rest of the communities they serve are immense, especially since the most vulnerable populations in terms of exposure risk are those involved in the vital infrastructure that keeps our society going–which is precisely why they can’t just stay home: law enforcement, power grid maintenance crews, communications technicians, food distribution workers, and so on.

The local healthcare system breaks when we run out of hospital beds, ICU rooms, and ventilators due to the surge of COVID19 cases, and the hospital staff start getting infected themselves. At that point all of the other people that we are used to taking care of under “normal” circumstances who present with heart attacks, strokes, trauma, cancer-related disease, etc. have no one left to care for them, and such aftershocks ripple throughout entire communities. All this exacerbates the kinds of shut downs we’re seeing now which have caused the economy to nearly grind to a halt.

We can take lessons from the nations who have done a good job in containing the virus in their regions, as well as those who have not. The most important and pressing goals for any community, including ours are: 1.) prevent the looming breakdown of our local hospital-based healthcare systems and 2.) safely get people back to work as fast as we can. But we have a narrow window of opportunity, and only two main tools. How we harness and implement those tools will determine whether we follow the path of northern Italy, or that of Taiwan, Singapore, South Korea, and other countries who have been much better at flattening the curve.

The first tool is to continue what we are now doing in Boulder County and our state as a whole (and many other states have joined in): following strict social distancing directives, travel restrictions, and the active quarantining of anyone who is sick with viral symptoms. The second tool is the rapid expansion of a wide-scale testing program.

Cloud Medical has been in discussions with the Boulder County Health Department and a group of grass-roots community organizers looking at several options to deploy rapid, scalable community-wide testing for a large percentage of our county. You can read the current document here. New tests which are becoming available not only identify whether an individual is currently infected with the virus, but also if they have previously been infected and are now in the “convalescent” or recovery phase—implying that they are now immune (although precisely how quickly immunity develops and how long it will last has not yet been fully answered). The faster we begin accumulating this data on the greatest swath of our community population and using it to guide measures to limiting transmission by those infected, the better we will be able to accomplish the two main goals.

If you are willing to help, please read on…

Our community-based task force is working through various scenarios to identify the best strategy that will enable the greatest number of tests to be rapidly distributed to the largest percentage of the population. Wide-scale population testing (like they’re doing in Telluride and all nations that are successfully dealing with COVID19) requires a base or “hub” from which to operate. And that hub must be very rapidly scaleable, so that many such hubs can be rapidly deployed and we’re able to get a meaningful portion of the community tested at once. We’ve discussed pros/cons of using neighborhood bases, drive-by stations in high traffic areas, etc. But all of those are problematic and pose expansion problems (due to logistical, medicolegal, privacy, HIPAA-compliance, & communication issues, etc…).

I believe that the best such “hub” is the primary care clinic. All infrastructure is already in place and no wheels require reinventing.

So…we plan to test all 1000 Cloud Medical members (or as many as are willing to participate) as quickly as possible at a patient-funded cost of around $25-$50 per test. And I believe we can test nearly everyone in a week and then repeat testing 2 wks later. We are also building protocols for precise quarantine methods based on patient demographic and clinical data which we’re reviewing with an epidemiologist. If our pilot here at Cloud Medical works (alongside and in concert with other potential community-based initiatives) then we will have a very pragmatic model, based on the rapid iteration of lessons we will quickly learn in the process that can be quickly expanded via countless other primary care practices…in BoCo, metro Denver, and beyond.

We at Cloud Medical are in a position to coordinate rapid testing for our members on-site at (or near) our 3 locations in Boulder County. We are also actively working on acquisition of large numbers of test kits. For this effort to have meaningful impact two things need to happen:

      1. A large percentage of Cloud members proceed with testing, and if successful…
      2. Our “proof of concept” of wide-scale community-based testing using primary care clinics as testing hubs is widely adopted by lots of other primary care practices in Boulder county and beyond.

    I personally have many reasons to believe that using primary care practices as hubs will likely be the most promising method by which to quickly expand testing for large segments of the population. This of course is merely an assumption and a theory, but if we can demonstrate success at Cloud, and other primary care practices in our region follow suit, our community-based prototype can serve as a model for many other communities nationwide who are facing the same issue—and you will personally be playing a crucial role in helping to bring this pandemic to an end.

    It’s the best path I can think of to protect our hospital-based healthcare staff, keep our medical system working, and get the rest of us back to work as quickly and safely as possible.

    So here is our simple ask:

    Are you willing to participate in a Cloud Medical-based COVID19 testing program at a cost of $25-$50 per test? (Please let us know either way!)

    All existing Cloud members should have received an email/newsletter with a survey asking you to respond with a yes or no answer. And yes, of course we will take extreme precautions to avoid any safety issues or exposure concerns for all of you as well as our amazing staff.

    Sending lots of positive energy to you. We are all in this together.

    Dr.T and your Cloud Medical Team