Dr. Megan Ranney, an ER physician at Rhode Island Hospital and associate professor at Brown University, is our guest this week on Political Roundtable.



Here's a transcript of the conversation, which also includes Ted Nesi from WPRI-TV, Channel 12, and URI emeritus professor of political science Maureen Moakley..

Donnis: Let's start with the issue of vaccinations. Initially, there was a lot of criticism of the vaccination process in Rhode Island as being disorganized, confusing, and so forth. I think the matter might be a little bit academic now, because it seems that everyone who wants to get vaccinated should get that opportunity within roughly two months or so. But Dr. Ranney, I wonder how you assess the state's performance on vaccination.

Ranney: I think that in the early days of vaccine distribution we were really in the same position as every other state around the country, where we simply didn't have enough supply. And there was no perfect way to make decisions about who to get it out to when there wasn't enough. There were going to be people who were disappointed. Our state made a very intentional decision to distribute vaccines according to risk of infection and death, which meant going to nursing homes and going to those super high-risk zip codes first. But that very targeted vaccination strategy potentially slowed things down a little in those first months. I'm very happy to see our rate of vaccination now approximating that of states that opened up eligibility further, earlier on, while we're also seeing one of the greatest drops in hospitalizations and deaths due to that intentional targeting of high risk groups. So I think it's kind of been a winner in the end.

Donnis: You've been on the frontlines of the pandemic, you were working 20 hour days back when this situation first came up. Now that there is some more encouraging news and vaccination is taking greater hold, how would you expect that life in Rhode Island road in Rhode Island will be different three months from now?

Ranney: So I'll say as a health care provider, my life has already shifted dramatically. I'm having very few colleagues who are getting sick, missing work. And I'll be honest, we can now eat lunch in our break room or eat dinner in our break room without fear. I'm expecting that within three months we're going to see the same thing across the state. If we continue to vaccinate at the rate that we currently are, we're going to see schools more fully opened, we're going to see greater safety in dining, we're going to start to see more indoor activities start to open up. And I think that by the time we get to summer, assuming that everybody goes out and gets vaccinated, when they get their chance, we're going to be really close to what we all remember normal as being.

Nesi: Dr. Ranney, I feel like as a reporter, maybe we're in a somewhat better place, both Rhode Island and nationally than I expected. I'm looking at the calendar March 11, a crazy day a year ago. And it feels like maybe as vaccinations have happened, things are improving fast, you watch the drop in hospitalizations and infections. But I'm curious if you agree with that, or you thought this is where we'd be by March 11.

Ranney: This is a much better place than I thought we were going to be in, for a couple of different reasons. The first is, I never anticipated that we would have three effective vaccines approved by the FDA and actively being distributed by this point in the pandemic. The second is that these new vaccines that got out, we were worried as to whether the novel variants were going to evade the vaccines. And so far, it looks like they're doing a good job, certainly against that B1-7 variant from the UK, and possibly also against some of the other new variants. And then the third thing is, is that I think that our country finally started to take this seriously. And we saw the result of that over the last couple months. So this is a much better space than I thought we were going to be in as of six or nine months ago. Although at the same time, if you would ask me a year ago, right on that day that things shut down, I think it was difficult to imagine at that point that the numbers were going to get as high and that the situation was going to be as bad as it was this winter.

Moakley: Well, although you know that things have gone remarkably well, looking back, the one really frustrating failure was the ability for people to register. And the question is, how did this happen? You have experience with digital health Why can't we develop a uniform health registry. especially since you know the idea of boosters is probable in the future?

Ranney: Oh, Maureen, that's the million dollar question. It's tied into so many things around health care financing and our lack of a single health care system here in this state and around national interoperability requirements. I mean, to me, that's one of the big challenges that COVID has presented to us, and I think it's one of the big opportunities as well is for us to reform or refine the things that we always knew were broken -- and that we're shining a very bright light on right now. And I would love nothing more than for to see us have a national database to allow people to easily show up for those booster shots, to allow us to get people enrolled in preventive health care, and to not miss those opportunities to take care of themselves. I think in some ways has a lot more to do with politics than that it has to do with the technology itself.

Moakley: Would it be more easy to do at the state level,

Ranney: I do think it would be easier to do at the state level. And I'll say here, we do have the Rhode Island Quality Institute, which for folks right now you have to opt into it. But if you do opt in, your your information gets tracked across the state. I'll also say that our Department of Health has made huge strides in the last year. I was on their tech workgroup, right, that started right about a year ago today. And you know, at that point, we were getting COVID test results and doing contact tracing by hand and with spreadsheets and with faxes. You know, now they've contracted with Salesforce and have a digital database. And we've got that lovely dashboard that we all look at, which is just a great example of data transparency. So I think there is great potential there, both for the Department of Health or for non-governmental entities to do this in our state.

Donnis: Dr. Ranney, the comedian john Oliver on his HBO show recently had a segment -- I don't know if you saw it -- but he was talking about how there are a lot of factors that make the growth of new viruses and possibly new pandemics much more likely than in the past. So I wonder how you look at that question. Are we going to see more pandemics in the years ahead? Or is it going be more like, you know, as a century since the Spanish influenza, would be a relatively rare occurrence?

Ranney: I wish I got to watch John Oliver. These days, I mostly watch shows that my nine-year-old and 12-year-old like to watch. I do, sadly, think that pandemics are going to be much more frequent. You look at the past decade, and we've had H1N1, Ebola, Zika. Now the SARS-Cov virus, SARS, Cov-2 virus. I think that we're gonna see more and more as a combination of climate change and the ease of global travel stuff doesn't stay put in one spot. And that's been one of the challenges since day one with this pandemic is that this is a virus that crosses borders, whether they borders between states, or borders between countries. It's really one of the reasons that Dr. Jha and i have made such a commitment at the School of Public Health to developing pandemic preparedness as a core function of the School of Public Health. And it's why we're teaching that pandemic problem-solving course right now. Because although we may be vanquishing, fingers crossed, this virus, we'd be deluding ourselves if we think we're not going to get another one in a couple of years. 

Nesi: Dr. Ranney, you have one foot at Brown University, you have one foot in Lifespan-Rhode Island Hospital. So I have to if you have any view on this big merger proposal. I was just talking to the executives the other day for this weekend's Newsmakers. They're all very excited. I know, it's a hot potato for all the docs. But I'm curious what you think.

Ranney: So I actually think that it is not just exciting, but necessary. If we're going to maintain any sort of local health care system, we need to go through with this merger. Lifespan and Care New England need to be one entity. Otherwise, we're going to be taken over from the north and from the south. I also think it's going to be really great for our ability to deliver population health. I think that we're going to be able to do things like Maureen's question about having, you know, the ability to deliver care to populations that often get left behind, to invest in community health resources and delivery that somehow always get forgotten about when you've got two health institutions that are constantly competing. And I think that ultimately, it's going to result in lower costs and better care for most Rhode Islanders.

Nesi: Do you hear just briefly, from the other doctors a lot of concern, and you hear a lot who feel the way you do?

Ranney: I think the majority of folks that I've talked to feel the way that I do. There's certainly some concern, but you know what? Most of us have been swallowed up by either Lifespan or Care New England already. So what's the difference between that and being combined together? I also think there's a recognition that, you know, as you said, I have my feet at both Brown and at Rhode Island Hospital. And I think there's the recognition of the tremendous value of being a true academic medical center, both in being able to do the kinds of life-saving research that so many of us care about. And in terms of being able to involve students and folks from other disciplines who can help make our health care system better. I think we have the potential to make Rhode Island be -- you know, we talk often about this ideal of us being a living lab where this small state we can create these great examples. And I think that we the merger and some intentionality behind it, we have the possibility to really do that, to set the standard for the country in terms of what great equitable health care can look like.

Moakley: I'd like to talk to you about funding for public health. The last administration gutted funding for public health initiatives. Are you hopeful for the future? And what would you like to see happen so that we can move along and have a better holistic healthcare system?

Ranney: In case you haven't already figured it out, I'm a perennially optimistic person. So therefore, yes, I am hopeful for the future. But I do want to say that although yes, the Trump administration gutted funding for public health, it hasn't been well funded in a long time, whether under Democrats or under Republicans. This is not a purely partisan issue. It's that our country tends to not invest in prevention and in monitoring of new diseases or injuries when they break out. It's far more interested in spending a lot of money at the back end on saving people than on trying to get trying to keep them from getting sick in the first place. That said, we've seen the chickens come home to roost, right? The underfunded public health departments, both in our state and elsewhere had a lot of really quick catch up to do. And my hope is, is that all of us who've been on the front lines, we'll keep pushing for continued funding, I think we have seen the power of what a well-funded public health department can do. We're also seeing the limitations of what lack of funding can do. And I think the logistics behind vaccine distribution and vaccine registration are a great example of where lack of funding really tied our hands a little bit. So my hope is, is that we'll keep pushing for it. And that we will see greater integration between public health and the health care system. So they won't be seen as two separate things, but rather as really more of the same. The same goal in the same project going forwards.

Donnis: Dr. Ranney, in addition to being a physician and an academic you're something of a media star, you've made a number of appearances on CNN. You have more Twitter followers than me and Ted combined. And I think you obviously see this as part of the importance of getting good information out to the public. But we live in an age that is rife with disinformation We saw how the former president kind of dismissed the value of facts. Do you have any grounds for optimism that people who most need information but perhaps who are more reluctant to seek it out will get it in this day and age?

Ranney: I think this is going to be a long road. I think we've seen tremendous dichotomization of our American public over the last four years, although, again, it didn't start in 2016. It predated that. And I think we have a long road to go in terms of reuniting the American public and our sources of information. One of the things that I've learned most deeply about COVID-19 is the importance of having honest, nuanced and thoughtful voices out there. And it's why I have continued to tweet and go on TV, despite the needs of my day job. I think it's important for those of us on the front lines to have our voices shared. And I hope that will continue to do that. I think that those personal stories make a difference. And by getting the facts out there, that's going to be a lot of work. We have a lot to do with engaging credible messengers from different communities, because not everybody is going to listen to me. There's going to need to be different voices out there for different folks.