In this episode we talk with experts at Johns Hopkins in pulmonology and critical care, as well as public health awareness. Additionally, we bring back our resident experts in cybersecurity, Mary Beth Borgwing and our CISO, Chris Roberts.
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Welcome back everybody NeoCast Podcast. We are excited to bring to you the next bonus COVID-19 episode. We were excited to have Chris Roberts and Ed Bassett, as well as Mary Beth Borgwing with us last week to talk to you a little bit about healthcare, data transfer, cybersecurity, and so forth in this scary age. This week we wanted to actually bring to you some folks from the front lines in the healthcare system, so we’re very excited to welcome back our experts, Mary Beth and Chris, in cybersecurity. Thank you so much for rejoining us here.
Mary Beth Borgwing, again is the founder of the Cyber Guild as well as a founder and chief strategy officer for the Cyber Clan. Thank you so much for joining us here again. Also, representing United Women in Cybersecurity, so thank you. Chris Roberts, one of the leading experts in cybersecurity and managed IT, so thank you for joining us again. And this week we have two newcomers. We’ve got Dr. Panagis Galiatsatos. I am hoping I pronounced that right. Thank you so much for joining us from internal medicine, Pulmonary and Critical Care at Johns Hopkins University, as well as [inaudible 00:01:31] joining us with RNB Associates. She’s the CEO there as well as being a research associate for the Johns Hopkins School of Medicine. Thank you all for being here.
Thank you for having us.
Dr. Panagis Galiatsatos:
Yeah, glad to join and well done with the names.
Thank you. I try, you guys really threw me for a loop today. So just to get right to it, I know we’re on a little bit of a deadline, but also the world is crashing all around us here, so let’s just get straight to the front line observations. I’m Dr. Panagis, if you could give us maybe some of your initial reactions to, we’re in maybe a month into this now, Maryland’s been on a shutdown for maybe two weeks now. What are you seeing out there? Especially because so many of the critical care issues are coming in the pulmonary perspective?
Dr. Panagis Galiatsatos:
Excellent, great question. So from that standpoint, yes, being a pulmonologist and a critical care doctor, I have my feet kind of in both the outpatient world and the inpatient world. I can tell you over the last several weeks I’ve had an influx of calls from all of my patients just to discuss our symptoms. The coronavirus 19 symptoms are very nonspecific with the organs they infect, specifically the lungs. While the lungs are an amazing organ, it doesn’t really give you very specific symptoms towards the diseases it has. You can have a cough from both a virus and from cancer, so trying to differentiate what’s going on takes some time. So I have had an influx of calls for many patients to discuss their symptoms.
And that’s actually you’re highly important because screening’s the first way for us to evaluate if someone should be tested. Since we don’t have a plethora of tests and kits, we have to do a first line of screening to see if patients would qualify for testing. And again, that’s important to note. We can’t really test everyone. If we test everyone, we’re going to get a lot more false positives. So we want to test those who are the high probability of having the virus. And because of the limited testing kits, we want to test those specifically who are likely to be admitted to the hospital or are in a position where they’re going to likely infect other people, like for instance, living in housing units with communal areas. So from an outpatient world, a lot of phone calls for a lot of screening and so forth.
From an inpatient standpoint, yes, the front lines of that has been highly unsettling. The coronavirus in the more severe patients has taken a significant toll against the lung specifically. It has some other consequences. It can lead to things like renal failure, shock where patients would have to be put on medications to support the blood pressure, but the respiratory failure is by far the most concerning.
A lot of it has to do with, while it causes a syndrome that we are fully aware about for the last six decades, something called acute respiratory distress syndrome. It’s actually what’s been interesting over the last month of managing this disease in the intensive care unit is that the strategies that we’re seeing that really help the patients during this moment of supportive care tends to be things like proning, meaning so if you are put on a breathing machine, as you probably saw on pictures on movies and so forth, everyone’s usually laying on their back with a tube coming out of their mouth. Proning means we actually flip the patient so they’re lying on their chest and their back is kind of exposed to all of us. We’re doing that because it helps the lungs kind of expand in a different way and are finding easier abilities to oxygenate those patients as well. So that’s one strategy that we’re implementing that seems to be working rather well for patients to oxygenate them appropriately and hopefully see them through this.
The ICU is always a very humbling place because really what we offer is supportive therapies at the most extremes and hoping, with our fingers and toes crossed, that the patient’s own bodies tend to begin to heal and recover. It takes a lot of men and women power at the moment because we have to wear so much protective gear and we’re all coming up with our own novel strategies and how to best protect ourselves as well as implementing the care that these patients need. For instance, taking out a breathing tube, it’s also very difficult because when you pull that out, everything out of the lungs comes out. So while they may not need a breathing tube anymore, they may still be actively infected. So we are taking novel approaches with that.
So overall, this disease at the moment, this infection, is really testing all of us at the most extremes. The one thing I do want to emphasize is while we physicians and nurses appreciate being called the frontline staff, I would emphasize we’re actually the last line staff. If the proper public health precautions are implemented and executed and followed through, I’m hoping no one needs to see the inside of an intensive care unit.
That’s a great point. Thank you so much for pointing that out. One question that we will certainly deal with it towards the end of this podcast when we really get into cyber security, but your response sort of conjured it up in my head, as you are being, I guess the frontline from a screening perspective with clients and individuals who are coming to you with symptoms, how have you seen the systems, whether it’s data systems and other systems that you’re able to enter in some of these symptoms, how have you seen that been helping you, and doctors across the country, connect so that you all can start to really figure out what are some of the trends? Because I know that that’s one of the challenges with this particular disease, is that it’s so new and people really don’t know what to exactly be looking for and it’s been very difficult for doctors to share that kind of critical information. Have you been engaging in different and new systems to transfer that data to other medical professionals that you can share the information you’re gathering?
Dr. Panagis Galiatsatos:
Yes. By all means, data sharing is right now the most pivotal. We are all trying to find novel, unique things that are specific to this infection that can really raise our attention to immediately start thinking of it. Because when we see things like fevers, yes, fevers can happen for a variety of reasons, doesn’t necessarily mean that it’s virus. If we say shortness of breath, yes, many things cause it. So data sharing to be able to share all the characteristics of the signs and symptoms of this virus has been very important at this time.
And every day, getting emails for more data insight and input from colleagues from Seattle to New York, to cities in Europe and China, and so forth, it’s been such an amazing time to see us all kind of unite together to share all of our insights because the more we can identify those patients and put the most likely patients who likely have the virus to go get tested, the better it helps us utilize the limited resources we have. We really can’t test everyone. We need to be smart about who we test, so we still need to make sure we have proper screenings. But if we can identify unique symptoms, unique specifically to this virus, the more likely we are to funnel those patients to get tested and identify them and take the proper precautions. So yes, the data sharing world has become so important at the moment and I haven’t really come across any barriers to it. If anything, just an influx of a ton of emails, so half my morning’s probably spent trying to find which ones are really valuable to go through, and so forth.
That’s great. Thank you so much. And before we turn to Chris and Mary Beth to address perhaps what some of those hidden barriers might be to making sure we are in fact protecting that data and verifying that data is coming from reliable sources, and so on and so forth, I want to quickly turn to you, [inaudible 00:09:01]. I know that you are working a lot in the public health space, not only talking about prevention but also talking about our mental and emotional wellbeing during this time. Can you share with us your thoughts on that?
Yes, absolutely. And I just want to echo Panagis said in that the primary strategy to address this pandemic is through prevention. Prevention is also really important, prevention is easier than intervention, and that’s why in many places that we have a lockdown, or shutdown, whatever you want to call it. So it is absolutely important for everyone to cooperate. And then in most cases, we’re seeing people really adhering to policies or guidelines set by administratives, whether they are governors or the white house or specific agencies.
So when we talk about prevention, what are some of the things we’re talking about besides the lockdown? So we’re talking about really frequently washing hands, at least for 20 seconds of washing hands with soap or with sanitizers. Social distancing, that’s really moving ourselves six feet from people around us and limiting our interaction with people as much as possible and staying indoors. And avoiding contact with your hands and eyes and mouth because you’re constantly touching things and putting things on your eyes and mouth and that transfers the virus because you’re touching all kinds of materials and putting it inside of you and then contract the disease.
And then also how we practice respiratory hygiene. So instead of coughing in your hands, you have to cough in your elbows. I saw a PSA, well intentioned PSA, about washing and then coughing with your hands. I was like, “Okay, all right. That’s not a really accurate PSA public service announcement that I would promote.” So really the respiratory hygiene is also very, very important. And as you have fever, if you feel like you are sick, the most important thing is contact doctor directly, or your county or city health department because you do not want to quickly go to the hospital because you’d not know what to expect there. We want to really keep people that do not need to be in hospitals away from hospitals and infecting people.
So those are the public health measures that we want to promote. So with social isolation, people feeling stuck and confined to small space, it creates all kinds of emotional distress. We’re already distressed and feeling anxious because of the pandemic, because of so uncertainties in terms of our own vulnerabilities. But also, would we get it? Would our family members get it or relatives get it? So we’re constantly worried. So how do we really promote emotional health at this very difficult time. One would be to limit our exposure to news, so not really staying 24/7 and accessing information about the virus, but finding ourselves limiting how much time we spend on the news.
And also really thinking about what is it that we can do to promote our health? What are some of the things that we enjoy doing that can be a really wonderful distraction from the situations. Can we practice mindfulness? Can we meditate? Can we exercise? I’ve been hearing, “I myself, I’ve been exercising almost every day and I’ve lost 30 pounds.” I’m like, “Yeah.” And I was on a conference call earlier with someone who lost five pounds just having conference calls [crosstalk 00:12:56] conference calls five miles a day.
So doing something that you literally enjoy doing, reading. And this is a really wonderful time to stay cooped up with your loved ones, whether it’s your partner, whether it’s your kids. And so those are some of the ways for men to any emotional health. Then reaching out to your friends. People you haven’t talked to in a long time, checking on the elderly. So what you give out, you get back in return, and that also promotes emotional health.
Absolutely. Well being someone who is not only high risk from an immune issue but a pulmonary issue as well, thank you so much for giving us those pieces of advice. It’s taken to heart because it is very easy to get overwhelmed and feel like you’re sinking in all of the information that’s going around.
Capitalizing on that thought and going back to what Panagis was sharing with us about how data is now needing to be transferred between doctors and different systems, while he on the last lines, I shall say, as a medical professional may not see the present barriers to sharing that information that way. Mary Beth and Chris, could you maybe chime in on this for us in thinking through how so much of the equipment in so many of the systems that people are now relying on in the medical profession and field are things like ventilators and connected systems and data transfers, and so forth. What are maybe some of the invisible barriers that we’re not thinking about, or as [inaudible 00:14:24] was referring to, what are some of the preventive measures we need to be thinking about to keep all of that data safe and make sure that the health information is still intact?
Mary Beth Borgwing
Sure. I think we can take it from the inside the hospital to all the people that are externally working and also people working from home, talking about hygiene and mental health. We probably need to think about the docs and nurses that are inside the hospital are only thinking about the patient’s safety, and as they should, and they think about how they’re going to help them. But I think there’s a lot of data that probably wouldn’t be moving so fast as it is now, including with some of the folks that are trying to put clinical trials together to put these vaccines together quickly. And having been exposed to clinical trials in my career, there’s a lot of protocols that have to go on, and if we’re skipping and missing some of those, we may inadvertently cause a data breach.
And so I think sticking to our protocols and process to keep data hygiene and cyber hygiene intact from the inside out is really important. So I think the clinical staffs are really overwhelmed, so we probably need to have some of the partners that are working with the hospitals being very mindful of where data comes from and how they use data. And I think that’s a key issue right now because I think there’s a lot of people that might be having what we call idle fingers and could cause a lot of problems and take over a lot of these respirators and these machines very easily. Not just from a data perspective, but just from an online perspective, the hospital is full of toys that bad actors like to work with and to see if they can get into their systems and hold them ransom and cause all kinds of other havoc, especially if anybody is a disgruntled employee or wanting to be causing an insider threat.
Yeah, I’ll add on top of that. To Mary Beth’s point, now is the time for causing maximum havoc now. Saying that, there’s been a lot of discussion with a number of us who know some of the adversarial groups to try to get their attention turned away from the healthcare. And actually some of them to, not sure if I’d say to their credit, some of them to their humanity have decided to avoid hitting healthcare systems. But that’s not all of them. There’s still a lot of chaos and mayhem, and quite honestly if I was looking to maximize from a financial standpoint, now is the time I would hit. And we’re seeing it. We’re obviously seeing an uptake on messages going out, mails going out, social engineering attacks, human engineering attacks, people taking advantage of the situation and hiding among the clutter that’s out there.
Now, as good humans, and as meant to be good custodians to the previous couple of points, we just need to keep doing what we’re doing, which is ask more questions, think before you do something, think about the consequences of those actions and everybody share information. The logic of this is, to the healthcare professionals, this point is they are the last bastions. And quite honestly, we need to be at the last bastions. The people that are sitting between the keyboard on the computer need to be the ones that are really thinking about this and acting accordingly. Yes, information has to flow, we understand that, but we can still make that information flow in a slightly safer way than maybe we are doing at the moment.
Mary Beth Borgwing
Yeah. And I think everything outside of the essentials around the virus, people are canceling their doctor’s appointments and whatnot and they’re being asked to go on portals. And I think that healthcare institutions maybe need to think about the process and a protocol for making sure people understand how to safely access their data. Because I think there’s a lot of people who maybe haven’t done that before because they’d relied on the office staff and other people to do that. So I think that all of these are very lucrative points of entry for the bad actors.
Absolutely. Well, I know we want to wrap up and keep people to about a 15 minute podcast here, but I wanted to leave us with this one thought and I’ll throw it out to the entire group. A lot of people are looking at the response of the government in the medical community and maybe losing their minds a little bit going, “Oh my gosh, is this lockdown really necessary? Is the quarantine really necessary? Are all these things really necessary?” And frankly, the cybersecurity industry is someplace where we can see a very easy analog to exactly this kind of common sense reaction and incident response, if you will, to the work that Mary Beth’s organization really works in.
But this happens all the time. When a computer is infected with a virus, there are very standard modus of operandi that you guys go into to help quarantine that virus and protect the end users as well as any machines connected in data, and so on and so forth. I just wonder how helpful it might be for people to see that these are all normal and regular SOPs that should be out there for the way that we’re dealing with this particular virus, even if they don’t feel familiar to us in a medical crisis like this. Do any of you have any parting thoughts that you could either offer to each other from cybersecurity to medical or vice versa, or just to our general listening audience, about some of the safeguards that have been put into place to help prevent the spread of this particular disease?
Dr. Panagis Galiatsatos:
Yeah, so as a pulmonologist, what I can say is going through my medical training from medical school to residency to fellowship, I can tell you probably have about once a year a conversation around pandemics, and I have never lived through one. Usually my colleagues and even the professor hasn’t either. But what we’re implementing is things that we’ve often discussed or would be necessary to keep the spread of the virus. The challenge that we fully recognize now that we’re requesting this to be implemented is that the plausibility of the understanding behind it, sometimes it’s difficult to meet the practicality of implementing it. We are all social by nature and I recognize that, I understand that and a lot of is being asked of many of us, but I can promise you this is what is needed in order to curb the spread of this virus.
If we don’t, our hospital systems will be overwhelmed. We will have to make ethical decisions that many of us do not. Can you imagine saying he or she doesn’t get a breathing machine and he does. It is not a decision any physician or nurse wants to make. So that’s why, as a physician, we are pleading with everyone to take these recommendations seriously. And the other part was that I told you with this podcast is making sure we get the right information out there. We have to stop the spread of the virus as well as about the spread of any misinformation out there that would add to anxiety and fears for everyone. So that’s my closing thoughts on this.
And I would agree and think one of the reasons why people are just in panic mode is listening to misinformation that is out there. So really advising the general population about searching through credible resources for information on the coronavirus is absolutely essential. Another thing that I want to mention is that globalization, or this world becoming smaller, we’re all traveling is one of the reasons why it’s so easily transmitted, the virus, in just a short period of time through many, many continents. So really staying put lockdown, shutting borders, all are really important measures in order to contain this virus, this epidemic, and let the public health and medical practitioners lead the efforts in terms of what other steps that are necessary to fought to prevent and also cure this coronavirus and we all have to be partners supporting their efforts and their sacrifices.
Mary Beth, how could you help people maybe from an incident response perspective, think through the rationale of all of this and just put people at ease that what’s happening here is absolutely analogous to what you all might do in cybersecurity and there is no reason for people to think that these are random thoughts and random ways in which to shut these things down?
Mary Beth Borgwing
So the first thing is I think the most important thing is what [inaudible 00:23:02] and others have been saying is don’t panic, stay calm. And what we’re doing is we’re working virtually 100%, and our company’s always been virtual. So if you think about everybody has physical reactions to things, but I think what we need to do is to think what can we do to help each other virtually and be in connection and collaborate and ask each other questions because I think that’s where teams go wrong when they don’t collaborate enough, even when they’re virtual. So we’re in a crisis mode 24/7 365 because we get up in 15 minutes on any problem a client has. And I think we can do that as long as we stay calm. So I think we’re used to being the fire, the fire department in the cyber area and I think right now, we’ve challenged everyone in our country to sort of do their best. So I think staying calm is the first priority.
Well, thank you so much to all of you. I know that this is an ongoing situation, week by week, day by day there’ll be new information. We would love to call on you again should things change, hopefully for the better. But we really appreciate you sharing your expertise through this podcast. And to Panagis’s statement, it is helpful to get the real and right information out to others and make sure that we aren’t spreading any disinformation, misinformation, that there isn’t an infodemic going on, which is a lot of people are talking about. And I just think all of the medical professionals on the front and last lines, as well as all of our cybersecurity experts who are out there protecting our data and making sure that this information can move around rapidly so that we can find some vaccines, cures, and everything else we might need in this particular time of need quickly, effectively, and without any issues for any company or individuals. So thank you all so much for being with us. We really appreciate it.
Dr. Panagis Galiatsatos:
Mary Beth Borgwing