Latest / StartUp Health NOW Podcast / Dispatch From the Frontlines of a U.S. Pandemic Response With KnowNOW’s Dr. Marcelo Venegas

Transcript

Dispatch From the Frontlines of a U.S. Pandemic Response With KnowNOW’s Dr. Marcelo Venegas · StartUp Health NOW Podcast

• 0:02
  [upbeat music] Two, one, go. [beeping] Welcome to "Startup Health Now," the podcast where we celebrate health's most innovative entrepreneurs and the health moonshots they're working to achieve.
• 0:14
  I'm Nicole Clark, Startup Health Senior Writer. Today, I'm pleased to be talking with Dr.
• 0:19
  Marcelo Venegas, co-founder of KnowNow, a startup that's on a mission to provide, provide screening for important medical conditions, especially for those who would not otherwise get tested.
• 0:30
  They're pivoting to expand services to help meet the rising demand for telemedicine and virtual care visits since the COVID-19 outbreak. Marcelo, thank you for joining me. Hi, Nicole. Thank you for inviting me.
• 0:44
  So just to get started, do you mind introducing yourself and just giving a little bit of background on both your, uh, work in healthcare as well as your, your entrepreneurial journey? Absolutely.
• 0:57
  So, um, I've been a practicing physician here in New York and New Jersey for 20 years. Uh, my training was in internal medicine, um, at Montefiore Medical Center in the, in the Bronx.
• 1:10
  I also did emergency medicine, and then along the way, picked up an interest in HIV care.
• 1:16
  Um, that led to many different jobs, including being an ER attending at Bronx-Lebanon, uh, then changing my role and doing outright HIV care, uh, where I managed, uh, a healthcare system for, um, an organization that does HIV and advocacy, Housing Works.
• 1:35
  I ran all their medical programs for, like, six years. And that led me to Lutheran Hospital to be in charge of HIV and Hepatitis C, which is now known as NYU Brooklyn, and I was there for, like, another six years.
• 1:49
  And currently, I work, uh, as an urgent care provider, uh, for one of the largest urgent care centers here in, um, New York and New Jersey, and I also work as an HIV provider for AIDS Healthcare Foundation.
• 2:02
  So- Oh, and yeah, sorry. I forgot the other, the other part of your question was around, uh, tech and, um, you know, kind of like startup health. Um- Yeah. Yeah. Yeah. Was gonna follow up. We came... Yeah.
• 2:12
  So my colleagues are all, um, from the Bronx, and they trained at Montefiore as well.
• 2:18
  Uh, they're fierce women doctors that I have always respected and worked with, and, um, they have always been on the side of the poor, always done primary care, um, and specialty care as well.
• 2:31
  Two of them have done, uh, have gone on to do specialty care. And so Dr. Ramirez, Dr. Berg, Dr. Lears, uh, we teamed up, and we created KnowNow Health, uh, approximately three years ago now.
• 2:44
  And, uh, the goal was really to create access to care, particularly STD testing, which was really not available if you go to just a regular lab, and also to offer PrEP, which is pre-exposure prophylaxis, one tablet a day to prevent HIV.
• 2:59
  So, um, that's our origin. And, you know, our whole goal was to really get an app to provide access to care, medical care, both testing and treatment, and we became really successful very quickly.
• 3:11
  We really didn't have, you know, a business in mind as much as really our goal or a mission to help others.
• 3:16
  And so, uh, we received attention from the New York State, uh, AIDS Institute, and we've been in meetings with them for the last year, uh, around technology and healthcare.
• 3:27
  And because of their, um, intervention as well, we went on to create a platform that, of software as a service where, where we actually offer telehealth services based on our model, and als- so that we can sell the technology, and that's KnowNow Health Solutions.
• 3:45
  And now we're pivoting, as you mentioned, to offer, uh, just a complete virtual care offering of, uh, any medical condition, particularly COVID-19 and patients that may be as outpatient struck by the virus and how we can have really an intervention, uh, to help them out.
• 4:06
  Well, I, I absolutely appreciate you taking time out of your, out of your day. Um- Of course... I realize you are, you are covering a lot of ground in- Yes... the healthcare space. Yes. And
• 4:19
  in particular, more recently, you, um, you have had experience working as a doctor at urgent care facilities in Queens, New York. Yes.
• 4:29
  Now, you were, um, you were featured in a Washington Post story here a few weeks ago in mid-March that really put a spotlight on doctors, nurses, and EMTs like yourself that are working to help patients with the virus, and many times putting themselves at risk for contracting COVID-19.
• 4:48
  I... Now, I realize, I will say, I understand that, you know, a lot of health organizations are limiting, you know, how much they want [chuckles] health workers to share about their direct experiences.
• 5:01
  So with, you know, with that disclaimer, I am curious, you know, as much as you're willing to share,
• 5:07
  what has it looked like, um, at the epicenter of the coronavirus in the US right now for you as a, as a doctor on the front lines? Yeah. So the government's currently bringing in PPE equipment to the major hospitals.
• 5:21
  Um, uh, you know, the, the un- the overlying thought that had been for many providers, w- I have a chat of, like, 10 doctors I'm with, uh, daily, uh, who are ER doctors and urgent care doctors, and so they're there in the front lines, both in Queens and Brooklyn.
• 5:37
  And it has-- We've had to buy our own protective gear because, you know, this virus is an unknown. It's a complete unknown. Um, we know that it infects the airways.
• 5:48
  We know that, that it, um, can create havoc on your immune system, and we know that, um, the mortality is pretty high.
• 5:57
  Um, and it's also affecting young people, particularly here in the United States, particularly here in New York City.Where, you know, when you look at the ER, uh, hospitalizations, they are, you know, at least I think it's, like, 20% people under 40 years old, which is pretty high.
• 6:11
  And these are people who are really sick, having to get intubated.
• 6:14
  And so, um, with that being said, we r- that we really have been unprepared in terms of our protective equipment, uh, from the lack of N95 masks, which are really the, the best filtering mask, much better than a surgical mask.
• 6:28
  Um, not that a surgical mask won't work, or anything around your nose and mouth that can filter, but at the same time, that's really what's, what's correct.
• 6:36
  And also this kind of reusing of masks, re- using them, um, like, uh, for a week or so, it's really inappropriate.
• 6:43
  Um, also, you know, when you look at, like, a simple snapshot of China or Italy, you see these providers completely covered with head gear, boots, you know, shoe coverings, um, goggles.
• 6:55
  You know, it can go through your eyes. The viral particles can go into your eyes as well, so, you know, your eyes should be covered. And, and really, like, just simple things like a face shield, you know.
• 7:05
  And you don't see that in our providers. When you look at the ER, just photos or videos of what's going on in the front lines or just experience from ourselves, we know it's not happening.
• 7:14
  So what you're seeing is a lot of providers getting sick. Um, you know, I was pretty sick. I was out for two weeks.
• 7:20
  And, uh, my test came back negative, by the way, and a lot of providers have had their tests come back negative. We're a little bit doubtful of that original government test and how actually accurate it was. Um- Yeah.
• 7:32
  And do, do you mind sharing a little bit about your experience as far as, uh, the symptoms- Yeah... that you felt and- Yes... where and how you got tested? Yeah. So I had, I felt like I had the flu.
• 7:45
  I had fever of 101, I was coughing and I had this... You know, I, I had asthma as a child, but I had this, like, wheezing type dry cough, you know, and I was really concerned, obviously, for my family.
• 7:57
  So I started wearing a mask here at home. And on the second day, I said, you know, "I feel really weak and achy," and I went to get tested at one of the local urgent care sites here by the house. Um,
• 8:09
  and, you know, they did the test right away because of my symptoms and, you know, I fulfilled the criteria as a healthcare provider. And, um, the test came back 10 days later and it was negative.
• 8:20
  Um, by then I did start feeling a little better. I- they did start me on antibiotics and, um, you know, thankfully I, I, I'm feel like, feeling 100% better now. Um, but, you know, I had- Yeah, and I think- Yeah, sorry.
• 8:33
  I think it's worth note... Oh, that's okay. I was gonna say it's worth noting that i- in the Washington Post story, you mentioned how you've only ever taken sick leave twice in eight years. Yeah. Yeah.
• 8:45
  And, you know, I think there has been this notion initially that young healthy people, you know, while they're more resilient, um, you know, I think we were kind of taking that as a pass. Um- Yeah...
• 8:58
  and that, you know, again, in, in the effort to kind of counter misinformation, just to- Yeah... stress on the importance of, you know, following the guidelines, um, and being aware, you know, of, of your health.
• 9:13
  So, so for you, um, you've been on the mend. Uh, how long did you have to self-quarantine for? Yeah. So I quarantined myself for 14 days. And, um... But I did work from home.
• 9:27
  So we did the, like, we've done the know-it-all startup work. So, uh, just from mostly friends, families, and relatives.
• 9:34
  You can think about five docs and how many, what that circle of friends and families goes really far. So we've been treating at least 40 patients with fever and COVID-like symptoms since then, uh, as outpatients.
• 9:48
  And from that group we've had, like, three patients hospitalized, um, which we followed up as outpatient doctors, and none of them have been intubated to date. And actually, I think only one is in the hospital still.
• 10:01
  Um, so I've been working from home diligently, putting pa- patients in our, our, our system, following up with them d- on a daily basis.
• 10:08
  One of them is, like, uh, there's a family of four in a household, they're all positive. They got tested, and thankfully, they're all doing well. Um, we have, like, uh, elderly patients as well.
• 10:20
  And then I'm, I'm working from home, also seeing the AIDS patients that I take care of.
• 10:24
  So y- you can imagine I start off early in the morning and don't go, uh, don't finish in terms of outpatient care till, like, 10 o'clock at night. It's also, these patients are not gonna be admitted.
• 10:34
  The hospitals are to capacity. They're only admitting patients that need to be in the intensive care unit or, uh, on ventilators. And so they're sending these patients home.
• 10:43
  If you read time and time again these cases where patients with fever and pneumonia are being sent home, a lot of times without antibiotics, and they're coming a week later just to be hospitalized and intubated.
• 10:54
  And so if we can grab those patients and treat them with whatever we can and, um, make sure... Like, we're treating with zinc, vitamin C.
• 11:04
  We got some old, what's called Kapik, which is, like, these HIV medication that, like, boost your immune system. Not HIV, like, it's a supplement, you know.
• 11:13
  So, like, uh, all the selenium, zinc, and so on that have been proven to boost your immune system. And so- Right... we're putting these patients on whatever we can find, uh, and they're actually fine. You know, I have...
• 11:26
  And they've turned around, and they were, they were ready to croak. We're talking about, you know, heart rates in the 130s, 140s when we talk to them and, you know, they stabilize at a home. Uh, thank God, you know.
• 11:38
  Mm-hmm. So we feel like we've done in the last two weeks an amazing amount of work seeing these patients, and we feel really good about it. Is there...
• 11:47
  You know, I feel like in the US in particular, we're, we're kind of living in this narrative of looking at what's happened in China, looking at what's happened in Italy. Do you...
• 11:59
  As far as the work that you've been doing as a, a medical professional-Have you seen any kind of lessons learned that have been adopted or implemented, you know, at the pace that's needed, uh, in the US healthcare systems?
• 12:13
  Or has the response been more myopic? Response has been completely myopic. I mean, from the early testing that... You know, we were offered the World Health Organization test, which was a German test, and we declined.
• 12:27
  We said we were gonna make our own test, and that was a faulty test where they had three different kind of like strands that they were testing, or areas.
• 12:34
  Um, because of not having a coordinated healthcare system where it's like every man for themselves in terms of private, uh, companies out there, we end up right now with like the governor of New York talking about how he's on eBay competing with other people to get protected here, you know?
• 12:53
  It's, it's ridiculous. It's, it's like, you know, I have people calling me saying, "I can get you 30,000 masks, but I need $5 apiece from them." So they've been hoarded. They've been... Th- there's no centralized system.
• 13:06
  And, you know, the national centralized system, which is supposed to be the emergency preparedness one, is complete depleted. So we...
• 13:14
  From the testing, which didn't happen due to our own arrogance where we could have easily taken on this test.
• 13:20
  Uh, there was a, a Korean rapid test that we declined, and now, just now, a month later, Abbott comes out with their rapid test. We could have had it a month ago, uh, from... if we had just taken that Chinese test.
• 13:32
  You know? And so, um, you know, they were using the Chinese test in Italy. They were u- I'm, I'm sorry, the Korean test in Italy. They've been, they've been doing such a great job, I think, of testing, where we haven't.
• 13:44
  The testing would lead to recommendation around isolation, uh, recommendation even now around mask use, that everybody should wear a mask.
• 13:53
  You remember like a couple of weeks ago, they were saying people don't need masks. Mm-hmm. Um, which is, which is a completely ludicrous... When we saw that, we were like, "This is, this is insane.
• 14:01
  How are you gonna tell us you don't need masks when we know it's a droplet or, even worse, airborne disease?" And so it's true.
• 14:09
  If you're outside with air moving, you don't really need a mask unless you're close to somebody.
• 14:14
  But whenever you're in an enclosed space, whether it's a supermarket or going to a pharmacy now or, you know, a store, um, or back then, you know, we were having people flying or on buses and so on, you know, this is...
• 14:28
  And they weren't using masks because that wasn't the indication. We could have prevented thousands, if, if not millions of infections, you know?
• 14:36
  And, you know, even like if it were talking about like New Orleans and Mardi Gras. I mean, February they were having Mardi Gras for crying out loud [laughs], you know?
• 14:43
  And where you have millions of people coming together, and there was no like intervention saying, you know... Or, or sports events, you know.
• 14:51
  Uh, we were all shocked when the NBA closed down for the season, you know, because players had to come down with it. Instead of thinking, "Hey, we shouldn't be having crowds," from January. You know?
• 15:00
  We should have heeded that call back then. So now we're stuck with a problem where we have not isolated these patients that are potentially infectious.
• 15:09
  And so, you know, like this whole flattening the curve, we're so late to the game now, uh, and counting. But we're a much larger country, and we don't have a public health or preventive health system.
• 15:21
  So, uh, these patients, I, I think it's gonna turn out... Like, this 200,000 number that is being thrown around is scary- Mm-hmm...
• 15:29
  but it may be true, you know, because we haven't hit the apex, which is the peak of infections where we can start saying the numbers are going down.
• 15:38
  We haven't even hit it, and it's expected to happen now in April or towards the end of April, even the beginning of May. Right. So it, it feels right now, you know, um,
• 15:51
  listening to your experiences, and you're somebody that has taken initiative.
• 15:57
  You know, you, you have your startup KnowNow that you have built in previous years for one objective that you're now pivoting to be able to use to meet the, the, the needs and the demands on our current healthcare system.
• 16:13
  Can you, can you talk a little bit about how you are using your KnowNow platform to be able to address the needs of, of COVID-19 patients? Yeah.
• 16:24
  So, you know, we were always impressed as providers of what the power of telemedicine could be, and I think the world pivoted at that moment because, you know, when you look at telehealth and telemedicine, it was still really underused here in the United States, like employers offering it for free.
• 16:39
  People really wanted to see their doctors.
• 16:41
  But now with this kind of like stay-at-home quarantine, um, access to care has become very, very different, and we still think it's still staggered with people who have insurance and people who have
• 16:55
  access to the telehealth out there, um, uh, being able to, you know, get to their, their providers. But I'll tell you, it's also kind of like what I've seen from a lot of these health organizations.
• 17:05
  They're scrambling to get telehealth. They're scrambling to implement some kind of system that they didn't have from before. And so with that said, we, you know, we pivoted, and we're open. We're actually...
• 17:17
  Our app is going live this Monday coming up. I think it's the 6th of April. It'll be on both Apple and Android. And it's a simple app.
• 17:25
  It's nothing special except the idea that patients can, uh, make appointments to see providers, our providers. They can, um, have...
• 17:34
  It's like their health record is there in the app where they can, you know, cut and a- add on, like, uh, paste their, um, uh, whatever paperwork they want.
• 17:44
  We can send prescriptions to their pharmacy, which are gonna be open. Uh, we can see them live through video. We can chat with them through text for like an entire week to make sure that they're okay.
• 17:55
  And, uh, we're offering this all for a low cost. Initially, we were gonna just do it based on donation.
• 18:00
  Then we decided to ha- have a fixed rate of $50 per visit.That if a patient can't afford it, we'll go down, uh, to wherever they c- they can afford or pay at that moment.
• 18:11
  And so we're looking for other doctors to come on our platform as well. None of us are getting paid.
• 18:15
  We're doing this all pro bono, and if we make money, we're gonna put it right back into our system to see how we can expand it in terms of, like, either the, the marketing or, um, or, you know, improving our, our software.
• 18:28
  That's amazing. Yeah. And thank you for what you're doing. Of course. I- We're, we're very excited. We need, we need to do this. It's the only way...
• 18:36
  You know, there's a lot of talk about, you know, United will come to- you know, together we'll survive, and it's gonna take that. It's gonna take
• 18:44
  simple, ordinary people, you know, coming to the table and saying, "This is what I have to offer." Mm-hmm.
• 18:50
  Um, you know, because, because I don't think the government or the, the head of these agencies are really able to get it, you know?
• 18:58
  And so if, if I as a individual can buy the protective gear through, you know, eBay and Amazon and spend some of, you know, my money to protect myself, there's no reason that the, you know, heads of these organizations aren't accountable for their employees.
• 19:13
  And frankly, you know, I'll give you an example. Uh, I, I reached out to one of the heads of one of the organizations. I said, "You know, uh, we do have these...
• 19:20
  You know, I had this offer for, like, N95 masks, but they're quite expensive. Would you be willing to, uh, maybe have a convers- " I wouldn't make any money, obviously.
• 19:28
  "Have a conversation with, you know, Barner, maybe bring it down?" And they're like, "No, no. We're okay."
• 19:33
  And yet all their front desk staff have, you know, the simple, like, surgical masks and are not, uh, not just covered. And it's not just about masks. It's about the full protective gear that people need.
• 19:46
  There's, there's something else I wanted to talk to you about that struck me about your, your startup, KnowNow.
• 19:55
  So the, the mission of your company was initially to open up access to s- getting screening and tested, um, for ST- STDs, HIV testing, um, women's sexual health issues.
• 20:08
  And as a part of the work that you were doing, there was an education component that was working to dispel any kind of stigma, shame, distrust, discrimination that came along with STD, HIV testing.
• 20:25
  You know, I think that your company's guiding philosophy and, and your, your own personal ethos, you know, just offering so much of the work you're doing right now for free, I, I feel like a lot of that can shed some light on, you know, some of the stigma or discrimination that we've started to see crop up around the coronavirus in particular.
• 20:46
  Yeah. Do you, do you mind talking a little bit around kind of that, some of that shame and the stigma that comes w- with, with disease and maybe offer some guidance on how we can make sure as a,
• 21:00
  as humans that we are, you know, kind of clearing ourselves of any of those blind spots right now? That's a brilliant question.
• 21:08
  You know, most of us who have been in the sexual health field, uh, know that it's a very sensitive topic.
• 21:14
  And, uh, we have this puritanism that we have in the United States where, you know, it's like hush-hush about your sexuality, and yet, you know, it's like the biggest...
• 21:22
  one of the biggest users of, like, porn industry, and like, you know, dating apps and so on. So it's kinda like a, a dialect between those two things, you know?
• 21:31
  And we've always been very open about talking with our patients about sexual health. When we opened the app, we actually put...
• 21:39
  W- we worked with an organization called The Hit Lab out of Columbia University, and, uh, we did a pilot where we put ads on Craigslist, and we got tons of people coming in, and I, I'll send you kind of science, ki- kind of like some of their reports.
• 21:52
  But they were so happy that they could talk to a doctor in an anonymous way or semi-anonymous way, and, uh, there was no judgment. We sent their meds. They got their meds, whether it was PrEP or STD treatment.
• 22:05
  And, um, you know, now that everybody's quarantined, it's, it's been kind of crazy in terms of what's going on because we don't know.
• 22:13
  We do know that, like, in Grindr and other apps, it's, like, increasing in terms of usage, and we know that sexuality is gonna happen no matter what.
• 22:22
  And what's gonna happen with those patients that do have STD-like symptoms? So, uh, we've been barraged through our app, actually through the website [laughs] with people having symptoms at home.
• 22:32
  And without having really good access to testing, we're treating them. So I had, like, the case of a young lady. She thought she had herpes.
• 22:39
  Uh, we sent her herpes treatment, and it didn't work because then it wasn't herpes. So we did an alternative treatment three days later, and she got better, you know, for a simple vaginitis.
• 22:48
  And, and we've, we've been doing this for, like, years, so we feel totally comfortable. But there's a stigma out there, and it's just not sexual health.
• 22:56
  It's also, like, people don't feel comfortable talking to their doctors. Um, and so, um, you know, they'll come for us for PrEP, but they'll keep their primary care doctor somewhere else.
• 23:06
  And, you know, we totally don't mind it as long as our patients can get something that is, like, life-saving, like one pill a day to prevent you from getting HIV.
• 23:15
  Um, but now also I think with this whole kind of like shroud around corona and COVID-19, you know, people should be getting care right away. Like, if you have a cough or a fever... I see it time and time again.
• 23:27
  They're like... Young people, they're like, "Oh, no, I'll be fine."
• 23:30
  And they reach out to us on, like, the fifth or sixth day when they've had fever, and we're like, "Why did you not reach out to us like five days earlier?
• 23:37
  We could have started you at least on an antibiotic because you fulfill the criteria, and we could have monitored your progress."
• 23:44
  Um, and so it's like people, especially I think millennials or young people, think that they're invincible and that it won't get to them, and, and they'll be quiet around their symptoms. We see this in doctors.
• 23:54
  We were... I was on a video call with a doctor o- on p- part of our group the other day, and he's an ER doctor. And we see him, like, huffing and puffing on the screen, and it... We're like, "Why don't you just...
• 24:05
  We know you have one of those machines to see your, your pulse." Put on this thing or the pulse ox. His heart rate was 130We said, you know, "You gotta go to the ER. You cannot stay at home."
• 24:15
  He's like, "Well, maybe I should." You know?
• 24:18
  And, but people think they're, like, immune, and that they shouldn't get care, and I think this is really important around even the stigma around, like, being infected and thinking, "Oh, no, I'm fine."
• 24:29
  Um, everybody's vulnerable at this point, and I think that it's a call to, like, if you're having symptoms, right away you should reach out to a medical provider. Dr.
• 24:38
  Marcelo, I appreciate, again, you making the time to talk with me here on the StartUp Health NOW podcast. Absolutely. Um, you know, I, I wish you all of the health and safety with Gusto as- Thank you...
• 24:54
  the world is really leaning on medical professionals like you right now, not just for the care that you're providing, but for being a voice of truth, uh, you know, amidst otherwise a slew of misinformation. So,
• 25:10
  thank you, and for our listeners, if you'd like to get more information about KnowNow, you can visit startuphealth.com/knownow. It's been a couple of weeks since I spoke with Marcelo.
• 25:24
  Since then, New York's governor, Andrew Cuomo, said that he would extend New York state's shutdown from April 29th to May 15th. This is in coordination with other states.
• 25:35
  While New York has made progress in containing the coronavirus, infection would have to slow considerably more before restrictions are lifted.
• 25:42
  As other states follow in suit, officially extending shutdowns and stay-home orders into early summer and most likely beyond, health entrepreneurs like Marcelo, who've built telemedicine platforms, will become more and more critical to an effective pandemic response.
• 25:58
  You can access affordable medical care and COVID-19 evaluation and treatment at KnowNow's new website, knownowhealth.com. StartUp Health invests in health entrepreneurs like Marcelo,
• 26:11
  and we're doubling down on our support of solutions for the coronavirus.
• 26:16
  On April 18th, during Global Citizen and the World Health Organization's One World: Together At Home COVID-19 broadcast, we're announcing the official launch of our 12th Health Moonshot, a Pandemic Response Moonshot.
• 26:30
  Here's what that means. In the coming weeks, we're committing to invest in 10 startups that are focused on pandemic response COVID-19 solutions, and there are plans to invest in many more in the coming months.
• 26:42
  Entrepreneurs and innovators who would like to be part of our Pandemic Response Moonshot can learn more and apply on startuphealth.com. I appreciate you joining me today.
• 26:52
  Next week, we'll hear from West Schell, CEO, chairman, and co-founder of Conversa Health.
• 26:58
  His company's digital care and communication platform is helping top health systems in the US triage people with virtual COVID-19 screenings. Meanwhile, stay safe, stay healthy, and if you can, stay home.
• 27:13
  We're all in this together. Three, two, one, go. [upbeat music]