Reaction to Philadelphia’s New Mask Orders: “A Little Premature”

Robert Wachter

[ Music ]

Marianne O’Hare : Welcome to Conversations on Health Care . This week we welcome Dr.
Bob Wachter, Chair of the Department of Medicine at UC San
Francisco and big influencer in these past two years on COVID.

Dr. Robert Wachter: A nd so I think we're go ing to be seeing a natural experiment where
certain communities respond to an uptick in cases and go back to
more restricted policies, other communities don't do that, and we will
see what happens.

Marianne O’Hare : Lori Robertson checks in from F act C heck.o rg and we end with a bright
idea improving health and well being in everyday lives. Now, here are
your hosts Mark Masselli and Margaret Flinter.

[ Music ]

Mar k Masselli: Our guest ’s knowledge an d views about COVID get noticed. In the last
two years his tweet s had been seen over 400 million times by 250,000
followers and served as a trusted source of information on the clinical
public health and policy issues surrounding the pandemic. We're
going to ask him directly the questions about the current state of
COV ID .

Margaret Flinter: Dr. Robert Wachter is a professor and Chair of the Department of
Medicine at the University of California, San Francisco. He also wrote
The Digital Doctor: Hope, Hype a nd Harm at the Dawn of Medicine ’ s
Computer Age, which was a New Yo rk Times science bestseller.

Mark Masselli: Well, Dr. Wachter , it's great to have you back as a guest again, and
like you were tracking the latest COVID news and Philadelphia is going
to again require its citizens to wear masks indoors , it’s the first majo r
U . S . city to take this step. Just wondering from your vantage point, is
this the right move and do you think other cities will follow?

Dr. Robert Wachter: Thanks for having me Mark a nd Margaret . It's a fascinating time,
because there are just so many swi rling currents and still a fair
number of unknowns despite being two years into this. So if you knew
for sure that the mild surge that we're beginning to see in the
Northeast would lead to the kinds of surges we've seen b efore, then
there's no question. Yo u would pull back on some of the openness,
you would reinstitute mask requirements and if you knew for sure
that the mild surge that we're seeing will stay mild and not be
associated with a significant increase in hospitalizations and sick
people, which is what we're seeing so far over the last two or three
weeks, then you probably wouldn't . The answer is we don't know
either of those for sure. We do know people are pretty tired of the
restrictions and of masking, etc . after two years. And so I think we're
going to be seeing a natural experiment where certain communities
respond to an uptick in cases and go back to more restricted policies.

Robert Wachter

Other communities don't do that . And we will see what happens.

I think it feels a little premature on the part of Phil adelphia . If I were
me, I might have waited a little bit longer to see what happens
b ecause if it's going to be that even a very minimal uptick in cases
with no uptick in hospitalizations leads to more masking
requirements, you'd see a ton of masking requi rements and I think
the pushback from the public is going to be pretty big. I think we kind
of want the public to trust us at this point that the masks can stay off
unless you want to wear one unless there really is a significant threat
to the community. A nd I think it might be a little bit premature to
make that call right now.

Margaret Flinter: Well, we're seeing the news coming in from multiple places now ,
right . W e have the White House COVID czar Ashish Jha saying he's not
overly concerned about the ris ing BA.2 cases in the Northeast , but the
Policy Lab at Children's Hospital of Philadelphia came right out and
said they were against the mandate. Do you think we've learned
anything about how to give messages to the public, which are
sometimes not as clear and straightforward as we'd like and get them
to pay? What's your strategy when you talk to people to keep them
from tuning out?

Dr. Robert Wachter: I think we've learned a fair amount and I have to say Ashish, who's a
very old friend and trained here at UCSF, is as good at this as anybody
in the universe. So it will be wonderful watching him in this role as
sort of communicator in chief . He's really, really good at it. If anybody
can do it, he will . One of the elements of COVID is that it happened in
2020 at a time where everyone can choose their own adventure when
it comes to their media and their communication. So I've been
gratified by having a quarter of a million followers, but I think they are
people who have chosen to listen to me. And for whatever reason,
that's a particular lane, I have a particular point of view , I'm probably
sort of in the middle, there are people who are much less restrictive
than I am people who are more restricted than I am. And so I think
the problem with communication under conditions of real uncertainty
with massive politicization of almost everything, even the question of
you know, masking, for example, on airplanes, I think that's going to
be the big issue of the next week.

I think reasonable people could disagree on that one. And I think it
would be wonderful to have a reasoned conversation about pluses
and minuses of mask requirements on airplanes. I'm probably going to
do that on my Twitter feed later today. But much of the public is
already you know, burrowed into thei r position. It's either a terrible
thing that they have to wear a mask in part because of a libertarian
point of view or because they think Oh, it's over. They want it to be
o ver . Or it's a wonderful thing, because it's risky , and I'm sitting in this

Robert Wachter

alumi num tube for six hours next to someone who I don't know. So
my philosophy has been lay out the facts in as plain English as you
possibly can sort of make clear that you see both sides of the issue,
try to be empathetic to people who disagree with you recog nize that
there are some issues that I think are not controversial, and yet they
are controvert. I mean, whether to get vaccinated should not be
controversial. It's a no brainer. And yet, obviously, some people feel
differently, but on issues like reinstat ing the masking requirements or
what to do on the airplanes, I think the way to approach this is have a
conversation about what we know, what we don't know, that here
are both sides of the arguments a nd here is where I come down. But I
think that's sort of the best way to approach this. But it's very, very
hard. And I think we do have to weigh the fact that we're two years
into this a nd people really are tired of it. And you can't sort of wish
that away. It is an important fact on the ground you have to pay some
attention to .

Mark Masselli: I noticed that most recent report they got published about Fox News
reporters who were asked to pay to listen to CNN and sort of their
responses after they seem to revert back after the study to their own
tribe. And so yo u have really people who are following those people
that they've somehow gotten comfortable with. And really all of these
get down to the trust that we're trying to build up. And you were
talking about aeroplanes and the decision that's coming up by the
th
De partment of Transportation, I think, April 18 . But tell us what you
do from San Francisco to visit Ashish Jha in Providence, what would
you wear when you're on the aeroplane?

Dr. Robert Wachter: Yeah, I would do nothing different than I have been doing a year and a
half since I've started doing some traveling. And I've made three cross
country airplane trips in the last five weeks . I wear N 95 or a KN 95. I
put it on as I'm entering the airport . I tried very hard not to take it off
until I leave the airport on the other end . We know that airplanes are
quite safe in terms of the airflow, the ventilation, it has the kind of
airflow we'd love to have in school rooms and in our offices. So that
part is terrific. On the other hand, airplanes morph into flying
res taurants at some point during the flight. And at that point, you
have people taking their masks off and maybe in a week or two or
three more pe ople will take their masks off.

I think one of the things we've learned is the value of one way
masking. I mean, the early mantra that my mask protects you but
doesn't protect me is wrong. If you're wearing an N95 , your mask is
protecting you really, really well. I mean, I know that because we take
care of people with COVID in the hospital, and we very rarely get
CO VID from our patients. And so my feeling is if I keep that N 95 on for
the vast majority of the flight and take it off very briefly , and I do I
take off very briefly to gobble down some food and chug my

Robert Wachter

cranberry juice and put it right back on and I try to do that when if I
look around me when everybody else has their masks on. I think that's
a pretty safe thing to do. The flight is not super high on t he list of
things that worry me. But I'm much more worried about going to a
reception at a conference I went to the other day in Tennessee where
there were a few 100 people there and we were eating and drinking
and in a room that was probably less well ventilated than airplane.

So even if the Feds make the decision to take away the mask
mandate, I think that wi ll actually increase even more likely to keep
my mask on the entire flight. And I think if I do, it will keep me safe.
And that is why I think ultimately if the case rates don't skyrocket, I
think the government probably will take down the mask mandate .
Wh ether they do it next week or they wait a few more weeks to see
what happens with this BA.2 surge I'm not sure. But I think they
probably will take it down in part because we now know that
individuals, someone who's at three or in my case four shots, and i s
wearing an N 95 for the entire flight , I've done everything I can to keep
me safe, even if the person sitting next to me is unvaccinated and is
not wearing a mask.

Margaret Flinter: But another decision point that's out there. You said you got a fourth
do se of the vaccine pretty recently. But Americans over 50 can now
get their second booster if it's been at least four months since their
first one. What's your advice to people about getting it now or waiting
until later off of some of the concerns about de clining immunity? Dr.
Fauci says we are likely t o see another surge in the fall. Would you
advise patients to wait and to get it a little closer to the fall or what's
your advice?

Dr. Robert Wachter: Yeah, I th ink it's a tough call. I got it. I'm a 64 year old pretty healthy
person I've got mild asthma but you know, I'd prob ably fall on the
medium to high - ish risk be just because of my age. And I felt like the
data from Israel is quite convincing that the second booster or the
fourth dose significantly low e rs the chance of getting infected, and
significant ly lowers the chance of getting severely infected, by which I
mean going to the hospital and getting very sick and dying, and that
was enough for me now six or seven months after my first booster, to
feel l ike, I'd like to get it now . I sort of felt like, you know, waiting until
you hear that there's more of an upsurge in your region, sort of like
trying to time the stock market . It just doesn't generally work very
well . You're better off buying a good stock and holding. And so the
idea of waiting and timing, that part wasn't very attractive to me,
because I sort of figured if I get it now, and this one also lasts six
months, then I'll probably get another one.

You know, when the time comes, if you need anot her one in the fall,
or they've come out with a better vaccine in the fall not clear yet that

Robert Wachter

that's going to be true, I didn't think there was real value in waiting . I
changed my thinking a little bit on that with the study in the New
England Journal last week that show that the length of protection
from booster number two was going to be similar to that of booster
number one, meaning that it lasted four to six months, and then it
started decaying. What was a little surprising was that it only lasted
about two months in terms of protection against symptomatic
infection. And so if that's the window you have, it's only going to work
now not probably last longer than that in terms of protection against
severe infection. So that's comforting. But if the window is only going
to be a couple of months, it seems unlikely that you're going to get
another booster two months from now, then it felt like if I'm a
younger, healthier person, I'm six months out from shot number
booster number one, then I think I ’d probably wait b ecause my risk of
getting very sick and dying.

If I've had three shots, and I'm younger, your risk of having a severe
infection is very low. The amount of COVID in the environment now
even though there has been a little bit of an uptake is still fai rly low, I
think it probably makes better sense to sort of use your two month
window better. Maybe in the summer, if you're going to be in the
south, maybe waiting till the fall if you're going to be in the north, but
it's a lot of guesswork. In my thinkin g about all of this, I have to say
there's a part of it, that's all about severe infection, am I going to get
sick and die . There's a part of it that is about long COVID, which is I
still really don't want to get COVID if I can avoid it . The data that's
co me out about long COVID In the last six weeks is pretty scary. Two
months ago, three months ago, we talked about long COVID as
symptomatic badness that you still felt crummy and six months later
you br ain fog or fatigue or whatever.

There have been four s tudies in the last month or so that showed
increased risk of blood clots, increased risk of heart attacks, increased
risk of diabetes, you know, a couple others, brain shrinkage, we don't
really know what that means. So that's part of the tension here is
w hat are you trying to do prevent symptomatic infection, serious
infection , so that's a long and complex answer but it's really this is like
in fourth grade when they taught you about deploying fractions with
fractions , this is it on steroids . It’s really p retty tricky to think this
through. But I think the really short duration of protection from shot
number two does push me for a young healthier person to wait a little
bit until there are more unmistakable signs of a surge.

Mark Masselli: You know, we're s eeing in Washington and lots of our leaders
reporting that they've tested positive for COVID in recent days, and I
think back in 2020, then President Trump had COVID. And at that
time, you said you were in favor of Trump being assessed for
alterations in h is judgment. To be fair, we need to ask you, do you

Robert Wachter

think such an assessment should be required of those and they're
pretty high up in terms of the leadership should also be tested for any
issues? And I say that in particular, given all the reports that yo u just
indicated about long COVID and its potential impact on so many parts
of the body systems .

Dr. Robert Wachter: No, I don't think so. I think the President has a special place. I mean,
we don't have a 25th a mendment for a M ember of Congress or for a
S enator. And, you know, for every person, there's always a risk of
cognitive decline. And we don't go around and test people for
dementia, whether they're a Congress person or a physician, for that
matter. I don't think the risk is so high. I think in Presi dent Trump's
case, there we re a few issues that were going. First of all, it was quite
clear, he had a severe case, even though they fa bricated and
assembled about it. It was quite clear that he had a low oxygen level
that he was actually at substantial ri sk of a bad outcome.

It was in the first wave of COVID, where we didn't have the kinds of
treatments that we have now. And so there is a 25th amendment for
a reason he you know, the President controls the nuclear button. So I
think it's a very, very speci al case. The virus that people are getting
now, particularly if they're getting a breakthrough infection which I
assume all of these Congress people have been fully vaccinated ,
Omicron is milder than the virus that Trump got. There was no
vaccine when Trum p got his infection. These folks are now getting
breakthrough infections, which makes it even milder than it was
before so we don't really know what the risk of long COVID is in the
setting of these folks. We know sort of the risk of long COVID f or
people that got infected a year ago. But there's no such thing as
someone who got a breakthrough Omicron infection a year ago, there
was barely a vaccine that just come out and there was no Omicron.

So my guess is that Omicron has proven itself to be milder, tha t
breakthrough infections tend to be milder, that the risk of long COVID
b oth in terms of symptoms and cognitive issues and ultimate risk
factor for things like heart attacks and blood clots will be lower for the
person who gets a breakthrough infection wi th Omicron th a n from
the prior infections, and so we got to be a little bit reluctant to
extrapolate with a straight line saying, h ere's what we know, a year
later after an infection, I think the setting is somewhat different, I
hope so, you know, the idea that, the almost half of the country that
got Omicron, most of them break through infections, that they will all
be at a significant higher risk for things like diabetes and heart attacks.
I mean, that's really troubling if that turns out to be the case . I think
it's too soon to make the call. But in my mind, it is one reason that I
don't want to get infected, if I can avoid it .

I am not of the school that we should all be over it and if we get it, it's

Robert Wachter

going to be mild and so don't worry about it . I still think it's a
worthwhile pursuit, if you can live your life to the extent that you can
and have joy in your life a nd to me, that means traveling periodically,
but not put yourself under undue risk b ecause there is some
possibility that this long COVID thin g will still be a thing, even if it's a
relatively mild initial infection with Omicron in someone who's
already been vaccinated.

Margaret Flinter: Well, Dr. Wachter, I'd like to ask you about some of the long term
changes associated with COVID, not some of the behavior changes
that we're going to see in healthcare. It's been more than two years
since I've seen the faces of some of the folks in our primary care
teams and our primary care clinics , and I imagine that's probably true.
At UCSF, we're still under an emergency order here in Connecticut by
the governor for health care facilities to all be masked . Do you think
it's possible that this will just become a normal part of being in a
healthcare setting that people will wear masks? Is there a going back
eve n post COVID? What's your thought on that? What are we likely to
see?

Dr. Robert Wachter: I'm guessing that we will stick with masking in healthcare delivery
setting, certainly I think in hospitals, but this may be regional. I mean,
you know, I think in Sa n Francisco, which has been a very m asky place
and a very I think that, I'm guessing that I will always be required to
wear a mask when I have patient contact, at least for the next several
years. Who knows what things will feel like 10 years from now ? I t hink
there'll probably be other parts of the country where the masks
become sort of so non - normative in all se ttings that they go back to
non - masking except for having a lower threshold to wearing a mask
when the provider has a sniffle or the patient has s ome respiratory
illness . I think we'll have to see . I have to say it's been in my
workplace, we continue to have to wear a mask with patient care. But
if I'm having a meeting with a colleague in my office, we don't have to,
and that's been wonderful. I thi nk we are all kind of learning our way
back around social graces.

My younger son who is autistic said to me a few months ago, when he
went out to see a concert and met a friend, and he came back and he
had a huge smile on his face. And I said, Benji , what up, and he said,
it's great that nobody knows how to socialize anymore. It was sort of
a great equalizer for people that are kind of neuroatypical. And so I
think we're all kind of learning a lot of stuff, you know, I mean, I can't
figure out the handshak e versus the elbow bump, you know, every
time it feels like it needs to be negotiated. So I think we're all going to
have to sort of be charitable with ourselves and get used to this new
normal and figure it out, but you know, I think for at least the next
couple of years in healthcare settings we will wear masks, and we
probably should .

Robert Wachter

Mark Masselli: You've written so well about the digital revolution in medicine and
COVID is really its first big test. But the Harvard Business Review
recently wrote that d igital and artificial intelligence really failed in so
many ways, bad data sets, complex, uneven global contexts. Where
do we go from here in terms of digital technology?

Dr. Robert Wachter: You know, my worldview is that we are heading toward a universe
w here healthcare is as digitally facilitated as the other parts of your
life. As you know, the way you handle your finances and your travel,
which now we're almost completely digital and work better than they
used to when they weren't. And so healthcare is not that in part
because we were very late to this game and in part because it's
complicated and a lot of reasons. It's the regulations, the HIPAA, all
that kind of stuff. It's just harder. I think COVID accelerated us in a few
ways. I t hink telemedicine f acilitation was really important, although
sadly, I see a lot of states putting back some of the regulatory bar riers
that will push back on it, but I think now that clinicians and health
systems and patients have tasted it, there will be a real demand and
what's great about telemedicine is not just a visit replacement, but it
sort of changes the geography of healthcare, the idea that all
healthcare is delivered when you go to a doctor's office or go to an
ER, it has been blown up by telemedicine . I think wi ll continue to get
blown up by all sorts of digital hea lth that people can do at home. So I
think that move d us probably five years ahead.

I think another thing that's less sexy, but I think has been very cool, is
the use of digital dashboards. I go onto my UCSF website every
morning, and I can see the data I need to know about COVID, patients ,
and test positivity rate, and you know, people in the hospital and
whether they were vaccinated or not and whether --- and it's beautiful,
it's beautifully visualize, it's well laid out. And I think once you've
tasted that, you say why don't I have that for all my patients with
diabetes and my patients with cancer. And up until recently, we
measured everything. But then, you know, when a clinician needed
data, or a hea lthcare leader needed data, you sent them a
spreadsheet, it was stupid. So I think this has moved us forward in the
understanding that collecting the data digitally doesn't do anything
until you then can process it and deliver it to decision makers in a
fo rm that's really usable.

I'd say AI, I thought might have it shiny moment during COVID. I don't
think did. I think it's going to be a really important technology and
advance d . But it's harder than people think it's harder than the
people who've done AI in other industries who think that they can
come into healthcare and fix us, in part because the data sources are
so bad and the bias, all the usual reasons that problems with data
sharing . I think it will have its moment eventually, but it did not hit its
t ipping point now, but I think overall COVID moved forward the

Robert Wachter

digitization of healthcare by five years . I think we will hit some of the
digital Nirvana in 2025, rather than in what might have been 2030 or
2035.

Margaret Flinter: Okay, I'm looking forward t o digital Nirvana in 2025. But Dr. Wachter,
you've been a great communicator throughout COVID and you
mentioned your followers, I think you said 200,000 .

Dr. Robert Wachter: 260,000.

Margaret Flinter: 260,000 followers.

Dr. Robert Wachter: Not all of them are family members , so it's pretty gratifying.

Margaret Flinter: Well, that is impressive. But there's also issues w ith Twitter where we
read that the New York Times just said its reporters do not need to be
on Twitter because so many of them have become t argets for
harassment. Do you think Twitter is nearing a point not of Nirvana,
but a point of where it's just more trouble than it's worth for public
health education?

Dr. Robert Wachter: Yeah, I'm a fan. Certainly it can be assessable. Certainly, it can b e a
source of disinformation. And I've seen lots of abuse. I've received
some, but I think mine has been reasonably benign. And I have to say,
it's partly because I'm a white guy. My colleagues who are not, I think
get more abuse, which is really quite ter rible. For me, the ability to go
on to Twitter and see what 100 or 150 people I really respect who are
looking at COVID world class virologists or epidemiologists or aerosol
scientists or sociologists, what they're thinking what they're reading,
to be able to sort of see the latest literature as synthesized, for
example, by Eric Topol. And then for me then to take it all in and say,
all right , here's what I'm thinking about the airplanes and be able to
communicate it with force brevity in a way that immedia tely goes to,
you know, quarter of a million people, I think it's pretty fabulous.

And if your goal was to keep up to date on this thing and
communicate out to people who are looking for information from a
trusted sou rce, I think it's irreplaceable. Free speech is free speech.
There's no filter. And so there's just a huge amount of garbage out
there. It's also a massive time sink that The New Yorker comic writer
Andy Barr , several years ago, wrote on Twitter, I thought quite funny,
he said, I'm signing off Twitter for a whi le, my family has left me and I
need to find out when. You now, t hat’s the funniest thing you can say
and that for your character , but overall, I think, for me, it's been a
G odsend. And I think for the people that follow me and people lik e
me, it has provided a source of trusted information that's really up to
date that I think can't be replica ted by any other form of media.

Mark Masselli: Well, let's try to pull on some of that knowledge that's up to date,
because we're hearing about a BA .3 and a BA .4 variant that people

Robert Wachter

are keeping an eye on . Tell us what you're seeing out there. What
keeps you up at night about this? And do we have a good early
warning system in place here in the United States?

Dr. Robert Wachter: Yeah, we're better prep ared than we were, you know, a year or two
ago. We're watching it very carefully. I think it's a little bit
embarrassing that the data systems we have in the United States are
so poor and so poorly developed. And we do have to rely so much on
the data from other countries, particularly Britain and Israel, but
many of the European countries. I think it's a wake up call for us. We
need better data systems, better monitoring. I think wastewater isn't
advanced, we need better surveillance. I don't love the idea that
we're going to use hospitalizations as our metric because that's two
weeks, three weeks behind . For me to decide whether I want to wear
a mask or go out to an indoor restaurant, I'm not really looking at
hospitalizations, I'm trying to figure out what are the chances that my
waiter is infected, or that somebody at the next table is infected. And
I don't get that from hospitalization . I need to know what the
prevalence is in the community.

So the problem is there are variants that pop up all the time. And so it
is going to take some time and work to suss out each one and
whether this is a scariant as they say, or a really, truly worrisome
variant. But I think the key thing is we're watching now we're
monitoring, we're looking at genetics, to be able to say we're seeing
an uptick here that we wouldn't have expected. You know, am I
worried? Yeah, anybody who said t here can't be anything more
infectious than Delta was proven wrong with Omicron. And anybody
who said all right, now Omicron is as bad as I get was proven wrong
with BA .2. The thing that worries the most, you know, I am over it has
become a governing philosophy. And so I am not convinced that we
will do what we need to do if we see a particularly nasty new bug
come out, you know, what we would ha ve done a year ago and I think
what we'd still do in a place like San Francisco is okay, this one's nasty
a gain, we're going back to masking we're going back to be more
careful. There are lots of parts of the country wher e that will simply
not be true. And then we'll have to see whether they get away with it
or not. I think there's a decent chance that they won't.

Margaret Flinter: Well, thank you, Dr. Wachter, for your advice, your guidance and your
incredible contributions to health and health care over d ecades. You
can learn more about Conversations on Health Care at
www.chcradio.com . Dr. Wachter , thank you so much for joining us.

Dr. Robert Wachter: Thank you so much for having me. It was a delight.

[ Music ]

Mark Ma sselli: At Conversations on Health Care we want our audience to be truly in

Robert Wachter

the know when it comes to the facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. Politics.
Lori, what have you got for us this week?

Lori Robertson: Weekly rates of COVID - 19 hospitalizations and deaths by vaccination
status are published monthly by the Cent ers for Disease Control and
Prevention on its website. The deaths data were last posted on March
th st
17 and the hospitalization data on March 31 . But a viral tweet
claimed that CDC is no longer releasing the information. The tweet
was later deleted by its author. But as we've seen before when
something goes viral, it is still being shared by other people on other
platforms. The CDC monitors rates of COVID 19 cases and deaths by
vaccination status and age group. According to the CDC website
COVID - 19 case and death information is collected from jurisdictions
that can link their case surveillance data to immunization data, and
identify the vaccination status of people who test positive. The data
on COVID - 19 hospitalizations are collected by COVID - Net, a
surveil lance system that collects data on hospitalizations of children
and adults with a confirmed infection through a network of o ver 250
hospitals in 14 states. According to this data, unvaccinated people
over five years old were 2.4 times more likely to test positive for
COVID 19 a nd nine times m ore likely to die from COVID 19 in January .
And i n February, unvaccinated adults, ages 18 and older were five
times more likely to have a COVID - 19 associated hospitalization than
fully vaccinated adults.

And t hat's my fact check for this week. I'm Lori Robertson, Managing
Editor of FactCheck.org.

[ Music ]

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at th e University of Pennsylvania. If you have a fact that you'd
like checked, e- mail us at www.chcradio.com , we'll have
FactCheck.org's Lori Robertson check it out for you here on
Conversations on Health Care.

[ Music ]

M argaret Flinter: Each week Conversations highlights a bright idea about how to make wellness a part of our communities and everyday lives. Stanford
based bio engineer Manu Prakash has a simple goal. He wants to create a portable medical lab small enough to fit in a backpack and
he's already developed a tool that fits the bill. While sitting under a tree in Uganda, he noticed that the local medical clinics door was propped open by an expensive centrifuge machine, one that was

Robert Wachter

reliant on electricity, now brok en and no longer in use. And he
wondered how could he create a portable centrifuge that would be
inexpensive to make easy to operate and easy to replace . His
inspiration came from a simple childhood toy, the whirligig , a toy that
functions by pulling two e nds of a string threaded through a round
object like a button.

Manu Prakash: So we spent a significant portion of this time truly understanding the
mathematical phase space for how you can convert linear motion into
rotational motion. There's some beautifu l mathematics hidden inside
this object.

Margaret Flinter: So he took this s imple toy idea to another level, creating a human
power centrifuge made from simple components, paper, twine and
plastic. All together each Paperfuge, as he calls it, can be constr ucted
in under two minutes and costs only 20 cents and yet remarkably it
works extremely efficiently.

Manu Prakash: With this set of principles, we're able to essentially make a centrifuge
that spins all the way to 120,000 rpm. In the lab, we can separate and
pull o ut malaria parasites from blood, separate blood plasma .

Margaret Flinter: It's currently being tested for malaria diagnoses, but it's being readied
for far more complex diagnostic challenges.

Manu Prakash: This is a tool that requires no electricity, no infrastructure, and you
can carry them around in your pockets for a price point of 20 cents .

Margaret Flinter: The Paperfuge, a cheap but highly effective field through for
clinicians, providing a portable solution to diagnostic challenges
creating a quicker pathway to diagnosis and treatment. Now that's a
bright idea.

[ Music ]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health

[Music]

Ma rianne O’Hare : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
[email protected] or find us on Facebook or Twitter. We love
hearing from you. This show is brought to you by the Community Health Center .

Robert Wachter
[ Music ]