Insights on COVID-19 from our Chief Medical Officer

Dr. Don Kosiak (00:00): Even if we're not impacted by the disease, even if we don't think we'd get that sick, helping keep the disease from passing from person to person to person easily is going to be the best lesson learned from this disease and others.

Bridget Bell (00:18): Welcome to Mindset, a Leidos podcast. I'm your host, Bridget Bell.

Meghan Good (00:23): And I'm your host, Meghan Good. Join us as we talk with pioneers in science, engineering, and technology to understand their creative mindset and share their stories of innovation.

Bridget Bell (00:35): We're recording midday on Wednesday, March 18th. While this podcast usually covers differentiated technology, today, we're speaking with Dr. Don Kosiak, the Leidos chief medical officer, on what's on everybody's mind, the new coronavirus or COVID-19.

Meghan Good (00:53): In this episode, we cover the scientific basics of the coronavirus, what it means to be a pandemic, and what we can all do to help flatten the curve.

Bridget Bell (01:03): We also go into how Leidos is involved and how we're leveraging our 50 plus years of helping our customers solve hard challenges and what that means in our current state.

Meghan Good (01:15): We also talked about agility, and what it means to adapt, particularly in a world where there are so many things unknown.

Bridget Bell (01:23): Given the rapidly changing nature of this virus, there may be new and different information by the time you are listening to this podcast. We encourage you to refer to the latest guidance from the CDC and World Health Organization for updates. Now, let's get started with our conversation with Dr. Kosiak.

Bridget Bell (01:46): Welcome, Dr. Kosiak.

Dr. Don Kosiak (01:48): Hey, thank you for having me.

Bridget Bell (01:50): I know you've held leadership roles for several national and international projects, so can you start by telling us a little bit about your background and role at Leidos?

Dr. Don Kosiak (01:59): Sure. Well, thanks again for having me. My role at Leidos as the chief medical officer changes every day. So I say I have one of the most exciting jobs at Leidos. I've had a couple of decades worth of experience working in the healthcare space. I'm an emergency medicine physician that has spent the last decade or so doing both clinical practice and administrative work. In the administrative world, I've had jobs like a traditional chief medical information officer at commercial health systems. That means in charge of electronic health records and those kinds of things. And the last five to seven years of that career before joining Leidos was spent on building command centers or tele-health centers for commercial and federal entities. So I've had the opportunity to serve on committees looking at disaster response globally for organizations like NATO and others.

Dr. Don Kosiak (02:53): I've had a 20 plus year career in the US Army currently serving in the South Dakota Army National Guard. So I have had the opportunity to really, really put my skills to the test, particularly as we start doing some of this pandemic planning. So again, happy to be here.

Meghan Good (03:11): So let's start with the basics. What is a coronavirus?

Dr. Don Kosiak (03:14): The coronavirus is something that's been around for many, many years. There's different varieties of coronaviruses, and most of them are the cause of the common cold. There are several coronaviruses that have caused trouble in the last, let's say, decade or two that we've heard about that are a little more scary. So like the Middle East virus that went around for a while or the SARS-1 viruses that we dealt with in the early 2000s are different kinds of viruses that were previously unknown to the world and so therefore caused some troubles as they started to spread. This particular coronavirus, first identified in late December of 2019, probably came from an animal model is the best guests. Usually coronaviruses will hang out in animals like bats and sometimes they'll cross over to human. So there are coronaviruses that are very specific to animals. Cats and dogs get certain kinds of coronaviruses that they don't pass to their humans and vice versa.

Dr. Don Kosiak (04:17): Every once in a while, you'll get a virus that jumps from an animal host to a human host. And again, that's both likely what's happened with this particular virus. If that virus passes over to a human population that's never seen it before, it has that ability to rapidly spread like we're seeing now. So from an unknown vector three months ago to worldwide deployment of that virus is pretty impressive to see.

Bridget Bell (04:44): What makes this new COVID-19 different from other past viruses. What makes it a pandemic?

Dr. Don Kosiak (04:50): So what's needed for a pandemic is generally something that we have never seen before in a human immune system and the ability to be infectious and spread. So this particular virus is spread by droplets largely, and that allows it to be easily spread from person to person. It also has a high infectivity rate, meaning that when a normal person gets the virus, they tend to spread it to two or sometimes three people causing that string of infection to go on. And because you can play that chain game of, I have it, I give it to two or three people, they have it, they give it to two or three people, you can see how you can quickly multiply the number of people that have it. So how do you combat a virus like this? Much like influenza that we see every year in the system, it's about building up host immunity. So we can build up host immunity several ways. The first way is, I've had that virus before and therefore my body recognize it is a foreign entity and it can fight that.

Dr. Don Kosiak (05:54): Sometimes, it's something else like a vaccine that will provide that host immunity. So we'll get vaccinated for lots of different things and that is to allow our body to recognize that as foreign. The other way, of course, is to have everybody exposed to the virus, and once you have enough people exposed to that virus, you'll have what's called host immunity. So as we go through the ability to fight off the infection as a population, we look at those things, how often have we seen it before as a human? Do we have a vaccination that can help us build up the antibodies towards that? So if we see it's not as devastating to our body. Then three, how do we keep it from spreading through the population or is that the only source that we have to fight off the infection?

Meghan Good (06:44): When we're dealing with host immunity, as you just described, and how to build all of that and then with these transmission rates, I'm hearing that there's a lot of math involved. On this podcast so far, we've talked a lot about different technologies and now we're talking about something new that's very infectious. Now at Leidos, we deal with a span of different kinds of technologies and missions to make the world safer, healthier, and more efficient. And you're really in that group that's focused on the healthier aspects of the mission. So can you give us a little bit more about what Leidos' role is in the healthcare space?

Dr. Don Kosiak (07:17): Leidos has spent the last 50 plus years solving big problems for our customers. Initially, that was mostly a federal-based customer. It still is today. We are traditionally a federal customer-based organization. But we are in the commercial health space in particular. We have had a large footprint for many years. So the things that we work on in Leidos Health Group fall into several big buckets. The first bucket would be the life sciences bucket, the one that we're going to talk about here in detail. And so I'm going to save that one actually until the end. Outside of the life sciences world, we have what we call Leidos Biomedical, still life sciences work, a wholly owned subsidiary of Leidos. That is where we have 1200 plus PhD researchers that go to work every day on behalf of the federal government to solve big problems like HIV, cancer, and some of these emerging viruses and illnesses.

Dr. Don Kosiak (08:13): Another group in the health group is focused on our VA and DOD population. Another subsidiary of Leidos called QTC is where we do most of our patient care. And by patient care, I mean we do think of those insurance physicals that you might've had or disability physicals that you've ever had in your life or have heard from other people. We do that at scale largely for our federal customer but also in the commercial base. We then have a focus on those other governmental agencies like CDC, HHS, FDA, where we do all sorts of different support for them. Then our commercial facing arms fall in two different divisions. One is called Digital Health Solutions. That's about really, how do you transform the health system from the lessons we've learned in helping the government transform their systems about modernizing their IT platform, turning on and off different applications that may no longer be needed and migrate those to newer more advanced platforms?

Dr. Don Kosiak (09:13): Then in our CareC2 business... CareC2 standing for care, command and control, we're taking lessons learned from our intelligence and defense groups at Leidos and using some of that command and control experience to apply it to healthcare.

Bridget Bell (09:28): Wow. It sounds like we really touch a variety of different areas of health care. It gives you that wide view, going back to today's topic of the coronavirus, of how it can impact broadly. Can you go into more specifics of how Leidos is supporting the efforts to help contain COVID-19?

Dr. Don Kosiak (09:45): Yeah. So because of the depth and breadth that Leidos can bring to the table, particularly around disease surveillance, the processing of new medications, new technologies to be applied in the healthcare space, we think we're at a unique advantage to help us solve many crises but this one in particular. So I said I'd come back to our life sciences business. In our life sciences business, we do very important research around vectors like malaria. Malaria doesn't impact the general population of the United States all that much, but there's places around the world where some of our soldiers, airmen, and sailors might have to go that malaria might be a big impact. So for many, many years, we've been doing some research along that lines and others trying to develop unique and different vaccines. So we're taking that knowledge base of, how do you interact with the disease and then build up that immunity for the human genome and the human immune system and applying it to this new vector or illness that we're trying to fight?

Dr. Don Kosiak (10:48): The good news is, there's lots of smart people in the world, lots of them we're lucky enough work at Leidos, that are helping us bring some of this technology to bear. So if it's around organizing the scientific research and helping others do their job better, or perhaps it's about helping a drug... a small company that's developed a new drug or new technology and helping them bring through the governmental process of FDA clearance and approval, or maybe it's frontline people being deployed to the hot zones or to the area where we're actually delivering vaccines in clinical trials. That depth and breadth of experience of doing the stuff instead of just reading about this stuff really allows us the flexibility that we can help that federal customer, a commercial customer or a partner who's really going to need that extra knowledge and expertise as we combat this disease.

Bridget Bell (11:43): So we can apply this 50 plus years of solving hard challenges for our customers to really be hands-on in helping prevent the spread?

Dr. Don Kosiak (11:51): Yes, we have this ability to take a lineage of solving very complex hard problems. It's not just a mission statement, it's not just a value statement, it's how we live our lives, the corporate culture is around, how do we step forward and solve big problems. And if there's ever a company designed to step into the void and say, "We're here to help," it's Leidos.

Meghan Good (12:14): Speaking of that too, agility is one of our values and I think we've had to learn how to do that over the course of the last week, maybe even longer as we plan for our own response. As an employee, I certainly understand some of the efforts that the company has taken, but for the broader audience here, can you describe some of the measures that we've taken as a company to limit the spread of the virus between employees and customers?

Dr. Don Kosiak (12:41): Well, we've spent a lot of time and energy making sure that, first and foremost, we keep our employees safe. We have from the very early days of this new vector popping up on the radar been tracking things like the World Health Organization and the Centers for Disease and Control, the CDC, here in the United States and we have followed their best practice guidance. Almost immediately when they change something, we're pushing that forward to our leadership to make sure that we're adapting to the best knowledge and best known use cases and practices that are being put out by those agencies. So early on we were on line with many other organizations that halted travel to some of those areas that had initial outbreaks. We have encouraged the use of telecommuting again very early on and now even more so as the governmental agencies and others are pushing for social distancing.

Dr. Don Kosiak (13:38): We'll continue to have that desire to spread our population, our workforce out. By spreading that population out, we're able to help decrease that disease burden. So again, as I said earlier in the podcast, the way that this disease is spread is by close contact with other humans. If I'm infected, I have to cough or sneeze or be around you, usually defined in somewhere around six feet or so, for you to get sick from me. So if I can, in the workspace, allow some flexibility for things like spreading out from our workforce, having you work from home or perhaps doing shift work, so perhaps some people come in early in the morning to a mid-day shift and other half of the employees come in mid-day shift to later in the evening, I'm cutting down the chances that I'm able to pass that virus off to other individuals. So that's one of the reasons you're seeing people like the CDC and organizations like the World Health Organization talking so much about social distancing.

Dr. Don Kosiak (14:40): Because we want to protect everybody in the society, particularly in our workforce, we want to make sure we have that opportunity to protect those and still get the mission done. We also understand because of the critical nature of the work that we do for our customers and partners, that there's not always the ability to go home or shut off the lights. We at Leidos are involved in many of the critical functions of our federal government, and commercial entities as well, from providing energy to helping our defense and intelligence organizations get organized around the globe. It's not always possible for us to say, "Okay, employees, just go home and telework." So in those situations, we're trying to be as flexible as possible and help with some of those solutions that we talked about to keep them safe.

Bridget Bell (15:27): Okay. Then I'm curious, on an individual basis, what do you recommend as the best practices to help limit the spread of this virus?

Dr. Don Kosiak (15:36): On an individual level, the best practices that we can do are the ones that you've been reading about and are probably tired of hearing, but at the end of the day, they still are the best practices. It is things like washing your hands. Washing your hands for 20 seconds with soap and water is one of the best things you can do to prevent yourself from getting the illness. Now people say, "Do I continuously wash my hands?" No. But as you think about, "Have I touched a new surface? Have I been exposed to something that may impact me carrying or picking up a virus on my hands?" Or things like right before you eat or other times like that, you want to wash your hands. If soap and water isn't available, using something that has more than 60% alcohol, usually the standard hand sanitizer that you see in most offices and rubbing that in well will do a great job of protecting yourself.

Dr. Don Kosiak (16:27): The second thing you can do is, if you are sick, stay home. It doesn't matter if you think it might be a cold or a flu, it doesn't matter if you say, "I always get a sinus infection on March 17th and therefore I'm going to come to work." We want you to stay home. We're giving you the flexibility to stay home. And that's not just Leidos, the entire country right now wants you to stay home. They want you to stay home because we can't tell if that's the start of something bad or your usual diseases. If you must cough and sneeze, we want you to do those best practices again that your mom probably taught you, which is to sneeze or cough into your elbow, not into your hand. Coughing into your hand would of course cause the spread of that virus to your hands. If you're going to blow your nose, we'd like you to blow your nose and that's okay. We want you to throw that tissue immediately in the garbage. It's not one that you would want to save up your sleeve or use multiple times.

Dr. Don Kosiak (17:21): Then this concept of social distancing, I like to say physical distancing. Currently, everybody's really afraid and so being social is okay, interacting, as we are right now. It's very important to continue to keep yourself viable in the workplace and viable at home, but physical distancing is very important as you're working in teams. So the best practice for physical distancing is try to stay six feet away from those that you're working with. If you're in a conference room, spread out. If you're working in cubicles, make sure that you have a place to be able to spread out a little bit and do your work so that you're not bothered by those that are next to you, particularly if they happen to be ill and not know it or if they happen to cough or sneeze. Again, this is a droplet precaution or a droplet virus. That means it's not an airborne virus where it just floats around in the air and will infect you.

Dr. Don Kosiak (18:14): It has to be within a certain radius of somebody that's ill shedding that virus, again, usually by coughing or sneezing. Now, we've all seen someone sneeze and liquid comes out of their nose and where does that go? Right? That liquid can stay in the air for a little bit of time, right, so you may walk right through it. Again, social distancing, that's why we want to stay away from it. Or it may land on a surface like a conference table or a bathroom stall or the elevator button or a door handle. Those are areas where we want to use extra precaution. So if you're coming new into the workspace, you may want to wipe down the area in which you work. If you're at a conference table, you can wipe that area down. If you're going to touch door handles and push elevator buttons, may be do it with a paper towel or a napkin or a cloth or part of your clothing instead of with your finger.

Dr. Don Kosiak (19:03): If you have to touch the door to open it, then that might be a good opportunity to wash your hands before you touch your face or nose. Just having it on your hands isn't a part where you're going to get the virus, it doesn't soak through your fingers, it's having the virus on your hands and then touching your nose or face, which is where it causes the problem. So those are some best practices, that again, you can go to almost any website of any health system or any governmental organization or most employers including Leidos, sharing those best practices.

Meghan Good (19:32): Certainly, at this point in time in the US, I think the testing we've seen is getting up and running, that the numbers being reported are changing all the time, and we've seen this outbreak already infecting areas like Italy and other parts of Europe, whereas you're having these conversations both within Leidos and then with our customers as well, there've been a lot of focus around what lessons we're learning about this outbreak and about trends or things that we're seeing that might be coming in the days ahead.

Dr. Don Kosiak (20:04): You know what? I still think we have some time to have a look back on what we could have done better and that after action review, but I'll tell you a couple of things that we've learned so far. Flattening the curve is going to be very important in helping with the disease. What I mean by that is, our goal of this social distancing and physical distancing is to spread out that disease burden so that not everybody is getting sick at once. In the early countries in China and Italy, we've seen large numbers of people getting sick all at the same time and that tends to overwhelm the health system. People say, "Well, how can they not plan for that?" Well, like most business entities, health systems run at about 90% occupancy in order to make themselves financially viable. Because of that, people still get heart attacks and have strokes and have chronic disease and need surgery even if there's a new virus that's going around scaring everyone.

Dr. Don Kosiak (21:01): But I want to remind people that 80% of everybody that will contact this virus will have mild to moderate symptoms. In fact, the age of really 29 and under, looks like most people in that age group have mild symptoms. In fact, the risk in the age group is that they don't have any symptoms and yet they're shedding the virus. What we've seen worldwide is 10 and under, so newborns, young infants, elementary age children really don't have much of a disease burden at all, and those that do have headaches and mild flu like symptoms. As we tend to get older, we see more and more issues over... The risk really starts to go up about 40, just mildly, 50 even more. Then after 60, you start to see this increase in risk, particularly if you have other comorbidities they say, so things like diabetes, heart conditions, asthma, lung problems, possibly cancer. Those kinds of things will lead to an increased risk of having a bad outcome from this disease.

Dr. Don Kosiak (22:05): So tie that extra disease burden of that 10 or 20% that are going to have something that may require a hospital, about 10% of the time, or an ICU level care 5% of the time, you really can overwhelm the health system. So by doing and practicing that social distancing, keeping the disease from easily spreading from person to person to person will allow us the ability to slow down that curve so our health system can keep up with it. Some people would say, "Well, I'm 30 so it doesn't impact me." Well, it could because 30 year olds get into car accidents and have chronic disease and sometimes have bad things happen to them that have nothing to do with the virus. And if your health system is taxed out and can no longer take any additional patients or handle any critical care because they're taking care of a lot of influenza and COVID-19 patients, it may impact your care.

Dr. Don Kosiak (23:00): And we've seen case reports of that happening again in China and Italy and other places where the disease burden is high, that although the standard of care is really good, normally if you have a heart attack or a stroke, because the health system is so overwhelmed, they can't give you that same standard of care they'd be used to giving you and that you would be expecting because of the disease burden. So I think that's a big lesson learned about how we can help even if we're not impacted by the disease, even if we don't think we'd get that sick, helping keep the disease from passing from person to person to person easily is going to be the best lesson learned from this disease and others.

Meghan Good (23:37): So I think with all of us working from home, using technology in different ways, maybe even accessing the same websites, we're starting to see these different cybersecurity implications. You and I work with different viruses, so are you seeing that as you're having these conversations within Leidos and with our customers, are the cybersecurity implications of this kind of a pandemic crisis response coming to the surface?

Dr. Don Kosiak (24:04): Well, first, I'll address it from an employee standpoint. Our company Leidos has been excellent at providing the maximum flexibility for those to do remote or telework. They've done so much to increase the bandwidth and the ability to reach out from home, but certainly not everybody had that flexibility. And as we talked about before, not everybody has the flexibility to work remote. So we're certainly in some cases challenged by the fact that maybe they didn't have a company laptop or maybe some of our employees didn't routinely have to log into the Leidos network through a VPN network. And on the IT side, we may be aren't used to having 10 or 15,000 employees logging in from afar. So those challenges are being dealt with every day and helping with the fight. On the healthcare front, certainly every day we deal with cyber challenges, mostly around protecting health information and things like HIPAA compliance where we want to make sure that if we're sharing data, you only need to share it in certain ways.

Dr. Don Kosiak (25:08): The government has done a really nice job, health and human services of... I wouldn't say eliminating those things, but perhaps relaxing some of those standards, particularly when it comes to technology and how we might care for patients virtually. So traditionally, if I wanted to have a telehealth visit and I lived in an urban population, I either had to pay for it with my own money or do some kind of other direct to consumer network. If I wanted to have a standard cardiology or pulmonology visit, there was rules and regulations against that. You could only really serve underserved areas or rural or frontier areas at scale with telehealth. The government has since relaxed those, one, because of the virus, and two, because of the virus, people are going to still need chronic disease management. So if we have an elderly couple that usually had to come once a quarter for their checkup, we want to keep those people at home, and if we can, manage them appropriately from afar and not having to have them visit their doctor's offices.

Dr. Don Kosiak (26:05): At the same time, we don't want to ask those doctors and nurses and healthcare systems to do it for free, and so this would be a way to drop some of those barriers. Additionally, as we look at scaling, the ability to take care of patients from afar or mass amounts of patients, think about an emergency department that's maybe used to taking five to 10 people an hour checking in and now having 30 or 40 using those technology to help screen and process people and direct them to the right place, we're starting to see more of that. And again, the government, in particular health and human services, has been very thoughtful in the way that they've relaxed some of those regulations so that maybe the security standards aren't as high as they would be in normal operating procedures, but they're certainly not at a level where the average ten-year-old could hack into your system and get into the information. So they're doing a fine job of balancing that need and fulfillment of the information.

Meghan Good (27:02): Well, that's all good to hear. Thanks.

Bridget Bell (27:04): And it's clear that this virus is impacting in a variety of different ways like we're talking about. But as we wrap up, I'm curious, do you have any final guidance that you would offer to our listeners?

Dr. Don Kosiak (27:17): The final guidance I would offer to the listeners is, again, stay calm, stay patient, know that the systems are all changing the way that they do things from your employer offering flexibility and trying to keep you safe. They may not always get it right on the first shot or it might be that you're fighting over the last roll of toilet paper in the store. Again, take a breath, relax, know that most people, again, aren't going to be overwhelmingly ill from this disease, but there's a certain percentage that will and that percentage is enough to really do some catastrophic damage to our health system and therefore lose the protections for all of us to be able to care for us when we get ill. So back to the original things that we talked about, right? Wash your hands, social distancing, don't touch your face, and really help out where you can to make the world safer, better, and more efficient.

Bridget Bell (28:13): Thank you so much for that and thank you for joining us today. It's been a wonderful conversation, Dr. Kosiak.

Dr. Don Kosiak (28:19): You as well. Thank you for the opportunity.

Meghan Good (28:22): And thank you to our audience for listening to Mindset. For more episodes, please check out leidos.com/mindset.