Episode 89: How COVID Is Accelerating Crazy Healthcare Innovations w. Dr. Krishnan Chakravarthy

Mar 15, 2021

This Episode

Interview w/ Dr. Krishnan Chakravarthy

You Will Learn

– Dr. Charkravarthy breaks down the new COVID delivery method using micro-needle technology
– The way that doctors are analyzing the progress that we have been making as it relates to public health
– “COVID Fatigue” is becoming more and more noticeable as thing pandemic continues. Dr. Chakravarthy reveals how he has been able to deal with it and some thoughts for others.

Resources & Links

I talk with Dr. Krishnan Chakravarthy about parts of the healthcare ecosystem, and pain treatments in particular, where technology and methods for patient care have evolved rapidly in light of the COVID pandemic (including COVID test patches and vending machines!).  We also discuss what specific data he tracks to understand public health impact of the virus and how ASPN is issuing COVID-related guidance to help its clinician members stay ahead of the curve in patient care.


Justin (00:58)
Hello, and welcome to episode 89 of APM success. I’m very pleased to be joined by returning guests. Dr. Krishnan Chakravarthy Dr. [inaudible] Has joined us. It’s hard to believe almost 22 episodes ago. Now he’s anesthesia and pain boarded. He’s got a PhD in immunology. He’s running something called the Chakravarthy Lab out of UCS, D lots of work in nanomedicine nanotech and other advanced feats of micro engineering. I’m very pleased to be joined by Dr. Chakravarthy today.

Dr. Krishnan Chakravarthy (01:25)
Yeah. Thanks Justin. It’s always a fun conversation with you. I mean, I feel like you’re one of my favorite podcasts people. We discover something different and talk about important topics. So really glad to be here too.

Justin (01:38)
Well, thank you. It’s always a lot of fun. So I want to start off as I was preparing for this interview, I was just Googling around and I happened to run across your name associated with this thing called the lifeboat foundation. And as I was cruising around on this website, it was very, it was very interesting. If anybody wants to check it out, we’ll put it in the show notes, but essentially what this lifeboat foundation does for our listeners in their about us section is essentially getting smart people together to think about systemic risks, to humankind like pandemics and asteroids and nuclear Holocaust and things like that. So I’m curious describe your you know, experience with the lifeboat foundation.

Dr. Krishnan Chakravarthy (02:15)
Yeah, so it’s you know, with all things practical, to be honest, I haven’t thought about it since you bring it up. So, you know, I got sometimes I feel a lot of these interesting things that your name gets connected to, certainly the good and bad of it, but let’s set aside what the validity or lack thereof of kind of where the thought process behind a foundation like that. I think one thing that’s come from our current role in society and how we’re dealing with the pandemic is nothing can be taken for granted. It’s pretty amazing how you know, just, just prior to this kind of recording of this conversation in the podcast, we were talking really heavily about how fast technology has changed. The speed at which we are thinking about bigger problems, whether it’s artificial intelligence, whether it’s making human beings, multiplanetary ad or dealing with a one of the largest pandemics in the last hundred years in our human population. So you know, I, I think the concept is nice to be tied to how much is it actually going to get into a specific actionable things. I, I’m not certain of, but nonetheless, it’s always good to see your name getting flashed in Google for different things, I guess.

Justin (03:35)
Understood. one of the things we were also discussing before the call you, you described an article in the journal, the wall street journal recently about a new drug delivery system, specifically vaccine delivery for COVID and using micro needle technology to be able to circumvent the usual poke in the arm that people like me to test. Tell me a little bit about that.

Dr. Krishnan Chakravarthy (03:58)
Yeah. This is an a, this is a really, I think, an amazing conversation for lots of reasons. So, you know, look at where we are today with COVID is, and you hear a lot nationally about this topic that your every time that a virus is around in a demographic or population, it continues to mutate and as viruses mutate, their natural proclivity is to mutate things that our immune system wants to target, because the idea is for viruses, you are replicating and passing on that genome and reproducing more viral copies to infect other people. And so partially that becomes a challenge in how do you, one, one approaches, we talk a lot about herd immunity, which is as more people get infected, they naturally build a tolerance and immune response to these viral strains. And you get more antibodies that essentially target different receptors on these viruses and, and a larger and larger population curb that kind of spread.

Dr. Krishnan Chakravarthy (05:05)
And what happens with that is what may be a pandemic strain becomes what we define as endemic, which means kind of like flu every year. Even though you have a little bit of a variation in the strain, you get a flu vaccine that helps you protect against that. Now the, the challenge for vaccine delivery today, one is you have a lot of companies producing different vaccines, whether it’s a Johnson and Johnson’s approach, or, and, or the Pfizer bio Pfizer BioEnTech and, or Madonna, everybody’s coming up with production of as many doses as possible. But the, the crazy part in that is it’s not just about the production end. It’s how do you actually get this into patients? And, you know, you see a lot of the mass campaigns that are going on, and today we are still trying to, no matter what Island, the political landscape, you sit on, the bottom line is infrastructure development, whether it’s in large mass campaign strategies of vaccinating people to universities stepping in university physicians, stepping into help putting vaccines into patients.

Dr. Krishnan Chakravarthy (06:16)
The bottom line is ease of access is determining a race that we’re having with this virus, because what you expect is at some point, the more people that are infected, the more likelihood the virus will mutate. And in the off chance, it mutates a surface receptor. That’s important in an antibody response, all of a sudden, you’ve got yourself a second search or a third surgeon in this case afford surge of this type of COVID-19 virus. So how quickly you can distribute vaccines is as much a part of this prob solution as how quickly you could make the vaccine. So one of the things that I think is interesting is how do you get the vaccine today? It’s an injectable. So you have two separate injections over three weeks with a booster. And that’s the data that is the most relevant from the clinical trials that these companies have done.

Dr. Krishnan Chakravarthy (07:14)
So to get that to happen pretty consistently in a coordinated effort, it’s challenging. I mean, you have to be able to set that up. You have to coordinate, you have to have patient compliance and you see a lot of different data. Now in the United Kingdom, they’re talking about a single dose being 70 to 75% are the coding, some numbers on the efficacy. So one of the thoughts that has really become much more at the forefront is could we develop ways that you can almost have a patch technique where you can deliver vaccines into patients without actually doing anything, injectable, something that’s almost like a band-aid that you put on your skin and off you go in the past, the challenge with that is that your skin is a very strong you know, great barrier for protecting you against infection, but it’s just as effective and a barrier to prevent things from going in.

Dr. Krishnan Chakravarthy (08:09)
So we were actually pretty excited that we recently looked at that model with a micro technology. So microneedles are actually small needles, a smaller the diameter of a human hair, and we’ve actually, lithographically printed them on almost something as small as a band-aid to penetrate the skin painlessly. But once you’ve crossed that bigger barrier or more protective barrier things diffuse a lot faster. So what were in fact, that wall street journal today was talking that article was really talking about how this could be, how in maybe a two to three-year timeframe, you’re going to just get a patch. You come in, put a patch, painlessly, you get your vaccine delivered and you just go home. And I mean, I think to imagine how impressive that could be in how something as seasonal as vaccine delivery being changed, head on its head in terms of the, how it gets delivered is really, I mean, pretty innovative, I think

Justin (09:12)
Vaccine delivery. I mean I, I would imagine that the way that vaccines have been delivered has been the same for as long as they have been delivered. And so innovating on something like the delivery system itself, I think is pretty exciting.

Dr. Krishnan Chakravarthy (09:24)
Yeah. I mean, and it’s, you know, it’s, again, a Testament, somebody was making the comment in what other time in human history, have we been able to accelerate vaccine development within a year of identifying a pandemic? And I think one of the incredible parts about this is that even the vaccines today that Pfizer and Moderna use have nano materials in them. And so the whole lipid solubility, or some of the actual compounds are nanomaterials based. So, you know, it it’s, it, to me, it’s an evolution in technology that has just been given a super surcharge and acceleration into the marketplace. So I think there’s some amazing things around the corner, but at the same time, we’re learning things about, you know, patient responses, where are they allergic to certain things and, you know, traditional vaccines to newer vaccines. But I think overall as more and more people are getting, it’s a Testament to the safety and how impressive science has come. And how far does,

Justin (10:27)
You said lithographically printed? What does that mean to make these little micro needles,

Dr. Krishnan Chakravarthy (10:32)
3D printing? So really we actually template what these needles look like, and we print them on a 3d printer and you actually, the materials that the needles are made of, you can control their degradation rates. So in fact, you can actually have something delivered instantaneously or have something delivered for months on end at the rate, the actual material degrades biologically. So a lot of the, I mean, you’re getting to the fine tuning of releasing as well as sensing what you’re delivering. So you can imagine, I mean, it’s fascinating in drugs that you can control concentration as they’re going across the skin, as well as knowing the speed at which they’re getting to the patient.

Justin (11:16)
Sounds like the, the materials science is at least as relevant, if not more than the actual medicine itself.

Dr. Krishnan Chakravarthy (11:23)
Yeah, yeah. A hundred percent. I mean, and that’s where it’s the concept of drug delivery has been around for awhile, but I think right now we’re really seeing the impact of it in, in the practical aspect of the science. So, you know, for, if you think about what the vaccines are, when is the last time I think the Clinton era people were talking about gene therapy being at the forefront of medicine, we are seeing the impact of that in some ways in this pandemic where you’re applying that technology, but for gene therapy, the biggest limitation was how do you deliver this stuff? Because natural genes have are exogenous material. They get degraded really fast. The body sees them as something not unique. So, I mean, for a lot of folks that are in the science world, I mean, this is like, it’s like amazing time to be in medicine. Right.

Justin (12:17)
I always enjoy talking to you because I feel like all the most cutting edge and exciting things of the things that you’re working on at any given time. It’s so cool. And you mentioned, so I want to zoom in specifically on how is you know, in the context of a lot of the changes that we’re seeing right now with COVID and everything, how is COVID and the response to COVID impacting clinical pain care for patients and for physicians and specifically, I know you mentioned Aspen, the American society of pain and neuroscience is issuing guidelines about COVID vaccines and how that plays into treatment for patients. Can you describe a little bit about the thinking there?

Dr. Krishnan Chakravarthy (12:53)
Yeah, absolutely. So, you know, I think one of the awesome parts about being working with a society like Aspen was that I think we really we went through phases in our approach to educating pain physicians globally about where we were in the pandemic last year to this year and the challenges in each of those phases going forward. So at first, really we, the pain field has to some extent, really changed to being much more. We trying to discover our role within the interventional paradigm. We were getting more and more products that are coming into the space that require us to act more surgically access to training appropriately for these products so that we can apply them into the clinical setting. So with the advent of the evolution that is happening in the pain field, that is rapid, I mean, the amount of new products, literally if you go on social media within three to six months, you see another new product popping up the, how do you train people effectively, especially when you’re in a academic center, on a private practice center to do these things safely when the education medium has drastically changed.

Dr. Krishnan Chakravarthy (14:09)
Right? So one part is understanding the pandemic, which we did a lot of the educational content coming up. The second part was really, once you understood it, how did you deliver care in that model? So we went through that period of testing, understanding, contact, tracing, understanding the the benefits of personal PPEs and all the staff. And I think as a field, we’ve done a really good job. And I think whether it’s in private practices or large academic centers, everybody’s adopted a strategic plan for the most part in terms of their state mandated guidelines, as well as individual outpatient centers on how to deliver. Now, the topic that ultimately where we’re faced with now in the climate of vaccinations is should we or not hold specific interventional therapies that have immunosuppressants like steroids within the context of somebody getting a vaccine. And when we looked at that data, we just are that just got accepted in, in a peer reviewed journal.

Dr. Krishnan Chakravarthy (15:16)
What we are finding is that there isn’t any precedent for holding these interventional therapies in the context of, would you put a patient at higher risk for less vaccine efficacy? And I think where that, that debate, whether, you know, you see some of the other guidelines that may or may or societies that may suggest waiting two weeks versus not. I think we obviously, each individual patient has to be addressed individually by their clinician, but we right now would recommend continuing the current course. We don’t think necessarily there’s enough data to warrant changing our current treatment paradigm. So that that’s been kind of our guideline. And as we go forward, I think, you know, obviously it’s a very fluid situation. We may change that. But we’re doing our best to kind of educate the group on what that looks like.

Justin (16:04)
I know another thing that you mentioned is as far as access to testing you mentioned out there in California, you now have COVID tests and vending machines, which I think is pretty remarkable. Can you just describe what’s where out here in Philly, we don’t have such things. So tell me about that.

Dr. Krishnan Chakravarthy (16:19)
Yeah. So, you know, I, I think that as one of the, the two parts of this, and I think the testing theory of trying to get as many people tested is really important because one, it helps us from a population epidemiological perspective, trying to track how effective vaccines are doing and kind of curbing that are we really flattening the curve? Are we reaching a plateau or are we worried that there’s going to be new restraints? So, you know, just yesterday I was walking off campus with my fellow and he’s like, Hey, you know, we have to implement at least within our center at UCLA, we do once a week testing for all staff. They want to make sure that we, if there’s any issues where obviously even post vaccination to make sure that everybody’s negative for COVID. But part of that is once a week, you need easy accessibility.

Dr. Krishnan Chakravarthy (17:08)
So now, now what they’re suggesting is on campus, you can actually get some of these rapid COVID tests on a vending machine. And it’s pretty amazing that it was set up something like that. It’s really a very novel way of access. And, but even beyond that at multiple centers within the campus, you could go there, get a 15 minute rapid test and kind of rule out your rule-out active COVID. So I, I think it’s it’s interesting. I don’t know whether that model is going to apply to other parts of the country. I know certainly you see a very different situation in Texas now where, you know, there’s just no masks or any of that parts of it. So I still firmly believe testing is going to be important, not maybe not simply from a treatment perspective in terms of what I would do with a positive or negative test for an asymptomatic person, but at least to be able to do continue doing contact tracing and looking at case loads and case volumes.

Justin (18:04)
I’m curious, you know, there’s a lot of data flying around as it relates to the progression of the virus and whether or not it’s, you know, how it’s behaving in terms of public health and trends and things, as you look at sort of where we’re at right now, and obviously this is changing daily it’s, I think today’s March 4th or fifth. And by the time this show airs, we may be in a different spot altogether, but is there any data points specifically that you sort of hone in on, whether it’s like, you know, ICU capacity or, you know, the trend there’s, you can find a chart to suit your perspective no matter how you kind of look at how things are progressing. So is there any specific as it relates to public health and, and progress towards resuming, I mean, whatever normal is going to look like post COVID, what, what are you paying attention to?

Dr. Krishnan Chakravarthy (18:48)
Yeah, so there is a really nice website that looks at the metrics on predicting mortality rates based on, I think either at university of Washington or one of the specific sites that, and the whole idea is at the early part of the pandemic is really interesting. What you would observe is after every major holiday event, you would see a spike in the number of cases, as well as higher number of mortalities. Right? And so to me at the end of the day, this, again comes back to a very important philosophical debate about, and maybe it’s more practical one, which is how do you take responsibility for individual actions that have a clear impact on you know, downstream effects on larger population of people. So why that I get back to that is if I’m looking at it purely from an epidemiological perspective, I talk about caseload.

Dr. Krishnan Chakravarthy (19:53)
I talk about number of new cases. I talk about mortality rates. I talk about, I mean even within UCS, Dr. COVID tracker literally looks at number of patients with COVID, how many ICU beds are available and how does that decision for usage and capacity impact? How do we triage elective versus urgent cases? So where I get back to that is, is there a possibility for normalcy in the next month? Probably not. I mean, I think we’re probably looking at another six months to a year, and there was some suggestion again on the scientific community that we may be wearing masks for some time. And I, I think this idea are we getting to the point of herd immunity maybe possible, but unless we really test and get over 70% of our population, either vaccinated and or suggestive of some antibody response or really not there.

Dr. Krishnan Chakravarthy (20:51)
So I think the challenges that the pressures of whether you look at it in a small microcosm of, I need to keep my practice open, to continue feeding and supporting the things that I need to continue having in my life and my family versus a, this is still an ongoing public health issue. We haven’t quite solved it yet. And the more we loosen that set of strict guidelines that are in place, that’s going to reflect it’s pure mathematics. I mean, in the sense that viruses don’t discriminate, they continue to replicate, they keep doing it with a profound efficiency. So the things that you put in place essentially curved that kind of numbers going up,

Justin (21:38)
Take a minute and describe the, sort of the clinical settings that you interact in at UCF. And how has your sort of the treatment sort of philosophy and the actual, like operations and mechanics of caring for patients as COVID is progressed, how has that evolved and what does it look like right now?

Dr. Krishnan Chakravarthy (21:55)
Yeah. You know, I I’ll tell you it is very challenging. And I, I think what strikes me is I, and I, I can’t imagine the number of patients, you know, I, you know, it’s a fascinating, a lot of people think pain is an elective thing that we do. And one of the things you realize through this process in this pandemic is how much that these interventions that we take for granted, that patients receive every three months it’s life-changing for them. So, you know, if you’re, if you can’t even get out of bed or if you’re non-functional because you don’t have the ability to get into an outpatient center to get these injections that are deemed elective, then it becomes really difficult for patients. So what I realized in, you know, the protocol we have is today, you still need a COVID test 72 hours before your deemed ready to go for that intervention or, and whether it’s an epidural to any of the more advanced interventional procedures.

Dr. Krishnan Chakravarthy (22:57)
But the bottom line is when you’re talking about people, traveling to get these tests done, the challenges with, can you, when you have multiple procedures, can they put them in within that 10 day window? What happens to patients that get test COVID positive have waited for an operative procedure for months, and now are again delayed. So I think it’s, it is been, I would say, not easy. I think there are a lot of patients that have really been challenged by the whole climate of it. I think we’re doing better. But again, as more people are getting vaccinated, things are starting to open up to the way that it was. But I think this, this, this process has really highlighted how impactful pain med management is. And is it truly elective or not as kind of the real question that I think we’re starting to ask?

Justin (23:49)
Yeah. It seems like someone who says a pain treatment is elective as someone who’s not in pain. How much variability do you perceive among your peers elsewhere in the country, as far as the testing, the 72 hour window, like the procedure around exactly what you described. Is there a broad variability as far as the way those questions are answered or is there a lot of uniformity?

Dr. Krishnan Chakravarthy (24:13)
I think there is a lot of broad variability, and then that’s where the challenge comes in. Is it, can we be more prescriptive or is that an unfair assessment? Because let’s be Frank. I mean, at UCFD when you have a large institution or, and you have the backing of all of these different services, it makes sense, but I’m sure there are people on this podcast that are in a small private practice, how much resources do they have, but I, I think the one thing that is a consistent theme is we have to, there are certain things that everybody can do wearing masks, proper screening at the door for temperature, things that, you know, look for things that are symptomatic, those things can be done independent of a lot of investment resources. Do I think I would love to see testing be a part of every pain center.

Dr. Krishnan Chakravarthy (25:05)
Absolutely. Is that an expectation that may require individual decisions on different folks that are able to do it or not do it? I, you know, I’m, I am sensitive to that, but you know, we are where we’re at, but, you know, I, the question I always come back to, if you say you had a positive case, now you’re shut down for X number of weeks, then your contact tracing within your own clinic. So there are some sensible things that we can all do that follows each of your state mandated guidelines, but at the end of the day, there are sensible things and PPE and testing that can be implemented. That could be low costs that I think would make a lot of sense.

Justin (25:44)
Once vaccination happens more broadly, or those types of shutdowns and co is, is that still going to be necessary or is that still currently necessary or do the vaccines change that equation?

Dr. Krishnan Chakravarthy (25:55)
I think that, so, you know, I think the vaccines contains that equation depending on how quickly you can do broad-scale vaccination, because the whole whole idea is that can we get to the point that you essentially vaccinated enough people in a population that no matter how fast the virus mutates, it doesn’t have a chance to become a new viral strain. Now, that being said, the beauty of some of the technology with this vaccine, and you could probably hedge your bet that the NIH and all of the smart folks that are on the vaccine development side are already thinking about strains that have mutated or developing booster shots that would be relevant to that. Now the, the, that part of it is also an educational piece, you know, and there was a lot of questions around vaccine efficacy. There are a lot of people still don’t believe that it’s relevant, right?

Dr. Krishnan Chakravarthy (26:52)
And very educated people who think that why should I get a vaccine? Why not just get them actual infection and write it out? So we have to do our part in viewing it again, as it may be. You’re the guy who’s lucky enough not to have something significantly symptomatic, but we’re not thinking about just you as an individual person. We’re thinking about the larger global community. And there are people that get really sick from this. So it’s it is a tough debate because we really need large-scale vaccination to really have it be effective.

Justin (27:25)
Yeah. There, there’s no easy answers in these types of questions. I want to pivot a little bit and talk about the opioid situation and the way that in light of what’s happening with COVID, the opioid epidemic has kind of taken a backseat, although it has not abated, it has just sort of diminished in the headlines. There was a recent article willing to in the show notes it was a, it was an a press release actually from the CDC in December of 2020 that talked about some of these very startling statistics, 37 of 38 us jurisdictions with available synthetic opioid data saw increases in overdose deaths in 10 States out West, there was a cumulative 98% increase in reported synthetic opioid involved deaths, et cetera. There’s a lot of numbers here that all tell the same story that there’s, there’s still a big problem. And a lot of that, I mean, it’s probably a multifactorial problem, but what do you think when you see numbers like those?

Dr. Krishnan Chakravarthy (28:21)
Yeah. I mean, I’m not surprised, you know if you looked at prior to the COVID pandemic, you know, one of the major topics on the national forum was the opioid epidemic. In fact, millions to billions of dollars was being invested in alternatives to opiates. How do we curb abuse? How do we start to have the major lawsuits against Purdue pharma was really becoming front and center of the news section about how they, you know, understanding what fueled the opiate epidemic, how are we going to help deal with that? So to assume that that public health issue has suddenly disappeared, seems to me, doesn’t really make logical sense. I mean, I think in fact, the, the challenges patients are having in terms of access to care is only probably fueling this concept that we need to be much less maybe as prescriptive, but biggie really focusing on individual patients and not putting them in the context of large, broad scale guidelines necessarily.

Dr. Krishnan Chakravarthy (29:25)
So one of the things I, and you see a lot of this, some of the key thought leaders talking about this, which is, you know, people that have been on maintenance doses for long, long periods of time, is it fair to necessarily ostracize or think about it in a light because they’ve been on that maintenance dose for a long time. And what is our approach to that? Versus folks that are clearly, there may be some pathology or psychosocial issue. There may be some addiction seeking behavior. Now, all of a sudden they’re not getting any access. And that, that is clearly translating into over misused in ways that they are not able to necessarily be managed properly. So I think that this is a pressing issue. I think that it’s just going to be something as a society, as an individual clinicians, we’re probably going to have to work much harder than we might’ve probably in terms of addressing this, because it’s now added the element of another, probably six months to a year on, you know, within another pandemic now becoming an endemic strain, how do we get deal with the ongoing public health issues?

Dr. Krishnan Chakravarthy (30:37)
So I’m not really surprised by the numbers that the CDC put out.

Justin (30:41)
Are there any ways that the whether it’s policy or just you know, broadly accepted clinical best practice is evolving in light of COVID to try to address the opioid problem, knowing that there’s so many moving parts?

Dr. Krishnan Chakravarthy (30:55)
Yeah, I think that’s a good question. I mean, I think that CDC task force that came together that put those original guidelines. I think one of the thing, things that would be important to probably address is getting that back, that taskforce back together and reevaluate within this pandemic. How do we, again, if you give broad guidelines to health centers, or should we be helping patients that are under withdrawal and, or seeking more immediate access to care without the, you know, as rigorous stipulations on, okay, I can’t see you because for X, Y, and Z reasons. So I think that that is an ongoing work, and I think it’s a really wonderful point that maybe that’s a call to action for across societies and for interventionalists to start thinking about that.

Justin (31:46)
I know one of the things that you do is collaborate with industry to develop technologies and advanced different clinical approaches. And I’m curious in your conversations with your industry, peers and partners, how has first of all, how has COVID impacted those businesses? And, and secondly, have you seen any ideas or opportunities or other interesting things sort of start on the industry side of things that has been adopted by, by physicians?

Dr. Krishnan Chakravarthy (32:15)
No. So that’s a fantastic question. You know, I, I think one of the, the elements that we are getting challenged with, and I think from an industry perspective is education and where, where that comes into it is you’re seeing today in the pain space, a tremendous evolution of what the definition of an interventional pain doctor had been in the past. You know, you could say, I, I did spinal cord stimulation was the advanced therapy, but the reality is that’s not the case. You have everything that is spanning from you know, percutaneous SSI, joint fusions to some of the spinal stenosis work with mild or Virta flax in a year, a lot of these different procedures. And now still ongoing more procedures that are quote unquote becoming more minimally invasive. The, the challenges that we as a field have always looked at pain, treat pain training as a one-year fellowship.

Dr. Krishnan Chakravarthy (33:14)
And the, the bridge in that educational piece is on-site cadaver training. I mean, literally that has been our go-to where faculty would come you’d educate folks over the weekend, or, and then they would learn the technique and they would all go apply it into their practice. And so that has been completely revolutionized in the last year and year and a half. And to the point where a lot of that educational content is coming through some form of digital media through digital content. But I think the challenge that comes ultimately though, is that in a, in a field that is very hands-on, there’s only so much you can do in a virtual forum. So for industry today, the big questions are, how do I effectively train future generation physicians to use my product in a context of an ongoing pandemic? Should I incorporate testing? And every time I bring faculty together, what are the requirements and the number of people in a training site before I can even actually implement a training program.

Dr. Krishnan Chakravarthy (34:19)
So I think there, there are some guidelines that we’re starting to see, you know, maintaining social distancing, six feet among people that are there masks you know, temperature, screening, symptomatic screening. Is it rigorous enough that we can go back to what we had before we need to train 40 people in a single weekend? Probably not. But I think that one thing that comes from this though, is I think there is a definitive call to action among companies to start standardizing those training protocols. Because I do worry that if everybody’s not applying that same set of criteria, that it’s in the off chance, that there is an, you know, suddenly like a cluster that breaks out because a bunch of people came in together, then that’s going to reflect badly for the entire space. So that that theme applies to now conferences. People are tired of hearing webinar content coming out to the point that they’re like, Hey, I’m so antsy to get to a conference in live real time. What is the next one available? So I think we’re still working out those mechanics. I, I just, I’m hoping that we do it in a standardized manner. And I think the industry really partnering with societies to give those guidances are going to be really impressive.

Justin (35:32)
I was going to say, do you think something like an Aspen would be a place where that conversation would happen? Yeah.

Dr. Krishnan Chakravarthy (35:38)
I mean, we’re trying are, we’re going to be setting up the first live meeting this summer. And there’s other smaller societies that are looking to do live training events earlier part of April may now is the recommendation that you should get vaccinated before traveling to these sites. Should we still continue to screen everybody that’s there? And really making sure that we’re protecting the participants as well as folks that are teaching. Yeah, absolutely. Do we think six all the same guidances that everybody’s giving, should we adopt? Yes. I think the challenge, you know, is it going to come back to, by the end of this year where everybody is totally back to baseline? I think that’s going to be a little bit more challenging. I think we’ve got some work to do.

Justin (36:22)
You alluded to this in your prior remarks, this idea of COVID fatigue, it’s something that we’re all experiencing in varying degrees. I’m curious, sort of like how you’re walking through that yourself and how you’re, you’re perceiving that among your peers and how’s it going in that regard?

Dr. Krishnan Chakravarthy (36:37)
Oh, I think I, you know

Justin (36:39)
And Diego, you can still get a little sunshine here in the Northeast has been a really a brutal winter.

Dr. Krishnan Chakravarthy (36:43)
So if you ask this to my wife with a five and three year old, she is beyond, COVID fatigued at this point, you know, this is total life changing for a lot of people. Cause I mean, with kids and everything, you’re stuck with a lot of, you know, if they’re not going back to school, it’s like home education and, and the frustrations around that, you know, I, I come back to this it’s it’s the best analogy I give is if you were very, very, very disciplined at the beginning, you could fix, you’re going to try to fix these situations a lot sooner, but then it’s like the the guy that goes on a diet and then he wants to cheat and have a bunch of like dessert. You know, it’s like, man, I really can’t handle this anymore. So I would have said that at this point, we’re going to have to just accept that this is a part of our life now, how that impacts decisions that, you know, whether you’re visiting family loved ones or, you know, holidays or weddings or whatever, we’re planning the thing again, goes back to, you know, where do we see ourselves as decisions we make as individuals versus things that we impact the broader community?

Dr. Krishnan Chakravarthy (37:51)
I don’t have a, I mean, that’s where you eat everyone individually decides that. But I, I, yeah, I agree there is COVID fatigue significantly, but the worry I have is that’s exactly where, you know, you keep pushing this along and now there’s some concerns that it’s not completely like you’re flattening the curve or plateauing. So are we as a virus kind of getting ahead of us at some point

Justin (38:15)
Any other, and I appreciate your time here, Dr. Chakravarthy, we’ll wrap it up here in a minute. Are there any other sort of thoughts, reflections, or words of wisdom for re either regarding some of the things we’ve, we’ve touched on that listeners might be interested in, or else just for doctors who are out there who are like slugging it out and feeling like they’re really getting with this COVID fatigue and they’re like feeling the strain and the burden of all the extra effort and steps and decreased patient volume in spite of all that effort. And how would you, what would you share with somebody like that to help them soldier on

Dr. Krishnan Chakravarthy (38:51)
Agreed. I mean, I look how often, historically, a pandemic of this magnitude happens once every hundred years, right? The last big one was in 1918. And the, the thing that you have to take is how much science has helped in curb. I mean, you talk about what 1918, there was 50 to 70 million deaths globally. I mean, it wasn’t, it wasn’t a six-month effort. That was a, they define it as a two year pandemic. And in fact it was 19, 19 after the first wave of Spanish flu that the mortality rates really climbed. So I think that, you know, when you put it into that context, I feel you know, it’s interesting that you look at other species on this planet. They’re much more communal like you look at animals, have certain limitations to almost a sense of their belonging in an environment.

Dr. Krishnan Chakravarthy (39:56)
And so as we continue as, as human beings, as we continue to populate this planet and the impact that technology and things that we do to the environment, deforestation, things that were traditionally meant to be wildlife and Ricardo expand into that, the idea that natural viral strains that can become more pandemic is, is going to be something we’re going to have to deal with. I think that the, I, as we, you know, resources get less and we overpopulate more, more via novel strains that skip from animals to humans is just the by-product. And that’s what we’re finding with this whole COVID story. But what the message in that is though, is I think that from take that from a global view to something more practical I think we should be really proud of how, how far we’ve come as a field and we’ll work together and how we’ve disseminated information and looking at I know it’s really hard when you think about your monthly paycheck and all the sacrifices we have to make, but I think it’s a, maybe a time for reflection.

Dr. Krishnan Chakravarthy (41:01)
I mean, I, I think it’s easier said than done, but you know, what was the from South India at the time when India was getting into independence? A lot of people were asking Gandhi about where he drew his philosophical ideas and it was after a Russian philosopher by the name of Tolstoy. And he had this concept of this community where no individual activity was viewed as any less or more valuable within that. So whether you were the janitor and or the guy who was overseeing everybody, doing their job, everybody was treated in the same way. So that concept today, maybe more telling than any other time in our history, like how do we take ourselves beyond an individual perspective and what we’re doing for the greater good. So so it’s an interesting concept.

Justin (41:55)
Absolutely. And just cultivating the idea of our shared humanity and a mutual respect for one another and appreciation for the role that each of us serve in there’s, you know, in a time of COVID when, like we need the truck drivers and the people who stock the shelves at the grocery store, you know, everyone, you know, everyone has a role to play and there’s a lot more, there’s a lot of essential contributions out there just beyond the ones that are obvious.

Dr. Krishnan Chakravarthy (42:21)
And I think what you’re doing just as an amazing thing, because I feel so few times people are at the front end of education, how much information gets filtered through every one of us and this stigma around science and data and why it’s important, not important. And with the idea of COVID fatigue that gets even more amplified because nobody really wants to hear things that they think is going to curtail their day-to-day life. Right. And so from that perspective, I think all of the efforts that you guys are making, I think is so critical. I mean, I just, it gives everybody another opportunity to re reflect and think about what am I doing in my everyday life.

Justin (43:02)
Well, Dr. Christian shocked of Arthur, thank you very much for joining us on this episode of APM success. It’s been a pleasure, absolutely wonderful talking to you. If you liked what you heard this week, head on over to APM success.com, where you can find more content and free resources to help you build a successful career in anesthesia and pain management. If you want it to leave a review in iTunes, that also really appreciate it. Thanks for using some of your valuable time to join me today on APM success.