The novel coronavirus pandemic has shaken many things up; it’s created new partnerships, new habits, new businesses, new ways of looking at the world.
It’s also speeding up some changes that already had begun, as the world has begun to take increasingly seriously the imperative to work together, to collaborate, to share; to stop wasting time and energy competing when it’s possible to move forward more efficiently and more effectively — and more creatively and more compassionately — together.
The Chaim Sheba Medical Center in Tel Aviv is Israel’s largest such center; in both 2019 and 2020 Newsweek magazine named it among the world’s top 10. It focuses not only on patient care but also on research and innovation. That’s why it’s a big deal that Sheba chose Holy Name Medical Center in Teaneck, an independent institution that similarly specializes in research as well as patient care, as its local partner in what it calls its Accelerate, Redesign, and Collaborate programs — ARC, for short.
Dr. Ravit Barkama of Tenafly is Holy Name’s assistant vice president for clinical development, a position she holds as the culmination of decades of work in clinical medicine, research, and healthcare management. She’s also a native Israeli, which makes her understanding of Sheba intuitive; that’s a good thing, because she’s overseeing the relationship from the Holy Name side.
Sheba focuses on healthcare innovation; it works with startups and funders toward that end. “We have partnered with them to help redesign health care in the next decade,” Dr. Barkama said.
One of the ways to that huge goal is what she calls digital health, which “basically means using various software solutions to be able to enhance healthcare. The focus is on digitizing, so it is looking a lot at data at various ways.” It involves inventing or repurposing or rethinking or recombining innovations in other fields; it’s about thinking creatively and basing that creative thought and intellectual freedom in vast oceans of data.
Dr. Barkama, like just about everyone else at Holy Name, is a survivor of the intense battle Holy Name waged against covid-19 in March and April.
“We had the first peak in mid-March,” Dr. Barkama said. “The first patients came around March 5 or 6, and then it rose until at some point we had 250 covid patients in the hospital, with 50 of them on mechanical ventilation in the ICU. It was really a roller coaster, between the emotions of the success of being able to see patients improve and eventually go home, and the devastation of losing patients.
“It was rough. It was rough on all of us. It was endless working hours, but on the other hand a lot of adrenaline. I worked so many hours every day, and for 25 days I didn’t take even one day off. I just went home for a few hours to sleep each night.
“But it wasn’t just me! A lot of people did that. We had no idea what day of the week it was, we were just so focused on what we were doing.”
At the beginning, nobody knew very much about what to expect from this new disease, or how to handle it — it wasn’t called a novel coronavirus for nothing. But although doctors and scientists still know far less than there is to be known about it, they’ve learned quite a bit, both through first-hand experience and through collaboration and information-sharing.
“Remdesivir” — a drug that doctors think can cut back the amount of time some patients must stay in the hospital, although it is not a cure and does not stave off death, it seems — “wasn’t even available for emergency use then,” Dr. Barkama continued. “You could just get it at first for compassionate use.” That means that every time doctors wanted it to use it, they’d have to petition for its use. “I contacted the FDA every single time,” she said. “Initially we got it for most of them, but we lost some patients along the way.
“Eventually we were able to join an expanded access program from Gilead” — Remdesivir’s manufacturer — “and we had a lot of patients transferred from New York City. We had patients transfer from some of the biggest academic centers in the city.” Part of that was luck, and part good management. “We didn’t have happen here what happened in the city,” Dr. Barkama said. “We continued to function.”
As time went on, Holy Name got access to other drugs from the federal government’s emergency use program.
“We were like a lot of hospitals — we used a lot of drugs that eventually we learned were not effective, so we stopped the process.”
Among those drugs is Pluristem placenta-derived cells, as well as Regeneron’s monoclonal antibody treatment. “We were the first in the United States to use those cells to treat covid patients, and we were the first in the world to use Regeneron’s spike antibodies,” Dr. Barkama said
How did that happen? “We partnered with Regeneron on other drugs, and they know that we provide high-quality data,” she explained. “We enroll patients, we do a good job with clinical research, we are very systematic, and we have a great researchers.”
On its end, the hospital wanted to work with the drug because “the mechanism of the antibodies made so much sense that we worked hard and made sure that the regulatory process is done really fast. We wanted it for our patients because we believe that its mechanism of action is promising. And as of September 29, Regeneron released preliminary data showing this antibody’s preliminary effectiveness and safety.”
The hospital’s doctors and healthcare workers and scientists were able to learn a great deal about what worked and what didn’t, and they also knew how to collect and manage their data.
“We are looking at various databases that we can use to share data in a de-identified way,” Dr. Barkama said. For example, researchers can look at the data to see areas where the rate of breast cancer has gone down. When they also see, as they can in that data, that the rate of mammograms has gone down as well, they know that they are not seeing less disease but instead less vigilance. “Even though these are covid times, we have to keep on doing screenings, because other diseases are not going away,” Dr. Barkama said.
“That’s a lot of what public health is about. One of the things that digital health does is it goes from the level of public health to the level of the individual better, and it also looks at intervening at the population level.”
When Holy Name works with Sheba and its other partners, all the organizations will be able to share data. “If we have a clinical pathway that is worth sharing, we are open to sharing it with Sheba,” Dr. Barkama said. That means not necessarily waiting for peer review, although it does not mean skipping that step. It means juggling imperatives — speed versus accuracy, for one, to overgeneralize — in this odd, pressing time.
“First and foremost, we always go by science,” Dr. Barkama said. “We use the drugs that have become standard, and we also put every single patient on a clinical trial, in addition to the standard of care. With most diseases we treat the standard of care is sufficient, but with covid, even what today is considered the standard is not good enough.
“So we experiment out of necessity. When standard medicine isn’t good enough — and standard medicine sometimes is good enough — we always strive to do better.”
ARC is just beginning. “This can go beyond Sheba and Holy Name,” Dr. Barkama said. “There is venture capital involved, and a lot of startup and other entities, beyond Holy Name.”
ARC is not Holy Name’s first project with Sheba. The relationship between the two institutions goes back about 10 years ago. It began when Angelica Berrie of Englewood, the president of the Russell Berrie Foundation, brought “a group of northern New Jersey leaders who were not from the Jewish community to Sheba,” Ruth Salzman, the foundation’s CEO, said. “She always had the view that there were ways in which both communities could really leverage one another, learn from one another. Each had things to offer the other.”
Michael Maron, Holy Name’s president was one of those leaders, and certainly he both contributed to and learned from what he saw in Israel in general, and at Sheba in particular. “Sheba’s one of the biggest medical centers in the world, and there is nothing of comparable size and complexity in the U.S.,” Ms. Salzman said. “If you put Israeli innovation in digital health with the data that is available, you could create the opportunity to transform health care. And that is their stated goal.”
Holy Name was a desirable partner because “it is really a nimble player,” Ms. Salzman said. “One of my favorite statements that I’ve heard from Holy Name is that ‘we can’t do everything — but we can do anything.’”
The Berrie Foundation is a philanthropy that takes the art and craft of philanthropy seriously. “We find leaders with vision, passion, talent, capability, and a heart,” Ms. Salzman said. Once it discovered such people, the foundation not only funds them but also helps them meet other people in other fields and develop relationships. Creativity and innovation flourish with that kind of cross-fertilization.
It made sense to Ms. Berrie, Ms. Salzman, and the other leaders at the Berrie Foundation to pair Sheba and Holy Name. (ARC is not the two groups’ first collaboration; they already worked together to create Holy Name’s simulation center.)
“Our role was to do a shidduch” — make a match — “between Holy Name and Sheba,” Angelica Berrie said. If institutions can be said to have chemistry, the way people do, then it’s fair to say that there were sparks flying between Holy Name and Sheba. And ARC seemed a perfect place to consummate the union. Holy Name already is involved in three out of the six areas where ARC focuses — telemedicine, digital health and medical information systems, and clinical research.
Ms. Berrie excited about ARC, which she describes as a model that puts together researchers and entrepreneurs who can combine data, creativity, and the funds they need to pursue their wild dreams. In the attempt to create a sustainable model, “they put together researchers with an incubator model and got permission from the Israeli government to launch an investment fund using whatever results they got from their research so create commercial ventures. So this is a very out-of-the-box entrepreneurial fund. It will be very interesting, when you think about hospital and all the restrictions they have, and all the nonprofit experiences of running a hospital and make it sustainable. I believe that this is the model for us to look at when we ask how we can create sustainable models.
“The model is giving Israeli startups a home at Sheba and creating an incubator in the hospital where they can get access to the data, and then investment people can go there and are able to bring those ideas to market, and Sheba gets to participate in the revenue stream that will be able to sustain the hospital,” Ms. Berrie said.
“So what made Holy Name is that Holy Name was on the front lines in New Jersey at the beginning of the pandemic. Sheba was shocked to find out how many covid patients Holy Name had, compared to Israel.” Holy Name had gathered enormous amounts of data on patients with covid. “Sheba said that this gives us a base to collaborate,” Ms. Berrie said. “Holy Name has been on the forefront of digital innovation.” Unlike many other hospitals, both big and small, it has a proprietary IT system that covers everything in the hospital; it doesn’t have systems that do not speak to each other, as many hospitals ludicrously do.
“And in this pandemic, one of the first things that everyone learned is that everyone had to shift to telemedicine, ready or not. Holy Name had an advantage, because it had been studying telemedicine models already, and being a first mover is always an advantage.”