By: Justin Lafleur, Lehigh Sports Communications
 
Cynthia Izuno Macri '79 likes to think outside the box.
 
As a Lehigh student, Macri played on the men's soccer team (and went on to become a founding member of the Lehigh's women's soccer program). Following graduation, she enjoyed a long a career as a doctor in the Navy.
 
Today, she's thinking outside the box in the fight against COVID-19.
 
Macri currently serves as the chief medical officer for a big data analytics company called EagleForce Heath.
 
"We are a health analytics company," she said. "We develop different solutions for some of the nation's biggest healthcare issues, including ensuring that the distribution and sale of brand-name medications from big pharma companies does not run afoul of the Federal Anti-Kickback Statute. I'm focused on development of tools that can help people manage their own health conditions."
 
Macri's creative thinking proves valuable in managing all sorts of conditions and circumstances, including the COVID-19 pandemic.
 
Thinking Differently
EagleForce Health is approaching the pandemic in a different way than most, and it's due in large part to Macri's mindset.
 
"It feels like everybody wants to capitalize on the same things everyone else is doing," she said. "We've pivoted to software development and produced an artificial intelligence enhanced application for a holistic COVID response."
 
Important aspects of COVID response include adequate testing and contact tracing, developing therapeutics, and ultimately a vaccine. But right now, mitigation is the greatest tool at society's disposal and Macri looks at mitigation in a non-linear way.
 
"One of the first things I identified was the CDC's response, and that general response has symptoms which lag behind the published literature," she said. "I've read 350 to 400 articles and found that this obsession we have with temperatures is not accurate.
 
"In fact, it's potentially dangerous."
 
The danger lies behind the details of what having a fever actually means.
 
"People who already have a fever generally feel bad anyway," said Macri. "As a doctor, I know you don't need an elevated temperature to tell people to stay home. If somebody comes to your business and you take their temperature, you expect it to be normal."
 
That's no coincidence. I someone had a temperature, they likely would not feel well and should not be out in the first place.
 
There are other issues surrounding mitigation efforts happening around the country. If someone develops symptoms, it's often several days after becoming contagious. That person could spread COVID-19 to others before knowing they're sick – or if they're asymptomatic, without knowing at all.
 
Macri realizes the importance of not only helping stop the spread, but also helping treat those who come down with the coronavirus.
 
"The CDC says stay home until your lips turn blue," she said. "Well… your lips are going to turn blue long after your oxygen saturation level demonstrates that perhaps you need some supplemental oxygen, a chest x-ray or some other confirming evidence in absence of an accurate test. And you can take as many tests as you want, but the problem is getting the results back in a timely fashion because the labs are backlogged.
 
"Furthermore, there are a lot of people staying home when they should be communicating with their health care provider about their chronic conditions like diabetes, heart disease, asthma, lung disease and even pain and substance use disorders."
 
An Important Tool
In response to the pandemic's challenges, EagleForce Health has developed an app for any smartphone.
 
"It allows you to self-monitor your symptoms with supporting evidence like temperature and oxygen saturation levels," said Macri. "If those change, it would trigger you to get a chest x-ray or another diagnostic test like a CAT scan or MRI."
 
Macri hopes EagleForce Health's app can help empower individuals to manage their own symptoms, chronic conditions and contact with others, which would lower their chances of contracting or spreading COVID-19. It would also help their chances of fighting off the virus if they do contract it.
 
"The literature is full of information about age and race, but it's just now starting to get into some of those other risk factors that we call social determinants of health," said Macri. "I'm focused now on associated chronic conditions inclusive of housing, economics, race, employment and access to health care. We need something, a tool, for every human being that could engage them and optimize their current chronic medical problems."
 
This all-encompassing app tailors to each and every person.
 
"We're trying to integrate all of the components that make you who you are," said Macri. "It's almost like personalized medicine. You eat different foods. You eat out more or less than someone else… stuff you don't even think about. The app is trying to integrate all these inputs because AI (artificial intelligence) now has that capability."
 
Take someone with chronic diabetes as one example, because staying on top of one's blood glucose levels is one (of many) invaluable tools. Research has shown that COVID-19 may spike blood glucose levels, and increase the likelihood of an unfavorable outcome.
 
But there are ways to manage it.
 
"We have something called remote patient monitoring," said Macri. "It's something you can accomplish on your cell phone with your doctor, without ever having to go to your doctor's office. Your physician can look at your numbers and communicate back to you via the app. Maybe you need your medication adjusted. Maybe you need this or that. It's been clear in the literature that a spike in your blood glucose is a bad sign, even if you don't already have diabetes."
 
Preventive health is another topic that has been overlooked by many, but not Macri.
 
"It's becoming clear that people are not doing their routine physicals and not showing up for their basic screenings," she said. "In the pediatric population, kids are now missing their regular immunizations. Even more frightening than COVID, we also have to wonder if we're going to see a resurgence of preventable diseases like measles, mumps and rubella."
 
A Doctor's Perspective
As a former Navy doctor, Macri brings an invaluable perspective to EagleForce Health, which includes so many different types of people from different backgrounds.
 
Macri doesn't work on coding the app (that's for the engineers), but she provides the clinical insight – making the company's products clinically relevant, user-friendly, and more efficient for busy medical practices.
 
"With our app, we can send out routine reminders that are based on age and different conditions," she said. "More than being based on just age, race and how close you are to somebody else's cell phone, we can also offer up a risk score of having COVID, for example, in absence of a reliable test. We can score the potential severity of the disease because our algorithms have looked at social determinants of health – including things like living conditions and jobs where people aren't able to work from home."
 
Another factor is community spread in one's home area.
 
"Someone will bring with him/her the potential for the same level of community spread to an area where the spread is lower," said Macri. "The app also factors in things like personal propensity to protect yourself and others, and your living arraignments. There are a lot of mitigating factors, which are disproportionately adhered to in different communities."
 
Mental health amidst the pandemic hasn't been forgotten, either.
 
"One of the significant changes in people's lives is social isolation," said Macri. "A benefit of people's mental health is socialization with communities and individuals who speak the same language, come from the same area or have shared life experiences. I'm third-generation Asian American – I don't speak any Asian language because I was born in Minnesota – but I can relate to people who had previously socialized in certain settings such as religious settings or other community-based settings such as adult day health care, wellness centers and even veterans clubs or events.
 
"All of these people are now socially isolated," she continued. "The platform we have actually offers a list of resources so people can either engage in counseling if necessary, or in other opportunities to socially engage."
 
Macri's Wide-Ranging Impact
Macri is working at EagleForce Health after a long and successful career as a Navy doctor. After Lehigh, she attended medical school at Temple, which was made possible due to the Navy's Health Professionals Scholarship Program.
 
"All three armed services, plus the Public Health Service (PHS), have this amazing Title X scholarship and it's to enhance the health care workforce in the military and other Federal institutions like Indian Health Service and Bureau of Prisons," said Macri. "It's a full-ride scholarship to medical school with books, tuition and required fees, all paid for by the military or PHS. You get a free education, lots of cool experiences, great training, lifelong friendships, and the choice to get out after paying back just four years of service as a fully-trained doctor (a year for every year of med school)."
 
Macri ended up staying for 35 years.
 
One of the reasons Macri has been so successful in every role she's held has been her tendency to break away from the "standard" and not think so linearly. When she was at Lehigh, she could have accepted the fact that no women's soccer team meant she couldn't play soccer. But because of her non-linear thinking, she tried out and made the team.
 
That thinking has certainly continued.
 
"I'm an OBGYN cancer surgeon, so I have to be a rigid thinker because I have to cut out the bad cells," said Macri. "But it's important to instead think what this piece of tissue means to someone."
 
In other words, it would be easy for doctors to think very black and white – how to get from point a to point b – but Macri has always thought about the big picture.
 
"As a doctor, you're not just treating the patient," she said. "You're treating the whole family.
 
"And if you're looking at the family, you're also looking at helping improve the health of the community."
 
Whether she was practicing as a doctor, or is doing clinical research to help create an app, Macri is doing so with the big picture in mind.
 
And she's thinking outside the box every step of the way.

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