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The Lack of Persuasion as a Failure Against COVID-19

By RAFAEL FONSECA, MD

Reopening safely out of the current pandemic ought to be done via persuasion, not coercion.

It has been more than five months since the world first learned about COVID-19. Models predicted a sharp increase in the number of cases, and a seemingly high likelihood the pandemic would overwhelm our hospitals. These models were often inaccurate, and we have all come to learn about the imprecision of epidemiological prediction.  Nevertheless, the infection is far worse than anyone initially accepted – becoming a staple of our generation. Fearing uncountable deaths and the possible need to prioritize resources for those affected, initial government measures were put in place to curtail the spread of the virus. Images of the Lombardic tragedy compelled all to stay in place and wait for the storm to pass, and with few exceptions most complied. Realizing the gravity of the situation, governments gradually implemented measures to prevent infections.  With some vacillation, we evolved from travel restrictions, to social distancing, shelter in place and universal mask use.

As the pandemic ensued, we watched the horror stories taking place in New York City and Boston. Even while we are in the midst of the so-called first wave, with thousands of deaths per day, many have started to wonder how long society will remain isolated and locked. Politicians look to experts for recommendations regarding policies that might save lives, and for the most part they have complied. However, as the weeks ensue, we see growing jobless claims, lines for food banks, and impatience.

This brewing impatience is a response to an unknown future dictated by the vagaries of nature and the lack of a coherent strategy to resume a life with a resemblance to normal. The public searches for guidance from federal agencies, state governments, and health authorities. A lack of clear direction from these institutions has heightened this anxious impatience. Additionally, the conversation is now ideological, with an almost Manichaean division between those wanting to save lives more so than the economy, and vice versa, creating cartoons of opposing perspectives.  Even for those recognized as  accomplished, dissenting from orthodoxy is punished severely. In the background, the public’s patience is running thinner.

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RWJF Apps Closing Soon: Apply Today!

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By CATALYST @ HEALTH 2.0

Catalyst @ Health 2.0 and The Robert Wood Johnson Foundation are seeking digital solutions that can support the needs of individuals affected by a large scale health crisis. As the current COVID-19 pandemic illustrates, individuals in communities affected by large-scale emergencies must contend with multiple challenges.

The public faces a deluge of information, misinformation, and recommendations. In addition, they may lack access to vital resources like health care, medications for chronic conditions, emotional support, food, and shelter. Lack of credible, easy to understand information and resources during an emergency may have potentially life-threatening implications for individuals and their communities.

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Even Covid-19 May Not Be Causing Your Doctor To Wash His Hands

By MICHAEL MILLENSON

If you think the grim coronavirus death toll is causing health care workers everywhere to always wash their hands, think again.

A recent research letter published in The Journal of Hospital Infection examined whether it’s “possible to achieve 100 percent hand hygiene compliance during the Covid-19 pandemic.” The medical center involved in the research, Queen Mary Hospital in Hong Kong, had reached a pre-Covid-19 hand hygiene rate of over 75 percent.

Yet the hospital’s goal of complete compliance proved surprisingly elusive. In one pediatric ward devoted to suspected or confirmed Covid-19 patients, doctors and nurses followed hand hygiene rules 100 percent of the time, but in another ward with similar patients and staff, compliance was 83 percent, or about one-fifth less.

Given Covid-19’s risk to providers as well as patients, this was “unexpected,” the researchers admitted. Most Popular In: Healthcare

The Queen Mary study supports what infection control experts have long maintained: awareness isn’t enough. Doctors and nurses, particularly during a pandemic, understand that hand hygiene is “the most important intervention” to reduce the staggering death toll from infections, as the American Journal of Infection Control put it.

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Primary Care Practices Need Help to Survive the COVID-19 Pandemic

Ken Terry
Paul Grundy

By PAUL GRUNDY, MD and KEN TERRY

Date: June 20, 2022.

The Smithsonian National Museum of Natural History has reported its biggest number of visitors in more than 2 ½ years. There’s a string of new Broadway musicals that are well-attended every night. It’s safe to shop in malls, eat out in restaurants and go to movie theaters again.

Of course, this has all been made possible by an effective vaccine against COVID-19 that was widely administered in the fall of 2021. Vaccinated citizens of the world are now confident that it’s safe to go out in public, albeit with appropriate precautions.

However, U.S. residents who have health problems are facing a new challenge. Five years ago, in 2017, the median wait time of new patients for doctor appointments was six days. In 2022, the wait time is six months or more.

The reason for this is no mystery. While life has started to return to what we think of as the new normal, the U.S. healthcare system has taken an enormous financial hit, and primary care practices have been especially affected. Many primary care physicians have closed their practices and have retired or gone on to other careers. Consequently, the shortage of primary care has been exacerbated, and access to doctors has plummeted. Urgent care centers, retail clinics and telehealth have not filled this gap.

Because of the long waiting times for primary care appointments, many more people now seek care in emergency departments (EDs). The waiting rooms of these EDs are overcrowded with people who have all types of complaints, including chronic and routine problems as well as emergencies. And this is not just a common sight in inner-city areas, as it once was; it’s now the same pretty much everywhere.

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What’s a diagnosis about? COVID-19 and beyond

By MICHEL ACCAD

Last month marked the 400th anniversary of the birth of John Graunt, commonly regarded as the father of epidemiology.  His major published work, Natural and Political Observations Made upon the Bills of Mortality, called attention to the death statistics published weekly in London beginning in the late 16th century.  Graunt was skeptical of how causes of death were ascribed, especially in times of plagues.  Evidently, 400 years of scientific advances have done little to lessen his doubts! 

A few days ago, Fox News reported that Colorado governor Jared Polis had “pushed back against recent coronavirus death counts, including those conducted by the Centers for Disease Control and Prevention.”  The Centennial State had previously reported a COVID death count of 1,150 but then revised that number down to 878.  That is but one of many reports raising questions about what counts as a COVID case or a COVID death.  Beyond the raw numbers, many controversies also rage about derivative statistics such as “case fatality rates” and “infection fatality rates,” not just among the general public but between academics as well.  

Of course, a large part of the wrangling is due not only to our unfamiliarity with this new disease but also to profound disagreements about how epidemics should be confronted.  I don’t want to get into the weeds of those disputes here.  Instead, I’d like to call attention to another problem, namely, the somewhat confused way in which we think about medical diagnosis in general, not just COVID diagnoses.

The way I see it, there are two concepts at play in how physicians view diagnoses and think about them in relation to medical practice.  These two concepts—one more in line with the traditional role of the physician, the other adapted to modern healthcare demands—are at odds with one another even though they both shape the cognitive framework of doctors.  

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THCB Gang, Episode 11

Episode 11 of “The THCB Gang” was live-streamed on Thursday, May 27th and you can see it again below

Joining me were three regulars, patient safety expert Michael Millenson (MLMillenson), writer Kim Bellard (@kimbbellard), health futurist Ian Morrison (@seccurve), and two new guests: digital health investment banker Steven Wardell (@StevenWardell) and MD turned physician leadership coach Maggi Cary (@MargaretCaryMD)! The conversation was heavy on telemedicine and value based care, and their impact on the stock-market, the economy and the health care system–all in a week when we went over 100,000 deaths from COVID-19.

If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels — Matthew Holt

Health in 2 Point 00, Episode 125 | Amwell, Mindstrong, Big Sky Health, Medwing

Today on Health in 2 Point 00, we have more than $300 million in deals to cover! On Episode 125, Jess asks me about Amwell raising $194 million although they haven’t gone public (yet), Mindstrong getting $100 million and a new CEO from Uber in another big raise for their mental health app, Big Sky Health landing $8 million for its intermittent fasting, meditation and alcohol consumption apps, Tava Health raising $3 million to expand its teletherapy program, and German startup Medwing getting $30 million to address Europe’s shortage of healthcare workers. Don’t miss Jess speaking at the AHIP discussion on How Digital Self-Care is Transforming Mental Health Care tomorrow at 1pm ET! —Matthew Holt

The 2020 COVID Election

By KIM BELLARD

Many believe that the 2020 Presidential election will be a referendum on how President Trump has handled the coronavirus pandemic.  Some believe that is why the President is pushing so hard to reopen the economy, so that he can reclaim it as the focal point instead.  I fear that the pandemic will, indeed, play a major role in the election, but not quite in the way we’re openly talking about.  

It’s about there being fewer Democrats.

Now, let me say right from the start that I am not a conspiracy believer.  I don’t believe that COVID-19 came from a Chinese lab, or that China deliberately wanted it to spread.  I don’t even believe that the Administration’s various delays and bungles in dealing with the pandemic are strategic or even deliberate.  

I do believe, though, that people in the Administration and in the Republican party more generally may be seeing how the pandemic is playing out, and feel less incentive to combat it to the fullest extent of their powers.  Let’s start with who is dying, where.

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Catalyst @ Health 2.0 Launches Subsidized Rapid Response Open Calls (RROCs)

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By CATALYST @ HEALTH 2.0

In collaboration with the Robert Wood Johnson Foundation, Catalyst @ Health 2.0 is proud to announce funding for health care providers with limited resources and urgent needs to identify and source digital health innovation during COVID-19 through our Rapid Response Open Calls (RROC). RROCs are streamlined calls for applications that connect health care providers to digital health solutions. Deployed as part of Catalyst’s Health Tech Responds to COVID-19 platform, RROCs can be launched within days to meet the host’s needs.

Catalyst created the RROC to address an urgent need from Brigham and Women’s Hospital (BWH) Emergency Department for provider-facing, text-based platforms to help healthcare professionals self-monitor symptoms of coronavirus, report burnout, and access helpful resources. Within one day, the Brigham and Women’s Health RROC was launched. In a 7-day application period, Catalyst received an overwhelmingly positive response with more than 80 quality submissions. BWH was able to evaluate the submissions through a streamlined process and 5 innovators were selected to demo their solutions to the BWH ED team. BWH began pursuing a potential partnership with one of the semi-finalists. 

If you are a healthcare provider with limited resources during COVID-19 (e.g. FQHCs, community health centers, etc.), apply for a subsidized RROC HERE!

How to Practice High-Quality Telemedicine in the Era of COVID-19

By ANISH MEHTA, MD

My practice received its first question about coronavirus from a patient on January 28, 2020. Though there were over 200 deaths reported in China by that time, no one could have imagined how drastically this would come to disrupt our lives at home.

Thankfully, I had a head start.

As a doctor at an integrated telemedicine and primary care practice in New York City, nearly two out of every three of my medical encounters that month was already virtual.

I spent much of January caring for patients who had contracted seasonal viruses, like influenza or norovirus (i.e. the stomach flu). My patients reached out nearly every day with bouts of fevers, fatigue, diarrhea, and vomiting. Our team did all we could to encourage each of these patients to stay home and avoid spreading their highly contagious virus throughout the community (sound familiar?).

We are now guiding our patients through the COVID-19 outbreak using the same tools we use to guide them through any healthcare need – real-time monitoring, proactive outreach, and team-based care.

After our first COVID-19 question, our team started compiling information about every patient who reached out with symptoms that even slightly resembled COVID-19. This soon turned into a comprehensive patient registry containing the epidemiologic risk factors, clinical risk factors, symptoms, and a follow-up plan for each patient. Based on their total risk level, we follow up with these patients every 24 to 120 hours.

Every day, one provider on the team texts or schedules a video visit with each follow-up patient, reassesses their symptoms, and re-stratifies their risk. Most patients respond with a text message letting us know that their symptoms are the same or slowly improving. But for patients at higher risk, we want more information. We help these patients acquire a thermometer or pulse oximeter to follow up on their respiratory vitals. With this data, our team can provide patients and their families with thresholds on when to seek out a higher level of care.

Our job for these patients is clear: provide treatment at home and only recommend the hospital if there is no other option. By centralizing data and establishing clear triggers for a new plan of care, a single provider can follow up with over 30 COVID-19 patients in a single day.

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