Smart Quarantine as the next step to combat COVID-19
As the nation and the world grapple with the impact of the COVID-19 pandemic, there is growing consensus among experts that we need a sustainable system of specific lockdowns, social distancing, and extreme resource provision in terms of labor, ventilators and PPE to arm hospitals and health providers as they deal with the onslaught of patients. Even while some American states start to slowly open up, we need a system that can manage COVID-19 over the coming months and years–especially if this Fall brings a second wave.
Writing in the NY Times on April 7, Harvey Fineberg and colleagues summarized an as yet overlooked issue. There are many patients who may or do have COVID-19, but are not sick enough to need hospital care, or who have been discharged from hospitals. We need to keep these patients away from hospitals but if they shelter in place in their household there is a high risk they will infect their families or housemates. This likelihood is even higher if they are homeless, incarcerated, or living in other group arrangements.
Instead of sheltering in place at home Fineberg and colleagues suggest those patients enter “smart quarantine” in temporary isolated accommodation, such as hotels or college dormitories, where they can be looked after by medical teams and tested semi-regularly. But whether they are at home or in temporary accommodation, leaving those patients with minimal support to be tested at the end of 14 days is not enough. A significant proportion of them will develop COVID-19 and some of those are going to be admitted to hospital. In addition several patients have been discharged from hospital, but still need to be monitored. We are going to need to be able to closely monitor a significant number of people even while the majority of them will need relatively limited amounts of care.
The good news is that we have had a couple of decades of development of the technologies and services required to both care for and monitor these patients, while keeping the main resources such as ventilators for those in hospitals. Pulling together available technologies and services, we will be able to quickly and accurately manage these patients, ensure their best outcomes, and spare scarce hospital resources. There are seven main components of this process, which I am calling “smart care in quarantine.”
Upon either a positive test for COVID-19 or a suspicion of those symptoms awaiting testing, patients can be admitted to isolation at home or in, say, empty hotels.
1. Monitoring equipment. Patients can be given FDA regulated monitoring devices which will work using bluetooth and WiFi (or 4G cellular). The main monitoring tools required are:
The COVID crisis has shown us clearly that major portions of the American care system are extremely dysfunctional and some are now badly broken. We need to put in place a cash flow for American health care that can help our care sites survive and ultimately thrive, and we need to put that approach to save the sites in place now because a vast majority of hospitals and medical practices are badly damaged and some are financially crippled and even destroyed by their response to the crisis.
We have learned a lot in the COVID crisis that we need to use now in building our next steps and our collective response to the crisis.
The COVID crisis has shown us all that our care sites do not have good patient data, do not have good patient linkages, usually do not have team care of any kind in place, and most are so dependent on current piecework fee volumes from patients that they quickly collapse financially when that volume is interrupted.
We should be on the cusp of a golden age of care delivery that uses all of the best patient support tools to deliver continuously improved care — and we now know that the piecework way we buy almost all of our care today will keep that golden age from happening for the vast majority of American patients for the foreseeable future until we change the way we buy care.
We need to buy care in a way that both requires the use of those tools and rewards caregivers and care teams when they use them.
We need a dependable cash flow for care to anchor that process.
We are unlike most of the rest of the industrialized world in not having a dependable cash flow now to buy care. We rely on a hodgepodge and mishmash of unlinked, unaligned and uncoordinated payment sources now and that lack of coordination in payment creates a vast and damaging lack of coordination in the delivery of care.
We can make a huge improvement in that entire process and we can give our health care system a stable and functionally useful future cash flow by becoming a much more highly skilled purchaser of coverage and care. We need a flow of money to make that happen.
We actually can create that flow relatively quickly and fairly easily by imposing a payroll tax on every employee that exactly copies the approach we use now for our Social Security payroll tax process and then using that money in a health care purchasing pool to buy health coverage for every person who is not on Medicaid.
Is the beginning of the end in sight? Perhaps. After much stress and strain, many experts believe we’re seeing early signs of a COVID-19 plateau in some states and cities. Everything could change tomorrow, but healthcare leaders should be preparing now to reopen their shuttered operating rooms and get back to business.
When restrictions loosen, lost days and weeks could have dire implications for health systems already weakened by months of deferred and canceled elective procedures. These surgeries — joint replacements, tumor biopsies, gallbladder removals, and cosmetic procedures, for instance — underpin the economics of hospitals and physician groups. Delay some of these surgeries for too long and patient care can also suffer. Essential? Absolutely.
Unfortunately, healthcare leaders will be reopening their doors to a world unlike anything they’ve seen before. Aren’t we all seeing our personal health through a new lens?
Today on Episode 122 of Health in 2 Point 00, Jess asks me about LetsGetChecked raising $71M for at-home testing, Vida Health raising $25M for virtual chronic-conditions-management programs, Medable securing $25M for clinical trials, and Livongo publishing their Q1 earnings report (and their stock rising 10% days before the report was released!). I am excited to see their CFO, Lee Shapiro, go on a buying spree in the space now — Matthew Holt
“This pandemic highlights why we need that free flow of healthcare data. So that we can make better decisions sooner.”
In the way that Covid-19 has proven the utility of telehealth as a means for health systems to reach their patients, has the pandemic also become the final argument for healthcare data interoperability? Has this pandemic been the worst case scenario we needed to make our best ‘case-in-point’ for why U.S. healthcare needs a national health data infrastructure that makes it possible for hospitals to share information with one another and government health organizations?
Interoperability advocates have been clamoring for this for years, but Dan Burton, CEO of data-and-analytics health tech company, Health Catalyst, says this public health crisis has likely created an inflection point in the interoperability argument.
Matthew Holt talks to David Smith who is working on the Medicaid Transformation Project at Avia, which is looking at how hospitals & health plans can improve health outcomes and in turn, lose less money on Medicaid programs. David talks about the tremendous amount of capital being poured into Medicaid, and how the problem is only getting worse. So the focus of the project is trying to reduce healthcare delivery organizations’ spend on these services. At Avia, they are trying to take the best of model science and the best of digital capabilities to help create more efficient care models for their clients as well as reduce costs.
Zoya Khan is the Editor-in-Chief of THCB and a Strategy Manager at SMACK.health
By POOJA RAO, TARUN RAJ, BHARGAVA REDDY, MANOJ TLD, and PREETHAM SRINIVAS
In March 2020, we re-purposed our chest X-ray AI tool, qXR, to detect signs of COVID-19. We validated it on a test set of 11479 CXRs with 515 PCR-confirmed COVID-19 positives. The algorithm performs at an AUC of 0.9 (95% CI : 0.88 – 0.92) on this test set. At our most common operating threshold for this version, sensitivity is 0.912 (95% CI : 0.88 – 0.93) and specificity is 0.775 (95% CI : 0.77 – 0.78). qXR for COVID-19 is used at over 28 sites across the world to triage suspected patients with COVID-19 and to monitor the progress of infection in patients admitted to hospital
The emergence of the COVID-19 pandemic has already caused a great deal of disruption around the world. Healthcare systems are overwhelmed as we speak, in the face of WHO guidance to ‘test, test, test’ . Many countries are facing a severe shortage of Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests. There has been a lot of debate around the role of radiology — both chest X-rays (CXRs) and chest CT scans — as an alternative or supplement to RT-PCR in triage and diagnosis. Opinions on the subject range from ‘Radiology is fundamental in this process’  to ‘framing CT as pivotal for COVID-19 diagnosis is a distraction during a pandemic, and possibly dangerous’ .
Episode 8 of “The THCB Gang” was live-streamed on Thursday, May 7th at 1pm PT- 4pm ET! You can see it below.
Joining me were our regulars: patient advocate Grace Cordovano (@GraceCordovano), data privacy lawyer Deven McGraw (@HealthPrivacy), policy expert Vince Kuraitis (@VinceKuraitis), radiologist Saurabh Jha (@RogueRad) (who snuck in late), and writer Kim Bellard (@Kimbbellard). We had a great conversation including a lot of detail around access to patient records, and some fun about infectious disease epidemiologists behaving badly! If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels from Friday— Matthew Holt
Stan Kachnowski, Director of the Digital Health Program at Columbia Business School, joins Matthew to talk about the Virtual Executive Education in Digital Health Strategy Program they have coming up from May 12-14th. The program is built around health care executives understanding and implementing digital health strategies at their organizations almost immediately after the course. For 3 days, attendees will participate in workshops, lectures, and discussions which will help them identify the key players in health tech along with which methodologies will work at their specific organizations. Matthew will also be a guest lecturer for the program where he will speak about his “Flipping the Stack” model for health technology’s future.
A year ago, if you’d
used or even heard about Zoom, you were probably in the tech industry.
Today, if you haven’t used Zoom, your friends or colleagues must not like you
very much. COVID-19 has made most of us homebound most of the time, and video
services like Zoom are helping make that more bearable.
healthcare is finally paying attention.
Zoom was founded in 2011, poking along under the radar for several years, overshadowed by competitors like Skype or WebEx. For the entire month of May 2013 it only had a million meeting participants. Even by December 2019 it could boast “only” 10 million daily users.
Then — boom — COVID-19 hits and people start staying at home. Daily users skyrocketed to 200 million in March and as many as 300 million in April (well, not quite). Daily downloads went from 56,000 in January 2020 to over 2 million in April. Zoom is now used by businesses and families alike, drawn by its simplicity and ease of use.
By all rights, we should
be using WebEx for business video calls and Skype for personal ones. Both
had been around longer, offered credible services, and still exist. But
both were acquired along the way, WebEx by Cisco, and Skype ultimately by
Microsoft. As with its acquisition of Nokia, once acquired Microsoft
didn’t quite seem to know what to do with it. Each left openings that
Zoom plunged through when the pandemic hit.