2020 has been an awful year. Hurricanes, wildfires, murder hornets, unjustified shootings, a divisive Presidential election, and, of course, a pandemic. Most of us are spending unprecedented amounts of time sheltering in place, millions have lost their jobs, the economy is sputtering, and over a quarter million of us didn’t survive to Thanksgiving. If you haven’t been depressed at some point, you haven’t been paying enough attention.
Within the last two weeks, though, there has finally been some cause for hope. Whether you want to credit Operation Warp Speed or just science doing what it does, we are on the cusp of having vaccines to battle COVID-19. First Pfizer/BioNTech, then Moderna, and most recently, AstraZenica, announced vaccines that appear to be highly effective.
We’re having our Paul Revere moment, only this time with good news. The vaccines are coming! The vaccines are coming!
It strikes me, though, that our enthusiasm about these vaccines says a lot about why the U.S. has had such a hard time with the pandemic; indeed, it tells us a lot about why our healthcare system is in the state it is. We’re suckers for the quick fix, the medical intervention that will bring us health.
Unless you were alive when Woodrow Wilson was President, COVID-19 has been the worst public health crisis of our lifetime. It took some time for us to fully realize how bad it was going to be, and, even then, most of us underestimated exactly how bad that would be. We may still be underestimating how bad these next few months will be.
With the emergence of two vaccines with high levels of effectiveness, there’s a strong prospect of having powerful new tools to combat Covid-19 in the months ahead. But the road between a vaccine and society returning to normal is far from certain. Millions of doses will need to be produced and intelligently distributed, and critically, people must be willing to take them. The last few months have seen already-low confidence in such a vaccine fall even further, with just two-thirds of Americans expressing a willingness to be vaccinated when one becomes available. Similar trends are playing out globally.
Bringing the pandemic under control will likely require successfully vaccinating 60–70% of the population to halt community transmission. Vaccine skepticism puts rapidly reaching that goal in jeopardy. Can the government at the state or federal level mandate vaccination? What is motivating this growing skepticism in Covid vaccination and how might those sentiments shift over time? This week, Phillip looked at 28 articles from 24 sources to explore likely pathways toward vaccination, as well as related vaccine skepticism.
As we struggle to control a second wave of Covid-19, we are reminded once again of the nurses and doctors who place themselves at risk willingly and consistently. They are struggling uphill with a deeply segmented health care system that chronically rewards the have’s over the have-not’s, and a President clearly intent on creating as much havoc as is humanly possible on the way out the door.
Filling the leadership void this week, we witnessed the unusual appearance on network television of two national leaders from the professions of Nursing and Medicine, Dr. Susan Bailey (President, AMA) and Debbie Hatmaker (Chief Nursing Officer, ANA) appearing in tandem.
The united front presented by these two women leaders was reassuring. They didn’t pull punches, but spoke truth to power, describing the nation’s condition as “very grim” and “quite stark.”
In many ways, their joint appearance was a reflection of a changing reality in communities large and small across America. A Medscape survey released this week found that women’s roles in health care are growing in leaps and bounds. For example, in Family Medicine, close to 40% of the physicians are now women, and they work approximately the same number of hours per week as their male counterparts.
These women doctors are increasingly working in team settings. The majority of Family Physicians (71%) now work within a team that includes either a Nurse Practitioner (NP) or Physician’s Assistant (PA).
I’m a primary care doctor at a clinic providing care to uninsured and under-insured patients in central Texas. As COVID-19 cases rise around the country, one thing has become crystal clear: social workers are more critical to our work than ever, and we don’t have enough of them.
I’m reminded of this one day with a patient I’ll call David. It’s late September, and he’s back for a 3-month follow-up visit. Behind the pane of a face shield, I look at his phone as he shows me pictures. By now I’m used to the blur as the shield fogs from my mask, but it adds to the disorienting feeling of these moments.
In the clinic room, his own vision blurs as tears flow freely down his cheeks. We look at FaceTime screenshots from last week: his elderly mother in a hospital bed, her face obscured by tape and tubes; his similarly bedridden cousin with a fully gowned nurse in the background; a man in his twenties smiling and hugging a squirming toddler. He shows me those who are already dead, and those who are left behind.
I don’t want to dismiss the grief that hangs in the air like an unseen cloud, but the ticking clock forces me to push ahead. “David, I’m concerned about your blood pressure and sugar,” I say. His numbers are worsening. He nods his head wearily, explaining how he lost his health insurance along with his job and can no longer afford his medications. His grief comes in waves and he can’t sleep. He is suffering.
We had a bridge fire here in Cincinnati last week. Two semis collided in the overnight hours. The collision ignited a blaze that burned at up to 1500 degrees Fahrenheit and took hours to quell. Fortunately, no one was killed or injured, but the bridge remains closed while investigators determine how much damage was done. It is expected to remain closed for at least another month.
Unfortunately, the bridge in question is the Brent Spence Bridge, which is the focal point for I-71 and I-75 between Ohio and Kentucky. It normally carries over 160,000 vehicles daily, and is one of the busiest trucking routes in the U.S. Over $1 billion of freight crosses each day. There are other bridges nearby, but each requires significant detouring, and none were designed for that traffic load.
What makes this all so galling is that it has been recognized for over 25 years that the bridge has been, to quote the Federal Highway Administration, “functionally obsolete” – yet no action was taken to replace it. This most recent disaster was a disaster hiding in plain sight.
Just like, as the coronavirus pandemic has illustrated, we have in health care.
The Brent Spence Bridge was opened in 1963, intended to carry a maximum of 80,000 vehicles daily. That had been surpassed by the 1990’s, causing calls to replace it with a newer, bigger bridge. At one time, Rep. John Boehner, from the Cincinnati area, was Speaker of the House and Kentucky’s Mitch McConnell was Senate Majority leader, yet were not able to obtain funding for the replacement, despite strong support from then President Obama and, in turn, President Trump.
Even in this extraordinary year, this has been an extraordinary week. Last Tuesday we had what many believe to have been the most important Presidential election in recent times, maybe ever. The week also found the coronavirus pandemic reaching new heights. That was the week that was.
What struck me, though, is how both our election systems and our healthcare system rely on “ordinary” people to keep them going. They’ve never been more extraordinary than this year.
The pandemic first impacted voting earlier in the year, during primary season. Going to the polls suddenly seemed like potentially a life-threatening choice, and working at them practically suicidal. Dates of primaries were moved, many polling stations were closed, new voting procedures were put into place, and absentee ballots found a new popularity. And yet people turned out in droves to vote, often standing in line for hours.
President Trump upped the ante by constantly railing against absentee ballots and warning about voter fraud. Despite this, or perhaps because of it, record numbers of people voted early, in person or by mail. Several states had surpassed 2016 numbers of voters before Election Day. Tens of millions more showed up on Election Day. And, amazingly, Election Day passed with relatively few incidents.
As COVID-19 brought to light the lack of emergency response preparedness in the health care system, the Robert Wood Johnson Foundation (RWJF) and Catalyst @ Health 2.0 saw an opportunity to highlight digital health’s potential to support health care stakeholders and the general public. RWJF and Catalyst partnered to launch two Innovation Challenges on Emergency Response for the General Public and Emergency Response for the Health Care System.
The Emergency Response Innovation Challenges asked innovators to develop a health technology tool to support the needs of individuals as well as health care systems affected by a large-scale health crisis, such as a pandemic or natural disaster. The Challenges saw a record number of applications— nearly 125 applications were submitted to the General Public Challenge and over 130 applications were submitted to the Health Care System Challenge.
An expert panel of judges across the health tech, venture capital, design, and emergency response industries evaluated the entries and selected three finalists from each challenge to compete at a virtual pitch hosted by Catalyst @ Health 2.0 on Thursday, November 19th at 10am PT/1pm ET. Registration for this event is now open! RSVP for the pitch event HERE.
Finalists will present their solutions to an audience of investors, provider organizations, health plans, tech companies, foundations, government officials and members of the media. During the pitch, a judge panel will select the first, second, and third place winner based on impact, UX/UI, innovation/creativity, scalability and strength of presentation. The winners will be awarded $25,000 for first place, $15,000 for second place, and $5,000 for third place. To learn more about the finalists, click on the links listed below, and to RSVP for the pitch event, click HERE.
The most recent fiction dressed up as science about COVID comes to us courtesy of a viral Washington Post article. “How the Sturgis Motorcycle Rally may have spread coronavirus across the Upper Midwest” screams the headline. The charge made is that “within weeks” of the gathering that drew nearly half a million visitors the Dakota’s and adjacent states are experiencing a surge of COVID cases.
The Sturgis Rally happens to be a popular motorcycle rally held in Sturgis, South Dakota every August that created much consternation this year because it wasn’t cancelled even as the country was in the throes of a pandemic. While some of the week long event is held outdoors, attendees filled bars and tattoo parlors,(and that too without masks!), much to the shock and chagrin of the virtuous members of society successfully able to navigate life via zoom, amazon prime, and ubereats.
This particular Washington Post article’s sole source of data comes from a non-profit tech organization called The Center For New Data that attempted to use cellphone data to attempt to track spread of the virus from the Sturgis rally. Unfortunately, tracking viral spread using cellphone mobility data is about as hard as it seems. The post article references only 11,000 people that were able to be tracked out of a total of almost 500,000 visitors, and isn’t able to assess mask wearing, or attempts at social distancing. How many bars are there to stuff into in Sturgis anyway?? And so it isn’t surprising that even in an article designed to please a certain politic, this particular sentence appears:
“But precisely how that outbreak unfolded remains shrouded in uncertainty.”
When powerful politicians confront a life-threatening diagnosis, it can change policy priorities.
In addition to President Trump and a slew of top aides, five U.S. senators and 15 members of the House of Representatives have now tested positive or been presumed positive in tests for Covid-19 as of Oct. 5, according to a running tally by National Public Radio (NPR).
In that light, the recent burst of coronavirus infections could accelerate three significant innovations affecting every Covid-19 survivor.
1) Post-Covid Clinics
Even seemingly mild encounters with the coronavirus can trigger a cascade of lingering health consequences. While “there is no consensus definition of post-acute Covid-19,” noted an Oct. 5 JAMA commentary, symptoms that have been reported include joint pain, chest pain, fatigue, labored breathing and organ dysfunction “involving primarily the heart, lungs and brain.”
A survey by Survivor Corps, a patient support group, and the Indiana University School of Medicine found that Covid “long haulers” often suffer from “painful symptoms…that some physicians are unable or unwilling to help patients manage.” A similar survey by the Body Politic Covid-19 Support Group concluded that Covid long-haulers face “stigma and lack of understanding [that] compromise access to health care and quality of support.”
We need to stop arguing about whether schools should reopen and instead do the work to reopen schools safely. Community prevalence of COVID-19 infection helps to quantify risk, but reopening decisions should not be predicated on this alone. Instead of deciding reopening has failed when an infected student or teacher comes to school, we should judge efforts by our success in breaking transmission chains between those who come to school infected and those who don’t. We should judge our success by when we prevent another outbreak. We should pursue risk and harm reduction by layering interventions to make overall risk of transmission in schools negligible. This CAN be done, as healthcare workers all over the United States have shown us. Unlike politics, we should avoid thinking this is a binary choice between two polarized options. At the heart of these decisions about tradeoffs should be the assumption that the education of our children is an essential, public good.
I advocated for school closures in March. We had little understanding of the risks and transmission of COVID-19 and faced massive shortages of personal protective equipment (PPE). The closures were a blunt force instrument but bought precious time to learn and prepare. Pandemic control, by flattening the curve and buying time for discovery of more effective therapeutics, care and a vaccine, remains a critical tool to save lives. But COVID-19 will not be eradicated. We must come to terms with the reality that COVID-19 will circulate among us, likely indefinitely. Shutdowns slow spread but at a great cost, disproportionately paid by vulnerable groups including children, women, minorities, and those with the least financial resources. Getting children safely back to in-person school should be among our highest priorities.
Hospitals never considered closing. As healthcare workers, we cannot physically distance from patients. We watched in horror as hot spots like Bergamo suffered high nosocomial and staff infection rates as they were quickly overwhelmed. In response, we worked tirelessly and collaboratively to protect one another while continuing to provide care.
The good news is that we seem to have learned how to prevent in-hospital transmission of COVID-19. A recent study showed that at a large US academic medical center, after implementation of a comprehensive infection control policy, 697 of 9,149 admitted patients were diagnosed with COVID-19. But only TWO hospital-acquired patient infections were detected. COVID-19 is not “just the flu,” but it isn’t Ebola either. I no longer worry that I will become infected with COVID while working in my emergency department. It is not easy, comfortable nor cheap, but a bundle of universal masking and eye protection, appropriate PPE use, sanitation, improved room ventilation, and protective policies have proven effective at preventing in-hospital outbreaks.