The COVID-19 pandemic has been harsher and lasted longer than many of us would have predicted. While our media has been inundated with updates on death tolls and economic depression, there has been little conversation of healthcare beyond the era of COVID-19. The first question that we ask when we hear of deaths: was it COVID? We have grown to expect the primary cause of death to be of coronavirus. But the impact of COVID-19 will extend beyond the individual, effecting fundamental and long-lasting change to our healthcare system.
By this point, it is clear that the public health ramifications are reaching well beyond the physical impacts of the virus. Social isolation, economic depression, soaring unemployment, and mandated closures all contribute to the adversity that we have had to face – notwithstanding the explosive, ever-present sociopolitical climate of a pandemic that is killing Black Americans at a rate almost three times that of whites. This hardship will likely last for months more.
A recent Kaiser Family Foundation publication found that half of the public have skipped or postponed medical care due to the pandemic, with one-fourth reporting worse health as a result. Many of these people do not plan to receive the care they need within the next three months. The public is simultaneously reporting declines in mental health. Furthermore, over 30% say they have had difficulty paying for household expenses, like food, rent, and medications. The figures are disproportionately damning among Black and Hispanic populations.
Taken together, the inaccessibility of medical care, deteriorating mental health, increasing poverty, worsening access to nutrition, and host of other challenges present a dark, impending storm. Cancer, diabetes, and other chronic diseases will all be rearing their untreated heads post-pandemic. Communities and policymakers must therefore act quickly and decisively to heal not only a sick population, but a fraying social fabric.
The COVID-19 pandemic has been a testing time for the already testy academic discourse. Decisions have had to be made with partial information. Information has come in drizzles, showers and downpours. The velocity with which new information has arrived has outstripped our ability to make sense of it. On top of that, the science has been politicized in a polarized country with a polarizing president at its helm.
As the country awoke to an unprecedented economic lockdown in the middle of March, John Ioannidis, professor of epidemiology at Stanford University and one of the most cited physician scientists who practically invented “metaresearch”, questioned the lockdown and wondered if we might cause more harm than good in trying to control coronavirus. What would normally pass for skepticism in the midst of uncertainty of a novel virus became tinder in the social media outrage fire.
Ioannidis was likened to the discredited anti-vax doctor, Andrew Wakefield. His colleagues in epidemiology could barely contain their disgust, which ranged from visceral disappointment – the sort one feels when their gifted child has lost their way in college, to deep anger. He was accused of misunderstanding risk, misunderstanding statistics, and cherry picking data to prove his point.
The pushback was partly a testament to the stature of Ioannidis, whose skepticism could have weakened the resoluteness with which people complied with the lockdown. Some academics defended him, or rather defended the need for a contrarian voice like his. The conservative media lauded him.
In this pandemic, where we have learnt as much about ourselves as we have about the virus, understanding the pushback to Ioannidis is critical to understanding how academic discourse shapes public’s perception of public policy.
Imagine three months from now when the predicted ‘second wave’ of COVID-19 is expected to resurge and we’re still without a vaccine. Telehealth has become the entry-point to care, widely adopted by patients both young and old. Now, when an elderly diabetic patient wakes up in the middle of the night with a dull ache on her left side and back, she doesn’t ignore the symptom, like she may have during the first COVID outbreak. Instead, she logs online to her local hospital’s website from a cell phone and accesses a simple questionnaire to report her health history and presenting symptoms. The whole process takes just a couple of minutes and she immediately hears back from her health provider with the suggestion to schedule an in-person appointment for further testing to rule out any kidney issues.
This patient doesn’t become one of the nearly 50% of Americans who delayed care during the initial COVID pandemic. She was able to access care without having to download an application or wait to schedule a virtual appointment during normal business hours. She receives virtual asynchronous care on-demand, coordinated to sync with her electronic health record. The next day, she receives a follow-up call from her primary care doctor to ensure her symptoms were alleviated with the over-the-counter pain medication she was prescribed.
I applaud the article written by Paul Grundy, MD, and Ken Terry, “Primary Care Practices Need Help to Survive the COVID-19 Pandemic,” in which they called on Congress to make health policy decisions that will provide immediate financial relief for primary care practices. We must mitigate the real risk we face: the highly possible shutdown of our healthcare system. Amid the coronavirus pandemic, the U.S. healthcare system has taken an enormous financial hit and primary care practices have been especially affected and are struggling to survive. As the authors point out, telehealth has taken the spotlight to fill the acute need for an influx of patients needing to access care under social distancing practices. Telehealth can increase access to care, relieve provider burden, reduce costs to systems, and improve patient outcomes. However, this is only possible with on-demand telehealth, or asynchronous care.
Trying to achieve pregnancy with fertility treatments can be challenging, stressful, and expensive in the best of times — let alone a global pandemic. Since the COVID-19 outbreak in the U.S., fertility care has been basically “paused,” and women attempting to conceive have been left with a very different set of decisions and options for care than were available pre-pandemic. So, how does fertility care shift from the clinic to the home? Tammy Sun, co-founder & CEO of fertility benefits startup Carrot Fertility, and Lea Von Bidder, co-founder & CEO of Ava, a women’s health tech startup best-known for its ovulation tracking bracelet, stop by to talk about how they are redefining the how, when, and where of fertility care for greater success outside the doctor’s office.
What’s smart about this partnership? How the two companies are working together to build off the biometric data collected by Ava’s tracker, basically adopting a remote monitoring approach to collecting and analyzing data in the home in effort to either help optimize the chances of getting pregnant naturally, or better inform the IVF or other medically-assisted procedures that will return as options as the pandemic wanes. From the impact on would-be-parents and their employers to the sentiment of women’s health investors, we talk through the opportunities and challenges of expanding fertility care in the home.
There have been disturbing reports of hospitals firing doctors and nurses for speaking up about inadequate PPE. The most famous case was at the PeaceHealth St. Joseph hospital in Washington, where Dr. Ming Lin was let go from his position as an ER physician after he used social media to publicize suggestions for protecting patients and staff. At Northwestern Memorial Hospital in Chicago, a nurse, Lauri Mazurkiewicz warned colleagues that the hospital’s standard face masks were not safe and brought her own N95 mask. She was fired by the hospital. These examples violate a culture of safety and endanger the lives of both patients and staff. Measures that prevent healthcare workers from speaking out to protect themselves and their patients violate safety culture. Healthcare workers should be expected to voice their safety concerns, and hospital executives should be actively seeking feedback from frontline healthcare workers on how to improve their institution’s Covid-19 response.
Share power with frontline workers
According to the Institute for Healthcare Improvement, it is common for organizations facing a crisis to assume a power grab in order to maintain control. As such, it is not surprising that some hospitals are implementing draconian policies to prevent hospital staff from speaking out. While strong leadership is important in a crisis, it must be balanced by sharing and even ceding power to frontline workers. All hospitals want to provide a safe environment for their staff and high-quality care for their patients. However, in a public health emergency where resources are scarce and guidelines change daily, it’s important that hospitals have a systematic approach to keep up.
Those of us of a certain age, or anyone who loves classic movies, remember the famous scene in “The Graduate” when Benjamin Braddock is given what is intended as a helpful clue about the future. “Plastics,” one of his father’s friends says. “There’s a great future in plastics.”
Well, we’re living in that future, and it’s not all that rosy. Plastics have, indeed, become an integral part of our world, giving billions of us products that we could never otherwise have or afford. But our future is going to increasingly be driven by an unintended consequence of the plastics revolution: microplastics.
And that’s not good.
Microplastics are what happens to plastic after it has gone through the wringer, so to speak. Plastic doesn’t typically decompose, at least not in any time frame we’re capable of grasping, but it does get broken down into finer and finer particles, until they reach microscopic levels (thus “microplastics”). We’ve known for some time that plastics were filling our landfills, getting caught in our trees and bushes, washing up on our shorelines, even collecting in huge “garbage patches” in the ocean. But it wasn’t until more recently that we’ve found that plastics’ reach is much, much broader than we realized, or could see.
Dr. Brahney was coauthor on a recent study that found microplastics were pervasive even in supposedly pristine parts of the Western U.S. They estimated that 1,000 tons of “plastic rain” falls every year onto protected areas there; 98% of soil samples they took had microplastics. Dr. Brahney pointed out that, because the particles are both airborne and fine, “we’re breathing it, too.”
Until scientists discover a vaccine or treatment for COVID-19, our economy and our privacy will be at the mercy of imperfect technology used to manage the pandemic response.
Contact tracing, symptom capture and immunity assessment are essential tools for pandemic response, which can benefit from appropriate technology. However, the effectiveness of these tools is constrained by the privacy concerns inherent in mass surveillance. Lack of trust diminishes voluntary participation. Coerced surveillance can lead to hiding and to the injection of false information.
But it’s not a zero-sum game. The introduction of local community organizations as trusted intermediaries can improve participation, promote trust, and reduce the privacy impact of health and social surveillance.
Balancing Surveillance with Privacy
Privacy technology can complement surveillance technology when it drives adoption through trust borne of transparency and meaningful choice.
As the U.S. reckons with centuries of structural racism, an important step toward making health care more equitable will require transferring control of health records to patients and patient groups.
The Black Lives Matter movement calls upon us to review racism in all aspects of social policy, from law enforcement to health. Statistics show that Black Americans are at higher risk of dying from COVID-19. The reasons for these disparities are not entirely clear. Every obstacle to data collection makes it that much harder to find a rational solution, thereby increasing the death toll.
In the case of medical research and health records, we need reform that strips control away from hospital chains and corporations. As long as hospital chains and corporations control health records, these entities may put up barriers to hide unethical behavior or injustice. Transferring power and control into the hands of patients and patient groups would enable outside auditing of health practices; a necessary step to uncover whether these databases are fostering structural racism and other kinds of harm. This is the only way to enable transparency, audits, accountability, and ultimately justice.
A recent review in STAT indicates that Black Americans suffer three to six times as much morbidity due to COVID-19. These ratios are staggering, and the search for explanations has not yielded satisfying answers.
With about one month left on the existing 90-day Public Health Emergency that’s eased regulations and improved reimbursement to help make telehealth, remote monitoring, and other virtual care services easier for providers to implement and patients to use, health tech companies across the US are wondering what it will take to make these changes permanent. One of digital health’s few ‘DC Insiders,’ Livongo Health’s VP of Government Affairs, Leslie Krigstein, gets us up-to-speed on what’s happening on Capitol Hill and what we can expect moving forward. What changes will (literally) require an Act of Congress? And what can be handled by HHS and CMS? From codes and co-pays to e-visits and licensing, Leslie breaks it down and tells us whether or not we can continue to expect a ‘health tech-friendly’ agenda in Washington DC.
I knew about TikTok, but not “TikTok Teens.” I was vaguely aware of K-Pop, but I didn’t know its fans had common interests beyond, you know, K-Pop. I’d been tracking Gen X and Millennials but hadn’t really focused on Gen Z. It turns out that these overlapping groups are quite socially aware and are starting to make their influence felt.
I can’t wait for them to pay more attention to health care.
This is the generation that has grown up during/in the wake of 9/11, the War on Terror, the War on Drugs, the 2008 recession, the coronavirus pandemic, and the current recession — not to mention smartphones, social media, online shopping, and streaming. Greta Thunberg is Gen Z, as is Billie Eilish, each of whom is leading their own social movements. This generation has a lot to protest about, and a lot of ways to do it.
They were in the news this past weekend due to, of all things, President Trump’s Tulsa rally. His campaign had boasted about having a million people sign up for the rally, only to find that the arena was less than a third filled. An outdoor rally for the expected overflow crowd was cancelled.
It didn’t take long for the TikTok Teens/K-Pop fans to boast on social media about their covert — to us older folks — campaign to register for the rally as a way to gum up the campaign efforts. Steve Schmidt, an anti-Trump Republican strategist, tweeted: “The teens of America have struck a savage blow against @realDonaldTrump.”