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Infection Control for COVID-19 Imaging

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By STEPHEN BORSTELMANN, MD

Occasionally, you get handed a question you know little about, but it’s clear you need to know more.  Like most of us these days, I was chatting with my colleagues about the novel coronavirus. It goes by several names: SARS-CoV-2, 2019-nCoV or COVID-19 but I’ll just call it COVID.  Declared a pandemic on March 12, 2020 by the World Health Organization (WHO), COVID is diagnosed by laboratory test – PCR.  The early PCR test used in Wuhan was apparently low sensitivity (30-60%), lengthy to run (days), and in short supply.  As CT scanning was relatively available, it became an important diagnostic tool for suspected COVID cases in Wuhan.

The prospect of scanning thousands of contagious patients was daunting, with many radiologists arguing back and forth about its appropriateness.  As the pandemic has evolved, we now have better and faster PCR tests and most radiologists do not believe that CT scanning has a role for diagnosis of COVID, but rather should be reserved for its complications. Part of the reason is the concern of transmission of COVID to other patients or healthcare workers via the radiology department.

But then someone asked: “After you have scanned a patient for COVID, how long will the room be down?” And nobody really could answer – I certainly couldn’t.  A recent white paper put forth by radiology leaders suggested anywhere from 30 minutes to three hours. A general review of infection control information for the radiologist and radiologic technologist can be found in Radiographics.

So, let’s go down the rabbit hole of infection control in the radiology department. While I’m a radiologist, and will speak about radiology-specific concerns, the fundamental rationale behind it is applicable to other ancillary treatment rooms in the hospital or outpatient arena, provided the appropriate specifics about THAT environment is obtained from references held by the CDC.

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Telehealth Startup CEO On How Covid-19 Is Changing Telemedicine Use In Hospitals | WTF Health

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By JESSICA DaMASSA, WTF HEALTH

Jamey Edwards, CEO of one of the larger in-hospital B2B telehealth startups in the US, Cloudbreak Health, is already seeing changes in the way hospitals are using his company’s telemedicine services in the wake of COVID-19.

From a noted rise in the rate of infectious disease consults, to “quarantine rooms” where telemedicine equipment is cleverly deployed to practice “clinical distancing” to minimize risk to front-line healthcare workers (and also preserve PPE), Jamey talks about what he’s seeing among hospital clinicians and what they seem to need most right now from telehealth providers amid the COVID-19 outbreak.

With changes to licensing regulations, HIPAA policies, and reimbursement changing the very infrastructure around telehealth, will we finally see virtual care become a true part of the healthcare system at-scale?

“One of the hardest things to do in our healthcare system is match cost to acuity,” says Jamey. “I’m not going to say we’ve overvalued the in-person encounter, but we certainly have been very hesitant to step away from it.”

“The fact of the matter is that that’s a bias. And so it’s up to us to look at these biases and say, ‘Well, no. What is the right way to do this?’”

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CT scanning is just awful for diagnosing Covid-19

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By LUKE OAKDEN-RAYNER, MBBS

I got asked the other day to comment for Wired on the role of AI in Covid-19 detection, in particular for use with CT scanning. Since I didn’t know exactly what resources they had on the ground in China, I could only make some generic vaguely negative statements. I thought it would be worthwhile to expand on those ideas here, so I am writing two blog posts on the topic, on CT scanning for Covid-19, and on using AI on those CT scans.

As background, the pro-AI argument goes like this:

  1. CT screening detects 97% of Covid-19, viral PCR only detects 70%!
  2. A radiologist takes 5-10 minutes to read a CT chest scan. AI can do it in a second or two.
  3. If you use CT for screening, there will be so many studies that radiologists will be overwhelmed.

In this first post, I will explain why CT, with or without AI, is not worthwhile for Covid-19 screening and diagnosis, and why that 97% sensitivity report is unfounded and unbelievable.

Next post, I will address the use of AI for this task specifically.

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Health in 2 Point 00, Episode 113 | Oura, Heartbeat Health, Vault & Bloomer Tech

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Today on Health in 2 Point 00, Jess and I are covering all the hard hitting news while surviving COVID-19. Before we turn to deals, Jess asks for my thoughts on the American Hospital Association, American Medical Association and American Nurses Association asking for $100 billion from Congress. For our funding news, Finnish smart ring startup Oura raises $28 million in a Series B; Heartbeat Health raises $8.2 million in a Series A for virtual cardiovascular care; Vault raises $30 million in a Series A, entering an already-crowded field alongside Roman and Hims; and Bloomer Tech raises $3 million for their smart bra. Finally, keep up with digital health innovators working on COVID-19 on Catalyst’s new site, covid19healthtech.com. —Matthew Holt

COVID-19 Pandemic Puts Rural and Tribal Communities at Great Risk

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Connie Chan
Brooke Warren
Phuoc Le

By PHUOC LE MD, CONNIE CHAN and BROOKE WARREN

Since the World Health Organization (WHO) officially declared COVID-19 a pandemic on March 11, 2020, we have been changing our daily lives to protect the highest-risk populations: older adults and people with chronic medical conditions. We are asked to follow sensible guidelines like social distancing and thorough hand-washing. Although one may have a gut-reaction to put their own safety at the forefront during these times of crisis, it is essential that we are taking the necessary steps to protect populations with additional vulnerabilities – rural tribal communities.

With the announcement that COVID-19 reached the Confederated Tribes of Umatilla Indian Confederation on March 9, 2020, it was evident the virus would not stay confined to urban and metropolitan centers like some previously predicted. The experience in China with COVID-19 clearly reflects the vulnerability of rural communities because many people travel routinely from urban to rural. Experts who conducted an epidemiological study in Hubei province, the initial epicenter of the COVID-19 pandemic, noted in their report: “…most public medical resources are concentrated in cities but are relatively scarce in rural areas. Therefore, prevention and treatment of 2019-nCoV in rural areas will be more challenging if new phases of the epidemic emerge.”

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Can AI diagnose COVID-19 on CT scans? Can humans?

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Vidur Mahajan
Vasanth Venugopal

By VASANTH VENUGOPAL MD and VIDUR MAHAJAN MBBS, MBA

What can Artificial Intelligence (AI) do?

AI can, simply put, do two things – one, it can do what humans can do. These are tasks like looking at CCTV cameras, detecting faces of people, or in this case, read CT scans and identify ‘findings’ of pneumonia that radiologists can otherwise also find – just that this happens automatically and fast. Two, AI can do things that humans can’t do – like telling you the exact time it would take you to go from point A to point B (i.e. Google maps), or like in this case, diagnose COVID-19 pneumonia on a CT scan.

Pneumonia on CT scans?

Pneumonia, an infection of the lungs, is a killer disease. According to WHO statistics from 2015, Community Acquired Pneumonia (CAP) is the deadliest communicable disease and third leading cause of mortality worldwide leading to 3.2 million deaths every year.

Pneumonias can be classified in many ways, including the type of infectious agent (etiology), source of infection and pattern of lung involvement. From an etiological classification perspective, the most common causative agents of pneumonia are bacteria (typical like Pneumococcus, H.Influenza and atypical like Legionella, Mycoplasma), viral (Influenza, Respiratory Syncytial Virus, Parainfluenza, and adenoviruses) and fungi (Histoplasma & Pneumocystis Carinii).

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Livongo Health’s Jenny Schneider on Covid-19 & Helping Patients with Chronic Conditions | WTF Health

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By JESSICA DaMASSA, WTF HEALTH

“What’s happening in COVID is those of us living with these chronic conditions are at highest risk — not to contract the disease, but highest risk for outcomes. Our unique ability to be able to see what’s happening in that population and deliver that care remotely is incredibly valuable always, but, particularly, in this strained time.”

Livongo Health has always been committed to helping its members (people with diabetes, heart disease, and other chronic conditions) manage their health “where they are.” Collecting loads of patient data along the way. As the traditional health system grapples with caring for those infected with COVID-19, what changes? What role will digital health companies like Livongo play as they continue to provide front-line, day-to-day care to their members and customers amidst the challenging environment of this pandemic?

Dr. Jennifer Schneider, Livongo’s President, stops by to chat about what’s happening at Livongo now as the country looks to virtual care solutions to help shore up capacity for the traditional health system. As the spotlight is turned to digital health, we get Jenny’s perspective on what it will take for health tech companies like hers to continue to prove their value to healthcare incumbents and to patients who have a growing need for their help managing their everyday health.

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American Telemedicine Has Gone Viral

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By HANS DUVEFELT, MD

It took a 125 nanometer virus only a few weeks to move American healthcare from the twentieth to the twenty-first century.

This had nothing to do with science or technology and only to a small degree was it due to public interest or demand, which had both been present for decades. It happened this month for one simple reason: Medicare and Medicaid started paying for managing patient care without a face to face encounter.

Surprise! In the regular service industries, businesses either charge for their services or give certain services away for free to build customer loyalty. In healthcare, up until this month, any unreimbursed care or free advice was provided on top of the doctors’ already productivity driven work schedules.

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COVID-19 Update: A Message From Concerned Physicians

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By HOWARD LUKS MD, JOEL TOPF MD, FACP, ETHAN WEISS MD, CARRIE DIULUS MD, NANCY YEN SHIPLEY MD, ERIC LEVI MBBS, FRACS, BRYAN VARTABEDIAN MD

“EVERYTHING WE DO BEFORE A PANDEMIC WILL SEEM ALARMIST. EVERYTHING WE DO AFTER WILL SEEM INADEQUATE”

—Michael Leavitt

Last updated 3/18/2020.

Why are we writing this? 

The COVID-19 pandemic has reached a point where containment is no longer possible. The COVID-19 threat is real, and rapidly getting worse. Many of you are very nervous, some are unsure of the validity of the information you are reading. As physician leaders, we felt it was important to craft a resource you can rely on as being scientifically accurate and one which contains as much actionable information and guidance as possible. 

Accurate, actionable information during an epidemic can save lives. Physicians are on the front line of this epidemic. Not only are we treating the sick, but we are also cringing at the misinformation spread through both traditional broadcast and social media. Evidence matters. Unfortunately, evidence is often slow, methodical, and boring and has a tough time against clicky headlines and exaggeration. We believe that an accurate representation of the current COVID-19 pandemic followed by a set of actionable steps you, your loved ones, politicians and local officials can utilize is of paramount importance and ultimately could save tens of thousands of lives. 

COVID-19 isn’t just the flu? 

COVID-19 has been described by some as “just a cold”, or just like the common flu. COVID-19 is not the common flu. COVID-19 is an order of magnitude worse than the flu. The fatality rate is approximately 10 times worse than the flu.

The flu spreads from September through April in the US, and June through August in the Southern Hemisphere. Yes, it does cause severe illness in many, but it does so over a longer time course. Time is a variable that is working against us during this COVID-19 outbreak. COVID-19 victims will be presenting to a hospital in need of critical care at a rate that is far higher than occurs with the flu.

In addition, these patients will be requiring hospital treatment over the course of a few weeks rather than the 3-4 months of a typical flu season. The healthcare system in the USA is not ready to handle tens of thousands or hundreds of thousands of people over a short time frame. In Italy, the healthcare system buckled under the strain and the healthcare teams are now forced to make horrible life and death decisions. 

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Tracking digital health innovation in response to COVID-19

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By INDU SUBAIYA & MATTHEW HOLT

Since the COVID-19 pandemic became very real for all of us a couple in the US a couple of weeks ago, our team at Catalyst @ Health 2.0 has been working on a way to support the wider health tech community. 

We have created a list of information on innovators who are working to address the COVID-19 pandemic. In order to maximize our response efforts to the coronavirus outbreak, we are collecting information on specific solutions for COVID-19 issues from digital innovators in several categories like telemedicine, artificial intelligence, and disaster preparedness. Our resource hub includes information on health technology developments, as well as news and interviews. We are by no means the only ones doing this and we are doing this cooperatively with HIMSS, Startup Health, Chilmark, HealthXL and others.

Our goal is to have as comprehensive and searchable a list as possible of these solutions. Today we are making our first effort live. Please come look at the site at covid19healthtech.com and please give us your feedback. In particular if you or your organization is working on a response to COVID-19 or you have expert insights on how to address the outbreak, please tell us about it! 

We hope to greatly expand the number of companies and organizations we feature in the coming days, and look forward to working with the wider health tech community to all do what we can to improve health care as much as we can in these very trying circumstances

Indu Subaiya & Matthew Holt are the co-founders of Health 2.0 LLC

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