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How Concerned Should Patients Be About An Irregular Heartbeat?

By KOUSIK KRISHNAN, MD

As many industries and individuals are struggling publicly with burnout, a new study from the European Journal of Preventative Cardiology links the “burnout syndrome” with atrial fibrillation (afib). The findings are both interesting and valuable. In general, the public benefits from anything that can raise awareness of heart disease, because early intervention directly impacts improved patient outcomes.

However, headlines that describe afib as a “deadly irregular heartbeat” go too far in the name of public awareness. The truth is, afib is not a sudden killer like a heart attack, cardiac arrest, or stroke. While afib is undeniably serious, it can often be identified in advance and managed with evaluation and treatment. 

Afib is a very common arrhythmia that has numerous risk factors, including hypertension, diabetes, obesity, and sleep apnea, to name just a few. When the heart goes into atrial fibrillation, the upper chambers go into a fast, chaotic and irregular rhythm that often makes the pulse race and feel irregular. Other symptoms can include palpitations, shortness of breath, and dizziness. Some people may not have any symptoms at all. Stroke is the most devastating consequence of atrial fibrillation, but is rarely the first manifestation of the disease.

It is also important to note that afib may not always be present. For this reason, often the arrhythmia is gone by the time someone seeks medical attention, making the arrhythmia harder to diagnose. Fortunately, consumer devices, such as the new Apple Watch, have algorithms to help detect atrial fibrillation. These technologies hold immense promise. They are already helping many people manage their health, and even potentially diagnose some people who never knew they had afib.

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Why Peak Viral Load makes temperature screening alone insufficient for COVID-19

By TONY ESTRELLA

And how South Korea and Taiwan’s approach to diagnosis and tracking is leading to positive results

By now, the sight of people wearing surgical masks, flinching at the sights and sounds of someone coughing or sneezing, governments restricting large gatherings, and sports leagues suspending or cancelling matches is familiar across the world.

Even though this newest coronavirus we now call COVID-19 is not the deadliest disease as measured by daily deaths, the concern over the outbreak is forcing urgent actions.

Daily deaths from COVID-19 compared to other diseases. Source: informationisbeautiful

One of the core concerns is limiting how quickly the virus can spread. Having too many people require urgent care can overwhelm healthcare systems. This anxiety has led to a call to ‘flatten the curve’ to avoid this challenge.

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Julia Cheek, Everlywell, & its response to COVID-19

I interviewed Julia Cheek, CEO of Everlywell about their response to COVID-19. Last week they issued a $1m challenge to labs to promote the rapid capability to develop COVID-19 testing. Her goal is to get the US up to 250K home tests per day within a month, but it won’t be easy. This is the first in a series of news and tracking that THCB & Catalyst @ Health 2.0 will be doing on health tech companies’ response to the pandemic — Matthew Holt

41 Countries Later, This Doc’s Pick for Best Health System “Hack” | Dr. Niti Pall, KPMG & AXA

By JESSICA DaMASSA, WTF HEALTH

Dr. Niti Pall has experience working in 41 different health systems around the world in her roles as Global Medical Director for KPMG, Senior Mobile Health Advisor for AXA, and as a General Practitioner in the U.K. With that type of diverse experience across health systems rich and poor, tech-enabled and not, OF COURSE we had to ask which was the best health system ‘hack’ she’s seen so far. The answer takes us to Bangladesh, involves a huge telecom company, and leads to a completely new category of healthcare provider. Is this a model we’ll see Amazon, Apple, Google or other non-traditional healthcare players take up as they head into the health industry? Niti talks about how tech is the underpinning of “proper 21st Century healthcare,” but that’s not all it will it take to overcome global clinician shortages and help consumers feel like they are getting value out of their healthcare dollars worldwide.

Filmed at Barcelona Health Hub Summit in Barcelona, Spain, October 2019.

Health in 2 Point 00, Episode 112 | COVID-19, HealthDevJam & loads of deals

Today on Health in 2 Point 00, Jess is joining somebody for their self quarantine in the Oval Office! Shenanigans aside, I give a quick coronavirus update and a shameless plug before diving into our regular coverage of all the deals. As for COVID-19, there’s a ton of activity going on in the digital health world with companies trying to figure out how they can help with this. Catalyst will be presenting some of that, either this weekend or early next week. Next, there’s an FHIR-related HealthDevJam event (free, online) TODAY at 1pm Eastern with lots of great people speaking.

Diving into some non-coronavirus related deals, eConsult company RubiconMD raises $18 million, Lyra Health getes a chunk of change—$75 million—for its mental health platform, Fruit Street Health gets $17 million from an unlikely source, b.well raises $16 million for what’s not a personal health record, and CVS announces that it added 5 digital health companies to its point solution management system. Finally, there’s been some sneaky stuff uncovered about Sanofi. Tune in for all the details on Episode 112. —Matthew Holt

There Is No Time for That

By ROMAN ZAMISHKA, MPA

Some of the most important engineering lessons were demonstrated on the tank battlefields of World War II when German Tigers faced off against Soviet T-34s.

The Tiger tank was a technical masterpiece of for its time with many features that did not appear in allied tanks until after the war. Despite its much heavier armor it was able to match the speed of lighter enemy tanks and keep up with its own light tank scouts. The armor featured almost artisanally welded interlocking plates. The ammunition featured innovative electric trigger primers and high penetration tungsten shells. The double differential steering system allowed the Tiger to rotate in place. A complex system of interleaving wheels distributed weight evenly, improved off-road mobility and even allowed mobility with damaged tracks.

But while the Tiger was a star on the blueprints, it was a disaster on the Eastern front, not because of its combat performance but because it was a logistical and operational nightmare. The heavy armor made the tank a gas guzzler, which made tanks inoperable when supplies were low. The electric trigger primers would fail in cold weather. When rotating in place the gearbox would often break and German training manuals forbid the maneuver. The highly specialized internal mechanics made production slow and meant the tank often could not be repaired in the field but had to be sent back to Germany, and the great logistic costs meant that Tigers couldn’t drive to the front but had to be brought there by rail.

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Pandemic Fears: What the AIDS Battle Should Teach Us About COVID-19

By ANISH KOKA, MD

As the globe faces a novel, highly transmissible, lethal virus, I am most struck by a medicine cabinet that is embarrassingly empty for doctors in this battle.  This means much of the debate centers on mitigation of spread of the virus.  Tempers flare over discussions on travel bans, social distancing, and self quarantines, yet the inescapable fact remains that the medical community can do little more than support the varying fractions of patients who progress from mild to severe and life threatening disease.  This isn’t meant to minimize the massive efforts brought to bear to keep patients alive by health care workers but those massive efforts to support failing organs in the severely ill are in large part because we lack any effective therapy to combat the virus.  It is akin to taking care of patients with bacterial infections in an era before antibiotics, or HIV/AIDS in an era before anti-retroviral therapy.  

It should be a familiar feeling for at least one of the leading physicians charged with managing the current crisis – Dr. Anthony Fauci.  Dr. Fauci started as an immunologist at the NIH in the 1960s and quickly made breakthroughs in previously fatal diseases marked by an overactive immune response.  Strange reports of a new disease that was sweeping through the gay community in the early 1980’s caused him to shift focus to join the great battle against the AIDS epidemic. 

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A Patient’s View of the Cures Regulations

By ADRIAN GROPPER, MD

How should we react to 1,718 pages of new regulation? Let’s start by stipulating the White House and HHS perspective

“Taken together, these reforms will deliver on the promise to put patients at their center of their own health care — you are empowered with control over your own health care choices.” 

Next, let’s stipulate the patient perspective via this video lovingly assembled by e-Patient Dave, Morgan Gleason, and the folks at the Society for Participatory Medicine. In less than 3 minutes, there are 15 patient stories, each with a slightly different take on success.

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Can the US health care system “pull an Italy?”

By MATTHEW HOLT

There has been a ton of analysis about COVID-19 and how bad it will get. Some like Joon Yun and Jeremy Faust say the panic is worse than the disease. Others have run the infection rate numbers and predicted that the US will run out of hospital capacity in early May and in Washington state much earlier (end of March).

But there’s no doubt that in the last week or so, sentiment has changed. This week I and 45,000 of my best friends are at home, not at HIMSS in Florida. Many big gatherings like SXSW, Comic-Con and Coachella have been cancelled. Most corporations that can are asking employees to work from home. Just this morning my local school district in California called off school plays and any gatherings with more than 100 people.

Part of this is the inevitable response to the ridiculous posing of Trump. He showed up at the CDC wearing a campaign hat and declared that he was a great doctor to be because his uncle was at MIT. The Director of the CDC and later the Surgeon-General made toadying remarks about how amazing he was. And neither Pence, Azar, Carson or anyone else allegedly in charge can give a straight answer to anything.

The nation has realized that there is no help or even basic honesty coming from the Federal government. This is after the CDC screwed up the creation of basic testing kits which put the US in a situation where it just can not know the extent of the outbreak. China denied the outbreak, then had to put Wuhan and much of their economy on lockdown. Iran may be in worse shape.

Meanwhile South Korea, Singapore and Taiwan have managed their outbreaks with very rapid testing, quarantining of those infected, and extremely rapid response. The US is still blundering around. Now the private sector is trying to step in as the Feds misstep again and again.

But a likely scenario is that many regions in the US will become like Northern Italy.

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Health in 2 Point 00, Episode 111 | #HIMSSpocalypse2020

Live from the tradeshow floor of HIMSS, it’s Health in 2 Point 00! And no, I’m not fading away from coronavirus on this episode—but how many people could I have singlehandedly infected had the conference gone forward? On Episode 111, Jess and I have some fun with virtual backgrounds and talk about all of the things we’re missing at HIMSS right now. From what Trump would’ve said had he gotten the opportunity to speak, to what conversation would’ve gone on about the new ONC rules, to the big funding announcement we missed, here’s everything that succumbed to #HIMSSpocalypse2020. —Matthew Holt

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