Life as we knew it and medicine as we had viewed it shapeshifted so dramatically in the past year that it is still hard to believe.
Medicine has started to move from an in-person only profession to one that finally recognizes that clinical assessment and treatment have fewer boundaries than people assumed. A patient of mine with newly diagnosed mastocytosis had a productive first consultation with an immunologist hundreds of miles away right from her own living room.
Efficiency increased when we could handle straightforward clinical issues electronically, even over the telephone, and still get paid. We were liberated from the perverted and miserly view by insurers that services not delivered in person should be free, as if fast food restaurants couldn’t charge for food at the drive through.
We delivered more virtual services to allow patients the safety of staying at home and avoiding lobbies, waiting rooms and exam rooms where airborne particles might linger.
Yet, when a primary care or mental health patient is in crisis or a person with new symptoms needs to be evaluated, a video visit is sometimes not enough. Step by step, we improvised screening protocols, not knowing which would be efficient or relevant as we didn’t know quite how the coronavirus behaved and transmitted.
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.
Yesterday Catalyst @ Health 2.0 hosted the finals of the RWJF Emergency Response Challenges, one for tools for the General Public and the other for the Health System. It was a great session, sadly virtual and not at a conference with cocktails afterwards. But the promise of the tools that have been built as part of these challenges is immense in the battle against this COVID-19 pandemic and the ones yet to come.
The finalists for the General Public challenge were
Binformed Covidata– A clinically-driven comprehensive desktop + mobile infectious disease, epidemic + pandemic management tool targeting suppression and containment of diseases such as COVID-19. The presenter was veteran health IT expert Rick Peters.
CovidSMS– A text message-based platform providing city-specific information and resources to help low-income communities endure COVID-19. In contrast to Rick, CovidSMS’ team were undergraduates at Johns Hopkins led by Serena Wang
Fresh EBT by Propel– A technology tool for SNAP families to address food insecurity & economic vulnerability in times of crisis – highlighted by Michael Lewis on his Against the Rules podcast about coaching earlier this year. Stacey Taylor, head of partnerships for Propel presented their solutions for those in desperate need.
The finalists for the Health System challenge were
PathCheck– A non profit just spun out of MIT. It has a raft of volunteers and well known advisors like John Brownstein and John Halamka among many others, and is already working with several states and countries. Pathcheck provides privacy first, free, open source solutions for public health to supplement manual contact tracing, visualize hot spots, and interface with citizen-facing privacy first apps. MIT Professor Ramesh Raskar was the presenter.
Qventus– A patient flow automation solution that applies AI / ML and behavioral science to help health systems create effective capacity, and reduce frontline burnout. Qventus is a great data analytics startup story. It’s raised over $45m and has lots of health system clients, and they have built a suite of new tools to help them with pandemic preparedness. Anthony Moorman, who won the best facial hair of the day award, showed the demo.
Tiatros Inc– A mental health and social support platform that combines clinical expertise, peer communities and scalable technology to advance mental wellbeing and to sustain meaningful behavioral change. They’ve done a lot of work with soldiers with PTSD and as you’ll see entered this challenge to get their tools to another group of extremely stressed professionals–frontline health care workers. CEO Kimberlie Cerrone and COO Seth Norman jointly presented.
Videos of the whole session and the demos will be up soon.
And the winners were…
A tie in General Public challenge between CovidSMS & BInformed, who split the $25,000 first prize (and the $10,000 second prize!)
Qventus in the Health System challenge who take home $25,000
But there were no losers. A great culmination of a lot of work to get tech solutions to help us deal with the pandemic.
Matthew Holt is Publisher of THCB and also Co-Chairman at Catalyst @ Health 2.0
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.
We are all are anxiously awaiting the approval and delivery of a cure to the novel coronavirus – or better yet, a vaccine.
Amid the race to develop a safe and effective vaccine, some may be inclined to give drug companies a pass on their well-established bad behavior related to pricing and market competition.
But that would be an awfully expensive mistake.
As the COVID-19 pandemic claims more lives and families’ livelihood, policymakers and the public must press drug makers for more information on the products they are developing. The country must be protected against price-gouging for therapies that could bring the pandemic to a halt.
Yes, we need America’s biopharmaceutical companies to develop a cure or vaccine so we can resume our normal lives. And yes, they should be compensated for their work.