The Health Care Blog – Page 165 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Escaping COVID-19

Jun 4, 2020

By RAGHAV GUPTA, MD

“In seeking absolute truth, we aim at the unattainable and must be content with broken portions.”
William Osler

A colleague shared an experience with me about testing one of his patients for the novel coronavirus and it left me a bit puzzled. An elderly gentleman with past medical history of severe COPD (chronic obstructive pulmonary disease) and heart failure came to the ER with shortness of breath, edema and fatigue. Chest x-day suggested pulmonary edema. He wanted to test him for SARS-CoV2 but hesitated. Eventually he was able to order it after discussions with various staff administrators. Dialogue included sentences like “why do we need testing? He has Congestive Heart Failure (CHF), not COVID-19” and “it could create panic amongst staff taking care of him”. I applauded his persistence as eventually the test was done. To not test is counter-intuitive and more like an escape from diagnosing the virus rather than escaping the virus itself.

One – the mere fact that we might hesitate before testing for a virus which is a cause of a (ongoing) pandemic should ring all the bells of concern about lack of an optimal strategy. Inadequate testing has remained the Achilles heel of our stand against COVID-19 because to have a lasting stand, we must know where to take the stand.

Two – the concern of CHF raised above is clinical and valid, but it is of grave importance to understand that CHF and COVID-19 are not mutually exclusive. We now know that even the infamous flu and COVID-19 are not mutually exclusive. Common protocols from a few months ago to test for flu in sick outpatients and not test for COVID-19 if flu was positive was like the prey closing its eyes and hoping the predator does not see it. It did defer the use of an already scarce resource at the time, testing. SARS-CoV2 is a virus and the disease caused by it is called COVID-19. Virus can be ubiquitous; disease does not have to be. A patient with CHF exacerbation can be an asymptomatic carrier of SARS-CoV2 but may not phenotypically express the disease manifestations of COVID-19. Or may be his COPD or CHF exacerbation has happened due to a milder COVID-19 inflammatory response? What we know about COVID-19 is that we don’t know enough about it and therefore we cannot rule out its presence. Especially while we are in the middle of a growing pandemic.

Call for Applications: Bayer G4A Partnerships 2020

Jun 3, 2020

Digital health is changing the world

From chronic disease management to prevention, G4A’s goal is to empower people with the tools and access they need to take control of their health. G4A does this through fostering a diverse and vibrant ecosystem of digital health partners to support their growth and impact.

On April 20th, G4A launched its 2020 Partnership Program with an open call for applications. The aim of the Partnerships Program is to work with companies across the globe on healthcare’s toughest challenges and innovate together towards a future of integrated care. This year G4A is seeking to collaborate with companies that are making an impact in the following areas:

Cardiometabolic and Renal Diseases – Heart health requires a 360-approach that encompasses lifestyle behaviors, remote monitoring, biomarker review, risk stratification, and more
Oncology – Utilizing targeted therapies and patient performance technologies can identify patients efficiently and slow disease progression
Women’s Health – Novel approaches are needed to manage gynecological conditions such as PCOS and Endometriosis, as well as Menopause, and provide answers to the unique needs of women’s health
Pharmacovigilance – The opportunity for innovation in drug safety is huge, specifically as it relates to adverse event detection

We Can’t Breathe

Jun 3, 2020• 4

By KIM BELLARD

I was wondering what might crowd COVID-19 off the news. The historic economic devastation caused by it has been subsumed into it, just another casualty of the pandemic. In better times, perhaps SpaceX’s efforts would inspire us. But, no, it took the police killing of yet another person of color to take our attention away.

Now, let me say right off that I am not the best person to discuss George Floyd’s death and the woeful pattern it is part of. I have certainly been the beneficiary of white male privilege. I’ve never been unjustly pulled over or arrested. I haven’t taken part in the protests. But people like me need to speak out. Writing about anything else right now seems almost irresponsible.

OK: you’ve seen the video. You’ve heard Mr. Floyd protest that he can’t breathe, that the officer was killing him. You’ve seen other officers stand by and not do anything — some even assisting — even as bystanders pleaded for them to let Mr. Floyd breathe. It’s disturbing, it’s distressing, and it’s nothing new.

I saw a video from one of the resulting protests where another officer restrained a protester — a black man, of course — in exactly the same way, although in this case another officer eventually moved the officer’s knee off the protester’s neck. He’d learned what that video looked like.

There now have been protests in over 140 U.S. cities, with the National Guard mobilized in almost half the states. Most protests have been peaceful, but there has been looting and there have been shootings. It’s a level of civil unrest not seen since the 1960’s.

And we thought it was bad when we just wanted the grocery stores to have toilet paper again, when wearing a mask was considered a hardship.

The Lack of Persuasion as a Failure Against COVID-19

Jun 2, 2020• 1

By RAFAEL FONSECA, MD

Reopening safely out of the current pandemic ought to be done via persuasion, not coercion.

It has been more than five months since the world first learned about COVID-19. Models predicted a sharp increase in the number of cases, and a seemingly high likelihood the pandemic would overwhelm our hospitals. These models were often inaccurate, and we have all come to learn about the imprecision of epidemiological prediction. Nevertheless, the infection is far worse than anyone initially accepted – becoming a staple of our generation. Fearing uncountable deaths and the possible need to prioritize resources for those affected, initial government measures were put in place to curtail the spread of the virus. Images of the Lombardic tragedy compelled all to stay in place and wait for the storm to pass, and with few exceptions most complied. Realizing the gravity of the situation, governments gradually implemented measures to prevent infections. With some vacillation, we evolved from travel restrictions, to social distancing, shelter in place and universal mask use.

As the pandemic ensued, we watched the horror stories taking place in New York City and Boston. Even while we are in the midst of the so-called first wave, with thousands of deaths per day, many have started to wonder how long society will remain isolated and locked. Politicians look to experts for recommendations regarding policies that might save lives, and for the most part they have complied. However, as the weeks ensue, we see growing jobless claims, lines for food banks, and impatience.

This brewing impatience is a response to an unknown future dictated by the vagaries of nature and the lack of a coherent strategy to resume a life with a resemblance to normal. The public searches for guidance from federal agencies, state governments, and health authorities. A lack of clear direction from these institutions has heightened this anxious impatience. Additionally, the conversation is now ideological, with an almost Manichaean division between those wanting to save lives more so than the economy, and vice versa, creating cartoons of opposing perspectives. Even for those recognized as accomplished, dissenting from orthodoxy is punished severely. In the background, the public’s patience is running thinner.

RWJF Apps Closing Soon: Apply Today!

Jun 1, 2020• 1

Even Covid-19 May Not Be Causing Your Doctor To Wash His Hands

Jun 1, 2020• 1

By MICHAEL MILLENSON

If you think the grim coronavirus death toll is causing health care workers everywhere to always wash their hands, think again.

A recent research letter published in The Journal of Hospital Infection examined whether it’s “possible to achieve 100 percent hand hygiene compliance during the Covid-19 pandemic.” The medical center involved in the research, Queen Mary Hospital in Hong Kong, had reached a pre-Covid-19 hand hygiene rate of over 75 percent.

Yet the hospital’s goal of complete compliance proved surprisingly elusive. In one pediatric ward devoted to suspected or confirmed Covid-19 patients, doctors and nurses followed hand hygiene rules 100 percent of the time, but in another ward with similar patients and staff, compliance was 83 percent, or about one-fifth less.

Given Covid-19’s risk to providers as well as patients, this was “unexpected,” the researchers admitted.

The Queen Mary study supports what infection control experts have long maintained: awareness isn’t enough. Doctors and nurses, particularly during a pandemic, understand that hand hygiene is “the most important intervention” to reduce the staggering death toll from infections, as the American Journal of Infection Control put it.

Primary Care Practices Need Help to Survive the COVID-19 Pandemic

May 29, 2020• 3

By PAUL GRUNDY, MD and KEN TERRY

Date: June 20, 2022.

The Smithsonian National Museum of Natural History has reported its biggest number of visitors in more than 2 ½ years. There’s a string of new Broadway musicals that are well-attended every night. It’s safe to shop in malls, eat out in restaurants and go to movie theaters again.

Of course, this has all been made possible by an effective vaccine against COVID-19 that was widely administered in the fall of 2021. Vaccinated citizens of the world are now confident that it’s safe to go out in public, albeit with appropriate precautions.

However, U.S. residents who have health problems are facing a new challenge. Five years ago, in 2017, the median wait time of new patients for doctor appointments was six days. In 2022, the wait time is six months or more.

The reason for this is no mystery. While life has started to return to what we think of as the new normal, the U.S. healthcare system has taken an enormous financial hit, and primary care practices have been especially affected. Many primary care physicians have closed their practices and have retired or gone on to other careers. Consequently, the shortage of primary care has been exacerbated, and access to doctors has plummeted. Urgent care centers, retail clinics and telehealth have not filled this gap.

Because of the long waiting times for primary care appointments, many more people now seek care in emergency departments (EDs). The waiting rooms of these EDs are overcrowded with people who have all types of complaints, including chronic and routine problems as well as emergencies. And this is not just a common sight in inner-city areas, as it once was; it’s now the same pretty much everywhere.

What’s a diagnosis about? COVID-19 and beyond

May 28, 2020• 2

By MICHEL ACCAD

Last month marked the 400th anniversary of the birth of John Graunt, commonly regarded as the father of epidemiology. His major published work, Natural and Political Observations Made upon the Bills of Mortality, called attention to the death statistics published weekly in London beginning in the late 16th century. Graunt was skeptical of how causes of death were ascribed, especially in times of plagues. Evidently, 400 years of scientific advances have done little to lessen his doubts!

A few days ago, Fox News reported that Colorado governor Jared Polis had “pushed back against recent coronavirus death counts, including those conducted by the Centers for Disease Control and Prevention.” The Centennial State had previously reported a COVID death count of 1,150 but then revised that number down to 878. That is but one of many reports raising questions about what counts as a COVID case or a COVID death. Beyond the raw numbers, many controversies also rage about derivative statistics such as “case fatality rates” and “infection fatality rates,” not just among the general public but between academics as well.

Of course, a large part of the wrangling is due not only to our unfamiliarity with this new disease but also to profound disagreements about how epidemics should be confronted. I don’t want to get into the weeds of those disputes here. Instead, I’d like to call attention to another problem, namely, the somewhat confused way in which we think about medical diagnosis in general, not just COVID diagnoses.

The way I see it, there are two concepts at play in how physicians view diagnoses and think about them in relation to medical practice. These two concepts—one more in line with the traditional role of the physician, the other adapted to modern healthcare demands—are at odds with one another even though they both shape the cognitive framework of doctors.

THCB Gang, Episode 11

May 28, 2020

Episode 11 of “The THCB Gang” was live-streamed on Thursday, May 27th and you can see it again below

Joining me were three regulars, patient safety expert Michael Millenson (MLMillenson), writer Kim Bellard (@kimbbellard), health futurist Ian Morrison (@seccurve), and two new guests: digital health investment banker Steven Wardell (@StevenWardell) and MD turned physician leadership coach Maggi Cary (@MargaretCaryMD)! The conversation was heavy on telemedicine and value based care, and their impact on the stock-market, the economy and the health care system–all in a week when we went over 100,000 deaths from COVID-19.

If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels — Matthew Holt

Health in 2 Point 00, Episode 125 | Amwell, Mindstrong, Big Sky Health, Medwing

May 27, 2020

Today on Health in 2 Point 00, we have more than $300 million in deals to cover! On Episode 125, Jess asks me about Amwell raising $194 million although they haven’t gone public (yet), Mindstrong getting $100 million and a new CEO from Uber in another big raise for their mental health app, Big Sky Health landing $8 million for its intermittent fasting, meditation and alcohol consumption apps, Tava Health raising $3 million to expand its teletherapy program, and German startup Medwing getting $30 million to address Europe’s shortage of healthcare workers. Don’t miss Jess speaking at the AHIP discussion on How Digital Self-Care is Transforming Mental Health Care tomorrow at 1pm ET! —Matthew Holt