The Health Care Blog – Page 168 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Calling Health Tech Companies: GuideWell is Seeking Solutions against COVID-19

Apr 27, 2020

Is the COVID-19 Antibody Seroprevalence in Santa Clara County really 50-85 fold higher than the number of confirmed cases?

Apr 24, 2020• 1

By CHRISTOS ARGYROPOULOS

I am writing this blog post (the first after nearly two years!) in lockdown mode because of the rapidly spreading SARSCoV2 virus, the causative agent of the COVID19 disease (a poor choice of a name, since the disease itself is really SARS on steroids).

One interesting feature of this disease is that a large number of patients will manifest minimal or no symptoms (“asymptomatic” infections), a state which must clearly be distinguished from the presymptomatic phase of the infection. In the latter, many patients who will eventually go on to develop the more serious forms of the disease have minimal symptoms. This is contrast to asymptomatic patients who will never develop anything more bothersome than mild symptoms (“sniffles”), for which they will never seek medical attention. Ever since the early phases of the COVID19 pandemic, a prominent narrative postulated that asymptomatic infections are much more common than symptomatic ones. Therefore, calculations such as the Case Fatality Rate (CFR = deaths over all symptomatic cases) mislead about the Infection Fatality Rate (IFR = deaths over all cases). Subthreads of this narrative go on to postulate that the lockdowns which have been implemented widely around the world are overkill because COVID19 is no more lethal than the flu, when lethality is calculated over ALL infections.

Whereas the politicization of the lockdown argument is of no interest to the author of this blog (after all the virus does not care whether its victim is rich or poor, white or non-white, Westerner or Asian), estimating the prevalence of individuals who were exposed to the virus but never developed symptoms is important for public health, epidemiological and medical care reasons. Since these patients do not seek medical evaluation, they will not detected by acute care tests (viral loads in PCR based assays). However such patients, may be detected after the fact by looking for evidence of past infection, in the form of circulating antibodies in the patients’ serum. I was thus very excited to read about the release of a preprint describing a seroprevalence study in Santa Clara County, California. This preprint described the results of a cross-sectional examination of the residents in the county in Santa Clara, with a lateral flow immunoassay (similar to a home pregnancy kit) for the presence of antibodies against the SARSCoV2 virus. The presence of antibodies signifies that the patient was not only exposed at some point to the virus, but this exposure led to an actual infection to which the immune system responded by forming antibodies. These resulting antibodies persist for far longer than the actual infection and thus provide an indirect record of who was infected. More importantly, such antibodies may be the only way to detect asymptomatic infections, because these patients will not manifest any symptoms that will make them seek medical attention, when they were actively infected. Hence, the premise of the Santa Clara study is a solid one and in fact we need many more of these studies. But did the study actually deliver? Let’s take a deep dive into the preprint.

Lessons from Zika in the Era of COVID-19

Apr 23, 2020

By CHADI NABHAN, MD, MBA, FACP

If you are a soccer fan, watching the FIFA World Cup is a ritual that you don’t ever violate. Brazilians, arguably more than any other fans in the world, live and breathe soccer—and they are always expected to be a legitimate contender to win it all. Their expectations are magnified when they are the host country, which was the case in 2014. Not only did the Germans destroy Brazilian World Cup dreams, but less than a year after a humiliating loss on their turf, Brazilians began dealing with another devastating blow: a viral epidemic. Zika left the country scrambling to understand how to manage the devastation caused by the virus and grappling with conspiracies theories of whether the virus was linked to the tourism brought by hosting the FIFA World Cup.

How did I become so interested in what happened in Brazil five years ago? Well, social distancing and being mostly at home in the era of COVID-19 seems to energize reflection. Watching politicians on TV networks blaming each other and struggling to appear more knowledgeable than scientists makes me marvel at the hubris. My mind took me back to several prior epidemics that we encountered from Swine Flu to Ebola, and I couldn’t help but think about the lessons lost. What did we miss in these previous crises to land us in this current state where Zoom is your best friend and you are more interested in commenting on tweets than doing a peer-review? One cannot help but wonder what is so different about this coronavirus that it has paralyzed the globe.

I decided to take a deep dive into the Zika epidemic in a hopeful effort to better understand the present public health crisis. I started by reading Zika: The Emerging Epidemic, by Donald G. McNeil Jr, who also covers global epidemics for the New York Times. The book is a fascinating read and offers illuminating parallels to the current failings we are seeing with national and global health protection agencies during the COVID-19 pandemic.

Health in 2 Point 00, Episode 119 | RDMD, Dorsata, XRHealth, OneDrop, and Akili

Apr 23, 2020

Today, we’re back with a serious episode of Health in 2 Point 00. On Episode 119, Jess asks me about RDMD raising $14 million; this is a company which groups patients with rare diseases together to gather real-world data. Maternity-focused health IT company Dorsata raises $5.2 million, and this is basically an EMR prenatal tracker. Next, XRHealth raises $7 million for its virtual reality telehealth platform. OneDrop acquires the assets & IP of Sano Intelligence’s noninvasive CGM patch, and Akili rolls out its video game for kids with ADHD after the FDA relaxed its regulation of digital therapeutics for mental health. —Matthew Holt

THCB Gang: Episode 6, LIVE 1PM PT/4PM ET, 4/23

Apr 22, 2020

Episode 6 of “The THCB Gang” was live-streamed on Thursday, April 23 at 1pm PT- 4pm ET! 4-6 semi-regular guests drawn from THCB authors and other assorted old friends of mine will shoot the sh*t about health care business, politics, practice, and tech. It’s available below and is preserved as a weekly podcast available on our iTunes & Spotify channels.

Our lineup included: Saurabh Jha (@roguerad), Ian Morrison (@seccurve), Kim Bellard (@kimbbellard), Grace Cordovano (@GraceCordovano),Vince Kuraitis (@VinceKuraitis), Brian Klepper (@bklepper1), and a special guest – Alexandra Drane (@adrane, founder of Eliza, Queen of the Unmentionables, CEO of ArchAngels and sometimes Walmart cashier). Lots of great conversation especially around palliative care, patient experience, the real prevalence of COVID-19 and much more.

And if you want to contact Alex about caregiving, here is her Youtube Channel or please *******@***ne.me“>email her. — Matthew Holt

Beware the COVID-tech Cowboys

Apr 22, 2020

By HUGH HARVEY, MBBS

Health tech has suddenly found its new focus in coronavirus – but are we at risk of doing more harm than good by rushing to use unproven solutions? To avoid chaos in the aftermath, we should focus on tried-and tested tech, and only use novel solutions where need is deemed greater than the acceptable risk.

The COVID pandemic is categorically not a black swan event.

Black swans are by definition unknowable and unpredictable. In contrast, a global viral pandemic was predicted by scientists decades before, from the potential impact, right down to the source of the virus. In fact, only last year The Johns Hopkins Center for Health Security in partnership with the World Economic Forum and the Bill and Melinda Gates Foundation hosted Event 201 (video below), a high-level pandemic exercise on October 18, 2019, in New York, NY to simulate and plan for this exact scenario involving a life-threatening respiratory agent. They accurately predicted the exponential spread of disease, the sudden economic crash, and the desolation it would impose on healthcare systems. Indeed, Bill Gates himself is on record in 2015 predicting at a TED event that it would be ‘microbes, not missiles’ that would would be the next existential threat to humanity.

Health in 2 Point 00, Episode 118 | Aledade, Medopad, Amblyotech and Yes Health

Apr 22, 2020• 1

Today on Health in 2 Point 00, Jess and I talk about HCA now that the real numbers have come out. On Episode 118, Jess asks me about Aledade raising $64 million. Founded by former ONC director Farzad Mostashari, they set up ACOs for independent physician practices and have been doing a lot around COVID-19. Medopad has rebranded as Huma and acquired Biobeats and Tarilian Laser Technologies (TLT); they’ve been doing remote monitoring and have been around for a while. Novartis acquires Amblyotech, a lazy eye digital therapeutic. Finally Yes Health gets $6 million – yet another “we’ll put you on a diet and have coaches bully you” platform. —Matthew Holt

Provide Emotional Personal Protective Equipment (PPE) for Physicians Facing Psychological Trauma From the COVID-19 Crisis

Apr 21, 2020• 1

By SUZAN SONG MD, MPH, PhD

The U.S. now has the highest number of COVID-related deaths in the world, with exhausted, frightened physicians managing the front lines. We need not only medical supplies but also emotional personal protective equipment (PPE) against the psychological burden of the pandemic.

As a psychiatrist, my role in COVID-19 has included that of a therapist for my colleagues. I helped start Physician Support Line, a peer-to-peer hotline for physicians staffed by more than 500 volunteer psychiatrists. Through the hotline and social media, physicians are revealing their emotional fatigue. One doctor shared her sense of powerlessness when she couldn’t provide comfort but instead had to watch her young patient with COVID-19 die alone from behind a glass window. Another shared his sorrow after his 72-year-old patient died by suicide. She was socially isolated and didn’t want to be a burden on anyone if she contracted COVID-19. An internist felt deep distress and alarm that her hospital was quickly running out of ventilators and had 12 codes in 24 hours.

Through a brief survey I conducted across the U.S., 269 physicians reported moderate to severe symptoms of anxiety (53%), depression (43%), and insomnia (16%). About 46% wanted to see or would consider seeing a mental health clinician for severe anxiety (30%), not feeling like themselves (27%), or being unhappy (21%). These are all similar statistics to the front line health care workers in Wuhan.

A Dream Deferred? Price Transparency in the American Healthcare System

Apr 21, 2020• 1

By JOANNE RODRIGUES-CRAIG

Financial well-being, or the state of an individual’s personal monetary affairs, is one of the six core indicators of wellness in the Gallup-Healthways Well-Being Index. Poor financial well-being can lead to a whole host of short and long term mental and physical health issues, including depression, anxiety, troubled relationships and chronic stress.^[1] ^[2]

It is surprising how American hospitals and other health providers have neglected financial well-being when considering their patients’ health. In a recent study by the American Cancer Association, 56% of Americans suffer from hardships related to the cost of care.^[3] Medical costs are the primary cause of 67% of all bankruptcies in the United States.^[4] To think that health care costs are not having a deleterious effect on American’s general well-being is a complete fallacy.

Even as a former health technology data scientist, I was largely in the dark about how health provider pricing works. Finding health provider pricing is like pulling teeth; it’s extremely time0consuming, frustrating (and sometimes painful) to get a health estimate for even the simplest procedures. Having poor or inadequate insurance can feel like a weight holding you down during your most vulnerable time, in the midst of a major health crisis.