The Health Care Blog – Page 169 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

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.

Nursing Students and Educators Must Be Part of a National Public Health Surveillance Strategy

Apr 20, 2020

By KAREN JOHNSON PhD, RN

Shortly before our world was turned upside down by COVID-19, I visited Space Center Houston with my family. We marveled at the collective ambition and investment it took to move from space travel being an aspirational dream to setting foot on the moon. I thought about my favorite scene from the movie Apollo 13, when Gene Kranz overhears the NASA Director saying “This could be the worst disaster NASA has ever experienced,” and candidly replies, “With all due respect, sir, I believe this is going to be our finest hour.”

Just months later, our entire planet is on a mission to turn tragedy into triumph. Only this time, Americans have not led the way in proactively translating science into action for the benefit of humankind. Instead, we ignored scientists who warned about the inevitability of a pandemic and now lead the world in most confirmed cases (which, due to our testing debacles, underestimates actual cases). As a public health nurse, this is not a race I want to see us leading. Future outbreaks are all but certain while we wait for a vaccine. Every single one of us must start preparing now, for we will all have a role to play.

To be sure, it is imperative that we all stay the course with current physical distancing efforts to prevent spread, minimize death, and avoid the collapse of our healthcare system and its ability to care for patients with COVID-19 and other life-threatening conditions that do not pause just because of a pandemic. But social distancing cannot be the only public health tool used to bring the pandemic under control.

Public health experts agree we need a coordinated national public health surveillance strategy that includes widespread testing in order to identify and isolate infected people early (this is crucial given how many contagious people are asymptomatic), contact tracing to figure out who has been exposed to infected individuals, and quarantining everyone who tests positive or has come in contact with an infected person. We must leverage technology to ensure testing provides fast and accurate results, and that we are able to safely and comprehensively track exposures. Without accurate, detailed, and timely data about the epidemiology of COVID-19, we cannot make scientifically sound decisions about how to ease social distancing or ethical decisions about how to equitably allocate scarce healthcare resources to communities of greatest need.

The Official Estimates of COVID-19 Deaths Are Way Too Low

Apr 17, 2020• 1

By KEN TERRY

While President Trump mulls whether to reopen the country again in May, and as Fox & Friends host Brian Kilmeade suggests that “only” 60,000 people will die from the coronavirus, there are some warning signs that the White House COVID-19 Task Force’s prediction of 100,000-240,000 deaths may be way too low.

That isn’t surprising, considering that Administration officials said this projection depended on us doing everything right. Of course, it appears that large sections of the country have done many things wrong—whether it’s Florida Governor Ron DeSantis’ reluctance to close houses of worship or the refusal of several state governors to issue stay at home orders. That doesn’t include Trump’s own refusal to admit the seriousness of the COVID-19 outbreak until mid-March and the continuing failure of the federal government to ensure an adequate supply of test kits, PPE and ventilators.

So here’s what all of this may be leading up to: a minimum of 600,000 COVID-related deaths in the U.S. over the next two years.

Wait — Robots Work But I Get Paid

Apr 17, 2020• 1

By KIM BELLARD

We’re not through the COVID-19 pandemic. We’re probably not even near the end of the beginning yet. That hasn’t stopped many pundits to start speculating about how our society (and our healthcare system) are likely to be permanently changed as a result, such as continued reliance on telecommuting and telemedicine.

OK, I’ll play too: I believe we need to greatly expand the role of robots, and begin something that resembles Universal Basic Income (UBI). They’re not the only changes that may result, but they are two that should.

Robots

We’ve been seeing robots infiltrating the workforce for many decades, such as in manufacturing but also in many other industries.

Still, though, as our economy pares down to “essential businesses” during the pandemic, I’ve been alarmed at how many of the jobs remain done by humans. Not just healthcare workers on the front lines but also all those people doing the cleaning for essential businesses, all those people in the supply chain of food and other vital materials, all those people making deliveries, all those first responders, all those people all those people keeping the power on, the water running, and the internet streaming, among others. And so on.

Health in 2 Point 00, Episode 117 | Wellthy, Lionrock Recovery, Datos and Gaido

Apr 16, 2020

On Episode 117, we bring you the late-night edition of Health in 2 Point 00. Jess asks me about Wellthy Therapeutics raising $4 million—they’re a digital therapeutics company I’ve been working with out of the Bayer group, definitely a space to watch. Lionrock Recovery raises $7 million, lots of activity in this area of telehealth for recovery and rehabilitation. Also getting $7 million is Datos Health, an Israeli company with a remote monitoring platform. Finally, Biofourmis acquired Gaido Health, expanding into the oncology space. —Matthew Holt

Rationale for Testing Anticoagulants Against COVID-19

Apr 16, 2020

By ETHAN WEISS, MD

We have seen and heard about the classic symptoms of COVID-19 at UCSF Medical Center, where I work as a cardiologist. Patients keep coming in with pulmonary distress, pneumonia, and ultimately, Acute Respiratory Distress Syndrome (ARDS) – the life-and-death situation that requires ventilators.

However, I’m beginning to learn about other symptoms that some doctors are noticing. There are numerous reports of other complications, especially in advanced disease.

One of the most interesting involves disruption of the blood’s coagulation system. New anecdotal reports have described clotting in test tubes and lines, derangements of clinical clotting assays, pulmonary emboli, large clots in the heart, as well as microvascular thrombosis.

Elevation in D-Dimer, (a biomarker of coagulation system activation) has been associated with dramatically increased risk of death from COVID-19. This has led some to speculate that empiric treatment with anticoagulants might improve outcomes in these critically ill patients. Indeed, there was this recent publication of a retrospective analysis of anticoagulation with heparin or low molecular weight heparin showing an association with improved outcomes in COVID-19 patients in China.