There are so many
stories about the coronavirus pandemic — some inspiring, some tragic, and
all-too-many frustrating. In the world’s supposedly most advanced
economy, we’ve struggled to produce enough ventilators, tests, even swabs, for
I can’t stop thinking
about infrastructure, especially unemployment systems.
We’d never purposely shut down our economy; no nation had. Each state is trying to figure out the best course between limiting exposure to COVID-19 and keeping food on people’s tables. Those workers deemed “essential” still show up for work, others may be able to work from home, but many have suddenly become unemployed.
The U.S. is seeing
unemployment levels not seen since the Great Depression, and occuring in a matter
of a couple months, not several years. As of this writing, there
are over 22 million unemployed; no one believes that is a complete count (not
everyone qualifies for unemployment), and few believe that will be the peak.
systems could not manage the flood of applications.
Paul O’Neill, who died from lung cancer earlier this month at age 84, was one of my personal heroes, but not because of anything he accomplished as Alcoa’s chief executive officer or as Secretary of the Treasury.
O’Neill was my hero because he saved patients’ lives.
Two decades ago, when few dared speak openly about medical error, this titan of industry put his considerable clout behind a radical idea: not a single patient should be injured or killed by their medical care. And in pursuit of that goal, hospitals had to continually make care measurably safer.
No one of O’Neill’s stature, before or since, has shown anything close to his dogged determination to make this ideal real.
O’Neill first embraced zero harm after Karen Wolk Feinstein, the president of a small, local foundation, had the chutzpah to ask him to serve as co-chairman of a coalition to radically improve Pittsburgh’s health care. He make this commitment even though it was a goal championed by a non-physician book author (me) and by a PhD in labor economics (Feinstein), while being denounced as naively unrealistic by respected local medical leaders.
After my posts on telemedicine were published recently, (this one on Manly Wellness before the pandemic and this one after it erupted, on A Country Doctor Writes, then reblogged on The Health Care Blog, KevinMD and many others), I have been asked about my views on telemedicine’s role in the future of primary care.
Things have changed quickly, and a bit chaotically, and there is a lot of experimentation happening right now in practices I work or speak with.
Before thinking about telemedicine in Primary Care, we need to agree on some sort of definition of primary care, because there are so many functions and services we lump together under that term.
Many people think of primary care mostly as treating minor, episodic illnesses like colds, rashes, minor sprains and the like. This is an area that has attracted a lot of interest because it is easy money for the providers, since the visits tend to be quick and straightforward and such televisits are also attractive for the insurance companies if they can keep insured patients out of the emergency room. With the technical limitations of video quality and objective data such as heart rate and rhythm, I think this is an absolute growth area for telemedicine. However, with all the other forms but mostly here, fragmentation of care could become a complicated problem. To put it bluntly, if we still expect a medical professional or a health care organization to keep an eye on reports from various sources, such as hospital specialists, walk-in clinics or independent telemedicine providers, they are going to want to get paid for it.
GuideWell has launched the COVID-19 Health Innovation Collaborative to identify and support solutions that can immediately increase the scope and scale of resources aimed at reducing the complex stress factors COVID-19 is bringing to bear on the U.S. health system.
There will be five categories of focus under
this collaborative, and proposed solutions must directly address at least one
of these categories:
Home-based self-testing solutions for the COVID-19 virus
Virtual, in-home care solutions for at-risk populations that have limited access to health care services
Solutions that reduce risk for health care providers in clinical settings, including approaches for increasing protection of clinical staff
Solutions focused on reducing social isolation due to COVID-19 diagnosis or social distancing
Solutions for delivering food and urgently needed supplies to at-risk populations and households with COVID-19 exposure or symptoms
The COVID-19 Collaborative’s overarching
objective is to source a diverse portfolio of innovative companies that
collectively have the potential to respond to the pandemic in the above
categories. For each category, a cohort of 3-5 companies will be selected to
work together to create a connected, high impact approach to addressing the
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.
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
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
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
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.
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.
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