The 5th F50 Global Capital Summit® (GCS) Spring 2020 on June 16-17, with the theme Elevating HealthTech Innovation opens for speaker nomination.
F50 Summit is one of the Bay Area’s flagship events for the startup venture ecosystem and has attracted many leaders in the startup venture system in the past. GCS Spring 2020 will be co-hosted by the F50 Elevate Accelerator, and the Silicon Valley Entrepreneur Community. GCS finds and connects the next generation of world-changing tech innovators with strategic partners to power their long-term impact. F50 especially focuses on creating partnerships that will help to improve human lives within the Healthtech, Agtech, sustainability areas.
F50 Summit Spring 2020 will include 60+ speaking sessions, 500 attendees from world-leading corporations, a large one-day investor summit, and many closed-door entrepreneur roundtable discussions ,and executive briefing designed for corporate executives. We expect leaders from all over the world to attend the event.
Features (Activities?) of the summit:
Keynote and thought leader presentation & insightful panels
Global Capital Insight Ranking Report
F50 Global Awards
Speaker & VIP Reception
F50 Elevate Connect Lounge (Demo Tables)
Intensive Bootcamps (by Bootup Ventures)
Investment trends in Healthtech
Early stage opportunities for Angels and seed investors (?)
Global impact by Venture Investing?)
Altruism and Capitalism?
Convergence of Technology in Health
The Smarter Medical Devices
Future of Surgeries
Future Virus outbreak prevention and responding
Aging and longevity
Food tech and innovation
DeepTech for Health
Many industry leaders will host and participate in the closed-door roundtable discussions. We are looking for leaders in the startup venture ecosystem who could bring great insight to our audience at this event.
The Global Capital Summit® (GCS) is organized by F50, Silicon Valley Entrepreneurs. GCS finds and connects the next generation of world-changing tech innovations with partnerships to power their long-term impact. The summit will feature 20+ extraordinary products and innovations, and over 700 attendees from world-leading corporations and the global investment ecosystem. The attendees are corporate executives, Angel investors, VCs, and a group of high-potential local founders.
When you hear the term “evolutionary tree,” you may think of Charles Darwin and the study of the relationships between different species over the span of millions of years.
While the concept of an “evolutionary tree” originated in Darwin’s “On the Origin of Species,” one can apply this concept to anything that evolves, including viruses. Scientists can study the evolution of SARS-CoV-2 to learn more about how the genes of the virus function. It is also useful to make inferences about the spread of the virus around the world, and what type of vaccine may be most effective.
I am a bioinformatician who studies the relationships between epidemics and viral evolution, and I am among the many researchers now studying the evolution of SARS-CoV-2 because it can help researchers and public health officials track the spread of the virus over time. What we are finding is that the SARS-CoV-2 virus appears to be mutating more slowly than the seasonal flu which may allow scientists to develop a vaccine.
How do sequences evolve?
Viruses evolve by mutating. That is, there are changes in their genetic code over time. The way it happens is a little like that game of telephone. Amy is the first player, and her word is “CAT.” She whispers her word to Ben, who accidentally hears “MAT.” Ben whispers his word to Carlos, who hears “MAD.” As the game of telephone goes on, the word will transform further and further away from its original form.
We can think of a biological genetic material as a sequence of letters, and over time, sequences mutate: The letters of the sequence can change. Scientists have developed various models of sequence evolution to help them study how mutations occur over time.
Much like our game of telephone, the genome sequence of the SARS-CoV-2 virus changes over time: Mutations occur randomly, and any changes that occur in a given virus will be inherited by all copies of the next generation. Then, much as we could try to decode how “CAT” became “MAD,” scientists can use models on genetic evolution to try to determine the most likely evolutionary history of the virus.
How can we apply this to viruses like COVID-19?
DNA sequencing is the process of experimentally finding the sequence of nucleotides (A, C, G and T) – the chemical building blocks of genes – of a piece of DNA. DNA sequencing is largely used to study human diseases and genetics, but in recent years, sequencing has become a routine part of viral point of care, and as sequencing becomes cheaper and cheaper, viral sequencing will become even more frequent as time progresses.
RNA is a molecule similar to DNA, and it is essentially a temporary copy of a short segment of DNA. Specifically, in the central dogma of biology, DNA is transcribed into RNA. SARS-CoV-2 is an RNA virus, meaning our DNA sequencing technologies cannot directly decode its sequence. However, scientists can first reverse transcribe the RNA of the virus into complementary DNA (or cDNA), which can then be sequenced.
Given a collection of viral genome sequences, we can use our models of sequence evolution to predict the virus’s history, and we can use this to answer questions like, “How fast do mutations occur?” or “Where in the genome do mutations occur?” Knowing which genes are mutating frequently can be useful in drug design.
Tracking how viruses have changed in a location can also answer questions like, “How many separate outbreaks exist in my community?” This type of information can help public health officials contain the spread of the virus.
One such initiative is Nextstrain, an open-source project that provides users real-time reports of the spread of seasonal influenza, Ebola and many other infectious diseases. Most recently, it has been spearheading the evolutionary tracking of COVID-19 by providing a real-time analysis as well as a situation report meant to be readable by the general public. Further, the project enables the global population to benefit from its efforts by translating the situation report to many other languages.
As the amount of available information grows, scientists need faster tools to be able to crunch the numbers. My lab at UC San Diego, in collaboration with the System Energy Efficiency (SEE) Lab led by Professor Tajana Simunic Rosing, is working to create new algorithms, software tools and computer hardware to make the real-time analysis of the COVID-19 epidemic more feasible.
Given that the SARS-CoV-2 genome is almost twice as large as the seasonal flu genome, it seems as though the seasonal flu mutates roughly four times as fast as SARS-CoV-2. The fact that the seasonal flu mutates so quickly is precisely why it is able to evade our vaccines, so the significantly slower mutation rate of SARS-CoV-2 gives us hope for the potential development of effective long-lasting vaccines against the virus.
While the focus of the COVID-19 pandemic has been on respiratory problems and securing enough ventilators, doctors on the front lines are grappling with a new medical mystery.
In addition to lung damage, many COVID-19 patients are also developing heart problems — and dying of cardiac arrest.
As more data comes in from China and Italy, as well as Washington state and New York, more cardiac experts are coming to believe the COVID-19 virus can infect the heart muscle. An initial study found cardiac damage in as many as 1 in 5 patients, leading to heart failure and death even among those who show no signs of respiratory distress.
That could change the way doctors and hospitals need to think about patients, particularly in the early stages of illness. It also could open up a second front in the battle against the COVID-19 pandemic, with a need for new precautions in people with preexisting heart problems, new demands for equipment and, ultimately, new treatment plans for damaged hearts among those who survive.
“It’s extremely important to answer the question: Is their heart being affected by the virus and can we do something about it?” said Dr. Ulrich Jorde, the head of heart failure, cardiac transplantation and mechanical circulatory support for the Montefiore Health System in New York City. “This may save many lives in the end.”
Virus Or Illness?
The question of whether the emerging heart problems are caused by the virus itself or are a byproduct of the body’s reaction to it has become one of the critical unknowns facing doctors as they race to understand the novel illness. Determining how the virus affects the heart is difficult, in part, because severe illness alone can influence heart health.
“Someone who’s dying from a bad pneumonia will ultimately die because the heart stops,” said Dr. Robert Bonow, a professor of cardiology at the Northwestern University Feinberg School of Medicine and editor of the medical journal JAMA Cardiology. “You can’t get enough oxygen into your system and things go haywire.”
But Bonow and many other cardiac specialists believe a COVID-19 infection could lead to damage to the heart in four or five ways. Some patients, they say, might be affected by more than one of those pathways at once.
Doctors have long known that any serious medical event, even something as straightforward as hip surgery, can create enough stress to damage the heart. Moreover, a condition like pneumonia can cause widespread inflammation in the body. That, in turn, can lead to plaque in arteries becoming unstable, causing heart attacks. Inflammation can also cause a condition known as myocarditis, which can lead to the weakening of the heart muscle and, ultimately, heart failure.
But Bonow said the damage observed in COVID-19 patients could be from the virus directly infecting the heart muscle. Initial research suggests the coronavirus attaches to certain receptors in the lungs, and those same receptors are found in heart muscle as well.
Initial Data From China
In March, doctors from China published two studies that gave the first glimpse at how prevalent cardiac problems were among patients with COVID-19 illness. The larger of the two studies looked at 416 hospitalized patients. The researchers found that 19% showed signs of heart damage. And those who did were significantly more likely to die: 51% of those with heart damage died versus 4.5% who did not have it.
Patients who had heart disease before their coronavirus infections were much more likely to show heart damage afterward. But some patients with no previous heart disease also showed signs of cardiac damage. In fact, patients with no preexisting heart conditions who incurred heart damage during their infection were more likely to die than patients with previous heart disease but no COVID-19-induced cardiac damage.
It’s unclear why some patients experience more cardiac effects than others. Bonow said that could be due to a genetic predisposition or it could be because they’re exposed to higher viral loads.
Those uncertainties underscore the need for closer monitoring of cardiac markers in COVID-19 patients, Jorde said. If doctors in New York, Washington state and other hot spots can start to tease out how the virus is affecting the heart, they may be able to provide a risk score or other guidance to help clinicians manage COVID-19 patients in other parts of the country.
“We have to assume, maybe, that the virus affects the heart directly,” Jorde said. “But it’s essential to find out.”
Gathering the data to do so amid the crisis, however, can be difficult. Ideally, doctors would take biopsies of the heart to determine whether the heart muscle is infected with the virus.
But COVID-19 patients are often so sick it’s difficult for them to undergo invasive procedures. And more testing could expose additional health care workers to the virus. Many hospitals aren’t using electrocardiograms on patients in isolation to avoid bringing additional staff into the room and using up limited masks or other protective equipment.
Still, Dr. Sahil Parikh, an interventional cardiologist at Columbia University Irving Medical Center in New York City, said hospitals are making a concerted effort to order the tests needed and to enter findings in medical records so they can sort out what’s going on with the heart.
“We all recognize that because we’re at the leading edge, for better or for worse, we need to try to compile information and use it to help advance the field,” he said.
Indeed, despite the surge in patients, doctors continue to gather data, compile trends and publish their findings in near real time. Parikh and several colleagues recently penned a compilation of what’s known about cardiac complications of COVID-19, making the article available online immediately and adding new findings before the article comes out in print.
Cardiologists in New York, New Jersey and Connecticut are sharing the latest COVID-19 information through a WhatsApp group that has at least 150 members. And even as New York hospitals are operating under crisis conditions, doctors are testing new drugs and treatments in clinical trials to ensure that what they have learned about the coronavirus can be shared elsewhere with scientific validity.
That work has already resulted in changes in the way hospitals deal with the cardiac implications of COVID-19. Doctors have found that the infection can mimic a heart attack. They have taken patients to the cardiac catheterization lab to clear a suspected blockage, only to find the patient wasn’t really experiencing a heart attack but had COVID-19.
For years, hospitals have rushed suspected heart attack patients directly to the catheterization lab, bypassing the emergency room, in an effort to shorten the time from when the patient enters the door to when doctors can clear the blockage with a balloon. Door-to-balloon time had become an important measure of how well hospitals treat heart attacks.
“We’re taking a step back from that now and thinking about having patients brought to the emergency department so they can get evaluated briefly, so that we could determine: Is this somebody who’s really at high risk for COVID-19?” Parikh said. “And is this manifestation that we’re calling a heart attack really a heart attack?”
New protocols now include bringing in a cardiologist and getting an EKG or an ultrasound to confirm a blockage.
“We’re doing that in large measure to protect the patient from what would be an otherwise unnecessary procedure,” Parikh said, “But also to help us decide which sort of level of personal protective equipment we would employ in the cath lab.”
Sorting out how the virus affects the heart should help doctors determine which therapies to pursue to keep patients alive.
Jorde said that after COVID-19 patients recover, they could have long-term effects from such heart damage. But, he said, treatments exist for various forms of heart damage that should be effective once the viral infection has cleared.
Still, that could require another wave of widespread health care demands after the pandemic has calmed.
Source: by [#item_author] from Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente. More Read More
When David Vega fell ill with the novel coronavirus in mid-March, fever, chills and nausea left the 27-year-old Indiana medical student curled up in bed for days.
After a test confirmed he had COVID-19, the disease caused by the coronavirus, his doctor advised Vega to isolate himself at home for an additional week. The week passed, and Vega improved. His doctor cleared him to get back to his regular routines without additional testing after he had gone three days without symptoms.
But getting an all-clear from his medical provider has not completely assuaged Vega’s fears. How can he be sure he no longer carries the virus? Is it safe for him to be with others? One of his roommates decided to move out, he said, and still acts cautiously around him.
“Even after the quarantine was over and I felt recovered,” he said in a message, “I felt paranoid and very [conscious] of the fact that I had COVID-19.”
As with so many other aspects of this novel coronavirus, determining when a patient has recovered is still fraught with uncertainties. Although federal officials have issued general guidelines, information about the disease is limited. Physicians said they can’t offer seemingly recovered patients who aren’t retested any guarantees about whether they will be able to transmit the virus.
“I feel that the public is kind of like my 91-year-old mom,” said Dr. Gary LeRoy, president of the American Academy of Family Physicians. The public is “asking these questions, and we as clinicians don’t have the answers like we’re used to.”
This predicament highlights how scientists still lack a complete picture of how COVID-19 is transmitted, doctors said. Generating more data on such mysteries as how much of the virus a person emits at different stages of infection could give doctors a clearer sense of a patient’s risk of sickening others.
The federal Centers for Disease Control and Prevention says doctors can verify whether a patient is healthy enough to leave home isolation in two ways. One method requires patients to test negative from samples taken at least 24 hours apart.
But the nationwide shortage of tests has made it difficult for doctors to vet patients in recovery with an exam, a fact the guidelines acknowledged. Several states including Minnesota have restricted testing to certain populations, such as hospitalized patients and health care workers.
“It’s still kind of an Easter egg hunt for the availability of testing materials and test kits to do COVID-19 tests,” said LeRoy.
The second method allows patients to come out of isolation at least seven days after symptoms begin or after being diagnosed and three days after they are symptom-free.
This option “will prevent most, but may not prevent all instances of secondary spread,” according to the CDC’s website. “The risk of transmission after recovery is likely very substantially less than that during illness.”
The agency declined a request for an interview.
Its recommendation gives state authorities and doctors the flexibility to amend their approach based on their circumstances.
“The guidelines are guidelines,” said Dr. Kathryn Edwards, a professor of pediatrics at Vanderbilt University who specializes in infectious diseases. “But they’re not the Ten Commandments.”
One vital piece of the recovery puzzle several doctors mentioned is figuring out when and how long people with COVID-19 are able to transmit the virus — particularly those who don’t develop symptoms at all.
David Vega, a medical student in Indianapolis who has recuperated from a COVID-19 infection, worries about how safe it is to be around others now, such as when he goes running or grocery shopping. “I think it’s still something in the back of my mind,” he says.(Courtesy of David Vega)
The number of asymptomatic patients could be sizable. CDC director Dr. Robert Redfield said in an interview with NPR that as many as 25% of those who test positive for the virus do not develop symptoms. And patients who eventually develop symptoms may be spreading the virus up to 48 hours before they start feeling ill, he added.
Even Vega, now symptom-free, said he hesitates to get close to others when he goes on a run or picks up groceries.
“I think it’s still something in the back of my mind,” he said. “I think that it’ll get better with time.”
The need to prevent transmission must be balanced against the benefit of the person returning to their daily life, said Edwards, especially if they are working in an essential industry like health care.
“We’re always between a rock and a hard place,” she said.
Other factors help determine when a patient is ready to leave isolation. A provider may choose to leave a person in home isolation longer if they work with a high-risk population, like the elderly, or if they have a spouse with preexisting conditions, said LeRoy.
Ultimately, medical providers will likely tailor their advice to the patient’s lifestyle, said Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.
“These are difficult questions that would likely be dealt with on a case-by-case basis,” he said.
People worried about getting the virus from someone who has recovered or doesn’t have symptoms can reduce their risk by practicing social distancing and good hygiene, such as frequent hand-washing, said Plescia.
Despite the uncertainty, Plescia said, it is important not to ostracize those who have recovered. He is concerned they could become stigmatized.
“In the back of everyone’s mind, whether they want to acknowledge it or not, people are going to be fearful about something they don’t know,” said LeRoy.
Source: by [#item_author] from Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente. More Read More
The coronavirus is certainly scary, but despite the constant reporting on total cases and a climbing death toll, the reality is that the vast majority of people who come down with COVID-19 survive it. Just as the number of cases grows, so does another number: those who have recovered.
In mid-March, the number of patients in the U.S. who had officially recovered from the virus was close to zero. That number is now in the tens of thousands and is climbing every day. But recovering from COVID-19 is more complicated than simply feeling better. Recovery involves biology, epidemiology and a little bit of bureaucracy too.
How does your body fight off COVID-19?
Once a person is exposed the coronavirus, the body starts producing proteins called antibodies to fight the infection. As these antibodies start to successfully contain the virus and keep it from replicating in the body, symptoms usually begin to lessen and you start to feel better. Eventually, if all goes well, your immune system will completely destroy all of the virus in your system. A person who was infected with and survived a virus with no long-term health effects or disabilities has “recovered.”
In general, once you have recovered from a viral infection, your body will keep cells called lymphocytes in your system. These cells “remember” viruses they’ve previously seen and can react quickly to fight them off again. If you are exposed to a virus you have already had, your antibodies will likely stop the virus before it starts causing symptoms. You become immune. This is the principle behind many vaccines.
Unfortunately, immunity isn’t perfect. For many viruses, like mumps, immunity can wane over time, leaving you susceptible to the virus in the future. This is why you need to get revaccinated – those “booster shots” – occasionally: to prompt your immune system to make more antibodies and memory cells.
Why have so few people officially recovered in the US?
This is a dangerous virus, so the Centers for Disease Control and Prevention is being extremely careful when deciding what it means to recover from COVID-19. Both medical and testing criteria must be met before a person is officially declared recovered.
Medically, a person must be fever-free without fever-reducing medications for three consecutive days. They must show an improvement in their other symptoms, including reduced coughing and shortness of breath. And it must be at least seven full days since the symptoms began.
Only then, if both the symptom and testing conditions are met, is a person officially considered recovered by the CDC.
This second testing requirement is likely why there were so few official recovered cases in the U.S. until late March. Initially, there was a massive shortage of testing in the U.S. So while many people were certainly recovering over the last few weeks, this could not be officially confirmed. As the country enters the height of the pandemic in the coming weeks, focus is still on testing those who are infected, not those who have likely recovered.
Knowing whether or not people are immune to COVID-19 after they recover is going to determine what individuals, communities and society at large can do going forward. If scientists can show that recovered patients are immune to the coronavirus, then a person who has recovered could in theory help support the health care system by caring for those who are infected.
Once communities pass the peak of the epidemic, the number of new infections will decline, while the number of recovered people will increase. As these trends continue, the risk of transmission will fall. Once the risk of transmission has fallen enough, community-level isolation and social distancing orders will begin to relax and businesses will start to reopen. Based on what other countries have gone through, it will be months until the risk of transmission is low in the U.S.
But before any of this can happen, the U.S. and the world need to make it through the peak of this pandemic. Social distancing works to slow the spread of infectious diseases and is working for COVID-19. Many people will need medical help to recover, and social distancing will slow this virus down and give people the best chance to do so.
Dr. Uli K. Chettipally, Emergency Physician, Author, Founder InnovatorMD. Dr.Uli gives insights into Corona Virus, scale of the problem, testing and possible responses. The ‘Home Shelter Policy’ by Bay Area Authorities and its significance is covered in his talk. More about Dr.Uli (www.linkedin.com/in/ulichettipally)
This discussion is moderated by David Cao, F50 Ventures & Hunniwell Lake Ventures and Amit Saha, Ph.D, Research Engineer, School of Medicine, Stanford University.
F50 Global Insights is a series of webinars on ‘Elevating HealthTech Innovation’ and brought to you by Silicon Valley based F50 & F50 Elevate. F50 serves is a community of VCs, Investors, angel investors, Corporates, startup founders, entrepreneurs and thought leaders. F50 Global Capital Summit(GCS) is among the leading investor events of Silicon Valley. F50 Elevate is a pre-Series A HealthTech startup accelerator based out of Silicon Valley. For details: F50 : http://www.F50.io F50 Global Capital Summit(GCS) : http://f50.io/summit/ F50 Elevate: http://f50.io/elevate/
David Cao: Good afternoon. Welcome to F50 Global Insights. I am David Cao, Managing Partner of F50 and Partner of Hunniwell Ventures. I will be your host today. Let me introduce my co-host Amit.
Amit Saha: Good afternoon. My name is Amit Saha. I am a research engineer at Stanford University School of Medicine. I’m a bio-engineer by training and my current research focus is on ‘Chronic Fatigue Syndrome’. Thank you everyone for being here.
David Cao: Today, we have a very distinguished speaker. He has been working in the hospital system for a very long time and also he leads a physician innovation program, company name is called innovator MD. Please give him a big welcome.
Dr.Uli : Thank you, David and thank you Amit. Thank you for having me on this program. I’m really, it’s a great privilege. My name is Uli Chettipally and I’m an emergency physician by training. I also was a researcher did that job for about 26 years at a large healthcare Company. So I have both of firsthand and frontline experience and also understand the data that comes in. It is first frontline experiences and we have been analyzing the data that comes through the emergence to look at different conditions. Currently I President and what InnovatorMD does is, we work with startups and we also work with healthcare companies and how to bridge that gap. That’s what we’re working on, bringing healthcare companies the knowledge and the domain expertise from healthcare, and also for healthcare companies bringing the technology and the current new innovations that are happening in the startup world. And so we host monthly meetings and also an annual meeting in January. It’s called the InnovatorMD Global Summit. The other hats I wear are you know, I’m active in the San Mateo County Medical Association and I’m the president elect currently. I also help run the Society of Physician Entrepreneurs, which is a non-profit that is again focused on how to get physicians to become entrepreneurs, or at least work with entrepreneurs. So that’s my background and I have been watching COVIT-19 very closely and some interesting things are popping up. So I’m happy to be here to share my thoughts and my instincts from what I have seen so far.
David Cao: Great, thank you Dr.Uli. I want to start with the question with where we are right now. You know, last 10 days, since there are significant developments and it changes in North American, particularly in Bay Area and Bay Area announced Home Shelter program in the last few days. So now everybody is in a panic mode. Can you tell us especially from the hospital care, hospital care stand point, where we are in terms of responding to this virus?
Dr. Uli: Sure, that’s a great question. So, initially, you know, we were thinking that we can control this, right, you know, we can catch people when they are symptomatic, and we can test them and then we can control you know, have them quarantined or have them stay at home. But I think we may have moved out of that stage. The reason being that this is a much bigger problem than we originally thought was. One of the big reasons is that you know, this condition has been brewing around for the last couple of months, at least in the community. Number two, there are a lot of cases where, you know, people may be asymptomatic, which means that, you know, they may not have any symptoms, but, you know, when you test them, you know, they test positive for this disease. And the second, the third thing is that, this is spreading pretty fast. What we have seen in other Countries, especially in Italy and China and South Korea, you know, it, it spreads really fast. And so, we are now at a very high level of alert where we are, we want to restrict people from exposing, you know, if they are a carrier, you know, we want to cut down the exposure. So the best way is to stay where you are and not go to places where you may be infecting others or catching infection. So we are in a very strict place where we want everybody to stay home basically.
David Cao: So, the second question I want to you to share with our audience as we have a larger number of entrepreneurs and investors in our community, so maybe you can share us with this disease looks like still a lot of infrastructures and innovations are needed, maybe you can tell us where we are, and where are the opportunities?
Dr.Uli: Sure. So I would divide the opportunities into four distinct areas, four big areas. The first one is in preparedness. You know, when you have a pandemic of this size, we, you know, we do get experience. We’ve seen that with the Chinese and in South Korea, where they had experience with other pandemics before and so, they are much more better prepared to tackle this and we have seen that in the in the outcomes. So number one is preparedness in the preparedness, you know, we have to think about the infrastructure, how do we connect these hospitals, how do we connect the public health system would be with the hospitals, which because right now they’re you know, very separate and very distant and not communicating with each other. So how do we develop an infrastructure where, you know, there is a way to track all the diseases, all the disease cases, in different areas from different hospitals and different so those kinds of connections and the network needs to be built, where it is easy to see where the new cases are coming from and, and that will give us some clues on where to implement what kind of strategies to control this disease. So, that’s number one, which is the preparedness.
The second area that I would direct the innovators to focus on is on prevention. Prevention is where, you know, that this disease is coming and how do you prevent from getting infected. What are the things that you need to do? Are there vaccinations that you need to do or develop? Are there any other barriers that you can build between people? Or how do you figure out what, whether it is a chemical or biological? Is there any way to block the spread of this disease? So that’s the second area, which is the prevention.
The third area, I would say is the diagnosis, you know, the diagnosis has been very difficult. The tests that have so far, a lot of tests were not performing well. And so there was a lag between detection and treatment. And so how do we test? How do we use novel technologies to be able to do a quick test rather than wait for the test to come back two days later, the test result? Because in the meantime, you know, that person will be spreading, you know, disease, and how do we track those people who have tested positive? Because the tracking system needs to be there where you know where this person is going and how the disease is spreading.
And the fourth and the last one area is where you are looking at treatment options. You know, what are the medications that help? Do we need to develop new medicines? Do we need to get, a novel treatment options? Can we find new medicines that may not have been used before or new medicines that work for other diseases and test it on these patients? Are those useful? Those are some of the areas. So those are the four areas that I would say definitely need it.
Amit Saha: Yeah. So it’s, it’s great, the way you divided this opportunity into four parts, right? I kind of focus on the latter two, you know, on the diagnosis and treatment and I have a specific question pertaining to these. As we know already, there are a lot of these symptoms which overlap with a lot of other conditions. Flu for example, right. So, when we are looking at diagnosing or treating, what should be our approach to address these overlaps and especially at a time when we are really hard pressed to test everyone? We cannot, we have to be very careful as to how to use our resources, right. So what should our approach be to tackle this issue?
Dr.Uli: Sure, that is a great question. So one of the things that I mean, there are several factors that go into the test. Number one, the test has to be accurate. Number two, the test has to be quick. Number three, you know, you have to pick the right people to test. Otherwise, you will run out of test very soon. So somebody suggested that, oh, we should test the whole population. You know, if you want to test the, you know, 40 million people in California, I was discussing this with another Physician, and I said, it will probably take 20 years or more with the number of tests we have right now, which is about 5000 a day. So, that is a challenge. That’s number one. Number two is that if you do any test, when you do a test, then it has to be followed by an action. Okay? So if you see a patient that is positive, and how do you treat that? How do you differentiate the treatment of a person who tested positive with the person who tested negative? And that’s where you know we will run into problems because there’s no cure for the people who have tested positive. You might say, oh, maybe they should be isolated or quarantined, that is true but it is also true because this disease can be asymptomatic, right. So there are a lot of people who are asymptomatic and who are running around or moving around within the community and they may be spreading the disease. So if you if you quarantine a few people that you have tested, that are symptomatic, it does not make a big difference in a later stage of an of a pandemic like this. In the earlier stage, it might make a difference like it did in China and South Korea, you know? And how, how strictly can you enforce these laws where, you know, you’re keeping people away from each other. So that’s where the biggest problem is. Let’s say you go, you have symptoms and you go and get tested. And if it is positive, you know, the first thing they would say is that, yeah, you have symptoms, but you’re not sick, right? We have to make sure that we preserve the ICU beds for the really sick ones where you cannot breathe. So my recommendation would be to stay home until you know you really, really need to be in the hospital. When you have, let us say a fever or cough or some symptom, you know, it can be any of the other viruses like the flu. So just by going into the hospital, going into an environment you’re not only at a higher chance of contracting something else, God forbid do you want to be in a place where there are other COVID-19 patients. So I would recommend that unless you’re having really severe symptoms where you’re having difficulty breathing, I would not recommend going to the hospital and that’s what you know, CDC has recommended also.
Amit Saha: Right, so the thing also is, you know, so that’s that that really helps right with the diagnosis. Now, let’s focus a little bit on the treatment right. Obviously, we do not have any treatments now. And you a Physician but from what I understand, right now, the only strategy is to be treating the symptoms correct. So one question that I have are concerned rather, especially for the US, is the is the extensively lengthy drug trial processes involved, right. So now even if one was to identify some potential candidate, how are we going to get that medicine to the people? Are there any specific strategies that can bypass the overall lengthy process or how can or how does that work?
Dr. Uli: So, FDA does have a fast track process where you know, in an emergency, you know, you can try different drugs and you can actually study and in fast track the process for approval. So that is not a problem and there are currently many studies are occurring throughout the country and so there are different drugs that people are trying. And so that in a case like this where it is an emergency, you know that will not be a problem, I don’t expect that, that that will be a problem. And the other thing is that we already have experience from other countries, you know, people have tried different drugs and until we can actually import some of those ideas, import some of those trials and see how we can build on top of those. So there’s already on top of what the current drugs that are being tried and so I don’t expect that to be a long process. Of course, it could be a long process when you compare to the current pandemic. Obviously, we want to get something out to the doctors as soon as possible. But in this case, it’s going to be a little, little tricky. It’s going to take some time.
Amit Saha: Okay, thank you.
David Cao: Okay, great. I think, the testing is one of the challenges. So what are the difficulties for the testing? What are the entrepreneur or startup opportunities in this area?
Dr.Uli: Sure. So number one problem is the availability of tests, right, so there’s not enough tests that can go around where you can test everybody. So that’s a problem. Number two problem is having a simpler and more rapid test. Right. You know, there’s always this question of, you know, if you get a test done, you know, do we have to wait two days, three days for the test results to come back?
I’m sure, you know the larger lab testing, testing companies are working on that problem. But one of the big, big ideas is that, can we develop a test which can quickly diagnose. Maybe using the breath or maybe using a drop of blood, maybe using a little bit of mucus. So we can do a point of care test, where you’re actually testing and the result comes out, comes back to you within a few minutes. That would be great, I think, in trying to understand the extent of this disease.
David Cao: You know what, that was my last question. But somebody, my partner suggested a very good question. So the Virus seems to have different versions and has been changing a lot. Will it affect how the testing being done?
Dr.Uli: Well, right now, right now, there’s nothing like that available. Of course, there are some places where healthcare workers were sent to the home of the person and where they drew sample and that was sent back to the lab. But self-testing or home testing is quite possible. But a lot of startups are thinking about it and working on this problem. But that would be great if somebody can come up with a test.
David Cao: Okay, great. I really think that’s our time today. We look forward to invite you to come back for another different topic for discussion. Thank you, Uli.
Dr.Uli: Thank you, David. Thank you for having me. It’s a pleasure.
Lu Zhang, Founder & Managing Partner, Fusion Fund, USA. Lu talks about investor thinking during challenging times and their approach. She believes the current situation is also an opportunity to fund good startups at lower valuations. She has advice for investor community in responding to the change.
David Cao, Managing Partner, F50 & F50 Elevate, Partner, Hanniwell Lake Ventures
Dr.Prathamesh Prabhudesai, Cofounder of Save BVM F50
Global Insights is a series of webinars on ‘Elevating HealthTech Innovation’ and brought to you by Silicon Valley based F50 & F50 Elevate. F50 serves a community of VCs, Investors, angel investors, Corporates, startup founders, entrepreneurs and thought leaders. F50 Global Capital Summit(GCS) is among the leading investor events of Silicon Valley. F50 Elevate is a pre-Series A HealthTech startup accelerator based out of Silicon Valley.
David Cao: Welcome to F50 Global Insights. Today is our week two of sessions. Today, we have two great speakers. First I want to first ask my co-host Om to introduce himself.
Prathamesh: Hi, my name is Prathamesh. I’m a physician by training and I’ve been working with F50 since the past one and half year. Along with that I have a medical device startup called SafePBM. And what we do is we make the manual resuscitator which is used in emergency airway management functions like a transport ventilator, which is used in critical care.
David Cao: Thanks Om. Lu.
Lu Zhang: Hi, everyone. This is Lu. I’m the Founder and Managing Partner of Fusion Fund. We are a Silicon Valley based VC firm focused on early stage tech and healthcare investment. Before I went to the dark side as an investor, I was running my own medical device company focused on Type-II Diabetes diagnostic. I sold that company to Boston Scientific and then later start to do investment also with a focus on healthcare.
David Cao: Great. So as you are investor, the question today is about the investment environment in Silicon Valley as well as in North America. I believe this virus outbreak is a sickness and the bigger than any people had predicted, especially for Silicon Valley as well as North America. What are the impacts to the venture capitalists in the valley? Maybe I’ve started this question to you, especially an impact to your fund.
Lu Zhang: Sure, so actually for us I would say definitely, as you said, is a huge impact on the economic and also Silicon Valley. And for VC, luckily, we have the flexibility of work remotely. So in terms of fund operation, we’re okay so we still be able to continue to fund operational talking with the founders and also spend more time on the portfolio management. I will say the only difference for us is now we’re being more picky when we’re talking to the new founder. And we’ll also focus more on their cash flow, management capability when we’re talking to the new founder. Meanwhile, we’re spending much more time with our existing portfolio company especially like roughly twelve company where seat on the board seats we want to make sure they have the right strategy to go through this crisis and meanwhile, have the enough cash flow bank for another 12 to 18 months is cash flow in order to you know, be the survivor and ultimately become the winner. So working with a close eye on our existing portfolio, but other than that, luckily, our investment sector focus does not impact at all as we always investing b2b focused business model type of company, tech savvy company and their revenue grow is pretty steady and solid. And for this corona virus, the company investor, the VC investor Consumer tech probably got the impact of most but for us, enterprise b2b actually have much better cash flow situation. But for the general VC industry, we definitely heard lots of changes. For example, we heard several VC from including bigger one, smaller one, they’re taking next three to six months off, which means they’re not actually making any new investment. They try to observe what’s going to happen at the progression of this crisis and probably allocate capital later. Another one we found is actually lots of the existing also VC they try to work a lot what spend lots of time with existing portfolio company but also not necessarily have enough pro-rata capital to support them in their later stage rounds. So we’re probably will see a much faster speed of you know, company going to die because not enough cash flow or not enough supporting capital from existing investor and also competition from VC going to get tougher as well as we’re gonna be more concentrated the capital to the top tier startup companies. So definitely going to be harder for founder to raise money and also going to be more trickier for investor to preserve the company. But in general, we always talk about the downturn is the best time to invest in a good company at earlier stage. No matter Facebook or Google they’re all founded at a downturn. And as I mentioned, as a capital we see going to be more concentrated, the chances for the company established now to become the future winner will be much higher. So it’s still good time to allocate capital just you need to vary capital about a strategy and also be proactively to interact with existing portfolio to protect an existing asset in will allocate a future company.
David Cao: Okay, great. But, the reality is that the pressure or the problem is not evenly distributed. There are many startup are dying. There’s a small number of startups get some very quick funding because their business are related. So, may be you can share us your insight, particularly in the HealthTech industry. What are the sectors has pretty big benefit? What other sectors are facing very big risk?
Lu Zhang: So yeah, so for healthcare industry, I would say definitely, as you mentioned, there’s also lots of strategy changes required for the VC. As I mentioned, we also see lots of VC start to think about general strategy to be more focused on B2B. Another is definitely healthcare, and this corona virus also really show us the big challenge in the healthcare industry that diagnostic devices, diagnostic technology is not good enough. So for us, we’ve been investing heavily in healthcare, especially diagnostic technology and also AI healthcare and new tech emerged as a healthcare for a long time. Now we saw, we heard more and more VC and the founder kind of reply to us saying that they really see this big challenge and also big opportunity, be able to bring new technology to the traditional sector, especially to healthcare and also say the good, like a huge value of doing the good diagnostic technology will always help us, well, definitely help us prevent a disease but also help us save loss of health care expenses if we could stop the disease to progression to the late stage. So I think that’s definitely a good indication for people to start allocating capital to healthcare focused innovation. And also on the other side, it’s a lesson learned for no matter VC and founder be able to really think about what is the long term opportunity versus only focus on short term gain.
Prathamesh: So another question is now because of the virus, there’s also a market crash and global lockdown. How does that affect someone like you who manages a large fund or is raising a fund?
Lu Zhang: Yeah, so definitely as I said I was talk about people ask me, okay this is corona virus Black Swan it is a one-time thing if you think it’s going to lasted longer. To me I kind of feel it’s just a regular business cycle recession. It just corona virus make it happen sooner but after this even corona virus getting better in the summer time we’re going still have suffered a recession now with other business like the economic cycle. So definitely a huge crisis as you mentioned, it’s also have big impact even long term impact for VC, VC venture capitalists. I definitely know lots of VC firm their star rating this year. Again, I’m a definitely going to take longer because institution LP, the amount of family office, our endowment funds. Fom what I heard, they are having all this urgent meeting because they have large allocation to the public market. So they are basically overwhelmed by the discussion of how to really deal with a situation. So definitely take longer for the VC who are trying to raise now, but on the other side, what another thing I heard is some traditional big institution LP and endowment fund that they found out, okay, the reason they have lots of loss during this crisis right now is because they don’t have enough diversity in their portfolio. Then they’re also thinking about having more diversity in the future allocation, especially for their VC investment, not only focusing on the traditional top tier VC, now sand hill, but also they’re looking for new emerging manager, especially emerging manager with a focus of a company that was more solid, under stable growth, be able to really go through this crisis with a steady growth.
So there’s definitely pro and con. And on the other side, as I mentioned for founder, it’s also good opportunity for VC to stand out during this crisis. Every time when we have a crisis, there’s also huge opportunity for people to really grow rapidly with the trend so that’s definitely a good thing as well. On the other side as mentioned, it’s not only corona virus, this is also the business cycle recession so unfortunately worried this process of double dip of recession so it might be worse even than the last recession of 2007 & 2008. And I also say that don’t blame corona virus for everything. Just corona virus really give opportunity to show the inefficiency of the health care no matter service or healthcare industry in general. Because corona virus without is a huge challenge especially for the global supply chain now we’re suffering the matter US, China, Europe, all this different country. And meanwhile, as I mentioned that the tech company in Silicon Valley, they start to really prepare themselves, for example, for new recruiting, try to cut internal costs since last year because people are saying that this might happen. And now the good thing is lots of the large company, they have huge cash on hand. So they are able to maintain their business they don’t need to worry about going through this virus. But also same thing for VC, if VC has enough capital for like different VC have different strategies. Some VC only have capital for initial investment without further capital support to the next stage like a pro-rata investment, then they may have a hard time to really for the support of their existing portfolio company. For the VC like us, we have to certify our founder allocate for pro rata investment. So for any $1 I invested Initially, I have at least $2 to $3 for following investment. Initially, definitely the purpose is try to help us to maximize the return want to put more capital into the winners, but now also give out the flexibility and leverage to really support our portfolio company to make sure they could become the market winner. And as I mentioned, who become the survivor, who cannot be the future market winner, because their competitor going to be much less after a couple months and meanwhile the market is going grow much faster when they’re only capable players on the market.
David Cao: I have a follow up question. I do believe still the pressure of all opportunities are not evenly distributed. Between the early stage Angeles, small VCs, maybe midsized VCs as well as late stage VCs or even PEs is which one do you think are better in the position of benefiting from this crisis? I’m talking about HealthTech investors.
Lu Zhang: Yeah, for HealthTech. I will say it’s kind of similar for HealthTech and also general tech investor maybe a little different as I will say for healthcare the investor, early stage company definitely a good time as I mentioned market downturn have opportunity for VC and even early angel investor be able to invest in good company with very cheap price. We are already seeing that valuation probably going to drop at least 20% or 30% in the next couple of months. Another thing is the capital will have more leverage be able to pick the good founder.
But for healthcare, another thing is, as I mentioned, we see this a huge challenge of inefficiency in the healthcare industry and also diagnostic technology is not mature enough or good enough for us to really know, for example, do the early stage diagnostic for Corona virus. So for some growth and late stage company with a mature technology focused on the diagnostic or AI in healthcare as computing healthcare to improve the efficiency of their healthcare system may also get good market opportunity. But in general for late stage, VC, late stage VC investor or late stage company now it’s a tough time.
We all know that for the past couple of years are so, challenging Silicon Valley is that high valuation? Well, let’s talk about high valuation is the illusion Why? Because when market goes down, high valuation also give the company a much hard time to raise next round because they need to justify their number with a much worse market situation. And for the growth or late stage companies, especially the work they are doing very well unfortunately, most of them has a pretty high valuation. And we probably will see some companies start doing down round and which can also be a big challenge for the growth and late stage VC because they need to think about which company they’re going to save to maintain their valuation or which company probably they have to let it go. You know, for growth and late stage, it is not like early stage, for example certain percentage of their companies go away. It is going to be very challenge for grow at a stage VC right now but on the other side as I mentioned, at this time capital is more even more important will probably be will probably have lots of complaints other mega funds previously saying this the fund size is too big like $3 billion, 8 billion dollar. But on the other side we have to admit now with this market situation, the mega firms will have much bigger leverage to deciding who’s going to be the survivor in the growth and late stage within their portfolio and also across the market. The VC firm who does not have that huge amount of capital, even they’re a good VC, they probably have a harder time for competition and they also help their portfolio company for competition.
David Cao: Okay, look, time is running very fast. So I want to invite Lu to give a summary of suggestions, especially to our investor community.
Lu Zhang: Yeah, I would say the first suggestion would be, really work closely with your existing portfolio company. From what we did. We send out an email since a couple of weeks ago to really kind of learn the founder about the corona virus situation. Actually, last year, we’re starting to, you know, talk with our existing portfolio company, potential risks on the market that they need to work on their cash flow issue. And we also have all this check on meeting check on conference call with them for the past month, in order to make sure they have the right strategy and because we do all of this, the preparation is already on. When we have a recent check with our existing portfolio company, they’ll have atleast 12 to 18 months or more than that for cash flow, which means they’re going to have much better situation going through this crisis. So definitely spend time with your existing portfolio company to make sure they have the right strategy, know where to find the capital if needed, and also encourage them to talk to their existing investor to find out how much capital support they could have. And another thing, as I said, reserve capital is very important. And once I would talk about reserve capital to support an existing portfolio company to make them become the future winner, but another thing we need to think about is having a reserve capital could also make sure you could place the dissent or defensive investment. What I mean is during last crisis, we’ll see the situation happen. And some investor may putting the term for the next stage and other VC basically to pay to play. If you don’t have reserve capital, you probably got kicked out from this round, even company continue to grow, you’re not in there in the game anymore. So it’s, that’s how we call the defensive play with the capital reserve. So that’s also related to the investment strategy. And that are saying, as I mentioned earlier, as really think about a strategy shift. If you’re more focused on consumer investment, and also meanwhile don’t be scared of the by the market. When there’s a big risk, there’s big opportunity. And if we grab the opportunity in the right way, we’re going to be for next generation of the future leader for the VC industry.
The last few weeks have brought previously unimaginable changes to the lives of people throughout the United States. Americans everywhere are waking up to a new reality in which they can’t go to work or school outside the home and they have to stay six feet away from others. More than 80% of Americans are under such stay-at-home orders.
A key reason for the delay between people severely restricting their movements and a drop in the number of new cases is that COVID-19 can have a long incubation period, the time between getting infected and becoming sick. The average incubation period is around 5 days, but it can be as long as 14 days or more. This means that a person infected before a stay-at-home order might not get diagnosed until days later.
Testing for COVID-19
Testing is another factor in the delay between the start of social distancing and seeing the results. Many Americans don’t even know if they’ve been infected with the new coronavirus – SARS-CoV-2. Though the United States is finally ramping up production of test kits in federal, state and private laboratories, there are stringent criteria on who can get tested. Testing is mostly limited to people with symptoms, frontline health care workers and first responders, and older people. However, scientists have found asymptomatic and presymptomatic transmission of COVID-19.
Asymptomatic spread has probably contributed to the explosive growth of COVID-19 in the United States. Overall, as restrictions on testing ease, case counts are going to rise because more people, including those with mild or no illness, will be able to get tested.
Finally, it’s important to note that current COVID-19 tests take 24 to 72 hours to generate a result. Even in China, where testing is widely available, the average time from the onset of symptoms to a diagnosis of COVID-19 is five days. It takes one to three days to get test results because the tests discover whether the virus’s genetic material is present inside a patient’s body. This requires replicating the virus’s genome using specialized laboratory equipment. Scientists are developing tests that look for telltale signs of the patient’s immune system response to virus, and these blood tests should provide quicker results.
Believing can help make it so
Unfortunately, people will, for the next few weeks, see increasing case counts even as they might be rigorously complying with government directives to avoid contact with other people. The lag time in reporting cases could make people feel that the actions they’re taking – staying at home and limiting in-person social interactions – aren’t working.
When people think that what they do works, they’re more likely to do it, a concept known as self-efficacy. It turns out to be an important predictor of human behavior. For example, people who expect to be able to quit smoking are more likely to quit. As self-efficacy diminishes, people could become less motivated and relax their adherence to stay-at-home orders.
Experience from previous pandemics in the 21st century shows that people’s behaviors and attitudes change over the course of the outbreak. As the 2009 H1N1 pandemic progressed, people became less likely to want a vaccine and to perceive themselves at risk. Researchers who conducted monthly interviews with Hong Kong residents over the course of the SARS outbreak found that people’s perceptions of the effectiveness of staying at home and avoiding going to work decreased as the outbreak wore on.
If Americans see increases in case counts and believe that their own actions are ineffective, they might be less inclined to follow through on social distancing. This could lead to increased contact among people, which could make it more difficult to bring the pandemic under control. Hopefully widespread testing and faster test results will lead to a more accurate understanding of who is and is not infected with the disease, not unlike what South Korea has accomplished so far. In the meantime, Americans should not take an increase in COVID-19 cases to mean that their sacrifices aren’t worth sustaining.
Fireside Chat: Dr. Poorya Sabounchi, Co-founder/COO, ixlaye Moderator: Amit Saha, Research Engineer, Stanford School of Medicine David Cao, Managing Partner, F50 | Partner, Hunniwell Lake Ventures
Poorya is co-founder and COO of ixlayer, a health data company for bio pharma, health systems, and clinical labs in the field of genomics. Ixlayer is at the center of the revolution in connecting patients to their data but successfully doing it by working with the existing stakeholders themselves.Previously Poorya was part of the Avantome founding team which was acquired by Illumina in 2008 and was a key scientist developing portable genetic sequencing technologies at Illumina. He spent two years coaching Illumina Accelerator startups with technology, operations, and business strategy. Poorya has Ph.D. and an MBA from UC Berkeley and Inventor of several key technologies for DNA sequencing platforms (including 10 patents).
AT ixlayer we power at-home complex lab testing and can plug into any health system and lab. Patients can use our platform to order a kit online, physicians can use it to order testing on their patients at home. The ixlayer platform combines 6 building blocks into an efficient flow:Clinical laboratory, CRM, Cloud, Scientific algorithms, Physician/Scientist, Patient portal and patient experience in order to offer COVID-19 testing. For more details please see this blog: https://ixlayer.com/blog/technology-solutions-for-covid-19-testing/
As city leaders across the country scramble to find space for the expected surge of COVID-19 patients, some are looking at a seemingly obvious choice: former hospital buildings, sitting empty, right downtown.
In Philadelphia, New Orleans, and Los Angeles, where hospitalizations from COVID-19 increase each day, shuttered hospitals that once served the city’s poor and uninsured sit at the center of a public health crisis that begs for exactly what they can offer: more space. But reopening closed hospitals, even in a public health emergency, is difficult.
Philadelphia, the largest city in America with no public hospital, is also the poorest. There, Hahnemann University Hospital shut its doors in September after its owner, Philadelphia Academic Health System, declared bankruptcy. While not public, the 496-bed safety-net hospital mainly treated patients on public insurance. Philadelphia Mayor Jim Kenney began talks with the building’s owner, California-based investment banker Joel Freedman, as soon as his administration saw projections that the demand for hospital beds during the pandemic would outpace the city’s capacity. Not long after negotiations started, city officials announced the talks were going badly.
“Mr. Freedman was difficult to work with at times when he was the owner of the hospital, and he is still difficult to work with as the owner of the shuttered hospital,” said Brian Abernathy, who is Philadelphia’s managing director and heading the city’s COVID-19 response.
In New Orleans, where the soaring COVID-19 infection rate is disproportionately high compared with its population, Charity Hospital sits vacant in the middle of town. The former public hospital never reopened after Hurricane Katrina in 2005. The Louisiana State University System, which owns the building, incorporated Charity Hospital into the city’s new medical center, but the original building remains vacant. Instead of using it during the pandemic, the New Orleans Convention Center is being converted to a “step-down” facility with the capacity to treat up to 2,000 patients after they no longer need critical care.
Elsewhere, city governments have struck deals with the owners of empty hospital buildings to lease their space. At St. Vincent Medical Center in Los Angeles, the city is paying $236 per night per bed, for a total of $2.6 million each month.
In Philadelphia, Freedman offered the Hahnemann building to the city for $27 per bed per night, plus taxes, maintenance and insurance, which the city would pay directly. All told, that added up to just over $900,000 per month.
“I think he is looking at how to turn an asset that is earning no revenue into an asset that earns some revenue, and isn’t thinking through what the impacts are on public health,” Abernathy said of Freedman. “I think he’s looking at this as a business transaction rather than providing an imminent and important aid to the city and our residents.”
This isn’t the first time Freedman has come under fire by Philadelphians for his handling of the hospital. Its closure sparked protests from city officials, health care unions, and even presidential hopeful Bernie Sanders. Critics speculated that Freedman, whose private equity firm bought the struggling hospital in 2018, didn’t try in earnest to save it and planned to flip it for its valuable downtown real estate. Notably, Hahnemann’s real estate was parsed out into a separate company, Broad Street Healthcare Properties, also owned by Freedman, and not included in Philadelphia Academic Health System’s Chapter 11 bankruptcy petition.
A representative for Freedman said the building has an interested buyer, and that is one reason Broad Street Healthcare will not let the city use the building at cost.
“We’re offering this facility because of the public benefit in a health crisis, but it comes at a cost to the property owner,” said Broad Street representative Sam Singer.
As urban hospitals have struggled in recent years, it’s become increasingly common for private equity to get involved: Big firms buy struggling medical centers with the promise of financial support and to improve their operations and business strategy. When things go right, the business succeeds, and the private equity firm sells it in a public offering or to another bidder for more than it paid.
In other cases, though, the firms load companies up with debt, take dividends out for themselves, sell off valuable real estate and charge fees and high-interest loans, leaving a company in a much weaker position than it would have been otherwise, and often on the verge of bankruptcy.
“The house never loses,” said Eileen Appelbaum, co-director at the Center for Economic and Policy Research. “The private equity firm makes money whether the company succeeds or it doesn’t.”
For instance, Steward Health Care was able to expand from its base in Massachusetts to a 36-hospital network nationwide with backing from Cerberus Capital Management. Now, said Appelbaum, the chain of community hospitals is stuck paying rent to a separate real estate company, on all its properties, while also struggling to stay in the black. The network announced last week it would furlough non-clinical workers across nine states because the requirement to cancel elective surgeries caused too great a financial strain.
Freedman’s private equity firm is called Paladin Healthcare, and it has previously bought and managed hospitals in California and Washington, D.C., where it helped the struggling Howard University Hospital out of the red. Paladin then sold the hospital to Adventist HealthCare last summer.
Urban hospitals like Hahnemann have struggled to stay afloat in recent years, in part due to their lack of privately insured patients. Hospitals often finance the care of uninsured patients or those on Medicaid by treating those with private insurance, which reimburses the hospitals faster and at a higher rate. At Hahnemann, two-thirds of patients were on Medicaid or Medicare. While a financially struggling public or nonprofit hospital might continue serving a poorer community, a for-profit hospital has different incentives, said Vickie Williams, a former law professor for Gonzaga University.
“If your urban hospital is purchased by a for-profit company and it doesn’t perform sufficiently, they don’t have the same necessarily mission-driven directives to keep that hospital functioning for the good of the community at a loss,” said Williams, who is now senior counsel for CommonSpirit Health in Tacoma, Washington.
Freedman has said that he tried to sell the Hahnemann property to a nonprofit and requested money from the city and state to keep it open, but neither option worked.
Following news that Philadelphia had abandoned negotiations with Freedman, calls to seize the property in order to save lives came pouring in, including from elected officials.
“Eminent Domain was created for situations like #Hahnemann,” City Council member Helen Gym wrote on Twitter. “This is a public health emergency and Philly is the largest city in the nation WITHOUT a public hospital. We cannot allow unconscionable greed to get in the way of saving lives. Eminent domain this property.” Legal experts say the lengthy process of eminent domain and the requirement to pay the owner fair market value for the building make it an unlikely mechanism for an instance like this.
But in public health emergencies, local, state and federal governments do have broad authority to commandeer private property, such as hotels, convention centers, university dormitories or even defunct hospitals for disaster response. Williams, whose research has focused on preserving hospital infrastructure during a pandemic, said that so far in the United States, that hasn’t had to happen – at least not in the traditional sense.
In Pennsylvania, the governor’s emergency declaration gives him the authority to “commandeer or utilize any private, public or quasi-public property if necessary to cope with the disaster emergency.” A health department representative said all options remain on the table in the event that the city’s hospital bed capacity is overrun.
In the interim, the mayor made a deal with Temple University to use its basketball arena, which would have the capacity to treat 250 non-critical patients, at no cost to the city.
This story is part of a partnership that includes WHYY, NPR and Kaiser Health News.
[Correction: This article was revised at 5:30 p.m. ET on April 2, 2020, to clarify Steward Health Care’s real estate situation.]
Source: by [#item_author] from Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente. More Read More
In an effort to free up critical beds and resources, all elective surgeries have been canceled. Health officials are even urging people symptomatic for COVID-19 but less vulnerable – those who are generally healthy and under 60 years of age – to stay home and away from emergency rooms for fear of infecting others or taking up much-needed beds.
With access to in-person care extremely limited – and potentially dangerous – many hospitals have started treating and meeting patients through phone calls and over the internet.
A perfect answer to pandemic problems
I am a former member of the Medical Board of California and have been working with telemedicine regulation since 2006 when California Gov. Arnold Schwarzenegger appointed me to the board. After years of steady but frustratingly slow growth in telehealth across the U.S., it is exciting to see telehealth finally being utilized as an important tool to deliver care.
Telehealth, also known as telemedicine, has long been discussed as an effective way to give people access to medical professionals from the comfort of their own homes. Using a phone, a tablet or a computer, a health care provider can diagnose, treat, prescribe and educate a patient sitting miles away. In response to the coronavirus, hundreds, if not thousands, of care providers across the country have gone partially digital and patients are flocking to these systems.
Prior to the coronavirus, my own university hospital, Keck Medicine at the University of Southern California, used telemedicine primarily for certain cancer and dermatology patients. Over the last week, however, the USC health system encouraged and initiated more than 5,000 telemedicine appointments, the majority of which were not for COVID-19 symptoms. Across the country, Boston Medical Center launched a telemedicine site on March 16 and within 48 hours, 1,500 patients scheduled virtual visits. By using telehealth services, these hospitals are freeing up valuable resources for those who need them most while simultaneously limiting risk to those who can be treated at home.
Telehealth services can deal with a large range of problems including skin issues, minor infectious diseases like the flu or cold, psychiatry and minor orthopedic problems like sprains. Physicians can also prescribe medications after a video or phone discussion.
But despite telehealth’s obvious benefits during this crisis, it is remarkably underutilized. Only a few hospital systems in the nation have the technological capability to ramp up to even 50% virtual care.
And perhaps more importantly, there are unnecessary regulatory roadblocks preventing telehealth from use at a mass scale across the nation.
The fight to go digital
In the early 1990s, disparities in health care in rural counties and an aging population with greater needs prompted California to consider telemedicine. The University of California at Davis launched a telemedicine program in 1992 to assist with fetal monitoring in rural counties. In 1996, California passed the first law regulating telehealth which allowed only California-licensed physicians to treat residents of California through telehealth technology. Legally, to this day, a doctor from Iowa, for instance, cannot treat a person living in Los Angeles.
As laws went on the books around the country, access to telehealth remained difficult. Many states required written consent from patients before they could receive virtual care. Others required at least one in-person medical examination before telehealth appointments. Insurers refused to reimburse telehealth providers at the same rates as in-person health care visits. Reasons for refusal included the simple interpretation of a definition of a medical office visit to concerns about the quality of care. These laws were meant to protect patients, but reflected concerns of the traditional face-to-face medicine and were counterproductive to the use of this technology.
Patient advocacy groups and some state agencies – like the California Medical Board that I was a part of – saw the potential of telehealth. In the years that followed, many of the restrictive laws and regulations were removed or changed. Additionally, laws were added in many places that forced insurance companies or government-provided health coverage to pay physicians the same amount for a virtual visit as an in-person visit.
For all this progress, 21 states and a few territories still do not allow the practice of medicine across state lines – arguably in the interest of protecting their own licensees and the quality of care. My home state of California is one of these states, as is New York, although a bill was introduced in the state house last month to allow telehealth across state lines. Particularly now, the ability for a patient in New York – where medical resources are extremely overburdened – to have a virtual appointment with a qualified physician in some place not yet as badly affected would be invaluable. Old regulation is preventing this.
Telehealth to fight COVID-19
For the last few years momentum has been on the side of telehealth technology but utilization had still remained low. This year 91% of employers will offer telemedicine to their employees. Less than 10% of Americans have ever used the technology. The coronavirus crisis has demonstrated the need unlike anything before. As health care providers have moved en masse to virtual medicine, regulators and government officials are showing unheard of support for this tool that will almost certainly save lives.
This support and interest for telehealth is unprecedented and it seems the nation has finally realized what a powerful and valuable tool telehealth can be. Harder-hit areas are literally begging doctors from other states for help and if laws would allow it, telehealth could get them there instantly. Of course not all medicine can be done virtually, but a lot can, both now and in the future.
Which tests are good and which tests are bad isn’t immediately apparent. According to a March 30 press release from the FDA, “The FDA revised the process to allow labs to begin testing prior to FDA review of their validation data. This policy change was an unprecedented action to expand access to testing.” The guidance the FDA provides to test makers requires laboratories provide some evidence of their assay’s performance and consistency in results. It also ensures that reasonable thought is put into assay design. Assays meeting these requirements may then be permitted for clinical use prior to receiving approval by the FDA.
SARS-CoV-2 is the virus that causes the disease. It is a novel virus from the coronavirus family that was first identified in November 2019 in Wuhan, China. Like other viruses, this one is believed to have first infected animals and then jumped over to humans. Because of their zoonotic origins, these viruses are often ill-suited to spread from person to person. What makes COVID-19 so different is it’s readily spread between people, which lies at the heart of the current pandemic.
There is a lot that we just don’t yet know about COVID-19.
For example, for most respiratory viruses we develop antibodies that protect us from getting infected by them again. This is referred to as immunity. We assume that we’ll develop immunity from having been exposed to COVID-19 infections, but it hasn’t exactly been around long enough for us to know this for certain. Will this virus mutate so that our immunity won’t work? Will this virus become seasonal, much like the flu? Only time will tell.
Developing a test to detect this novel virus has been at the center of the efforts in the U.S. to combat its spread. If infected people can be quarantined early, they are much less likely to transmit it to others.
Most of the available tests are based on collecting the virus’s RNA (ribonucleic acid) and converting it to DNA (deoxyribonucleic acid). This is the easy part of test development because all these tests use the same basic methods. The next step is making many millions or billions of copies of the DNA so that it can be detected. This is where most tests differ. COVID-19 is a large virus with many different genes that can be used to detect it. While one test may target one or more virus genes, another test may target a completely different set of genes.
These regulations were lifted at the end of February 2020, and centers across the U.S. were finally free to develop their own tests. There was so much pent-up energy to develop COVID-19 tests that the country rapidly ended up with a surplus of different tests. Because the U.S. never settled upon a single standard for detecting the virus, companies, hospitals and academic centers were left to their own devices to forge their own paths forward.
Who’s right, who’s wrong?
So which test is the best available right now in the U.S.? There’s no certain answer. None of these tests from different manufacturers have been around long enough to know which is best at detecting the virus.
The most common question I get asked is, “What is the accuracy of my institution’s COVID-19 test?” It’s impossible to answer because my institution uses five different tests, each of which will likely have different performance characteristics. These tests generally differ in the virus’s genes they target and the laboratory instrumentation on which they are performed. We have tests that can detect as few as 100 copies of a virus gene and tests that require as many as 400 copies for detection. We have chosen to use so many tests because testing kits to detect the virus are so limited that when we run out of kits from one manufacturer, we switch to another.
It is inevitable that we will learn that some tests are better than others. They were all developed so quickly that it’s unlikely they’ll have the same performance characteristics. We can only hope that none of the assays currently in use performs poorly.
The FDA regulates COVID-19 testing
Many of us laboratory directors in the U.S. have a love-hate relationship with the FDA. We love the FDA because their stringent oversight helps to protect us from using products that don’t work well. The hate stems from their standards being so high that products often come to market in Europe and Canada before they make it to the U.S.
The FDA took a decidedly different approach to regulating COVID-19 diagnostics. Due to the dearth of available testing in the U.S., they allowed hospitals, academic centers and companies to develop their own tests and begin using them if they could meet minimal standards.
The FDA will eventually do their due diligence in evaluating the COVID-19 tests that are available. Until that happens, we may have tests in use in the U.S. that don’t live up to their normal high standards.
Adam Schlifke, Founder & CEO, COVIDvent, Stanford School of Medicine
Host: David Cao, F50 F50 Global Insights
Adam Schlifke, MD, MBA is a board certified anesthesiologist with more than 15 years of experience in digital health. Dr. Schlifke is faculty at Stanford University where in addition to a clinical practice has a digital health appointment.
On March 14, 2020, Dr. Schlifke wrote a two page call to action and operational plan that called for creating more critical care space by repurposing unused space, such as surgery centers.
David: Welcome to F50, this is David and I am your host today. We have a very special guest, Dr.Adam. He is faculty from Stanford and he runs two startups. He has a very interesting initiative, just launched very recently to help COVID19 patient.
Dr.Adam: Good morning everybody. It is a pleasure to be here. Thank you very much for having me. My name is Adam Schlifke, I am faculty at Stanford University, where I’m a clinical assistant professor. In addition, I do have a digital health appointment within the Department of Anesthesia. I’ve been in practice since 2007. I trained at UCSF, I moved to Stanford about a year ago to get more involved in the digital health initiatives going on at Stanford and about a month ago when this sort of the pandemic really started in this country, I saw an opportunity to really raise awareness around the critical care shortage, we were going be facing in this country very very soon.
David: Okay great, so I hear you have a great presentation and you can share to our audience there right now. So for the audience, we are recording this event as well as the live broadcasting on YouTube and ask some questions at the end.
Dr.Adam: Great, before I go into the actual business, I want to take an opportunity to speak about where this all started. On March 14th, I wrote a two-page paper which was an action plan and a call to action around converting space in hospitals and surgery centers into critical care areas and in fact I’ll go a step further not just critical care areas but using the promise of digital health to do virtual critical care.
So we’ve spent the next two weeks operationalizing the plan. You can’t just move an anesthesia machine and expect to have a virtual ICU. It’s actually extremely complicated and we spent night and day with a team of about 10 people thinking through all the operational plans it would take to convert all these spaces and in fact we are talking to states like New York and other States at every levels of government about how to do this.
Governor Cuomo said yesterday that there are five days left in New York to have vents if we converted every single operating room and surgery center to a virtual critical care area we could have a hundred thousand more vents tomorrow. Okay, there are only a hundred and fifty thousand vents in this country we can add a hundred thousand tomorrow if we operationalize that plan. But we haven’t stopped there we have created a full offering around remote patient monitoring, because the truth is that we can bring care to the home. Why are patients going to the emergency room if they can be treated at home? The promise of digital health in my mind has not been recognized. I’ve been in digital health for 20 years and to be honest I’ve seen a lot of money go into the sector and very little come out in terms of treating patients with chronic disease. I come at this as a provider I am an anesthesiologist but I also see the writing on the wall that we have to move tear outside of the four walls of the hospital. This is our opportunity to redo the system. We don’t need big hospitals anymore, we don’t need perverse incentives. We don’t need all the for-profit systems being on the sidelines not helping fight this fight which is really trying to save lives in New York and the rest of the States in this country. So that’s where all this comes from.
We started with the idea that we could take very lightweight technology and bring it to the home and then what we do is we take that lightweight technology and the weak connected with emergency rooms where providers are not working. Now you might ask me what do you mean, I thought the ears are overwhelmed that’s only true in pockets of the country certainly in the ERs in New York they’re overwhelmed but there are people sitting on the sidelines in other States. The beauty of the telehealth regulations now is that all the regulations have been relaxed so now if you’re a provider in Seattle or in LA or in San Francisco and you’re not that busy why not offer virtual services to another emergency room or virtual critical care services to another ICU whether it’s in the surgery center or somewhere else that’s where the real opportunity is.
So we’ve thought about remote monitoring in a very complex way and the way I see I’m sorry there’s some typos on the slide I have not seen these slides before we’ve been we’ve been working 24 hours a day to get this all these pieces together. But the problem with remote monitoring in general is that it’s very piecemeal even Teladoc and AM, well they have great offerings but they can’t complete the last mile problem which is how do you get to patients at home and how do you connect them not to just providers in their network but how do you connect them to their facilities. So our plan is actually to connect all the dots in digital health. We bring patients care at home, we send them a package which is a full offering of monitoring solutions right and our partners are some of the best partners in the world. Massimo is one of the best medical device companies in the world and by the way Massimo is super interested in being engaged with us because they see us as thought leaders. We have grown a grassroots movement, we’ve been involved with a petition on change.org which has involved 1.3 million signatures, so I’m not saying that all those people are behind us in this business initiative, but what we’ve done is we brought all the technology to bear that’s already been developed and we’re taking digital health to the next level. Digital health you know for many years has been on the cusp of doing something very meaningful, but it’s been more about treating sore throats and UTIs than it has been about treating real chronic care patients. What if you had a home offering where you’ve had everything wrapped up together where you could basically do 90% of what you’re offering in hospitals at home. So the future I see in healthcare is that eventually patients will be getting 90% of their care at home, the hospitals will be ICUs, ERs but the rest of it is unnecessary you’ll have some areas in for dialysis but like you don’t need patients sitting in beds not doing anything. In fact you want them walking around you know. May be you do physical therapy virtually, maybe you provide very low cost technology enable services at home so that 90% of this stuff that’s happening in a hospital is actually happening in a home.
Oh and by the way there’s a group of physicians who are actually advocating trip treating COVID patients at hotels. So why would you do that, well you don’t want them standing in line in an emergency room there’s that’s a way for them to get make other patients sick. So it you know this is a complex system it’s a complex process we have worked out all the details and I encourage you to get involved. We have town hall meetings every day where we have industry people, technology people talking about how to move mountains to save lives in New York. We’re actually having those conversations every day and honestly I’m in this and the people that are in this are in it for the right reasons and the right reasons in my mind are to bring technology to bear that already exists. Why are all these companies reinventing the wheel we need to bring all the tech that’s possible today together to change lives in New York. Today we only have five days left it might be too late in New York but may be it’s not and so. I’m gonna keep pushing in New York, I’m gonna keep talking to the Legislators and the Governor you know. The Governor’s office and CMS and all these people it will take to move mountains but with your help and your or I’m confident that we can do that.
This is our opportunity to redesign the system. I’m just gonna reiterate that like I’ve spent 20 years in clinical practice. I know what the providers are feeling on the front lines. The reason why there is 50% physician burnout. It’s very clear there’s no autonomy, the administrators are sitting in offices they’re not supporting the providers. Providers are getting sued as a result of speaking out about the problems for those of you who have who don’t know ZDoggMD. You should look at his video that he published yesterday ZDogg basically was calling out every single administrator in this country because it’s time that leave the physicians and the providers and the clinicians and the nurses take back health care right there’s too much money in the system that doesn’t go to patients and providers there’s too much money in too much as at stake here with patients lives to continue operating business as usual.
Thanks, I’ll get off my soapbox now but if you want to join us come to our website be a part of the conversation we don’t have any time to waste.
David: Thanks Adam, looks like you have a great initiative. I have a couple questions first start is that so what do you need to move forward with your initiative? Especially with F50 Global Insight we have a global investor network as well as lots of entrepreneurs in Silicon Valley we’ll be watching this video. What do you need them to help you?
Adam: Are you asking today or next week or next month?
David: Now and next few weeks.
Adam: So today we need some money, we have no money today. Today what I had is about 10, what I always say that I built a team that money can’t buy because the people on my team are some of the best people in the industry, which I haven’t announced yet but the reason they’re at the table and the reason they’re making these slides and talking to executives is because they believe in in their heart of the mission and these are people that I’ve known for 20 years. So one of the things I’ve done over the last 20 years is built a great network of people and these people I brought to the table to affect change. So if you’re asking me what I need to do today I need people to help with the initiatives I’m happy to involve as many people but one of them be involved that have expertise to offer and I need a little bit on money to get things off the ground but I’ll tell you in the next week I expect to have some very big contracts and when those contracts happen I’ll need as many people as humanly possible to operationalize all these ideas as quickly as possible.
David: Okay. Can you be little bit specific a little bit, other than money, what type of people you need to operate and how they can help.
Adam: So our remote patient monitoring , so if you think about it so Massimo is a good there this is a good example of so Massimo makes a lot of monitors they have they have a network throughout 50 states they could be selling their monitors in all 50 states the one thing I’m not aware that they have is really a date a way to manage all that data think of all the data that will come from their probes that will need to be managed in the cloud and you can’t just have it does it’s that all the people on this call know technology that’s not that is not a problem that can be solved with a workforce that is technology scale at its core and Massimo and I believe we can help. Massimo help design a system that will enable the monitoring of millions of people simultaneously and so to build that we need about 10 and engineers and we need about a million dollars of revenue or a million dollars of money and we can probably build that in about two weeks. So we need people on the ground that are talking to executives, we need technology people that are actually building the system that we’re putting together and then we need a little money to make those operations happen.
David: So how far are you from your plan, so sounds like one million investment is a pretty big commitment where are you right now?
Adam: We are ready to go so I’m in the final stages of negotiating at a deal with Massimo as I said we are approaching big hospital systems right now we don’t have a signed contract yet but it’s sort of the chicken and the egg problem. I have been talking to the highest levels of government both at the White House and states within this country. I think with just one contract and a little bit of money we will be off to the races.
David: Specific question, what type of patient because COVID19 Corona Virus actually is the infection symptoms are very different between different people. There are people with no symptoms at all and there are very highly ill people, so what is your target group of patients.
Adam: It is a fantastic question. Something we spent a lot of time thinking about and my answer to you will be the following. That’s up to the hospital system that we work with, if you think about it what we do is we bring all these technology resources to bear and we help the hospital or ER manage a very lightweight technology enable system with big data. They can decide for themselves what the criteria are for which patients they manage or we can tell them. We know which patients should be managed at home with this technology but we don’t want to be prescriptive because at the end of the day it’s the clinicians that providers at the hospital systems that need to take ownership of this process. We can help them with those decisions but we’re not going to tell them what to do.
David: Okay, so I understand the challenge ER system but to take care of the patient at home it is not the ER Department’s issue right?
Adam: It’s both, so what we’re doing is we are repurposing the emergency rooms to take care of these patients and if the ER doesn’t have enough staff and will involve primary care providers as well. So I’ve been in discussions with Teladoc and with AM Well we have the potential to have access to five thousand physicians tomorrow if we want it. But ideally my job is to repurpose the non-working physicians that are already in the system because I’m a provider like I understand what it means to be an emergency room physician and not to be working. One of my best friends works at the Vituity CEP America there are a billion dollar revenue professional services organization that contracts with hospitals for emergency medicine services. I know firsthand that some of their emergency rooms are overwhelmed and some of their emergency rooms aren’t working at all I can fix that disparate resources through this technology platform.
David: So right now we are in California, what is the process to deploy your services to somebody in New York or Washington?
Adam: So it depends if you’re asking me about that we have two separate businesses here so it depends if you’re asking me about the Surgery Center conversions or if you’re asking about the remote patient Monitoring. To be honest it is all connected because the vision that we have is you’re treating patients at home and then they go to the surgery center where it becomes a mini-hospital. Remember surgery centers typically only operate they don’t take care of patients for chronic diseases but if you repurpose the surgery centers in New York, then you can treat patients that are hospitalized but now you are not in a hospital you’re in the surgery center and then if they get very sick you provide critical care services right so we’ve connected all the dots and then on top of that you implement a low-cost technology solution that follows them from home to hospital to surgery center to critical care. Now you have ground truth now you have data at every part in the process. We are not epic, we are not creating a silo ecosystem of data. We are freeing the data which is what everybody talks about but which is very hard to do. We are sending the data to the cloud, we are sharing it with our partners, we are making it relevant so that in real-time data you can predict surge, you can relocate people, you can reallocate resources. In our minds this is the way to use technology and bring it to bear so that we can create a more efficient system. I am not on this call to sell anything to anybody. The reason why we’re in this is for the right reasons. It is to save lives. It is to save lives in New York, is to save lives in Florida, it’s to save lives in California. The way we do that is, we decompress the ERs We stop spreading infection in lines, when patients are in lines on the emergency rooms. We repurpose surgery centers so they are being used and not sitting on the sidelines. We put providers back to work. We put nurses back to work. This is what is driving us, not trying to make a buck in a system that is like is failing, you know significantly.
David: Okay great. Kaiser actually published a article few days ago stating that there are 5,000 outpatient surgery centers and nationwide. We re-purpose them definitely is one of the great solutions, but how? I understand you probably are one story, but what are the alternatives and how do you compare with different solutions?
Adam: We were the ones calling for repurposing surgery centers that Kaiser helped news. If you notice, I was actually speaking about this. So there are 5,000 surgery centers in this country the problem with surgery centers is that they’re independently owned and operated. So surgery centers are a perfect example of everything that is wrong in this country, okay. If surgery centers are owned and run by administrators then they’re controlled by administrators and administrators honestly are concerned about the bottom line. They are pure economic actors. I have I read you know I wrote a USA Today op-ed about three days ago you’re free to go look at it I call out HCA and that op-ed, okay. I used to work in an HCA hospital I know innately intimately what it means to run an HCA hospital. I was the medical director of an anesthesia group at a HCA Hospital. The reason I call out HCA is because they are one of the worst actors in all of this. They are a huge for-profit health system who is doing the wrong thing and they know it. They have a hundred and thirty surgery centers throughout the country and I in a cut at least a couple of days ago it was business it usual at these surgery centers. The surgery centers are working and there’s doing things that they shouldn’t be doing. Why would you be doing elective surgery when there’s this COVIDt problem. You should be diverting all your resources to being taken care of COVIT positive patients and to answer your question it’s very clear why this is happening it’s because of the perverse incentives. If the hospital system is making all their money doing elective surgery and surgery centers then of course they’re not going to re-purpose their surgery centers. So to answer your question, we had a proposal in front of CMS in front of Seema Varma to create a carrot and stick for the system. The surgery centers that are the good actors should be paid, the surgery centers that are the bad actors should not get reimbursement. It should be a very black-and-white conversation. Nobody should be doing cataracts today in this country. I think I’m pretty confident that most anesthesiologist would support me when they say like why are we repurposing, why are we committing resources to taking care of unbelievably elective cases what in New York they don’t even have enough masks to protect themselves for COVID. It is just in my mind insane and honestly it’s where I come from with all of this because it’s so disheartening for providers who are on the front lines.
I mean, have you seen any of the interviews with like nurses and physicians crying about having to inhabit patients around the clock and having to have these conversations with families and not having the masks and the supplies and the equipment that they need. So to get back to your question, two days ago CMS came out with change reimbursement, I can’t tell you for sure that we were responsible for it, but I can tell you for sure that we were involved in that conversation and in that conversation they decided to change reimbursement. So if you’re a surgery center and you’re a good actor you will get paid from a buck for providing critical care services, but guess what it’s still business as usual. So that’s not enough because they created the carrot but there’s no stick. If they’re a bad actor they can still be a bad actor and in fact what HCA, their response is well there are no COVID positive patients and where we’re working. Is that the answer? If you’re not testing patients, does that even matter? You don’t know who’s asymptomatic? You are putting providers lives at risk, you are putting patients lives at risk. If you’re operating on a cataract patient and they are COVID positive, even if you don’t know it, they may die because when you have surgery your body is stressed, your immune system is compromised. Why would you put patients lives at risk for this, for surgery that is unnecessary, when you have people dying in New York. So until you change the reimbursement, until you change you make carrots and sticks, until you have very black-and-white guidelines about what should be done and what should not be done, providers are going to be in the middle and honestly this is the problem today and it’s still why we fight.
David: Okay, got it. So very honestly, policy part is much less what we can do. We do have a big group of entrepreneurs will be listening to your audio. So how can other startup founders help you?
Adam: Listen I am happy to talk to anybody. Text me, call me, email me, get on the town halls. We have calls every single day at 9:00 a.m. Pacific. I do those calls every day for a while. We were doing them two times a day. The more people we have at the table today the more we can move mountains.
I’m not doing this alone, I’m not on a soapbox here. I’m doing it with my friends, I’m doing with my partners, I’m doing with my colleagues, I’m doing it for the right reasons, not to make a couple bucks.
David: Okay got it. Can you tell us a bit more about to how other people can participate? You said, we have townhall meeting, how can people find out your townhall, you talked about?
Adam: If you go to our website, right now that there’s a problem with the website. So I need to figure out what’s going on with the website but essentially we have a zoom meeting every day and I can give you that information offline. You’re welcome to publish the zoom invitation, it’s 9:00 a.m. Pacific Pacific everyday.
David: Okay, sure you send me the link and I will publish with this video. So the last questions, there are lots of people on the help the fight with COVID19. Do you have any other ideas or solutions which is not related to your startup but other startup you think should implement?
Adam: Yeah, that’s a great question. Listen, I feel very strongly that we have a new world here that we’re going to have a better system. A system that actually works for patients and providers and everybody that’s actually on the front lines and that not for that the people on the sidelines just pulling money out of the system. So it’s an opportunity to really think big, think outside the box. I am an entrepreneur at heart, I’ve been doing this for 15 years. I don’t have all the answers, but I may know people that do so like reach out. You know, let’s talk about what we can do together. I’m not in here to compete with other startups. I want all the startups engaged and I want everybody to be successful, who’s trying to solve these problems.
Amid the chaos of an epidemic, those who survive a disease like COVID-19 carry within their bodies the secrets of an effective immune response. Virologists like me look to survivors for molecular clues that can provide a blueprint for the design of future treatments or even a vaccine.
Researchers are launching trials now that involve the transfusion of blood components from people who have recovered from COVID-19 to those who are sick or at high risk. Called “convalescent-plasma therapy,” this technique can work even without doctors knowing exactly what component of the blood may be beneficial.
For the pioneering work of the first treatment using therapeutic serum in 1891 (against diphtheria), Emil von Behring later earned the Nobel Prize in medicine. Anecdotal reporting of the therapy dates back as far as the devastating 1918-19 influenza pandemic, although scientists lack definitive evidence of its benefits during that global health crisis.
The extraordinary power of this passive immunization has traditionally been challenging to harness, primarily due to the difficulty of obtaining significant amounts of plasma from survivors. Due to scarce quantities, infusions of plasma pooled from volunteers were reserved for those most vulnerable to infection.
Fast forward to the 21st century, and the passive immunization picture changes considerably, thanks to steady advances in molecular medicine and new technologies that allow scientists to quickly characterize and scale up the production of the protective molecules.
Immune system’s defense workers
The immune systems of COVID-19 survivors figured out how to combat and defeat the invading SARS-CoV-2 virus.
Neutralizing antibodies are one kind of immunological front-line response. These antibodies are proteins that are secreted by immune cells called B lymphocytes when they encounter an invader, such as a virus.
Antibodies recognize and bind proteins on the surface of virus particles. For each infection, the immune system designs antibodies that are highly specific for the particular invading pathogen.
For instance, each SARS-CoV-2 virus is covered by distinctive spike proteins that it uses like keys to unlock the doors to the cells it infects. By targeting these spikes – imagine covering the grooves of a key with tape – antibodies can make it nearly impossible for the virus to break in to human cells. Scientists call these kind of antibodies “NAbs” because they neutralize the virus before it can gain entry.
A holy grail for vaccinologists is figuring out how to spark the production of these ingenious antibodies. On first infection, your B lymphocytes train themselves to become expert producers of NAbs; they develop a memory of what a particular invader looks like. If the same invader is ever detected again at any time, your veteran B lymphocytes (known as memory B cells by this stage) spring into action. They rapidly secrete large quantities of the potent NAbs, preventing a second illness.
Vaccines capitalize on this ability, safely provoking an immune response and then relying on the immune system’s memory to be able to fend off the real pathogen if you ever encounter it.
Passive immunization is a process in which neutralizing antibodies from one individual can be used to protect or treat another. A clever example of this process exploited by nature is breastmilk, which passes protective antibodies from the mother to the infant.
Example of Ebola virus disease
In addition to their potential preventative role, neutralizing antibodies are starting to prove beneficial in novel treatments for viral disease. Harnessing their protective power has been challenging, though, primarily because isolating enough antibodies to be effective is laborious.
Recent advances in the technology of molecular medicine at last allowed the kind of scale-up that enabled researchers to test the immunological principle. In 2014-15, Ebola virus disease surfaced in West Africa, triggering an epidemic that raged for over a year, killing more than 11,000 people. About 40% of those infected died. There were no treatments and no vaccine.
By the time Ebola again emerged from the rainforest, this time in 2018 in the Democratic Republic of Congo, the science was ready. In November 2018, doctors launched three parallel trials comparing three different antibody cocktails. Nine months later, spectacularresults allowed for an immediate end of the experimental trials so the cocktails could be used in the field.
While ZMapp did not work as well as anticipated, the trials identified two other antibody-based therapies from two different companies that did suppress Ebola symptoms in infected patients. The earlier in their infection that patients received therapy, the better the protection.
While the rapid move to evaluate this novel treatment is a moment for celebration, the science must keep moving. Convalescent plasma, which is isolated from recently recovered survivors, is in too short of a supply to be broadly useful. The most potent neutralizing antibodies must be quickly characterized and then produced efficiently in large quantities. Several companies, as well as a number of powerhouse academic labs, aim to meet the challenge of identifying and generating these life-saving NAbs.
At the fore isRegeneron, the pharmaceutical company that designed the effective Ebola treatment. Although targeting a different virus, their overall strategy remains the same. They’ve isolated and characterized NAbs and plan to engineer a cocktail of the most potent molecules. The viral target of these antibodies is the SARS-CoV-2 spike protein; the NAbs work by preventing the virus from entering cells.
Clinical trials are planned for early summer, essentially three months’ time. It is a breakneck pace for the development of such a sophisticated tool of intervention.
As the U.S. enters the exponential phase of COVID-19’s spread, this treatment cannot come soon enough.
You have a choice to make when it comes to the coronavirus pandemic.
Do you treat this time as an insurmountable threat that pits you against everyone else? This option entails making decisions based solely on protecting yourself and your loved ones: stockpiling supplies regardless of what that leaves for others; continuing to host small gatherings because you’re personally at lower risk; or taking no precautions because the effort seems futile.
Or do you treat the coronavirus as a collective challenge that will require shared sacrifices to achieve a difficult but not impossible goal? That option would mean taking recommended precautions: practicing social distancing, hand-washing and restricting travel. These actions might not be your most desired or convenient path as an individual, but they contribute to the broader social good, reducing the spread of COVID-19.
The way people process threatening events matters a lot for how well they’ll manage this period of uncertainty. Some identification of threat is useful and will mobilize you to action, but a rigid overestimation of threat makes you panic or immobilizes you.
Letting the threat dictate your response
When you perceive a situation as a dire threat, it changes how you process information.
No longer do you consider the pros and cons of your choices evenhandedly, looking at the situation from multiple perspectives. Instead, your attention narrows, selectively focusing on cues that reinforce your sense of danger and vulnerability.
Why is this a problem? After all, the world really is in the grip of an objectively dangerous pandemic. Paying attention to this threat seems vital for staying safe.
The issue occurs when you believe that your personal resources are insufficient to meet the demands of the situation. If you feel the threat is insurmountable, then you give up. Why try if you’re doomed to fail? And if you feel that your resources – be it food, money, time, energy – are inadequate or threatened, then you have nothing to share with others, and hoard what you can for yourself.
Feeling threatened can make you hyperfocused on monitoring for signs of danger, which can in turn mean consuming terrifying stories about COVID-19 almost nonstop. It’s important to stay informed, but prior research makes clear that people are more prone to mental health problems, like anxiety and post-traumatic stress disorder, if they don’t limit media exposure. In turn, reading about COVID-19 all the time increases the perception of threat, further fueling the need to monitor for danger signs in a vicious cycle that makes the world seem ever scarier.
Better to conceive a threat as a challenge
It’s better for your mental health to see this time as a collective challenge – one that is extremely difficult but which can be met if everyone works together.
When you size something up as a challenge, it’s easier to rise to the occasion. Instead of withdrawing from the problem, you shift to problem-solving. People with this mindset draw on others to help, and they offer their own support to those in need. Research has shown that working collaboratively and helping others has great mental health benefits for the helper.
Research on cognitive behavior therapy shows that shifting one’s outlook to perceive something as a motivating challenge rather than an insurmountable threat can be a successful way to treat anxiety disorders.
Cognitive therapy promotes questioning your thoughts instead of assuming the first one that pops into your mind is the most helpful. An individual becomes a scientist, weighing the evidence for and against ideas to reach more balanced conclusions. You become an explorer, thinking flexibly to consider new approaches to solving problems. If you sniffle once, you don’t immediately assume you have COVID-19 – you maintain precautions, but also consider whether this month is when your allergies usually act up and see if allergy medicine works.
It would be ludicrous not to acknowledge the real threats the world faces right now, and the disproportionate impact this difficult time has on already marginalized communities. But you need not define this threat as insurmountable and get stuck there. Choose instead to work together – albeit remotely – and accept the coronavirus challenge. The shift from threat to challenge might just make it a little easier to stay home, to close the browser and stop reading about COVID-19 24/7, to wash your hands for a full 20 seconds and to buy just what you need at the store so others can do the same.
As the number of COVID-19 cases continues to rise, a group of anesthesiologists wants to convert America’s surgery centers into critical care units for infected patients.
Many of the country’s more than 5,000 outpatient surgery centers have closed or sharply cut back on the number of elective procedures they perform, to comply with requests from government agencies and professional societies. But those surgery centers have space and staff, as well as anesthesia machines that could be repurposed into ventilators — all of which could be especially crucial in hard-hit areas like New York.
“Half of the surgery centers in New York are not doing anything,” said Adam Schlifke, an anesthesiologist and clinical assistant professor at Stanford University in California, who is leading the push for the centers to help. “All these anesthesiologists and nurses who are sitting on the sidelines, they want to help. They don’t know how to help. There’s nowhere for them to help. What if they could work in the surgery centers?”
Opening such outpatient centers nationwide to coronavirus patients would nearly double the number of facilities nationwide, up from the country’s fewer than 6,200 hospitals. But turning day facilities into places for 24/7 care worries some anesthesiologists. There are questions about staffing, regulations and payment. They also fear that using surgery centers as critical care units would do more harm than good if the centers aren’t properly equipped to handle severe cases of COVID-19.
“Even if we lifted the regulatory restrictions, surgery centers are licensed to do a certain thing,” said Dr. Steven Dalbec, a private practice anesthesiologist in Columbia, Missouri, who once ran a surgery center in Arizona. “If we could say, ‘OK, we’re going to lift all those restrictions and let you take care of critically ill patients,’ it’s not something that could happen overnight.”
Still, that’s exactly why Schlifke argues that it’s important to start now, especially in parts of the country with fewer cases. His group has created a blueprint that outlines the steps needed for surgery centers to convert.
In the coming days, Schlifke said, he and the approximately 75 members of the CovidVent coalition of anesthesiologists he’s helping organize will call for a federal executive order to enable the conversion of surgery centers and hospital operating rooms into COVID-19 care sites to help save lives.
The order is needed, he said, because he recognizes that providers want to get paid. The idea is so new, he said, there’s no reimbursement plan in place for surgery centers that agree to treat COVID-19 patients.
What’s most troubling, Schlifke said, is the number of anesthesiologists who cannot help with the pandemic because their center is either closed or they are busy with elective surgeries that aren’t necessary. It’s a frustrating dilemma.
“They want to work,” Schlifke said.
The CovidVent group also wants to make sure surgery centers follow Centers for Medicare & Medicaid Services recommendations that call for them to end nonessential elective surgeries to keep front-line medical providers safe amid shortages of protective supplies such as masks. Many of those surgery centers are in states like New York, California and Washington where hospitals can’t keep up with the demand.
“An important question for hospitals and health systems that continue to perform elective and nonessential surgeries is, ‘Why?'” said Dr. Greg Martin, president-elect of the Society of Critical Care Medicine, which represents intensive care doctors. “How do they justify the risk to the otherwise healthy individuals, justify the risk to the health care provider workforce who may be imminently needed elsewhere, and justify the unnecessary consumption of health care resources such as masks, gloves and gowns?”
But William Prentice, CEO of the Ambulatory Surgery Center Association, an industry group, argued that some surgeries remain necessary. “We’re pushing things off that can be pushed off,” he said.
Meanwhile, in Washington, D.C., Vice President Mike Pence has already come out in support of the use of anesthesiology equipment as ventilators.
Anesthesia machines used in the operating room can be repurposed as mechanical ventilators, Martin said. “But they function differently and do not have all the same settings as ICU ventilators, so employing them in COVID-19 care requires education or oversight from those who are expert in using them.”
Dalbec also supports converting anesthesia machines into ventilators. He now works at Boone Hospital Center in Columbia, Missouri, which he said is prepared to do that if needed. As of Friday, he said, the 230-bed hospital hasn’t treated a confirmed COVID-19 patient.
But creating new intensive care units is challenging, according to both Dalbec and Martin.
Dalbec, who ran a surgery center in Tucson, Arizona, for 10 years, worries a lot of surgery centers don’t have the training, skills or supplies to care for critically ill patients.
“Time is of the essence,” Dalbec said. “And so that would make the care for these patients considerably challenging.”
An ICU has sophisticated equipment, such as bedside machines to monitor a patient’s heart rate and mechanical ventilators to help them breathe, Martin said. Ventilators need to be hooked up to oxygen and gas lines, which supply patients with the appropriate mix of air.
Only a few areas of the hospital have the equipment and gas hookups to provide ventilator care to critically ill patients, Martin said. These include the operating room, emergency department and units used for post-anesthesia care. To convert an ordinary hospital unit to an ICU, Martin said, “You would literally need to tear down the wall and run the piping in.”
Hospitals are already looking to use operating rooms for intensive care, Martin said.
“Using OR space, equipment and staff to care for sick COVID-19 patients is the right thing to do,” Martin said. “This is one approach that most health systems are already considering and using.”
Many outpatient operating rooms at surgery centers already have the required gas and oxygen hookups, Martin said. “Some will have fully configured operating rooms with ventilators,” he said. “It would be one way to expand ICU-level patient care space.”
But they are unlikely to stock all the medications used in an ICU.
Another challenge, he said, would be that staff from most surgery centers may be pulled into hospitals — anesthesiologists, nurses and nurse anesthetists — and surgery centers would not have all the pharmacists, respiratory therapists and other staff.
Intensive care units are staffed by specially trained doctors, nurses and respiratory therapists, who set up ventilators and closely monitor patients’ breathing, Martin said. “The hardest thing to change is the staffing,” he said. “We only have a certain number of doctors, nurses and respiratory therapists.”
CovidVent is working with several telemedicine groups that could help treat patients in areas where the staff lacks the expertise, Schlifke said.
Outpatient surgery centers would need to receive a waiver from federal regulators to keep patients overnight or perform medical care they don’t currently perform, Prentice said.
Prentice said he’s optimistic that the Centers for Medicare & Medicaid Services will make an announcement about such waivers in coming days.
“Once we get that flexibility, we can find the best way to help,” Prentice said. “Decisions about how to best to use ambulatory surgery centers need to be made in conjunction with hospitals at the local level.”
Source: by [#item_author] from Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente. More Read More
Meetup, one of the world’s first social media platforms and the only one dedicated to groups that meet in-person or online during times of crisis, today announced that the company has been acquired. The consortium of investors is led by Kevin Ryan’s AlleyCorp and includes mission-driven private funds and accomplished technology executives. Ryan joins as Chairman of the board. David Siegel will stay on as CEO of Meetup, board member, and he will continue to lead the company.
Meetup will divest from The We Company (“WeWork”) and operate independently after two-and-a-half years as a subsidiary. The company will continue to service its growing 49 million members and over 230,000 organizers, who collectively produce an average of 15,000 in-person events daily. Meetup’s enterprise business solutions will also continue under Meetup Pro, a community building and engagement platform with more than 1,500 clients including Adobe, Google, Microsoft Azure, IBM, Twitter, and Looker and hundreds of entrepreneurs.
“This acquisition provides the long-term capital to ensure that Meetup focuses on what is most important: the organizers who make Meetup successful, our passionate members, and our dedicated employees,” said David Siegel, CEO of Meetup. “We are excited to continue on our mission of empowering personal growth through real human connections, and I’m happy to have brought in a team of smart investors who share and support the same values.”
“We are confident in the enormous potential of the business and Meetup’s mission of bringing people together in substantive ways,” said Kevin Ryan of AlleyCorp, who is the lead investor and Chairman of the Board. “We are very excited to collectively serve and grow Meetup’s extensive and incredibly engaged user base.”
A predecessor to Facebook, YouTube, Instagram, TikTok, and Twitter, Meetup shares a similar global member reach, throughout 193 countries. Contrastingly, Meetup’s business is built around using online social media to help people be more social offline — without using its users’ private data for the purpose of targeted advertising. In 2019, Meetup drove 30 million hours of real-life human connection and experienced a 40% growth in its enterprise business. In 2020, the company updated its policy to allow organizers to host events online during the Coronavirus pandemic.
Meetup was founded in 2002 as a platform for finding and building local communities. While the company and its user base have significantly expanded and evolved since then, the mission has remained the same. Meetup will always foster human connection. This acquisition will propel Meetup to continue exploring and growing innovative new ways of bringing communities together.
“We thank David and the entire Meetup team for their many contributions to WeWork over the past two and a half years,” said Rohit Dave, Head of Corporate Development, WeWork. “Our decision to divest Meetup aligns with WeWork’s renewed focus on the company’s core workspace business and marks a positive step forward for both WeWork and Meetup.”
About Meetup Meetup is the leading social media platform dedicated to connecting people in person or online during times of crisis. Established in 2002, its mission is to help people grow and achieve their goals through real-life, human connections. From professional networking to craft brewery crawls to coding workshops and more, people use Meetup to get out from behind their screens to meet new people in real life who share those same passions or professional aspirations. Meetup uses technology and social media to help people get away from technology and become more social. Join Meetup to try something new, or to start a group and find other passionate people, at Meetup (https://www.meetup.com/) and follow company news on Twitter, Instagram, and Facebook (@Meetup). For enterprise business solutions visit Meetup Pro (https://www.meetup.com/pro).
Meetup supports 49 million members, 330,000 groups, and 100,000 events per week in 193 countries and 2,000 cities around the world.
Host – David: Coronavirus–what is it? How is it related to the flu? The experts in Europe say that 70% of population will get it. What will happen next winter?
Host – Admit: How do we differentiate in terms of Chinese medicine?
Dr. Liu: Diagnostic testing is more advanced in biomedicine. Biomed wants to know what exactly is invading. Chinese medicine cares more about how the body reacts. The biomed immune system is equivalent to Chinese medicine’s Lung System: that includes the Lung Zang-organ, the skin and pores, the Large Intestine Fu-organ, their corresponding channels, etc.
Now we know viruses are not live organisms, but parasites that host themselves in our cells. When there are no vaccines available yet [to prevent people from getting sick in the first place, the question is] how to maintain the body functions while antibodies are being made by our immune system to counter the virus. Chinese medicine has the advantage when it comes to treatment. We basically look at what level or depth the virus has penetrated to and improve the situation at that level.
Q: Everyone is working from home here in the Silicon Valley. How do we raise the immune system?
Dr. Liu: To raise the immune system we need to improve Lung organ function. The Lung has 2 exit pathways: 1. Lung and skin i.e. biǎo 表 ‘exterior’ takes 20-30% of garbage out through sweating.
2. Lung and digestion i.e. intestines take 80-90% out through excretion. The digestion is responsible for both excretion and absorption of nutrients from the food we eat to maintain metabolism for metabolic function of the rest of the body. The liver, kidney and pancreas are in charge of creating antibodies ASAP.
Q: Same strategy for high risk groups?
Dr. Liu: Same. Wash hands, wear masks, use Lysol or alcohol on surfaces. Keep the air dry; this is actually a time when turning up your forced air heater is actually helpful because the virus prefers cool moist environment. Use a dehumidifier if you have one.
Q: In Europe they are recommending self quarantine at home for lighter cases. Do you have any recommendations for home remedies?
Dr. Liu: The course of this pandemic appears to be 9 days. The first 5 days are light. Day 1 symptoms include sore throat, no fever, no fatigue, regular appetite/thirst. Here the virus is just affecting the most superficial part of you, the nose and throat. If we can keep it here the disease has no chance to get much deeper. Okay, the first 3 days are like this.
After that it progresses to more painful sore throat, body aches, rasping in the voice, still no fever, headache, diarrhea and digestive dysfunction. People with weaker digestive function are more likely to get this disease. We noted this when the virus first started infecting people in Wuhan; all the patients have obvious lower digestive function.
America has disadvantages, even though our housing is not so dense (unlike China). We have less rain here in the Bay Area, so the air is more dry. This is a disadvantage for airborne diseases like pneumonia droplets. People eat salad and fruit which dampens the digestion. The dampness goes into organs, clogging up the digestive exit pathway, so you can’t just treat the exterior to resolve the issue when it’s gotten in this far.
No digestive signs and symptoms = light case If you do not protect your digestion, it is very hard to control the disease’s progress.
aches/digestive symptoms have started*
Improve immune system’s communication btw organs and surface, promote sweating.
We’ve changed the dosing a little, and added some modifications. Most notably, we are using a high dose of chai hu to speed up the body’s internal communications to keep the disease in the exterior part of the body and block it from penetrating the interior. Of course, it’s better to consult your herbalist and have a professional monitor you recovery.
Q: That’s for people who have already contracted Coronavirus. How about the people who have not gotten it yet? Also [because of panic buying] a lot of herbs are out of stock. Do you have any dietary recommendations for that?
Dr. Liu: This is a very good question. I devised a small formula for people to take as a preventative measure. Please make note of the preparation process because it’s a bit more complicated than usual. Herbs shēng jiāng 生薑 fresh ginger 20g yáng cōng 洋蔥 onion 200g chén pí 陳皮 aged tangerine peel 10g sugar or honey to taste
Preparation: 1. Decoct 10g ginger and 10g chen pi first for 10-15 minutes. (Ginger, when cooked longer than 5 minutes, supports the digestive system without promoting sweating. Chen pi is great for transforming phlegm and increasing peristalsis.) 2. Add 10g ginger and one large onion for 3-5 minutes. (This harnesses the aromatic volatiles to open the pores.) We say in Chinese, xīn gān huà yáng 「辛甘化陽」”Spicy [and] sweet transform [into] yang.” This is why adding a little sweetness to spicy gives us more energy, i.e. more yang. Use honey for diabetics, it affects the blood sugar less.
Q: Self acupressure suggestions?
Dr. Liu: Yes. (see demo in video at 22:30) For activating the exterior, rub the Lung and Large Intestine channels [btw LI4-LI6, Lu10-Lu6] gently. You only have to stimulate the skin because the goal is to activate the pores.
Because every individual’s constitution and health situation differs, please consult your primary treating physician of Chinese medicine before using herbs.
For digestion, put both hands on your abdomen, over the belly button [Ren8]; men with the left hand under, women with the right hand under. Rub in a circle 36 times clockwise, 36 times widdershins. Stomach 36 and Gallbladder 34 are also good points to massage. Moxa is good, especially ginger moxa [where you put the dried mugwort on a coin-thick slice of ginger perforated with toothpick holes, and place the ginger over the point]. Heating the low back area is also good. Really anything that improves the circulation at the surface and the digestive function.
Q: Can we come back to the question of how far this virus is going to affect us into the future?
Dr. Liu: It won’t disappear. It’s here. But it is, as we have already seen, limited by environment. First of all, we’ve seen that most infections are happening around 40 degrees north latitude. That’s one example of environment. Secondly, here on Earth we are affected by the position of the five planets [closest to us]. This is why we say that often in the year of gēng zǐ 庚子 there are often virulent plagues. This is because some of the microorganisms here on Earth are affected by the magnetic field of the positions of the planets around us; the interference causes mutation and outbreaks to happen. As the planets rotate, at some point the magnetic resonance disappears, and the effects [here on Earth therefore] diminish. My personal opinion is that after the end of March, this virus will weaken, so if we can all make it through this time, even if you get the virus later, it will be a weaker version of itself, and its effects will not be so terrible. But as a virus, it will survive, just differently. Studies are already showing that the virus is changing; we are seeing second and third generations. This is nothing to panic about. Those of you who are parents, your kids look different than you right? So the virus, when it replicates itself, its offspring also looks different from them. This is natural. Kids are supposed to be different from their parents.
Q: Okay let’s look at some clarifying questions from the participants! 1. Do we massage both hands?
Dr. Liu: Yes.
Q: 2. For your tangerine peel, ginger, onion, and honey formula, how much water do we use for the decoction?
Dr. Liu: Three cups cold water decocted to 2 cups of beverage.
Q: 3. If Coronavirus patient has diarrhea, do we want to stop the diarrhea with medication or help the body detox by allowing it to happen?
Dr. Liu: Practitioners of Chinese medicine don’t usually stop diarrhea per se; we improve your Stomach and Intestines’ functionality. With better function, whatever is supposed to be excreted goes out, and the diarrhea stops on its own. In some cases we do see, usually when you actually have been poisoned, where we support the diarrhea to help you detox. But mostly we’re improving the digestive function. Huo Xiang Zheng Qi San is a good example of this; it’s a formula for diarrhea, but it doesn’t concern itself with stopping the diarrhea. It improves your digestive function, and the diarrhea stops on its own.
Q: 4. What foods and supplements should we eat?
Dr. Liu: I have some opinions on this subject. There’s a lot of experts recommending Vitamins C, D, and E. I disagree. If you read Dr. Wu’s article closely you’ll see it actually recommends Vitamin C and E after the patient has been very severely ill and is now recovering. In other words the patient has to be past the severe stages, have recovered from their illness, before taking Vit. C and E.
This is because Vitamin C is a very strong astringent. It’s highly acidic; this will close the pores, tighten the body. So if you are going out, going into hospital for example, and you are in the high risk group, taking a dose of Vitamin C to “seal up” your body makes sense, and does decrease your risk of contracting a virus. However, remember that closing up the pores shuts off one of the Lung’s two exit pathways. Also, right now we are in the season of Spring. Spring belongs to Liver, and the Liver needs to express itself; it needs to release/disperse. [This is the same verb fā 發 “to express” as in fā rè 發熱 “to express fever/heat” and the same verb sàn 散 “to disperse” as “to scatter”…and the same character sǎn 散 as we use in powdered formulas.] The body’s energy in Spring is supposed to flow from the internal organs outward toward the limbs. Vitamin C interrupts this flow. It[s action] is not aligned with the nature of Spring. So I recommend against Vitamin C. Now Vitamin E is great for nourishing yin. What we mean when we say something nourishes yin, it increases the fluids inside your body. In other words, it creates more dampness. When our insides are more damp, the digestion weakens. Gut motility slows down. In other words it impacts your Lung and digestive tract’s exit pathway. This is great for people who have lost a lot of fluids, for example after sweating profusely in prolonged severe illnesses, but we do not recommend it as an everyday preventative. Vitamin D is okay to take.
Q. 5. Preventative measures for pregnant ladies?
Dr. Liu: This is very dangerous. Get tested asap. Pregnancy is so individualized, so unique to each individual, I can’t make any generalizations. Go see your doctor about it.
Q. 6. After contact with inflected, how to prevent self from getting sick?
Dr. Liu: Take 3-5 days Chái Gé Jiě Jī Tāng 柴葛解肌湯 dosed for mild/early stage. It will speed up your progression through
Q. 7. Would Xiǎo Chái Hú Tāng 小柴胡湯 work?
Dr. Liu: Xiao Chai Hu Tang only opens the communication between the interior and exterior, but it doesn’t really have the power to push things outward… it lacks momentum, and also it doesn’t really benefit the digestion much, so its benefits here will be much less.
Because every individual’s constitution and health situation differs, please consult your primary treating physician of Chinese medicine before using herbs.
Lukas Kopacki, home from college after the coronavirus pandemic closed his campus, was feeling lousy for days with headaches, sore throat and difficulty breathing through his nose. But he worried that a trip to a doctor’s office might make him sicker.
“I had no desire to go into that cesspool of bacteria and viruses,” said Kopacki, 19, of Ringwood, New Jersey.
So, last week the University of Vermont student called Teladoc, a company that connects patients to doctors by phone nationwide. Its physician diagnosed his sinus infection and sent a prescription for an antibiotic to his local pharmacy. With his Aetna health coverage, which earlier this month temporarily waived its $45 patient copayment for virtual care, Kopacki paid out-of-pocket $1.44, which covered his costs for the drug.
“It was quick and easy,” he said.
Getting heath care by phone or video conferencing has been around for several decades, but the outbreak of coronavirus has led to an increase in telemedicine use as never seen before, according to health systems and provider groups across the country.
Millions of Americans are seeking care by connecting with a doctor electronically, many for the first time. Health systems, insurers and physician groups said it allows people to practice social distancing while reducing the spread of the disease and protecting health workers.
Private technology companies such as Teladoc, Doctor On Demand and Amwell and large health care systems can provide a doctor directly to someone who contacts them. Other patients may seek a telemedicine appointment with their regular physician, who can use computer applications through smartphones and computers. All types of primary and specialty care and mental health services can be provided via telemedicine.
Many hospitals have recently added telemedicine services to keep patients concerned about the coronavirus from clogging their emergency rooms.
Also spurred by the goal to keep patients away from crowded medical facilities, government and private insurers have increased the payment for telemedicine visits so they are on par with in-person visits. Before the outbreak, insurers paid less than half that amount, which dissuaded many doctors from offering the services.
Medicare last week allowed all enrollees to use telemedicine — an option that previously was available only to people living in remote areas and for a specific, short checkup. The federal government also said doctors could practice across state lines during the pandemic to treat Medicare patients virtually, even if not licensed in the patient’s state. California, Florida and other states have also waived their requirements that a physician be licensed in the state to provide care.
The Cleveland Clinic is on track to log more than 60,000 telemedicine visits in March, according to officials there. Before March, that health system – which has hospitals in Ohio and Florida — averaged about 3,400 virtual visits a month.
Its Express Care Online system serves patients across the country 24 hours a day. About 75% of the calls now come from people worried they have COVID-19, said Dr. Matthew Faiman, medical director of the service. Like many other health systems, Cleveland Clinic’s virtual urgent care is waiving patient copays during the pandemic.
“We are seeing a significant upsurge in demand from patients seeking care – both the worried well and patients who are sick and wanting to know how to manage their symptoms,” Faiman said. The clinic has pulled more doctors into the telehealth work since elective surgeries were canceled and fewer patients are making in-person visits.
He applauded the Medicare changes and predicted such changes will likely stay after the national emergency ends.
Dr. Manish Naik, chief medical information technology officer at the Austin Regional Clinic in Texas, also predicted it will be hard to go back.
“Telemedicine has been on the brink for a while now,” Naik said. “And doctors and patients are going to find that when this is all over and the dust settles there are a lot of people who are going to want the telemedicine option to stay.”
Of course, such visits have limitations, such as when doctors need to listen to a patient’s lungs or order an X-ray to check for pneumonia. But Naik said telemedicine also gives doctors a more complete view of the patients through “observation around the home” and interactions there that shows “things we never could see before.”
Before March, NYU Langone Health in New York had about 50 virtual visits a day through its urgent care telemedicine platform. During the week of March 23, the hospital system is averaging about 900 a day.
For 80% of telemedicine visits, cough is the chief complaint followed by fever, said Dr. Paul Testa, its chief medical information officer. NYU Langone has 170 doctors who attend to telemedicine patients, up from 35 two weeks ago, he said.
“We are not recommending testing for everyone, but we are recommending self-care, hydration and self-isolation,” Testa added. “The goal is to create a new front line for these patients rather than have them rush into an urgent care or ER.”
If a patient is having trouble breathing or otherwise is in distress, an NYU telemedicine provider will direct them to call an ambulance if necessary or go to the ER and alert the hospital the patient is coming.
Teladoc is averaging 15,000 patient visits a day in the United States, 50% higher than in February. Wait times have increased from minutes to hours in some cases, a spokesperson said.
At the Austin Regional Clinic, which has 340 doctors in 28 offices, nearly half of patient visits are now virtual compared with a fraction before the outbreak.
“With the COVID-19 situation, we have patients who are nervous about coming in, and we don’t want patients with symptoms coming in and exposing others,” Naik said.
He said that for years the clinic made the telemedicine option available, but it did not make sense financially to promote it because insurers paid less than half the rate they would for an in-person visit.
The Medicare payment change can’t be understated, he said, because it covers such a large number of patients and because private insurers usually follow Medicare policies. “That’s really allowed us to open things up,” Naik said.
Advocates for decades have called on Medicare to expand telemedicine coverage, but federal officials held back because of concerns about increased costs. Critics worried telemedicine would not replace in-person doctor visits but lead to more total visits because of the ease with which people could connect to their doctors via telemedicine.
The Trump administration had been moving to widen telemedicine options even before the pandemic. In 2019, it allowed Medicare for the first time to pay doctors on average about $14 for a five-minute “check-in” phone call with their patients.
Ken Prussner, 74, of Herndon, Virginia, used his home computer Monday to connect with his longtime physician.
Prussner had a gastrointestinal illness and a low-grade fever and his family wanted to make sure he didn’t have COVID-19. His doctor’s office sent him a website link and his physician spoke to him as if he was in the office. He allayed Prussner’s fear, telling him he had a typical lower-bowel infection that would clear up on its own within three to five days.
“It was pretty seamless,” said Prussner, a retired U.S. Foreign Service officer.
Source: by [#item_author] from Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente. More Read More