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How Apple and Google will let your phone warn you if you’ve been exposed to the coronavirus


On April 10, Apple and Google announced a coronavirus exposure notification system that will be built into their smartphone operating systems, iOS and Android. The system uses the ubiquitous Bluetooth short-range wireless communication technology.

There are dozens of apps being developed around the world that alert people if they’ve been exposed to a person who has tested positive for COVID-19. Many of them also report the identities of the exposed people to public health authorities, which has raised privacy concerns. Several other exposure notification projects, including PACT, BlueTrace and the Covid Watch project, take a similar privacy-protecting approach to Apple’s and Google’s initiative.

So how will the Apple-Google exposure notification system work? As researchers who study security and privacy of wireless communication, we have examined the companies’ plan and have assessed its effectiveness and privacy implications.

Recently, a study found that contact tracing can be effective in containing diseases such as COVID-19, if large parts of the population participate. Exposure notification schemes like the Apple-Google system aren’t true contact tracing systems because they don’t allow public health authorities to identify people who have been exposed to infected individuals. But digital exposure notification systems have a big advantage: They can be used by millions of people and rapidly warn those who have been exposed to quarantine themselves.

Bluetooth beacons

Because Bluetooth is supported on billions of devices, it seems like an obvious choice of technology for these systems. The protocol used for this is Bluetooth Low Energy, or Bluetooth LE for short. This variant is optimized for energy-efficient communication between small devices, which makes it a popular protocol for smartphones and wearables such as smartwatches.

Bluetooth allows phones that are near each other to communicate. Phones that have been near each other for long enough can approximate potential viral transmission.
Christoph Dernbach/picture alliance via Getty Images

Bluetooth LE communicates in two main ways. Two devices can communicate over the data channel with each other, such as a smartwatch synchronizing with a phone. Devices can also broadcast useful information to nearby devices over the advertising channel. For example, some devices regularly announce their presence to facilitate automatic connection.

To build an exposure notification app using Bluetooth LE, developers could assign everyone a permanent ID and make every phone broadcast it on an advertising channel. Then, they could build an app that receives the IDs so every phone would be able to keep a record of close encounters with other phones. But that would be a clear violation of privacy. Broadcasting any personally identifiable information via Bluetooth LE is a bad idea, because messages can be read by anyone in range.

Anonymous exchanges

To get around this problem, every phone broadcasts a long random number, which is changed frequently. Other devices receive these numbers and store them if they were sent from close proximity. By using long, unique, random numbers, no personal information is sent via Bluetooth LE.

Apple and Google follow this principle in their specification, but add some cryptography. First, every phone generates a unique tracing key that is kept confidentially on the phone. Every day, the tracing key generates a new daily tracing key. Though the tracing key could be used to identify the phone, the daily tracing key can’t be used to figure out the phone’s permanent tracing key. Then, every 10 to 20 minutes, the daily tracing key generates a new rolling proximity identifier, which looks just like a long random number. This is what gets broadcast to other devices via the Bluetooth advertising channel.

When someone tests positive for COVID-19, they can disclose a list of their daily tracing keys, usually from the previous 14 days. Everyone else’s phones use the disclosed keys to recreate the infected person’s rolling proximity identifiers. The phones then compare the COVID-19-positive identifiers with their own records of the identifiers they received from nearby phones. A match reveals a potential exposure to the virus, but it doesn’t identify the patient.

The Australian government’s COVIDSafe app warns about close encounters with people who are COVID-19-positive, but unlike the Apple-Google system, COVIDSafe reports the contacts to public health authorities.
Florent Rols/SOPA Images/LightRocket via Getty Images

Most of the competing proposals use a similar approach. The principal difference is that Apple’s and Google’s operating system updates reach far more phones automatically than a single app can. Additionally, by proposing a cross-platform standard, Apple and Google allow existing apps to piggyback and use a common, compatible communication approach that could work across many apps.

No plan is perfect

The Apple-Google exposure notification system is very secure, but it’s no guarantee of either accuracy or privacy. The system could produce a large number of false positives because being within Bluetooth range of an infected person doesn’t necessarily mean the virus has been transmitted. And even if an app records only very strong signals as a proxy for close contact, it cannot know whether there was a wall, a window or a floor between the phones.

However unlikely, there are ways governments or hackers could track or identify people using the system. Bluetooth LE devices use an advertising address when broadcasting on an advertising channel. Though these addresses can be randomized to protect the identity of the sender, we demonstrated last year that it is theoretically possible to track devices for extended periods of time if the advertising message and advertising address are not changed in sync. To Apple’s and Google’s credit, they call for these to be changed synchronously.

But even if the advertising address and a coronavirus app’s rolling identifier are changed in sync, it may still be possible to track someone’s phone. If there isn’t a sufficiently large number of other devices nearby that also change their advertising addresses and rolling identifiers in sync – a process known as mixing – someone could still track individual devices. For example, if there is a single phone in a room, someone could keep track of it because it’s the only phone that could be broadcasting the random identifiers.

Another potential attack involves logging additional information along with the rolling identifiers. Even though the protocol does not send personal information or location data, receiving apps could record when and where they received keys from other phones. If this was done on a large scale – such as an app that systematically collects this extra information – it could be used to identify and track individuals. For example, if a supermarket recorded the exact date and time of incoming rolling proximity identifiers at its checkout lanes and combined that data with credit card swipes, store staff would have a reasonable chance of identifying which customers were COVID-19 positive.

And because Bluetooth LE advertising beacons use plain-text messages, it’s possible to send faked messages. This could be used to troll others by repeating known COVID-19-positive rolling proximity identifiers to many people, resulting in deliberate false positives.

Nevertheless, the Apple-Google system could be the key to alerting thousands of people who have been exposed to the coronavirus while protecting their identities, unlike contact tracing apps that report identifying information to central government or corporate databases.

[You need to understand the coronavirus pandemic, and we can help. Read The Conversation’s newsletter.]

This article is republished from The Conversation under a Creative Commons license. Read the original article here:Read More

Startups & Investors in Middle East, Mandar Joshi, Angel Investor, Dubai, UAE.


F50 presents ‘Startups & Investors in Middle East’, by Mandar Joshi, Strategic Advisor & Angel Investor, Dubai, UAE. Mandar Joshi is a well known Startup Advisor and Angel Investor based out Dubai, UAE. He advices, mentors and invests into early stage startups in the Middle East. He talks about the startup ecosystem in Middle East and emerging opportunities for Founders & Investors. Read about or connect with Mandar Joshi (https://www.linkedin.com/in/mandar-jo…).

This discussion is moderated by Pavan Kumar, Partner, F50 Elevate.

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.

F50 Global Committee joined by 20 investors and medical experts as advisory board for Global Capital Summit 2020


The F50 Global Capital Summit® (GCS) is Silicon Valley’s largest international investor conference taking place from June 16th to June 17th, online globally. 

The F50 Global Committee is the advising board for the summit  content which include 20 members of investors, medical professional, and media partners, more members from India, europe will join soon. The committee members are calling global investor communities  to support the innovations to help fight the COVID-19 pandemic.

The spread of the coronavirus has highlighted the imperative for new technologies and solutions in the health and medical area. Innovators, leaders and influencers in the startup ecosystem, are vital to accelerating progress worldwide. This special summit is calling for action to fight with COVID-19, and this is our first online and offline event.  The content will be featured on F50 Global Insights Youtube channel and SVE Channel.

  • Dr. Ossama Hassanein, Chairman, Rising Tide VC
  • Dr. Patrick Carroll, CMO, HIMS/HERS; Former Chief Medical Officer at Walgreens
  • Dr. Sean Randolph, Sr. Director, Bay Area Council Institute
  • Dr. Shafi Ahmed,”Professor, Associate Dean”,Barts Medical School
  • Dr. Uli K. Chettipally, MD., MPH., Founder & President InnoMD
  • Dr. Xiang Qian, Medical Director, International Medical Services,Stanford Health Care
  • Jinbo Liu, President, Netease USA
  • Keith Teare, Angel Investor
  • KumarSripadamChairman
  • Lu Zhang, Founding Partner, Fusion Capital
  • Dr. Minesh Khashu M.B.B.S, MD, FRCPCH, FRSA, Q Fellow (Health Foundation & NHSI), Consultant Neonatologist, Poole Hospital NHS
  • Oana Marcu, Scientist, SETI(NASA)
  • Ossama Hassanein, Chairman, Rising Tide Fund
  • Pavan Kumar, Partner, F50 Elevate
  • Roger Royse, Partner
  • Roger Sanford Cofounder, Healthgrid
  • Sean Randolph, Senior Director, Bay Area Council Economic Institute
  • Stephaine Marrus, Managing Director, UCSF Entrepreneur Center
  • Steve Lau, Founding Partner, Eagle Fund

Visit f50.io/summit for more information.

The Inside Story Of How The Bay Area Got Ahead Of The COVID-19 Crisis


Sunday was supposed to be a rare day off for Dr. Tomas Aragon after weeks of working around-the-clock.

Instead, the San Francisco public health officer was jolted awake by an urgent 7:39 a.m. text message from his boss.

“Can you set up a call with San Mateo and Santa Clara health officers this a.m., so we can discuss us all getting on the same page this week with aggressive actions, thanks,” said the message from Dr. Grant Colfax, director of San Francisco’s Department of Public Health.

“Will do, getting up now,” Aragon responded.

It was March 15, two days before St. Patrick’s Day, a heavy partying holiday and nightmare scenario for public health officials.

The novel coronavirus was spreading stealthily across the San Francisco Bay Area and public health officials were alarmed by the explosion of deaths in Italy and elsewhere around the globe. Silicon Valley would be next, case counts indicated.

Until then, they had primarily focused on banning mass gatherings. But they knew more had to be done — and wanted to present a united front.

Within a few hours of the text, Bay Area public health leaders jumped on a series of calls to debate options, including the most dramatic — a lockdown order that would shutter businesses, isolate families and force millions of residents to stay home.

They decided they had no choice. And they were able to move swiftly because they had a secret weapon: a decades-long alliance seeded in the early days of the AIDS epidemic that shields them from political blowback when they need to make difficult decisions.

Together, they would issue the nation’s first stay-at-home order, likely saving thousands of lives and charting the course for much of the country. Three days later, Gov. Gavin Newsom followed with his own order for California. New York came next, as have dozens of states since.

“This was one exhausting and difficult day for all of us,” Aragon later wrote in his journal. “We all wish we did not have to do this.”

Now, officials nationwide are weighing how to lift isolation orders as the rate of COVID-19 transmission slows — and protests against the orders mount. The Bay Area is again poised to lead, but with a warning: All of this could be for naught if it isn’t done right.


The coalition of county public health officers didn’t set out to lock down the Bay Area that fateful Sunday morning in mid-March. But as they discussed the exponential increase in Santa Clara County cases, where the hospitals were becoming overwhelmed by infected patients falling ever sicker, what they needed to do “started to crystalize,” said Dr. Sara Cody, the county’s public health officer.

“It felt huge to me,” she recalled, “because I knew how disruptive it would be.”

Elsewhere in the region, diagnosed cases were sparse. But decades of experience had shown the health officers that while they represent different jurisdictions, they are one region when it comes to infectious diseases. “We knew that it would be a matter of time before that was our experience,” said Dr. Matt Willis, Marin County’s public health officer, who contracted COVID-19 days later.

Cody told her colleagues that Italy was under siege, and her county was just two weeks away from a similar fate. If she could have locked down sooner, she told them, she would have.

“That was compelling,” said Dr. Lisa Hernandez, the public health officer for the city of Berkeley, which had not yet recorded any cases of community transmission. “We knew there was going to be St. Patrick’s Day parades and celebrations, so the timing was critical.”

Dr. Scott Morrow, California’s longest-serving public health officer, who heads operations in San Mateo County, said he also felt the urgency. “We thought, ‘Yes, the clock is ticking,'” he recalled.

County health officers in California have immense power to act independently in the interest of public health, including the authority to issue legally binding directives. They don’t need permission from the governor or mayors or county supervisors to act.

Even for this group, though, with all its collective strength, telling millions of Californians to shelter in place seemed risky at first. But the health officers involved had grown to trust one another, even if they don’t always see eye to eye.

For instance, they currently disagree on whether to require residents to wear face coverings. Some counties, including San Francisco and Marin, are requiring them in public, while others, like Santa Clara, are not.

On the first Sunday morning call, Aragon floated the idea of developing a coordinated recommendation that Bay Area residents stay at home. By the next confab, Cody, Santa Clara County’s health official, made the case that for social distancing to work, it had to be an order.

“Sara Cody was the courageous leader!” Aragon later wrote in his journal.

So forceful a move can be unpopular, but evidence shows it can also be the most effective, in the absence of treatment or a vaccine. “Here’s the rub on these methods — they only work if you do it really early,” said Dr. Howard Markel, a medical historian at the University of Michigan and an expert on the 1918 flu pandemic.

“When you do a quarantine, you stop the commerce, you stop the flow of money,” he said. “But on the other side of that are those whose lives are saved.”


This isn’t the group’s first pandemic. The alliance, formally called the Association of Bay Area Health Officials, was born in 1985 in the early days of the AIDS epidemic.

Dr. David Werdegar, who became health officer for San Francisco that year, was analyzing AIDS data for surrounding counties and asked their health officers to join him for dinner at Jack’s, an old bordello-turned-political hangout in the city that has since shuttered.

Most of the infectious disease research was happening in San Francisco at the time, but HIV was spreading, and one city couldn’t fight it alone.

“It was important that we share all the information we had,” said Werdegar, now in his 80s and retired.

Dr. Robert Melton, a former Monterey County health officer, said that working for nearly two decades with Bay Area public health giants taught him tremendous lessons. “Camaraderie is important in maintaining the energy to be able to focus on the common good, through good and bad,” he said.

That close-knit relationship among the 13 health officers — representing counties stretching across a large swath of Northern California from Napa to Monterey — continues to this day. Collectively, their public health actions touch about 8.5 million people.

They meet monthly and communicate regularly on Slack, a messaging app. Their diverse backgrounds and expertise, especially in an era of funding cuts, provide a deep well of public health knowledge from which to draw. Together, the group has joined forces to combat youth vaping, air pollution and measles outbreaks.

And they have also tackled various influenza scares, which is why they had an emergency response blueprint at the ready when cases of what would later be called COVID-19 first cropped up in Wuhan, China.

“We spent a couple years as a region thinking about pandemic planning, and that really helped us come a long way thinking about these policies for COVID-19,” said Dr. Erica Pan, the interim health officer for Alameda County.

So when they jumped on the call that Sunday, they were already in mid-conversation about how to respond. They brought their lawyers and, working into the predawn hours, translated their lockdown plan into legalese, one that would be enforceable with fines and misdemeanor charges.

They would make prime-time announcements across the region the next day, alongside elected officials. “This is not the moment for half-measures,” said San Jose Mayor Sam Liccardo. “History won’t forgive us for waiting an hour more.”

At first, the stay-at-home order applied just to the “Big Seven” counties surrounding the San Francisco Bay, whose officers peeled off from the larger group to issue it first. They shared their model ordinance with the others, who quickly followed.

Dr. Gail Newel, an OB-GYN and Santa Cruz County’s health officer, is not an infectious disease expert. She has relied heavily on the group’s expertise throughout her career, and especially now.

“It’s this incredible bank of knowledge and wisdom and experience that’s freely shared among the members,” she said. “And the whole Bay Area benefits by that shared knowledge bank.”


Roughly one month after they made the unprecedented decision to close the local economy, the risk seems to have paid off. It will be years before researchers have fully analyzed its impact, but officials across the Bay Area are cautiously optimistic. Others haven’t been so lucky.

Though there are important differences between the two regions, New York City, which issued a stay-at-home order four days after the Bay Area, saw its hospitals completely overwhelmed and had recorded more than 14,600 deaths as of Monday.

By comparison, the counties represented by the alliance have documented more than 215 deaths and hospitals haven’t been overtaken by a surge. In fact, hospitals brought online specifically to accommodate an overflow of patients are sitting largely empty.

Even within California, communities that waited to issue lockdown orders have emerged as COVID-19 hot spots, including Los Angeles, where Mayor Eric Garcetti followed suit three days after the Bay Area.

Internally, some of the Bay Area health officials have wondered if they made the right call. But “anytime I have any doubt, I just read another news report from New York or Detroit or New Orleans,” said Dr. Chris Farnitano, Contra Costa County’s health officer.

And the close-knit band is already undertaking its next task: reopening the economy without causing another spike in cases.

Before the orders are lifted, the officials say there must be rapid, widespread testing across the population. They want to hire disease investigators by the hundreds, if not the thousands, to trace the virus and quarantine those who have been infected. And until there is a vaccine, they may ask people to wear masks in public and continue social distancing, even in bars, restaurants and schools when they reopen.

“I was concerned that we might get a lot of resistance and it might get interpreted as alarmist and overreach,” said Marin County’s Willis. “Time has shown that it was really a vital step to take when we took it.”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Related Topics

Public Health States

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The Other COVID Risks: How Race, Income, ZIP Code Influence Who Lives Or Dies


At first, Shalondra Rollins’ doctor thought it was the flu. By April 7, three days after she was finally diagnosed with COVID-19, the 38-year-old teaching assistant told her mom she was feeling winded. Within an hour, she was in an ambulance, conscious but struggling to breathe, bound for a hospital in Jackson, Mississippi.

An hour later, she was dead.

“I never in a million years thought I would get a call saying she was gone,” said her mother, Cassandra Rollins, 55. “I want the world to know she wasn’t just a statistic. She was a wonderful person. She was loved.”

Shalondra Rollins, a mother of two, had a number of factors that put her at higher risk of dying from COVID-19. Like her mother, she had diabetes. She was black, with a low-salary job.

And she lived in Mississippi, whose population is among the unhealthiest in the country.

She was one of 193 Mississippi residents who have died of COVID-19, and one of more than 4,800 with confirmed illnesses.

Doctors know that people with underlying health conditions – such as the 40% of Americans who live with diabetes, hypertension, asthma and other chronic diseases – are more vulnerable to COVID-19. So are patients without access to intensive care or mechanical ventilators.

Yet some public health experts contend that social and economic conditions – long overlooked by government leaders, policymakers and the public – are even more powerful indicators of who will survive the pandemic. A toxic mix of racial, financial and geographic disadvantage can prove deadly.

“Most epidemics are guided missiles attacking those who are poor, disenfranchised and have underlying health problems,” said Dr. Thomas Frieden, a former director of the Centers for Disease Control and Prevention.

Federal health officials have known for nearly a decade which communities are most likely to suffer devastating losses – both in lives and jobs – during a disease outbreak or other major disaster. In 2011, the CDC created the Social Vulnerability Index to rate all the nation’s counties on factors such as poverty, housing and access to vehicles that predict their ability to prepare, cope and recover from disasters.

Yet the country has neglected to respond to warning signs that these communities – where people already live sicker and die younger than those in more affluent areas – could be devastated by a pandemic, said Dr. Otis Brawley, a professor at Johns Hopkins University.

“This is a failure of American society to take care of the Americans who need help the most,” Brawley said. Although vulnerable counties are scattered throughout the country, they are concentrated across the South, in a belt of deprivation stretching from coastal North Carolina to the Mexican border and deserts of the Southwest.

Some of the most vulnerable communities are in Mississippi, which has the highest poverty rate of any state; Indian reservations in New Mexico, the second-poorest state, where thousands of households lack running water; and cities such as Memphis, Tennessee, a hot spot for asthma that recently ranked among the bottom 15 metro areas in offering safe, livable housing to its residents.

The first U.S. COVID-19 cases were detected in metropolitan areas, with Hispanics and blacks making up a disproportionate number of deaths in New York City. Outbreaks are now flaring in rural communities, the South and Upper Midwest. Both the New Orleans and Albany, Georgia, areas have infection rates above 1% of their populations. More than 1,600 people have been diagnosed with COVID-19 in the Sioux Falls, South Dakota, home to a meat-packing plant that employs immigrants and refugees from around the world.

Whether COVID-19 patients live or die probably depends more on their baseline health than whether they have access to an intensive care bed, Brawley said. Some hospitals report that only about 20% of COVID-19 patients on ventilators survive.

Many public health experts fear that COVID-19 will follow the same trajectory as HIV and AIDS, which began as a disease of big coastal cities – New York, Los Angeles and San Francisco – but quickly entrenched in the black community and in the South, which is considered the epicenter of the nation’s HIV/AIDS outbreak today.

Like HIV and AIDS, the first COVID-19 cases in the United States were diagnosed in “jet-setters and people who traveled to Europe and other places,” said Dr. Carlos del Rio, professor of infectious diseases at the Emory University Rollins School of Public Health. “As it settles in America, [COVID-19] is now disproportionately impacting minority populations, just like HIV.”

Mississippi: The Legacy Of Segregation

One in 5 Mississippi residents live in poverty.

It is also in the heart of the “Stroke Belt,” a band of 11 Southern states where obesity, hypertension and smoking contribute to an elevated rate of strokes. Blacks make up 38% of the state population – but more than half of COVID-19 infections in which race is known. They also account for nearly two-thirds of deaths from the virus, according to the state health department.

Medical and socioeconomic conditions put Mississippians at higher risk of COVID-19 in several ways, said Frieden, now CEO of Resolve to Save Lives, a global public health initiative.

People in low-income or minority communities are more likely to work in jobs that expose them to the virus – in factories or grocery stores and public transit, for example. They’re less likely to have paid sick leave and more likely to live in crowded housing. They have high rates of chronic illness. They also have less access to health care, especially routine preventive services. Mississippi is one of 14 states that have not expanded Medicaid.

“If they do have chronic conditions such as hypertension or diabetes,” Frieden said, “the health system doesn’t work as well for them, and they are less likely to have it under control.”

Minority communities suffer the legacy of segregation, which has trapped generations in a downward economic spiral, said Dr. Steven Woolf, a professor at Virginia Commonwealth University in Richmond.

“The fact that African Americans are more likely to die of heart disease is not an accident,” Woolf said. “COVID-19 is a very fresh, vivid example of an old problem.”

Research shows that “stress, economic disadvantage, economic deprivation not only affect the people experiencing it, but it’s passed on from one generation to another,” Woolf said.

Tonja Sesley-Baymon, president and CEO of the Memphis Urban League, noted that social distancing is a privilege of the affluent. Just getting to work can put people at risk if they ride the bus. “If you take public transportation, social distancing is not an option for you,” she said.

Cassandra Rollins with daughter Shalondra(Courtesy of the Rollins family)

Dr. LouAnn Woodward, the University of Mississippi Medical Center’s top executive, has treated many people in the emergency room whose life-threatening crises could have been prevented with routine care. She’s seen diabetes patients with blood sugar levels high enough to put them in a coma.

Health insurance is only part of the problem, she said. When Woodward asked one woman why she waited so long to seek treatment for her breast tumor, the woman said, “I just got a ride.”

Cassandra Rollins, the youngest of 11 siblings, knows hardship. Two of her sisters were murdered. She helped raise their children, who are now grown.

She raised four of her own children as a single mother. Shalondra, the eldest, often acted as a second mom to her brother 18 years younger. Shalondra even attended her brother’s parent-teacher conferences when her mother couldn’t leave work.

In September, her brother died by suicide at age 20.

When her daughter was diagnosed with COVID-19, Cassandra Rollins said, “we had just gotten to a point where we didn’t cry every day.”

The Navajo: Health Suffers In Food Deserts

The coronavirus is battering impoverished communities. More than 1,200 COVID-19 cases and 48 deaths have been diagnosed in the Navajo Nation, the country’s largest Indian reservation, located on 27,000 square miles at the junction of Arizona, New Mexico and Utah.

There are few hospitals in the region, an area the size of West Virginia, and most lack intensive care units.

The communities that make up the Navajo Nation have among the worst scores on the CDC’s Social Vulnerability Index. Thirty-nine percent of residents live in poverty.

With a shortage of adequate housing, many live in modest homes with up to 10 people under one roof, said Jonathan Nez, Navajo Nation president. That can make it harder to contain the virus.

“We’re social people,” Nez said. “We take care of our elders at home.”

The first residents tested positive in mid-March, and cases skyrocketed within weeks. In the eight counties comprising the Navajo, Hopi and Zuni nations, 1,930 residents have tested positive and 79 have died. That’s more cases per 100,000 residents than the Washington, D.C., area.

The Navajo Nation has taken aggressive steps to control the outbreak, including weekend curfews enforced by checkpoints and patrols.

But more than 30% of its households lack a toilet or running water, according to the Navajo Water Project, a nonprofit that installs plumbing in homes. Residents often drive long distances to fill containers with water, Nez said.

Having no running water makes it difficult to properly wash hands to prevent coronavirus infections.

Navajo patients with diabetes have long struggled to clean skin infections, said Dr. Valory Wangler, chief medical officer at Rehoboth McKinley Christian Health Care Services in Gallup, New Mexico.

Maintaining a healthy weight on the reservation is challenging, Nez said. Residents commonly spend hours daily traveling by car to and from work, leaving little time to exercise or cook. While the region has fast-food restaurants, far fewer stores sell fresh fruits and vegetables, he said, adding, “we’re in a food desert.”

Memphis: Childhood Diseases Take Their Toll

Most children with COVID-19 are at low risk of death. But many adults felled by the disease suffer the long-term effects of health damage they suffered as children, such as lead exposure or asthma, said Brawley of Johns Hopkins.

More than 208,000 homes in Memphis, Tennessee, pose potential lead hazards. Lead – toxic at any level – can cause brain damage and lead to hypertension and kidney disease, conditions that increase the risk of complications in COVID-19 patients.

Shelby County, which includes Memphis, is home to 937,000 residents, 14% of the state’s population. Its COVID-19 burden is outsized, representing one-quarter of the cases and deaths in Tennessee. Where race is known, most patients have been black.

The National Center for Healthy Housing ranked Memphis the worst metropolitan area for housing in 2013, although its rating has since improved slightly.

Memphis, with older housing stock and one of the poorest big U.S. cities, is a hot spot for asthma, which afflicts up to 13.5% of its children. The CDC has said that people with asthma may be at higher risk from COVID-19, although some hospitals haven’t seen higher death rates in this population.

Blacks are almost three times as likely to die of asthma as whites, according to the Health and Human Services’ Office of Minority Health. Many children develop asthma after being exposed to tobacco smoke or substandard housing with dust mites, cockroaches, rodents and molds. Some suffer for a lifetime.

Many poor people can’t afford asthma medications and have no regular source of medical care to monitor their disease, said Dr. Robin Womeodu, chief medical officer at Methodist University Hospital.

Asthma patients often go through “a revolving door in and out of the emergency department,” with an increased risk of death, she said.

Health experts say these health risks could remain long after the pandemic passes.

“The question is, ‘Do we value all life equally?'” said Dr. James Hildreth, president and CEO of Meharry Medical College in Nashville, a historically black college. “If we do, we will find a way to address these things.”

KHN data editor Elizabeth Lucas contributed to this report.


Kaiser Health News analyzed COVID-19 case rates across the country and compared them to a number of demographic factors. KHN obtained COVID-19 data by county from The New York Times and populations from 2019 U.S. Census Bureau Population Estimates to calculate cases per 100,000 residents. The national map displays COVID-19 case rates per 100,000 by commuting zone, defined as a group of counties that approximate local economies and can cross state boundaries.

The charts comparing COVID-19 cases in Mississippi and Shelby County, Tennessee, by population and race are irrespective of Hispanic ethnicity because ethnicity is coded separately in the data.


COVID-19 cases and deaths by county: The New York Times

Commuting zone definitions: Urban Institute, with adjustments for recent county boundary changes

Hospitals and ICU beds: Kaiser Health News analysis, Centers for Medicare & Medicaid Services

Population: U.S. Census Bureau Population Estimates, 2019

Race, ethnicity and age: U.S. Census Bureau American Community Survey, 2018

Health insurance: U.S. Census Bureau Small Area Health Insurance Estimates, 2018

Poverty: U.S. Census Bureau Small Area Income and Poverty Estimates, 2018

Social Vulnerability: Centers for Disease Control and Prevention Social Vulnerability Index, 2018

Related Topics

Multimedia Public Health States

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Robots are playing many roles in the coronavirus crisis – and offering lessons for future disasters


A cylindrical robot rolls into a treatment room to allow health care workers to remotely take temperatures and measure blood pressure and oxygen saturation from patients hooked up to a ventilator. Another robot that looks like a pair of large fluorescent lights rotated vertically travels throughout a hospital disinfecting with ultraviolet light. Meanwhile a cart-like robot brings food to people quarantined in a 16-story hotel. Outside, quadcopter drones ferry test samples to laboratories and watch for violations of stay-at-home restrictions.

These are just a few of the two dozen ways robots have been used during the COVID-19 pandemic, from health care in and out of hospitals, automation of testing, supporting public safety and public works, to continuing daily work and life.

The lessons they’re teaching for the future are the same lessons learned at previous disasters but quickly forgotten as interest and funding faded. The best robots for a disaster are the robots, like those in these examples, that already exist in the health care and public safety sectors.

Research laboratories and startups are creating new robots, including one designed to allow health care workers to remotely take blood samples and perform mouth swabs. These prototypes are unlikely to make a difference now. However, the robots under development could make a difference in future disasters if momentum for robotics research continues.

Robots around the world

As roboticists at Texas A&M University and the Center for Robot-Assisted Search and Rescue, we examined over 120 press and social media reports from China, the U.S. and 19 other countries about how robots are being used during the COVID-19 pandemic. We found that ground and aerial robots are playing a notable role in almost every aspect of managing the crisis.

R. Murphy, V. Gandudi, Texas A&M; J. Adams, Center for Robot-Assisted Search and Rescue, CC BY-ND

In hospitals, doctors and nurses, family members and even receptionists are using robots to interact in real time with patients from a safe distance. Specialized robots are disinfecting rooms and delivering meals or prescriptions, handling the hidden extra work associated with a surge in patients. Delivery robots are transporting infectious samples to laboratories for testing.

Outside of hospitals, public works and public safety departments are using robots to spray disinfectant throughout public spaces. Drones are providing thermal imagery to help identify infected citizens and enforce quarantines and social distancing restrictions. Robots are even rolling through crowds, broadcasting public service messages about the virus and social distancing.

At work and home, robots are assisting in surprising ways. Realtors are teleoperating robots to show properties from the safety of their own homes. Workers building a new hospital in China were able work through the night because drones carried lighting. In Japan, students used robots to walk the stage for graduation, and in Cyprus, a person used a drone to walk his dog without violating stay-at-home restrictions.

Helping workers, not replacing them

Every disaster is different, but the experience of using robots for the COVID-19 pandemic presents an opportunity to finally learn three lessons documented over the past 20 years. One important lesson is that during a disaster robots do not replace people. They either perform tasks that a person could not do or do safely, or take on tasks that free up responders to handle the increased workload.

The majority of robots being used in hospitals treating COVID-19 patients have not replaced health care professionals. These robots are teleoperated, enabling the health care workers to apply their expertise and compassion to sick and isolated patients remotely.

A robot uses pulses of ultraviolet light to disinfect a hospital room in Johannesburg, South Africa.

A small number of robots are autonomous, such as the popular UVD decontamination robots and meal and prescription carts. But the reports indicate that the robots are not displacing workers. Instead, the robots are helping the existing hospital staff cope with the surge in infectious patients. The decontamination robots disinfect better and faster than human cleaners, while the carts reduce the amount of time and personal protective equipment nurses and aides must spend on ancillary tasks.

Off-the-shelf over prototypes

The second lesson is the robots used during an emergency are usually already in common use before the disaster. Technologists often rush out well-intentioned prototypes, but during an emergency, responders – health care workers and search-and-rescue teams – are too busy and stressed to learn to use something new and unfamiliar. They typically can’t absorb the unanticipated tasks and procedures, like having to frequently reboot or change batteries, that usually accompany new technology.

Fortunately, responders adopt technologies that their peers have used extensively and shown to work. For example, decontamination robots were already in daily use at many locations for preventing hospital-acquired infections. Sometimes responders also adapt existing robots. For example, agricultural drones designed for spraying pesticides in open fields are being adapted for spraying disinfectants in crowded urban cityscapes in China and India.

Workers in Kunming City, Yunnan Province, China refill a drone with disinfectant. The city is using drones to spray disinfectant in some public areas.
Xinhua News Agency/Yang Zongyou via Getty Images

A third lesson follows from the second. Repurposing existing robots is generally more effective than building specialized prototypes. Building a new, specialized robot for a task takes years. Imagine trying to build a new kind of automobile from scratch. Even if such a car could be quickly designed and manufactured, only a few cars would be produced at first and they would likely lack the reliability, ease of use and safety that comes from months or years of feedback from continuous use.

Alternatively, a faster and more scalable approach is to modify existing cars or trucks. This is how robots are being configured for COVID-19 applications. For example, responders began using the thermal cameras already on bomb squad robots and drones – common in most large cities – to detect infected citizens running a high fever. While the jury is still out on whether thermal imaging is effective, the point is that existing public safety robots were rapidly repurposed for public health.

Don’t stockpile robots

The broad use of robots for COVID-19 is a strong indication that the health care system needed more robots, just like it needed more of everyday items such as personal protective equipment and ventilators. But while storing caches of hospital supplies makes sense, storing a cache of specialized robots for use in a future emergency does not.

This was the strategy of the nuclear power industry, and it failed during the Fukushima Daiichi nuclear accident. The robots stored by the Japanese Atomic Energy Agency for an emergency were outdated, and the operators were rusty or no longer employed. Instead, the Tokyo Electric Power Company lost valuable time acquiring and deploying commercial off-the-shelf bomb squad robots, which were in routine use throughout the world. While the commercial robots were not perfect for dealing with a radiological emergency, they were good enough and cheap enough for dozens of robots to be used throughout the facility.

Robots in future pandemics

Hopefully, COVID-19 will accelerate the adoption of existing robots and their adaptation to new niches, but it might also lead to new robots. Laboratory and supply chain automation is emerging as an overlooked opportunity. Automating the slow COVID-19 test processing that relies on a small set of labs and specially trained workers would eliminate some of the delays currently being experienced in many parts of the U.S.

Automation is not particularly exciting, but just like the unglamorous disinfecting robots in use now, it is a valuable application. If government and industry have finally learned the lessons from previous disasters, more mundane robots will be ready to work side by side with the health care workers on the front lines when the next pandemic arrives.

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Coronavirus Fuels Explosive Growth In Telehealth – And Concern About Fraud

Over the shoulder shot of a patient talking to a doctor using of a digital tablet

Verma temporarily lifted a variety of federal restrictions on the use of the service, which had been limited to rural areas. She praised telehealth, saying it could handle routine care for an older patient with diabetes without risking a visit to a medical office. She said a Medicare recipient with mild flu-like symptoms could receive advice from a doctor at home “instead of leaving the house and sitting in a waiting room full of other vulnerable people.”

But the Trump administration’s action also raised concerns that it could inadvertently unleash a wave of billing fraud and abuse and risk patient safety — especially if officials yield to industry pressure to make many of the emergency policy changes permanent.

“There are unscrupulous providers out there, and they have much greater reach with telehealth,” said Mike Cohen, an operations officer with the Health and Human Services Inspector General’s Office, which investigates health care fraud. “Just a few can do a whole lot of damage.”

Telehealth — or telemedicine, as it’s also known — covers a broad range of services via video, telephone or email. In early March, the Centers for Medicare & Medicaid Services approved dozens of new billing codes to allow medical professionals to bill for these services. That means patients can consult with doctors about everything from flu symptoms or a backache to a psychiatry visit.

Federal officials also allowed telemedicine providers to waive patient deductibles and copayments during the coronavirus emergency. Under normal conditions, these actions can be construed as a kickback because they discourage patients from complaining about charges or can lead to overuse of medical services. Such tactics normally can lead to civil or criminal penalties.

Cohen said anti-fraud “guardrails have been removed under this epidemic. The concern is that things will never go back to what they were. … There will be a lot of pressure on CMS to make at least some of these changes permanent.”

Officials worry that some telemedicine companies may take advantage of Medicare patients they contact at their homes. Some of the largest recent Medicare fraud cases have implicated this sort of marketing, often for bogus genetic testing, or prescribing unnecessary pain creams or delivering unwanted medical equipment. In some cases, the companies have employed telemarketers to call thousands of people on Medicare and offer them a free service in order to obtain their patient ID numbers, which can be used to bill the government.

These fraudulent activities can become massive because phone rooms operating anywhere in the world can target thousands of patients and Medicare may have difficulty differentiating improper bills from those submitted by a legitimate telehealth operation.

In September 2019, the Justice Department charged 35 people in connection with a telemedicine scheme that allegedly ripped off more than $2.1 billion from Medicare, among the largest such frauds in U.S. history.

Cohen said investigators already are seeing “tons” of fraud cases linked directly to COVID-19, including using patient accounts to bill for “coronavirus emergency kits” that contain nothing but gloves and hand sanitizer or bogus testing kits. Once marketers obtain a patient’s billing numbers, they often tack on thousands of dollars in genetic tests that are of no value to the medical case, investigators said.

Other rollbacks in telehealth regulations could prove controversial and affect patient safety — from relaxing restrictions on opioid prescriptions via video to easing licensing requirements for doctors who practice across state lines.

In a statement to Kaiser Health News, CMS said it is “instructing its payment and audit contractors to review claims during this public health emergency based on all agency waivers and flexibilities that have been put into place. This includes claims for services furnished under the telehealth flexibilities.” CMS also said it would put “a strong emphasis” on program integrity and cost in considering whether to make any telehealth changes permanent.

The telemedicine industry argues that its operations are no more prone to billing abuses than any other branch of health care.

“A crisis always spawns fraudsters,” said Krista Drobac, executive director of the Alliance for Connected Care, which advocates for telehealth.

She said the alliance hopes “to show the value of telehealth” and help win wide acceptance of virtual visits to doctors. The group wants to see some of the regulatory changes made permanent in order to assure the industry’s viability once things return to normal.

Telehealth advocates also argue they have successfully stepped in to fill a void caused by many doctors temporarily shutting down their offices.

The coronavirus has “stopped [the medical] profession in its tracks, and we need to adapt to a new reality,” said Dr. Joseph Kvedar, a Harvard Medical School professor and president-elect of the American Telemedicine Association, a nonprofit that promotes access to the technology.

Kvedar said virtual visits at Partners HealthCare, where he is a senior adviser, have jumped from 1,600 virtual visits in February 2019 to 90,000 in March.

He said other health networks have reported similar spikes, in one case in New York City ramping up from zero to 5,500 visits in a single day. “There’s a lot more interest now that people have to stay home.”

Congress did much to speed acceptance of telehealth as part of the $2 trillion stimulus package. The CARES Act awards $200 million through the Federal Communications Commission to medical groups to help them install the technology and fund broadband installations. The groups also can apply for $27 billion in a public health emergency fund.

In the March 17 briefing, Verma added that CMS wanted to give medical professionals relief from regulations that could take time away from treating patients.

“In an emergency, those on the front lines shouldn’t have to worry about federal rules and red tape hamstringing them when they need flexibility above all else. And we’re doing everything in our power to make sure that that doesn’t happen,” Verma said.

CMS also is allowing Medicare Advantage plans, which together treat more than 22 million Americans, to use telehealth to help set payment rates. On March 30, CMS said it would suspend some efforts to recover hundreds of millions of dollars in overpayments made to the health plans.

Lindsey Copeland, federal policy director for the Medicare Rights Center, said her group agreed that telehealth could help ensure that people on Medicare would “not be forced to put themselves in harm’s way to obtain needed care.”

Copeland said making some of the telehealth changes permanent might make sense. But she said, “We urge caution in rushing such policymaking.”

By contrast, the industry sees itself as on a roll. InSight + Regroup, a national telepsychiatry company, noted that it “feels strongly about advocating to keep the telehealth-friendly regulations that were rapidly put into place in response to COVID-19.”

“Telehealth is going mainstream,” said company CEO Geoffrey Boyce. “It has been on the fringes for a number of years. We’re at the point now where there is no going back.”

His company also wants to reverse Medicare’s prohibition on doctors living outside the U.S. treating patients here using telehealth. Boyce said the company would use only doctors who trained and are certified in this country.

There’s little doubt that the coronavirus crisis has brought telehealth to the forefront of medicine, something that years of lobbying in Washington couldn’t accomplish.

The Alliance for Connected Care, a group that advocates telehealth and whose more than three dozen members range from Amazon to the Michael J. Fox Foundation for Parkinson’s Research, spent more than $1 million on lobbying from 2016 to 2019, according to the Center for Responsive Politics.

But now “the numbers of [virtual] visits are astounding,” said Drobac, the alliance’s executive director.

Related Topics

Health Industry Medicare Public Health

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

Big Brother Wants To Track Your Location And Health Data. And That’s Not All Bad.


A growing mix of health and technology experts are convinced that if the United States is to ever effectively track the coronavirus and slow its spread, then both self-reported and more surreptitiously gathered personal data — a mix of information about location, travel, symptoms and health conditions – must be gathered from millions of Americans.

With the pandemic far from over, public health needs are paramount. Public health experts say that collecting personal data may be the only way to analyze information on the massive scale needed. But how that information is used and by whom worries some privacy advocates.

A number of academics, data firms and technology companies are using mobile devices to gather data. Some use the phones’ Bluetooth signals to aid in contact tracing by registering other nearby devices. Location information recorded on smartphones can help them map whether people are staying home and where they do venture out. Others have built symptom-tracker apps designed to predict where the virus might turn up next.

And more may be coming. Just look to other countries, including Taiwan, Singapore and Ireland, which are using big data or apps to aid in their pandemic responses. As the United States contemplates its move to open back up for business, organizations such as the left-leaning Center for American Progress and the conservative American Enterprise Institute have recommended a range of steps, including much more testing and digital surveillance.

A report from Johns Hopkins Bloomberg School of Public Health noted that such tech-heavy efforts might not fly in the U.S. because of privacy concerns. Privacy advocates have long argued for increased protection of personal health information on fears that marketers, data bundlers or even hackers could sell or divulge the information, possibly affecting people’s jobs and credit or leading to identity theft. This tracking and tracing of data could include comings and goings normally closely guarded — from doctors’ or therapists’ visits, pot dispensaries and any number of activities one might want to keep secret.

But, in the current situation, some say privacy concerns must take a back seat.

“In a plague, civil liberties have to be suspended. There are good reasons for that,” said Arthur Caplan, a professor of medical ethics at NYU Langone Medical Center. He noted that because of the enormous amount of data already collected about Americans by marketers, the “genie is already three-quarters of the way out of the bottle.”

So the benefit of increased surveillance and contact tracing will be a loosening of stay-at-home restrictions, he said. “If it gets us back to work and school, we don’t care. We can fix it later.”

However, the pandemic may be pushing the United States to a point of no return.

Jake Laperruque, senior counsel and a privacy expert at the Project on Government Oversight, likens the current circumstances to the period after the terrorist attacks of Sept. 11, 2001, when former President George W. Bush signed into law the Patriot Act. The measure allowed the government to more easily surveil Americans’ phone and computer records in the name of national security.

“A lot of times during various types of emergencies, we see things happening that we’re doing just because it’s an emergency. It’s really hard to claw back from those and turn them off,” said Laperruque.

Contact Tracing Via Bluetooth

A longtime public health strategy, “contact tracing,” involves identifying individuals who have contracted an infectious disease, notifying others who have been in contact with them and ensuring that those with the disease manage it safely. South Korea and Singapore have reported some success in managing the outbreak in part because of aggressive contact tracing.

Typically, public health workers handle the tracing. But the sheer size of this pandemic calls for more automation, said supporters of a data-driven approach.

On April 10, Google and Apple announced they were teaming up to develop smartphone software that would allow phones to sense via Bluetooth whether a phone user had been near someone who has the coronavirus, similar to the TraceTogether app used in Singapore. For it to work, phone users must download an app provided by public health officials and be willing to share their health information, including whether they’ve tested positive for the coronavirus.

The companies said that they won’t collect user location data or personally identifiable information and that those who test positive would not be made known to Google or Apple.

Ideally, the information could be useful to public health departments, said Dr. Georges Benjamin, executive director of the American Public Health Association.

While he has no problem with public health officials getting data – after all, laws already require reporting of infectious diseases to try to thwart outbreaks — he cited potential privacy problems if it’s a commercial venture doing the gathering.

In an interview on Snapchat’s “Good Luck America,” Dr. Anthony Fauci, a member of the White House coronavirus task force and director of the National Institute of Allergy and Infectious Diseases, had a similar take, saying that from a public health standpoint, “it makes absolute sense.” He also noted that pushback on privacy issues and civil liberties “would be considerable.” In his view, government rather than private-sector involvement might amplify these concerns.

Ultimately, though, public health officials – including Centers for Disease Control and Prevention Director Robert Redfield — are clear that finding a doable means to advance contact tracing is critical to getting the country back to normal.

Caplan agrees.

“That’s the biggest reason to want to yield on privacy,” said Caplan. “If we don’t get a vaccine or a cure miraculously soon, the only way we’re getting out of isolation and quarantine is to track who is positive and who isn’t and who they are around.”

But questions remain – while the apps may indicate whether a person has come within a few feet of someone with the virus, the smartphone can’t differentiate between close, person-to-person interaction or a signal detected from the other side of an apartment wall, possibly resulting in people being asked to self-isolate who don’t need to. Issues could also arise if those who have been exposed cannot access coronavirus tests, or if the self-quarantines of those who receive alerts about their exposure are not enforced. There is also the possibility that users’ phones or the database holding the coronavirus test results could be hacked.

Location Tracking

Smartphone users are constantly sharing their location information, often unknowingly, through apps. That data can be shared with advertisers, data collection companies and other third-party groups.

And it is now being harnessed to understand how well Americans are complying with “stay-at-home” orders.

In early April, Tennessee Gov. Bill Lee said he looked at a movement map from a data collection company called Unacast to help make his decision to issue a “stay-at-home” order since he saw movements around the state remained at “pre-COVID-19” levels.

Google has also started sharing public county and state “community mobility reports,” which show how people’s movements among grocery stores, parks, workplaces and residential homes have increased or reduced, compared with their normal baseline movements. Apple just released a similar initiative.

These companies say they protect user privacy by keeping information aggregated and anonymous.

Laperruque said as long as data stays aggregated, or combined and sorted into groups, he thinks it can provide valuable information, but it must be summarized to ensure the information remains anonymous. If reports started including certain features, such as addresses or neighborhoods, it could make identities “pretty easy” to figure out, he said.

Indeed, research studies and a 2019 New York Times investigation have shown that it can be relatively simple to identify individuals from anonymized data.

Symptom Tracking

Another type of data sharing aims to crowdsource COVID-19 symptoms and pinpoint ongoing and emerging hot-spots.

The COVID Symptom Tracker, for example, is a mobile app created by researchers at Harvard with data firm Zoe and Kings College London.

After downloading the app, users give their ZIP code, age, gender at birth, height, weight and general questions about health, then check in every day. If they feel fine, it’s a 10-second effort. If they’re feeling unwell, they note what symptoms they are experiencing. Rolled out initially in parts of the United Kingdom, where it now has more than 2 million users, the COVID Symptom Tracker launched in the U.S. the first week of April.

One of the app’s creators, Andrew Chan, a professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, said they have no intention of ever commercializing the data, and it is aggregated and anonymized.

The group plans to share information with other researchers, some of whom aim to launch similar trackers. New York City also created its own tracker, a website that asks users to self-report symptoms, COVID-19 diagnoses and quarantine statuses.

Questions remain, however, about how useful such data will be. It depends on how many people sign up and how accurate they are in reporting.

Even if something is opt-in, privacy advocate David Carroll, an associate professor at the New School in New York, recommended that anyone who wants to use it first read the privacy policy carefully. Those that follow European or California privacy rules are providing the most protection.

“It’s still the wild West.” he said. “You have to do your work and read your policies and try to make sense of them. I read the policy of the NYC tracker. It was pretty clear, but I didn’t see enough information about how long the data will be held.”

Weighing The Trade-Offs

To be sure, there could be benefits of sharing data via our mobile phones.

Public health officials may be better equipped to track who has the coronavirus and warn those who have been in contact so they can self-isolate. State and local governments can understand whether stay-at-home orders are working. And researchers may be able to pinpoint emerging hot spots.

But, privacy experts say these measures should be taken only if responsible consumer protection policies are put in place: obtaining clear consent from users, ensuring public presentation of data remains anonymous and implementing limits on what data is gathered and how long it is held.

Many also note that after this crisis ends, it will be a struggle to recover the protections set aside.

“We will have overcompensated, and we should plan for that,” Carroll said.

Related Topics

Public Health

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

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Digital surveillance can help bring the coronavirus pandemic under control – but also threatens privacy


Israel’s top spy agency has been using secretly collected cellphone data to retrace the movements of those who tested positive for the coronavirus.

The Polish government launched the “Home Quarantine” app so that people in quarantine can upload geo-located photos proving they’re at home.

The South Korean government is using a combination of mobile phone data, credit card information and facial recognition software to track the movements of people who test positive for COVID-19. The government posts the details publicly to alert people who might have come in contact with the infected person.

Public health benefits? Certainly. Privacy risks? Certainly as well.

As a technology, law and security scholar at American University Washington College of Law, I study questions of privacy and surveillance. The pandemic is confronting Americans with important questions about how much and what kinds of surveillance and tracking to accept in support of better health, as well as a revitalized economy.

Deaths in the U.S. from the coronavirus are projected to reach six digits, which adds urgency to decisions that have long-term consequences. Should location data be used to identify and warn those who have been exposed to the virus? Data be used to enforce quarantines? Can digital information be used to serve compelling health needs without boosting the reach of the surveillance state?

Already, cellphones, apps and digitally connected devices provide a range of data that can be used to track movements and associations with varying degrees of specificity. Though some of this digital surveillance requires users to opt-in to data collection, a lot is already in the hands of companies that are now using it to predict trends.

A smart thermometer company, for example, is using real-time temperature data to forecast the next COVID-19 hot spots, something it’s done successfully to predict the seasonal flu. Google has been compiling data from Google Maps to chart shifts in people’s movement over time. The company is repurposing data used to predict traffic flows to help officials determine how well the population is engaging in social distancing. Both are examples of population-level analysis, using aggregated data to assess trends in ways that, if designed and implemented properly, can provide important health information while also protecting personal privacy.

Data collected by smart thermometer companies can give public health authorities warnings of potential disease outbreaks.
Julien G./Flickr, CC BY

Tracking individuals

Things get more complicated, however, with the move from aggregated analysis to individual-level tracking. There are, broadly speaking, three key forms of individual tracking being pushed, each raising unique policy and legal considerations.

The first, contact tracing, is used to map the movements of sick individuals in order to warn unsuspecting contacts so they can take appropriate steps to protect themselves and others. The second uses location- and time-stamped photos to monitor compliance with quarantine orders and travel restrictions. The third identifies and tracks those who have tested positive for SARS-CoV-2 antibodies. This type of tracking – being contemplated in Germany and England – could be used to provide immunity passes to allow people who are no longer at risk to return to work or otherwise engage socially.

Several universities, companies, nonprofit organizations and governments are developing contact tracing apps that identify when someone has been in contact with other people who have tested positive for the disease. Stanford University-based COVID Watch, for example, is developing an app that uses Bluetooth technology to map where and when people cross paths, which can then be used to anonymously notify those who have had contact with sick people who have a compatible app. This is an open source, decentralized system, without the need for any government data collection. Singapore’s TraceTogether app is also an open source system that relies on Bluetooth technology to map associations and issue warnings.

These kinds of decentralized tracking systems are designed to better protect privacy than government-collected or other centrally maintained datasets. But these apps are opt-in, meaning people have to actively choose to use them. As a result, they will only be as effective as they are widespread, something that depends in part on whether users trust the security and other privacy protections built into the system design.

Check-ins and blood tests

Other forms of tracking raise both privacy-related and other civil liberties considerations. Quarantine monitoring systems like Poland’s Home Quarantine app or Singapore’s quarantine requirements, coupled with twice daily digital check-ins, raise the specter of Big Brother, achieved via digital monitoring.

In the United States, this kind of monitoring runs up against the Fourth Amendment’s protections against unreasonable search and seizure. But the Fourth Amendment is not an absolute. Digital monitoring could be court-ordered in response to someone’s demonstrated failure to abide by criminally enforceable quarantine orders, many of which are now in place.

Some people might choose to use their mobile phones to prove they’re abiding by quarantine orders rather than have police officers check up on them.
28704869/Flickr, CC BY

Meanwhile, the police could be employed to knock on doors and check compliance with quarantine orders – even in the absence of a demonstrated failure to abide by the orders. Individuals could, as a result, presumably consent to digital monitoring as an alternative to daily check-ins by police. Depending on the design, digital check-ins might also be deemed valid under the “special needs” exception to the Fourth Amendment. In such cases, the central question is the validity of the quarantine orders rather than the means of enforcement.

Meanwhile, even the seemingly innocuous tracking of those who test positive for antibodies may not be as innocuous as it seems. If and when such testing becomes reliable and available, it could provide critical, albeit imperfect, assurances on both the individual and community level. But whereas aggregate-level analysis can help determine when it’s appropriate to lift restrictions, individual tracking risks dividing communities into groups of “clean” and “dirty,” with privileges doled out according to status.

Principles for protecting privacy

As society works through these difficult issues, a few key principles should guide decision-making.

First, design matters. Tracking systems should, to the extent possible, be open source, decentralized and designed in a way to share the key health data without gathering or revealing the movements and contacts of those involved. The best contract tracing apps do just that, incorporating key principles of privacy by design and back-end limitations on things like who can access the data and to whom it can be disseminated. Importantly, data should not be retained any longer than it is needed.

Second, whatever system is put in place, whether privately developed or government-mandated, it should be carefully tailored to serve a specified and compelling health need.

Third, any claims that governments need new authority should be examined carefully and warily, particularly given the trove of data already available. If adopted, any new authority should be explicitly time limited, with clear and constrained criteria for extending the time limits.

When the last massive pandemic hit a century ago, the population did not walk around with tracking devices. Now we all do. This is data that can both protect people and confine them. It should be used to save lives but in ways that also protect core freedoms.

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Porn use is up, thanks to the pandemic


Across the globe, the coronavirus pandemic is affecting almost all aspects of daily life. Travel is down; jobless claims are up; and small businesses are struggling.

But not all businesses are experiencing a downturn. The world’s largest pornography website, Pornhub, has reported large increases in traffic – for instance, seeing an 18% jump over normal numbers after making its premium content free for 30 days for people who agree to stay home and wash their hands frequently. In many regions, these spikes in use have occurred immediately after social distancing measures have been implemented.

Why are people viewing more pornography? I’m a professor of clinical psychology who researches pornography use. Based on a decade of work in this area, I have some ideas about this surge in online pornography’s popularity and how it might affect users in the long run.

What’s the point of pornography?

People use pornography for a variety of reasons, but the most common reason is quite obvious: pleasure.

In 2019, my colleagues and I published a review of over 130 scientific studies of pornography use and motivation. We found that the most common reason people report for why they view pornography is sexual arousal. Research is abundantly clear that the majority of time that pornography is used, it is used as a part of masturbation.

Knowing that people use pornography to masturbate doesn’t explain a great deal about why they might be using more pornography now.

My colleagues and I found that there are several additional reasons people might use pornography. For example, greater levels of psychological distress often predict higher levels of pornography use. People feeling lonely or depressed often report greater desire to seek out pornography; many people report using pornography to cope with feelings of stress, anxiety or negative emotions.

In short, people often turn to pornography when they are feeling bad, because pornography (and masturbation) likely offer a temporary relief from those feelings.

Boredom can be a big driver to online pornography.
niklas_hamann/Unsplash, CC BY

Psychology researchers also know that people use porn more when they are bored. I suspect this relationship between pornography use and boredom is quite likely one of those exponential functions that’s been in the news so much in recent weeks. It’s not just that more boredom predicts greater pornography use – extreme boredom predicts even higher levels of use. The more bored someone is, the more likely they are to report wanting to view pornography.

Is more pornography now a problem later?

The spread of the coronavirus and social distancing measures meant to help contain it have led to increases in social isolation, loneliness and stress – so increases in pornography use make sense.

But are there likely to be negative effects down the road?

Already, numerous anti-pornography activists have expressed grave concerns about these increases in use, with many groups providing resources for fighting those rises.

As a scientist, however, I’m skeptical of blanket claims that increased use right now will translate to widespread negative outcomes such as addiction or sexual dysfunction. Like most aspects of the ongoing coronavirus crisis, there are probably not enough data yet for researchers to make definitive predictions, but past studies do provide some ideas.

Generally speaking, most consumers do not report any problems in their lives as a result of pornography use. Among people who use pornography frequently – even every day – a large percentage report no problems from that use.

Some research, though, does find links between pornography use and potentially concerning outcomes. For example, for men, pornography use is often linked with lower levels of sexual satisfaction, but the current evidence doesn’t untangle whether men use pornography more when they are dealing with sexual dissatisfaction or if men using pornography more leads to more sexual dissatisfaction.

For women, the results are even more unclear. Some studies have actually found that pornography use is associated with more sexual satisfaction, whereas others have found that it is not associated with sexual satisfaction at all.

Studies related to pornography use and mental health have found that hours spent using pornography do not necessarily cause depression, anxiety, stress or anger over time. The same holds for sexual dysfunctions. Although there are cases of people who state that pornography led them to experience erectile dysfunction, large-scale studies have repeatedly found that mere pornography use does not predict erectile dysfunction over time.

Cooped up alone, people are looking for distraction.
Siavash Ghanbari/Unsplash, CC BY

A distraction at a boring, anxious time

There is certainly evidence that some people who use pornography also report having mental health concerns or sexual problems in their lives; so far, though, the evidence linking pornography to those things does not appear to be causal.

In short, porn does not seem to be causing widespread problems, and it is probably offering people a distraction from the boredom and stress of current events.

Despite the fact that, prior to COVID-19, 17 states introduced or passed legislation calling pornography use a public health crisis, public health professionals have argued that it really is not one, and I tend to agree. COVID-19, on the other hand, certainly is a public health crisis.

Although humanity has survived countless pandemics over the ages, the current one is the first to occur in the digital age. As disruptive as the coronavirus has been, for many people, opportunities for entertainment and distraction remain greater than they have been at any other point in history.

When social distancing measures are lifted and people are once again permitted to safely spend time with friends, strangers and potential sexual partners, I would expect that pornography use will return to pre-COVID-19 levels. For most users, pornography is probably just another distraction – one that might actually help “flatten the curve” by keeping people safely occupied and socially distanced. Combined with the fact that many people are isolating alone, pornography may provide a low-risk sexual outlet that does not cause people to risk their own safety or the safety of others.

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Here’s how scientists are tracking the genetic evolution of COVID-19


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.

Charles Darwin’s first diagram of an evolutionary tree, drawn in 1837.
Cambridge University Library

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.

For COVID-19, there has been a global initiative to share viral genomes with all scientists. Given a collection of sequences with sample dates, scientists can infer the evolutionary history of the samples in real-time and use the information to infer the history of transmissions.

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.

Evolutionary tree of COVID-19 genomes inferred by Nextstrain.
from nextstrain.org/ncov

What have we learned about the epidemic?

Based on current data, it seems as though SARS-CoV-2 mutates much more slowly than the seasonal flu. Specifically, SARS-CoV-2 seems to have a mutation rate of less than 25 mutations per year, whereas the seasonal flu has a mutation rate of almost 50 mutations per year.

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.

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Mysterious Heart Damage, Not Just Lung Troubles, Befalling COVID-19 Patients


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.”

Facing Obstacles

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.

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After COVID-19: Doctors Ponder Best Advice As Patients Recover From Coronavirus


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.

Early research has suggested that patients who have recovered from COVID-19 may also continue to spread the virus.

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.

Related Topics

Global Health Watch Public Health

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What does ‘recovered from coronavirus’ mean? 4 questions answered about how some survive and what happens next


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.”

Your immune system finds and destroys viruses in the body, and will remember invaders it has seen before.
Keith Chambers/Science Photo Library via Getty Images

On average, a person who is infected with SARS-CoV-2 will feel ill for about seven days from the onset of symptoms. Even after symptoms disappear, there still may be small amounts of the virus in a patient’s system, and they should stay isolated for an additional three days to ensure they have truly recovered and are no longer infectious.

What about immunity?

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.

Since this coronavirus is so new, scientists still don’t know whether people who recover from COVID-19 are immune to future infections of the virus. Doctors are finding antibodies in ill and recovered patients, and that indicates the development of immunity. But the question remains how long that immunity will last. Other coronaviruses like SARS and MERS produce an immune response that will protect a person at least for a short time. I would suspect the same is true of SARS-CoV-2, but the research simply hasn’t been done yet to say so definitively.

A coronavirus test kit. Necessary before a person can be declared officially recovered.
AP Photo/David J. Phillip

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.

In addition to those requirements, the CDC guidelines say that a person must test negative for the coronavirus twice, with the tests taken at least 24 hours apart.

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.

Many more people are being tested now that states and private companies have begun producing and distributing tests. As the number of available tests increases and the pandemic eventually slows in the country, more testing will be available for those who have appeared to recover. As people who have already recovered are tested, the appearance of any new infections will help researchers learn how long immunity can be expected to last.

Drive-by testing stations are opening across the U.S. as tests become more available.
AP Photo/David J. Phillip

Once a person has recovered, what can they do?

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.

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COVID19 Testing vs Treatment | Dr. Uli K. Chettipally | HealthTech Innovation


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.

COVID-19, Investor Perspective during the pandemic, Lu Zhang, Fusion Fund


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.

Read about Lu Zhang (https://www.linkedin.com/in/luzhangvc/). This discussion is moderated by

  • 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.

For details: F50 : www.F50.io F50 Global Capital Summit(GCS) : http://f50.io/summit/ F50 Elevate: http://f50.io/elevate/

Full Interview

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.

David Cao: Thank You.

Coronavirus case counts are going to go up – but that doesn’t mean social distancing is a bust


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.

People are also seeing charts in the news showing rapidly increasing case counts. This is likely to continue to occur. The United States surpassed Italy and China to have the most confirmed cases of any country.

Americans might begin to wonder if these social distancing measures are working if the case numbers keep climbing. The problem is that the number of reported cases is not the same as the number of people who are infected. It takes time for people to develop symptoms, seek treatment and get tested and for the results to come back. So the effects of social distancing might not be obvious from the numbers for a while. As an epidemiologist at the University of Michigan, I can assure you that staying at home is one of the most effective ways to slow the spread of COVID-19.

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.

A nurse prepares a COVID-19 testing kit in Richardson, Texas.
AP Photo/Tony Gutierrez

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.

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This article is republished from The Conversation under a Creative Commons license. Read the original article here:Read More

ixlayer, testing COVID-19 online, Dr. Poorya Sabounchi, Co-founder/COO


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/