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Pandemic-Stricken Cities Have Empty Hospitals, But Reopening Them Is Difficult

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As city leaders across the country scramble to find space for the expected surge of COVID-19 patients, some are looking at a seemingly obvious choice: former hospital buildings, sitting empty, right downtown.

In Philadelphia, New Orleans, and Los Angeles, where hospitalizations from COVID-19 increase each day, shuttered hospitals that once served the city’s poor and uninsured sit at the center of a public health crisis that begs for exactly what they can offer: more space. But reopening closed hospitals, even in a public health emergency, is difficult.

Philadelphia, the largest city in America with no public hospital, is also the poorest. There, Hahnemann University Hospital shut its doors in September after its owner, Philadelphia Academic Health System, declared bankruptcy. While not public, the 496-bed safety-net hospital mainly treated patients on public insurance. Philadelphia Mayor Jim Kenney began talks with the building’s owner, California-based investment banker Joel Freedman, as soon as his administration saw projections that the demand for hospital beds during the pandemic would outpace the city’s capacity. Not long after negotiations started, city officials announced the talks were going badly.

“Mr. Freedman was difficult to work with at times when he was the owner of the hospital, and he is still difficult to work with as the owner of the shuttered hospital,” said Brian Abernathy, who is Philadelphia’s managing director and heading the city’s COVID-19 response.

In New Orleans, where the soaring COVID-19 infection rate is disproportionately high compared with its population, Charity Hospital sits vacant in the middle of town. The former public hospital never reopened after Hurricane Katrina in 2005. The Louisiana State University System, which owns the building, incorporated Charity Hospital into the city’s new medical center, but the original building remains vacant. Instead of using it during the pandemic, the New Orleans Convention Center is being converted to a “step-down” facility with the capacity to treat up to 2,000 patients after they no longer need critical care.

Elsewhere, city governments have struck deals with the owners of empty hospital buildings to lease their space. At St. Vincent Medical Center in Los Angeles, the city is paying $236 per night per bed, for a total of $2.6 million each month.

In Philadelphia, Freedman offered the Hahnemann building to the city for $27 per bed per night, plus taxes, maintenance and insurance, which the city would pay directly. All told, that added up to just over $900,000 per month.

“I think he is looking at how to turn an asset that is earning no revenue into an asset that earns some revenue, and isn’t thinking through what the impacts are on public health,” Abernathy said of Freedman. “I think he’s looking at this as a business transaction rather than providing an imminent and important aid to the city and our residents.”

This isn’t the first time Freedman has come under fire by Philadelphians for his handling of the hospital. Its closure sparked protests from city officials, health care unions, and even presidential hopeful Bernie Sanders. Critics speculated that Freedman, whose private equity firm bought the struggling hospital in 2018, didn’t try in earnest to save it and planned to flip it for its valuable downtown real estate. Notably, Hahnemann’s real estate was parsed out into a separate company, Broad Street Healthcare Properties, also owned by Freedman, and not included in Philadelphia Academic Health System’s Chapter 11 bankruptcy petition.

A representative for Freedman said the building has an interested buyer, and that is one reason Broad Street Healthcare will not let the city use the building at cost.

“We’re offering this facility because of the public benefit in a health crisis, but it comes at a cost to the property owner,” said Broad Street representative Sam Singer.

As urban hospitals have struggled in recent years, it’s become increasingly common for private equity to get involved: Big firms buy struggling medical centers with the promise of financial support and to improve their operations and business strategy. When things go right, the business succeeds, and the private equity firm sells it in a public offering or to another bidder for more than it paid.

In other cases, though, the firms load companies up with debt, take dividends out for themselves, sell off valuable real estate and charge fees and high-interest loans, leaving a company in a much weaker position than it would have been otherwise, and often on the verge of bankruptcy.

“The house never loses,” said Eileen Appelbaum, co-director at the Center for Economic and Policy Research. “The private equity firm makes money whether the company succeeds or it doesn’t.”

For instance, Steward Health Care was able to expand from its base in Massachusetts to a 36-hospital network nationwide with backing from Cerberus Capital Management. Now, said Appelbaum, the chain of community hospitals is stuck paying rent to a separate real estate company, on all its properties, while also struggling to stay in the black. The network announced last week it would furlough non-clinical workers across nine states because the requirement to cancel elective surgeries caused too great a financial strain.

Freedman’s private equity firm is called Paladin Healthcare, and it has previously bought and managed hospitals in California and Washington, D.C., where it helped the struggling Howard University Hospital out of the red. Paladin then sold the hospital to Adventist HealthCare last summer.

Urban hospitals like Hahnemann have struggled to stay afloat in recent years, in part due to their lack of privately insured patients. Hospitals often finance the care of uninsured patients or those on Medicaid by treating those with private insurance, which reimburses the hospitals faster and at a higher rate. At Hahnemann, two-thirds of patients were on Medicaid or Medicare. While a financially struggling public or nonprofit hospital might continue serving a poorer community, a for-profit hospital has different incentives, said Vickie Williams, a former law professor for Gonzaga University.

“If your urban hospital is purchased by a for-profit company and it doesn’t perform sufficiently, they don’t have the same necessarily mission-driven directives to keep that hospital functioning for the good of the community at a loss,” said Williams, who is now senior counsel for CommonSpirit Health in Tacoma, Washington.

Freedman has said that he tried to sell the Hahnemann property to a nonprofit and requested money from the city and state to keep it open, but neither option worked.

Following news that Philadelphia had abandoned negotiations with Freedman, calls to seize the property in order to save lives came pouring in, including from elected officials.

“Eminent Domain was created for situations like #Hahnemann,” City Council member Helen Gym wrote on Twitter. “This is a public health emergency and Philly is the largest city in the nation WITHOUT a public hospital. We cannot allow unconscionable greed to get in the way of saving lives. Eminent domain this property.” Legal experts say the lengthy process of eminent domain and the requirement to pay the owner fair market value for the building make it an unlikely mechanism for an instance like this.

But in public health emergencies, local, state and federal governments do have broad authority to commandeer private property, such as hotels, convention centers, university dormitories or even defunct hospitals for disaster response. Williams, whose research has focused on preserving hospital infrastructure during a pandemic, said that so far in the United States, that hasn’t had to happen – at least not in the traditional sense.

In Pennsylvania, the governor’s emergency declaration gives him the authority to “commandeer or utilize any private, public or quasi-public property if necessary to cope with the disaster emergency.” A health department representative said all options remain on the table in the event that the city’s hospital bed capacity is overrun.

In the interim, the mayor made a deal with Temple University to use its basketball arena, which would have the capacity to treat 250 non-critical patients, at no cost to the city.

This story is part of a partnership that includes WHYY, NPR and Kaiser Health News.

[Correction: This article was revised at 5:30 p.m. ET on April 2, 2020, to clarify Steward Health Care’s real estate situation.]

Source: by [#item_author] from Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente. More Read More

Coronavirus: Telemedicine is great when you want to stay distant from your doctor, but older laws are standing in the way

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As of April 1, there are more than 179,000 confirmed cases of COVID-19 in the U.S. Nowhere has been hit harder than New York City where there are more than 76,000 confirmed cases and 1,550 people have died. As many had feared, the city failed to “flatten the curve” and medical need has exceeded what the health system can provide.

In an effort to free up critical beds and resources, all elective surgeries have been canceled. Health officials are even urging people symptomatic for COVID-19 but less vulnerable – those who are generally healthy and under 60 years of age – to stay home and away from emergency rooms for fear of infecting others or taking up much-needed beds.

Samaritan’s Purse hospital in New York City is setting up emergency room field tents in Central Park.
AP Photo/Mary Altaffer

With access to in-person care extremely limited – and potentially dangerous – many hospitals have started treating and meeting patients through phone calls and over the internet.

A perfect answer to pandemic problems

I am a former member of the Medical Board of California and have been working with telemedicine regulation since 2006 when California Gov. Arnold Schwarzenegger appointed me to the board. After years of steady but frustratingly slow growth in telehealth across the U.S., it is exciting to see telehealth finally being utilized as an important tool to deliver care.

Telehealth, also known as telemedicine, has long been discussed as an effective way to give people access to medical professionals from the comfort of their own homes. Using a phone, a tablet or a computer, a health care provider can diagnose, treat, prescribe and educate a patient sitting miles away. In response to the coronavirus, hundreds, if not thousands, of care providers across the country have gone partially digital and patients are flocking to these systems.

Patients and medical facilities alike are turning to telehealth like never before.
Ariel Skelley/DigitalVision via Getty Images

Prior to the coronavirus, my own university hospital, Keck Medicine at the University of Southern California, used telemedicine primarily for certain cancer and dermatology patients. Over the last week, however, the USC health system encouraged and initiated more than 5,000 telemedicine appointments, the majority of which were not for COVID-19 symptoms. Across the country, Boston Medical Center launched a telemedicine site on March 16 and within 48 hours, 1,500 patients scheduled virtual visits. By using telehealth services, these hospitals are freeing up valuable resources for those who need them most while simultaneously limiting risk to those who can be treated at home.

Telehealth services can deal with a large range of problems including skin issues, minor infectious diseases like the flu or cold, psychiatry and minor orthopedic problems like sprains. Physicians can also prescribe medications after a video or phone discussion.

But despite telehealth’s obvious benefits during this crisis, it is remarkably underutilized. Only a few hospital systems in the nation have the technological capability to ramp up to even 50% virtual care.

And perhaps more importantly, there are unnecessary regulatory roadblocks preventing telehealth from use at a mass scale across the nation.

The fight to go digital

In the early 1990s, disparities in health care in rural counties and an aging population with greater needs prompted California to consider telemedicine. The University of California at Davis launched a telemedicine program in 1992 to assist with fetal monitoring in rural counties. In 1996, California passed the first law regulating telehealth which allowed only California-licensed physicians to treat residents of California through telehealth technology. Legally, to this day, a doctor from Iowa, for instance, cannot treat a person living in Los Angeles.

As laws went on the books around the country, access to telehealth remained difficult. Many states required written consent from patients before they could receive virtual care. Others required at least one in-person medical examination before telehealth appointments. Insurers refused to reimburse telehealth providers at the same rates as in-person health care visits. Reasons for refusal included the simple interpretation of a definition of a medical office visit to concerns about the quality of care. These laws were meant to protect patients, but reflected concerns of the traditional face-to-face medicine and were counterproductive to the use of this technology.

Patient advocacy groups and some state agencies – like the California Medical Board that I was a part of – saw the potential of telehealth. In the years that followed, many of the restrictive laws and regulations were removed or changed. Additionally, laws were added in many places that forced insurance companies or government-provided health coverage to pay physicians the same amount for a virtual visit as an in-person visit.

For all this progress, 21 states and a few territories still do not allow the practice of medicine across state lines – arguably in the interest of protecting their own licensees and the quality of care. My home state of California is one of these states, as is New York, although a bill was introduced in the state house last month to allow telehealth across state lines. Particularly now, the ability for a patient in New York – where medical resources are extremely overburdened – to have a virtual appointment with a qualified physician in some place not yet as badly affected would be invaluable. Old regulation is preventing this.

There is unprecedented support for telehealth but state laws are preventing truly widespread use.
AP Photo/Evan Vucci

Telehealth to fight COVID-19

For the last few years momentum has been on the side of telehealth technology but utilization had still remained low. This year 91% of employers will offer telemedicine to their employees. Less than 10% of Americans have ever used the technology. The coronavirus crisis has demonstrated the need unlike anything before. As health care providers have moved en masse to virtual medicine, regulators and government officials are showing unheard of support for this tool that will almost certainly save lives.

On Monday, the Federal Communications Commission announced US$200 million in funding to support telehealth services across the U.S. On March 17, Medicare and Medicaid expanded the range of telehealth services that will be reimbursed. And state governments around the nation are requiring insurers to more broadly cover telehealth appointments.

This support and interest for telehealth is unprecedented and it seems the nation has finally realized what a powerful and valuable tool telehealth can be. Harder-hit areas are literally begging doctors from other states for help and if laws would allow it, telehealth could get them there instantly. Of course not all medicine can be done virtually, but a lot can, both now and in the future.

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

There are many COVID-19 tests in the US – how are they being regulated?

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When it comes to COVID-19 testing in the United States, the situation is about as messy as it gets.

The U.S. went from having no tests, or assays, available for COVID-19 diagnostics to having multiple different tests available in a span of just a few weeks. Today more than 230 test developers have alerted the Food and Drug Administration that they are requesting emergency authorization for their tests; 20 have been granted. And 110 laboratories around the country, including my own, are also using their own tests. Having this number of diagnostic tests available to detect a single virus in such a short time frame is unprecedented.

Which tests are good and which tests are bad isn’t immediately apparent. According to a March 30 press release from the FDA, “The FDA revised the process to allow labs to begin testing prior to FDA review of their validation data. This policy change was an unprecedented action to expand access to testing.” The guidance the FDA provides to test makers requires laboratories provide some evidence of their assay’s performance and consistency in results. It also ensures that reasonable thought is put into assay design. Assays meeting these requirements may then be permitted for clinical use prior to receiving approval by the FDA.

I am a physician scientist who studies viruses in my research laboratory and directs a clinical microbiology facility for a large hospital system. Since COVID-19 made it to the U.S., laboratory directors like me haven’t had a spare moment to focus on anything other than developing tests to respond to this pandemic.

There’s still a lot to learn

SARS-CoV-2 is the virus that causes the disease. It is a novel virus from the coronavirus family that was first identified in November 2019 in Wuhan, China. Like other viruses, this one is believed to have first infected animals and then jumped over to humans. Because of their zoonotic origins, these viruses are often ill-suited to spread from person to person. What makes COVID-19 so different is it’s readily spread between people, which lies at the heart of the current pandemic.

There is a lot that we just don’t yet know about COVID-19.

For example, for most respiratory viruses we develop antibodies that protect us from getting infected by them again. This is referred to as immunity. We assume that we’ll develop immunity from having been exposed to COVID-19 infections, but it hasn’t exactly been around long enough for us to know this for certain. Will this virus mutate so that our immunity won’t work? Will this virus become seasonal, much like the flu? Only time will tell.

Developing a test to detect this novel virus has been at the center of the efforts in the U.S. to combat its spread. If infected people can be quarantined early, they are much less likely to transmit it to others.

But right now there are at least 22 different COVID-19 tests on the U.S. market, not including at least 110 developed by individual laboratories across the country. So you many be wondering: Why do we need so many?

Why so many different tests?

Most of the available tests are based on collecting the virus’s RNA (ribonucleic acid) and converting it to DNA (deoxyribonucleic acid). This is the easy part of test development because all these tests use the same basic methods. The next step is making many millions or billions of copies of the DNA so that it can be detected. This is where most tests differ. COVID-19 is a large virus with many different genes that can be used to detect it. While one test may target one or more virus genes, another test may target a completely different set of genes.

The World Health Organization developed testing specifications for COVID-19 in January 2020. The U.S., led by the Centers for Disease Control and Prevention, developed separate testing specifications in early February 2020. The CDC started off as the single testing center for the U.S., but as demand rose, they distributed their test to public health laboratories across the country. This first CDC test probed the sample for three short sections of the virus’s genetic material.

Within days, testing kits manufactured and distributed by the CDC were proven to be problematic, likely from impurities in the testing materials that caused them to provide faulty results.

Despite increasing testing demand and problems with the CDC assay, the FDA remained steadfast that hospitals, academic centers and companies were not to develop their own COVID-19 tests.

These regulations were lifted at the end of February 2020, and centers across the U.S. were finally free to develop their own tests. There was so much pent-up energy to develop COVID-19 tests that the country rapidly ended up with a surplus of different tests. Because the U.S. never settled upon a single standard for detecting the virus, companies, hospitals and academic centers were left to their own devices to forge their own paths forward.

Who’s right, who’s wrong?

So which test is the best available right now in the U.S.? There’s no certain answer. None of these tests from different manufacturers have been around long enough to know which is best at detecting the virus.

The most common question I get asked is, “What is the accuracy of my institution’s COVID-19 test?” It’s impossible to answer because my institution uses five different tests, each of which will likely have different performance characteristics. These tests generally differ in the virus’s genes they target and the laboratory instrumentation on which they are performed. We have tests that can detect as few as 100 copies of a virus gene and tests that require as many as 400 copies for detection. We have chosen to use so many tests because testing kits to detect the virus are so limited that when we run out of kits from one manufacturer, we switch to another.

It is inevitable that we will learn that some tests are better than others. They were all developed so quickly that it’s unlikely they’ll have the same performance characteristics. We can only hope that none of the assays currently in use performs poorly.

The FDA regulates COVID-19 testing

Many of us laboratory directors in the U.S. have a love-hate relationship with the FDA. We love the FDA because their stringent oversight helps to protect us from using products that don’t work well. The hate stems from their standards being so high that products often come to market in Europe and Canada before they make it to the U.S.

The FDA took a decidedly different approach to regulating COVID-19 diagnostics. Due to the dearth of available testing in the U.S., they allowed hospitals, academic centers and companies to develop their own tests and begin using them if they could meet minimal standards.

The FDA will eventually do their due diligence in evaluating the COVID-19 tests that are available. Until that happens, we may have tests in use in the U.S. that don’t live up to their normal high standards.

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

Supporting the care of COVID+ patients at home with a digital health platform – Adam Schlifke

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Adam Schlifke, Founder & CEO, COVIDvent, Stanford School of Medicine

Host: David Cao, F50 F50 Global Insights

Adam Schlifke, MD, MBA is a board certified anesthesiologist with more than 15 years of experience in digital health. Dr. Schlifke is faculty at Stanford University where in addition to a clinical practice has a digital health appointment.

On March 14, 2020, Dr. Schlifke wrote a two page call to action and operational plan that called for creating more critical care space by repurposing unused space, such as surgery centers.

Since then, a grassroots movement has led to the creation of a operational plan for doing these conversions and to the formation of a company which is creating a digital health platform which will fully support the care of COVID+ patients at home – thereby decompressing the hospitals and emergency departments. Founder & CEO, http://www.covidvent.com Founder & CEO, http://www.expandcare.com #moreVentsNOW #RaisetheBar F50 Global Insights Youtube channel https://www.youtube.com/channel/UCC5Q…

Full interview on youtube

The full transcript

David: Welcome to F50, this is David and I am your host today. We have a very special guest, Dr.Adam. He is faculty from Stanford and he runs two startups. He has a very interesting initiative, just launched very recently to help COVID19 patient. 

Dr.Adam: Good morning everybody. It is a pleasure to be here. Thank you very much for having me. My name is Adam Schlifke, I am faculty at Stanford University, where I’m a clinical assistant professor. In addition, I do have a digital health appointment within the Department of Anesthesia. I’ve been in practice since 2007. I trained at UCSF, I moved to Stanford about a year ago to get more involved in the digital health initiatives going on at Stanford and about a month ago when this sort of the pandemic really started in this country, I saw an opportunity to really raise awareness around the critical care shortage, we were going be facing in this country very very soon.

David: Okay great, so I hear you have a great presentation and you can share to our audience there right now. So for the audience, we are recording this event as well as the live broadcasting on YouTube and ask some questions at the end.

Dr.Adam: Great, before I go into the actual business, I want to take an opportunity to speak about where this all started. On March 14th, I wrote a two-page paper which was an action plan and a call to action around converting space in hospitals and surgery centers into critical care areas and in fact I’ll go a step further not just critical care areas but using the promise of digital health to do virtual critical care. 

So we’ve spent the next two weeks operationalizing the plan. You can’t just move an anesthesia machine and expect to have a virtual ICU. It’s actually extremely complicated and we spent night and day with a team of about 10 people thinking through all the operational plans it would take to convert all these spaces and in fact we are talking to states like New York and other States at every levels of government about how to do this. 

Governor Cuomo said yesterday that there are five days left in New York to have vents if we converted every single operating room and surgery center to a virtual critical care area we could have a hundred thousand more vents tomorrow. Okay, there are only a hundred and fifty thousand vents in this country we can add a hundred thousand tomorrow if we operationalize that plan. But we haven’t stopped there we have created a full offering around remote patient monitoring, because the truth is that  we can bring care to the home. Why are patients going to the emergency room if they can be treated at home? The promise of digital health in my mind has not been recognized. I’ve been in digital health for 20 years and to be honest I’ve seen a lot of money go into the sector and very little come out in terms of treating patients with chronic disease. I come at this as a provider I am an anesthesiologist but I also see the writing on the wall that we have to move tear outside of the four walls of the hospital. This is our opportunity to redo the system. We don’t need big hospitals anymore, we don’t need perverse incentives. We don’t need all the for-profit systems being on the sidelines not helping fight this fight which is really trying to save lives in New York and the rest of the States in this country. So that’s where all this comes from. 

We started with the idea that we could take very lightweight technology and bring it to the home and then what we do is we take that lightweight technology and the weak connected with emergency rooms where providers are not working. Now you might ask me what do you mean, I thought the ears are overwhelmed that’s only true in pockets of the country certainly in the ERs in New York they’re overwhelmed but there are people sitting on the sidelines in other States. The beauty of the telehealth regulations now is that all the regulations have been relaxed so now if you’re a provider in Seattle or in LA or in San Francisco and you’re not that busy why not offer virtual services to another emergency room or virtual critical care services to another ICU whether it’s in the surgery center or somewhere else that’s where the real opportunity is. 

So we’ve thought about remote monitoring in a very complex way and the way I see I’m sorry there’s some typos on the slide I have not seen these slides before we’ve been we’ve been working 24 hours a day to get this all these pieces together. But the problem with remote monitoring in general is that it’s very piecemeal even Teladoc and AM, well they have great offerings but they can’t complete the last mile problem which is how do you get to patients at home and how do you connect them not to just providers in their network but how do you connect them to their facilities. So our plan is actually to connect all the dots in digital health. We bring patients care at home, we send them a package which is a full offering of monitoring solutions right and our partners are some of the best partners in the world. Massimo is one of the best medical device companies in the world and by the way Massimo is super interested in being engaged with us because they see us as thought leaders. We have grown a grassroots movement, we’ve been involved with a petition on change.org which has involved 1.3 million signatures, so I’m not saying that all those people are behind us in this business initiative, but what we’ve done is we brought all the technology to bear that’s already been developed and we’re taking digital health to the next level. Digital health you know for many years has been on the cusp of doing something very meaningful, but it’s been more about treating sore throats and UTIs than it has been about treating real chronic care patients. What if you had a home offering where you’ve had everything wrapped up together where you could basically do 90% of what you’re offering in hospitals at home. So the future I see in healthcare is that eventually patients will be getting 90% of their care at home, the hospitals will be ICUs,  ERs but the rest of it is unnecessary you’ll have some areas in for dialysis but like you don’t need patients sitting in beds not doing anything. In fact you want them walking around you know. May be you do physical therapy virtually, maybe you provide very low cost technology enable services at home so that 90% of this stuff that’s happening in a hospital is actually happening in a home. 

Oh and by the way there’s a group of physicians who are actually advocating trip treating COVID patients at hotels. So why would you do that, well you don’t want them standing in line in an emergency room there’s that’s a way for them to get make other patients sick. So it you know this is a complex system it’s a complex process we have worked out all the details and I encourage you to get involved. We have town hall meetings every day where we have industry people, technology people talking about how to move mountains to save lives in New York. We’re actually having those conversations every day and honestly I’m in this and the people that are in this are in it for the right reasons and the right reasons in my mind are to bring technology to bear that already exists. Why are all these companies reinventing the wheel we need to bring all the tech that’s possible today together to change lives in New York. Today we only have five days left it might be too late in New York but may be it’s not and so. I’m gonna keep pushing in New York, I’m gonna keep talking to the Legislators and the Governor you know. The Governor’s office and CMS and all these people it will take to move mountains but with your help and your or I’m confident that we can do that.

This is our opportunity to redesign the system. I’m just gonna reiterate that like I’ve spent 20 years in clinical practice. I know what the providers are feeling on the front lines. The reason why there is 50% physician burnout. It’s very clear there’s no autonomy, the administrators are sitting in offices they’re not supporting the providers. Providers are getting sued as a result of speaking out about the problems for those of you who have who don’t know ZDoggMD. You should look at his video that he published yesterday ZDogg basically was calling out every single administrator in this country because it’s time that leave the physicians and the providers and the clinicians and the nurses take back health care right there’s too much money in the system that doesn’t go to patients and providers there’s too much money in too much as at stake here with patients lives to continue operating business as usual.

Thanks, I’ll get off my soapbox now but if you want to join us come to our website be a part of the conversation we don’t have any time to waste.

David: Thanks Adam, looks like you have a great initiative. I have a couple questions first start is that so what do you need to move forward with your initiative? Especially with F50 Global Insight we have a global investor network as well as lots of entrepreneurs in Silicon Valley we’ll be watching this video. What do you need them to help you?

Adam: Are you asking today or next week or next month?

David: Now and next few weeks.

Adam: So today we need some money, we have no money today. Today what I had is about 10, what I always say that I built a team that money can’t buy because the people on my team are some of the best people in the industry, which I haven’t announced yet but the reason they’re at the table and the reason they’re making these slides and talking to executives is because they believe in in their heart of the mission and these are people that I’ve known for 20 years. So one of the things I’ve done over the last 20 years is built a great network of people and these people I brought to the table to affect change. So if you’re asking me what I need to do today I need people to help with the initiatives I’m happy to involve as many people but one of them be involved that have expertise to offer and I need a little bit on money to get things off the ground but I’ll tell you in the next week I expect to have some very big contracts and when those contracts happen I’ll need as many people as humanly possible to operationalize all these ideas as quickly as possible.

David:  Okay. Can you be little bit specific a little bit, other than money, what type of people you need to operate and how they can help.

Adam:  So our remote patient monitoring , so if you think about it so Massimo is a good there this is a good example of so Massimo makes a lot of monitors they have they have a network throughout 50 states they could be selling their monitors in all 50 states the one thing I’m not aware that they have is really a date a way to manage all that data think of all the data that will come from their probes that will need to be managed in the cloud and you can’t just have it does it’s that all the people on this call know technology that’s not that is not a problem that can be solved with a workforce that is technology scale at its core and Massimo and I believe we can help. Massimo help design a system that will enable the monitoring of millions of people simultaneously and so to build that we need about 10 and engineers and we need about a million dollars of revenue or a million dollars of money and we can probably build that in about two weeks. So we need people on the ground that are talking to executives, we need technology people that are actually building the system that we’re putting together and then we need a little money to make those operations happen.

David: So how far are you from your plan, so sounds like one million investment is a pretty big commitment where are you right now?

Adam:  We are ready to go so I’m in the final stages of negotiating at a deal with Massimo as I said we are approaching big hospital systems right now we don’t have a signed contract yet but it’s sort of the chicken and the egg problem. I have been talking to the highest levels of government both at the White House and states within this country. I think with just one contract and a little bit of money we will be off to the races. 

David: Specific question, what type of patient because COVID19 Corona Virus actually is the infection symptoms are very different between different people. There are people with no symptoms at all and there are very highly ill people, so what is your target group of patients.

Adam: It is a fantastic question. Something we spent a lot of time thinking about and my answer to you will be the following. That’s up to the hospital system that we work with, if you think about it what we do is we bring all these technology resources to bear and we help the hospital or ER manage a very lightweight technology enable system with big data. They can decide for themselves what the criteria are for which patients they manage or we can tell them. We know which patients should be managed at home with this technology but we don’t want to be prescriptive because at the end of the day it’s the clinicians that providers at the hospital systems that need to take ownership of this process. We can help them with those decisions but we’re not going to tell them what to do.

David: Okay, so I understand the challenge ER system but to take care of the patient at home it is not the ER Department’s issue right?

Adam:  It’s both, so what we’re doing is we are repurposing the emergency rooms to take care of these patients and if the ER doesn’t have enough staff and will involve primary care providers as well. So I’ve been in discussions with Teladoc and with AM Well we have the potential to have access to five thousand physicians tomorrow if we want it. But ideally my job is to repurpose the non-working physicians that are already in the system because I’m a provider like I understand what it means to be an emergency room physician and not to be working. One of my best friends works at the Vituity CEP America there are a billion dollar revenue professional services organization that contracts with hospitals for emergency medicine services. I know firsthand that some of their emergency rooms are overwhelmed and some of their emergency rooms aren’t working at all I can fix that disparate resources through this technology platform.

David: So right now we are in California, what is the process to deploy your services to somebody in New York or Washington?

Adam: So it depends if you’re asking me about that we have two separate businesses here so it depends if you’re asking me about the Surgery Center conversions or if you’re asking about the remote patient Monitoring. To be honest it is all connected because the vision that we have is you’re treating patients at home and then they go to the surgery center where it becomes a mini-hospital. Remember surgery centers typically only operate they don’t take care of patients for chronic diseases but if you repurpose the surgery centers in New York, then you can treat patients that are hospitalized but now you are not in a hospital you’re in the surgery center and then if they get very sick you provide critical care services right so we’ve connected all the dots and then on top of that you implement a low-cost technology solution that follows them from home to hospital to surgery center to critical care. Now you have ground truth now you have data at every part in the process. We are not epic, we are not creating a silo ecosystem of data. We are freeing the data which is what everybody talks about but which is very hard to do. We are sending the data to the cloud, we are sharing it with our partners, we are making it relevant so that in real-time data you can predict surge, you can relocate people, you can reallocate resources. In our minds this is the way to use technology and bring it to bear so that we can create a more efficient system. I am not on this call to sell anything to anybody. The reason why we’re in this is for the right reasons. It is to save lives. It is to save lives in New York, is to save lives in Florida, it’s to save lives in California. The way we do that is, we decompress the ERs We stop spreading infection in lines, when patients are in lines on the emergency rooms. We repurpose surgery centers so they are being used and not sitting on the sidelines. We put providers back to work. We put nurses back to work. This is what is driving us, not trying to make a buck in a system that is like is failing, you know significantly.

David: Okay great. Kaiser actually published a article few days ago stating that there are 5,000 outpatient surgery centers and nationwide. We re-purpose them definitely is one of the great solutions, but how? I understand you probably are one story, but what are the alternatives and how do you compare with different solutions?

Adam: We were the ones calling for repurposing surgery centers that Kaiser helped news. If you notice, I was actually speaking about this. So there are 5,000 surgery centers in this country the problem with surgery centers is that they’re independently owned and operated. So surgery centers are a perfect example of everything that is wrong in this country, okay. If surgery centers are owned and run by administrators then they’re controlled by administrators and administrators honestly are concerned about the bottom line. They are pure economic actors. I have I read you know I wrote a USA Today op-ed about three days ago you’re free to go look at it I call out HCA and that op-ed, okay. I used to work in an HCA hospital I know innately intimately what it means to run an HCA hospital. I was the medical director of an anesthesia group at a HCA Hospital. The reason I call out HCA is because they are one of the worst actors in all of this. They are a huge for-profit health system who is doing the wrong thing and they know it. They have a hundred and thirty surgery centers throughout the country and I in a cut at least a couple of days ago it was business it usual at these surgery centers. The surgery centers are working and there’s doing things that they shouldn’t be doing. Why would you be doing elective surgery when there’s this COVIDt problem. You should be diverting all your resources to being taken care of COVIT positive patients and to answer your question it’s very clear why this is happening it’s because of the perverse incentives. If the hospital system is making all their money doing elective surgery and surgery centers then of course they’re not going to re-purpose their surgery centers. So to answer your question, we had a proposal in front of CMS in front of Seema Varma to create a carrot and stick for the system. The surgery centers that are the good actors should be paid, the surgery centers that are the bad actors should not get reimbursement. It should be a very black-and-white conversation. Nobody should be doing cataracts today in this country.  I think I’m pretty confident that most anesthesiologist would support me when they say like why are we repurposing, why are we committing resources to taking care of unbelievably elective cases what in New York they don’t even have enough masks to protect themselves for COVID. It is just in my mind insane and honestly it’s where I come from with all of this because it’s so disheartening for providers who are on the front lines. 

I mean, have you seen any of the interviews with like nurses and physicians crying about having to inhabit patients around the clock and having to have these conversations with families and not having the masks and the supplies and the equipment that they need. So to get back to your question, two days ago CMS came out with change reimbursement, I can’t tell you for sure that we were responsible for it, but I can tell you for sure that we were involved in that conversation and in that conversation they decided to change reimbursement. So if you’re a surgery center and you’re a good actor you will get paid from a buck for providing critical care services, but guess what it’s still business as usual. So that’s not enough because they created the carrot but there’s no stick. If they’re a bad actor they can still be a bad actor and in fact what HCA, their response is well there are no COVID positive patients and where we’re working. Is that the answer? If you’re not testing patients, does that even matter? You don’t know who’s asymptomatic? You are putting providers lives at risk, you are putting patients lives at risk. If you’re operating on a cataract patient and they are COVID positive, even if you don’t know it, they may die because when you have surgery your body is stressed, your immune system is compromised. Why would you put patients lives at risk for this, for surgery that is unnecessary, when you have people dying in New York. So until you change the reimbursement, until you change you make carrots and sticks, until you have very black-and-white guidelines about what should be done and what should not be done, providers are going to be in the middle and honestly this is the problem today and it’s still why we fight.

David: Okay, got it. So very honestly, policy part is much less what we can do. We do have a big group of entrepreneurs will be listening to your audio. So how can other startup founders help you?

Adam: Listen I am happy to talk to anybody. Text me, call me, email me, get on the town halls. We have   calls every single day at 9:00 a.m. Pacific. I do those calls every day for a while. We were doing them two times a day. The more people we have at the table today the more we can move mountains. 

I’m not doing this alone, I’m not on a soapbox here. I’m doing it with my friends, I’m doing with my partners, I’m doing with my colleagues,  I’m doing it for the right reasons, not to make a couple bucks.

David: Okay got it. Can you tell us a bit more about to how other people can participate? You said, we have townhall meeting, how can people find out your townhall, you talked about?

Adam: If you go to our website, right now that there’s a problem with the website. So I need to figure out what’s going on with the website but  essentially we have a zoom meeting every day and I can give you that information offline. You’re welcome to publish the zoom invitation, it’s 9:00 a.m. Pacific Pacific everyday.

David: Okay, sure you send me the link and I will publish with this video. So the last questions,  there are lots of people on the help the fight with COVID19. Do you have any other ideas or solutions which is not  related to your startup but other startup you think should implement?

Adam:  Yeah, that’s a great question. Listen, I feel very strongly that we have a new world here that we’re going to have a better system. A system that actually works for patients and providers and everybody that’s actually on the front lines and that not for that the people on the sidelines just pulling money out of the system. So it’s an opportunity to really think big, think outside the box. I am an entrepreneur at heart, I’ve been doing this for 15 years. I don’t have all the answers, but I may know people that do so like reach out. You know, let’s talk about what we can do together. I’m not in here to compete with other startups. I want all the startups engaged and I want everybody to be successful, who’s trying to solve these problems.

David: Okay great thank you.

Adam:  Thank You.

Antibodies in the blood of COVID-19 survivors know how to beat coronavirus – and researchers are already testing new treatments that harness them

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Amid the chaos of an epidemic, those who survive a disease like COVID-19 carry within their bodies the secrets of an effective immune response. Virologists like me look to survivors for molecular clues that can provide a blueprint for the design of future treatments or even a vaccine.

Researchers are launching trials now that involve the transfusion of blood components from people who have recovered from COVID-19 to those who are sick or at high risk. Called “convalescent-plasma therapy,” this technique can work even without doctors knowing exactly what component of the blood may be beneficial.

For the pioneering work of the first treatment using therapeutic serum in 1891 (against diphtheria), Emil von Behring later earned the Nobel Prize in medicine. Anecdotal reporting of the therapy dates back as far as the devastating 1918-19 influenza pandemic, although scientists lack definitive evidence of its benefits during that global health crisis.

The extraordinary power of this passive immunization has traditionally been challenging to harness, primarily due to the difficulty of obtaining significant amounts of plasma from survivors. Due to scarce quantities, infusions of plasma pooled from volunteers were reserved for those most vulnerable to infection.

Fast forward to the 21st century, and the passive immunization picture changes considerably, thanks to steady advances in molecular medicine and new technologies that allow scientists to quickly characterize and scale up the production of the protective molecules.

Immune system’s defense workers

The immune systems of COVID-19 survivors figured out how to combat and defeat the invading SARS-CoV-2 virus.

Neutralizing antibodies are one kind of immunological front-line response. These antibodies are proteins that are secreted by immune cells called B lymphocytes when they encounter an invader, such as a virus.

Antibodies recognize and bind proteins on the surface of virus particles. For each infection, the immune system designs antibodies that are highly specific for the particular invading pathogen.

An enlarged 3D model of a single spike protein in the foreground; in the rear is a model of a SARS-CoV-2 virus covered with many of these spike proteins.
NIH, CC BY

For instance, each SARS-CoV-2 virus is covered by distinctive spike proteins that it uses like keys to unlock the doors to the cells it infects. By targeting these spikes – imagine covering the grooves of a key with tape – antibodies can make it nearly impossible for the virus to break in to human cells. Scientists call these kind of antibodies “NAbs” because they neutralize the virus before it can gain entry.

A holy grail for vaccinologists is figuring out how to spark the production of these ingenious antibodies. On first infection, your B lymphocytes train themselves to become expert producers of NAbs; they develop a memory of what a particular invader looks like. If the same invader is ever detected again at any time, your veteran B lymphocytes (known as memory B cells by this stage) spring into action. They rapidly secrete large quantities of the potent NAbs, preventing a second illness.

Vaccines capitalize on this ability, safely provoking an immune response and then relying on the immune system’s memory to be able to fend off the real pathogen if you ever encounter it.

Passive immunization is a process in which neutralizing antibodies from one individual can be used to protect or treat another. A clever example of this process exploited by nature is breastmilk, which passes protective antibodies from the mother to the infant.

Example of Ebola virus disease

In addition to their potential preventative role, neutralizing antibodies are starting to prove beneficial in novel treatments for viral disease. Harnessing their protective power has been challenging, though, primarily because isolating enough antibodies to be effective is laborious.

Recent advances in the technology of molecular medicine at last allowed the kind of scale-up that enabled researchers to test the immunological principle. In 2014-15, Ebola virus disease surfaced in West Africa, triggering an epidemic that raged for over a year, killing more than 11,000 people. About 40% of those infected died. There were no treatments and no vaccine.

In the midst of the devastation came innovation: ZMapp, a mix of three synthetic NAbs showed early promising results in ameliorating disease in people infected with EBOV.

Researchers inserted engineered DNA into plant leaves to produce antibodies to fight the Ebola virus.
Sean Gallup/Getty Images News via Getty Images Europe

By the time Ebola again emerged from the rainforest, this time in 2018 in the Democratic Republic of Congo, the science was ready. In November 2018, doctors launched three parallel trials comparing three different antibody cocktails. Nine months later, spectacular results allowed for an immediate end of the experimental trials so the cocktails could be used in the field.

While ZMapp did not work as well as anticipated, the trials identified two other antibody-based therapies from two different companies that did suppress Ebola symptoms in infected patients. The earlier in their infection that patients received therapy, the better the protection.

Infectious disease experts around the globe heralded the results as a vital breakthrough.

At that time last fall, it would have been difficult to imagine that within six months there’d be an even greater need for the powerful strategy of passive immunization.

A doctor who has recovered from COVID-19 holds up a bag of his own donated plasma in Wuhan, China.
STR/AFP via Getty Images

Applying the technique to SARS-CoV-2

While the SARS-CoV-2 virus is moving quickly, with almost 1 million confirmed infections worldwide as of this writing, the science is racing to catch up.

Days ago a report published by scientists working in Shenzhen, China, suggested that plasma – which contains antibodies – from survivors of COVID-19 was successful in treating five critically ill patients. At the end of March, the FDA approved the use of convalescent plasma in treating severely ill people here in the U.S. In addition, Mt. Sinai in New York has established a collaboration with the FDA and other hospitals to begin clinical trials to scientifically determine whether this strategy of passive immunization is viable.

While the rapid move to evaluate this novel treatment is a moment for celebration, the science must keep moving. Convalescent plasma, which is isolated from recently recovered survivors, is in too short of a supply to be broadly useful. The most potent neutralizing antibodies must be quickly characterized and then produced efficiently in large quantities. Several companies, as well as a number of powerhouse academic labs, aim to meet the challenge of identifying and generating these life-saving NAbs.

At the fore is Regeneron, the pharmaceutical company that designed the effective Ebola treatment. Although targeting a different virus, their overall strategy remains the same. They’ve isolated and characterized NAbs and plan to engineer a cocktail of the most potent molecules. The viral target of these antibodies is the SARS-CoV-2 spike protein; the NAbs work by preventing the virus from entering cells.

Clinical trials are planned for early summer, essentially three months’ time. It is a breakneck pace for the development of such a sophisticated tool of intervention.

As the U.S. enters the exponential phase of COVID-19’s spread, this treatment cannot come soon enough.

[You need to understand the coronavirus pandemic, and we can help. Read our newsletter.]

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Feeling overwhelmed? Approach coronavirus as a challenge to be met, not a threat to be feared

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You have a choice to make when it comes to the coronavirus pandemic.

Do you treat this time as an insurmountable threat that pits you against everyone else? This option entails making decisions based solely on protecting yourself and your loved ones: stockpiling supplies regardless of what that leaves for others; continuing to host small gatherings because you’re personally at lower risk; or taking no precautions because the effort seems futile.

Or do you treat the coronavirus as a collective challenge that will require shared sacrifices to achieve a difficult but not impossible goal? That option would mean taking recommended precautions: practicing social distancing, hand-washing and restricting travel. These actions might not be your most desired or convenient path as an individual, but they contribute to the broader social good, reducing the spread of COVID-19.

As a professor of psychology and licensed clinical psychologist who studies how people think differently when they’re anxious, I recognize this global pandemic has all the ingredients to fuel a threat-oriented mindset. The trajectory of the coronavirus is uncertain and unpredictable, the very features that fuel anxiety and threat-processing in the brain.

The way people process threatening events matters a lot for how well they’ll manage this period of uncertainty. Some identification of threat is useful and will mobilize you to action, but a rigid overestimation of threat makes you panic or immobilizes you.

Letting the threat dictate your response

When you perceive a situation as a dire threat, it changes how you process information.

No longer do you consider the pros and cons of your choices evenhandedly, looking at the situation from multiple perspectives. Instead, your attention narrows, selectively focusing on cues that reinforce your sense of danger and vulnerability.

Your interpretations become biased, so that you assume the worst when a situation is ambiguous – as almost all situations are.

And you preferentially remember information that confirms a prior belief that the world is a dangerous place and you don’t measure up.

Why is this a problem? After all, the world really is in the grip of an objectively dangerous pandemic. Paying attention to this threat seems vital for staying safe.

The issue occurs when you believe that your personal resources are insufficient to meet the demands of the situation. If you feel the threat is insurmountable, then you give up. Why try if you’re doomed to fail? And if you feel that your resources – be it food, money, time, energy – are inadequate or threatened, then you have nothing to share with others, and hoard what you can for yourself.

Tuning in to news 24/7 can be counterproductive.
fizkes/iStock via Getty Images Plus

Feeling threatened can make you hyperfocused on monitoring for signs of danger, which can in turn mean consuming terrifying stories about COVID-19 almost nonstop. It’s important to stay informed, but prior research makes clear that people are more prone to mental health problems, like anxiety and post-traumatic stress disorder, if they don’t limit media exposure. In turn, reading about COVID-19 all the time increases the perception of threat, further fueling the need to monitor for danger signs in a vicious cycle that makes the world seem ever scarier.

Better to conceive a threat as a challenge

It’s better for your mental health to see this time as a collective challenge – one that is extremely difficult but which can be met if everyone works together.

When you size something up as a challenge, it’s easier to rise to the occasion. Instead of withdrawing from the problem, you shift to problem-solving. People with this mindset draw on others to help, and they offer their own support to those in need. Research has shown that working collaboratively and helping others has great mental health benefits for the helper.

Research on cognitive behavior therapy shows that shifting one’s outlook to perceive something as a motivating challenge rather than an insurmountable threat can be a successful way to treat anxiety disorders.

Cognitive therapy promotes questioning your thoughts instead of assuming the first one that pops into your mind is the most helpful. An individual becomes a scientist, weighing the evidence for and against ideas to reach more balanced conclusions. You become an explorer, thinking flexibly to consider new approaches to solving problems. If you sniffle once, you don’t immediately assume you have COVID-19 – you maintain precautions, but also consider whether this month is when your allergies usually act up and see if allergy medicine works.

It would be ludicrous not to acknowledge the real threats the world faces right now, and the disproportionate impact this difficult time has on already marginalized communities. But you need not define this threat as insurmountable and get stuck there. Choose instead to work together – albeit remotely – and accept the coronavirus challenge. The shift from threat to challenge might just make it a little easier to stay home, to close the browser and stop reading about COVID-19 24/7, to wash your hands for a full 20 seconds and to buy just what you need at the store so others can do the same.

[You need to understand the coronavirus pandemic, and we can help. Read our newsletter.]

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The Nation’s 5,000 Outpatient Surgery Centers Could Help With The COVID-19 Overflow

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As the number of COVID-19 cases continues to rise, a group of anesthesiologists wants to convert America’s surgery centers into critical care units for infected patients.

Many of the country’s more than 5,000 outpatient surgery centers have closed or sharply cut back on the number of elective procedures they perform, to comply with requests from government agencies and professional societies. But those surgery centers have space and staff, as well as anesthesia machines that could be repurposed into ventilators — all of which could be especially crucial in hard-hit areas like New York.

“Half of the surgery centers in New York are not doing anything,” said Adam Schlifke, an anesthesiologist and clinical assistant professor at Stanford University in California, who is leading the push for the centers to help. “All these anesthesiologists and nurses who are sitting on the sidelines, they want to help. They don’t know how to help. There’s nowhere for them to help. What if they could work in the surgery centers?”

Opening such outpatient centers nationwide to coronavirus patients would nearly double the number of facilities nationwide, up from the country’s fewer than 6,200 hospitals. But turning day facilities into places for 24/7 care worries some anesthesiologists. There are questions about staffing, regulations and payment. They also fear that using surgery centers as critical care units would do more harm than good if the centers aren’t properly equipped to handle severe cases of COVID-19.

“Even if we lifted the regulatory restrictions, surgery centers are licensed to do a certain thing,” said Dr. Steven Dalbec, a private practice anesthesiologist in Columbia, Missouri, who once ran a surgery center in Arizona. “If we could say, ‘OK, we’re going to lift all those restrictions and let you take care of critically ill patients,’ it’s not something that could happen overnight.”

Still, that’s exactly why Schlifke argues that it’s important to start now, especially in parts of the country with fewer cases. His group has created a blueprint that outlines the steps needed for surgery centers to convert.

In the coming days, Schlifke said, he and the approximately 75 members of the CovidVent coalition of anesthesiologists he’s helping organize will call for a federal executive order to enable the conversion of surgery centers and hospital operating rooms into COVID-19 care sites to help save lives.

The order is needed, he said, because he recognizes that providers want to get paid. The idea is so new, he said, there’s no reimbursement plan in place for surgery centers that agree to treat COVID-19 patients.

What’s most troubling, Schlifke said, is the number of anesthesiologists who cannot help with the pandemic because their center is either closed or they are busy with elective surgeries that aren’t necessary. It’s a frustrating dilemma.

“They want to work,” Schlifke said.

The CovidVent group also wants to make sure surgery centers follow Centers for Medicare & Medicaid Services recommendations that call for them to end nonessential elective surgeries to keep front-line medical providers safe amid shortages of protective supplies such as masks. Many of those surgery centers are in states like New York, California and Washington where hospitals can’t keep up with the demand.

“An important question for hospitals and health systems that continue to perform elective and nonessential surgeries is, ‘Why?'” said Dr. Greg Martin, president-elect of the Society of Critical Care Medicine, which represents intensive care doctors. “How do they justify the risk to the otherwise healthy individuals, justify the risk to the health care provider workforce who may be imminently needed elsewhere, and justify the unnecessary consumption of health care resources such as masks, gloves and gowns?”

But William Prentice, CEO of the Ambulatory Surgery Center Association, an industry group, argued that some surgeries remain necessary. “We’re pushing things off that can be pushed off,” he said.

Meanwhile, in Washington, D.C., Vice President Mike Pence has already come out in support of the use of anesthesiology equipment as ventilators.

Anesthesia machines used in the operating room can be repurposed as mechanical ventilators, Martin said. “But they function differently and do not have all the same settings as ICU ventilators, so employing them in COVID-19 care requires education or oversight from those who are expert in using them.”

Dalbec also supports converting anesthesia machines into ventilators. He now works at Boone Hospital Center in Columbia, Missouri, which he said is prepared to do that if needed. As of Friday, he said, the 230-bed hospital hasn’t treated a confirmed COVID-19 patient.

But creating new intensive care units is challenging, according to both Dalbec and Martin.

Dalbec, who ran a surgery center in Tucson, Arizona, for 10 years, worries a lot of surgery centers don’t have the training, skills or supplies to care for critically ill patients.

“Time is of the essence,” Dalbec said. “And so that would make the care for these patients considerably challenging.”

An ICU has sophisticated equipment, such as bedside machines to monitor a patient’s heart rate and mechanical ventilators to help them breathe, Martin said. Ventilators need to be hooked up to oxygen and gas lines, which supply patients with the appropriate mix of air.

Only a few areas of the hospital have the equipment and gas hookups to provide ventilator care to critically ill patients, Martin said. These include the operating room, emergency department and units used for post-anesthesia care. To convert an ordinary hospital unit to an ICU, Martin said, “You would literally need to tear down the wall and run the piping in.”

Hospitals are already looking to use operating rooms for intensive care, Martin said.

“Using OR space, equipment and staff to care for sick COVID-19 patients is the right thing to do,” Martin said. “This is one approach that most health systems are already considering and using.”

Many outpatient operating rooms at surgery centers already have the required gas and oxygen hookups, Martin said. “Some will have fully configured operating rooms with ventilators,” he said. “It would be one way to expand ICU-level patient care space.”

But they are unlikely to stock all the medications used in an ICU.

Another challenge, he said, would be that staff from most surgery centers may be pulled into hospitals — anesthesiologists, nurses and nurse anesthetists — and surgery centers would not have all the pharmacists, respiratory therapists and other staff.

Intensive care units are staffed by specially trained doctors, nurses and respiratory therapists, who set up ventilators and closely monitor patients’ breathing, Martin said. “The hardest thing to change is the staffing,” he said. “We only have a certain number of doctors, nurses and respiratory therapists.”

CovidVent is working with several telemedicine groups that could help treat patients in areas where the staff lacks the expertise, Schlifke said.

Outpatient surgery centers would need to receive a waiver from federal regulators to keep patients overnight or perform medical care they don’t currently perform, Prentice said.

Prentice said he’s optimistic that the Centers for Medicare & Medicaid Services will make an announcement about such waivers in coming days.

“Once we get that flexibility, we can find the best way to help,” Prentice said. “Decisions about how to best to use ambulatory surgery centers need to be made in conjunction with hospitals at the local level.”

Related Topics

California Global Health Watch Health Industry Public Health States

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Meetup Spins Off From WeWork Fostering Commitment to its 49 Million Members

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Meetup, one of the world’s first social media platforms and the only one dedicated to groups that meet in-person or online during times of crisis, today announced that the company has been acquired. The consortium of investors is led by Kevin Ryan’s AlleyCorp and includes mission-driven private funds and accomplished technology executives. Ryan joins as Chairman of the board. David Siegel will stay on as CEO of Meetup, board member, and he will continue to lead the company.

Meetup will divest from The We Company (“WeWork”) and operate independently after two-and-a-half years as a subsidiary. The company will continue to service its growing 49 million members and over 230,000 organizers, who collectively produce an average of 15,000 in-person events daily. Meetup’s enterprise business solutions will also continue under Meetup Pro, a community building and engagement platform with more than 1,500 clients including Adobe, Google, Microsoft Azure, IBM, Twitter, and Looker and hundreds of entrepreneurs.

“This acquisition provides the long-term capital to ensure that Meetup focuses on what is most important: the organizers who make Meetup successful, our passionate members, and our dedicated employees,” said David Siegel, CEO of Meetup. “We are excited to continue on our mission of empowering personal growth through real human connections, and I’m happy to have brought in a team of smart investors who share and support the same values.”

“We are confident in the enormous potential of the business and Meetup’s mission of bringing people together in substantive ways,” said Kevin Ryan of AlleyCorp, who is the lead investor and Chairman of the Board. “We are very excited to collectively serve and grow Meetup’s extensive and incredibly engaged user base.”

A predecessor to Facebook, YouTube, Instagram, TikTok, and Twitter, Meetup shares a similar global member reach, throughout 193 countries. Contrastingly, Meetup’s business is built around using online social media to help people be more social offline — without using its users’ private data for the purpose of targeted advertising. In 2019, Meetup drove 30 million hours of real-life human connection and experienced a 40% growth in its enterprise business. In 2020, the company updated its policy to allow organizers to host events online during the Coronavirus pandemic.

Meetup was founded in 2002 as a platform for finding and building local communities. While the company and its user base have significantly expanded and evolved since then, the mission has remained the same. Meetup will always foster human connection. This acquisition will propel Meetup to continue exploring and growing innovative new ways of bringing communities together.

“We thank David and the entire Meetup team for their many contributions to WeWork over the past two and a half years,” said Rohit Dave, Head of Corporate Development, WeWork. “Our decision to divest Meetup aligns with WeWork’s renewed focus on the company’s core workspace business and marks a positive step forward for both WeWork and Meetup.”

About Meetup
Meetup is the leading social media platform dedicated to connecting people in person or online during times of crisis. Established in 2002, its mission is to help people grow and achieve their goals through real-life, human connections. From professional networking to craft brewery crawls to coding workshops and more, people use Meetup to get out from behind their screens to meet new people in real life who share those same passions or professional aspirations. Meetup uses technology and social media to help people get away from technology and become more social. Join Meetup to try something new, or to start a group and find other passionate people, at Meetup (https://www.meetup.com/) and follow company news on TwitterInstagram, and Facebook (@Meetup). For enterprise business solutions visit Meetup Pro (https://www.meetup.com/pro).

Meetup supports 49 million members, 330,000 groups, and 100,000 events per week in 193 countries and 2,000 cities around the world.

CEO Blog on meetup.com

COVID-19: How to prepare yourself, an Oriental Medicine Prospect by Dr. Hao Liu

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Recorded and Edited by Amy Chang L.Ac 

Speaker: Hao Liu, Hao’s Healing Lounge

Moderator: David Cao, F50 Ventures; Amit Saha, Research Engineering, School of Medicine Stanford

About Dr. Hao Liu: http://www.thehealinglounge.net/index… Organizer: Silicon Valley Oriental Medicine Study Group, Silicon Valley Entrepreneurs Community

Host – David: Coronavirus–what is it? How is it related to the flu? The experts in Europe say that 70% of population will get it. What will happen next winter? 

Host – Admit: How do we differentiate in terms of Chinese medicine? 

Dr. Liu: Diagnostic testing is more advanced in biomedicine. Biomed wants to know what exactly is invading. Chinese medicine cares more about how the body reacts. The biomed immune system is equivalent to Chinese medicine’s Lung System: that includes the Lung Zang-organ, the skin and pores, the Large Intestine Fu-organ, their corresponding channels, etc. 

Now we know viruses are not live organisms, but parasites that host themselves in our cells. When there are no vaccines available yet [to prevent people from getting sick in the first place, the question is] how to maintain the body functions while antibodies are being made by our immune system to counter the virus. Chinese medicine has the advantage when it comes to treatment. We basically look at what level or depth the virus has penetrated to and improve the situation at that level. 

Q: Everyone is working from home here in the Silicon Valley. How do we raise the immune system? 

Dr. Liu: To raise the immune system we need to improve Lung organ function. The Lung has 2 exit pathways: 1. Lung and skin i.e. biǎo 表 ‘exterior’ takes 20-30% of garbage out through sweating. 

2. Lung and digestion i.e. intestines take 80-90% out through excretion. The digestion is responsible for both excretion and absorption of nutrients from the food we eat to maintain metabolism for metabolic function of the rest of the body. The liver, kidney and pancreas are in charge of creating antibodies ASAP. 

Q: Same strategy for high risk groups? 

Dr. Liu: Same. Wash hands, wear masks, use Lysol or alcohol on surfaces. Keep the air dry; this is actually a time when turning up your forced air heater is actually helpful because the virus prefers cool moist environment. Use a dehumidifier if you have one. 

Q: In Europe they are recommending self quarantine at home for lighter cases. Do you have any recommendations for home remedies? 

Dr. Liu: The course of this pandemic appears to be 9 days. The first 5 days are light. Day 1 symptoms include sore throat, no fever, no fatigue, regular appetite/thirst. Here the virus is just affecting the most superficial part of you, the nose and throat. If we can keep it here the disease has no chance to get much deeper. Okay, the first 3 days are like this. 

After that it progresses to more painful sore throat, body aches, rasping in the voice, still no fever, headache, diarrhea and digestive dysfunction. People with weaker digestive function are more likely to get this disease. We noted this when the virus first started infecting people in Wuhan; all the patients have obvious lower digestive function. 

America has disadvantages, even though our housing is not so dense (unlike China). We have less rain here in the Bay Area, so the air is more dry. This is a disadvantage for airborne diseases like pneumonia droplets. People eat salad and fruit which dampens the digestion. The dampness goes into organs, clogging up the digestive exit pathway, so you can’t just treat the exterior to resolve the issue when it’s gotten in this far. 

No digestive signs and symptoms = light case If you do not protect your digestion, it is very hard to control the disease’s progress. 

aches/digestive symptoms have started* 

Improve immune system’s communication btw organs and surface, promote sweating

We’ve changed the dosing a little, and added some modifications. Most notably, we are using a high dose of chai hu to speed up the body’s internal communications to keep the disease in the exterior part of the body and block it from penetrating the interior. Of course, it’s better to consult your herbalist and have a professional monitor you recovery. 

Q: That’s for people who have already contracted Coronavirus. How about the people who have not gotten it yet? Also [because of panic buying] a lot of herbs are out of stock. Do you have any dietary recommendations for that? 

Dr. Liu: This is a very good question. I devised a small formula for people to take as a preventative measure. Please make note of the preparation process because it’s a bit more complicated than usual. Herbs shēng jiāng 生薑 fresh ginger 20g yáng cōng 洋蔥 onion 200g chén pí 陳皮 aged tangerine peel 10g sugar or honey to taste 

Preparation: 1. Decoct 10g ginger and 10g chen pi first for 10-15 minutes. (Ginger, when cooked longer than 5 minutes, supports the digestive system without promoting sweating. Chen pi is great for transforming phlegm and increasing peristalsis.) 2. Add 10g ginger and one large onion for 3-5 minutes. (This harnesses the aromatic volatiles to open the pores.) We say in Chinese, xīn gān huà yáng 「辛甘化陽」”Spicy [and] sweet transform [into] yang.” This is why adding a little sweetness to spicy gives us more energy, i.e. more yang. Use honey for diabetics, it affects the blood sugar less. 

Q: Self acupressure suggestions? 

Dr. Liu: Yes. (see demo in video at 22:30) For activating the exterior, rub the Lung and Large Intestine channels [btw LI4-LI6, Lu10-Lu6] gently. You only have to stimulate the skin because the goal is to activate the pores. 

Because every individual’s constitution and health situation differs, please consult your primary treating physician of Chinese medicine before using herbs. 

For digestion, put both hands on your abdomen, over the belly button [Ren8]; men with the left hand under, women with the right hand under. Rub in a circle 36 times clockwise, 36 times widdershins. Stomach 36 and Gallbladder 34 are also good points to massage. Moxa is good, especially ginger moxa [where you put the dried mugwort on a coin-thick slice of ginger perforated with toothpick holes, and place the ginger over the point]. Heating the low back area is also good. Really anything that improves the circulation at the surface and the digestive function. 

Q: Can we come back to the question of how far this virus is going to affect us into the future? 

Dr. Liu: It won’t disappear. It’s here. But it is, as we have already seen, limited by environment. First of all, we’ve seen that most infections are happening around 40 degrees north latitude. That’s one example of environment. Secondly, here on Earth we are affected by the position of the five planets [closest to us]. This is why we say that often in the year of gēng zǐ 庚子 there are often virulent plagues. This is because some of the microorganisms here on Earth are affected by the magnetic field of the positions of the planets around us; the interference causes mutation and outbreaks to happen. As the planets rotate, at some point the magnetic resonance disappears, and the effects [here on Earth therefore] diminish. My personal opinion is that after the end of March, this virus will weaken, so if we can all make it through this time, even if you get the virus later, it will be a weaker version of itself, and its effects will not be so terrible. But as a virus, it will survive, just differently. Studies are already showing that the virus is changing; we are seeing second and third generations. This is nothing to panic about. Those of you who are parents, your kids look different than you right? So the virus, when it replicates itself, its offspring also looks different from them. This is natural. Kids are supposed to be different from their parents. 

Q: Okay let’s look at some clarifying questions from the participants! 1. Do we massage both hands? 

Dr. Liu: Yes. 

Q: 2. For your tangerine peel, ginger, onion, and honey formula, how much water do we use for the decoction? 

Dr. Liu: Three cups cold water decocted to 2 cups of beverage. 

Q: 3. If Coronavirus patient has diarrhea, do we want to stop the diarrhea with medication or help the body detox by allowing it to happen? 

Dr. Liu: Practitioners of Chinese medicine don’t usually stop diarrhea per se; we improve your Stomach and Intestines’ functionality. With better function, whatever is supposed to be excreted goes out, and the diarrhea stops on its own. In some cases we do see, usually when you actually have been poisoned, where we support the diarrhea to help you detox. But mostly we’re improving the digestive function. Huo Xiang Zheng Qi San is a good example of this; it’s a formula for diarrhea, but it doesn’t concern itself with stopping the diarrhea. It improves your digestive function, and the diarrhea stops on its own. 

Q: 4. What foods and supplements should we eat? 

Dr. Liu: I have some opinions on this subject. There’s a lot of experts recommending Vitamins C, D, and E. I disagree. If you read Dr. Wu’s article closely you’ll see it actually recommends Vitamin C and E after the patient has been very severely ill and is now recovering. In other words the patient has to be past the severe stages, have recovered from their illness, before taking Vit. C and E. 

This is because Vitamin C is a very strong astringent. It’s highly acidic; this will close the pores, tighten the body. So if you are going out, going into hospital for example, and you are in the high risk group, taking a dose of Vitamin C to “seal up” your body makes sense, and does decrease your risk of contracting a virus. However, remember that closing up the pores shuts off one of the Lung’s two exit pathways. Also, right now we are in the season of Spring. Spring belongs to Liver, and the Liver needs to express itself; it needs to release/disperse. [This is the same verb 發 “to express” as in fā rè 發熱 “to express fever/heat” and the same verb sàn 散 “to disperse” as “to scatter”…and the same character sǎn 散 as we use in powdered formulas.] The body’s energy in Spring is supposed to flow from the internal organs outward toward the limbs. Vitamin C interrupts this flow. It[s action] is not aligned with the nature of Spring. So I recommend against Vitamin C. Now Vitamin E is great for nourishing yin. What we mean when we say something nourishes yin, it increases the fluids inside your body. In other words, it creates more dampness. When our insides are more damp, the digestion weakens. Gut motility slows down. In other words it impacts your Lung and digestive tract’s exit pathway. This is great for people who have lost a lot of fluids, for example after sweating profusely in prolonged severe illnesses, but we do not recommend it as an everyday preventative. Vitamin D is okay to take. 

Q. 5. Preventative measures for pregnant ladies? 

Dr. Liu: This is very dangerous. Get tested asap. Pregnancy is so individualized, so unique to each individual, I can’t make any generalizations. Go see your doctor about it. 

Q. 6. After contact with inflected, how to prevent self from getting sick? 

Dr. Liu: Take 3-5 days Chái Gé Jiě Jī Tāng 柴葛解肌湯 dosed for mild/early stage. It will speed up your progression through 

Q. 7. Would Xiǎo Chái Hú Tāng 小柴胡湯 work? 

Dr. Liu: Xiao Chai Hu Tang only opens the communication between the interior and exterior, but it doesn’t really have the power to push things outward… it lacks momentum, and also it doesn’t really benefit the digestion much, so its benefits here will be much less. 

Important note:

Because every individual’s constitution and health situation differs, please consult your primary treating physician of Chinese medicine before using herbs. 

Hao Liu OMD L. Ac http://www.thehealinglounge.net/

10201 S De Anza Blvd, Cupertino, CA 95014
Tel: 650-759-4675 Fax: 844-270-1945

Telemedicine Surges, Fueled By Coronavirus Fears And Shift In Payment Rules

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

Lukas Kopacki, home from college after the coronavirus pandemic closed his campus, was feeling lousy for days with headaches, sore throat and difficulty breathing through his nose. But he worried that a trip to a doctor’s office might make him sicker.

“I had no desire to go into that cesspool of bacteria and viruses,” said Kopacki, 19, of Ringwood, New Jersey.

So, last week the University of Vermont student called Teladoc, a company that connects patients to doctors by phone nationwide. Its physician diagnosed his sinus infection and sent a prescription for an antibiotic to his local pharmacy. With his Aetna health coverage, which earlier this month temporarily waived its $45 patient copayment for virtual care, Kopacki paid out-of-pocket $1.44, which covered his costs for the drug.

“It was quick and easy,” he said.

Getting heath care by phone or video conferencing has been around for several decades, but the outbreak of coronavirus has led to an increase in telemedicine use as never seen before, according to health systems and provider groups across the country.

Millions of Americans are seeking care by connecting with a doctor electronically, many for the first time. Health systems, insurers and physician groups said it allows people to practice social distancing while reducing the spread of the disease and protecting health workers.

Private technology companies such as Teladoc, Doctor On Demand and Amwell and large health care systems can provide a doctor directly to someone who contacts them. Other patients may seek a telemedicine appointment with their regular physician, who can use computer applications through smartphones and computers. All types of primary and specialty care and mental health services can be provided via telemedicine.

Many hospitals have recently added telemedicine services to keep patients concerned about the coronavirus from clogging their emergency rooms.

Also spurred by the goal to keep patients away from crowded medical facilities, government and private insurers have increased the payment for telemedicine visits so they are on par with in-person visits. Before the outbreak, insurers paid less than half that amount, which dissuaded many doctors from offering the services.

Medicare last week allowed all enrollees to use telemedicine — an option that previously was available only to people living in remote areas and for a specific, short checkup. The federal government also said doctors could practice across state lines during the pandemic to treat Medicare patients virtually, even if not licensed in the patient’s state. California, Florida and other states have also waived their requirements that a physician be licensed in the state to provide care.

The Cleveland Clinic is on track to log more than 60,000 telemedicine visits in March, according to officials there. Before March, that health system – which has hospitals in Ohio and Florida — averaged about 3,400 virtual visits a month.

Its Express Care Online system serves patients across the country 24 hours a day. About 75% of the calls now come from people worried they have COVID-19, said Dr. Matthew Faiman, medical director of the service. Like many other health systems, Cleveland Clinic’s virtual urgent care is waiving patient copays during the pandemic.

“We are seeing a significant upsurge in demand from patients seeking care – both the worried well and patients who are sick and wanting to know how to manage their symptoms,” Faiman said. The clinic has pulled more doctors into the telehealth work since elective surgeries were canceled and fewer patients are making in-person visits.

He applauded the Medicare changes and predicted such changes will likely stay after the national emergency ends.

Dr. Manish Naik, chief medical information technology officer at the Austin Regional Clinic in Texas, also predicted it will be hard to go back.

“Telemedicine has been on the brink for a while now,” Naik said. “And doctors and patients are going to find that when this is all over and the dust settles there are a lot of people who are going to want the telemedicine option to stay.”

Of course, such visits have limitations, such as when doctors need to listen to a patient’s lungs or order an X-ray to check for pneumonia. But Naik said telemedicine also gives doctors a more complete view of the patients through “observation around the home” and interactions there that shows “things we never could see before.”

Before March, NYU Langone Health in New York had about 50 virtual visits a day through its urgent care telemedicine platform. During the week of March 23, the hospital system is averaging about 900 a day.

For 80% of telemedicine visits, cough is the chief complaint followed by fever, said Dr. Paul Testa, its chief medical information officer. NYU Langone has 170 doctors who attend to telemedicine patients, up from 35 two weeks ago, he said.

“We are not recommending testing for everyone, but we are recommending self-care, hydration and self-isolation,” Testa added. “The goal is to create a new front line for these patients rather than have them rush into an urgent care or ER.”

If a patient is having trouble breathing or otherwise is in distress, an NYU telemedicine provider will direct them to call an ambulance if necessary or go to the ER and alert the hospital the patient is coming.

Teladoc is averaging 15,000 patient visits a day in the United States, 50% higher than in February. Wait times have increased from minutes to hours in some cases, a spokesperson said.

At the Austin Regional Clinic, which has 340 doctors in 28 offices, nearly half of patient visits are now virtual compared with a fraction before the outbreak.

“With the COVID-19 situation, we have patients who are nervous about coming in, and we don’t want patients with symptoms coming in and exposing others,” Naik said.

He said that for years the clinic made the telemedicine option available, but it did not make sense financially to promote it because insurers paid less than half the rate they would for an in-person visit.

The Medicare payment change can’t be understated, he said, because it covers such a large number of patients and because private insurers usually follow Medicare policies. “That’s really allowed us to open things up,” Naik said.

Advocates for decades have called on Medicare to expand telemedicine coverage, but federal officials held back because of concerns about increased costs. Critics worried telemedicine would not replace in-person doctor visits but lead to more total visits because of the ease with which people could connect to their doctors via telemedicine.

The Trump administration had been moving to widen telemedicine options even before the pandemic. In 2019, it allowed Medicare for the first time to pay doctors on average about $14 for a five-minute “check-in” phone call with their patients.

Ken Prussner, 74, of Herndon, Virginia, used his home computer Monday to connect with his longtime physician.

Prussner had a gastrointestinal illness and a low-grade fever and his family wanted to make sure he didn’t have COVID-19. His doctor’s office sent him a website link and his physician spoke to him as if he was in the office. He allayed Prussner’s fear, telling him he had a typical lower-bowel infection that would clear up on its own within three to five days.

“It was pretty seamless,” said Prussner, a retired U.S. Foreign Service officer.

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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

Sean Randolph: COVID-19 Impact on Startups & Business in Bay Area

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F50 Global Insights presents Covid19 Home Shelter Policy by Bay Area Authority – Impact on Startups & Business’ by Sean Randolph, Senior Director, Bay Area Council Economic Institute, Bay Area Science and Innovation Consortium. Sean provides insights into impact of Corona Virus on Startups, Businesses and impact on local economy in San Francisco Bay Area, including San Francisco, Oakland and Silicon Valley. Read about or connect with Sean Randolph (https://www.linkedin.com/in/sean-rand…).

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.

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

Coronavirus: A new type of vaccine using RNA could help defeat COVID-19

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A century ago, on July 26, 1916, a viral disease swept through New York. Within 24 hours, new cases of polio increased by more than 68%. The outbreak killed more than 2,000 people in New York City alone. Across the United States, polio took the lives of about 6,000 people in 1916, leaving thousands more paralyzed.

Although scientists had already identified the polio virus, it took 50 more years to develop a vaccine. That vaccine eradicated polio in the U.S. in less than a decade. Vaccines are one of the most effective modern disease-fighting tools.

As of this writing, the fast-spreading COVID-19 has already infected almost half a million worldwide, and has killed over 22,000 patients. There is an urgent need for a vaccine to prevent it from infecting and killing millions more. But traditional vaccine development takes, on average, 16 years.

So how can scientists quickly develop a vaccine for SARS-CoV-2?

As immunologists, we are trying to expedite development of vaccines and antibody therapeutics. We’re currently developing novel vaccine candidates for Zika, and have successfully developed a potential protective antibody-based treatment – in 90 days – to stop that viral disease. Fast-track “sprints” like these are part of the Pandemic Protection Platform Program run by the Defense Advanced Research Agency of the U.S. Department of Defense to help us identify and deploy protective antibody treatments against viral outbreaks, such as SARS-CoV-2. Now other colleagues of ours are working on expediting a new type of vaccine for COVID-19.

A primer on vaccines

A vaccine trains the body’s immune system to recognize some signature viral protein called an antigen. SARS-CoV-2, like other coronaviruses, is named for the crown-like spikes on its surface. There are three proteins on the surface of these viruses: the envelope, membrane and spike, which encapsulate a strand of RNA. This RNA molecule holds the genetic instructions that make up the virus.

The virus SARS-CoV-2 uses the spike proteins (red) adorning its outer surface to invade the human cells. SARS-CoV-2 causes the disease COVID-19.
CDC/Alissa Eckert, MS; Dan Higgins, MAM

But viruses do not make their own components. Instead, a coronovirus enters into the lung and possibly other respiratory track cells by attaching through to them via its spike protein. Once inside, the viral RNA becomes part of the host cell’s protein production machinery, and produces new copies of viral proteins and RNA which then assemble into thousands of new viruses to spread the disease.

So one way to stop a disease is to block the virus from entering the cells. Vaccines do that by training the body to identify and attack the virus before it can infect healthy human cells.

A vaccine is essentially a pure preparation of one or more key components of the virus – such as the envelope, spike or a membrane protein – that is injected in the body to give the immune system a preview of the virus without causing disease. This preview tells the immune system to seek out and attack the virus containing those specific proteins if the real virus ever shows up.

However, developing vaccines based on viral proteins takes anywhere from years, such as for the human papilloma virus, to several decades, such as for rotavirus. Protein-based vaccines require mass production of viral proteins in facilities which can guarantee their purity. Growing the viruses and purifying the proteins at medically acceptable pharmaceutical scales can take years. In fact, for some of recent epidemics, such as AIDS, Zika and Ebola, to date there are no effective vaccines.

How to make a new type of vaccine quickly

To make an effective vaccine more quickly against never-before-seen, fast-spreading viruses such as SARS-CoV-2, researchers at Vanderbilt and elsewhere are using alternate approaches. In one approach, instead of proteins, a new generation of vaccines, called mRNA vaccines, will carry the molecular instructions to make the protein.

Rather than produce a protein vaccine, scientists at Moderna are instead giving patients the mRNA (the vaccine) that allow the individual’s body to manufacture the vaccine proteins itself.
udaix/Shutterstock.com

Instead of the standard vaccines where viral proteins are used to immunize, an mRNA vaccine provides a synthetic mRNA of the virus, which the host body then uses to produce the viral proteins itself.

The biggest advantage of the mRNA vaccines is that they can bypass the hassle of producing pure viral proteins, sometimes saving months or years to standardize and ramp up the mass production.

The mRNA vaccines basically mimic the natural infection of the virus, but they contain only a short synthetic version of the viral mRNA which encodes only the antigen protein. Since the mRNA used in vaccination cannot become part of the person’s chromosomes, they are safe to use. Such mRNA vaccines would also be safer than the weakened viral or protein-based vaccines because they do not carry the risk of the injected virus becoming active, or a protein contamination.

An mRNA vaccine for COVID-19 to undergo trial

Using this strategy, biotechnology firm Moderna Inc. announced on Feb. 24 that it had rapidly developed an experimental COVID-19 mRNA vaccine called mRNA-1273, ready for clinical trials in humans. This vaccine candidate is funded by the Coalition for Epidemic Preparedness Innovations, in collaboration with the National Institute of Allergy and Infectious Diseases. The mRNA-1273 encodes for a stable form of the SARS-CoV-2 spike protein.

The idea of using mRNA to ask the human body to read the instructions and manufacture the viral proteins is not new. Researchers almost two decades ago demonstrated that externally supplied mRNA is translated into the encoded protein. However, mRNA is not a very stable molecule, which prevented those mRNA vaccines from becoming a reality. The mRNA-1273 vaccine being developed today uses chemical modifications to stabilize the mRNA and packages it into an injectable form using liquid nano particles.

The new mRNA vaccine provides the body with the instructions to manufacture the SARS-CoV-2 spike protein. This protein gives the immune system a preview of the virus.
NIH

RNA-based antibodies

Besides using mRNA as a vaccine, scientists are also using mRNA as a drug that can be given intravenously. In this case the mRNA encodes an antibody protein that is known to attack the virus. So instead of giving the patient a delivery of protein antibodies, physicians could instead give them the mRNA infusion for instructions to make their own copies of disease-fighting antibody proteins.

Effective antibodies can be quickly identified by screening the survivors of a disease. But producing such antibodies for therapy often faces hurdles of poor yields, inefficient purification and incorrect protein modifications.

The effectiveness of such strategy has already been demonstrated by James Crowe’s team here at Vanderbilt. In animal studies, an antibody previously isolated from a survivor of Chikungunya, an emergent, mosquito-borne tropical viral infection that causes chronic and debilitating joint pain and arthritis was encoded as an mRNA and given to mice. The mRNA encoded antibody protected mice against infection and virus-associated arthritis, and also created protective antibodies in macaques. The mRNA based antibody is now undergoing clinical trials.

Similarly, specific antibodies against SARS-CoV-2 are being isolated from COVID-19 survivors. The genetic instructions for the most effective anti-coronavirus antibodies can be encoded as mRNA. These mRNA encoded antibodies can be used to treat patients needing urgent care.

While there are several promising new approaches, all of these are still experimental. Our best protection against COVID-19 currently remains prevention and containment of the disease. Until we have a good vaccine against SARS-CoV-2, social distancing and vigilance is our best weapon.

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

Help Wanted: Retired Doctors And Nurses Don Scrubs Again In Coronavirus Fight

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job vacancy - white doctor coat on hanger in hospital hallway

Laura Benson retired from nursing in 2018, but this week she reported for work again in New Rochelle, New York, where the first cluster of COVID-19 cases occurred a few short weeks ago.

“Nurses are used to giving of themselves,” she said. “If there’s not enough people, you just do it.”

With more than 39,000 confirmed cases, New York is now the epicenter in the U.S. of the novel coronavirus outbreak, accounting for almost half of the more than 85,500 cases nationwide as of late Thursday evening. Anticipating a severe shortage of medical personnel to treat the influx of sick patients, Gov. Andrew Cuomo and other officials put out a call for retired doctors, nurses and other medical professionals to dust off their scrubs and return to work. By Thursday, 52,000 people had responded.

Officials in other states, including California, Colorado and Illinois, have issued similar pleas for retired medical professionals to step forward.

In New York’s Westchester County, which includes New Rochelle and other towns north of New York City, County Executive George Latimer said about 90 retired nurses and a handful of doctors responded after he posted a message on the county’s Facebook page about a week ago seeking help.

There’s no definite plan for deploying the medical volunteers, Latimer said. They may be needed to replace personnel sidelined by the coronavirus or to help staff the Westchester County Center being repurposed as a temporary hospital.

Benson, 60, is working for the county health department. A nurse practitioner with a specialty in oncology, she spent 20 years at the Albert Einstein Cancer Center in the Bronx. She eventually retired from a job at a medical device company, where she worked with patients who have brain tumors. She also teaches nursing students at a community college.

Nurses are used to giving of themselves. If there’s not enough people, you just do it.

Laura Benson

(Photo courtesy of Laura Benson)

On her first day as a retiree volunteer, Benson phoned patients who had recently been tested for the novel coronavirus to talk them through the guidelines they should follow to protect themselves and others.

If there’s a need, she said, she is “absolutely” willing to work directly with patients who have COVID-19, the illness caused by the coronavirus.

“I think about the person laying in that bed,” she said. “I’d want someone to take care of them.”

Benson is not particularly worried about the virus, having worked through the AIDS crisis, treating patients before people understood what that disease was. “You follow the guidelines and protect yourself,” she explained.

The best role for many retired medical professionals may be to fill in behind the scenes, said experts, freeing up younger colleagues to focus on direct patient care.

One reason for this: age.

“My only concern is that many of these retired folks fall into high-risk groups” more likely to be seriously affected by COVID-19, said Dr. Arthur Fougner, president of the Medical Society of the State of New York, a professional group for physicians.

Another concern is whether retirees are up-to-date in their medical knowledge.

“If they’re out for more than two to three years, you have to worry about them being current,” said Dr. Janis Orlowski, chief health care officer for the Association of American Medical Colleges, which represents the academic medical community.

In addition, health care providers’ state licenses may have lapsed if they’ve been retired for more than a few years. Renewing them can be time-consuming.

Still, “if someone still has their licensing and is willing to come back, we should grab that,” Orlowski said.

Michele Pedicone is one such professional. The respiratory care therapist left her job in Seattle last year to head up clinical education at SUNY Upstate Medical University’s respiratory therapy education department in Syracuse, New York. With her classes now mostly happening online and student clinical placements on hold, she has time to step back into clinical care. She contacted two nearby hospitals to see if they could use her services and expects to work three or four days a week.

“I honestly don’t know what they’re paying me; the money isn’t an issue,” said Pedicone, 54. “It’s the right thing to do.”

Respiratory therapists, critical care physicians and nurses trained in operating ventilators that help hospitalized patients breathe are among the specialists expected to be in severely short supply as the coronavirus pandemic worsens in New York and elsewhere, according to an analysis by the Society of Critical Care Medicine.

Expanding the supply of intensive care workers will be key to managing the coronavirus pandemic, said Ashish Jha, director of the Harvard Global Health Institute, at a briefing this week on health care workforce issues sponsored by the Commonwealth Fund.

I honestly don’t know what they’re paying me, the money isn’t an issue. It’s the right thing to do.

Michele Pedicone

One option policymakers have discussed is that states could allow, for example, medical professionals who retired in the past five years with licenses in good standing to get an automatic three- or six-month license without having to do a lot of paperwork, Jha said.

In the meantime, health care systems are developing their own strategies. Northwell Health owns and operates 19 hospitals in New York City, Westchester County and Long Island. This week, the health system has more than 700 patients with COVID-19, compared with just 40 patients last week, according to Terry Lynam, a senior vice president at the health system.

Northwell has been planning how to beef up staff since January, said Judy Howard, vice president of talent acquisition at the health system who oversees hiring, except for physician leadership. They developed a list of 200 retired nurses whom they’ve been contacting to gauge their interest in returning to paid work in some capacity. So far, 28 have signed on, Howard said.

At this time, they’re asking retired nurses to work at the health system’s call center and share responsibilities for training new nurse employees. Some are working in direct patient care. Another possibility is for retired nurses to staff facilities that Northwell has put in place to care for staff members’ children during the coronavirus pandemic.

“Whether someone really wants to work four hours a week or would like to work 10 hours a week, we’ll work with them to meet their needs,” Howard said.

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Source: 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

F50 Global Capital Summit 2020 calls global investors to support healthtech innovation for COVID19

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The 5th F50 Global Capital Summit® (GCS) Spring 2020 on June 16-17, with the theme Elevating HealthTech Innovation opens for speaker nomination. The event is co-hosted by the Bay Area Council Economic Institute, UCSF Entrepreneur Center, and SVE (Silicon Valley Entrepreneurs). This special summit is calling investors, entrepreneurs, and physicians to support the innovations which are fighting with COVID-19. 

The spread of the coronavirus has highlighted the imperative for new technologies and solutions in the health and medical area. 20+ leaders including leading physicians, investors, and infinluciers had joined the Global Committee which is the volunteering advising board and curation of the content for the summit.  Innovators, leaders and influencers in the startup ecosystem, like you, are vital to accelerating progress worldwide. A public presentation including committee members, content tracks is included here.  The content will be featured on the F50 Global Insights Youtube channel.

The summit is one of Bay Area’s most sought after events for investors and industry leaders, connecting the next generation of world-changing innovators with strategic partners to power their long-term impact. 

Building on F50’s focus on healthtech innovation over the past year, the Summit is an outstanding opportunity to bring together healthtech experts, entrepreneurs, and the global investor community to elevate health innovation at this critical time.

Global Capital Summit – Confirmed Speakers

  • Bill Reichert,Garage Venture,Managing Director
  • Braj Agrawal, MD, Physician (Neurologist), Investor, Author, Chair IGS2020 at UCSF, Asst Prof Stanford
  • Brian Modoff, EVP, Qualcomm
  • Canice Wu, Vlocity, Head of Insurance Practice
  • Che Voigt,North Bay Angels,Board Chair
  • Daniel Kraft, Chair of Medicine, Singularity Exponential
  • David Cao, Partner, F50 | Hunnwell Lake Ventures
  • Dr. Daniel Teo, Founding Partner, Hunniwell Lake Ventures
  • Dr. Guoliang Yu,Crown Biosicence,Executive Chairman
  • Dr. Heldley Rees,Poole Hospital (NHS)
  • Dr. Mang Yu,Stanford University
  • Dr. Minesh Khashu M.B.B.S, MD, FRCPCH, FRSA, Q Fellow (Health Foundation & NHSI), Consultant Neonatologist, Poole Hospital NHS
  • Dr. Oana Marcu, Scientist, SETI(NASA)
  • Dr. Ossama Hassanein, Chairman, Rising Tide Fund
  • 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. Shiyi Chen, Fudan University
  • Dr. Uli K. Chettipally, MD., MPH., Founder & President InnoMD
  • Dr. Xiang Qian, Medical Director, International Medical Services,Stanford Health Care
  • Gary Goldman MD, DDS, Sutter Enterprise Physician Informatics Lead
  • Haiping Hu, Chairman, Global Mentor Board,
  • Henry Xue,Stanford Angels,
  • James Sowers, Angel investor, PopUp Ventures, Forbes top 50 Angel Investor
  • Jinbo Liu, President, Netease USA
  • Jordan Wahbeh,Bay Angels,Managing Partner
  • Keith Teare, Angel Investor
  • Lu Zhang, Founding Partner, Fusion Capital
  • Nikolai Oreshkin,Elysium Venture Capital,Managing Partner
  • Orrin Ailloni-Charas, MD, MBA, Managing Partner at Global Health Impact Fund
  • Paul Singh, Angel Investor, Board Member, Tie
  • Pavan Kumar, Partner, F50 Elevate
  • Philipe Kahn, Inventor, Founder of FullPower, LightSurf, Starfish,Borland Soft
  • Randy Williams,Keiretsu Forum,CEO/Founder
  • Richard Fang,Hunniwell Lake Ventures,Founding Partner
  • Roger Royse, Partner,Hayne Boone
  • 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
  • Thomas C. Südhof, Nobel Laureate, 2013 Nobel Prize in Physiology or Medicine
  • Wei Zhou,Centrillion,CEO

The Summit is known for the exceptional quality of its speaking program as well as its select audience.  It will include around 60 speaking sessions, panel discussions, and invitational roundtable discussions for the industry leaders. This event is free to professional investors and medical professionals.  We hope to attract 100,000 attendees from around the world. Attendees from leading corporations, VCs, angel investors, founders and thought leaders will participate online.

More information

Register today for Comp ticket registration

https://forms.gle/k3Kn8wfhxvcENEJU9

Nominate a Speaker

This is our formal speaker invitation letter:

https://www.linkedin.com/pulse/covid-19elevating-healthtech-innovation-f50-global-capital-david-cao/

Here is the speaker registration / nomination form.

Volunteering

As a past volunteer leader myself for Startup Weekend, SVE ToastMasters,  SV Android, I would like to invite more experienced volunteers join the event as volunteers:

Donate services: summit@f50.io

Features  of the online  summit:

  • Keynote and thought leader presentation & insightful panels
  • Global Insights Investor Report
  • F50 Global Impact Awards
  • Executive (Speaker & VIP ) Roundtable discussions
  • Breakout sessions from India, Euroope, China, Latin America, Europe, etc.
  • F50 Elevate Connect Lounge

About F50:

F50 identifies the most promising early-stage technology companies in North America by leveraging the collective intelligence of its deep roots of Silicon Valley-based developer and startup communities, the large reach of corporate partners and investor network, and industry experts. We support the growth of these companies with corporate partnerships, market development, and venture financing; together with our global network.

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About the Global Capital Summit 2020

The Global Capital Summit®  is organized by F50, Silicon Valley Entrepreneurs. The Summit finds and connects the next generation of world-changing tech innovations with partnerships to power their long-term impact. The summit will feature 60+ extraordinary sessions, and over 1000 attendees from world-leading corporations and the global investment ecosystem. The attendees are corporate executives, Angel investors, VCs, and a group of high-potential local founders. We dont expect to general any profit from this event. But if we do, we will donate the profit to the entrepreneur organizations who are helping the fight with COVID-19

Labs are experimenting with new – but unproven – methods to create a coronavirus vaccine fast

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The coronavirus has ground social, economic and educational exchanges to a halt around the world. For now, public health officials are relying on tools like social distancing to minimize the harm of the virus, but in the long term, a COVID-19 vaccine is the best hope of a return to normalcy.

It normally takes a few years to development a vaccine, but in the face of the coronavirus, biotechnology companies and regulatory agencies are taking aggressive steps to make a COVID-19 vaccine widely available sooner than that.

I study biomanufacturing and synthetic biology, and it is fascinating to watch this unprecedented effort push at the limits of vaccine development. Public and private labs around the world are pursuing cutting-edge vaccine engineering strategies that have never been tested on such a large scale. If these efforts succeed, the vaccine would become an essential tool to fight or prevent future COVID epidemics.

How vaccines work

The first time the body is exposed to a new virus, it takes weeks to build antibodies and other defense mechanisms that will fight it off. This gives the virus plenty of time to replicate and make someone sick.

However, the immune system has memory. If it has encountered a virus before, the body can quickly deploy its defenses against the invader and neutralize the virus before a full infection develops.

This is the idea behind vaccines: give the body an opportunity to build defenses against a virus it may encounter in the future. Not all vaccines produce the same level of immunological preparedness – the stronger the initial immune response, the better the vaccine – but some preparation is better than none.

Vaccines have been around for nearly 150 years, and until recently, the science hasn’t fundamentally changed.
AP Photo/File

The traditional way of developing a vaccine is to grow and inject patients with inactivated viruses. These don’t make you sick, but once exposed to these “dead” viruses, the immune system will have the weapons to fight off that virus in the future, if it needs to.

Unfortunately, figuring out how to grow a new virus on an industrial scale is complicated, and once done, the process itself is often slow, difficult and potentially risky. For example, the flu vaccine is produced by growing the virus in millions of chicken eggs. The process takes four months. In addition, when dealing with a virus for which there is no drug or vaccine, it is safer to avoid growing it in large quantities for fear that it might accidentally leak out of the factory and make the situation even worse than it already is.

With the coronavirus literally making time a matter of life and death, nearly 50 public and private labs are turning to newer, safer and faster methods to develop a coronavirus vaccine.

Protein-based vaccines

Rather than injecting the whole virus, it is possible to vaccinate a person with a single virus component. The pieces most commonly used are proteins from the surface of a virus. If a live virus enters the body, these surface proteins are easily recognized by the immune system. This approach is easier, faster and safer because the virus protein can be produced in cell cultures.

By using proteins from the surface of the virus, it is possible to vaccinate a person without going through the complicated process of growing a dangerous virus.
ayvengo/iStock/Getty Images Plus via Getty Images

Two companies, Sanofi and Novawax, are both developing protein vaccines based on the SARS-CoV-2 spike protein, the tower-shaped structures on the surface of the new coronavirus that causes COVID-19.

Protein-based vaccines, also known as recombinant vaccines, are already used to vaccinate against viral infections like HPV. They are far simpler to produce compared to traditional whole-virus vaccines, but it can still take a year to develop a new process and several weeks to produce the vaccine after the manufacturing process has been developed. The world needs something faster.

Gene-based vaccines

Theoretically, the simplest and fastest way to make a vaccine would be to have a person’s own cells produce minute quantities of the viral protein that trigger an immune response. To do that researchers are turning to genetics.

The first genetic approach uses DNA. A single gene that codes for a protein from the coronavirus is injected into the patient’s cells in the hopes that a small fraction of the DNA molecules will find their way into the cell nucleus. There they would be copied into an RNA molecule which is then read by the cell to produce the viral protein. But it is difficult to get the human body to produce enough protein using this approach. Frequently, very little DNA makes it to the cell nucleus and the cell does not produce the protein in sufficient quantity to trigger a strong enough immune response.

As of yet, there are no DNA vaccines currently approved by the FDA for human use and the success of this method has been limited. But there is promise. In 2016, several groups developed candidate Zika vaccines using this technology and at least one company, INOVIO Pharmaceuticals, Inc. is developing INO-4800, a DNA vaccine candidate for the coronavirus.

The bottleneck of DNA vaccines is getting the DNA to the nucleus to be transcribed into RNA. Vaccines that use RNA directly might be able to overcome this problem. Since RNA is translated into proteins as soon as it enters the cell, this approach results in stronger immune responses than DNA vaccines. However, RNA breaks down faster than DNA.

This has not deterred a number of companies from trying it though. Notable in the U.S. is Moderna, and on March 16, the National Institutes of Health started a clinical trial of Moderna’s lead coronavirus vaccine candidate, mRNA-1273.

On March 16, 2020, Jennifer Haller of Seattle, Wash., became the first person to try Moderna’s experimental RNA vaccine.
AP Photo/Ted S. Warren

Manufacturing DNA and RNA relies on standardized and fairly simple processes. DNA vaccines are produced in bacteria that grow overnight while RNA vaccines are produced in test tubes using a biochemical reaction that only takes hours. Gene-based vaccines could be produced extremely quickly compared to traditional or protein-based vaccines.

Friendly virus vaccines

The main issue with gene-based vaccines is getting the DNA or RNA to where it needs to be. One elegant way to solve this challenge is to use a harmless virus as a delivery system. Viruses are extremely good at penetrating cells; once inside, a virus with genes from SARS-CoV-2 could use the machinery of the cell to produce proteins to trigger an immune response for the coronavirus.

This technique is being pursued by a few companies around the world. For example, Hong Kong-based CanSino Biologics is inserting the coronavirus gene that codes for the spike protein into an adenovirus. They used this strategy to produce the first government-approved Ebola vaccine, and clinical trials of an engineered adenovirus that would protect against the coronavirus have already started in China.

The production of vaccines delivered by harmless viruses is slower than producing DNA or RNA vaccines because it involves the culture of slow-growing mammal cells. However, like the production of gene-based vaccines, they rely on existing processes that take advantage of viruses that have been optimized for manufacturing.

Containing the epidemic with imperfect vaccines

While the pace of COVID-19 vaccine development is unprecedented, the timeline to mass vaccination still remains uncertain. While the large number of approaches being pursued may give the impression of desperation and confusion, it is actually reassuring. This multipronged approach is a way to hedge the vaccine development bet.

It is unlikely the first vaccines developed will be 100% effective and easy to produce on a massive scale. Realistically, researchers will develop a number of good-enough vaccines that can be produced using different kinds of manufacturing infrastructures. While these vaccines may at first have a limited efficacy, the diversity in manufacturing processes will allow companies to make and distribute them quickly, buying time and helping contain the current epidemic and prevent future outbreaks.

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

Americans disagree on how risky the coronavirus is, but most are changing their behavior anyway

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As the coronavirus began to spread in the United States, people faced an unknown risk and evolving health recommendations. Policy measures to curb the coronavirus epidemic have turned the world upside down, and the true impact of this global pandemic is yet to be seen.

Researchers are still learning more about the virus every day, but how do members of the general public perceive the risks associated with COVID-19? Do these beliefs affect what people have been doing to protect themselves? As social scientists, we’re interested in understanding how people’s beliefs and behaviors evolved in the face of this novel threat.

We launched a survey through the University of Southern California’s Understanding America Study to find out. Running from March 10 through March 16, the survey covered a period of time when the information available to the public and the situation on the ground were both rapidly changing. We were able to see how people’s perceptions of risk and their actions were changing from day to day.

As this crisis continues, it is important to understand what people think about the risks and how they are behaving. If, for example, people are seeing low risks and not implementing recommended actions, then public health communications may need to address that.

Do people in the US think they’ll get COVID-19?

Theories of health behavior suggest that people who think that a risk is higher are more likely to implement protective behaviors.

Because SARS-CoV-2 is a new virus, the risks are still not fully understood by experts, much less the general public. Perhaps as a result, most of our survey respondents initially believed that their chance of getting the coronavirus was relatively low.

But over the course of our weeklong survey, reported coronavirus cases in the U.S. rose from 937 to 4,226. Additionally, halfway through our survey, the government imposed multiple travel bans, barring most travelers from Europe.

As people in the U.S. learned of these events, their perceived risk of getting the coronavirus increased. To measure this, we asked people what they thought their chances were for getting the coronavirus over the next three months.

The median belief on March 10, at the beginning of our survey, was 10% – meaning half of those surveyed thought their chances were less than 10% and half thought their chances were greater.

When we closed out the survey on March 16, the median prediction had gone up to 15%. The increase suggests that people were updating their beliefs as the virus started to spread across the United States day by day. They were perhaps starting to realize that they may be more vulnerable than they’d initially thought.

When we dug deeper into our survey data, we found that not everyone was convinced that they would be getting infected with the coronavirus. The distribution was skewed to the left, with its peak at the low end of the scale. Across all of our respondents, nearly a quarter thought they had a zero or near-zero chance of getting coronavirus in the next three months. Yet, a not-insignificant number of people thought they had a very high chance of getting it. Perhaps that explains why some people were still out partying over the weekend of March 14-15 while others stayed home and committed to social distancing.

Time will tell which of these risk perceptions is correct. However, it may be overly positive to think that the chances will be zero. Psychologists have suggested that people have a tendency to underestimate their personal risks of experiencing negative events to help cope with an uncertain and scary world. This idea that “it can’t happen to me” is called unrealistic optimism and could explain the large number of people who think they face almost no risk getting the coronavirus.

This group worried us. Because risk perceptions tend to inform behaviors, people who see low risks of getting sick may not feel the need to follow recommended health behaviors like hand-washing and social distancing. Unexpectedly, this is not what we found.

What are people doing?

In our survey, we asked people whether they had engaged in behaviors to keep safe from the coronavirus, like hand-washing, canceling travel or social distancing. And to our surprise, most people said that they had already started doing these things – even if they saw relatively low chances of getting sick. By the end of the week, on March 16, nearly 89% of respondents said they were practicing social distancing, 32% higher than on the first day of the survey.

So why this seeming contradiction between belief and behavior? We think one reason could be that people felt safer as a result of implementing those actions. Doing something may have given them a feeling of control and a sense of security.

Another reason for stepping up protective actions could be that people wanted to respond to the messages to “flatten the curve” and to protect others – especially those who are older or have underlying health conditions.

Even in regular flu seasons, some people may be motivated to take protective actions to help others. Such altruistic motives may make people feel good about themselves, while also supporting the optimistic view that they themselves were not at risk. Engaging in those actions together with others in the community may also have further contributed to this positive outlook.

Our survey captured an interesting time of rapid change during the early days of this pandemic. It showed that there is large variation in how likely people think they are to get the coronavirus. But we also found that the vast majority of people are stepping up their protective actions – even among those that didn’t expect to get sick themselves. These findings suggest that people seem to be responding to calls to change their behavior, no matter how vulnerable – or invulnerable – they think they are.

[Get facts about coronavirus and the latest research. Sign up for our newsletter.]

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

COVID-19:Elevating HealthTech Innovation @ F50 Global Insights

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The ‘Home Shelter Policy’ announced yesterday by Bay Area Authorities to control COVID-19 outbreak and developing situation has created lots of challenges and uncertainty to the founders and investors in our community. It highlights the need for innovation and early solutions in the health and medical space. Innovators, leaders and influencers in the startup ecosystem like you, are vital to educate and enlighten the community and create positive global impact.

The F50 Global Insight series of video talks will include numerous speaking sessions, panel discussions, interviews etc. Our online viewers include the world’s leading corporations, VCs, angel investors, startup founders, entrepreneurs and thought leaders. At this critical time, building on F50’s focus on HealthTech innovation over the past year, as well as the upcoming F50 Global Capital Summit on June 16, is a dire necessity to bring together healthtech experts, entrepreneurs, and the global investor community to Elevate HealthTech Innovation.

F50 is known for the exceptional quality of its speaker programs as well as its select audience. As an industry leader, you would contribute greatly to the community and have your message heard by one of the largest communities in the venture ecosystem. The discussion will be conducted over Zoom and the video will be live streamed through youtube, and posted on our global channels.

COVID-19: F50 Global Insights – Elevating HealthTech Innovation

Tuesday, Mar 17, 2020, 2:00 PM

Online Linkedin
SiliconValley Palo Alto, ca

19 Founders,Entrepreneurs,Investors Attending

The ‘Home Shelter Policy’ announced today by Bay Area Authorities to control COVID-19 outbreak and developing situation has created lots of challenges and uncertainty to the founders and investors in our community. It highlights the need for innovation and early solutions in the health and medical space. Innovators, leaders and influencers in the s…

Check out this Meetup →

Youtube Channel https://www.youtube.com/channel/UCC5QoSulk-MvoaiZnKlgojA

Zoom meeting: https://zoom.us/j/882923076

David Cao

CEO, F50

Managing Partner, F50 Ventures, F50 Elevate

Partner, Hunniwell Lake Ventures

First group of sessions on March 17

2PM Testing vs Treatment

Dr. Uli K. Chettipally, MD. COVID-19: 

Moderator:

David Cao, F50 Ventures, Hunniwell Lake Ventures

Amit, Research Engineering, School of Medicine, Stanford 

2:20 Fireside chat: Sean Randolph, Bayarea Council,

Moderators: Pavan Kumar, Partner, F50 Elevate

2:45 Chat How startups can use the lockdown time

Keith Teare, ADV CapitalModerators: Pavan Kumar, Partner, F50 Elevate

More information

About F50:

F50 identifies the most promising early-stage technology companies in North America by leveraging the collective intelligence of its deep roots of Silicon Valley-based developer and startup communities, the large reach of corporate partners and investor network, and industry experts. We support the growth of these companies with corporate partnerships, market development, and venture financing; together with our global network.

During A Pandemic, States’ Patchwork Of Crisis Strategies Could Mean Uneven Care

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A possible coronavirus pandemic could overwhelm the nation’s hospitals and force doctors into difficult decisions about how to allocate limited resources. Yet, experts say, only a handful of states have done the work necessary to prepare for such worst-case scenarios.

How would hospitals handle overflowing emergency rooms? What would doctors do if they ran out of medicines or ventilators? How would they decide who gets prioritized if they can’t treat everyone?

Many fear the rapid spread of the virus invites a repeat of disaster scenarios like those that occurred in 2005 after Hurricane Katrina, when some health care providers in New Orleans were accused of euthanizing elderly patients.

To ensure that would never happen again, a group of clinicians, ethicists and legal experts created a framework more than a decade ago for “crisis standards of care,” through which states could help hospitals, doctors and front-line health care workers prepare for the tradeoffs that arise in a crisis.

“You definitely don’t want people making those decisions in the heat of the moment, when they haven’t slept and they haven’t eaten and there’s no air conditioning,” said Dr. Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado’s Anschutz Medical Campus. “You make worse decisions under those circumstances.”

In worst-case scenarios, the health care system likely will not be able to provide the same quality of care as in calmer times. While federal officials can provide recommendations, such public health emergencies fall under the purview of individual states. Triggered only when a governor or local municipality declares a state of emergency, state plans allow for the waiver of regulations that might limit how hospitals and doctors treat patients.

“COVID is not Hurricane Katrina; COVID could be far worse,” said James Hodge, a professor of health law and ethics at Arizona State University. “We will be testing our capacity as a nation and, I daresay, there will be some failures. But I think those failures will be far fewer than before we actually talked through the crisis standards of care issue post-Katrina.”

But while 36 states have drawn up crisis plans that could be enacted amid a COVID-19 pandemic, many of those states just copied the language from national recommendations, said Dr. John Hick, medical director for emergency preparedness at Hennepin Healthcare in Minneapolis. They did not detail how the plans would be implemented locally.

Hick declined to name which state plans didn’t measure up, and cautioned that some states without plans have done much of the necessary work but haven’t released them.

“Very few states have done a good job,” Hick said. “A lot of states have turned their plan in and that’s where things ended. There’s going to be a lot of catching up to do over the next few weeks.”

‘You Have To Be Ready For What This Might Bring’

“The overall goal is to do the most good for the most people,” said Dr. Stephen Cantrill, an emergency physician at Denver Health public hospital, who helped pen the first national crisis standard of care recommendations for states to use as a starting point. “This is a way of trying to give some structure, some uniformity and some clarity to those very difficult times.”

In worst-case scenarios, doctors may have to make decisions about who will die and who will live. To be sure, those discussions are not easy.

“They do make politicians nervous because we actually have to set out specific resource allocation schemes,” Hodge said.

In some states, he said, government officials have shut down discussions over crisis standards or indicated that plans wouldn’t necessarily be followed.

“But the political accountability from not planning is also horrendous,” Hodge said. “Any state caught without that is going to be in bad shape with regards to what we’re seeing with COVID. You have to be ready for what this might bring.”

‘Graceful Degradation Of The Quality Of Care’

Crisis standards of care are also designed to provide cover for doctors and other health care workers who are forced by circumstances to provide less than the highest quality of care.

The standards allow doctors to make the necessary, albeit controversial, choices without the fear of being arrested or sued for those decisions.

For example, ethicists have debated what doctors should do if they run out of ventilators during a flu or coronavirus pandemic. The machines help people with respiratory infections breathe and are often the difference between life and death for critically ill patients. Even with a national emergency stockpile of ventilators, the U.S. health system has only so much capacity.

Doctors may be forced to consider whether to take a ventilator away from a patient who isn’t improving to help save another patient who might.

“You’re asking clinicians to basically function in a way that might be contrary to how they’ve been trained,” said Jennifer Nuzzo, an epidemiologist with the Johns Hopkins Center for Health Security in Baltimore. “They need to understand why. They need to feel that this is in the best interest of all patients. It’s not something that can just be dropped in their lap.”

But crisis standards of care plans are also designed to help avoid those situations. Hick said well-crafted plans, like those developed by Minnesota, Utah and Colorado, spell out intermediate steps that could be taken to avoid such stark choices.

Minnesota’s plan, for example, directs hospitals to first try to find additional ventilators from vendors, partner hospitals or government stockpiles. As demand grows, doctors could increase the threshold for who gets put on a ventilator, stretch supplies and cancel elective surgeries that might leave patients in need of a ventilator.

Hospitals could sterilize and reuse ventilator tubing rather than discarding it after every patient. And if supplies continue to run short, they could use transport ventilators or even positive airway pressure machines, similar to the devices sleep apnea patients use at home.

Wynia said that, if demand continues to grow, hospitals might even ask to borrow sleep apnea machines from the public.

“What you’re aiming for in a disaster or catastrophe is the graceful degradation of the quality of care you’re capable of delivering,” he said.

The goal is to take steps to slow that decline, he added, make things less chaotic and avoid the dire life-or-death conundrums.

The plans detail how to deal with staffing issues, particularly as health care workers get sick themselves, such as pulling administrators with medical training back into patient care or asking families to help with feeding and personal hygiene. As hospitals swell with patients, they could be doubled up in rooms or moved to conference rooms or other unused space, grouped among less serious cases.

Hospital and public health officials are now trying to review their crisis standards of care plans with an eye toward the specifics of COVID-19 infections.

Daily Challenges Prepare For Strain

Hospitals already have experience operating in crisis situations. Doctors routinely have to work around medication shortages, using sometimes less-than-ideal alternatives. A severe flu season might mean that people on ventilators must stay in the emergency department because of a shortage of ICU beds.

“Having a tough couple of years of heavy flu season and maxing out our hospital capacities has definitely forced us to start thinking outside the box,” said Dr. Kari Scantlebury, an emergency physician with Inova Health System in Falls Church, Virginia. “It’s given us a good jump-start to preparing for a potential pandemic.”

The COVID-19 situation will likely test whether hospitals are truly better prepared for a crisis situation than at the time of Hurricane Katrina.

“We have a way to talk about this now,” said Dr. Dan Hanfling, an emergency physician and executive with In-Q-Tel, a nonprofit venture capital firm based in Arlington, Virginia. “In 2005, talking about potential allocation of scarce resources, which was essentially rationing, was a bugaboo. You could not bring up that discussion.”

That framework has been used during regional disasters, such as the Haiti earthquake in 2010 and in Puerto Rico after Hurricane Maria in 2017. But it’s been a while since the world has experienced a true pandemic threat, as the coronavirus poses.

“People don’t understand how close the health system runs to capacity every day. We just don’t have the trained staff to staff much beyond what we have now,” Hick said. “Patients are waiting in the emergency department in many cities on a routine basis. Then you talk about adding a pandemic onto that? There are going to be compromises.”

Related Topics

Global Health Watch States

Source: 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