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We designed an experimental AI tool to predict which COVID-19 patients are going to get the sickest

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COVID-19 doesn’t create cookie cutter infections. Some people have extremely mild cases while others find themselves fighting for their lives.

Clinicians are working with limited resources against a disease that is very hard to predict. Knowing which patients are most likely to develop severe cases could help guide clinicians during this pandemic.

We are two researchers at New York University that study predictive analytics and infectious diseases. In early January, we realized that it was very possible the new coronavirus in China was going to make its way to New York and we wanted to develop a tool to help clinicians deal with the incoming surge of cases. We thought predictive analytics – a form of artificial intelligence – would be a good technology for this job.

In a general sense, this type of AI looks at existing data to find patterns and then uses those patterns to make predictions about the future. Using data from 53 COVID-19 cases in January and February, we developed a group of algorithms to determine which mildly ill patients were likely become severely ill.

Our experimental tool helped predict which people were going to get the most sick. In doing so, it also found some unexpected early clinical signs that predict severe cases of COVID-19.

The algorithms we designed were trained on a small dataset and at this point are only a proof-of-concept tool, but with more data we believe later versions could be extremely helpful to medical professionals.

All AI relies on data – in this case, the medical history of 53 COVID-19 patients in China.
Siriporn Kingkaew/EyeEm via Getty Images

How we did the work

To build this tool, we first needed data. We teamed up with an infectious disease specialist, Xiangao Jiang, in Wenzhou, Zhejiang, China. When we started working on this in early January, Wenzhou had the largest outbreak outside of Hubei, of which Wuhan is the capital. Between January and February, Dr. Jiang’s team collected and shared with us information from 53 COVID-19 patients at two hospitals. We got data on symptoms like fever, cough and diarrhea, lab values like blood cell counts, kidney function, inflammatory markers and vital signs and also X-rays.

Before we could start building the algorithms, we needed to wait until all the patients recovered or died so that we would know the final outcome of their cases. Thankfully, the Wenzhou outbreak wasn’t bad and by mid-February all the patients, even those with severe cases, had recovered.

From this data, we developed a set of algorithms that use predictive analytics to identify early symptoms in the body of a person with COVID-19. The algorithms then look for patterns and figure out which of those symptoms correlate with severe cases of COVID-19.

When medical problems are complicated and subtle, AI is the perfect tool.
Boris Zhitkov / Moment via Getty Images

What did you find?

For the 53 people in our study, the algorithms predicted with an accuracy of 70-80% the people who became extremely sick. That is pretty close to other uses of AI in medicine. We are now conducting further validations with large datasets.

This ability to predict which patients are going to decline could be very useful for clinicians, but the symptoms the AI identified to make these predictions could also provide valuable information to researchers.

Our predictive models found that slightly high levels of liver enzymes called ALT, elevated levels of hemoglobin – that is, red blood cells – and body aches were the strongest predictors of oncoming severe COVID-19. In a normal setting, doctors wouldn’t be concerned by slight elevations in ALT and hemoglobin, but it appears these are important signs during a coronavirus infection.

Since our study came out, other medical researchers have corroborated what our algorithms suggested. In one study, researchers found that slightly high liver enzyme levels may correlate with worsened COVID-19 outcomes.

Additionally, higher hemoglobin levels are known to increase the risk of blood clots and blood clots are proving to be a significant and mysterious cause of death for coronavirus patients.

AI is not going to replace doctors, but it is another tool they can use to provide better health care.
Reza Estakhrian/The Image Bank via Getty Images

Why it matters

COVID-19 is a new disease, one that doctors haven’t seen before and signs of an impending severe case are hard to spot. AI, which can recognize many elusive patterns simultaneously, is the perfect tool to help doctors identify high-risk patients early. This gives them time to better prepare for these cases and could save lives.

Additionally, the symptoms that the AI algorithms found to be important suggested that SARS-CoV-2 was affecting many more parts of the body than just the lungs. This ability to spot what symptoms are important could help doctors as they search for the many ways the virus attacks the body.

What’s next

It’s important to recognize the limitations of AI. Before a tool like this is put into use we need to give our system much more data to learn from. Since the AI was only trained on a small number of patients in one setting, its accuracy is limited to that setting. We are in the process of getting more data from other sources and will use this data to make the algorithms are more accurate and broadly applicable.

While the AI we designed is only a first test, the results are extremely encouraging. We believe AI has a role to play in fighting this pandemic and hope to soon put our system to work helping doctors on the front lines.

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

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

Chasing The Elusive Dream Of A COVID Cure

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Although scientists and stock markets have celebrated the approval for emergency use of remdesivir to treat COVID-19, a cure for the disease that has killed nearly 260,000 people remains a long way off — and might never arrive.

Hundreds of drugs are being studied around the world, but “I don’t see a lot of home runs right now,” said Dr. Carlos del Rio, a professor of infectious diseases at the Emory University Rollins School of Public Health. “I see a lot of strikeouts.”

Researchers have launched more than 1,250 studies of COVID-19. Pharmaceutical companies are investing billions to develop effective drugs and vaccines to help end the pandemic.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was cautious when announcing the results of a clinical trial of remdesivir last week, noting it isn’t a “knockout.” Although remdesivir helped hospitalized COVID-19 patients recover more quickly, it hasn’t been proved to save lives.

“This [drug] is opening the door,” Fauci said. “As more companies and investors get involved, it’s going to get better and better.”

Researchers have already announced that they will combine remdesivir with an anti-inflammatory drug, baricitinib — now used to treat rheumatoid arthritis — in the hope of improving results.

But COVID-19 is an elusive enemy.

Doctors treating COVID patients say they’re fighting a war on multiple fronts, battling a virus that batters organs throughout the body, causes killer blood clots and prompts an immune system overreaction called a “cytokine storm.”

With so many parts of the body under siege at once, scientists say, improving survival rates will require multiple routes of attack — and more than one drug. While some of the experimental medications target the virus, others aim to prevent the immune system from inflicting collateral damage.

“There are so many pieces of this, and they will all require different therapies,” said Dr. Lewis Kaplan, president of the Society of Critical Care Medicine, whose doctors provide intensive care.

High-tech approaches include using stem cells, virus-specific T cells and synthetic antibodies to neutralize the coronavirus.

Scientists are also taking a fresh look at existing medications that might be repurposed to fight COVID-19. These include antivirals for influenza, arthritis drugs, estrogen patches and even antacids. If repurposed drugs are successful, they could reach patients relatively quickly, because doctors are already familiar with their side effects and safety concerns.

Some doctors are skeptical that drugs for heartburn or hot flashes have any chance of treating a killer like COVID-19.

Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, said he fears that hype over unproven products will harm patients, even if it temporarily boosts company stock prices. Patients who demand antacids or antimalarial drugs being studied in COVID-19 could be harmed by side effects, for example. Those who hoard drugs — on the hope of protecting themselves from COVID-19 — could deprive other patients of medications they need to stay healthy. Some people may refuse to participate in clinical trials because they fear being given a placebo.

“This rush to get every imaginable treatment into a study, it’s not prudent,” Nissen said. “It’s not good medicine. It’s an act of desperation.”

Other experts say scientists should cast a wide net.

“I don’t think we want to rule anything out because it sounds out of the ordinary,” said Dr. Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh.

Antivirals In The Spotlight

Antivirals such as remdesivir aim to prevent viruses from replicating, said Dr. Peter Hotez, a professor at Baylor College of Medicine in Houston.

That doesn’t always work. A small Chinese study of remdesivir, published last month in The Lancet, found no benefit to severely ill COVID-19 patients. Remdesivir had previously failed when tested against Ebola.

Antivirals tend to be most helpful in the early stages of infection, when most of the harm to the patient is caused by the virus itself, rather than the immune system, Hotez said.

Remdesivir is just one of many antivirals being tested against COVID-19.

International researchers are studying the antiviral favipiravir, developed to fight the flu.

The antimalarial drugs chloroquine and hydroxychloroquine — which have been heavily touted by President Donald Trump — also have antiviral effects. Although the Food and Drug Administration approved forms of those drugs for emergency use against COVID-19, the agency later warned that they could cause dangerous heart rhythm problems.

A study in the New England Journal of Medicine likewise found no benefit in giving two antivirals used to treat HIV -a combination of lopinavir and ritonavir, sold as Kaletra– in adults hospitalized with severe COVID-19.

Harnessing The Immune System

One of the therapies generating excitement is also one of the oldest: antibody-rich blood from COVID survivors.

The immune system produces antibodies in response to invaders such as viruses and bacteria, allowing the body to recognize and neutralize them. Antibodies also recognize and neutralize the virus the next time that person is exposed.

Doctors hope that patients who develop antibodies against the novel coronavirus will become immune, at least for a few years, although this hasn’t been proved.

Scientists developing this “convalescent plasma” are studying whether COVID-19 survivors can share this immunity with others by donating their plasma, the liquid part of blood that contains antibodies, said Dr. Shmuel Shoham, an associate professor of medicine at the Johns Hopkins University School of Medicine.

In addition to treating people who are already sick, donated plasma could potentially prevent people exposed to the virus — such as health care workers — from developing symptoms.

Donated antibodies – and any immunity they might provide — don’t last forever, said Dr. William Schaffner, a professor at the Vanderbilt University Medical Center. The body destroys aging antibodies as part of its routine maintenance, he said. In general, half of donated antibodies are eliminated in about three weeks.

The use of convalescent plasma goes back more than a century. It was used during the 1918 flu pandemic and was shown to improve survival during the 2009-10 H1N1 pandemic.

Doctors don’t know yet whether convalescent plasma will benefit people with COVID-19.

In general, convalescent plasma is expected to be more effective in preventing illness than in treating it. It may be less likely to help someone in intensive care, Shoham said.

Researchers are also studying the use of prepackaged plasma, called intravenous immunoglobulin, in COVID patients. This product, known as IVIG, is taken from healthy donors in the general population and has long been used to help patients with weakened immune systems fight off infections. Hospitals keep it in stock and some are already using it to treat COVID patients.

Although the antibodies in prepackaged IVIG don’t specifically target the coronavirus, researchers hope they will tamp down the immune response.

In a third form of immune therapy, researchers are trying to identify the specific antibodies that are most important for neutralizing the coronavirus, then reproduce them as drugs called monoclonal antibodies. Monoclonal antibodies are already used to treat a variety of conditions, from cancer to rheumatoid arthritis and migraines.

“When we give people an antibody, they are immediately at least partially immune to that specific virus,” said Dr. James Crowe, director of the Vanderbilt Vaccine Center, who hopes to have antibodies ready for a clinical trial in a few months. “We’re moving the immune system from one person to another.”

Ideally, doctors would develop a very potent monoclonal antibody or a cocktail of antibodies for COVID-19 patients, to ensure the best chance of success, Crowe said. But manufacturing these drugs can be complicated, expensive and time-consuming.

“Making two antibodies would be at least twice as complicated as making one,” Crowe said. “A cocktail might be preferred, but cocktails are harder to move quickly.”

Calming The Immune System

In most cases of COVID-19, the immune system neutralizes the coronavirus and patients recover without going to the hospital.

For reasons that doctors don’t totally understand, the immune system of some COVID-19 patients becomes hyperactive, attacking not just the virus but the patient’s own cells. A “cytokine storm,” in which the immune system floods the body with inflammatory chemicals, can do more damage than the virus itself.

In an effort to calm the immune system, researchers are testing immune-suppressing drugs, including monoclonal antibodies already used to treat autoimmune diseases such as rheumatoid arthritis, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

Dr. Anar Yukhayev, pictured on March 24, was hospitalized at Long Island Jewish Medical Center for COVID-19. He agreed to join a clinical trial of Kevzara, an immune suppressant.(Courtesy of Dr. Anar Yukhayev)

Health care giant Roche is conducting large clinical trials of its drug, Actemra, in the hope of preventing cytokine storms, which can cause organ failure and a life-threatening condition called sepsis. Actemra is designed to lower levels of an inflammatory chemical, interleukin-6, which has been found to be elevated in some COVID-19 patients.

Scientists are also studying similar drugs, anakinra and siltuximab.

Another immune suppressant from Regeneron and Sanofi, called Kevzara, has had disappointing results in clinical trials. The manufacturers plan to continue studying the drug to see if it can help certain types of patients.

Dr. Anar Yukhayev, a New York OB-GYN who was hospitalized with COVID-19 on March 16, agreed to join a clinical trial of Kevzara.

“I was having so much trouble breathing that I was desperate for anything to help,” said Yukhayev, 31, who was treated at Long Island Jewish Medical Center.

About 36 hours after receiving an infusion, as Yukhayev was being treated in intensive care, his symptoms began to improve. He was able to avoid being put on a ventilator. Doctors didn’t tell him if he received Kevzara or a placebo, but his liver enzymes also began to rise, suggesting the organ was under stress. Elevated liver enzymes are a known side effect of Kevzara.

Yukhayev made a full recovery and went back to work full time April 13. He donated his plasma to researchers.

Until vaccines and other preventive medicines are developed, the best way to prevent coronavirus infections is to maintain social distancing, Adalja said.

“Social distancing is a blunt tool,” he said, “but it’s all that we have.”

Dr. Anar Yukhayev donates plasma on April 18, after making a full recovery from COVID-19.(Courtesy of Dr. Anar Yukhayev)

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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

Rescue Trade – Sean Randolph

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By Sean Randolph

Bay Area Council Economic Institute | F50 Global Committee

We are naturally focused these days on economic vulnerabilities close to home. As discussion turns to how business resumes, however, we also need to watch the global economy that we’re part of. Developments there point to another level of vulnerability that could prolong the new recession.

Consider that California is the fifth largest economy in the world, and its major ports — Los Angeles, Long Beach and Oakland — are among the nation’s largest. Most U.S. imports from and exports to Asia pass through them. Also, the Bay Area is also one of the most global economies in the nation, and a leading exporter of technology, medical devices, biopharmaceuticals and other products, and of services such as education, consulting, accounting and engineering services. It is also a leading portal for agricultural exports from the Central Valley. What happens in other economies therefore matters deeply. And there, the news isn’t good.

Shipping through the Port of Oakland, which supports 84,000 jobs in the region, dropped 11% in March compared to one year earlier. Long Beach and Los Angeles, the state’s two largest ports, also experienced large drops. The composite IHS Markit Purchasing Managers Index (PMI) shows plummeting activity around the world: 13.3 for the Eurozone, 12.9 for the UK and 27.8 for Japan (a level below 50 denotes shrinkage). Export orders will follow those numbers down.

National economic numbers support this. The International Monetary Fund predicts a drop in Eurozone GDP of 7.5%, and contractions of the United Kingdom 6.5%, Japan 5.2%, and China 4.9%. Mexico and Canada will also see major declines. These are California’s largest trading partners. Emerging economies, will be also be hit hard as commodity prices collapse and remittances fall. More than 100 countries are currently exploring emergency funding. Overall, the IMF predicts a 3% contraction in the world economy in 2020, compared to just a .1% drop in 2009 at the height of the Great Recession.

All this will directly impact trade. The World Trade Organization expects global trade to fall between 13% and 32%. Services such as travel and transport will be most affected. Trade will also fall in sectors such as electronics and automotive products that have complex supply chains. That will impact countries such as the United States, China, Korea, Singapore, Mexico and Canada. Besides shrinking markets, US exporters face another challenge: as the U.S. dollar strengthens the cost of what we export will increase.

The breadth of that projected range, 13%-32%, suggests the high level of uncertainty. There are two scenarios: one with a sharp drop now followed by an early recovery later this year, and another where the decline is steeper, the recession prolonged, and the recovery less complete — pushing a rebound into 2021 or 2022. The speed at which economies re-open is the major variable.

Another variable is trade policy. The last several years have seen the undermining of international institutions such as the World Trade Organization, and a broad-based U.S. withdrawal from multilateral engagement and leadership. Bilateral trade conflicts have grown, with tariffs imposed by the United States on a spectrum of countries, which have often retaliated. This pushed world trade growth into negative territory in 2019, even before the crisis, and increased costs for consumers. As just one example, Section 301 tariffs imposed in 2018 on imported medical supplies from China have increased costs and reduced U.S. access to urgently needed supplies. In a world on the brink of deep recession or worse, we can ill-afford unilateral restrictions that threaten to repress the world economy even more.

This is the time for a reset. We benefit from a global economy and cannot isolate ourselves from it. It is critical at this moment that the United States and its trading partners come together to reduce tariff and other economic barriers and strengthen global cooperation to keep trade flowing. Bilateral and regional trade negotiations should be approached from a new perspective, and focused efforts should be made to reform and strengthen — not undermine — the WTO.

All countries and their economies are impacted by the pandemic, and in this moment of peril we need national and global policies that help to lift all boats.

This commentary by Sean Randolph, Senior Director of the Bay Area Council Economic Institute, was published by the Silicon Valley Business Journal on May 4, 2020. https://www.bizjournals.com/sanjose/news/2020/05/04/trade-needs-a-rescue-package.html

Reopening In The COVID Era: How To Adapt To A New Normal

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As many states begin to reopen — most without meeting the thresholds recommended by the White House — a new level of COVID-19 risk analysis begins for Americans.

Should I go to the beach? What about the hair salon? A sit-down restaurant meal? Visit Mom on Mother’s Day?

States are responding to the tremendous economic cost of the pandemic and people’s pent-up desire to be “normal” again. But public health experts remain cautious. In many areas, they note, COVID cases — and deaths — are still on the rise, and some fear new surges will follow the easing of restrictions.

“Reopening is not back to normal. It is trying to find ways to allow people to get back out to do things they want to do, and business to do business,” said Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials. “We can’t pretend the virus has gone away. The vast majority of the population is still susceptible.”

So far, state rules vary. But they involve a basic theme.

“They are making assumptions that people will use common sense and good public health practice when they go out,” said Dr. Georges Benjamin, executive director with the American Public Health Association.

As states start to reopen, people will have to weigh the risk versus benefit of getting out more, along with their own tolerance for uncertainty. The bottom line, health experts say, is people should continue to be vigilant: Maintain distance, wear masks, wash your hands — and take responsibility for your own health and that of those around you.

“It’s clearly too early, in my mind, in many places to pull the stay-at-home rules,” said Benjamin. “But, to the extent that is going to happen, we have to give people advice to do it safely. No one should interpret my comments as being overly supportive of doing it, but if you’re going to do it, you have to be careful.”

An added caveat: All advice applies to people at normal risk of weathering the disease. Those 60 or older and people with underlying health conditions or compromised immune systems should continue staying home.

“Folks who are at higher risk of having a more severe reaction have to continue to be very careful and limit contact with other people,” Plescia said.

So, should I go to the beach?

There’s nothing inherently risky about the beach, said Benjamin. But, again, “if you can, avoid crowds,” he said. “Have as few people around you as possible.”

Maintain that 6-foot distance, even in the water.

“If you are standing close and interacting, there is a chance they could be sick and they may not know it and you could catch it,” Plescia said. “The whole 6-foot distance is a good thing to remember going forward.”

Still, “one thing about the beach or anywhere outside is that there is a lot of good air movement, which is very different than standing in a crowded subway car,” he said.

Even so, recent images of packed beaches and parks raise questions about whether people are able or willing to continue heeding distancing directives.

But if we’re all wearing masks, do we really need to stay 6 feet apart?

Yes, for two reasons. First, while masks can reduce the amount of droplets expelled from the mouth and nose, they aren’t perfect.

Droplets from sneezing, coughing or possibly even talking are considered the main way the coronavirus is transmitted, from landing either on another person or surface. Those who touch that surface may be at risk of infection if they then touch their face, especially the eyes or mouth. “By wearing a mask, I reduce the amount of particles I express out of my mouth,” said Benjamin. “I try to protect you from me, but it also protects me from you.”

And, second, masks don’t protect your eyes. Since the virus can enter the body through the eyes, standing further apart also reduces that risk.

Should I visit Mom on Mother’s Day?

This is a complex choice for many families. Obviously, if Mom is in a nursing home or assisted living, the answer is clearly no, as most care facilities are closed to visitors because the virus has been devastating that population.

There’s still risk beyond such venues. Data from the Centers for Disease Control and Prevention shows 8 out of 10 reported deaths from the coronavirus are among those 65 or older. Underlying conditions, such as heart or lung disease and diabetes, appear to play a role, and older adults are more likely to have such conditions.

So, what if Mom is healthy? There’s no easy answer, public health experts say, because how the virus affects any individual is unpredictable. And visitors may be infected and not know it. An estimated 25% of people show no or few symptoms.

“A virtual gathering is a much safer alternative this year,” said Benjamin.

But if your family insists on an in-person Mother’s Day after weighing Mom’s health (and Dad’s, too, if he’s there), “everyone in the family should do a health check before gathering,” he said. “No one with any COVID symptoms or a fever should participate.”

How prevalent COVID is in your region is also a consideration, experts say, as is how much contact you and your other family members have had with other people.

If you do visit Mom, wear masks and refrain from hugging, kissing or other close contact, Benjamin said.

My hair is a mess. What about going to the salon?

Again, no clear answer. As salons and barbershops reopen in some states, they are taking precautions.

States and professional associations are recommending requiring reservations, limiting the number of customers inside the shop at a given time, installing Plexiglas barriers between stations, cleaning the chairs, sinks and other surfaces often, and having stylists and customers wear masks. Ask what steps your salon is taking.

“Employees should stay home if they are sick or in contact with someone who is sick,” said Dr. Amanda Castel, professor of epidemiology at Milken Institute School of Public Health at the George Washington University. “Also, employers should make sure they don’t have everyone congregating in the kitchen or break room.”

Some salons or barbers are cutting hair outside, she noted, which may reduce the risk because of better ventilation. Salons should also keep track of the customers they see, just in case they need to contact them later, should there be a reason to suspect a client or stylist had become infected, Castel said.

Consider limiting chitchat during the cut, said Plescia, as talking in close proximity may increase your risk, although “it feels a little rude,” he admitted.

What if your stylist is coughing and sneezing?

“I would leave immediately,” he said.

What about dining at a restaurant?

Many states and the CDC have recommendations for restaurants that limit capacity — some states say 25% — in addition to setting tables well apart, using disposable menus and single-serve condiments, and requiring wait staff to wear masks.

“That’s the kind of thing that does help reduce the chance of spread of infection,” Plescia said.

If your favorite eatery is opening, call to ask what precautions are in place. Make a reservation and “be thoughtful about who you are having dinner with,” said Plescia. Household members are one thing, but “getting into closer physical contact with friends is something people should be cautious about.”

Overall, decide how comfortable you are with the concept.

“If you’re going to go to a restaurant just to sit around and worry, then you might as well do takeout,” he said.

And travel?

Consider your options and whether you really need to go, say experts.

Driving and staying in a hotel may be an option for some people.

If hotels are adequately cleaned between guests, “you could make that work,” said Plescia. Bring cleaning wipes and even your own pillows. Again, though, “if you’re going to see an elderly parent, you don’t want to contract something on the way and give it to them.”

Regarding air travel — airlines are taking steps, such as doing deep cleaning between flights. Fresh and recirculated air goes through special HEPA filters. While there is little specific research yet on the coronavirus and air travel, studies on other respiratory and infectious diseases have generally concluded the overall risk is low, except for people within two rows of the infected person. But a case involving an earlier type of coronavirus seemed to indicate wider possible spread across several rows.

Maintaining distance on the plane and in the boarding process is key.

“Wear a mask on the plane,” said Benjamin.

And plan ahead. How prevalent is the coronavirus in the areas you are traveling to and from? Are there any requirements that you self-isolate upon arrival? How will you get to and from the airport while minimizing your proximity to others?

But if it’s not essential, you might want to think twice right now.

“People who absolutely don’t have to travel should avoid doing it,” said Plescia.

Worship services are important to me. What precautions should be considered?

The distance rule applies as houses of worship consider reopening.

“As much as you can within religious rules, try to avoid contact,” said Benjamin.

He is not giving any advice on Holy Communion, saying that is up to religious leaders. But, he noted, “drinking from the same cup raises the risk if a person is sick or items are touched by anyone who is sick.”

Finally, keep in mind that much is being learned about the virus every day, from treatments to side effects to how it spreads.

“My own personal approach is, try to play it on the cautious side a bit longer,” said Plescia.

Castel agreed.

“We need a little more time to fully understand how COVID-19 works and more time to ramp up our testing, find treatments and hopefully a vaccine,” she said. “We all have social distancing fatigue. But we can continue to save lives by doing this.”

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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

SVE Demo Global on F50 Global Capital Summit

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SVE Demo, the largest and oldest community demo event will host a Global online Demo on June 16 at F50 Global Capital Summit.

This is for the selected startups and winners of the recent monthly SVE Demo Event, the largest and oldest community demo event in Silicon Valley. These startups are also from nominations by Mentors and Partner Organizations. The winners will be selected by the Judges Panel.

#SVE Demo Global | #F50Summit

Tuesday, Jun 16, 2020, 4:30 PM

Online event
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16 Founders,Entrepreneurs,Investors Attending

#SVE Demo Global is the SVE Demo event on a global stage @ F50’s Global Capital Summit. The winners of the recently SVE Demo monthly event will be invited to demo (fee waived) This demo is on zoom. Zoom id is visible to registered attendees. This demo event is part of the F50 Global Capital Summit 2020, live streaming through youtube, and several i…

Check out this Meetup →

The upcoming SVE Demo online May 27:

#SVE Demo Online | SVE.io

Wednesday, May 27, 2020, 4:30 PM

Online event
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30 Founders,Entrepreneurs,Investors Attending

#SVEDemo is the largest community demo event in Silicon Valley/SF. Its network includes founders, entrepreneurs, Angels, corporations, investors, and professionals. As early-stage fundraising has become more difficult than ever, SVE and F50 Elevate™ will help you break through this problem. This demo is on zoom. Zoom id is visible to registered att…

Check out this Meetup →

SVE Demo hosted demo events in Google, Microsoft, Draper University in 2019.

Find some of the demos on SVE Youtbue channel

Marketing during COVID19 Times – Advice to Founders & Investor – Roger Sanford

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F50 presents ‘Marketing During Crisis’, by Roger Sanford, co-founder, HealthGrid Alliance, Strategic Advisor, Anaplan.

Roger Sanford is a well known expert on Marketing, Innovation and Strategy. He worked for over 40 years in the space with leading companies & startups in Silicon Valley. In this webinar, he gives insights into marketing during Covid times and how to navigate. Read about or connect with Roger Sanford (https://www.linkedin.com/in/rogersanford/). This discussion is moderated by Pavan Kumar, Partner, F50 Elevate.

Healthcare: Preparedness & Opportunities, Dr. Minesh Khashu UK

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F50 presents ‘Healthcare: Readiness & Opportunities’, by Dr.Minesh Khashu, UK. Dr.Minesh Khashu, is the Consultant Neonatologist & Prof. of Perinatal Health, UK. He talks about the COVID19 outbreak in UK, readiness of Healthcare systems and near term opportunities. Read about or connect with Dr.Minesh Khashu (https://www.linkedin.com/in/minesh-kh…). This discussion is moderated by Pavan Kumar, Partner, F50 Elevate.

Looking For A Path To Reopen, Employers Weigh COVID Testing Of Workers

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Just a few miles from Disney World, Harris Rosen’s hotel empire is mostly closed because of the COVID pandemic.

One crucial condition for reopening will be testing any of his 4,000 employees who show potential signs of having the disease, he said.

Since March, the company has tested more than 500 workers at its employee health clinic and its impromptu drive-thru site in Orlando, Florida. Sixteen were confirmed cases of COVID-19.

When Rosen Hotels & Resorts, which comprises eight hotels with nearly 7,000 rooms in the Orlando area, reopens later this spring or summer, it plans to have employees regularly fill out a questionnaire about their health and travel history. All employees will get their temperature taken when they arrive, and those with fevers above 99?F will not be allowed on the worksite. Rosen is still working out details of its strategy, but it also plans to give workers with a fever and other COVID-19 symptoms a diagnostic test for the virus.

The Rosen chain is ahead of many businesses still weighing options for reopening. That’s partly because since 1991 it has provided medical care to workers through its employee health clinic.

“Companies are asking what is necessary to reopen businesses safely, and they see testing as one of the key things,” said Stephen Ezeji-Okoye, chief medical officer of Crossover Health, which manages worksite health clinics.

Across the U.S., and across industries, companies have closed their worksites for the past month or so, or operated at significantly reduced capacity. Meat-processing plants in the Midwest have been closed because tight workspaces helped spur outbreaks, nursing homes across the country have seen deaths among staff members needed to care for ailing residents, and flight attendants report increasing cases of the disease.

Now, as half of the states begin the delicate task of lifting stay-at-home orders and allowing businesses to reopen, Rosen is one of many employers being thrust into the debate about how to keep employees and customers safe.

Some employers say testing and screening can help reduce disease transmissions and workers’ fears.

“Employers are tremendously interested in testing because they want to make sure their workplaces are as safe as possible,” said Dr. Jeff Levin-Scherz, a national co-leader of Willis Towers Watson, a consulting firm. “Testing needs to be a component of a way to reduce the risk, but it’s not the entire strategy.”

Yet COVID-19 testing has vexed health officials and politicians since March. Federal and state leaders have bickered over whether supplies of tests are adequate.

Rosen Hotels & Resorts, however, says it does not anticipate any problems securing test kits. While there are still parts of the country with a paucity of testing, central Florida is not one of them. The Orlando area has at least two dozen testing sites, and Gov. Ron DeSantis said during a meeting at the White House last week, “Our ability to test exceeds the current demand.”

For many companies, however, moving toward a testing program is much less certain.

“It’s a difficult time for employers trying their best to protect employees,” said Dr. Mohannad Kusti, corporate medical director of Pittsburgh-based U.S. Steel Corp. The company hopes to decide this month whether to start testing its roughly 18,000 employees at locations in Pennsylvania, Indiana, Alabama and other states.

Kusti said testing isn’t perfect but could add to the arsenal of weapons against the virus, which include requiring workers to wear gloves and face masks and increasing social distancing when applicable.

The company has hesitated to start testing partly because of a lack of tests and concerns over accuracy, he said.

In Nevada, Wynn Resorts, which owns two large hotels in Las Vegas, is partnering with University Medical Center of Southern Nevada to provide free testing to all its Las Vegas employees, either at the workplace or a hospital-designated site.

“This will ensure that Wynn employees that would like to be tested will have access to reliable and accurate COVID-19 testing well in advance and leading up to the opening of the resort,” Wynn said in a statement.

Since March, health clinic staff for Rosen Hotels & Resorts have tested at least 500 workers for the coronavirus at its clinic and drive-thru testing site in Orlando, Florida. As of press time, 16 had tested positive. (Courtesy of Rosen Hotels & Resorts)

‘Uncharted Waters’

Employers with on-site health clinics are best positioned to test because they likely have access to the supplies and the providers needed to administer them, said Mike Thompson, CEO of the National Alliance of Healthcare Purchaser Coalitions.

For example, earlier this year Microsoft began a testing program for workers at its Redmond, Washington, headquarters. Intel Corp. said it is looking into the issue but has not decided how to proceed. Amazon said it is setting up a system of labs to begin testing its workers across the country.

“Regular testing on a global scale, across all industries, would both help keep people safe and help get the economy back up and running,” Amazon CEO Jeff Bezos wrote in a recent shareholder letter.

San Francisco recently partnered with a private genomics testing company, Color, to provide COVID-19 testing to any city employees, contractors and other “essential” workers with symptoms of the disease.

“The reality is we are all in uncharted waters,” said Color CEO Othman Laraki. Employers want to offer testing to help their workers and customers they serve feel more secure, he said.

About one-third of employers surveyed by the Pacific Business Group on Health in April said they are testing employees at or near the workplace or considering it.

Some experts, however, question whether such efforts will make a difference.

Dr. Jamal Hakim, chief operating officer at Orlando Health, a large hospital system in the Florida city, said he doesn’t see employer testing as a panacea. A more effective strategy, he suggested, would be making sure that employees stay home if they have any COVID symptoms, such as fever and dry cough, and that they wash hands often and don’t touch their face.

“Those behavior modifications will dwarf testing in terms of importance going forward,” Hakim said.

Part of the challenge with testing is someone newly infected may not show a positive result for several days. Someone can also get infected following the test. It also takes at least a day to get results back, giving the virus more time to spread unchecked.

New EEOC Guidance

Employers are generally not allowed to inquire about workers’ medical conditions. But the Equal Employment Opportunity Commission, the federal agency that enforces workplace civil rights laws, issued new rules in April permitting employers to test for COVID-19 as a condition of entering the workplace. The one caveat is that employers must test all employees, or, if only certain employees are selected for testing, the employer must have a reasonable reason for doing so — such as testing employees who exhibit persistent coughs or other symptoms associated with the disease.

Harris Rosen, president of Rosen Hotels & Resorts, is providing free COVID-19 testing to employees suspected of having the disease. (Courtesy of World Health Care Congress)

Despite the drawbacks of testing, many major employers are moving forward in an effort to keep workers safe.

St. Louis-based Watlow, a global manufacturer of thermal products with 1,600 U.S. employees, this month began testing workers who believe they may have been exposed to people with COVID-19, as well as workers who are traveling to its Mexico plant, to see if they have the virus or previously had it and now have antibodies for the disease. In addition, the temperatures of all employees are taken when they arrive for work, and anyone above 99.2?F is sent home. Employees wear masks on the job, and barriers were installed between some workstations to promote social distancing.

As of May 6, Watlow has tested fewer than a dozen people at its onsite health clinic, said Sheryl Hicks, vice president of human resources. The company is weighing whether it can or should test everyone.

“We are learning as we go,” Hicks said. “There is a cost to these things, but if it gives us more information to keep people safe or provide a safer environment for folks, then that is not necessarily a bad thing.”

Related Topics

States

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What needs to go right to get a coronavirus vaccine in 12-18 months

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I, like many Americans, miss the pre-pandemic world of hugging family and friends, going to work and having dinner at a restaurant. A protective vaccine for SARS-Cov2 is likely to be the most effective public health tool to get back to that world.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, cautiously estimates that a vaccine could be available in 12 to 18 months.

I am a professor of microbiology and immunology and study how the immune system develops. I think Dr. Fauci’s estimate is an optimistic one, but possible.

Traditional vaccine development is a long and complicated process. Only about 6% of vaccine candidates are eventually approved for public use, and the process takes 10.7 years, on average.

Anthony Fauci is estimating a coronavirus vaccine will be developed faster than any other vaccine in history.
AP Photo/Patrick Semansky

But these are not traditional times. Researchers around the world are innovating the process of vaccine development in real time to develop a vaccine as fast as possible. So how close are we to a vaccine?

A step-by-step process

Vaccines prevent disease by boosting a person’s natural immune response against a microbe that they have not encountered before. There are a number of different types of vaccines in development for SARS-CoV-2 and they fall into three broad categories: traditional killed-virus vaccines, protein-based vaccines and gene-based vaccines. No matter the type, every single vaccine candidate must go through the same vetting process before it can be put into use.

Once researchers have developed a potential candidate, they begin the first step of testing in laboratories, called preclinical studies. Scientists use laboratory animals to examine if the candidate vaccine induces an immune response to the virus and to check whether the vaccine causes any obvious medical problems.

Once a vaccine is proven safe in animals, researchers begin human testing. This is where the federal Food and Drug Administration begins to regulate the process.

Phase 1 studies test for safety and proof-of-concept. Researchers give a small number of human volunteers the vaccine. Then they look for medical problems and see if it induces some sort of immune response.

In Phase 2 studies, researchers give the vaccine to hundreds of volunteers to determine the optimal vaccine composition, dose and vaccination schedule.

The final step before a vaccine is approved by the FDA for broad use is a Phase 3 trial. These involve thousands of volunteers and provide data on how good the vaccine is at preventing infection. These large trials will also uncover rarer side effects or health issues that may not show up in the smaller trials.

Some side effects are rare, so testing must be thorough before a vaccine is approved.
Jose Luis Pelaez Inc/DigitalVision via Getty Images

If in any of these phases a vaccine candidate appears to be ineffective or cause harm to people, the researchers must start over with a new candidate.

After a vaccine candidate successfully completes these clinical trials, a medical regulatory panel in the FDA looks at the evidence, and if the vaccine is effective and safe, approves it for general use. Experts estimate that the whole process costs between US$1 billion and $5 billion.

But approval is not the only hurdle. As has been demonstrated by the severe lack of coronavirus testing, easy and fast production of a test or vaccine is as critical as having one that works.

Both clinical efficacy and ease of production must be considered when asking how long until a vaccine is ready.

Current promising candidates

As of April 30, 2020, there were eight vaccine candidates currently in Phase 1 (or joint Phase 1/Phase 2) clinical trials and 94 vaccines candidates in preclinical studies.

Three of the eight are traditional vaccines that use inactivated or killed virus. Two of the others are protein-based vaccines that use a modified cold virus to deliver the protein that will stimulate the immune response.

The final three vaccines in Phase 1 or 2 trials, and the only two in the U.S., are gene-based vaccines. To me, these seem like the most promising.

Gene-based vaccines contain a gene or part of a gene from the virus that causes COVID-19, but not the virus itself. When a person is injected with one of these vaccines, their own cells read the injected gene and make a protein that is a part of the coronavirus. This one protein isn’t dangerous by itself, but it should trigger an immune response that would lead to immunity from the coronavirus.

Gene-based vaccines come in DNA form, like the vaccine in Phase 1 clinical trials from Inovio Pharmaceuticals in the U.S., or in RNA form, like the vaccine in a simultaneous Phase 1/Phase 2 trial from the German company BioNTech and the vaccine in Phase 1 trials from the U.S.-based Moderna.

Gene-based vaccines are unproven, but offer effective protection and ease of production.
KATERYNA KON/SCIENCE PHOTO LIBRARY via Getty Images

No gene-based vaccines have ever been approved for human use, but DNA vaccines are used on animals, and a few were in clinical trials for the Zika virus.

In the past, researchers have struggled to develop DNA vaccines that produce strong immune responses, but new techniques look promising. RNA vaccines tend to be more effective in animal studies but have also required innovations before human use. It may be that the time of gene-based vaccines has arrived.

Another benefit of gene-based vaccines is that manufacturers would likely be able to produce large amounts much faster than traditional vaccines. DNA and RNA vaccines would also be more shelf-stable than conventional vaccines since they don’t use ingredients like cell components or chicken eggs. This would make distribution, especially to rural areas, easier.

Still a long road to implementation

The three gene-based vaccines and the five other candidates face many challenges before you or I will be vaccinated. The fact that they are in Phase 1 and 2 trials is encouraging, but the very point of clinical trials is to reveal any problems with a vaccine candidate.

And there are a lot of potential problems. The preclinical results in laboratory animals might not translate well to people. The level of immune protection might be low. And people may react adversely when injected with the vaccine.

Any coronavirus vaccine could also produce a dangerous reaction called immune enhancement, where the vaccine actually worsens the symptoms of a coronavirus infection. This is rare, but has happened with past vaccine candidates for dengue fever and other viruses.

So, how long before we have a vaccine against the COVID-19 virus?

No vaccines have made it through Phase 1 or Phase 2 trials yet, and Phase 3 trials generally take between one and four years. If researchers get lucky and one of these first vaccines is both safe and effective, we are still at least a year away from knowing that. At that point manufacturers would need to start producing and distributing the vaccine at a massive scale.

It is unclear what percent of the population would need to be vaccinated against SARS-CoV-2, but in general, you need to immunize between 80% and 95% of the population to have effective herd immunity. Depending on what the virus does in the coming months, that might not be necessary, but if it is, that’s 260-300 million people in the U.S. alone.

Researchers are doing everything they can to develop a vaccine as fast as possible while still making sure it is effective and safe. Manufacturers can help by preparing flexible systems that could be ready to produce whichever candidate gets across the finish line first.

If everything goes well, Fauci’s 12- to 18-month prediction may be right. If so, it will be thanks to the tireless work of scientists, the support of international organizations and manufacturers all innovating and working together to fight this virus.

[Research into coronavirus and other news from science Subscribe to The Conversation’s new science newsletter.]

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Infected with the coronavirus but not showing symptoms? A physician answers 5 questions about asymptomatic COVID-19

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Blood tests that check for exposure to the coronavirus are starting to come online, and preliminary findings suggest that many people have been infected without knowing it. Even people who do eventually experience the common symptoms of COVID-19 don’t start coughing and spiking fevers the moment they’re infected.

William Petri is a professor of medicine and microbiology at the University of Virginia who specializes in infectious diseases. Here, he runs through what’s known and what isn’t about asymptomatic cases of COVID-19.

How common is it for people to contract and fight off viruses without knowing it?

In general, having an infection without any symptoms is common. Perhaps the most infamous example was Typhoid Mary, who spread typhoid fever to other people without having any symptoms herself in the early 1900s.

My colleagues and I have found that many infections are fought off by the body without the person even knowing it. For example, when we carefully followed children for infection by the parasite Cryptosporidia, one of the major causes of diarrhea, almost half of those with infections showed no symptoms at all.

In the case of the flu, estimates are that anywhere from 5% to 25% of infections occur with no symptoms.

For the most part, symptoms are actually a side effect of fighting off an infection. It takes a little time for the immune system to rally that defense, so some cases are more aptly considered presymptomatic rather than asymptomatic.

How can someone spread coronavirus if they aren’t coughing and sneezing?

Everyone is on guard against the droplets that spray out from a coronavirus patient’s cough or sneeze. They’re a big reason public health officials have suggested everyone should wear masks.

But the virus also spreads through normal exhalations that can carry tiny droplets containing the virus. A regular breath may spread the virus several feet or more.

Spread could also come from fomites – surfaces, such as a doorknob or a grocery cart handle, that are contaminated with the coronavirus by an infected person’s touch.

What’s known about how contagious an asymptomatic person might be?

No matter what, if you’ve been exposed to someone with COVID-19, you should self-quarantine for the entire 14-day incubation period. Even if you feel fine, you’re still at risk of spreading the coronavirus to others.

Most recently it has been shown that high levels of the virus are present in respiratory secretions during the “presymptomatic” period that can last days to more than a week prior to the fever and cough characteristic of COVID-19. This ability of the virus to be transmitted by people without symptoms is a major reason for the pandemic.

To find out what percentage of people have anti-coronavirus antibodies in their blood, health departments are starting to sample the public, as at this grocery store in New York.
Xinhua News Agency via Getty Images

After an asymptomatic infection, would someone still have antibodies against SARS-CoV-2 in their blood?

Most people are developing antibodies after recovery from COVID-19, likely even those without symptoms. It is a reasonable assumption, from what scientists know about other coronaviruses, that those antibodies will offer some measure of protection from reinfection. But nothing is known for sure yet.

Recent serosurveys in New York City that check people’s blood for antibodies against SARS-CoV-2 indicate that as many as one in five residents may have been previously infected with COVID-19. Their immune systems had fought off the coronavirus, whether they’d known they were infected or not – and many apparently didn’t.

How widespread is asymptomatic COVID-19 infection?

No one knows for sure, and for the moment lots of the evidence is anecdotal.

For a small example, consider the nursing home in Washington where many residents became infected. Twenty-three tested positive. Ten of them were already sick. Ten more eventually developed symptoms. But three people who tested positive never came down with the illness.

When doctors tested 397 people staying at a homeless shelter in Boston, 36% came up positive for COVID-19 – and none of them had complained of any symptoms.

In the case of Japanese citizens evacuated from Wuhan, China and tested for COVID-19, fully 30% of those infected were aymptomatic.

An Italian pre-print study that has not yet been peer-reviewed found that 43% of people who tested positive for COVID-19 showed no symptoms. Of concern: The researchers found no difference in how potentially contagious those with and without symptoms were, based on how much of the virus the test found in indiduals’ samples.

The antibody serosurveys getting underway in different parts of the country add further evidence that a good number – possibly anywhere from around 10% to 40% – of those infected might not experience symptoms.

Asymptomatic SARS-CoV-2 infection appears to be common – and will continue to complicate efforts to get the pandemic under control.

[Research into coronavirus and other news from science. Subscribe to The Conversation’s new science newsletter.]

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

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

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

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

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

Bluetooth beacons

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

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

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

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

Anonymous exchanges

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

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

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

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

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

No plan is perfect

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

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

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

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

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

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

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

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

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

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

F50 Global Insights is a series of webinars on ‘Elevating HealthTech Innovation’ and brought to you by Silicon Valley based F50 & F50 Elevate. F50 serves a community of VCs, Investors, angel investors, Corporates, startup founders, entrepreneurs and thought leaders. F50 Global Capital Summit(GCS) is among the leading investor events of Silicon Valley. F50 Elevate is a pre-Series A HealthTech startup accelerator based out of Silicon Valley.

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

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

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

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

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

Visit f50.io/summit for more information.

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

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

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

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

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

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

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

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

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

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

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

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

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

***

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

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

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

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

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

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

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

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

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

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

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

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

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

***

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

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

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

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

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

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

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

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

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

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

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

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

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

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

***

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

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

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

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

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

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

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

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

 


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

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

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

An hour later, she was dead.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mississippi: The Legacy Of Segregation

One in 5 Mississippi residents live in poverty.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Navajo: Health Suffers In Food Deserts

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

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

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

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

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

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

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

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

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

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

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

Memphis: Childhood Diseases Take Their Toll

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

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

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

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

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

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

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

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

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

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

KHN data editor Elizabeth Lucas contributed to this report.

METHODOLOGY

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

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

DATA SOURCES

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

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

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

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

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

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

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

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

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

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

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

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

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

Robots around the world

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

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

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

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

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

Helping workers, not replacing them

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

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

A robot uses pulses of ultraviolet light to disinfect a hospital room in Johannesburg, South Africa.
MICHELE SPATARI/AFP via Getty Images

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

Off-the-shelf over prototypes

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

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

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

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

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

Don’t stockpile robots

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

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

Robots in future pandemics

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

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

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Coronavirus Fuels Explosive Growth In Telehealth – And Concern About Fraud

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Contact Tracing Via Bluetooth

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

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

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

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

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

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

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

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

Caplan agrees.

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

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

Location Tracking

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

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

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

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

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

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

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

Symptom Tracking

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

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

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

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

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

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

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

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

Weighing The Trade-Offs

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

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

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

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

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

Related Topics

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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

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

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

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

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

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

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

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

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

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

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

Tracking individuals

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

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

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

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

Check-ins and blood tests

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

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

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

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

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

Principles for protecting privacy

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

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

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

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

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

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