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Coronavirus: A CEO’s reading list

Health Evolution’s curated hub of actionable advice being posted around the web to help our community separate signal from noise.

Tom Sullivan and Gabriel Perna | March 31, 2020

Amid the COVID-19 pandemic, health care provider, payer and life sciences CEOs’ time is more constrained than ever.  With so much noise it can be hard to find the more insightful and actionable articles that tend to get lost in the fray.

As a service to readers, Health Evolution will hand-pick and curate the most-appropriate articles from around the web to share here — and we’ll update this page as frequently as is appropriate.

May 26, 2020 4 pm

 

9 ways COVID-19 has changed health care forever. STAT surveyed a number of policy experts who determined what the health system will look like for decades post COVID-19. Among the predictions – the rapid acceleration of telemedicine, the decline in nursing homes coupled with a rise in home health aides, an inflection point in racial disparities, another reckoning on drug pricing and more. STAT interviewed former CMS Administrator Don Berwick, EmblemHealth CEO Karen Ignani, Rep. Donna Shalala, Democratic congresswoman from Florida and former Clinton administration health secretary and others.

Quote: “The pandemic could help bring about an end to the American tradition of tying health insurance to employment status. It could prompt a reckoning about why Black people and other historically marginalized populations have long suffered so disproportionately — not just from Covid-19, but from nearly every common health condition.”

The full list can be read here.

May 26,  2020 12:30 pm

Why COVID-19 is more common in adults than kids. New research published in JAMA from Mount Sinai discovers why children are more immune to COVID-19 than adults. The researchers say that he virus that causes COVID-19 uses a receptor known as ACE2, found on the surface of certain cells in the human body, to enter its victims. According to research, children have lower levels of ACE2 gene expression than adults.

Quote: “The coronavirus uses ACE2 to enter the human body, where it spreads. ACE2 is known to be present in our airway, kidneys, heart, and gut. In our study, we took this knowledge a step further, finding that there are low levels of ACE2 expression in the nasal passages of younger children, and this ACE2 level increases with age into adulthood. This might explain why children have been largely spared in the pandemic,” says Supinda Bunyavanich, MD, Professor of Genetics and Genomic Sciences and Pediatrics, Icahn School of Medicine at Mount Sinai.

More on this study here.

May 19, 2020 10:30 am

For-profit hospitals benefit in CARES funding. Kaiser Family Foundation looked at how money is distributed from the CARES Act to hospitals. Specifically, researchers examined the implications of the decision to allocate funding based on total net patient revenue, which is total patient revenue minus contractual allowances and discounts. According to their findings, by distributing $50 billion of the CARES Act based on patient insurance revenue, hospitals with the highest share of private insurance will receive the most money.

  • Findings: “…hospitals with the highest share of private insurance revenue are less likely to be teaching hospitals (10 percent vs 38 percent) and more likely to be for-profit (33 percent vs 23 percent).” The hospitals with the highest share of private insurance revenue also had higher operating and provided less uncompensated care as a share of operating expenses, the researchers found.

Medical malpractice laws shift during COVID-19. Kaiser Health News reports that governors in Connecticut, Maryland, Illinois and several other states have ordered that most providers be shielded from civil as well as some criminal lawsuits over medical treatment during the COVID-19 pandemic. A group of 36 physician and hospital associations, including the American Hospital Association and American Medical Association, have appealed to congressional leaders for federal legislation.

  • Takeaway: The immunity laws for providers are an extension of the usual protection for a “good Samaritan.” This is when a doctor or nurse who sees a car accident, for example, and stops to help the injured. The law says that since the provider doesn’t have the equipment and support of a hospital, they shouldn’t be held to the same standards.
  • Quote: “When you are asking nurses to work around-the-clock and the ICU has 2½ times as many people than it was engineered for, well, my goodness, doesn’t this make common sense?” said Kenneth Raske, president and CEO of the Greater New York Hospital Association told Kaiser Health News.

Social distancing measures worked. Researchers at the University of Kentucky studied the impact of national and local shelter-in-place measures on the growth rate of confirmed COVID-19 cases across US counties between March 1, 2020 and April 27, 2020. The researchers say that without these shelter in place orders cases would have been 10 times higher without shelter in place (10,224,598) and 35 times higher (35,257,098) without any social distancing restrictions.

  • Takeaway: Shelter in place orders and closures of restaurants/bars/entertainment-related businesses substantially slowed the spread of COVID-19, the researchers found. “We did not find evidence that bans on large events and closures of public schools also did, though the confidence intervals cannot rule out moderately sized effect,” the authors wrote in Health Affairs.

The study results can be read here.

May 11, 2020 1:33 pm

Researchers create AI-enabled COVID-19 diagnostic tool. Researchers at King’s College London, Massachusetts General Hospital and health science company ZOE have developed an artificial intelligence diagnostic that can predict whether someone is likely to have COVID-19 based on their symptoms. The AI model uses data from the COVID Symptom Study app, from ZOE, to predict COVID-19 infection, by comparing people’s symptoms and the results of traditional COVID tests.

Takeaway: The researchers analyzed data from just under 2.5 million people in the UK and US who had been regularly logging their health status in the app, around a third of whom had logged symptoms associated with COVID-19. Of these, 18,374 reported having had a test for coronavirus, with 7,178 people testing positive. Researchers found loss of taste and smell (anosmia) was one major factor in diagnosis, with two thirds of users testing positive for coronavirus infection reporting this symptom compared with just over a fifth of the participants who tested negative.

Quote: “Our results suggest that loss of taste or smell is a key early warning sign of COVID-19 infection and should be included in routine screening for the disease. We strongly urge governments and health authorities everywhere to make this information more widely known, and advise anyone experiencing sudden loss of smell or taste to assume that they are infected and follow local self-isolation guidelines,” Professor Tim Spector from King’s College London said in a statement.

Coming soon: The CEO Guide to AI and Machine Learning: The most pressing elements CEOs need to consider when determining how AI figures into the overall strategy.

Health benefits changing thanks to COVID-19. A new survey from Willis Towers Watson of 816 employers reveals that many of them are changing health benefits to expand access for its employees during COVID-19. More than three in four employers are offering or expanding access to virtual mental health services.

Takeaway: While some employers are enacting furloughs, pay cuts and reductions in 401(k) matching contributions to reduce costs, many are preserving wellbeing plans at a time when employees are facing significant challenges. Others are actually expanding these programs. Nearly 50 percent are enhancing health care benefits, 45 percent are broadening wellbeing programs, and 33 percent plan to make changes to paid time off (PTO) or vacation programs.

Quote: “Although most employers anticipate a significant negative impact from COVID-19, many are taking steps to protect the health and wellbeing of their employees,” Regina Ihrke, senior director and wellbeing leader, North America, Willis Towers Watson, said in a statement. “Employers are doing what they can to support their workers through this difficult time. The pandemic has led to high levels of employee anxiety and stress, so employers are making it easier for employees to get help across all aspects of the wellbeing spectrum.”

May 5, 2020 3:30 pm est

Data Interoperability and Exchange to Support COVID-19 Containment. The Duke-Margolis Center for Health Policy convened a multi-stakeholder working group to identify feasible, short-term steps to improve interoperability and exchange of key data for COVID-19 containment.  Their findings were outlined in a paper authored by Farzad Mostashari, MD, CEO of Aledade and Mark McClellan, MD, Director, Duke-Margolis Center for Health Policy & Robert J. Margolis, M.D., Professor of Business, Medicine and Policy; Duke University. The working group called on government and private stakeholders to focus on a 30-to-60-day plan and to use existing systems, rather than building new ones.

Takeaways: Mostashari and McClellan say three immediate, feasible steps will enable public health programs to work more effectively with health care providers, clinical laboratories, and other critical partners in COVID-19 containment efforts. The three steps include:

  • Improve commercial lab reporting: The authors say electronic test reporting systems should be expanded to include demographic information provided at the time a test is ordered or immediately thereafter.
  • Supplement case investigations with clinical data. Authors say state and local health officials should use their existing public health legal authority to define the minimum data necessary for the COVID-19 containment “use case” as a routine part of onboarding into widely-used clinical data exchanges.
  • Enhance use of National Syndromic Surveillance Program (NSSP): Authors say federal, state, and local public health officials should agree on a consensus set of protocols governing which data from NSSP state “lockers” can be used for Federal surveillance and how that data may be used at the Federal level.

More can be found here.

May 1, 2020 3:51 pm

CMS offers COVID-19 flexibility for ACOs, workforce.  With ACOs set to face tremendous financial struggles thanks to the COVID-19 pandemic, CMS threw a lifeboat to them this week. The agency said its making to the financial methodology to account for COVID-19 costs so that the 517 ACOs in the Medicare Shared Savings program will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic. They’re also forgoing the application cycle for 2021 and giving ACOs whose participation is set to end this year the option to extend for another year. 

“We’re appreciative of the thoughtful ways CMS will modify the Shared Savings Program during the public health emergency, especially by removing spending associated with COVID-19 patients from performance calculations,” said Clif Gaus, Sc.D., President and CEO of the National Association of ACOs in a statement.

CMS also introduced flexibility around workforce availability, allowing nurse practitioners, clinical nurse specialists, and physician assistants to provide home health services. It will also not penalize teaching hospitals that shift their residents to other hospitals to meet COVID-related needs. It also allowed physical therapists, occupational therapists, and speech language pathologists to provide telehealth services on top of doctors, nurse practitioners and physician assistants.

The complete list of CMS changes can be found here.

April 29, 2020 1:29 pm

Nearly 20% of employees are exposed to infections on the job. A University of Washington research team used federal employment data to determine that 14.4 million workers face exposure to infection once a week and 26.7 million at least once a month in the workplace. This equates to 10 percent of the workforce are exposed to disease or infection happens at least weekly and 18.4% exposed at least monthly. Health care was naturally at the top of the pack, in terms of exposure risk.

Takeaway: While health care occupations represent the bulk of workers exposed to infection and disease, police officers, firefighters, childcare workers, and personal care aides are also at risk, said Marissa Baker, an assistant professor in the UW School of Public Health, lead author of the report.

Advice: “The public health implications from our study are that workplaces need to make sure that they are not only protecting their workers at work, but also coming up with contingency plans to make sure that sick workers are not coming to work, and that can be accomplished through training workers to fill in for each other, providing additional paid sick leave during this time and similar measures.”

Update April 27, 2020 10:38 am ET

CMS suspends advanced payment program. CMS announced on April 26, 2020 that it’s reevaluating the amounts that will be paid under its Accelerated Payment Program and suspending its Advance Payment Program to Part B suppliers effective immediately.  CMS says it is suspending the program in light of Congress passing $175 billion in relief funds for providers as part of the CARES Act and the Paycheck Protection Program and Health Care Enhancement Act. Before those two bills were passed, CMS expanded the Advanced Payment program. In the last several weeks, CMS had approved more than 24,000 applications and advanced more than $40 billion to Part B suppliers and more than 21,000 in applications totaling $59.6 billion in payments to Part A providers, which includes hospitals. 

More here.

Update April 23,  2020 11:34 am ET

Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. Researchers at Northwell Health in New York City have come out with a paper that provides characteristics and early outcomes of patients hospitalized with COVID-19 in the New York City area.

  • Takeaway: The most common comorbidities were hypertension (56.6%), obesity (41.7%), and diabetes (33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/minute, and 27.8% received supplemental oxygen. The average age was 63 years old and it was a 60-40 split in favor of males. Mortality rates were higher for male compared with female patients at every 10-year age interval older than 20 years.
  • Insight: “To our knowledge, this study represents the first large case series of sequentially hospitalized patients with confirmed COVID-19 in the US. Older persons, men, and those with pre-existing hypertension and/or diabetes were highly prevalent in this case series and the pattern was similar to data reported from China.”

Full study is here.

Updated April 22, 2020 at 10:12 am ET

The National Institutes of Health published COVID-19 treatment guidelines that were created by a panel consisting of physicians, statisticians and other experts.

  • Takeaway: “The guidelines consider two broad categories of therapies currently in use by healthcare providers for COVID-19: antivirals, which may target the coronavirus directly, and host modifiers and immune-based therapies, which may influence the immune response to the virus or target the virus,” NIH explained in the announcement.
  • What else to know: NIH’s guidelines also include information about evaluating and stratifying patients based on risk, best practices for managing patients at different stages, guidance on treating critically ill patients, and more. The agency said it will update the guidelines as new data enters the literature.

CMS relaxes interoperability rule for six months.

  • What happened: “Recognizing that hospitals, including psychiatric hospitals, and critical access hospitals, are on the front lines of the COVID-19 public health emergency, CMS is extending the implementation timeline for the admission, discharge, and transfer (ADT) notification Conditions of Participation (CoPs) by an additional six months,” CMS wrote.
  • CMS Administrator Seema Verma explains: “Now more than ever, patients need secure access to their healthcare data. Hospitals should be doing everything in their power to ensure that patients get appropriate follow-up care. Nevertheless, in a pandemic of this magnitude, flexibility is paramount for a health care system under siege by COVID-19. Our action today will provide hospitals an additional 6 months to implement the new requirements.” 

Updated April 20 at 12:16 pm

COVID-19 population data shows race disparity. New data released by the CDC shows that 33% of people who’ve been hospitalized with COVID-19 are African American. Research from Johns Hopkins found similar statistics. Considering only 13% of the U.S. population is African American, why is there such a disproportionate number? NPR reported on this disparity and why it exists.

  • Takeaway: One reason, experts tell NPR, is there’s a higher prevalence of obesity, high blood pressure and diabetes among African Americans. People with these chronic conditions are more likely to get hospitalized and sicker from COVID-19, according to various studies. There are other societal reasons, experts believe, for this race disparity.
  • Insightul Quote: “Every major crisis or catastrophe hits the most vulnerable communities the hardest,” Marc Morial, president and CEO of the National Urban League, told NPR. “Black workers are more likely to hold the kinds of jobs that cannot be done from home. There also is bias among health care workers, institutions and systems that results in black patients … receiving fewer medical procedures and poorer-quality medical care than white individuals.”

AHA issues roadmap for return to elective surgeries. The AHA, American College of Surgeons (ACS), American Society of Anesthesiologists (ASA) and Association of periOperative Registered Nurses (AORN) developed a roadmap to guide readiness, prioritization and scheduling for the return of elective surgeries. The groups say facilities should not resume elective procedures until there has been a sustained reduction in the rate of new COVID-19 cases in the area for at least 14 days.

  • Takeaway: AHA says there are multiple principles hospitals should follow when developing a timeline on resuming elective surgeries. Those are Timing, testing, adequate equipment, prioritization and scheduling, data collection and management, COVID-19- related safety and risk mitigation surrounding a second wave, and other issues, including the mental health of health care workers, patient communications, environmental cleaning and regulatory issues.

Here’s the complete roadmap.

The financial situation for hospitals is dire.  Industry groups are calling on the government to provide for funds in the “Provider Relief Fund.” The initial $100 billion won’t be enough to keep many hospitals afloat, says the Federation of American Hospitals in a policy brief.  The government has begun the second round of distributing funds from the CARES Act this week. 

  • Takeaway:  “A recent analysis by JPMorgan found that the $100 billion in stimulus funds for providers included in the CARES Act would only be sufficient to cover hospitals’ losses for two months – not including additional costs associated with increasing capacity and purchasing supplies to fight the outbreak.”
  • Author’s advice: “The infusion of funds for providers from the CARES Act is a start, but unfortunately nowhere near enough. Swift action is necessary to ensure that our nation’s caregivers can continue to serve all the patients who depend on them every day. Congress must act quickly to protect hospitals before these dire warnings become a grim reality.”

Social distancing works. It really works. A new study from researchers at Columbia University Mailman School of Public Health finds that almost 185,000 deaths in the Northeast and 33,000 deaths in the Midwest could be averted by reducing person-to-person contact through actions such as travel restrictions, social distancing, and self-isolation for sick individuals.

The researchers created an online tool identifying U.S. counties that are at risk of exceeding their critical care surge capacity limits within six weeks and estimated the lives that could be saved with enhanced social distancing and ramped up medical care.

  • Takeaway: “A 40% contact reduction could decrease the number of counties exceeding their critical care bed limits between 81.5% – 87.3%, and a high intensity patient surge response could decrease the number of counties exceeding their critical care bed limits between 24.6% – 48.0%.”
  • Author’s advice: “Courageous medical providers are saving lives in dire circumstances and they could better do their jobs and minimize their own risks of COVID-19 if counties across the nation adopt and maintain stringent social distancing policies,” Charles Branas, PhD, professor and chair of epidemiology said in a statement.

Rural Hospitals feel the squeeze. Before COVID-19 ever entered the picture, rural hospitals were already in trouble. In 2019, a record-setting 19 rural hospitals closed. It’s not accelerating at an even faster pace and it won’t get any easier thanks to COVID-19, NPR reports. Decatur County General Hospital in Tennessee will shut down indefinitely by April 15, it will be the ninth small-town hospital to close in 2020 alone.

  • Takeaway: “The loss of revenue over the last few weeks due to the inability to provide non-emergency care is destabilizing core health services in rural America,” the National Rural Health Association said in a statement.
  • What’s next: “Health policy experts say a rural hospital’s ability to stay open through the coronavirus pandemic may depend in part on whether the state it’s in has expanded Medicaid. Idaho has, but Tennessee, where Decatur County General is slated to close, has not.”

New York is merging all its hospitals to battle the coronavirus. Vox reports on the bold plan that essentially “socializing the entire system,” to fight against the pandemic.

  • Takeaway: “From Buffalo to NYC, hospitals will be sharing staff, patients, and supplies for the foreseeable future, with Albany overseeing the distribution of resources,” according to Vox.
  • Reasons the plan is remarkable: “There are about 200 hospitals in New York state, totaling 53,000 beds before Cuomo told them to double their capacity. About 20,000 of those beds are in New York City,” Vox reported. “It is a matter of necessity, as New York has already seen more than 100,000 COVID-19 cases and 1,500 deaths — with the peak still projected to be a week away, according to the Institute for Health Metrics and Evaluation’s estimates, requiring as many as 100,000 beds.”

Helping public health officials combat COVID-19, by Google SVP Jen Fitzpatrick and Chief Health Officer Karen DeSalvo, MD.

  • Takeaway: “We’re publishing an early release of our COVID-19 Community Mobility Reports to provide insights into what has changed in response to work from home, shelter in place, and other policies aimed at flattening the curve of this pandemic,” according to Fitzpatrick and DeSalvo.
  • What’s next: “Given the urgent need for this information, where possible we will also provide insights at the regional level,” they explain. “In the coming weeks, we will work to add additional countries and regions to ensure these reports remain helpful to public health officials across the globe looking to protect people from the spread of COVID-19.”

The Federation of American Hospitals is collecting COVID-19 resources relative to issues and advocacy.

Updated Tuesday, March 31 at 12:28 am EST

The top 3 Coronavirus priorities for the next month, as outlined by former CMS Acting Administrator Andy Slavitt.

  • Takeaway: Slavitt outlines three jobs to be done:
      1.          Support the front-line workers
      2.          Continue or improve social isolation to bend the curve
      3.          Give scientists enough time to work on therapies, cures and a vaccine
  • Author’s advice: “We’ve reached 2,000 deaths in the US and in a couple days will be passing 9/11 totals. And 10s of thousands [are] unheard of. “What happens beyond that point is history not yet written.”

COVID-19 Priorities Checklist for State Leaders. Slavitt is currently Board Chair at United of States of CARE, which issued the 10-page document and described it as a dynamic list of best practices.

  • Takeaway: “Our goal is to continue to elevate best practices and push forward new approaches to the unprecedented medical and public health challenges that more American cities and states will have to confront.”
  • Author’s advice: Immediately prioritize these five areas:
      1.                   Take action to slow the spread of the virus
      2.                   Build and sustain the supplies, health system capacity and workforce needed to cover the immediate medical challenge
      3.                   Ensure access to health care for those with COVID-19 and those losing their coverage as a result of the economic downturn
      4.                   Protect individuals most at risk for COVID-19
      5.                   Lay groundwork for the long-term approach to the epidemic and economic recovery

National Coronavirus Response: A Road Map to Recovering, published by the American Enterprise Institute and written by former FDA Commissioner Scott Gottlieb, MD, and former CMS Administrator Mark McClellan, MD, former FDA medical device center Deputy Director Lauren Silvis, Johns Hopkins epidemiologist Caitlin Rivers and Johns Hopkins professor and health security expert Crystal Watson.

  • Takeaways: The report lays out a phased approach that begins with slowing the spread, then transitions into state-by-state reopening, establishing immune protection and reducing physical distancing and ultimately includes preparing for the next pandemic.
  • Author’s advice: “In each phase, we outline the steps that the federal government, working with the states and public-health and health care partners, should take to inform the response. This will take time but planning for each phase should begin now so the infrastructure is in place when it is time to transition.”

Read more about it in our brief summary. Or access the full report.

Updated Monday March 30 at 10:00 am EST

Given the ongoing pandemic— and because the in-person Health Evolution Summit has been postponed — we are hosting a virtual gathering, Pandemic Response: A Public-Private Call to Action. During the webcast, CEOs and other C-level leaders will learn from each other and from federal and state government officials about insights and best practices for preparedness, mitigation, education and communication. Leaders will also discuss lessons learned on the front lines of the battle and share information about the available diagnostics, treatments, cures and forthcoming vaccines.

When: April 2, 2020 beginning at 8 am ET.

View the agenda and register. (Here’s the FAQ about postponement.) 


CEO Reading List

COVID Community Vulnerability Map. Jvion, a health care analytics company, has released a COVID Community Vulnerability Map. The interactive map identifies populations down to the census block level that are at risk for severe outcomes upon contracting a virus like COVID. It also is overlaid with points of interest, such as hospitals, food sources and transportation, in relation to the at-risk communities.

  • Takeaway. This map can help “inform providers, public health organizations and community support agencies as they look to deploy interventions, outreach and other services to keep individuals from contracting the virus and, once infected, manage their care towards a positive outcome.”

Check out the map here.

Perceptions of COVID-19 among the general public. The Annals of Internal Medicine assessed knowledge and perceptions about COVID-19 among a convenience sample of the general public in the United States and United Kingdom.

  • Takeaway: While the nearly 6,000 residents in the U.S. and UK had good knowledge of the main mode of disease transmission and common symptoms, the results showed several important misconceptions on how to prevent acquisition of COVID-19, including falsehoods that have been repeated on social media.
  • Author’s advice: “In conclusion, the general public in the United States and United Kingdom appears to have important misconceptions about COVID-19. Correcting these misconceptions should be targeted in information campaigns organized by government agencies, information provision by clinicians to their patients, and media coverage.”

Singapore modelling study estimates impact of physical distancing on reducing spread of COVID-19. A new study in The Lancet looked at the impact of physical distancing on reducing spread of COVID-19.

  • Takeaway: Researchers looked at the effective measures from the country of Singapore in stopping COVID-19. They found that quarantining of people infected with the new coronavirus and their family members, school closures plus quarantine, and workplace distancing plus quarantine, in that order, work the best with a combination of all three being most effective in reducing cases.
  • Author’s advice: “If the preventive effect of these interventions reduces considerably due to higher asymptomatic proportions, more pressure will be placed on the quarantining and treatment of infected individuals, which could become unfeasible when the number of infected individuals exceeds the capacity of health-care facilities. At higher asymptomatic rates, public education and case management become increasingly important, with a need to develop vaccines and existing drug therapies,” Alex R Cook, PhD National University of Singapore

The COVID Tracking ProjectThis is an independent, volunteer-run accounting of every coronavirus test conducted in America. “We attempt to include positive and negative results, pending tests, and total people tested for each state or district currently reporting that data,” the website states.

TAKE ME TO THE DATA

COVID-19 response reveals why public-private partnership is vital to health care. The newest Leadership Matters column from Health Evolution Founder and Executive Chairman David Brailer, MD,

  • Takeaway: “I believe that a future investigation into early coronavirus testing will not show that federal agencies failed to follow rules, but rather that the rules themselves were obsolete and not adequate for today’s challenges.  It is a systematic institutional failing that demonstrates the huge downside of having the government too much in control of health care.”
  • Author’s advice: “Over the next few weeks, we will face a once-in-a-century fight for the health and wellbeing of our citizens and our nation.  When it is done – and we will put it behind us – we will then ask what we learned and what we should do differently next time.  I hope this includes an exploration of how much we benefit from our America’s unique public-private collaboration and how we can make it stronger and deeper in the future.”

COVID-19 is sparking a lot more questions than answers right now. Here’s one from Paul Keckley: Coronavirus: A gray rhino that will the re-shape the U.S. health system?

  •  Takeaway: “Is this coronavirus pandemic a Black Swan that caught most by surprise or is it a gray rhino that lurked obviously but was ignored? It’s a legitimate question. In my view, it’s a gray rhino.”
  • Author’s advice: “What’s clear from prior pandemics is that quick action is necessary to contain the spread and mitigate longer-term adverse outcomes. The fast and dramatic actions taken in China, Taiwan were successful: mass quarantines and lockdowns, significant limits on gatherings and mass testing proved effective.”

Updated Monday, March 16, 11:00 AM ET.

Virtually Perfect? Telemedicine for Covid-19. Judd Hollander, MD, Associate Dean for Strategic Health Initiatives at Sidney Kimmel Medical College at Thomas Jefferson University andBrendan G. Carr, MD, Associate Dean of Healthcare Delivery Innovation at Thomas Jefferson University write in The New England Journal of Medicine about why telemedicine and AI are ideal for Covid-19 screening. 

  • Takeaway:  While there are barriers to telemedicine, specifically coordination of testing, credentialing, program implementation and payment parity, it’s well suited to help combat the pandemic.  It will reduce the number of patients that will get exposed to the virus and will address concerns about workforce capacity. 
  • Author’s advice: “A central strategy for health care surge control is “forward triage” — the sorting of patients before they arrive in the emergency department (ED). Direct-to-consumer (or on-demand) telemedicine, a 21st-century approach to forward triage that allows patients to be efficiently screened, is both patient-centered and conducive to self-quarantine, and it protects patients, clinicians, and the community from exposure.”

Coronavirus: Health care accelerates innovation in pandemic response.  Health Evolution contacted executives from Providence at the U.S. epicenter of the outbreak in Seattle, as well as Spectrum Health, Ginger and Blue Cross Blue Shield Association to report on how they are handling the outbreak. Amid so much bad coronavirus news, we found innovative spirits pushing ahead even harder than usual.

Combating Coronavirus starts with keeping workers well. By Michelle Williams, Dean of Faculty at Harvard T.H. Chan School of Public Health and Arianna Huffington, founder and CEO of Thrive Global in Fortune.

  • Takeaway: “We’re already seeing the tremendous toll — physical, mental, and emotional —that the coronavirus is taking on the world’s public health workforce.”
  • Authors’ advice: “It’s imperative that we prioritize well-being in our own lives — building healthy habits around sleep, movement, nutrition, and hydration that help us mitigate stress, avoid burnout, and truly recharge. Ultimately, these are the most important disease prevention steps all of us can take.”

 Why it’s not impossible that COVID-19 kills a million Americans,  by former CDC Director Tom Frieden, MD, in an article on Think Global Health.

  • Takeaway: “During the three major emergency responses I oversaw at CDC in the past decade — H1N1, Ebola, and Zika — CDC and state and local health departments were able to learn quickly and act quickly to protect people. The COVID-19 pandemic is an unprecedented threat — never before has a new respiratory pathogen been identified then spread around the world.”
  • Author’s advice: Frieden offers 10 action items: protect the vulnerable, stop non-essential visits to nursing homes and long-term care facilities, accelerate work on treatments and vaccines, cancel large gatherings, protect health care workers, stop handshake, stay inside if ill, telework while virus is in your area, assess school closure and learn more as fast as we can.

Taiwan’s impressive efforts to thwart coronavirus.  
Based on data in the Journal of the American Medical Association, we created this infographic demonstrating why Taiwan is something of a success story amid the chaos.

  • Takeaway: Despite being close to mainland China, Taiwan had only 44 cases as of the first week in March because “the government activated its Central Epidemic Command Center for severe special infectious pneumonia,” to significantly reduce spread.
  • Advice: “Proactive testing, big data analytics, and new tech innovation [can] keep coronavirus rates down, according to the research in JAMAThis includes leveraging its national health insurance (NHI) database and integrating it with its immigration and customs database for analytics, usage of clinical real-time alerts, QR scanning and online reporting of travel history and health symptoms to classify travelers’ infectious risks based on flight origin and travel history in the past 14 days. They also sought out patients with severe respiratory symptoms based on the NHI database.”  

How should hospitals develop a strategy for coronavirus?

Vineet Chopra MD, Associate Professor of Medicine and Chief of the Division of Hospital Medicine at Michigan Medicine, and a team of researchers write in Annals of Internal Medicine about the steps U.S. hospitals should take to prepared for COVID-19.

  • Takeaway: The “best-case scenario estimates suggest that COVID-19 will stress bed capacity, equipment, and health care personnel in U.S. hospitals in ways not previously experienced.” The authors’ say providers should be developing a strategy for patient volume and complexity, protecting and supporting health care core workers on the front lines, figuring out how to allocate resources, and creating a robust open communication policy.
  • Authors’ advice: On patient volume and complexity, the authors suggest hospitals attempt to geographically cohort patients with COVID-19 to limit the number of health care personnel exposed and conserve supplies. When it comes to communication, the authors say, “crisis communications should ideally occur via several media, such as a telephone hotline, the hospital Web page, social media platforms, or text-based messages.”

 

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