The Occasional Perspective - 3/2/20

Considerations from current events…

 Cracks In The Foundation – Over the past week, the coronavirus (or, Covid-19) has moved to a far off problem in China to a front-and-center focus of the American public. Here in the Boston area, I learned that one of our premier institutions is having a problem with patients “stealing” masks from exam rooms as part of what seems a hording exercise.  Panic is beginning to brew as it does with all pandemics.  The coronavirus is now clearly recognized as a global threat not only from a public health perspective but, now as a financial one as well with the markets reacting in a very negative way to the news of the spread.  In my estimation, Michael Osterholm, MD is right on target.  He is on the faculty at the University of Minnesota (or, as we North Dakotans like to say “Eastern North Dakota”) and serves as the Director of the Center for Infectious Disease Research and Policy. Osterholm recently observed, “I don’t think the answer is shutting down the world to stop this virus. It’s already out.” By the time this blog comes out, there will be even more news on more cases no doubt spreading across the USA just like the virus has done on all of the places where it has invaded across the globe.  Therefore, I’m not going to point you to a specific article on the threat because by the time I get this out (in the last 24 hours), everything will have changed. 

It’s clear that quarantine is not going to work.  Isolating people on cruise ships or in make-shift hospitals has not worked. I’m not a public health expert and my training in public health has been limited to what I’ve learned or, am learning, from our daughter who serves as an epidemiologist and state health officer. So, it seems to me that we need to get back to basics.  So, the question gets asked: What to do?  Here are some thoughts:

1. The first order of business is to not panic! Everything from handshakes, to how to pass out communion, to sharing dinners, to attending large gatherings and all manner of other questions related to transmission have been thrown my way in the last 72 hours.  So, let’s not panic. 

2. But, the second order of business is to be realistic about how contagious this virus is among humans! The word among researchers is that they currently believe coronavirus is a very contagious viruses, akin to MERS or SARS. It is exhibiting very efficient person-to-person transmission and most troubling, many of the people shedding the virus do not appear to have symptoms. So, our traditional way of identifying people (e.g. coughing, fever, chills, etc.) are not as effective until the disease is further along in its course.

3. Next, this is NOT an ethnic problem! Blaming China, the Chinese, Asian-Americas, banning Chinese food, and all of the other nonsense must stop. This is a “human” problem that requires the mobilization of human resources to prevent further spread of the disease.

4. Mobilization of testing capability is an essential first step for being able to accurately identify those individuals who are carrying the virus and provide appropriate interventions. The lackluster response of the Trump Administration has been a problem. Not only is science generally under attack but the White House’s budget for the coming year which was issued a couple of weeks ago contains huge cuts in the CDC budget. How ironic that such a proposal comes at the point of greatest need…  In addition, even if we muster the resources so that screening can be done on a ubiquitous basis across the USA, the are many countries throughout the world with wholly insufficient infrastructure or capacity for mobilizing such interventions.  Africa comes to mind.  Evidently, there are only two countries (South Africa and Senegal) in that vast continent with sufficient resources to host effective lab testing to manage an outbreak on the scale we’ve seen across the globe to date. 

5. We should not rely upon the warmth of Spring as the source for controlling the spread of the virus. Yes, the flu season comes and goes according to the weather patterns. But, Covid-19 is not your usual flu virus.  Be forewarned. It’s possible that we will continue to see the spread of the disease across all weather seasons with re-inoculations occurring in communities and countries over time.

6. The classic flu symptoms may not be the only symptoms! A recent JAMA article forewarned us that there are other symptomatic presentations for Covid-19.  It appears that some patients present with abdominal symptoms (e.g. cramping, diarrhea, etc.) rather than usual runny nose, cough and viral pneumonia of ordinary winter flu.

7. Wearing those masks may not be effective and, in fact, probably are not effective. The types of masks people are using (tie behind the head, throw away types) do not effectively capture the virus. As a result, coughing (and breathing) through them does not protect you in either direction. So, I would not put much countenance in those masks.  The masks we use in surgery are much more effective – but, they’re not generally available…

8. A 2% fatality rate is 20X the usual flu fatality. What can I say?

9. Be vigilant and circle back to #1 – don’t panic! Be observant of those around you. Do an elbow bump instead of a handshake to greet a friend. Be careful about close engagements (i.e. touching, embracing) with others. And, keep your ear to the ground in “your community”. This is a virus that spreads by human contact. It will appear based on that fact but when it does you can even be more proactive.

10. Finally, listen for the updates on the local and national news media. We are learning as we go on this one. 

So, What Can Tech Do to Assist in Resolving the Covid-19? If you’re interested in the tech side of the equation, Health Tech Magazine had a good overview of five tools that could be used to help tackle the Covid-19 problem.  They include:

1. Use of videoconferencing to reduce risk of exposure. The Sheba Medical Center in Tel Aviv, Israel recently opened a coronavirus telemedicine program to physically isolate and treat patients. The use of telemedicine and telecare is on a massive upswing across the USA. Perhaps the pandemic will serve as a wake-up call to the traditional health care delivery models for embracing virtual care delivery – when appropriate and effective. But, it will be awhile in coming.  To make this work, the USA needs a 5G networking capability which will require a massive infrastructure investment for the entire nation – akin to our interstate highway system started in the 1950s under the Eisenhower Administration.  Even if we started today, it would take a good chunk of time to deploy the types of systems available in Israel.  But, there is “next time…”

2. Use robots to assist in care delivery. Providence Regional Medical Center in Everett, Washington recently used a robot to help in providing care to a patient with a serious infection. Such systems are starting with basic support functions but down the road we’ll see more of this activity.  In the shorter term, the deployment of robots that emit ultraviolet C light can be used for the sterilization of rooms in a whole range of facilities from hospital rooms, to operating rooms to airports and beyond. 

3. Apply Machine Learning and Artificial Intelligence (ML/AI). The use of these technologies may provide us more information, more quickly than all of the other technologies. Last week, I received a notice that the ML/AI analysis was showing that Italy and Russia were going to experience the next series of Covid-19 outbreaks and, sure enough, it happened. Now, we need to be diligent on this front.  KPMG, an international consulting firm, recently released a report noting that “the use of artificial intelligence is proliferating in American health care – outpacing the development of government regulation.” The report went on to say that more than “half of health-care insiders said the industry is ahead of other fields in AI adoption.” Yet, “U.S. lawmakers have yet to pass comprehensive legislation regulating the artificial technology’s impact on a variety of industries and the personal data it mines to become smarter.”

4. Deploy chatbots using diagnostic algorithms focused on Covid-19. 98point6 – a virtual, real-time provider of primary care services – recently released a coronavirus screening chatbot. It’s not perfect but their team is working on continuous improvement of the algorithm for identifying symptom-specific changes in patients who call in to their system. There are no doubt others that will be released in the coming weeks. I’m sure the Google Health does not want to be left out :-) .

5. Deploy wearable sensors. We already have many wearable sensors for detecting how many steps we walk, our pulse rate, even blood pressure monitoring the like. In fact, the Shanghai Public Health Center deployed a continuous temperature sensor for monitoring the spread of Covid-19 in China. Apple – we need an app for the iPhone.

Again, these are just of few of the ideas which will no doubt be becoming available in the very near future.  Some will require time.  Others could be deployed tomorrow.  We will have to wait and see how the National Task Force under the direction of Trump & Pence does in adopting technology at the forefront of the Covid-19 pandemic.  Stay tuned…

Staying Tuned-In to the Progression of the Covid-19 Pandemic – Here’s an innovation that you all should be looking at on a regular basis if you want to monitor the progress of the spread of Covid-19 on a real-time basis.  The Boston Children’s Hospital has deployed an online resource – HealthMap – for monitoring all sorts of outbreaks using real-time surveillance. And, the site is FREE! The system uses data from a variety of resources, including social media websites, to analyze the environment and pick-up signals on where the virus is spreading. Again, that ML/AI thing keeps popping up.  Expect that to be a continuing theme in health care for the foreseeable future.