Previous work has specifically described the potential for using telemedicine in disasters and public health emergencies. No telemedicine program can be created overnight, but U.S. health systems that have already implemented telemedical innovations can leverage them for the response to COVID-19. 

Health workers fear U.S. hospitals will become coronavirus hot spots

Doctors and nurses are increasingly worried they will become the spreaders of the coronavirus rather than the healers, as hospitals themselves become a hot spot for the pandemic.

That fear is already a reality in Italy, the global epicenter of the pandemic, where researchers have found hospitals overloaded by COVID-19 patients have become transmission points. Public health officials, like those at the World Health Organization, have increasingly warned that health care workers themselves could be vectors for the disease — accelerating its spread and undermining the ability of countries’ health systems to combat it.

The full Politico article can be viewed at this link.  

The Toughest Triage — Allocating Ventilators in a Pandemic

The COVID-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the prospect of having to ration medical goods and services on this scale.

Of all the medical care that will have to be rationed, the most problematic will be mechanical ventilation. Several countries, but not the United States, have already experienced a shortage of ventilators. Acute care hospitals in the United States currently have about 62,000 full-function ventilators and about 98,000 basic ventilators, with an additional 8900 in the Office of the Assistant Secretary for Preparedness and Response Strategic National Stockpile. The Centers for Disease Control and Prevention estimates that 2.4 million to 21 million Americans will require hospitalization during the pandemic, and the experience in Italy has been that about 10 to 25% of hospitalized patients will require ventilation, in some cases for several weeks. On the basis of these estimates, the number of patients needing ventilation could range between 1.4 and 31 patients per ventilator. Whether it will be necessary to ration ventilators will depend on the pace of the pandemic and how many patients need ventilation at the same time, but many analysts warn that the risk is high.

The full perspective can be downloaded below.  

Keeping COVID-19 from Infecting Health-Care Workers

The message is getting out: #StayHome. In this early phase of the coronavirus pandemic, with undetected cases accelerating transmission even as testing ramps up, that is critical. But there are many people whom the country needs to keep going into work—grocery cashiers, first responders, factory workers for critical businesses. Most obviously, we need health-care workers to care for the sick, even though their jobs carry the greatest risk of exposure. How do we keep them seeing patients rather than becoming patients?

The full New Yorker article can be viewed at this link.  

Coronavirus Will Have Long-Lasting Impacts on the U.S. Health Care System—And the Poorest Will Suffer Most

The worsening coronavirus epidemic in the U.S. has upended the country’s medical system. It has led to system-wide disruptions that physicians say are necessary for combatting the immediate, un-ignorable threat of COVID-19—but that may, by default, force patients who do not have coronavirus to shoulder a heavy burden. Those with chronic conditions will have to fight harder to get the care they need, not only now but also after the outbreak ends, when hospitals are left to deal with backlogs from appointments canceled en masse. Anyone with the misfortune to get into a car accident or have a heart attack during the outbreak will be at the mercy of a strained system. And in this environment, the gulf between people who can and cannot afford to spend the time and money to seek out good care will become ever-more apparent.

The full TIME article can be viewed at this link.  

Shuttered Hospitals Re-Opening Across U.S. For Coronavirus Cases

Hospitals that only recently were closed after struggling financially are now being re-opened by state and local governments to treat the sickest of patients stricken by the Coronavirus strain COVID-19.

In the south Chicago suburb of Blue Island, Ill., for example, a hospital with more than 300 beds may re-open to treat Coronavirus patients, Chicago Mayor Lori Lightfoot said Tuesday. And in California, the Orange County Board of Supervisors said this week the state is looking at re-opening the former 73-bed Saddleback Memorial Medical Center in San Clemente while 158-bed Community Hospital in Long Beach is preparing to re-open after being closed just two years ago, according to media reports.

“We have just shy of 75,000 licensed beds,” California Gov. Gavin Newsom said earlier this week of the state’s hospitals. “We need an additional 50,000 beds in our system.”

The full Forbes article can be viewed at this link.  

CVS To Waive Co-Pays For Aetna Member Coronavirus Hospitalizations

CVS Health said it will waive co-payments and related out-of-pocket cost-sharing of commercially insured Aetna members’ inpatient admissions related to the Coronavirus strain COVID-19.

The move is among the more significant thus far among health insurance companies that are expanding coverage and eliminating plan member cost-sharing for everything from doctor office visits for Coronavirus tests to telehealth consultations for screening of the disease.

The full Forbes article can be viewed at this link.  

Fair Allocation of Scarce Medical Resources in the Time of COVID-19

Governments and policy makers must do all they can to prevent the scarcity of medical resources. However, if resources do become scarce, we believe the six recommendations we delineate should be used to develop guidelines that can be applied fairly and consistently across cases. Such guidelines can ensure that individual doctors are never tasked with deciding unaided which patients receive life-saving care and which do not. Instead, we believe guidelines should be provided at a higher level of authority, both to alleviate physician burden and to ensure equal treatment. The described recommendations could shape the development of these guidelines.

Previous proposals for allocation of resources in pandemics and other settings of absolute scarcity, including our own prior research and analysis, converge on four fundamental values: maximizing the benefits produced by scarce resources, treating people equally, promoting and rewarding instrumental value, and giving priority to the worst off. Consensus exists that an individual person’s wealth should not determine who lives or dies. Although medical treatment in the United States outside pandemic contexts is often restricted to those able to pay, no proposal endorses ability-to-pay allocation in a pandemic. 

Each of these four values can be operationalized in various ways. Maximization of benefits can be understood as saving the most individual lives or as saving the most life-years by giving priority to patients likely to survive longest after treatment. Treating people equally could be attempted by random selection, such as a lottery, or by a first-come, first-served allocation. Instrumental value could be promoted by giving priority to those who can save others, or rewarded by giving priority to those who have saved others in the past. And priority to the worst off could be understood as giving priority either to the sickest or to younger people who will have lived the shortest lives if they die untreated.

The proposals for allocation discussed above also recognize that all these ethical values and ways to operationalize them are compelling. No single value is sufficient alone to determine which patients should receive scarce resources. Hence, fair allocation requires a multivalue ethical framework that can be adapted, depending on the resource and context in question.

These ethical values — maximizing benefits, treating equally, promoting and rewarding instrumental value, and giving priority to the worst off — yield six specific recommendations for allocating medical resources in the COVID-19 pandemic: maximize benefits; prioritize health workers; do not allocate on a first-come, first-served basis; be responsive to evidence; recognize research participation; and apply the same principles to all COVID-19 and non–COVID-19 patients.

The full article with recommendations from The New England Journal of Medicine can be downloaded below.  

How wearable robots are helping people with paralysis walk again

Wearable robots are helping people with paralysis walk again.

Over the last few years, there have been major developments in this field, giving hope to people with spinal cord injuries, neurological disorders and strokes. The use of these devices during rehab is growing and their benefits becoming more widely recognized. 

The full CNBC article can be viewed at this link.  

These charts show how fast COVID-19 is spreading — and what it takes to flatten the curve

As U.S. public officials, health-care workers and epidemiologists struggle to track the course of the coronavirus pandemic, they are being hampered by a dearth of data on exactly how far and how fast the virus is spreading.

Despite frequent updates by the news media, public health agencies and independent researchers tracking the outbreak, the available data represents only a portion of the total number of cases, many of which have gone unreported.

That lack of data in the U.S. is largely the result of delays in rolling out widespread testing in the early stages of the outbreak.

“Without knowing the extent and availability of testing, it is very hard to know what to make of the reported numbers,” said Yonatan Grad, a professor of Immunology and Infectious Diseases at the Harvard T.H. Chan School of Public Health. “For the U.S., when we see reports of numbers, they are best understood not as new cases but as identified cases where the true number of cases is unknown.”

But as testing becomes more widespread and the number of confirmed cases rises, a sharper picture is beginning to emerge of the pace of the spread of the virus.

To better track the speed of the pandemic’s spread, CNBC analyzed two months of data collected by researchers at Johns Hopkins University from multiple sources, including the World Health Organization, the U.S. Centers for Disease Control and Prevention, and various other national and local public health agencies around the world. The analysis looks at the pace of growth of new cases in U.S. states and in countries around the world beginning from time the outbreak began to accelerate. (To make that comparison, we adjusted each time series to start on the day each country or state began reporting more than 100 confirmed cases.)   

The full article from CNBC can be viewed at this link.