More than one million Americans were killed by Covid-19 in just over two years, the CDC reports. But the disease has hit some segments of the U.S. population far more than others. Photo illustration: Todd Johnson
It’s one of the tiniest machines on the planet — about a hundred times smaller than the average cell. It’s so small that no scientist can spot it through a typical light microscope. Only with an electron microscope can we see its spiky surface. It’s not alive, and it’s not what most of us would think of as “dead.” This teensy machine seems to survive in a kind of purgatory state, yet it has traveled across continents and oceans from host to host, and brought hundreds of nations to a standstill. Despite its diminutive size, the novel coronavirus, dubbed SARS-CoV-2, has seemingly taken the world by surprise with its virulence.
From the Wall Street Journal (June 1, 2020):
“The biggest problem has been staying asleep,” says Philip Muskin, a professor of psychiatry at Columbia University Medical Center in New York. “People aren’t exercising, their days have no structure at all.”
Preliminary results from a survey taken by around 1,600 people from 60 countries show that 46% reported poor sleep during the pandemic, while only 25% said they had slept poorly before it, according to Melinda Jackson, a senior lecturer at the Turner Institute for Brain and Mental Health at Monash University in Melbourne, who studies how stressful events affect people’s sleep. Forty percent also reported increased alcohol consumption.
The key is to prevent the sleep problem from becoming chronic, she says. It is important to avoid associating your bed or bedroom with a place where you are awake. Experts recommend that if you can’t fall asleep, or wake up in the middle of the night and are unable to go back to sleep after 20 minutes, get out of bed and do something relaxing.
Originating during the Black Death of the Middle Ages, face coverings to protect against the transmission of disease are not just medical requirements; they’re now a fashion statement. Mark Phillips talks with medical historian Mark Honigsbaum (“The Pandemic Century”) about the purpose and style of facemasks.
Medicine has always operated in the context of theory, which is easier to generate than fact. The medieval physician with the “bird mask” thought he was protecting himself from “miasma”, which was theorized to be the means by which PLAGUE was spread. In fact, the masks’ main function was to hide his identity from his Patient, whom he could not help. The painting makes him appear to be the Grim Reaper himself.
The story of Guaiac, another illustration medieval medicine, is entwined with Syphillis, the stigmatizing STD of post Columbian Europe. Each country blamed Syphillis on its’ rival- the English called it the French disease, for instance-until they were able to blame it on the “new world”. Since it came from the Americas, so must its’ HERBAL REMEDY, according to theory.
GUAIAIC, the resin from the small tree from the Caribbean, became a popular cure. It might have even lessened suffering from Siphillis, since it was used instead of the highly toxic MERCURY.
Guaiac eventually found a use in Criminology, as a test for blood at the crime scene. When Guaiac is mixed with a suspicious spot and peroxide, it changes color rapidly to a bright blue. Medicine later used Guaiac as a test for hidden (occult) Blood In the stool; a positive, brilliant blue test throws suspicion on intestinal cancer as the culprit.
We come full circle to present day mask usage in the Covid epidemic. Some countries outlaw masks because masks interfere with criminal investigation. This interdict had to be relaxed during The Pandemic. How convenient for the rioters and looters in Minnesota!
From a John Locke Foundation article (May 13, 2020):
A combination of stay-at-home orders, recommendations from health professionals, and the rollback of restrictive telehealth regulations boosted the use of telehealth.
….with an eye toward the future, the authors offer recommendations for all interested parties to consider moving forward. These recommendations were informed by our research and a stakeholder meeting of industry groups who work with telehealth. These groups included Doctor on Demand, the American Medical Association, and the Center for Connected Health Policy. The paper’s recommendations are as follows:
- Data on COVID-19 telehealth administration and programs must be collected and analyzed.
- Regulatory flexibility should be built into telehealth to accommodate the range of use cases.
- Telehealth services should be utilized for primary care to reduce service redundancies.
- States should be empowered to move away from parity models to reduce the cost of telehealth services.
- Telehealth services should be available to the medically underserved.
- Innovation, privacy, and data security in telehealth services should be the norm.
Telemedicine is an “almost perfect” extension of Medical Care for the Covid epidemic (1). As we ease away from Panic, we will not be abandoning distancing, cleanliness, and other personal measures that keep us well. SARS-CoV-2, or the next Pandemic Virus will be lurking in the background.
Likewise, Medicine will always embrace Telemedicine for its’ convenience, safety, and efficiency, if we can overcome the roadblocks discussed in the above article.
One efficiency in particular, discussed in the previous RPA( from Australia) article stood out; the use of Nurse-triage to direct telephone (or someday audio-visual) Patients to the most appropriate destination; ER, Urgent Care, after-hours clinic, or home care.
The Schmidtt-Thompson protocol ( which guides triage) has been used since 1980, having stood the test of time and lawyers. It is available in electronic form, and when fully automated, it should be made available without cost.
Just imagine all of the unnecessary ER visits And Physician Visits potentially saved!
Telemedicine has indeed added convenience and safety in the Era ( it seems like forever) of Covid.
There are many Telemedicine ideas that will still be used when Covid hopefully takes its’ place in the Influenza immunization vial.
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.
It can allow physicians and patients to communicate 24/7, using smartphones or webcam-enabled computers. Respiratory symptoms — which may be early signs of Covid-19 — are among the conditions most commonly evaluated with this approach.
Health care providers can easily obtain detailed travel and exposure histories. Automated screening algorithms can be built into the intake process, and local epidemiologic information can be used to standardize screening and practice patterns across providers.
Disasters and pandemics pose unique challenges to health care delivery. Though telehealth will not solve them all, it’s well suited for scenarios in which infrastructure remains intact and clinicians are available to see patients. Payment and regulatory structures, state licensing, credentialing across hospitals, and program implementation all take time to work through, but health systems that have already invested in telemedicine are well positioned to ensure that patients with Covid-19 receive the care they need. In this instance, it may be a virtually perfect solution.
From a ComputerWorld article (April 27, 2020):
“While the pandemic will prove the value of virtual care in a crisis, it will also demonstrate the effectiveness for ongoing chronic care management,” she said. “This moment will have a lasting effect on the adoption of virtual care and accelerate the shift from in-person care to virtual first engagement for multiple conditions and use cases.”
While the need for remote care will not be as acute once the pandemic crisis subsides, demand for telehealth systems will likely remain high. Forrester now expects more than one billion virtual care visits this year, the vast majority of them related to COVID-19.
“…After the crisis subsides, there will be a patient population that will want to continue to receive care online for some things, like managing chronic conditions, follow-up visits after an inpatient stay, surgery or to discuss diagnostic results,” she said.
In this case, it will be important for healthcare providers to ensure that patients are aware of the availability of services.
Benjamin Thompson, Noah Baker, and Amy Maxmen discuss the role of antibody tests in controlling the pandemic, and how public-health spending could curtail an economic crisis. Also on the show, the open hardware community’s efforts to produce medical equipment.
In this episode:
02:08 Betting on antibodies
Antibody tests could play a key role in understanding how the virus has spread through populations, and in ending lockdowns. We discuss concerns over their reliability, how they could be used, and the tantalising possibility of immunity.
10:25 Economy vs public health, a false dichotomy
Jim Yong Kim, former president of the World Bank, argues that strong investment in public health is crucial to halt the ongoing pandemic and to prevent a global financial crisis. We discuss his work with US governors to massively increase contact tracing, and his thoughts on how researchers can help steer political thinking.
19:00 One good thing this week
Our hosts talk about staying positive, and pick a few things that have made them smile in the last 7 days, including a tiny addition to the team, a newspaper produced by children in lockdown, and a gardening update.
22:51 Open hardware
Researchers are stepping up efforts to design and produce ventilators and personal protective equipment for frontline medical staff. We hear how the open hardware movement is aiding these efforts, and the regulations that teams need to consider if their designs are to make it into use.
Technology Feature: Open science takes on the coronavirus pandemic
Coronavirus Testing and Tracking (1) are the two pillars of surveillance which will hopefully replace the “shotgun” method of universal distancing that America has tried so far. Quarantining only those who are contagious makes much more social and economic sense than quarantining everybody, and it seemed to work in South Korea (2) and Taiwan (3).
There are problems both with testing-accuracy and availability- and tracking, which is in tension with individuality and freedom.
Still we have no choice but to try, because people and businesses need to socialize and make some money.
Some epidemiologists predict that Covid 19 will smolder on, hopefully not overtaxing our health system, until “herd immunity” gets to 60-70 percent of the population.
As a highly susceptible octogenarian, I plan to keep my distance and become one of the minority protected by herd. And maybe an effective immunization or drug will come along.