Stewardship: We Worry More About the Environment than Our Own Bodies

By HANS DUVEFELT

Sooner, rather than later, we will be driving electric cars because of the environment. We use energy efficient light bulbs and recyclable packaging for the same reason. And there is a growing debate about the environmental impact of what kind of food we produce and consume. But I still don’t hear enough about the internal impact on our own bodies when we consider stewardship of natural resources.

Our bodies and our health are the most important resources we have, and yet the focus in our culture seems to be on our external environment.

Just like the consumption culture has ignored its effect on our planet in favor of customer convenience and business profits, it has ignored the effect it has had on the health of the human beings it set out to serve. And just as we now are fearing for the future of our planet, we ought to be more than a little bit concerned about the future of the human race.

But, just as we really can’t expect the corporate world to lead the environmental effort, unless we can engineer a way for them to see profit in doing that, we cannot expect it to lead any kind of effort to make the population healthier. That is something that has to start with the individual.

We all need to take responsibility for our actions, large and small, external and internal. Idling your car to warm it up before your morning commute is bad for the environment and eating corn flakes, instant oatmeal or pop tarts for breakfast is bad for your body. And, for lunch, I see cars lined up, idling, at takeout restaurants that don’t have fruit, vegetables or unprocessed grains on their menu. And just think of the soft drinks that come with those meals.

Driving to make a short, nearby errand is bad for the environment. Choosing not to walk that distance on foot is bad for your body.

The one good thing that may have come with the Covid pandemic is that people are cooking and eating more at home and I hear there is a renewed interest in growing your own vegetables. Someone wrote recently that in some way our physical world has gotten smaller and more important to us while the nation and the world have come to feel almost virtual.

Maybe that offers some hope that we will pay more attention to our own health and our own habits.

If we don’t, the chronic diseases plaguing the industrial world will dominate our lives in ways that one day will make the environmental disasters seem irrelevant to the growing majority who will suffer from the failures and breakdowns of their own bodies.

Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.

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What, Us Worry

By KIM BELLARD

2020 has been an awful year.  Hurricanes, wildfires, murder hornets, unjustified shootings, a divisive Presidential election, and, of course, a pandemic.  Most of us are spending unprecedented amounts of time sheltering in place, millions have lost their jobs, the economy is sputtering, and over a quarter million of us didn’t survive to Thanksgiving.  If you haven’t been depressed at some point, you haven’t been paying enough attention.

Within the last two weeks, though, there has finally been some cause for hope.  Whether you want to credit Operation Warp Speed or just science doing what it does, we are on the cusp of having vaccines to battle COVID-19.  First Pfizer/BioNTech, then Moderna, and most recently, AstraZenica, announced vaccines that appear to be highly effective. 

We’re having our Paul Revere moment, only this time with good news.  The vaccines are coming!  The vaccines are coming!

It strikes me, though, that our enthusiasm about these vaccines says a lot about why the U.S. has had such a hard time with the pandemic; indeed, it tells us a lot about why our healthcare system is in the state it is. We’re suckers for the quick fix, the medical intervention that will bring us health.

Unless you were alive when Woodrow Wilson was President, COVID-19 has been the worst public health crisis of our lifetime.  It took some time for us to fully realize how bad it was going to be, and, even then, most of us underestimated exactly how bad that would be.  We may still be underestimating how bad these next few months will be.

We knew, of course, that we didn’t have any vaccine for this new virus, and that, at best, it would take some time to develop one.  We didn’t initially know what to expect when someone became infected, didn’t know the right treatments, didn’t know which therapeutics might help.  We weren’t even really sure how COVID-19 spread.  There have been many hard-won lessons. 

What we did know, though, was that we needed to take precautions.  Physical distancing, limiting social gatherings, wearing masks, contact tracing; we knew these things would help.  They wouldn’t prevent COVID-19 from spreading, they certainly wouldn’t cure it once infected, but they would mitigate. 

We couldn’t even do those right.

Mask wearing became a political issue.  It is not a coincidence that some of the areas with the lowest percent of people wearing masks are among the hottest spots for spread of COVID-19, such as North Dakota, which has the highest COVID-10 death rate in the world right now. 

While overall mask wearing has improved from the spring, to the point as many as 90% of Americans claim they usually wear a mask in public, it varies widely, as illustrated below:

Similarly, business shutdowns and stay-at-home orders have faced great resistance, again more along political lines than to intensity of COVID-19 cases.  There are no doubt grave economic impacts to them, as we’ve seen, but whatever such measures we tried in the spring are now seen as a price we are no longer willing to pay. 

Of course, if we had quicker and more widespread testing, and better contact tracing, we might not need such extreme measures, but we’re not very good at them.  We don’t have enough tests,  they take too long for accurate results, and a sizeable number of Americans view contact tracing with suspicion. 

The CDC pleaded with us to celebrate Thanksgiving at home with only the people we live with.  Do we listen?  Of course not; nearly 40% of us plan to attend large gatherings.  Over a million Americans flocked to the airport yesterday – the highest daily number since mid-March – with millions more expected to travel between now and Thanksgiving.  That is admittedly down from previous years, but at a time we are regularly breaking daily records for cases, hospitalizations, and deaths, it seems rather foolhardy. 

Why should we worry?  There’s a vaccine coming. 

Of course, no vaccine has yet been approved, none is in full production, there are tremendous production and logistical issues to overcome.  It will take many months to have enough supply to vaccinate enough people to make an impact on COVID-19’s spread. 

Equally troubling, experts estimate that, even with a vaccine that is over 90% effective,  over 70% of people have to get vaccinated.  That may be a problem; fewer than 60% of Americans say that would be willing – and that’s up from earlier in the year.  Even healthcare workers, who are expected to be first in line when vaccines become available, are not yet convinced they’ll take it.

There may be a light at the end of this particular tunnel, but it’s a long tunnel. 

We’ve all got pandemic fatigue, we all want COVID-19 gone, we all want to go back to our “normal lives,” but we don’t seem quite able to bring ourselves to do the things we should in order to help bring those about.  Somehow, we assume, doctors and scientists will fix things for us.  It’s par for the course.

We don’t do enough about our diet and exercise; it’s easier to just take pills for our high blood pressure and bad cholesterol.  We don’t eat enough fruits and vegetables, so we take supplements to get the necessary vitamins and minerals.  We don’t stay active enough, so we end up with hip and knee replacements.  We claim to worry about the safety of vaccines, but give processed food manufacturers carte blanche to tailor their products to maximize our consumption. 

 We debate the need for universal coverage, but don’t spend nearly enough time talking about food or housing insecurity.  We not only can’t persuade ourselves to take climate change seriously, we don’t even care to ensure that our water and atmosphere are safe now.

It’s easier to trust health care to protect our health than to take responsibility ourselves, even though medical care is estimated to only account for 10-20% of our health.  So why wear a mask?  Why social distance?  Why stay in our family bubble?  Soon there will be a vaccine.  We need to stop acting like the proverbial damsel in distress waiting to be rescued, and start taking more responsibility for our own health – for COVID-19 and all the health issues we face. 

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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THCB Book Club: Rosemarie Day – Marching Towards Coverage

Rosemarie Day has been a long time health care consultant and operator, most prominently as the COO of the Massachusetts Health Connector–the first real state exchange that was created as part of Romneycare (which with a few twists later became Obamacare!) Following the 2017 Women’s March, Rosemarie decided to write her own book, Marching Towards Coverage. It’s really four books in one. A personal patient & caregiver journal; a history of the slow march towards universal health care; a policy document; and a primer on how to become an activist. All in less than 200 pages! For the November THCB Book Club Jessica DaMassa and Matthew Holt talked with Rosemarie about what we can all do to really get to better health care for everyone.

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#Healthin2Point 00, Episode 169 | They’re real and they’re SPACtacular!

Today on Health in 2 Point 00, It’s a whacky SPACy world, as a new SPAC rolls “UpHealth” and has me singing Bob Marley, meanwhile there’s $91m for remote clinical trial software player Medable, $76m more for Spring Health joining the throng of mental health companies, while K-Health gets $42m to introduce chat bot front ends to Korean pop music…or something like that. —Matthew Holt

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The Art of Listening: Beyond the Chief Complaint

By HANS DUVEFELT

A doctor’s schedule as typical EMR templates see it only has “Visit Types”: New Patient, 15 minute, 30 minute. But as clinicians we like to know more than that.

One patient may have a brand new worrisome problem we must start evaluating from scratch, while another is just coming in for a quick recheck. Those are diametrically opposite tasks that require very different types of effort.

Some visits require that test results or consultant reports are available, or the whole visit would be a waste of time. How could you possibly plan your day or prioritize appointment requests without knowing more specifically why the patient needs to be seen?

So, as doctors, we usually want our daily schedules to have “Chief Complaints” in each appointment slot, like “3 month diabetes followup”, “knee pain” or “possible dementia”. That helps everybody in the office plan their day.

I always bristled at “not feeling well” because that is too nonspecific. After all, that could be something that would have been better handled with a 911 call. But there is also a danger in being too simplistic when classifying what people come in for. We like to pigeon hole clinical concerns a little too quickly sometimes.

I had such a situation recently. It hinged on the patient’s choice of one common word over another.

A middle aged woman wanted to be seen for “throat pain”. It was halfway into a busy afternoon and between the three providers in our office, we had no openings to offer her.

Autumn asked me, “can we fit in a throat pain today? I’ve got Nicole Bamford on hold”.

“What kind of throat pain?” I asked. “You mean just a sore throat?” I was working on refills between patients. Autumn asked the patient to elaborate while I continued to work.

“She says she can swallow all right but for the last few days she gets this pain in her throat every time she does anything heavy.”

“Does she have pain right now?” I asked.

Autumn checked. “No.”

“Have her come right over.”

Nicole had no cold symptoms. She had normal vital signs. She had a two week history of throat and occasionally jaw or ear pain after minor exertion, never more than a few minutes. Sometimes she felt a little short of breath at the same time.

Her exam and her EKG were normal. She was a smoker with a family history of heart disease.

“Call the ambulance, 54 year old woman with new angina, no pain right now. I’m calling the ER”, I told Autumn after I explained my assessment to Nicole. She had seemed to accept my diagnosis of unstable angina without questioning and also my recommendation that we get her to the hospital by ambulance without expressing any sign of surprise or emotion.

When I saw her in followup after her ER visit, transport to the tertiary care center and successful stenting of a 95% blockage of one of her coronary arteries, she told me “I thought you were crazy”.

I thought to myself that this could have played out very differently if the nuance between “throat pain” and “sore throat” had gone unnoticed.

It’s nice to know what a patient is coming in for, but that isn’t necessarily the diagnosis they leave with.

Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.

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Comcast, Independence BlueCross’s Quil: Fast-Forward Past Video Content to Home Sensors for Seniors

By JESSICA DaMASSA, WTF HEALTH

It’s not just eyeballs that Comcast NBCUniversal and Independence BlueCross’s joint venture, Quil, is after these days. Carina Edwards, Quil’s CEO, paints a compelling picture of the full-scale business model for “health-in-the-home” that her company is enacting. What started out with trusted healthcare content for surgery prep (able to be deployed across a household’s army of devices, including their TV for those 1.3M Comcast Xfinity cable subscribers) is now expanding with more tech and more services to meet the needs of seniors aging-in-place and the fifty million unpaid caregivers looking after them. Ambient, “context-aware” sensors. Voice integrations with smart speakers. And that’s nothing to say of the caregiver-focused programming that addresses everything from caregiver burnout to tackling tough conversations about a range of issues from paying for care to end-of-life wishes. Quil’s pilot of this new senior-focused offering will be rolled out with Comcast’s help this winter, with the full direct-to-consumer commercial launch expected in Q3 2021. As Carina says, “Comcast knows how to pilot technology.” And, Quil has shown its ability to impact healthcare quality measures thanks to studies around its initial surgery-prep offering. Will it be enough to take on others looking to help turn our living rooms into exam rooms? Tune-in around 17:20 to hear just how integrated Comcast and IBX are in the strategy at Quil.

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Can the Government Mandate a Covid-19 Vaccine? Will It Have To?

By PHILLIP MEYLAN

With the emergence of two vaccines with high levels of effectiveness, there’s a strong prospect of having powerful new tools to combat Covid-19 in the months ahead. But the road between a vaccine and society returning to normal is far from certain. Millions of doses will need to be produced and intelligently distributed, and critically, people must be willing to take them. The last few months have seen already-low confidence in such a vaccine fall even further, with just two-thirds of Americans expressing a willingness to be vaccinated when one becomes available. Similar trends are playing out globally. 

Source: The Economist

Bringing the pandemic under control will likely require successfully vaccinating 60–70% of the population to halt community transmission. Vaccine skepticism puts rapidly reaching that goal in jeopardy. Can the government at the state or federal level mandate vaccination? What is motivating this growing skepticism in Covid vaccination and how might those sentiments shift over time? This week, Phillip looked at 28 articles from 24 sources to explore likely pathways toward vaccination, as well as related vaccine skepticism. 

Growing Vaccination Skepticism

A big surprise of the last few months has been that skepticism of a Covid-19 vaccine has intensified even while the virus has become increasingly worse — netting 1 million new cases in a single week and bringing the U.S. death toll to above 250,000. This shift in opinion is problematic for pursuing effective vaccination and is not specific to the U.S. All but three countries monitored in an Ipsos-MORI poll in October found that willingness to take a Covid-19 vaccine had fallen since the previous poll in August, bringing the worldwide average down from 77% to 73%. The U.S., with roughly 65% willing to vaccinate, scores similarly with some other countries such as Spain and Italy that have been hard-hit by the pandemic, while France, an outlier, scored just 54%.

Given the grim conditions, declining trust in a Covid-19 vaccine may be intuitively surprising, and most see this pushback as a general skepticism about the speed with which Covid-19 vaccines are being pursued, not growth of the anti-vaccination movement. Through inherent complexity and novelty but also human error, the pandemic has created no shortage of uncertainty and misinformation, which has at times reflected poorly on government authorities and at others provided fuel to those that want to cast doubt on both scientific and governmental authority.

Source: PBS

No wonder then that people globally are equally worried about potential side-effects (34%) and the fast pace of clinical trials (33%). In the U.S. in particular, the public has expressed concern about undue political pressure from the Trump administration to approve a vaccine, particularly given the Food and Drug Administration’s mixed record on resisting such pressure. The two vaccines that have emerged, from Pfizer/BioNTech and Moderna, have passed phase 3 trials with 43,000 and 30,000 participants, respectively. Fully analyzing the efficacy of either vaccine, including their potential side effects, which at this point look minimal, will have to wait for the release of full clinical data. It’s important to note that vaccines in recent history have an excellent track record in terms of safety and that early signs suggest these vaccines will be safe.

In the weeks and months that it might take for either to reach the public, much work remains to be done to address this skepticism. Even if these vaccines swiftly receive approval and are rapidly produced in the quantities needed, effective vaccination will depend on enough of the population taking part, leaving many to speculate about whether the government has a right to force specific populations to vaccinate and whether it will need to exercise such a power. 

Pathways to Vaccination

Vaccine believers and skeptics alike are interested in the same question: can the government force people to take vaccines? In the U.S., matters of public health are generally in the purview of state governments, and historic precedent shows that states are within their rights to enact vaccine mandates within their jurisdictions. The federal government, by contrast, would have a much more difficult time enacting such a mandate, though they and the private sector could use a variety of incentives encourage widespread vaccination. 

State

The legal precedent for vaccination mandates at the state level is laid out by a Supreme Court case from 1905, Jacobson v Massachusetts, which confirmed a state’s right to enact “reasonable regulations established by legislature to protect public health and safety.” In addressing an outbreak of smallpox in Massachusetts, this case clarified that such an order is not a violation of the 14th Amendment right to liberty, but rather that liberty could not exist if individuals could act in a way that is injurious to others, for example, by carrying a disease that could otherwise be vaccinated against. In determining if an action such as vaccination is helpful or harmful to public health, the state has a right to refer to a board of qualified individuals to make such an assessment. Furthermore, “it is immaterial whether or not the vaccine is actually effective, so long as it is the belief of state authorities that the mandatory vaccine will promote common welfare and is a reasonable and proper exercise of the police power.”

“While compulsory vaccination requirements have faced legal challenges since Jacobsen . . . courts have consistently rejected these challenges and given considerable deference to the use of the states’ police power to require immunizations to protect the public health.” – Congressional Research Service

This precedent has held since 1905, having most recently been the basis for mandatory vaccinations in several zip codes in New York City following a measles outbreak in 2019. But states don’t just exercise this power in times of major disease outbreaks — there are mandatory vaccinations for K-12 schoolchildren in all 50 states, as well as mandatory vaccinations for many college students and individuals that work in healthcare facilities and nursing homes. While some religious and philosophical exemptions exist, states like California and New York have ended these, citing that “religious exemptions are not constitutionally required under the First Amendment’s free exercise clause since mandatory vaccination does not single out religion and is not motivated by a desire to interfere with religion.”

In short, states almost certainly have the ability to force vaccinations within their jurisdictions and weather any legal challenges, though this doesn’t necessarily mean they will seek to do so.

Federal

The federal government would face more challenges if it wanted to mandate vaccinations for Americans, chiefly because the Constitution leaves the right to govern public health to states. But this hasn’t stopped people from musing about how, if the pandemic required, the federal government might press the issue. The federal government could, for example, take advantage of its right to regulate interstate commerce and transportation to mandate that individuals crossing state borders are vaccinated, though the Supreme Court could potentially rule that Congress was overreaching by doing so. Realistically, such a strategy seems doubtful given the legal constraints, but unprecedented times may call for unprecedented measures.

Far more likely, the federal government might exercise influence over spending in a way to incentivize states to pursue vaccination mandates. The federal government has expansive control in taxing and spending for general welfare, meaning they could tie funds distributed to states to adherence to vaccination goals. This strategy has been used in the past, such as to force states to raise the legal drinking age to 21 by withholding federal highway funding.

So, while federal measures to force vaccination seem improbable at present, they are not out of the question. In a similar vein, as many countries enact nationwide mask mandates, such a move in the U.S. would almost certainly face a strong legal challenge. This leads many to favor a strategy focused on persuasion and incentivization rather than punitive action.

Private

As with most issues of governance, there are those that favor a hands-off approach, letting the private market and personal discretion decide what’s right. The thinking here is that government mandates would be overkill, especially when businesses have rights and incentives to demand that customers vaccinate, as long as these measures are not discriminatory. As put in the Wall Street Journal, “[p]rivate entities have financial and reputational incentives to protect their employees, patrons and residents, and are therefore well-positioned to determine what protective measures, including vaccination, need to be taken in specific circumstances.” Furthermore, some argue that government action invites a higher risk of inefficiency by distorting the vaccine marketplace for personal, country-specific benefits. 

“Private initiatives creating narrow mandates that target those most likely to benefit from vaccines, alongside voluntary vaccination, will maximize public health while minimizing the threat to individual liberties.” – Wall Street Journal

Instead, proponents of the free market argue that positive incentives might be more effective. If someone wants to attend a sporting event, the venue may require proof of vaccination to protect against liability. Similarly, those who wish to travel by air may be forced by airlines to have a vaccination certificate or similar documentation. At a more granular level, however, this method would require many smaller businesses to follow through as well. The risk is that too few entities comply or that pockets or communities of people disproportionately skirt the needs for such action, permitting Covid-19 transmission to continue and potentially re-emerge. 

Conclusion

As governments assess how to contend with reaching effective levels of vaccination, they are preparing to tread carefully around vaccine skepticism while transparently and apolitically addressing common concerns about safety and due process. Attitudes could change as vaccines are distributed to the public and, hopefully, demonstrate safety and effectiveness, encouraging individuals to rapidly vaccinate.

For government, a heavy-handed approach could backfire, fueling further anti-government/anti-science sentiment, but not pursuing vaccination with ample vigor could mean a prolonged timeline for controlling the virus and returning to normal, raising human and economic costs. That’s why the likely approach to vaccination will lie in some combination of policies: using mandates only were strategically viable and necessary but relying on public and private incentives to reach most of the population.

Appendix

This appendix shows each of the articles used to inform the findings of this article, as well as how the articles scored according to The Factual’s credibility algorithm. To learn more, read our How It Works page.

Title	Author	Publisher	Publisher Bias	Credibility Grade
Q&A: How far can Trump go in pushing a COVID-19 vaccine that isn’t ready?	Melissa Healy	LA Times	Moderate Left	90%
Call to Action: CSIS-LSHTM High-Level Panel on Vaccine Confidence and Misinformation	Katherine E. Bliss, J. Stephen Morrison, Heidi J. Larson	Center for Strategic and International Studies	Center	88%
Why Americans have grown more hesitant about the COVID-19 vaccine	Laura Santhanam	PBS	Moderate Left	88%
Could employers and states mandate COVID-19 vaccinations? Here’s what the courts have ruled	Debbie Kaminer	The Conversation	Center	86%
As U.S. Reaches 250,000 Deaths From COVID-19, A Long Winter Is Coming	Laurel Wamsley	NPR	Moderate Left	86%
The Final Pandemic Surge Is Crashing Over America	Robinson Meyer	The Atlantic	Moderate Left	85%
Biden’s Call for ‘National Mask Mandate’ Gains Traction in Public Health Circles	Sheryl Gay Stolberg	New York Times	Moderate Left	85%
Historical Vaccine Safety Concerns	N/A	CDC	Center	84%
Vaccine Nationalism Threatens Politicized Decisions to Fight a Global Pandemic	J.D. Tuccille	Reason	Moderate Right	84%
Trump has launched an all-out attack on the FDA. Will its scientific integrity survive?	Lev Facher	STAT	Center	83%
FDA commits to high safety standards in coronavirus vaccine review	Cassidy Morrison	Washington Examiner	Moderate Right	83%
COVID-19 vaccines could become mandatory. Here’s how it might work.	Jillian Kramer	National Geographic	Center	83%
Pfizer and Moderna Covid vaccines 95% effective in clinical trials	Sukee Bennett	PBS	Center	81%
Black Americans face higher COVID-19 risks, are more hesitant to trust medical scientists, get vaccinated	John Gramlich, Cary Funk	Pew Research Center	Center	80%
Why the US president can’t mandate a Covid-19 vaccine	Katherine Ellen Foley	Quartz	Moderate Left	80%
Exclusive: Two-thirds of Americans say they won’t get COVID-19 vaccine when it’s first available, USA TODAY/Suffolk Poll shows	Sarah Elbeshbishi, Ledyard King	USA Today	Moderate Left	78%
Fever, aches from Pfizer, Moderna jabs aren’t dangerous but may be intense for some	Meredith Wadman	Science Magazine	Center	77%
What you need to know about the Moderna and Pfizer coronavirus vaccines	Carolyn Y. Johnson, Aaron Steckelberg	Washington Post	Moderate Left	76%
Pfizer’s Art of the Deal	Brent Orrell	The Bulwark	Moderate Right	76%
One-Third of Americans Won’t Get Coronavirus Vaccine, Poll Finds	Alexa Lardieri	U.S. News	Moderate Left	75%
STAT-Harris Poll: Most Americans won’t get a Covid-19 vaccine unless it cuts risk by half	Ed Silverman	STAT	Center	74%
Lower Flu Vaccination Rates Among Black, Hispanic, and Low-Income Seniors Suggest Challenges for COVID-19 Vaccination Efforts	Juliette Cubanski, Tricia Neuman, Anthony Damico	Kaiser Family Foundation	Center	74%
KFF Health Tracking Poll – September 2020: Top Issues in 2020 Election, The Role of Misinformation, and Views on A Potential Coronavirus Vaccine	Liz Hamel, Audrey Kearney, Ashley Kirzinger, Lunna Lopes, Cailey Muñana, and Mollyann Brodie	Kaiser Family Foundation	Center	74%
Worried About The Safety And Effectiveness Of The Covid-19 Vaccine? The SAVE Act Aims To Make Transparency A Priority	Robert Glatter	Forbes	Moderate Right	74%
The world will soon have covid-19 vaccines. Will people have the jabs?	N/A	The Economist	Center	59%
Is Mandatory Vaccination Legal in Time of Epidemic?	Sara Fujiwara	AMA Journal of Ethics	N/A	N/A
We Don’t Need Government Mandates for Covid Vaccination	Joel M. Zinberg	Wall Street Journal	Moderate Right	N/A
Pfizer, BioNTech Ask FDA to Authorize Their Covid-19 Vaccine	Jared S. Hopkins	Wall Street Journal	Moderate Right	N/A

Phillip Meylan is an Adjunct Fellow @ the Center for Strategic and International Studies and Political Analyst @ The Factual where this piece was first published.

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RWJF Emergency Response Challenge Results!

by MATTHEW HOLT

Yesterday Catalyst @ Health 2.0 hosted the finals of the RWJF Emergency Response Challenges, one for tools for the General Public and the other for the Health System. It was a great session, sadly virtual and not at a conference with cocktails afterwards. But the promise of the tools that have been built as part of these challenges is immense in the battle against this COVID-19 pandemic and the ones yet to come.

The finalists for the General Public challenge were

• Binformed Covidata– A clinically-driven comprehensive desktop + mobile infectious disease, epidemic + pandemic management tool targeting suppression and containment of diseases such as COVID-19. The presenter was veteran health IT expert Rick Peters.
• CovidSMS– A text message-based platform providing city-specific information and resources to help low-income communities endure COVID-19. In contrast to Rick, CovidSMS’ team were undergraduates at Johns Hopkins led by Serena Wang
• Fresh EBT by Propel– A technology tool for SNAP families to address food insecurity & economic vulnerability in times of crisis – highlighted by Michael Lewis on his Against the Rules podcast about coaching earlier this year. Stacey Taylor, head of partnerships for Propel presented their solutions for those in desperate need.

The finalists for the Health System challenge were

• PathCheck–  A non profit just spun out of MIT. It has a raft of volunteers and well known advisors like John Brownstein and John Halamka among many others, and is already working with several states and countries. Pathcheck provides privacy first, free, open source solutions for public health to supplement manual contact tracing, visualize hot spots, and interface with citizen-facing privacy first apps. MIT Professor Ramesh Raskar was the presenter.
• Qventus–  A patient flow automation solution that applies AI / ML and behavioral science to help health systems create effective capacity, and reduce frontline burnout. Qventus is a great data analytics startup story. It’s raised over $45m and has lots of health system clients, and they have built a suite of new tools to help them with pandemic preparedness. Anthony Moorman, who won the best facial hair of the day award, showed the demo.
• Tiatros Inc– A mental health and social support platform that combines clinical expertise, peer communities and scalable technology to advance mental wellbeing and to sustain meaningful behavioral change. They’ve done a lot of work with soldiers with PTSD and as you’ll see entered this challenge to get their tools to another group of extremely stressed professionals–frontline health care workers. CEO Kimberlie Cerrone and COO Seth Norman jointly presented.

Videos of the whole session and the demos will be up soon.

And the winners were…

A tie in General Public challenge between CovidSMS & BInformed, who split the $25,000 first prize (and the $10,000 second prize!)

Qventus in the Health System challenge who take home $25,000

But there were no losers. A great culmination of a lot of work to get tech solutions to help us deal with the pandemic.

Matthew Holt is Publisher of THCB and also Co-Chairman at Catalyst @ Health 2.0

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THCB Gang Episode 33, Thursday 11/19 at 1pm PT/4pm ET

Episode 33 of “The THCB Gang” will be live-streamed here today Thursday, November 19th, 1pm PT/4pm ET.

Matthew Holt (@boltyboy) will be joined by some of our regulars: CEO of Day Health Strategies Rosemarie Day (@Rosemarie_Day1), writer Kim Bellard (@kimbbellard), data privacy expert Deven McGraw (@healthprivacy), patient safety expert Michael Millenson (@MLMillenson) and health futurist Ian Morrison (@seccurve). While the chaos of the post election legal shenanigans goes on, we’ll explore what the Biden team might and can do, and look at the pre- and post-vaccine COVID-19 future.

If you’d rather listen to the episode, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan, producer

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Women Leaders Increasingly Visible In The Fight Against Covid-19

By MIKE MAGEE, MD

As we struggle to control a second wave of Covid-19, we are reminded once again of the nurses and doctors who place themselves at risk willingly and consistently.  They are struggling uphill with a deeply segmented health care system that chronically rewards the have’s over the have-not’s, and a President clearly intent on creating as much havoc as is humanly possible on the way out the door.

Filling the leadership void this week, we witnessed the unusual appearance on network television of two national leaders from the professions of Nursing and Medicine, Dr. Susan Bailey (President, AMA) and Debbie Hatmaker (Chief Nursing Officer, ANA) appearing in tandem. 

The united front presented by these two women leaders was reassuring. They didn’t pull punches, but spoke truth to power, describing the nation’s condition as “very grim” and “quite stark.”

In many ways, their joint appearance was a reflection of a changing reality in communities large and small across America. A Medscape survey released this week found that women’s roles in health care are growing in leaps and bounds. For example, in Family Medicine, 34% of the physicians are now women, and they work approximately the same number of hours per week as their male counterparts.

These women doctors are increasingly working in team settings. The majority of Family Physicians (71%) now work within a team that includes either a Nurse Practitioner (NP) or Physician’s Assistant (PA).

Covid-19 has placed a huge burden on this workforce physically and financially. Aside from the obvious risk of contracting the disease themselves, regulatory precautions have impeded normal access to care. During the first wave of the pandemic, physician practices reported a 55% decline in revenue and a 60% decrease in patient volume. In March of 2020 alone, 43,000 healthcare workers were laid off nationwide, and nearly 1 in 10 practices closed their doors, at least temporarily.  Picking up some of the slack, reimbursable virtual patient visits increased 225%.

While our attention over the past months has centered on emergency departments and intensive care units, it’s important to remind our selves that our system of care (where it exists) relies heavily on a primary care base for access to both standard and emergency evaluation and treatment. And among Primary Care doctors, women are especially disadvantaged. The just released Medscape survey documented a striking gender gap in salary, with males earning 26% more than women.

Regardless of gender, 2/3’s of Family Medicine doctors would chose the same career path again, reporting that the three top sources of their job satisfaction are: 1) Gratitude/relationships with patients, 2) Knowing I’m making the world a better place by helping others, 3) Being very good at what I do/ Finding answers, diagnoses.

ANA surveys of nurse satisfaction levels roughly mirror the same determinants. In both professions, these women and men are physically, emotionally, and spiritually exhausted.

What can we do to help them?

1)  Give Thanks: Expressing gratitude is always welcome. But perhaps the best way to express this in 2020 is to limit gatherings around Thanksgiving, What we don’t need at the moment is super-acceleration of an already bad situation.

2)  Drop the Political BS. The election is over, and going mask-less in meaningless, and dangerous. Be a good citizen. Wear your mask and a smile.

3)  Be Patient and Compliant. We’ve got vaccines on the way. But we have a few months to go. When they arrive, get vaccinated without delay.

Mike Magee is a Medical Historian and Health Economist and author of “Code Blue: Inside the Medical Industrial Complex.“

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