Covid-19 Pandemic Likely to Last Two Years, Report Says -

Video of Anthony Fauci M.D.

 Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, says he's "almost certain" coronavirus will return in the winter, but he's optimistic researchers will develop a vaccine. He speaks to David Rubenstein, host of "Peer-to-Peer Conversations."

The coronavirus pandemic is likely to last as long as two years and won’t be controlled until about two-thirds of the world’s population is immune, a group of experts said in a report.

Because of its ability to spread from people who don’t appear to be ill, the virus may be harder to control than influenza, the cause of most pandemics in recent history, according to the report from the Center for Infectious Disease Research and Policy at the University of Minnesota. People may actually be at their most infectious before symptoms appear, according to the report.


After locking down billions of people around the world to minimize its spread through countries, governments are now cautiously allowing businesses and public places to reopen. Yet the coronavirus pandemic is likely to continue in waves that could last beyond 2022, the authors said. 

Where do we go from here?

I think the American public is distinguishing today between government officials like Fauci, Birx, Centers for Disease Control and Prevention Director Robert Redfield, Food and Drug Administration Commissioner Stephen Hahn on one hand, and politicians on the other. Their trust in government direction and leadership may be solid while politicians, rightly or wrongly, are looked at as another tribe. Hopefully, leaders in both political parties will look at what Edelman has shown about their tarnished brands and whether craven or not, at least position themselves so they appear allied with science and the desperate needs of citizens today rather than an opponent of it.

CORONAVIRUS NUMBERS AT A GLANCE

Covid Case Map of U.S. by County

Global Map of Covid. Cases

There are 3,247,648 reported cases of coronavirus cases around the world. 230,615  have died from the virus. 61,547 have died in America.

 The U.S. is reporting 1.053,036. Spain 239,639. Italy 205,463. 166,628 cases in France. 166,443 in the U.K. 120,204 in Turkey, Russia is now reporting 106,498 cases. Iran 94,640. China 83,944. 16,117 in Pakistan. 3,037 in Bahrain. 2,954 cases in Thailand — where daily infections have stayed in the single digits for four consecutive days. 

 New York is reporting 304,372  cases. New Jersey 116,365 cases. Massachusetts 60,265. 50,538 in Illinois. 48,870 in California. 46,458 in Pennsylvania. Iowa is reporting 7,147 cases. 6,950 in Alabama. 6,520 in Wisconsin. 5,136 in Minnesota. Nevada reports 5,025. 

With testing capabilities now at the center of the national reopening debate, the U.S. has conducted 6,065,570 coronavirus tests. 124,449 in the US have reported full recoveries from COVID-19.

WASHINGTON WATCH

US intelligence agency says COVID-19 “not manmade or genetically modified.” The top U.S. spy agency in a rare public statement Thursday said it agreed with "the widespread scientific consensus" that the coronavirus was "not manmade or genetically modified," but also said it was investigating whether it emerged from a laboratory in Wuhan, China. (The Hill)

Pentagon moves to increase the production of coronavirus testing swabs. Pentagon spokesman Lt. Mike Andrews said in a Wednesday statement, Puritan Medical Products “will quickly establish a new manufacturing facility capable of doubling its current monthly output of 20 million to 40 million swabs." (The Hill)

 A bipartisan group of lawmakers back efforts to expand telehealth services for seniors. Lawmakers on both sides of the aisle are throwing their support behind efforts to expand telehealth services, especially for elderly patients, to help combat the coronavirus. Speaking at The Hill’s first virtual event on Wednesday, Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) highlighted how telehealth allows elderly patients to receive proper medical care and checkups during the pandemic while staying at home. (The Hill)

What you need to know about the COVID-19 vaccine | Bill Gates

It is not very often when a politician deflects powerful business interests to do the right thing for his constituents.  However, in California Governor Gavin Newsome has done that. He extended the lockdown for California until mid-July.  This at the least will allow for an accurate testing program to begin. It is essential that we not resume normal activities until we know scientifically what the coronavirus penetration in our communities. In California, there was only one rural county without the virus present. 


Back to work returning to work will take place gradually and not across entire states or the entire country.  President Trump is throwing the country under the bus by his ridiculous statements. We are fortunate that some Governors are enforcing more reasonable steps in their states and following scientific protocols to protect their citizens responsibly.

These remarks which follow are from The Gate's Notes, a blog written by Bill Gates, former CEO of Microsoft and now co-head of the Bill and Melinda Gates Foundation. Gates is one of the supporters to eliminate AIDs and Ebola in Africa.  His knowledge base comes from global experience with epidemics, and his success rate of dwelling those two catastrophic illnesses o humanity.  Cool heads must prevail across the world. 

Our problem in the United States is not a unique one.  Countries with far fewer resources make our situation look easy.

Humankind has never had a more urgent task than creating broad immunity for coronavirus. Realistically, if we’re going to return to normal, we need to develop a safe, effective vaccine. We need to make billions of doses, we need to get them out to every part of the world, and we need all of this happen as quickly as possible.

That sounds daunting because it is. Our foundation is the biggest funder of vaccines in the world, and this effort dwarfs anything we’ve ever worked on before. It’s going to require a global cooperative effort like the world has never seen. But I know it’ll get done. There’s simply no alternative.

The world is creating this vaccine on a historically fast timeline.

Dr. Anthony Fauci has said he thinks it’ll take around eighteen months to develop a coronavirus vaccine. I agree with him, though it could be as little as 9 months or as long as two years.

Although eighteen months might sound like a long time, this would be the fastest scientists have created a new vaccine. Development usually takes around five years. Once you pick a disease to target, you have to create the vaccine and test it on animals. Then you begin testing for safety and efficacy in humans.

Safety and efficacy are the two most important goals for every vaccine. Safety is exactly what it sounds like: is the vaccine safe to give to people? Some minor side effects (like a mild fever or injection site pain) can be acceptable, but you don’t want to inoculate people with something that makes them sick.

Efficacy measures how well the vaccine protects you from getting sick. Although you’d ideally want a vaccine to have 100 percent efficacy, many don’t. For example, this year’s flu vaccine is around 45 percent effective.

To test for safety and efficacy, every vaccine goes through three phases of trials:

• Phase one is the safety trial. A small group of healthy volunteers gets the vaccine candidate. You try out different dosages to create the strongest immune response at the lowest effective dose without serious side effects.
• Once you’ve settled on a formula, you move onto phase two, which tells you how well the vaccine works in the people who are intended to get it. This time, hundreds of people get the vaccine. This cohort should include people of different ages and health statuses.
• Then, in phase three, you give it to thousands of people. This is usually the longest phase, because it occurs in what’s called “natural disease conditions.” You introduce it to a large group of people who are likely already at the risk of infection by the target pathogen, and then wait and see if the vaccine reduces how many people get sick.

After the vaccine passes all three trial phases, you start building the factories to manufacture it, and it gets submitted to the WHO and various government agencies for approval.

This process works well for most vaccines, but the normal development timeline isn’t good enough right now. Every day we can cut from this process will make a huge difference to the world in terms of saving lives and reducing trillions of dollars in economic damage.

So, to speed up the process, vaccine developers are compressing the timeline. This graphic shows how:

In the traditional process, the steps are sequential to address key questions and unknowns. This can help mitigate financial risk, since creating a new vaccine is expensive. Many candidates fail, which is why companies wait to invest in the next step until they know the previous step was successful.

For COVID-19, financing development is not an issue. Governments and other organizations (including our foundation and an amazing alliance called the Coalition for Epidemic Preparedness Innovations) have made it clear they will support whatever it takes to find a vaccine. So, scientists are able to save time by doing several of the development steps at once. For example, the private sector, governments, and our foundation are going to start identifying facilities to manufacture different potential vaccines. If some of those facilities end up going unused, that’s okay. It’s a small price to pay for getting ahead on production.

Fortunately, compressing the trial timeline isn’t the only way to take a process that usually takes five years and get it done in 18 months. Another way we’re going to do that is by testing lots of different approaches at the same time.

There are dozens of candidates in the pipeline.

As of April 9, there are 115 different COVID-19 vaccine candidates in the development pipeline. I think that eight to ten of those look particularly promising. (Our foundation is going to keep an eye on all the others to see if we missed any that have some positive characteristics, though.)

The two priorities, as I mentioned earlier, are safety and efficacy. Since we might not have time to do multi-year studies, we will have to conduct robust phase 1 safety trials and make sure we have good real-world evidence that the vaccine is completely safe to use.

We have a bit more wiggle room with efficacy. I suspect a vaccine that is at least 70 percent effective will be enough to stop the outbreak. A 60 percent effective vaccine is useable, but we might still see some localized outbreaks. Anything under 60 percent is unlikely to create enough herd immunity to stop the virus.

The big challenge will be making sure the vaccine works well in older people. The older you are, the less effective vaccines are. Your immune system—like the rest of your body—ages and is slower to recognize and attack invaders. That’s a big issue for a COVID-19 vaccine, since older people are the most vulnerable. We need to make sure they’re protected.

The shingles vaccine—which is also targeted to older people—combats this by amping up the strength of the vaccine. It’s possible we do something similar for COVID, although it might come with more side effects. Health authorities could also ask people over a certain age to get an additional dose.

Once we have a vaccine, though, we still have huge problems to solve. That’s because…

We need to manufacture and distribute at least 7 billion doses of the vaccine.

In order to stop the pandemic, we need to make the vaccine available to almost every person on the planet. We’ve never delivered something to every corner of the world before. And, as I mentioned earlier, vaccines are particularly difficult to make and store.

There’s a lot we can’t figure out about manufacturing and distributing the vaccine until we know what exactly we’re working with. For example, will we be able to use existing vaccine factories to make the COVID-19 vaccine?

What we can do now is build different kinds of vaccine factories to prepare. Each vaccine type requires a different kind of factory. We need to be ready with facilities that can make each type so that we can start manufacturing the final vaccine (or vaccines) as soon as we can. This will cost billions of dollars. Governments need to quickly find a mechanism for making the funding for this available. Our foundation is currently working with CEPI, the WHO, and governments to figure out the financing.

Part of those discussions center on who will get the vaccine when. The reality is that not everyone will be able to get the vaccine at the same time. It’ll take months—or even years—to create 7 billion doses (or possibly 14 billion, if it’s a multi-dose vaccine), and we should start distributing them as soon as the first batch is ready to go.

Most people agree that health workers should get the vaccine first. But who gets it next? Older people? Teachers? Workers in essential jobs?

Another moral and ethical dilemma exists. Which countries will get the first doses of vaccine? History has demonstrated that the wealthy countries and people will be favored by sheer economics.  How would the United States deal with that? America has always stepped up to support WHO efforts for global health initiatives.  Are we up to that task now given our current economic collapse.  We cannot afford to say no because we would be harming ourselves. America has a very small percentage of the global population of over 7 billion human lives. A worldwide outbreak again would easily be transmitted to the U.S. unless and if we were willing to isolate our country from the rest of the world.

The world has other significant financial resources: The Gavi Vaccine Alliance Even social media platforms such as TikTok are donating considerable sums to the effort

Harnessing Social Media for the COVID-19 Pandemic

                              Milton visiting Galileo in the prison of the Inquisition. Credit: Tony Baggett Getty Images

Galileo's Lessons for Living and Working Through a Plague

The person who returns to work and finds someone in his or her household will have a never-ending sense of despair which will last far longer than any financial effects of being locked in. 

The consequence of prevention is much less than a severe or fatal illness.






Humankind has never had a more urgent task than creating broad immunity for coronavirus.





What you need to know about the COVID-19 vaccine | Bill Gates:

How to Stay Calm During a Pandemic - Are we in a Stockholm Syndrome ?

Two Errors Our Minds Make When Trying to Grasp the Pandemic

Mental and physical health are inevitably intertwined. It is about like the old song "Love and Marriage", You can't have one without the other.  As the lockdown proceeds the financial and emotional toll will mount.

Disappointment and uncertainty are inevitable. But we don’t have to turn them into suffering.

It is a good time to reevaluate our lives, where we have been, and where we want to go. Some of us will try to pick up the pieces of a shattered life and security. Others will use their energy to move on. Some fortunate people will be able to resume a near-normal life. Those who have some assets or are in the top 10% may be able to adjust and carry on.  For most that will be impossible.

A key quality for survival is adaptability and the ability to think and do outside the box. Look around you and separate your wants from your needs (ie food and shelter) No matter how we plan life takes you on a path.  No one escapes it. Rich or poor, we all have regrets, and they are as painful when you are rich.  Material things don't hug you or love you.  If that is what gives you jollies, you are missing the most important thing about life as a human being.

My own life experiences brought me up short 30 years ago. It took me another ten years to grasp reality.  My initial response was I would bounce back, after all, I was young, less than 40 years old. I could always file bankruptcy, wait 7 years, and resume life...I was not business-wise and did not separate my business from personal life. I mixed funds between business and private.

When you wake up every day, are your first thoughts are about what would have been doing if it weren’t for the virus. Do you spend hours reading and watching everything she can about what the models are projecting and what the experts are saying about the crisis?  

A lot of people are feeling this way as the quarantine drags on. There’s so much we are missing from our old lives—graduations, weddings, family get-togethers, religious celebrations. There’s so much uncertainty about what we can expect in the coming weeks and months.

It’s natural to feel this way, of course. But many of us are likely fueling these negative feelings more than necessary, because of subtle cognitive errors. With knowledge and a little practice, these errors are easy to correct. By doing so, we can improve our outlook on the current situation and learn to be better thinkers in the future. 

ERROR 1: CONFUSING DISAPPOINTMENT WITH REGRET
My late father was a notorious pessimist. I remember once during a long road trip in rural Montana, he announced that we were probably going to run out of gas and have to spend the night in the car on the side of the road. I looked at the gas gauge and saw that the tank was more than half full. I asked why he assumed the absolute worst-case scenario was going to happen. “If I assume the worst, I’m less likely to be disappointed,” he told me.

ERROR 2: CONFUSING UNCERTAINTY WITH RISK
Why does my friend spend so much time-consuming information about the coronavirus? She isn’t a scientist and doesn’t work on anything related to the pandemic. Still, she visits the Johns Hopkins Coronavirus Resource Center every day to see if the curve of cases and deaths is flattening. She watches hours of news in which experts are interviewed about the pandemic’s trajectory and when they think life will return to normal.

She is making another cognitive error: She is mistaking uncertainty for risk. Uncertainty involves unknown possible outcomes and thus unknowable probabilities. Risk involves known possible outcomes and probabilities that we can estimate. Risk is not especially scary, because it can be managed—indeed, risk management is the core business of the insurance industry. Uncertainty, on the other hand, is scary, because it is not manageable: We can’t measure the likelihood and impacts of the unknowable.

At present, COVID-19 is more of uncertainty than a risk. Will you get the virus? What happens if you do? When will the crisis end? Are we creating an economic depression? People can opine and make informed guesses, but no one really knows the answers to these questions.

Read: Regret is the price of free will

"I could have done more. I should have done more."

Most of us have probably thought this very thing at several points in our lives, but this particular quote was from Bob Ebeling, who was an engineer on the space shuttle Challenger. Last January, on the 30th anniversary of the shuttle’s explosion, NPR ran a heartbreaking interview with Ebeling about his attempt to warn NASA that it was too cold to launch, and his regret that he failed to convince them.

Feeling in control of your life is good for you, but it can also lead to heartbreak over mistakes and lost opportunities.

Dear Therapist’s Guide to Staying Sane During a Pandemic



How to Stay Calm During a Pandemic - The Atlantic:

Dealing with anxiety, mental health during COVID-19

It seems like there’s a new development every day regarding the 2019 novel coronavirus, COVID-19. The evolving situation can cause anxiety and stress, and it’s important to protect your mental health during the uncertainty.

By now you have adjusted to staying at home, wearing a mask, and sanitizing. If you have not then you probably test Covid19 positive if you can even get a test.

One of the issues that create anxiety and can affect mental health is uncertainty, about when it will end, about do you have Covid19, and even about what covid19 (coronavirus (SARS 2019) The illness goes by a number of names creating more confusion.  Confusion is a bad mindset, and the politicians create even more of the same with Presidents, Governors, and local politicians contradicting opinions. Most people take with a grain of salt what political leaders say about Covid. Political leaders seem to ignore and even contradict scientific opinions from noted authorities in public health such as the CDC and NIH.

COVID-19 can cause anxiety and stress. Psychiatrist says it’s important to protect your mental health during the uncertainty.

Nutrition, exercise, and wellness routines become even more important. Our normal physical activity is disrupted by the very nature of having to isolate and stay home. Our favorite sports, golf, tennis, gyms, yoga, and even hiking have been placed on hold. Beaches and boating have been effected. It's a good time to learn how to eat healthily and cook at home. 

David J. Puder, MD, medical director of the MEND program at the Loma Linda University Behavioral Medicine Center (BMC), says the news can increase a person’s fear of a topic. “It can make it feel like it’s happening right outside their front door,” he says. “I don’t believe minimizing the virus is good preparation, but it’s important to keep things in perspective.

Loma Linda University is best known for its Nutrition and Wellness programs. Loma Linda University was a center for excellence long before wellness programs became popular. I was a clinical professor at the Loma Linda University School of Medicine. Many of the residents of the community lived active lives well into their nineties and beyond. I never saw an obese person on the campus.  They did not smoke, drink alcohol, and even avoided caffeinated beverages. Most of these people were taught by parents how to lead balanced lives.  Perhaps you did not have that advantage, however, it is never too late to reverse the poor lifestyle choices you have made in the past.

The Covid19 pandemic is a good time to evaluate your life and is an opportune time to study and implement healthy living as part of your life. Look forward to a new life and remain positive.

Take a break from the news
While it may feel important to know everything that’s going on, the damage from this might outweigh the good. Try scheduling times in your day where you take a break from the news. “This can be helpful for those of us who are empathic and deeply feel for the stories we are hearing,” Puder says.

Log out of social media
When you’re physically distanced from your friends, family or co-workers, you can be tempted to spend a lot of your day on social media, but this can quickly become overwhelming. “When we see other people’s worst-case scenarios, it can create the same type of stress in us,” Puder says. “We can be aware without letting it consume us.” Staying connected is important, but Puder warns against using social media as our source of information.

Exercise
Getting out to exercise is more important than ever during stressful times. Fresh air and physical activity are good for both your mental health and physical well-being. “We store stress in our bodies, so it’s essential to stay active to release all that stress,” he says. “Get your blood flowing and receive the positive benefits of moving around a bit.” If you’re not comfortable going out, it’s easy to find workout videos you can follow along at home.

Practice deep breathing
Breathing may feel basic, but deep breaths can be important in both getting oxygen to the brain and in calming the body. “You can find video tutorials online that show you how to use breathing to bring your body and mind back into a myelinated parasympathetic state — that rest and relaxation state,” Puder says.

Eat healthily
Eat as healthy as you can while you’re isolated. This is especially important if you have limited ability to go outside or be as physically active as you’re used to. “It feels like some people are hoarding for a six-month ordeal,” Puder says. “But it’s important to keep fresh fruits and vegetables in your diet — both for your mind and your body.”

Connect with others
It’s important to stay connected to your loved ones, especially when you’re feeling like you’re missing a connection with the people you value. “Call people, text them, stay involved in what’s going on with them,” Puder says. “Stay in contact with people who make you happy.”


















Dealing with anxiety, mental health during COVID-19 | LLUH News:

Maps of Influenza Symptoms as percentage of Population

COVID RESOURCE CENTER

The Latest from Facebook Maps

Some states are modifying their strict rules for social distancing in an effort to return to near normal activity and hopefully resuscitate the economy. Public health officials remain conservative as to how quickly and safely normalcy can resume. Statistics can mislead future planning.  Most cases of the Corona Virus occurred in New York.  Serology revealed that there are already six or more individual COVID strains.  Some Governors are anxious to restart their economies.  The Mayor of Las Vegas, NV asked that Las Vegas citizens would act as a control population to compare against other cities that remain on lockdown.  The Mayor's idea was badly flawed and could never be considered an objective study. It also points out the confusion and misinformation promulgated by elected officials, another dystopian example of life in America.

The United States led the world in cases of Covid19, with over four times the number of cases than the nearest country. After the United States, the next countries  were

Confirmed Cases by Country/Region/Sovereignty

965,435 US

226,629 Spain

197,675 Italy

162,220 France

157,770 Germany

154,037 United Kingdom

110,130 Turkey

90,481 Iran

83,911 China

80,949 Russia

Public health authorities are still studying the numbers. The figures from China are open to question for many reasons. Experts attribute the high rate in the U.S. as due to inadequate testing and delays in social distancing. The case incidence appears to have stabilized and is diminishing, however, there are still many active cases. The elevated case rate for the U.S. may be due to over-reporting without accurate testing.

Health Plan Costs Keeping Unemployed from Coverage in COVID-19

Another reason to eliminate employer-based health plans.

Many individuals recently unemployed are struggling to find a new health plan due to health plan costs and limited availability.

Those who have been recently unemployed are finding health insurance costs to be a major barrier when replacing their employer-sponsored health plans during the coronavirus pandemic.

The study surveyed 1,500 US residents who had recently lost their jobs and their employer-sponsored health plan between March 9 and March 27, 2020. The poll itself was taken March 27 through March 29.

The exercise of obtaining a new health plan was not easy for many respondents. Over half of the individuals who were unemployed (54.7 percent) expressed that they had experienced difficulty in the process of looking for a new health plan. These problems ranged from finding a few plan options to encountering red tape barriers.

The number of unemployed persons skyrocketed between January and today. The latest figures available are only through March 31, 2019 

There are several items that may mitigate the acute financial impact on hospitals, providers, and patients.  The American Hospital Insurance Plans have outlined the plans for payors and recommend waivers for deductibles, copays, an extension for premium payments and other urgent accommodations to lessen financial impacts.

Health Insurance Providers Respond to Coronavirus (COVID-19) If approved the suggestions will afford several months for readjustments to occur.

For patients in the lowest income group at or below the poverty line Medicaid is an alternative, as well as the health insurance exchanges as part of the Affordable Care Act (ObamaCare)  In California more information, can be found at Covered California.









Health Plan Costs Keeping Unemployed from Coverage in COVID-19:

CMA issues guidelines on reopening California’s health care system

CMA issued guidelines and recommendations for reopening the health care system. The document was developed by a task force of practicing physicians from different parts of the state and different sizes...

As the COVID-19 pandemic spread throughout the world, California and the United States took steps to limit the transmission and impact of the virus by implementing shelter in place orders. While this has so far prevented any surges overwhelming our hospitals, it has also meant that many other parts of the health care system have been idled to preserve resources and capacity in the system and limit the opportunity for transmission or exposure of the virus.

Physician practices and health care facilities have seen massive drops in patient visits, caused by a combination of shelter in place orders and patient fear. This may lead to much more complex problems in the future, as patients miss routine screenings and preventative care. With proper safety precautions, a doctor’s office is one of the safest places for a patient to be. Reopening the health care system in a thoughtful and safe way is a necessary and important step for California to take.

Reopening California’s health care system will not happen all at once, and will not be the same in all parts of the state. Reopening should be in phases based on testing, treatment and data, and the regional capacity within local health care systems throughout the state

Why your doctor's office is the safest place.

All physicians will be adhering to the guidelines from the CDC.

It is important for patients to visit their physicians in the next several months. This is especially so for those with chronic medical conditions such as diabetes, hypertension, those with immunosuppression or any condition requiring regular followup. Call your physician for an appointment.  In many cases, medical practices have adopted telehealth which sometimes can substitute for a visit. In some cases, you can obtain monitoring devices such as blood pressure devices, glucometers for diabetes, spirometers for COPD, and pulse oximeters to measure oxygen levels.   Your doctor may send you to a lab for blood work. In order to minimize clinic visits ask your doctor for a 90 day supply. Consider using a mail order pharmacy. Some insurance companies and HMOs offer zero copayments for pharmaceuticals if you use a designated pharmacy.

Hospitals are now allowed to perform elective surgeries as well.















CMA issues guidelines on reopening California’s health care system:

The Latest Smart Device: Circular Ring:

We have seen the Desktop, laptop, tablet, smartphone, and now a smart ring from circular.xyz

And no, contrary to opinion it is not the latest futuristic smart item from Apple Computer. Sorry Tim Cook, Steve Jobs is turning over in his smart coffin. Given Apple's size and market share don't be surprised if Apple buys Circular Ring. Amazingly this powerful smart device can be pre-ordered for only $199.00. 

Control your ring, visualize your trends, your progress, and benefit from personalized advice to energize your life and improve your daily performance over the long term. Circular is a smart ring that includes Personal & Smart Alarm Clock, Sleep and Fitness tracking, Wellness monitoring, Alert notification, Pushbutton.

The Circular Ring has many functions:

Sleep quality score

The score reflects how well you slept based on valuable metrics calculated during your sleep.

Sleep overview

Quickly overview the times you slept. Edit your sleep logs.

Sleep metrics

See the result of each sleep component so that you can directly identify what to change.

Sleep/wake detection, Naps detection, Real sleep, Sleep debt, Time to fall asleep, Sleep stages monitoring, Circadian Rhythm, Disturbances, SpO2, HR, Night HRV, Sleep quality score©.

Sleep graphs

In-depth insights about sleep metrics. You can compare to your own short- and long-term trends and get to know your evolution.

Activity Tracking
Quantify your physical activities with empowering metrics
Circular keeps track of your daily activities and fitness goals at any time

Activity overview
Quickly see when you've practiced sports. Edit your activity logs.

Activity metrics
Quantify each component of your physical activity.

Automatic activity recognition, Activity intensities and volumes, Steps counter, Walking equivalency, Calories burned, Active minutes, SpO2, Heart training zone.

Activity graphs
In-depth information about numerous metrics for you to quantify your current performance and compare it to your own short-and long-term trends to get to know your evolution.

Wellness Monitoring
Find the perfect balance
Monitor your overall wellness and energy with day & night advanced cross analyses

Wellness metrics
Make your own wellness extra correlation with advanced metrics.

Day HRV, Heart recovery, RHR, Sleep balance, Live heart rate, VO2 max, Energy Score©.
Energy score
The score reflects your energy level for the day based on your sleep and activity data. Get to know when you can push yourself to max out your daily performances or when you may take it easy.

Wellness graphs
You can compare your wellness metrics on your own short- and long-term trends and get to understand the impact of your lifestyle on your well-being in order to improve it.

The device is only in pre-order status, so I would be very cautious, as this may just be pre-marketing hype.





Circular Ring: Features: .

Why you should remember your anesthesiologist’s name

 This article was reproduced from KevinMD written by TIFFANY POULDAR, MD | 

You’ve probably thanked them countless times for getting you through a scary time. Whether they excised your cancerous tissue, repaired your ACL, or removed your inflamed gallbladder, you have likely sung their praise, time, and time again.

But do you remember who your anesthesiologist was the day of your surgery? Probably not, and that’s okay. You may recall them as the quiet doctor, or maybe they eased your nerves prior to placing your IV. You might not remember anything at all if it was an emergent or urgent case, and you were “put to sleep” before you even saw their face.

The view for the Anesthesiologist in the O.R.

Your anesthesiologist is the man or woman behind the drape, at the head of the bed, next to a machine with a bunch of buttons that no one but they understand. They’re skilled with procedures, have a cart full of drugs that they know inside and out, and monitor patient’s hemodynamics throughout the case. They resuscitate you when you are losing too much blood. They keep you breathing. They make sure your blood continues to circulate and perfuse your organs. They control your pain. They make sure you don’t remember any of the surgery. And most importantly, they make sure you wake up.

Anesthesia in the I.C.U. for Covid19 intubation

But right now, amidst the COVID-19 pandemic, they’re the people in my hospital who are running into possible or confirmed COVID-19 patient rooms to place a breathing tube to give patients a fighting chance.  Despite this being the most aerosolizing of procedures, anesthesiologists and ICU doctors are gowning up and facing COVID-19 head-on. I can only speak for my own hospital, but they are being pulled left and right to make sure that patients receive appropriate and timely endotracheal intubations. And they’re not complaining about it. While none of us expected this virus to have this kind of impact on society, they’re still fearlessly waking up early in the morning, heading to work, and delivering admirable patient care.

Unfortunately, it feels as though it took a pandemic to remind us that medicine relies on the interdisciplinary efforts of multiple team members. Because the reality is, this pandemic hasn’t changed anything. Anesthesiologists have been doing exactly what they’ve been doing for years. They work with nurses, respiratory therapists, pharmacists, surgeons, ICU doctors, and hospitalists on a daily basis, to better serve the critically ill patients who need them the most. Now more than ever, they have been putting their oaths and vows to the test, jeopardizing their own health and wellness to help patients.

So the next time you come across an anesthesiologist, or respiratory therapist, pharmacist, nurses, and even the janitorial staff, make an effort to remember their name and thank them. 

Why you should remember your anesthesiologist’s name: 

I’m an E.R. Doctor in New York. None of Us Will Ever Be the Same. - The New York Times

A Covid diary: This is what I saw as the pandemic engulfed our hospitals.

A few days from now, I will come across the name of Guido Bertolini, a clinical epidemiologist who studies intensive care. Through a colleague of his, I reach out to him over Whats­App, and we begin corresponding. He had been high up in the Italian Alps through the last day of February, when the distressing messages started to come in from colleagues asking him to join a new Coronavirus Crisis Unit for Lombardy, a region in northern Italy. Some of the pleas had an Excel file attached. When Bertolini opened it, he tells me, he couldn’t believe the numbers. He had to see the situation for himself.  With an E.R. doctor from Milan, he drove to the Lombardy city of Lodi the next day. He was horrified by what he witnessed. “So many patients, in every corner,” he says. “They were attached to oxygen in all possible ways.” Individual oxygen dispensers, meant for single patients, were being split among four people at a time. “When we came out, we were silent for all the journey home,” he says. “We could not speak.” He knows the hospital has already passed its maximum capacity.

Inside t

I’m an E.R. Doctor in New York. None of Us Will Ever Be the Same. - The New York Times: I’m an E.R. Doctor in New York. None of Us Will Ever Be the Same.

The COVID-19 Tsunami: The Tide Goes Out Before It Comes In

Most people in the US have withdrawn from their daily routines unless their jobs are essential. Quiet streets, shuttered stores, silent schools. More than 400,000 live with the knowledge that they have the disease, but the slowness of our testing means that multiples of that number are likely to be infected. In pockets around the country, hospitals feel the earliest surges from those most vulnerable to COVID-19, but countrywide, the tsunami is still out at sea.

The devastating effects of a tsunami are usually preceded by an abnormally fast and long low tide, as water is actually pulled away from shore toward the epicenter of the underwater earthquake. Most of the US currently sits in that temporary equipoise. Most Americans who receive any health care in a given year do so in a primary care setting, (CLICK THIS LINK) to see where primary care fits into health care. where they generally have the relationships that they count on most when they are sick—or scared that they might be. In 2016, primary care provided 54.5 percent of all patient care visits and despite representing only 30.0 percent of the physician workforce, primary care physicians manage the majority of the care of people with the same high-risk conditions that put them at risk for the coronavirus. Research published in 2016 reminded us that the “Ecology” of care-seeking and receiving behavior in the US has not changed in 60 years. In a given month, 113 people in 1,000 visited primary care clinicians, while only eight were hospitalized and less than one was cared for in any of the university hospitals that dominate the US health care landscape and conversation. Primary care clinicians are the predominant providers of health care in small towns and rural areas where they often also staff many of the rural and critical access hospitals that those communities depend on. And although the relationship between the US population and its primary care workforce should, therefore, serve as protective breakers in the face of an unprecedented pandemic tsunami, the outgoing tide may actually be undermining the defensive wall before the surge arrives.  

Most primary care practices are seeing a 30-70 percent reduction in visit volume due to the pandemic. Simultaneously, many are being asked to self-finance a total transformation to telemedicine to provide needed care while reducing patient exposure to COVID-19. Most practices still live on fee-for-service contracts and will struggle to bear that loss of revenue. Nearly one in three family medicine practices remain independent and are not only financially hemorrhaging but cannot even afford the jump to telemedicine, meaning that they either choose to stop seeing patients or to put themselves and their patients at risk by continuing face-to-face visits. Many practices are facing difficult decisions about laying off staff or closing due to the likelihood that operating margins will run out in a matter of a few weeks to a few months. These vulnerable family medicine practices are just a subset of the wider group of practices facing these difficult choices. We estimate that a 50 percent reduction in visits will mean a $700 million loss for independent practices across the country over the next three months, more if they are unable to implement telemedicine. The rest of the primary care workforce will lose much more, and we estimate the total loss in primary care to range from $10 billion to $15 billion.

Although CMS (Medicare/Medicaid) and private payers have quickly authorized reimbursement for telehealth visits this requires acquiring available telehealth solutions as well as training how to adapt it to a practice setting. It is unknown whether the loss of income due to reduced in-person visits will be offset by telehealth reimbursement.  Telehealth function is available by subscription service to a cloud provider such as one of these. 

Nevertheless here is some of the bad news..The National Rural Health Association has reported that more than half of rural hospitals were already operating in the red, and deep losses in their traditional fee-for-service functions mean many will run out of cash in the next month. Federally qualified health centers (FQHC), which provide care to 1 in 12 people in the US and are mostly staffed by primary care, are projected to lose more than $3 billion over the next three months and more than one-quarter becoming bankrupted. All frontline primary care practices also face unplanned costs related to the epidemic beyond implementing telemedicine. These include stocking up on protective equipment and working with public health and hospitals to figure out how to manage the waves of people needing triage or intensive care that are about to crash down on our health system. The third and most recent stimulus package related to the pandemic offers $100 billion for health care providers, most of which is likely to go to hospitals. While $1.3 billion was appropriately allocated for the sustenance of FQHCs, nothing was specifically directed toward other frontline clinicians. While independent and small practices may be able to eventually apply for support created for small businesses, they have no special standing and little idle time to queue for this funding.

Many frontline primary care physicians are displaying tremendous professionalism as bulwarks for their patients and the public at great personal cost. They are fulfilling their commitment to the social contract, and it is on stark display. The government should respect this contract and help keep them whole in ways that directly reach this workforce. It would be a potent signal that they can focus on serving their patients and the public with faith that their practices will survive.

Understanding the tide of the COVID wave is already out, and a giant wave is visible on the horizon, but without more help, the primary care bulwark against the tsunami and its aftermath is in real jeopardy.  And like a tsunami wave the first is not the largest.

https://tinyurl.com/yclngrec