Mask Exemptions During the COVID-19 Pandemic—A New Frontier for Clinicians | Global Health | JAMA Health Forum | JAMA Network

Mask Exemptions During the COVID-19 Pandemic—A New Frontier for Clinicians

To mask, or not to mask, that is the question.   Americans obsess about their freedoms, the constitution was written to protect them.  It was originally intended to prevent despots from suppressing the possibility of overthrowing a government by allowing contrary views.  Since 1776 many have taken the liberty of using it for other purposes. Historically many individuals and groups have repurposed the amendment II to validate their argument. This is also true for many. constitutional amendments. 

What are the risks of not masking? It depends on where you are and how many other individuals are close to you.  That begs the questions, how close, and what locations?

In an article by The Journal of the American Medical Association  Doron Dorfman,LLB, JSD; Mical Raz, MD, Ph.D., MSHP write about exemptions for disability under the definition of the Americans with Disability Act (ADA).  This further confounds the answer. Dorfman and Raz make a rational if not more complex about wearing masks during a pandemic.

Masking or face covering amid the global coronavirus disease 2019 (COVID-19) pandemic has emerged as a highly polarizing practice, with surprising partisan divisions. While masking remains contentious, there is bipartisan agreement among policymakers that medical exemptions for masking are necessary and appropriate. Yet there is a dearth of guidance for clinicians on how to approach a request for an exemption. We analyze the medical and legal standards to guide this debate.

Medical Exemptions

Few guidelines exist regarding medical exemptions. Beyond the CDC’s recommended exemptions—children younger than 2 years, people with difficulty breathing, and anyone unable to place or remove the mask—there are certain categories of disability that undoubtedly warrant medical exemptions. In this evidence-free zone, clinicians must make individual determinations as to whether a patient should be exempt from mask-wearing. Some individuals, particularly children, with sensory processing disorders may be unable to tolerate masks. Facial deformities that are incompatible with masking are an additional category of exemption. Other situations, such as chronic pulmonary illnesses without an active exacerbation, are less clear. An individual with a chronic pulmonary illness is at higher risk for severe disease from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. Conversely, if that same individual were infected with SARS-CoV-2, he or she would likely also be at higher risk for spreading viral illness because many pulmonary illnesses are associated with a chronic cough. There is a risk-benefit ratio that must be carefully considered. Professional societies would provide a valuable service to clinicians if they could provide clear guidelines that include objective measures, such as a decrease in pulse oximetry results, to guide determinations. It is likely that chronic pulmonary disease in itself is a compelling reason for masking, rather than a category of exemption.

Legal Grounds for Exemption

A medically necessary exemption from masking is considered a disability modification under the Americans With Disabilities Act (ADA). Individuals with disabilities have clearly defined legal protections under both federal and state law. Title II of the ADA prohibits disability discrimination in “programs and activities of state and local government entities.” Title III prohibits disability discrimination “in the full and equal enjoyment of…services” at places of “public accommodation.” These are privately owned establishments and include restaurants, hotels, and grocery stores, which may require customers to mask. The “full and equal enjoyment” standard can be fulfilled via the use of “reasonable modifications in policies, practices, or procedures.” A reasonable disability modification might be a masking exemption, but this is not the sole remedy. Amid a global pandemic, reasonable accommodations for masking intolerance can and should include avoidance measures, such as curbside services and delivery.3

Employers can legally require masking at their workplace, and workers may be asked to provide medical documentation for an exemption. This presents a unique challenge to clinicians who understand the necessity for individuals with disabilities to maintain job security. Yet few medical conditions are truly incompatible with all forms of mask-wearing, and the same guiding principles of preserving public health and reducing individual risk remain relevant. As other workers cannot reasonably exempt themselves from the presence of an unmasked coworker, workplace accommodations should be conceptualized in a broader framework than a simple mask exemption. These accommodations might include remote work, placement in non–public-facing positions, or, under certain conditions, leave. These may all be considered reasonable accommodations under title I of the ADA, which regulates employment.⁴

Employers restaurants and other public gathering places may utilize methods to ensure distancing.

The solutions beg creativity

Mask Exemptions During the COVID-19 Pandemic—A New Frontier for Clinicians | Global Health | JAMA Health Forum | JAMA Network

Former CDC directors: Trump has politicized science more than any past president. - The Washington Post

         

      The administration is undermining public health

                      

It fouls the mind when a politician makes decisions that are contrary to educated people. Even giving the President the benefit of the doubt he should delegate decisions such as public health decisions to those who know and have the experience to make rational decisions.

                                         

                

Public health authorities throughout the United States already have legal authority locally and at state, levels to make decisions without consulting the Executive branch.  It is the Executive Branches duty to support the states in their decisions.

In addition to those in authority, there are many qualified experts who have served previously in the CDC. such as Tom Frieden, MD, Jeffrey Koplan M.D., and David Satcher, M.D. all who served as Director of the CDC.  

Former CDC Directors Richard Besser, Tom Frieden, Jeffrey Koplan, and David Satcher explain why the agency's guidance on reopening schools must be based on sound science, not political pressure—and centered on safety and health equity.

As America begins the formidable task of getting our kids back to school and all of us back to work safely amid a pandemic that is only getting worse, public health experts face two opponents: COVID-19, but also political leaders and others attempting to undermine the Centers for Disease Control and Prevention. As the debate, last week around reopening schools more safely showed these repeated efforts to subvert sound public health guidelines introduce chaos and uncertainty while unnecessarily putting lives at risk.

As of this date, the CDC guidelines, which were designed to protect children, teachers, school staffers, and their families — no matter the state and no matter the politics — have not been altered. It is not unusual for CDC guidelines to be changed or amended during a clearance process that moves through multiple agencies and the White House. But it is extraordinary for guidelines to be undermined after their release. Through last week, and into Monday, the administration continued to cast public doubt on the agency’s recommendations and role in informing and guiding the nation’s pandemic response. On Sunday, Education Secretary Betsy DeVos characterized the CDC guidelines as an impediment to reopening schools quickly rather than what they are: the path to doing so safely. 

CDC updates expands list of people at risk of severe COVID-19 illness only valid reason to change released guidelines is new information and new science — not politics.

Older Adults.                         People of any age with these conditions

The latest from the CDC (video)

COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)

The CDC is home to thousands of experts who for decades have fought deadly pathogens such as HIV, Zika, and Ebola. Despite the inevitable challenges of evolving science and the public’s expectation of certainty, these are the people best positioned to help our country emerge from this crisis as safely as possible. Unfortunately, their sound science is being challenged with partisan potshots, sowing confusion and mistrust at a time when the American people need leadership, expertise, and clarity. These efforts have even fueled a backlash against public health officials across the country: Public servants have been harassed, threatened, and forced to resign when we need them most. This is unconscionable and dangerous.

We’re seeing the terrible effect of undermining the CDC play out in our population. Willful disregard for public health guidelines is, unsurprisingly, leading to a sharp rise in infections and deaths. America now stands as a global outlier in the coronavirus pandemic. This tragic indictment of our efforts is even more egregious in light of the disproportionate impact we’ve witnessed on communities of color and lower-income essential workers. China, using the same mitigation tools available to us and with a far larger population, has had just a tiny fraction of the 3.1 million cases reported here. The United States now has more cases and deaths than any other country and the sixth-highest rate of any large country in the world — and we are gaining on the other five. The United States is home to a quarter of the world’s reported coronavirus infections and deaths, despite being home to only 4.4 percent of the global population.

Perhaps when tragedy strikes a sense of humor can confound the true gravity of a situtation. 

 

Comedy and Cartoons

Former CDC directors: Trump has politicized science more than any past president. - The Washington Post

How Coronavirus Kills Some People But Not Others - I'm a Lung Doctor (ME...

If you want to learn much more about how Covid-19 makes people so ill and how they die. Its complicated and has similar methods as other lethal diseases. Besides causing pulmonary insufficiency it causes increased coagulation in other organs such as the heart, lungs, kidneys, and brain. 









Dr. Mike Hanson is an outstanding clinician and an outstanding communicator. I highly recommend this video as a credible source.



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Telehealth and the Future

2020 witnessed amazing explosive growth in telehealth.  Although an infrastructure for telehealth developed in the prior five years by visionary entrepreneurs there was slow to non-existent adoption by providers, hospitals, and allied health providers.  Much of the reticence was due to poor reimbursement by health plans.  

During January 2020 to current times telehealth became an established and at times preferred method for outpatient visits.  This was due to an existing crisis fueled by a viral epidemic (pandemic) by a novel coronavirus (COVID-19). Social and physical distancing was mandated by public health officials globally.  This served to radically alter the health care setting. Physician office visits plummeted, even for the normal population. Elective surgical procedures were canceled and postponed. 

How COVID-19 is affecting internet performance

According to Fastly, to understand how the internet is performing with the changes in internet use brought on by the COVID-19 pandemic, we investigated two key metrics during February and March in some of the countries and states that were hit hardest by the virus: changes in the traffic volume served to those regions as a reflection of changes in internet use, and changes in download speed measured at our servers as a reflection of internet quality. In almost all regions, the largest increases in traffic volume occurred immediately after public policy announcements, such as school closures or stay-at-home orders. Similarly, the most dramatic decreases in download speed followed the official starts of those policies — presumably when populations made the shift to staying home.

Table 1 reveals the sharp uptick in internet traffic by country and state and the effect on broadband speed.  The findings reveal metropolitan areas suffered the least, most likely due to penetration and redundancy of the internet in cities.  Italy suffered the most increase in usage and the decrease in broadband speed. In the U.S.A. rural states such as Michigan saw a marked decrease in internet speed. Michigan is a rural state and the penetration and less redundancy in infrastructure caused network speeds to decrease by almost 40%.

Definition of High-speed internet

Perhaps the best modern measurement of whether an Internet connection is “high speed” is in what services are supported at that speed. Virtually any broadband, or non-dialup, connection can support a home user’s standard browsing habits. Streaming of standard-definition video, with a pixel width of 480, requires a minimum 1Mbps connection. Low-end high-definition video, with a pixel width of 720, requires at least 2.5Mbps. Streaming high-definition 1080p video needs at least a 9Mbps pipeline to avoid buffering delays. And these numbers only take into account a single device — if five users in your office network simultaneously stream separate 1080p videos, your 10Mbps will not seem “high speed.”   

If one lives in a rural area there may be severe limitations on live streaming used by telehealth.

The. Brookings Institute published a breakdown of what type of internet customers can access.  There are some surprising results

The lack of internet broadband access in the mid-south has created a need for cellular coverage.  While 4G/LTE is widely available there are some areas that only provide 3G. 4G/LTE may be adequate for video streaming when signal strength is strong. As 5G cell coverage becomes ubiquitous it becomes mainstream.   A recent test on T-mobile cell coverage in Southern California revealed a 60-75 MPs download and 40 MPs upload speed. That is adequate for live streaming as indicated by calls on Zoom and other video conferencing apps such as GoToMeeting, Google Meet, Webex, or Cisco.

Webinar: What is the future for telehealth?  REGISTER

There are some indications that some payor and Medicare are planning to re-institute restrictions on telehealth reimbursement once the acute pandemic ends.  However, that is a big contingency since the ongoing pandemic is still evolving.

Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows | Henry Ford Health System - Detroit, MI

There have been conflicting comments and opinions on the efficacy of Hydroxychloroquine for the treatment of Covid-19 patients. Many have opined on the failure of HCQ to reduce morbidity and death in patients with Covid-19.

The patients studied at HFH Systems were treated early in their disease. 

In a large-scale retrospective analysis of 2,541 patients hospitalized between March 10 and May 2, 2020 across the system’s six hospitals, the study found 13% of those treated with hydroxychloroquine alone died compared to 26.4% not treated with hydroxychloroquine. None of the patients had documented serious heart abnormalities; however, patients were monitored for a heart condition routinely pointed to as a reason to avoid the drug as a treatment for COVID-19.

                                      


Patients treated with hydroxychloroquine at Henry Ford met specific protocol criteria as outlined by the hospital system’s Division of Infectious Diseases. The vast majority received the drug soon after admission; 82% within 24 hours and 91% within 48 hours of admission. All patients in the study were 18 or over with a median age of 64 years; 51% were men and 56% African American.

“The findings have been highly analyzed and peer-reviewed,” said Dr. Marcus Zervos, division head of Infectious Disease for Henry Ford Health System, who co-authored the study with Henry Ford epidemiologist Samia Arshad. “We attribute our findings that differ from other studies to early treatment, and part of a combination of interventions that were done in supportive care of patients, including careful cardiac monitoring. Our dosing also differed from other studies not showing the benefit of the drug. And other studies are either not peer-reviewed, have limited numbers of patients, different patient populations or other differences from our patients.”

Dr. Zervos also pointed out, as does the paper, that the study results should be interpreted with some caution, should not be applied to patients treated outside of hospital settings and require further confirmation in prospective, randomized controlled trials that rigorously evaluate the safety and efficacy of hydroxychloroquine therapy for COVID-19.

“Currently, the drug is "off label" and should be used only in hospitalized patients with appropriate monitoring, and as part of study protocols, in accordance with all relevant federal regulations,” Dr. Zervos said.

Treatment with Hydroxychloroquine Cut Death Rate Significantly in COVID-19 Patients, Henry Ford Health System Study Shows | Henry Ford Health System - Detroit, MI

FDA MedWatch - Hand Sanitizers with Methanol

In a rush to manufacture and distribute hand sanitizers some companies took shortcuts and had defective alcohol production methods resulting in the production of methanol.  This was also a problem during the era of prohibition in the 1920s.  Methanol is toxic to the optic nerve and will cause blindness.   A MedWatch Safety Alert was added to the FDA Drug Safety and Availability webpage.  TOPIC: Hand Sanitizers with Methanol: FDA Updates  AUDIENCE: Consumer, Health Professional  ISSUE: FDA is warning consumers and health care providers that the agency has seen a sharp increase in hand sanitizer products that are labeled to contain ethanol (also known as ethyl alcohol) but that have tested positive for methanol contamination. The agency is aware of adults and children ingesting hand sanitizer products contaminated with methanol that has led to recent adverse events including blindness, hospitalizations, and death. Methanol is not an acceptable active ingredient for hand sanitizers and must not be used due to its toxic effects. FDA’s investigation of methanol in certain hand sanitizers is ongoing. The agency will provide additional information as it becomes available. Recent recalls include:  All Clean Hand Sanitizer, Moisturizer and Disinfectant by ITECH 361 Mystic Shield Protection Topical Solution by Transliquid Technologies BACKGROUND: Substantial methanol exposure can result in nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma, permanent damage to the nervous system or death. Although all persons using these products on their hands are at risk, young children who accidently ingest these products and adolescents and adults who drink these products as an alcohol (ethanol) substitute, are most at risk for methanol poisoning.

RECOMMENDATION: FDA reminds consumers to wash their hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after coughing, sneezing, or blowing one’s nose. If soap and water are not readily available, the Centers for Disease Control and Prevention (CDC) recommend consumers use an alcohol-based hand sanitizer that contains at least 60 percent ethanol. This chart outlines the information on hand sanitizer labels for consumers to use to identify a product that has been tested by FDA and found to contain methanol, that is being recalled by the manufacturer or distributor, or that is purportedly made at the same facility as products that have been tested by FDA and found to contain methanol. FDA advises consumers not to use hand sanitizers from these companies, or products with these names or NDC numbers. Consumers and health professionals are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program: Complete and submit the report online. Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the form, or submit by fax to 1-800-FDA-0178.

FDA MedWatch - Hand Sanitizers with Methanol

How can the Coronavirus pandemic end?

As we struggle to re-open our economic and social fabric in the United States we wonder how will the pandemic end?

There are two ways it can end.

1. Herd Immunity (also called herd effect, community immunity, population immunity, or social immunity)



In our present setting, the coronavirus only affects a very small percentage of the world population.  Even so, it is causing major disruption to the economy and to social functions.

A mathematical model for the unrestricted spread of infectious diseases, such as smallpox,  pertussis, measles, or coronavirus has been developed.  The model has been tested and proven by previous pandemics.  The variables in the equation are R (the number of infections transmitted by a single host) and S ( the proportion of the population who are susceptible to infection and setting this product to be equal to 1.

Viral entity                                R0                                   HIT       

Measles Airborne                    12–18                              92–95%

Pertussis Airborne droplet 12–17[51]                      92–94%

Diphtheria Saliva                       6–7                              83–86%

Rubella Airborne droplet          6                                       83–86%

Smallpox                                       5–7                                       80–86%

Polio Fecal-oral route

Mumps Airborne droplet           4–7                                 75–86%

COVID-19

(COVID-19 pandemic)              2–6                                50–83%

SARS

(2002–2004 SARS outbreak)               2–5                    50–80%

Ebola

(Ebola virus epidemic Bodily fluids      1.5–2.5               33–60%

Influenza

(influenza pandemics) Airborne      1.5–1.8                    33-40%

These are the facts, numbers do not lie.  

Prevention at the moment (summer 2020) may reduce the numbers, or flatten the curve but has the disadvantage of population variables, such as political motivation, willingness to comply with distance, wearing PPE, following CDC and WHO guidelines.  As we have experienced as soon as PPE, social distancing are removed the infectious rate quickly returns to a high level since the vast majority of the population is naive to coronavirus.


2  An effective vaccine.

Belgian virologist Guido Vanham, the former head of virology at the Institute for Tropical Medicine in Antwerp, Belgium, and asked him: how will this pandemic end? And on which factors might that depend?

Guido Vanham (GV): It will probably never end, in the sense that this virus is clearly here to stay unless we eradicate it. And the only way to eradicate such a virus would be with a very effective vaccine that is delivered to every human being. We have done that with smallpox, but that's the only example - and that has taken many years.

So it will most probably stay. It belongs to a family of viruses that we know - the coronaviruses - and one of the questions now is whether it will behave like those other viruses.

It may reappear seasonally - more in the winter, spring and autumn and less in the early summer. So we will see whether that will have an impact.

But at some point in this epidemic - and certainly in the countries that are most affected, like Italy and Spain - there will be saturation, because according to predictions, up to 40% percent of the Spanish and 26% of the Italian population are or have been infected already. And, of course, when you go over 50% or so, even without doing anything else, the virus just has fewer people to infect - and so the epidemic will come down naturally. And that's what happened in all the previous epidemics when we didn't have any [treatments]. The rate of infection and the number of those susceptible will determine when that happens.

This natural course, prior to vaccines places a demand on health services, significant morbidity, and mortality.  The cost of a natural process would exceed the cost of quickly developing an effective vaccine. Despite media exaggerating the mortality rate coronavirus kills few that it effects, mainly older and the chronically ill. Examining the R0 and HIT covid-19 is far less infectious than Pertussis and Measles.

Measles have been a chronic illness of children and when a vaccine developed it was eliminated very quickly.

The charts above display the rapid diminution of viral epidemics once vaccination begins. Normally the development of a safe and effective vaccine may take several years using previous technology.  Vaccines are now manufactured using RNA technology rather than growing batches of viral particles to be injected.  If the proper RNA is developed it can be injected directly into humans and the normal biochemistry of cells will develop the protein segment of the virus to be used as a vaccine. This means an entire viral particle is not necessary to produce immunity.

Several other factors could take place.  Covid-19 has exhibited some mutations in serotype already which are minor thus far.  A mutation could evolve spontaneously that would alter it immunologically and also it's pathophysiology.

Today pharmacology allows a pipeline to be developed to manufacture like products without having to reinvent the entire process.

Antibody Research Q&A | Baseline COVID-19 Research Project

If you or a friend have had documented Covid-19 this important information will help others who are ill.  You may be able to donate your blood (plasma) for their treatment.  Studies have revealed it reduces mortality from Covid-19

Coronavirus vaccine will not be available until 2021.  However  Coronavirus serum antibodies are available now. The vaccine will induce immunity and is preventive, while the results of antibodies are immediate.

3 Wishes Project – Helping to make meaningful memories at end-of-life

End of life conundrum for families with parents in ICUs

As her mother lay dying in a Southern California hospital in early May, Elishia Breed was home in Oregon, 800 miles away, separated not only by the distance but also by the cruelty of the coronavirus.  Even at times when family members cannot attend the end of life activities for a loved one, there are means of addressing this challenge. As her mother lay dying in a Southern California hospital in early May, Elishia Breed was home in Oregon, 800 miles away, separated not only by the distance but also by the cruelty of the coronavirus.  Unlike many families of dying COVID patients, Breed and her family were able to find some comfort in her mother’s final hours because of the 3 Wishes Project, a UCLA Health end-of-life program repurposed to meet the demands of the coronavirus crisis. In the U.S., where more than 120,000 people have died of COVID, it’s part of a wider push for palliative care during the pandemic.

At 5 p.m. on May 10, Mother’s Day, before Breed-Rabitoy’s life support was removed, more than a dozen family members from multiple cities and states gathered on a Zoom call to say goodbye. John Denver’s “Rocky Mountain High,” one of her soft-rock ’70s favorites, played on speakers. Online, a chaplain prayed. 

  

The project was developed in Canada but co-launched at UCLA Health in 2017 by Dr. Thanh Neville, an intensive care physician who serves as 3 Wishes’ medical director. It aims to make the end of life more dignified and personalized by fulfilling small requests for dying patients and their families in the ICU.

“I would still say the majority of COVID patients die without families at their bedside,” Neville said. “There are a lot of reasons why they can’t come in. Some are sick or old or they have small kids. A lot of people don’t want to take that risk and bring it home.”

                                                      Overall Goal

To improve the quality of the dying experience for patients and their families

Start Up Guide

The 3 Wishes Project Start-Up Guide was developed as a tool to help clinicians to try to improve the quality of the dying experience in ICU and to assist those who are interested in starting the project or adapting it to their own site.

A study published by Neville and colleagues last year found that 3 Wishes is a “transferrable, affordable, sustainable program” that benefits patients, families, clinicians and their institutions. They calculated that the mean cost of a single wish, funded by grants and donations, was $5.19.

Email milo@mcmaster.ca for a free copy of the 3Wishes Project Start-Up Guide.

3 Wishes Project – Helping to make meaningful memories at end-of-life

COVID-19 Spawns an Important New MD Job Title

Author: Gary M. Levin M.D., Health Train Express

The coronavirus pandemic has caused a massive rewrite of the way we deliver healthcare in the United States. Perhaps most consequential among many changes has been the remarkably rapid pivot to telehealth.

Bernard Godley, MD, PhD

Regulators and payers have relaxed patient privacy and reimbursement policies that had inhibited the use of telehealth, dramatically altering the playing field. We can safely assume that the widespread use of telehealth will outlive the pandemic and become a fixture of patient/provider interactions.

As a result, it's critical to develop a new job title that will integrate telehealth into health system operations and maximize its still untapped potential. As the healthcare system moved away from the transactional model of care and toward the experiential model, a new title was created: Chief Experience Officer.

Another new title was created for leaders guiding their systems from volume- to value-based delivery: Chief Transformation Officer. The Chief Medical Information Officer role was created to drive integration of EMRs and other digital platforms in support of system transformation.

Now an additional title is likely to become common in the C-suites of many hospitals, health systems, and large medical groups post-COVID-19. This title is so new that there is as yet no name for it. Our proposal: Chief of Distance Care Delivery. It might more simply be called Chief of Telehealth, while CMO for Telehealth or Chief Digital Care Officer are other options.

Post-COVID-19, convenience, and lower cost will continue to drive the expanded use of telehealth. As the crisis subsides, regulatory and reimbursement organizations will require that policies be enacted to bring quality, safety, privacy, and other benchmark standards in line with those of traditional delivery methods.

An emerging leadership position will have to be assigned to oversee what could become the primary method of providing ambulatory care, along with artificial intelligence-driven interfaces and remote patient monitoring technology. What would be the duties of this role, and who would qualify?

Briefly stated, the Chief of Distance Care Delivery (CDCD) would conceptualize, implement, and maintain high-quality telehealth services across the hospital, health system, or group. In academic environments, the role also might entail an outcomes research component.

Key to the role would be developing and overseeing quality, patient experience, and safety care measurements and protocols. Similar to other dyad structures, the role may evolve to have an administrative and/or nursing partner as telehealth becomes a major source of revenue, potentially overwhelming traditional ambulatory care delivery in some settings.

Joseph Kvedar, MD, president of the American Telemedicine Association and professor of dermatology at Harvard Medical School, has personally observed how health systems, physicians, and patients have rapidly embraced telehealth. He notes that at the Brigham and Women's/Massachusetts General Hospital–affiliated Partners Healthcare System, a network of about 7000 physicians, there were only 1600 virtual patient encounters in February 2020. In April 2020, that number had jumped to 242,000.

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COVID-19 Spawns an Important New MD Job Title

We test a home antibody kit for tracking Covid-19 transmission

Easy-to-use postal tests may be important for monitoring community transmission.

Home testing kits will likely be an important part of monitoring Covid-19. Swab tests can tell whether a person is currently infected, while antibody tests look for signs of past infection. But before tests like these are rolled out, researchers need to make sure they're reliable and easy for people to use at home. We tried one of the home testing kits and spoke to researcher Christina Atchinson about the REACT (real-time assessment of community transmission) study being run by Imperial College London in the UK.

Information from Nature. doi: 10.1038/d41586-020-01677-y

Exploring the Role of Supply Chain Management in Healthcare

How many lessons have we learned from the Covid-19 pandemic?

1. Plans to deal with health emergencies alone are not enough to deal with crises. A written battle plan will not work until the proper and adequate support and training are part of the plan. This requires annual inventory and sufficient workers (in reserve) to meet the needs.  All manuals must be dated and reviewed annually.  Diagnostic testing and treatment protocols can change quickly with the new condensed development times for testing and treatments.

2. Expect routine supply chains (wholesale distribution, transportation, and trucking services to be disrupted, so that new supply chains must be readily available. Rather than using normal distribution channels, alternative delivery services can be utilized, such as USPS, UPS, FedEx, DHL, and Amazon Fulfillment Centers can be brought online quickly. The lack of PPE, sanitizing solutions is a critical product for controlling the spread of infection.

3. The workforce will be disrupted by public health measures such as distancing and a  possible lockdown to prevent further spread of infectious diseases.  Public services such as light rail, bus transportation, airlines may become unavailable.

New York Subway during Covid19 Lockdown

TSA at Airport

Artificial intelligence and machine learning must be developed to study this pandemic to model for inevitable future events.  Historical stories may not be applicable comparing 1919 (Spanish flu) with SARS, MERS, nor COVID-19.  Projections into the future may not be valid when shifts in technology occur. For instance, the changes in transportation (airline flight), medical technology (diagnostic testing, treatments, and the use of new forms of medication and vaccine development.)

The use of newer forms of vaccine manufacturing using RNA technology vs the use of introducing foreign proteins in the body to form an immune reaction.

     How can providers overcome common challenges in healthcare supply chain management?

Some healthcare organizations have found success with supply chain management through cost transparency. By harnessing price and utilization data, healthcare organizations can track and manage inventory more efficiently and construct more informed purchasing contracts with manufacturers.

“Due to vertical internal structures, supplies and supply data historically have been siloed and firewalled so that information important for efficient business operations is fragmented,” Steve Kiewiet, Vice President of Supply Chain Operations at BJC HealthCare, told RevCycleIntelligence.com in June 2015. “We end up spending billions of dollars of inventory within these various silos because we live in a world where you can never run out of anything ever, in the interest of what is best for the patient.”   

All of these factors operate during 'normal times: If a public health emergency occurs, all bets are off.  Typical laws of economics, supply and demand begin to operate, and costs soar as manufacturers seek to profit.

During the current Covid-19 pandemic prices soared for masks and sanitizers and all other     PPE. Hoarding and preferential sales to emergency workers, hospitals, and essential workers prevented almost everyone else from obtaining needed PPE.

Gowns up 2,000%

The largest reported price increases have been for isolation gowns (2,000%), N95 masks (1,513%), 3-ply masks (1,500%), and reusable face shields (900%). The most remarkable rise was for 3M N95 masks, which rose from $0.11 to $6.75 each (6,136% increase), though they are currently unavailable, according to SHOPP.

 

Present and Future Price Trends

Global Personal Protective Equipment Market 2020: Application, Revenue Status, Leading Player, Demand, Growth, Future Opportunity & Forecast to 2024

Wild Card Vendors/suppliers/manufacturers

The widespread use of online shopping has given visibility to many DIYers who manufacture small orders for masks. The potential for the small home-based business to manufacture face masks and protective eye shields.  This niche market is also driven by word of mouth at hospitals and is also available on Youtube

Exploring the Role of Supply Chain Management in Healthcare