#51 - So, viral is a bad thing now?

Supply chain issues, virtual outbreaks, and more

Hello handout readers!

We’re in a global health crisis and I’m currently not employed, so there’s a lot of news to read and I have a lot of time to read it. I’m going to continue publishing on an irregular, more frequent, schedule for the foreseeable future, but only when there’s enough news to fill out a newsletter (so about every 10 - 15 minutes). 

Stay home. Stay healthy. 

- Isaac

Things That Happened

Supply drain. At least one ventilator manufacturer thinks significantly boosting production volumes is doable, according to William Baldwin in Forbes. Ventilators are a critical component in caring for patients with later-stage symptoms of coronavirus, and while there are varying estimates for how many we have and how many we’ll need, they all agree that we don’t have anything close to the number of ventilators we’re going to need. 

Paris Martineau writes in Wired about life inside the US’ biggest surgical mask manufacturer right now. One reason this situation is particularly dire: “95 percent of surgical masks and 70 percent of respirators used in the US are made overseas, and China is one of the biggest producers” With China’s production slowed by countrywide shutdown, and their own need for expanded production, theres an increased (and likely temporary) need for domestic sources for masks and other protective equipment like masks, gloves, and goggles, as well as the specialized swabs used in testing for the virus. 

In the meantime, at least one hospital administrative staff has been pressed into service to make DIY face shields, while in Italy a startup used their 3D printer to print replacement valves for ventilators at the request of clinicians (and are now being threatened with a lawsuit by the regular manufacturer, who was unable to meet demand). For more in the space of applying ingenuity to the problem, see helpwithcovid.com, a place where people can post projects to help with the outbreak and others can volunteer to help out. 

Supply issues will also manifest in terms of available hospital beds. ProPublica recently published their analysis of projections released by the Harvard Global Health Institute demonstrating regional hospital capacity in different coronavirus severity scenarios. Even in the most optimistic scenarios, American hospitals will be operating well above normal capacity for months on end. 

While more ventilators and protective equipment would resolve short-term shortfalls and hospital capacity represents a looming crisis, supply chain issues represent only some of the increasingly complex set of motions we must undertake to flex our healthcare supply to meet the massive and almost-inevitable tidal wave of demand. The most critical challenge will be assembling teams of clinicians who can provide unprecedented levels of patient care while staying healthy themselves. 

We can hold out hope for a medically-derived savior in the form of improved treatment protocols or even miracle drugs, but it’s more likely this global-scale challenge will be overcome by solving supply chain issues and improving clinical organizational design: remaking our entire healthcare infrastructure to meet this glut of demand. 

Signal in the noise. Twitter has its demons (and misinformation), but it is a fantastic resource for getting up-to-the minute expert opinions on things that are happening. Not sure where to start, or looking to build out your “following” list? Here’s a list of 40+ twitter accounts of trusted epidemiologists, researchers, and health reporters. 

Better late than never. The White House and HHS have been iterating on response team members as they try to overcome their late start in dealing with coronavirus. Politico examines the mix of veteran government administrators and those pulled from the private sector. 

The doctor will Skype you now. HHS made a slew of announcements Tuesday concerning rules for telehealth. Specifically, Medicare will expand payments to cover more telehealth visits (previously constrained chiefly to rural beneficiaries) and will also allow providers to waive copays. They’re also saying they won’t enforce HIPAA for telehealth services performed in “good faith” using non-HIPAA compliant tools like Facetime and Skype, among others. 

Opening up technology platforms could be a huge win for getting people to use telehealth, especially given the reported growing pains existing telehealth platforms are encountering when trying to meet demand (both technical issues and running low on clinical staff).

Things To Read

“If there was any source of comfort for the hospital, it could be found in the supply room. The staff had more than 40 cartons of medical gloves in storage. It had at least 50 gallons of hand sanitizer, 4,000 medical gowns, and four boxes of precious N95 respirator masks that an employee had found hidden away on the shelves of Tractor Supply and City Lumber.” Eli Saslow takes us behind the scenes of a hospital in rural Washington preparing for the coming wave of patients. Rural hospitals are typically poorly-resourced and struggle with staffing, not to mention the fact they typically serve populations that skew older and with more co-morbidities. 

The underlying problem had far less to do with the faulty tests produced by the C.D.C. than it did with a system that could not contemplate, let alone manage, the possibility that the C.D.C. might end up producing faulty tests.“ Robert Baird wrote a comprehensive chronology of America’s failure to get large-scale coronavirus testing online. It’s a story of predictable and anticipated technical failures frustrated by a thicket of slow-moving bureaucracy and overlapping rules and requirements, none of which considered the possibility that plan A might not work. 

We often view epidemics as these things that sort of happen to people. There's a virus and it's doing things. But really it's a virus that's spreading between people, and how people interact and behave and comply with authority figures, or don't, those are all very important things.” Jennifer Ouellette writes about how in 2005, the creators of the massive multiplayer online game World of Warcraft accidentally introduced a disease into the game that behaved much like a virus coming into contact with a human population. Because of the fidelity and abundance of data on how humans reacted to this digital contagion, it has been used in studies on how humans react to biological viruses. 

Thanks for reading The Healthcare Handout, a regular update on tech and business in healthcare from Isaac Krasny. Criticize, praise, hire, or otherwise get in touch with Isaac via isaac@healthcarehandout.com, or on twitter @isaackrasny

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