Technology Helps Doctors, Health Industry Track Patients, Treatments

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As the COVID-19 pandemic threatens to overwhelm doctors and hospitals throughout the country, medical technology firms and health centers are trying to gain “situational awareness” — giving doctors what they need to know about the sick patients filling emergency rooms.For doctors and staff, “it’s really hard to know what sorts of patients are coming,” said Warren Ratliff, the chief executive of MDmetrix, a software firm that provides analysis of health care inside hospitals.The staff “can see they’re backing up,” he said. But they have few tools to compare patients showing up today with those admitted yesterday, or to show what treatments might be working on certain groups of patients, he added.A frustrated doctorMDmetrix was created by a doctor frustrated that he couldn’t analyze data across patients. With electronic medical records, which have been in use in the U.S. for years, mostly for tracking and billing, physicians typically view one patient’s record at a time.   Enter medical technology firms like MDmetrix, which offer information dashboards and apps so that doctors and hospitals can look for trends and insights across patient outcomes. The technology pulls data from patients’ electronic medical records.As they deal with the patients in front of them, hospitals and doctors are struggling to answer what may seem like simple questions, Ratliff said. How many ventilators are being used? Is low oxygen an indicator of COVID-19? Has anyone followed up on patients who were tested and sent home?The demand for information extends to whether there are different treatments for different groups, he said.Different patients, different treatments“Is there a difference in the treatment between smokers or nonsmokers?” Ratliff said. “In a couple of years, an after-action report will come out. But that’s way too late if you’re fighting a battle right now.”With the push of a button, clinicians and hospital administrators get MDmetrix’s COVID-19 dashboard of charts and graphs that they can view to improve patient care. The information is a real-time snapshot of “whether treatment protocol A is working better than protocol B for any subset of patients,” Ratliff said.As for privacy concerns, data pulled from patient records is stripped of its identity and aggregated, complying with health care privacy laws, Ratliff said.MDmetrix is being used at the University of Washington Medical Center and Harborview Medical Center, both in Seattle. The company is providing its “COVID-19 Mission Control” software for free to hospitals and medical centers.Leveraging the electronic health recordA recent paper in the Journal of American Medical Informatics Association outlined efforts at the University of California San Diego Health to quickly build new dashboards based on electronic health records to manage the growing crisis.  The authors conclusion: Electronic health records “should be leveraged to their full potential.”Over the past several years, there’s been an explosion of technology tools to analyze and aggregate data drawn from electronic health records, said Julia Adler-Milstein, an associate professor of medicine at the University of California-San Francisco. But the COVID-19 pandemic is pushing hospitals and companies to find ways – sometimes in just days – to analyze data and get critical information to decision-makers.“This has been a pressure test,” she said. “How can we get cuts of our data for the new disease?”Figuring out trends inside a hospital is also the work of TransformativeMed, an electronic record-keeping application that tracks a patient as he or she moves through the hospital. It is being used at the University of Washington Medical Center and Harborview Medical Center; MedStar Health in the Washington, D.C., area; and VCU Health Center in Richmond, Virginia.Tracking a patient — from symptoms, lab results and treatments — can help a hospital understand how a disease is progressing through a community, how effective treatments are and what isn’t working, said Dr. Rodrigo Martinez, chief clinical officer at TransformativeMed and an ear, nose and throat doctor.A generational opportunityThe battle against COVID-19 could be a once-in-a-generation opportunity to greatly improve the health care system, he said. The social distancing requirements will boost telehealth, with patients and their health care providers likely to appreciate how much can be accomplished through video chat, he said. 3-D printing, which is being used to repair and create ventilators, will help the medical supply chain. And home lab tests will also likely grow.Add to the list companies such as TransformativeMed and MDmetrix, which are finding trends in patients’ electronic health records.“It’s not that we are creating new technologies,” Martinez said. “We’ve had technologies waiting in the wings, waiting for the opportunity to be applied.”

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Governor to Take Ventilators for NYC as Hospitals Buckle

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With coronavirus deaths climbing rapidly in New York, the governor announced Friday he will use his authority to take ventilators and protective gear from private hospitals and companies that aren’t using them, complaining that states are competing against each other for vital equipment in eBay-like bidding wars.”If they want to sue me for borrowing their excess ventilators to save lives, let them sue me,” Gov. Andrew Cuomo said.The executive order he said he would sign represents one of the most aggressive efforts yet in the U.S. to deal with the kind of critical shortages around the world that authorities say have caused health care workers to fall sick and forced doctors in Europe to make life-or-death decisions about which patients get a breathing machine.The number of the people infected in the U.S. reached a quarter-million and the death toll climbed past 6,000, with New York state alone accounting for more than 2,900, a surge of over 560 dead in just one day. Most of the dead are in New York City, where hospitals are being pushed to the breaking point.The move by Cuomo came as the outbreak snapped the United States’ record-breaking hiring streak of nearly 10 years. The U.S. government said employers slashed over 700.000 jobs in March, bringing a swift end to the nation’s 50-year-low unemployment rate.The true picture, though, is far worse, because the government figures do not include the last two weeks, when nearly 10 million thrown-out-of-work Americans applied for unemployment benefits.Worldwide, confirmed infections surged past 1 million and deaths topped 54,000, according to a tally by Johns Hopkins University. Experts say both numbers are seriously undercounted because of the lack of testing, mild cases that were missed and governments that are underplaying the extent of the crisis.Europe’s three worst-hit countries — Italy, Spain and France — surpassed 30,000 dead, or over half of the global toll. From those countries, the view remained almost unrelentingly grim, a frightening portent for places like New York, the epicenter of the U.S. outbreak, where bodies are being loaded by forklift into refrigerated trucks outside hospitals.Shortages of critical equipment have led to fierce competition among buyers from Europe, the U.S. and elsewhere. A regional leader in Paris described the scramble to find masks a “worldwide treasure hunt.” Cuomo warned this week that New York could run out of ventilators in six days.  In Florida, hundreds of passengers on a cruise ship where four people died were finally being allowed to disembark after a days-long standoff. More than a dozen critically ill patients were taken to hospitals, while people healthy enough to travel were taken to the airport for chartered flights home.  One Spanish hospital turned its library  into an intensive care unit. In France, space was set aside for bodies in a vast food market. The French prime minister said he is “fighting hour by hour” to ward off shortages of essential drugs used to keep COVID-19 patients alive.Philippe Montravers, an anesthesiologist in Paris, said medics are preparing to fall back on older drugs such as the opiates fetanyl and morphine that had fallen out of favor, because newer painkillers are in short supply.  “The work is extremely tough and heavy,” he said. “We’ve had doctors, nurses, caregivers who got sick, infected … but who have come back after recovering. It’s a bit like those World War I soldiers who were injured and came back to fight.”  France canceled its high-school exit exam known as the Baccalaureat, a first in the 212-year history of the test.Some glimmers of hope emerged that Italy, with nearly 14,000 dead, as well as Spain and France might be flattening their infection curves and nearing or even passing their peaks in daily deaths.  Spain on Friday reported 932 new deaths, down slightly from the record it hit a day earlier. The carnage most certainly included large numbers of elderly who authorities admit are not getting access to the country’s limited breathing machines, which are being used first on healthier, younger patients. More than half of Spain’s nearly 11,000 deaths have come in the last seven days alone.In a vast exhibition center in Madrid that was hastily converted into a 1,300-bed field hospital, bed No. 01.30 held patient Esteban Pinaredo, age 87.”I’m good, I love you,” Pinaredo told his family via Skype. “I will run away as soon as I can.”  
The facility’s organizer, Antonio Zapatero, said Spain’s nationwide lockdown must be maintained.”Otherwise, this is what you are facing,” he said, pointing at the rows of beds.Elsewhere in Europe, officials began talking tentatively about how to lift lockdowns that have staved off the total collapse of strained health systems but also battered economies.  Austria said it will set out a timetable next week for what could be “a slow startup” of closed parts of the economy. The head of Germany’s national disease control center said he expects that any easing of the country’s lockdown, which this week was extended to April 19, will be staggered.With forecast glorious spring weather likely to tempt stir-crazy families out of lockdown this weekend, the firm message across the continent remained: “Stay home.”Paris police set up roadblocks out of the city to stop those trying to escape for Easter vacation.
In Britain, which locked down later than its European neighbors, the infection peak is still ahead, threatening the National Health Service with the biggest test in its 72-year history after austerity cuts that have strained the institution and its promise of quality care for all. Meanwhile, British Prime Minister Boris Johnson, who tested positive last week, said in a video message on Twitter that he is feeling better but still has a fever and will remain in isolation.  For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough. But for others, especially older adults and people with health problems, it can cause pneumonia. The World Health Organization said this week that 95% of the deaths in Europe were of people over 60.

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How Social Distancing Can Impact Your Mental Health

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Social distancing and isolation can be hard, as New York Gov. Andrew Cuomo recently pointed out during a daily briefing on the status of COVID-19 in his state. “Don’t underestimate the personal trauma, and don’t underestimate the pain of isolation. It is real,” Cuomo said. “This is not the human condition — not to be comforted, not to be close, to be afraid and you can’t hug someone. … This is all unnatural and disorienting.”  Experts already know that years of loneliness or feelings of isolation can lead to anxiety, depression and dementia in adults. A weakened immune system response, higher rates of obesity, high blood pressure, heart disease and a shorter life span can also result. A Pittsburgh Public Works employee removes a basketball rim from a city court in an effort to encourage social distancing, March 30, 2020.Children who have fewer friends or are bullied or isolated at school tend to have higher rates of anxiety, depression and some developmental delays. But when it comes to a global pandemic like COVID-19, there is no documentation to which medical experts can refer.  “The studies that we have are more about forced isolation and no support,” said Elena Mikalsen, chief of the Psychology Section at Children’s Hospital of San Antonio. “The situation we’re in now, there’s a lot of social support … and social support is one of the big predictors of good health and mental health outcomes.” She adds that it is helpful that the entire world is basically in the same situation, a commonality that is leading to the rapid development of coping strategies from multiple sources, including friends, schools and businesses.  Playground equipment is wrapped in crime scene tape to prevent its use as part of the effort to slow the spread of the coronavirus March 31, 2020, in St. Louis, MIssouri.During this period, Mikalsen is advising her patients to stay connected with people,  exercise regularly, and keep to a schedule so that everybody in the household has some sort of purpose in their day. Waiting around and worrying about getting sick can lead to increased anxiety. A key factor driving people’s decisions on whether to isolate could come down to personality.  “Extroverts have this strong need to always be around other people. … The idea of being in a quiet place with no entertainment is extremely anxiety provoking,” Mikalsen said. “Versus, you know, an introvert is perfectly happy in a tiny little room with nothing. You can lock up an introvert in a New York City apartment and have them not come out for two months and they’ll be perfectly happy.” New York Gov. Andrew Cuomo with daughter, Cara Cuomo, in Mt. Kisco, N.Y., Nov. 6, 2018.Meanwhile, Cuomo told reporters that he is focusing on the positives in the current situation, like having his grown daughter, Cara, 25, working with him during the crisis.  “They’ll come for the holidays. They’ll come when I give them heavy guilt,” he said of his three grown daughters. “But I’m now going to be with Cara, literally, for a few months. What a beautiful gift that is, right? I would have never had that chance, and that is precious. … This crazy situation, as crazy as it is, gave me this beautiful gift.” 

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Prince Charles Opens Fast-Tracked London Hospital

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Prince Charles on Friday remotely opened the new Nightingale Hospital at London’s main exhibition and conference center, a temporary facility that will soon be able to treat 4,000 people who have contracted COVID-19.
Charles said he was “enormously touched” to be asked to open the temporary facility at the ExCel center in east London and paid tribute to everyone, including military personnel, involved in its “spectacular and almost unbelievable” nine-day construction.
“An example, if ever one was needed, of how the impossible could be made possible and how we can achieve the unthinkable through human will and ingenuity,” he said via video link from his Scottish home of Birkhall.
“To convert one of the largest national conference centres into a field hospital, starting with 500 beds with a potential of 4,000, is quite frankly incredible.”
The new National Health Service hospital will only care for people with COVID-19, and patients will only be assigned there after their local London hospital has reached capacity.
Charles, who earlier this week emerged from self-isolation after testing positive for COVID-19, said he was one of “the lucky ones” who only had mild symptoms, but “for some it will be a much harder journey.”
He expressed his hope that the hospital “is needed for as short a time and for as few people as possible.”
The hospital is named after Florence Nightingale, who is widely considered to be the founder of modern nursing. She was in charge of nursing British and allied soldiers in Turkey during the Crimean War of the 1850s, her selfless care earning her the reputation as the “Lady with the Lamp.”
Natalie Grey, the head of nursing at NHS Nightingale, unveiled the plaque formally opening the hospital on the prince’s behalf.
Further new hospitals are being planned across the U.K., including in Birmingham, Glasgow and Manchester, to alleviate the pressure on the NHS during the coronavirus pandemic.
“In these troubled times with this invisible killer stalking the whole world, the fact in this country we have the NHS is even more valuable that before,” said Health Secretary Matt Hancock, who also contracted COVID-19 and only emerged from his self-isolation on Thursday.
The number of people in Britain dying after testing positive for COVID-19 has been increasing sharply over the past couple of weeks. The latest U.K. figures showed that the number of people to have died increased in a day by 569 to 2,921.
Like many other countries, Britain is in effective lockdown, with bars and nonessential shops closed in order to reduce the rate of transmission, the hope being that it will eventually reduce the peak in deaths. Hancock would not be drawn across several interviews about when he expects the peak to be, beyond that it’s likely to occur in “coming weeks.”

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Ships With Coronavirus Patients Dock in Florida

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A cruise ship where at least two passengers died of coronavirus while barred from South American ports finally docked Thursday in Florida after two weeks at sea and days of negotiations with initially resistant local officials.
The Zaandam and a sister ship sent to help it, the Rotterdam, were allowed to unload passengers at Port Everglades after working out a detailed agreement with officials who feared it would divert needed resources from a region that has seen a spike in virus cases.  
Broward County officials and Holland America, the company that operates the ships, announced the agreement shortly before the ships pulled into port.  
Holland America initially said 45 people who were mildly ill would stay on board until they recovered, but the docking plan released later Thursday indicated that 26 passengers and 50 crew members were ill. The plan noted that the company had secured access at two local hospitals for 13 passengers and a crew member who needed medical care.  
For nearly three weeks, passengers have not been able to step on dry land. Four elderly passengers died on the Zaandam, at least two from COVID-19, said William Burke, chief maritime officer for Carnival Corp., which owns the ships. Nine people had tested positive for the new coronavirus, Burke said earlier this week.
There were 442 guests and 603 crew on the Zaandam, and 808 guests and 583 crew on the Rotterdam. The Rotterdam was sent last week to take in some of the passengers and provide assistance to the Zaandam since it was denied permission to dock at ports in South America.
 
About 250 people have reported influenza-like symptoms since March 22, including 17 aboard the Rotterdam, according to the docking plan.
Originally firmly opposed to the ships’ arrival, Florida Gov. Ron DeSantis said Wednesday that he had a change of heart after realizing many passengers were U.S. citizens and about 50 of them Floridians.  
He went further on Thursday, telling Fox News that allowing the ships to dock and transferring critically ill patients to hospitals was “the humanitarian thing to do.”  
“I think the accommodations have been made, and I think that things are going to be done very thoughtfully,” he said later at a news conference. “It’s going to be a very controlled exit from these ships.”  
The docking plan indicated that Florida residents would leave the ship first, with the disembarkation of all passengers not concluding until Friday night.  
Passengers who have no symptoms of the virus will be bused to airports and put directly on charter flights without passing through the terminals, DeSantis said.  
Emily Spindler Brazell, of Tappahannock, Virginia, was still in her cabin waiting for instructions from the Rotterdam’s captain but said she was relieved to be back home.  
“People greeted us, came out to their balconies, blew air horns and shouted, ‘Welcome home!'” she said. “It was surprising. We went to many countries that said, ‘We are not going to talk to you.'”
Passenger Laura Gabaroni, of Orlando, said she would not be comfortable until she disembarked. She was transferred to the Rotterdam last Saturday, along with husband Juan Huergo and other passengers not showing signs of illness.
“Many broken promises so far, so I’ll believe it when I see it,” she told The Associated Press via a WhatsApp message.

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Medics: Iraq has Confirmed Thousands More COVID-19 Cases Than Reported

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Iraq has thousands of confirmed COVID-19 cases, many times more than the 772 it is has publicly reported, according to three doctors closely involved in the testing process, a health ministry official and a senior political official.
 
The sources all spoke on condition of anonymity. Iraqi authorities have instructed medical staff not to speak to media.
 
Iraq’s health ministry, the only official outlet for information on the COVID-19 disease, could not immediately be reached for comment. Reuters sent voice and written messages asking its spokesman if the actual number of confirmed cases was higher than the ministry had reported and if so why.
 
The ministry said in its latest daily statement on Thursday that the total recorded confirmed cases for Iraq were 772, with 54 deaths.
 
But the three doctors, who work in pharmaceutical teams helping test suspected COVID-19 cases in Baghdad, each said that confirmed cases of the disease, based on discussions among fellow medics who see daily results, were between about 3,000 and 9,000 although they each gave different estimates.
 
The health ministry official, who also works in testing for COVID-19, the disease caused by the new coronavirus, said that there were more than 2,000 confirmed cases from eastern Baghdad alone, not counting the number in other areas or provinces.
 
The political official, who has attended meetings with the health ministry, also said thousands of cases were confirmed.
 
The new coronavirus has hit Iraq’s neighbor Iran worse than any country in the region. Iraq has close trade and religious ties with Iran and a large border, which Iraq shut in February over fears of the spread of the infection.
 
Iraq’s healthcare system, among other infrastructure, has been stretched by decades of sanctions, war and neglect, one among several problems that spurred mass anti-government protests in recent months.
 Pilgrims
 
Governments across the world have struggled to cope with the COVID-19 pandemic. The United States, Italy and Spain are the countries worst hit by the disease, which has infected nearly a million people worldwide and killed nearly 47,000.
 
The three Iraqi doctors and the political official said national security officials have attended health ministry meetings and urged authorities not to reveal the high figures because it could create public disorder with a rush on medical supplies, and make it harder to control the disease’s spread.
 
The health ministry did not immediately reply to a request for comment on any such discussions.
 
One of the doctors said the death toll was also likely higher than the official toll, but not by much. “On Saturday last week alone, about 50 people were buried who died from the disease,” he said. At that time the official death toll was 42.
 
Testing facilities are limited and Iraq has publicly acknowledged that the actual number of cases must be higher than the number of confirmed cases.
 
Many doctors blame the accelerating spread of the disease on people refusing to be tested or isolated and on the flouting of a nationwide curfew, including by thousands of pilgrims who flocked to a Shi’ite Muslim shrine in Baghdad last month.
 
The three doctors and the health official said many new cases were from eastern Baghdad where those pilgrims live.
 
Separately, some Shi’ite pilgrims returning to Iraq from Syria have tested positive for coronavirus, a senior Iraqi official and health officials said on Sunday.

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Twitter Deletes Egypt, Saudi Accounts Over ‘Pro-Govt Direction’

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Twitter said Thursday it has removed thousands of accounts in Egypt, Saudi Arabia, Honduras, Indonesia and Serbia that allegedly took direction from governments or pushed pro-government content.A network of accounts associated with Saudi Arabia and operating out of multiple countries including KSA, Egypt and UAE, were amplifying content praising Saudi leadership, and critical of Qatar and Turkish activity in Yemen. A total of 5,350 accounts were removed.— Twitter Safety (@TwitterSafety) April 2, 2020″We removed 2,541 accounts in an Egypt-based network, known as the El Fagr network,” the San Francisco-based tech firm posted in a series of tweets.”The media group created inauthentic accounts to amplify messaging critical of Iran, Qatar and Turkey. Information we gained externally indicates it was taking direction from the Egyptian government.”El Fagr’s online managing editor Mina Salah vehemently pushed back.”Yes we are loyal to the state but we don’t receive instructions from anyone. We’re merely defending our country and its position is clear vis-a-vis Iran, Qatar and Turkey,” he told AFP.He said Twitter was effectively censoring the newspaper’s content and that journalists were banned from even creating new personal accounts.The platform also deleted 5,350 accounts from regional heavyweight Saudi Arabia for “amplifying content praising Saudi leadership, and critical of Qatar and Turkish activity in Yemen”.Rights groups have accused the conservative kingdom of spying on dissidents and critical online users on Twitter.The Saudi-linked accounts were run out of the kingdom and the United Arab Emirates, where Twitter’s Middle East headquarters is based, as well as Egypt.Toward the end of last year, we identified clusters of accounts engaged in inauthentic coordinated activity which led to the removal of 8,558 accounts working to promote Serbia’s ruling party and its leader.— Twitter Safety (@TwitterSafety) April 2, 2020After an internal investigation, Twitter also removed clusters of accounts in Honduras allegedly propagating pro-government content, in Serbia promoting the “ruling party and its leader” and Indonesian accounts pushing information targeting the West Papuan independence movement.Earlier this week, it removed two of Brazilian President Jair Bolsonaro’s tweets questioning quarantine measures aimed at containing the novel coronavirus on the grounds that they violated the social network’s rules.

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