Monthly Archives: April 2020

‘We are not immune’: Henry Ford Health says 734 employees positive for COVID-19

Posted on by • Posted in Clinical Testing, Coronavirus, Crisis, Crisis Management, Health System, Healthcare Providers, Hospital, Hospital Industry, Infection Control, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety • Leave a comment

https://www.beckershospitalreview.com/workforce/we-are-not-immune-henry-ford-health-says-734-employees-positive-for-covid-19.html?utm_medium=email

Detroit hospital: More than 600 employees tested positive for ...

More than 700 employees of Detroit-based Henry Ford Health System have tested positive for COVID-19, the health system confirmed to Becker’s.

Adnan Munkarah, MD, executive vice president and chief clinical officer, said Henry Ford has tested nearly 2,500 employees since tracking began March 12, and the majority have tested negative. However, as of April 6, 734 employees, or 2.1 percent of the health system’s workforce, have tested positive. Positive cases include employees not working directly on the front lines or those who contracted the virus in the community.

In announcing the update, Dr. Munkarah pointed to the health system’s strict adherence to the use of personal protective equipment during the pandemic, as well as other measures that have been put in place to protect employees and patients. Those measures include a universal mask policy for employees and visitors and the prioritization of testing for employees exhibiting even mild symptoms.

“As a health system caring for a large majority of our region’s COVID-19 patients, we know we are not immune to potential exposure and we remain grateful for the courage and dedication of our entire team,” said Dr. Munkarah.

Michigan is one of the states hardest hit by the pandemic. As of 7:25 a.m. CDT April 7, there were 17,221 confirmed cases of COVID-19 in the state.  

 

 

 

 

TED Esther Choo. Emergency physician and public health advocate. Life on the medical front lines of the pandemic

Posted on by • Posted in Coronavirus, Crisis, Crisis Management, Health Policy, Health System, Healthcare Providers, Hospital, Hospital Bed Shortage, Hospital Industry, Housing for Healthcare Workers, Hydroxychloroquine, Infection Control, Infectious Virus, Intensive Care (ICU), Pandemic, Public Health, Public Safety, Quarantine, Rural Health, Rural Hospital, Social Distancing • Leave a comment

https://www.ted.com/about/programs-initiatives/ted-connects-community-hope

Doctors give OHSU's Esther Choo a standing ovation for gender bias ...

Esther Choo is an emergency physician and associate professor at the Oregon Health & Science University. She is a popular science communicator who has used social media to talk about racism and sexism in healthcare. She was the president of the Academy of Women in Academic Emergency Medicine and is a member of the American Association of Women Emergency Physicians.

As the coronavirus pandemic sweeps the globe, it’s hard to know where to turn or what to think. TED Connects is a free, live, daily conversation series featuring experts whose ideas can help us reflect and work through this uncertain time with a sense of responsibility, compassion and wisdom.

 

 

Special Report: Doctors embrace drug touted by Trump for COVID-19, without hard evidence it works

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Certainty, Clinical Research, Clinical Testing, Coronavirus, Crisis, Crisis Management, Evidence, Expectations, Health Policy, Hope, Hydroxychloroquine, Intensive Care (ICU), Opinion, Pandemic, Physician, Public Health, Public Safety, Side Effects, Uncertainty • Leave a comment

https://www.reuters.com/article/us-health-coronavirus-usa-hydroxychloroq/special-report-doctors-embrace-drug-touted-by-trump-for-covid-19-without-hard-evidence-it-works-idUSKBN21O2VO

Special Report: Doctors embrace drug touted by Trump for COVID-19 ...

The decades-old drug that President Donald Trump has persistently promoted as a potential weapon against COVID-19 has within a matter of weeks become a standard of care in areas of the United States hit hard by the pandemic — though doctors prescribing it have no idea whether it works.

Doctors and pharmacists from more than half a dozen large healthcare systems in New York, Louisiana, Massachusetts, Ohio, Washington and California told Reuters they are routinely using hydroxychloroquine on patients hospitalized with COVID-19. At the same time, several said they have seen no evidence that the drug, used for years to treat malaria and autoimmune disorders, has any effect on the virus.

Use of hydroxychloroquine has soared as the United States has quickly become the epicenter of the pandemic. More than 355,000 people in the United States have tested positive for the novel coronavirus, and more than 10,000 have died. The federal government estimates that as many as 240,000 people in the country may die from the disease before the outbreak is over.

Facing those numbers, and in the absence of any known effective treatments, doctors on the frontlines said they began using hydroxychloroquine and the related chloroquine on patients who are deteriorating based on a few small studies suggesting a possible benefit. Some said they had come under pressure from patients to use the therapies widely touted by Trump and other supporters.

“I may take it,” Trump said on Saturday, referring to hydroxychloroquine, though he has twice tested negative for coronavirus, according to the White House. “We’re just hearing really positive stories, and we’re continuing to collect the data.”

Potential side effects of hydroxychloroquine include vision loss and heart problems. But doctors interviewed by Reuters say they are comfortable prescribing the drug for a short course of several days for coronavirus patients because the risks are relatively low and the therapies are inexpensive and generally available.

However, protocols directing how these drugs should be used vary from one hospital to another, including when to introduce them and whether to combine them with other drugs. In addition, some studies showing promise involve patients who took the therapies for mild or early-stage illness. Many of those people are likely to recover from the virus on their own.

Patients admitted to the hospital in the United States are generally much sicker than the mildly ill cases cited in such studies when they receive therapy. These factors, doctors said, have made it difficult for them to determine whether the drugs are making a difference. “I have seen hundreds of patients with severe COVID and most of these people are on hydroxychloroquine,” Dr Mangala Narasimhan, regional director of critical care at Northwell Health, a 23-hospital system in New York, said in an email. “In my opinion, although it is very early, I do not see a dramatic improvement from the hydroxychloroquine in these patients.” Dr Daniel McQuillen, an infectious disease specialist at Lahey Hospital & Medical Center in Burlington, Massachusetts, said he has prescribed a course of hydroxychloroquine for about 30 COVID-19 patients so far because the drug has shown “a little bit of antiviral activity.” But he has not seen “marked improvement for patients.”

“Anecdotally, it may have had limited effect in patients with milder disease,” McQuillen said. The therapy “has had no effect in limiting or slowing progression of our patients that have been at or near ICU level when they arrived.”

‘SEE WHAT STICKS’

The experience of David Lat, a legal recruiter and commentator who founded the blog Above the Law, reflects the mixture of hope and uncertainty surrounding the drugs now being pursued as possible coronavirus treatments.

Since early March, the 44-year-old New Yorker has chronicled his near-fatal infection with coronavirus in social media posts followed by thousands of people. Lat’s case has resonated with a U.S. audience that has begun to recognize the risk that coronavirus poses not only to elderly patients with serious medical conditions, but also to generally healthy younger adults.

After more than a week of worsening symptoms, Lat was admitted to NYU Langone Medical Center on March 16 and later placed on a ventilator. On March 28, he shared on Facebook that his doctors had taken him off of the ventilator and had moved him out of intensive care after his condition improved dramatically.

In an exchange of text messages with Reuters, Lat said he was treated with hydroxychloroquine and the antibiotic azithromycin. He also received the experimental therapy clazakizumab, which aims to regulate an overreaction by the body’s immune system thought to trigger the respiratory distress seen in severe COVID-19. After the story was published, Lat clarified that he received a fourth therapy, the antiviral Kaletra, not Kevzara, as he had initially recalled.

“The doctors haven’t concluded what caused my recovery,” Lat said. “The state of coronavirus research is very much ‘throw stuff against a wall and see what sticks’ – but when something does stick, in terms of a good patient outcome, you’re not sure what stuck.” Lat’s doctors were not immediately available to comment on his treatment.

Some doctors have been vocal in advocating the drug. Dr Vladimir Zelenko, a general practitioner in upstate New York, has claimed that a three-drug cocktail of hydroxychloroquine, azithromycin and zinc sulfate has helped mitigate the infection in nearly 200 hundred of his patients before they became sick enough to require hospitalization. His recommendations have attracted the attention of Trump’s supporters. Zelenko wasn’t immediately available for comment.

Despite such encouraging reports, hard evidence that any of the therapies now under study will work is weeks and possibly months way.

Early, but mixed, data has emerged from COVID-19 trials of the malaria drugs in China. A research team in Marseilles, France, has published data showing that out of 80 mild COVID-19 patients treated with hydroxychloroquine and azithromycin, 93 percent had no detectable levels of the virus after eight days.

Doctors have questioned the value of the Marseille study and several papers from China as being too small or poorly designed to offer hard evidence of benefit. Most do not compare outcomes of patients who received the malaria therapies with people who did not, considered the most reliable measure of a drug’s effectiveness. Last week, doctors in Paris reported that they tried to replicate the results of the Marseille study and failed. Results from a trial conducted in Wuhan, China, were released that included a control group of patients who did not receive the anti-malarial therapy for comparison. But critics questioned why information on the trial’s main goal — detecting viral load — was not disclosed, and said data was missing for some patients. More rigorous U.S.-led trials are now underway. But most focus on whether the drugs can help prevent illness in people exposed to the coronavirus, such as healthcare workers or relatives of confirmed patients, and not people who are already sick. Randomized, controlled trials of the drugs are being conducted in other countries, including China, Brazil and Norway.

Until the evidence is in, “each institution is setting their own treatment guidelines,” said Dr Otto Yang, an infectious disease specialist at the University of California, Los Angeles Medical Center. “There is simply no data,” he said. “It is a matter of opinion, and opinions differ.”

GAME-CHANGER?

Trump is deeply invested in the idea that the malaria drugs will show a benefit, and personally pressured federal health officials to make them available, Reuters reported on Saturday. The president announced on Twitter last month that hydroxychloroquine, when combined with azithromycin, has the potential to become “one of the biggest game changers in the history of medicine.”

 

 

 

 

New Zealand isn’t just flattening the curve. It’s squashing it.

Posted on by • Posted in Collective Purpose, Coronavirus, Crisis, Crisis Management, Expectations, Health Policy, Infection Control, Infectious Virus, Leadership, Leadership Centralized, Leadership Commitment, Leadership Trust, Pandemic, Public Health, Public Safety, Quarantine, Strategy • Leave a comment

https://www.washingtonpost.com/world/asia_pacific/new-zealand-isnt-just-flattening-the-curve-its-squashing-it/2020/04/07/6cab3a4a-7822-11ea-a311-adb1344719a9_story.html?fbclid=IwAR0G_nNMxXlu82cnEElI4E3napU5ug5XyMQqeiFyhfl0Cx_aIH4K91GwdUY&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

New Zealand isn't just flattening the curve. It's squashing it. #1 ...

 It’s been less than two weeks since New Zealand imposed a coronavirus lockdown so strict that swimming at the beach and hunting in bushland were banned. They’re not essential activities, plus we’ve been told not to do anything that could divert emergency services’ resources.

People have been walking and biking strictly in their neighborhoods, lining up six feet apart while waiting to go one-in-one-out into grocery stores, and joining swaths of the world in discovering the vagaries of home schooling.

It took only 10 days for signs that the approach here — “elimination” rather than the “containment” goal of the United States and other Western countries — is working.

The number of new cases has fallen for two consecutive days, despite a huge increase in testing, with 54 confirmed or probable cases reported Tuesday. That means the number of people who have recovered, 65, exceeds the number of daily infections.

“The signs are promising,” Ashley Bloomfield, the director-general of health, said Tuesday.

The speedy results have led to calls to ease the lockdown conditions, even a little, for the four-day Easter holiday, especially as summer lingers on.

But Prime Minister Jacinda Ardern is adamant that New Zealand will complete four weeks of lockdown — two full 14-day incubation cycles — before letting up. She has, however, given the Easter Bunny special dispensation to work this weekend.

How has New Zealand, a country I still call home after 20 years abroad, controlled its outbreak so quickly?

When I arrived here a month ago, traveling from the epicenter of China via the hotspot of South Korea, I was shocked that officials did not take my temperature at the airport. I was told simply to self-isolate for 14 days (I did).

But with the coronavirus tearing through Italy and spreading in the United States, this heavily tourism-reliant country — it gets about four million international visitors a year, almost as many as its total population — did the previously unthinkable: it shut its borders to foreigners on March 19.

Two days later, Ardern delivered a televised address from her office — the first time since 1982 that an Oval Office-style speech had been given — announcing a coronavirus response alert plan involving four stages, with full lockdown being Level 4.

A group of influential leaders got on the phone with her the following day to urge moving to Level 4.

“We were hugely worried about what was happening in Italy and Spain,” said one of them, Stephen Tindall, founder of the Warehouse, New Zealand’s largest retailer.

“If we didn’t shut down quickly enough, the pain was going to go on for a very long time,” he said in a phone interview. “It’s inevitable that we will have to shut down anyway, so we would rather it be sharp and short.”

On the Monday, March 23, Ardern delivered another statement and gave the country 48 hours to prepare for a Level 4 lockdown. “We currently have 102 cases,” she said. “But so did Italy once.”

From that Wednesday night, everyone had to stay at home for four weeks unless they worked in an essential job such as health care, or were going to the supermarket or exercising near their home.

There have been critics and rebels. The police have been ordering surfers out of the waves. The health minister was caught — and publicly chastised by Ardern, who said she would have fired him if it weren’t disruptive to the crisis response — for mountain biking and taking his family to the beach.

But there has been a sense of collective purpose. The police phone line for nonemergencies has been overwhelmed with people calling to “dob in,” as we say here, others they think are breaching the rules.

The response has been notably apolitical. The center-right National Party has clearly made a decision not to criticize the government’s response, and in fact to help it.

These efforts appear to be paying off.

After peaking at 89 on April 2, the daily number of new cases ticked down to 67 on Monday and 54 on Tuesday. The vast majority of cases can be linked to international travel, making contact tracing relatively easy, and many are consolidated into identifiable clusters.

Because there is little evidence of community transmission, New Zealand does not have huge numbers of people overwhelming hospitals. Only one person, an elderly woman with existing health problems, has died.

The nascent slowdown reflected “a triumph of science and leadership,” said Michael Baker, a professor of public health at the University of Otago and one of the country’s top epidemiologists.

“Jacinda approached this decisively and unequivocally and faced the threat,” said Baker, who had been advocating for an “elimination” approach since reading a World Health Organization report from China in February.

“Other countries have had a gradual ramp-up, but our approach is exactly the opposite,” he said. While other Western countries have tried to slow the disease and “flatten the curve,” New Zealand has tried to stamp it out entirely.

Some American doctors have urged the Trump administration to pursue the elimination approach.

In New Zealand’s case, being a small island nation makes it easy to shut borders. It also helps that the country often feels like a village where everyone knows everyone else, so messages can travel quickly.

New Zealand’s next challenge: Once the virus is eliminated, how to keep it that way.

The country won’t be able to allow people free entry into New Zealand until the virus has stopped circulating globally or a vaccine has been developed, said Baker. But with strict border control, restrictions could be gradually relaxed and life inside New Zealand could return to almost normal.

Ardern has said her government is considering mandatory quarantine for New Zealanders returning to the country post-lockdown. “I really want a watertight system at our border,” she said this week, “and I think we can do better on that.”