There seems to be a lot of doom and gloom in the air these days and it's not hard to understand why. While I admit to sometimes playing the role of Negative Nelly myself, the truth is that all that negativity unfairly and inaccurately distorts our perception of reality.
While the news media may follow the "if it bleeds, it leads" mantra, we at CyberMDX are beholden to no such guidance. Instead, we thought it would be worthwhile and perhaps even emotionally invigorating to help paint a fuller, more robust, picture of the current situation for our readers. There's plenty to worry about sure, but there's also a lot of genuinely positive and hopeful developments that ought to be savored in the midst of all this craziness.
Leaving alone for a moment the challenges this situation poses for our personal psychologies and the shared economy, the main challenges we face as a society have to do with diagnosis, severity assessment, tooling, and treatment. It's with regards to those challenges that we are pleased to bring to you some much needed good news.
Accelerating Testing & Assessment
The trouble with COVID-19 is not only a function of how the virus could overwhelm the body, but how its super fast spread among the population could overwhelm the healthcare system. In such a situation, with the virus continuing to proliferate at current rates and access to care can no longer assured, an eminently treatable case of the virus could easily prove fatal.
Because of that, it's essential that the rate at which the COVID-19 is spreading be slowed. Of course, slowing the spread of a disease is a simple matter of containment strategy and in that department there are plenty of tried-and-true approaches.
To effectively contain something though, you need to be able to measure and track it. With COVID-19, that measurement and tracking has proven exceptionally difficult.
At its core, this is a matter of identifying who's sick, where they've been, and who've they've come into contact with. That data is needed not only to begin containing the spread, but to better understand the consequentiality of risk factors and the vulnerability of risk groups. With that information, the infection totals can be tallied and the effective rate of transmission can be calculated.
As the virus is better understood, it can be better modeled, and good measurement can give way to good management.
As it is right now though, we have only a very rough idea of how big the problem truly is and how fast it spreads. This is because testing for the virus has been too slow and too narrow. Testing has been stymied by an array of factors, including design complexities, production difficulties, and poor planning.
This is troubling not only because many of those showing symptoms are denied timely access to tests, but because the virus is believed to have a high rate of asymptomatic carriers. In other words, we really don't know where or how far the virus has spread.
Pushed to expand testing availability and accessibility, there's been a lot of quick and creative problem solving.
The introduction of things like drive-through testing and supermarket testing share the same guiding wisdom, which is to make testing convenient, safe, and fast — for both the testees and testers. These elegantly simple solutions make a big difference in helping us dramatically increase our sample size and by extension our epidemiological insights.
Less simple, but just as elegant are the testing innovations taking place at the scientific level. One great example could be found in the Oxford-designed testing framework capable of rendering diagnoses from RNA analysis alone — obviating the complex and time-consuming step of DNA conversion. We've also seen innovation from startups, like the development of a highly scalable CRISPR based rapid diagnosis system. That's just to give a couple examples.
Of course, it's not only a matter of knowing who has the disease, but of quickly and accurately assessing the severity of the case so that limited resources can be wisely allocated for treatment. For this, some obvious headway can be made even without much additional information. For instance, all else being equal, giving special attention to elderly patients and those pre-existing conditions.
At some point though, to effectively manage and treat the influx of patients, a smarter, better informed and more discriminating process will need to be put to work. Running a full workup on each new admission would be neither feasible nor timely. Instead, a possible path forward is presented by a fast-thinking and resourceful doctor in Italy who is using ultrasound imaging to triage COVID-19 patients.
These are just some examples of the many "quick and dirty" field solutions being devised by those on the front lines of the testing and assessment battle in the war against novel coronavirus. It's not to say that there's not still a lot to overcome and much work to be done, but it does offer a basis for confidence going forward.
Medical Equipment Shortages
Almost by definition, a pandemic will impose extraordinary strains on the healthcare system. Lots of people getting sick in short order — in addition to the normal and ongoing rate of unrelated hospitalizations — means that medical resources, both human and material, are inevitably going to be in short supply.
In the case of COVID-19 specifically, being a member of the SARS family, the virus is characterized by its assault on the human respiratory system. As such, to launch an effective response, healthcare systems all around the world will need to prepare for a rapid influx of patients requiring respiratory assistance. That means that hospitals will need to dramatically increase the number of operable ventilators they have on hand.
Most hospitals don't have nearly enough ventilators to deal with the cases of respiratory complication expected to result from the spread of COVID-19. While efforts are underway and will surely continue to try and source additional machines, in most major metropolitan areas, a wide gap has already begun to emerge between what is needed, what is currently available, and the time it will take to fulfill emergency procurements.
Of course, it's not just ventilators, the demand for medical supplies like masks, scrubs, and sanitizer is also skyrocketing. With respect to those items too, we're seeing incredible developments capable of simultaneously inspiring us and restoring us to a more hopeful outlook.
We've seen spirits distilleries and perfume manufacturers upend their businesses and devote their staff, equipment, and facilities to producing hand sanitizer. We've seen high end fashion brands and sportswear companies rebuild their production lines to quickly turn out tens of thousands of hospital gowns and face masks. We've even seen 3-D printing technology put to good use in accelerating the delivery of badly needed personal protective equipment (PPE) for healthcare workers.
Still, owing to cost, design, and manufacturing complications, the ventilator shortage is clearly the trickiest medical equipment shortage to solve. This predicament lays at the heart of the fear (come reality) that ostensibly treatable cases will prove deadly for lack of effective intervention.
Rest assured though, not only are medical technologists and manufacturers on the case, but so is the wider business community.
The problem is being tackled with great zeal from a variety of different angles:
- There are efforts to produce more of existing designs.
- There are efforts to come up with new designs that can be more straightforwardly and scalably manufactured.
- There are efforts to develop barebones, open-source DIY ventilator kits that can be assembled mostly with parts on hand.
- There are efforts to recalibrate or retrofit other available devices to serve as functional replacements for proper ventilators.
- There are efforts to coax more care capability out of each ventilator.
- And then there are efforts to simply get more players and greater push on the supply side of the equation.
In terms of efforts to produce more of existing designs, beyond the above-cited case of Ford and GE Healthcare working together to ramp up production of Airon Corp's ventilator design, other notable examples include GM's plan to produce Ventec Life Systems' design and Tesla's role in ramping up production of Medtronic models.
It's these efforts and the incredible manufacturing partnerships that have emerged that are likely to deliver the biggest impact. One after another, medical device vendors and automotive manufacturing have been joining forces and combining efforts to get push the needle.
What started as a single team up quickly became a trend and now the medical device industry's meticulously designed machines are being built to order by the auto industry's unrivaled production prowess at a scale previously unimaginable. At least in the US, that trend was helped along by an invocation of the Defense Production Act.
When it comes to efforts to reinvent the ventilator with simpler and more scalable designs — in addition to the great work we referenced above being done by Dyson — we've seen some really smartly stripped down streamlined device designs coming from smaller, scrappier players in the industry as well as from academia.
And while the above-cited example of a makeshift apparatus — consisting of an Ambu bag placed on a pedestal to be rhythmically compressed by a mechanical paddle — is unlikely to go mainstream, provided it receives FDA approval, in a pinch it would at least offer a serviceable lifeline for a patient in need.
In terms of efforts to adapt other available devices to serve the basic functionality of a ventilator, it's not only the example given above of CPAP and BIPAP machines, but anesthesia machines as well.
When it comes to efforts to coax more care capability out of each ventilator, the creative if not highly controversial practice of device splitting, is not the only option. Other innovative approaches revolve around smarter allocation processes — powered alternatively by an inter-state demand database for resource sharing or by more efficient inventory and utilization management.
Many HDOs are also looking at using more surgical maintenance models as a way to enable more continuous device use while exacting less of a toll of performance. Accelerating the sterilization process separating a device's patient assignments can also play a not insignificant role in increasing overall care capacity. One really interesting example of this can be found in the case of the Israeli arms developer that has been enlisted into the fight against COVID-19 and is championing the use of UV-light tech for rapid sterilization.
In terms of efforts to simply get more players involved on the supply side of the equation, nothing has been more surprising or uplifting than when Medtronic publicly shared all the design schematics for its Puritan Bennett 560 (PB 560) ventilator. The move was made in the hopes that putting the information out there would enable other entities with surplus manufacturing capacity to turn out the device. When you consider the fact that this pandemic will likely be behind us in a year's time and that, in taking these steps, Medtronic has taken the wind out of the sails of a high-value product line for the long run, it's hard not to be impressed by the move.
Again, these are just some notable examples of the many incredibly resourceful and important solutions that our healthcare, business, and government leaders are coming up with. The shortage of medical equipment remains a very real problem, but already much less so than it was just one short week ago.
The road through the coronavirus crisis may be bumpy, but there's no question that as a society we'll emerge on the other side in many ways improved.
Treatment & Patient Flow
Even in the best of times, a hospital is a chaotic place. In corona times, that chaos is several orders of magnitude greater. Ultimately, that creates obstacles liable to impede the reliable delivery of quality care. Not only does the HDO need to responsibly attend to COVID-19 patients and issues, but it needs to make sure that its normal operations and routine care continues unabated.
Treating any novel disease is going to be an uphill battle. The fact that COVID-19 is so contagious means that over and above the medical challenge, we're looking at very significant administrative, operational, and logistical challenges. Put simply, making the necessary accommodations for COVID-19 patients will consume a lot of the time and resources needed for the healthcare system's routine (but still essential) operations.
With lives quite literally on the line, this is why you probably keep hearing about the need to "flatten the curve" so that the infected can be effectively cared for without putting a spoke in the wheels of the healthcare system as a whole.
Most smart solutions to complex problems take a layered or multi-lateral approach; which is exactly what the healthcare community is doing. The first step to solving treatment and patient flow problems in the midsts of the coronavirus crisis is freeing up capacity in advance of the rush.
As it happens, the main bottleneck to healthcare capacity is not doctors or medicine, but facilities. Even more granularly, within those facilities, the main bottlenecks are beds and the medical devices required for emergency or intensive care. To preemptively free up capacity therefore, it's imperative that hospitals and clinics find ways to safely get rid of patients who don't need emergency or intensive care. That means moving routine doctor's visits and consultations online, expanding home care and outpatient services, as well as improving remote monitoring capabilities so that patients in recovery can be discharged earlier.
With respect to these goals, we've seen an explosion in the already fast-growing telehealth industry. After the US President authorized an expansion of Medicare to cover telehealth, it fell to state legislatures to deregulate and empower telehealth providers to offer the full range of services typical of in-person physicians. Indeed, telehealth has been widely noted as an essential tool in facilitating the continued care of all those in need — both those suffering from the coronavirus and those unrelated — throughout the pandemic.
Even individuals who believe they may have contracted COVID-19 are being advised to treat telehealth as their first port of call — consulting with medical professionals by phone or video before seeking care outside of the home. This is a key component of the strategy to not only avoid clogging the system, but to prevent exponentially increasing the potential exposure radius. The idea is to keep everyone safe and cared for while only admitting the most critically ill to hospitals. In so doing, the drain on the system's critical care capacity would minimized.
Already, healthcare technology companies like Philips have answered the call and developed closed-loop systems to help hospitals diagnose, monitor, and treat COVID-19 patients at alternative points of care.
After freeing up existing capacity, the second order of business for hospitals looking to remove obstacles to effective COVID-19 treatment is expanding capacity. The main ways that this is being achieved is by opening field hospitals, converting vacant properties into temporary quarantine accommodations or basic care facilities, and in the case of Wuhan, quickly building new hospitals. While these aren't examples of innovation or resourcefulness per se, they are striking examples of industriousness and logistical/managerial excellence.
Once the demands placed on vital care capacity have been minimized and the capacity itself has been expanded, the next logical steps to take will revolve around accelerating patient flow and improving the efficiency of treatment.
Of course, with something like the novel coronavirus that is highly contagious, it's especially important that hospitals also be properly sectioned and that patient flows be controlled to avoid unnecessary contact that could trigger a secondary outbreak. With this type of ward management and process mapping in mind, one New York based hospital recently reached out to CyberMDX for help.
They requested our assistance in hacking additional functionality out of their infusion pumps. They explained that — as an alternative to wasting time and energy continuously putting on, decontaminating, and taking off HAZMAT suits in order to attend to infected patients — they had decided to temporarily move bedside equipment outside of the patients' rooms. When it came to administering medication through infusion pumps though, they found that the additional tubing needed to reach from the patient to the hallway complicated the flow and wasted valuable meds. They wanted us to help them deliberately exploit a vulnerability in their pump's software to enable the device's remote control. If they could do this, they reasoned, they could move the infusion pump back to the bedside while ensuring quality care, minimal exposure risk, and optimal efficiency.
For ethical, legal, and safety reasons we were not able to oblige the request, but it did give us some first-hand insight to the very sophisticated and outside-of-the-box thinking with which problems to do with COVID-19 treatment were being approached. Even though we weren't able to help with this request, we left the interaction thoroughly impressed with and inspired by the thoughtfulness, intelligence, creativity, and devotion with which these challenges are being tackled.
Of course, no review of the challenges to do with treating COVID-19 would be complete without mentioning the treatment itself. Here too we can find resourcefulness and good news. After all, what's more resourceful than repurposing an existing toolset to meet a new challenge! From Remdesivir to Favipiravir, Kaletra to Actemra, Interferon alfa-2b to Leronlimab, to Azithromycin and (Hydroxy)chloroquine, there's reason to believe that existing drugs or a combination of existing drugs may prove effective in treating the virus. At the same time, there's plenty of pre-clinical research currently underway with the goal of developing novel treatments for COVID-19.
Interestingly, many countries have initiated hyperimmune globulin, or "passive immunity" treatment programs. These treatments are built around plasma donations from recovered COVID-19 patients; the idea being that the plasma of recovered patients will be imbued with antibodies developed in response to the virus and that successfully fought it off. This type of treatment can be seen as the precursor to effective drug development. Examining the blood and plasma of recovered COVID-19 patients, researchers can examine B cells looking for the most effective antibodies. Once identified, those antibodies can be produced at scale in laboratory environments and be made more widely available for use in treatment.
Of course, there are challenges beyond those of testing & assessment, medical supply shortages, treatment, and patient flow. Some of the biggest things that come to mind are the challenges to do with working and living in isolation and what all of this means for our individual and collective financial fortunes. In these areas too, while there is abundant cause for concern, there is also ample good news..
In an effort to improved remote productivity and comfort, big tech companies like Microsoft, Google, and Zoom have made their products available to wider public free of charge. Facebook also announced a series of guaranteed bonuses to help its workers through this difficult period.
For its part, and to the relief of parents everywhere, Amazon has made a point of removing paywalls around its kid-friendly streamable content.Many gaming companies have made their properties free to play for the duration of the crisis. And so many EdTech companies have offered free programs that UNESCO has felt is necessary to put together a directory.
At the same time, despite the larger economic uncertainty, big retailers that have seen their revenues spike due to the panic buying that's resulted from the coronavirus crisis have rolled out plans for expanding their workforces and improving their employee benefits.
And beyond the countless private and corporate donations being made and volunteer forces being mobilized are significant financial relief program being rolled out by governments.
Through it all, one thing is abundantly clear: the human spirit is indefatigable and we are much much stronger than SARS-CoV-2. We've never been better positioned to deal with such a monumental threat and we've probably never done as admirable a job as we're doing now.
They say "necessity is the mother of invention" and so far that refrain has proven prescient in the face of the 21st Century's first major global pandemic. There's little reason to think that it won't continue to be the case as we bear down. If I were a betting man, I'd put my money on the power of the human spirit and human ingenuity to persevere.
In the space of this article, I've tried to bring to your attention just some of the many available example of truly inspiring acts of resourcefulness in the face of COVID-19. All things considered, there's plenty of reason to be hopeful.