Pandemic modelers providing new COVID-19 insights

As a Yale University postdoctoral researcher, economist Jude Bayham studied the potential consequences of a global pandemic that could shutter schools, close businesses, and strain hospitals. That was back in 2013.

Now, as the world grapples with the coronavirus, the Colorado State University economist and a multi-institutional team are turning those prescient modeling exercises into real insights for policymakers.
“We’re repurposing models we had done a while back that frankly at the time, people didn’t really care about,” said Bayham, assistant professor in the Department of Agricultural and Resource Economics. “It’s an ‘I told you so’ moment. I’m not happy about it. It’s unfortunate.”
In the last several weeks, Bayham and Yale collaborator Eli Fenichel have run a series of analyses illustrating the toll that long-term school closures may have on U.S. health care providers. They’re now fielding inquiries from all over the world, from state governments to child care needs assessment professionals, who think the economists’ work could help them navigate the here and now. In the last two weeks, the researchers created an interactive dashboard for drilling down statistics on child care needs by state, city and industry sector. Their data were published in The Lancet Public Health April 3.
Bayham and Fenichel have also created another dashboard for viewing COVID-19 complication risk factors in the workforce.
A third of health workers care for young children
For their health care worker analysis, the researchers used data from the U.S. Current Population Survey to show that about a third of health care workers—doctors, nurses, hospital staff—care for children ages 3-12. Fifteen percent of those households don’t have other adults or older children who can help with child care.
At the time they did their original analysis, a long-term school closure was a far-off hypothetical. Now, as school districts nationwide shutter for weeks or months, Bayham’s work of yore takes on new significance, and the team is scrambling to update it with current figures.
School closures are intended to slow the transmission of the virus. But Bayham and Fenichel find that the toll school closures take on health care workers could potentially negate any mortality benefits from the closures. Their calculations indicate that if the health care workforce declines by 15 percent, due to the workers now having to care for their children, it could lead to an increase in coronavirus deaths, because the workers aren’t there to care for sick people. Specifically, they report that assuming a 15 percent loss of the health care labor force, a coronavirus infection mortality rate increase of just 0.35 percentage points would net a greater number of deaths than would be prevented by the closures.
These calculations are just that—calculations, which don’t take into account, for example, the potential rollout of state or federal programs to offer child care relief to workers. And the estimates aren’t perfect; the researchers don’t claim to know, down to a precise number, what one health care worker’s absence portends.
“We don’t know, in terms of a productivity measure, the estimate of one nurse saving this many lives or reducing mortality,” Bayham said. “But we think it’s not zero. So essentially we are getting at how productive they need to be for us to be concerned about how school closures would undermine the goal of saving lives.”
The work is a sobering reminder of the societal and public-health tradeoffs of large-scale disruptions like long-term school closures.
Forming networks
As the pandemic continues to unfold, Bayham and colleagues at Yale, Northwestern University and other institutions have quickly formed a network of economists and epidemiologists to continue this and other lines of work. They hope to help inform decisionmakers on questions not only of tradeoffs of school closures, but also, strategies for peeling back such restrictive measures when the time is right.
As researchers all over the world converge their expertise around the pandemic, Bayham and colleagues are also jumping into other projects to help. For example, Bayham is serving on a U.S. Forest Service task force that will examine potential outcomes of coronavirus on firefighters as fire season returns.
And along with department colleagues Becca Jablonski and Dawn Thilmany, Rebecca Clary, Rebecca Hill and Alexandra Hill, he is also serving on a Colorado Department of Agriculture-focused task force looking at effects of social distancing measures on food supply chain issues. CSU’s vice president for engagement and extension, Blake Naughton, established the CSU Task Force on Colorado Food Supply to conduct research on several key areas: food access and security; designating food retail establishments as “essential services;” food supply chain workforce readiness; and consumer expenditure and farm market access.

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More information: Link to interactive dashboard with child care needs by state: covid.yale.edu/resources/childcare/Link to interactive dashboard with COVID-19 complication risk factors: foodsystems.colostate.edu/covi … ty-labor-force-risk/ Jude Bayham et al, Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study, The Lancet Public Health (2020). DOI: 10.1016/S2468-2667(20)30082-7
https://medicalxpress.com/news/2020-04-what-if-scenarios-real-pandemic-covid-.html

Scripps researchers may have found coronavirus’ Achilles heel

There may be some good news on the coronavirus horizon, as Scripps Research reported it may have found COVID-19’s Achilles heel.
The research shows a specific area of the virus could be “targeted with drugs and other therapies, a finding that also could help with the development of a vaccine,” according to the San Diego Tribune.
The targeted area, according to biologist Ian Wilson, who led the scientific team, “is crucial to spreading the highly contagious virus, and … its composition suggests that it would be vulnerable to drugs.”
The discovery was published Friday in the journal Science and comes as scientists globally are working feverishly to find a vaccine or cure for the pandemic that has devastated global markets and caused more than 63,000 deaths worldwide.
An antibody taken from a SARS patient years earlier was used in the discovery, as researchers realized it had attached itself to a specific part of the virus, and were able to repeat the phenomenon with COVID-19, helping to identify a coronavirus weakness, according to the report.
“That high degree of similarity implies that the site has an important function that would be lost if it mutated significantly,” Scripps Research said in a statement Friday.
Sadly, the weak spot isn’t easy to find.
“We found that this (spot) is usually hidden inside the virus, and only exposed when that part of the virus changes its structure, as it would in natural infection,” Wilson’s colleague, Meng Yuan, said in a statement.
The institute is seeking the public’s help and is looking for COVID-19 survivors who would be willing to donate some of their blood, which would then be screened for potentially useful antibodies.
https://nypost.com/2020/04/04/researchers-may-have-found-coronavirus-achilles-heel/

4 Things to Know About Funerals and Costs During the Coronavirus Crisis

Funeral planning and funeral services have been complicated by the coronavirus pandemic, adding stress at a time when many who are grieving are also struggling with their finances and an uncertain future.

While funeral homes have adopted guidelines from health-care professionals and officials to keep themselves and grieving families and friends safe during the pandemic, consumers should expect a number of changes and be aware of their rights.
“It’s certainly affecting the way people make their decisions on what they’re going to do and how they’re going to memorialize their loved one,” says Jeffrey Wages, president at Wages & Sons Funeral Homes & Crematories in Lawrenceville, Ga.

Health Considerations

The Centers for Disease Control and Prevention, in recently issued guidelines, says that a funeral or visitation service can be held for a person who has died of the virus, but people should consider not touching the body, and activities such as kissing, washing, and shrouding should be avoided. The rules also suggest that anyone who may be infected or who is experiencing a fever, cough or other symptoms of Covid-19 not attend services.

Embalming can be conducted and burials or cremations can take place in line with any state or local requirements on handling remains of those who have died of certain infectious diseases, the CDC says. Open-casket funerals are still permitted.

Crowd Limits

In addition to CDC health guidelines, many states have issued their own recommendations on crowd sizes. The New York State Department of Health, for example, has recommended that gatherings, including wakes and memorial services, be limited to no more than 50% of the maximum capacity of the funeral home or to 50 individuals, whichever is lower.
The White House, meanwhile, has issued guidelines that people should avoid social gatherings of more than 10 people through the end of April.
To keep gatherings small, many funeral homes are webcasting or livestreaming services for those who cannot attend. Others are rotating small groups of mourners into the home. Some are presenting family members with video recordings of services that they can share with others.

“Maybe a state only allows 10 guests, but with webcasting and Facebook Live, we can broadcast that service so more people can attend,” says Douglas “Dutch” Nie, president of Nie Family Funeral Home and Cremation Service in Ann Arbor, Mich. “We have people at the door so guests don’t need to touch the doorknobs, and we do a lot of wiping down between guests.”
The National Funeral Directors Association, where Nie is spokesman, has information on how to handle visitations and funerals during the crisis on its website.

Delaying Services

Some families are holding burials or cremation services with only immediate family members, then planning a memorial service for a later date, such as the deceased’s birthday. Nie, for instance, says he has several such memorial services planned for later in the year, the latest one set for August.
In some cases, embalmed bodies can be held in climate-controlled rooms until a traditional burial may be held. Wieting Family Funeral Home in Chilton, Wisc., is now holding some embalmed bodies so that family members can have the type of services they want later in the year, says funeral director Jamie Wieting. She isn’t certain how long the bodies can be held, but in the past, the home has held bodies for as long as three months after death before burial, she says.

Remain Vigilant on Costs

The “Funeral Rule,” which is enforced by the Federal Trade Commission, gives consumers the right to buy only the goods and services that they want, and consumers shouldn’t allow themselves to be coerced into buying a package that they don’t want, says Patti Poss, a senior attorney with the FTC’s Bureau of Consumer Protection. In addition, the rule ensures their right to buy separate items, like caskets or urns, and services, such as embalming, from a third party and bring them to the funeral home.
Consumers also have the right to obtain pricing information on funeral goods and services over the telephone. The FTC offers a guide on shopping for funeral services on its website, which includes a checklist of funeral goods and services for which consumers may want to compare costs.

The Funeral Consumers Alliance, a nonprofit group that monitors the funeral industry, offers information on shopping around for a funeral, one’s legal rights when planning a funeral and planning a funeral during the pandemic on its website.
“If we need to work with people on price, we’re going to do that,” says Adam Martin, president of Martin Funeral, Cremation & Tribute Services, which operates several funeral homes in mid-Michigan.

One final warning: While Poss said she isn’t aware of any funeral-related scams targeting families affected by the coronavirus, it pays to be on guard because scammers often try to take advantage of disasters like the pandemic.
https://www.barrons.com/articles/four-things-to-know-about-funerals-and-costs-during-the-coronavirus-crisis-51586005202

Hospital Admits Surge, Ventilator Making Ramps, but Not Soon Enough

Intensified manufacturing efforts aren’t moving fast enough to meet the rising U.S. need for ventilators that can keep critical coronavirus patients breathing, hospital and medical-device company officials say.
A frantic global effort is under way to manufacture more of the breathing machines. Traditional ventilator makers including Medtronic PLC and Hamilton Medical AG are more than doubling their weekly output. New entrants Ford Motor Co. and General Motors Co. have promised a few thousand ventilators as early as this month before sharply ramping up manufacturing.
The federal government has also taken steps to find and distribute ventilators, shipping ventilators from its strategic stockpile and the Federal Emergency Management Agency.
Yet the reinforcements aren’t likely to arrive soon enough and in sufficient numbers for U.S. hospitals confronting a surge of cases or gearing up for the next wave, hospital and medical-device industry officials say.
Hospitals in the U.S., which have about 60,000 ventilators on hand, will be about 25,000 short of what they need when the surge in coronavirus patients peaks around the middle of this month, estimated Neil Carpenter, who consults for hospitals at Array Advisors.
“I really need them now,” said Chris Van Gorder, chief executive of Scripps Health, which operates five hospitals in San Diego County, Calif.
Scripps placed a roughly $1 million order for 30 ventilators in early March, Mr. Van Gorder said. Yet delivery is scheduled in eight to 10 weeks, which is likely too late, Mr. Van Gorder said. Without the new orders, doctors are preparing to use one ventilator for two patients.
Scripps also hopes to secure more ventilators from San Diego County, which placed its own order. The county hasn’t yet received a delivery date, according to its procurement office.
Hospitals outside the U.S. are also struggling with an insufficient number of ventilators on hand and being delivered.
Ventilators, complicated machines often the size of a desktop printer, have emerged as a crucial weapon in hospital coronavirus treatment. They are used to aid critically ill coronavirus patients, whose infections have all but overwhelmed their lungs and choked off breathing. Many don’t survive even after being hooked up to one.
Hospitals, which typically use the devices on premature babies and pneumonia patients, didn’t have enough of the machines to cope with the influx of coronavirus patients. As their demand jumped, facilities said they searched frantically for ventilators to fill mounting needs.
Northwell Health, in New York City and the surrounding region, is converting up to roughly 270 anesthesia machines and outfitting about 350 other devices with 3-D printed parts so they can function as ventilators, a spokesman said. It is waiting on an order for more than 500 ventilators placed weeks ago to be totally fulfilled, said Phyllis McCready, who oversees the health system’s supply chain.
On Friday, New York Gov. Andrew Cuomo signed an executive order allowing the National Guard to take ventilators from hospitals in areas of the state that don’t have a lot of cases, and redistribute to hospitals in need.
Manufacturers are ratcheting up production. Yet companies say it takes time to move employees around, add production lines and arrange a supply chain for the hundreds of components in each machine.
Altogether, medical-device manufacturers are making on average 2,000 to 3,000 ventilators per week, compared with 700 per week before the crisis, said the Advanced Medical Technology Association industry group. It expects production to increase to 5,000 to 7,000 ventilators a week in the coming weeks.
“We could double or triple capacity and still not be able to meet global demand,” said Eric Honroth, head of North America for Getinge AB, a Sweden-based maker of ventilators that is moving to increase production by 60% to make 16,000 ventilators this year.
General Motors is working with ventilator maker Ventec Life Systems to make 10,000 machines a month, and possibly up to 20,000, but it would take till late spring or summer to reach full capacity.
General Electric recruited about 100 current employees and retirees in the region to raise production at its Madison, Wis., plant. It has been training the new plant workers before giving them jobs like quality inspection, material handling or filling a spot on the manufacturing line.
Medtronic, which is transferring employees from a pacemaker plant to its nearby ventilator factory in Galway, Ireland, plans to double production by the end of this month and make an estimated 30,000 ventilators in the next six months, said Bob White, head of the company’s minimally invasive therapies unit.
The company also took the unusual step of sharing online the designs for one of its ventilator models, so other companies could make the model. By Thursday, the designs had been downloaded more than 84,000 times, a spokeswoman said, though the company wasn’t aware of any firm plans by others to make the machines.
Florida-based hospital operator AdventHealth, which projects the pandemic will peak across its markets in starting in May, is exploring whether it would be able to get excess ventilators from hospitals after they have passed their peak needs, officials at the operator said. Meantime, it struck deals Thursday with three ventilator manufacturers who pledge to deliver equipment starting this month and into May, said Marisa Farabaugh, the system’s supply chain chief.
https://www.marketscreener.com/MEDTRONIC-PLC-20661655/news/Medtronic-As-Coronavirus-Hospitalizations-Surge-Ventilator-Manufacturing-Ramps-Up-but-Not-Soon-En-30316546/

Telehealth, retail clinic use up in turn to lower-priced medical delivery sites

• Consumer use of telehealth and retail clinics spiked from 2017 to 2018, while use of urgent care centers, ambulatory surgery centers and emergency rooms dropped as consumers increasingly turn to cheaper sites of care for low-acuity medical needs.
• Telehealth use grew 12% and retail clinic use grew 10% during the time period, according to a new report from health cost nonprofit FAIR Health. At the same time, urgent care center use fell 11%, ambulatory surgery center use fell 12% and ER use fell 15%.
• However, despite increased use of telehealth and retail clinics, use of all five places of health service has slowed overall. Retail clinics and virtual care saw growth from 2013 to 2018, but at a much slower rate compared to 2012 to 2017, FAIR Health found. Similarly, for urgent care centers, ambulatory surgery centers and ERs, growth in 2009 to 2018 was at a much slower rate than 2008 to 2017.

The report is the latest in a pile of research finding consumers are pivoting to less expensive medical delivery sites for non-urgent needs as healthcare costs continue to skyrocket in the U.S.
The need for cheaper and more easily accessible front doors to healthcare has been highlighted by the ongoing coronavirus outbreak, with virtual care in particular trumpeted as a means to ameliorate stress on doctor’s offices and health systems.
The Trump administration has scaled back regulations on telehealth use, including allowing traditional Medicare to cover virtual care visits over the phone or video using common methods like Skype or Facetime and urging states to roll back licensing restrictions on out-of-state physicians.
As a result, telemedicine vendors have seen utilization of their platforms skyrocket over the past few weeks.
The benefits of telehealth may be compounded in rural areas, where residents could be dozens of miles away from the closest doctor or hospital.
However, FAIR Health found retail clinics and telehealth both saw higher utilization in urban areas from 2017 to 2018, but that was offset by a small decrease in use in rural areas. Last year’s report found American’s use of telehealth jumped more than 50% between 2016 and 2017, outpacing the growth of all other sites.
Increased utilization of telehealth and retail clinics has the potential to lower healthcare costs on individual patients and the system as a whole. Retail clinic use overall grew by 10% from 2017 to 2018, mostly in northern states like Minnesota, Montana, New Jersey and Delaware, while virtual care usage bumped 12% in that year.
Urgent care use decreased 11%, ambulatory surgery center use fell 12%, and ER use dropped 15% from 2017 to 2018.
However, ERs accounted for more than 2% of all medical claims in 2017 and 2018, FAIR Health found. Urgent care centers accounted for more than 1% of all medical claims and retail clinics accounted for less than 0.1%, illustrating consumers selecting retail and telehealth options when they have a choice, but emergency needs will still result in a costlier visit to the ER or urgent care.
The report is based on an analysis of a database of more than 30 billion privately billed medical claims.
https://www.healthcaredive.com/news/telehealth-retail-clinic-use-increasing-in-pivot-toward-lower-priced-medic/575226/

Amgen teams up with Adaptive Bio to both treat and prevent COVID-19

After The Wall Street Journal first broke the news this week, Amgen and new partner Adaptive Biotechnologies have confirmed they are the latest pharma-biotech duo joining forces against the pandemic.
The pair, which said it will “start work immediately,” will develop fully human neutralizing antibodies targeting the COVID-19-causing virus, SARS-CoV-2, to potentially prevent or treat the disease currently infecting a million people around the globe and showing little sign of slowing down, especially in Europe and the U.S.
The collab sees the pair tap into Adaptive’s immune medicine platform to seek out virus-neutralizing antibodies and work this alongside Amgen’s expertise in immunology and antibody therapy development.

In an unusual move (but not unusual in these weird times), both said they would “finalize financial details and terms in the coming weeks” and hadn’t as yet, given the speedy nature of the tie-up.
They join the growing list of pharmas and biotechs working on treatments and vaccines for the disease. Research has ramped up massively in the past month and covers everything from repurposed antivirals to RNAi tech and using antibodies from those who have recovered to fight new treatments. It’s the latter approach Amgen and Adaptive will be going after.

In a statement, the pair explained that neutralizing antibodies defend healthy cells by interfering with the biological function of an invading virus. “These antibodies may be used therapeutically to treat someone currently fighting the disease and can be given to people who have heightened risk of exposure to SARS-CoV-2, such as healthcare workers,” the companies added.
Drilling down into the details of the pact, Adaptive will ramp up use of its high-throughput platform to “rapidly screen” the massive genetic diversity of the B-cell receptors from those that have recovered from COVID-19. This will help them quickly find antibodies they can select to neutralize SARS-CoV-2.
Then, in steps, Amgen will use its antibody engineering and drug development tech to select, develop and manufacture antibodies designed to bind to and neutralize SARS-CoV-2. Meanwhile, deCODE Genetics, an Amgen subsidiary, will provide genetic insights from patients who were previously infected with COVID-19. It’s an unusual move for Amgen, which is better known for its work in cancer.
“Working with Adaptive and using their viral-neutralizing antibody platform will expedite our ability to bring a promising new medicine into clinical trials as quickly as possible,” said Robert Bradway, chairman and chief at Amgen.
“We are extremely motivated to join forces with our trusted partner, Amgen, to tackle this global health crisis,” added Chad Robins, CEO and co-founder of Adaptive Biotechnologies. “This partnership expands our drug discovery capabilities, demonstrating the power and versatility of our immune medicine platform.”
https://www.fiercebiotech.com/biotech/amgen-teams-up-adaptive-to-both-treat-and-prevent-covid-19

Companies roll out remote COVID-19 monitoring tools to free up hospital space

Late last month, the FDA began giving developers of remote patient monitoring devices some extra leeway when it comes to making marketing claims, allowing them to pitch their use to hospitals responding to the COVID-19 crisis.

The ultimate goal is to move as many patients as possible out of the clinic that don’t need immediate, critical care. For example, a person who tested positive for the novel coronavirus but has only mild symptoms could stay at home and have their temperature, respiration and heart rates tracked wirelessly for signs of progression.

Now, LifeSignals announced that it is fast-tracking its single-use biosensor patch for COVID-19 patient monitoring. Self-affixed on the chest for five days, the showerproof device records a person’s vital signs, movement and the heart’s electrical activity with a two-channel ECG.

If stronger symptoms develop, the device and its data platform can alert healthcare workers to take additional action, while cumulative vital sign data could be used to identify geographical COVID-19 hot spots.

The company also plans to roll out an updated version of the patch that includes blood oxygen saturation tracking, slated for this June, for monitoring patients recovering in intensive care units and clearing them to be moved to other wards or off-site.

“As soon as the serious nature of the COVID-19 outbreak became apparent, we started investigating where our wireless biosensor technology could help,” said LifeSignals co-founder and CEO Surendar Magar. “We identified two key areas where healthcare systems are choked—consumers calling in about symptoms they are experiencing and lack of critical care hospital beds—and have designed these two biosensor patches which are suited for mass production.”

LifeSignals aims to move 1 million units in the next few months, Magar told FierceMedTech, under a mass-market oriented business model targeting a variety of service providers.

Elsewhere, former FierceMedTech Fierce 15 winner Spry Health launched a clinician-led monitoring service employing its previously FDA-cleared Loop wearable. The wrist-worn device remotely tracks heart rates, pulse oximetry and breathing.

“After talking to dozens of healthcare leaders over the past few weeks, it is clear many organizations are nearing their maximum capacity due to the large influx of patients showing up to emergency departments, often without meeting the necessary criteria for testing set by the CDC,” said Pierre-Jean Cobut, Spry’s co-founder and CEO.

“Clinicians can focus on the patients that need critical care, while we help monitor high-risk populations and intervene in advance of an emergency when early signs of deterioration are detected,” Cobut added. “The last thing we need now is to continue to flood the ED with avoidable visits, and possibly increase exposure to COVID-19, when care can be delivered remotely in the patient’s home.”

Patients with deteriorating symptoms will be contacted by telephone, treated remotely if possible or directed to the appropriate level of local care, the company said.

Other companies, such as UTM:Healthcare, have begun incorporating Bluetooth-enabled thermometers into the use of smartphone apps to keep people in touch with their doctors.

Meanwhile, ObvioHealth launched a virtual COVID-19 patient registry to track symptoms and immune responses across the general population.

The study will follow individuals for six months, detailing medical histories and risk factors associated with the infection and daily developments in order to provide insights for global health policy. The project includes plans to ship fingerstick blood tests to assess antibody and immune responses once they become available in the U.S., the company said.

https://www.fiercebiotech.com/medtech/companies-roll-out-remote-covid-19-monitoring-tools-to-free-up-hospital-space