You should have an advance directive

‘It’s hard to talk about end-of-life care. You should do it anyway...On this episode of Social Distance, James Hamblin and Katherine Wells talk with Edo Banach, the president and CEO of the National Hospice and Palliative Care Organization. They discuss how to create an advance directive and how to broach the topic in conversations with loved ones.’

Read here (The Atlantic, May 14, 2020)

Covid-19: A doctor’s concerns

‘The challenge for the public will be adhering to guidelines like social distancing, hand washing, cleansing and face masks in public. We have to learn to internalise such behaviour (an example will be the brushing of teeth) so that the need for monitoring and surveillance is minimised...

‘Another concern is the lack of public consultation. Like what happens with our annual haze (who knows, we may, thanks to Covid-19 and the movement control order escape the haze this year!), the voices of the public are not being solicited by the authorities. We see this happening at federal, state and local council levels. Why this “us” vs “them” mindset which pervades our country?’

Dato’ Seri Dr T Devaraj is a retired physician who has been involved in hospice work for many years.

Read here (Aliran, May 12, 2020)

‘The past six weeks have been unlike anything I’ve known’: A GP on how the pandemic has changed his work

‘It’s clear that though the lockdown has slashed transmission, it is provoking a silent epidemic of despair. Panic attacks, sleeplessness and plunging moods are all difficulties GPs are encountering daily – tough conversations to have at the best of times, but even tougher on the phone. Within our area of the city, we already know of suicides triggered by bankruptcies and business closures; and of marriages breaking down. Alcohol-induced injuries are up, as are injuries from assaults.’

Read here (The Guardian, May 12, 2020)

Study warns 1.1 million children, 56,000 mothers, could die as pandemic interrupts access to food & medical care

A new report finds 1.1 million children under 5 could die, and 56,700 maternal deaths occur, in the next six months from secondary impacts of the pandemic, like disruptions to health services and access to food... ‘Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1,157,000 additional child deaths and 56,700 additional maternal deaths.’

Read here (The Lancet, May 12, 2020)

How the novel coronavirus attacks our entire body

‘Of course, the lungs and airways are the main focus of attention with the COVID-19 respiratory disease. Since the new SARS-CoV-2 pathogen mainly attacks the lower respiratory tract, infected persons who experience a moderate or severe course of the disease have a dry cough, shortness of breath and/or pneumonia. However, there are now numerous indications that the new coronavirus also attacks other organs on a massive scale and can severely affect the heart, blood vessels, nerves, brain, kidneys and skin.’

Read here (DW, May 11, 2020)

Access to lifesaving medical resources for African countries: COVID-19 testing and response, ethics, and politics

‘Having navigated Ebola, HIV, and tuberculosis epidemics, and a range of annual, sporadic, and concurrent outbreaks, several African countries have unparalleled disease response capacity. African governments are offering rare examples of effective international cooperation on COVID-19. The African Union started early to strengthen response with readiness assessments, an emergency ministerial meeting, and a continental strategy. However, with a highly transmissible and fast spreading virus these strengths can quickly be overwhelmed.’

Read here (The Lancet, May 7, 2020)

Guides to the other side: The problem-solvers working to get us through the pandemic

‘They are immigrants and the children of immigrants, public servants, people on their second careers. They are planners and problem-solvers. What they lack in swagger they make up for in empathy, skill and statistical rigor. Their greatest power is their ability to learn from the mistakes of the past. They are the right people in the right place at the right moment, like physician-researcher Andre Kalil, a veteran of past epidemics trying to find a cure for this pandemic, and Anar Yukhayev, a New York obstetrician-gynecologist who was severely ill with covid-19 when he enrolled in a clinical trial for an untested treatment. “If there was any chance it could potentially help someone,” Yukhayev said, “it was the least I could do.”

‘They don’t offer easy answers or miracle cures; they know there is no resurrecting the lives they once had. Still, they’re giving what they can to a moment that demands it. When it is most difficult to imagine the world getting better, they’ve summoned the creativity — and the courage — to invent the world anew.’

Read here (Washington Post, May 7, 2020)

National action plan for expanding and adapting the healthcare system for the duration of the Covid pandemic

This 24-page report by the Johns Hopkins Center for Health Security offers answers and recommendations related to the following problems, for which there are tractable solutions:

• How can we improve infection prevention in hospitals and maintain a robust supply chain for personal protective equipment (PPE)?
• What approach should we take to restarting deferred healthcare services?
• What financial support is needed for hospitals and healthcare providers?
• How should the healthcare workforce be sustained and augmented?
• How can we provide mental health support for healthcare workers in this crisis?
• How can we provide medical care and sick leave for all people in the United States?
• How can we make telemedicine a new normal?
• How can we reduce the number of undiagnosed infectious diseases in our hospitals?
• How can we better protect emergency medical services (EMS) personnel from infectious diseases?
• How can we better coordinate the healthcare response to COVID and the next pandemic?

Read and download here (Johns Hopkins Center for Health Security, May 5, 2020)

Historic financial decline hits doctors, dentists and hospitals — despite covid-19 — threatening overall economy

‘Most elective surgeries nationwide were postponed beginning in mid-March. Dentists offices were closed. Physicians stopped seeing all but the sickest patients in their offices. Stay-at-home orders didn’t just prevent people from dining in restaurants — they led people to avoid medical services, too, amid concerns about the disease the virus causes, covid-19. More than 200 hospitals, including Children’s National Hospital in Washington, have furloughed workers, according to a tally by Becker’s Hospital Review.’

Read here (Washington Post, May 4, 2020)

Covid-19 and the harsh reality of empathy distribution

‘Empathy has a substantial genetic contribution, about half as much as height, a group of researchers found in 2018. Inevitably, some individuals inherit more pro-empathy genes than average. Moreover, since they are likely to be born from empathic parents, such children will also witness empathic behaviors and be rewarded for performing them. Thus, learning and family values reinforce the pro-social neural circuitry. Such individuals are likely to become professional caregivers.’

Read here (Scientific American, May 2, 2020)

The rise of ‘health entertainment’ to convey lifesaving messages in the Covid-19 pandemic

‘An unprecedented global crisis demands unprecedented creativity in the health communication field. The world’s most trusted voices in public health urgently need to be heard by meeting their audiences on social media and capturing their attention through innovative message design. We’ll never come up with impactful, innovative solutions if we stay inside our comfort zone.’

Read here (Scientific American, May 1, 2020)

Long-term care industry calls for expanded testing and funding for nursing homes and assisted-living communities

‘The American Health Care Association and National Center for Assisted Living (AHCA/NCAL), representing more than 14,000 nursing homes, assisted living communities and other long term care facilities across the country that provide care to approximately five million people each year, today called on state and federal government agencies to provide expanded and priority testing for nursing homes and assisted living communities and emergency funding to help the profession respond to the deadly outbreak of COVID-19 in long term care facilities across the country.

‘Despite recent data and reports showing the outsized impact of the novel coronavirus on long term care residents, particularly those with underlying health conditions, industry leaders say nursing homes and assisted living communities have not been a priority for supplies, testing or resources.’

Read here (AHCA, April 29, 2020)

Invest in the overlooked and unsung: Build sustainable people-centred long-term care in the wake of COVID-19

‘This pandemic has shone a spotlight on the overlooked and undervalued corners of our society. Across the European Region, long-term care has often been notoriously neglected. But it should not be this way. Looking to the future, transitioning to a new normal, we have a clear investment case for setting up integrated, person-centred long-term care systems in each country.

‘We have inherited the European rights, values and opportunities that define us from the generations that came before – so we must care for them. It is our duty to leave no-one behind. We must step up. So what must we do? (1) Empower care workers (2) Change how long-term care facilities operate and (3) Build systems that prioritise people’s needs.’

This is a press statement by Dr Hans Henri P Kluge, WHO Regional Director for Europe.

Read here (WHO, April 23, 2020)

Potential to develop a more effective cloth mask with finer weave, more layers and a better fit

This study, which compares the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs), says the following: ‘Cloth masks are used in resource-poor settings because of the reduced cost of a reusable option. Various types of cloth masks (made of cotton, gauze and other fibres) have been tested in vitro in the past and show lower filtration capacity compared with disposable masks.

‘The protection afforded by gauze masks increases with the fineness of the cloth and the number of layers, indicating potential to develop a more effective cloth mask, for example, with finer weave, more layers and a better fit.

‘Pandemics and emerging infections are more likely to arise in low-income or middle-income settings than in wealthy countries. In the interests of global public health, adequate attention should be paid to cloth mask use in such settings. The data from this study provide some reassurance about medical masks, and are the first data to show potential clinical efficacy of medical masks.’

Read here (NCBI, April 22, 2015)

We should applaud the Cuban health system — and learn from it

‘Like most of the world, Cuba is now grappling with coronavirus. As of April 20, there were 1,137 confirmed cases, with 38 deaths. But Cuba’s free and universal health care system, including a robust cadre of health professionals, puts the island in a better position to deal with this crisis than most countries. With its intense focus on training health professionals, Cuba has the highest density of physicians in the world. Its ratio of medical professionals to patients is roughly three times higher than in the United States.’

Read here (Jacobin, April 22, 2020)

Ensuring safe environment for primary healthcare settings — Dr Amar-Singh HSS, Dr Lee Chee Wan, Dr Paranthaman and Dr Timothy William

‘This guideline is written to offer ideas to general practitioners (GP) and those working in out-patient clinic settings (OPD) on what precautionary measures to take to curb the spread of Covid-19 disease and protect themselves when the relevant government authorities ease our lockdown.

‘It may also be useful for other clinic settings like speciality clinics, antenatal clinics, dental clinics, etc. We are sharing it to the general public as it may be useful for patients and the community to think though some of these issues.’

Read here (The Malay Mail, April 15, 2020)

Google provides info on community mobility in response to Covid-19

‘As global communities respond to COVID-19, we’ve heard from public health officials that the same type of aggregated, anonymised insights we use in products such as Google Maps could be helpful as they make critical decisions to combat COVID-19.

‘These Community Mobility Reports aim to provide insights into what has changed in response to policies aimed at combating COVID-19. The reports chart movement trends over time by geography, across different categories of places such as retail and recreation, groceries and pharmacies, parks, transit stations, workplaces, and residential.’

Read here (Google, constantly updated)

Intermittent social distancing may be needed through 2022 to manage Covid-19

‘On-and-off periods of social distancing will likely be needed into 2022 to ensure that hospitals have enough capacity for future Covid-19 patients in need of critical care, according to a new modeling study from researchers at Harvard TH Chan School of Public Health.

‘The research, published April 14, 2020 in the journal Science, predicted several scenarios for how the coronavirus might spread over the next five years, taking into account factors such as whether or not the virus will exhibit seasonality, whether people who are infected go on to develop short-term or long-term immunity, and whether people would get any cross-protective immunity from having been infected with other types of coronaviruses that cause common colds.’

Read here (Harvard School of Public Health, April 14, 2020)

Health insecurity and its impact on refugees in Malaysia

Refugees and asylum seekers in Malaysia have always struggled with a lack of identification and healthcare. How have these issues impacted the Government’s response to Covid-19? What are some of the challenges that will still need to be addressed beyond the MCO?

Read here (ISIS Malaysia, April 10, 2020)

Stanford University epidemiologist John Ioannidis calls out media for panicking the public over COVID-19, reasons that ‘flattening the curve’ may make things worse for overall health system

‘Flattening the curve to avoid overwhelming the health system is conceptually sound—in theory,’ he wrote in a paper in March. ‘A visual that has become viral in media and social media shows how flattening the curve reduces the volume of the epidemic that is above the threshold of what the health system can handle at any moment. Yet if the health system does become overwhelmed, the majority of the extra deaths may not be due to coronavirus but to other common diseases and conditions such as heart attacks, strokes, trauma, bleeding, and the like that are not adequately treated,’ he continued. ‘If the level of the epidemic does overwhelm the health system and extreme measures have only modest effectiveness, then flattening the curve may make things worse… Instead of being overwhelmed during a short, acute phase, the health system will remain overwhelmed for a more protracted period. That’s another reason we need data about the exact level of the epidemic activity.’

Read here (Straight, April 10, 2020)