From Stat

This Is Supposed to Be Telemedicine’s Time to Shine. Why Are Doctors Abandoning It?

June 25, 2020

Telemedicine — the delivery of care by a clinician in one location to a patient in another — is seen as a vital component of the nation’s response to the Covid-19 pandemic. The Centers for Disease Control and Prevention and the World Health Organization have urged physicians and other health care providers to use telemedicine, and both the federal government and private health plans have implemented numerous temporary regulatory and payment changes to facilitate its use.

Physicians initially responded to these changes. Based on a sample of more than 50,000 clinicians who are clients of Phreesia, a health care technology company where two of us (D.L. and H.H.) work, we saw a sudden and dramatic rise in telemedicine (see the chart below). From almost no telemedicine visits before the pandemic struck in the U.S., by early April almost 14% of the usual weekly number of pre-pandemic visits were being conducted via telemedicine.

Telemedicine — the delivery of care by a clinician in one location to a patient in another — is seen as a vital component of the nation’s response to the Covid-19 pandemic. The Centers for Disease Control and Prevention and the World Health Organization have urged physicians and other health care providers to use telemedicine, and both the federal government and private health plans have implemented numerous temporary regulatory and payment changes to facilitate its use.

Physicians initially responded to these changes. Based on a sample of more than 50,000 clinicians who are clients of Phreesia, a health care technology company where two of us (D.L. and H.H.) work, we saw a sudden and dramatic rise in telemedicine (see the chart below). From almost no telemedicine visits before the pandemic struck in the U.S., by early April almost 14% of the usual weekly number of pre-pandemic visits were being conducted via telemedicine. The assumption among many was that, after witnessing the benefits of telemedicine, physicians and patients would embrace it and growth would continue….

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Major Study Finds Common Steroid Reduces Deaths Among Patients With Severe Covid-19

June 18, 2020

A cheap, readily available steroid drug reduced deaths by a third in patients hospitalized with Covid-19 in a large study, the first time a therapy has been shown to possibly improve the odds of survival with the condition in the sickest patients.

Full data from the study have not been published or subjected to scientific scrutiny. But outside experts on Tuesday immediately embraced the top-line results. The drug, dexamethasone, is widely available and is used to treat conditions including rheumatoid arthritis, asthma, and some cancers.

A cheap, readily available steroid drug reduced deaths by a third in patients hospitalized with Covid-19 in a large study, the first time a therapy has been shown to possibly improve the odds of survival with the condition in the sickest patients.

Full data from the study have not been published or subjected to scientific scrutiny. But outside experts on Tuesday immediately embraced the top-line results. The drug, dexamethasone, is widely available and is used to treat conditions including rheumatoid arthritis, asthma, and some cancers.

In a statement, Patrick Vallance, the U.K. government’s chief scientific adviser, called the result “tremendous news” and “a ground-breaking development in our fight against the disease.” Scott Gottlieb, a former commissioner of the U.S. Food and Drug Administration, called it “a very positive finding” in an interview on CNBC. “I think it needs to be validated, but it certainly suggests that this could be beneficial in this setting….”

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Immunity to the Coronavirus Remains a Mystery. Scientists Are Trying to Crack the Case

June 11, 2020

Scientists stress that just because someone has recovered from Covid-19 and produced antibodies to the coronavirus does not mean they are protected from contracting it a second time. No one’s yet proven that.

That, then, leaves open the question: What does immunity look like?

Experts anticipate an initial coronavirus infection will lend people some level of immunity for some amount of time. But they still don’t know what potpourri of antibodies, cells, and other markers in a person’s blood will signify that protection. And determining those “correlates of protection” is crucial both so individuals can know if they are again at risk, and so researchers can understand how well potential vaccines work, how long they last, and how to accelerate their development….

Scientists stress that just because someone has recovered from Covid-19 and produced antibodies to the coronavirus does not mean they are protected from contracting it a second time. No one’s yet proven that.

That, then, leaves open the question: What does immunity look like?

Experts anticipate an initial coronavirus infection will lend people some level of immunity for some amount of time. But they still don’t know what potpourri of antibodies, cells, and other markers in a person’s blood will signify that protection. And determining those “correlates of protection” is crucial both so individuals can know if they are again at risk, and so researchers can understand how well potential vaccines work, how long they last, and how to accelerate their development….

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New Research Rewrites History of When COVID-19 Took Off in the U.S. — and Points to Missed Chances to Stop It

May 26, 2020

New research has poured cold water on the theory that the Covid-19 outbreak in Washington state — the country’s first — was triggered by the very first confirmed case of the infection in the country. Instead, it suggests the person who ignited the first chain of sustained transmission in the United States probably returned to the country in mid-February, a month later.

The work adds to evidence that the United States missed opportunities to stop the SARS-CoV-2 virus from taking root in this country — and that those opportunities persisted for longer than has been recognized up until now.

New research has poured cold water on the theory that the Covid-19 outbreak in Washington state — the country’s first — was triggered by the very first confirmed case of the infection in the country. Instead, it suggests the person who ignited the first chain of sustained transmission in the United States probably returned to the country in mid-February, a month later.

The work adds to evidence that the United States missed opportunities to stop the SARS-CoV-2 virus from taking root in this country — and that those opportunities persisted for longer than has been recognized up until now.

“Our finding that the virus associated with the first known transmission network in the U.S. did not enter the country until mid-February is sobering, since it demonstrates that the window of opportunity to block sustained transmission of the virus stretched all the way until that point,” the authors wrote in the paper. The paper has been posted to a preprint server, meaning it has not yet been peer-reviewed or published in a journal….

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Nine Ways COVID-19 May Forever Upend the U.S. Health Care Industry

May 19, 2020

In the U.S. alone, Covid-19 has claimed nearly 100,000 lives and 30 million jobs. Beyond grinding day-to-day life to a halt, the pandemic has prompted a reckoning throughout the country’s health care infrastructure, shattering decades-old assumptions about how Americans conceive of medicine, and the doctors, hospitals, insurance companies, and pharmaceutical manufacturers they pay to provide it.

Already, the coronavirus has led to sweeping changes in who can receive care and how they access it. Millions of Americans, newly out of work, are also newly uninsured. Millions more who still have insurance have been forced to delay necessary but noncritical treatments. At the same time, doctors across the country have been granted broad flexibility to treat patients remotely, using telemedicine, instantly reshaping services ranging from routine checkups to addiction treatment.

In the U.S. alone, Covid-19 has claimed nearly 100,000 lives and 30 million jobs. Beyond grinding day-to-day life to a halt, the pandemic has prompted a reckoning throughout the country’s health care infrastructure, shattering decades-old assumptions about how Americans conceive of medicine, and the doctors, hospitals, insurance companies, and pharmaceutical manufacturers they pay to provide it.

Already, the coronavirus has led to sweeping changes in who can receive care and how they access it. Millions of Americans, newly out of work, are also newly uninsured. Millions more who still have insurance have been forced to delay necessary but noncritical treatments. At the same time, doctors across the country have been granted broad flexibility to treat patients remotely, using telemedicine, instantly reshaping services ranging from routine checkups to addiction treatment.

STAT surveyed a host of prominent health policy experts — top health advisers to both Republican and Democratic presidents, lawmakers, executives, physicians, and top lobbyists — who forecast a new status quo that they say will upend what American health care looks like for decades….

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