Unrest: Injustice Under the Law and in Health

Unrest: Injustice Under the Law and in Health

A Message from our CEO, David S. Williams III

-George Floyd (and others)

Yesterday was a rough day. I spent the morning delivering groceries to a family with special needs children. They are unable to go to the store because of COVID-19. The family lives in the Fairfax district of Los Angeles and the protests were just getting started at 10am. By the early evening, the protesters were clashing with police within steps of where this extremely vulnerable family lives.

In these extraordinary, and now turbulent times, we must understand the context of unrest and uprising. In a recent Treat Us Right podcast episode, I reviewed how COVID-19 exploded the impact of health disparities--the statistically proven reality that people of color, the poor, disabled, and seniors receive inadequate healthcare in the United States.

"It seems that Black folks are dying at a rate DOUBLE our population representation in each community across the country. This begs the question of why? The conclusion: Health disparities are caused by racial inequities."

The death of George Floyd and the footage of the white police officer kneeling on Mr. Floyd's neck has caused an eruption. Black people were already sensitive based on the disproportionate deaths due to COVID-19 in our community.  Mr. Floyd's death ripped open an already bleeding wound. With protests raging across the country, the reason for this unrest is injustice. This is all about fairness.

None of this is new. In 2016, I published a post entitled Leading Toward Justice in Healthcare highlighting the health and racial inequities of the day.

Focusing on the present, this past Friday, Javier Alberto Soto, President of The Denver Foundation (and a very good friend), published this piece as a way to give context to our current state of events:

Moving Towards Justice Requires All of Us, by Javier Alberto Soto

I encourage you to read the entire post, but here's a poignant excerpt:

It’s clear, for example, that the way you experience the pandemic depends a lot on who you are. If you are poor, black, brown, undocumented, disabled, older, or a worker on the front lines of a hospital or grocery store, you are at greater risk from the health and/or economic impacts of this public health crisis. It is also certain that if you contract the virus and belong to one or more of these categories, your outcome is likely to be much worse than someone who does not.

Here’s what else is certain: The people who bear the brunt of this terrible moment are the same people who suffer under the inequitable and unjust systems that span American life, from criminal justice and public health to education and even our democracy. Pick an indicator: In almost every case, the outcomes nearly always leave people of color and other marginalized groups at a deficit. The coronavirus has made this more obvious, but it’s been certain for a long time. 

Again, we are in extraordinary and turbulent times. Care3 was founded to address the reality that the most vulnerable members of our society including seniors, people of color, and the disabled do not have equal access to healthcare and receive woefully inadequate quality of care in their homes and communities. Mr. Floyd's death once again underscores the lack of equality under the law that black people experience each and every day. At Care3, it is our mission to achieve equality.

We believe healthcare equality is possible. We believe racial equality is possible.

Please take care of yourself, your family, and everyone you love. There is hope. Let's work together to create a world where we achieve equality in health, care, and justice.

Take care,

David S. Williams III, MBA
Founder & CEO, Care3, Inc.
www.care3.co/about

Subscribe to the Treat Us Right Podcast on Apple Podcasts.

The Latest Data on COVID-19: New Cases and Spread as of May 5, 2020

Karen Health Community:

Here’s an article from Axios with the latest COVID-19 statistics on cases and spread. We have brought “the bottom line” to the top:

The bottom line: The virus isn't just some other states' problem. It's everyone's problem.

Stay home. Stay safe.

Axios, Caitlin Owens, 5-6-2020

The latest in the U.S.

Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios. This graphic includes "probable deaths" that New York City began reporting on April 14.

New York state's Democratic presidential primary will again be held on June 23, after a federal district judge reinstated the contest on Tuesday.

President Trump said Tuesday it's "possible" that some lives will be lost as states reopen their economies amid the coronavirus pandemic, in an interview with ABC's David Muir.

The economic downturn caused by the coronavirus pandemic will likely make the U.S. space industry even more focused on government money and funding —and potentially set back advancements toward commercializing the industry, Axios' Miriam Kramer reports.

New York state yesterday reported more than 1,700 previously undisclosed coronavirus deaths at nursing homes and adult care facilities, AP reports.

Former President Obama and Michelle Obama announced Tuesday that they will participate in a set of virtual graduation ceremonies amid the coronavirus crisis.

Of all the conspiracy theories floating around the internet related to the coronavirus, the disinfectant one has by far gone the most viral, Axios' Sara Fischer writes.

_______________________________________________________________

Where the virus is spreading

Data: The Center for Systems Science and Engineering at Johns Hopkins, U.S. Census Bureau; Map: Andrew Witherspoon/Axios

The Trump administration's reopening guidelines detail that in order to start lifting restrictions and reopening the economy, a state needs to report 14-day trends of fewer cases or fewer positive tests (though local officials do get some leeway in adjusting the metrics).

• Not a lot of states meet that criteria, Axios editor-in-chief Nick Johnston writes.

Our chart compares each state's seven-day average of new cases from Monday and the seven-day average from a week prior, April 27.

• By this metric, Minnesota, Nebraska and Puerto Rico have the most worrisome trends, while Arkansas and Wyoming have the most positive trends. Twelve states are moving in the right direction.

• But more than a third of the nation still has growing numbers of cases. And that includes states such as Texas and Virginia, where Republican and Democratic governors are beginning to unveil re-opening plans.

Yes, but: These trends only tell us so much.

• Some states may see their case counts rise not necessarily because their outbreaks are getting dramatically worse, but because their testing is getting better, so they're catching more cases.

• That's why health officials are also pulling in other metrics — including the number of deaths, the number of hospitalizations and the percentage of tested patients who test positive. A higher percentage means you're probably missing people.

• Still, public-health guidance calls for a steady decrease in cases before opening up, and few states have achieved that.

The bottom line: The virus isn't just some other states' problem. It's everyone's problem.

Care3 CEO David Williams and DXC Technology Discuss COVID-19 and Consumer Health Technology

On Monday May 4 at 2:30pm ET/11:30am PT (also known as #StarWarsDay) Karen by Care3, Inc. CEO David Williams (@DSWIII) and DXC Technology were live on Twitter and LinkedIn for a #DXCHealth live tech talk about COVID-19 and how Care3 helps you and your family #BeReady for any health situation.

More than 18,000 people viewed our last #DXCTechTalk.

CDC Adds 6 Symptoms to COVID-19 List - NPR

According to NPR, the CDC has added six (6) new symptoms to its COVID-19 list. The original symptoms CDC identified were fever, cough, and shortness of breath.

The updated symptoms are:

• Chills

• Repeated Shaking (with chills)

• Muscle Pain

• Headache

• Sore Throat

• Loss of Taste or Smell

At Karen, we were early in taking the CDC guidance even if symptoms were only reported sometimes. If you want to update your COVID-19 symptoms tracking journal with these new symptoms, email us at covid@yeskaren.com.

Initial CDC and WHO COVID-19 symptoms comparison

More Evidence Why Coronavirus is NOT "The Flu"

A prominent and misleading narrative among some media circles is that coronavirus and COVID-19 are just a different iteration of the seasonal flu virus. This could not be further from the truth and here’s more data to prove it.

COVID-19 is much more deadly than the seasonal flu as compared in the chart below.

Source: https://www.thenewatlantis.com/publications/not-like-the-flu-not-like-car-crashes-not-like

Stay home. Stay safe. We will get through this together.

Pulse Oximeter: Early Detection of COVID-19 Pneumonia - NYT Opinion

Editor’s Note: This opinion piece is one of the best medical reviews of COVID-19, how it impacts the body, and how we can detect the silent reduction of oxygen in our bodies.

From the New York Times Opinion section 4/20/20.

Opinion

The Infection That’s Silently Killing Coronavirus Patients

This is what I learned during 10 days of treating Covid pneumonia at Bellevue Hospital.

By Richard Levitan

Dr. Levitan is an emergency doctor.

·        April 20, 2020

A pulse oximeter can provide early warning of the kinds of breathing problems associated with Covid-19 pneumonia.Credit...Giorgos Moutafis/Reuters

I have been practicing emergency medicine for 30 years. In 1994 I invented an imaging system for teaching intubation, the procedure of inserting breathing tubes. This led me to perform research into this procedure, and subsequently teach airway procedure courses to physicians worldwide for the last two decades.

So at the end of March, as a crush of Covid-19 patients began overwhelming hospitals in New York City, I volunteered to spend 10 days at Bellevue, helping at the hospital where I trained. Over those days, I realized that we are not detecting the deadly pneumonia the virus causes early enough and that we could be doing more to keep patients off ventilators — and alive.

On the long drive to New York from my home in New Hampshire, I called my friend Nick Caputo, an emergency physician in the Bronx, who was already in the thick of it. I wanted to know what I was facing, how to stay safe and about his insights into airway management with this disease. “Rich,” he said, “it’s like nothing I’ve ever seen before.”

He was right. Pneumonia caused by the coronavirus has had a stunning impact on the city’s hospital system. Normally an E.R. has a mix of patients with conditions ranging from the serious, such as heart attacks, strokes and traumatic injuries, to the nonlife-threatening, such as minor lacerations, intoxication, orthopedic injuries and migraine headaches.

During my recent time at Bellevue, though, almost all the E.R. patients had Covid pneumonia. Within the first hour of my first shift I inserted breathing tubes into two patients.

Even patients without respiratory complaints had Covid pneumonia. The patient stabbed in the shoulder, whom we X-rayed because we worried he had a collapsed lung, actually had Covid pneumonia. In patients on whom we did CT scans because they were injured in falls, we coincidentally found Covid pneumonia. Elderly patients who had passed out for unknown reasons and a number of diabetic patients were found to have it.

And here is what really surprised us: These patients did not report any sensation of breathing problems, even though their chest X-rays showed diffuse pneumonia and their oxygen was below normal. How could this be?

We are just beginning to recognize that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.

Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.

To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.

In emergency departments we insert breathing tubes in critically ill patients for a variety of reasons. In my 30 years of practice, however, most patients requiring emergency intubation are in shock, have altered mental status or are grunting to breathe. Patients requiring intubation because of acute hypoxia are often unconscious or using every muscle they can to take a breath. They are in extreme duress. Covid pneumonia cases are very different.

A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.

We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.

Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until oxygen levels plummet. In effect, patients are injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.

By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.

Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)

A major reason this pandemic is straining our health system is the alarming severity of lung injury patients have when they arrive in emergency rooms. Covid-19 overwhelmingly kills through the lungs. And because so many patients are not going to the hospital until their pneumonia is already well advanced, many wind up on ventilators, causing shortages of the machines. And once on ventilators, many die.

Avoiding the use of a ventilator is a huge win for both patient and the health care system. The resources needed for patients on ventilators are staggering. Vented patients require multiple sedatives so that they don’t buck the vent or accidentally remove their breathing tubes; they need intravenous and arterial lines, IV medicines and IV pumps. In addition to a tube in the trachea, they have tubes in their stomach and bladder. Teams of people are required to move each patient, turning them on their stomach and then their back, twice a day to improve lung function.

There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.

Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.

Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment. When they noticed their oxygen levels declining, both went to the hospital and recovered (though one waited longer and required more treatment). Detection of hypoxia, early treatment and close monitoring apparently also worked for Boris Johnson, the British prime minister.

Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.

People using the devices at home would want to consult with their doctors to reduce the number of people who come to the E.R. unnecessarily because they misinterpret their device. There also may be some patients who have unrecognized chronic lung problems and have borderline or slightly low oxygen saturations unrelated to Covid-19.

All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus don’t know it.

There are other things we can do as well to avoid immediately resorting to intubation and a ventilator. Patient positioning maneuvers (having patients lie on their stomach and sides) open up the lower and posterior lungs most affected in Covid pneumonia. Oxygenation and positioning helped patients breathe easier and seemed to prevent progression of the disease in many cases. In a preliminary study by Dr. Caputo, this strategy helped keep three out of four patients with advanced Covid pneumonia from needing a ventilator in the first 24 hours.

To date, Covid-19 has killed more than 40,600 people nationwide — more than 10,000 in New York State alone. Oximeters are not 100 percent accurate, and they are not a panacea. There will be deaths and bad outcomes that are not preventable. We don’t fully understand why certain patients get so sick, or why some go on to develop multi-organ failure. Many elderly people, already weak with chronic illness, and those with underlying lung disease do very poorly with Covid pneumonia, despite aggressive treatment.

But we can do better. Right now, many emergency rooms are either being crushed by this one disease or waiting for it to hit. We must direct resources to identifying and treating the initial phase of Covid pneumonia earlier by screening for silent hypoxia.

It’s time to get ahead of this virus instead of chasing it.

Richard Levitan, an emergency physician in Littleton, N.H., is president of Airway Cam Technologies, a company that teaches courses in intubation and airway management.

COVID-19 Cases in the US Surpass 200,000. Stay Home.

Confirmed COVID-19 cases in the US continue to rise. As testing becomes more universal, positive cases show just how spread the coronavirus is. #StayAtHome or Shelter-in-Place orders have been adopted by most US States.

Check your state’s Stay-at-Home order status here. Georgia and Florida are the latest to issue orders.

Governor Brian Kemp of Georgia stated that he just learned that yesterday that coronavirus could be spread by people even if they are not showing symptoms. This fact is driving the Stay at Home orders around the country. Staying at home can reduce the spread of coronavirus. That is the key. Please follow these mandates. It will save lives!

FREE COVID-19 Health Journal

To track common symptoms of COVID-19, download the latest version of the Karen mobile app.

It is very important to chart your health information even if you are well and show on symptoms. Getting into this habit will help you know yourself better through your health. And documenting your health experience will help you when you interact with the healthcare system because they can visualize what has happened with your health over time.

COVID-19 Has Changed Everything. How Will You Respond?

Exclusive Karen COVID-19 Health Journal

COVID-19 has impacted how we all work. For example, at Karen, we decided not to renew our office lease because we are all working from home for the foreseeable future.

Our interactions with the heath care system are also changing radically right now. Telehealth is emerging as the preferred option for initial and well visits while ERs and hospitals are being recognized as ONLY for the most acute patients. This is how it should be.

One other behavior change emerging is people *actively* documenting their daily health experience. You can see how important it is for care professionals to know your experience before you are under their care on how COVID-19 is treated. This is the new reality.

Let your data lead the way. Let your data speak for you. Let your data tell your story before you say a word to your physician.

To get to know yourself through your health data, sign up for the Karen COVID-19 Health Journal. It will be delivered as a new journal in your Karen mobile app.

#healthcare #healthinformation #telehealth #ownyourhealth #myphi #digitalhealth #healthtech

Common Symptoms of Coronavirus, Cold and Flu - WHO, CDC

Are you experiencing symptoms and aren’t sure if they’re associated with COVID-19? See the chart above to compare common symptoms. Call your doctor if you require medical attention.

CDC Official Coronavirus (COVID-19) Page

This is the official website of the Centers for Disease Control and Prevention (CDC) on coronavirus. Get information on how to protect yourself, your home, and what to do if you think you’re sick.

https://www.cdc.gov/coronavirus/2019-nCoV/index.html

Note: Karen does not endorse any data or programs highlighted by non-health care or political groups that may be linked on the CDC website.

Covert coronavirus infections could be seeding new outbreaks-Nature

PUBLISHER’S NOTE: With your Karen COVID-19 Health Journal, symptom tracking is for you to understand if you’re experiencing any symptoms. If you are not experiencing symptoms, it is still important to stay at home and practice social distancing, because you could still be contagious.

Covert coronavirus infections could be seeding new outbreaks-Nature

From the study:

Scientists are rushing to estimate the proportion of people with mild or no symptoms who could be spreading the pathogen.

As coronavirus outbreaks surge worldwide, research teams are racing to understand a crucial epidemiological puzzle — what proportion of infected people have mild or no symptoms and might be passing the virus on to others. Some of the first detailed estimates of these covert cases suggest that they could represent some 60% of all infections.

Read the entire study: https://www.nature.com/articles/d41586-020-00822-x

COVID-19 #Coronavirus Data Pack-informationisbeautiful

Updated 3/19/20, these data visualizations put COVID-19 in context for all of us.

Click or tap the image to see more data visualizations of COVID-19.