This article was written by Jasmine Su, a summer intern with ACCESS Health China. She is currently studying Health Policy Modelling at Yale University and aspires to combine her interests in journalism and public health in the future. Covid-19 broke out in China shortly before the Chinese New Year holiday. Within a few days, the virus sent many cities, towns, and counties into lockdown, and most businesses were asked to cease operation. At the same time, the medical industry was completely overwhelmed, and many hospitals had to rely on other companies to either provide medical equipment, manage medical supplies, or develop digital platforms. With most employees stuck in their homes, companies had to embark on uncharted pathways to help hospitals and governments. We observed four key ways that Chinese businesses collaborated with each other during the coronavirus outbreak. Many companies collaborated with businesses they have already worked with before, or businesses within the same supply chain. ViewHigh, for instance, is a medical resource management company. During the Covid-19 outbreak, it built a medical supply management platform where hospitals could track their medical supply, donors could make direct contributions, and medical supply suppliers could take orders from hospitals. ViewHigh collaborated directly with suppliers and conducted quality control on behalf of the hospitals. Other companies also relied on existing suppliers to help hospitals during the outbreak. United Imaging, for instance, is a medical imaging company that provided remote diagnosis systems and imaging equipment for hospitals across Wuhan during the Covid-19 outbreak. With Wuhan city under strict lockdown, however, it was difficult to acquire components needed to build the equipment and systems. Payment for this equipment was also uncertain given the situation. United Imaging eventually convinced its suppliers to take the risk and provide components for the imaging equipment. These companies, by capitalizing on their existing relationships with suppliers and hospitals, were able to quickly respond to changing demands as well. Zuo Shou Yi Sheng (ZSYS), a telemedicine company, initially developed a pre-appointment consultation robot for hospitals. After China's National Health Commission announced that hospitals should also proactively follow-up with discharged Covid-19 patients, ZSYS quickly developed new products that allowed hospitals to manage and send push notifications to discharged patients. Companies like ZSYS were able to respond to changing demands because they had solid existing relationships with hospitals, suppliers, and other businesses in the supply chain. This allowed them to capitalize on these business ties during the crisis. Another common model of business collaboration during the outbreak was launching services and reaching new customers through other businesses. Many companies, for instance, launched their services through WeChat, China's biggest social media platform, to reach millions of users. DCHealth, a medical big data company that collected resident health data for the Honghu County government, told ACCESS Health International during an interview that WeChat provided ample backend support and that DCHealth's engineers were already familiar with WeChat's system, making the social media company its top choice for collaboration. ZSYS, the telemedicine company, also launched its Covid-19 self-diagnose robot through WeChat, which allowed ZSYS to reach tens of millions of Chinese WeChat users. Another example of companies collaborating with each other to publicize their services was WeDoctor. The telemedicine company launched medical services for common and chronic disease patients across Guangzhou, Tianjin, Shandong, Jinan, and Taian early on in the Covid-19 outbreak, as many non-coronavirus patients couldn't access hospitals. Once WeDoctor's telemedicine portal launched, many medical insurance companies and banks voluntarily publicized the portal on their own websites and applications. These include China's top five government-owned banks, as well as multiple other private banks and insurance companies. The third business collaboration model that surfaced during China's Covid-19 outbreak was to combine expertise from subsidiaries and affiliates. Alibaba's project in Zhejiang, where it is headquartered, is a prime example. As a multinational technology conglomerate, the Alibaba Group combined expertise from its subsidiaries to build an integrated one-stop platform for all Covid-19 related services in Zhejiang. Alipay, Alibaba Group's mobile payment application, became the launching ground for so-called "health code," which became a widely used, digital travel permit across China during the outbreak. Alibaba Cloud, the conglomerate's cloud services subsidiary, provided all the cloud infrastructure, and DAMO Academy-Alibaba Group's R&D arm- helped develop an Artificial Intelligence CT scan system. Alibaba Group, by bringing in almost all of its subsidiary businesses, was able to complete its project single-handedly without outsourcing any part of its operation and construction. The last type of business collaboration was to simply forge new business ties. Many of these collaborations happened under pressing circumstances, causing some companies to collaborate in innovative and unprecedented ways. When United Imaging was installing remote diagnosis systems in makeshift hospitals, the company realized that many hospitals didn't have the internet infrastructure needed to transmit high-quality CT images. United Imaging thus collaborated with telecommunication companies to build 5G infrastructure in makeshift hospitals. WeDoctor, the telemedicine company, worked with health insurance companies and funds to allow patients to be reimbursed when they are using WeDoctor's telemedicine services. This is rather unprecedented, given that traditionally one of the biggest roadblocks for telemedicine companies in China was that most health insurance did not cover telemedicine services. The urgency of the coronavirus situation, however, pressured both insurance companies and the government to incorporate telemedicine into their business models. WeDoctor also began to collaborate directly with medical suppliers and delivery companies during the outbreak to deliver medicine to patients' homes. These new models of collaboration between telemedicine companies and pharmaceutical, delivery, and health insurance businesses are likely going to continue shifting China's telemedicine scene in the post-Covid-19 future. While the Covid-19 outbreak brought many businesses together and saw the private sector play a much larger role in providing social services, business collaborations remained challenging. During interviews with ACCESS Health International, many companies shared that, as private businesses, even when providing social services, they have interests and financial concerns. Oftentimes conflicting interests between companies can slow progress. The government's role in mediating and coordinating business collaboration in […]
Greater Trust, Better Communication: How Chinese People’s Relationship with Businesses Evolved Throughout Covid-19
This article was written by Jasmine Su, a summer intern with ACCESS Health China. She is currently studying Health Policy Modelling at Yale University and aspires to combine her interests in journalism and public health in the future. Chinese citizens have been familiar with big-brand technology firms long before the spread of Covid-19. Mega technology conglomerates like Alibaba, Baidu, and Tencent developed products that permeate almost every aspect of a Chinese citizen's daily life- from grocery shopping to paying, booking appointments, and sending money. Even before Covid-19, receiving social services from, or through, technology firms was already a common scene in China. The Covid-19 outbreak, however, put millions of people in lockdown and created a spike in consumer demand for technological solutions and services. In many cases, these technology firms became the only avenue for many who were locked in their homes to access services outside. Luckily, technology firms were quick to respond to this spike in demand for services, some under government requests, and many others doing so voluntarily. Chinese people found themselves relying on these technology firms for integrated information on Covid-19, with many users actively participating in data gathering for these companies. This formed a new feedback ecosystem where users provide information, and technology companies take that information, process it, and present it back to the public in digestible graphics or summaries. There is thus a growing level of trust between technology companies and people in terms of information reliability. Personal data privacy and security issues, however, remain a concern. Meanwhile, the increased use of telemedicine suggests that more people are open to digital medical solutions now. In short, amid the Covid-19 outbreak, Chinese people's relationship with technology firms evolved in three key areas: communication, data security, and telemedicine. Digital technology companies surfaced as the authority in informing the Chinese public about Covid-19 and public health developments. Overwhelmed with information, citizens have turned to these companies for easily digestible, reliable, and integrated information. The private sector has been very effective in communicating public health information to the public for two key reasons. First, technology companies are better able to integrate information from various government agencies and present them on a one-stop platform. DingXiangYuan (DXY), China's leading medical information platform, for instance, provided a one-stop Covid-19 information platform where users can monitor the virus' real-time development throughout China. The information is color coded, and users can also select their circumstances- such as "going out", "staying at home", or "with kids"- and read about recommended precautionary measures specific to those circumstances. Its "Covid-19 myth buster", which is easily accessible for the general public, also generates infographics that debunk key Covid-19 myths. In Zhejiang province, Alibaba developed a one-stop platform that integrates a variety of services for citizens, allowing them to access Covid-19 news, consult with a Q&A robot, and log their health status all in one place. One of its services even includes an "itinerary checker" that allows users to check if anyone on the same public transport was tested positive. Secondly, technology firms can tap into their existing user base when disseminating public health information. Many companies, such as DXY, Digital China Health (DCHealth), and Zuo Shou Yi Sheng (ZSYS), worked with WeChat during the outbreak. Given that WeChat is China's biggest social media platform, companies that disseminated information or provided services through WeChat were able to reach more people than any government broadcast platform could. Not only have people grown more reliant on information provided by technology firms, their interaction with these companies has also changed throughout the outbreak. Because Covid-19 developments are volatile and information relies heavily on real-time data, many technology firms chose to also engage their users in the data collection process. DXY's "Covid-19 myth buster," for instance, has a "report a myth" function. Alibaba's services platform in Zhejiang also incorporated a "report suspected coronavirus cases" portal. While Chinese citizens have grown reliant on technology companies to obtain information and are more willing to partake in certain data collection processes, data privacy and security remain a key concern. Many technology firms have to access raw data from hospitals or obtain health status information from citizens in order to build information platforms. DCHealth, for instance, is a medical big data company that integrated epidemiological, clinical, and community data for the Honghu government, a county not far from Wuhan. In order to gather daily health status data from citizens, the company had to rely on the government's credibility. It built its health status upload system under "Honghu Today," which is Honghu government's official WeChat account, so that citizens understand that they are submitting their health status information for governmental purposes. DCHealth's decision shows that Chinese citizens remain wary of granting companies access to personal data and are more comfortable with submitting personal information to the government. Chinese citizens are also shifting their attitudes towards telemedicine amidst the Covid-19 outbreak. During interviews with several telemedicine companies, such as ZSYS and WeDoctor, said that people are now realizing that telemedicine goes beyond just online consultation. WeDoctor, a telemedicine company founded in 2015, also began to provide medicine delivery, pharmaceutical, and health insurance services during the outbreak. These services allowed patients with chronic diseases and other non-Covid-19 patients, who were unable to reach hospitals during the outbreak, to continue accessing medical services. During the outbreak, telemedicine companies also conducted prediagnosis questionnaires that helped triage patients accordingly- keeping those who are likely not infected at home and focusing medical resources on highly suspected cases. According to China's National Health Commission, telemedicine services in March 2020 increased by 17-fold compared to the volume in March 2019[1]. Increased usage of telemedicine suggests that more patients will be open to using telemedicine going forward, even after Covid-19 eases. As more citizens rely on technology companies for information, and more companies voluntarily compile data for the public, communication between consumers and businesses will likely increase as the battle against Covid-19 drags on. This strengthened trust between the private and the public sector will […]
ACCESS Health Launches a New Family Guide to Covid
ACCESS Health Chair and President William A. Haseltine today launched his latest book, A Family Guide to Covid: Questions & Answers for Parents, Grandparents, and Children. In it, he answers tough questions about Covid-19 honestly, with equal measures of clarity and compassion. As he writes in the book, Dr. Haseltine remembers a time in his childhood when polio overshadowed his young life. As he got older, he realized that diseases didn’t just harm individuals, they crippled communities and devastated entire countries. He became a scientist, dedicating his life to understanding the diseases that threaten us most and figuring out ways to stop and prevent them. Today, Dr. Haseltine finds that his children, his grandchildren and many of his friends and extended family members are coming to him with question after question. Why have our lives changed? Are my children in danger? When will this be over? Will there be a vaccine or a cure and if so, when? When will our lives return to normal? This book attempts to answer those questions about COVID-19 honestly, with equal measures of clarity and compassion. It is written especially for those who are faced with the difficult task of not only protecting themselves, but of protecting their families, their children, their spouses, and their parents. Split into two sections, the first section seeks to give answers to questions that children and grandchildren may ask. Each question has in fact been asked by someone under twelve, some as young as four and five. The second section provides short answers to many of the difficult questions adults from ages eighteen to one hundred and ten ask themselves to understand this new reality. Again these are real questions people have asked. As our understanding of Covid-19 evolves, so too will this book. When a purchase is made, readers will be given entry to a password protected section of Dr. Haseltine's website. There, readers can download subsequent editions freely and have the most up to date answers to the most critical Covid questions of the day. As Dr. Haseltine sees it, "Our children and grandchildren will one day look back as I do and remember a time when disease stalked the streets and changed their life. My hope is that some of those children will be inspired to dedicate their lives to science and medicine so that their own children and grandchildren and for that matter no child anywhere should have to endure what they did." A Family Guide to Covid Book Can be purchased for $1.99 here: http://accessh.org/covidfamilyguide/
The Science and Technology Behind Healthy Aging
Singapore's life expectancy is one of the highest in the world and its population is aging rapidly. According to recent predictions, one fourth of all Singaporeans will be aged 65 and above by 2030. Thus, the question of what comprises healthy aging is vital for a country such as this one. Dr. Brian Kennedy, Director of the National University Health System Centre for Healthy Ageing, Singapore gave an insightful presentation on targeting human aging, focusing on whether or not we can extend healthspan. The main aspects covered were the understanding and prevention of various diseases plaguing seniors and the ability to live independently with the use of technology despite old age. Following Dr. Kennedy's presentation, ACCESS Health Southeast Asia Director for Business Development, Adrienne Mendenhall, moderated an informal discussion about the science and technology advancements which make healthier aging possible, which was then succeeded by a question and answer session. The webinar was organized by SGInnovate. Please click on the video below to view a recording of the event:
Introduction to the COVID-19: Learning Diary from India
ACCESS Health India has developed a learning diary which records India's response to COVID-19 along with its understanding of the virus. The aim of the diary is to enable tracing of legislative, judicial, and social response to the epidemic at a country level, which will then allow for a reflection of where the government went wrong and prevent the same mistakes from happening in the future. India's response is not only interesting because it is one of the neighboring countries of China, the country where the virus was first observed, but also because it is a country already hurt by urban sprawl and disease, making it even more vulnerable to a virus such as COVID-19. However, despite its unfavorable conditions, India has been rather effective in containing the disease. While the country was effective in restricting COVID-19 cases and deaths, the government has faced certain challenges. Thus, the learning diary also discusses potential future measures that India can implement to arise successfully from its current situation, and which will help build a more resilient health system.
India’s Covid-19 Testing Capacity Must Grow by a Factor of 10
The Center for Global Development, in partnership with ACCESS Health India, has recently released a publication on the subject of India's Covid-19 testing supply chain. Many experts believe that a tenfold increase in the country's testing rate is necessary to keep positivity rates below 10 percent, as recommended by the World Health Organization. The publication discusses the current approach towards testing of the Indian government and highlights its insufficiency. Moreover, the note gives further explanations on the organization of India's Covid-19 testing supply chain along with its structural bottlenecks, as well as recommendations for the way the country can successfully expand testing.
An Urgent Need To Reopen Medical Care For All
A shorter version of this article was originally published in The Hill. Each day in America and in most countries around the world brings with it a new story of crowded hospitals packed with panicked patients and exhausted health workers. But there is another story, equally tragic, unfolding in the privacy of our homes, with countless numbers of Americans with chronic conditions and other serious illnesses languishing in isolation without access to care. While hospitals have of course remained open throughout the Covid-19 crisis, only the most urgent cases pass through the doors. Less critical patients are offered virtual visits instead, despite the fact that many are managing equally serious and life-threatening conditions. A close friend of mind was recently diagnosed with colon cancer at one of the top hospitals here in New York. While the treatment for his condition is clear, the timeline to be treated is not. He was told via a virtual visit that he would have to wait for surgery to remove the growth, since his condition was not yet urgent enough to warrant immediate care. My friend is better off than many others. The New York Times recently wrote about a blood cancer patient in Philadelphia in need of chemotherapy. Unfortunately, blood supplies were rationed across the city and the patient couldn't get enough transfusions to allow his chemotherapy to begin. His clinic visits were canceled, his condition worsened, and by the middle of April, he had passed away, a death expedited by Covid-19. Stories like these are just the tip of the iceberg. Doctors across the country have been reporting concerning trends among patients, with many delaying much needed care because of concerns about contracting Covid during an emergency room visit. A survey of nine major hospitals published earlier this month in the Journal of the American College of Cardiology found that the number of patients presenting with severe heart attacks had dropped by nearly forty percent since March. Vaccinations and well-child visits have seen a similar deterioration, with millions of children now at greater risk of infection of other preventable diseases due to the stark decline. All this reinforces the undeniable fact that the first facilities to reopen in our communities must be our hospitals. The Centers for Medicare & Medicaid Services (CMS) recently released guidance for reopening healthcare facilities for non-emergent cases, but the advice included is vague at best. While the guidance includes recommendations for screening patients and staff and creating non-Covid care zones to provide safe care to patients who test negative, it offers no advice on when to screen patients or how to set up non-Covid care zones. Though perhaps counterintuitive, the first step to reopen our hospitals is to assume everyone is infected and infectious. Working under this assumption, patients, providers and hospital administrators alike will behave with the necessary caution to keep people safe. Screening and testing of providers and patients is critical, as is the need for a plan for what should be done if someone tests positive, especially staff members who risk spreading the infection to other patients. Unfortunately, state guidance on this front is woefully inadequate and, in some cases, downright dangerous. State departments of health in even the hardest hit areas suggest that healthcare professionals can return to work after testing positive for Covid-19, assuming they have been symptom free for just three days and seven days have passed since their symptoms first developed. This despite the fact that studies have shown that some people may be infectious for up to ten days after obvious symptoms have resolved. In the absence of more careful guidance, many medical centers have developed more stringent guidelines for their healthcare professionals, providing greater protection for them and their patients than the current guidance requires. Some hospitals are already facing lawsuits from staff who claim that hospitals have not done enough to protect healthcare workers from home, alleging shortcomings ranging from a lack of personal protective equipment to inadequate training for staff redeployed to Covid wards. Their concerns are not unfounded — one in five people in the United States with Covid-19 are healthcare professionals. In addition to designing their own strategies to protect healthcare workers, hospitals are also crafting their own plans to protect patients. Some hospital systems have created broad networks of ambulatory care centers that operate as outpatient facilities. These clinics are far more robust than your average walk in clinic, with some health systems providing up to eighty percent of all surgeries — including complex neurosurgery and total hip replacements — in ambulatory care settings. Some hospital administrators think their best bet may be to funnel patients suspected of Covid-19 to the hospitals while maintaining a steady supply of high quality services for non Covid patients through the ambulatory care centers. This would keep hospital beds free for the worst Covid patients and still provide high quality care to other patients in need. To ensure that the non Covid facilities remain Covid free, patients and providers might be screened in the days leading up to appointments, as well as on the appointment day itself. All of this extra effort will require additional resources, something that is becoming a pivotal challenge for all hospitals large and small. A substantial portion of a hospital's income comes from elective surgeries. Ever since facilities were forced to cancel these procedures to ramp up Covid care, they have been hemorrhaging cash in extraordinary amounts. In New York State alone, one of the Buffalo region's smallest hospitals has said they are losing roughly $1 million each month. In New York City, some of the major medical centers are losing as much as $450 million. The same is happening in hospitals throughout the country. A USA Today investigation found that almost half of all counties with coronavirus cases are served by a hospital that reported a net loss in 2017. Their analysis predicts that, because of the Covid crisis, more than one hundred hospitals could shutter within a year. Many of these hospitals are in rural communities it means that when these hospitals close, there will […]
The Global Syndemic of Obesity, Undernutrition and Climate Change
Climate change and non-communicable diseases are two sweeping global health challenges that share an underlying lack of urgency, political will, strengthened action, and accountability. ACCESS Health Southeast Asia’s former intern, Lavanya Prakash, proposed a solution, based on the Lancet Commission's piece "The Global Syndemic of Obesity, Undernutrition and Climate Change". Her report calls for an innovative solution, a syndemic approach that brings health and non-health sectors to address the underlying commercial, social and environmental determinants of noncommunicable disease. Lavanya calls for a "a paradigm shift in the way we as civil society, development agencies, healthcare professionals and everyone in-between view and develop healthcare policy - which is to serve not only humanity but also the planet." Consider downloading and reading Lavanya’s report by clicking HERE or visit the websites of some local and international organizations adopting the planetary health approach in tackling health and environmental crises: Planetary Health Alliance, Health in Harmony, PM Haze, Centre for A Responsible Future, Water.Org
Telemedicine and Healthcare: The impact of Covid-19
The novel coronavirus outbreak brought with it a paradigm shift in how healthcare is delivered, with a marked increase in the number of tele-consultations offered to patients as extreme physical distancing orders are put in place. The shift is changing the face of healthcare, perhaps irreversibly. What does the paradigm shift mean for the future of healthcare and its many stakeholders? The India based think tank, Voice of Healthcare, recently hosted a webinar with experts from the United Kingdom, Belgium and India to discuss how Covid-19 is reshaping the future of health. Featured as part of the discussion was ACCESS Health India’s Pankaj Gupta, the head of our digital health team. View a recording of the webinar below.
Improving Patient Engagement for Seniors Amidst the Covid-19 Crisis
While physical distancing and other safety measures are necessary to curb the spread of COVID-19, they can also leave seniors more isolated and disengaged from their families and communities. ACCESS Health Southeast Asia and Aging2.0 are co-hosted a webinar to address these challenges and to discuss ways to improve communication and engagement with the elderly population in Singapore, while also keeping them from harm. Please click below to view a recording of the webinar. The full list of panelists is also available below. Panelists: Dr. Carol Tan Yean Eng, Geriatrician at Mount Alvernia Hospital and head of The Good Life Co-operative: Speaking from a community programming perspective on safe engagement activities for seniors Dilpreet Singh, founder & CEO of Juvoxa: Discussing how digital technology solutions can improve engagement and care for seniors during COVID-19 Dr. Manju Chandran, Senior Consultant and Director of Osteoporosis and Bone Metabolism Unit at Singapore General Hospital: speaking from a clinician perspective on how we can help promote senior health during this time in order to reduce disability and injury, relieving the burden on the healthcare system