Is This Coronavirus Epidemic The Big One?

This article, authored by ACCESS Health Chair and President William A. Haseltine, was originally published on Forbes. When a friend asked me if this was the big one two weeks ago, I was not sure.  Today I can answer: Yes. This is a big one in terms of lives that will be affected and lost, and economies destroyed. But... It is a big one, not as a consequence of an intrinsic property of the virus, but entirely the result of human action and inaction. The course of the epidemic in China shows that the epidemic can be controlled without an effective vaccine or antiviral drug. Rigorous people to people contact control can halt the spread of infection. Lack of short-term and long-term preparedness has doomed both the US and Europe and may well devastate other continents as well.  Forewarned long in advance that a pandemic respiratory infection from an influenza or coronavirus was inevitable, our government failed to prepare and to support the research needed to create the vaccines and drugs needed to prevent and treat infections. We also failed to develop the necessary health system infrastructure needed to cope. This despite repeated warnings over the last thirty-five years since the advent of HIV/AIDS that this day would surely come. Failures over the past three months are of a different sort. They are failures of leadership and of government. We are plagued by a President who, more than three quarters through his term, still claims that the buck stops with Obama. He is deaf to the agonized pleas of our health care professionals who, unprotected, must risk their lives and those of their family to treat the ill. The economic toll is yet to be measured but surely will include an unprecedented global depression, bankruptcies of national and state governments, businesses large and small and untold millions of people around the world that depend on their jobs for food and shelter.  What may mount to well more than 100 trillion dollars in economic damage could have been prevented by a few billion dollars of investments in research and a few hundred billions in health infrastructure. I fear ten years from now (one, two, three Presidencies hence) we will revert to our natural state of complacency, distracted by present exigencies and fail to prepare for nature's next inevitable big one.

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Healthcare must be Affordable and Accessible, but also High Quality

This post, authored by Valerie Shelly (ACCESS Health International), Susann Roth (Asian Development Bank) and Kirthi Ramesh (Asian Development Bank), originally appeared on the Asian Development Bank blog. Universal health coverage must be high quality to improve patients' health outcomes Shakina lives in a developing country. Although there is a public hospital near her home, she chooses to travel four hours by bus to go to a well-liked, private hospital in the city. She has heard from her friends and neighbors that they were pleased with the care they received at this hospital and to her they seem healthier and happier when they get back. She has heard bad stories from other friends who went to the closer, more affordable, public hospital – they returned home sicker than when they left. Shakina's story reminds us that all people, regardless of socioeconomic class and means, want high-quality healthcare and that they will often choose higher quality care even if it is more expensive and less accessible. Under the World's Health Organization's definition of universal health coverage, all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. The concept of quality has only recently been built into universal health coverage policies and has not yet been sufficiently addressed. If health investments are to lead to the emergence of more productive and equitable societies and economies, countries need to focus on improving quality. The three priorities of health care delivery - cost, quality, and access - need not be at odds with each other. Greater use of health care facilities due to lower costs and shorter distances to travel will only lead to better health outcomes if quality of care is guaranteed. Therefore, we must make high-quality healthcare services affordable and accessible in order to effectively implement universal health coverage. Simply providing access for more people to lower quality care won't achieve universal health coverage. Poor-quality care is wasteful, costly, and dangerous. It is estimated that between 5.7 million and 8.4 million people die each year in low- and middle-income countries due to poor-quality care. In other words, in many countries, a person has a greater chance of dying from receiving poor quality care than from going without care entirely. In addition to the human cost, poor quality also has an economic cost. Poor productivity and wastefulness, resulting from poor quality of health care, costs these countries around $1.4 trillion to $1.6 trillion per year. Poor-quality care proves costly for societies when unhealthy adults are less productive at work and unhealthy children cannot perform well at school. High-quality care is cost-effective and leads to an earlier and higher return on investment. Approximately 15% of hospital expenditures in high-income countries are used to correct preventable complications of care and patient harm. This is a price that is an inconvenience to high-income economies and completely unaffordable for low- to middle-income countries. In addition, poor-quality care affects the poor and vulnerable disproportionately. While investing in higher quality health systems costs more upfront, costs are lowered over the long-term through more efficient workflow; fewer medical errors and preventable complications; elimination of ineffective treatments and procedures; fewer duplicated services; and less waste overall. Even during a crisis or epidemic, resilient health systems can deliver high-quality services Quality health services make health systems resilient. They are prepared for anything, can maintain core functions amongst changing situations, and are informed by lessons learned, constantly adapting and improving. Even in a crisis during times of political unrest, or during an epidemic, resilient health systems can rely on their basic processes to deliver high-quality services. Secondly, quality health services make health systems trustworthy and transparent. Poor- quality care, even when taken to the far reaches of the world, erodes trust, puts patients at risk, and is completely unsustainable. High-quality care builds trust in the health system, nourishes a culture of respect towards individuals, improves patient safety and produces better patient outcomes. A truly transparent healthcare organization is open and honest about successes as well as failures, ensuring care is based best practice clinical protocols, building complete trust and long-lasting relationships with their patients. Finally, quality health services make health systems patient-centered. A central feature of quality health services is that they are patient-centered and give great consideration to the patient's individual needs, culture, and beliefs. Patient-centered care is vital to the implementation of universal health coverage, as we know that people who are engaged in their own care suffer fewer complications and enjoy better health and overall happiness. A central aspect to achieving patient-centered care is seeking feedback on patients' care experience. Improving quality requires a holistic approach. Countries that want to improve quality of care need to consider interventions across different domains (leadership, information, patient and population engagement, regulation and standards, organizational capacity, models of care) across different levels of the health care system. Building a national strategy for quality is an important first step to agree on a clear set of goals, define suitable interventions and tools and align different stakeholders' efforts to improve quality of care. Shakina chose to travel a long distance for high-quality care instead of taking her chances on accessible, poor-quality care. We need to make it easier for Shakina to receive the high-quality care she deserves, at a reasonable distance from her home, from a skilled health professional that puts her at the center of her care. By doing this, we will see that in the end, high-quality care really does pay off.  

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Digital Solutions to Manage and Contain Disease Outbreaks

Since the outbreak of the new coronavirus at the end of 2019, Chinese citizens have united to fight against the epidemic. The United Nations, the World Health Organization (WHO) and the international community have given high praise to China’s effective measures in preventing the spread of the epidemic. Here, the ACCESS Health China team summarizes the efforts and contributions of our alliance members who provide innovative digital solutions to the outbreak control in China. We hope the cases would give insights and lessons to our partners and related enterprises all over the world. At the same time, we sum up the experience and the lessons we learn from the shortcomings exposed in the process of epidemic prevention, and promote the application of digital health in disease control, and further improve China’s capability in responding to public health emergencies. 1. Disease prevention, treatment and management: Telemedicine Case 1: WeDoctor In order to minimize the risk of cross-infection and reduce the burden of first-line Health facility, WeDoctor launched the "WeDoctor Consultation and Prevention Center" on January 23 to support the prevention and control of the new coronavirus. More than 40,000 doctors in respiratory, infection, general and critical disease gathered at the platform and provided free online consultation to patients across the country. At the same time, in response to the panic caused by the virus,  the platform has also set up a psychological consultation sector. Citizens can conduct self-assessment of post-traumatic stress disorder, anxiety and depression, and can also consult online experts. on March 10th , the platform had more than 120 million visits, and provided a total of 1.599 million medical consultation services. On March 14th, partnering with China International Exchange and Promotive Association for Medical and Health Care (CPAM), WeDoctor launched the Chinese-English bilingual WeDoctor Global Consultation and Prevention Center. This digital health platform brings together medical resources at home and abroad and provides medical consultation to more than 60 million Chinese citizens and international friends overseas.Users can access to free online health consultation (graphic, voice and other forms of service) and clinically proven epidemic prevention knowledge through the WeChat official account “WeDoctor Health”. The service is not limited to any countries and has unlimited times of uses, the purpose of the service is to help people around the world to scientifically protect themselves from and overcome the disease. Case 2: More Health More Health undertook the data collection of “Healthy Wuhan” mobile application led by Wuhan Health Commission. More than 10,000 copies of thermometers and oximeters were presented to Wuhan citizens free of charge through the app. Citizens only need to log in to the "Healthy Wuhan" APP, fill out relevant information to get such medical equipment.  These batches of thermometers, oximeters and other disease prevention equipment are smart devices with data transmission functions. Symptoms of COVID-19 infection are not obvious at first, the common clinical diagnosis is persistent high fever and sudden decrease in blood oxygen concentration. With data connecting smart thermometer and oximeter, residents can continuously monitor their own bodies at home and ask for online diagnosis when abnormalities are found.  By doing this, a large amount of common cold patients can be diagnosed and treated online and avoid cross-infection in hospital. Case3: JuniperMD In order to support the country’s relentless effort on preventing the virus, reducing the burden on hospitals and eliminating possible cross-infection during medical treatment, JuniperMD teamed up with Healthfutures partners China Primary Health Care Foundation and jointly launched a series of free live broadcasts. During the broadcast, experts from Sino-US medical service institutions such as Columbia University Medical School, Boston Medical Center, Shanghai Jiao Tong University School of Medicine, and New York Presbyterian Hospital provided patients with remote healthcare consultation. The lectures also focused on  topics such as “How to distinguish between common flu and new coronavirus “, “Traditional Chinese and modern at home treatment techniques for common diseases”, and “psychological health maintenance during self isolation”.  Case 4: Judong Health Judong Health launched a 5G CT screening vehicle with Campo Imagining based on the original integrated first-aid platform. Compared with the traditional CT screen equipment, the 5G CT screen vehicle has extremely high mobility and flexibility. This vehicle is equipped with the latest 5G wireless data transmission function, which enables remote transmission of image data for remote diagnosis and serves hospitals and patients at the fastest speed. 2. Social Support Case 1: Viewhigh Technology (Social Support: Online Donation Platform) Based on smart supply chain technology, cloud services and big data technology, Viewhigh technology launched  “hospital emergency supply management platform”, the platform help establish rapid communication channels for hospitals, material suppliers, non-profit organizations, individuals at all levels throughout the country. Among them, Viewhigh cloud and the supply-side system has the level 3 national information security protection, which is the highest level of national certification for non-bank institutions. The platform iteratively launches information on hospital emergency supplies needs and purchase orders to over 40,000 medical material suppliers. Hundreds of medical institutions, such as Wuhan Jinyintan Hospital, Wuhan Central Hospital, Wuhan Lei Shenshan Hospital, Wuhan Children’s Hospital, and other frontline hospitals against COVID-19 have issued emergency material shortage announcements through platform, and successfully obtained emergency supplies. As of February 24, a total of 154 registered hospitals, 79 announcements have been issued, 7.1 million RMB have been traded and donated. Case 2: Wonder Technology (Mental Health) People, while accepting an exploration of virus related information, are easily vulnerable to depression, hopelessness, anger, fear, and other emotions. At the same time, front-line medical staffs not only face high-intensity work load and lack of rest, but also bear the anger from some patients do not cooperate. Pressure on both physical and mental health are tremendous.  Wonder Technology carried out an “emotional mask” project, where people can use mobile app capture their own voice and get a 3-minute plan that is suitable for solving current emotional problems. The application is developed base on world’s most accurate emotion perception AI model, the accuracy can reach to 88.5-95%. The project  has radiated more than 20,000 users, and will continue to grow in the future. 3. Epidemiologic study Cooperating with Tsinghua University, More Health’s officially launched the first version of “New Coronavirus Open Knowledge Graph […]

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Partners In Health Rwanda: Lessons In Eliminating Barriers To Care

This article, authored by ACCESS Health Chair and President William A. Haseltine, originally appeared in Forbes. In late February, Dr. Krishna Reddy, Country Director of ACCESS Health India, and I traveled to Rwanda to learn more about health systems strengthening from an organization that has proven itself to be a formidable leader in the field: Partners in health and the affiliated University Global Health Equity.  Partners In Health was officially established in 1987 by co founders Ophelia Dahl, Paul Farmer, Thomas J. White, Todd McCormack, and Dr. Jim Yong Kim (former President of the World Bank). It was partly chance that brought them together: Dahl and Farmer met years earlier while volunteering in rural Haiti, where they ran a community clinic that thrived despite a lack of institutional support. Their grassroots gumption, combined with their steadfast commitment to health as a social good and human right, has landed Partners In Health opportunities everywhere from Malawi and Sierra Leone to Mexico and Peru.  As might be expected, partnership-"accompaniment", Farmer calls it-is the organization's preferred mode of engagement, whether with national governments or community workers at the frontlines of health systems. Training and supporting local health providers that can deliver nonclinical services to people in their villages and homes is a top priority, so much so that nearly all of the Partners In Health employees stationed around the world are actually from the places where they work. Former Minister of Health Dr. Agnes Binagwaho first invited Partners In Health to Rwanda in 2005, having taken note of their success protecting poor communities in Haiti and Peru from tuberculosis and HIV/AIDS. In the fifteen years since, their partnership with the Rwandan government has resulted in the renovation or inauguration of three district hospitals and dozens of community health centers, as well as the employment of thousands of community health workers. Partners In Health in Rwanda (Inshuti Mu Buzima)  When Partners In Health first came to Rwanda, it was to pilot an HIV treatment program that had been  successful in Haiti and Peru. Partners In Health accompagnateurs equipped members of participating communities with the skills, tools, and knowledge they needed to dismantle the barriers that keep HIV patients from seeking and receiving treatment. Many of those trained to provide counseling, transport, food, and other forms of support were HIV patients themselves. Other early and ongoing projects include the Program on Social and Economic Rights (POSER), dedicated to mitigating social and economic barriers to healthcare; the provision of nutritional support, in the form of thousands of food packages, to patients with HIV and tuberculosis; and the renovation and refurbishment of community health centers and district hospitals. In Rwanda, Partners In Health is known as Inshuti Mu Buzima. Dr. Joel Mubiligi, executive director of Inshuti Mu Buzima, showed me and Dr. Reddy during our stay how the organization's projects interface multiple dimensions of health service delivery: Community health workers, community health centers, district hospitals, and district leadership.  Butaro District Hospital, a collaboration between Partners In Health, the Clinton Foundation, and the Ministry of Health located on a hilltop adjacent to the University of Global Health Equity works in all four dimensions. Butaro Hospital After Partners In Health had success implementing an innovative rural healthcare model in two of Rwanda's poorest districts, the Rwandan government invited them to lead the creation of a hospital in the Burera district in northern Rwanda. Plans for Butaro Hospital were first hatched in late 2007. To build Butaro Hospital, Partners In Health made the decision not to enlist major contractors or suppliers, but local labor and, when possible, local materials. Construction began in December 2008 and was finished expediently, in just two years. When the hospital opened its doors to the general public in early 2011, visitors found themselves amid the vegetal handiwork of Jean Baptiste, a Rwandan "master gardener" who collaborated with MASS Design Group to design facilities that felt open ended and restorative-even capable of healing. Far from frivolous-though some locals, exploring the property at first sight, did ask Farmer if it was a resort-the landscape of gardens, terraces, and courtyards functions as a low tech, cost efficient strategy for infection control. Poor ventilation is a major cause of airborne tuberculosis transmission and the "biggest problem for hospitals in Africa," according to Farmer. At Butaro Hospital, air cycles in and out of the wards a dozen times an hour at the least-an arrangement as practical for the health of patients as it is a source of pleasure.  Butaro Hospital is also home to cutting edge health facilities, technology, and services, furnished by $1.4 million dollars of medical equipment courtesy of the Ministry of Health. Among its specialized treatment centers and surgical programs is a neonatal intensive care unit created to address health problems prevalent throughout the region, such as prematurity, malnutrition, and low birth weight. There is also an outpatient mental health specialty clinic run by government employed psychiatric nurses and a psychologist-one example of a nationwide effort, another partnership between Partners In Health and the Ministry of Health, to decentralize and integrate mental health care into primary care. Prior to the construction and opening of Butaro Hospital, Burera district, home to more than 320,00 residents, had not a single hospital or even a doctor. Reaching the nearest hospital took several hours by foot and two hours by vehicle. Health indicators were at rock bottom-the country's worst. Within a year of opening, Butaro Hospital had served almost 25,000 patients total. The hundreds of successful surgeries, deliveries, and HIV screenings completed from 2011 to 2012 have since multiplied into thousands. One area of care in particular stands out as a landmark addition to health service delivery systems not just in Rwanda, but East Africa: the cancer center. Butaro Cancer Center of Excellence Infectious diseases currently cause more deaths in Africa than noncommunicable diseases like cancer, but this won't always be the case. Noncommunicable diseases are expected to become the most common cause of death as early as 2030, beating […]

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Study Shows Hydroxy Chloroquine Is Ineffective Against Covid-19 — So What Now?

This article by ACCESS Health President and Chair William A. Haseltine originally appeared in Forbes. Results from a controlled clinical trial from China on the use of hydroxy chloroquine as a treatment for Covid-19 have shown no significant differences in health outcomes between the control group and patients who received the experimental drug.  Thirty patients hospitalized for Covid-19 participated in the trial. Fifteen were treated with 400mg of chloroquine for five days and fifteen received standard supportive care. A week after the treatments started both groups were evaluated and results showed that no measurable difference in the progression of the disease. There are still important lessons to draw from the results. We must redouble our efforts towards the best and quickest medical solution — the development of therapeutic antiviral drugs that treat infection and prophylactic antiviral drugs that prevent infection. In the wake of the SARS and MERS outbreaks, a number of highly promising drug candidates emerged, though none of them were brought to fruition due to a glaring lack of funding and flagging interest in coronaviruses once each outbreak ended. Now, with renewed interest and resources, these drug candidates are moving quickly to clinical trials. Recently a small trial was held to determine whether lopinavir-ritonavir, a combination HIV treatment that inhibits coronavirus proteases, would deter the virus in Covid-19 patients. Unfortunately, as researchers recently reported in an article for the New England Journal of Medicine, the drug failed to cure or diminish infection.  But those early and unimpressive results aren't conclusive and, more importantly, the clinical trial only focused on only one of the virus' most promising targets, the protease. SARS-CoV-2 has favorable targets for antiviral drugs: the proteases, the helicase, and the RNA-dependent RNA polymerase.  A second takeaway from the Shanghai hydroxy chloroquine study is also critical — while medical solutions are promising, they are no guarantee. It is far too soon for us to abandon more aggressive actions that can be implemented immediately and effectively to slow the spread of Covid-19 in the United States.  To date, our response to Covid-19 has been among the worst in the world. Testing per capita here lags far behind other developed nations — including countries like Italy and the United Kingdom who are faring poorly in the face of this disease. In countries like Singapore and South Korea, aggressive contact tracing combined with widespread testing and selective isolation and quarantine has contained their outbreaks, dragging down the number of new infections each day and helping those countries avoid the extreme lockdown measures that have been used elsewhere, including here the United States.  There are now more than 55,000 cases of Covid-19 in the United States. In New York, the number of cases is doubling every three days. Thousands lie in hospital beds. Hundreds have already lost their lives. This is not the time for excuses or inaction – we must test, we must trace the contacts of those infected, and we must isolate all those at risk of spreading the disease further. And while we do so, we wait for a medical solution that will hopefully soon be at hand. Tara Haelle discussed the Chinese hydroxy chloroquine study in an earlier post today.

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Making Global Health Equity The Basis Of Health Education

This article, authored by ACCESS Health International President William A. Haseltine, originally appeared in Forbes. In a world where the dream of global health equity is made real, every single person-no matter who they are or where they come from-has the ability to lead a healthy and productive life. Health equity has become a hot topic, a guiding principle, and in some cases a main objective for many in the health sector. Few institutions, however, can profess as pragmatic or pervasive a commitment to this ideal as the University of Global Health Equity, a private, Rwanda based medical and public health school founded in 2015 and wholly owned by Partners In Health.  Run in close cooperation with the Rwandan government and key development partners in the region, the University trains students in the art of "not just building, but sustaining" health systems strong enough-and savvy enough-to solve our biggest global health challenges. Last month, I was invited to visit the University with my colleague, Dr. Krishna Reddy. It was an honor and great privilege to meet the students and speak to them about health systems strengthening.  The aspiring health professionals admitted are as brilliant and passionate as they come, but for many reasons-funding not the least among them-many once considered quality medical education to be a goal out of reach. Thanks in no small part to the generous support of international donors, to date the University of Global Health Equity has been able to give every single student scholarship funding, with the average award somewhere in the ballpark of 91 percent of their tuition fees. Until last year, classes were held on a provisional basis in Kigali, the capital. Today, the University has its own 250 acre campus in the hills of Butaro, a rural, low income region 80 miles away. Reaching the campus takes about an hour on paved roads-on dirt roads, another hour and a half. Neither the Uganda nor the Democratic Republic of Congo border is far.  Partners In Health, known by locals as Inshuti Mu Buzima, has worked in Rwanda since 2005, and both Dr. Joel Mubiligi, the executive director of Inshuti Mu Buzima, and Paul Farmer, co founder of Partners In Health, know the area well. So did my host John C. Urschel, a director of partnership development at the University. They may not have accompanied me on my gorilla trekking expedition, but they certainly taught me a thing or two about how a single place of learning can tackle health problems we experience worldwide. Why Rwanda? As a nation and a people, Rwanda has much to teach us about resilience, recovery, and the difficult task of building a better future for all. The 1994 genocide that took one million lives and harmed millions more had an immeasurable impact on the health of Rwandans and their ability to heal. Health facilities were in ruins, drug supply chains had fallen to pieces, and health workers who hadn't been killed, fled. Of the nurses and physicians who stayed behind, there remained a deep suspicion of complicity with the genocide. Understandably, trust in the health system was at an all time low-and for the health system to survive anew, trust would have to be rebuilt in tandem. In the years that followed, a health policy platform was pieced together that prioritized access and accountability. Solidarity and equity had also become part of the framework by the early aughts, as policymakers gradually devolved the power to manage healthcare and make health related decisions to the community level. Civil society representatives became regular attendees of once exclusive parliamentary meetings. Community based health insurance was piloted in a handful of districts, then scaled up nationwide in 2005. Community health leaders were elected by each of Rwanda's 15,000 villages and trained by the Ministry of Health to care for their neighbors, creating a base nearly 60,000 members strong by 2019. Population trust in the health system has since skyrocketed-and so has the availability and uptake of health services. In 2018, Rwandans reported levels of confidence in their hospitals and health clinics higher than those of any other population in the world. Nearly 100 percent of Rwandans have healthcare. Life expectancy has doubled, immunization coverage has more than tripled, and premature mortality rates have plunged. These accomplishments are nothing short of remarkable. But according to Agnes Binagwaho, who served the Rwandan government as Minister of Health from 2011 and 2016 and now leads the University of Global Health Equity as Vice Chancellor, one critical gap remains: education. Without more training opportunities for aspiring doctors and health professionals, what Rwanda has taken two decades to build might still be lost. Medical program: Bachelor of Medicine and Bachelor of Surgery For Rwandans aspiring to become doctors and health professionals, the options for quality medical education are limited. The only public medical school in the country-one of four total, including the University of Global Health Equity-offers training programs for general practitioners, but to specialize students must study abroad.  To fill this outstanding gap, the University of Global Health Equity created a dual degree program-a joint Bachelor of Medicine and Bachelor of Surgery, plus a Master of Science in Global Health Delivery-open to all Rwandans. The six and a half year program ensures that students meet all existing requirements for medical doctors, but radically departs from traditional paradigms of medical education otherwise. The minds behind the design of the curriculum, such as Vice Chancellor Binagwaho and Deputy Vice Chancellor Abebe Bekele, knew what it was like to receive training in a Western context and leave ill equipped to treat people in remote areas. Health equity isn't just one component of the University curriculum-it's the foundation. Speaking to various faculty and staff over the course of my trip, I found they embraced this vision wholeheartedly. First item on the docket for a new student? Six months of lessons on African history. This is accompanied and followed by coursework on human rights, gender studies and social justice, patient […]

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Interview with an American Quarantined in China for Covid-19

Quarantine is a powerful approach to curbing the spread of infectious disease. But the term can often be disquieting, evoking images of the sick and defenseless being dragged from homes and locked away with hundreds of potentially infectious strangers. The reality of quarantine in the age of coronavirus though is far different. A friend of ACCESS Health Chair and President William A. Haseltine was forced to quarantine in China after exposure to the highly transmissible virus, SARS-CoV-2. Dr. Haseltine’s interview with his friend provides insight into what quarantine in today's world looks like in practice. It also highlights the steps that must be taken in the event of an infectious disease outbreak to test those who are suspected of being infected, trace all those the suspect person came in contact with, and move them to safe zones of isolation and quarantine. Read the full interview HERE.

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Coronavirus pandemic could end in these ways – Maybe sooner than we expect

This piece by ACCESS Health Chair and President William A. Haseltine originally appeared on Fox News Opinion. The way public life has changed in the wake of the coronavirus pandemic may feel new and frightening to many. But the older among us have lived through similar times and similar fears. There is one thing we know that may bring solace: there will be an end to this pandemic and – if we take advantage of the most promising drug options available today – the end may come sooner than most think. Those of us who have lived long lives can remember the intense panic that summer used to bring, as “polio season” approached. Pools were shut down, movie theatres emptied, and most of us were isolated from the majority of our friends. Our fear was not unfounded. In 1952, nearly 60,000 children were infected with the virus and more than 3,000 died. Thousands who survived were left paralyzed by the disease. But a year later, researchers announced a new vaccine had been successfully tested in humans. Eventually, thanks to their work and the work of many other scientists and public health leaders, the epidemic was contained. The current coronavirus pandemic will end as well, despite how heavily it besieges us today. The only question is how. There are four possible ways: If the coronavirus proves to be seasonal in temperate climates, meaning that new infections eventually decline on their own as the weather warms. But in this scenario, the coronavirus would return when cold weather returns – although we hope that by then our health system is better prepared to help those who fall severely ill to recover. Through herd immunity, where a significant percentage of the population becomes infected, recovers and develops a natural immunity. The challenge is that reaching herd immunity will take a significant amount of time. While we wait, it’s possible that as many as 200,000 to 1.7 million Americans may die. Development of a vaccine that would be made widely available. There are at least five vaccines currently in some phase of development, with one starting clinical trials just this week. That’s a promising development, but just the first phase of a lengthy process. Even in the best-case scenario, it will still be many months before a successful vaccine is available to the general public. Accelerated development of therapeutic drugs that treat infections and, depending on the drug, prevent further infection from occurring. One option in this scenario is an antiviral drug combination that targets the RNA at the center of the coronavirus responsible for the pandemic sweeping across the world today. In the midst of the SARS and MERS outbreaks, a number of drug candidates that target key proteins in coronaviruses underwent lengthy laboratory and preclinical study. But the drugs were never advanced to clinical trials. That’s because there was no market for them and no government was willing to step in to guarantee the market with a commitment to stockpile the drugs. Thankfully, there is renewed interest today in these therapeutic solutions, with some antiviral drugs currently moving through clinical testing. There are also clinical studies now underway of other drugs that treat the respiratory consequences of infection but not the virus directly. With the right leadership and opportunity on our side, we may be able to begin moving toward the end of the current pandemic. But when this happens, we shouldn’t turn away from the lessons we are learning today. Someday there will be another lethal coronavirus epidemic. There will also be another highly lethal and transmissible strains of influenza, a global spread of antibiotic-resistant tuberculosis and antibiotic-resistant bacteria. The biological threats we face are not unknown – just like the current coronavirus outbreak was not unexpected among scientists. This outbreak is yet another lesson from the natural world – one we have ignored in the past and ignore in the future at our peril. If you live in an earthquake zone, you build earthquake-proof houses. If you live near a volcano, you pay close attention to the local seismometer and clear out when it goes off. Now we are on the alert today to take actions to protect ourselves against a dangerous virus. But will we forget again tomorrow? We will we ready for the next viral epidemic or pandemic? It is up to us to hold our leaders accountable now and in the future to step in and bring lifesaving drugs to market when others won’t or can’t.

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Social workers have a key role to play in the war against coronavirus

This piece by ACCESS Health Chair and President William A. Haseltine originally appeared on Fox News Opinion. As the number of Americans critically ill from coronavirus mounts, one thing is becoming increasingly clear: it's the oldest among us who are most vulnerable. Among the most recent deaths reported in the United States were a 69-year-old man, a man and a woman, each in their 70s, and another woman in her 80s. Their deaths reflect a wider story that those tracking the lethality of this new disease are just beginning to understand - in the fight against COVID-19, the younger fare far better than the old. Early research by the Chinese Center for Disease Control and Prevention has shown that the fatality rate of this new disease differs widely by age. For those confirmed cases between the ages of 10 and 39, only 0.2 percent die. For those 80 or older, the fatality rate is 14.8 percent. So while health care workers in hospitals and clinics may be the first line of defense for those feeling ill, it is the social workers and caregivers in our nursing homes and long-term care centers who are truly on the front lines of this outbreak. And yet, our national response has all but ignored this critical community. To redress our oversight, we must work immediately to integrate social workers and long-term care providers into our overall response to the outbreak. Social workers are the ones who will be able to identify those most at risk, who can alert authorities at the first sign of a patient falling ill, and who can pinpoint the patients who are likely to have the most severe and fatal reactions to COVID-19. Beyond simply linking social workers to the wider effort, we must also ensure that they have the knowledge, training and equipment to deliver immediate care for those in need - including the protective equipment in such scarce supply today. Without such equipment, social workers risk spreading infections to other patients and are at serious risk themselves as they move about facilities where the scope of the outbreak may not yet be fully understood. Now that testing kits are becoming increasingly available across the United States, long-term care facilities across the country and especially in communities with known cases should be the first among those to receive them. When a medical solution becomes available, we must prioritize these facilities as well, as they are home to the most vulnerable among us. History has taught us how critically important social workers can be in the face of a public health epidemic. They were the messengers who first warned us about the spread of tuberculosis in Victorian slums. They were the ones to first understand and advocate for AIDS patients in the earliest years of the epidemic. Today, they are the ones who can help us push back the boundaries of this epidemic and help prevent it from spreading across our country.

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MSNBC with Stephanie Ruhle Features ACCESS Health

MSNBC’s Stephanie Ruhle invited ACCESS Health Chair and President William A. Haseltine to explored the development of new drugs to treat Covid-19 and to help prevent further infection. The full clip is available here.

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