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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Terrified of Quarantine? Here’s What It Actually Looks Like (Part 2 of 2)

This piece by ACCESS Health Chair and President William A. Haseltine originally appeared in Psychology Today. There have been many unfortunate moments in America's quarantine history, from the forced confinement of Typhoid Mary to the barbed wire strung around parts of San Francisco's Chinatown in the midst of an outbreak of bubonic plague. But quarantine in the time of coronavirus will likely have no barbed wire moments. Still, even the possibility of forced quarantines have provoked fear among many. Recently a friend of mine and his wife were forced to quarantine in Shanghai. It was late February and they were returning from Europe back to their home in Shanghai. The city they were traveling from had yet to report a single confirmed case of Covid-19 — though they would do so just a day later — but upon their return, they agreed to two weeks of voluntary isolation in their homes. This experience was much like what many of us are doing here in New York — they went for walks and bought their groceries, but they stayed home most of the time. They were required to take their temperature twice a day and upload the results to an app so authorities could monitor their health from afar. Roughly 90% of people infected with Covid-19 experience a fever as one of the symptoms. Three days later, all that changed. My friends received calls from the police, the Shanghai Center for Disease Control (CDC) and their district CDC telling them a passenger on their flight had tested positive for infection and my friend and his wife were to be moved to a controlled quarantine location. This is different from self-quarantine, where you are asked not to leave your home, even to go out for food. With controlled quarantine measures, you are taken from your home and taken to a secure location for monitoring. A day later, my friend and his wife were taken by van to a three star hotel in the city, which had been taken over by authorities for quarantined individuals — not dissimilar to the quarantine motels set up in Washington State as the outbreak unfolded there. With suitcases in hand, they were taken to two separate rooms on the same floor and told they would be separated for the duration of their quarantine. Food would be brought to them three times a day and left in front of their doors. And once a day, their trash would be cleared and their room disinfected. With access to the internet and cell service, life on the inside was not all that different than life on the outside. They woke up, exercised, ate breakfast, and went on with their day, working remotely from a table in their rooms. They kept a video feed on with each other throughout the day so they could check in and group chat with friends. And they were even allowed to receive care packages with fresh fruit, wine, and other items that made life much more manageable, like warmer clothes, comfortable linens, and books to pass the time. While perhaps not enjoyable, in this case quarantine was most definitely liveable. Their story will hopefully bring relief to those who are afraid of what quarantine might bring. But despite the good news inherent in their story, there is still reason for a judicious amount concern. Quarantine was bearable for my friends because their government was prepared. They tested the traveller who was initially infected, traced all his contacts, and had a plan in place for quarantine. Rules for quarantine were given to my friends at the hotel's front door, along with a thermometer, soap, and even a bucket with dissolving disinfectant tablets that they were to use after going to the bathroom to prevent ongoing infection. Would that be our experience here? The answer is unclear. Already our healthcare leaders and health systems are scrambling to keep up with a surge in demand. In places where we have set up similar quarantine facilities there have been reports of inadequate controls to keep those who may be infected in place. Each of us have a responsibility to ourselves and each other to stay as safe and healthy as possible, even if it means we are inconvenienced and forced out of our daily routines. Only by alleviating the pressure on our health system now can we free up resources to ensure that our response to this outbreak and the support for those infected is as smooth and efficient as it was for my friends.

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Wondering What A Coronavirus Quarantine Is Really Like? (Part 1 of 2)

This piece by ACCESS Health Chair and President William A. Haseltine originally appeared in Forbes. Quarantine is an often disquieting term. From the mid 1300s to today, the word has evoked images of the sick and defenseless being dragged from their homes and locked away with dozens if not hundreds of potentially infectious strangers. The reality in the age of coronavirus though is far different. I had the opportunity this week to speak to a friend of mine who was forced into quarantine, along with his wife, in Shanghai. Many news outlets have reported on the Draconian measures introduced by China, describing   "hazmat suit-clad goons dragging people from their homes". Yet for my friends, the picture they paint of life under quarantine is different.  Their journey to quarantine started in late February, when they hopped a plane from Europe back to their home in Shanghai. The city they were traveling from had yet to report a single confirmed case of Covid-19 and Europe overall hadn't yet been dubbed a hot spot of infection. Upon their arrival at the Shanghai airport, they were screened like all other travelers - they walked through an infrared temperature check, they filled out a form describing where they had traveled, then they grabbed their suitcases, hopped into a waiting car, and headed home to their apartment.  The next day, when my friend went down to his lobby's front desk, the clerk examined him with friendly suspicion.  "He was asking me where I had been, since he hadn't seen me or my wife around the apartment for a few weeks. Once I told him I'd been traveling, his whole attitude changed. The only thing he wanted to talk about from then on was self-isolation." In China, there are three levels of isolation and quarantine. The first is self-isolation, which means you stay home, monitor your temperature, and record it via a mobile app that helps the city monitor the health of people in isolation from afar. You can go out to buy groceries and for walks, but other than that you are meant to confine yourself to your home. The second level is home quarantine, where you're still at home but cannot step outside your home. And the third is controlled quarantine, where you are taken out of your home and sent to a supervised quarantine facility. The government of Shanghai had asked all those traveling into the city from elsewhere to voluntarily self-isolate for two weeks to be sure they weren't unknowingly spreading infections. There was no doubt that my friend and his wife would comply.  "For the next three days, we stuck very close to home. We could leave to get groceries if we needed to, but mostly my wife and I ordered in. But even ordering food was different than it used to be before the outbreak. Instead of bringing the food to our apartment, the delivery people had to leave it on a set of tables and shelves that had been temporarily placed by the front gate. At least we could go down to pick it up, since we were only self-isolating. If you're told to self-quarantine you can't leave your apartment - someone from the building has to bring it up to you." "Then that Tuesday, three days after we'd arrived back in Shanghai, everything changed. Our phone rang incessantly that day - the police, the Shanghai Center for Disease Control, and the district CDC all called us to let us know that a passenger on our flight to Shanghai had tested positive for infection. But that isn't really what shocked us - what alarmed us the most is when they told us we would have to finish out the rest of our fourteen day period of self-isolation in a controlled quarantine facility. They wanted to take us from our home." "The word quarantine was terrifying. I was thinking of quarantine as somehow a lot of very, very sick people locked up together. Not, you know, a rational thing. Sort of like solitary confinement - you are cut off in some sense from the rest of the world. I even checked with the American consulate to see if it was really necessary. But they told us there was no other option, we would have to accept the forced quarantine or risk the consequences of non-compliance." "That night we each packed a suitcase of our personal things and a bag with our laptops and tablets then the next morning we went downstairs at 11:00am, as they'd asked. A person comes in wearing a mask and some sort of surgical gown and walks us over to a van. Then he drove us over to a local hotel. Oddly enough, we looked it up later and found out it was actually a three star hotel when it was operational." Much like the quarantine motels set up in Washington State here in the United States, the Chinese government had taken over hundreds of hotels to use as quarantine facilities to help contain the spread of the disease. "When we arrived, there was another person in a hazmat suit standing outside waiting for us. It was nothing like the usual hotel check in process. We walked inside and were greeted by a very nice woman in a surgical mask and gown sitting behind a card table with forms and instructions. She politely but firmly explained that we would have to stay in separate rooms. She gave me a form which included rules for the next eleven days of our stay. We couldn't leave our rooms. We couldn't receive guests. And when we received our three meals a day - at 8:30am, 12:00pm and 6:00pm - we would listen for a knock on our door then wait thirty seconds before opening the door, getting our food as quickly as possible, and shutting the door behind us." "It was all a bit unnerving at first. We asked if we could room together, but they said no […]

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

This article by ACCESS Health Chair and President William A. Haseltine originally appeared on FOX 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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Coronavirus Mismanagement Is Risking American Lives

This article by ACCESS Health Chair and President William A. Haseltine originally appeared in Forbes. It is now clear that the U.S. response to the potential dangers of the coronavirus infection is inadequate, confused, and-worst of all-putting us all at much greater risk than we need to be. Our first mistake was in choosing to develop our own diagnostic testing kits, instead of following the available WHO guidelines. It  took more than a month since the beginning of the outbreak for the CDC to deliver tests to a handful of labs across the country, only to discover that the kits that were sent were flawed.  The second mistake was in determining who qualified for testing. Initially only patients with recent travel to China and who showed symptoms of COVID-19 were approved for testing. It was only this week, on Tuesday, when the administration relented and allowed all Americans to be tested, if needed. But even with this step forward, our mistakes continue. Our government is now punting the testing problem down to the States. While finally allowing States to develop their own FDA approved testing kits to make testing more available, the government is now holding States solely accountable for tracking the number of people tested. On Monday, the CDC stopped reporting national numbers of people tested on their website, claiming that now that States were conducting tests themselves the CDC no longer had the most up to date figures.  Without clear reporting from the CDC or transparent communication from the administration, the scope of the outbreak in America is still a complete unknown. A new analysis out of the Fred Hutchinson Cancer Research Center in Seattle suggests that this new strain of coronavirus has been spreading unseen and undetected in the area for weeks. Some models suggest up to 1,500 people could already be infected in the greater Seattle area alone.  Calling out the government for their failures isn't about politicizing public health-it's about protecting our nation from a growing danger. The mistakes we made allowed COVID-19 to come to our country unseen and undetected. The mistakes allowed the virus to spread to places like the Life Care Center, where more than 50 residents and staff continue to struggle with the disease, and seven residents-the oldest and most vulnerable among us-have died.  And the mistakes we continue to make in shielding the facts from Americans is making it harder for us to make the tough decisions around possible self-quarantines, social distancing measures, and school or business related shutdowns.  It is astounding that while China can now distribute more than a million tests per week and South Korea has rolled out drive-thru testing clinics and disinfecting drones, we have no one in government who can give us clear numbers around how many Americans have been tested and how many patients are under investigation for the disease. We can and should do better. The administration, Congress, and our entire government leadership must be called on to deliver a more transparent, a more effective, and a more robust response than what we have done to date.

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Integrating social care and elder care has many benefits

This piece by ACCESS Health Chair and President William A. Haseltine originally appeared in McKnight’s Senior Living. The social needs of older adults are multifaceted, diverse and, more often than not, unmet. This is especially true for older adults living with disabilities, low incomes or multiple chronic conditions. For many, day-to-day mobility is restricted to the community or the home, limiting their access to elder care services outside the scope of either. Fortunately, emergent solutions such as person-centered long-term care are helping caregivers accommodate the full complexity of the people they serve. There is no escaping the fact, however, that it will take systems-level change for a solution so individualized to reach the entirety of an aging population. A new report published by the National Academies of Sciences, Engineering, and Medicine proposes a paradigm shift that might just fit the bill - the integration of social care and medical care. The report urges public health leaders and healthcare providers to acknowledge the relevance of social needs to medical needs and adjust their service delivery systems accordingly. Because social care and person-centered long-term care are both designed to give residents and patients the fullest continuum of supports and services possible, elder care providers would have much to gain from social care integration. The areas of overlap outlined below are just a few reasons why. Home- and community-based care According to the National Academies report, enveloping social care organizations into the fold of the traditional healthcare systems would rebalance services between clinical and community settings, on the one hand, and make them more responsive to the social conditions of patients on the other. Older adults who have easy access to social and medical services as they age stand a better chance of managing certain health risks and behaviors early on, as well as remaining an active participant in community life. Home- and community-based services also make it possible for older adults to spend as much of their lives as they can in the comfort of their own homes (including senior living, if that's where they live). Caregivers who provide home-based care, a branch of healthcare that generally falls under social care, are trained to identify and honor the natural rhythms and preferences of individuals. This example of person-centered care functions as a much-needed corrective to the current reality for many older adults, in which they shuffle from provider to provider and never come away fully satisfied. Interdisciplinary care teams Family caregivers, home health aides and gerontologists are just a few of the types of professionals who make up the social care workforce. Their unique perspective on the social needs of those in their care, especially in the case of older adults, should prove valuable to any healthcare provider accustomed to approaching and conceiving of health through a strictly medical lens. With social care integration comes the opportunity to form interdisciplinary care teams that can coordinate, for any given resident or patient, the distribution of responsibilities between social and traditional healthcare workers. In addition to being incredibly convenient for older adults, who would alternatively spend unnecessary amounts of time and energy navigating fragmented social and medical service delivery systems, interdisciplinary care teams are more capable of maintaining stable relationships between caregivers and with patients. Interdisciplinary care, in addition to bridging gaps between services, also alleviates providers of the burdens produced by redundancy, miscommunication and other inefficiencies caused by poor coordination. In Uppsala, Sweden, for example, a central care coordination group formed by doctors, occupational therapists, nurses and municipal support agents does this for the town's primary care physicians by conducting care-planning meetings for their patients. The delegation of that task alone not only frees up overburdened physicians but also opens up a healthy channel of ongoing communication between providers. Shared care philosophy Social care integration, like person-centered elder care, can equip healthcare providers and systems around the world with the tools, knowledge and capabilities needed to treat older adults with the comfort, respect and dignity they deserve. It also is cost-effective, as demonstrated by initiatives such as the CAPABLE (Community Aging in Place-Advancing Better Living for Elders) program, which yielded cost savings six times the amount spent on implementation. A care philosophy that emphasizes the whole of a person, rather than reducing an individual to his or her health problems and limitations, is precisely what older adults deserve. Although it will require substantial policy support and organizational buy-in, countries that integrate social and medical care are building health systems that can live up to that philosophy - for the aging populations of today and for future generations.

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ACCESS Health Southeast Asia and Finn Partners Asia Release Report on the Impact of Digital Innovations on Healthcare in Asia

Finn Partners Asia, a global marketing and communications agency, and the ACCESS Health Southeast Asia office recently announced the launch of its What The Tech: Impact of Digital Innovations on Healthcare in Asia report As the press release about the launch noted, “Asia is a region where people have better access to a smart phone than to a doctor. The demand for high quality healthcare products and services will continue to rise as the middle-income group grow and age or as lifestyles change. In eight out of ten Southeast Asian countries, more than a third of healthcare expenses are paid out-of-pocket by individuals. Cloud-based platforms, emerging technologies, and modern data centres are breaking down barriers in terms of access, cost, and computing power, allowing data-driven health research to reach a new frontier.” The report looks at how digital innovation - specifically innovations related to healthcare delivery, financing, and discovery - has the potential to bridge the widening healthcare coverage gap in the region. Upon the release of the report, ACCESS Health Country Director for Singapore stated, "Without digital transformation, there is no health transformation. In Asia, we are at a pivotal point where the combined power of political commitment and digital technology will help countries achieve the goal of health for all citizens. We're excited to collaborate with Ying Finn on this report which highlights some of the biggest trends in this space in Asia." "There is a tremendous opportunity to increase affordable healthcare coverage through digital solutions in Asia Pacific. We are seeing incredible innovation by both traditional healthcare organizations and new healthtech players that is transforming this dynamic market," said Shuchi Joseph, Vice President, PR & Asia Health Practice, Finn Partners. "Health is Finn Partners' largest global practice today. I am very proud to be working with our experts in Consumer, Health, and Technology to support all the brands in the health ecosystem as they navigate the brave new world of tech-powered patient care." The release of this report follows the launch of FINN Wellness Collaborative, a global offering dedicated to elevating brands that support a better, healthier world. Download a copy of the What The Tech: Impact of Digital Innovations on Healthcare in Asia report here: https://cutt.ly/Wr3XsVG

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