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Building surge ICU capacity during COVID-19

Building surge ICU capacity during COVID-19

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Medical University of South Carolina team is one of nine chosen by U.S. Army to build a prototype for increasing ICU surge capacity during COVID-19.

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Credit: Emma Vought, Medical University of South Carolina

To prepare for current and future waves of COVID-19, the U.S. Army’s Telemedicine and Advanced Technology Research Center asked teams from across the country to compete to build a telehealth prototype that would provide adequate ICU capacity when cases surge. Of the 78 teams that competed, only nine were invited to complete a series of tasks designed to establish the feasibility of their prototypes. A Medical University of South Carolina team of bioinformatics, telehealth and critical care experts was one of those nine.

The ultimate goal of the competition is to create and coordinate a “virtual ward” that would offer technology-based and patient-centered care solutions. Networking technologies would connect medical devices and smartphone applications to health care information technology systems, such as the electronic health record. These virtual wards are intended to bring high-quality critical care capability to nearly every bedside, be it a health care facility, field hospital or gymnasium. They will be low-resource and flexible so that they can be mobilized to provide superior intensive care to places that lack adequate critical care expertise and the resources necessary for care of COVID-19-related illnesses.

Each of the nine teams was awarded up to $1 million dollars and given 15 days to complete the first of five tasks necessary to deploy its prototype. MUSC has just completed Task 1 and submitted it for evaluation. Only those teams whose efforts at completing Task 1 are judged successful will be invited to participate in Task 2. The ultimate goal is to narrow down to three or so teams that will collaborate to roll out these virtual critical care networks nationally.

The MUSC team is led by Leslie Lenert, M.D., MUSC assistant provost for data science and informatics and chief research information officer, and Dee Ford, M.D., director of the MUSC Telehealth Center of Excellence and professor in the Division of Pulmonary and Critical Care.

“We are a great team in that I can provide the technical foundation, but Dee can offer the practical telehealth experience and critical care expertise to make sure this is more than a science project,” said Lenert.

Their proposed prototype, known as Portable Remote Operational Wireless Enabled Surge Specialist ICU, or Prowess-ICU, builds on MUSC’s more than 15 years of experience with telehealth, including tele-ICU, and the strong regional partnerships that it has created. Since 2013, MUSC has partnered with Advanced ICU Care to provide remote monitoring of ICUs throughout the state, invaluable experience for the task at hand.

“We were selected to develop a prototype because, as a national leader in telehealth, we have the institutional knowledge, expertise and experience on how to build outreach tools,” explained Ford.

According to Ford, the project management and research infrastructure provided by the South Carolina Clinical & Translational Research Institute has also been invaluable. SCTR is one of about 60 Clinical and Translational Science Awards hubs nationwide funded by the National Institutes of Health. Their purpose is to help speed research breakthroughs into the clinic.

Lenert agrees. “This project would not have been possible without the substantial and highly enthusiastic logistical and organizational support provided by SCTR,” he added.

Also key was the technical expertise of Lenert and the teams at the Biomedical Informatics Center, which will be building the digital infrastructure for the project and customizing off-the-shelf sensors, such as pulse oximeters and thermometers, to collect COVID-19-relevant data. Information Solutions, the Epic team and the analytics team run by Matt Turner, MUSC chief data officer, are all making critical contributions to the project.

“I think that this particular combination of technical, operational, clinical and telehealth expertise that we were able to bring was quite compelling,” added Ford.

One strength of PROWESS-ICU is that it proposes a model for COVID-19 care that is tightly integrated within existing regional health care networks. According to Ford and Lenert, lack of such integration has thus far limited the usefulness of field hospitals, making providers less likely to refer patients and preventing the sharing of data about treated patients back to local providers.

“If providers don’t know you, at least by reputation, they’re not going to trust you and send you patients,” said Lenert. “So we don’t want field hospitals or surge ICUs that are untethered from existing health care delivery. That can lead to lack of trust, lack of knowledge and inadequate data sharing.”

Prowess-ICU would build on long-standing relationships between MUSC Health and regional providers to provide comprehensive solutions to addressing COVID-19 surge capacity. These include virtual care visits to determine whether a patient needs testing; remote home monitoring, for those who test positive but do not develop severe symptoms; and austere or advanced surge ICUs for sicker patients. Austere ICUs, or makeshift ICUs that can be deployed very rapidly in response to a surge, would be replaced in time by more robust and better-equipped advanced ICUs, if needed. MUSC Health, a regional critical care and telehealth leader, would act as the “mothership,” caring for the sickest of the sick.

The ICUs would be fitted with wireless monitoring technology, tailored to collect data that is clinically relevant to COVID-19. Data from the sensors and monitoring technology will stream to the Azure cloud, where artificial intelligence algorithms will analyze them for indications that a patient is improving or declining clinically. Those data will then be “downstreamed” hourly into a common electronic health record, where they can be accessed by remote specialists at MUSC or other motherships to decide whether the patient needs to be moved to a different level of care.

An impressive array of partners has signed onto the project, including Microsoft, whose Azure cloud technology is essential to its infrastructure and which has been instrumental in forging key partnerships; Advanced ICU Care, which will assist with monitoring the austere and advanced ICUs and help to train remote staff; Masimo and Medtronic, which will provide the sensors both for home monitoring and ICUs; and Doxy.me, a telehealth platform that can facilitate video visits and communications between providers and patients. The project will also leverage the expertise of technology, emergency response and patient safety experts at a number of other universities, including Massachusetts General Hospital, university hospitals affiliated with Case Western Reserve University, Dartmouth University and University of California, San Diego.

Lenert and Ford are particularly proud of the “modular” structure of PROWESS-ICU. Teams are organized in the same way at every level of care from the surge ICU teams in the community to remote specialists at MUSC.

“Each surge unit is a replica of the organizational structure of the mothership so that respiratory therapy experts at one unit can talk to respiratory therapists at another unit or the mothership, nurses can talk to nurses and so on,” explained Lenert. “The idea is that there’s an organized way for people to get help and to communicate with the person that has their role inside the mothership organization.”

Another advantage of this modular approach is that surge ICUs can be built and moved nimbly as the epidemic evolves, and even the mothership function can be moved to another institution should the first one become overwhelmed.

Ford believes that another strength of MUSC’s prototype is its responsiveness to the needs of rural and minority communities during the COVID-19 crisis.

“How to deploy 1,000 beds in a major urban center is an important component of any COVID-19 response,” explained Ford. “But equally important is how to deploy eight or 12 beds in a rural underserved community to make sure all citizens are getting the support they need. We’ve been intentional about how we think through those kinds of health disparities issues.”

Responding to COVID-19 will require a united front, according to Lenert and Ford.

“The problem is bigger than any one hospital or health system or region can handle, and so we need to work together,” said Lenert.

###

About the Medical University of South Carolina

Founded in 1824 in Charleston, MUSC is the oldest medical school in the South as well as the state’s only integrated academic health sciences center with a unique charge to serve the state through education, research and patient care. Each year, MUSC educates and trains more than 3,000 students and 800 residents in six colleges: Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy. The state’s leader in obtaining biomedical research funds, in fiscal year 2019, MUSC set a new high, bringing in more than $284 million. For information on academic programs, visit http://musc.edu.

As the clinical health system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest quality patient care available while training generations of competent, compassionate health care providers to serve the people of South Carolina and beyond. Comprising some 1,600 beds, more than 100 outreach sites, the MUSC College of Medicine, the physicians’ practice plan and nearly 275 telehealth locations, MUSC Health owns and operates eight hospitals situated in Charleston, Chester, Florence, Lancaster and Marion counties. In 2019, for the fifth consecutive year, U.S. News & World Report named MUSC Health the No. 1 hospital in South Carolina. To learn more about clinical patient services, visit http://muschealth.org.

MUSC and its affiliates have collective annual budgets of $3.2 billion. The more than 17,000 MUSC team members include world-class faculty, physicians, specialty providers and scientists who deliver groundbreaking education, research, technology and patient care.

About the SCTR Institute

The South Carolina Clinical and Translational Research (SCTR) Institute is the catalyst for changing the culture of biomedical research, facilitating sharing of resources and expertise and streamlining research-related processes to bring about large-scale change in the clinical and translational research efforts in South Carolina. Our vision is to improve health outcomes and quality of life for the population through discoveries translated into evidence-based practice. To learn more, visit https://research.musc.edu/resources/sctr

Media Contact
Heather Woolwine
woolwinh@musc.edu

Original Source

https://web.musc.edu/about/news-center/2020/07/08/surge-icus

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Are Voters Recoiling Against Disorder?

Are Voters Recoiling Against Disorder?

Authored by Michael Barone via The Epoch Times (emphasis ours),

The headlines coming out of the Super…

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Are Voters Recoiling Against Disorder?

Authored by Michael Barone via The Epoch Times (emphasis ours),

The headlines coming out of the Super Tuesday primaries have got it right. Barring cataclysmic changes, Donald Trump and Joe Biden will be the Republican and Democratic nominees for president in 2024.

(Left) President Joe Biden delivers remarks on canceling student debt at Culver City Julian Dixon Library in Culver City, Calif., on Feb. 21, 2024. (Right) Republican presidential candidate and former U.S. President Donald Trump stands on stage during a campaign event at Big League Dreams Las Vegas in Las Vegas, Nev., on Jan. 27, 2024. (Mario Tama/Getty Images; David Becker/Getty Images)

With Nikki Haley’s withdrawal, there will be no more significantly contested primaries or caucuses—the earliest both parties’ races have been over since something like the current primary-dominated system was put in place in 1972.

The primary results have spotlighted some of both nominees’ weaknesses.

Donald Trump lost high-income, high-educated constituencies, including the entire metro area—aka the Swamp. Many but by no means all Haley votes there were cast by Biden Democrats. Mr. Trump can’t afford to lose too many of the others in target states like Pennsylvania and Michigan.

Majorities and large minorities of voters in overwhelmingly Latino counties in Texas’s Rio Grande Valley and some in Houston voted against Joe Biden, and even more against Senate nominee Rep. Colin Allred (D-Texas).

Returns from Hispanic precincts in New Hampshire and Massachusetts show the same thing. Mr. Biden can’t afford to lose too many Latino votes in target states like Arizona and Georgia.

When Mr. Trump rode down that escalator in 2015, commentators assumed he’d repel Latinos. Instead, Latino voters nationally, and especially the closest eyewitnesses of Biden’s open-border policy, have been trending heavily Republican.

High-income liberal Democrats may sport lawn signs proclaiming, “In this house, we believe ... no human is illegal.” The logical consequence of that belief is an open border. But modest-income folks in border counties know that flows of illegal immigrants result in disorder, disease, and crime.

There is plenty of impatience with increased disorder in election returns below the presidential level. Consider Los Angeles County, America’s largest county, with nearly 10 million people, more people than 40 of the 50 states. It voted 71 percent for Mr. Biden in 2020.

Current returns show county District Attorney George Gascon winning only 21 percent of the vote in the nonpartisan primary. He’ll apparently face Republican Nathan Hochman, a critic of his liberal policies, in November.

Gascon, elected after the May 2020 death of counterfeit-passing suspect George Floyd in Minneapolis, is one of many county prosecutors supported by billionaire George Soros. His policies include not charging juveniles as adults, not seeking higher penalties for gang membership or use of firearms, and bringing fewer misdemeanor cases.

The predictable result has been increased car thefts, burglaries, and personal robberies. Some 120 assistant district attorneys have left the office, and there’s a backlog of 10,000 unprosecuted cases.

More than a dozen other Soros-backed and similarly liberal prosecutors have faced strong opposition or have left office.

St. Louis prosecutor Kim Gardner resigned last May amid lawsuits seeking her removal, Milwaukee’s John Chisholm retired in January, and Baltimore’s Marilyn Mosby was defeated in July 2022 and convicted of perjury in September 2023. Last November, Loudoun County, Virginia, voters (62 percent Biden) ousted liberal Buta Biberaj, who declined to prosecute a transgender student for assault, and in June 2022 voters in San Francisco (85 percent Biden) recalled famed radical Chesa Boudin.

Similarly, this Tuesday, voters in San Francisco passed ballot measures strengthening police powers and requiring treatment of drug-addicted welfare recipients.

In retrospect, it appears the Floyd video, appearing after three months of COVID-19 confinement, sparked a frenzied, even crazed reaction, especially among the highly educated and articulate. One fatal incident was seen as proof that America’s “systemic racism” was worse than ever and that police forces should be defunded and perhaps abolished.

2020 was “the year America went crazy,” I wrote in January 2021, a year in which police funding was actually cut by Democrats in New York, Los Angeles, San Francisco, Seattle, and Denver. A year in which young New York Times (NYT) staffers claimed they were endangered by the publication of Sen. Tom Cotton’s (R-Ark.) opinion article advocating calling in military forces if necessary to stop rioting, as had been done in Detroit in 1967 and Los Angeles in 1992. A craven NYT publisher even fired the editorial page editor for running the article.

Evidence of visible and tangible discontent with increasing violence and its consequences—barren and locked shelves in Manhattan chain drugstores, skyrocketing carjackings in Washington, D.C.—is as unmistakable in polls and election results as it is in daily life in large metropolitan areas. Maybe 2024 will turn out to be the year even liberal America stopped acting crazy.

Chaos and disorder work against incumbents, as they did in 1968 when Democrats saw their party’s popular vote fall from 61 percent to 43 percent.

Views expressed in this article are opinions of the author and do not necessarily reflect the views of The Epoch Times or ZeroHedge.

Tyler Durden Sat, 03/09/2024 - 23:20

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Veterans Affairs Kept COVID-19 Vaccine Mandate In Place Without Evidence

Veterans Affairs Kept COVID-19 Vaccine Mandate In Place Without Evidence

Authored by Zachary Stieber via The Epoch Times (emphasis ours),

The…

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Veterans Affairs Kept COVID-19 Vaccine Mandate In Place Without Evidence

Authored by Zachary Stieber via The Epoch Times (emphasis ours),

The U.S. Department of Veterans Affairs (VA) reviewed no data when deciding in 2023 to keep its COVID-19 vaccine mandate in place.

Doses of a COVID-19 vaccine in Washington in a file image. (Jacquelyn Martin/Pool/AFP via Getty Images)

VA Secretary Denis McDonough said on May 1, 2023, that the end of many other federal mandates “will not impact current policies at the Department of Veterans Affairs.”

He said the mandate was remaining for VA health care personnel “to ensure the safety of veterans and our colleagues.”

Mr. McDonough did not cite any studies or other data. A VA spokesperson declined to provide any data that was reviewed when deciding not to rescind the mandate. The Epoch Times submitted a Freedom of Information Act for “all documents outlining which data was relied upon when establishing the mandate when deciding to keep the mandate in place.”

The agency searched for such data and did not find any.

The VA does not even attempt to justify its policies with science, because it can’t,” Leslie Manookian, president and founder of the Health Freedom Defense Fund, told The Epoch Times.

“The VA just trusts that the process and cost of challenging its unfounded policies is so onerous, most people are dissuaded from even trying,” she added.

The VA’s mandate remains in place to this day.

The VA’s website claims that vaccines “help protect you from getting severe illness” and “offer good protection against most COVID-19 variants,” pointing in part to observational data from the U.S. Centers for Disease Control and Prevention (CDC) that estimate the vaccines provide poor protection against symptomatic infection and transient shielding against hospitalization.

There have also been increasing concerns among outside scientists about confirmed side effects like heart inflammation—the VA hid a safety signal it detected for the inflammation—and possible side effects such as tinnitus, which shift the benefit-risk calculus.

President Joe Biden imposed a slate of COVID-19 vaccine mandates in 2021. The VA was the first federal agency to implement a mandate.

President Biden rescinded the mandates in May 2023, citing a drop in COVID-19 cases and hospitalizations. His administration maintains the choice to require vaccines was the right one and saved lives.

“Our administration’s vaccination requirements helped ensure the safety of workers in critical workforces including those in the healthcare and education sectors, protecting themselves and the populations they serve, and strengthening their ability to provide services without disruptions to operations,” the White House said.

Some experts said requiring vaccination meant many younger people were forced to get a vaccine despite the risks potentially outweighing the benefits, leaving fewer doses for older adults.

By mandating the vaccines to younger people and those with natural immunity from having had COVID, older people in the U.S. and other countries did not have access to them, and many people might have died because of that,” Martin Kulldorff, a professor of medicine on leave from Harvard Medical School, told The Epoch Times previously.

The VA was one of just a handful of agencies to keep its mandate in place following the removal of many federal mandates.

“At this time, the vaccine requirement will remain in effect for VA health care personnel, including VA psychologists, pharmacists, social workers, nursing assistants, physical therapists, respiratory therapists, peer specialists, medical support assistants, engineers, housekeepers, and other clinical, administrative, and infrastructure support employees,” Mr. McDonough wrote to VA employees at the time.

This also includes VA volunteers and contractors. Effectively, this means that any Veterans Health Administration (VHA) employee, volunteer, or contractor who works in VHA facilities, visits VHA facilities, or provides direct care to those we serve will still be subject to the vaccine requirement at this time,” he said. “We continue to monitor and discuss this requirement, and we will provide more information about the vaccination requirements for VA health care employees soon. As always, we will process requests for vaccination exceptions in accordance with applicable laws, regulations, and policies.”

The version of the shots cleared in the fall of 2022, and available through the fall of 2023, did not have any clinical trial data supporting them.

A new version was approved in the fall of 2023 because there were indications that the shots not only offered temporary protection but also that the level of protection was lower than what was observed during earlier stages of the pandemic.

Ms. Manookian, whose group has challenged several of the federal mandates, said that the mandate “illustrates the dangers of the administrative state and how these federal agencies have become a law unto themselves.”

Tyler Durden Sat, 03/09/2024 - 22:10

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Low Iron Levels In Blood Could Trigger Long COVID: Study

Low Iron Levels In Blood Could Trigger Long COVID: Study

Authored by Amie Dahnke via The Epoch Times (emphasis ours),

People with inadequate…

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Low Iron Levels In Blood Could Trigger Long COVID: Study

Authored by Amie Dahnke via The Epoch Times (emphasis ours),

People with inadequate iron levels in their blood due to a COVID-19 infection could be at greater risk of long COVID.

(Shutterstock)

A new study indicates that problems with iron levels in the bloodstream likely trigger chronic inflammation and other conditions associated with the post-COVID phenomenon. The findings, published on March 1 in Nature Immunology, could offer new ways to treat or prevent the condition.

Long COVID Patients Have Low Iron Levels

Researchers at the University of Cambridge pinpointed low iron as a potential link to long-COVID symptoms thanks to a study they initiated shortly after the start of the pandemic. They recruited people who tested positive for the virus to provide blood samples for analysis over a year, which allowed the researchers to look for post-infection changes in the blood. The researchers looked at 214 samples and found that 45 percent of patients reported symptoms of long COVID that lasted between three and 10 months.

In analyzing the blood samples, the research team noticed that people experiencing long COVID had low iron levels, contributing to anemia and low red blood cell production, just two weeks after they were diagnosed with COVID-19. This was true for patients regardless of age, sex, or the initial severity of their infection.

According to one of the study co-authors, the removal of iron from the bloodstream is a natural process and defense mechanism of the body.

But it can jeopardize a person’s recovery.

When the body has an infection, it responds by removing iron from the bloodstream. This protects us from potentially lethal bacteria that capture the iron in the bloodstream and grow rapidly. It’s an evolutionary response that redistributes iron in the body, and the blood plasma becomes an iron desert,” University of Oxford professor Hal Drakesmith said in a press release. “However, if this goes on for a long time, there is less iron for red blood cells, so oxygen is transported less efficiently affecting metabolism and energy production, and for white blood cells, which need iron to work properly. The protective mechanism ends up becoming a problem.”

The research team believes that consistently low iron levels could explain why individuals with long COVID continue to experience fatigue and difficulty exercising. As such, the researchers suggested iron supplementation to help regulate and prevent the often debilitating symptoms associated with long COVID.

It isn’t necessarily the case that individuals don’t have enough iron in their body, it’s just that it’s trapped in the wrong place,” Aimee Hanson, a postdoctoral researcher at the University of Cambridge who worked on the study, said in the press release. “What we need is a way to remobilize the iron and pull it back into the bloodstream, where it becomes more useful to the red blood cells.”

The research team pointed out that iron supplementation isn’t always straightforward. Achieving the right level of iron varies from person to person. Too much iron can cause stomach issues, ranging from constipation, nausea, and abdominal pain to gastritis and gastric lesions.

1 in 5 Still Affected by Long COVID

COVID-19 has affected nearly 40 percent of Americans, with one in five of those still suffering from symptoms of long COVID, according to the U.S. Centers for Disease Control and Prevention (CDC). Long COVID is marked by health issues that continue at least four weeks after an individual was initially diagnosed with COVID-19. Symptoms can last for days, weeks, months, or years and may include fatigue, cough or chest pain, headache, brain fog, depression or anxiety, digestive issues, and joint or muscle pain.

Tyler Durden Sat, 03/09/2024 - 12:50

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