“EVERYTHING WE DO BEFORE A PANDEMIC WILL SEEM ALARMIST. EVERYTHING WE DO AFTER WILL SEEM INADEQUATE” – Michael Leavitt
Why are we writing this?
The COVID-19 pandemic has reached a point where containment is no longer possible. The COVID-19 threat is real, and rapidly getting worse. Many of you are very nervous, some are unsure of the validity of the information you are reading. As physician leaders, we felt it was important to craft a resource you can rely on as being scientifically accurate and one which contains as much actionable information and guidance as possible.
Accurate, actionable information during an epidemic can save lives. Physicians are on the front line of this epidemic. Not only are we treating the sick, but we are also cringing at the misinformation spread through both traditional broadcast and social media. Evidence matters. Unfortunately, evidence is often slow, methodical, and boring and has a tough time against clicky headlines and exaggeration. We believe that an accurate representation of the current COVID-19 pandemic followed by a set of actionable steps you, your loved ones, politicians and local officials can utilize is of paramount importance and ultimately could save tens of thousands of lives.
COVID-19 isn’t just the flu?
COVID-19 has been described by some as “just a cold”, or just like the common flu. COVID-19 is not the common flu. COVID-19 is an order of magnitude worse than the flu. The fatality rate is approximately 10 times worse than the flu.
The flu spreads from September through April in the US, and June through August in the Southern Hemisphere. Yes, it does cause severe illness in many, but it does so over a longer time course. Time is a variable that is working against us during this COVID-19 outbreak. COVID-19 victims will be presenting to a hospital in need of critical care at a rate that is far higher than occurs with the flu.
In addition, these patients will be requiring hospital treatment over the course of a few weeks rather than the 3-4 months of a typical flu season. The healthcare system in the USA is not ready to handle tens of thousands or hundreds of thousands of people over a short time frame. In Italy, the healthcare system buckled under the strain and the healthcare teams are now forced to make horrible life and death decisions.
There are only 2177 cases … why is everyone so worried?
If only a snapshot in time had relevance, then perhaps stating that only there are “only” 2177 cases (March 14, 2020) [3,000 cases 3/15/20, 6 AM ET; now 3,774 cases 3/16/20 6AM; now 4300 at 5 PM, ET; 4700 cases 3/17/20, 6AM; 6496 cases 3/18/20, 6AM ET.] would be relevant and somewhat comforting. Italy had 15,000 cases March 14, 2020, today (March 18, 2020) they have 31,506 cases — they only had a few hundred cases a 10 days ago. Stating that we only have 2177 cases today is absolutely irrelevant in the face of a pandemic virus spreading under exponential conditions. We will help put the term exponential spread into context down below.
Immunologically naive populations:
Viruses have been circulating around the globe for millennia. One family of viruses that have been circulating are referred to as Coronaviruses. About a quarter of common colds are caused by Coronaviruses. Our bodies form antibodies to foreign invaders such as bacteria or viruses. If we have antibodies from a previous exposure then we can rapidly ramp up the production of those antibodies if we are infected by that same virus at a later date. This is why you only get Chicken Pox and the Measles once. The first episode generates protective antibodies so you can’t get infected a second time. For other infections, previous exposures do not make you immune to future infections but it does make subsequent exposures milder.
COVID-19 is a severe respiratory illness caused by the virus named SARS-CoV2. It is a novel virus, which means that no one in the world has antibodies to it because no one has ever been infected by it before. As such, when the COVID-19 virus invades our body we do not have antibodies. We do not have a template to utilize from a previous exposure to rapidly create a defense against the virus. Because no one has antibodies, everyone is at risk for catching the virus, becoming ill, and spreading the virus so that it can infect those around you.
Exponential math is very hard to grasp. Every person with the COVID-19 virus infects approximately 2 people. Some less, some more.
The doubling time of COVID-19 that is widely quoted is 6 days. Some scientists are saying it may be as short as 2–3 days (unpublished first-hand information).
Let’s say the infection rate doubles every 3 days. That means that if 50,000 people have the virus today, then in 3 days 100,000 people will have it. In another 6 days it’s 400,000 and less than 10 days later it’s over a million people. We have 330 million people in the US. The experts expect that 40-70% of people will be infected. Exponential growth does not take that long to get to those scary high numbers. Every 3 days we delay the mitigation measures we will discuss, the number of infections double. This YouTube video does a great job of explaining this.
Is it time to panic? NO.
This document is trying to help you to understand the situation at hand and not to terrify you. We want to make sure you understand the facts and understand what is at stake. This is a Pearl Harbor moment for our country. We are facing a real threat and we need to face it with all of our resources. When people decry the seriousness of this moment they are steering our country off a cliff, we need everyone to understand that this is important and if we work together to slow the spread we will get through this as we are learning from Singapore, Hong Kong, South Korea, and China.
The effectiveness of our healthcare system to deal with a sudden tsunami of respiratory illness is what is at risk. If our healthcare system buckles under the strain of tens of thousands of patients then we could be looking at a catastrophe.
Personal risk vs Systemic Risk
When we talk about risk, there are many different elements to consider. Naturally, we are concerned about ourselves and our loved ones. This is an example of personal risk. By and large, your personal risk is low. The overall fatality rate for COVID-19 appears to be around 0.6%-6%. The lower bound (0.6%) comes from the South Korea data. But the fatality rate could potentially be as high as 6%. Why? Two reasons. First, once healthcare resources are strained it is impossible to offer a high level of expert care to everyone. Second, deaths occur up to 6 weeks after the onset of the infection. The most severe complications appear to arise after 3-4 weeks after the onset of symptoms. It is that lag that makes the fatality rate appear lower than it really is.
As we will discuss later, certain populations with certain diseases carry an increased risk of a serious life-threatening infection.
What we as physicians are most concerned about is systemic risk. Complex systems, such as our healthcare system, function because all the moving pieces fit together and interact with one another in such a way that the system functions under normal loads, lower than normal loads, and slightly higher than normal loads but may break down under the very high loads we anticipate with COVID19. We have watched in horror at what is taking place in Italy where their healthcare system is failing. The healthcare system was overwhelmed by a flood of people requiring critical medical care all arriving too close together in time. Italy does not have enough ICU beds, ventilators (mechanical breathing machines), and medications to manage all the patients that needed it. Physicians in Italy are judging who gets an ICU bed and critical care and who does not because there is not enough supply to take care of everyone. We do not want to see this happen here. This should be very clear:
This will happen here, and it will happen soon – possibly in one to two weeks – if we do not take very bold steps at this time.
Who’s at risk?
The bottom line is, we are all at risk. The elderly and those with medical issues such as hypertension and diabetes appear to be at higher risk of a severe disease course and death. Children may be spared the consequences of severe disease, though they can be asymptomatic to minimally-symptomatic carriers of the virus – placing those who are vulnerable at higher risk.
South Korea, which has reported the lowest coronavirus death rates, has a COVID-19 death rate more than eight times higher than that of the flu. Mortality rate reported in South Korea increases by age brackets from 0.4% in the age group 50-59 to 8.23% in those above 80 years old.
If our healthcare system fails then we will all suffer. If the hospital is choked with COVID-19 patients, people with appendicitis, heart attacks, broken ankles and so on will not be able to be treated. This is the picture of systemic risk. Everyone is at risk if there is a systemic failure of our healthcare system, not just those with COVID-19.
The challenge is this: By following the appropriate recommended social isolation measures, you will be saving lives of not just those at increased risk who are infected, but also those who need other critical healthcare services, including potentially yourself. You will be saving the lives of people you will never meet.
Who should follow our suggested social isolation measures? EVERYONE. If you do not need to go out for a mission-critical purpose, do not. Again, you WILL be saving the lives of at-risk members of your own family, as well as people you will never have the pleasure of meeting.
What SHOULD we do? — The Importance of Social Isolation.
Containment of COVID-19 is no longer possible. The virus is already in the country and is currently spreading. We need to slow the spread. Mitigation is the best current strategy. It involves strict social isolation. If 50% of the US population becomes infected, 5% of infected people will need a ventilator in an ICU, and if we have only a limited number of ventilators available in the country, you can quickly see the issue at hand.
This is an extremely time-sensitive and serious issue that needs to be addressed now. We can’t simply manufacture the number of ventilators necessary. We need to slow the spread and decrease the overall rate at which people will be coming to the hospital.
We use the description: We must Flatten The Curve. That means that we need to slow the rate of infection so that the number of people who need hospital services remains in the range that our healthcare system can supply. With mitigation efforts we are no longer trying to contain the virus, we merely are trying to slow the rate of infection to keep the healthcare system from collapsing. In reality, we cannot flatten the curve enough to prevent many thousands of people from becoming ill. But every single one of you who stays indoors and follows strict isolation measures will save countless lives. Many of the lives you save will be folks you will never meet.
Who should follow our suggested social isolation measures? EVERYONE. If you do not need to go out for a mission-critical purpose, do not. Again, you WILL be saving the lives of at-risk members of your own family, as well as people you will never have the pleasure of meeting.
All of you can save lives starting now.
The actions you take starting today will save the lives of people you will never meet.
Support the #CancelEverything and #SocialDistancingWorks movements.
Mitigation Measures For COVID-19
- Support your schools’ decisions to close: Proactive school closings save more lives than reactive school closings. Your schools should close now… before infections are present. Closed schools do not mean playdates for children – this counteracts the social distancing the school closures are meant to create in the first place.
- 6 feet: The COVID-19 virus spreads through droplets. They can move 6 feet before gravity brings them to earth. Stay 6 feet away from people if you need to go outside.
- Meticulous hand washing: Wash thoroughly and wash often. Alcohol-based hand sanitizer works well if your hands are otherwise clean.
- Do not touch your face. This is hard. This is a learned skill… practice often.
- Clean doorknobs, toilets, cellphones, countertops, refrigerator handles and so on many times each day. The virus could live on certain surfaces for 4-72 hours.
- If you can work from home, work from home.
- No tournaments, no sports events, no soccer, baseball, dance, volleyball, softball, gymnastics, concerts, martial arts, etc. We don’t care how much they claim they will clean the equipment.
- Cancel vacation travel. We know you planned this for a long time. You will be saving many lives by doing so… perhaps someone you know.
- Cancel weddings/ Bar/Bat Mitzvahs, birthday parties and so on. Help other people live so they can celebrate future events too.
- If you are over 60 years old you should stay home. You should only go out if there is a critical need.
- If you have parents/grandparents in a nursing home you should consider moving them home for now.
- Do not congregate in a restaurant, bar, etc. Again, you will save the lives of people you will never meet.
- If you feel sick stay home. It doesn’t matter if you don’t feel too sick. Going to work will put countless other people at risk of suffering or dying.
- Cancel all business travel. Your life and the lives of others are more important.
- Possible supply chain issues: Work with your doctor to try to get a 3 month supply of medication.
- Many grocery stores have order ahead options with either pick up or delivery. There are online grocery delivery services available in many areas. Wash your hands thoroughly after unpacking groceries.
Reliable news sites:
- Stat news
- Johns Hopkins Center for Health Security
- Your local health dept.
- CDC: fact sheets
- A worthy read: Gnawing Anxiety and Under Reaction
- An Open Letter from physicians to Mike Pence.
- Howard J Luks, M.D.; @hjluks
- Joel Topf, MD FACP; @Kidney_Boy
- Ethan J. Weiss, M.D.; @ethanjweiss
- Carrie Diulus, M.D.; @Cadiulus
- Nancy Yen Shipley, M.D.; @_NancyMD
- Eric Levi, MBBS FRACS; @DrEricLevi
- Bryan Vartabedian, M.D., @Doctor_v
If you like this you might like our 33 charts COVID-19 Archives.
The post COVID-19 Update – A Message from Concerned Physicians appeared first on 33 Charts.
Avricore Health Signs Master Agreement to Pilot HEALTHTAB™ Platform For Diabetes Management in Select Shoppers Drug Mart® Pharmacies
Avricore Health (AVCR) announces that patients will soon have access to its innovative point-of-care blood screening and health-data management platform, HealthTab™…
“Next Level Dystopian Sh*t”: Amazon Rolls Out Portable Panic Booth For Warehouse Employees To Collect Themselves
"Next Level Dystopian Sh*t": Amazon Rolls Out Portable Panic Booth For Warehouse Employees To Collect Themselves
After years of reports of Amazon warehouse employees being forced to urinate in bottles, forego medical care, and work through…
After years of reports of Amazon warehouse employees being forced to urinate in bottles, forego medical care, and work through injuries - causing hundreds to launch petitions and revolt, the online retail giant has come up with a solution...
...a special sensory deprivation booth that allows stressed out employees to collect themselves before heading back out to the floor.
Known simply as the “ZenBooth,” the new apparatus, according to a video released by the company on Wednesday, is an “interactive kiosk where you can navigate through a library of mental health and mindful practices to recharge that internal battery.” -daily dot
Amazon's Leila Brown used her background in sports medicine and her passion in alternative therapies to create a space where our employees could focus on their mental well-being. https://t.co/bvk2bw9Lke pic.twitter.com/cEQhsTH0Od— Amazon News (@amazonnews) May 26, 2021
The "ZenBooth" is part of Amazon's WorkingWell program, which allows employees to "recharge and reenergize" with a series of "physical and mental activities, wellness exercises, and healthy eating support."
The panic booth features a small fan, some plants, and a library of meditation videos. Hopefully it features a toilet too.
(Did we mention most COVID-19 transmission occurs via aerosolized particles hanging in the air, particularly in poorly ventilated spaces?)
As the daily dot notes, the announcement received lots of pushback from Twitter users.
"why not just improve working conditions?" said one user.
"Or you could pay your employees well, not treat them like garbage, and accept unionization," added another.
"This is some next level dystopian shit. Maybe just pay people more and let them have bathroom breaks," read yet another tweet.
This is some next level dystopian shit. Maybe just pay people more and let them have bathroom breaks— katie ???? ???? (@Ah_occ_o) May 27, 2021
At least this is a step up from their now-abandoned, patented 'worker cages.'
Avricore Health’s CEO Discusses Abbott Diagnostics and Rapid COVID-19 Testing Rollout
Hector Bremner, CEO of Avricore Health Inc. (AVCR:CSE & AVCRF:OTC) Explains How HealthTab works with Abbott’s IDNow for Rapid COVID-19 testing
The following is an interview with Hector Bremner, CEO of Avricore Health Inc. (AVCR:CSE & AVCRF:OTC)
Avricore Health Inc. (AVCR) has been generating a lot of interest and excitement recently on the news of a partnership with U.S. health giant Abbott Laboratories and sizeable financings. In an exclusive interview, Avricore CEO Hector Bremner explains the upside at the Vancouver-based company.
Corona Stocks: Investors have zeroed in on your relationship with Abbott Diagnostics. Can you explain how you are well positioned to assist in Canada’s COVID-19 response?
Hector Bremner: For us it is huge. Abbott’s commitment to human health and point of care is by far second to none. Abbott is as equally focused on pharmacy as us and we have been really grateful to their team, we work quite closely right now and we think that relationship is going to mature over this year. Their device offerings have been fantastic and offer us the type of product offerings that we think fit pharmacy, particularly with the Afinion 2 which is the device that this quarter people will read and see a bit about from us. The Afinion 2 is a blood chemistry device, uses a very small sample, it is right there in the pharmacy. The test is conducted right there and it is screening for diabetes, conducting an A1C test and also testing lipids. So we think that the relationship with Abbott has been really tremendous. It is a really powerful partnership. We have this totally unique service that really brings the devices to life.
Corona Stocks: There was a disclosure that you are meeting with federal health officials along with Abbott and you are together seeking a federal government contract to create a platform using Abbott’s ID Now molecular testing device and Avicore’s HealthTab to test patients for COVID-19. The platform would use Avicore’s software to automatically report results from Abbott’s ID Now, presumably to government health authorities. Can you share any details on that?
Hector Bremner: We are actively pursuing conversations at all levels of government as we think HealthTab is missing piece to a truly successful rapid testing program and this is going very well. And, thankfully in the past few weeks, the focus of the conversation in the media and in government announcements has been moving positively towards rapid testing again. Up until very, very recently rapid testing has been seen as not as important as [getting vaccines]. Now everyone is stepping back and realizing that we are better off using these rapid tests as a way of getting a better line of sight as to what we are actually fighting, and quarantining, containing the virus into areas, really getting on top of it. You can’t fight something when you are in the dark.
Corona Stocks: What role would you play in this effort?
Hector Bremner: Fundamentally, we are a data generating and reporting platform, so that means using HealthTab to better track test results being done with rapid tests. There have several stories lately showing that much of the tests purchased by government have not been deployed. We are also hearing that tests are ending up on the black market. And, what is used, has created a lot of labor and questions about who and how to report this information to. So, HealthTab can automate a great deal of the labor and workflow and ensure timely disclosures and increase people’s confidence in these testing programs overall.
Corona Stocks: More testing will likely mean more cases, correct?
Hector Bremner: Yes, there was even a study this weekend that current estimates are that there are many times more cases than are ever announced at any time due to the lack of testing. We think rapid testing in 2021 and 2022 is going to play a critical role. And going forward for travel, and for certain workplaces and major events, having a real-time rapid reporting system in place to watch for virus outbreaks is something that is going to be part of the 21st century. This isn’t the first major virus outbreak over the last 20 years, it certainly has been the most impactful. We are seeing these viruses mutate very rapidly. The vaccine will get out there but we will be living with virus outbreaks. We have an incredible number of humans on the planet and they are very mobile and traveling all over the place, interacting with each other. The reality is we need to be very, very vigilant and we can’t let this happen again. Testing and real-time reporting is critical to this.
“Rapid testing, and having real-time reporting of [virus outbreaks], and breaking down the silos of communication, which is what HealthTab does, that is going to be critical to maintaining and avoiding future shutdowns.”
Corona Stocks: COVID-19 made for a crazy year for markets, but is a net positive for Avricore, correct?
Hector Bremner: It certainly opened up a business line that didn’t exist in the sense that viral testing – our platform is really fantastic for rapid response and getting real time eyes on the pandemic. We are still in those conversations and we are very bullish on where they are going. Canada in particular hasn’t been as progressive on the rapid testing front as other jurisdictions.
This said, we are making great strides in advancing our blood screening of diabetes and heart disease in pharmacy, and this demonstrates that while we can operate and succeed in today’s environment, we are going to excel beyond it.
Corona Stocks: It also seems given vaccine shortages becoming political dynamite, that governments are very motivated to be seen doing something positive?
Hector Bremner: I think so. We don’t want to do this again. This is a very costly endeavor and I am confident that the economy is going to rebound very quickly when we reopen and the fundamentals are still strong. But the reality is we got to this situation and after Bird Flu, Swine Flu, all of these outbreaks were contained and we were not vigilant, we were not taking them seriously. We need to ensure the infrastructure is there to monitor and respond quickly. We also need a healthcare approach of proactiveness. We offer an important tools in these efforts.
And it’s not just viruses, it’s the big costly killers like diabetes and heart disease that need more screening and monitoring. These issues are linked, and the expenses and deaths associated with them are avoidable. That’s our responsibility today, to act now and make tomorrow safer and healthier.
Corona Stocks: You already have Ontario pharmacy operators endorsing HealthTab, what support do you see coming from the health care industry this year?
Hector Bremner: Pharmacists recognize that they need to change their scope of practice. The future looks like point of care technology and cognitive services. We provide that platform so they are really leaning in on that. We know the patient has also made that decision. Good examples are 23andMe and Ancestry and health apps. With HealthTab and their community pharmacist, patients can take direct control and don’t have to spend huge amount so time to find out what they can now find out in minutes. They can walk in and learn if they have diabetes or if they already have it work with their pharmacists to manage it better. And the drug companies have already been going towards real-world evaluation and modifying the way they are doing studies to lower studies, which HealthTab facilitates in some really powerful ways.
All the players are making the decisions and right now the process is being adopted. Over the course of this year people are going to see from us that major pharmacy groups are really leaning in on the (HealthTab) system, they are going to be see drug makers and private players like insurance companies really leaning in on using our platform and trying to engage their customers better and also enhance their own operation.
Corona Stocks: Is there a competitor to HealthTab in the market?
Hector Bremner: Not directly, everybody is sort of adjacent to us. There are a million and one health dashboard apps, as I call them, that seek to be a digital interface for healthcare. But they are limited in terms of plug-ins and who can connect to them, which reduces their true effectiveness. There are also B2B enterprise solutions, and there are some device specific solutions, but again we are so successful is that we bring the patient, healthcare team, and researcher together by acting as a middleware, allowing for other technologies to be enhanced by the data we are able to generate and share.
So, our approach is entirely unique, and while someone else might have something similar, we have solved the shortcomings out there and will win the sector. It’s kind how Facebook overtook Myspace, both may seem similar, but won was just built better and put the focus on the user experience. That is what we are doing with HealthTab.
Corona Stocks: You are raising a lot of money, $3 million in the last few months. What is the reasoning behind that?
Hector Bremner: When you are running a public company, you are actually running two businesses as the same time. You are running the actual business where you are expected to be a subject matter expert and that is more than enough to fill your day. Then you have the market side of your business which is a whole other universe of activities. We did not want to head into this year, given our very full business development hopper, being split in our focus.
So late last year and into January-February we wanted to make sure we were fully capitalized, we will be debt free at the close of this current round and we will have sufficient capital to roll out what we plan to this year. As much of a dumpster fire that 2020 was, Avricore had a 10X year and we’re going to have another one. We think that we have got a lot of wind at our backs.
Corona Stocks: With your government background, coming to Avricore a year ago, it seems like the company is much more focused today on delivering the promise of HealthTab and playing a key role in fighting COVID-19.
Hector Bremner: My career has largely been in strategic communications and turning things around. We were no doubt in a tough situation when I first got involved, however we’ve done the hard work and sacrifices it takes to succeed and today, we are much more focused.
We fundamentally believe that all the sacrifices, all the hard work, were worth it because HealthTab is just that important. This team has done so much. Roger Seccombe, who developed HealthTab, our CTO, and everybody involved, they have all leaned in and made a lot of sacrifices, especially last year.
Today, we are getting to a place where other people are starting to now see it too and we are really excited. There are big things to come.
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