From a New England Journal of Medicine article (March 11, 2020):
A central strategy for health care surge control is “forward triage” — the sorting of patients before they arrive in the emergency department (ED). Direct-to-consumer (or on-demand) telemedicine, a 21st-century approach to forward triage that allows patients to be efficiently screened, is both patient-centered and conducive to self-quarantine, and it protects patients, clinicians, and the community from exposure.
It can allow physicians and patients to communicate 24/7, using smartphones or webcam-enabled computers. Respiratory symptoms — which may be early signs of Covid-19 — are among the conditions most commonly evaluated with this approach. Health care providers can easily obtain detailed travel and exposure histories. Automated screening algorithms can be built into the intake process, and local epidemiologic information can be used to standardize screening and practice patterns across providers.
More than 50 U.S. health systems already have such programs. Jefferson Health, Mount Sinai, Kaiser Permanente, Cleveland Clinic, and Providence, for example, all leverage telehealth technology to allow clinicians to see patients who are at home. Systems lacking such programs can outsource similar services to physicians and support staff provided by Teladoc Health or American Well. At present, the major barrier to large-scale telemedical screening for SARS-CoV-2, the novel coronavirus causing Covid-19, is coordination of testing. As the availability of testing sites expands, local systems that can test appropriate patients while minimizing exposure — using dedicated office space, tents, or in-car testing — will need to be developed and integrated into telemedicine workflows.
From an MIT Technology Review article (March 11, 2020):
Here are six differences between coronavirus and the flu:
Coronavirus appears to spread more slowly than the flu. This is probably the biggest difference between the two. The flu has a shorter incubation period (the time it takes for an infected person to show symptoms) and a shorter serial interval (or the time between successive cases). Coronavirus’s serial interval is around five to six days, while flu’s gap between cases is more like three days, the WHO says. So flu still spreads more quickly.
Shedding: Viral shedding is what happens when a virus has infected a host, has reproduced, and is now being released into the environment. It is what makes a patient infectious. Some people start shedding the coronavirus within two days of contracting it, and before they show symptoms, although this probably isn’t the main way it is spreading, the WHO says.
Secondary infections. As if contracting coronavirus wasn’t bad enough, it leads to about two more secondary infections on average. The flu can sometimes cause a secondary infection, usually pneumonia, but it’s rare for a flu patient to get two infections after the flu. The WHO warned that context is key (someone who contracts coronavirus might already have been fighting another condition, for example).
Don’t blame snotty kids—adults are passing coronavirus around. While kids are the primary culprits for flu transmission, this coronavirus seems to be passed between adults. That also means adults are getting hit hardest—especially those who are older and have underlying medical conditions. Experts are baffled as to why kids seem protected from the worst effects of the coronavirus, according to the Washington Post. Some say they might already have some immunity from other versions of the coronavirus that appear in the common cold; another theory is that kids’ immune systems are always on high alert and might simply be faster than adults’ in battling Covid-19.
Coronavirus is far deadlier than the flu. Thus far, the mortality rate for coronavirus (the number of reported cases divided by the number of deaths) is around 3% to 4%, although it’s likely to be lower because many cases have not yet been reported. The flu’s rate is 0.1%.
There is no cure or vaccine for the coronavirus. Not yet, anyway, although work is under way. There is, however, a flu vaccine—and everyone should get it, not least because being vaccinated could help lessen the load on overstretched medical services in the coming weeks.
A tiny new species of bird-like dinosaur has been discovered, preserved in a lump of 99-million-year-old amber. The tooth-filled skull is only 7.1mm long, suggesting that this ancient creature would have been the size of a hummingbird – far smaller than other dinosaurs known from that time. Unusual features include large, side-facing eyes and a large number of sharp teeth suggesting a predatory lifestyle. The species has been named Oculudentavis khaungraae and is evidence of previously unimagined biodiversity in the Mesozoic era.
Hear the latest science news, brought to you by Shamini Bundell and Nick Howe. This week, a newly discovered bird species from the time of the dinosaurs, and microbes hundreds of metres below the ocean floor.
John Swarbrooke from Dickinson Gallery explains the beauty and play of light behind the cast of Auguste Rodin’s Eve.
François Auguste René Rodin (12 November 1840 – 17 November 1917) was a French sculptor. Although Rodin is generally considered the progenitor of modern sculpture, he did not set out to rebel against the past. He was schooled traditionally, took a craftsman-like approach to his work, and desired academic recognition, although he was never accepted into Paris’s foremost school of art.
Eve is a nude sculpture by the French artist Auguste Rodin. It shows Eve despairing after the Fall.
n 1880 Rodin was commissioned to produce The Gates of Hell, for which he exhibited Adam at the 1881 Paris Salon. In a sketch for Gates Rodin showed a central silhouette possibly intended as Eve (both the sketch and Gates are now in the Musée Rodin), but in October 1881 he decided to produce Eve as a pair for Adam, with the two sculptures flanking a huge high-relief bas-relief. This would be the first free-standing female sculpture he had produced since the destruction of his Bacchante in an accident between 1864 and 1870. He began Eve in 1881, later abandoning his intended colossal version of it when he realised his model, probably Adèle Abruzzesi, was pregnant. It was first exhibited to the public at the 1899 Paris Salon. It shows a strong influence from Michelangelo, picked up by Rodin in Italy in 1876.
He also produced an autograph white marble version in 1884 (now in the Museo Soumaya in Mexico City), a version in patinated plaster and a much-reproduced 71 cm high bronze version in 1883 (known as the Petite Ève or Little Eve, whose original is also in the Musée Rodin in Paris). He also reused the same figure of Eve in his marble Eve and the Serpent (1901) and his plaster Adam and Eve (1884).
From a Harvard Gazette online article (March 10, 2020):
There’s a symptom review, there’s a travel review, and there’s an exposure review. And if the answer to any of those questions is yes, then you’re asked to not come in. And so far people have been compliant and have left. So that is a good thing.
If you have a cough and a fever, if you’ve got respiratory symptoms and you’re short of breath, if you’ve traveled to a place of concern or if you may have been exposed to someone who did — especially if you’re symptomatic — then I would definitely ask, “Do I really need to visit my grandma today? Can I wait and can I Skype her? Can I do FaceTime?”
I know that’s hard for some of our older adults who aren’t technologically savvy, but maybe now is the time to get them hooked up. It really would be heartbreaking if, in wanting to do something positive for someone’s emotional or mental health, you ended up infecting them.
Harvard-affiliated Hebrew SeniorLife offers a continuum of care for 3,000 elderly people daily, with a range of services including residential assisted living, short-term rehabilitation, outpatient services, and long-term care for those with chronic illness. In a Q&A interview aimed at understanding the challenges involved, Harvard Medical School Assistant Professor Helen Chen, Hebrew SeniorLife’s chief medical officer, discussed steps the facility has taken to combat the virus and the outlook going forward.