Global Health
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When an experienced provider opts to leave a healthcare workforce (attrition), there are significant costs, both direct and indirect. Turnover of healthcare providers is underreported and understudied, despite evidence that it negatively impacts care delivery and negatively impacts working conditions for remaining providers. In the Veterans Affairs (VA) healthcare system, attrition of women’s health primary care providers (WH-PCPs) threatens a specially trained workforce; it is unknown what factors contribute to, or protect against, their attrition.

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Journal of General Internal Medicine
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2020
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Even before the covid-19 pandemic, virtual consultations (also called telemedicine consultations) were on the rise, with many healthcare systems advocating a digital-first approach. At the start of the pandemic, many GPs and specialists turned to video consultations to reduce patient flow through healthcare facilities and limit infectious exposures. Video and telephone consultations also enable clinicians who are well but have to self-isolate, or who fall into high risk groups and require shielding, to continue providing medical care. The scope for video consultations for long term conditions is wide and includes management of diabetes, hypertension, asthma, stroke, psychiatric illnesses, cancers, and chronic pain. Video consultations can also be used for triage and management of a wide range of acute conditions, including, for example, emergency eye care triage. This practice pointer summarises the evidence on the use of video consultations in healthcare and offers practical recommendations for video consulting in primary care and outpatient settings.

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The British Medical Journal
Authors
C. Jason Wang
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2020
Authors
Herbert Lin
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Data collected by the National Center for Health Statistics and the Census Bureau revealed that over 40 percent of the U.S. population in the third week of July 2020 exhibited symptoms of anxiety or depression disorder, which are clinical diagnoses. The comparable figure from the same survey given in the January–June 2019 time frame was 26 percent. Symptoms of anxiety or depression disorder included frequently having little interest or pleasure in doing things; feeling down, depressed, or hopeless; feeling nervous, anxious, or on edge; and not being able to stop or control worrying.

Read the rest at  The National Interest

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Even if effective treatments and vaccines for coronavirus become available soon, we must start thinking about the mental health dimensions of national recovery.

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Julien de Troullioud de Lanversin
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This is not the first time that the world has faced the outbreak of a coronavirus which originated in China.

But the consequences have been very different this time around.

Read the rest at The Bulletin of Atomic Scientists

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Seventeen years ago, an outbreak of SARS—a disease caused by the coronavirus SARS-CoV-1—emerged in China. Back then, a fruitful partnership emerged between the United States and China, that contributed to the successful control of the outbreak and nurtured the careers of young Chinese virologists and epidemiologists.

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Although health care billing claims data have been widely used to study health care use, spending, and policy changes, their use in the study of infectious disease has been limited. Other data sources, including from the Centers for Disease Control and Prevention (CDC), have provided timelier reporting to outbreak experts. However, given the scope of SARS-CoV-2—the causative agent responsible for the novel coronavirus disease 2019 (COVID-19) pandemic—and the multidimensional impact of the crisis on the health care system, analyses relying on health care claims data have begun to appear. Claims-based COVID-19 studies have a role, but it is critical to understand the limitations of these data. We are concerned that many weaknesses are not recognized by those familiar with other forms of patient-level data. Below, we examine several major considerations and make suggestions about where claims data may be best leveraged to inform policy and decision making.

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Health Affairs
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Sherri Rose
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2020
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Epidemiological modeling has emerged as a crucial tool to help decision-makers combat COVID-19, with calls for non-pharmaceutical interventions such as stay-at-home orders and the wearing of masks. But those models have become ubiquitous and part of the public lexicon — so Nirav Shah and Jason Wang write that they should follow an impact-oriented approach.

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Journal of General Internal Medicine
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C. Jason Wang
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2020
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Stanford Health Policy’s Joshua Salomon, a professor of medicine and senior fellow at the Freeman Spogli Institute for International Studies, and colleagues developed a mathematical model to examine the potential for contact tracing to reduce the spread of the coronavirus. They modeled contact tracing programs in the context of relaxed physical distancing under different assumptions for case detection, tracing coverage and the extent to which contact tracing can lead to effective quarantine and isolation.

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JAMA Network Open
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Joshua Salomon
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2020
Authors
Herbert Lin
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Almost since its first emergence, the spreading SARS-CoV-2 outbreak has also been accompanied by a widespread proliferation of misinformation and disinformation, what the World Health Organization (WHO) described as “a massive ‘infodemic’—an over-abundance of information … that makes it hard for people to find trustworthy sources and reliable guidance when they need it.”

Misinformation can be information that is false or inaccurate, whether deliberately or inadvertently so. Disinformation refers to information that is intended to mislead, whether or not the information is literally true.

Read the rest at Bulletin of Atomic Scientists

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Almost since its first emergence, the spreading SARS-CoV-2 outbreak has also been accompanied by a widespread proliferation of misinformation and disinformation, what the World Health Organization (WHO) described as “a massive ‘infodemic’… that makes it hard for people to find trustworthy sources and reliable guidance when they need it.”

Authors
Gary Mukai
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The sports world has been dramatically affected by COVID-19. Not only has there been a significant decline of events for the spectator—both in person and on television—but the impact on the participants themselves has also been unprecedented. Due to social gathering restrictions, organized youth sports have been almost completely shuttered. High schools and colleges have been cancelling their practices and competitive seasons. The PAC-12 recently postponed its football season. The pandemic has also had a dramatic effect on sports at the highest level. Only fairly recently have there been abbreviated attempts to reinstitute professional sports seasons such as Major League Baseball and the National Basketball Association. Even the 2020 Olympic Games in Tokyo were postponed to 2021.

SPICE is helping to develop the CoviDB Speaker Series, a TeachAids initiative which provides free online videos to educate the general public about the ongoing COVID-19 pandemic. For episode 4 of the CoviDB Speaker Series, TeachAids Founder and CEO Dr. Piya Sorcar decided to provide a glimpse into how the pandemic has impacted the lives of two of the world’s greatest athletes. Sorcar enlisted the support of Emmy Award-winning sportscaster Ted Robinson to interview three-time Olympic diver and gold medalist Laura Wilkinson and five-time Olympic gold medalist swimmer and Stanford student Katie Ledecky.

The interview can be viewed here. Robinson drew out insightful perspectives from Ledecky and Wilkinson concerning the uncertainty that they lived with while awaiting the decision about whether the 2020 Olympics would be held, and also their feelings once the decision to postpone the Olympics was made. Wilkinson reflected, “What was frustrating at first, turned out to be really special” as she reflected upon things like spending extra time with her family, including four children. Ledecky added that being able to focus more on her studies at Stanford University definitely helped to create a little more balance in her life. In response to Robinson’s question about maintaining the discipline to train in light of the postponement, Ledecky responded

I tried to stay focused on my goals. We are going to do whatever it takes to be the best and put in the work that we know is necessary to reach our goals.
Katie Ledecky

During a segment of the interview that focused on advice for youth, Ledecky noted, “The work that you put in doesn’t go away… It is always in the bank… At some point in the future, you are going to be able to compete again, have those opportunities to let that work show.” Wilkinson added, “When you want something, it doesn’t matter what people say about you or what they think of you. If you think you want to do this, if this is your goal, you have to go after it because you’re capable of more than you probably think you are. And other people’s opinions do not need to define you or what you’re capable of doing. You define that.”

For each of the first four episodes in the CoviDB Speaker Series, SPICE has developed a teacher’s guide to encourage the showing of the episodes in U.S. classrooms at the secondary school level. Each of the guides includes (1) a summary of the questions that were asked by the interviewer, including terms and definitions, (2) guiding questions for small-group work, and (3) debriefing activities. In the area of debriefing activities, writing prompts such as the following for episode 4 are offered to students.

  • Laura and Katie commented on how their lives have been disrupted since the pandemic. Write a diary entry about how your life has been disrupted. What has been especially challenging? What lessons have you learned from the experience?
  • Write about a time when you were disappointed with the cancellation of something. How did you cope with it? Did you learn something positive from the experience? Have you ever been in limbo about whether an event was going to happen or not? How did this make you feel?


Other suggested debriefing activities involve the designing of an artistic image, writing of a poem, or writing lyrics to a song that captures the significance of quotes from the interview such the following:

  • Laura: The sun is a great healer in a lot of ways, both emotionally and physically.
  • Katie: The Olympics is … an opportunity for the world to come together.
  • Laura: I think that it [COVID-19] has reminded us of how connected we are as a world and how we all need to be doing our individual parts to combat this.
  • Ted: I have been around athletes in team sports who at some point have said that they kept playing because they wanted their kids to see them.


As TeachAids and SPICE think about their work with youth, two statements from the interview were especially poignant to the staffs. Ledecky noted, “This is history [the time of COVID-19] but you don’t have to be afraid of it. Fear is really a mindset… so if you do everything that you can do, there is no point in worrying beyond that because worrying does not help you at all. It is not going to change anything. Do what you can control. Worry about the things that you can control and things that you cannot control, you have to let those go.” Wilkinson stated, “This [challenging time] could be that gift to you. This could be that opportunity to rise to a whole new level. Don’t look at this and be sad and upset. Look at this as an opportunity of how you can get ahead.” Though the statements were intended as advice for youth, in fact, the statements seem relevant today to all of us.

The CoviDB Speaker Series is a TeachAids initiative that is co-sponsored by the Stanford Center for Innovation in Global Health, the University of California San Francisco’s Institute for Global Health Sciences, and the Stanford Program on International and Cross-Cultural Education (SPICE).

 

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CoviDB Speaker Series

In collaboration with TeachAids, Stanford Medicine, and the University of California, San Francisco, SPICE is helping to develop the CoviDB Speaker Series, which seeks to provide free online videos to educate the general public about the ongoing COVID-19 pandemic.
CoviDB Speaker Series
CrashCourse filming at Stanford University
Blogs

CrashCourse: The Prevention and Treatment of Concussions

CrashCourse: The Prevention and Treatment of Concussions
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For episode 4 of the CoviDB Speaker Series, TeachAids Founder and CEO Dr. Piya Sorcar provides a glimpse into how the pandemic has impacted the lives of two of the world’s greatest athletes.

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Beth Duff-Brown
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Stanford postdoc Ashley Styczynski was working on newborn antimicrobial resistance in Bangladesh when the pandemic hit. The infectious disease physician realized she had to switch gears and began working with the ministry of health to prepare hospitals for the onslaught of COVID-19 patients.

“During my trainings on infection control in Bangladeshi hospitals, I learned that many health-care workers were paralyzed by the fear of not knowing how to protect themselves against COVID-19 while caring for patients, especially during shortages of PPE,” she said. “I think this has substantially contributed to the large number of health-care workers becoming infected during the pandemic. In fact, Bangladesh has the highest rate of physician mortality from COVID of any country.”

So Styczynski turned to her Stanford colleagues back home and proposed a set of infographics that could help health-care workers in Bangladesh and other under-resourced countries. Armed with a seed grant from the Stanford Center for Innovation in Global Health, they have established a website devoted to the creation and use of personal protective equipment (PPE). Bangladesh Ministry of Health has adopted their guidelines and Styczynski hopes other health ministries will do the same.

“I want them to be a tool to empower health-care workers — not just in Bangladesh but also in other low- and middle-income countries — to protect themselves with whatever resources they have access to,” Styczynski said. She said the team of collaborators from Stanford grew when researchers from other institutions heard about the research and wanted to get involved.

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An infographic to help health-care workers with their personal protective equipment.

 

The website also includes a video on PPE donning-and-doffing techniques, illustrations for building ultraviolet germicidal irradiation (UVGI) cabinets to decontaminate masks, and the PPE infographics in other languages.

Stephen P. Luby, MD, a core faculty member at Stanford Health Policy and senior fellow at the Freeman Spogli Institute for International Studies and the Woods Institute for the Environment, said the project grew out of Styczynski’s background in infectious disease epidemiology and her deep engagement with collaborators in Bangladesh.

“These scientifically sound, easy-to-understand visuals provide a clear example of how deep engagement in a high-need context allows Stanford researchers to make contributions that impact lives globally,” Luby said.

Styczynski is this year’s Rosenkranz Prize winner for her ongoing research into why Bangladesh is among the top 10 countries with the highest number of stillbirths. She believes intrauterine infections may be an underrecognized factor contributing to the stillbirths and is performing metagenomic sequencing on placental tissues of stillborn babies to examine the genetic and bacterial diversity.

She recently returned to the States to marry her now-husband, Adam Gsellman, a graphic designer who did all the infographics pro bono for the project. Styczynski met him in Bangladesh, where he was working at an IT startup focused on developing travel management software.

“After having lived in Bangladesh for nearly 6 years, he is intimately connected to the country and cares deeply about the people there as well,” she said.

Other Stanford faculty involved in the project include bioengineer Manu Prakash, one of the inventors of the cheap paper microscope, the Foldscope, now used around the world, and Thomas Baer, director of the Stanford Photonics Research Center.

During the initial planning stages, Styczynski connected with Thomas Weiser, MD, MPH, a general and trauma surgeon at Stanford Medicine and the consulting medical officer for Lifebox, a nonprofit working to improve surgical safety in resource-limited settings.

"Lifebox's work is focused on infection prevention in surgery, including decontamination of surgical instruments and appropriate PPE use for surgery,” Weiser said. "We had experience doing this in the operating room, so with Ashley's help we expanded the work to include other health-care workers at risk of infection."

He added that COVID-19 presented them with additional challenges.

"But we felt it was important to prepare the surgical ecosystem to help respond to the new demands for PPE and decontamination processes that would need to be put in place," he said.

Ashley Styczynski

Ashley Styczynski

Infectious Disease Fellow
Styczynski researches the global threat of antimicrobial resistance.
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Rosenkranz Prize Winner: Infectious Diseases Physician Examines High Stillborn Incidence in Bangladesh, Helps With COVID-19 Preparedness

Stanford postdoc Ashley Styczynski will investigate the epidemiology behind the alarmingly high rate of stillbirths in Bangladesh while helping prepare for the coming onslaught of coronavirus in the densely populated South Asian nation.
Rosenkranz Prize Winner: Infectious Diseases Physician Examines High Stillborn Incidence in Bangladesh, Helps With COVID-19 Preparedness
An illustration by Irene Servillo
News

An 8-Point Plan to Tackle COVID-19 Among Women in Mumbai Slums

“We’ve never been closer to each other or to those we serve," says Health Policy PhD candidate Suhani Jalota, founder of the Myna Mahila Foundation, a Mumbai-based women’s health and employment nonprofit. Its mission is to create the next generation of women leaders in urban slum communities — but COVID-19 isn't making it easy.
An 8-Point Plan to Tackle COVID-19 Among Women in Mumbai Slums
A mother and child in the fields in Sierra Leone.
Commentary

Millions of Children at Risk of Measles as Vaccination Campaigns Take Back Seat to COVID-19

SHP's Eran Bendavid Warns that millions of young children around the world are at risk of missing their measles vaccines as health-care workers focus on COVID-19.
Millions of Children at Risk of Measles as Vaccination Campaigns Take Back Seat to COVID-19
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Stanford postdoc Ashley Styczynski and collaborators build a website devoted to protecting health-care workers in under-resourced countries, using infographics and videos to show them how to create, wear and preserve personal protective equipment.

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