Tuesday, April 7, 2020

Allocating and reallocating scarce medical supplies

An op-ed in USA today points out that shortages of critical hospital supplies are occurring and will continue to occur at different times in different states, allowing for increased efficiencies in sharing (which is hampered by a vacuum in leadership at the Federal level).

One of the authors, Dr. Deborah Proctor, is in fact an experienced market designer, who led the (re-)adoption of a fellowship match for gastroenterology fellows.*

National redistribution of hospital supplies could save lives
Taking supplies from less stressed hospitals and sharing them with overwhelmed ones, we could maximize the use of equipment and save more lives.
Diane R. M. Somlo, Dr. Howard P. Forman and Dr. Deborah D. Proctor

"Since we now know more about the predicted peaks in COVID-19 across the U.S., we can see that peak demand will likely occur at different times in different states and cities, starting in early April and extending through May. While some hospitals are already starting to drown, other hospitals that are further from their peak demand have stockpiles of unused equipment lying in wait. 

"What if there was a nation-wide system that allowed hospitals that have equipment but have lower present and predicted demand to lend some reusable (ventilator) and non-reusable equipment (PPE, testing kits) to hospitals that are currently being overwhelmed? Then, as demand in one area rises and the other falls, freed up ventilators could be re-distributed, and manufacturers will have had more time to generate non-reusable equipment for hospitals that lent their equipment. By taking from stockpiles of less stressed hospitals and sharing it with currently overwhelmed ones, we could maximize the use of our national inventory of equipment and save more lives.
" redistribution approaches in other settings have enabled vast functional expansions of limited supplies, including kidney transplants and donated food for food pantries across the U.S. Bottom line: Redistribution has the potential to improve the trajectory of COVID-19 mortality in the U.S. Our country is already on track to employ these measures at a state level or voluntarily, so delaying set up of cross-state exchange only means missing out on the maximal benefit of redistribution. In fact, as of this writing, New York’s Governor Andrew Cuomo has just signed an executive order enabling redistribution of medical supplies to struggling hospitals within New York state and Oregon has sent ventilators to New York.
"In these coming trying times, our healthcare system is facing an unprecedented, deadly burden, and we need to make supplies available where they are needed most —independent of state lines. Now is the time to start making the changes, to call on the federal government, national leaders, and private partnerships to coordinate our efforts as a nation, so we can provide the best care possible with our limited supplies. Lives depend on it."
Niederle, Muriel, Deborah D. Proctor and Alvin E. Roth, ''The Gastroenterology Fellowship Match: The First Two Years,'' Gastroenterology , 135, 2 (August), 344-346, 2008.

Monday, April 6, 2020

Transplantation slows in Canada, too...

Ventilators in short supply may be part of the problem (since most deceased donations involve ventilators), but there's also a general risk aversion at play...

Donated organs not being used as hospitals scale back transplants for COVID-19

"OTTAWA — Transplant centres across the country have massively scaled back organ transplants as hospitals try to make sure they are able to accommodate COVID-19 cases.

"Living-donor surgeries have largely shut down across the country, and deceased-donor transplants are happening only when the case is urgent.

"Dr. Atul Humar, past president of the Canadian Society of Transplantation, said that means many organs are not going to good use.

“There’s some donors, deceased organ donors, and we’re not sending teams to procure those organs,” said Humar, who is also the director of the transplant program at Toronto General Hospital.

“It’s quite tragic.”

"Patients who go through certain types of organ donation often require time in the intensive care unit on a ventilator — resources desperately needed by patients with serious cases of COVID-19.

"At Humar’s hospital, organ transplant surgeries have decreased by about 80 per cent, though the numbers vary from province to province."

Sunday, April 5, 2020

Eating cats and dogs banned in Shenzhen

The distinction between pets and pet food just became a little clearer in Shenzhen.

The BBC has the story:

Shenzhen becomes first Chinese city to ban eating cats and dogs  

"The new law will come into force on 1 May.

"Thirty million dogs a year are killed across Asia for meat, says Humane Society International (HSI).

"However, the practice of eating dog meat in China is not that common - the majority of Chinese people have never done so and say they don't want to.

"Dogs and cats as pets have established a much closer relationship with humans than all other animals, and banning the consumption of dogs and cats and other pets is a common practice in developed countries and in Hong Kong and Taiwan," the Shenzhen city government said, according to a Reuters report."

Saturday, April 4, 2020

Sheltering in place (or maybe someplace else), repugnantly

Many fewer things would be regarded as repugnant were it not for underlying inequality. So it shouldn't surprise us to see new repugnances emerge as  we are all--rich and poor and in between-- asked to shelter in place to halt the spread of the COVID-19 corona virus.

Here's an example from the Guardian:

"A luxurious southern California retreat for wealthy participants to wait out the coronavirus pandemic has folded before the program could even open its doors.

"As millions of Americans face strict social distancing orders amid the pandemic, the “Harbor” proposed the opposite for those who could afford it: a two-month retreat in an exclusive villa where guests could “meet, mingle and collaborate with some of the brightest, forward-thinking individuals – no facemask required”.

Frankly, it sounded like a cruise ship to me...

Friday, April 3, 2020

Choosing who to interview in the sports medicine fellowship match

Little is known about what goes on between application to fellowship (or residency) programs, and rank-ordering for the relevant medical Match.  Here's an attempt at looking into the black box of choosing who to interview, and combining interview information with other information to determine rank order lists:

Factors Used by Program Directors in the Orthopedic Sports Medicine Fellowship Match
Travis Menge, Ashley Nord, Kendall Hamilton, Monica LaPointe and Peter J.L. Jebson
Journal of Surgery [Jurnalul de chirurgie], Volume 16:2, 2020

Background: Obtaining an orthopedic sports medicine fellowship position is becoming more difficult, as the number of residents seeking post-graduate training continues to increase.
Objective: To identify factors that orthopedic surgery sports medicine fellowship program directors deem valuable in selecting applicants.
Methods: A web-based questionnaire was sent to all ACGME accredited sports medicine fellowship program directors in the United States in 2016. The questionnaire was designed to identify the most important criteria in selecting applicants for an interview, and ranking candidates to match into their program.
Results: Thirty-five of ninety-one program directors responded. The criteria for offering an applicant an interview were quality of recommendation letter, technical competence, and residency program reputation. Letters of recommendation that held the highest value were from the chief of sports medicine and another sports medicine surgeon in the department. The most important features of the interview were the applicant’s ability to articulate thoughts, the maturity of the applicant, and the ability of the applicant to listen well. The attributes deemed most important in high ranking a candidate included the applicant’s commitment to hard work, quality of the interview, and quality of letters of recommendation.

Thursday, April 2, 2020

Bikes and guns while sheltering in place in Santa Clara County (bikes are essential, guns are not)

From the Santa Clara County Department of Public Health, a new shelter in place order that defines, among other things, "essential businesses" which are those that can keep operating from their traditional premises (as opposed to only making home deliveries):

Coronavirus Frequently Asked Questions

"This new Order requires that most people continue sheltering in their place of residence until May 3, 2020.  This new Order replaces the prior Shelter-in-Place Order, which was set to expire on April 7, 2020.  It also adds to the list of restrictions to slow the spread of the COVID-19 disease.

"You are still allowed to participate in “essential activities” or to work for an “essential business” if it is not possible for you to work from home."

There follows a long list of essential businesses, and a long set of Q's and A's to guide the perplexed.

Among the Essential businesses:

"Bicycle repair and supply shops"

and there's this Q&A:

"Can gun shops selling firearms and ammunition continue to keep their storefronts open? 

"No.  Gun shops are not essential businesses under the Order.  The Order allows delivery of inventory directly to customers at their residences in compliance with applicable laws and regulations, but gun shops may not make sales from their storefronts. "
I imagine the situation is different in Texas.

Expect a case to reach the Supreme Court in a few years...

Wednesday, April 1, 2020

Headlines that could be dated April 1

Something was in the air this year: many headlines in serious outlets struck me as appropriate for April Fools Day.

Non-political ones come first:

Coffee beans not vital for human survival, Switzerland decides

Dairy Queen burgers are not made of human flesh, county coroner is forced to confirm

The Ohio State University wants to trademark its favorite word: ‘The’
"officials filed Application No. 88571984 with the U.S. Patent and Trademark Office last week, seeking a trademark for the word “THE” to use it on items including T-shirts, caps and hats."

Bodyguard to Saudi king reportedly shot dead by friend
...with friends like these...

A Prisoner Who Briefly Died Argues That He’s Served His Life Sentence
A court in Iowa found that a murderer who was revived “is either still alive, in which case he must remain in prison, or he is actually dead, in which case this appeal is moot.”

Investors who lost $190m demand exhumation of cryptocurrency mogul
Canadian company founder took crucial password to the grave

Are vegetables vegan?

Wisconsin town to legalize snowball fights after 50-year ban

Judge blocks California’s alligator ban after Louisiana sues

Why is Gwyneth Paltrow selling a candle that smells like her vagina?

‘Mad’ Mike Hughes, who vowed to prove the flat-Earth theory, dies in homemade-rocket disaster

Alabama bill may lift yoga ban in public schools but prohibit 'namaste' greeting

Nevada Brothels Requiring Customers To Wear Masks

Astrophysicist gets magnets stuck up nose while inventing coronavirus device

Turkmenistan Has Banned Use Of The Word 'Coronavirus'

And a special section of (American) politics, if you can call it that:

Donald Trump’s interest in buying Greenland stuns Denmark
‘Greenland is not for sale, and can’t be sold,’ says island’s government

Trump cancels Denmark trip after PM says Greenland is not for sale
President says he is postponing meeting with Mette Frederiksen because she was not interested in discussing transaction

Trump blasts report claiming he wanted to nuke hurricanes

Trump border wall between US and Mexico blows over in high winds

Trump’s border wall, vulnerable to flash floods, needs large storm gates left open for months

Sarah Palin stuns TV viewers by rapping Baby Got Back dressed as a bear