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Dennis OConnor

Coronavirus Pandemic Update 37: The ACE-2 Receptor - The Doorway to COVID-19 (ACE Inhib... - 0 views

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    "Dr. Michael Kurisu D.O." called this video "molecurlar biology 101" It is from the Youtube Channel: MedCram - Medical Lectures Explained CLEARLY
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    Forwarded to the Project Apollo listserve by "Dr. Michael Kurisu D.O." from Christina Mnatzaganian. This is from the UCSD Family Medicine Faculty Listserve. Hi Deepa, The statement below is from ACC/HFSA/AHA on March 17th. Essentially, there is no human data yet and data is evolving. See below, particularly the red area: *The following joint statement from the ACC, American Heart Association and Heart Failure Society of America was posted online on March 17 and addresses using renin angiotensin aldosterone system (RAAS) antagonists in COVID-19. "The continued highest standard of care for cardiovascular disease patients diagnosed with COVID-19 is top priority, but there are no experimental or clinical data demonstrating beneficial or adverse outcomes among COVID-19 patients using ACE-I or ARB medications," said Richard J. Kovacs, MD, FACC. "We urge urgent, additional research that can guide us to optimal care for the millions of people worldwide with cardiovascular disease and who may contract COVID-19. These recommendations will be adjusted as needed to correspond with the latest research." Patients with underlying cardiovascular diseases appear to have an increased risk for adverse outcomes with coronavirus disease 2019 (COVID-19). Although the clinical manifestations of COVID-19 are dominated by respiratory symptoms, some patients also may have severe cardiovascular damage. Angiotensin converting enzyme 2 (ACE2) receptors have been shown to be the entry point into human cells for SARS-CoV-2, the virus that causes COVID-19. In a few experimental studies with animal models, both angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been shown to upregulate ACE2 expression in the heart. Though these have not been shown in human studies, or in the setting of COVID-19, such potential upregulation of ACE2 by ACE inhibitors or ARBs has resulted in a speculation of potential increased risk for COVID-19 infection in patients with
Dennis OConnor

Doctors on the Frontlines of the Coronavirus Fight - The Atlantic - 0 views

  • Yui had always counted herself lucky to be among a family of doctors. Now the family is facing the greatest challenge of their lives as they wrestle with the dilemma of caring for their patients even though this risks exposing their loved one
  • Will her family survive the crisis intact?
  • Doctors across America are facing similar predicaments, made all the more acute by the government’s failure to protect them—to warn the public, to provide tests, and to supply enough protective equipment.
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  • When it comes to us being doctors, I worry about [family members] Stephanie and Alex and Jennifer and Pam—about their health, and about the eventual burnout due to everything that’s going on,”
  • As a primary-care physician, she’s the first point of contact with the medical system for many patients.
  • Pam recommended a hospital visit to be tested. “It was already too late for me and my family,” Pamela told me—she had been potentially exposed. Her patient got tested on March 12, and is still waiting for results. “My patient’s test was sent from Baltimore to a lab in Utah, then due to a reagent shortage [a substance needed to process the tests] sent from Utah to Arizona, Arizona back to a lab in North Carolina,” she said.
  • This is a mirror of the dysfunction and delays surrounding the country’s testing crisis, a major factor hamstringing the fight against the virus.
  • Meanwhile, she started feeling sick on Tuesday, and took the test herself. Self-quarantined at home, she thinks it’s only a matter of time, if she does have the virus, before she infects her two children—totally isolating from them would be all but impossible.
  • As a health-care provider, if I test positive, it has big implications for my office, my staff, and all the patients,”
  • Emergency-room doctors, he noted, are among those most at risk.
  • Her emergency room has been seeing more and more patients who have symptoms
  • She wears protective equipment but knows that the hospital could run out.
  • It’s not lost on Koo and her family that medical professionals worldwide have been dying fighting the coronavirus.
  • the main dilemma they’re grappling with is not so much getting sick themselves but spreading the virus to their families, their patients, and the public.
  • his might be the greatest fear of doctors across the country—that they’ll move from being part of the solution to part of the problem.
  • should. It weighs heavily on people.”Yui, for her part, told me she’d never let her fears over the virus stop her from doing her job.
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    Dr. Michael Kurisu D.O.: Another article capturing the dialogue that i hear from a lot of my colleagues and others. We have doctors as well In my family : -My sister is Neuro ICU and director of stroke at Tri city hospital in Oceanside -Her husband is ER doc -My little sister is the PhD in sociology. (She specializes in education programs for the incarcerated and has interest on health access for prisons - which is a frightful place during this pandemic)
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    We are in a war against this virus. First responders are the first line of defense. There is a lack of supplies and central leadership. However, there is no shortagage of courage. When you meet a first responder, say, "Thank you for your service."
Dennis OConnor

What We Know So Far About SARS-CoV-2 - The Atlantic - 0 views

  • March 20, 2020
  • One of the few mercies during this crisis is that, by their nature, individual coronaviruses are easily destroyed.
  • These viruses don’t endure in the world. They need bodies.
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  • To be clear, SARS-CoV-2 is not the flu. It causes a disease with different symptoms, spreads and kills more readily,
  • his family, the coronaviruses, includes just six other members that infect humans
  • OC43, HKU1, NL63, and 229E—have been gently annoying humans for more than a century, causing a third of common colds
  • MERS and SARS (or “SARS-classic,” as some virologists have started calling it)—both cause far more severe disease.
  • hy was this seventh coronavirus the one to go pandemic?
  • The structure of the virus provides some clues about its success. In shape, it’s essentially a spiky ball. Those spikes recognize and stick to a protein called ACE2
  • This is the first step to an infection
  • he exact contours of SARS-CoV-2’s spikes allow it to stick far more strongly to ACE2 than SARS-classic did
  • But in SARS-CoV-2, the bridge that connects the two halves can be easily cut by an enzyme called furin, which is made by human cells and—crucially—is found across many tissues. “This is probably important for some of the really unusual things we see in this virus,” says Kristian Andersen of Scripps Research Translational Institute.
  • SARS-CoV-2 seems to infect both upper and lower airways,
  • his double whammy could also conceivably explain why the virus can spread between people before symptoms show up
  • All of this is plausible but totally hypothetical; the virus was only discovered in January, and most of its biology is still a mystery.
  • The closest wild relative of SARS-CoV-2 is found in bats, which suggests it originated in a bat, then jumped to humans either directly or through another species.
  • Another coronavirus found in wild pangolins also resembles SARS-CoV-2
  • Indeed, why some coronaviruses are deadly and some are not is unclear. “There’s really no understanding at all of why SARS or SARS-CoV-2 are so bad but OC43 just gives you a runny nose,” Frieman says.
  • Once in the body, it likely attacks the ACE2-bearing cells that line our airways.
  • The immune system fights back and attacks the virus; this is what causes inflammation and fever
  • in extreme cases, the immune system goes berserk
  • These damaging overreactions are called cytokine storms.
  • they’re probably behind the most severe cases of COVID-19.
  • During a cytokine storm, the immune system isn’t just going berserk but is also generally off its game, attacking at will without hitting the right targets.
  • But why do some people with COVID-19 get incredibly sick, while others escape with mild or nonexistent symptoms
  • Age is a factor.
  • other factors—a person’s genes, the vagaries of their immune system, the amount of virus they’re exposed to, the other microbes in their bodies
  • “it’s a mystery why some people have mild disease, even within the same age group,”
  • Coronaviruses, much like influenza, tend to be winter viruses.
  • In the heat and humidity of summer, both trends reverse, and respiratory viruses struggle to get a foothold.
  • irus is tearing through a world of immunologically naive people, and that vulnerability is likely to swamp any seasonal variations.
  • And one recent modeling study concluded that “SARS-CoV-2 can proliferate at any time of year.
  • Unless people can slow the spread of the virus by sticking to physical-distancing recommendations, the summer alone won’t save us.
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    Dr. Michael Kurisu D.O.: We've known about SARS-CoV-2 for only three months, but scientists can make some educated guesses about where it came from and why it's behaving in such an extreme way.
Dennis OConnor

In the coronavirus pandemic, we're making decisions without reliable data - 4 views

  • A fiasco in the making? As the coronavirus pandemic takes hold, we are making decisions without reliable data
  • This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19.
  • As most health systems have limited testing capacity, selection bias may even worsen in the near future.
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  • The one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers. The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher.
  • Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%).
  • Although successful surveillance systems have long existed for influenza, the disease is confirmed by a laboratory in a tiny minority of cases.
  • Some worry that the 68 deaths from Covid-19 in the U.S. as of March 1610 will increase exponentially to 680, 6,800, 68,000, 680,000 … along with similar catastrophic patterns around the globe. Is that a realistic scenario, or bad science fiction? How can we tell at what point such a curve might stop?
  • In the absence of data, prepare-for-the-worst reasoning leads to extreme measures of social distancing and lockdowns.
  • This has been the perspective behind the different stance of the United Kingdom keeping schools open12, at least until as I write this. In the absence of data on the real course of the epidemic, we don’t know whether this perspective was brilliant or catastrophic.
  • One of the bottom lines is that we don’t know how long social distancing measures and lockdowns can be maintained without major consequences to the economy, society, and mental health.
  • At a minimum, we need unbiased prevalence and incidence data for the evolving infectious load to guide decision-making.
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    Dr. Michael Kurisu D.O. "My take is this article is written by a very credible source. John P.A. Ioannidis is from Stanford and great resource. Makes argument that we are basing a LOT of our decisions on faulty or NO data ! Its fascinating to me that there has been less than 10,000 deaths globally and we have had SO MUCH DISRUPTION in the economy. I definitely feel we should be tracking the amount of deaths that are going to occur from people that will be pushed into poverty as well as the number of people being denied access to medical care right now. Yes… with COVID19, it CAN get much worse…. But maybe not… we don't know yet. This article actually increased my morale and put me on track to help GET MORE DATA. Then we can make informed decisions. And then TRACK ALL THE DATA moving forward.
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    DeAunne Denmark, MD, PhD, "Excellent piece spelling out the pervasive and critical issues due to abysmal lack/tardiness in US testing, especially of large populations where initial outbreaks occurred, for those both visibly sick and not. And most importantly, healthcare workers. We cannot even begin to estimate CFR, much less develop reliable projection models, without valid data on everybody who is carrying. "The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections."
Dennis OConnor

Part 1 - BVS' San Diego's Multi-faceted Attack Against the COVID-19 Pandemic Virtual Co... - 0 views

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    "Panelists: Erica Ollmann Saphire, Ph.D., Professor and Coronavirus Task Force Member, La Jolla Institute for Immunology Evan Y. Snyder, M.D., Ph.D., F.A.A.P, Professor, Sanford Burnham Prebys (SBP) Medical Discovery Institute Joseph Payne, Founder, President and CEO, Arcturus Therapeutics Kate Broderick, Ph.D., Senior VP R&D, Inovio Pharmaceuticals 11:45 AM - 12:30 PM - PANEL DISCUSSION San Diego's Multi-faceted Attack Against the COVID-19 Pandemic From a Diagnostic Perspective Moderator: Pam Gardner, President & CEO, BVS, Inc. Panelists: Doug Bryant, President & CEO, Quidel Corporation Joshua Trotta, Sr. Director, Global Business Development - Clinical Solutions, Genetic Sciences Division, Thermo Fisher Maurice Exner, Ph.D., Vice President, R&D, Assay Development and Clinical Affairs, Hologic, Inc. Susan Tousi, Senior Vice President, Product Development, Illumina, Inc."
Dennis OConnor

Open Notes: Feel More in Control - 1 views

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    "Feel More in Control OpenNotes isn't a product. It's a movement that makes health care more open and transparent by encouraging doctors and other professionals to share their visit notes. Reading your notes can help you manage your health care. Ask your doctor for them!"
Dennis OConnor

OpenNotes - Patients and clinicians on the same page - 1 views

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    "OpenNotes is the international movement that's making health care more transparent. It urges doctors, nurses, therapists, and others to invite patients to read the notes they write to describe a visit."
Dennis OConnor

Frequency and Types of Patient-Reported Errors in Electronic Health Record Ambulatory C... - 0 views

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    Recommended by Tyler Orion: Conclusions and Relevance In this study, patients who read ambulatory notes online perceived mistakes, a substantial proportion of which they found to be serious. Older and sicker patients were twice as likely to report a serious error compared with younger and healthier patients, indicating important safety and quality implications. Sharing notes with patients may help engage them to improve record accuracy and health care safety together with practitioners. Meaning  As health information transparency increases, patients may perceive important errors in their visit notes, and inviting them to report mistakes that they believe are very serious may be associated with improved record accuracy and patient engagement in safety."
Dennis OConnor

Frontiers | Using Self-Study and Peer-to-Peer Support to Change "Sick" Care to "Health"... - 1 views

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    "Camille Nebeker, Bethany Weisberg, Eric Hekler, and Michael Kurisu Frontiers in Digital Health - This paper is also posted on our PHE Website
Dennis OConnor

A mysterious company's coronavirus papers in top medical journals may be unraveling | S... - 0 views

  • On its face, it was a major finding: Antimalarial drugs touted by the White House as possible COVID-19 treatments looked to be not just ineffective, but downright deadly. A study published on 22 May in The Lancet used hospital records procured by a little-known data analytics company called Surgisphere to conclude that coronavirus patients taking chloroquine or hydroxychloroquine were more likely to show an irregular heart rhythm—a known side effect thought to be rare—and were more likely to die in the hospital. Within days, some large randomized trials of the drugs—the type that might prove or disprove the retrospective study’s analysis—screeched to a halt. Solidarity, the World Health Organization’s (WHO’s) megatrial of potential COVID-19 treatments, paused recruitment into its hydroxychloroquine arm, for example.
  • The study doesn’t properly control for the likelihood that patients getting the experimental drugs were sicker than the controls
  • Other researchers were befuddled by the data themselves. Though 66% of the patients were reportedly treated in North America, the reported doses tended to be higher than the guidelines set by the U.S. Food and Drug Administration, White notes. The authors claim to have included 4402 patients in Africa, 561 of whom died, but it seems unlikely that African hospitals would have detailed electronic health records for so many patients, White says.
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  • This was very, very annoying, that The Lancet were just going to let them write this absurd reply … without addressing any of the other concerns,”
  • 200 clinicians and researchers, that calls for the release of Surgisphere’s hospital-level data, an independent validation of the results
  • But the revision had other problems, Chaccour and his colleagues wrote in their blog post. For example, the mortality rate for patients who received mechanical ventilation but no ivermectin was just 21%, which is strikingly low; a recent case series from New York City area found that 88% of COVID-19 patients who needed ventilation died. Also, the data shown in a figure were wildly different from those reported in the text. (Science also attempted to reach Grainger, but received no reply to an email and call.)
  • Surgisphere’s sparse online presence—the website doesn’t list any of its partner hospitals by name or identify its scientific advisory board, for example—have prompted intense skepticism.
  • wondered in a blog post why Surgisphere’s enormous database doesn’t appear to have been used in peer-reviewed research studies until May.
  • how LinkedIn could list only five Surgisphere employees—all but Desai apparently lacking a scientific or medical background—if the company really provides software to hundreds of hospitals to coordinate the collection of sensitive data from electronic health records.
  • Desai’s spokesperson responded to inquiries about the company by saying it has 11 employees and has been developing its database since 2008.
  • The potential of hydroxychloroquine for treating COVID-19 has become a political flashpoint, and the questions around the Lancet paper have provided new fodder to the drug’s supporters. French microbiologist Didier Raoult, whose own widely criticized studies suggested a benefit from the drug, derided the new study in a video posted today, calling the authors “incompetent.” On social media, some speculated that the paper was part of a conspiracy against hydroxychloroquine.
  • Chaccour says both NEJM and The Lancet should have scrutinized the provenance of Surgisphere’s data more closely before publishing the studies. “Here we are in the middle of a pandemic with hundreds of thousands of deaths, and the two most prestigious medical journals have failed us,” he says.
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    Recommended by Mike Kurisu, DO.
Dennis OConnor

COVID-19 Racial Health Disparities Stress Patient Trust Pitfalls - 0 views

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    Recommended by DeAunne Denmark MD Phd. "New data showed black patients have less trust in COVID-19 mitigation, underscoring decades of racial health disparities and limited patient trust."
Dennis OConnor

The epic battle against coronavirus misinformation and conspiracy theories - 0 views

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    Recommended by Tyler Orion: "For researchers who track how information spreads, COVID-19 is an experimental subject like no other. "This is an opportunity to see how the whole world pays attention to a topic," says Renée diResta at the Stanford Internet Observatory in California. She and many others have been scrambling to track and analyse the disparate falsehoods floating around - both 'misinformation', which is wrong but not deliberately misleading, and 'disinformation', which refers to organized falsehoods that are intended to deceive. "
Dennis OConnor

Vicky A. Newman Memorial (Full) March 15, 2020 - YouTube - 0 views

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    "Vicky Newman's memorial was held in the midst of the coronavirus epidemic on 03-15-1986"
Dennis OConnor

The CDC and States Are Misreporting COVID-19 Test Data - The Atlantic - 0 views

  • A negative test result means something different for each test. If somebody tests negative on a viral test, a doctor can be relatively confident that they are not sick right now; if somebody tests negative on an antibody test, they have probably never been infected with or exposed to the coronavirus. (Or they may have been given a false result—antibody tests are notoriously less accurate on an individual level than viral tests.) The problem is that the CDC is clumping negative results from both tests together in its public reporting.
  • Mixing the two tests makes it much harder to understand the meaning of positive tests, and it clouds important information about the U.S. response to the pandemic, Jha said. “The viral testing is to understand how many people are getting infected, while antibody testing is like looking in the rearview mirror. The two tests are totally different signals,” he told us. By combining the two types of results, the CDC has made them both “uninterpretable,” he said.
  • “Combining a test that is designed to detect current infection with a test that detects infection at some point in the past is just really confusing and muddies the water,” Hanage told us.
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    "The government's disease-fighting agency is conflating viral and antibody tests, compromising a few crucial metrics that governors depend on to reopen their economies. Pennsylvania, Georgia, Texas, and other states are doing the same."
Dennis OConnor

Coronavirus Hub: Cell Press - 0 views

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    Recommended by DeAunne Denmark MD Phd, "At Cell Press, we recognize the urgent need to quickly share information about SARS-CoV-2, the coronavirus that causes COVID-19. On this hub page, curated by members of our editorial team, you'll find the latest content about the outbreak as it appears in Cell Press journals."
Dennis OConnor

Empowering patients and reducing inequities: is there potential in sharing clinical not... - 0 views

  • engages them actively in their care, improves their sense of control over their health and enhances safety.
  • older, less educated, non-white or whose first language is not English report even greater benefits than do their counterparts
  • we suggest that open notes may, over time, prove important in the care of patients who are at risk of experiencing healthcare disparities.
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  • in the USA, the likelihood of receiving an access code to activate health portals is significantly lower for minorities, the uninsured, non-English speakers and older patients.11
  • Research suggests that negative implicit biases can affect the quality of health interactions and are associated with fewer signals of support and empathy towards patients representing some disadvantaged demographic groups, including racial and ethnic minorities, low-income, less educated and older patients.1
  • Open notes might be viewed as extending the visit, potentially thereby elongating and strengthening patient–physician interactions before and after the pressures of the clinical encounter.
  • investigators found that patients who were non-white or less educated reported more benefits than their counterparts:
  • Although some health organisations provide portals in a range of languages, clinical notes are typically offered in one language only.
  • access to open notes appears to help some patients who speak another primary language by allowing them, or a care partner, to read and recall information.
  • 77% (357/462) reported reading their notes as extremely important for remembering their care plan,
  • It is estimated that, on average, patients do not recall about half of the health information communicated during visits, with this figure likely higher among those with lower levels of health literacy.2
  • health literacy is now recognised as a driver of health disparities.
  • By offering patients access to records that document what was discussed during visits, open notes may provide a novel forum for augmenting health literacy among some patients.
  • As one patient noted: “I like my summaries because I can go back and revisit them”.1
  • in a large study of patients who read notes, 38% (8588/22 753) reported sharing them with others, predominantly family members
  • Limitations
  • Open notes are becoming increasingly common, and preliminary data suggest they may hold particular benefits for vulnerable patient populations
  • Second, as preliminary evidence suggests, it is possible that open notes may increase trust between patients and clinicians, reduce transmission of bias and increase patient engagement, especially among vulnerable patient populations
  • co-creation of medical notes holds promise and is currently under investigation
Dennis OConnor

11 HIPAA and Medical Records Privacy Myths for Patients - 0 views

  • You can be an empowered patient or advocate by knowing the basics of HIPAA and having the confidence to request records from providers. Here are some myths about HIPAA and how they affect you, the patient.
  • Myth: HIPAA Prevents Sharing of Information With Family Members
  • Myth: Only Patients or Caregivers May Get Copies of Health Records
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  • Myth: Employers Are Payers and Can Gain Access to an Employee's Records
  • Myth: HIPAA Laws Prevent Doctors From Exchanging Email With Their Patients
  • Myth: Providers Are Required by Law to Provide All Medical Records to You
  • Myth: Patients Denied Access to Their Records May Sue to Get Copies
  • Myth: HIPAA Laws Cover Privacy and Security for All Medical Records
  • Myth: Providers Are Required to Correct Any Errors Found in Patient Records
  • Myth: Your Health and Medical Records Cannot Affect Your Credit Records
  • Myth: Medical Information Cannot Be Legally Sold or Used for Marketing
  • Myth: HIPAA Can Be Used as an Excuse
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    "You can be an empowered patient or advocate by knowing the basics of HIPAA and having the confidence to request records from providers. Here are some myths about HIPAA and how they affect you, the patient."
Dennis OConnor

NIH mobilizes national innovation initiative for COVID-19 diagnostics | National Instit... - 0 views

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    "The National Institutes of Health today announced a new initiative aimed at speeding innovation, development and commercialization of COVID-19 testing technologies, a pivotal component needed to return to normal during this unprecedented global pandemic. With a $1.5 billion investment from federal stimulus funding, the newly launched Rapid Acceleration of Diagnostics (RADx) initiative will infuse funding into early innovative technologies to speed development of rapid and widely accessible COVID-19 testing. At the same time, NIH will seek opportunities to move more advanced diagnostic technologies swiftly through the development pipeline toward commercialization and broad availability. NIH will work closely with the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention and the Biomedical Advanced Research and Development Authority (BARDA) to advance these goals."
Dennis OConnor

Swimming with the High-Tech Sharks to Improve COVID-19 Testing - NIH Director's Blog - 0 views

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    "So much has been reported over the past six months about testing for coronavirus disease 2019 (COVID-19) that keeping up with the issue can be a real challenge. To discuss the latest progress on new technologies for SARS-CoV-2 diagnostic testing in the United States, I spoke recently with NIH's Dr. Bruce Tromberg, director of the National Institute of Biomedical Imaging and Bioengineering (NIBIB). Not only does Bruce run a busy NIH institute, he is helping to coordinate the national response for expanded testing during the COVID-19 pandemic."
Dennis OConnor

COVID-19 data and tools - Coronavirus COVID-19 Response - 0 views

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    Just announced. June 25, 2020 - California goes Open Source on Covid-19 Data
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