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The scent of sickness: 5 questions answered about using dogs – and mice and ferrets – to detect disease
Could medical detection animals smell coronavirus?
Northwell Health is using insights from website traffic to forecast COVID-19 hospitalizations two weeks in the future.
- The machine-learning algorithm works by analyzing the online behavior of visitors to the Northwell Health website and comparing that data to future COVID-19 hospitalizations.
- The tool, which uses anonymized data, has so far predicted hospitalizations with an accuracy rate of 80 percent.
- Machine-learning tools are helping health-care professionals worldwide better constrain and treat COVID-19.
The value of forecasting<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNTA0Njk2OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMzM2NDQzOH0.rid9regiDaKczCCKBsu7wrHkNQ64Vz_XcOEZIzAhzgM/img.jpg?width=980" id="2bb93" class="rm-shortcode" data-rm-shortcode-id="31345afbdf2bd408fd3e9f31520c445a" data-rm-shortcode-name="rebelmouse-image" data-width="1546" data-height="1056" />
Northwell emergency departments use the dashboard to monitor in real time.
Credit: Northwell Health<p>One unique benefit of forecasting COVID-19 hospitalizations is that it allows health systems to better prepare, manage and allocate resources. For example, if the tool forecasted a surge in COVID-19 hospitalizations in two weeks, Northwell Health could begin:</p><ul><li>Making space for an influx of patients</li><li>Moving personal protective equipment to where it's most needed</li><li>Strategically allocating staff during the predicted surge</li><li>Increasing the number of tests offered to asymptomatic patients</li></ul><p>The health-care field is increasingly using machine learning. It's already helping doctors develop <a href="https://care.diabetesjournals.org/content/early/2020/06/09/dc19-1870" target="_blank">personalized care plans for diabetes patients</a>, improving cancer screening techniques, and enabling mental health professionals to better predict which patients are at <a href="https://healthitanalytics.com/news/ehr-data-fuels-accurate-predictive-analytics-for-suicide-risk" target="_blank" rel="noopener noreferrer">elevated risk of suicide</a>, to name a few applications.</p><p>Health systems around the world have already begun exploring how <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315944/" target="_blank" rel="noopener noreferrer">machine learning can help battle the pandemic</a>, including better COVID-19 screening, diagnosis, contact tracing, and drug and vaccine development.</p><p>Cruzen said these kinds of tools represent a shift in how health systems can tackle a wide variety of problems.</p><p>"Health care has always used the past to predict the future, but not in this mathematical way," Cruzen said. "I think [Northwell Health's new predictive tool] really is a great first example of how we should be attacking a lot of things as we go forward."</p>
Making machine-learning tools openly accessible<p>Northwell Health has made its predictive tool <a href="https://github.com/northwell-health/covid-web-data-predictor" target="_blank">available for free</a> to any health system that wishes to utilize it.</p><p>"COVID is everybody's problem, and I think developing tools that can be used to help others is sort of why people go into health care," Dr. Cruzen said. "It was really consistent with our mission."</p><p>Open collaboration is something the world's governments and health systems should be striving for during the pandemic, said Michael Dowling, Northwell Health's president and CEO.</p><p>"Whenever you develop anything and somebody else gets it, they improve it and they continue to make it better," Dowling said. "As a country, we lack data. I believe very, very strongly that we should have been and should be now working with other countries, including China, including the European Union, including England and others to figure out how to develop a health surveillance system so you can anticipate way in advance when these things are going to occur."</p><p>In all, Northwell Health has treated more than 112,000 COVID patients. During the pandemic, Dowling said he's seen an outpouring of goodwill, collaboration, and sacrifice from the community and the tens of thousands of staff who work across Northwell.</p><p>"COVID has changed our perspective on everything—and not just those of us in health care, because it has disrupted everybody's life," Dowling said. "It has demonstrated the value of community, how we help one another."</p>
At the height of the first wave, many people took heart from the drop in air pollution resulting from global lockdowns.
Experts agree that the legacy of the COVID-19 pandemic will be with us for years, even after the immediate threat has passed.
Source: Oxfam<h3>5. Immunization has been set back by the pandemic</h3><p>While the world has been focused on fighting coronavirus, deadly diseases have not gone away. But <a href="https://www.weforum.org/agenda/2020/07/immunization-disruption-covid-19/" target="_blank">efforts to combat them by immunization have taken a back seat</a> to combatting COVID-19, and the results could be serious unless inoculations pick up the pace.</p><p><a href="https://data.unicef.org/resources/immunization-coverage-are-we-losing-ground/" target="_blank" rel="noopener noreferrer">UNICEF estimates that 80 million children under the age of one could go unvaccinated</a> due to the disruption of immunization programmes. "Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health," <a href="https://www.who.int/news-room/detail/22-05-2020-at-least-80-million-children-under-one-at-risk-of-diseases-such-as-diphtheria-measles-and-polio-as-covid-19-disrupts-routine-vaccination-efforts-warn-gavi-who-and-unicef" target="_blank" rel="noopener noreferrer">says Dr Tedros Adhanom Ghebreyesus, World Health Organization Director-General</a>.</p><p>"Disruption to immunization programmes from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles," he adds. <a href="https://data.unicef.org/resources/immunization-coverage-are-we-losing-ground/" target="_blank" rel="noopener noreferrer">UNICEF agrees</a>: "As we recover from COVID-19, our aim should not be to just make up lost ground, but to break through the long stagnation that has held us back for the last decade."</p>
The federal government and private insurers greatly increased Americans' telehealth access during the pandemic. Will these changes be permanent?
- When telehealth visits began skyrocketing after the pandemic began, hospitals had to increase their number of virtual appointments by magnitudes. Most did it seamlessly.
- Big Think spoke to Dr. Martin Doerfler, senior vice president of clinical strategy and development at Northwell Health, about this transition and how it benefited patients.
- Telehealth has proven its value during the pandemic, but it might stop evolving unless the federal government redesigns the regulatory framework so that insurers cover it and patients can afford it.
What are the obstacles facing telehealth?<p>One of the biggest obstacles to widespread adoption of telehealth has been a lack of national legislation providing financial incentive for health centers to adopt it.</p><p>States laws vary on how practitioners are paid for telehealth visits. In some states, laws require insurance providers to cover telehealth visits at parity—at the same rate as in-person visits. But in states without parity laws, there's little incentive for health care organizations to invest in telehealth infrastructure and training.</p><p>Access is also a major obstacle. The Centers for Medicare and Medicaid Services (CMS) generally reimburse practitioners for telehealth visits only when patients live in "designated rural underserved areas."</p><p>But not all underserved areas are in small, remote places. After all, a single parent living in Brooklyn, New York, might also have trouble accessing quality health care.</p><p>"Three hours to drive 200 miles is no different than three hours to take two trains, two buses and a cab," Doerfler said. "So access is almost certainly going to be improved by the greater availability of telehealth in that direct-to-patient, in-their-home-or-office, setting."</p><p>Lack of internet access is also a problem. A <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2768771?appId=scweb" target="_blank" rel="noopener noreferrer">paper</a> published by the JAMA Network in August found that 41 percent of Medicare beneficiaries don't have a computer at home with access to high-speed internet, and roughly the same number don't have a smartphone with an unlimited data plan.</p>
What is the future of telehealth?<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDU1NTU1Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NjA1MjkxMH0.1UuR6tky1k58rOeE9Vcgt8bUfhA2vut6yaCAXik1MEY/img.jpg?width=980" id="9f55b" class="rm-shortcode" data-rm-shortcode-id="4549f30a0347a85c7145690870cf742c" data-rm-shortcode-name="rebelmouse-image" alt="Caucasian female doctor delivering telemedicine consultation to a patient" data-width="5600" data-height="3150" />
Credit: Daniilvolkov via AdobeStock<p>Lawmakers in both parties and health care professionals have indicated a desire to make permanent some of the regulatory changes to telehealth enacted during the pandemic. That's key, because without the financial incentives to continue expanding telehealth, health care providers may revert to the pre-pandemic approach.</p><p>"One issue, which is important for health care and non-health-care folks to know, is that telehealth will continue to expand dramatically as long as there's funding and reimbursement for it," said Michael Dowling, Northwell's president and CEO. "If the insurance companies and government decide, 'We don't want to pay for telehealth going forward or virtual visits,' then it's going to slow down. If there is no delivery system, no health care system, hospital, or doctor is going to continue to expand telehealth if they don't get reimbursed for it."</p><p>Yet some of the nation's biggest insurers have already stopped waiving telehealth deductibles and copays for some customers, even though there's no clear end in sight for the pandemic.</p><p>The long-term solution, Doerfler said, is for CMS to start paying for telehealth services, a<a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a><a target="_blank" rel="noopener noreferrer"></a>t parity, up and down the chain, and passing federal legislation that requires <a href="https://www.siia.org/i4a/pages/Index.cfm?pageID=4546#:~:text=What%20is%20a%20self%2Dinsured%20health%20plan%3F&text=A%20self%2Dinsured%20group%20health,care%20benefits%20to%20its%20employees." target="_blank">self-insured health care plans</a> to pay for telehealth services as they would in-person visits.</p><p>Telehealth is proven to work for urgent care, primary care and some specialty care, and it clearly expands access to behavioral health care, according to Doerfler. "Some have said that costs of providing telehealth are lower than face-to-face care, but most of the costs are unchanged, and new ones are added with technology requirements. When the patient receives a very specific service there are billing codes used to define that service. If the service is less, the code represents that. If the service is the same, the code will represent that and needs to be paid at parity."</p><p>Doerfler added that, while telehealth can't replace all traditional health care services, it should be "<a href="https://www.northwell.edu/news/insights/how-to-have-an-effective-telehealth-visit" target="_blank">in the toolbox</a>" for patients and physicians.</p><p>"In the modern world, where this type of technology is being used for all sorts of personal and business uses, excluding something as personal as your care between you and your doctor from fitting into that modern paradigm makes no sense," Doerfler said.</p>
Spoiler: Most people actually approved of their government's approach.
Image: Pew Research Center<p>Denmark recorded the highest government response approval rating of the countries surveyed (95%), followed closely by Australia.</p><p>Support for their government's actions was also shown in countries like South Korea and Canada, along with European nations like Germany, the Netherlands, Italy and Sweden, where more than two-thirds of respondents approved.</p><p>But a different picture emerged in the US and UK, where delayed action to combat COVID-19 received less emphatic support. More than half of those polled in each country said they thought the pandemic had been handled poorly.</p>
Image: Pew Research Center<h3>Divided or united?</h3><p>Opinions were also split on whether the pandemic had increased the sense of national unity.<br><br>Again, Denmark proved to have the most optimistic outlook with 72% of respondents believing the country more united following the virus outbreak. In Canada, Sweden, South Korea and Australia, over half of respondents believed their country was more united.<br><br>Despite approving of their country's response to the pandemic, in European nations like Spain, Belgium, Italy and the Netherlands, a majority of people thought their country was more divided post-lockdown.<br><br>In the US, in an era of divisive politics and with no coordinated response to the pandemic in place, more than three-quarters of respondents believed their country was now more divided than before the pandemic.</p><p>The perceived strength of national unity is linked to trust in others, the report found. As a general principle, people who thought others couldn't be trusted were more likely to see divisions in their own country.<br><br>National divisions were most pronounced in France, where almost two-thirds of respondents who think people can't be trusted also see the country as more divided than before the pandemic.</p>
Image: Pew Research Center<h3>The role of international cooperation</h3><p>But did this perceived drop in national cohesion prevent countries seeking international help to combat the spread of the virus? And would cross-border cooperation have resulted in fewer cases?<br><br>For the majority of respondents, the answer was yes.<br><br>Across the 14 countries surveyed, 59% of respondents believed greater international cooperation would have reduced the number of coronavirus cases in their own country. In Europe, this average increases to 62%, with seven of the nine countries surveyed expressing belief in the benefits of international cooperation, which was strongest in countries like Belgium, the UK and Spain.</p><p>Outside of Europe, support for international cooperation was also notable in the US (58%) and South Korea (59%), according to the report.</p><p>In Denmark, however, 78% of people thought international cooperation would not have reduced the number of cases. A majority of people in Australia, Germany, Canada and Japan also held little store in international cooperation to tackle the pandemic.<br><br>The World Bank, in collaboration with the World Economic Forum and other stakeholders, held a virtual roundtable to devise an action plan <a href="https://www.worldbank.org/en/news/statement/2020/04/21/the-world-bank-wef-gsma-and-itu-mobilized-in-the-fight-against-covid-19" target="_blank">to facilitate international cooperations and communications to better tackle the pandemic</a>.</p><p>International <a href="https://www.chathamhouse.org/expert/comment/hurdles-developing-covid-19-vaccine-why-international-cooperation-needed" target="_blank" rel="noopener noreferrer">cooperation is a key element of producing an effective vaccine at scale</a> to protect the global population against COVID-19, according to Chatham House. By working together, researchers, business leaders, policy-makers and other stakeholders can more quickly overcome scientific, regulatory and market challenges to developing and distributing a vaccine.</p><p>Reprinted with permission of the <a target="_blank" href="https://www.weforum.org/" rel="noopener noreferrer">World Economic Forum</a>. Read the <a target="_blank" href="https://www.weforum.org/agenda/2020/09/covid-19-survey-trust-unity-cooperation/" rel="noopener noreferrer">original article</a>.</p>
After the unrelenting negativity of 2020, we may need a refresher on the benefits of a positive affect.
1. Positivity correlates with better health<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="67cab64f293633035f0c699f71a5d426"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/vyJ_hhninDw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>It's difficult to say whether a positive outlook nurtures health, success, and life satisfaction or if people who are healthy, successful, and satisfied maintain a positive outlook for, well, obvious reasons. While establishing a causal relationship has been difficult, research does suggest that happiness, extraversion, and optimism—the traits of a <a href="https://www.verywellmind.com/positive-affect-and-stress-3144628#:~:text=%22Positive%20affect%22%20refers%20to%20one's,negativity%20in%20relationships%20and%20surroundings" target="_blank" rel="noopener noreferrer">positive affect</a>—influence beneficial life outcomes as much as it is a byproduct.</p><p>A longitudinal study published in <a href="https://journals.sagepub.com/doi/10.1177/0956797620953883" target="_blank" rel="noopener noreferrer">Psychological Science</a> found that enthusiastic, cheerful people experienced less memory decline with age. The researchers tested nearly 1,000 middle-aged and senior U.S. adults and found a strong association between having a positive affect and a stronger performance on the memory test.</p><p>As study authors Claudia Haase and Emily Hittner, an associate professor and a Ph.D. graduate at Northwestern University, respectively, <a href="https://www.psychologicalscience.org/news/releases/2020-oct-positive-outlook-memory.html" target="_blank">said in a release</a>: "Our findings showed that memory declined with age. However, individuals with higher levels of positive affect had a less steep memory decline over the course of almost a decade."</p><p>Preliminary research looking at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3122271/" target="_blank" rel="noopener noreferrer">the broaden-and-build theory</a> suggests that a positive affect not only helps people cope with stress but makes them more psychologically resilient to future stressors. And <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-power-of-positive-thinking" target="_blank" rel="noopener noreferrer">studies have found</a> that a positive outlook boosts immune responses while reducing the likelihood of heart attacks or other coronary problems. (Though, again, it is unclear in the literature whether positive people make healthier choices or if the positive affect influences these boons).</p>
2. Positivity is contagious<p>The <a href="https://www.psychologytoday.com/us/blog/high-octane-women/201210/emotions-are-contagious-choose-your-company-wisely" target="_blank" rel="noopener noreferrer">emotional contagion phenomenon</a> describes the tendency for us to acquire the emotions of the people around us. Hanging out with happy, enthusiastic people, researchers have discovered, makes us happier and more enthusiastic ourselves, leading to windfalls such as less stress and increased energy. Of course, the phenomenon works in the opposite direction, too. Our minds can become the harbors of others' misery. </p><p>"Just as some diseases are contagious, we're found that many emotions can pulse through social networks," sociologist Nicholas Christakis told <a href="https://hms.harvard.edu/magazine/science-emotion/contagion-happiness" target="_blank" rel="noopener noreferrer">Harvard Medicine in an interview</a>. Unlike a real disease, however, emotions don't have to be transmitted through contact. They can infect our minds through social networks and even online.</p><p><a href="https://www.sciencedaily.com/releases/2007/10/071004135757.htm" target="_blank" rel="noopener noreferrer">A study out of the University of Chicago</a> found that researchers could alter people's opinions of a product by simply revealing peer evaluations. Sharing the negative opinions of others turned previously positive opinions sour and entrenched the already negative ones. </p><p>As Christakis added later in the interview, "Rather than asking how we can get happier, we should be asking how we can increase happiness all around us. When you make positive changes in your life, those effects ripple out from you and you can find yourself surrounded by the very thing you fostered."</p>
3. Social connections support positivity<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="d5c6236f760ae82fc9ed12daecff4847"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/OAsTZGwc3Kw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>If emotions are contagious, then it stands to reason that positive social connections support personal positivity. And that's exactly what the research shows. </p><p>In 2019, the American Psychological Association published <a href="https://doi.apa.org/fulltext/2019-55803-001.html" target="_blank" rel="noopener noreferrer">a meta-analysis</a> surveying two decades of longitudinal research. All told, the report analyzed more than 47,000 participants across 52 studies looking at the effect social relationships had on self-esteem. The researchers found that social relationships, social support, and social acceptance helped develop positive self-esteem throughout people's lives.</p><p>"For the first time, we have a systematic answer to a key question in the field of self-esteem research: Whether and to what extent a person's social relationships influence his or her self-esteem development, and vice versa, and at what ages," Michelle A. Harris, study author and psychologist at the University of Texas, Austin, <a href="https://www.sciencedaily.com/releases/2019/09/190926092416.htm" target="_blank" rel="noopener noreferrer">said in a release</a>. "The reciprocal link between self-esteem and social relationships implies that the effects of a positive feedback loop accumulate over time and could be substantial as people go through life." Harris added that the effect did not differ significantly across the studies analyzed, suggesting a robust finding.</p>
4. We have a bias toward positive language<p><a href="https://www.sciencedaily.com/releases/2015/02/150209161143.htm" target="_blank" rel="noopener noreferrer">Researchers at the University of Vermont</a> wanted to test the Pollyanna Hypothesis, the idea that there is a universal human tendency to—feel free to whistle along—look on the bright side of life. </p><p>To test it, they asked the native speakers of ten different languages to rate individual words on a 9-point scale. Nine equaled broad-smiley face, while one was for deep-frowny face. For example, among English speakers, "laugher" rated a happy 8.5, "the" a neutral 4.98, and "terrorist" a depressing 1.3. The researchers then gathered a data set containing billions of words from 24 sources in those languages, from books to tweets, websites to music lyrics, and, of course, news stories.</p><p><a href="https://www.pnas.org/content/112/8/2389" target="_blank" rel="noopener noreferrer">An analysis of the data</a> showed that humans typically use language to imbue a, in the researcher's words, "usage-invariant positivity bias." Every one of their 24 sources rated above the neutral score of five across all ten languages. Though it's certainly not true of all songs or novels—no amount of data massaging could turn "<a href="https://en.wikipedia.org/wiki/The_Road" target="_blank" rel="noopener noreferrer" style="">The Road</a>" into anything other than a bummer—the researchers found that overall humanity "use[s] more happy words than sad words." Counterintuitive as it sounds, Twitter really is a gathering of the Pollyannas.</p>
5. Positivity is not a self-fulfilling prophecy<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="adc4ace82b7a0f39e0c2ba4fd07f8201"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/-xA5xgAqj1I?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Do these findings mean we should give ourselves over to the cult of positivity come 2021? Should we ignore every one of life's difficulties, view every rain cloud as a cotton-candy-laced fantasy, and use positive thinking to ween away our every foible until we become new-age Übermenschs? Absolutely not. Without realism to serve as ballast, positivity can become a flight of fancy that drifts us over dangerous territories.</p><p><a href="https://journals.sagepub.com/doi/10.1177/0146167220934577" target="_blank">One study</a> compared people's financial expectations in life with their ultimate outcomes over 18 years. They found that participants who set realistic expectations based on accurate assessments of their situations had higher well-being than those who set unrealistic expectations based on overly positive attitudes. Crucially, realists had a higher well-being score than pessimists, too.</p><p>"I think for many people, research that shows you don't have to spend your days striving to think positively might come as a relief. We see that being realistic about your future and making sound decisions based on evidence can bring a sense of well-being, without having to immerse yourself in relentless positivity," Chris Dawson, study author and associate professor of business economics at Bath University, said <a href="https://www.sciencedaily.com/releases/2020/07/200707113230.htm" target="_blank" rel="noopener noreferrer">in a release</a>.</p><p>Positivity must also be measured against a realistic accounting of our emotions. Sometimes, life just sucks. It isn't fair. We lose the people we love, our hard work goes under-appreciated, and we struggle to traverse the paths that others seem to bypass. To just think positively and assume everything will be fine is what psychologist Susan David calls the "tyranny of positivity." Rather than ignore these parts of our life, David suggests that we should accept them.</p><p>"Difficult experiences are part of life. They are part of life's contract with the world. They're part of our contract with the world simply by virtue of being here," David told <a href="https://bigthink.com/videos/susan-david-on-our-unhealthy-obsession-with-happiness" target="_self">Big Think during an interview</a>. "It is really important that as human beings, we develop our capacity to deal with our thoughts and emotions in a way that isn't a struggle, in a way that embraces them and is with them and is able to learn from them."</p><p>Positive realists don't ignore life's hardships and challenges, nor do they let the negativity bias worsen such struggles. They approach both rationally and with measured expectations. When remembering a year or period in their lives, they may also choose to treasure its positive qualities. And after a year like 2020, we can all be forgiven if, in 2021, we err on the bright(er) side of life. </p>
Jonathan Berman wants us to have better dialogues.
- In his book, "Anti-vaxxers," science educator Jonathan Berman aims to foster better conversations about vaccines.
- While the anti-vax movement in America has grown, more Americans now say they'll get a COVID-19 vaccine.
- In this Big Think interview, Berman explains why he's offering an ear to the anti-vax movement.