TaNefer Camara, a lactation consultant at Highland Hospital, is also preparing for the birth of her fourth child. Photo: Pete Rosos
In the age of coronavirus, some medical needs can be postponed. Childbirth isnt one of them. Oakland midwives, doulas and obstetricians are reimagining how they work with and support pregnant women during this crisis, and the challenges are immense.
Reproductive health workers are swapping in-person visits for virtual appointments and navigating equipment shortages and new hospital rules that can make childbirth lonelier and riskier.
More mothers are discharging early from the hospital against medical advice, and in some cases, they dont show up at all, opting to give birth at home rather than risk COVID-19 exposure at the hospital.
Lactation consultants and doulas have started offering late-night breastfeeding video consults to help new mothers struggling with the dual isolation of the postpartum period and quarantine.
Some practitioners say hospitals havent fully thought through the realities of giving birth in the midst of this crisis, and how pregnant women will be impacted by new emergency measures.
The community and individuals are stepping up, but health systems are not acknowledging that they cant think about anything beyond COVID-19, said TaNefer Camara, a lactation consultant at Highland Hospital who is currently pregnant herself, expecting her fourth child. Its sad that our health systems are so dysfunctional that one disease can shut down all other care.
We spoke with a number of local health care providers and pregnant women to understand what its like to be expecting in Oakland right now, how local hospitals and support workers are adjusting, and what resources are out there to help ensure a safe and healthy pregnancy in an extremely challenging time.
Kaiser Permanente Hospital, a major East Bay delivery center, has canceled in-person classes that help new parents prepare for labor and delivery, breastfeeding and life with a newborn.
We signed up for all the classes at Kaiser, and every single one was canceled, said Emily Ahsoon Wightman, a teacher at Urban Montessori Charter School who is set to deliver in May. For each cancellation, I got an email and a phone call. So it was another nail in the coffin: Oh, there goes breastfeeding, there goes the newborn care.
Dr. Amanda Williams, physician maternity director of Kaiser Permanente East Bay, said prenatal and breastfeeding videos are available online. Some prenatal appointments, such as scheduled ultrasounds, still happen in person. Kaiser has offered telemedicine for many years, but it has become more important since the COVID-19 pandemic began. We customize the plan for combining in-person and virtual visits based on the status of the individual pregnancy, with shared decision making between the prenatal care provider and the patient, said Williams.
Ahsoon Wightman said shes checked out the videos online, but so far, she hasnt found them as useful as an in-person class or a lesson with a doula. They kind of look like a PowerPoint presentation that theyre talking over, she said.
Telemedicine certainly has advantages. Health workers dont need to don personal protective equipment to talk to patients by phone, conserving valuable resources for those on the frontlines of the COVID-19 response. It also protects the patient from unnecessary exposure to the virus.
Patients who visit Oaklands public Highland Hospital, many of whom have lower incomes and rely on MediCal insurance, often struggle with the time and money it takes to get to and from doctor appointments. The shift to more phone appointments has alleviated some of that burden, said Simone Lance, a midwife at Highland.
Some local midwives and doulas have also transitioned from in-person support to virtual support. Linda Jones, a co-founder of Black Women Birthing Justice, has worked as a pregnancy and postpartum doula for 30 years. Shes offering prenatal, labor, and postnatal support through phone and video calls. Whether or not a video call is permitted during labor depends largely upon the physicians preference and hospital policy.
I feel for the women who are pregnant during this, Jones said. I tell people its like theyre having to grieve what theyve lost. Theyve been planning birth to look a certain way, and now its not anything like they imagined.
New rules about who can accompany women in the delivery room can compound the anxiety. In an effort to combat the spread of COVID-19, only one visitor is allowed in the delivery room at Kaiser Oakland and Highland Hospital. A pregnant woman who may have been counting on several people supporting her through labora partner, friends or relatives, a doulamust now pick only one.
The visitor policy has been a really heartbreaking adaptation, said Lance, a certified nurse-midwife at Highland.
Midnight Milk Club, led by lactation consultant TaNefer Camara, is open to mothers who are looking for breastfeeding support, advice, and community.
The Bay Area Breastfeeding Support Group is led by lactation consultant and nurse Serena Meyer, and is open to birth workers and breastfeeding professionals.
Evidence Based Birth created a crash course on birthing in the time of COVID-19 available for free on YouTube and has built a directory of virtual doulas. This site is a resource used by local midwives Mason Cornelius and Simone Lance.
Kaiser Permanentes Baby 101 module offers important information for new mothers and their partners from the first trimester to the first few weeks at home with your baby. Kaiser Permanentes YouTube Channel offers a number of videos about prenatal, labor and delivery, and postpartum care for mothers and infants.
Highland Hospital and Kaiser have differing policies if a woman in labor, or her support partner, comes into the hospital with COVID-19-like symptoms such as a fever or a dry cough.
As doulas, our superskill is that we adapt well to changes and we keep calm in times that might seem stressful for a lot of people, said Katelyn Gonzalez, a Hayward-based doula with many Oakland clients who is also pregnant, and due in July. Research has shown that women who have good support during labor can experience lower rates of C-sections and better birth outcomes than those who give birth alone.
At Kaiser, a person with symptoms gets tested, according to Lisa Cowan, director of regional services for maternal and child health. If they are COVID-19-positive, have symptoms, or have been exposed, hospital health workers will don protective equipment, mask the mother and her companion, and manage the labor as they would for any other patient.
Highland Hospitals current policy is to separate the mother from her support person if either the mother or support person screen positive for COVID-19. In that situation, the mother would be tested for COVID-19 and separated from her support person. It usually takes about 24 hours to get the COVID-19 test results back.
I understand that desperate times call for desperate measures, but I think we need to acknowledge the risk were taking by not allowing a woman to have continuous labor support, said Lance. It doesnt have to be a doula, but I do think the potential risk of having a woman birth alone needs to be acknowledged. Its more than just sad or a pityit has a potential negative impact.
Usually, mothers will stay in the hospital for at least 24 hours after a vaginal delivery, said Serena Meyer, nurse and lactation consultant at Kaiser. During that time, nurses will monitor the baby for jaundice and other potential problems, and lactation consultants will help establish breastfeeding and keep an eye out for dehydration, tongue ties, or other feeding problems.
Meyer is the founder of the Bay Area Breastfeeding Support Group, a Facebook group for related professionals. She said that since the COVID-19 pandemic, shes seen more people discharging quickly from the hospital, against medical advice, than she has ever seen at any other point in her career.
Ive never seen so many people try to have their baby and bounce up off the floor so fast. Theyre just headed out the door, and I dont know what theyre heading out the door to, said Meyer. We cant stop them, but we are scared for them.
Normally, lactation consultants with a private practice would offer in-home visits after birth, but due to COVID-19 concerns, Meyer shut-down her private practice entirely, while Camara moved hers to virtual visits only.
There are also a growing number of online support groups. Camara runs the Midnight Milk Club, a Facebook group that provides nighttime breastfeeding support for new moms. Since the COVID-19 pandemic, shes been contacted by panicked mothers who are seeing the supply of formula, diapers and other essential baby-care items dwindling in stores. To help answer new questions and manage stress, she has increased the number of group calls to twice a week.
I dont feel that there is enough being done to really support pregnant women at this time, in terms of just the increase in anxiety and depression around having a baby and being confined to the home and not being able to have visitors, said Camara, who is due in August.
Will we see an increase in preterm birth because of the stress that women are under? How is this affecting my baby? How is this affecting me emotionally in the long term?
Wary of new rules and aware that local hospitals are also treating COVID-19 patients, some pregnant women are now completely rethinking their birth plans.
Mason Cornelius, a licensed midwife at Nova Midwifery in Oakland, said that East Bay midwives have recently received an increase in requests from women who want to switch from a hospital birth to a home birth. Sometimes these calls come as soon as two or three weeks before the due date.
Theyre worried that they are going to arrive in labor, and that the hospitals will change policy and they will have to birth alone, said Cornelius. They dont feel safe there without an advocate.
Reproductive health experts worry some mothers will be caught in the middle: too afraid to go to the hospital, but unable to afford a midwife or a doula to assist with a safe home birth. This is most likely to affect women who already face other disparities in the healthcare system. Black women are more likely to die in childbirth than any other population, and black babies are more likely to be born preterm or face other adverse outcomes, which makes giving birth without the support of a doctor or midwife that much riskier.
I am fearful that were going to lose Black women that will do this, said Linda Jones of Black Women Birthing Justice. We need to have alternatives.
The American College of Obstetrics and Gynecology generally cautions against home births, particularly for women with complicated pregnancies and those who are considered high-risk. Some of the factors that might make a pregnancy high-risk, or more likely to deliver preterm, include pre-existing medical conditions such as high blood pressure, diabetes, obesity or past preterm births, according to the National Institutes for Health.
Camara, the lactation consultant at Highland, has always had healthy pregnancies and opted for home births. Currently pregnant herself, she will be giving birth to her fourth child at her home in Oakland. Now that her prenatal appointments are all virtual, Camara is self-monitoring her pregnancy by measuring her belly, tracking her blood pressure, and staying vigilant about her physical health and safety.
Ive just had more anxiety. My heart rate has been elevated because of these things I havent really struggled with before, said Camara. Ive already had healthy pregnancies and natural births, and I want things to go good with this baby as well.
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Polluting industries around the world are using the coronavirus pandemic to gain billions of dollars in bailouts and to weaken and delay environmental protections.
The moves have been described as dangerous and irresponsible by senior figures. They say the unprecedented sums of money being committed to the global recovery are a historic opportunity to tackle the climate crisis, but such action has not been taken to date.
The fossil fuel industry, which already benefits from a $5tn-a-year subsidy, according to the IMF, has had the biggest wins during the coronavirus pandemic in the US and Canada.
In China, as the worst impacts of the virus outbreak passed, there was a surge in permits for new coal-fired power plants. From 1 to 18 March, more coal-fired capacity was approved than in the whole of 2019. In South Korea, the major coal plant builder Doosan Heavy Industries got a $825m government bailout; green groups say the company was in deep financial trouble before the pandemic. In Australia, lobbyists welcomed the South Australia governments move to defer taxes and other commitments to oil and gas explorers.
In the US, assistance for the green energy sector was not included in the $2tn support package on 26 March, three days after 24 rightwing thinktanks, including the Competitive Enterprise Institute, said they were deeply disturbed by possibility of funding for unreliable green energy programs. However, New York state did pass new laws to speed up clean energy projects.
In Brazil, the energy regulator has indefinitely postponed green power auctions scheduled for 2020 and in South Africa, the state-owned power giant Eskom, which relies heavily on coal, said it will cut the wind power it had committed to buy.
In the US, the EPA finalised its rollback of Obama-era rules that made cars less polluting. In the EU, lobby groups argued for a delay in emissions reduction laws, although VW, BMW and Daimler say they are aiming to comply regardless of the virus crisis.
A leaked letter from the International Air Transport Association describes its aggressive lobbying approach and includes a call for relief from corporate taxes, sales taxes, employer-paid payroll taxes and passenger ticket taxes.
In the US, aviation got a $60bn bailout package and the suspension of many taxes. In the UK, major carrier easyJet got a 600m soft loan, weeks after its biggest shareholder received almost 60m in dividends.
In the EU, the farmers association Copa-Cogeca called for a further postponement of the farm to fork strategy, which is aimed at making agriculture less polluting. The call is backed by the rightwing EPP bloc, the largest group in the European parliament.
In Germany, its farming lobby pushed for an easing of environmental standards, particularly those restricting fertiliser use, which are intended to reduce pollution. In the US, the American Farm Bureau Federation and the National Cattlemens Beef Association lobbied heavily and won a $23.5bn bailout package. Agricultural pollution is the cause of a huge dead zone in the Gulf of Mexico.
In the US, the plastic industry lobbied to remove bans on single-use plastic bags, citing hygiene concerns, and saw bans lifted in Maine, New Hampshire, Oregon and Massachusetts. The EPA also weakened the Toxic Substances Control Act for many chemical and petrochemical manufacturers.
In the EU, plastic industry lobbyists asked the European commission to postpone implementation of the single-use plastic directive, intended to cut plastic pollution. However, the commission rejected this call. In England, a ban on plastic straws, stirrers and cotton buds that was due in April has been postponed.
In Indonesia, the trade ministry revoked rules requiring basic certification that wood exports were legally produced in response to lobbying from the furniture and logging industries, according to campaign group Mighty Earth.
The Covid-19 crisis has seen some backing for a sustainable recovery and rejections of polluter lobbying. G20 finance ministers committed to an environmentally sustainable and inclusive recovery and EU leaders backed measures necessary to get back to a normal functioning of our societies and economies and to sustainable growth.
The European commission has not delayed its consultation on a new green finance strategy and is now considering imposing new requirements on firms to reduce the risk of biodiversity loss and pandemics. This is despite coal-heavy states including Poland and the Czech Republic urging the bloc to abandon its Green Deal plan and emissions trading scheme.
In France, the government has approved 288 wind and solar energy projects and has relaxed deadlines and cancelled a planned withdrawal of rooftop solar subsidies. Germany rejected calls to ease the planned shutdown of its coal industry, while in Canada prime minister Justin Trudeau rejected the call from Albertan companies to postpone an increase in the federal carbon tax.
The fallout from the pandemic is also delaying a number of big fossil fuel projects, from LNG terminals in Australia to coal plants in Indonesia.
More than 2,600 health care workers in the Detroit area either have been out sick with symptoms similar to those of COVID-19 or have tested positive for the coronavirus. Above, a police car leaves Henry Ford Hospital in Detroit on April 7. Jeff Kowalsky/AFP via Getty Images hide caption
More than 2,600 health care workers in the Detroit area either have been out sick with symptoms similar to those of COVID-19 or have tested positive for the coronavirus. Above, a police car leaves Henry Ford Hospital in Detroit on April 7.
Cyndi Engelhardt woke up at 5 a.m. one day last month, and laying there in bed she just knew it. She was sick.
She'd had some chest congestion the night before. Now her muscles ached. So in those dark early hours, she got up to take her temperature: 102 degrees.
"And I went back to my bed, and I just put my head in my hands and I was just crying. And I was thinking, 'How am I supposed to help everybody when I'm stuck at home?' " said Engelhardt, an assistant clinical manager at an intensive care unit in Detroit's Henry Ford Hospital. "It just makes you feel like you're helpless."
Part of Engelhardt's job is caring for other nurses including putting together the massive monthly shift schedule. And just then, they needed her more than ever. Over the last few days, their unit had been filling up with COVID-19 patients. Engelhardt had been scrambling to help reorganize and get the staff as much personal protective equipment as the hospital could find.
Now, alone in her home, she reached out to her manager.
"The first thing I said was, 'I'm so, so, so sorry. But I think I may have COVID.' "
Two days later, a test confirmed it: She was positive.
A growing club
Dr. Lamont Jones is vice chair of the Department of Otolaryngology Head and Neck Surgery at Henry Ford Hospital. And he started having symptoms shortly after his wife, Dr. Teniesha Wright-Jones, got sick. They drove together to get tested, and her results came back first: positive.
So they brought their daughters, ages 10 and 14, into the room and broke the news.
"We had a real discussion about that their mom had tested positive, that I had gotten tested. And it's likely that I would be positive, and what it meant for them. They likely were or eventually would be positive," he said. "So it was a pretty real conversation. And one of my daughters did start crying afterwards because she had been reading everything in the news about people coming down with COVID-19 and that people were dying from it."
When Jones' test came back positive as well, he joined a growing club: health care workers in the metro Detroit area who have contracted COVID-19.
Nobody knows how many, exactly, because some health systems aren't sharing or collecting that data.
But more than 2,600 health care workers in the area either have been out sick with symptoms similar to those of COVID-19 or have tested positive for the coronavirus.
From an office job to the COVID-19 unit
In the meantime, hundreds of people like Heather Haener-Svoboda have been redeployed.
"It's a hospital I've never been at, on a unit I've never been on, on a shift that I'd never work," she said. Haener-Svoboda spent the last few years at an office job as a quality and safety administrator at Beaumont Health. Prior to that, she'd been an operating room nurse.
When her employer started surveying the staff about possible redeployments asking which hospital they'd prefer work at, what shifts they could do and what kind of care they felt most comfortable doing she was upfront: She hadn't done that kind of patient care in 20 years.
"But we all felt like, 'We're nurses. We're reading to step up to the plate. The people of metro Detroit need us,' " Haener-Svoboda said. "So I think everybody is out of their comfort zone. But everybody is realizing they're pretty brave."
Now she's working overnight shifts in the unit where COVID-19 patients are sent after they've left the ICU.
"And they're so helpless and they're so scared," she said. "And you really just feel for them. And we're doing the best we can to take care of them and keep them comforted and encourage them, and holding their hand. And you just really feel like you're doing something important."
Guilt, hope and wanting to help
It's especially important in a city and a state that are among those hit hard by the virus.
At least seven health care workers in Michigan have died, including Lisa Ewald. She was a nurse at Henry Ford Hospital, where Engelhardt works.
"You see that and you just think, 'Why was I OK?' " Engelhardt said. "I had some survivor's guilt with that."
Like the majority of health care workers who have contracted COVID-19, Engelhardt has recovered. And after 14 long, frustrating days stuck at home, she returned to work.
"There's a little bit of feeling guilty that I wasn't here, because there are all these people that are fighting for their lives," she said. "And I was home with, like, this mild cold in my eyes. And I don't deserve to be recognized like they do. They're working hard, and I wasn't working hard. I was on this COVID vacation," she added.
Jones and his wife have also returned to work, even though Wright-Jones is still experiencing some shortness of breath.
Since so many of his surgeries have been postponed, Jones has volunteered to clean and disinfect hospital rooms and work in the emergency room.
He says in some ways, having COVID-19 has actually been an asset. Because he presumes he's likely immune, he's taking over some of the higher-risk procedures for his colleagues.
"And so to some degree, it made us feel like we could be more helpful," he said.
Engelhardt also said one good thing has come out of her illness it has given her co-workers a visible reminder that there is hope.
"They saw a lot of hurt," she said. "You know, these patients being alone [when they died]." So when her colleagues see her back at work healthy, energetic and ready to help again it gives them some relief, she said. She's their proof that contracting the virus "doesn't [have to] mean death."
All skilled-nursing residents of a Phoebe Ministries care facility in Montgomery County -- including many battling COVID-19 -- have been moved to the Allentown location, according to a letter to residents and their families.
The 37 residents, who average 84 years old on the skilled-nursing floor, require constant care, a spokeswoman said. Independent living and personal care residents can remain in their apartments at Phoebe Wyncote, the letter said. There is adequate staffing to care for them there, the letter said.
More than two dozen Phoebe Wyncote residents were sick with COVID-19, the disease caused by the coronavirus, as of Friday and many are now recovering under specialized care, a spokeswoman said. None was hospitalized, a spokeswoman said. Ten staff members had been self-quarantined after positive tests and two have recovered and returned to work, a spokeswoman said.
No one has died from COVID-19 at either location, a spokeswoman said.
The Phoebe Allentown facility has largely avoided experiencing an outbreak of the virus, the letter said. One pool employee ttested positivethere before the Wyncote patients were brought north, a spokeswoman said.
With so much staff sidelined in Wyncote, which is a neighborhood in Cheltenham Township, the move was necessitated to provide the most appropriate and highest degree of care for our residents, the letter stated.
A resident in her 80s told the Philadelphia Inquirer that, They told us that we were going to be moved. They didnt ask if we wanted to be. It was mandatory. My family is too far away to do anything about it anyway.
Normally, a nursing facility cant move patients without their permission, Diane Menio, executive director of the Center for Advocacy for the Rights and Interests of the Elderly, a Philadelphia nonprofit, told the newspaper. But a lot of the regulations have been suspended, she added.
The 1 West and 2 West neighborhoods at the Allentown facility, 1925 W. Turner St., are equipped with specially trained staff and resources (including necessary personal protective equipment) and will be solely dedicated to caring for COVID-19 positive residents, the letter said. Neighborhoods are units within a building, the spokeswoman said. The 3 West neighborhood will be used for patients from Wyncote who have not tested positive for COVID-19, yet need to be closely monitored for symptoms, the letter said.
Teams are dedicated to these units and they have separate entrances that restrict crossover between employees and residents, Phoebe Ministries said.
Families were advised about the move, which took place on Wednesday as social distancing was created in buses, the letter stated. Staff on board wore appropriate protective gear, the letter said.
The arrangement will last until affected members of the Wyncote staff are able to recuperate and return to work, Phoebe Ministries said.
Tell us your coronavirus stories, whether its a news tip, a topic you want us to cover, or a personal story you want to share.
Tony Rhodin may be reached at arhodin@lehighvalleylive.com. Follow him on Twitter @TonyRhodin. If theres anything about this story that needs attention, please email him. Find lehighvalleylive.com on Facebook.
Virginia on Friday reported 602 more cases of COVID-19 and 23 more deaths in the last 24 hours.
Fauquier has 35 confirmed cases as of Friday morning up three since Thursday, according to the Virginia Department of Health.
Virginia has 7,491 cases and 231 deaths attributed to the pandemic as of Friday. (The case total includes those tested positive and those with symptoms and known exposure to COVID-19.)
Those numbers stood at 6,889 and 208 a day earlier.
So far, 48,997 people had been tested in Virginia with 1,221 hospitalized for treatment of COVID-19.
Among the states 8.53 million residents, 0.57 percent have been tested.
In the five-county Rappahannock-Rapidan Health District, which includes Fauquier, 1,174 people had undergone tests for the virus. That accounts for 0.6 percent of the districts population of about 180,000.
The statistics reflect information that healthcare providers and laboratories reported to the health department by 5 p.m. Thursday. VDH updates its statistics each morning.
Curbside testing started last week in Warrenton.
The five-county region has two confirmed deaths:
An 80-year-old Warrenton man who died early Tuesday evening, April 7, at Fauquier Hospital.
A woman in her 80s with chronic medical conditions, who died Tuesday, March 31.
The five-county region has 95 known cases including 32 in Culpeper, 19 in Orange, 8 in Madison and 1 in Rappahannock as of Friday morning.
The Madison total includes a patient in a long-term care facility there, the regional health district office reported late Friday afternoon, April 10.
The heath department reports 665 cases and 37 deaths among 66 Virginia long-term care facilities that have experienced outbreaks.
The caseload in Virginia will peak April 27, according to the latest projection from the University of Washington.
But, a study from the University of Virginia Biocomplexity Institute indicates the states cases will peak in mid-July to late August, with about 15,000 confirmed infections.
Virginias most-populous jurisdiction, Fairfax County has 1,476 confirmed cases, up 101 since Thursday, followed by:
Prince William County, 644.
Henrico County, 532.
Arlington County, 485.
Loudoun County, 385.
Virginia Beach, 265.
City of Alexandria, 321.
Chesterfield County, 291.
City of Harrisonburg, 214.
City of Richmond, 201.
James City County (including Williamsburg), 157.
City of Chesapeake, 147.
Stafford County, 128.
Virginia had its first confirmed case Feb. 16.
Nationwide, the number of confirmed cases stood at 662,045 with 28,998 deaths and 54,703 patients who had recovered as of Friday morning.
The Virginia Hospital & Healthcare Association reported:
1,308 hospitalized patients with confirmed COVID-19 or test results pending as of Friday morning.
224 of those patients on ventilators.
1,110 confirmed COVID19 patients who have been released from hospitals.
The states hospitals have 2,862 ventilators on hand, with 22 percent of them in use, including those for patients not receiving treatment or COVID-19.
The statewide bed availability stood at 5,587.
Six hospitals report difficulty in obtaining or replenishing PPE (personal protection equipment) in the next 72 hours.
Before the world was alerted to the threat of a novel coronavirus spreading out from China, Hadley Sikes was already well acquainted with developing molecular technology to improve diagnosis and treatment of diseases. Now working on a crucial diagnostic test to find people with Covid-19, the Esther and Harold E. Edgerton Associate Professor of chemical engineering at MIT and principal investigator of the Antimicrobial Resistance Interdisciplinary Research Group at Singapore-MIT Alliance for Research and Technology (SMART), and her collaborators have managed to condense months of work into a matter of a few weeks.
Q: Where does your work fit in with the global Covid-19 research effort?
A: The Covid-19 pandemic has presented a huge challenge for the worlds capacity for diagnostic testing. It has given us a clearer picture of what our actual capabilities are because all the countries in this effort are as motivated as they could ever be to deploy technologies that can test populations as quickly and accurately as possible.
Scientists have only been able to deploy one kind of test so far to identify people who have Covid-19. The coronavirus that causes this illness is made out of proteins and RNA, and so far, we only detect its RNA. RNA tests are complicated and can take hours, or even days, for doctors to receive the results. A faster version of an RNA test was just announced, but it also requires laboratory equipment and it is difficult to produce as many tests are needed.
What Ive been working on at MIT and SMART, MITs research enterprise in Singapore, is developing protein tests that are quick to run and dont require laboratories. These tests can find out if viral proteins are present in bodily fluids and also if a patients immune system has responded to the SARS-CoV-2 virus.
That is information that is critical, especially in this situation whereby countries are shutting down. If you know who has had the infection and recovered, and thus now has immunity, you have the potential to keep things running without putting more people at risk.
Before this outbreak, we had been working with support from the Deshpande Center on protein tests to diagnose malaria, dengue, and tuberculosis. Our goal was to find a way to capture more of the proteins made by these pathogens by developing binding reagents that concentrate the proteins within a testing device. We also wanted our tests to be affordable and easy to produce in large quantities.
Developing the reagents is a slow but crucial part of the process of developing a clinical protein diagnostic, and typically takes longer than for nucleic acid tests.
Dr. Eric Miller, who is in my lab at MIT, and Dr. Patthara Kongsuphol at SMART, have been working on engineering reagents that capture more of the scarce viral proteins in a patients bodily fluids. If more of these viral proteins can be captured, the test can be more sensitive.
With the Covid-19 pandemic as his motivation, Dr. Miller figured out how to engineer these binding agents in just two weeks much sooner than the several months it might typically take. On the SMART side, Dr. Kongsuphol has been leading our efforts in Singapore to integrate these agents into diverse test formats that can be challenged with clinical samples.
We are aiming to create a test that can work in 10 minutes and doesnt require specialized instruments or laboratory infrastructure. In this way, it can be carried out at an airport or a clinic to accurately show if a person either has or is immune to Covid-19. Its challenging to make a test that is sensitive and accurate enough, and also a huge challenge to scale up production of such a test fast enough to have an impact when a new pathogen emerges.
Q: What influence has Singapore had on your work?
A: I have been at MIT for 10 years and started working with SMART two years ago. Joining an interdisciplinary research team in Singapore has given me a really great chance to work on a pressing medical problem of our time, which is antimicrobial resistance. It allows me to work with world-class clinicians and government agencies that are international leaders in public health, and with top researchers at Nanyang Technological University, the National University of Singapore, and the Agency for Science, Technology and Research.
I spent January in Singapore and went back again at the beginning of March, just as the outbreak was emerging in the United States. I really wanted to learn more about how Singapores experience during the SARS outbreak in the early 2000s allowed them to respond so effectively to this outbreak, particularly with diagnostic testing.
It was nerve-wracking being separated from my family at this time. I have three young children and a husband who has a full-time job. Because of the 12-hour time difference with Boston, we had a lot of late-night and early-morning FaceTime chats.
They have been really supportive of the work my team and I are trying to do. I think they are glad I went to Singapore because they see that I am doing what I can to play a role in figuring out effective responses to this, and future public health crises. The mission provides a powerful sense of purpose.
The United States is fortunate that it had not experienced the SARS or MERS outbreaks Singapore and other Asian countries had been through, but this means we are lacking in the knowledge and experience these countries have gained. The United States and other countries can learn a lot from Singapore.
After that event, Singaporean officials analyzed everything that happened and put in place new public health measures designed to effectively manage and contain any future outbreaks. By doing this, they have developed a world-class response.
Q: What did you learn in Singapore?
A: I valued getting to speak to the doctors on the ground who were fighting the Covid-19 outbreak in Singapore and learning what they had seen during their case management amid the crisis.
When I arrived in Singapore, I was honored to get to speak with Dr. Sidney Yee, CEO of the Diagnostics Development Hub, who had worked to rapidly produce a high-performing RNA test and ensure it was quickly deployed as part of Singapores effective response to Covid-19.
I was also able to talk to my colleague at SMART, Dr. Tsin Wen Yeo, while he was doing shifts in the Intensive Care Unit, caring for Covid-19 patients. He gave me his views about what was required from a diagnostic protein test. I think it was an incredible opportunity to understand the needs of doctors in different settings and it focused the efforts of my team. Understanding how diagnostic tests will be used allows us to prioritize the things that doctors find most important.
You could make all sorts of diagnostic tests, but the ones we focus our effort on are the ones that are going to provide doctors with actionable information that will help them treat their patients.
This is a really interesting time now that there is a sudden emphasis on needing better, faster diagnostics for the worlds health-care systems. Engineers have a big role in providing these, for the benefit of patients and health workers, and also to help economies get back on their feet. I hope that this desire for more practical diagnostic research continues after we recover from this outbreak.
BRANDON, S.D. (KELO) Gates Corporation is shutting down its Brandon manufacturing plant from April 20-24, after nine employees tested positive for COVID-19. But the company says that is not the reason it is temporarily closing.
Gates says the decision came because of the decreased demand for its product due to the economic slowdown.
As soon as we received notification of the first positive diagnosis, we instructed the employee and any coworkers believed to have been in close contact with the employee to self-quarantine for 14 days. We repeated our self-quarantine directive for any subsequent coworkers that have been in close contact with the additional six employees who received a positive diagnosis. Additionally, enhanced cleaning and sanitation practices were immediately initiated in the facility.
Gates has 270 employees at its Brandon facility. The company says it will continue to provide benefits during this time. Gates plans to reopen the facility April 27.
The financial toll of the coronavirus is even hitting hospitals and other health care facilities.
Spectrum Health announced Friday it is making budget cuts because of COVID-19.
Spectrum said they lost millions of dollars in revenue in just one month when non-emergency and non-urgent surgeries were canceled. And expenses increased because of the urgent need for masks, gloves, face shields and other personal protective equipment for staff during the pandemic.
It also expects a drop in patients, saying unemployment and other economic pressures will likely discourage people from seeking medical help.
As a result, executives are taking 40% pay cuts and donating surplus paid time off to team members in need of PTO.
Company matches to employee retirement contributions are suspended from July until December.
And it said more actions will need to be taken to reduce expenses and continue to serve the community.
In Michigan, Ms. Whitmer, who imposed one of the strictest stay-at-home orders in the nation, said Friday that she hoped to loosen the regulations in two weeks time, on May 1.
Ms. Whitmer, a Democrat who has faced criticism from some residents and business leaders, said that any decision would depend on what the data on infections says as that date approaches. Her state trails only New York and New Jersey in the number of residents whose deaths have been tied to the virus.
Its two weeks away, and the information and the data and our ability to test is changing so rapidly, its hard to predict precisely where well be in a week from now, let alone two weeks, the governor said on ABCs Good Morning America days after thousands of demonstrators, who mostly remained in vehicles, protested outside the State Capitol in Lansing and accused Ms. Whitmer of going too far.
Gov. Phil Scott of Vermont, a Republican, said Friday that he would allow some businesses in the state to reopen by Monday, provided that they involve very low contact and involve no more than two people.
The governor gave the green light to a handful of businesses property managers, real estate agents and some construction crews but said they must comply with safety guidelines, such as social distancing and wearing a mask. The state will open its farmers markets on May 1st. So far, the state has registered 779 cases and 35 deaths.
Gov. Tony Evers of Wisconsin, a Democrat, said on Thursday that golf courses could open with certain restrictions and that for-hire lawn care could be carried out if it was performed by one person. Stores selling materials to make face masks can open for curbside pickup, he said.
In Idaho, Gov. Brad Little, a Republican, has said businesses that were once deemed nonessential, such as craft stores, candle shops or dog groomers, could open to allow for curbside or delivery services until at least the end of the month. He noted that they should prepare to reopen altogether in May with social distancing and sanitation rules in place.
Mammoth Biosciences and researchers at the University of California, San Francisco are working on a coronavirus test that could run multiple samples at once, with results in 35-40 minutes. Even better, they say, it doesn't require the sophisticated, expensive equipment used in other tests for the virus. Mammoth Biosciences hide caption
Mammoth Biosciences and researchers at the University of California, San Francisco are working on a coronavirus test that could run multiple samples at once, with results in 35-40 minutes. Even better, they say, it doesn't require the sophisticated, expensive equipment used in other tests for the virus.
Being able to test for coronavirus infections is a critical component to reopening society even a little bit after the initial wave of COVID-19. So there is an urgent need for faster, cheaper tests than the ones available at present.
One approach to the next generation of tests is being developed by the University of California, San Francisco Medical School and Mammoth Biosciences. In a paper released Thursday in the journal Nature Biotechnology, researchers describe a test based on a new technology known as CRISPR.
CRISPR systems have been widely used by researchers to modify the genetic material in living cells. In this case, a system known as CRISPR-Cas12 is used to recognize genetic signatures of the coronavirus that causes COVID-19 and then make cuts in it to release a fluorescent molecule that will show whether the virus is present.
Like the test developed by the Centers for Disease Control and Prevention, this CRISPR-based test can run multiple samples at once. And while the CDC version delivers answers in hours, the test from UCSF and Mammoth Biosciences is faster providing results in 30-45 minutes.
The test is self-contained, so it doesn't require sophisticated, expensive equipment that is used in other tests for the virus.
"I can run it now myself at home," explains Dr. Charles Chiu, professor of laboratory medicine at UCSF and co-lead developer of the new test although he notes it does require some expertise to conduct it. He says he and his colleagues hope to submit the current version of their test next week for FDA approval. But it probably won't be the final iteration.
"What we really want to develop is something like a handheld, pocket-sized device using disposable cartridges," says Chiu something that could even be use by nonexperts as a home-based test. Chiu is confident such tests could be manufactured at a scale that would be widely available.
Other labs, including two at the Broad Institute in Cambridge, Mass., are also working on CRISPR-based diagnostic tests.
Sara Sawyer, a virologist at the University of Colorado, is trying to go one step further in the testing world. She's trying to develop a low-cost test people could use at home that would reveal whether they are infected days before they show any symptoms.
"For two years, we've been working on trying to develop a diagnostic that can pick up on the earliest stages of common respiratory diseases," Sawyer says. Her test doesn't look for the virus itself. Instead, it looks for a response to the virus by the cells of a person who is infected.
The idea is that once cells in the nose and throat are infected, certain genes are switched on that aren't normally switched on. Sawyer says it's possible to detect those "up-regulated" genes in saliva instead of the nasal swab other coronavirus tests rely on. The question is, can she distinguish the new coronavirus from other viruses. She thinks she can.
But do others agree?
"The answer is maybe," says Benjamin tenOever, a virologist at the Icahn School of Medicine at Mount Sinai in New York City. He says yes, infection by the virus that causes COVID-19 results in different genes being up-regulated, compared with flu or other viruses. He's just skeptical the technology exists to be able to detect those differences.
"I'd say theoretically it is possible," tenOever says. "She's a very smart scientist. And so if she says she can do it, I would give her the benefit of the doubt."
Sawyer has formed a company to build her test kit. If society is to reopen, she says, there will have to be easy ways for people to check their infection status. She's in the process of designing and raising money for a study to validate her test's accuracy.
"We think saliva is the key to moving these tests out of the doctor's office," Sawyer says, because all people would have to do to collect a sample is spit in a cup. No blood draws, no nasal swabs. Easy.
If it works.
