By Dennis Thompson

HealthDay Reporter

TUESDAY, April 28, 2020 (HealthDay News) — Supplies of personal protective equipment remain scarce across the United States, especially the N95 respirator masks that health care workers use to protect themselves from the new coronavirus.

To help extend the useful life of available equipment, researchers and hospitals are turning to a long-known, if little-used, means of disinfection — ultraviolet radiation.

“It’s generally well known that UV-C radiation kills microbes,” said Bob Karlicek Jr., director of the Center for Lighting Enabled Systems and Applications at Rensselaer Polytechnic Institute in Troy, N.Y. “What’s not known is the specific quantities of UV-C radiation that is required to fully disinfect complex equipment like N95 masks, because you have to get the light to the inside of the mask.”

Karlicek led a team that created a UV-C system designed to disinfect N95 masks. It’s being tested at Mount Sinai Hospital in New York City.

President Donald Trump was ridiculed last week after publicly speculating that UV light could be used to treat COVID-19 infection inside the human body.

“Supposing we hit the body with a tremendous — whether it’s ultraviolet or just very powerful light — and I think you said that hasn’t been checked, but you’re going to test it,” Trump said at a media briefing. “And then I said, supposing you brought the light inside the body, which you can do either through the skin or in some other way, and I think you said you’re going to test that, too. Sounds interesting.”

Experts quickly came forward to note that UV light can be harmful to humans, and that it would be impossible for ultraviolet rays to reach deep within the body to kill coronavirus in the lungs and other organs.

That’s also part of the problem with using UV light to disinfect protective gear like masks, gowns and gloves, Karlicek said.

UV light disinfects by breaking down the genetic structure of coronaviruses and other microbes, he said. The virus either dies or is rendered incapable of replicating.

But that means the ultraviolet rays must directly strike the virus — meaning every square inch of the equipment must be exposed to UV light to be properly disinfected. Any part that falls within a shadow might still carry active coronavirus, Karlicek said.

Continued

The UV rays must also be very powerful. Mere sunlight alone will not kill the coronavirus, experts say.

The Rensselaer team’s solution is a conveyor system that runs N95 masks through a battery of mercury UV lights.

“That allows us to have a vertical arrangement of UV-C mercury lamps and then suspend the masks carefully on a moving framework that would go in between the lamps, so you could simultaneously irradiate masks from both sides,” Karlicek said.

The system stands about 8-feet tall and about 8-feet long. The masks are hung on a series of hooks, and the speed of the conveyor belt determines how much radiation the masks receive.

Mount Sinai doctors are testing the system to figure out the exact level of UV exposure needed to fully disinfect the masks, Karlicek said.

“There’s no doubt we’ll be able to deactivate the virus at the right dose,” he said. “The question is how many uses can we get? Does the UV light damage the straps that hold the mask on the face? These are things that need to be worked out.”

Other groups also are trying to develop similar solutions. For example, a team at the University of California, Santa Barbara, is working on a system that would use LED lights to sterilize protective gear with UV-C radiation.

“Anything we can do to extend the life of N95 masks in particular — those are in relatively short supply pretty much everywhere — that’s certainly something I would like to see developed,” said Dr. Matthew Heinz, a hospitalist and internist with Tucson Medical Center in Arizona.

“Of course, we have to take proper precautions and make sure we are adequately sterilizing the personal protective equipment,” he added.

Karlicek’s team assembled its prototype for about $10,000, but he warned that supply issues would hamper efforts to make more light-disinfecting machines.

“One of the biggest challenges we had in building the system was finding a supply of mercury lamps that were commercially available now, as opposed to being backordered for five or six weeks,” Karlicek said.

Continued

Similar devices — including wands, boxes and bags — are already available for disinfecting at home using UV light, he noted.

“People are selling UV-C disinfection systems for the home, in particular UV-C wands you can wave over surfaces,” Karlicek said, adding he doesn’t consider them a good idea.

“You have no idea how much UV-C light you’re getting from one of these wands, and you have no idea how to use it to get an appropriate dose,” he said of home users. “In order to disinfect well, you really need a good amount of UV-C light.”

These devices also can be hazardous to people. While UV-C light cannot penetrate the skin, it is bright enough to damage the eyes, Karlicek said.

About

The Good Place Points refers to a series of TikTok videos where TikTokers announce things they’ve done that would increase or decrease their chances of getting into heaven. The videos, which became popular in April 2020, are based on the NBC sitcom The Good Place. In The Good Place universe people are judged after death by the amount of negative or positive points acquired during their life with their actions. In the TikTok videos, TikTokers directly reference the show using the The Good Place theme song.

Origin

On April 7th, 2020, TikToker doofenshmirtz48 uploaded the earliest known example of a TikTok Good Place Points video using the sound clip “original sound – kayl_juice” which is the show’s theme song composed by David Schwartz. The video indicated that she lost points for telling a professor an assignment she forgot about is late because of the time difference” (shown below). The video gained over 34,400 likes in 21 days.

Spread

On April 7th, 2020, TikToker jewishbobduncan uploaded her variation explaining that she ran a scam and lost points (shown below, left). The video garnered over 42,700 likes in 21 days. On April 17th, TikToker wahmeko claimed she gained points for not damaging her hair during quarantine and received over 63,000 likes in 11 days (shown below, center). On April 19th, TikToker Joey Heitzmann ·uploaded a variation where his points increased adding the text “Preventing the birth of a serial killer” and captioned “POV: you’re leaving a guys house after a gr!ndr hu and your good place score goes up” (shown below, right). The video garnered over 76,300 likes in nine days.

Various Examples

Search Interest

Know Your Meme Store

External References

What your doctor is reading on Medscape.com:

APRIL 27, 2020 — Betsy Nicoletti, MS, a nationally recognized coding expert, will take your coding questions via email and provide guidance on how to code properly to maximize reimbursement. Have a question about coding? Send it here.

In this column, Nicoletti outlines some key guidance for using telemedicine. These rules would apply during the Centers for Medicare & Medicaid Services (CMS) emergency rule expanding the use of the technology during the coronavirus pandemic.

Selecting the Right Level of Service for Telehealth Visits

Q: I’m a family medicine physician new to telemedicine. How do I select the level of service for office visits via telehealth? Don’t new patients require an in-person exam first?

A: New-patient visits may be billed via telehealth and don’t require an in-person exam first. When performing a new- or established-patient visit via telemedicine, documentation guidelines require the clinician to select the level of service, based either on the key components of history, exam, and medical decision-making or on time, if counseling dominates the visit.

On March 30, 2020, however, CMS set new guidance for billing evaluation and management (E/M) services via telehealth amid the COVID-19 pandemic. The effective date for these changes is March 1, 2020, prior to the published rule.

CMS said that a practitioner could use total time or medical decision-making alone to select the level of E/M services. During the time of the public health emergency, however, history and exam are not key components in selecting the code. This mirrors the upcoming 2021 E/M changes.

If using time, CMS no longer requires that the visit be dominated by counseling. CMS said, “with time defined as all of the time associated with the E/M service on the day of the encounter.” Do not include staff time.

If using medical decision-making to select the level of service, use the definition in the 1995/1997 documentation guidelines.

Any specialty physician, nurse practitioner, or physician assistant may perform telehealth services. Telehealth services may also be done by social workers and clinical psychologists, and by registered dietitians and nutrition professionals. For Medicare patients, there is a full list of services that may be performed via telehealth in this fact sheet.

What your doctor is reading on Medscape.com:

APRIL 26, 2020 –Certain species of anaerobic bacteria have been linked to dramatic increases in colorectal cancer (CRC), often within a year of infection, although whether or not the bacteria are causal has yet to be determined, say Danish researchers.

“We are not convinced that all the bacteria are directly involved in CRC development — they could just be innocent bystanders that invade the blood stream when the cancer [itself] has caused a breach in the intestinal wall,” lead author Ulrik Justesen, MD, Odense University Hospital, Denmark, told Medscape Medical News in an email.

“But an algorithm for colonoscopy based on the [infecting] species which could then be supplemented with specific characteristics [of the bacteria] along with age is certainly a realistic perspective,” he added.

The study was to have be presented at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Paris, France, but the conference was cancelled due to COVID-19.

Another study suggesting a link between bacteria and CRC was published earlier this year in Nature, as reported at the time by Medscape Medical News. That study, from the Netherlands, suggests that a strain of Escherichia coli may be involved in the development of CRC.

Population-Based Study

The latest study from Denmark was a population-based study involving over 2 million people.

From this large cohort, blood culture data from the years 2007 and 2016 were analyzed.

“We combined blood culture data with the national register for colorectal cancer — the Danish Colorectal Cancer Group Database — and identified incident CRC after bacteraemia,” the investigators state.

The risk for incident CRC was investigated specifically for the anaerobic bacteria Bacteroides spp, Clostridium spp, and Fusobacterium spp.

Incident rates were then compared to those from nonanaerobic bacteria, including the Streptococcus bovis group, Escherichia coli, and Staphylococcus aureus, as well as from negative blood samples.

“We included 45760 bacteraemia episodes, of which 492 or 1.1% were diagnosed with CRC after the bacteraemia; 241 ― 0.5% ― within 1 year,” the researchers report.

The risk for CRC was notably increased in association with most anaerobic species compared with negative blood cultures and with E coli and S aureus cultures, for which the risk was similar to that of negative blood cultures.

What your doctor is reading on Medscape.com:

APRIL 26, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today: 

Outpatient Visits Decimated

A massive decline in outpatient office visits — 60% in mid-March and at least 50% since early February — suggests patients are deferring needed care, according to data compiled by Harvard University and healthcare technology company Phreesia. The analysis was reported online April 23 by The Commonwealth Fund.

New England and Mid-Atlantic states saw the steepest drops with declines as high as 66%, whereas visits by patients living in mountain states were down by 45% as of April 16. Not surprisingly, the declines have had the most impact on procedure-oriented specialties, and the youngest and oldest age groups were most likely to skip visits.

Despite a major push to reach patients via telemedicine, which accounted for about 30% of visits as of mid-April vs zero in February, virtual visits have made up for only a tiny portion of the decline in office visits.

Vaccine Access and Equity

Equitable access to a successful vaccine will be the key to tackling the COVID-19 pandemic, especially as the disease spreads in less developed countries, according to an expert panel convened by the National Academies of Sciences, Engineering, and Medicine (NAS).

“Vaccine is really going to be the answer,” said Susan R. Weiss, professor of microbiology, University of Pennsylvania School of Medicine, Philadelphia. She, along with other NAS panelists, including Anthony Fauci, MD, Director of the National Institute of Allergy and Infectious Diseases (NIAID), agreed there is no room for what Richard J. Hatchett, CEO of the Coalition for Epidemic Preparedness Innovations, called “vaccine nationalism.”

The agency’s first obligation is to the US, Fauci said, adding, however, that NAS is “very sensitive to the fact that, as a country that has a big research and development operation, we do have a global responsibility,” and that it will be crucial to ensure that any successful vaccine be distributed equitably around the world.

Tele-hospitalization?

“Hospital at home” is not a new concept, but it is getting more attention as hospitals seek ways to manage COVID-19 surges while continuing to provide quality care to other patients in need.