When Jenn Morson Frederick went into labor with her baby in Annapolis, Maryland, she remembers being hooked up intravenously to an infusion pump because she needed antibiotics. She readily admits that the last thing on her mind was what would happen to the pump after she was done with it.
"Ten minutes from where I live, in Oakland, there are children who can't afford care and there are smaller practices just getting eaten up on cost."
In fact, the pump might go on to assist the labor of another new mother at a rural hospital many miles away, thanks to an innovative online marketplace called Medinas Health. Founded last year by a 27-year-old entrepeneur, Medinas Health buys used medical supplies and sells them to under-resourced hospitals who are happy to get functioning equipment at discounted prices.
The startup is built on a machine learning algorithm that uses historical data for medical devices to predict how much longer they can be used and still be sold at optimum prices on the secondary market. This allows hospitals to squeeze the most use out of their supplies.
Such transactions are the lifeblood for rural or critical access hospitals, says Chloe Alpert, the founder and CEO of Medinas. She first came up with the idea when she noticed a glaring discrepancy in the healthcare marketplace: From 2010 to 2016, 79 hospitals had closed their doors and hundreds more were at risk. At the same time, according to the National Academy of Medicine, the United States wastes medical supplies to the tune of $765 billion every year. On a household level, many people are saddled with medical debt: One in six Americans has past due healthcare bills. The numbers shocked Alpert.
What's more, she found that many used medical supplies were being shipped off to developing countries, partly to minimize the hospitals' liability. "[The model was] fundamentally flawed," she says. "I live in San Francisco and ten minutes from where I live, in Oakland, there are children who can't afford care and there are smaller practices just getting eaten up on cost."
Now, through Medinas, hospitals can offload unwanted clinical assets, and other medical offices can buy them at discounted prices. Since its launch in August 2017, the startup has sold just over 100 items, ranging from infusion pumps to an MRI machine.
Typically, hospitals hold onto their medical supplies as long as possible. Proprietary data from Medinas place the life expectancy of something like an infusion pump at ten years.
"Hospitals' biomed departments are going to try to keep that unit going for as long as they can because you have to replace an entire fleet and that's a significant financial overlay," says Suzi Collins, Director of Materials Management at Mountain Vista Medical Center in Gilbert, Ariz.
"I wanted to do something that would actually make an impact. Imagine healthcare costs going down instead of up."
But after many rinse-and-repeat repairs, it might be time to spring for a new unit. Medinas conducts cost-benefit analyses to show whether it's worth the financial cost for a hospital to hold on to old, creaky equipment. In some cases, manufacturers introduce a new version of a pump and discontinue support for older models, forcing hospitals' hands.
That's when Medinas may step in to facilitate the sale of older medical devices to different hospitals, connecting the lives of urban moms like Frederick to rural moms like Kelly Burch, who recently delivered her baby at the Alice Peck Day Memorial Hospital in rural Lebanon, New Hampshire.
At press time, Medinas had recently received more than 700 infusion pumps to sell from an Arizona medical center and was in negotiations with healthcare facilities who might be interested in buying them. For her work with Medinas, Alpert won $500,000 as part of the Forbes 30 Under 30 competition.
"It really blows my mind to see all these inefficiencies in healthcare, to know that Medinas is doing something tangible to address disparities in care," Alpert says. "I wanted to do something that would actually make an impact. Imagine healthcare costs going down instead of up. That is really neat."
No human has run a distance of 100 meters faster than Usain Bolt’s lightning streak in 2009. He set this record at age 22. But what will Bolt’s time be when he’s 105?
At the Louisiana Senior Games in November 2021, 105-year-old Julia Hawkins of Baton Rouge became the oldest woman to run 100 meters in an official competition, qualifying her for this year's National Senior Games. Perhaps not surprisingly, she was the only competitor in the race for people 105 and older. In this Leaps.org video, I interview Hawkins about her lifestyle habits over the decades. Then I ask Steven Austad, a pioneer in studying the mechanisms of aging, for his scientific insights into how those aspiring to become super-agers might follow in Hawkins' remarkable footsteps.
Following the Footsteps of a 105-Year-Old SprinterNo human has run a distance of 100 meters faster than Usain Bolt’s lightning streak in 2009. He set this record at age 22. But what will Bolt’s time be when ...
A new virus has emerged and stoked fears of another pandemic: monkeypox. Since May 2022, it has been detected in 29 U.S. states, the District of Columbia, and Puerto Rico among international travelers and their close contacts. On a worldwide scale, as of June 30, there have been 5,323 cases in 52 countries.
The good news: An existing vaccine can go a long way toward preventing a catastrophic outbreak. Because monkeypox is a close relative of smallpox, the same vaccine can be used—and it is about 85 percent effective against the virus, according to the World Health Organization (WHO).
Also on the plus side, monkeypox is less contagious with milder illness than smallpox and, compared to COVID-19, produces more telltale signs. Scientists think that a “ring” vaccination strategy can be used when these signs appear to help with squelching this alarming outbreak.
How it’s transmitted
Monkeypox spreads between people primarily through direct contact with infectious sores, scabs, or bodily fluids. People also can catch it through respiratory secretions during prolonged, face-to-face contact, according to the Centers for Disease Control and Prevention (CDC).
As of June 30, there have been 396 documented monkeypox cases in the U.S., and the CDC has activated its Emergency Operations Center to mobilize additional personnel and resources. The U.S. Department of Health and Human Services is aiming to boost testing capacity and accessibility. No Americans have died from monkeypox during this outbreak but, during the COVID-19 pandemic (February 2020 to date), Africa has documented 12,141 cases and 363 deaths from monkeypox.
Ring vaccination proved effective in curbing the smallpox and Ebola outbreaks. As the monkeypox threat continues to loom, scientists view this as the best vaccine approach.
A person infected with monkeypox typically has symptoms—for instance, fever and chills—in a contagious state, so knowing when to avoid close contact with others makes it easier to curtail than COVID-19.
Advantages of ring vaccination
For this reason, it’s feasible to vaccinate a “ring” of people around the infected individual rather than inoculating large swaths of the population. Ring vaccination proved effective in curbing the smallpox and Ebola outbreaks. As the monkeypox threat continues to loom, scientists view this as the best vaccine approach.
With many infections, “it normally would make sense to everyone to vaccinate more widely,” says Wesley C. Van Voorhis, a professor and director of the Center for Emerging and Re-emerging Infectious Diseases at the University of Washington School of Medicine in Seattle. However, “in this case, ring vaccination may be sufficient to contain the outbreak and also minimize the rare, but potentially serious side effects of the smallpox/monkeypox vaccine.”
There are two licensed smallpox vaccines in the United States: ACAM2000 (live Vaccina virus) and JYNNEOS (live virus non-replicating). The ACAM 2000, Van Voorhis says, is the old smallpox vaccine that, in rare instances, could spread diffusely within the body and cause heart problems, as well as severe rash in people with eczema or serious infection in immunocompromised patients.
To prevent organ damage, the current recommendation would be to use the JYNNEOS vaccine, says Phyllis Kanki, a professor of health sciences in the division of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health. However, according to a report on the CDC’s website, people with immunocompromising conditions could have a higher risk of getting a severe case of monkeypox, despite being vaccinated, and “might be less likely to mount an effective response after any vaccination, including after JYNNEOS.”
In the late 1960s, the ring vaccination strategy became part of the WHO’s mission to globally eradicate smallpox, with the last known natural case described in Somalia in 1977. Ring vaccination can also refer to how a clinical trial is designed, as was the case in 2015, when this approach was used for researching the benefits of an investigational Ebola vaccine in Guinea, Kanki says.
“Since Monkeypox spreads by close contact and we have an effective vaccine, vaccinating high-risk individuals and their contacts may be a good strategy to limit transmission,” she says, adding that privacy is an important ethical principle that comes into play, as people with monkeypox would need to disclose their close contacts so that they could benefit from ring vaccination.
Rapid identification of cases and contacts—along with their cooperation—is essential for ring vaccination to be effective. Although mass vaccination also may work, the risk of infection to most of the population remains low while supply of the JYNNEOS vaccine is limited, says Stanley Deresinski, a clinical professor of medicine in the Infectious Disease Clinic at Stanford University School of Medicine.
Other strategies for preventing transmission
Ideally, the vaccine should be administered within four days of an exposure, but it’s recommended for up to 14 days. The WHO also advocates more widespread vaccination campaigns in the population segment with the most cases so far: men who engage in sex with other men.
The virus appears to be spreading in sexual networks, which differs from what was seen in previously reported outbreaks of monkeypox (outside of Africa), where risk was associated with travel to central or west Africa or various types of contact with individuals or animals from those locales. There is no evidence of transmission by food, but contaminated articles in the environment such as bedding are potential sources of the virus, Deresinski says.
Severe cases of monkeypox can occur, but “transmission of the virus requires close contact,” he says. “There is no evidence of aerosol transmission, as occurs with SARS-CoV-2, although it must be remembered that the smallpox virus, a close relative of monkeypox, was transmitted by aerosol.”
Deresinski points to the fact that in 2003, monkeypox was introduced into the U.S. through imports from Ghana of infected small mammals, such as Gambian giant rats, as pets. They infected prairie dogs, which also were sold as pets and, ultimately, this resulted in 37 confirmed transmissions to humans and 10 probable cases. A CDC investigation identified no cases of human-to-human transmission. Then, in 2021, a traveler flew from Nigeria to Dallas through Atlanta, developing skin lesions several days after arrival. Another CDC investigation yielded 223 contacts, although 85 percent were deemed to be at only minimal risk and the remainder at intermediate risk. No new cases were identified.
How much should we be worried
But how serious of a threat is monkeypox this time around? “Right now, the risk to the general public is very low,” says Scott Roberts, an assistant professor and associate medical director of infection prevention at Yale School of Medicine. “Monkeypox is spread through direct contact with infected skin lesions or through close contact for a prolonged period of time with an infected person. It is much less transmissible than COVID-19.”
The monkeypox incubation period—the time from infection until the onset of symptoms—is typically seven to 14 days but can range from five to 21 days, compared with only three days for the Omicron variant of COVID-19. With such a long incubation, there is a larger window to conduct contact tracing and vaccinate people before symptoms appear, which can prevent infection or lessen the severity.
But symptoms may present atypically or recognition may be delayed. “Ring vaccination works best with 100 percent adherence, and in the absence of a mandate, this is not achievable,” Roberts says.
At the outset of infection, symptoms include fever, chills, and fatigue. Several days later, a rash becomes noticeable, usually beginning on the face and spreading to other parts of the body, he says. The rash starts as flat lesions that raise and develop fluid, similar to manifestations of chickenpox. Once the rash scabs and falls off, a person is no longer contagious.
“It's an uncomfortable infection,” says Van Voorhis, the University of Washington School of Medicine professor. There may be swollen lymph nodes. Sores and rash are often limited to the genitals and areas around the mouth or rectum, suggesting intimate contact as the source of spread.
Symptoms of monkeypox usually last from two to four weeks. The WHO estimated that fatalities range from 3 to 6 percent. Although it’s believed to infect various animal species, including rodents and monkeys in west and central Africa, “the animal reservoir for the virus is unknown,” says Kanki, the Harvard T.H. Chan School of Public Health professor.
Too often, viruses originate in parts of the world that are too poor to grapple with them and may lack the resources to invest in vaccines and treatments. “This disease is endemic in central and west Africa, and it has basically been ignored until it jumped to the north and infected Europeans, Americans, and Canadians,” Van Voorhis says. “We have to do a better job in health care and prevention all over the world. This is the kind of thing that comes back to bite us.”