The novel coronavirus that later got termed as COVID-19 had claimed over 400,000 lives at the time this article was being written. As the virus spread across the world, it stretched healthcare systems and facilities beyond what most of us had ever imagined. As the world prays for recovery, the private healthcare industry is praying too. There are pressures around survival as the dynamics of running these institutions have changed rapidly and significantly. Here is what the new normal will entail for the healthcare providers.

Cashflow precedence

To ride this storm, healthcare providers will need to ensure cash availability in the short term at least. With a drastic drop in OPD patients and with elective surgeries non-existent for a period of two months or more, the hospitals have not invoiced the amounts that they were used to. This will have a ramification in the coming months. The money will not be coming in the way it used to. There is also a strong probability that the penchant towards consuming healthcare will be dented for a long period even beyond the pandemic. This will continue to challenge the providers and their cashflows.

The providers will want to be paid faster by the third-party payers. They will also try and push their payouts to the vendors as far in the future as they can. Some of them will turn towards banks and other sources for ensuring cash in the short term.

Almost all players in the industry will be pushed to have a hard look at their cost structures. Already, as this piece is being written, there are talks about salary rationalisations and right-sizing in some healthcare groups in the region. On the clinical side, the biggest brunt will be borne by the departments and personnel who work in specialities, which see more of ‘discretionary,’ non-urgent patients. On the non-clinical side, we will see rightsizing and higher salary reductions in the support functions. Hospitals will want to preserve the essentials and let go of the non-obligatory functions and personnel.

Hospitals have already reduced inventory levels for some of the consumables and medicines. This is likely to continue for many more months to come. Suppliers will have to look at providing alternate and additional categories of goods to their regular buyer hospitals, and that too, at extended credit periods.

Technology transition

There is a lot of talk about providing the remote health of late. Many thinkers have predicted that this trend will continue to garner interest and investments in future. They are right in their thinking. With people apprehensive of going to a hospital or a clinic unless it is very necessary, a remote health platform provides them with an alternative solution.

One of the services which has been in demand is teleconsultations with doctors. The magnitude of the sharp rise in demand can be assessed by the fact that analysts have predicted 200 million virtual visits globally this year, as opposed to the original forecast of 36 million. Within the GCC regions, there has been a surge in teleconsultation requests. Regulators have amended the framework for these online doctor consults in some geographies in GCC. Providers are reporting that apart from seeking doctors advise, patients also opt for the online consultations for follow-up on treatment and for second opinions.

One more technological advancement in clinical care will be in the area of remote health monitoring. There was sporadic and sluggish progress in this field before the COVID-19 era in the region. With a high burden of chronic ailments like diabetes and hypertension, remote monitoring platforms are seeing a stable growth in demand. According to various reports, the remote health monitoring market will grow at a CAGR of around 15 per cent for the coming five years.

Industry experts also predict several new technology-related innovations in the new normal after COVID-19. Remote monitoring of non-critical home care patients is one such example. There is also talk of intensive care units that can be managed remotely by consultants. We have also seen some initial trends in remote managing of mental health patients.

We will also witness a higher demand for wearables and mobile health apps. There is a renewed and more proactive mindset towards preventive health since the last few months. This is likely to continue, hence, augmenting the need for mobile health apps and gadgets.

The transition towards an amplified use of Artificial Intelligence (AI) is on the anvil as well. With various online platforms, new data and algorithms are possible, thus aiding the accuracy of diagnosis and prognosis. The new era will see healthcare providers and their embracing AI as a usual practice rather than a novelty.

As time goes by, we are likely to see many firsts in the region pertaining to technology.

Redefining operations

Running hospitals will never be the same again. The pandemic has taught many lessons to the leaders and administrators who run healthcare establishments. There is a new realisation among the administrators that many functions can actually be performed remotely. It is not necessary, for say, the staff payroll manager to be in the office every day from morning to evening. The same is true for some of the accountants in the system. Invoicing to the insurance companies need not be done from the premises and need not be a completely manual process.

In other words, work from home and automation will be the new normal. Work from home also augurs well for reduced office space and overheads, hence, cost optimisation. Providers will need to create a schedule for rotations and even perpetual work from home scenarios for select employees and departments.

Providers will also embrace automation in a bid to enhance efficiency and reduce mid to long term costs. There are plenty of options being explored already. For example, a hospital group is testing automated closure of books of accounts. In addition, more and more hospitals are embarking on fully automating their pharmacies. A few providers have also expressed interest in automating service level costs so that they can have a handle on how much each procedure costs them.

The modern healthcare systems will have costs at the centre of almost everything that they do. As long as patient safety and treatment outcomes are not compromised, hospitals will look to hang on to the cash and reduce the payouts wherever they can.

COVID-19 has taught some harsh lessons that will change a few things forever. We can conclude that the new normal in healthcare delivery is here to stay.

Vivek Shukla

Normality as we know it has come to a sudden halt due to the coronavirus (COVID-19) pandemic, with the globe facing a level of uncertainty not experienced since the outbreak of the Second World War. With more than 8 million cases and over 450,000 fatalities worldwide thus far, figures are expected to continue to rise as countries strive to ‘flatten the curve’. The repercussions are not yet known, the impacts speculative, but some economic forecasts suggest the worst economic crisis since the Great Depression of 1929 may be upon us.

In recent times, we have seen significant health challenges that have posed a substantial threat to life as we know it – 2002 SARS outbreak (less than 10,000 cases globally, less than 1,000 deaths); 2009 Swine Flu outbreak (up to 1.4 billion cases, fatalities in the hundreds of thousands); 2012 MERS outbreak (more than 2500 confirmed cases, under 1,000 deaths).

Yet despite the previous difficulties of the 21st century, healthcare systems have proved resilient and nations always prevailed. Undeniably, the time has come to do so again – responding quickly to treat patients and ensuring the health and safety of all personnel is essential. At Boston Consulting Group (BCG), we are highlighting the main issues facing healthcare providers in the Middle East and the measures they must take:

Patient and caregiver confidence – patients are worried about the capacity of healthcare providers to cope with COVID-19, and caregivers are concerned about catching the disease and passing it on to family members.

Business continuity – there is a looming worry regarding supply chain disturbances and resource shortages in terms of workforce, medical supplies, and infrastructure.

Resiliency and sustainability – COVID-19 could continue to be around for a while as cases rise and future waves may occur, which impacts overall economic and business growth.

Healthcare providers across the region must do everything in their power to safeguard patient and caregiver confidence and manage the crisis – ensure staff safety and wellness, handle employees’ expectations, ensure clear and constant communication and mobilise staff to meet increased demand.

Following this, sustained surges in demand must be accommodated for – effectively rotating staff to alleviate workforce stress, securing the supply chain for necessary resources, ensuring equipment readiness and maintenance, making sure technology is safe, resilient, and scalable to increase automation; securing liquidity and managing cash carefully and strategically due to reduced revenues and increased expenditure.

Many healthcare providers in the region are already focused on the current crisis at hand to safeguard patient and caregiver confidence and ensure business continuity during the surge. However, it is critical to also shift mindsets to the future – to the post-COVID-19 era – and begin planning for it today so that they are resilient and sustainable, and come out of the crisis stronger.

Healthcare providers must prepare for the potential implications of worst-case COVID-19 scenarios and invest for the future to implement lasting change and learn from the crisis – instilling agility into operations to switch between COVID-19 and normal modes, implementing efficiency programmes to run lean, rolling out new business models such as telemedicine and remote monitoring, and investing in attractive growth opportunities.

Taking these actions today will ensure emergence from this crisis more resilient than ever before. Practically speaking, the formation of a COVID-19 Response Team (CRT) is recommended for public and private sector healthcare providers in the Middle East to ensure they can navigate the ongoing difficulties and lay the foundations for a sustainable future. The CRT will support decision-makers navigate the fluidity of the situation and its constant evolution.

Serving as an information hub and focusing on scenario planning, communication, and program management, the CRT will deliver tangible outputs to ensure organisational resiliency and future-readiness. The CRT and its crisis management toolkit will effectively manage the crisis with limited impact on patients, caregivers, and business continuity. The CRT will enable the navigation towards the future by developing scenarios along with detailed contingency plans for each – and these scenario planning capabilities will be embedded into the organisation to deal with uncertainty in the future.

The CRT coordinates with and supports existing organisational functions relating to specific tasks in the future plan, including business development and mergers and acquisitions, clinical operations, supply chain management, IT, HR, and finance. Healthcare providers can leverage this crisis into an opportunity to become more agile organisations that can adapt quickly to future needs and the changing environment, gain an advantage and leapfrog competition through a future-proof business model, boast a stronger in-house team prepared for future crises and uncertainties and benefit from sustainable long-term growth through investment.

The world has seen pandemics before. The latest is unfolding right now. And without question, more lay ahead in years to come. By investing in the capabilities of the future today, healthcare providers will thrive in the post-COVID-19 era – and be prepared for the crisis of tomorrow. 

Public Health England’s innovative approach to preventing diabetes using new behavioural change techniques combined with digital technologies can be tailored to tackle the rapidly increasing rates of diabetes in the Middle East, in response to the health needs of individual families in the region.

All over the world, rates of diabetes are increasing rapidly. The Middle East and North Africa region (MENA) in particular has experienced an alarming growth in the number of cases over the past 20 years. In the UK, where 90 per cent of diabetes cases are type 2, major digital innovations have been introduced by Public Health England (PHE) to support the treatment, diagnosis and prevention of the condition – including digital interventions promoting behaviour change. With the risk of developing type 2 diabetes linked with obesity, and potentially preventable or manageable by lifestyle changes, these pioneering technologies are paving the way for a new model of preventative care for the Middle East.

The Middle East has the highest global ratio of obesity among adults, with between 27 per cent and 40 per cent of the total population affected.

The increasing numbers of people living with obesity is challenging. Globally, health officials are grappling with the burden on services trying to support people who are struggling with obesity, helping to prevent cases of related health conditions such as type 2 diabetes, musculoskeletal and cardiovascular complications, and mental health problems. Obesity is believed to account for 80-85 per cent of the risk of developing type 2 diabetes.

Like the rest of the world, this burden is being increasingly felt in the Gulf nations, where levels of obesity amongst men and women have been steadily increasing over the last two decades. A 2018 report by Colliers International – part of the Arab Health Market Series – forecasts that the economic burden of diabetes in the region will rise by 67 per cent to US$ 35.5 billion by 2045.

In the UK – where the Office for National Statistics estimates that 1.2 million lives are lost each year due to obesity-related illnesses – doctors, scientists and health marketing experts at PHE have begun to explore how blending changes in the physical environment, urban infrastructure and food types combined with clever digital tools aimed at shifting behavioural choices can have an impact on tackling the obesity epidemic. Similarly, adoption of preventative health technology has been a priority in the MENA region, allowing it to leapfrog over the mistakes made by other health authorities and providers in other parts of the world, addressing the burden of obesity and type 2 diabetes.

PHE has been working with governments across the Gulf region and has in the last year worked successfully with the Kingdom of Saudi Arabia’s Ministry of Health to consider ways it can share this learning and expertise to help promote and raise awareness about changing lifestyle habits. This includes top tips on improving diet and forming better exercise habits to counter the growth of diabetes amongst its populations. More recently, PHE has formalised a relationship with the Abu Dhabi Public Health Centre with the aim of sharing experiences and learning in the context of non-communicable disease.

Dynamic approach to diabetes

Tackling levels of obesity is a key priority across Government health agencies and the NHS in the UK, where the national target is to reduce childhood obesity and associated harms by half by 2030.

Existing healthy weight management face-to-face services are well received by families and support behaviour change when families engage and participate. However, such services are not available across all local authority areas in England, and those services on offer sometimes do not reach all the target families.

This is an area where a digital approach can provide families with an option to explore behaviour change and to do this at scale and in a way that works with face-to-face services and empowers people to engage with and access support. UK technology innovations, from online tools to wearable devices, is opening new opportunities to monitor our health, identify problems earlier and reach people with tailored advice and support. Moreover, the expanding role of technology in public health goes hand-in-hand with advances in how personal data is collected, combined, analysed, and utilised for different population groups.

Previously, the national campaign Change4Life combined digital tools and marketing to communicate information on how to make healthier activity and food choices, which had positive results. For example, 42 per cent of respondents reported that they had made a switch to a low sugar product as a direct result of the campaign in a follow-up survey. Additionally, PHE has successfully delivered activity campaigns for children in the last few years with commercial partners such as Disney and their innovative online ‘10 Minute Shake Up’ summer campaign for children.

Now PHE is pioneering a dynamic digital approach via a new app, ‘Our Family Health’, which brings together digitally-driven predictive prevention, kitemarked by the NHS and PHE that encourages healthier food options.

PHE has taken a combined approach by seamlessly integrating expertise in healthy eating, healthy weight management and behavioural science to develop a digital approach to preventative self-care with a focus on the end-user. This approach could sit alongside the myriad of apps and websites families now use in their everyday lives for work and provide a digital option for those families who wouldn’t ordinarily use a face-to-face service.

The app developers and PHE’s Diet, Obesity and Physical Activity team spent time with parents and children nearly every week over the development phase. This allowed them to better understand lifestyles, motivations and challenges, to shape and prototype an approach that is designed to work for its target audience that can support families on their ‘healthy weight journey’.

The concept is underpinned by behavioural change data, which guides the information and approaches to the end-user and sets tailored goals at the right time to those who need it. The fundamental principle at the heart of the design is a focus on improving and maintaining family health, not weight per se.

Key features, explored with families, include ways to support access to information from trusted sources. This includes information on how to set goals one step at a time, a dashboard that shows progress towards achieving each goal, access to a community of peers that can be used for support and encouragement at any time and information highlighting relevant local activities. The concept has also explored how to produce a safe, creative and engaging space for children through gamification techniques.

PHE’s effort in this area has helped to identify a gap in meeting each family’s individual needs when it comes to supporting and encouraging whole family behaviour change. PHE will continue to press ahead with the development phase of Our Family Health and work with local authorities to explore how it can support families living in some of the most deprived areas in England, associated with high childhood obesity rates.

The team also hopes to work in close collaboration with our peers and partner with experts in the Middle East to share learning, knowledge and expertise as we work to combat the common challenge of rising obesity levels. This is key to evolving innovative ways to enable populations to improve their health and overall well-being.

With the number of diabetic patients in the MENA region expected to increase by 110 per cent to 82 million in the next 25 years, the need for effective prevention strategies has never been greater.

Shadi Abu-Hayyeh

The COVID-19 pandemic is more than a threat to life and physical health. It also menaces mental well-being. Research indicates that the virus and the resulting grief, anxiety, and lockdowns have resulted in considerable psychological damage in a short space of time. Timely and astute mental health interventions in the GCC countries can prevent or alleviate the suffering that is now widespread. In the light of lessons learned during the crisis, governments also need a long-term strategy for robust mental health services.

A recent survey by the American Psychiatric Association found that more than one third (36 per cent) of Americans feel that COVID-19 is seriously affecting their mental health, while most (59 per cent) feel that it is having a serious impact on their daily life. There is no reason to believe that the GCC region is any different.

Global mental health initiatives

Governments throughout the world, including in the GCC, have already launched initiatives to deal with the mental health dimension of COVID-19. These have mostly focused on providing immediate resources for support.

In India, for example, Maharashtra state now has a 24/7 mental health helpline through which people speak with mental health counsellors, clinical psychologists, and psychiatrists. In the UAE, the National Programme for Happiness and Wellbeing has introduced a series of programmes to help residents overcome mental challenges, including daily online live sessions with mental health professionals, awareness-raising videos by mental health experts, and virtual support groups to support community segments. China has implemented a psychological crisis intervention and the National Health Commission of China issued “Principles for Emergency Psychological Crisis Intervention for COVID-19 Pneumonia Epidemic.”

Timely interventions

Similar timely and astute short-term mental health interventions in GCC countries can avert widespread suffering with potentially serious implications. In devising these interventions, it is important to differentiate the needs of three target groups among the population: people directly or indirectly affected by COVID-19; healthcare workers providing treatment at the front line; and the general population.

The direct and indirect victims of COVID-19 have suffered psychological effects. Those diagnosed with the virus have often been confined to the hospital, ill and alone. Healthcare providers can stop patient anxiety before it escalates by incorporating proactive counselling into treatment protocols. Meanwhile, bereavement counselling can ease the anguish of grief for family members who have lost loved ones to the disease.

Frontline healthcare workers are experiencing considerable stress. Hospitals should provide easy and confidential access to mental health services for their staff. For example, they can create helplines for one-on-one counselling when needed. Within the GCC region, the Abu Dhabi Health Services Company (SEHA) created the SEHA Employees Psychological Support Taskforce (SEPST) in the initial phase of the outbreak in anticipation of the pandemic’s adverse effects on frontline staff. SEPST organises weekly webinars in which experts guide the staff on stress management and mental wellbeing. SEHA has also launched a telephone helpline for staff to access in times of distress.

The general population has endured social isolation, while uncertainty about economic conditions and personal finances have created anxiety. Authorities should establish hotlines to receive distress calls. People should have access to mental health treatment through virtual and telephone consultations. Governments can also counter feelings of isolation through mental health awareness campaigns on social media, radio, and television.

Robust strategy

GCC governments also need to go further than mobilising mental health resources to stabilise the current situation. They need to invest resources in building a robust mental health care strategy for the long-term. This should define the target model of care for mental health conditions, with the ultimate goal of prevention, removing the stigma around mental health problems, early detection, and effective treatment in the most appropriate setting.

Target models of care also need to include comprehensive mental health crisis plans. These are components of general revamped crisis management and emergency response strategies. A strong virtual and telemedicine component for mental health, drawing on invaluable experience gained during the crisis, would ensure seamless service.

The fundamentals also need to be in place. That means having a sufficient number of psychologists, psychiatrists, nursing staff, and social workers, together with insurance schemes providing appropriate coverage of mental health conditions.

The crisis has brought the issue of mental health further into the open and weakened the associated taboo. There is now a greater awareness of the vital importance of establishing a robust and resilient mental healthcare model which can react to all eventualities. Now is the time for governments to respond by strengthening mental health services for after the COVID-19 outbreak.

Multiplex assays enable the measurement of multiple analytes in low input samples, including tumour biopsies and circulating tumour derived cells, exosomes, cell-free DNA (cfDNA) and other molecules. Molecular classification of primary tissue, tumour heterogeneity, metastatic tissue, and early detection of therapy resistance requires the development of sensitive and precise multiplex assays with a streamlined and robust workflow.

The Innoplex assay is an RNA bead-based multiplex assay that determines the expression of multiple genes, through direct analysis of lysed samples and signal amplification (no need for nucleic acid extraction and amplification). This method utilises the xMAP Luminex Technology and the Invitrogen QuantiGene Plex Assay (Thermo Fisher), combined with biomarker panels derived from research outputs. In this article, we describe the applications of innovative methodologies to classify tumours and study disease progression, utilising low abundance tissue samples, circulating cells and cellular components in blood.

Introduction

Molecular classification of tumours, their heterogeneity and propensity to metastasis are the leading cause of cancer-related death. Globally, cancer accounted for 9.6 million deaths in 2018, hence, innovative methods are an unmet clinical need to support early diagnosis, proper diagnosis of heterogenous disease and provide the tools for patient surveillance for early detection of disease progression (metastasis) and therapy resistance.

The innovative multiplex assays (Innoplex) are RNA bead-based assays that measure expression of multiple tumour associated biomarkers in low abundance samples. These methodologies were optimised for multiplex digitalised readout using various sample sources ranging from archival formalin fixed paraffin embedded tissues and blood derived exosomes. In this article, we summarise the Innoplex assays based on the xMAP Luminex Technology and the Invitrogen QuantiGene Plex Assay, the research outputs from the University of Malta in terms of the biomarker panels and the commercialisation of the assays through Omnigene Medical Technologies Ltd.

Workflow of the innovative molecular profiling technology

The Innoplex multiplex assays are based on the integration of the Invitrogen QuantiGene Plex Assay (Thermo Fisher Scientific) and the xMAP Luminex technology enabling multiplexing of the technique, and on novel panel of biomarkers developed by the Laboratory of Molecular Oncology at the University of Malta, headed by Professor Godfrey Grech. The technologies and the research output provide the versatility of the assays. To date, a breast cancer molecular classification panel and a colorectal cancer metastatic panel were developed and are currently being optimised for the clinical workflow by Omnigene Medical Technologies Ltd through the miniaturisation and automation of the RNA-bead plex assay.

The Innoplex RNA-bead plex assays utilise the Quantigene branched-DNA technology that runs on the Luminex xMAP technology. Specific probes are conjugated to paramagnetic microspheres (beads) that are internally infused with specific portions of red and infrared fluorophores, used by the Luminex optics (first laser/detector) to identify the specific beads known to harbour specific probes. The Quantigene branched-DNA technology builds a molecular scaffold on the specifically bound probe-target complex to amplify the signal that is read by a second laser/LED.

The workflow of the assay can be divided into a pre-analytical phase involving the lysis/homogenisation of the tissue or cells, and the analytical phase that involves hybridisation, pre-amplification and signal amplification with a total hands-on time of two hours. This is comparable to the time required to prepare a 5-plex qRT-PCR reaction. Increased multiplexing within a reaction will result in an increase in hands-on time for qRT-PCR, while the same two hours are retained for the Innoplex assays. As shown by Scerri et al, qRT-PCR 40-plex reactions will require nine hours to prepare as compared to the bead-based assay, which retains a two-hour workflow. Hence, the bead-based assays have the advantage for high-throughput analysis in multiplex format.

Performance of the Innoplex assay

We have shown in previous studies, using breast cancer patient material, that gene expression can be measured using our RNA-based multiplex assays in formalin fixed paraffin embedded patient archival material that was of low quality and low input. Using a 40-plex assay, we show that receptor status and heterogeneity in formalin fixed paraffin embedded tissue can be measured using stained micro dissected material. Comparison with the reference methods, using snap-frozen and FFPE tissues derived from patient and xenograft samples, the bead-based multiplex assays outperformed the qRT-PCR when using FFPE-tissue- derived RNA, giving reliability coefficients of 99.3-100 per cent as compared to 82.4-95 per cent for qPCR results, indicating a lower assay variance.

Multiplexing provides both sensitivity and versatility in biomarker validation and was instrumental in our hands to measure RNA transcripts in cells at low abundance, mimicking the isolation of circulating tumour cells from blood. In this study, we show that measurement of EPCAM, KRT19, ERBB2 and FN1 maintain a linear signal, down to 15 cells or less. In addition, the simple workflow with direct measurement using lysed cells, enables this assay to be translated more efficiently to clinical setting.

In conclusion, the innovative multiplex assays enable precise and personalised treatment taking into account heterogeneity of primary tumour, progression of tumour during therapy and the metastatic surveillance of the individual patient. The versatility of the method allows the development of various assays to support different applications. Our first innovative methods were developed for the molecular classification of luminal and basal breast cancer and to predict sensitivity to specific therapy in triple negative breast cancer subtype. The multiplex assays have a wide range of possible applications in the diagnosis of tumours and surveillance of tumours during therapy.

The main advantages of these methods include (a) implementation of high throughput analysis, which has a positive impact on remote testing and implementation of such assays in patient surveillance and clinical trials, (b) the digitalised result excludes subjectivity and equivocal interpretation, which are common events in image-based measurements, and also eliminates the need for highly specialised facilities and human resources, (c) accurate and precise detection of multiple targets in one assay, minimising the use of precious patient samples and (d) enables the measurement of gene expression in heterogeneous tumours and low input/low-quality patient material.

The method is streamlined with the current pathology laboratory practices resulting in a workflow that is cost-effective and with minimal turnaround time.

References available on request.

Did you ever ask yourself why knowing your heart rate is important or why there are more and more people wearing devices such as Apple Watch to monitor it?

You probably all remember that moment you learned how to measure your heart rate by taking your pulse on your wrist or neck. That feeling of taking ownership of your own health and wellness was magical as it would give you instant information about your condition. Being aware of your resting heart rate can help you realise when something in your body isn’t quite right. Now, an Apple Watch, Beats Per Minute (BPM) are just one of the countless metrics your wearable is constantly recording.

Ideal heart rate

Your heart rate is the number of times your heart beats per unit, usually minute. What is known as pulse, is a bulge of an artery from waves of blood that course through the blood vessels each time the heart beats. The pulse is often taken at the wrist or side of the neck to estimate the heart rate. The heart rate may be too fast or too slow depending on several factors. Normal heart rate varies from person to person and is based primarily on age rather than gender, although men tend to have slightly lower heart rates than women.

Dr Mohammed Fateh Arab, cardiovascular consultant in Dubai at Novomed Clinics shares: “The ideal resting heart rate for adults is 60 to 100 bpm. Healthy young adults or very fit individuals such as athletes may have resting heart rates below 60 bpm. This is because a fit heart has a larger stroke volume; meaning a higher amount of blood is pumped out of the heart per beat, so the number of beats necessary per minute to perfuse the body is reduced while hearts with higher stroke volumes don’t have to beat as frequently to maintain a normal cardiac output. A low heart rate with no other symptoms is usually the sign of a very healthy heart muscle. A consistently low heart rate (below 60 bpm when resting) is known as bradycardia while a consistently high heart rate (over 100 bpm when resting) is known as tachycardia.

"It’s normal to have an elevated heart rate when you’re exercising, stressed, anxious, sick, or have consumed caffeine. However, if your resting heart rate is lower than 60 bpm or over 100 bpm and you’re experiencing chest pain, dizziness, weakness, palpitation, or other concerning symptoms, this could be a sign of a serious underlying issue and you should be consulting a doctor”.

Dr Arab also adds: “Many of my patients have concerns over their heart health and few experience heart's palpitations but by the time they consult they are unable to explain what they have been through; the Apple Watch is the perfect support for such cases as it would constantly monitor your heart rate and send you a push notification if it detects an abnormal elevated or low resting heart rate. This information is then stored under the health app and it is easy to show or share with your cardiologist for further diagnosis.

“When speaking about health ownership and data democratisation, I can’t think of a better contributor than the Apple Watch and do recommend it to my concerned patients. Accessible for all, easy to use and simple to read the Apple Watch has the ability to draw its user's attention on what could be severe or dangerous health issues “

Focus on heart health

In order to promote healthy movement and improve cardiovascular health, Apple has recently launched in the U.S., in partnership with the American Heart Association “The Apple Heart and movement study”. The study will be looking into the connection of heart health and mobility signals by collecting consent data from its Apple Watch user through its Research app to help learn and understand how user’s activity and habits can contribute to a healthier heart.

Undoubtedly, no one needs to be told how important their heart is, but many of us could do with some help looking after ours. Risk of heart disease is dependent on several factors such as age, smoking habits, diabetes, weight, stress and genetics to name a few. But the good news is there are small lifestyle changes such as more physical activities that can considerably lower your risk of heart disease and contribute to better heart health.

Building a healthy heart

It has been proven that there’s a correlation between your heart health and your physical condition. A lot of studies have linked higher resting heart rates with lower physical fitness, as well as higher blood pressure and body weight. Therefore, increasing your aerobic fitness is an essential part of building a healthy heart. The more you exercise, the more you will be able to lower your resting heart rate, helping your lungs and heart become stronger while also considerably reducing your stress level for a better life balance.

You can track your effort on the working app on your Apple Watch and check your heart rate at the same time. You’ll be surprised to see improvements in your heart rate over time. If you don’t have time to hit the gym or play a sport, you can still count on your Apple Watch to encourage you to stand up, take a breath or simply close your rings through your daily routine. These small changes can help you get moving to achieve 150 min of cardio every week – as recommended by the Centers for Disease Control and prevention.

Enisa Glavovic, Nike Run Club Coach and CEO of Wellbeings worldwide consultancy says: “Exercise is essential for optimal heart health and monitoring your heart rate during your fitness routine can be a great help when you know which heart rate zone you should be aiming for. Target heart rates can be used to maximise the efficiency of your workouts, as well as reduce the risk of injury and mental fatigue. Typically, exercising at 60 to 85 per cent of your maximum heart rate is the most beneficial, while exercising at the lower end of this percentage or doing interval training (where your heart rate goes up and down) is ideal for fat burn. Meanwhile, exercising at the higher end is ideal for building your overall cardiovascular strength.

"Whether it’s to keep an eye on my heart health, set training goals or motivate myself to move more, I count on my Apple Watch to track my efforts and give me clear insights about my heart performance throughout my day to day routine. The Activity app enables me to share my daily movement with friends and also to monitor the running progress of runners within the community, helping them stay on track. For me, the Apple Watch is not only a wearable, it truly is my health companion."

Heart rate monitoring should be important to everyone, regardless of age or physical condition. If you feel the need to change your lifestyle over the long term to acquire a healthier, younger heart; it is maybe worth investing in a fitness and health companion such as an Apple Watch that will not only advise you, encourage you and alert you if something goes wrong but will most importantly respect your choice to share or not your personal collected data by keeping them securely private until you decide otherwise.

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This article was originally published on Conexión Expo Med.

Experts reflected on the shortage of health personnel in the COVID-19 health emergency in Latin America during the Omnia Health Live webinar "Identifying the healthcare professionals of the not too distant future: What changes can we expect?"

Related: Vaccination remains a priority in COVID-19 times

One of the main challenges in the Latin America region is the lack of human resources, especially intensive care doctors and pulmonologists, said Silvia Dallatomassina, surgeon and Emergency Coordinator in Latin America at MSF.

Dallatomassina also stressed that epidemiologists and specialists in public policy are needed “who can see public health policies more broadly.”

Related: Disinfection, sanitisation and cleaning: concepts of the “new normal”

When thinking about the training of doctors, the delegation of tasks should be taken into account, as well increasing the specialisation of nursing personnel, not only because of COVID-19 but because of other chronic diseases that require it, Dallatomassina said. 

According to the expert, a future post-pandemic challenge is environmental health – such as the treatment of diseases caused by chemical poisoning, as this speciality is not within the curriculum of a medical degree. Likewise the surgeon pointed out that it’s important to have a holistic method in the treatment of patients. Through such an approach during the clinical management process, for example, the victimisation of women who have suffered violence can be avoided. 

Management takes on relevance

According to Juan Ramon Fabregat, MPA academic at Panamericana university (UP), three areas must work together. “One is public health with a deep knowledge of statistics and the evolution of various diseases, many of them unknown,” said Fabregat.

“The second is advances in technology that help doctors provide remote care, so it’s not necessary to have all the doctors at the patient’s bedside. Also, doctors are not the ones taking care of the patients.”

“We need to increase the level of nursing personnel and increase the level of other health professionals who can provide effective care, even more than that of doctors, and not necessarily in hospitals,” added the academic.

Fabregat warned that with telemedicine we risk dehumanising the medical field, since there is no human approach. It few put all this together, we can develop real programmes in the selection of which specialists are needed, where they should be location, and which specialties should be included in the curriculum.

Samuel Barbosa, paediatrician, public health expert and presidential secretary of the Colombian Medical College, stated that it’s necessary to improve training programmes in all countries. He mentioned that doctors in Colombia are general practitioners – they do not have any specialisation. 

Patient care can be amplified by specialising in doctors. In the case of doctors in rural areas, we can improve their skills through virtual academic programmes, said the public health expert. 

Technology and the patient

Another opportunity can be found in training specialists in the use of technology for remote patient care.

Juan Carlos Vázquez, professor of pulmonology at the National Autonomous University of Mexico (UNAM-INER), pointed out that one of the biggest challenges is the importance of unifying the training of specialists in the country, since there are substantial differences between hospitals and states.

“Big cities and big hospitals have good training. When you go to hospitals in other states, or when the hospitals are not so large, the training is not of the same quality,” said the expert in pulmonology, adding that this is due to different reasons such as the level of investment not being the same. 

“We have very good quality hospitals and universities, but not everywhere,” said Vazquez. One of the big problems lies in both technological and educational resources since their improvement is needed to properly train doctors, nurses and specialists. 

Investment is another major challenge, to ensure quality training for health professionals.

“Investment in technology, including telemedicine, is very important. In the long run, it becomes cheap,” added the UNAM academic. He explained that the lack of investment is something that has become clearer with the crisis caused by COVID-19; however, the picture is the same for other diseases. He stressed the importance of continuing education to ensure appropriate training for health professionals, as well as the review of educational programmes, as both medical knowledge and technology are advancing rapidly. 

Mariana de Anda, a dermatologist surgeon at Dr Manuel Gea Gonzalez Hospital, highlighted access to technology as a challenge faced across the region in Latin America. 

First-level care is better in more developed countries than in the region. “In order to have better first-level care, we need to change the way we train doctors, so that we have good general practitioners and better coverage of health problems.” Likewise the dermatology specialist pointed out that there is a centralisation of specialists, and this produces a shortage in small towns. 

“After the coronavirus crisis, the way health professionals are trained academically can be changed, and investment in technology emphasised, as in the long run it will be the way we can ensure that people have good medical care around the world and in places where specialists cannot reach,” added De Anda. 

Medicine: a humanitarian vocation

In order to have more specialists, as well as good general practitioners, a balance is required between a good income – that ensures that the health professional can live adequately on their salary – and vocation.

Juan Carlos Vazquez said that on many occasions young people preparing to become doctors tend to choose specialise due to the quality of life that this offers, as well as income. 

In Mexico one of the biggest problems is family and general medicine. “For decades we have trained doctors to be specialists, not to be general practitioners. And if you’re not a specialist, you cannot be considered a good doctor; that is the general perception,” said Vazquez. However today it’s much clearer that primary medicine is needed in the country.

Juan Ramon Fabregat added that if an acceptable income can be guaranteed that ensures a good standard of living for the doctor, the other aspect that must be considered is vocation. “We choose our vocation when we are young, when we are idealists, and we want as doctors to help people,” he added. 

For new generations, it will be important to remember the value of the patient and not just look at income. Likewise Fabregat stressed that young people are more optimistic, so it’s easier to plant in them the need to help others and have a more humanistic approach to the planet.

He added that, without the vocation and heroic spirit, there would be no organisation like MSF, with health professionals determined to care for and help patients in complicated situations such as war zones or isolated areas. 

Dallatomassina stressed the importance of collaboration, creating networks of professionals such as general practitioners who can share their experience internationally is a push, because they can share scientific updates in addition to human experience. This is possible thanks to new technologies allowing a doctor to attend and collaborate remotely. 

This article was originally published on Conexión Expo Med.

Regional experts met to discuss challenges faced by healthcare systems, and the post-pandemic landscape they expect to see, in the panel session "Evaluating the transformation of Latin America's healthcare system after the COVID-19 pandemic" at Omnia Health Live.

Related: Vaccination remains a priority in COVID-19 times

Ruben Torres, dean of ISALUD university in Argentina, emphasised that while most nations are committed to pursuing universal health coverage, few have achieved results. “It depends on the political will of the leaders we have. There are only two possibilities: either we continue heading towards universal health coverage or we continue as before.”

If we want to bring about real change, we must review financial conditions, Torres said. Likewise, he pointed out that the care model must be worked on and primary care must be transformed by creating comprehensive and integrated networks of health services.

Technology and comorbidities

Related: Disinfection, sanitisation and cleaning: concepts of the “new normal”

According to Ignacio García Téllez, Director Health Industry at KPMG Mexico, cancer and cardiovascular problems account for 82% mortality in Latin American populations

He emphasised that the region should focus on other growing health concerns.  “To attack this type of problem, we need to improve the way in which medical device and pharmaceutical industries connect with the health system,” said Garcia Tellez.

He added that the most important factor for quality and effective healthcare is the human health professional. However, technology is also important, as it helps with the prevention, early diagnosis, treatment and control of disease.

The KPMG specialist further stated that the reconfiguration of the care model must take into account the use of technology and that it must offer solutions that integrate professional skills.

In Southeast Asia, for example, telemedicine and applications are used to monitor patients and treatments. He added that in other countries, such as Colombia, Chile and Mexico, remote surgery has been introduced.

Another problem the industry has faced is disruption to the supply chain, especially coming from India or China - so Latin America will need to strengthen its pharmaceutical industry.

In addition, while the manufacturing of ventilators and other devices such as diagnostic tests has been accelerated by COVID-19, this will not last forever. Experts will need to focus on treating risk factors faced by the population.

José Alarcón Irigoyen, external consultant and technical advisor to the Health Commission of the Business Coordinating Council (CCE) assured that, regardless of the health system, opportunities can be seen in Latin America.

“We need to see the COVID-19 crisis as a motive for making structural changes,” stressed Alarcon Irigoyen.  

In terms of structural changes, Guillaume Corpart, CEO of Global Health Intelligence, said that the use of technology is paramount, such as AI or telemedicine, which makes it possible to see patients in remote and inaccessible places. In addition, he pointed out that Chile is a leader in the use of this tool, and that it practically rivals the US in its use.

Countries at a disadvantage

Carla Castillo Laborde, a researcher at the Centre for Epidemiology and Health Policies-CEPS at Desarrollo University in Chile, warned that Chile is a clear example of a fragmented health system. With 19 million inhabitants and 16 regions, Chile has numerous isolated and rural areas which are sometimes impossible to reach.

The researcher highlighted that inequality in Chile resulted in a social crisis beginning in mid-October 2019, leading to political mistrust. He also pointed out that Chile has an important public sector, where 80 percent serve the population.

In Chile there is also structural deficit. “There are 2.5 doctors per 1000 inhabitants, compared to 3.5 on average in the OECD. There are 2.1 hospital beds per 1,000 inhabitants, when the average in the OECD is 4.7 – so this is a significant deficit, “ Castillo explained.

As in other countries in the region, the greatest number of COVID-19 cases are found in the metropolitan area, in the city of Santiago. “Almost 80 percent of cases and 86 percent of deaths are concentrated in the metropolitan area. In that region we have overcrowded areas, mostly in the poorest part,” said the researcher.  

As in other parts of Latin America, Chilean health systems were already stretched. Guillaume Corpart pointed out that the most recent data from Chile shows that the hospital occupancy rate exceeds 90 percent. 

“Meanwhile, access to consultations is below 60 percent. People are afraid to visit the doctor, and at the same hospitals are saturated when it comes to number of beds, and I’m sure it’s the entire region – this is not unique to Chile,” said Corpart.

Carla Castillo suggested that the pandemic took Latin America by surprise because it’s at a disadvantage compared to other European or developed countries. “We have to respond with what we have,” said the researcher, pointing out the lack of resources in the region.

To face the pandemic, it’s important to track cases and isolate them, but in a fragmented health system that represents a real challenge, since there are at least two sectors and the private sector is not controlled by the authorities.

Dr. Tedros Adhanom Ghebreyesus, Director General of the WHO, delivered a keynote video address at Omnia Health Live in which he stressed the need to build a better world with the global healthcare industry playing a critical role in its development. 

Speaking on Tuesday, he highlighted the broader impact of the COVID-19 pandemic, underlining that the crisis touches on all areas of society, and that it will be long-lasting:

We’re now 6 months into the defining health crisis of our times.

More than 8.4 million cases have been reported to the WHO.

More than 150,000 have lost their lives.

The situation is improving in some countries, globally it’s worsening. 

For the last 2 weeks, more than 100,000 cases have been reported daily.

It’s so much more than a health crisis. Millions have lost their jobs. The global economy is headed for the sharpest contraction since the Great Depression. The political, economic and social effect of the pandemic will be felt for years to come.

The health industry has never been more important.

The pandemic has told us that health is not a luxury item, but a human right and the foundation for social and economic development.

We learned the hard way that health is central to everything.

The health industry will play an essential role in creating a healthier, safer and fairer world we all want.

We should be all in this together.