Health24.com | Animal tests point to possible path to ultrafast insulin

  • Pharmaceutical companies have been trying to develop a faster-acting insulin for decades
  • A new formulation could translate to a fourfold decrease in the time insulin takes to reach peak activity in humans
  • Researchers have confirmed the ultrafast action of their formulation in pigs with diabetes

An experimental ultrafast-acting insulin could work four times more quickly than current fast-acting formulas, researchers say.

For the study, the researchers focused on a form of insulin called monomeric insulin. Though its structure should, in theory, allow it to act faster, monomeric insulin is too unstable for practical use, so the Stanford University team had to find a way around that problem.

“The insulin molecules themselves are fine, so we wanted to develop a ‘magic fairy dust’ that you add into a vial that would help to fix the stability problem,” said senior author Eric Appel, assistant professor of materials science and engineering.

“People often focus on the therapeutic agents in a drug formulation but, by focusing only on the performance additives – parts that were once referred to as ‘inactive ingredients’ – we can achieve really big advancements in the overall efficacy of the drug,” Appel added in a university news release.

Ultrafast action

His team identified an additive polymer that could stabilize monomeric insulin for more than 24 hours in stressed conditions. Current commercial fast-acting insulin stays stable for six to 10 hours under the same conditions.

The researchers confirmed the ultrafast action of their formulation in pigs with diabetes, the most advanced non-human animal model. Their results were published on 1 July in the journal Science Translational Medicine.

In the pigs, the experimental insulin reached 90% of its peak activity within five minutes of injection, while commercial fast-acting insulin began showing significant activity only after 10 minutes.

The experimental insulin’s activity peaked at about 10 minutes; commercial insulin required 25 minutes.

Though results of animal experiments are not always the same in humans, the researchers said the difference could be significant. It could translate to a fourfold decrease in the time insulin takes to reach peak activity in people.

“It’s really unprecedented,” Appel said. “This has been a major target for many big pharmaceutical companies for decades.”

Additional tests are underway with an eye to applying for US Food and Drug Administration (FDA) approval for clinical trials in humans.

Image credit: iStock

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Do we know what we want in a romantic partner? No more than a random stranger would

We all can describe our ideal partner. Perhaps they are funny, attractive and inquisitive. Or maybe they are down-to-earth, intelligent and thoughtful. But do we actually have special insight into ourselves, or are we just describing positive qualities that everyone likes?

New research coming out of the University of California, Davis, suggests that people’s ideal partner preferences do not reflect any unique personal insight. The paper, “Negligible Evidence That People Desire Partners Who Uniquely Fit Their Ideals,” was published last week in the Journal of Experimental Social Psychology.

“The people in our study could very easily list their top three attributes in an ideal partner,” noted Jehan Sparks, former UC Davis doctoral student and lead author of the study. “We wanted to see whether those top three attributes really mattered for the person who listed them. As it turns out, they didn’t.”

In the research, more than 700 participants nominated their top three ideals in a romantic partner — attributes like funny, attractive or inquisitive. Then they reported their romantic desire for a series of people they knew personally: Some were blind date partners, others were romantic partners, and others were friends.

Participants experienced more romantic desire to the extent that these personal acquaintances possessed the top three attributes. If Vanessa listed funny, attractive and inquisitive, she experienced more desire for partners who were funny, attractive and inquisitive.

“On the surface, this looks promising,” notes Paul Eastwick, a professor in the UC Davis Department of Psychology and co-author.

“You say you want these three attributes, and you like the people who possess those attributes. But the story doesn’t end there.” — Professor Paul Eastwick, UC Davis

What would a stranger say?

The researchers included a twist: Each participant also considered the extent to which the same personal acquaintances possessed three attributes nominated by some other random person in the study. For example, if Kris listed down-to-earth, intelligent and thoughtful as her own top three attributes, Vanessa also experienced more desire for acquaintances who were down-to-earth, intelligent and thoughtful.

“So in the end, we want partners who have positive qualities,” said Sparks, “but the qualities you specifically list do not actually have special predictive power for you.” The authors take these findings to mean that people don’t have special insight into what they personally want in a partner.

Eastwick compared it to ordering food at a restaurant. “Why do we order off the menu for ourselves? Because it seems obvious that I will like what I get to pick. Our findings suggest that, in the romantic domain, you might as well let a random stranger order for you — you’re just as likely to end up liking what you get.”

The findings have implications for the way people approach online dating. People commonly spend many hours perusing online dating profiles in the search of someone who specifically matches their ideals. Sparks and colleagues’ research suggests that this effort may be misplaced.

“It’s really easy to spend time hunting around online for someone who seems to match your ideals,” notes Sparks. “But our research suggests an alternative approach: Don’t be too picky ahead of time about whether a partner matches your ideals on paper. Or, even better, let your friends pick your dates for you.”

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Materials provided by University of California – Davis. Original written by Karen Nikos-Rose. Note: Content may be edited for style and length.

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Atomic ‘Swiss army knife’ precisely measures materials for quantum computers

It images single atoms. It maps atomic-scale hills and valleys on metal and insulating surfaces. And it records the flow of current across atom-thin materials subject to giant magnetic fields. Scientists at the National Institute of Standards and Technology (NIST) have developed a novel instrument that can make three kinds of atom-scale measurements simultaneously. Together, these measurements can uncover new knowledge about a wide range of special materials that are crucial for developing the next generation of quantum computers, communications and a host of other applications.

From smartphones to multicookers, devices that perform several functions are often more convenient and potentially less expensive than the single-purpose tools they replace, and their multiple functions often work better in concert than separately. The new three-in-one instrument is a kind of Swiss Army knife for atom-scale measurements. NIST researcher Joseph Stroscio and his colleagues, including Johannes Schwenk and Sungmin Kim, present a detailed recipe for building the device in the Review of Scientific Instruments.

“We describe a blueprint for other people to copy,” Stroscio said. “They can modify the instruments they have; they don’t have to buy new equipment.”

By simultaneously conducting measurements on scales ranging from nanometers to millimeters, the instrument can help researchers zero in on the atomic origins of several unusual properties in materials that may prove invaluable for a new generation of computers and communication devices. These properties include the resistance-less flow of electric current, quantum jumps in electrical resistance that could serve as novel electrical switches, and new methods to design quantum bits, which could lead to solid-state-based quantum computers.

“By connecting the atomic with the large scale, we can characterize materials in a way that we couldn’t before,” said Stroscio.

Although the properties of all substances have their roots in quantum mechanics — the physical laws that govern the Lilliputian realm of atoms and electrons — quantum effects can often be ignored on large scales such as the macroscopic world we experience every day. But for a highly promising class of materials known as quantum materials, which typically consist of one or more atomically thin layers, strong quantum effects between groups of electrons persist over large distances and the rules of quantum theory can dominate even on macroscopic length scales. These effects lead to remarkable properties that can be harnessed for new technologies.

To study these properties more precisely, Stroscio and his colleagues combined in a single instrument a trio of precision measuring devices. Two of the devices, an atomic force microscope (AFM) and a scanning tunneling microscope (STM), examine microscopic properties of solids, while the third tool records the macroscopic property of magnetic transport — the flow of current in the presence of a magnetic field.

“No single type of measurement provides all the answers for understanding quantum materials,” said NIST researcher Nikolai Zhitenev. “This device, with multiple measuring tools, provides a more comprehensive picture of these materials.”

To build the instrument, the NIST team designed an AFM and a magnetic-transport-measuring device that were more compact and had fewer moving parts than previous versions. They then integrated the tools with an existing STM.

Both an STM and an AFM use a needle-sharp tip to examine the atomic-scale structure of surfaces. An STM maps the topography of metal surfaces by placing the tip within a fraction of a nanometer (billionth of a meter) of the material under study. By measuring the flow of electrons that tunnels out of the metal surface as the sharp tip hovers just above the material, the STM reveals the sample’s atomic-scale hills and valleys.

In contrast, an AFM measures forces by changes in the frequency at which its tip oscillates as it hovers over a surface. (The tip is mounted on a miniature cantilever, which allows the probe to swing freely.) The oscillation frequency shifts as the sharp probe senses forces, such as the attraction between molecules, or the electrostatic forces with the material’s surface. To measure magnetic transport, a current is applied across a surface immersed in a known magnetic field. A voltmeter records the voltage at different places on the device, revealing the electrical resistance of the material.

The ensemble is mounted inside a cryostat, a device that chills the system to one-hundredth of a degree above absolute zero. At that temperature, the random quantum jitter of atomic particles is minimized and large-scale quantum effects become more pronounced and easier to measure. The three-in-one device, which is shielded from external electrical noise, is also five to 10 times more sensitive than any previous set of similar instruments, approaching the fundamental quantum noise limit that can be achieved at low temperatures.

Although it’s possible for three entirely independent instruments — an STM, an AFM and a magnetic transport setup — to make the same measurements, inserting and then retracting each tool can disturb the sample and diminish the accuracy of the analysis. Separate instruments can also make it difficult to replicate the exact conditions, such as the temperature and rotation angle between each ultrathin layer of the quantum material, under which previous measurements were made.

To achieve the goal of a three-in-one instrument with high sensitivity, the NIST team partnered with an international team of experts, including Franz Giessibl from the University of Regensburg, Germany, who invented a highly effective AFM known as the qPlus AFM. The team chose a compact design that increased the stiffness of the microscope and outfitted the system with a series of filters to screen out radio frequency noise. The atomically thin needle of the STM doubled as the force sensor for the AFM, which was based on a new force sensor design created by Giessibl for the three-in-one instrument.

For Stroscio, a pioneer in building ever-more-sophisticated STMs, the new device is something of a pinnacle in a more than three-decade career in scanning probe microscopy. His team, he noted, had been struggling for several years to dramatically reduce the electrical noise in its measurements. “We have now achieved the ultimate resolution given by thermal and quantum limits in this new instrument,” Stroscio said.

“This feels like I’ve climbed the highest peak of the Rocky Mountains,” he added. “It’s a nice synthesis of everything I’ve learned over the last 30-plus years.”

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Coronavirus: Fear over rise in animal-to-human diseases

A report says a rise in animal-to-human diseases will continue without urgent action.

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What ethical models for autonomous vehicles don’t address, and how they could be better

There’s a fairly large flaw in the way that programmers are currently addressing ethical concerns related to artificial intelligence (AI) and autonomous vehicles (AVs). Namely, existing approaches don’t account for the fact that people might try to use the AVs to do something bad.

For example, let’s say that there is an autonomous vehicle with no passengers and it is about to crash into a car containing five people. It can avoid the collision by swerving out of the road, but it would then hit a pedestrian.

Most discussions of ethics in this scenario focus on whether the autonomous vehicle’s AI should be selfish (protecting the vehicle and its cargo) or utilitarian (choosing the action that harms the fewest people). But that either/or approach to ethics can raise problems of its own.

“Current approaches to ethics and autonomous vehicles are a dangerous oversimplification — moral judgment is more complex than that,” says Veljko Dubljević, an assistant professor in the Science, Technology & Society (STS) program at North Carolina State University and author of a paper outlining this problem and a possible path forward. “For example, what if the five people in the car are terrorists? And what if they are deliberately taking advantage of the AI’s programming to kill the nearby pedestrian or hurt other people? Then you might want the autonomous vehicle to hit the car with five passengers.

“In other words, the simplistic approach currently being used to address ethical considerations in AI and autonomous vehicles doesn’t account for malicious intent. And it should.”

As an alternative, Dubljević proposes using the so-called Agent-Deed-Consequence (ADC) model as a framework that AIs could use to make moral judgments. The ADC model judges the morality of a decision based on three variables.

First, is the agent’s intent good or bad? Second, is the deed or action itself good or bad? Lastly, is the outcome or consequence good or bad? This approach allows for considerable nuance.

For example, most people would agree that running a red light is bad. But what if you run a red light in order to get out of the way of a speeding ambulance? And what if running the red light means that you avoided a collision with that ambulance?

“The ADC model would allow us to get closer to the flexibility and stability that we see in human moral judgment, but that does not yet exist in AI,” says Dubljević. “Here’s what I mean by stable and flexible. Human moral judgment is stable because most people would agree that lying is morally bad. But it’s flexible because most people would also agree that people who lied to Nazis in order to protect Jews were doing something morally good.

“But while the ADC model gives us a path forward, more research is needed,” Dubljević says. “I have led experimental work on how both philosophers and lay people approach moral judgment, and the results were valuable. However, that work gave people information in writing. More studies of human moral judgment are needed that rely on more immediate means of communication, such as virtual reality, if we want to confirm our earlier findings and implement them in AVs. Also, vigorous testing with driving simulation studies should be done before any putatively ‘ethical’ AVs start sharing the road with humans on a regular basis. Vehicle terror attacks have, unfortunately, become more common, and we need to be sure that AV technology will not be misused for nefarious purposes.”

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Materials provided by North Carolina State University. Note: Content may be edited for style and length.

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Studying Yourself

You can make a lot of interesting personal growth gains by studying yourself and your own responses instead of trying to follow someone else’s behavioral prescriptions. Studying yourself is especially useful in the areas of health and productivity habits.

What actually creates good results for you? Quite often you’ll find that what works best for you in real life won’t be found in any book or seminar. You can learn ideas from others to inspire your own experimentation, but you may get the best gains by assembling your own unique collection of behaviors and practices.

When doing self-experimentation, it’s important to protect your self-esteem from your behavioral results. Look at your behaviors and their effects separately, and honestly assess their impacts and results. Don’t wrap your self-esteem into the effects of your behaviors because problem behaviors can be changed. Beating yourself up for having a problematic behavior will only slow you down. Let the behavior be the problem you want to work on; don’t weave it into your self-image.

As I mentioned previously, I’ve been engaging in a detailed self-study of my diet for the past 7.5 weeks. I’m raising my awareness about what I’m actually eating and how different meals affect me. Based on what I’m learning, I’m making lots of micro-adjustments and doing small tweaks to optimize my eating habits.

The main part of this is food logging, which involves writing down everything I’m eating, so I can see the rational truth as it really is. Pen and paper is far superior to memory here. I also add up the calories to get a sense of how calorically dense each meal is.

This helps me do little experiments, such as seeing what happens if I eat 500, 700, or 1000 calories before noon. Is it better to have a lighter 300-calorie dinner or a denser 700-calorie one? What happens if I mix walnuts into my steel cut oats versus a little coconut oil versus not adding any fat? Soon I’ll test eliminating the oats and eating something else for breakfast, like roasted potatoes, onions, and peppers with zucchini hummus.

Later this month I also plan to start testing what happens if I go grain-free and legume-free at the same time. I’ve done grain-free and legume-free tests before, but I haven’t done both at the same time except while I was also eating 100% raw.

One result I pay attention to, which is partly subjective, is how my morning runs feel. Do I feel energetic or sluggish? Do I feel motivated or run, or do I feel like skipping more days? I can also check my pacing since my watch records that. I’ve learned, for instance, that if I have a relatively low-calorie day (like 1600-1700 calories), I’m likely to run slower and feel less energetic during an early morning run the next day. Skimping on calories just makes me feel less energetic.

I can also see that just the act of measuring and paying more attention to what I’m eating is making it very easy to lose weight. I’ve now dropped 10.8 pounds since I started on May 14. This seems like a very easy way to slim down. It’s really about paying attention, which leads to better choices.

I like that there are no rules with this approach. I’m just paying closer attention to some of my body’s responses, and I’m making refinements based on that.

Another side effect is that I’m enjoying good food more than ever.

I’m really loving peaches and typically eat a few each day now, as long as we have some ripe ones. I’m buying 24 of them at a time to make sure I don’t run out so quickly. Costco has been having some really amazing yellow peaches in stock lately. I’m also eating lots of blueberries, strawberries, apricots, broccoli, zucchini, yellow squash, bok choy, kale, mixed greens, celery, and spinach.

You can extend this kind of experimentation to other areas of life. This can lead to some real breakthroughs.

I love the way I generate income, which I arrived at through many years of experimentation. I enjoy the combination of doing launches a few times per year plus passive income streams in the background.

I also love having an unusual relationship. I don’t know of any other couples who relate to each other like Rachelle and I do. Our relationship is rich is laughter, cuddling, affection, playfulness, and sexiness. Even after 10+ years together, the relationship still feels spicy. To make that possible, we just had to go our own way and do what works for us.

Some people resist going off script to experiment because of judgment from other people. But improving your results is a good antidote to that. If someone complains that you’ve gone off the deep end, poke fun at them for only playing in the shallow end where all the kids are peeing. The deep end is where you’ll find better results.

If you’re really worried about other people’s approval, however, you’ll likely get more of it from the people you respect if you stop chasing approval from people you don’t respect. Why on earth would you respect someone who criticizes you for using the perfectly valid and rational tool of self-study?

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Earth’s magnetic field can change 10 times faster than previously thought

A new study by the University of Leeds and University of California at San Diego reveals that changes in the direction of the Earth’s magnetic field may take place 10 times faster than previously thought.

Their study gives new insight into the swirling flow of iron 2800 kilometres below the planet’s surface and how it has influenced the movement of the magnetic field during the past hundred thousand years.

Our magnetic field is generated and maintained by a convective flow of molten metal that forms the Earth’s outer core. Motion of the liquid iron creates the electric currents that power the field, which not only helps guide navigational systems but also helps shield us from harmful extra terrestrial radiation and hold our atmosphere in place.

The magnetic field is constantly changing. Satellites now provide new means to measure and track its current shifts but the field existed long before the invention of human-made recording devices. To capture the evolution of the field back through geological time scientists analyse the magnetic fields recorded by sediments, lava flows and human-made artefacts. Accurately tracking the signal from Earth’s core field is extremely challenging and so the rates of field change estimated by these types of analysis are still debated.

Now, Dr Chris Davies, associate professor at Leeds and Professor Catherine Constable from the Scripps Institution of Oceanography, UC San Diego, in California have taken a different approach. They combined computer simulations of the field generation process with a recently published reconstruction of time variations in Earth’s magnetic field spanning the last 100,000 years

Their study, published in Nature Communications, shows that changes in the direction of Earth’s magnetic field reached rates that are up to 10 times larger than the fastest currently reported variations of up to one degree per year.

They demonstrate that these rapid changes are associated with local weakening of the magnetic field. This means these changes have generally occurred around times when the field has reversed polarity or during geomagnetic excursions when the dipole axis — corresponding to field lines that emerge from one magnetic pole and converge at the other — moves far from the locations of the North and South geographic poles.

The clearest example of this in their study is a sharp change in the geomagnetic field direction of roughly 2.5 degrees per year 39,000 years ago. This shift was associated with a locally weak field strength, in a confined spatial region just off the west coast of Central America, and followed the global Laschamp excursion — a short reversal of the Earth’s magnetic field roughly 41,000 years ago.

Similar events are identified in computer simulations of the field which can reveal many more details of their physical origin than the limited paleomagnetic reconstruction.

Their detailed analysis indicates that the fastest directional changes are associated with movement of reversed flux patches across the surface of the liquid core. These patches are more prevalent at lower latitudes, suggesting that future searches for rapid changes in direction should focus on these areas.

Dr Davies, from the School of Earth and Environment, said: “We have very incomplete knowledge of our magnetic field prior to 400 years ago. Since these rapid changes represent some of the more extreme behaviour of the liquid core they could give important information about the behaviour of Earth’s deep interior.”

Professor Constable said: “Understanding whether computer simulations of the magnetic field accurately reflect the physical behaviour of the geomagnetic field as inferred from geological records can be very challenging.

“But in this case we have been able to show excellent agreement in both the rates of change and general location of the most extreme events across a range of computer simulations. Further study of the evolving dynamics in these simulations offers a useful strategy for documenting how such rapid changes occur and whether they are also found during times of stable magnetic polarity like what we are experiencing today.”

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Materials provided by University of Leeds. Note: Content may be edited for style and length.

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Injections much safer when nurses use revamped guidelines

The UK’s National Health Service (NHS) is changing the way it writes its guidelines for giving injections in hospitals, following groundbreaking research from the University of Bath.

The Bath study, funded by the National Institute for Health Research (NIHR), found that hospital nurses make far fewer mistakes when administering medicines intravenously if they follow instructions written with nurses in mind. Researchers used a process called ‘user testing’, which identifies where mistakes are being made and introduces changes so the instructions are easier to use.

Current NHS guidelines on intravenous injections are written by pharmacists with little input from their primary audience — nurses. These instructions can be confusing or overly complicated, which contributes to 30-50% of intravenous doses being incorrect in some way.

Injection-related mistakes form a major part of the 237 million medication errors that occur annually in England, and they can arise because nurses struggle to find relevant, unambiguous information in the NHS guidelines, explained Dr Matthew Jones, who led the research from the University’s Department of Pharmacy and Pharmacology in collaboration with colleagues from the Universities of Leeds and Strathclyde, and UCL School of Pharmacy.

“When nurses follow modified guidelines that present the same information in a more user-friendly way, nearly two and half times more doses are given without mistakes,” he said. “As a bonus, the injection procedure is also completed faster and nurses feel more confident about their decisions.”

He added: “Current instructions are usually written by pharmacists using a format and language that makes immediate sense to other pharmacists, but not necessarily to nurses.

“Different professions think about things in different ways as a result of the different training they receive, and we need injection guidelines to be written in a way that is understood by nurses because they prepare and administer most injections.”

In developing the Bath study, researchers collaborated with Luto Research, a University of Leeds spin-out company with expertise in user testing. The study involved 273 nurses and midwives who regularly administer injections from four NHS hospitals.

Participants were taken part way through a shift and asked to give an injection to a rubber dummy simulating a patient’s arm. Around half of participants were given the current NHS guidelines and the other half the modified guidelines. A researcher watched to identify guideline-related errors.

“The results make it clear that busy, stressed staff need information to be presented in a way that is easy to understand and quick to find,” said Dr Jones. “User testing allowed us to identify where the information needed improving and how we could do that.”

The study’s findings have triggered a review of how injection guidelines are produced for the NHS Injectable Medicines Guide. This website-based guide provides information on the correct procedures for preparing and administering over 350 intravenous medicines in over 120 hospitals. It is accessed approximately 3-million times per year, mostly by hospital nurses.

Dr Jones said: “To improve patient safety, most injectable medicines’ guidelines should be user-tested. This is particularly important when high-risk and complex decisions are being made.”

According to the World Health Organisation, unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world. Globally, the cost associated with medication errors is estimated at US$42 billion every year.

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Materials provided by University of Bath. Note: Content may be edited for style and length.

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Harmful microbes found on sewer pipe walls

Can antibiotic-resistant bacteria escape from sewers into waterways and cause a disease outbreak?

A new Rutgers study, published in the journal Environmental Science: Water Research & Technology, examined the microbe-laden “biofilms” that cling to sewer walls, and even built a simulated sewer to study the germs that survive within.

They found that these biofilms often contain harmful, antibiotic-resistant bacteria and can withstand standard treatment to disinfect sewers. Cleaning with bleach can reduce the density of biofilms but not entirely remove them, potentially leaving wastewater treatment workers and the public exposed to health risks.

Still, disinfecting a sewer line may be a good idea before sewer maintenance is done, especially following events such as a disease outbreak or bioterrorism incident that might expose sewer lines to high-risk microbes. Luckily, with respect to SARS-CoV-2, the coronavirus causing COVID-19, water and wastewater are not expected to be important transmission routes.

Normally, what’s flushed down a toilet goes to a wastewater treatment plant. But rainfall can cause overflows of untreated waste into bays, rivers, streams and other waterways. The researchers say a potential worst-case scenario would be an infectious disease outbreak following a sewer overflow that releases wastewater, sewer solids and biofilms to surface water.

“Given the current interest in wastewater-based epidemiology for monitoring the coronavirus, our study highlights the need to consider sewer processes and how best to combat pathogens,” said senior author Nicole Fahrenfeld, an associate professor in the Department of Civil and Environmental Engineering in the School of Engineering at Rutgers University-New Brunswick. “We will work to repeat a portion of our experiments to understand how long the coronavirus may linger in sewers and if that will impact monitoring of it in wastewater.”

The researchers found that sewer pipe materials (concrete or PVC plastic) did not affect the formation of biofilms but played a role in the effectiveness of bleach to disinfect them. Bleach is better at removing biofilms from PVC than from concrete, likely because PVC is smoother.

The lead author is William R. Morales Medina, a Rutgers doctoral student. Alessia Eramo, who earned a doctorate at Rutgers, and Melissa Tu, a Rutgers undergraduate student, contributed to the study.

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Materials provided by Rutgers University. Note: Content may be edited for style and length.

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Health24.com | OPINION | Cape Town’s community health workers deliver during Covid-19 pandemic

  • Cape Town community health workers have been delivering medication parcels to people’s homes
  • This means that people at risk of Covid-19 don’t need to use public transport or wait in queues to obtain their medication
  • Missing or incorrect details was an issue, but a WhatsApp automated messaging system helped to address the problem 

Public sector primary care facilities in Cape Town care for a large number of people with chronic conditions such as HIV/Aids, tuberculosis, diabetes, hypertension, asthma and chronic bronchitis and emphysema. Many of these patients are over the age of 55, which puts them at an increased risk of more severe Covid-19 infection. 

It is, therefore, laudable that community health workers (CHWs), in partnership with the Western Cape Metropolitan Health Services and non-profit organisations, delivered 184 000 parcels of medication to people’s homes in Cape Town during May 2020. This was something that had never been done before. People with the aforementioned chronic conditions had their medication hand-delivered by their local community health workers to their homes. Given that we could still see a rise in infections in the Western Cape, these life-saving actions of CHWs are very important. 

More community-orientated primary care

During the Covid-19 epidemic, the home-delivery of medication has meant that people who are more at risk of severe Covid-19 have not exposed themselves to infection on public transport or at health facilities in order to obtain their medication. This has undoubtedly saved lives and enabled facilities to reduce numbers and maintain physical distancing. In addition, by delivering medication at home, facilities have had more capacity to prepare for the surge of patients with Covid-19.

Prior to the onset of Covid-19, the Metro Health Services had invested in teams of community health workers across the city as part of a move towards more community-orientated primary care. Teams are employed through local non-profit organisations, linked to primary care facilities and responsible for defined groups of households. Under normal circumstances, community health workers would visit their households and identify people with health risks who need assistance. These include, for example, people with symptoms of TB, people on treatment for chronic diseases, women who are pregnant, or people who need family planning or immunisations. 

Having this system already in place enabled a rapid re-organisation of CHWs to deliver medication and also assist with community screening and testing for Covid-19. Most of the components needed to deliver medication at home were already in place and just needed to be brought together. The Metro Health Services already had a system for pre-packaging medication and delivering to health facilities for those with stable chronic diseases. The one missing piece of the puzzle was how to get the medication parcels from the facility’s pharmacy to the non-profit organisation. This was solved in a variety of innovative ways, using Uber drivers, bicycles and scooters from local entrepreneurs, as well as drivers employed by the Western Cape Department of Health or non-profit organisations.

Screening for symptoms of Covid-19

One of the major difficulties with the system was that people had not registered their correct address or telephone number with the Department of Health. It was very difficult to reach people to confirm their address. Out of the 184 000 parcels delivered, 16 600 were returned. In order to solve this problem, the department has created a WhatsApp automated messaging system where people can send in their correct details. If you want to access this system then send the message “Hi” to 0872406325. You will need your appointment card details, address and contact number.

Other benefits of the home delivery system include the ability to screen households for symptoms of Covid-19 (recent onset of sore throat, cough, fever or shortness of breath) when making the delivery. By definition, these households contain individuals who are more at risk of severe disease. In those with mild Covid-19 symptoms, the department of health is currently only testing people who are over the age of 55 years or with co-morbidities. The same system can be used to deliver non-pharmaceutical materials or nutritional supplements.

We hope that this service will also improve collaboration between facility-based and community-based services. In addition, the stature and acceptability of CHWs within communities should be enhanced by performing such a valuable task. 

Patient responses have so far been very positive and this innovation is possibly something that will stay with us beyond the epidemic.

*Prof Bob Mash heads the Division of Family Medicine and Primary Care at Stellenbosch University. Dr Zameer Brey is an employee at the Bill and Melinda Gates Foundation and Charlyn Goliath and Darrin Roman work at the Western Cape Metropolitan Health Services. This is an abridged version of an article published in the African Journal of Primary Health Care & Family Medicine recently.

Image credit: Getty Images

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