Video Conferencing and Privacy

Video Conferencing and Privacy

The Kaiser Family Foundation conducted a poll in the beginning of March showing that a third of their respondents said that the coronavirus (COVID-19) outbreak had a minor or major negative impact on their mental health. That proportion jumped up to nearly half (45%) when they conducted the poll again between March 25th to the 30th. In response, the HHS has relaxed telemedicine and telemental health restrictions so more individuals and families can get access to care safely. This is an important and necessary measure to increase access to care but with the recent Zoom privacy debacle (e.g., NPR; CNBC), I couldn’t help but wonder what this means for the privacy of patients and therapists, or any one of us who has used or currently uses video conferencing software to speak with a doctor, socialize, or work. After researching different options, I found that you don’t have to compromise your privacy or security and I shared a list of secure and unsecure options below.

Quick background on HIPAA for

First, here’s quick primer on HIPAA, which got me thinking about this topic in the first place.

HIPAA (Health Insurance Portability and Accountability Act of 1996) is United States legislation that provides data privacy and security provisions for safeguarding medical information. The legislation essentially requires that all healthcare practitioners and administrators must protect our Protected Health Information (PHI) through a secure system that ensures that only authorized individuals can access our data. This is true whether the information is on paper or in a computer system, including any information transmitted over the internet like video conferences. You can read more about HIPAA through the HHS website.

Quick non-technical explanation of video conferencing software in relation to HIPAA

Prior to the coronavirus pandemic, HIPAA restrictions meant that telehealth practitioners had to use video communication systems that incorporate end-to-end encryption (E2EE) for video and audio to be HIPAA compliant. I’m going to oversimplify this here but that essentially means that when our computers are transmitting the audio and video from our meetings to someone else’s computer, the data needs to be scrambled so that only meeting participants can access and unscramble the audio and video content in a meaningful way (using keys). The details are a bit more complicated though because there are different ways to encrypt this data, which can be confusing if you don’t look into the details. For example, in the case of Zoom, the company does use encryption, but they use a type of encryption (transport encryption rather than E2EE) that enables Zoom to access the audio and video content of the meetings that it hosts. With E2EE, Zoom would not be able to access this content.

There are apps and software out there that offer or use E2EE (and have been consistently transparent about whether they use E2EE or not). Here is a list of some that I found:

Video conferencing software that DOES use E2:

* indicates that it is free or there is a free version available.

–Some of these are only free during the pandemic and will begin charging once distancing measures are lifted.–

Video conferencing software that DO NOT use E2EE:

The following video communication apps also do not use E2EE and are public facing so they should never be used for telehealth:

  • Facebook Live
  • Twitch
  • TikTok

 

In closing

None of these companies can guarantee that your PHI or any information that you disclose over video conferencing will be 100% safe. There will always be the risk from hackers, for example, that can jeopardize your security and privacy. If you’re using video conferencing professionally, it’s important to disclose this risk. If you’re a health care practitioner, I especially hope that you will consider using software that protects the privacy of your patients. There are free options available, so there really is no excuse for using a less secure option.

 

 

 

 

 

DIY Masks

DIY Masks

The CDC has been reconsidering their recommendation on the use of non-medical masks among the general public (see NPR article). To preserve surgical masks for professionals, I’ve shared some links to patterns and instructions for making your own mask below. I also added some information about what type of materials are recommended.

*If you choose to make a mask, make sure that you keep it clean. There isn’t an official recommendation but keep in mind that bacteria grows in moist environments and the science is still out on whether COVID-19 can survive on fabric (or how long). Also, wash your hands after taking it off.

Materials

To make a mask, you’ll need the following:

  • Tightly woven fabric –see below for more information
  • Scissors
  • Ribbon / Elastic / String
  • Marking pen
  • Needle or Sewing Machine
  • Sewing pins
  • Thread
  • Iron (optional)

The Stanford Anesthesia Informatics and Media Lab has shared a table of materials you can use for non-medical masks, ranked by effectiveness:

Effectiveness of Non-surgical Mask Materials
Effectiveness of Non-surgical Mask Materials from the Stanford Anesthesia Informatics and Media Lab

 

Basically, you want to use a breathable material that can filter out germs. For thinner materials, like cotton t-shirts, scarfs, and pillowcases, consider doubling the number of layers. For the two materials on the top of the list (vacuum cleaner bags and tea towels), I included a brief description below.

Vacuum_bags_Kenmore_Panasonic_HomeDepot
3-pack Kenmore/Panasonic vacuum bags from Home Depot

Vacuum Cleaner Bags: These bags are often made of a tight blend of cotton or synthetic cloth or paper but be careful if you decide to go this route because many are difficult to breathe through. You can buy vacuum cleaner bags from stores like Walmart, Target, Amazon, etc. The image above is a set of replacement vacuum bags from Home Depot that are $6.49 for 3.

Tea Towel: These towels are typically made of linen, cotton, or a combination of the two. Note that tea towels are not the same as dish towels. Dish towels are made of terry cloth, which are much heavier (like the towels in you likely have in your bathroom). Tea towels are more tightly woven than dish towels and should be much thinner. Tea towels can be expensive though, especially if they’re made from high quality linen. Another cheaper option is a car shop towel, which you can get in the auto section of stores like Lowe’s, Home Depot, Walmart, or Target, or from an auto store like AutoZone. See link below for a mask tutorial using car shop towels.

 

Mask Patterns & Tutorials

Regardless of the pattern you use, you want to make sure that the nonsurgical mask (1) covers your nostrils and (2) goes below your chin. You also want the edges of the mask to touch your face. With that said, here are some good tutorials on how to make your own mask.

 

Pro-tip from my mom: she added a layer of gauze and a dryer sheet to the inside of her mask:

gauze
Example of what gauze looks like

You may find gauze in a first aid kit somewhere in your house. If not, you can easily get some from a drug store or the pharmacy aisle of a grocery store.

You also may have noticed that medical masks have aluminum clips on them to press the mask down over the bridge over your nose:

maskmetalclip
Example of metal clip found on medical masks

This is harder to find and I haven’t found a good solution to this. You might be able to use a an old bread twist tie. You may also be able to use thin aluminum wire from a craft store or home depot:

aluminum_craft_wire
Aluminum wire for crafting or jewelry

 

You can also join the Open Source COVID19 Medical Supplies group on Facebook for more information or to share your designs.

In Closing

There are still mixed messages about the effectiveness of DIY nonsurgical face masks in protecting you from getting sick. Here’s my take: If it makes you feel better, go for it! It doesn’t hurt–unless you’ve chosen material that you can’t breath through. Also, it’s a decent way to prevent yourself from touching your face and by making your own, you’re preserving the protective equipment for those who need it most like doctors, policemen, and grocery store workers.

It’s important to remember though that face masks are not a substitute for social distancing or washing your hands. Keep doing both to keep yourself and others safe.

 

 

Remote Volunteering Opportunities

Remote Volunteering Opportunities

I am so overwhelmed by the amazing sacrifices that people are making around the world to help others during this crisis. If you would like to help as well but are unable to physically or financially,  I’ve compiled a list of remote opportunities. Please share any that I missed in a comment below and I’ll add it to this list.

Remote Volunteer Sites

 

Tech

CV19 is a volunteer organization based in the UK that provides Cyber support.

New York State COVID-19 Technology SWAT Team needs teams of professionals (preferably from a single institution located in the Eastern or Central U.S.) with experience in product management, software development / engineering, hardware deployment and end-user support, data science, operations management, design, or other similar areas. Volunteers must commit for a minimum of 90 days.

Join the COVID-19 Open Research Dataset Challenge, or CORD-19 to develop text and data mining tools using AI and machine learning techniques. The goal is to help provide answers for 10 tasks, or lines of inquiry about the disease. The prize for each of the tasks in the CORD-19 challenge is $1,000, delivered as cash or as a charitable donation to research and relief efforts.

Donate computing resources to the Folding@Home project. The software models protein folding in a search for pharmaceutical treatments that will weaken the ability of COVID-19 to attack the human immune system. You can read more about the project in this post and how to set it up here.

 

Research

Help find service manuals for critical medical equipment. There are several types of medical equipment made by different manufacturers. Researchers and engineers need access to the manuals so that the equipment can be quickly repaired if and when they break. Read more about the project and how to volunteer here.

 

Marketing & Social Media

Marketing, social media and branding experts are needed to help promote PandemicVolunteers.org. More details here.

 

Food shortages

Host a virtual food drive with Golden Harvest Food Bank to fundraise for their COVID-19 Response Campaign.

 

Communication or Admin

The American Red Cross has various remote volunteering opportunities to help support volunteers in the field, fundraise, and/or spread the word about critical needs such as blood donation.

The United Nations has posted several remote volunteer opportunities, from translating COVID-19 response policies from English to Chinese to data entry related to COVID-19. The UN also lists many other opportunities as well.

Work with Project N95 to support and coordinate with federal and state government institutions to secure and distribute personal protective equipment for medical workers around the country. You can also provide your information and background to the Digital Response Team, which will match you with an opportunity based on your skills.

 

Caring and Active Listening

I mentioned 7cups, a free therapy organization, in a previous post. You can volunteer for them as an active listener and help someone who is in need of support.

Prefer to text rather than chat over the phone? You can train to become a crisis counselor with Crisis Text Line. They ask that you volunteer 4 hours a week for at least 200 hours. You can also help by sharing resources for managing stress and anxiety related to the pandemic such as VirusAnxiety.

There’s also Kind Connection, which involves kindly and thoughtfully listening to individuals who need support with COVID-19 related struggles (this is a program based in the state of Colorado).

Makers

Help sew protective masks for medical workers (also see Bassett Healthcare Network). The #millionmaskchallenge Twitter feed is a great source of inspiration and information.

3D print protective gear for medical workers. Several companies and organizations, like HP and the NIH, are sharing free 3D printable design files. This document also shares useful information and considerations, if you help print gear like face shields. You can also join/follow the Open Source COVID-19 Medical Supplies group on Facebook or browse through this list of opportunities and communities curated by Women in 3D Printing. Also consider adding your information to this international crowdsourced list of 3D printers.

It’s important to note that these DIY projects are only secondary to FDA approved products, such as the N95 mask. Make sure to keep up with the latest information about the safety and acceptability of homemade gear.

 

Staying Connected and Entertained while Social Distancing

Staying Connected and Entertained while Social Distancing

Context: Coronavirus

Unless your from another planet or just returned from a long solitary meditation retreat (like actor, Jared Leto), you have likely been asked to take several precautions in the face of this novel coronavirus (also referred to as Covid-19 and SARS-CoV-2) outbreak, which has been characterized as a pandemic by the World Health Organization as of March 11, 2020. The situation remains dire and Legislators around the world are asking us to each do our part in minimizing the spread of the virus.  Visit the CDC’s website for the latest recommendations on ways to prevent the spread and measures to take if you think you’ve been exposed.

Ideas to stay safe, connected, and entertained

Since the grim news about the infection rate, mortality rate, and social and economic toll (e.g., Washington PostVox; CNN; fivethirtyeight; NPR) is being thoroughly covered by the media, I thought I would follow the lead of my mother-in-law and fellow blogger, Yvette Francino, in sharing ideas for safely socializing, up-skilling, volunteering, donating and staying healthy and entertained during the outbreak. Before you go through my list, I highly recommend that you look through her list of great ideas, which you can read on her blog (full disclaimer: I am featured on her blog because I celebrated my birthday virtually through the meeting app, Zoom):

Zoom Birthday Celebration because of the Coronavirus
Celebrating my birthday virtually over the meeting app Zoom with my family because of the coronavirus (also referred to as SARS-CoV-2 or Covid-19). Credit: Yvette Francino

Socialize

Virtual Meetings for 3+ people

  • Zoom works on most devices (e.g., Mac, Windows, Linux) and offers a free basic plan. One thing to note is that if you sign up for the free tier, your meetings are limited to 40 minutes if there are 3+ participants meetings a with the max number of participants capped at 100. There are no time caps for 1:1 meetings. If you are a K-12 educator, Zoom is currently offering you access to their platform for free (see this Forbes article for details).
  • Skype also works on most devices and offers a free plan. It’s unclear whether Skype allows multiple participants.
  • Google Hangouts also works on most devices and is free, with a Google account. You can host up to 10 people under the free plan.

Stay Entertained

Gaming Platforms

  • Steam is a popular game distributor that works on Windows, Mac, Linux, and mobile devices. They have some games that are available for free but most games are not free. Some of my favorites are the Jackbox Party series, which you can play with friends by hosting a game on one of the virtual meeting apps I listed above. Note that to play the Jackbox games virtually with your friends, they’ll need two devices: one for the meeting app to view the shared screen and another to play the games (they recommend a mobile device).
  • Origin is another popular gaming platform that works on most devices and offers free games but most games are not free.

Not a gamer but enjoy watching others play games? Then there’s always Twitch. You can also watch and support artists and musicians on Twitch as well (e.g. musicians channel).

Virtual Concerts & Tours

Read

or listen to a free audio book from LibriVox.

Stay Healthy

Exercise

  • Practice yoga for free with great YouTube instructors like Sara Beth who has 10-60 minute videos on different types of practices with modifications to accommodate all skill levels and abilities. You can also pay for platforms like CorePower Yoga.
  • Several studios are also streaming free fitness classes online, like LifeTime Fitness, YMCA360, Blink Fitness and Planet Fitness, or cardio dance classes like 305 Fitness.

Mental Health

  • Breathe2Relax is a free stress management app for iOS and Android that was developed by the U.S. Department of Veterans Affairs for anyone coping with trauma and anxiety. The VA has also developed other free apps that you may enjoy as well, like the Mindfulness app.
  • 7 Cups for iOS and Android is a free app that connects you to caring listeners for emotional support. They also provide online therapy for as little as $150 a month.
  • Talkspace for iOS and Android is an app that connects you with licensed therapists. They have multiple pricing tiers that range from $260 a month to $396 a month. They also offer couples therapy. More information on pricing here.
  • BetterHelp is an online text-based or chat-based counseling platform that connects you to therapists that specialize in individuals, couples, and adolescents. They charge between $40 to $70 per week.
  • Gottman Apps for iOS and Android is a free app developed by clinical psychologists, John and Julie Schwartz Gottman, and designed for couples.
  • Calm is a free mediation app for iOS and Android devices. Headspace for iOS and Android is a guided meditation app. It’s available by subscription only and costs $12.99 a month or you can pay $95.88 for the full year.

If you’re in serious crisis, you can always call the Suicide Prevention Lifeline, toll-free, at 1-800-273-8255.

Learn

Helping others if you can

If you’re healthy and able, also consider helping others by:

  • Picking up a few shifts at a local grocery store or distribution center and delivering food to support local businesses and their employees who are trying to keep their doors open, shelves stocked, and make sure people are fed.
  • Donating blood to organizations like the Red Cross. According to their website, we’re currently facing “a severe blood shortage due to an unprecedented number of blood drive cancellations during this coronavirus outbreak.” Make an appointment here or call 1-800-RED-CROSS to find a local donation site.
  • Donating funds to No Kid Hungry, which is an organization that ensures that millions of young children get access to food while schools are closed. You can also donate money, food, or hygiene items to Feed the Children, which partners with food pantries, soup kitchens, churches, and shelters around the country. There’s also Feeding America, which is a nationwide network of 200 food banks and 60,000 food pantries that serve vulnerable communities of children and adults across the country (find your local food bank here).
  • Donating to nonprofit organizations like Direct Relief or Center for Disaster Philanthropy Covid-19 Response Fund, which help to equip the amazing healthcare workers and service providers across the country that are putting themselves at risk everyday with lifesaving resources like masks, gloves, and gowns.
  • Donating or volunteering with Meals on Wheels, which is an organization that checks on vulnerable seniors, in addition to providing them with food, healthcare supplies, and transportation.
  • Contribute to Covid-19 community funds to help local restaurant workers, artists, people in extreme poverty, and other community members that are facing economic hardship because of the outbreak.

There are many other wonderful charities out there that are doing amazing work. If you want to check if a charity that you’re interested in is one of them, I recommend researching them on GiveWell.

Please remember that even if you are unable to do any of the above, you are doing plenty enough by following the general suggested guidance of maintaining your distance from others (especially if you are sick)avoiding the urge to hoard, and staying informedBy maintaining your distance and avoiding public spaces, you’re saving lives by reducing the risk of transmission.

Thank you for doing your part! Please share your ideas in a comment below or through another medium like twitter or a blog to inspire others.