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  • The Simple Science Behind Why Masks Work
    on August 5, 2020 at 1:26 am

    A growing amount of evidence shows us why wearing face masks is one of the most effective things we can do to stop the spread of COVID-19. Getty Images The CDC continues to advise wearing face masks to prevent the spread of COVID-19.Masks work by creating a physical barrier to the spread of virus-containing respiratory droplets.Growing evidence supports their effectiveness.While many Americans have objected to wearing masks, experts say their concerns are unfounded. The Centers for Disease Control and Prevention (CDC) continues to strongly advise the wearing of face masks to prevent the transmission of SARS-CoV-2, the virus that causes COVID-19. On July 14, 2020 the CDC Director Dr. Robert Redfield said in a press release: “Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus — particularly when used universally within a community setting.” While these recommendations have been met with some skepticism among the public, scientific evidence continues to show that masks do work. As to the reasons why, the experts say the science is quite simple. Why face masks work Transmission of the coronavirus is thought to occur through respiratory droplets that are released when people speak, sneeze, or talk, according to Dr. MeiLan Han, a professor of medicine in the division of pulmonary and critical care at the University of Michigan. If these droplets land in the mouth or nose of people nearby, or are inhaled into the lungs, a person can contract the virus. Masks create a physical barrier that catches these droplets and prevents them from spreading as far into the surrounding air as they normally would. Han said the masks become even more important because a significant proportion of people who get COVID-19 either don’t exhibit symptoms or there’s a delay before symptoms show up. Studies show, however, that these people can still transmit the virus to people around them. The data suggest that the use of face coverings can help limit the spread of the disease by these asymptomatic and presymptomatic individuals, said Han. Growing evidence supports mask effectiveness In the July 14, 2020 issue of the Journal of the American Medical Association (JAMA), the authors of an editorial piece said that “the time is now” for universal mask wearing. In support of their opinion, they pointed to two case studies that were published that same day. The first study showed that a universal mask wearing policy in a Boston hospital system reduced the transmission of SARS-CoV-2. Prior to the institution of the mask policy, new cases among healthcare workers who had either direct or indirect patient contact were increasing exponentially. After the policy was put into place, however, the proportion of symptomatic healthcare workers who tested positive for COVID-19 “steadily declined,” according to the report. The editorial additionally spoke about a report in the CDC’s Morbidity and Mortality Weekly Report (MMWR) which showed that wearing a mask appeared to prevent two Missouri hairstylists from spreading the disease to their customers. Both stylists had continued to see customers for several days after developing symptoms, but wore face masks as per local government ordinance. Ninety-eight percent of their customers wore masks as well. Of the 139 customers that the stylists saw before being diagnosed, none developed COVID-19 symptoms during the follow-up period. None of their secondary contacts developed symptoms either. In addition, of the 67 clients who agreed to be tested, none were positive for the virus. Answering the skeptics Despite the scientific evidence supporting the wearing of masks, many Americans have voiced objections to their use. We asked Dr. Vinisha Amin, hospital medicine physician at University of Maryland Upper Chesapeake Health to counter some of the more frequently raised concerns and misinformed myths that are currently being spread. 1. Masks don’t work “Let’s disintegrate that myth!” said Amin. “Masks are helpful and effective in protecting you and your loved ones from the virus.” “There is a plethora of scientific data and research to help solidify this recommendation,” she added. “In the scientific world, evidence-based medicine takes precedence, and we must put trust in our physicians and scientific community when they make such recommendations given that they are for your own and your loved ones’ medical/health safety,” Amin said. 2. They’re so uncomfortable to wear “That means you have only tried one mask and gave up quickly on finding one that works well,” said Amin. “Yes, they may create humidity, but in that situation, wear a cotton material mask which is a more breathable material than polyester,” she advised. “Yes, they might hurt your ears. In that situation find a mask where the elastic band that wraps around the ear is cloth covered or a softer elastic band which won’t irritate your skin,” she said. “Yes, they fog up glasses. I have the same issue,” she added. “In that situation, place your eyeglasses over the mask on the bridge of your nose to help hold the mask in place and also help mitigate the fog under your glasses.” 3. I’m worried about carbon dioxide building up and making me sick “There is absolutely no scientific reasoning that supports the claim that there is carbon dioxide buildup due to masks,” said Amin. “Healthcare professionals such as our physicians and surgeons have been utilizing tighter and more impenetrable masks for decades, yet we are still able to breathe through them,” she said. She continued, “Masks allow for oxygen to penetrate in just as readily as they allow for carbon dioxide to penetrate out.” 4. I’m not at high risk Amin acknowledged that the most vulnerable people are those with comorbid conditions or those who are immunocompromised. She noted, however, that “although you may be healthy and fit, you might not even be aware that you have acquired the virus and could be shedding high viral loads to your vulnerable loved ones at home.” “We are all co-dependent on each other for our well-being and health as a community,” she explained. The bottom line There’s growing evidence that masks do work in preventing the spread of COVID-19. Masks works in a very simple way by capturing the virus-containing droplets we emit when we speak, cough, or sneeze. Although the principle behind masks is a simple one, they’re a very important part of containing the disease. Experts say they work best when we all cooperate and wear them.

  • Another Reason to Get the Flu Shot, Study Finds It May Decrease Risk of Alzheimer’s
    on August 5, 2020 at 1:26 am

    Experts are learning about how getting certain vaccines may decrease your risk of Alzheimer’s disease. Two new studies have found that the flu shot and pneumonia vaccine may protect people from Alzheimer’s disease. Experts aren’t sure why vaccines may help prevent Alzheimer’s disease.Past research suggests the widespread inflammation caused by these infections could impact brain health.  There’s another good reason to get your flu shot each year. Two new studies have found that the flu shot and pneumonia vaccine may protect people from Alzheimer’s disease.  The evidence, which was presented at the virtually-held Alzheimer’s Association International Conference in July, suggests that people who got at least one flu shot cut their risk of Alzheimer’s by about 17 percent, and those who regularly get vaccinated against the flu had an even lower risk of developing the disease. The new findings disprove the long-standing myth that the flu shot could give some people Alzheimer’s.  People with dementia have a greater risk of dying from an infection, by about three-fold, compared to those without dementia. Their increased risk of mortality from an infection further highlights the importance of vaccinating this group.  “Adding to the evidence dispelling the myth that flu shots may cause Alzheimer’s disease, two studies presented at the Alzheimer’s Association International Conference again found a reduced risk of Alzheimer’s disease associated with influenza and pneumonia vaccinations,” said Dr. Scott Kaiser, a geriatrician and the director of Geriatric Cognitive Health for Pacific Neuroscience Institute at Providence Saint John’s Health Center.  Vaccines protect against cognitive decline  The first study, which came out of the University of Texas, set out to understand if vaccinations provide some degree of protection against Alzheimer’s.  The researchers looked at the health records of over 9,000 people aged 60 and older and found that people who received one flu vaccination had a 17 percent lower risk of developing Alzheimer’s. Those who got two or more flu shots had an additional 13 percent lower risk. The second study was conducted by researchers from Duke University and the University of North Carolina. They looked at the health records of over 5,000 people ages 65 and up and found that people who got a pneumonia vaccine before age 75 were about 25–30 percent less likely to develop Alzheimer’s.  According to the researchers, the findings suggest the pneumococcal vaccine may be a promising Alzheimer’s prevention tool.  A third study presented at the conference spoke to the value of vaccines in people with dementia. Looking at the health data of over 1.4 million people, researchers from Denmark found that people with dementia who were hospitalized with an infection were 6.5 times more likely to die compared to people who didn’t have an infection or dementia.  That heightened risk of mortality among people with dementia existed in both the short term, within 30 days of contracting an infection, and the long term, or about 10 years after the first infection.  Why do vaccines have this effect? It’s still unclear as to why these vaccines are associated with a reduced risk of Alzheimer’s disease.  The long-term effects of influenza and pneumonia haven’t been thoroughly studied. However, some past research suggests the widespread inflammation caused by these infections could impact brain health.  Dr. Guy Mintz, the director of cardiovascular health and lipidology at Northwell Health’s Sandra Atlas Bass Heart Hospital in Manhasset, New York, said that inflammation from recurrent infections leads to plaque instability, which could affect the blood vessels and blood supply to the brain and lead to impairment.  One study from 2018 found that mice infected with two different types of flu strains experienced changes in the structure and functioning of their brains. A different 2018 study also identified long-term neuroinflammation following an influenza infection. A report from 2017 found that while influenza doesn’t directly cause neurodegenerative disorders, it could prime the brain to be more susceptible to other factors that do cause neurodegeneration.  “Getting sick with the flu or pneumonia, particularly with bad cases, can be taxing on the brain and increase your long-term risk of dementia. So protecting yourself from flu and pneumonia, through vaccination, may very well be protecting your brain too,” said Kaiser. Kaiser said other research has linked a weakened immune system — which can occur after battling an illness like the flu or pneumonia — with a higher risk of Alzheimer’s disease.  This is likely because a weakened immune system may allow more viruses and bacteria to get into the central nervous system, according to Kaiser. People who regularly get vaccinated may also see their doctors more frequently and receive more medical care.  “Another possibility is that patients go for regular preventive visits and get the flu shot or interaction with their primary care physicians, which is a greater opportunity for cardiovascular risk assessment and modification of associated risk factors,” said Mintz. Vaccines are crucial in people with dementia Because people with dementia have an increased risk of dying from an infection like the flu or pneumonia, regular vaccines are encouraged in those who are older than 65 or have Alzheimer’s disease.  Serious infections and the inflammation they trigger can potentially worsen preexisting cognitive issues.  “Beyond the increased risk of serious complications and death, the experience of the flu or pneumonia can be particularly problematic for people with Alzheimer’s,” said Kaiser. The infections may affect memory and cognitive function and lead to delirium, Kaiser added.  We need more research Health experts hope to see more studies examining how vaccines can be used to prevent Alzheimer’s disease.  Scientists are just beginning to identify the link between vaccinations and cognitive health, and there are still a lot of questions that remain unanswered.  “More research needs to be done to see if there is a direct mechanism between the vaccine, influenza, and reduction of the incidence of Alzheimer’s disease,” Mintz said. Kaiser would like to see more research digging into the underlying causes, pathways, and targets of Alzheimer’s disease so we can keep our brains healthy and prevent neurodegeneration. “This is an area we must better understand to better prepare for what’s to come,” Kaiser said.  The bottom line New research has found that the flu shot and pneumonia vaccine can reduce people’s risk of developing Alzheimer’s disease. It’s unclear why these vaccines provide protection, but some health experts suspect it keeps our brains healthy and protected from the widespread inflammation these infections are known to cause. More studies taking a deeper look at the link between vaccines, infections, and cognitive decline are needed so healthcare providers can better understand how vaccines can be used to prevent Alzheimer’s disease. 

  • The Death Toll from Excessive Alcohol Consumption: What You Need to Know
    on August 5, 2020 at 1:26 am

    Experts say alcohol misuse is causing both long- and short-term deaths. Getty Images Researchers say excessive alcohol consumption in the United States is causing both long- and short-term deaths.They add that an increase in drinking during the COVID-19 pandemic is exacerbating the trend.They advise people to exercise, read, or talk with friends and family to avoid drinking too much. Excessive alcohol use is responsible for 93,000 deaths and 2.7 million years of potential life lost every year in the United States. This means an average of 255 Americans die every day from excessive drinking, shortening their lives by an average of 29 years.  That’s according to a new study from the Centers for Disease Control and Prevention (CDC).  Researchers used the Alcohol-Related Disease Impact application to estimate national and state average annual alcohol-attributable deaths and years of potential life lost from 2011 to 2015. The researchers concluded that while more than half of these deaths were due to health effects from drinking too much over time, the short-term health effects from consuming a large amount of alcohol in a short period of time accounted for the majority of the years of potential life lost. Long-term effects of excessive drinking resulting in death included various types of cancer, liver disease, and heart disease. The short-term effects included deaths due to suicide, motor vehicle accidents, and poisonings involving another substance in addition to alcohol.  COVID-19 adds to the challenge In addition, experts are saying the ongoing COVID-19 pandemic is further increasing the risks and effects of excessive drinking for those with alcohol and substance use disorders as well as the general population. “We know that alcohol use has increased dramatically as a result of the pandemic,” said Pat Aussem, LPC, MAC, the associate vice president of consumer clinical content development at the Partnership to End Addiction.  “While alcohol-related car fatalities may have declined due to quarantining, it’s not a stretch to believe that increased alcohol consumption will contribute to loss of life in other ways related to injuries, violence, and chronic health conditions,” she told Healthline.  “Many people have always turned to alcohol as a way of relieving stress,” added Dr. Todd Sontag, a family medicine physician with Orlando Health Physician Associates in Florida. “With the pandemic going on, it is only natural that more people are experiencing more stressors than usual,” he told Healthline. Sontag lists the following factors affecting drinking rates during the pandemic: less social interactionfrustration with politicslack of job securityconcerns about the economyboredom due to imposed restrictionsCOVID-19-related concerns  He says all of these factors have led to increased stress with a corresponding increase in alcohol use.   “People have concerns about the virus itself, as in, what would happen if they or a loved one would happen to catch the virus, and would they be the type that contracts it and doesn’t have any symptoms, or would they be the type that could have a severe response to the virus?” he said. Aside from the viral implications, people are also stressed about the ripple effects from the virus, says Sontag. “Many are worried about their income and potential for being laid off from employment,” he said. “And people have taken sides about the severity of the virus, and with social media playing such a big role in our lives, it can only lead to increased stress when we see people we care about think very differently about the virus.” Aussem added that the “‘wine o’clock memes’ and the like suggest that for some people the lack of structure and routine provided by going to an office or work in general may have loosened boundaries around when and how much they consume.” People may be also consuming alcohol during the pandemic to help them fall asleep more quickly, she adds.  Defining excessive alcohol use Life may be different during the pandemic, but the U.S. Dietary Guidelines for Alcohol remain the same. This means that if you’re of legal drinking age and choose to drink alcohol, you should consume it in moderation.  The guidelines define moderate drinking as up to one drink a day for women and two drinks per day for men. Any alcohol consumption exceeding those guidelines is considered excessive.  “It’s important to note that a ‘drink’ is 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of hard alcohol, so a Tallboy beer or a mixed drink with two shots would be considered two drinks, even though it’s only one serving,” Aussem said.   Additionally, the CDC says the guidelines aren’t intended as an average over several days, but rather the amount consumed on any single day. “Binge drinking, on the other hand, is when women consume four or more drinks or men consume five or more drinks in a 2-hour period,” Aussem said. “It’s a pattern of drinking that raises a person’s blood alcohol concentration (BAC) to 0.08 g/dL or higher — above the legal limit for driving.” Marissa Esser, PhD, lead study author and team lead of the alcohol program at the CDC’s National Center for Chronic Disease Prevention and Health Promotion, says their most recent data can help people understand the importance of the guidelines in helping reduce the risk of alcohol-related harms.  It also emphasizes that more progress can be made in reducing excessive drinking in states, she says.  Tips for reducing alcohol use Esser says alcohol-related deaths can be prevented with more widespread use of evidence-based, population-level strategies that reduce the affordability, availability, and accessibility of alcohol.  “These interventions have been found highly effective for improving public health and reducing excessive alcohol use,” Esser told Healthline.   On an individual level, Sontag reminds us there’s a safe level of alcohol use. “Generally speaking, one to two drinks a night are considered to be safe,” he said. “If you find your drinking has increased recently or you are above what’s considered a safe amount, it’s important to find ways to limit your use.” “Talk to your friends, family, and doctor if you feel like you need help in reducing your intake,” he added. “Go for a walk, pick up the phone, or do something else you enjoy to help redirect your increase in consumption.” “For some, you may find meditation, exercise, yoga, or reading to be helpful to limit your use,” Sontag noted. “Your primary care doctor will typically have resources for you should you need outside help.” Aussem adds that if you need help, you can text “Reduce” to 55753 to subscribe to Partnership to End Addiction’s free text message app. “The app provides daily messages of support as well as useful tips and resources to reduce or abstain from drinking,” she said.

  • From Toddlers to Teens: How to Talk to Kids About Wearing Masks
    on August 5, 2020 at 1:26 am

    Experts say modeling good mask behavior is one way to get your kids more excited about doing the same. Getty Images Medical experts recommend wearing masks to slow the spread of COVID-19, alongside social or physical distancing and handwashing.Children of all ages are more likely to embrace wearing masks if their parents are modeling that behavior.As children get older, you can be more transparent with information about COVID-19.It’s important, however, to monitor your child’s anxiety levels and adjust your conversation based on their individual needs and age. Most adults understand the need to wear face masks to prevent the spread of COVID-19 and the science behind several studies that have proven their effectiveness. However, getting children to comprehend the importance of wearing masks during the pandemic can come with its own set of unique challenges depending on a child’s age. Here’s how experts advise parents should approach the topic of mask wearing to children at different ages in order to help them best understand how to keep themselves and others safe during the COVID-19 crisis. Practice makes perfect Dr. Shauna Gulley is a pediatrician and parent serving as chief clinical officer at Colorado-based Centura Health. She is on the front lines managing the COVID crisis and has personal experience getting her own kids on board with mask wearing. For kids and adults, she acknowledges the need to get used to mask wearing. “As with most things, comfort will come with time — think of jeans as an example. Once broken in, they’re really comfortable, but getting there takes time,” she said. She suggests allowing children that time to build up to regular wearing, perhaps practicing for increasing intervals each day. Gulley also said it’s important to customize the language you use about masks to meet individual age ranges and needs. Talking to toddlers For 2- to 4-year-olds, Gulley says the most important thing parents can do is wear masks themselves. “Every toddler is different, but the majority will want to do as others are doing — particularly those they care the most about. If mom, dad, and siblings are wearing masks, they’ll want to wear a mask too,” she said. She added that style and design matter at this age, something developmental psychologist Cynthia Northington-Purdie, PhD, of William Paterson University’s College of Education agrees with. “For toddlers and preschoolers, the wearing of masks should be made into a fun game, like peekaboo,” Northington-Purdie explained. “Masks for toddlers should be colorful and related to things that they recognize.” Examples might be animal prints or characters from books and television shows they love. “For older toddlers, masks can also represent facial expressions, as emotional intelligence is now part of the preschool curriculum,” Northington-Purdie said. She suggests letting kids this age have fun with masks that have smiles and frowns, or even ones that look like animal faces once they put them on. Gulley added, “The approach at this age is to lead by example and make the process of wearing a mask as fun and comfortable as possible — but also, give yourself a break if your child isn’t tolerating the mask. The worst thing you can do at this age is turn mask wearing into a power struggle.” If your toddler seems scared or fearful of wearing a mask, Gulley suggests showing them pictures of other kids wearing masks, drawing masks on characters they’re coloring, or putting a mask on a favorite stuffed animal. “Even though it’s not necessary to wear masks at home, with toddlers it’s a valuable exercise to get them more comfortable with the idea in public,” Gulley said. Early education: Kindergarten to second grade With kids in kindergarten through second grade, Gulley said the greatest impact is still being made by those around them. “Modeling good mask behavior will get your kids more excited about doing the same,” she explained. It’s also a good time to start talking to kids about the “why” of mask wearing. “Parents can explain we’re all wearing masks right now to keep our germs to ourselves,” Gulley said. “Consider something like, ‘By wearing a mask, you’re protecting your friends from getting any of your germs, and the masks they wear are protecting you — it’s a nice thing to do.’” Kids this age are gaining a better understanding of taking care of others. They are compassionate and want to do the right thing, which is why framing the conversation like this may help them get on board. Gulley said early education kids also have a firm understanding of rules, so reminding them that masks now need to be worn just like shoes to the store can help them better understand and embrace this new directive. “Parents can also consider using a relatable analogy as part of their child-friendly language,” Gulley suggested. She gave this example, “Like Batman wears a mask and cape to shield him from the bad guys, we’re now going to wear masks when we’re out in public too.” Elementary school-aged kids As children grow a little older, the differences in what they are able to understand may vary widely. “For that reason, it’s imperative that parents gauge their child’s unique ability to understand and process the realities of the pandemic and make decisions on how and what to share accordingly,” Gulley explained. In general, she said parents of elementary school-aged children should be clear and factual with them, using terms that minimize worry while maximizing the behavior you want. Gulley suggests telling your kids that we have some germs in our community that are making some people sick. You can then add ways we can help, such as wearing masks, keeping distance between ourselves and our friends, and washing our hands. “And then pour on the reassurance,” Gulley said. “Let your kids know that there are lots of smart scientists and doctors working hard to help, and they need us to wear masks, wash our hands, and not get together in large groups.” Terms like germs versus virus can be adjusted based on your child’s unique ability to understand. Northington-Purdie added that mask wearing can be encouraged for all school-aged children by allowing kids to make their own masks. “The craft of designing and/or creating their own masks will facilitate ownership. A child might be more likely to wear a mask that they customized with water-based markers and stickers than one that was not,” she said. Preteens By the time your kids reach middle school, they will likely have a better grasp of what is going on in the world. But Gulley said parents should keep in mind that every middle schooler is different and parents may need to be aware of individualized needs, particularly for those who exhibit higher levels of anxiety. “In general, talk with your preteen using information about the state of the pandemic in your community, without using alarming terms. We want to minimize worry while maximizing compliant behavior,” Gulley said. Gulley also said it’s important to make sure preteens understand this is a rule, not an option. “Set clear expectations for your preteen and get them to buy in on being part of the solution to fighting the pandemic. Parents should also consider limiting exposure to the news or media outlets at this age. Be mindful of bombarding kids with COVID fears or myths,” she said. Preteens are also prone to embarrassment and following the path led by their peers. That’s why Northington-Purdie said it can be helpful to provide evidence of everyone else wearing masks to your tween. “Beyond the safety of it, the case must be made that mask wearing is culturally and socially relevant,” Northington-Purdie explained. “Find photographs and video examples from TikTok or pop culture celebrities. If their favorite musical artists or social icons are featured online wearing masks, it might be viewed more favorably by tweens.” Teenagers By the time kids reach their teen years, they are pretty adept at getting information for themselves. That’s why Gulley said it’s important to steer them toward trusted sources. “Share the CDC’s website and then have a family meeting to discuss what they read and how they feel about it. Once your child understands what’s happening, you can then discuss the value of mask wearing and why it’s so important,” she said. At this age, Gulley said kids also need to know that while they may not be at heightened risk for getting sick from the virus, they could potentially pass it on to someone who could get very sick — someone they love, like their grandparents. Understanding the danger to those they care about, and the responsibility they have to help keep others safe, may help with mask compliance. If your teenager is still resisting, Northington-Purdie advises parents to keep incentive-based motivation in mind as a possibility to get them to wear a mask. “Perhaps access to something of value to them can be strategically linked to wearing a mask,” she said. “I do not recommend monetary compensation, but access to the PlayStation, Xbox, or car keys, for example, can be linked to mask wearing.” Most kids want to do the right thing. If you’re modeling good mask wearing behavior yourself, and if your family is having conversations about why masks are important and how they can help to keep others safe, you’ll likely find that your child follows suit pretty easily.

  • How Pooled Testing Can Help Us Fight Spread of COVID-19
    on August 5, 2020 at 1:26 am

    Using pooled testing may help stop testing bottlenecks that delay results. Getty Images According to the FDA, sample pooling allows more people to be tested quickly using fewer testing resources. It does this by allowing saliva from several people to be analyzed by just one test.Recently published data confirms the advantages of sample testing.However, if many people have the disease in the community the pooled testing could mean more headaches and work for physicians. One method used to reduce spread of COVID-19 is lockdowns, which involve closing schools, small business, and restricting activities that bring people into close proximity, which can increase infection risk. Another one is testing, which identifies those people who can leave quarantine because they’re negative for the virus. If enough people can be tested, then we might be able to resume many currently restricted activities. Such as getting our children back in school. The problem is that we lack the capacity to PCR test (which detects the virus’s genetic material) enough of the U.S. population to be effective. However, businesses can’t remain shut forever, and the new school year is only weeks away. One solution, recently given emergency authorization by the Food and Drug Administration (FDA), is sample pooling PCR tests, meaning multiple samples are tested together. What is sample pooling? According to the FDA, sample pooling allows more people to be tested quickly using fewer testing resources. It does this by allowing saliva from several people to be analyzed by one test. “Sample pooling has several advantages,” Jack W. Lipton, PhD, department chair and professor of translational neuroscience, College of Human Medicine at Michigan State University, told Healthline. “It allows diagnostic laboratories to increase the number of samples they can run per day.” According to Lipton, a great deal of time is saved by combining individual samples together and “conducting a single determination for the pool,” rather than individually for each sample. He emphasized that sample pooling can also help relieve the shortage of reagents needed to conduct these tests because, “Each pool uses the same amount of reagent that a single determination would use.” “The FDA has advised that testing pools limited to five samples are reasonably sensitive,” Lipton continued. “However other pooling schemes and strategies are amenable to much larger samples of 10, 25, or 100.” When need for testing is high, but infection rate is low Data recently published in JAMA Network Open, confirms the advantages of sample testing. “A new mathematical model we developed suggests that pool testing for COVID-19 would offer advantages over individual testing for screening groups of people where the need for tests is high but the rate of infection in the population is relatively low,” said Dr. Peter Kotanko, research director at Renal Research Institute, a division of Fresenius Medical Care North America. Kotanko, who supervised the study, emphasized that the research team observed a low risk for false negatives and substantial cost savings. “The strategy can be very useful in natural group settings, such as in first responders, shift workers, classrooms, hospital departments, local clusters, households, conventions and events, and long-term care facilities, to name a few,” concluded Kotanko. “As schools and businesses look to reopen in the coming months, pool testing proves to be a safe and reliable way to detect COVID-19 in those working or learning in close proximity.” Where sample pooling works best This type of testing only works well under certain circumstances. “When a pool is negative, we know with reasonable confidence that everyone in that pool is negative,” said Lipton. “When a pool is positive, the lab needs to go back and rerun individual tests to determine which samples in the pool were positive.” As the positivity increases, Lipton asserted, the usefulness of a pool decreases, as more time and materials are used analyzing the samples to find which are positive. This means pooling works best “when positivity is low.” “Here is the caveat: Pooled testing boosts capacity if the infection levels are low because we expect most tests to come back negative,” said Stefan Thomke, PhD, professor at Harvard Business School and author of “Experimentation Works: The Surprising Power of Business Experiments,” in an emailed statement.  Thomke confirmed that when infection levels in the sample pool rise quickly, “the capacity benefit disappears as most individuals would have to be retested.” He added that “decisions on pool size require thoughtful planning and adaptability,” so that optimal pool sizes are maintained based on not only positivity, sensitivity, and capacity but also the supply of reagents needed to conduct testing. Limitations of sample pooling Lipton said that sample pooling presents two challenges — sensitivity, and positivity, which could impact the tests’ accuracy. “There is only so much room in the tiny reaction chamber where we measure for the presence of viral genetic material,” he said. When samples are combined, only a portion of each is added, meaning “each sample in the pool is more dilute.” So a positive sample in the pool might not give as strong a signal as if it were tested alone, increasing the risk of a false negative. Again if many people have the disease the pooled testing could mean more headaches and work for physicians. Lipton pointed out, as infections increase in the population, the odds that pools will be positive also increases. Possibly sending healthcare providers back to square one. “Think about pools of 10 with a 10 percent positivity rate,” Lipton explained. “Nearly all pools would come back positive, adding extra work and time to determine who is positive in the pool, eliminating time and materials savings.” The bottom line Testing is necessary to reopen the economy and schools — however it’s almost impossible to do this using conventional testing methods. The FDA has recently authorized a technique called sample pooling to significantly increase the number of people being tested. Sample pooling is most effective in areas where infection levels are low, otherwise the time and expense of retesting may outweigh the benefits.

  • Why Herman Cain’s Death Hasn’t Changed People’s Perspective on COVID-19
    on August 5, 2020 at 1:26 am

    Former Republican presidential candidate Herman Cain died on July 30, a month after he was diagnosed with COVID-19. Getty Images Experts note that the death of former Republican presidential candidate Herman Cain has had little impact on people’s views on the COVID-19 pandemic.Experts say part of the reason is the entrenched views on the virus from those who agreed with Cain’s political stances.They also note that misinformation about the pandemic is also fueling people’s refusal to change their perspective. When actor Tom Hanks and his wife, Rita Wilson, reported they had been infected with the novel coronavirus in early March, the importance many people attached to the pandemic immediately shifted.  The two have since recovered, yet they remain public faces of how people should behave during the COVID-19 pandemic. “There’s really only three things we can do in order to get to tomorrow: Wear a mask, social distance, wash our hands,” Hanks recently said at a press conference. “Those things are so simple, so easy, if anybody cannot find it in themselves to practice those three very basic things — I just think shame on you.” But others continued to think that not wearing a mask is not only a sign of personal freedom, but also something that should be celebrated.  Herman Cain, a 2012 Republican presidential candidate, posted a photo of himself sitting closely with other people not wearing masks at a campaign rally for President Donald Trump on June 20 in an indoor arena in Tulsa, Oklahoma. Nine days later, Cain tested positive for the virus. The 74-year-old died from COVID-19 on July 30 after spending most of the month in an Atlanta-area hospital. However, it’s becoming clear that Cain’s death won’t have a historical impact on people’s view of the virus like Hanks’ infection did, or how actor Rock Hudson’s death from AIDS in 1985 changed how people saw that health crisis.  Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University in Tennessee, says despite Cain’s popularity with conservatives, his death “kind of came and went.”  He said Cain’s death seemed to have little impact on people who were already resistant to wearing a mask, physical distancing, or gathering in large groups. “So there was no lesson there,” Schaffner told Healthline. “People mourned his passing quickly but drew no lessons from the hazard he had exposed himself to. I just found that sobering and saddening.”  The lesson, however, wasn’t lost on everyone. Stacy Harris, a publisher and executive editor, supported Cain during his 2012 presidential run, but she said she can’t defend “his recent irresponsibility in any way.”   “Cain’s death only reinforced my resolve to do whatever is in my power to remain coronavirus-free and to wear a mask out of consideration for others,” Harris told Healthline.  The impact of misinformation One problem in combatting the coronavirus is the misinformation about the disease.  After Cain’s death, many people speculated his death was related to colon cancer, which he had in 2006, and not COVID-19. His staff, however, did confirm his death was related to the novel coronavirus.  Tina Willis, a Florida personal injury attorney, says she’s seen no change whatsoever among her Republican friends before or after Cain’s death. She also noticed little coverage of the death by the conservative news outlet Fox News.    Willis is critical of Fox News for failing to report what she considers the true impact of COVID-19 on people’s health and lives.   “People are dead because of their reporting, and they should be ashamed as should every single Republican lawmaker,” Willis told Healthline. “Trump voters do not understand reality and many of them, or their family members, will die as a result.” The view from conservatives David E. Johnson’s public relations firm, Strategic Vision, works with Republican and conservative candidates. He described Cain as “a rock star for conservatives,” but he says his death is not the game changer that many thought it would be in regards to COVID-19.  “Conservatives believe the government does not have the right to impose the restrictions they are imposing. Rather, conservatives believe it is up to the individual to make a decision on whether to wear a mask, social distance, or even close down,” Johnson told Healthline. “Rather than change that outlook on COVID-19, Herman Cain’s death has reinforced that view and many are using his own words to justify their belief in this.” Jamie Miller, the former executive director for the Republican Party of Florida, says as the pandemic continues, more people will know someone who has been sickened by the virus or even died from it. Those who personally knew Cain are among those people.  “When someone famous or to whom someone feels an emotional connection dies, they feel personally impacted. People’s views of Herman Cain are no different,” he said. “For those who knew, followed, or respected his business or political careers, there is a sense of true loss.”

  • The Safe and Unsafe Ways People Are Worshipping During COVID-19
    on August 5, 2020 at 1:26 am

    Many churches are now holding outdoor worship services with proper distancing as COVID-19 cases rise. Getty Images Churches in Texas, Alabama, and other places have experienced COVID-19 outbreaks after holding indoor services.Many churches have switched to outdoor services or online sermons as COVID-19 cases increase.Experts say worshippers should follow safety guidelines such as physical distancing and mask wearing if they do go to services. On Sundays, hugs and smiles are now being replaced by bursts of heart emoticons flying across a screen. As COVID-19 continues to grip the nation, Sunday school classes at the First Congregational Church of Canton Center in Connecticut have shifted to Facebook Live with children and their families tuning in for a virtual chat, book reading, and message. “I wanted to be able to have some sort of connection with the kids because it’s a really tough thing to be like ‘here’s this scary virus and you’re not going to school,'” said Sarah Pradhan, the director of the church’s faith formation who started the meetings in March when lockdowns began. “It’s a time where I feel like a lot of people need to lean into their faith. So, we needed to have some sort of presence,” Pradhan said. Places of worship all over the country are facing the challenge of how to connect with their parishioners during the pandemic. While some are coming up with creative ways to gather — via Zoom or distanced outdoor services — others are ignoring public health guidelines and, in some cases, spreading the virus.  When worshipping gets people sick COVID-19 is spreading at religious services across the country and in some areas, worshippers may be tempting fate. In Texas, more than 50 congregants at the Calvary Chapel of San Antonio tested positive for the virus after in-person services were held. In Alabama, more than 40 people developed COVID-19 after attending a multi-day church revival.  Both states are currently in a federal “red zone” of serious COVID-19 outbreaks, which means they’re reporting more than 100 new cases per 100,000 people in the last week.  As cases surge in California, Los Angeles County health officials are investigating several churches for holding gatherings despite restrictions. There have also been a series of large religious gatherings on beaches without distancing or masks.  Experts warn that religious services have all the elements the novel coronavirus needs to spread: close proximity to others, singing, and the sharing of materials. “It’s really quite simple: The virus will take advantage of every opportunity it encounters to propagate,” Dr. Michael S. Saag, a professor of medicine in the division of infectious disease at the University of Alabama at Birmingham, told Healthline. Saag said that the likelihood of a single person contracting the virus in a gathering of 40 like the one in Strawberry, Alabama, is more than 65 percent right now. “So [at] the church gathering, at least one, and possibly more individuals were already infected when they came to the event,” he explained. “We know that the peak time of transmission occurs in the 24-hour period prior to the onset of symptoms, so those who were infected at the time of the revival did not have a clue they were infected and unwittingly infected the others in the room.” While there hasn’t been a church outbreak in Colorado — a state not currently in the red zone — it’s not outside the realm of possibility.  According to recent reports, 500 congregants sang together at a church service in Colorado Springs while few wore masks. Several churches in the state are defiant about mask wearing. It’s behavior that worries Dr. Michelle Barron, the medical director of infection prevention and control at UCHealth University of Colorado Hospital. “I think unfortunately the whole mask thing and many of these things have become so politicized there’s certainly so much information out there that’s just terrible and it’s left a lot of people on the fence in terms of really understanding what’s at stake,” Barron told Healthline. “I think if you just broke it down to: your neighbor or your friend may be healthy and fine and is worshipping with you, but they live with someone who’s got cancer, or they have an infant at home, or you brought the infant with you along with your grandma [to church]. Those are highly vulnerable populations and by wearing the mask you are protecting them,” she said. “I don’t imagine you would ever want somebody to be in direct harm because of something you did,” Barron added. Barron also said that the social experience of going to church poses risks.  “There can be hugging. There can be handshakes. There can be singing. There’s all these lovely wonderful elements that are part of that experience,” she said. “I have yet to be at a service that is short — most of these are 30 minutes or longer — and then after the service you then go get coffee. This could be a multi-hour potential exposure event even without thinking about it.”  While worshipping outdoors is better, most people still have difficulty distancing in that type of situation.  “The problem again becomes when you get too close to each other,” Barron said. “It’s natural. We are drawn to people and you want to be able to be near them. It seems very awkward to constantly talk from a distance and wearing masks also is very unnatural.” Barron understands those frustrations, “but long term we will get through this quicker if we just follow the rules.” Getting creative with worship Many congregations are doing their best to be cautious and come up with unique ways to gather. The Love in Action Community Ministries in Battle Creek, Michigan, began holding outdoor services on July 12 as the state reopened.  While masks are encouraged but not required at these services, Pastor John Boyd told Healthline that most people wear them and going forward he plans to emphasize the wearing of facial coverings even more.  “We don’t want to be a cause of [cases] going in the wrong direction,” said Boyd, who previously worked in the healthcare field. Three different color wristbands are offered at these services, each signifying the attendee’s comfort level with social interaction. “Even with the mask on, some people still don’t want contact at all — totally get it — and so you wear a red wristband,” explained Boyd, who wears a yellow wristband. “Yellow is ‘I’m OK with some contact. But don’t come in for a hug because I’m not ready for that.’ Green was full go ahead, people didn’t mind hugging. The wristbands have been a really big hit.” Boyd said they’re trying to do their best to “stay as safe as possible and provide that coming together — people really need that — people didn’t realize, myself included, how much we miss being around people.” He’s also not telling parishioners that physically being at the church is of the utmost importance. “Being at the building isn’t the cream of the crop,” he said, noting the online streaming of these services. “Technology has provided us a great way to reach out to people and reach people.” At the Wesley United Methodist Church in Kenosha, Wisconsin, in-person services — with masks, distancing, and temperature checks at the door — resumed on June 21. People were asked to call or email in advance of their visit. Other safety measures were in place such as a hand sanitizer station outside the sanctuary. The singers and pastor were more than 20 feet away from the congregation. Congregants were also asked not to sing, and the pastor greeted everyone outside afterward with a wave or virtual hug. “It was triple the work, but we did it,” Pastor Grace Cajiuat told Healthline. “But every day, I would look at our city’s numbers and the county’s numbers of cases and deaths. It kept me awake or would wake me up in the middle of the night worried.” The July 19 service ended up being the final in-person service. “There were too many who came who didn’t let us know and I got nervous,” Cajiuat said. “We have a small sanctuary that could squeeze in 150. We squeaked in with safe physical distance, but that was a close call.” Additionally, that day at the door, one person’s temperature registered nearly 100 degrees — an awkward scenario that they hadn’t prepared for. The next day the church decided to suspend in-person services due to the recent spike in COVID-19 cases. “Like many churches, we have many high risk members,” Cajiuat explained. “[We] agreed that it wasn’t worth having in-person worship with the big spike in cases.” “It was apparent that we had to stop the in-person and just offer the e-service until numbers would merit going back to phase two. It was a difficult but necessary call,” she said. Parishioners are “graciously” accepting of the services going virtual. “It is a tough time for churches now. I would rather err on the abundance of caution than be the cause of sickness,” Cajiuat said.  Rabbi Ron Shulman of Congregation Beth El in La Jolla, California is on the same page. When the shutdown began in California in March, his services immediately went online. The services are available on Facebook Live and Zoom and feature three clergy members in the sanctuary. “We wanted you to be able to see the sanctuary, wanted you to see the Torah scrolls, we wanted you to feel like you were having as an authentic experience as you could. The way our building is configured and our cameras and such, we’re able to do that,” Shulman told Healthline. “The feedback we’re getting is overwhelming,” he said. “While everybody misses being together and hopes this will end soon, this is fulfilling their needs at the moment absolutely.” As San Diego County experiences a spike in cases, Shulman has thoughts on church gatherings seen on California beaches. “I think it’s irresponsible to be gathering. Our religious tradition teaches that health and safety and public welfare come first. That you serve God by taking care of one another. And that there’s an absolute circumstance here where everybody has to be a little more humble and a little more interested in the common good than any self-interest,” Shulman said. “Fundamentally, I understand everybody’s angst and pain and longing for what they used to have,” he said. “I don’t understand why religious institutions should behave any differently toward the common good than anybody else.” How to protect yourself If going to church or synagogue is something you deem an essential activity, consider two things first, said Barron. “[First] assess your own heath — what are your risk factors? Are you healthy? Do you have any underlying medical issues? Are you putting yourself potentially in a scenario in which you could get sick and you’re going to have more severe illness?” she said. “If that is the situation, maybe it’s not worthwhile attending this in-person,” she added. “There are so many ways to be able to access these communities now,” Barron said. “They do things on TV. There are videos. There are podcasts. There [are] all sorts of ways where you can still have that enriching event. You could even have somebody FaceTime it for you — and that way you can still be part of the community without having the risk.” Secondly, ask yourself: Do you live with or spend time with someone that might be at risk? “You’re healthy and fine, but you went [to church], you didn’t wear a mask, or you just got into the moment, got too close to people. Who do you live with and are you now putting them at risk?” said Barron. “Those are things to really think through before you decide to go because again you would not want to put someone that you live with or that you care for in a position that they could get ill from this,” she said. If you’re in a state such as Alabama where a church outbreak recently occurred, Saag said you shouldn’t attend services until infection rates are lower.  “Stay at home as much as you can. When you go out, avoid crowds of more than 5 people and any group of people where masks are not being worn,” he said. “Wear a mask any time you are around any other people.” “When encountering others, keep physical distance of at least 6 feet and try to keep as much of your activity around others outdoors,” he added. Additionally, Saag stressed the ease and convenience of gathering virtually instead of in-person.  “There are other ways to ‘gather’ for religious services in our modern world via electronic media,” he noted. “Fortunately, we have this as a viable option and many congregations are using this approach very successfully and in many cases, quite creatively.” “We are living in unprecedented times,” he said, “and unfortunately, sacrifices need to be made in order to lower the infection rate and prevent further deaths. The question is: Are we willing to do what it takes to protect ourselves, our families, and our communities?”

  • Dr. Anthony Fauci Talks COVID-19 Vaccine and School Openings
    on August 5, 2020 at 1:26 am

    Dr. Anthony Fauci addressed the five things everybody can do to help prevent COVID-19 from spreading.They include wearing face masks, physical distancing, staying away from places where people congregate, choosing outdoor activities over indoor ones, and practicing good hand hygiene.He said we need to practice safety measures to bring the number of daily cases down so we can enter fall with a low baseline. In a live Q&A session hosted by JAMA Monday, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases and member of the White House Coronavirus Task Force, discussed the key learnings from the pandemic along with what may be in store for us. Unless we get a handle on the current surges and start seeing a decrease in new daily cases, the pandemic may be even worse come fall.  “I do not know nor can anyone know what the fall is going to bring,” Fauci said in the Q&A. “We need to get those numbers down. If we don’t get them down, then we’re going to have a really bad situation in the fall.”  Fauci also addressed the five things everybody can do to help prevent resurgences from occurring.  They include wearing face masks, physical distancing, staying away from places where people congregate, choosing outdoor activities over indoor ones, and practicing good hand hygiene.  “It’s not rocket science but it really can be effective,” Fauci said.  Here are the main points Fauci addressed during his conversation with Dr. Howard Bauchner, the editor-in-chief of JAMA. Do we need to close down again?  What unfolds in the fall will really depend on how we respond to areas currently reporting an uptick in cases.  According to Fauci, we now understand that before becoming a hotspot, states have first detected a gradual increase in percent positivity, or the number of people testing positive out of everyone tested. If the percent positivity number is going up — even by just 1 or 1.5 percentage points — it could be indicative of an impending surge. “If it continues to go up, it generally doesn’t spontaneously come down — it means it’s a good predictor of a surge,” Fauci said. We are seeing this trend in some yellow states, like Tennessee, Kentucky, Ohio, and Minnesota.  When states experience an early uptick, they may need to reassess their reopening plans.  States may need to pause their reopening plans and ramp up safety measures to blunt the spread. The best ways to blunt resurgences The most effective way to prevent resurgences, according to Fauci, is to adhere to five safety protocols. People need to consistently wear masks, physically distance, avoid bars and areas where people congregate, opt for outdoor rather than indoor activities, and wash their hands. We are still learning a lot about how particles stay afloat in the air in indoor and outdoor spaces, but Fauci says it’s clear the risk is greater indoors where air is circulated compared to outdoors.  Fauci says we need to keep hammering home the importance of masks. By consistently wearing a mask, people who don’t know they’re infected can avoid spreading the coronavirus to others. Without these best practices, the virus will keep resurging, Fauci said.  For those who want an extra degree of protection, Fauci suggests wearing goggles or a face shield as you can contract COVID-19 though your eyes. How readily do children spread COVID-19? As schools prepare to reopen, health experts continue to study children’s role in community transmission, according to Fauci.  Recent data suggests that older children — ages 10 to 19 — don’t get as serious a disease, but they can spread the virus just as readily as adults. Children younger than 10 don’t seem to spread it as much, Fauci pointed out. Fauci says there’s no question children have a lower risk of becoming seriously ill with COVID-19. The big question that needs to be studied is how readily younger kids spread it. A recent study found evidence that very young children who are infected can have a high viral load in their nasal pharynx.  “You can make a reasonable assumption that if very young children have a higher viral load in their nasal pharynx that they’re capable of transmitting it,” Fauci said.  What to know about a vaccine and treatments Fauci is hopeful we will have a vaccine later this year or early next year, although there are no guarantees. Though people are eager for it, Fauci says we can’t rush the process.  Researchers need time to show the vaccines are safe and effective. When they have, the data collected through clinical trials needs to be transparent and readily available to the public, says Fauci.  “Even a safe but ineffective vaccine could lead to a false sense of security,” says Fauci. A vaccine needs not only efficacy but safety, he added.  One concern Bauchner brought up is if the vaccine could trigger an overwhelming immune response in people who already had contracted the virus. This type of aberrant inflammatory response to vaccines is rare, and will need to be evaluated in the controlled trials currently taking place before the vaccine becomes publicly available. “What we really do need, and these are things that are being pursued very actively now, are things for early disease,” Fauci said.  What’s up next? Fauci says it’s impossible to predict exactly what will occur in the fall.  We’re still in the middle of the first wave — the country is seeing about 50,000 to 60,000 cases and 1,000 deaths a day.  Fauci says we need to practice those safety measures to bring the number of daily cases down so we can enter fall with a low baseline.  If we don’t contain the outbreaks, we may see the surges continue with force in the fall, especially as people head back indoors and flu season kicks in.  “We gotta get our arms around that and get it contained as we enter into the fall,” Fauci said.  The bottom line In a live Q&A with JAMA Monday, Dr. Anthony Fauci addressed the key learnings from the pandemic along with what may be in store for us this fall. Unless we contain the current surges, the pandemic may be even worse in the fall as people head indoors and deal with flu season. To prevent resurgences, Fauci recommends wearing masks, physical distancing, washing hands, avoiding crowded spaces, and choosing outdoor activities over indoor activities.

  • Rural America Could Be the Region Hardest Hit by the COVID-19 Outbreak
    on August 5, 2020 at 1:26 am

    Experts say rural areas have older populations that are less healthy and have fewer medical facilities than urban and suburban regions. Jeremy Hogan / Echoes Wire/Barcroft Media via Getty Images The COVID-19 pandemic has already swept through cities and urban centers. It attacked the Sun Belt with a vengeance this summer and then shifted its focus to the Midwest. Now, the illness appears to be building like an infectious prairie fire in rural America. That wasn’t the case during the initial surge of cases this spring. “Many rural communities aren’t seeing anything. They’re simply having to prepare for what they know is coming,” Dr. Randall Longenecker, the assistant dean for rural and underserved programs at Heritage College of Osteopathic Medicine at Ohio University, told Healthline in late March. “[But] it will come, no matter what.” Longenecker’s prediction appears to be coming true. On Sunday, Dr. Deborah Birx, a member of the White House coronavirus task force, said COVID-19 is now “extraordinarily widespread” in rural areas in the United States. “To everybody who lives in a rural area, you are not immune or protected from this virus,” Birx said in an interview on CNN. A daily tracking graph done by the New York Times shows 13 states where new confirmed COVID-19 cases have increased the past two weeks. Among the states are Missouri, Minnesota, Oklahoma, South Dakota, Wyoming, and Nebraska. It also shows 29 states where COVID-related deaths have increased the past 14 days. Among those states are Oklahoma, Iowa, Montana, South Dakota, Missouri, Wisconsin, Utah, Indiana, and Nebraska. A weekly tracking graph updated on Monday by Reuters showed that in past 7 days new COVID-19 cases have increased by 15 percent in Oklahoma, 14 percent in South Dakota, 9 percent in Missouri, and 2 percent in Nebraska. All of this has had experts worried for months about what’s in store for the middle of the country. A potential recipe for disaster Rural areas may end up being among the hardest hit regions due to their demographics and lack of resources.  The 15 percent of people in the United States who live in rural areas are largely a higher-risk population that’s particularly vulnerable to serious outcomes with COVID-19. In addition, many people in rural areas live 30 or more miles away from the nearest hospital. “Systems that are under stress during routine times will be more stressed during disasters and times of crisis. Sometimes we forget those systems that are at the brink,” said Tricia Wachtendorf, PhD, director of the Disaster Research Center at the University of Delaware. Rural health systems already stretched financially are therefore particularly vulnerable, but so are rural areas that don’t have as deep a bench of resources to tap when times get tough. “When you start thinking about recovery trajectories and impacts, the extent to which there is community functioning before a disaster has strong implications in that recovery trajectory post-disaster,” Wachtendorf told Healthline in late March. “That goes right down the spectrum: transportation systems, employment support, hospitals and public health, food security — all the key systems. If those are low pre-disaster, those are going to have substantial effects on what communities experience during the disaster, as well as their post-disaster recovery.” Older and less healthy Rural populations tend to be older and face a higher risk of death from heart disease, cancer, lower respiratory disease, stroke, and unintentional injuries. Nearly 20 percent of the population in completely rural counties is 65 and older, according to U.S. census data, compared with around 15 percent in mostly urban centers. Americans living in rural areas also tend to have higher rates of cigarette smoking, high blood pressure, and obesity, compared with their urban counterparts. Both older age and cigarette smoking are two factors tied to a higher risk of severe illness or death from COVID-19. Despite these statistics, there’s a sense among some experts that some people in rural communities, as well as political leaders in these states, haven’t taken the threat of COVID-19 seriously enough. Initially, “Less dense areas might be at an advantage compared to geographic areas that are more densely populated, and they may also be less connected to some areas where there’s a concentrated case,” Wachtendorf said. But once these communities do start to see cases, they might struggle to fill basic public safety and administrative roles, especially if people such as police officers and firefighters get sick and have to self-quarantine. Experts say any lack of physical distancing could have ripple effects that overwhelm rural hospitals and disrupt essential services down the line. “If someone gets sick in those areas or an agency or department gets sick, there may be fewer people within those agencies to continue operations, leaving that particular community more vulnerable,” Wachtendorf said. A lack of hospitals The town of Rockton, Illinois, issued a shelter-in-place order in the spring, but many parts of the Midwest and South didn’t implement such procedures. Getty Images Medical facilities known as critical access hospitals, which have 25 beds or fewer and are 35 miles away from the closest facility, are among the ones that have closed at the highest rates in the past two decades, even as their closure rate slowed somewhat thanks to provisions in the Affordable Care Act. “Rural hospitals, on the whole, they’re going to see their curve, whether it’s flat or not, start a whole lot later, maybe 3 weeks, 6 weeks,” Longenecker told Healthline. In the meantime, however, “Rural hospitals right now are seeing a steep decline in activity, empty beds, and empty practices, so for right now there’s a steep loss of revenue.” For those rural hospitals — ones that remain after more than 80 have closed since 2010 and nearly 700 more found themselves on the brink of closure — that loss of revenue illuminates a dangerous teetering in our health system, as administrators try to balance the costs of staying afloat against the predicted flood of eventual COVID-19 cases.  In the meantime, many of these critical access hospitals are operating with bare-bones staff.  “What’s happening is the wave hasn’t come yet here,” said Jane, a travel nurse working at a critical access hospital in Wisconsin. “We’re down to two teams working here per day, which is OK most days because procedures keep getting canceled and falling off, but yesterday, we were working our (tails) off and I’m wondering why are we down to a skeleton crew? It’s because they’re trying to save money for when the s— really hits the fan.”  By then, supply shortages and other issues may have already rocked the system, Longenecker said.  “Hopefully some things will be worked out, like the supply of testing and supply of personal protective equipment, or not. They may have already sent them to the city,” he said. Jane agreed. “What scares me is that — because there’s not confirmed cases up here yet and there’s only two in the county. I’m just worried that we’re going to get overlooked when it happens, and we’re going to be up a creek,” she told Healthline. “I think a hospital is not a place you want to be right now unless you absolutely have to be.” System shock Part of the reason rural areas are so vulnerable to the COVID-19 health crisis is that they were vulnerable to begin with.  Rural zip codes lost almost 20 percent of their hospital beds between 2006 and 2017, according to a study from the Economic Innovation Group (EIG), a bipartisan public policy organization.  But that doesn’t tell the whole story. Within this study, EIG found that economically distressed rural areas were especially affected.  Put another way, “There are fewer than half as many hospital beds per capita reasonably accessible from the average rural distressed zip code as are from the average rural prosperous one,” the report says.  Wachtendorf noted the example of hospital closures funneling people from a wide geographic radius into central, overburdened regional health centers, as well as local clinics that aren’t full hospitals, as potential points of strain in the system in a crisis.  Rural areas that rely on farming as a main source of income might also find themselves in a particular bind. “It’s not like you could just take 2 weeks off and think the crops will still be there,” Wachtendorf said. “Some of that seasonal work is very much dependent on timing. And it’s not just a matter of pushing off that production for 2 weeks or a month. It’s either done now or it’s not done at all.” Is telemedicine the answer? One way in which hospitals and doctors are dealing with this ongoing crisis in rural and urban centers is through telemedicine.  Not every patient is a patient with COVID-19, so those who can receive care from their homes and thus stay out of overburdened hospitals are a benefit to the system at large.  “Prior to COVID-19, we were seeing much more of a demand for telehealth in rural areas,” said Pamela Ograbisz, DNP, FNP-BC, director of telehealth at LocumTenens.com, a healthcare staffing agency.  “In a way, COVID-19 leveled the playing field in healthcare by erasing the boundaries between rural areas and large cities. It doesn’t matter where patients are located; they need care.  “Because of this and because clinicians are overwhelmed, demand for telehealth has gone up across the board,” Ograbisz told Healthline.  But telemedicine can only go so far, and won’t fix the fragmentary nature of the American healthcare system, Longenecker said.  “It’s hard, as individualistic as we are as Americans, for us to think about the good of the community or think epidemiologically, which is a very different way of thinking than just thinking about me and my family,” he said. “But anything we could do to be less fragmented and to be more systemic (as a healthcare system) would be really, really good.”

  • How Screen Time May Be Contributing to Dry Eye During the Pandemic
    on August 5, 2020 at 1:26 am

    Staring at screens for long periods of time can impact your eye health. Experts advise people to be more mindful of this as COVID-19 has forced us inside where people are watching more TV and looking at their phones more often. Getty Images Dry eye disease is a common condition where people don’t produce enough tears to lubricate their eyes.It can cause an intense sensitivity to light, the formation of mucus around the eyes, red and itchy eyes, and eye fatigue, among other symptoms. More than 16 million people in the United States have the condition.It’s more prevalent in women than in men, while the likelihood of developing dry eye increases more with age. About 4 years ago, Melanie Yarger, 42, started having trouble with her vision. She noticed her eyes were red and itchy, with her vision becoming blurry. At first, she assumed it was just deteriorating eyesight that comes with aging, but then the irritation just kept getting worse with no relief. Yarger, who works in Wood County, Ohio, as a service coordinator with children who have developmental disabilities, said she needs to have full use of her “acute vision” to do her job properly. She told Healthline that it became hard to not just help the children in her care and interact with their families, but made it difficult to read and write and see well while driving. Beyond all of this, Yarger said her bothersome eyes made her irritable, in turn, making day-to-day life hard as a mom of three. She tried everything — opting for glasses instead of contacts and cycling through expensive over-the-counter remedies that didn’t work. Ultimately, she saw an ophthalmologist and was diagnosed with dry eye disease, or simply, dry eye. What is it? It’s an all-too-common condition where you don’t produce enough tears to lubricate your eyes, according to Mayo Clinic. In addition to the symptoms Yarger experienced, it can cause an intense sensitivity to light, the formation of mucus around your eyes, or eye fatigue, among others. What causes dry eye There’s no uniform cause for everyone who has dry eyes. Aging is one of the main culprits, along with decreases in your tear production. Additionally, an over-reliance on staring at screens can impact your eye health, a common concern as COVID-19 has forced us inside, staring at computer monitors during endless video conferencing sessions and binge-watching your favorite shows on your TV or phone. Yarger said it was a big relief to receive her diagnosis and to become better educated about “the anatomy of my eye” and how crucial eye health is to maintain. She was ultimately prescribed a medication called Xiidra that alleviates dry eye-causing inflammation. Her story isn’t unusual. A report from the American Journal of Ophthalmology revealed that more than 16 million people in the United States have the condition. It’s more prevalent in women than in men, while the likelihood of developing dry eye increases more with age. Dr. Preeya K. Gupta, a corneal specialist and ophthalmologist at Duke Health, said dry eye is sometimes a condition that flies under the radar, since not every clinician is automatically looking for it. “In my own clinical practice, it’s something I see in patients earlier and earlier. Patients sometimes see dry eye as always something that happens when you got older or have certain risk factors, but I’m seeing, these days, with our digital lifestyle, that something is changing,” Gupta told Healthline. She’s noticed that more people are coming in with “nontraditional symptoms” beyond redness, irritation, and scratchiness. For example, people are telling her their vision is blurry, fluctuating in and out. Gupta added that it’s crucial that you reach out to an eye doctor or your primary care physician first before self-diagnosing. She said issues with eye health in general are unfortunately problems where people easily turn to Google searches first before seeking medical guidance. “As a clinician, I often wish that patients would come in sooner. The reason is, this disease process responds to treatments better when patients are at an earlier stage of their disease,” Gupta explained. “It doesn’t just improve quality of life but also disease progression — I love to see patients earlier in their disease process.” Dr. Craig See, a cornea specialist at Cleveland Clinic Cole Eye Institute, told Healthline that, beyond sometimes being caused by a lack of tear production, it can also be evidenced in something called “evaporative dry eye,” when there is a lack of quality tear production resulting in oil gland blockages around the eyelids. This clogging up of these oil glands can lead to stye, a pimply blockage that can be painful and cause irritation. When it comes to our obsession with screen time, both See and Gupta say they’ve treated a lot of people lately whose dry eyes have been made worse by watching or reading screens, staring fixedly for long periods of time without blinking. See said there isn’t any data to conclusively show whether this has been made worse by the current COVID-19 lockdown, but he added that over time, as people spend most of their days staring at smartphones and looking at their computers at work, dry eye has become a regular part of modern daily life. “Our digital lifestyle” has played a “significant role” in the prevalence of dry eye, Gupta added. She said that if you find yourself spending too much time with your screens, the remedy is simple: “Take a break.” Why eye health is important, too Both Gupta and See were in agreement again when asked whether eye health in general is less prioritized by people compared to other health concerns. “I think, sometimes, we are really good at putting aside things that are obviously bothering us in a way that we would prioritize other things in our lives,” Gupta said. “I do think that patients have a hard time also making association of dry eye and blurry vision, and if it was more clear-cut that there was a problem, then they would focus on it.” “It’s obvious when I can’t bend my finger that, ‘Maybe something broken.’ It’s not an obvious association with dry eye disease, and that makes it even tougher for patients prioritize eye health,” she added. See said that people generally are diagnosed with dry eye only after seeking medical health for something unrelated. People usually don’t seek treatment for the condition on its own. He added that people usually become more concerned if their initial blurred vision starts to get progressively worse. He said if your vision keeps decreasing, you should certainly seek a doctor’s help. “Most dry eye is not vision threatening,” See added. “There is a tendency to say, ‘Oh, it’s not a big deal.’ In most cases, people are OK. But it’s important that they listen to their eyes.” For her part, now that she has been taking her medication to reduce inflammation and can put her finger on what was wrong with her vision in the first place, Yarger has been doing well. “When I first heard ‘dry eye,’ it sounded really simple to me, but understanding how complex it is and how it does impact your eye and also affects your life, it really does make a vast impact on your whole state of living,” she said. “You really have to take care of your eyes. You only have one pair of them, you don’t want to miss out on life’s moments.”

  • COVID-19 Damaged Heart of Elite Athlete: What Does That Mean for the Rest of Us?
    on August 5, 2020 at 1:26 am

    Boston Red Sox pitcher Eduardo Rodriguez has inflammation in the heart muscle after developing COVID-19. Getty Images New research shows that people with mild SARS-CoV-2 infection can have lingering symptoms for weeks, including signs of inflammation in the heart.Boston Red Sox pitcher Eduardo Rodriguez had heart inflammation after developing COVID-19 earlier this year. A study, published this week in the medical journal JAMA Cardiology, found that the vast majority of people with a mild form of COVID-19 are also showing signs of heart damage, sometimes months later. Boston Red Sox pitcher Eduardo Rodriguez has been benched for a least a week after being diagnosed with inflammation of the heart muscle, possibly stemming from a SARS-CoV-2 infection earlier this year. The condition, known as myocarditis, is typically caused by a viral infection and can cause abnormal heart rhythms or impair the ability of the heart to pump blood. Although SARS-CoV-2, the coronavirus that causes COVID-19, is a respiratory virus, it can also damage the heart and other organs. Many studies have found this kind of damage in patients hospitalized with COVID-19. But new research shows that people who had only a mild SARS-CoV-2 infection and were never hospitalized can show signs of heart damage months after their initial infection. In addition, doctors around the country are reporting that a growing number of patients who had a mild or moderate form of COVID-19 are now seeking treatment for lingering symptoms like cough, shortness of breath, and fatigue, as well as headache, poor concentration, and weakness. Dr. Zijian Chen, an endocrinologist and medical director of Mount Sinai’s Center for Post-COVID Care in New York City, says many patients are showing up at the center with symptoms like this — sometimes weeks or months after their initial illness. And they don’t all fall into groups at higher risk of a severe form of COVID-19, such as older adults and those with underlying health conditions. “We’re looking at younger people who were perfectly healthy prior to getting infected with coronavirus — no medical problems, not taking any medications,” said Chen. “And now, in spite of not being in the hospital for COVID-19, they’re having trouble resuming their everyday life.” Effects of COVID-19 linger for weeks or longer The World Health Organization estimated in March that about 80 percent of SARS-CoV-2 infections are mild or asymptomatic, while the rest are severe and often require hospitalization. But for some people, mild or asymptomatic doesn’t mean smooth sailing. The results of a survey released last week by the Centers for Disease Control and Prevention (CDC) show that people who were never hospitalized for COVID-19 can experience “prolonged illness and persistent symptoms,” even if they are young and have no underlying medical conditions. Of the 292 people surveyed, around one-third still had symptoms up to 3 weeks after they tested positive for the novel coronavirus. This included around one-quarter of 18- to 34-year-olds. People with underlying medical conditions were more likely to report ongoing symptoms, but almost one-fifth of younger adults with no chronic medical condition had not fully recovered weeks after the initial infection. Compare this to seasonal influenza, where one study found that over 90 percent of people who had the flu and weren’t hospitalized had fully recovered within 2 weeks of having a positive test result. Another study, published this week in the medical journal JAMA Cardiology, found that the vast majority of people with a mild form of COVID-19 are also showing signs of heart damage, sometimes months later. About two-thirds of the people in the study had recovered at home, with mild to moderate illness. Overall, 78 percent of people had abnormal cardiac MRI results, a sign of structural changes to the heart. Sixty percent had ongoing inflammation in the heart. The authors of the study wrote that even people with no preexisting heart problems and mild illness showed signs of inflammation as well as structural changes to the heart. Long-term effects on the heart are unknown Dr. Jeffrey Goldberger, a cardiologist with the University of Miami Health System, says that although we don’t know much yet about the long-term effects of COVID-19 on the heart, there’s no question that the novel coronavirus can affect this organ. “Approximately 30 percent of hospitalized patients have evidence of damage to their heart cells,” he said, with elevated levels of troponin, an enzyme that is also released when you have a heart attack. Viruses can damage the heart in several ways: by infecting the cells directly, by causing blood clots in the small vessels of the heart, or through an overactive immune response of the body to the virus. In some cases, these effects can be severe. “We know from other viral infections of the heart that some patients go on to get heart failure,” said Goldberger. “But some patients recover completely.” It’s not clear what this means for the long-term heart health of people who had mild or moderate SARS-CoV-2 infections. But Goldberger says with so many of these cases accumulating in the United States, doctors will be able to evaluate people who had COVID-19 for these kinds of problems. “I would imagine there is going to be a range of effects on the heart in people who survive COVID-19,” said Goldberger. “Hopefully most people will have no long-term effects at all, but some fraction are likely to have some involvement of the heart.” Goldberger and his colleagues have called for ongoing tracking of patients with COVID-19 and clinical trials to see if some patients develop “post-COVID-19 cardiac syndrome.” Ongoing fatigue after SARS-CoV-2 infection While most viral infections can cause fatigue, for some people who’ve had COVID-19, it’s severe enough that they struggle to do everyday tasks like take a shower, make meals, or even get out of bed. National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci noted earlier this month that some of the long-term symptoms after COVID-19 resembled myalgic encephalomyelitis, originally known as chronic fatigue syndrome. This debilitating condition is poorly understood, but has been linked by some studies to viral infections. Many people with this condition report severe fatigue that often worsens after exercise or mental exertion. Treating patients with lingering symptoms of SARS-CoV-2 infection is not always easy, because there is not a clear cause. Chen says treatment often involves a team of specialists and starts with medications known to relieve the symptoms that people have.  However, “What we’re seeing is that some of these patients, despite medications, don’t get better,” he said. “So we’re also looking at new treatment modalities.” This includes things like physical rehabilitation to help them regain their functioning, or treating a patient’s anxiety or depression to see if that helps. Chen cautions that with novel coronavirus cases continuing to surge in the United States, the virus still poses a danger to people of all ages, including those without underlying health problems. “Even if you don’t die from coronavirus infection, that may not be the end,” he said. “You could continue to have illness, sometimes bad enough that it can change your life.”

  • Yes, the Government and Your Employer Can Make You Get a COVID-19 Vaccine
    on August 5, 2020 at 1:26 am

    Experts say a COVID-19 vaccine mandate might be difficult to enforce, so public education or a limited mandate might be better solutions. Getty Images Experts say it appears government agencies and even employers can require people to get a COVID-19 vaccine once it’s available.However, they say such a mandate might be difficult to enforce, so public education might be a better option.Another alternative would be to mandate that healthcare workers and people in high-risk groups get vaccinated. It’s still a long ways away, but the debate over COVID-19 vaccinations has already begun. And if recent experiences with measles vaccines and face masks are any indication, all those months of waiting might be needed to have enough time to build public support. Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told Congress on Friday that he’s cautiously optimistic that we’ll have a vaccine by the end of this year and as we go into 2021. But as researchers race to develop and test potential vaccines, groups have shown up at rallies against lockdown orders or face mask requirements. And there’s skepticism in even the less-extreme segments of the population as well. A May survey found that less than two-thirds of U.S. adults were “very” or “somewhat” interested in getting a COVID-19 vaccine. In a different survey, nearly a quarter said they wouldn’t be willing to get a COVID-19 vaccine, including nearly two-thirds of those who were skeptical of vaccines in general. And a June survey found about 27 percent of adults would “probably” or “definitely” not get a COVID-19 vaccine. “One group will start running and rolling up their sleeves, and one group is not so sure and will wait to see if anything bad happens and then consider it,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee, told Healthline. Skepticism about an as-yet unproven and nonexistent medication that promises to return the world to “normal” life may seem understandable for now. But the open, albeit still hypothetical, question is whether that skepticism will remain if a vaccine has been proven safe and effective. If so, can governments or employers mandate that people get vaccinated? And will they? The answer to the first question appears to be yes. There are already vaccine requirements for diseases, such as measles or tuberculosis, to attend or work at many schools. And there are requirements for diseases such as polio to travel to most countries. Certain exemptions to those requirements have been tightened up in many states as high-profile outbreaks of measles in places like Disneyland revealed the extent of the anti-vaccination movement in some communities. But while voluntary compliance in the name of protecting yourself and others is ideal, the anti-vaccination movement underlines why the nation might need requirements in an emergency, such as the current pandemic. “What concerns me is when I see the types of fights over wearing a mask. I can’t even imagine what would happen over vaccines,” said Debbie Kaminer, a law professor at Baruch College in New York who has written about the legal questions around vaccination laws and exemptions. Plan A: Education Kaminer recently wrote about the legality of states and employers requiring people to get a COVID-19 vaccine. In her column, she writes, “People are often surprised to learn that states would likely have the legal right to enforce such a rule.” Still, the ideal scenario would be compliance through public education. To Kaminer, though, that public education needs to have already begun by now — not once a vaccine is available. “At the very least, there should be an enormous public education campaign going on right now, and that really hasn’t been happening the way it should,” she told Healthline. Kaminer says a big part of that should be relying on people who can get the attention of particular communities. She notes how polio vaccine rates surged after a young Elvis Presley got the vaccine on “The Ed Sullivan Show” in 1956, and how the Orthodox Jewish Nurses Association played a key role in convincing some people in Orthodox Jewish neighborhoods to get the measles vaccine amid an outbreak in New York last year. “Find the people who communities listen to and start that campaign now,” Kaminer said. The catch could be that the opposite may be true in communities skeptical of a vaccine. An April study found Americans who voted for President Donald Trump are more concerned about potential harms of vaccines than other voters, and that the president’s tweets can firm up their opposition. But it can also work both ways. In one of the earlier surveys about attitudes toward a potential COVID-19 vaccine, more than a third of respondents said they would be less — not more — willing to get a vaccine if President Trump said it was safe. Only 14 percent said Trump saying it was safe would make them more willing to get it. “We have both anti-vaxxers and those who don’t trust Trump, who think he just wants to say he has a vaccine,” Kaminer noted. “So there’s people on both sides.” That makes this a unique situation, she says, adding that the name of the current White House vaccine project doesn’t help. “I could not think of a worse name than Operation Warp Speed,” Kaminer said. That’s because the title implies the vaccine is being rushed through. Plan B: Targeted mandates So, with education an ideal but tricky option in the current scenario, requiring certain high-risk groups could be an important tool. This would include before the vaccine becomes plentiful and widely available. “When vaccines first become available, they won’t be available in a sufficient quantities to vaccine everyone on day one,” Schaffner said. As in past emergencies, such as 2009’s H1N1 outbreak and 2014’s Ebola outbreak, a Centers for Disease Control and Prevention (CDC) advisory committee is going through a “very rigorous process… to figure out, to put it colloquially, who should go to the front of the line, who should go to the middle of the line, and who should wait a little bit,” Schaffner said. He notes that education has an important role to play here, too, and that it would be important to be transparent about who’s getting the vaccine and why. But, Schaffner says, there appears to be a “rather a uniform opinion in surveys that the first folks should be healthcare workers in contact with COVID, because we need to keep them as healthy as possible so they can take care of people with COVID and not get sick themselves.” The CDC committee’s emerging thinking appears to follow that idea, with a preliminary five-tier sketch of the plan placing those workers in the top tier, followed by others working in healthcare and essential jobs, as well as those deemed high-risk of severe COVID-19 complications. Schaffner says attention is being paid to focus equity and make sure all segments of the population are considered as any prioritization scheme is set up. But as for requiring certain segments to get it once it’s available to everyone, the picture is less clear. As for employers being able to require a COVID-19 vaccine, Kaminer notes in her article that while most employers would likely be hesitant to try it, they likely could, especially given the “significant cost to having an unimmunized workforce” amid the pandemic. Schaffner says it’s possible that healthcare institutions could require workers get the COVID-19 vaccine, as some states already require they get flu shots. Or maybe people in the armed forces would be required to get it. But it’s just speculation for now, and Schaffner sees it’s probably unlikely. “If you come on our property at Vanderbilt Medical Center and want to enter a building, you’re going to have your temperature taken, but that’s very different than obliging people to get a vaccine, and I don’t think that will happen,” he said. “There may be some subpopulations where there is a requirement, but I would be hugely surprised if there’s a broader requirement,” he added. Plan C: General mandates That broader requirement — while likely legal — would be a last resort and unlikely option, experts say. The U.S. Supreme Court has rejected multiple lawsuits stating that vaccine mandates infringed on people’s liberties. But in addition to the potential outcry and conspiracy theories, enforcing a broad requirement may just be too difficult to enforce.  “I don’t think anybody is going to compel people to get a vaccine,” Schaffner said. So, to avoid that, education may be key. There may be a ways yet to go. After her article about the legal underpinnings for vaccine requirements was posted, Kaminer says “almost all” the comments were from people who were anti-vaccine. But there’s still plenty of time. A safe, effective vaccine is — at least — many months away.

  • COVID-19 Survivors Share How to Recover During Pandemic
    on August 5, 2020 at 1:26 am

    People recovering from COVID-19 are sharing their stories in groups online. Getty Images People who have recovered from COVID-19 are sharing their unusual experiences online.Because so many people with an infection are asymptomatic, it can disrupt the feeling of being safe. More people are reporting experiencing symptoms of depression and anxiety now than this time last year, or even 6 months ago. That can be from having COVID-19, being exposed to the virus, or simply living through a pandemic. There are support groups for just about every physical or mental health condition, and COVID-19 is now on the list. A variety of coronavirus support groups have emerged as a way to help those who have had, or been affected by, the virus. Jessica Stapleton began looking for a COVID-19 support group soon after she came down with symptoms. She joined a group on Facebook in March; there were about 800 members. “I had scoured the internet looking for stories of COVID sufferers to see if what I was experiencing was typical. There was nothing in March,” Stapleton, an Indiana resident, told Healthline. “When I found the page I also found people just like me: scared, sick, and needing support.” The group has grown to more than 18,000 members. Facebook isn’t the only place to find support. James Chok, PhD, a clinical neuropsychologist from Pennsylvania, began a free video conference support group during March. “I wanted this group to be a predictable thing in people’s lives, something they could count on each week,” Chok told Healthline.   Because so many people with an infection with the new coronavirus are asymptomatic, it can disrupt the feeling of being safe. That’s particularly difficult with people who have obsessive-compulsive disorder, he says. Several people attend each week via video, which is the perfect way to connect — especially when many people experience anxiety about leaving home. Moderating the group has shown Chok how many people are having difficulty coping, and how isolating the virus has made life. “The gratitude members have had also been a refreshing surprise,” he said. “People are thankful to have a place to gather (even if virtually) and are thankful to each other for sharing their experiences. It has helped people not feel so alone.” Seeking answers The Facebook group was just what Stapleton needed, because she struggled with symptoms, getting a diagnosis, and receiving treatment as well as isolating away from her family. “I was surprised that I had come down with a cold when I had been so careful to wash my hands and take all the recommended precautions. It wasn’t a cold. The symptoms continually got worse,” Stapleton said. She experienced everything from gastrointestinal ailments to rash and hallucinations. She never developed a fever. “It was difficult to concentrate enough to even follow conversations. I would forget simple words and forget what I was even talking about for weeks,” she recalled. “The symptoms would come in waves, convincing me that I was getting better and then I was not.” Almost a month later, she began wheezing and got a cough. “My chest felt like an elephant was sitting on it,” she said. The burning and numb feeling still exists. She also experienced loss of taste and smell, but only of some things and not others. She did go to the emergency room but was discharged because her oxygen levels were within a normal range and she could walk. She saw doctors online, and it took weeks to get an appointment with a pulmonologist. “I felt like I couldn’t breathe for 2 months,” she added. “I still have issues catching my breath.” The group also offers support for those with lingering symptoms like Stapleton is experiencing. Support at last Luckily, the Facebook group helped Stapleton navigate life as a COVID-19 patient. Jay Sinrod founded the group after family members experienced COVID-19 symptoms. The New York resident soon assembled a team of administrators to manage participants and content. Stapleton, one of the administrators, says the response of the group has been great, and it’s restored her faith in humanity. When people realize they’re not alone, it provides support and peace of mind that’s “definitely an amazing thing to see.” “We were all flying blind and isolated and unheard, but then we found each other,” Stapleton said. “I think the ones that are freshly sick have comfort knowing that so, so many of us have lived through it and can offer support.” Teri Brister, PhD, LPC, national director of research and quality assurance at the National Alliance on Mental Illness, said support groups give people encouragement as well as valuable insights not available from healthcare providers. “With the scope and reach that COVID-19 is having on our society, it is only logical that support groups would be seen as a valuable resource for people who have experienced its effects firsthand,” Brister told Healthline. More people are reporting experiencing symptoms of depression and anxiety now than this time last year, or even 6 months ago. That can be from having COVID-19, being exposed to the virus, or simply living through a pandemic. “The experience of a mass trauma… learning to navigate an environment with uncontrolled exposure to an airborne pathogen with no known vaccine or cure is stress-inducing,” Brister said. Stapleton and Sinrod’s group is private, as many people don’t want friends and family to see their medical information. That’s why the group of administrators works so hard to screen members upon joining. “This is really the safest place on social media without all the negativity,” Stapleton said. “The worst thing about this time in history is all the people with their theories, their lack of compassion, and their total disregard for others.” “It is really, really hard to see this when you are suffering. We try to keep that out of the group,” she added.

  • How and When Children Should Return to Sports During COVID-19
    on August 5, 2020 at 1:26 am

    Experts say small group practices and clean common areas should be among the guidelines before children return to the playing field. Getty Images The American Academy of Pediatrics has issued guidelines for children playing sports during the COVID-19 pandemic.Experts say parents should consider how a team practices and plays, as well as the spread of the disease within their community.They also recommend coaches start the season with individual skill drills and then move on to small group practices.Experts say parents should also consider the physical and psychological benefits of children playing sports. As the United States struggles to figure out if athletic competition is safe during the COVID-19 pandemic, the American Academy of Pediatrics (AAP) has issued interim guidelines for children returning to the sports field. The key may depend on what sport the young athletes play, as well as where they play it, according to the recommendations released last week. “Weighing the risk versus benefit of return to sport is driven by the sport and setting, local disease activity, and individual circumstances, including underlying health conditions that place the athlete or household contacts at high risk of severe disease should they contract SARS-CoV-2 infection,” the academy stated. The point is to start the conversation with parents and answer some preliminary questions before turning children loose on the playing field. “As children present for health supervision visits and pre-participation physical evaluations, parents and athletes likely will ask questions about how to best ensure safety when considering a return to sports participation,” the guidelines state. Caution with children Opinions vary as to how vulnerable children are to COVID-19. While the AAP points out children contract SARS-CoV-2 less frequently than adults and typically have a less severe reaction to COVID-19, some states are reporting recent surges in the number of children with the novel coronavirus. On July 16, the Florida Department of Health reported that 23,170 children had tested positive in that state since the pandemic began. By July 24, that number soared to 31,150 — a 34 percent increase in new cases among children in 8 days. There’s also the COVID-19 outbreak among the Miami Marlins baseball team to consider. “When deciding about participation, parents must assess the risk,” Alicia Filley, PT, MS, a physical therapist and the editor of Sports Injury Bulletin, a resource for coaches and sports clinicians, told Healthline. “How prevalent is the virus in their area? Is their child able to maintain appropriate distancing from other children during practices and games? Team and individual sports that are outside, like soccer, baseball, tennis, and golf, will be easier and safer to implement.” Filley suggests coaches start with individual drills with plenty of physical distancing, followed by pod drills. Pods are small groups of kids who move together through drill stations during every practice “By forming interactive pods, kids limit their exposure risk,” Filley said. “The next step is to progress to full team practices.” Dr. Sharon Nachman, the chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital in New York, told Healthline that parents need to look to their municipalities and other adults first when determining whether to let kids play. “It’s not about the sport nearly as much as it is about the community and county numbers,” Nachman said. “Those numbers tell us much more about the adults and give us a sense of asymptomatic spread and what percentage of kids are getting sick.” “How many kids are part of the team? How are they training? How are they hanging out together in the dugout, locker (room), or bench? Are they social distancing, masking, handwashing?” she added. The Training Centres of Canada have recently reopened, observing strict COVID-19 protocols. Dan Blackburn, the program’s co-owner and trainer, told Healthline that parents should start with honest conversations with their child athletes. “Parents (should) open an ongoing dialogue with their kids about what they enjoy doing and discuss the fears/apprehension/concerns that the kids and parent might have about returning to sports after a 3- to 4-month hiatus,” he said. Government guidance Relying on municipalities can be problematic for parents and coaches due to overlapping guidelines coming from cities, counties, and states. Dr. Jalan Burton, the founder of Healthy Home Pediatrics in Washington, D.C., told Healthline the federal government could make things easier for everyone involved. “The return to sports and activities during COVID-19 should be national or at least regional,” Burton said. “State by state does not make sense when dealing with an international pandemic.” “I am licensed in D.C., Maryland, and Virginia, and even though I can venture to all of these jurisdictions in an average day as a house call pediatrician, the responses varied and the policies varied significantly,” Burton said. “To truly open our country, we must get ahead of the curve, as they say. If this requires us to take our time returning to organized sports, let’s do it,” she added. The issue of testing Not only do parents have to worry about their children, but there will also be contact with coaches and parent volunteers. That can be problematic if someone hasn’t been tested. The AAP guidelines discourage testing for athletes “unless an athlete is symptomatic or has been exposed to someone known to be infected.” “As a parent volunteer at my son’s District of Columbia public school, I saw a huge shift in pre-volunteering clearance this school year,” Burton said. “This year, for the first time, a background check and tuberculosis screening was required. I do not think it’s realistic to ask parent volunteers to have COVID-19 testing because it would require multiple tests, maybe even for each volunteer activity. That is costly and time-consuming and may have little return for investment.” The benefits of sports There’s a reason why Burton and other doctors are putting lots of thought into how kids can return to sports and other activities. Athletics can be critical to a child’s development. The AAP points out that 35 to 45 million children between the ages of 6 and 18 participate in some form of athletics in the United States, and doing so has significant physical and psychological benefits. “Youth sports are an excellent way to promote and enhance a child’s development,” said John Gallucci Jr., MS, ATC, PT, DPT, the chief executive officer of JAG-ONE Physical Therapy and the former head athletic trainer for the New York Red Bulls of Major League Soccer. “Not only will the child benefit from exercise and learning a new sport, but they will also develop fine and gross motor skills and learn to socialize and interact with their peers. Additionally, the child will learn to set and attain goals, build self-confidence, and work together as a team.” Looking to the future Many agree that when scientists finally get a handle on controlling COVID-19, youth sports won’t be the same moving forward. “We must work together during these stressful times to ensure that our youth has the opportunity to participate in athletics safely,” Gallucci told Healthline. “As we work toward a vaccine, we may have to adapt or adjust length of season, timing of season, practice and game schedules, illness reporting, and a number of other factors. Although this may be difficult or not ideal in the beginning, remember that the ultimate goal is allowing for our youth to have a safe environment and to see and interact with friends, get some exercise, and develop critical milestones along the way.”   Here are some tips from the AAP for families and coaches returning to youth sports from COVID-19 lockdown: Families should review and discuss school and league COVID-19 policies as well as CDC recommendations for youth sports. Always follow safety protocols.Prioritize noncontact activity, including drills maintaining physical or social distancing.If physical distancing can’t be maintained, use cloth face coverings or masks.Reinforce appropriate hygiene and respiratory etiquette through signage, education, and use of handwashing stations or hand sanitizer.Maintain practice pods in small sizes without mixing athletes.Minimize travel to other communities and regions.Clean and disinfect frequently touched surfaces on the field, court, or play surface, as well as drinking fountains. This should be done at least daily or as much as possible.Reduce use of shared equipment and communal spaces, such as locker rooms.Avoid poorly ventilated areas and small spaces. Use fans or open doors and windows when possible.Don’t allow athletes to share food and drink. Participants should always use their own water bottles.

  • COVID-19 Is Likely to Be the Third-Leading Cause of Death in the U.S. This Year
    on August 5, 2020 at 1:26 am

    New projections show weekly COVID-19 death tolls of more than 10,000 this month in the United States. Getty Images New estimates are projecting the number of COVID-19 deaths could top 180,000 in the United States by the end of August.At that pace, the viral illness would be the third-leading cause of death in the United States in 2020, behind only cancer and heart disease.Experts say the only way to reverse the trend is for people to strictly observe guidelines, such as physical distancing and facial coverings. The news about COVID-19 deaths is grim and projected to get even worse. So far, more than 155,000 people in the United States have died from COVID-19 in just 5 months. A new estimate from the Centers for Disease Control and Prevention (CDC) projects that the weekly death toll in the United States could reach 11,000 by the end of August. At that pace, experts say the viral illness is on track to become the third-leading cause of death in the United States in 2020. The latest CDC statistics show the projected COVID-19 death toll would only trail cancer and heart disease. It would surpass accidental deaths. “It’s stunning,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee, told Healthline. “This is the most striking demographic change since HIV/AIDS.” By the numbers The latest projections indicate the death toll will likely rise rapidly. Yahoo News recently uncovered an internal CDC document dated July 28. It predicts the U.S. death toll from COVID-19 will top 180,000 by ‪Aug. 22. Just a few days ago, researchers at the Institute for Health Metrics and Evaluation (IMHE) at the University of Washington released their latest estimate on COVID-19 deaths. Based on current projections, they’re forecasting that 230,000 Americans could be dead by ‪Nov. 1. “Unfortunately, that is the track we’re on,” said Ali Mokdad, PhD, a professor of global health at the IMHE. “We have pretty much totally relaxed some of our social distancing mandates because there is a big concern about the economy,” Mokdad told Healthline. “Some states have [reinstituted] some of these measures, but it’s not enough to contain the virus because all of us are susceptible.” “These are not just numbers. These are loved ones, family members, essential workers who sustain our economy,” he added. Historical perspective “The only precedent I can recall is when AIDS hit the scene. At the time, the death rate for young men aged 20 to 40 was very low, then it shot up like a rocket,” Schaffner said. “At the time, that was the most stunning demographic change in two generations of looking at that data.” “AIDS has settled in and everything went down because of our treatments,” Schaffner noted. “Now, much faster than HIV/AIDS, comes this virus that is taking all ages and rocketing it up.” “If we were to analyze the data by subgroups, age, race, and ethnicity, I think we would see similar increases that would also be striking,” he added. “The change for people of color might be even more dramatic because that group has been disproportionately affected.” Historians are still studying the 1918 flu pandemic to learn about the impact the high death toll had on society. “There are things that were very, very different back then,” said Mari Webel, PhD, a medical historian and an assistant professor in the department of history at the University of Pittsburgh in Pennsylvania. “In 1918-19, the seasonal influenza eventually tapered off on its own. Everything I understand about our current situation is that is unlikely,” Webel told Healthline. “One thing to consider is we’re still in the middle of this thing. Some of the impact in terms of cause of death won’t really be clear until further down the line,” she added. “We are only months into a totally novel coronavirus disease. It is unprecedented and it is serious,” she said. “And there are no cookie-cutter experiences we can look to.” The path forward “If all the data are not sufficiently sobering, it calls to attention once again that profoundly, sadly, we continue to not have a national strategy for controlling this virus,” Schaffner said. “We’re not going to get control of this virus until we can all sing from the same page,” he added. “And our national leaders are doing nil to bring us together.” “We haven’t done a good job so far containing the virus,” Mokdad said. “We have to be very careful. We cannot sustain this level of mortality.” “It’s very frustrating when you put out these projections and you tell people to wear a mask,” he explained. “We can save lives and save our economy if we do the right thing.” Mokdad says the virus has already changed the way we live. The way we shop, our education, our vacations are all different. It also has left many people isolated. “We sacrificed a lot as a country when we locked down the first time,” he said. “Those sacrifices, especially those who paid the highest price, should not be wasted.”

  • Many Early Vaccine Trials Show Promise. Most Still Fail. Here’s Why
    on August 5, 2020 at 1:26 am

    Developing new drugs and vaccines that are safe and effective is a long, complicated, and expensive process. Getty Images Developing new drugs and vaccines is an expensive and time consuming endeavor.In addition, many promising treatments will simply fail to make it through the process.It may be years before a drug is developed.But experts remain hopeful a vaccine could potentially be available by the end of the year. Since the beginning of the COVID-19 pandemic, the race has been on to develop an effective drug or vaccine to help in the fight against the disease. While many people are hoping this will happen quickly, making it possible to return to “normal” life once more, experts say it may take much longer than many people realize before an effective drug or vaccine is developed. And it may take even longer still before it’s widely available. How new drugs and vaccines are developed According to Dr. Thad Stappenbeck, chair of the department of inflammation and immunity at Cleveland Clinic’s Lerner Research Institute, new drugs and vaccines go through four phases of testing: Phase I The goal of this phase is to determine whether it’s safe. In addition, it assesses side effects. This phase usually involves using a small group of healthy people, says Stappenbeck. Phase II In this phase, work is done to determine the maximum tolerated dose, the optimal schedule for dosing, and whether the immune system is responding as desired. These studies usually involve a few hundred participants, Stappenbeck says. If the drug or vaccine appears to be effective at this stage, it will move on to phase II. However, many studies will halt here and never proceed further because of poor results. Phase III At this point, testing will be done on a larger group of people, usually numbering in the thousands. Stappenbeck notes that people who are at increased risk for infection may be included at this stage of testing. Phase IV These studies seek to gather additional information about the treatment’s safety and effectiveness. They may extend testing to additional populations, such as children and pregnant women, who were previously excluded. Stappenbeck further explains that in all phases of testing, certain controls are used. There will be two groups of participants: those who are receiving the therapeutic agent and those who are receiving an inactive placebo. They’re assigned to one of these two groups at random, with neither the participants nor their caregivers knowing which group they’re in. Stappenbeck says these controls are used increasingly as the drugs and vaccines progress through each phase. Why it will probably take longer to get a COVID-19 drug or vaccine Nikolai Petrovsky, PhD, director of endocrinology at Flinders Medical Centre and professor of medicine at Flinders University in Australia, explains that it usually takes around 10 to 15 years to develop a new drug or vaccine due to the complexity of the process. It can be very difficult to compress this process into a matter of months. A delay in receiving a needed piece of equipment or an important reagent might not significantly affect the overall timeline when you’re working on a scale of years, he says. However, the effect can be “massive” when you’re trying to develop a vaccine in a matter of months. In addition, Petrovsky says, we need to consider the impact of the pandemic itself. “Because we are in a pandemic, this means nothing is working normally so everything is slowed down by up to tenfold,” Petrovsky said. Petrovsky further points out that, even under the best of circumstances, promising new treatments will often fail to make it through the process. One common reason for failure, he says, is that the underlying science is simply not good enough. Perhaps the treatment isn’t effective enough, or it’s targeting the wrong receptor or virus pathway. Another common reason for failure is that something unexpected — such as a severe side effect or a safety issue — emerges during clinical trials. Finally, drug development is a very expensive process, with costs of up to $2 billion being typical. So, a lack of financing might be a barrier. Where we are right now in the search for an effective COVID-19 treatment As far as drug treatments, Petrovsky points to dexamethasone and remdesivir as being the most promising at the moment. “Dexamethasone so far is the biggest breakthrough as it is cheap, readily available, and has been shown to improve clinically significant outcomes,” Petrovsky said. “Remdesivir may have some modest benefits, although whether these are clinically meaningful and worth the expense remains a matter of debate,” he added. Petrovsky says chloroquine and hydroxychloroquine have been the biggest failures so far. “Despite all the hype, they have delivered effectively nothing,” he explained. Regarding potential vaccines, Petrovsky says the most effective vaccines are those based on traditional protein-based approaches. These include the inactivated whole-virus approaches being used by several Chinese companies, as well as the recombinant vaccine approaches being utilized by companies such as Vaxine, Novavax, and Sanofi. So far, these have shown high levels of protection when tested on animals, he says. At the other end of the spectrum are adenovirus vaccines, Petrovsky says. These have failed to control virus replication in animal models. In addition, they can cause high levels of side effects in humans, including dangerous fevers. Also, since they use live viruses, they can’t be used in anyone with a compromised immune system. A vaccine that’s both safe and effective on all groups of people is needed to stop the pandemic, he explains. What’s the soonest we might expect a drug or vaccine to be available? A true antiviral treatment for COVID-19 will take years to develop, says Petrovsky. What’s more likely in the short term is that we will be using currently existing drugs like dexamethasone that can suppress inflammation pathways. While the timing on a vaccine is hard to predict, Stappenbeck says that if the earliest vaccines in trials make it through phase III, we could begin to see vaccine production and delivery by late this year or early next year. Many of the companies are producing large amounts of the vaccines at the same time as they continue testing them to have them ready to go as soon as they’re approved. Everything hinges on these vaccines being proven safe and effective, however. The bottom line Developing new drugs and vaccines is a costly, complicated, and time consuming process. It can be very difficult to condense what would normally be years of work into a few short months. In addition, even under the best of circumstances, many drugs and vaccines will fail. While researchers are working very hard to develop a safe, effective drug or vaccine for COVID-19, it may take longer than we’d like. It may be years before we see a new drug treatment. If all goes well, however, we might see a vaccine in late 2020 or early 2021.

  • Researchers ID 6 COVID-19 Symptom Sets: How That Will Help High-Risk Patients
    on August 5, 2020 at 1:26 am

    Researchers are learning how different sets of symptoms can be a warning signs for people with COVID-19. Getty Images COVID-19 presents differently in people. Some experience mild or no symptoms, while others may require hospitalization and oxygen support.Researchers in London were able to identify which COVID-19 symptom clusters tend to be more severe and require respiratory support. Cough, fever, and changes in smell were the most frequently reported symptoms, followed by headaches, muscle aches, fatigue, confusion, shortness of breath, and loss of appetite.  New research has discovered there are primarily six different symptom “sets” of COVID-19. COVID-19 presents differently in people. Some experience mild or no symptoms, while others may require hospitalization and oxygen support. Because of COVID-19’s unpredictability, it can be difficult for doctors to accurately predict which patients will need more intensive care.  Understanding not just the variety of symptoms but how different collections of symptoms are associated with worse outcomes can help doctors treat patients. Researchers from King’s College London published their findings this week and were able to identify which types tend to be more severe and require respiratory support, according to the study, which hasn’t yet been peer-reviewed.  Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City, says these findings offer an innovative solution to identifying who may be more at risk for developing a more serious form of COVID-19.   “It’s these patients we must be able to spot quickly, before they deteriorate and require ICU-level of care and monitoring,” Glatter told Healthline.  The clusters explained The researchers developed a phone application — called the COVID Symptom Study app — in which people with a COVID-19 diagnosis logged their symptoms on a daily basis.  The app’s machine-learning algorithm was able to map out which symptoms typically present together and whether that would indicate how severe the illness will be. Cough, fever, and changes in smell were the most frequently reported symptoms, followed by headaches, muscle aches, fatigue, confusion, shortness of breath, and loss of appetite.  After evaluating symptom trends, the research team identified six distinct symptom clusters: Flu-like with no fever: headache, loss of smell, muscle pain, cough, sore throat, chest pain, and no feverFlu-like with fever: fever, loss of appetite, headache, loss of smell, sore throat, hoarsenessGastrointestinal: diarrhea, headache, loss of smell, loss of appetite, sore throat, chest pain, no coughSevere level 1, fatigue: fatigue, headache, loss of smell, cough, fever, hoarseness, chest painSevere level 2, confusion: confusion, headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, muscle pain Severe level 3, abdominal and respiratory: shortness of breath, diarrhea, abdominal pain, headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain Here’s how severe the clusters are  The research team also wanted to see how severe each cluster tends to be.  They found just 1.5 percent of those with the first cluster (Flu-like with no fever), 4.4 percent of people with the second (Flu-like with fever), and 3.3 percent in the third (Gastrointestinal) needed respiratory support when hospitalized.  The severity increased with the latter half of clusters, which tended to include people who were frailer, older, and had underlying health conditions, such as diabetes or lung disease.  “It seems like, from the preliminary results of the study, that older, frailer, and medically complex patients (with preexisting conditions) have lots of symptoms, and thus more severe disease,” said Dr. Kirsten Bechtel, a Yale Medicine pediatric emergency medicine physician who has worked in the ICU during the pandemic, noting that this aligns with previous evidence. With cluster 4 (Severe level 1), 8.6 percent of people needed breathing support. Nearly 10 percent in cluster 5 (Severe level 2) and 19.8 percent in cluster 6 (Severe level 3) needed breathing support.  The researchers then factored in age, sex, body mass index (BMI), and preexisting health conditions to successfully predict who would experience which specific cluster just 5 days after they experienced their first symptom.  COVID-19 presents differently in people One of the factors about COVID-19 that’s had infectious disease specialists stumped is how differently the infection presents in people.  Where some people with an infection won’t have any symptoms, others will experience widespread inflammation along with life threatening lung and kidney damage.  Additionally, most people will be able to recover on their own at home, but a small percentage who develop a severe infection will need to get supportive care at the hospital.   Seeing as the disease presents so differently from person to person, it can be tricky for doctors to predict how the disease will play out in any given patient.  These findings could help doctors better predict which patients have a higher risk for death, says Bechtel.  The data may also be instrumental in helping doctors allocate available resources, according to Glatter. Why catching the disease early matters  It’s become increasingly clear that when people go to the hospital matters.  “Earlier diagnosis and intervention in patients with COVID-19 may potentially help to reduce the risk for requiring mechanical ventilation, decrease length of hospital stay, and risk for developing thrombotic complications,” Glatter said. Many people with severe COVID-19 don’t go to the hospital until they’ve been sick with COVID-19 for at least a week.  Multiple studies have found that late intervention is directly linked with a higher death rate.  “If patients wait, the inflammatory phase of the disease can lead to severe lung disease, which could lead to respiratory failure and the need for intensive respiratory support, like a ventilator,” Bechtel said.  Some people with COVID-19 experience hypoxia, a condition where the body doesn’t get enough oxygen. These people need oxygen support immediately; a delay could jeopardize the trajectory of the disease.  Furthermore, those with inflammation in the lungs need to rest, so avoiding daily responsibilities — like taking care of others, preparing food, and doing chores — is crucial.  Intervening early, with the help of these findings, can help improve the outcomes of people who get COVID-19.  The bottom line  New research from the United Kingdom has discovered there are six “types” of COVID-19, each of which is linked to a distinct set of symptom clusters. Because COVID-19 presents differently from person to person, it can be difficult for doctors to accurately predict which patients will need more serious intervention. These new findings can help doctors better predict who may need more intensive care. 

  • Walgreens to Open Doctor Offices: What This Means for Your Healthcare Services
    on August 5, 2020 at 1:26 am

    Walgreens is partnering with VillageMD to open more than 500 physician-staffed health offices during the next 5 years. Image via Walgreens Walgreens and VillageMD are collaborating to open hundreds of doctor offices inside Walgreens stores.The program is the latest move in the industry to combine pharmaceutical and healthcare services.Walmart, CVS, and Amazon have also entered this field. The doctor will see you now… at Walgreens. Walgreens Boots Alliance, the nation’s second-largest pharmacy chain, announced this month that it will become the first national pharmacy to offer “full-service doctor offices co-located in its stores on a large scale.” Amid a volatile, hypercompetitive era for U.S. pharmacy chains during the COVID-19 pandemic, Walgreens has decided to get into the physician business. The company is partnering with VillageMD, a national provider of primary care doctor services. Together, the companies plan to open 500 to 700 “Village Medical at Walgreens” physician-led primary care clinics in more than 30 U.S. markets during the next 5 years. The hope is to build hundreds more, Walgreens executives tell Healthline. It’s an ambitious plan. And somewhat risky. But it’s probably necessary for the long-term survival of the company, which has been a part of the American business landscape since its first store opened in Chicago nearly 120 years ago. “By integrating pharmacy and primary care in one location as well as online with our VillageMD’s telehealth programs, this will produce better patient outcomes,” Jamie Vortherms, vice president of healthcare services at Walgreens, told Healthline.  “Another way to think of this is that 6 in 10 patients live with at least one chronic condition that requires multiple medications,” she added. “As a pharmacist myself, I see how big a difference this integrative approach makes for patients.” Morphing and adapting Touting this new primary care venture is part of the Walgreens’ effort to morph from a pharmacy into a broader health and wellness destination. The announcement follows a trial run this past year of several doctor offices in Houston that Vortherms describes as “very successful.” Walgreens and VillageMD executives tell Healthline that the clinics will integrate the pharmacist as a critical member of the multidisciplinary team to deliver the best healthcare to patients. In a statement, Stefano Pessina, Walgreens executive vice chair and CEO, said the rollout is a “significant step forward in creating the pharmacy of the future, meeting many essential health needs all under one roof as well as through other channels.” Walgreens’ struggles Walgreens has struggled financially in recent years. The pharmacy announced in August 2019 that it was closing 200 Walgreens drugstores in the United States. That news came after the company disclosed it was closing 200 of its Boots pharmacies in the United Kingdom. The U.S. closures were part of a global “transformation cost management program” launched earlier last year, Walgreens’ representatives said at the time.  The cuts, Walgreens executives insist, were necessary to provide the funding needed to pay for the company’s new technology initiatives and perhaps pursue new developments, such as the new primary care offices. Walgreens, like so many other companies in so many sectors across the nation and around the world, is trying to figure out how to keep up with Amazon, the online giant. Walgreens took a major hit in value in 2018 when Amazon purchased PillPack, the well-known online pharmacy. Walmart was also vying for PillPack but was outbid by Amazon. VillageMD co-founder’s view Dr. Clive Fields, chief medical officer and a co-founder of VillageMD, tells Healthline that Village Medical at Walgreens will provide comprehensive preventive and wellness services. That includes management of acute infectious disease, minor trauma, and management of chronic disease, which he notes is the category that affects the nation’s healthcare system the most. The clinics will be operated by board certified primary care physicians and will integrate Walgreens pharmacists as “critical members of VillageMD’s multidisciplinary team all under one roof,” Fields explained. Fields, who sees patients weekly and serves on staff at Memorial Hermann Memorial City Medical Center in Houston, Texas, as well as the Methodist Hospital and CHI St. Luke’s Health-Baylor St. Luke’s Medical Center, says the clinics will also be staffed by nurses, social workers, and behavioral therapists. The primary care doctor offices will be staffed by more than 3,600 primary care providers, whom VillageMD will recruit. The clinics will offer comprehensive primary care across a broad range of physician services. Additionally, 24/7 care will be available via telehealth and at-home visits. There will be two physicians on staff and available at the clinic. The majority of co-located clinics will be in existing Walgreens stores. Each clinic will be equipped with state-of-the art technology and design, and provide privacy and a separate entrance and exit from the pharmacy, Fields says. Fields adds that the Village Medical at Walgreens clinics will accept a wide range of health insurance options and also provide separate entrances from the main Walgreens store. What will the clinics look like? An examination room at a Village Medical at Walgreens facility. Image via Walgreens Most of the clinics will be approximately 3,300 square feet each, with some as large as 9,000 square feet. They will optimize existing space in the store, which will also still provide a vast range of retail products to customers. The clinics will integrate Walgreens pharmacists as critical members of VillageMD’s multidisciplinary team all under one roof. There will also be digital opportunities to deliver healthcare through what Walgreens is calling a “simpler, more accessible, affordable and differentiated patient experience.” In a statement, Tim Barry, the chairman and CEO of VillageMD, explained: “In the U.S., we spend $4 trillion per year on healthcare, over 85 percent of that is tied to patients with chronic diseases. To improve our healthcare system and reverse the trajectory of health spending, we must meet the needs of all patients.” Barry added that this partnership will “unleash the power of primary care doctors and pharmacists, enabling them to work in a coordinated way to enhance the patient experience.” “The results of our initial pilot clinics highlight that these outcomes are infinitely achievable,” he said. What is Walgreens’ long-term plan? The Walgreens expansion into primary care follows a pilot program this past year in the Houston area. Vortherms says the program produced strong results and high patient satisfaction.  She adds that information collected from Walgreens’ current clinics shows an integrated primary care and pharmacy approach increases medication adherence, contributes to improved patient outcomes, and results in lower than average emergency room visits, unnecessary hospitalizations, and readmissions. Fields and Vortherms both explain that in late fall and into next spring Village Medical at Walgreens will add new markets. “We are still evaluating other market locations, which will be determined based on patient need. We will also see more markets in late fall, including Texas and Arizona,” Vortherms said. “More than 50 percent of the clinics will be in designated health professional shortage areas and medically underserved areas, so that we can provide more affordable and convenient care to patients,” she added. The money part This program, of course, is a for-profit venture. According to a Walgreens official, the company will invest $1 billion in equity and convertible debt in VillageMD over the next 3 years, including a $250 million equity investment completed earlier this month.  Of Walgreens’ investment, VillageMD will use 80 percent to fund the opening of the clinics and build the partnership, including integration with Walgreens digital assets, the company official said.  It’s anticipated, assuming full conversion of the debt, that Walgreens will hold an approximately 30 percent ownership interest in VillageMD at the completion of the investment. Conflicts of interest? National pharmacy chains are evolving to meet ever-changing consumer needs. But as disparate pieces of the healthcare sector continue to integrate, there is concern among some physicians and patient advocates that the full merger of doctor offices and pharmacies could be problematic. Dr. Amy Townsend, a patient advocate, board member of Physicians for Patient Protection, and delegate to the Texas Medical Association, says the Walgreens plan could mean a more corporate, bottom line approach to health and pose potential financial conflicts of interest for physicians that could negatively affect consumers. “You will have doctors working for a private equity firm, a company that is tied to a pharmacy. There is a lot of money involved in these vertical integrations within healthcare,” Townsend told Healthline. She says she’s become “frustrated” with the entrenched bureaucracy of the current healthcare system.  “When you roll all of these elements together, will doctors still have full autonomy to treat and prescribe what is in the best interest of patients, rather than what is good for the company’s bottom line?” she said. When asked that question, Fields says the physicians at Village Medical at Walgreens will be given “full autonomy to do what is right for patients” whether or not it involves more or less profit for Walgreens. The competitive pharmacy landscape As the national pharmacies continue to enter more diverse healthcare sectors to stay solvent and serve customers, independent pharmacies continue to suffer. Nearly 1 in 8 U.S. pharmacies closed in recent years with independent pharmacies taking a major hit, studies show. A University of Illinois at Chicago study published in JAMA Internal Medicine last October concluded that 9,654 pharmacies closed from 2009 to 2015, and that consumers are increasingly going to national chains to get their prescriptions filled. Independent pharmacies in both cities and rural areas were three times more likely to close than chain pharmacies. About 1 in 4 pharmacies in urban, low-income neighborhoods closed, compared to 1 in 7 pharmacies in rural, low-income neighborhoods, the study noted. In cities, pharmacies serving large numbers of uninsured or publicly insured patients with Medicare or Medicaid were two times more likely to close than other pharmacies, a difference that wasn’t evident in rural areas. Overall, the pharmacy market in the United States has exceeded $318 billion this year. Amazon is growing quickly The most disruptive force in the U.S. pharmacy sector is happening online, though. And Amazon is the primary player in this sector. Walgreens and the other national pharmacy chains are diversifying by providing such things as primary care doctor offices and health insurance. Can the brick-and-mortar shops realistically compete? According to a Zion Market Research report, the global e-pharmacy market was more than $42 billion in 2018 and is expected to generate more than $107 billion by 2025. PillPack, which is now called “PillPack by Amazon Pharmacy,” represents a direct threat to Walgreens, CVS, and Walmart. CVS making waves CVS made a splash in 2018 when it finalized the purchase of the Aetna insurance company for $69 billion. CVS also announced last year that it will expand its Houston-based, wellness-focused HealthHUB clinics in 50 additional markets, including Philadelphia, southern New Jersey, and Tampa, Florida, by the end of 2021.  The HealthHUB model is focused largely on chronic disease management, offering services such as blood draws and sleep apnea assessments. “Improving health outcomes starts with transforming the consumer health experience, connecting with people in their communities,” Dr. Alan Lotvin, the chief transformation officer for CVS Health, said in a statement. “Our HealthHUBs in Houston are generating tremendously positive customer response. The opportunity to engage with a team of in-store and remote colleagues, including pharmacists, nurse practitioners, care managers and support staff resonates with consumers. We’re thrilled to be creating this seamless, long overdue experience that consumers want,” Lotvin said. Walmart moving forward As Healthline reported last year, Walmart positioned itself as an official player in the primary care health market when it announced its first Walmart Health Clinic in Georgia. Unlike the company’s previously opened clinics, Walmart Health employs physicians along with nurse practitioners and other medical professionals. Walmart officials announced this month that they’re expanding their health superstore network into Florida next year. Walmart currently operates four large clinics, which include doctors and nurse practitioners, in Georgia and Arkansas. Walmart also plans to open additional health clinics in Georgia this year and will look into other locations, such as Chicago. Walgreens’ telehealth strategy Meanwhile, VillageMD and Walgreens are also showing a commitment to telehealth. The companies announced earlier this year the availability of Village Medical telehealth providers on Walgreens Find Care, an online platform that connects consumers with a wide range of health services. Village Medical notes in a press release that it will be part of a “national network of telehealth providers, connecting patients with convenient and affordable access to quality care from computers and mobile devices.” This initiative coincides with guidance from the Centers for Disease Control and Prevention (CDC) that encourages providers to address medical needs via telehealth, while also supporting physical or social distancing to minimize the spread of COVID-19. “As we continue to work through the COVID-19 pandemic, Village Medical is dedicated to ensuring all patients continue to receive personal, accessible and coordinated care,” Fields said. “Virtual visits are essential now, more than ever, to ensure the protection of providers, staff, and patients alike. We encourage all patients to leverage Find Care for everything from annual wellness visits to chronic condition follow-up,” Fields added.

  • COVID-19: How California Went from Model State to Hot Spot
    on August 5, 2020 at 1:26 am

    Experts say a major factor in California’s COVID-19 surge is that the people, especially in the southern part of the state, did not follow safety guidelines. Getty Images Experts say the surge in COVID-19 cases in California happened because businesses reopened too soon and people did not follow guidelines to prevent the spread of the disease.They note that Southern California is faring worse than Northern California.They say California may have to lock down again if the rollback measures instituted by the governor the past month do not stem the tide. Remember back in March when California was the envy of the nation? ‪It was the first state to issue a shelter-at-home order. ‪It moved quickly to shore up its equipment, personnel, and resources in light of dire predictions of a looming COVID-19 crisis. California was held up as something of a pandemic success story.‪  ‪But the accolades may have been premature. By Memorial Day, restrictions began to ease as restaurants and beaches opened back up. Not long after, the numbers began to move in the wrong direction. In a few short weeks, California went from model state to COVID-19 hot spot. ‪Now California has more than 467,000 confirmed COVID-19 cases, outpacing New York, the country’s one-time epicenter. Hospitalizations and death rates are also surging. ‪Last month California Governor Gavin Newsom issued an order mandating that people wear a mask when in public. In mid-July he began tightening the reins. He ordered a new statewide ban on indoor dining and movie theaters. Now 37 of California’s 58 counties are on the state’s watchlist and have even more severe restrictions. Churches and gyms as well as hair and nail salons had to shut back down in those counties. What went wrong? ‪Experts tell Healthline that even with its plan to open in phases, California likely reopened too quickly. However, the surges also had a lot to do with personal behavior.‪  ‪”The governor of California, the health departments of California, many doctors including me, many academics including me, expected that the California population would behave more responsibly than it has,” said Dr. John Swartzberg, FACP, a clinical professor in the division of infectious diseases and vaccinology at the University of California Berkeley-University of California San Francisco joint medical program. ‪”Somehow Californians don’t adequately understand we’re in a pandemic and how to act accordingly,” Swartzberg told Healthline.‪  ‪”The governor did come out strong and mandated things that were unpopular. But I wonder historically if we’re going to see that he may have succumbed to pressure,” added Dr. Mauricio Heilbron, a trauma surgeon and vice chief of staff at St. Mary Medical Center in Long Beach, California. ‪”I think the governor may have trusted his public a bit too much,” Heilbron told Healthline. ‪”Opening up the bars was not a good idea. People packed the bars. There were parties and gatherings with no social distancing. Frat parties with nobody wearing masks,” noted ‪George Lemp, DrPH, an infectious disease epidemiologist and former director of the California HIV/AIDS Research Program at the University of California. ‪”Backyard barbecues and indoor family parties are happening, and people aren’t wearing masks,” Lemp told Healthline. ‪”And when the surge came, we didn’t have the needed testing capacity and contact tracing sufficiently in place,” he said. “The testing and contact tracing just couldn’t keep up.” Southern Cal is driving the numbers ‪The experts say Southern California accounts for most of the COVID-19 cases. Lemp crunched the numbers using data from the California Department of Public Health.‪  ‪”Most of the cases, 68 percent, are coming from the Southland. The number one county is Los Angeles,” he explained. ‪”Why is Southern California doing so much worse than Northern California? Both are not doing well, but there is a big discrepancy in the state,” said Swartzberg. ‪”It’s difficult to speak to that, with the exception that in Northern California, culturally more people responded appropriately to public health dicta than Southern California,” he added. “Particularly in places like Orange County.” ‪Last month Orange County’s chief health officer resigned after receiving security threats in the midst of a controversy over her order to wear masks in public. ‪The county’s board of education has voted to reopen schools in the fall but not require masks or physical distancing. ‪”That’s utter madness,” said Heilbron. “As the father of a 17-year-old boy headed to high school, this is acutely personal to me.”‪  How California can flatten the curve ‪”We are in trouble and nobody’s doing anything about it right now. There is all this talk about shutting down again,” Heilbron said. “Let’s quit talking about it. It should have been done 10 to 14 days ago.” ‪Lemp says he doesn’t believe shutting back down is the answer. ‪”I think the number one thing would be if we can have people get effective masks and wear them properly, then they could move about,” he said. ‪Swartzberg says the state may have to wait a bit to see if the governor’s dialing back has worked. ‪”If what he did isn’t helping within the next week or two, he’s going to have to shut down the state,” he said. “If not, we will have more lives lost. Those are our choices.” ‪”This pandemic is a once in a century phenomenon. Everybody wants baseball, football, and other professional sports,” Swartzberg added. “Everybody wants the world to be what it was before the pandemic, but it’s not.” ‪  ‪  ‪ 

  • Many COVID-19 Patients Will Need Rehab Long After Infection Is Over
    on August 5, 2020 at 1:26 am

    Testing sites for COVID-19 are reaching capacity. Getty Images A March study published in the journal Lancet found that hospitalized survivors from China experienced a myriad of ailments after having COVID-19.About 42 percent had sepsis, 36 percent had respiratory failure, 12 percent had heart failure, 7 percent experienced acute respiratory distress syndrome, and 7 percent had problems with blood clotting.Experts are learning now what kind of rehab these patients will need to fully recover. New research has found that the novel coronavirus can affect a variety of bodily systems in addition to the lungs. As a result, survivors may have to deal with a wide range of ailments long after the virus has passed. It can take 6 weeks or longer for patients in critical condition to fully recover, the World Health Organization reported. Those who were treated in the ICU may need help gaining mobility again even after the virus has left their system. Even those never hospitalized for COVID-19 may need to go to rehab to help their injured lungs recover. Symptoms linger after virus has passed A March study published in journal Lancet found that hospitalized survivors from China experienced a myriad of ailments after having COVID-19. Of the survivors, just 1 percent were put on ventilators. Still, 42 percent had sepsis, 36 percent had respiratory failure, 12 percent had heart failure, 7 percent experienced acute respiratory distress syndrome, and 7 percent had problems with blood clotting.  In the United States, the issues could be worse since a higher percentage of people are put on ventilators for longer stretches of time. A July 2020 multi-state survey conducted by the Centers for Disease Control and Prevention (CDC) looked at symptomatic adults who tested positive for COVID-19 on an outpatient basis. Of them, 35 percent were not back to their usual health at 2 to 3 weeks after testing. Among those ages 18 to 34 with no chronic medical issues, 1 in 5 reported they were not fully recovered. How an ICU stay can affect the brain Doctors typically focus on improving physical strength and respiratory function in those were hospitalized. Lung, liver, gastrointestinal, kidney, and respiratory issues are common side effects of the coronavirus, especially in those who were older or had severe cases. But they aren’t the only issues survivors face. “After having COVID-19, it’s very difficult for some patients to think clearly, to process things,” said Dr. E. Wesley Ely, co-director of the Vanderbilt University Medical Center’s Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center in Nashville, Tennessee. The center studies intensive care unit (ICU) patients to understand the effects of delirium, which causes vivid hallucinations and delusions. Many patients have a hard time with executive functions such as paying attention and organizing information. The CIBS Center has several studies looking at COVID-19’s effect on cognitive function, depression, post-traumatic stress disorder, brain health, and more. The center is also evaluating a new drug for ICU delirium. Patients with COVID-19 can remain in an ICU far longer than the average of 3 to 4 days. Physicians report patients being on ventilators in the ICU for weeks or even months in some cases. This puts them at a greater risk for post-intensive care syndrome (PICS), which is characterized as the physical, cognitive, and psychological changes that happen after an ICU stay. Doctors are seeing PICS in COVID-19 survivors who were hospitalized — and in those who were not. Delirium is sometimes seen with patients who need ventilators or sedation, but “anecdotally, the delirium has appeared worse for many patients with COVID-19,” Katharine Seagly, PhD, a clinical neuropsychologist and an assistant professor of physical medicine and rehabilitation at Michigan Medicine, noted in a statement. The mental toll of a serious illness Depression and sadness are common in people with PICS, but Ely is seeing it in COVID-19 survivors, who also report trauma and nightmares. “All of these can happen to people who weren’t ever hospitalized,” Ely said. “It’s worse if you were.” Some mental health issues may be due to isolation many survivors faced, but there may be biological links to blame. Even minor symptoms of the disease can take a toll. Loss of taste and smell is a common symptom of the virus, and usually returns quickly — but not always. “I’ve heard of some who got them back within a week, others still haven’t recovered after more than three months,” said Dr. Otto Yang, a physician at UCLA Health. Rehabilitating after COVID-19 As a result of the ailments, many coronavirus survivors will need rehabilitation. But with a variety of conditions that can arise from a serious viral infection, people may need help from a variety of specialists including physical therapists, occupational therapists, speech therapists, and rehabilitation psychologists. “The complexity and variability of the damage caused by COVID-19, coupled with the pre-existing disabling long-term conditions that many patients will have, means that there is no single, COVID-19 specific method to determine the need for rehabilitation,” Dr. Derick Wade, a neurorehabilitation professor at Oxford Brookes University and author of a report on post-COVID-19 rehabilitation wrote in Clinical Medicine Journal. Patients who stayed in an ICU may have physical weakness, which can damage the nerves and muscles in the body, Dr. Sean Smith, an assistant professor of physical medicine and rehabilitation at Michigan Medicine, said in a statement. That can make it hard to walk or do everyday activities, and they wind up needing rehabilitation. Ely said weakness is common in those even without severe cases, or those without symptoms. Some hospitals have rehabilitation teams dedicated to helping coronavirus patients, such as the program at Massachusetts General in Boston. They are focused on getting the patients up and moving as soon as possible to offset issues from being immobile. “Bed rest is one of the worst things that can happen to the body’s musculoskeletal and nervous systems,” Smith said. Inpatients being treated for COVID-19 should be mobilized as soon as it’s safe, he noted. “We know from other diseases that cause ICU-level hospitalizations and neurologic disorders that the more — and earlier — rehabilitation occurs, the better the outcome,” Smith added. Jason Kindrachuk, PhD, an assistant professor of viral pathogenesis at the University of Manitoba in Canada, said doctors don’t know much about long-term recovery from COVID-19. “Unfortunately we are still in the early stages of COVID-19 in North America and recovered patients from the first waves of transmission are still providing early information on what recovery from COVID-19 looks like,” Kindrachuk told Healthline. With the outbreak less than a year old, even experts are at a loss for what long-term issues will occur for people who recovered from early cases of COVID-19. Amira A. Roess, PhD, a global health and epidemiology professor at George Mason University, said evidence from the SARS infection showed patients had long-term respiratory issues and other ailments. That data can help us understand COVID-19, but it will still take time for experts to understand exactly the long-term consequences of COVID-19. “There are long-term consequences of this disease that we simply won’t know about for a few more years,” Dr. Roess added.

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