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Millions of people are prescribed antidepressants for chronic pain. Do they work? | CNN

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CNN
—

Around one-third of people globally live with chronic pain — pain experienced for more than three months — and millions of people are prescribed antidepressants to relieve the condition.

However, a new review of prior research published Tuesday has found that most antidepressants used to relieve chronic pain are being prescribed without sufficient reliable evidence of their effectiveness. What’s more, potential harms haven’t been well studied.

A two-year study by the nonprofit group Cochrane found that only one antidepressant, duloxetine, was effective for short-term pain relief based on the available evidence. Cochrane is an international collaboration of researchers that produces the Cochrane Library, which includes a database of systematic summaries addressing key questions in health care.

Sold under the brand names Irenka and Cymbalta, duloxetine is a serotonin and norepinephrine reuptake inhibitor, or SNRI, and also boosts levels of the feel-good neurochemical dopamine.

“This is a global public health concern,” said lead author Tamar Pincus, a professor and chronic pain researcher at the University of Southampton in the United Kingdom.

“Chronic pain is a problem for millions who are prescribed antidepressants without sufficient scientific proof they help, nor an understanding of the long-term impact on health.”

The review included 176 studies with a total of 28,664 participants and looked at 25 different antidepressants. The studies mainly investigated three types of chronic pain: fibromyalgia, nerve pain and musculoskeletal pain.

The average length of the study was 10 weeks, and the studies were randomized controlled trials — regarded as the gold standard in medical research. Seventy-two of the studies were funded by pharmaceutical companies.

The most commonly prescribed antidepressant for chronic pain globally was amitriptyline, the study said. Sold in the United States under the brand names Elavil and Vanatrip, the antidepressant was approved in 1961 by the US Food and Drug Administration to treat depression in adults. The medication has significant side effects, so it is not commonly used for depression, but is prescribed to treat migraines and chronic pain such as diabetic neuropathy.

However, the authors found most of the studies on amitriptyline’s effectiveness were small and the evidence was not reliable.

Milnacipran, which is approved by the FDA for fibromyalgia, was also effective at reducing pain, the review found, but the scientists were not as confident about this drug compared with duloxetine due to limited studies with few people.

Anyone taking antidepressants for chronic pain relief should speak to their doctor before stopping their medication due to concerns over the new report, the authors stressed.

Antidepressants are thought to help with pain because the bodily systems that regulate mood and pain overlap, explained Ryan Patel, a research fellow studying chronic pain at the Wolfson Centre for Age-Related Diseases at King’s College London.

He said the key question for researchers to answer was not whether antidepressant drugs were effective for treating pain but “for whom are antidepressants effective?”

“Even when the cause of chronic pain is the same, the biological changes that occur in the nervous system are varied and so it is no surprise that pain presents differently from person to person, and not everyone will respond to the same drugs,” said Patel, who wasn’t involved in the review.

“What this comprehensive analysis demonstrates is that when clinical trials are designed poorly under the assumption that everyone’s experience of pain is uniform, most antidepressants appear to have limited use for treating chronic pain,” Patel added in a statement.

Even for the antidepressant duloxetine, there was no research looking at long-term use of the drug, the review found.

“Though we did find that duloxetine provided short-term pain relief for patients we studied, we remain concerned about its possible long-term harm due to the gaps in current evidence,” Pincus said.

The report said future research should address any unwanted effects of using antidepressants for chronic pain, noting that the existing data on this was “poor.”

“It (duloxetine) does look really good at the moment for short term pain relief, but I want to emphasize that patients aren’t prescribed duloxetine or any antidepressant for three weeks, four weeks, six weeks, they’re prescribed it for six months. So it’s really shocking that we don’t have any evidence for long term use of even duloxetine,” Pincus said.

Dr. Cathy Stannard, the clinical lead for the UK National Institute for Health and Care Excellence (NICE) guideline for chronic pain, and a pain specialist for NHS Gloucestershire’s Integrated Care Board in the UK, said that it was important to emphasize the social and psychological influences on how people experience pain and the importance of a patient’s relationship with their doctor.

“There is good evidence that for people with pain, compassionate and consistent relationships with clinicians remain the foundations of successful care,” Stannard, who wasn’t involved in the research, said in a statement.

“Research shows that what people want most is a strong, empathic relationship with their care provider. They want time to discuss what matters to them and they want easy access to support and to be partners in their care.”

Non-pharmaceutical interventions, such as support with mobility, debt management, trauma and social isolation, were also likely to help people living with pain, she added.

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Bacterial infection linked to recent baby formula shortage may join federal disease watchlist | CNN

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CNN
—

US health officials may soon ask states to notify them of any cases of infants with serious infections caused by Cronobacter sakazakii, bacteria that can contaminate infant formula.

Cronobacter infections typically strike infants who are less than 2 months old, and they can be fatal or permanently disabling.

In an outbreak that the US Centers for Disease Control and Prevention investigated last year, four babies were sickened, including two who died. All the infants had been fed baby formula manufactured at the same factory in Sturgis, Michigan, triggering an extensive investigation by the US Food and Drug Administration and ultimately stopping production at the facility for months. The shutdown worsened ongoing supply chain issues and threw the country into a nationwide shortage.

Ultimately, the FDA and the CDC could find no genetic links between Cronobacter samples from the facility and the bacteria found in the water and powder used to mix the formula that the infants had consumed.

These infections are thought to be infrequent, but the true burden in the US is unknown because Cronobacter is not currently part of the National Notifiable Diseases Surveillance System, a list of about 120 illnesses given special priority by the CDC because they’ve been deemed to be important to public health.

The Council of State and Territorial Epidemiologists, a nonprofit organization that advocates for effective disease surveillance, identified Cronobacter as a priority area for investigation this year.

A work group was formed in the winter to assess conditions, risks and surveillance processes related to the bacterial infection, and it will present recommendations to advance Cronobacter surveillance in June.

Adding Cronobacter infections to the national watchlist is among the strategies being considered.

“When we look back at large-scale outbreaks over the course of the last year, many of those outbreaks were associated with diseases and conditions that were nationally notifiable, but not all of them,” said Janet Hamilton, executive director of the council – and Cronobacter was one of the exceptions.

“So whenever we have something like that, that prompts the council to determine and assess whether we need to potentially be doing more.”

Adding an illness to the national list can have a sizable impact. After E. coli O157 was added to the notifiable disease list in 1994 and most states required doctors to report cases by 2000, the number of reported outbreaks tripled.

However, it would take quite some time for any changes to take effect.

If the Council of State and Territorial Epidemiologists votes in favor of adding Cronobacter infections to the national list of notifiable diseases, the recommendation will go to the CDC for approval. If the CDC deems an illness to be notifiable, it’s up to state and local governments to adjust their reporting laws and develop processes for doctors to report cases to health departments, which then forward those reports to the CDC.

The soonest that data collection could start is the beginning of 2024, and it would most likely be well into the year, depending on state legislative sessions.

Currently, only two states, Minnesota and Michigan, require doctors to report Cronobacter cases, which may be diagnosed more generically as sepsis or meningitis, conditions that can result from an infection.

“Unless detailed studies are done, the diagnosis as a Cronobacter illness may be missed,” FDA Commissioner Dr. Robert Califf wrote in a blog post last week. “The lack of mandatory reporting significantly hampers the ability to fully understand Cronobacter’s public health impact.”

Dr. Peter Lurie, executive director of the Center for Science in the Public Interest, applauded the potential move.

“I think it’s a necessary step. It is difficult to prevent diseases that you can’t count,” Lurie said.

In addition, Lurie says, manufacturers should be required to notify the FDA when a batch of baby formula tests positive for Cronobacter before it leaves the plant. The FDA has asked manufacturers to tell it about positive tests, but such reporting is voluntary.

Lurie says the FDA should also be doing more sampling and testing for Cronobacter in the environment to get a better understanding of where the bacteria can turn up.

“I think we have a lot to learn there,” he said.

Mitzi Baum, CEO of the group Stop Foodborne Illness, which has been advocating for the change, said she was grateful the Council of State and Territorial Epidemiologists was moving toward a vote on it.

She said greater awareness of the infection was long overdue.

“It’s always prefaced by ‘this is rare,’ but we don’t know how rare it is because it’s not reportable. And there needs to be a lot more education about this pathogen and a lot more research,” Baum said.

Baum said her group is working with the council to create an education campaign to raise awareness of the infection among doctors. The next step, she says, is getting funding.

The council’s Hamilton points out that “simply making something nationally notifiable doesn’t necessarily translate into awareness and recognition on the prevention side. If people don’t have the right set of information and education, by the time we’re doing public health surveillance for it, the disease or infection has already occurred.”

According to the FDA, Cronobacter sakazakii is a common natural pathogen that can enter homes and other spaces on hands, shoes and other contaminated surfaces. It is “especially good at surviving in dry foods,” such as powdered baby formula.

Infections are harmless for most people, but it can be life-threatening for infants, especially those who are born prematurely or with weakened immune systems. It’s particularly important to be sure that parents of high-risk infants know how to keep them safe, Hamilton said.

“Providing good education around how to stop infections is really what leads to the level of change that we would love to see,” she said.

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Covid-19 Pandemic Timeline Fast Facts | CNN

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CNN
—

Here’s a look at the coronavirus outbreak, declared a worldwide pandemic by the World Health Organization. The coronavirus, called Covid-19 by WHO, originated in China and is the cousin of the SARS virus.

Coronaviruses are a large group of viruses that are common among animals. The viruses can make people sick, usually with a mild to moderate upper respiratory tract illness, similar to a common cold. Coronavirus symptoms include a runny nose, cough, sore throat, possibly a headache and maybe a fever, which can last for a couple of days.

WHO Situation Reports

Coronavirus Map

CNN’s early reporting on the coronavirus

December 31, 2019 – Cases of pneumonia detected in Wuhan, China, are first reported to WHO. During this reported period, the virus is unknown. The cases occur between December 12 and December 29, according to Wuhan Municipal Health.

January 1, 2020 – Chinese health authorities close the Huanan Seafood Wholesale Market after it is discovered that wild animals sold there may be the source of the virus.

January 5, 2020 – China announces that the unknown pneumonia cases in Wuhan are not SARS or MERS. In a statement, the Wuhan Municipal Health Commission says a retrospective probe into the outbreak has been initiated.

January 7, 2020 – Chinese authorities confirm that they have identified the virus as a novel coronavirus, initially named 2019-nCoV by WHO.

January 11, 2020 – The Wuhan Municipal Health Commission announces the first death caused by the coronavirus. A 61-year-old man, exposed to the virus at the seafood market, died on January 9 after respiratory failure caused by severe pneumonia.

January 17, 2020 – Chinese health officials confirm that a second person has died in China. The United States responds to the outbreak by implementing screenings for symptoms at airports in San Francisco, New York and Los Angeles.

January 20, 2020 – China reports 139 new cases of the sickness, including a third death. On the same day, WHO’s first situation report confirms cases in Japan, South Korea and Thailand.

January 20, 2020 – The National Institutes of Health announces that it is working on a vaccine against the coronavirus. “The NIH is in the process of taking the first steps towards the development of a vaccine,” says Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases.

January 21, 2020 – Officials in Washington state confirm the first case on US soil.

January 23, 2020 – At an emergency committee, WHO says that the coronavirus does not yet constitute a public health emergency of international concern.

January 23, 2020 – The Beijing Culture and Tourism Bureau cancels all large-scale Lunar New Year celebrations in an effort to contain the growing spread of coronavirus. On the same day, Chinese authorities enforce a partial lockdown of transport in and out of Wuhan. Authorities in the nearby cities of Huanggang and Ezhou Huanggang announce a series of similar measures.

January 28, 2020 – Chinese President Xi Jinping meets with WHO Director General Tedros Adhanom in Beijing. At the meeting, Xi and WHO agree to send a team of international experts, including US Centers for Disease Control and Prevention staff, to China to investigate the coronavirus outbreak.

January 29, 2020 – The White House announces the formation of a new task force that will help monitor and contain the spread of the virus, and ensure Americans have accurate and up-to-date health and travel information, it says.

January 30, 2020 – The United States reports its first confirmed case of person-to-person transmission of the coronavirus. On the same day, WHO determines that the outbreak constitutes a Public Health Emergency of International Concern (PHEIC).

January 31, 2020 – The Donald Trump administration announces it will deny entry to foreign nationals who have traveled in China in the last 14 days.

February 2, 2020 – A man in the Philippines dies from the coronavirus – the first time a death has been reported outside mainland China since the outbreak began.

February 3, 2020 – China’s Foreign Ministry accuses the US government of inappropriately reacting to the outbreak and spreading fear by enforcing travel restrictions.

February 4, 2020 – The Japanese Health Ministry announces that ten people aboard the Diamond Princess cruise ship moored in Yokohama Bay are confirmed to have the coronavirus. The ship, which is carrying more than 3,700 people, is placed under quarantine scheduled to end on February 19.

February 6, 2020 – First Covid-19 death in the United States: A person in California’s Santa Clara County dies of coronavirus, but the link is not confirmed until April 21.

February 7, 2020 – Li Wenliang, a Wuhan doctor who was targeted by police for trying to sound the alarm on a “SARS-like” virus in December, dies of the coronavirus. Following news of Li’s death, the topics “Wuhan government owes Dr. Li Wenliang an apology,” and “We want freedom of speech,” trend on China’s Twitter-like platform, Weibo, before disappearing from the heavily censored platform.

February 8, 2020 – The US Embassy in Beijing confirms that a 60-year-old US national died in Wuhan on February 6, marking the first confirmed death of a foreigner.

February 10, 2020 – Xi inspects efforts to contain the coronavirus in Beijing, the first time he has appeared on the front lines of the fight against the outbreak. On the same day, a team of international experts from WHO arrive in China to assist with containing the coronavirus outbreak.

February 10, 2020 – The Anthem of the Seas, a Royal Caribbean cruise ship, sets sail from Bayonne, New Jersey, after a coronavirus scare had kept it docked and its passengers waiting for days.

February 11, 2020 – WHO names the coronavirus Covid-19.

February 13, 2020 – China’s state-run Xinhua News Agency announces that Shanghai mayor Ying Yong will be replacing Jiang Chaoliang amid the outbreak. Wuhan Communist Party chief Ma Guoqiang has also been replaced by Wang Zhonglin, party chief of Jinan city in Shandong province, according to Xinhua.

February 14, 2020 – A Chinese tourist who tested positive for the virus dies in France, becoming the first person to die in the outbreak in Europe. On the same day, Egypt announces its first case of coronavirus, marking the first case in Africa.

February 15, 2020 – The official Communist Party journal Qiushi publishes the transcript of a speech made on February 3 by Xi in which he “issued requirements for the prevention and control of the new coronavirus” on January 7, revealing Xi knew about and was directing the response to the virus on almost two weeks before he commented on it publicly.

February 17, 2020 – A second person in California’s Santa Clara County dies of coronavirus, but the link is not confirmed until April 21.

February 18, 2020 – Xi says in a phone call with British Prime Minister Boris Johnson that China’s measures to prevent and control the epidemic “are achieving visible progress,” according to state news Xinhua.

February 21, 2020 – The CDC changes criteria for counting confirmed cases of novel coronavirus in the United States and begins tracking two separate and distinct groups: those repatriated by the US Department of State and those identified by the US public health network.

February 25, 2020 – The NIH announces that a clinical trial to evaluate the safety and effectiveness of the antiviral drug remdesivir in adults diagnosed with coronavirus has started at the University of Nebraska Medical Center in Omaha. The first participant is an American who was evacuated from the Diamond Princess cruise ship docked in Japan.

February 25, 2020 – In an effort to contain the largest outbreak in Europe, Italy’s Lombardy region press office issues a list of towns and villages that are in complete lockdown. Around 100,000 people are affected by the travel restrictions.

February 26, 2020 – CDC officials say that a California patient being treated for novel coronavirus is the first US case of unknown origin. The patient, who didn’t have any relevant travel history nor exposure to another known patient, is the first possible US case of “community spread.”

February 26, 2020 – Trump places Vice President Mike Pence in charge of the US government response to the novel coronavirus, amid growing criticism of the White House’s handling of the outbreak.

February 29, 2020 – A patient dies of coronavirus in Washington state. For almost two months, this is considered the first death due to the virus in the United States, until autopsy results announced April 21 reveal two earlier deaths in California.

March 3, 2020 – The Federal Reserve slashes interest rates by half a percentage point in an attempt to give the US economy a jolt in the face of concerns about the coronavirus outbreak. It is the first unscheduled, emergency rate cut since 2008, and it also marks the biggest one-time cut since then.

March 3, 2020 – Officials announce that Iran will temporarily release 54,000 people from prisons and deploy hundreds of thousands of health workers as officials announced a slew of measures to contain the world’s deadliest coronavirus outbreak outside China. It is also announced that 23 members of Iran’s parliament tested positive for the virus.

March 4, 2020 – The CDC formally removes earlier restrictions that limited coronavirus testing of the general public to people in the hospital, unless they had close contact with confirmed coronavirus cases. According to the CDC, clinicians should now “use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested.”

March 8, 2020 – Italian Prime Minister Giuseppe Conte signs a decree placing travel restrictions on the entire Lombardy region and 14 other provinces, restricting the movements of more than 10 million people in the northern part of the country.

March 9, 2020 – Conte announces that the whole country of Italy is on lockdown.

March 11, 2020 – WHO declares the novel coronavirus outbreak to be a pandemic. WHO says the outbreak is the first pandemic caused by a coronavirus. In an Oval Office address, Trump announces that he is restricting travel from Europe to the United States for 30 days in an attempt to slow the spread of coronavirus. The ban, which applies to the 26 countries in the Schengen Area, applies only to foreign nationals and not American citizens and permanent residents who’d be screened before entering the country.

March 13, 2020 – Trump declares a national emergency to free up $50 billion in federal resources to combat coronavirus.

March 18, 2020 – Trump signs into law a coronavirus relief package that includes provisions for free testing for Covid-19 and paid emergency leave.

March 19, 2020 – At a news conference, officials from China’s National Health Commission report no new locally transmitted coronavirus cases for the first time since the pandemic began.

March 23, 2020 – United Nations Secretary-General António Guterres calls for an immediate global ceasefire amid the pandemic to fight “the common enemy.”

March 24, 2020 – Japan’s Prime Minister Shinzo Abe and International Olympic Committee (IOC) president Thomas Bach agree to postpone the Olympics until 2021 amid the outbreak.

March 25, 2020 – The White House and Senate leaders reach an agreement on a $2 trillion stimulus deal to offset the economic damage of coronavirus, producing one of the most expensive and far-reaching measures in the history of Congress.

March 27, 2020 – Trump signs the stimulus package into law.

April 2, 2020 – According to the Department of Labor, 6.6 million US workers file for their first week of unemployment benefits in the week ending March 28, the highest number of initial claims in history. Globally, the total number of coronavirus cases surpasses 1 million, according to Johns Hopkins University’s tally.

April 3, 2020 – Trump says his administration is now recommending Americans wear “non-medical cloth” face coverings, a reversal of previous guidance that suggested masks were unnecessary for people who weren’t sick.

April 8, 2020 – China reopens Wuhan after a 76-day lockdown.

April 14, 2020 – Trump announces he is halting funding to WHO while a review is conducted, saying the review will cover WHO’s “role in severely mismanaging and covering up the spread of coronavirus.”

April 20, 2020 – Chilean health officials announce that Chile will begin issuing the world’s first digital immunity cards to people who have recovered from coronavirus, saying the cards will help identify individuals who no longer pose a health risk to others.

April 21, 2020 – California’s Santa Clara County announces autopsy results that show two Californians died of novel coronavirus in early and mid-February – up to three weeks before the previously known first US death from the virus.

April 28, 2020 – The United States passes one million confirmed cases of the virus, according to Johns Hopkins.

May 1, 2020 – The US Food and Drug Administration issues an emergency-use authorization for remdesivir in hospitalized patients with severe Covid-19. FDA Commissioner Stephen Hahn says remdesivir is the first authorized therapy drug for Covid-19.

May 4, 2020 – During a virtual pledging conference co-hosted by the European Union, world leaders pledge a total of $8 billion for the development and deployment of diagnostics, treatments and vaccines against the novel coronavirus.

May 11, 2020 – Trump and his administration announce that the federal government is sending $11 billion to states to expand coronavirus testing capabilities. The relief package signed on April 24 includes $25 billion for testing, with $11 billion for states, localities, territories and tribes.

May 13, 2020 – Dr. Mike Ryan, executive director of WHO’s health emergencies program, warns that the coronavirus may never go away and may just join the mix of viruses that kill people around the world every year.

May 19, 2020 – WHO agrees to hold an inquiry into the global response to the coronavirus pandemic. WHO member states adopt the proposal with no objections during the World Health Assembly meeting, after the European Union and Australia led calls for an investigation.

May 23, 2020 – China reports no new symptomatic coronavirus cases, the first time since the beginning of the outbreak in December.

May 27, 2020 – Data collected by Johns Hopkins University reports that the coronavirus has killed more than 100,000 people across the US, meaning that an average of almost 900 Americans died each day since the first known coronavirus-related death was reported nearly four months earlier.

June 2, 2020 – Wuhan’s Health Commission announces that it has completed coronavirus tests on 9.9 million of its residents with no new confirmed cases found.

June 8, 2020 – New Zealand Prime Minister Jacinda Ardern announces that almost all coronavirus restrictions in New Zealand will be lifted after the country reported no active cases.

June 11, 2020 – The United States passes 2 million confirmed cases of the virus, according to Johns Hopkins.

June 16, 2020 – University of Oxford scientists leading the Recovery Trial, a large UK-based trial investigating potential Covid-19 treatments, announce that a low-dose regimen of dexamethasone for 10 days was found to reduce the risk of death by a third among hospitalized patients requiring ventilation in the trial.

June 20, 2020 – The NIH announces that it has halted a clinical trial evaluating the safety and effectiveness of drug hydroxychloroquine as a treatment for the coronavirus. “A data and safety monitoring board met late Friday and determined that while there was no harm, the study drug was very unlikely to be beneficial to hospitalized patients with Covid-19,” the NIH says in a statement.

June 26, 2020 – During a virtual media briefing, WHO announces that it plans to deliver about 2 billion doses of a coronavirus vaccine to people across the globe. One billion of those doses will be purchased for low- and middle-income countries, according to WHO.

July 1, 2020 – The European Union announces it will allow travelers from 14 countries outside the bloc to visit EU countries, months after it shut its external borders in response to the pandemic. The list does not include the US, which doesn’t meet the criteria set by the EU for it to be considered a “safe country.”

July 6, 2020 – In an open letter published in the journal Clinical Infectious Diseases, 239 scientists from around the world urge WHO and other health agencies to be more forthright in explaining the potential airborne transmission of coronavirus. In the letter, scientists write that studies “have demonstrated beyond any reasonable doubt that viruses are released during exhalation, talking, and coughing in microdroplets small enough to remain aloft in air and pose a risk of exposure at distances beyond 1 to 2 meters (yards) from an infected individual.”

July 7, 2020 – The Trump administration notifies Congress and the United Nations that the United States is formally withdrawing from WHO. The withdrawal goes into effect on July 6, 2021.

July 21, 2020 – European leaders agree to create a €750 billion ($858 billion) recovery fund to rebuild EU economies ravaged by the coronavirus.

July 27, 2020 – A vaccine being developed by the Vaccine Research Center at the National Institutes of Health’s National Institute of Allergy and Infectious Diseases, in partnership with the biotechnology company Moderna, enters Phase 3 testing. The trial is expected to enroll about 30,000 adult volunteers and evaluates the safety of the vaccine and whether it can prevent symptomatic Covid-19 after two doses, among other outcomes.

August 11, 2020 – In a live teleconference, Russian President Vladimir Putin announces that Russia has approved a coronavirus vaccine for public use before completion of Phase 3 trials, which usually precedes approval. The vaccine, which is named Sputnik-V, is developed by the Moscow-based Gamaleya Institute with funding from the Russian Direct Investment Fund (RDIF).

August 15, 2020 – Russia begins production on Sputnik-V, according to Russian state news agency TASS.

August 23, 2020 – The FDA issues an emergency use authorization for the use of convalescent plasma to treat Covid-19. It is made using the blood of people who have recovered from coronavirus infections.

August 27, 2020 – The CDC notifies public health officials around the United States to prepare to distribute a potential coronavirus vaccine as soon as late October. In the documents, posted by The New York Times, the CDC provides planning scenarios to help states prepare and advises on who should get vaccinated first – healthcare professionals, essential workers, national security “populations” and long-term care facility residents and staff.

September 4, 2020 – The first peer-reviewed results of Phase 1 and Phase 2 clinical trials of Russia’s Covid-19 vaccine are published in the medical journal The Lancet. The results “have a good safety profile” and the vaccine induced antibody responses in all participants, The Lancet says.

October 2, 2020 – Trump announces that he and first lady Melania Trump have tested positive for Covid-19. He spends three nights at Walter Reed National Military Medical Center receiving treatment before returning to the White House.

October 12, 2020 – Drugmaker Johnson & Johnson announces it has paused the advanced clinical trial of its experimental coronavirus vaccine because of an unexplained illness in one of the volunteers.”Following our guidelines, the participant’s illness is being reviewed and evaluated by the ENSEMBLE independent Data Safety Monitoring Board (DSMB) as well as our internal clinical and safety physicians,” the company said in a statement. ENSEMBLE is the name of the study. The trial resumes later in the month.

December 10, 2020 – Vaccine advisers to the FDA vote to recommend the agency grant emergency use authorization to Pfizer and BioNTech’s coronavirus vaccine.

December 14, 2020 – US officials announce the first doses of the FDA authorized Pfizer vaccine have been delivered to all 50 states, the District of Columbia and Puerto Rico.

December 18, 2020 – The FDA authorizes a second coronavirus vaccine made by Moderna for emergency use. “The emergency use authorization allows the vaccine to be distributed in the U.S. for use in individuals 18 years and older,” the FDA said in a tweet.

January 14, 2021 – The WHO team tasked with investigating the origins of the outbreak in Wuhan arrive in China.

January 20, 2021 – Newly elected US President Joe Biden halts the United States’ withdrawal from WHO.

February 22, 2021 – The death toll from Covid-19 exceeds 500,000 in the United States.

February 27, 2021 – The FDA grants emergency use authorization to Johnson & Johnson’s Covid-19 vaccine, the first single dose Covid-19 vaccine available in the US.

March 30, 2021 – According to a 120-page report from WHO, the novel coronavirus that causes Covid-19 probably spread to people through an animal, and probably started spreading among humans no more than a month or two before it was noticed in December of 2019. The report says a scenario where it spread via an intermediate animal host, possibly a wild animal captured and then raised on a farm, is “very likely.”

April 17, 2021 – The global tally of deaths from Covid-19 surpasses 3 million, according to data compiled by Johns Hopkins.

August 3, 2021 – According to figures published by the CDC, the more contagious Delta variant accounts for an estimated 93.4% of coronavirus circulating in the United States during the last two weeks of July. The figures show a rapid increase over the past two months, up from around 3% in the two weeks ending May 22.

August 12, 2021 – The FDA authorizes an additional Covid-19 vaccine dose for certain immunocompromised people.

August 23, 2021 – The FDA grants full approval to the Pfizer/BioNTech Covid-19 vaccine for people age 16 and older, making it the first coronavirus vaccine approved by the FDA.

September 24, 2021 – CDC Director Dr. Rochelle Walensky diverges from the agency’s independent vaccine advisers to recommend boosters for a broader group of people – those ages 18 to 64 who are at increased risk of Covid-19 because of their workplaces or institutional settings – in addition to older adults, long-term care facility residents and some people with underlying health conditions.

November 2, 2021 – Walensky says she is endorsing a recommendation to vaccinate children ages 5-11 against Covid-19, clearing the way for immediate vaccination of the youngest age group yet in the US.

November 19, 2021 – The FDA authorizes boosters of the Pfizer/BioNTech and Moderna Covid-19 vaccines for all adults. The same day, the CDC also endorses boosters for all adults.

December 16, 2021 – The CDC changes its recommendations for Covid-19 vaccines to make clear that shots made by Moderna and Pfizer/BioNTech are preferred over Johnson & Johnson’s vaccine.

December 22, 2021 – The FDA authorizes Pfizer’s antiviral pill, Paxlovid, to treat Covid-19, the first antiviral Covid-19 pill authorized in the United States for ill people to take at home, before they get sick enough to be hospitalized. The following day, the FDA authorizes Merck’s antiviral pill, molnupiravir.

December 27, 2021 – The CDC shortens the recommended times that people should isolate when they’ve tested positive for Covid-19 from 10 days to five days if they don’t have symptoms – and if they wear a mask around others for at least five more days. The CDC also shortens the recommended time for people to quarantine if they are exposed to the virus to a similar five days if they are vaccinated.

January 31, 2022 – The FDA grants full approval to Moderna’s Covid-19 vaccine for those ages 18 and older. This is the second coronavirus vaccine given full approval by the FDA.

March 29, 2022 – The FDA authorizes a second booster of the Pfizer/BioNTech and Moderna Covid-19 vaccines for adults 50 and older. That same day, the CDC also endorses a second booster for the same age group.

April 25, 2022 – The FDA expands approval of the drug remdesivir to treat patients as young as 28 days and weighing about seven pounds.

May 17, 2022 – The FDA authorizes a booster dose of Pfizer/BioNTech’s Covid-19 vaccine for children ages 5 to 11 at least five months after completion of the primary vaccine series. On May 19, the CDC also endorses a booster dose for the same age group.

June 18, 2022 – The CDC recommends Covid-19 vaccines for children as young as 6 months.

August 31, 2022 – The FDA authorizes updated Covid-19 vaccine booster shots from Moderna and Pfizer. Both are bivalent vaccines that combine the companies’ original vaccine with one that targets the BA.4 and BA.5 Omicron sublineages. The CDC signs off on the updated booster shots the following day.

May 5, 2023 – The WHO says Covid-19 is no longer a global health emergency.

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Kids need to gain weight during adolescence. Here’s why | CNN

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Editor’s Note: Michelle Icard is the author of several books on raising adolescents, including “Fourteen Talks by Age Fourteen.”

CNN
—

I’ve worked with middle schoolers, their parents and their schools for 20 years to help kids navigate the always awkward, often painful, sometimes hilarious in hindsight, years of early adolescence.

Most of the social and development stretch marks we gain during adolescence fade to invisibility over time. We stop holding a grudge against the kid who teased us in class for tripping, or we forgive ourselves our bad haircuts, botched friendships and cringy attempts at popularity.

But one growing pain can be dangerously hard to recover from, and ironically, it’s the one that has most to do with our physical growth.

Children are supposed to keep growing in adolescence, and so a child’s changing body during that time should not be cause for concern. Yet it sends adults into a tailspin of fear around weight, health and self-esteem.

Kids have always worried about their changing bodies. With so many changes in such a short period of early puberty, they constantly evaluate themselves against each other to figure out if their body development is normal. “All these guys grew over the summer, but I’m still shorter than all the girls. Is something wrong with me?” “No one else needs a bra, but I do. Why am I so weird?”

But the worry has gotten worse over the past two decades. I’ve seen parents becoming increasingly worried about how their children’s bodies change during early puberty. When I give talks about parenting, I often hear adults express concern and fear about their children starting to gain “too much” weight during early adolescence.

Parents I work with worry that even kids who are physically active, engaged with others, bright and happy might need to lose weight because they are heavier than most of their peers.

Why are parents so focused on weight? In part, I think it’s because our national conversations about body image and disordered eating have reached a frenzy on the topic. Over the past year, two new angles have further complicated this matter for children.

Remember Jimmy Kimmel’s opening monologue at the Oscars making Ozempic and its weight-loss properties a household name? Whether it’s social media or the mainstream press, small bodies and weight loss are valued. It’s clear to young teens I know that celebrities have embraced a new way to shrink their bodies.

Constant messages about being thin and fit are in danger of overexposing kids to health and wellness ideals that are difficult to extract from actual health and wellness.

Compound this with the American Academy of Pediatrics recently changing its guidelines on treating overweight children, and many parents worry even more that saying or doing nothing about their child’s weight is harmful.

The opposite is true. Parents keep their children healthiest when they say nothing about their changing shape. Here’s why.

Other than the first year of life, we experience the most growth during adolescence. Between the ages of 13 and 18, most adolescents double their weight. Yet weight gain remains a sensitive, sometimes scary subject for parents who fear too much weight gain, too quickly.

It helps to understand what’s normal. On average, boys do most of their growing between 12 and 16. During those four years, they might grow an entire foot and gain as much as 50 to 60 pounds. Girls have their biggest growth spurt between 10 and 14. On average, they can gain 10 inches in height and 40 to 50 pounds during that time, according to growth charts from the US Centers for Disease Control and Prevention.

Boys do most of their growing between ages 12 and 16 on average. They may even grow an entire foot.

“It’s totally normal for kids to gain weight during puberty,” said Dr. Trish Hutchison, a board-certified pediatrician with 30 years of clinical experience and a spokesperson for the American Academy of Pediatrics, via email. “About 25 percent of growth in height occurs during this time so as youth grow taller, they’re also going to gain weight. Since the age of two or three, children grow an average of about two inches and gain about five pounds a year. But when puberty hits, that usually doubles.”

The American Academy of Pediatrics released a revised set of guidelines for pediatricians in January, which included recommendations of medications and surgery for some children who measure in the obese range.

In contrast, its 2016 guidelines talked about eating disorder prevention and “encouraged pediatricians and parents not to focus on dieting, not to focus on weight, but to focus on health-promoting behaviors,” said Elizabeth Davenport, a registered dietitian in Washington, DC.

“The new guidelines are making weight the focus of health,” she said. “And as we know there are many other measures of health.”

Davenport said she worries that kids could misunderstand their pediatricians’ discussions about weight, internalize incorrect information and turn to disordered eating.

“A kid could certainly interpret that message as not needing to eat as much or there’s something wrong with my body and that leads down a very dangerous path,” she said. “What someone could take away is ‘I need to be on a diet’ and what we know is that dieting increases the risk of developing an eating disorder.”

Many tweens have tried dieting, and many parents have put their kids on diets.

“Some current statistics show that 51% of 10-year-old girls have tried a diet and 37% of parents admit to having placed their child on a diet,” Hutchison said in an email, adding that dieting could be a concern with the new American Academy of Pediatrics guidelines.

“There is evidence that having conversations about obesity can facilitate effective treatment, but the family’s wishes should strongly direct when these conversations should occur,” Hutchison said. “The psychological impact may be more damaging than the physical health risks.”

It’s not that weight isn’t important. “For kids and teens, we need to know what their weight is,” Davenport said. “We are not, as dietitians, against kids being weighed because it is a measure to see how they’re growing. If there’s anything outstanding on an adolescent’s growth curve, that means we want to take a look at what’s going on. But we don’t need to discuss weight in front of them.”

In other words, weight is data. It may or may not indicate something needs addressing. The biggest concern, according to Davenport, is when a child isn’t gaining weight. That’s a red flag something unhealthy is going on.

“Obesity is no longer a disease caused by energy in/energy out,” Hutchison said. “It is much more complex and other factors like genetics, physiological, socioeconomic, and environmental contributors play a role.”

It’s important for parents and caregivers to know that “the presence of obesity or overweight is NOT an indication of poor parenting,” she said. “And it’s not the child or adolescent’s fault.”

It’s also key to note, Hutchison said, that the new American Academy of Pediatrics guidelines, which are only recommendations, are not for parents. They are part of a 100-page document that provides information to health care providers with clinical practice guidelines for the evaluation and treatment of children and adolescents who are overweight or obese. Medications and surgery are discussed in only four pages of the document.

Parents need to work on their own weight bias, but they also need to protect their children from providers who don’t know how to communicate with their patients about weight.

“Working in the field of eating disorder treatment for over 20 years, I sadly can’t tell you the number of clients who’ve come in and part of the trigger for their eating disorder was hearing from a medical provider that there was an issue or a concern of some sort with their weight,” Davenport said.

Hutchison said doctors and other health providers need to do better.

“We all have a lot of work to do when it comes to conversations about weight,” Hutchison said. “We need to approach each child with respect and without (judgment) because we don’t want kids to ever think there is something wrong with their body.”

The right approach, according to American Academy of Pediatrics training, is to ask parents questions that don’t use the word “weight.” One example Hutchison offered: “What concerns, if any, do you have about your child’s growth and health?” 

Working sensitively, Hutchison said she feels doctors can have a positive impact on kids who need or want guidance toward health-promoting behaviors.

Kids can misunderstand doctors' discussions about their weight and internalize incorrect information.

Davenport and her business partner in Sunny Side Up Nutrition, with input from the Carolina Resource Center for Eating Disorders, have gotten more specific. They have created a resource called Navigating Pediatric Care to give parents steps they can take to ask health care providers to discuss weight only with them — not with children.

“Pediatricians are supposed to ask permission to be able to discuss weight in front of children,” Davenport said. “It’s a parent’s right to ask this and advocate for their child.”

Davenport advises parents to call ahead and schedule an appointment to discuss weight before bringing in a child for a visit. She also suggests calling or emailing ahead with your wishes, though she admits it may be less effective in a busy setting. She said to print out a small card to hand to the nurse and physician at the appointment. You can also say in front of the child, “We prefer not to discuss weight in front of my child.” 

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The way the US government tracks Covid-19 is about to change | CNN

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CNN
—

When the US public health emergency ends May 11, the US Centers for Disease Control and Prevention will have to change some of the ways it tracks Covid-19 in the United States, but the agency says it won’t lose its sightlines on the infection as it continues to be part of American life.

On Thursday, for the first time in three years, the CDC will stop posting a national count of Covid-19 cases. The agency’s color-coded maps of county-level transmission and disease burden will be retired, the CDC will no longer track variants down to the state level, and it will update its genomic surveillance estimates every two weeks instead of weekly.

“Though our data going forward will be different, they will continue to provide timely insights for CDC, for local health officials, as well as for the public to understand Covid-19 dynamics,” CDC Principal Deputy Director Dr. Nirav Shah said.

“In short, we will still be able to tell that it’s snowing, even though we’re no longer counting every snowflake.”

Instead of following Covid-19 cases, the agency will track the burden and spread of disease primarily through hospitalizations and deaths.

The move to stop posting a national case count is largely symbolic. The number of Covid-19 cases known to public health officials has long been undercounted. The percent of detected cases has only fallen further as people have turned to rapid home testing for a diagnosis. At some points in the pandemic, experts estimated that the true number of cases was more than 14 times higher than official counts.

Other metrics that people are used to seeing on the CDC’s Covid Data Tracker are also going to go away. As CNN previously reported, the CDC will stop publishing detailed, color-coded Covid-19 Transmission Levels and Covid-19 Community Level maps that have been tied to recommendations about when to wear masks, when it’s a good idea for people to test to prevent the spread of disease and when to avoid large indoor public gatherings.

When the public health emergency ends, more states are expected to stop reporting Covid-19 cases to CDC. Iowa, for example, has already stopped. So the CDC says it won’t be feasible to maintain a national count or update its maps.

Future recommendations for precautions like masking will instead be tied to hospitalization levels.

Covid-19 will retain its designation as a nationally notifiable disease, but that’s just a recommendation, says Dr. Brendan Jackson, who leads the CDC’s Covid-19 response. It doesn’t carry any authority for required reporting. When the public health emergency ends, it will be a state-by-state decision whether to share those numbers, Jackson said Thursday.

The CDC says it will still publish the case counts it gets from states, but that will be in a different section of its website, and the numbers won’t be totaled.

Some experts say they’re disappointed to see that the CDC will have to go back to an older, fragmented system of having to ask states to share data.

“We’re kind of reverting back to a system where the CDC kind of independently negotiates all these data sharing agreements with the states and they make it more voluntary,” said Beth Blauer, associate vice provost for public sector innovation at Johns Hopkins University.

“I think having the states do this all independently doesn’t make a ton of sense because it doesn’t help us understand, in the aggregate, the impact that disease is having on our communities,” Blauer said.

She also said it will be very difficult to scale this system back up should another large, immediate public health threat emerge.

Starting next week, vaccination counts will become discretionary. Jackson said that most, but not all, of the 64 jurisdictions that report to the CDC have signed data use agreements to share their vaccine administration numbers. They may not share as much as they have in the past about who is getting vaccinated or do it as frequently, which may limit the nation’s ability to spot widespread racial, ethnic or socioeconomic disparities for future vaccination campaigns. Starting in June, the CDC says, it will update its vaccination data on a monthly basis.

Laboratories will no longer be required to send testing data to the CDC, which will hamper the ability to understand test positivity rates, a metric that, early in the pandemic, helped public health officials know whether they were doing enough testing or if transmission in a community was going up or down. Positivity rates were used in the transmission maps but also for the CDC’s tracking of variants.

The CDC will still get some lab testing data from another system called the National Respiratory and Enteric Virus Surveillance System, a network of about 450 labs that help it track illnesses like influenza and respiratory syncytial virus, or RSV.

Variant tracking will continue, but the CDC will have to adjust some of the metrics it uses to model variant proportions. State-level estimates of variant proportions with go away, but regional levels will remain. Those will be updated twice a month going forward instead of weekly, as they are now.

The way the CDC will collect data on deaths will change, too. Instead of scraping numbers from state website and getting direct reports from states, which counted deaths based on the date they were reported, the CDC will switch to a national system that counts deaths based on death certificate data. The agency says this system has become much more timely and will be a more stable way to count Covid-19 deaths going forward. It will also add a new metric to its death reporting: the percentage of all deaths reported that week that are caused by Covid-19.

Hospitals will still have to report Covid-19 data through April 2024, but they won’t track as many metrics or submit that information as frequently. Hospitals have shared information daily through most of the pandemic, but now that reporting will be weekly.

Hospitalizations and deaths are known as lagging indicators because they increase only after people have gotten sick. Studies released Friday from CDC epidemiologists show that hospitalizations may not lag behind cases as much as we once thought they did.

The new studies, published in the CDC’s Morbidity and Mortality Weekly Report, show that Covid-19 hospitalizations lagged one day behind increases in reported cases and four days behind increases in emergency room visits.

The research also shows that the new system the CDC will be using to track deaths will show trends 13 days earlier than data collected from states, the system that’s being discontinued.

With case levels low across most of the country, the need for these kinds of insights has gone away, or scientists have found other ways to get the information, such as testing of wastewater, which begins to increase about a week before testing data reflects an uptick in spread. Wastewater testing is available in some places, but not all areas have this capability.

The CDC will also maintain traveler surveillance, testing wastewater on airplanes in an effort to spot new incoming threats.

The CDC will also maintain what it calls sentinel systems: smaller, but nationally representative networks of hospitals and laboratories that will feed in more detailed data. This is much the same way the agency tracks patterns in other respiratory diseases, such as the flu and RSV. The CDC says recent investments in these sentinel systems will help it maintain eyes on Covid-19.

Instead, it will be using hospitalizations and emergency room visits as the primary ways it tracks Covid-19 and as the basis for its recommendations. When hospitalization rates in an area are high, for example, it will be recommending that people wear masks, said Jackson.

CDC Director Dr. Rochelle Walensky acknowledged some of these data changes in a Senate committee hearing this week, although she emphasized that the CDC was not “changing the steam” of its work on Covid-19.

“As the public health emergency is set to end next week, I do want to just reiterate that we at CDC are not changing the steam at which we are working through resolving this public health emergency,” Walensky said at a hearing of the Senate Committee on Health Education, Labor and Pensions.

“It is the case at the end of the public health emergency, we will have less window as to the data,” she said. “We won’t get laboratory reporting. We won’t get case reporting. So we’ll lose some of that.”

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‘You’re not alone’: CNN Heroes share advice for Mental Health Awareness Month | CNN

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Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call or text the 988 Suicide & Crisis Lifeline to connect with a trained counselor or visit the Lifeline site.

CNN
—

May is Mental Health Awareness Month, and this year it seems to coincide with a flurry of violent headlines. For many, this constant bad news adds to the stress of everyday life, which may already feel overwhelming.

According to the National Alliance on Mental Illness, each year in the US, one in five adults experience mental illness and one in six children aged 6 to 17 experience a mental health disorder. That’s millions of people. In 2021, less than half of adults received treatment.

America’s mental health crisis is having a widespread impact that touches everyone.

“One of the things that we underestimate as a society is how our global mental health impacts us as individuals. And we have seen it over and over again as we experience gun violence,” said Michele Neff Hernandez, a 2021 CNN Hero who has helped millions navigate grief and loss through her nonprofit Soaring Spirits. “We can see what happens when people don’t get the help they need; there can be tragic consequences.”

Neff Hernandez is one of many CNN Heroes who have found unique ways to help people with their mental health. Some of them marked Mental Health Awareness Month by sharing advice and insight with CNN’s Elizabeth Belanger about what is working for their communities. Below are edited versions of their conversations.

For Neff Hernandez, whose organization helps widowed people connect with each other in a community of support, it’s important for everyone to know they aren’t alone in their struggle. Mental illness is common, yet the stigma surrounding it is often a hurdle for people seeking the treatment they need.

Michele Neff Hernandez: When our body isn’t working well, going to a doctor to seek the cause or to help alleviate symptoms is considered normal and even responsible. Yet, when we are struggling with our mental health for any reason – including grieving a death, experiencing a traumatic event, even coping with the global and national crises that are a part of our daily narrative – we so often hesitate to seek mental health support. The pervasive stigmatizing narrative that implies that seeking mental health support shows weakness or that a mental illness or the breakdown of our mental health for any reason is something to be ashamed of has a significantly negative impact on our society, especially our young people.

We have to model good mental health care by learning about mental health with the same vigor we use to learn about physical health. Imagine if meditation were as popular as weight loss. Or if picking up your mood stabilizing medication was viewed in the same way as picking up your blood pressure medication. Normalizing caring for and seeking help with mental health is a gift we can give ourselves and the next generation. We all need mental health support at many times in our lives; what a gift it would be if accessing that help were viewed as just part of normal life.

We see this in grief all the time: No one wants to allow people to be sad. We seek to fix instead of listen. We pressure grieving people to “get over it” to make others more comfortable. We set the definition of success after a traumatic event as “returning to normal,” even when returning to a past normal is impossible. The truth is we are always changed by the challenges we overcome, and integrating what we’ve learned about ourselves in the aftermath is one of the key elements of building resilience. When we stigmatize mental health care, we create an environment that ensures that the people who most need help will suffer alone.

Annette March-Grier is a 2014 CNN Hero and the founder of Roberta’s House, a bereavement center in Baltimore, Maryland. Their programs reach more than 4,000 people of all ages each year. In 2021, the organization moved into a new state-of-the-art center where it hosts in-person support groups and serves people who are suffering all types of loss.

March-Grier stresses the importance of putting yourself first to enhance mental well-being.

Annette March-Grier: Everyone is looking for some kind of balance, yet few are finding it. Your state of mind is where it all begins. Make self-care a priority for your mental wellness. “Self-care is not selfish.” It is a truth that if you don’t take care of yourself, you will have nothing to give others. This includes healthy relationships that can be jeopardized because of stress, burnout, and lack of self-care. Your physical health is also connected to your mental health. Negative thoughts and suppression of these can cause dis-ease, and over time this leads to disease.

Self-care means taking time out for self, creating a gratitude list, journaling, dancing, laughing, breathing fully, smelling the fresh air, being aware of surroundings, being in the moment, enjoying the stillness when you can, taking time out for self, playing with your pet, exercising, reflecting on the past, dreaming about the future, eating healthy, helping someone in need. All of these self-care activities increase the body’s endorphins and bring on relaxation and balance.

Sports helped 2012 CNN Hero Scott Strode overcome his addiction to drugs and alcohol. He founded The Phoenix in 2007 to provide free athletic activities and a sober support community to others battling addiction. Today, the organization is in more than 200 communities nationwide with nearly 200,000 members.

Strode’s work focuses on the intersection of exercise and personal connection to benefit mental health.

Scott Strode: Social connection is a powerful tool for creating positive mental health. At The Phoenix, every day we see the profound impact that belonging and social connection has on our members’ confidence and overall well-being. Just spending a few minutes daily in the presence of others can be inherently powerful, and thankfully it is now easier than ever to make these vital connections.

Whether it’s getting together for an activity or just talking about challenges being faced, social connectivity can help us all overcome mental health challenges.

Exercise can also be a powerful tool to improve mental health. We encourage you to get out for a 15- to 30-minute walk or run and consider inviting a friend to join you. Sharing these physical activities with supportive peers can create the vulnerability to begin to share about what else you might be experiencing.

Service dogs are often a helpful tool for members of the military returning from deployment and afflicted by conditions like PTSD, depression, and anxiety. 2012 CNN Hero Mary Cortani’s nonprofit, Operation Freedom Paws, has helped nearly 600 veterans, first responders, and others train their own service dogs.

Cortani emphasizes that not all wounds are visible, and silence is not a treatment for mental illness.

Mary Cortani: If the world has taught me anything, it has taught me to remember to be kind, do not judge what you cannot see. Pain is invisible. With all the craziness going on every day, breathe. It is okay to feel down, to feel overloaded, overwhelmed, sad, frustrated. Try not to hold onto it. Seek help, talk to your family, friends, pastor, priest – talk to someone. And for those listening, really hear, pay attention, because sometimes the silence says more than the words. There is no shame to ask for help. It takes courage, and we all have it within us.

It takes all of us to realize mental health needs to be talked about, not buried under the rug. We need open, honest conversations; we have a mental health crisis in this country that is only getting worse as we become more divided. Fear only adds to it. Mental health doesn’t just affect veterans and first responders; it can affect everyone. Trauma is trauma, and enough repeated exposure changes the brain. There is hope, and there can be healing, but we all need to work together to help those who need our help.

We need to stop the silence surrounding mental health and model healthy behaviors so that we can assist with support and help guide towards resources. We are not in this alone, nor are those suffering from mental health issues.

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US government is testing avian flu vaccines for birds, but ending the historic outbreak isn’t that simple | CNN

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CNN
—

The United States is facing what some experts are calling “a new era for bird flu.”

Since January 2022, the country has been battling the biggest outbreak yet of highly pathogenic avian influenza in wildlife. The virus is a major threat to commercial and backyard flocks, and it has started to show up in hundreds of mammals, including a handful of pet cats.

The risk to humans is low; there has been only one human case of this virus in the US since the outbreak began, according to the US Centers for Disease Control and Prevention, and nine cases globally, mostly among people who work with birds. The CDC says there are trials underway of vaccines that could be used to protect humans in case the virus changes and becomes more of a threat.

Separately, the US Department of Agriculture, the US National Poultry Research Center and labs at a handful of American universities have been experimenting with vaccine candidates to be used in birds.

The USDA’s Agriculture Research Service started trials of four vaccine candidates for animals in April and expects to have initial data on a single-dose vaccine available this month. A two-dose vaccine challenge study – in which animals are exposed to the virus to see how well the vaccine works – should produce results in June.

If the animal vaccines look to be protective, the USDA’s next step would be to work with manufacturers on whether it would be feasible to use them.

One manufacturer, Zoetis, announced April 5 the development of a vaccine geared toward currently circulating virus strains. The company says it would take about a year to get to the distribution stage in the US.

Vaccines are already available in other countries, including China, Egypt, Indonesia, Italy, Mexico and Vietnam, and some nations are vaccinating their commercial flocks.

However, in the United States, not all poultry experts are ready to use a vaccine, even if one becomes available – at least, not yet. Instead, their focus remains on eradicating the virus.

As of April 26, the CDC says, nearly 58.8 million poultry have been affected by avian flu since January 2022. The virus has been detected in at least 6,737 wild birds, and the number is likely to be much higher. There have been poultry outbreaks in 47 states.

Although this is the worst outbreak in history, improved biosecurity measures have vastly reduced the number of cases in the commercial sector, according to the USDA. When the outbreak began in early 2022, there were 51 detections among commercial poultry. In March 2023, there were only seven.

The USDA says close surveillance work among its Animal and Plant Health Inspection Service (APHIS) and state and industry partners led to the reduction in cases.

Generally, there ares two ways of confronting this kind of highly infectious disease in poultry, according to Rodrigo Gallardo, a professor in poultry medicine and a specialist in avian virology at the University of California, Davis.

“One of them is through vaccination action. And then the other one is through eradication,” he said.

In the United States, the latter is the approach for now, Gallardo said.

If farmers detect even a single case in a flock, they will put down the birds right away.

“The virus keeps replicating and amplifying if the birds are alive, so the only way of stopping the replication and limiting the dissemination is by depopulation,” Gallardo said.

Tom Super, the senior vice president for communications for the National Chicken Council, the national trade association for the US broiler chicken industry, said in an email to CNN that although it supports the ongoing discussions about a vaccination program, “currently we support the eradication policy of APHIS and believe that right now this is the best approach at eliminating [bird flu] in the U.S.”

The US Poultry and Egg Association said it’s “certainly a topic of discussion,” but the organization doesn’t have a position on implementing a vaccination program.

A vaccination program comes with several complications, Gallardo said. Vaccinated birds would be protected, but with this highly infectious disease, they still could shed some virus that could infect unprotected birds.

“So vaccination, in that case, creates amplification if it is not done right,” Gallardo said.

Plus, it’s difficult to detect the disease in vaccinated birds. Birds that are vaccinated don’t always show signs if they’re sick, so it would be hard to know what birds to keep separate from the others. Tests also have a hard time telling the difference between antibodies generated by vaccination and antibodies from an infection.

“If you’re not able to diagnose it, it might spread more than what it would do if you are able to diagnose it and eradicate it,” Gallardo said.

Countries that have chosen the vaccination route see more endemic strains develop, meaning the virus is never really totally wiped out.

“This is a very variable virus, and if you don’t update the vaccine that you’re applying to meet the change in the virus, then you won’t be able to completely protect the birds. Partial protection means more birds will be spreading the virus,” Gallardo said.

A vaccine has never been used against highly pathogenic avian influenza in the US, according to the USDA. The agency created a vaccine after an outbreak in 2014 and 2015, but that involved a different strain, so it wouldn’t work on the latest version of the virus.

The logistics of a vaccine like this are difficult, said Dr. Yuko Sato, an associate professor in the College of Veterinary Medicine at Iowa State University.

“You have to make sure that the new vaccine will protect against this current virus and hope that it doesn’t mutate or change so that the vaccine will continue to be protective,” Sato said.

“The vaccine is not a silver bullet. This is not going to prevent infection of the birds, so in order to have an exit strategy as the country, you would have to make sure that if you vaccinate, if you still have positive birds, you have to be able to make sure that you could stamp out the virus. Otherwise, we’ll never be looking at eradicating the virus from the United States.”

Another concern: Birds are a big business in the US.

The US has the largest poultry industry in the world, with 294,000 poultry farms. The market size for chicken and turkey meat production alone for 2023 is projected to generate $57.8 billion, according to market analysis firm IbisWorld.

Bird flu has hurt business in the US, but it could do so in a bigger way if the nation vaccinates poultry, according to the National Chicken Council.

“The National Chicken Council does not support the use of a vaccine for [bird flu] for a variety of reasons – the primary one being trade. Most countries, including the US, do not recognize countries that vaccinate as free of [bird flu] due to concerns that vaccines can mask the presence of the disease. Therefore, they do not accept exports from countries that do vaccinate,” Super wrote in his email.

The US broiler industry is the second largest exporter of chicken in the world. It exports about 18% of the chicken meat produced in the United States, valued at more than $5 billion annually.

“If we start vaccinating for [bird flu] in the U.S., the broiler industry will lose our ability to export which will have a significant impact on the industry – while costing billions and billions of dollars to the U.S. economy every year,” Super said.

With the way the disease is spreading, scientists would also probably have to vaccinate wildlife – which is nearly impossible.

Of the birds affected in this outbreak, about 76% are commercial egg-laying hens, 17% are turkeys, and only 5% are broilers, the chickens used for meat, Super said. The rest of the cases have been among ducks, backyard chickens and game birds.

“So the U.S. poultry sector that least needs a vaccine would have the most to risk from using one,” he said.

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Regular internet use may be linked to lower dementia risk in older adults, study says | CNN

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CNN
—

If your parents or grandparents ask you how to post on Instagram or how to send a birthday message to a Facebook friend, a new study suggests you might want to help them – not just to be nice but because getting them online may help their brain health, too.

A study published Wednesday in the Journal of the American Geriatrics Society suggested that older people who regularly used the internet were less likely to develop dementia.

The researchers saw this association after about eight years tracking 18,154 adults between the ages of 50 and 65 who did not have dementia when the study period began.

The adults were a part of the Health and Retirement Study, a multidisciplinary collection of data from a representative sample of people in the US that is gathered by the National Institute on Aging and the Social Security Administration.

Each of the participants was asked a simple question: “Do you regularly use the World Wide Web, or the Internet, for sending and receiving e-mail or for any other purpose, such as making purchases, searching for information, or making travel reservations?”

People who used the internet at the start of the study had about half the risk of dementia as people who were not regular users.

The researchers also looked at how often these adults were online, from not at all to more than eight hours a day. Those who used the internet for about two hours or less a day had the lowest risk of dementia compared with those that didn’t use the internet, who had a “notably higher estimated risk.”

The researchers noted that people who were online six to eight hours a day had a higher risk of dementia, but that finding wasn’t statistically significant, they said, and more research is needed.

Scientists still don’t know what causes dementia, so the new research can’t pinpoint the exact connection between internet usage and brain health. Study co-author Dr. Virginia W. Chang has a few ideas.

“Online engagement may help to develop and maintain cognitive reserve, which can in turn compensate for brain aging and reduce the risk of dementia,” said Chang, an associate professor of global public health at New York University’s School of Global Public Health.

The study also did not look at what people were exploring online. Although the internet is full of cat videos and conspiracy theories, it can also be intellectually stimulating, and some studies have shown that intellectual stimulation may help prevent dementia. A 2020 study found an association between cognitively stimulating jobs and a lower risk of dementia, for example.

As people age, it’s natural for brain processing speeds to slow a little, and it may get harder to remember what’s on all those open browser tabs on your computer. But in a healthy brain, routine memory and knowledge remains pretty stable. People with dementia have trouble with routine brain functions like making new memories, solving problems and completing normal tasks.

About 6.2 million people 65 and older have Alzheimer’s disease, the most common form of dementia, the US Centers for Disease Control and Prevention says. That number is expected to grow exponentially as baby boomers age.

“Overall, this is important research. It identifies another potentially modifiable factor that might influence dementia risk,” said Dr. Claire Sexton, the Alzheimer’s Association’s senior director of scientific programs and outreach, who was not involved in the new study. “But we wouldn’t want to read too much into this study in isolation. It doesn’t establish cause and effect.”

Beyond medications, experts have been looking for ways to help people keep dementia at bay.

The Alzheimer’s Association is working on the US Pointer Study, a two-year clinical trial to pinpoint exactly what lifestyle interventions may lower a person’s risk of dementia.

Risk factors like family history and age can’t be changed, but scientists think there are some healthy behaviors that can reduce the risk of this kind of cognitive decline.

Lifestyle factors like exercise, getting enough sleep, maintaining a healthy weight, keeping blood pressure in check, managing blood sugar, quitting smoking and staying engaged with others may help. Internet surfing isn’t one of the official activities listed by the CDC, but the new study adds to the growing body of evidence that suggests more research could better establish this connection.

The new research isn’t the first to find that the use of the internet may help reduce cognitive decline. One 2020 study found only a smaller cognitive decline in male internet users. Others have not seen a gender difference.

In the latest study, the difference in risk between regular users and those who did not use the internet regularly did not vary by gender, level of education, or race or ethnicity.

Some studies have also shown a benefit to training older adults on computers and have suggested that the internet can positively connect them to others and help them learn information or skills.

Research also suggests that most older adults most frequently use the internet for basic tasks like email, news or online banking. But a growing number are learning newer social platforms like BeReal or dancing and singing on TikTok. And learning new skills may be protective against dementia, studies suggest.

Older adults’ use of social networking sites can also increase their connections to other people and reduce isolation. Some studies have shown that older people who were lonely were three times more likely to develop dementia than those who said they felt socially connected to others.

“We need further evidence, not just from observational studies like this one but also interventional studies,” Sexton said. That way, doctors might someday treat people for dementia like they do with heart disease: by suggesting lifestyle changes in addition to medication.

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Free Covid-19 tests aren’t guaranteed after May 11, but there’s still time to stock up | CNN

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CNN
—

When the US Covid-19 public health emergency ends this month, coronavirus tests will still be available, but there will be changes to who pays for them.

Questions remain about exactly what those coverage changes will look like, but the guarantee of free testing will be lost for many – and some costs may shift to become out-of-pocket.

There are still ways to take advantage of the benefits provided by the public health emergency before it expires May 11.

For the past two years, the federal government has required private insurance companies to cover up to eight Covid-19 tests each month. Packs of home tests can be found at pharmacies and other local retailers, and costs may be covered upfront or reimbursed by insurance plans.

The Biden administration launched COVIDtests.gov in January 2022 to allow US households to order free Covid-19 test kits to be delivered to home. The site is still up and running, with four free tests available to any household that hasn’t ordered since December.

Also, the US Food and Drug Administration has extended the expiration date for many home tests beyond what is printed on the box. Check the agency’s website before throwing them out.

“People should go out and ensure that they have tests available, because what we know about Covid is it’s quite pernicious, and clearly, people can get it more than once,” said Mara Aspinall, a professor at Arizona State University’s College of Health Solutions and a testing and diagnostics expert.

“It’s critical that people have the ability to test and then isolate or stay at home if they test positive.”

Once the public health emergency ends, Covid-19 tests – both home tests and laboratory tests – will be subject to cost sharing, in which costs of services are divided between the patient and their insurance plan.

Private insurers will no longer be required to cover the costs of testing. The federal government has encouraged continued coverage, but each company will ultimately be able to make their own decision. So far, details on those plans are scarce.

The Blue Cross Blue Shield Association told CNN that it’s evaluating the best way to keep members informed of changes. Moving into the next phase, coverage may include “reasonable limits” on tests.

“As COVID-19 becomes endemic, each Blue Cross and Blue Shield company is looking at how best to support access to diagnostic testing for COVID-19, just as is done for all other diagnostic testing,” said David Merritt, senior vice president of policy and advocacy for the Blue Cross Blue Shield Association. “We are committed to protecting patients from unnecessary costs, while ensuring they receive the care they need, when they need it.”

Aetna told CNN that it did not have any details to share. Cigna, Humana and UnitedHealthcare did not respond to multiple requests for comment.

Medicare Part B beneficiaries will continue to have coverage for lab tests when ordered by a provider, but the same will not apply for home tests.

For those on Medicaid plans, all tests will continue to be covered for free until the end of September 2024.

The US Centers for Disease Control and Prevention will also continue to support uninsured individuals and socially vulnerable communities “pending resource availability,” according to a roadmap outlined by the US Department of Health and Human Services.

There may be other avenues to free or cheap testing, too – perhaps through state and local governments or other programs.

Recently, for example, the North Carolina Department of Health and Human Services announced the expansion of a program that now allows all state residents to order free tests through June.

The Rockefeller Foundation, a private philanthropic organization, has also extended a public-private partnership program that works with states to get free tests to at-risk communities.

“The testing phenomenon during Covid changed many times,” Aspinall said.

It was a core focus at the beginning, but the priority then shifted to vaccines, she said. The initial Omicron wave brought a renewed interest in testing, and long waits for lab-based tests drove people to home tests.

“It put power and privacy in an individual consumer’s hand,” Aspinall said.

Millions of households took advantage of free Covid-19 tests provided by the federal government in the months after it launched, and a recent CDC report shows that the program helped to get kits to many who otherwise wouldn’t have tested and improved equity in testing overall.

About 60% of US households ordered a test kit from COVIDTests.gov, and nearly a third of all US households reported using at least one of those tests by April or May last year.

Nearly a quarter of people who reported using the government-provided tests said that they probably would not have tested for Covid-19 if not for the free kits, according to the report – suggesting that more than 13 million people took a Covid-19 test who otherwise wouldn’t have. More than 1 in 5 people who used their free tests reported at least one positive result.

Overall, use of the free test kits was similar across racial and ethnic groups. This is a “considerable difference” from other home test kits, where use was “highly inequitable,” according to the report. Black people were more likely than White people to use tests provided through COVIDTests.gov but 72% less likely than White people to use other at-home test kits.

Now, however, Covid-19 cases are a third of what they were a year ago, and hospitalizations and deaths are about as low as they’ve ever been. Testing rates have dropped significantly, too.

Along with the decreased transmission, the volume of testing may have dropped as people better understand what the course of an infection looks like, Aspinall said.

She estimates that people may use an average of one or two tests per incident, down from an average of five or six.

While Covid-19 “remains a public health priority,” the federal government says “we are in a better place in our response than we were three years ago, and we can transition away from the emergency phase.”

Still, experts agree that continued monitoring is key. Advancements in technologies like wastewater surveillance have helped supplement dwindling testing data, but testing will continue to be an important tool for individuals to keep themselves and their loved ones safe and healthy.

“The public health emergency may be over but Covid is not over,” Aspinall said.

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Breast density changes over time could be linked to breast cancer risk, study finds | CNN

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CNN
—

Breast density is known to naturally decrease as a woman ages, and now a study suggests that the more time it takes for breast density to decline, the more likely it is that the woman could develop breast cancer.

Researchers have long known that women with dense breasts have a higher risk of breast cancer. But according to the study, published last week in the journal JAMA Oncology, the rate of breast density changes over time also appears to be associated with the risk of cancer being diagnosed in that breast.

“We know that invasive breast cancer is rarely diagnosed simultaneously in both breasts, thus it is not a surprise that we have observed a much slower decline in the breast that eventually developed breast cancer compared to the natural decline in density with age,” Shu Jiang, an associate professor of surgery at Washington University School of Medicine in St. Louis and first author of the new study, wrote in an email.

Breast density refers to the amount of fibrous and glandular tissue in a person’s breasts compared with the amount of fatty tissue in the breasts – and breast density can be seen on a mammogram.

“Because women have their mammograms taken annually or biennially, the change of breast density over time is naturally available,” Jiang said in the email. “We should make full use of this dynamic information to better inform risk stratification and guide more individualized screening and prevention approaches.”

The researchers, from Washington University School of Medicine in St. Louis and Brigham and Women’s Hospital in Boston, analyzed health data over the course of 10 years among 947 women in the St. Louis region who completed routine mammograms. A mammogram is an X-ray picture of the breast that doctors use to look for early signs of breast cancer.

The women in the study were recruited from November 2008 to April 2012, and they had gotten mammograms through October 2020. The average age of the participants was around 57.

Among the women, there were 289 cases of breast cancer diagnosed, and the researchers found that breast density was higher at the start of the study for the women who later developed breast cancer compared with those who remained cancer-free.

The researchers also found that there was a significant decrease in breast density among all the women over the course of 10 years, regardless of whether they later developed breast cancer, but the rate of density decreasing over time was significantly slower among breasts in which cancer was later diagnosed.

“This study found that evaluating longitudinal changes in breast density from digital mammograms may offer an additional tool for assessing risk of breast cancer and subsequent risk reduction strategies,” the researchers wrote.

Not only is breast density a known risk factor for breast cancer, dense breast tissue can make mammograms more difficult to read.

“There are two issues here. First, breast density can make it more difficult to fully ‘see through’ the breast on a mammogram, like looking through a frosted glass. Thus, it can be harder to detect a breast cancer,” Dr. Hal Burstein, clinical investigator in the Breast Oncology Center at Dana-Farber Cancer Institute, who was not involved in the new study, said in an email. “Secondly, breast density is often thought to reflect the estrogen exposure or estrogen levels in women, and the greater the estrogen exposure, the greater the risk of developing breast cancer.”

In March, the US Food and Drug Administration published updates to its mammography regulations, requiring mammography facilities to notify patients about the density of their breasts.

“Breast density can have a masking effect on mammography, where it can be more difficult to find a breast cancer within an area of dense breast tissue,” Jiang wrote in her email.

“Even when you take away the issue of finding it, breast density is an independent risk factor for developing breast cancer. Although there is lots of data that tell us dense breast tissue is a risk factor, the reason for this is not clear,” she said. “It may be that development of dense tissue and cancer are related to the same biological processes or hormonal influences.”

The findings of the new study demonstrate that breast density serves as a risk factor for breast cancer – but women should be aware of their other risk factors too, said Dr. Maxine Jochelson, chief of the breast imaging service at Memorial Sloan Kettering Cancer Center in New York, who was not involved in the study.

“It makes sense to some extent that the longer your breast stays dense, theoretically, the more likely it is to develop cancer. And so basically, it expands on the data that dense breasts are a risk,” Jochelson said, adding that women with dense breasts should ask for supplemental imaging when they get mammograms.

But other factors that can raise the risk of breast cancer include having a family history of cancer, drinking too much alcohol, having a high-risk lesion biopsied from the breast or having a certain genetic mutation.

For instance, women should know that “density may not affect their risk so much if they have the breast cancer BRCA 1 or 2 mutation because their risk is so high that it may not make it much higher,” Jochelson said.

Some ways to reduce the risk of breast cancer include keeping a healthy weight, being physically active, drinking alcohol in moderation or not at all and, for some people, taking medications such as tamoxifen and breastfeeding your children, if possible.

“Breast density is a modest risk factor. The ‘average’ woman in the US has a 1 in 8 lifetime chance of developing breast cancer. Women with dense breasts have a slightly greater risk, about 1 in 6, or 1 in 7. So the lifetime risk goes up from 12% to 15%. That still means that most women with dense breasts will not develop breast cancer,” Burstein said in his email.

“Sometimes radiologists will recommend additional breast imaging to women with dense breast tissue on mammograms,” he added.

The US Preventive Services Task Force – a group of independent medical experts whose recommendations help guide doctors’ decisions – recommends biennial screening for women starting at age 50. The task force says that a decision to start screening earlier “should be an individual one.” Many medical groups, including the American Cancer Society and Mayo Clinic, emphasize that women have the option to start screening with a mammogram every year starting at age 40.

“It’s also very clear that breast density tends to be highest in younger women, premenopausal women, and for almost all women, it tends to go down with age. However, the risk of breast cancer goes up with age. So these two things are a little bit at odds with each other,” said Dr. Freya Schnabel, director of breast surgery at NYU Langone’s Perlmutter Cancer Center and professor of surgery at NYU Grossman School of Medicine in New York, who was not involved in the new study.

“So if you’re a 40-year-old woman and your breasts are dense, you could think about that as just being really kind of age-appropriate,” she said. “The take-home message that’s very, very practical and pragmatic right now is that if you have dense breasts, whatever your age is, even if you’re postmenopausal – maybe even specifically, if you are postmenopausal – and your breasts are not getting less dense the way the average woman’s does, that it really is a reason to seek out adjunctive imaging in addition to just mammography, to use additional diagnostic tools, like ultrasound or maybe even MRI, if there are other risk factors.”

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Tag: diseases and disorders

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Breast density changes over time could be linked to breast cancer risk, study finds | CNN