Tag: pandemic

COVID at 3 Years: Where Are We Headed?

Post By Health , , , , , , , , , , , , , , , , ,

March 15, 2023 – Three years after COVID-19 rocked the world, the pandemic has evolved into a steady state of commonplace infections, less frequent hospitalization and death, and continued anxiety and isolation for older people and those with weakened immune systems.

After about 2½ years of requiring masks in health care settings,  the CDC lifted its recommendation for universal, mandatory masking in hospitals in September 2022.

Some statistics tell the story of how far we have come. COVID-19 weekly cases dropped to nearly 171,000 on March 8, a huge dip from the 5.6 million weekly cases reported in January 2022. COVID-19 deaths, which peaked in January 2021 at more than 23,000 a week, stood at 1,862 per week on March 8.

Where We Are Now

Since Omicron is so infectious, “we believe that most people have been infected with Omicron in the world,” says Christopher J.L. Murray, MD, a professor and chair of health metrics sciences at the University of Washington and director of the Institute for Health Metrics and Evaluation in Seattle. Sero-prevalence surveys — or the percentage of people in a population who have antibodies for an infectious disease, or the Omicron variant in this case — support this rationale, he says.

“Vaccination was higher in the developed world but we see in the data that Omicron infected most individuals in low income countries,” says Murray. For now, he says, the pandemic has entered a “steady state.”

At New York University Langone Health System, clinical testing is all trending downward, and hospitalizations are low, says Michael S. Phillips, MD, an infectious disease doctor and chief epidemiologist at the health system. 

In New York City, there has been a shift from pandemic to “respiratory viral season/surge,” he says. 

The shift is also away from universal source control – where every patient encounter in the system involves masking, distancing, and more – to a focus on the most vulnerable patients “to ensure they’re well-protected,” Phillips says. 

Johns Hopkins Hospital in Baltimore has seen a “marked reduction” of the number of people coming to the intensive care unit because of COVID, says Brian Thomas Garibaldi, MD, a critical care doctor and director of the Johns Hopkins Biocontainment Unit.

“That is a testament to the amazing power of vaccines,” he says. 

The respiratory failures that marked many critical cases of COVID in 2020 and 2021 are much rarer now, a shift that Garibaldi calls “refreshing.”

“In the past 4 or 5 weeks, I’ve only seen a handful of COVID patients. In March and April of 2020, our entire intensive care unit – in fact, six intensive care units – were filled with COVID patients.”

Garibaldi sees his own risk differently now as well. 

“I am not now personally worried about getting COVID, getting seriously ill, and dying from it. But if I have an ICU shift coming up next week, I am worried about getting sick, potentially having to miss work, and put that burden on my colleagues. Everyone is really tired now,” says Garibaldi, who is also an associate professor of medicine and physiology in the Division of Pulmonary and Critical Care Medicine at Johns Hopkins University School of Medicine. 

What Keeps Experts Up at Night?

The potential for a stronger SARS-CoV-2 variant to emerge concerns some experts.  

A new Omicron  subvariant could emerge, or a new variant altogether could arise.  

One of the main concerns is not just a variant with a different name, but one that can escape current immune protections. If that happens, the new variant could infect people with immunity against Omicron. 

If we do return to a more severe variant than Omicron, Murray says, “then suddenly we’re in a very different position. 

Keeping an Eye on COVID-19, Other Viral Illnesses

We have better genomic surveillance for circulating strains of SARS-CoV-2 than earlier in the pandemic, Phillips says. More reliable, day-to-day data also helped recently with the respiratory syncytial virus (RSV) outbreak and for tracking flu cases.

 Wastewater surveillance as an early warning system for COVID-19 or other respiratory virus surges can be helpful, but more research is needed, Garibaldi says. And with more people testing at home, test positivity rates are likely an undercount. So, hospitalization rates for COVID and other respiratory illnesses remain one of the more reliable community-based measures, for now, at least. 

One caveat is that sometimes, it is unclear if COVID-19 is the main reason someone is admitted to the hospital vs. someone who comes in for another reason and happens to test positive upon admission. 

Phillips suggests that using more than one measure might be the best approach, especially to reduce the likelihood of bias associated with any single strategy. “You need to look at a whole variety of tests in order for us to get a good sense of how it’s affecting all communities,” he says. In addition, if a consensus emerges among different measures – wastewater surveillance, hospitalization and test positivity all trending up – “that’s clearly a sign that things are afoot and that we would need to modify our approach accordingly.”

Where We Could Be Heading

Murray predicts a steady pace of infection with “no big changes.” But waning immunity remains a concern. 

That means if you have not had a recent infection – in the last 6 to 10 months – you might want to think about getting a booster, Murray says “The most important thing for people, for themselves, for their families, is to really think about keeping their immunity up.” 

Phillips hopes the improved surveillance systems will help public health officials make more precise recommendations based on community levels of respiratory illness. 

When asked to predict what might happen with COVID moving forward, “I can’t tell you how many times I’ve been wrong answering that question,” Garibaldi says.

 Rather than making a prediction, he prefers to focus on hope. 

“We weathered the winter storm we worried about in terms of RSV, flu, and COVID at the same time. Some places were hit harder than others, especially with pediatric RSV cases, but we haven’t seen anywhere near the level we saw last year and before that,” he says. “So, I hope that continues.”

“We’ve come very far in just 3 years. When I think about where we were in March 2020 taking care of our first round of COVID patients in our first unit called a biocontainment unit,” Garibaldi says. 

Murray addresses whether the term “pandemic” still applies at this point. 

“In my mind, the pandemic is over,” he says, because we are no longer in an emergency response phase. But COVID in some form is likely to be around for a long time, if not forever.  

“So, it depends on how you define pandemic. If you mean an emergency response, I think we’re out of it. If you mean the formal definition you know of an infection that goes all over the place, then we’re going to be in it for a very long time.”

Source link

#COVID #Years #Headed

Pope Francis: 10 years of papacy in 10 points

Post By World , , , , ,

It was just after 7 pm local time on 13 March 2013 when Jorge Mario Bergoglio looked out from his balcony over St Peter’s Square and said in Italian: ‘Brothers and sisters, good evening’.

This was the beginning of Pope Francis’ journey. A papacy marked by memorable moments, landmark journeys and phrases that would rewrite history.

To mark his 10th anniversary as head of the Roman Catholic Church here are ten of the most salient events of Bergoglio’s pontificate:

Alone in St Peter’s Square

On 27 March 2020, Pope Francis presided over a moment of prayer on the parvis of St Peter’s Basilica. In front of him, was an unusually empty square. A fortnight prior, the World Health Organization declared a pandemic and the whole of Italy went into lockdown. 

Francis prayed: “Lord, bless the world, give health to bodies and comfort to hearts,” he said before the adoration of the Blessed Sacrament and the Urbi et Orbi blessing.

The Pope of migrants

 “I felt I had to come here to pray”. With these words, Pope Francis began his homily at the Lampedusa stadium on 8 July 2013, for his first pastoral journey outside of Rome. 

Even then, the pontiff’s message was clear: “The globalisation of indifference has robbed us of the ability to weep. We ask forgiveness for our indifference”. And it was certainly not indifference that prompted him to take with him on the return flight from the Greek island of Lesbos, twelve refugees, who were hosted in Rome by the Catholic lay association, Sant’Egidio, in 2016.

The Vatican went on to host several families of migrants.

The Pope and women

 “A better, more just, inclusive and fully sustainable world cannot be pursued without the contribution of women,” wrote the pontiff in his preface to the book ‘More Women’s Leadership for a Better World’.

 According to a survey conducted by Vatican News, 1,165 women currently work in the Vatican, the highest number of female employees to ever work at the Holy See. 

At the beginning of Francis’ pontificate, there were 846. At the Dicastery for the Service of Integral Human Development, a female secretary was appointed for the first time in 2021, the highest position ever held by a woman at the Holy See.

Prayer at the Wailing Wall

 On 26 May 2014, just over a year after his election, Pope Francis visited Jerusalem. “Let no one instrumentalise the name of God for violence, but let us work together for justice and peace,” he said in the Holy City. 

He first met Grand Mufti Muhammad Ahmad Hussein on the Esplanade of the Mosques, a place sacred to Islam, then embraced the Argentinean Imam Aboud and the Buenos Aires rabbi Skorka at the Wailing Wall, where he stopped for a moment of prayer. 

Finally, he went to Mount Herzl, to visit the tomb containing the remains of the founder of the Zionist Movement and the Yad Vashem Holocaust memorial.

The trip to Congo and South Sudan

For his 40th apostolic journey, Pope Francis travelled from January 31 to February 5 to the Democratic Republic of Congo and South Sudan.

In Juba, Francis invited the population to “overcome those antipathies and aversions that, over time, have become chronic and risk pitting tribes and ethnic groups against each other”. 

Meeting with the authorities he asked: “No more bloodshed, no more conflict, no more violence and mutual accusations on those who commit them, no more leaving the people thirsting for peace”.

 Previously in Kinshasa, he had said “Hands off Africa! No more suffocating it: it is not a mine to be exploited or a land to be plundered”.

The penitential pilgrimage to Canada

In May 2021, the remains of 215 children are found in a mass grave on the grounds of a former Indian residential school in British Colombia.

A scandal soon emerged involving schools founded by the Canadian government in the 19th century and administered by the Catholic Church.

Under the 1876 Indian Act and the Indian Residential School System (IRSS) institutions removed the Indigenous children from their communities in a bid to replace Indigenous languages, culture and identity with Euro-Canadian values. 

In July 2022, Bergoglio visited Indigenous children and asked for forgiveness: “I am deeply saddened, I feel indignation and shame. I ask forgiveness for the ways in which, unfortunately, many Christians have supported the colonising mentality of the powers that have oppressed the Indigenous peoples”.

The washing of the feet

It was on March 28, 2013, two weeks after his election, when Bergoglio choose the juvenile prison of Casal del Marmo, Rome for maundy or the washing of the feet. 

Fifty young inmates, including girls, participate in the rite, letting the Pope wash their feet, dry them and kiss them. 

He later repeated the action in other prisons, centres for the disabled and migrant centres. According to his Holiness, it has always been an act of love, to repeat what Jesus did with his disciples in the Gospel.

“Who am I to judge?”

On a return flight from Brazil in July 2013, Pope Francis spoke about homosexuality: “The problem is lobbying of any tendency: political lobbying, Masonic lobbying and also gay lobbying. All lobbies are not good. Whereas if one is gay and seeks the Lord, who am I to judge him? These people should not be discriminated against or marginalised”. 

Ten years later, in an interview with the Associated Press, he crystallised the laws of states that criminalise homosexuality, calling them unjust. 

He urged Catholic bishops to welcome LGBTQ people into the Church. “Homosexuality is not a crime,” he said.

The Synod for the Pan-Amazonian Region

 The Synod for the Amazon opened in Rome on 6 October 2019, a major ecclesial, civil and ecological project which aimed to cross borders and redefine pastoral lines, adapting them for the modern age.

 The main objective, to use the pontiff’s words, was to “find new ways to evangelise to rural communities, particularly Indigenous groups, who are often forgotten about and without the prospect of a serene future, also because of the crisis of the Amazon forest, a lung of fundamental importance for our planet”.

Impromptu wedding

On a flight from the Chilean cities of Santiago to Iquique in January 2018, Francis surprisingly married a couple onboard. Two stewards with Latam Airlines had a civil ceremony but were forced to cancel their religious wedding because the church they had chosen had collapsed in the 2010 earthquake. Bergoglio decided to marry the pair himself.

While his Holiness is widely praised for his progressive views, his pontificate is also marred with several scandals, such as the disgraced Cardinal Angelo Becciu’s corruption trial or the more recent revelations of sexual abuse within the Portuguese Catholic Church.

Source link

#Pope #Francis #years #papacy #points

‘Breakthrough’ Study: Diabetes Drug Helps Prevent Long COVID

Post By Health , , , , , ,

March 9, 2023 – Metformin appears to play a role in preventing long COVID when taken early during a COVID-19 infection, according to a new preprint study from The Lancet. The preprint hasn’t yet been peer-reviewed or published in a journal.

In particular, metformin led to a 42% drop in long COVID among people who had a mild to moderate COVID-19 infection. 

“Long COVID affects millions of people, and preventing long COVID through a treatment like metformin could prevent significant disruptions in people’s lives,” says lead author Carolyn Bramante, MD, an assistant professor of internal medicine and pediatrics at the University of Minnesota.

Between January 2021 and February 2022, Bramante and colleagues tested three oral medications – metformin (typically used to treat type 2 diabetes), ivermectin (an antiparasitic), and fluvoxamine (an antidepressant) – in a clinical trial across the U.S. called COVID-OUT. The people being studied, investigators, care providers, and others involved in the study were blinded to the randomized treatments. The trial was decentralized, with no in-person contact with participants.

The researchers included patients who were ages 30-85 with overweight or obesity, had documentation of a confirmed COVID-19 infection, had fewer than 7 days of symptoms, had no known prior infection, and joined the study within 3 days of their positive test. The study included monthly follow-up for 300 days, and participants indicated whether they received a long COVID diagnosis from a medical doctor, which the researchers confirmed in medical records after participants gave consent.

The medications were pre-packaged into pill boxes for fast delivery to participants and to ensure they took the correct number of each type of pill. The packages were sent via same-day courier or overnight shipping.

The metformin doses were doled out over 14 days: with 500 milligrams on the first day, 500 milligrams twice a day for the next 4 days, and then 500 milligrams in the morning and 1,000 milligrams in the evening for the remaining 9 days.

Among the 1,323 people studied, 1,125 agreed to do long-term follow-up for long COVID, including 564 in the metformin group and 561 in the blinded placebo group. The average age was 45, and 56% were women, including 7% who were pregnant. 

The average time from the start of symptoms to starting medication was 5 days, and 47% began taking the drug within 4 days or less. About 55% had received the primary COVID-19 vaccination series, including 5.1% who received an initial booster, before enrolling in the study.

Overall, 8.4% of participants reported that a medical provider diagnosed them with long COVID. Of those who took metformin, 6.3% developed long COVID, compared to 10.6% among those who took the identical-matched placebo.

The risk reduction for metformin was 42% versus the placebo, which was consistent across subgroups, including vaccination status and different COVID-19 variants.

When metformin was started less than 4 days after COVID-19 symptoms started, the effect was potentially even greater, with a 64% reduction, as compared with a 36% reduction among those who started metformin after 4 or more days after symptoms.

Neither ivermectin nor fluvoxamine showed any benefits for preventing long COVID.

At the same time, the study authors caution that more research is needed. 

“The COVID-OUT trial does not indicate whether or not metformin would be effective at preventing long COVID if started at the time of emergency department visit or hospitalization for COVID-19, nor whether metformin would be effective as treatment in persons who already have long COVID,” they wrote. “With the burden of long COVID on society, confirmation is urgently needed in a trial that addresses our study’s limitations in order to translate these results into practice and policy.”

Several risk factors for long COVID emerged in the analysis. About 11.1% of the women had a long COVID diagnosis, as compared with 4.9% of the men. Also, those who had received at least the primary vaccine series had a lower risk of developing long COVID, at 6.6%, as compared with 10.5% among the unvaccinated. Only one of the 57 people who received a booster shot developed long COVID.

Notably, pregnant and lactating people were included in this study, which is important given that pregnant people face higher risks for poor COVID-19 outcomes and are excluded from most non-obstetric clinical trials, the study authors wrote. In this study, they were randomized to metformin or placebo but not ivermectin or fluvoxamine due to limited research about the safety of those drugs during pregnancy and lactation.

The results are now under journal review but show consistent findings from other recent studies. Also, in August 2022, the authors published results from COVID-OUT that showed metformin led to a 42% reduction in hospital visits, emergency department visits, and deaths related to severe COVID-19.

“Given the lack of side effects and cost for a 2-week course, I think these data support use of metformin now,” says Eric Topol, MD, founder and director of the Scripps Research Translational Institute and editor-in-chief of Medscape, WebMD’s sister site for health care professionals. 

Topol, who wasn’t involved with this study, has been a leading voice on COVID-19 research throughout the pandemic. He noted the need for more studies, including a factorial design trial to test metformin and Paxlovid, which has shown promise in preventing long COVID. Topol also wrote about the preprint in Ground Truths, his online newsletter.

“As I’ve written in the past, I don’t use the term ‘breakthrough’ lightly,” he wrote. “But to see such a pronounced benefit in the current randomized trial of metformin, in the context of it being so safe and low cost, I’d give it a breakthrough categorization.”

Another way to put it, Topol wrote, is that based on this study, he himself would take metformin if he became infected with COVID-19. 

Jeremy Faust, MD, an emergency medicine doctor at Brigham and Women’s Hospital in Boston, also wrote about the study in his newsletter, Inside Medicine. He noted that the 42% reduction in long COVID means that 23 COVID-19 patients need to be treated with metformin to prevent one long COVID diagnosis, which is an “important reduction.”

“Bottom line: If a person who meets criteria for obesity or overweight status were to ask me if they should take metformin (for 2 weeks) starting as soon as they learn they have COVID-19, I would say yes in many if not most cases, based on this new data,” he wrote. “This is starting to look like a real win.”

Source link

#Breakthrough #Study #Diabetes #Drug #Helps #Prevent #Long #COVID

Long COVID Takes Toll on Already Stretched Health Care Workforce

Post By Health , , , ,

March 6, 2023 — The impact of long COVID – and its sometimes-disabling symptoms that can persist for more than a year — has worsened health care’s already severe workforce shortage. 

Hospitals have turned to training programs, traveling nurses, and emergency room staffing services. While the shortage of clinical workers continues, support workers are also in short supply, with no end in sight.

“Our clinical staff is the front line, but behind them, several layers of people do jobs that allow them to do their jobs,” says Joanne Conroy, MD, president of Dartmouth-Hitchcock Medical Center, a 400-bed hospital in New Hampshire. “Lab and radiology and support people and IT and facilities and housekeeping … the list goes on and on.” 

Long COVID is contributing to the U.S. labor shortage overall, according to research. But with no test for the condition and a wide range of symptoms and severity – and with some workers attributing their symptoms to something else — it’s difficult to get a clear picture of the impacts on the health care system.

Emerging research suggests long COVID is hitting the health care system particularly hard.

 The system has lost 20% of its workforce over the course of the pandemic, with hospital understaffing at hospitals resulting in burnout and fatigue among frontline medical professionals, according to the U.S. Bureau of Labor Statistics.

Other research spotlights the significant impacts on health care workers:

  • In New York, nearly 20% of long COVID patients are still out of work after a year, with high numbers among health care workers, according to a new study of workers compensation claims.  
  • A new study in the American Journal of Infection Control reports nurses in intensive care units and non-clinical workers are especially vulnerable. About 2% of nurses have not returned work after developing COVID-19, according to a 2022 survey by the National Nursing Association, which represents unionized workers.  
  • In the United Kingdom, long COVID symptoms impact the lives of 1.5 million people, according to the Office of National Statistics, which is monitoring the impact of COVID. Nearly 20% report their ability to engage in day-to-day activities had been “limited a lot,” according to data from February.

While long COVID brain fog, fatigue, and other symptoms can sometimes last just a few weeks or months, a percentage of those who develop the condition – on or off the job – go on to have chronic, long-lasting, disabling symptoms that may linger for years. 

Several recent research studies suggest the impacts of long COVID on health care workers, who interact more closely with COVID patients than others on the job, are greater than other occupations and are likely to have a continuing impact.

About 25% of those filing COVID-related workers compensation claims for lost time at work are health care workers, according to a study from the National Council on Compensation Insurance. That was more than any other industry. At the same time,  the study – which included data from nine states – found that worker compensation claims for acute COVID cases dropped from 11% in 2020 to 4% in 2021.  

Last year, Katie Bach wrote a study for the Brookings Institution on the impact of long COVID on the labor market. She said in an email that she still thinks it’s a problem for the health care workforce and the workforce in general. 

“It is clear that we have a persistent group of long COVID patients who aren’t getting better,” she says.

Hospitals Forced to Adapt

Dartmouth-Hitchcock Medical Center is the largest health system — and one of the largest employers — in New Hampshire with 400 beds and 1,000 employees at the flagship hospital and affiliate. Human resource staff here have been tracking COVID-19 infections among employees.

The hospital is treating fewer COVID cases, down from a high of about 500 a month to between 100 and 200 cases month. But at the same time, they are seeing an increase in staff are who calling in sick with a range of COVID-like symptoms or consulting with the occupational medicine department, says Aimee M. Claiborne, the head of human resources for the Dartmouth Health system. 

“Some of that might be due to long COVID; some if it might be due to flu or RSV or other viruses,” she says. “We are definitely looking at things like absenteeism and what people are calling in for.”

They are also looking at “presenteeism” – where workers show up when they are not feeling well and they are not as productive, she says. 

Those who return to work can access the company’s existing disability programs to get accommodations – allowing people with low energy or fatigue or another disability to, for example, work shorter shifts or from home. Dartmouth-Hitchcock is also building more remote work into its system after trying the approach during the height of the pandemic, Claiborne says. 

Ultimately, some workers will not be able to return to work. Those who were infected on the job can also seek workers’ compensation, but coverage varies from employer to employer and state to state. 

On the other side of the country, Annette Gillaspie, a nurse in a small Oregon hospital, says she caught COVID – like many other health care workers – early in the pandemic before vaccines were available and protective measure were in place. 

She says she still hasn’t fully recovered 3 years later – she still has a cough as well as POTS (postural orthostatic tachycardia syndrome), a common post-COVID-19 condition of the automatic nervous system that can cause dizziness and fatigue when a sitting person stands up.

But she’s back at work and the hospital has made accommodations for her, like a parking space closer to the building. 

She remembers being exposed — she forgot to put on protective glasses. A few days later she was in bed with COVID. She says she never quite recovered. Gillaspie says she sees a lot of other people at work who seem to have some long COVID symptoms. 

“Some of them know it’s COVID related,” she says. “They’re doing just like I do — pushing through.”

They do it because they love their work, she says. 

Shortages Span the Country

Millions of people are living in what the federal government calls “health practitioner shortage areas” without enough dental, primary, and mental health practitioners. At hospitals, vacancies for nurses and respiratory therapists went up 30% between 2019 and 2020, according to an American Hospital Association (AHA) survey. 

Hospitals will need to hire to 124,000 doctors and at least 200,000 nurses per year to meet increased demand and to replace retiring nurses, according to the AHA. 

When the pandemic hit, hospitals had to bring expensive traveling nurses in to deal with the shortages driven by wave after wave of COVID surges. But as the AHA notes, the staffing shortfalls in health care existed before the pandemic.

The federal government, states, and health care systems have programs to address the shortage. Some hospitals train their own staff, while others may be looking at expanding the “scope of care” for existing providers, like physician assistants. Still others are looking to support existing staff who may be suffering from burnout and fatigue – and now, long COVID.

Long COVID numbers  — like the condition itself — are hard to measure and ever-changing. Between 10% and 11% of those who have had COVID have long COVID, according to the Household Pulse Survey, an ongoing Census Bureau data project.

A doctor in the U.K. recently wrote that she and others initially carried on working, believing they could push through symptoms. 

“As a doctor, the system I worked in and the martyr complex instilled by medical culture enabled that view. In medicine, being ill, being human, and looking after ourselves is still too often seen as a kind of failure or weakness,” she wrote anonymously in February in the journal BMJ.

Jeffrey Siegelman, MD, a doctor at Emory University Medical Center in the Atlanta, also wrote a journal article about his experiences with long COVID in 2020 in JAMA. More than 2 years later, he still has long COVID. 

He was out of work for 5 months, returned to practice part-time, and was exempt from night work – “a big ask,” he says, for an emergency department doctor. 

In general,  he feels like the hospital “bent over backwards” to help him get back to work. He is just about to return to work full-time with accommodations.

“I’ve been really lucky in this job,” Siegelman says. “That’s not what most patients with long COVID deal with.”

He led a support group for hospital employees who had long COVID – including clerks, techs, nurses, and doctors. Many people were trying to push through their symptoms to do their jobs, he says. A couple of people who ran through their disability coverage were dismissed.

He acknowledges that as a doctor, he had better disability coverage than others. But with no diagnostic test to confirm long COVID, he’s not exempt from self-doubt and stigma. 

Siegelman was one of the doctors who questioned the physiological basis for ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), a condition that mirrors long COVID and commonly appears in those who have lingering symptoms of an infection. He doesn’t anymore. 

Researchers are beginning to link ME/CFS and other long-term problems to COVID and other infections, and research is underway to better understand what is known as post-infection illnesses. 

Hospitals are dealing with so much, Siegelman says, that he understands if there’s a hesitancy to acknowledge that people are working at a reduced capacity. 

“It’s important for managers in hospitals to talk about this with their employees and allow people to acknowledge if they are taking more time than expected to recover from an illness,” he says. 

In medicine, he says, you are expected to show up for work unless you are on a gurney yourself. Now, people are much more open to calling in if they have a fever – a good development, he says.

And while he prepared to return to work, symptoms linger. 

“I can’t taste still,” he says. “That’s a pretty constant reminder that there is something real going on here.” 

Source link

#Long #COVID #Takes #Toll #Stretched #Health #Care #Workforce

Supreme Court ‘Skeptical’ Of Student Debt Relief, If You Can Believe That!

Post By Politics , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

The Supreme Court heard oral arguments yesterday in two cases challenging President Joe Biden’s student debt relief plan, and dear readers, we hope you are sitting down for this: The Court’s rightwing majority didn’t sound very open to the idea that the administration has the authority to forgive student loans, even under the 2003 law that the administration says is designed to allow exactly that. We won’t know for sure until the Court rules in the case, probably in June.

If there’s any chance for the policy to escape being overturned, it probably hinges on whether the Court decides that the plaintiffs in the two cases have standing to sue at all. If the Court decides they don’t, then it won’t address the legality of the program either way.

Of course, this being the Alito Court, it’s also possible the Supremes will just make shit up and decide that even if the plaintiffs lack standing, some obscure principle pulled from Brett Kavanaugh’s beer cooler — if you know what we mean and we’re not sure we do — makes it OK to address the merits of the case anyway.

Under the Biden plan, borrowers could have up to $10,000 of federal student debt forgiven; borrowers who received Pell Grants for low income families qualified for up to $20,000 in debt cancelled. The vast majority of debt relief was targeted at middle and lower-income borrowers.

Solicitor General Elizabeth Prelogar argued that the 2003 HEROES Act gives the Education Department all the authority it needs to make changes to student loan programs in a time of national emergency, since the law says the Education secretary has power to “waive or modify any statutory or regulatory provision” to keep borrowers from being wiped out financially during “a war or other military operation or national emergency.” And here we are, in a public health emergency so severe that most federal student loan payments have already been put on hold for almost three years.

Justice Elena Kagan agreed, saying that “Congress could not have made this much more clear,” and saying that compared to a lot of other cases, this was a slam dunk: “We deal with congressional statutes every day that are really confusing. This one is not.”

But of course nothing is clear if you don’t want it to be, so Chief Justice John Roberts kept insisting that whatever the plain text of the HEROES Act says, the total estimated cost of the debt relief program — about $400 billion over the next decade — was so big that it would need a specific extra double supersecret authorization from Congress, because of the “major questions doctrine” the Court pulled out of its ass in earlier cases under Roberts. To help make his point, Roberts repeatedly rounded that cost up by another hundred billion dollars, calling it a “half trillion dollar” program again and again.

Prelogar pointed out that the Education secretaries under both Donald Trump and Joe Biden have already used their authority under the HEROES Act to put federal student loans in forbearance, with no interest accruing, since March of 2020. Pausing loan payments, she said, means the federal government has lost roughly $100 billion a year, according to the Government Accountability Office.

“That has been an economically significant program,” Ms. Prelogar said of the pause. “It’s currently costing the federal government more per year than this loan forgiveness plan would cost the government annually.

What’s more, Prelogar said, ending that pause without also relieving debt would mean that scads of borrowers would default on their loans altogether, which could result in a shock to the economy at large. She didn’t even get into the fact that if hundreds of thousands of people default, that’s going to cost the federal government a lot, plus the knock-on effects of those people being ruined financially.

Justice Sonia Sotomayor echoed that argument, pointing out that the stakes for low-income borrowers could be pretty darn catastrophic:

There’s 50 million students who are – who will benefit from this. Who today will struggle. Many of them don’t have assets sufficient to bail them out after the pandemic. They don’t have friends or families or others who can help them make these payments. […]

And what you’re saying is now we’re going to give judges the right to decide how much aid to give them instead of the person with the expertise and the experience, the secretary of Education who’s been dealing with educational issues and the problems surrounding student loans.

We thought it was a pretty good argument, but then we’re liberal simps who think the government is there to help people, so we don’t count.

The question of whether the challengers to the policy have standing may be the best hope for the loan forgiveness program, since some of the rightwing justices seemed more skeptical of their claims that they’ll be harmed by student debt relief. We’ll just go with the CNN summary here:

In Biden v. Nebraska, a group of Republican-led states argued the administration exceeded its authority by using the pandemic as a pretext to mask the true goal of fulfilling a campaign promise to erase student loan debt.

The second case is Department of Education v. Brown, which was initially brought by two individuals who did not qualify for the full benefits of the forgiveness program and argue the government failed to follow the proper rulemaking process when putting it in place.

In the case involving the states, much of the argument involved how many angels can dance on the head of Missouri’s nonprofit agency what processes student loans, the “Missouri Higher Education Loan Authority,” aka MOHELA. It was set up to insulate the state itself from having to process loans, but the state is arguing that, for the purpose of standing, it may as well be the state.

But as Justice Kagan pointed out, MOHELA is a legally separate entity, and it didn’t choose to sue:

“Usually we don’t allow one person to step into another’s shoes and say, ‘I think that that person suffered a harm,’ even if the harm is very great,” she said.

If Missouri really controlled the loan authority, Justice Amy Coney Barrett asked James A. Campbell, Nebraska’s solicitor general, who represented the states, “why didn’t the state just make MOHELA come then?”

Campbell explained that was “a question of state politics,” which sounds to us like some bullshit, although we are not a lawyer.

Prelogar hammered on that point, saying that MOHELA would definitely have standing if it had sued, but it hadn’t, now had it? Justice Ketanji Brown Jackson chimed in too, saying that MOHELA’s

financial interests are totally disentangled from the state, it stands alone, it’s incorporated separately, the state is not liable for anything that happens to MOHELA. […] I don’t know how that could possibly be a reason to say that an injury to MOHELA should count as an injury to the state.

In the other case, the plaintiffs argued that the program isn’t fair, because their own loans don’t qualify for forgiveness. One plaintiff, Myra Brown, has private student loans that aren’t held by the government, and the other, Alexander Taylor, only qualifies for $10,000 in loan relief because he didn’t get a Pell grant in college, so his case claims he was cheated out of $10K in debt relief.

No, it doesn’t make a damn bit of sense that they think the solution to their woes is to eliminate all debt relief for 40 million other people. But there we go, thinking like a blogger instead of a Supreme Court justice. The New York Times notes that

Justices across the ideological spectrum seemed unpersuaded by the borrowers’ position.

“Talk about ways in which courts can interfere with the processes of government through two individuals in one state who don’t like the program can seek and obtain a universal relief barring it for anybody anywhere,” Justice Neil M. Gorsuch said.

Even so, some justices were really excited about the supposed “unfairness” of targeting debt relief to people who had the most to lose, and not to everyone who might conceivably get help. Roberts even wondered why it would be fair to relieve debt for student loans during the pandemic but not for, say a loan taken out by a hypothetical owner of a lawn care business.

Sotomayor had a pretty quick reply to that, pointing out that “everybody suffered in the pandemic, but different people got different benefits because they qualified under different programs.” Hello, PPP loans, for freaking instance (this is us cheerleading, not Sotomayor). (Also, your Wonkette got a PPP loan, and it was forgiven, which is the first time we’ve ever been part of the “so rich the government gives you money” crew.)

Justice Kagan reminded Roberts that the case is actually about student loans, not anything else, mister strict constructionist:

Congress passed a statute that dealt with loan repayment for colleges, and it didn’t pass a statute that dealt with loan repayment for lawn businesses… [Us, butting in again: PPP loans! We already said PPP loans, Elena.] And so Congress made a choice, and that may have been the right choice or it may have been the wrong choice, but that’s Congress’s choice.

The Court will rule in June, and even if the debt forgiveness program is thrown out, many borrowers should at least be able to get some relief under the Biden administrations’ revamped income-based repayment program, which everyone with federal student loans should at least look into.

DO THIS NOW!

Did Joe Biden Just Fix Student Loan Debt Going Forward? Mayyyyybe!

I Got My Student Loans Ready For Joe Biden’s Big Income-Based Forgive-A-Thon And You Should Too

Until of course conservative states and the SCOTUS fuck that over too, the end.

[NYT / CNN / AP]

Yr Wonkette is funded entirely by reader donations except for that time we got that PPP loan. if you can, please give $5 or $10 monthly to help us keep you in the know, for all the good “knowing stuff” does.

Do your Amazon shopping through this link, because reasons.



Source link

#Supreme #Court #Skeptical #Student #Debt #Relief

Fauci Q&A: On Masking, Vaccines, and What Keeps Him Up at Night

Post By Health , , , , , , ,

Jan. 30, 2023 – When he was a young boy growing up in Brooklyn, Anthony Fauci loved playing sports. As captain of his high school basketball team, he wanted to be an athlete, but at 5-foot-7, he says it wasn’t in the cards. So, he decided to become a doctor instead. 

Fauci, who turned 82 in December, stepped down as the head of the National Institute of Allergy and Infectious Diseases that same month, leaving behind a high-profile career in government spanning more than half a century, during which he counseled seven presidents, including Joe Biden. Fauci worked at the National Institutes of Health for 54 years and served as director of the National Institute of Allergy and Infectious Diseases for 38 years. In an interview last week, he spoke to WebMD about his career and his plans for the future. 

This interview has been edited and condensed.

It’s only been a few weeks since your official “retirement,” but what’s next for you?

What’s next for me is certainly not classical retirement. I have probably a few more years of being as active, vigorous, passionate about my field of public health, public service in the arena of infectious diseases and immunology. [I’ve] had the privilege of advising seven presidents of the United States in areas that are fundamentally centered around our response and preparation for emerging infections going back to the early years of HIV, pandemic flu, bird flu, Ebola, Zika, and now, most recently the last 3 years, with COVID. What I want to do in the next few years, by writing, by lecturing, and by serving in a senior advisory role, is to hopefully inspire young people to go into the field of medicine and science, and perhaps even to consider going into the area of public service. 

Almost certainly, I’ll begin working on a memoir. So that’s what I’d like to do over the next few years.

Are you looking forward to going back and seeing patients and being out of the public eye?

I will almost certainly associate myself with a medical center, either one locally here in the Washington, DC, area or some of the other medical centers that have expressed an interest in my joining the faculty. I am not going to dissociate myself from clinical medicine, since clinical medicine is such an important part of my identity and has been thus literally for well over 50 years. So, I’m not exactly sure of the venue in which I will do that, but I certainly will have some connection with clinical medicine.

What are you looking forward to most about going back to doctoring?

Well, I’ve always had a great deal of attraction to the concept of medicine, the application of medicine. I have taken care of thousands of patients in my long career. I spent a considerable amount of time in the early years of HIV, even before we knew it was HIV, taking care of desperately ill patients. I’ve been involved in a number of clinical research projects, and I was always fascinated by that because there’s much gratification and good feeling you get when you take care of, personally, an individual patient, when you do research that advances the field, and those advances that you may have been a part of benefit larger numbers of patients that are being taken care of by other physicians throughout the country and perhaps even throughout the world. 

So those are all of the aspects of clinical medicine that I want to encourage younger people that these are the opportunities that they can be a part of, which can be very gratifying and certainly productive in the sense of saving lives.

Looking back over your career, what were some of the highs and lows, or turning points?

I first became involved in the personal care and research on persons with HIV, literally in the fall of 1981. [That was] weeks to months after the first cases were recognized. My colleagues and I spent the next few years taking care of desperately ill patients, and we did not have effective therapies because the first couple of years, we did not even know what the ideologic agent was. Even after it was recognized after 1983 and 1984, it took several years before effective therapies were developed, so there was a period of time where we were in a very difficult situation. We were essentially putting Band-Aids on hemorrhages, metaphorically, because no matter what we did, our patients continued to decline. That was a low and dark period of our lives, inspired only by the bravery and the resilience of our patients. A very high period was in [the late 1990s] and into the next century [with the development] of drugs that were highly effective in prolonged and effective suppression of viral loads to the point where people who were living with HIV, if they had access to therapy, could essentially lead a normal lifespan.

We put together the President’s Emergency Plan for AIDS Relief program known as PEPFAR, which now, celebrating its 20th anniversary, has resulted in saving 20-25 million lives. So, I would say that is … the highest point in my experience as a physician and a scientist, to have been an important part in the development of that program.

Do you feel like there’s any unfinished business? Anything you would change? 

Certainly, there’s unfinished business. One of the goals I would have liked to have achieved, but that is going to have to wait another few years, is the development of a safe and effective vaccine for HIV. A lot of very elegant science has been done in that regard, but we’re not there yet, it’s a very challenging scientific problem. 

The other unfinished business is some of the other diseases that cause a considerable amount of morbidity and mortality globally, diseases like malaria and tuberculosis. We’ve made extraordinary progress over the 38 years that I’ve been director of the institute We have a vaccine, though it isn’t a perfect vaccine [for malaria]; we have monoclonal antibodies that are now highly effective in preventing malaria; we have newer drugs, better drugs for tuberculosis, but we don’t have an effective vaccine for tuberculosis. So, malaria vaccines, tuberculosis vaccines, those are all unfinished business. I believe we will get there.

These new COVID-19 variants keep getting more and more contagious. Do you see the potential for a serious new variant that could plunge us back into some level of public restrictions?

Anything is possible. One cannot predict, exactly, what the likelihood of getting yet again another variant that’s so different that it eludes the protection that we have from the vaccines and from prior infection. Again, I can’t give a number on that. I don’t think it’s highly likely that will happen. 

Ever since Omicron came well over a year ago, we have had sublineages of Omicron that progressively seem to elude the immune response that’s been developed. But the one thing that’s good and has been sustained is that protection against severity of disease seems to hold out pretty well. I don’t think that we should be talking about restrictions in the sense of draconian methods of shutting things down; I mean, that was only done for a very brief period of time when our hospitals were being overrun. I don’t anticipate that that is going to be something in the future, but you’ve got to be prepared for it. There are some things that have been highly successful, and that is the vaccines that were developed in less than 1 year. And now, our challenge is to get more people to get their updated boosters. 

There’s already been criticism of the FDA’s discussion of an annual COVID-19 vaccine. One criticism is that the COVID vaccines’ effectiveness appears to wane after several months, so it would not offer protection for much of the year. Is that a legitimate criticism?

There’s no perfect solution to keeping the country optimally protected. I believe that it gets down to, “It’s not perfect, but don’t let the perfect be the enemy of the good.” We want to get into some regular cadence to get people updated with a booster that is hopefully managed reasonably well to what the circulating variant is. There are certainly going to be people – perhaps the elderly, some of the immune-compromised, and perhaps children – who will need a shot more than once per year, but the FDA’s leaning towards getting a shot that is [timed] with the flu shot, would at least bring some degree of order and stability to the process of people getting into the regular routine of keeping themselves updated and protected to the best extent possible. 

Do you think we need to move on from mRNA vaccines to something that hopefully has longer-lasting protection?

Yes, we certainly want next-generation vaccines – both vaccines that have a greater degree of breadth, namely covering multiple variants, as well as a greater degree of duration. So, the real question is, “Is it the mRNA vaccine platform that is inducing a response that is not durable, or is the response against coronaviruses not a durable response?” That’s still uncertain. Yes, we need to do better with a better platform, or an improvement on the platform; that could mean adding adjuvants, that could mean a [nasal] vaccine in addition to a systemic vaccine. 

Do you always wear a mask when you go out into the world? How do you evaluate the relative risk of situations when you go out in public?

I’ve been vaccinated, doubly boosted, I’ve gotten infected, and I’ve gotten the bivalent boost. So, I evaluate things depending upon what the level of viral activity is in the particular location where I’m at. If I’m going to go on a plane, for example, I have no idea where these people are coming from, I generally wear a mask on a plane. I don’t really go to congregate settings often. Many of the events I do go to are situations where a requirement for [attending] is to get a test that’s negative that day. 

When you’re in a situation like that, even if it’s a crowded congregant setting, I don’t have any problem not wearing a mask. But when I’m unsure of what the status is and I might be in an area where there is a considerable degree of viral activity, I would wear a mask. I think you just have to use [your] judgment, depending on the circumstances that you find yourself in.

Doctors and health care professionals have been through hell during COVID. Do you think this might bring a permanent change to how doctors perceive their jobs?

Health care providers have been under a considerable amount of stress because this is a totally unprecedented situation that we find ourselves in. This is the likes of which we have not seen in well over 100 years. I hope this is not something that is going to be permanent, I don’t think it is, I think that we are ultimately going to get to a point where the level of virus is low enough that it’s not going to disrupt either society or the health care system or the economy. 

We’re not totally there yet. We’re still having about 500 deaths per day, which is much, much better than the 3,000 to 4,000 deaths that we were seeing over a year ago, but it is still not low enough to be able to feel comfortable. 

As a scientist, even a semi-retired one, what scares you? What wakes you up at night with worry? 

The same thing I have been concerned about for, you know, 40 years: the appearance of a highly transmissible respiratory virus that has a degree of morbidity and mortality that could really be very disruptive of us in this country and globally. Unfortunately, we’re in the middle of that situation now, finishing our third year and going into year 4. So what worries me is yet another pandemic. Now that could be a year from now, 5 years from now, 50 years from now. Remember, the last time a pandemic of this magnitude occurred was well over 100 years ago. My concern is that we stay prepared. [We may] not necessarily prevent the emergence of a new infection, but hopefully we can prevent it from becoming a pandemic.

Source link

#Fauci #Masking #Vaccines #Night

The FDA Wants an Annual COVID Vaccine: What You Need to Know

Post By Health , , , , , ,

Jan. 24, 2023 – Is pivoting to an annual COVID-19 shot a smart move? The FDA, which proposed the change on Monday, says an annual shot vs. periodic boosters could simplify the process to ensure more people stay vaccinated and protected against severe COVID-19 infection. 

A national advisory committee plans to vote on the recommendation Thursday.

If accepted, the vaccine formula would be decided each June and Americans could start getting their annual COVID-19 shot in the fall, like your yearly flu shot.  

Keep in mind: Older Americans and those who are immunocompromised may need more than one dose of the annual COVID-19 shot.

Most Americans are not up to date with their COVID-19 boosters. Only 15% of Americans have gotten the latest booster dose, while a whopping nine out of 10 Americans age 12 or older finished their primary vaccine series. The FDA, in briefing documents for Thursday’s meeting, says problems with getting vaccines into people’s arms makes this a change worth considering. 

“Given these complexities, and the available data, a move to a single vaccine composition for primary and booster vaccinations should be considered,” the agency says.

A yearly COVID-19 vaccine could be simpler, but would it be as effective? WebMD asks health experts your most pressing questions about the proposal.

Pros and Cons of an Annual Shot

Having an annual COVID-19 shot, alongside the flu shot, could make it simpler for doctors and health care providers to share vaccination recommendations and reminders, according to Leana Wen, MD, a public health professor at George Washington University and former Baltimore health commissioner.

“It would be easier [for primary care doctors and other health care providers] to encourage our patients to get one set of annual shots, rather than to count the number of boosters or have two separate shots that people have to obtain,” she says.

“Employers, nursing homes, and other facilities could offer the two shots together, and a combined shot may even be possible in the future.”

Despite the greater convenience, not everyone is enthusiastic about the idea of an annual COVID shot. COVID-19 does not behave the same as the flu, says Eric Topol, MD, editor-in-chief of Medscape, WebMD’s sister site for health care professionals.

Trying to mimic flu vaccination and have a year of protection from a single COVID-19 immunization “is not based on science,” he says. 

Carlos del Rio, MD, of Emory University in Atlanta and president of the Infectious Diseases Society of America, agrees. 

“We would like to see something simple and similar like the flu. But I also think we need to have the science to guide us, and I think the science right now is not necessarily there. I’m looking forward to seeing what the advisory committee, VRBAC, debates on Thursday. Based on the information I’ve seen and the data we have, I’m not convinced that this is a strategy that is going to make sense,” he says. 

“One thing we’ve learned from this virus is that it throws curveballs frequently, and when we make a decision, something changes. So, I think we continue doing research, we follow the science, and we make decisions based on science and not what is most convenient.” 

COVID-19 Isn’t Seasonal Like the Flu

“Flu is very seasonal, and you can predict the months when it’s going to strike here,” Topol says. “And as everyone knows, COVID is a year-round problem.” He says it’s less about a particular season and more about times when people are more likely to gather indoors. 

So far, European officials are not considering an annual COVID-19 vaccination schedule, says Annelies Zinkernagel, MD, PhD, of the University of Zurich and president of the European Society of Clinical Microbiology and Infectious Diseases. 

Regarding seasonality, she says, “what we do know is that in closed rooms in the U.S. as well as in Europe, we can have more crowding. And if you’re more indoors or outdoors, that definitely makes a big difference.”

Which Variant(s) Would It Target?

To decide which variants an annual COVID-19 shot will attack, one possibility could be for the FDA to use the same process used for the flu vaccine, Wen says.

“At the beginning of flu season, it’s always an educated guess as to which influenza strains will be dominant,” she says.

“We cannot predict the future of which variants might develop for COVID, but the hope is that a booster would provide broad coverage against a wide array of possible variants.”

Topol agrees it’s difficult to predict. A future with “new viral variants, perhaps a whole new family beyond Omicron, is uncertain.”

Reading the FDA briefing document “to me was depressing, and it’s just basically a retread. There’s no aspiration for doing bold things,” Topol says. “I would much rather see an aggressive push for next-generation vaccines and nasal vaccines.”

To provide the longest protection, “the annual shot should target currently predominant circulating strains, without a long delay before booster administration,” says Jeffrey Townsend, PhD, a professor of biostatistics and ecology and evolutionary biology at Yale School of Public Health. 

“Just like the influenza vaccine, it may be that some years the shot is less useful, and some years the shot is more useful,” he says, depending on how the virus changes over time and which strain(s) the vaccine targets. “On average, yearly updated boosters should provide the protection predicted by our analysis.”

Townsend and colleagues published a prediction study on Jan. 5, in the Journal of Medical Virology. They look at both Moderna and Pfizer  vaccines and how much protection they would offer over 6 years based on people getting regular vaccinations every 6 months, every year, or for longer periods between shots. 

They report that annual boosting with the Moderna vaccine would provide 75% protection against infection and an annual Pfizer vaccine would provide 69% protection. These predictions take into account new variants emerging over time, Townsend says, based on behavior of other coronaviruses.

“These percentages of fending off infection may appear large in reference to the last 2 years of pandemic disease with the massive surges of infection that we experienced,” he says. “Keep in mind, we’re estimating the eventual, endemic risk going forward, not pandemic risk.”

Source link

#FDA #Annual #COVID #Vaccine

Can ‘Radical Rest’ Help With Long COVID Symptoms?

Post By Health , , , , , , ,

Jan. 18, 2023 – On March 18, 2020, Megan Fitzgerald was lying on the floor of her Philadelphia home after COVID-19 hit her like a ton of bricks. She had a fever, severe digestive issues, and she couldn’t stand on her own. Yet there she was, splayed out in the bathroom, trying both to respond to work emails and entertain her 3-year-old son, who was attempting to entice her by passing his toys through the door. 

She and her husband, both medical researchers, were working from home early in the pandemic with no child care for their toddler. Her husband had a grant application due, so it was all-hands-on-deck for the couple, even when she got sick. 

“My husband would help me up and down stairs because I couldn’t stand,” Fitzgerald says.

So, she put a mask on and tried to take care of her son, telling him, “Mommy’s sleeping on the floor again.” She regrets pushing so hard, having since discovered there may have been consequences. She often wonders: If she’d rested more during that time, would she have prevented the years of decline and disability that followed? 

There’s growing evidence that overexertion and not getting enough rest in that acute phase of COVID-19 infection can make longer-term symptoms worse. 

“The concept that I would be too sick to work was very alien to me,” Fitzgerald says. “It didn’t occur to me that an illness and acute virus could be long-term debilitating.” 

Her story is common among long COVID-19 patients, not just for those who get severely ill but also those who only have moderate symptoms. It’s why many medical experts and researchers who specialize in long COVID rehabilitation recommend what’s known as radical rest – a term popularized by journalist and long COVID advocate Fiona Lowenstein – right after infection as well as a way of coping with the debilitating fatigue and crashes of energy that many have in the weeks, months, and years after getting sick.

These sustained periods of rest and “pacing” – a strategy for moderating and balancing activity– have long been promoted by people with post-viral illnesses such as myalgic encephalomyelitis, or chronic fatigue syndrome (ME/CFS), which share many symptoms with long COVID.

That’s why researchers and health care providers who have spent years trying to help patients with ME/CFS and, more recently, long COVID, recommend they rest as much as possible for at least 2 weeks after viral infection to help their immune systems. They also advise spreading out activities to avoid post-exertional malaise (PEM), a phenomenon where even minor physical or mental effort can trigger a flare-up of symptoms, including severe fatigue, headaches, and brain fog.

An international study, done with the help of the U.S. Patient-Led Research Collaborative and published in The Lancet in 2021, found that out of nearly 1,800 long COVID patients who tried pacing, more than 40% said it helped them manage symptoms.

Burden on Women and Mothers

In another survey published last year, British researchers asked 2,550 long COVID patients about their symptoms and found that not getting enough rest in the first 2 weeks of illness, along with other things like lower income, younger age, and being female, were associated with more severe long COVID symptoms.

It’s also not lost on many investigators and patients that COVID’s prolonged symptoms disproportionately affect women – many of whom don’t have disability benefits or a choice about whether they can afford to rest after getting sick. 

“I don’t think it’s a coincidence, particularly in America, that women of reproductive age have been hit the hardest with long COVID,” says Fitzgerald. “We work outside the home, and we do a tremendous amount of unpaid labor in the home as well.”

How Does Lack of Rest Affect People With COVID?

Experts are still trying to understand the many symptoms and mechanisms behind long COVID. But until the science is settled, both rest and pacing are two of the most solid pieces of advice they can offer, says David Putrino, PhD, a neuroscientist and physical therapist who has worked with thousands of long COVID patients at Mount Sinai Hospital in New York. “These things are currently the best defense we have against uncontrolled disease progression,” he says.

There are many recommended guides for rest and pacing for those living with long COVID, but ultimately, patients need to carefully develop their own personal strategies that work for them, says Putrino. He calls for research to better understand what’s going wrong with each patient and why they may respond differently to similar strategies. 

There are several theories on how long COVID infection triggers fatigue. One is that inflammatory molecules called cytokines, which are higher in long COVID patients, may injure the mitochondria that fuel the body’s cells, making them less able to use oxygen. 

“When a virus infects your body, it starts to hijack your mitochondria and steal energy from your own cells,” says Putrino. Attempts to exercise through that can significantly increase the energy demands on the body, which damages the mitochondria, and also creates waste products from burning that fuel, kind of like exhaust fumes, he explains. It drives oxidative stress, which can damage the body.

“The more we look objectively, the more we see physiological changes that are associated with long COVID,” he says. “There is a clear organic pathobiology that is causing the fatigue and post-exertional malaise.”

To better understand what’s going on with infection associated with complex chronic illnesses such as long COVID and ME/CFS, Putrino’s lab is looking at things like mitochondrial dysfunction and blood biomarkers such as microclots. 

He also points to research by pulmonologist David Systrom, MD, director of the Advanced Cardiopulmonary Exercise Testing Program at Brigham and Women’s Hospital and Harvard Medical School. Systrom has done invasive exercise testing experiments that show that people with long COVID have a different physiology than people who have had COVID and recovered. His studies suggest that the problem doesn’t lie with the functioning of the heart or lungs, but with blood vessels that aren’t getting enough blood and oxygen to the heart, brain, and muscles.

Why these blood vessel problems occur is not yet known, but one study led by Systrom’s colleague, neurologist Peter Novak, MD, PhD, suggests that the small nerve fibers in people with long COVID are missing or damaged. As a result, the fibers fail to properly squeeze the big veins (in the legs and belly, for instance) that lead to the heart and brain, causing symptoms such as fatigue, PEM, and brain fog. Systrom has seen similar evidence of dysfunctional or missing nerves in people with other chronic illnesses such as ME/CFS, fibromyalgia, and postural orthostatic tachycardia syndrome (POTS).

“It’s been incredibly rewarding to help patients understand what ails them and it’s not in their head and it’s not simple detraining or deconditioning,” says Systrom, referring to misguided advice from some doctors who tell patients to simply exercise their way out of persistent fatigue. 

These findings are also helping to shape specialized rehab for long COVID at places like Mount Sinai and Brigham and Women’s hospitals, whose programs also include things like increasing fluids and electrolytes, wearing compression clothing, and making diet changes. And while different types of exercise therapies have long been shown to do serious damage to people with ME/CFS symptoms, both Putrino and Systrom say that skilled rehabilitation can still involve small amounts of exercise when cautiously prescribed and paired with rest to avoid pushing patients to the point of crashing. In some cases, the exercise can be paired with medication.

In a small clinical trial published in November, Systrom and his research team found that patients with ME/CFS and long COVID were able to increase their exercise threshold with the help of a POTS drug, Mestinon, known generically as pyridostigmine, taken off label.

As is the case of many people with long COVID, Fitzgerald’s recovery has had ups and downs. She now has more help with child care and a research job with the disability-friendly Patient-Led Research Collaborative. While she hasn’t gotten into a long COVID rehab group, she’s been teaching herself pacing and breathwork. In fact, the only therapeutic referral she got from her doctor was for cognitive behavioral therapy, which has been helpful for the toll the condition has taken emotionally. “But it doesn’t help any of the physical symptoms,” Fitzgerald says.

She’s not the only one who finds that a problem.

“We need to continue to call out people who are trying to psychologize the illness as opposed to understanding the physiology that is leading to these symptoms,” says Putrino. “We need to make sure that patients actually get care as opposed to gaslighting.”



Source link

#Radical #Rest #Long #COVID #Symptoms

Heart Disease Deaths Spiked During COVID

Post By Health , , , , , , , , , ,

Nov. 29, 2022 – Deaths from heart disease and stroke among adults living in the United States have been on the decline since 2010. But the COVID-19 pandemic reversed that downward trend in 2020, new research shows. 

It was as if COVID had wiped out 5 years of progress, pushing rates back to levels seen in 2015, the researchers say.

Non-Hispanic Black people and those who were younger than 75 were affected more than others, with the pandemic reversing 10 years of progress in those groups. 

Rebecca C. Woodruff, PhD, presented these study findings at the American Heart Association 2022 Scientific Sessions.

The rate of death from heart disease had been falling for decades in the United States due to better detection of risk factors, such as high blood pressure, and better treatments, such as statins for cholesterol, she said.

The decrease in deaths from heart disease from 1900 to 1999 “has been recognized as a top public health achievement of the twentieth  century,” said Woodruff, who is an epidemiologist for the CDC.

The reversal of this positive trend shows that it is important that people “work with a health care provider to prevent and manage existing heart disease, even in challenging conditions like the COVID-19 pandemic,” she said. 

Woodruff advised that “everyone can improve and maintain their cardiovascular health and reduce the risk of cardiovascular disease by following the American Heart Association’s Life’s Essential 8 – eating better, being more active, quitting tobacco, getting healthy sleep, managing weight, controlling cholesterol, managing blood sugar, and managing blood pressure.” 

“COVID-19 vaccines can help everyone, especially those with underlying heart disease or other health conditions, and protect people from severe COVID-19,” she stressed.

Andrew J. Einstein, MD, PhD, from Columbia University Irving Medical Center in New York City, who was not involved with this research, says the results show “very disturbing changes” to the decline in deaths from heart disease over the past decade. 

The study findings underscore that “as a society, we need to take efforts to ensure that all people are engaged in the health care system, with one aim being improving heart health outcomes, which worsened significantly in 2020,” he says. 

“If you don’t actively see a primary care provider, it’s important to find one with whom you can have a good relationship and can discuss with you heart-healthy living; check your blood pressure, sugar, and cholesterol; ask you about symptoms and examine you to detect disease early; and refer you for more specialized heart care as needed,” he says. 

Some Study Findings

The researchers analyzed data from the CDC’s WONDER database.

They identified adults ages 35 and older with heart disease as cause of death.

They found that the number of people who died from heart disease in every 100,000 people (heart disease death rate) dropped each year from 2010 to 2019, but it increased in 2020, the first year of the pandemic.

This increase was seen in the total population, in men, in women, in all age groups, and in all race and Hispanic ethnicity groups.

In the total population, the heart disease death rate dropped by 9.8% from 2010 to 2019. But this rate increased by 4.1% in 2020, going back to the rate it had been in 2015.

Among non-Hispanic Black people, the heart disease death rate fell by 10.4% from 2010 to 2019, but it increased by 11.2% in 2020, going back to the rate it had been in 2010.

Similarly, among adults ages 35 to 54 and those ages 55 to 74, the rates of heart disease deaths decreased from 2010 to 2019 and increased in 2020 to rates higher than they had been in 2010.

In 2020, about 7 years of progress in declining heart death rates was lost among men and 3 years of progress was lost among women, the researchers said. 

Source link

#Heart #Disease #Deaths #Spiked #COVID

Is It Flu, RSV or COVID? Experts Fear the ‘Tripledemic’

Post By Health , , , , , ,


Oct. 25, 2022 – Just when we thought this holiday season, finally, would be the back-to-normal one, some infectious disease experts are warning that a so-called tripledemic – influenza, COVID-19, and RSV – may be in the forecast.

The warning isn’t without basis. 

  • The flu season has gotten an early start. As of Oct. 21, early increases in seasonal flu activity have been reported in most of the country, the CDC says, with the southeast and south-central areas having the highest activity levels. 
  • Children’s hospitals and emergency departments are seeing a surge in children with RSV.
  • COVID-19 cases are trending down, according to the CDC, but epidemiologists – scientists who study disease outbreaks – always have their eyes on emerging variants. 

Predicting exactly when cases will peak is difficult, says Justin Lessler, PhD, a professor of epidemiology at the University of North Carolina at Chapel Hill. Lessler is on the coordinating team for the COVID-19 Scenario Modeling Hub, which aims to predict the course COVID-19, and the Flu Scenario Modeling Hub, which does the same for influenza.

For COVID-19, some models are predicting some spikes before Christmas, he says, and others see a new wave in 2023. For the flu, the model is predicting an earlier-than-usual start, as the CDC has reported.  

While flu activity is relatively low, the CDC says, the season is off to an early start. For the week ending Oct. 21, 1,674 patients were hospitalized for flu, higher than in the summer months but fewer than the 2,675 hospitalizations for the week of May 15, 2022. 

As of Oct. 20, COVID-19 cases have declined 12% over the last 2 weeks, nationwide. But hospitalizations are up 10% in much of the Northeast, The New York Times reports, and the improvement in cases and deaths has been slowing down. 

As of Oct. 15, 15% of RSV tests reported nationwide were positive, compared with about 11% at that time in 2021, the CDC says. The surveillance collects information from 75 counties in 12 states. 

Experts point out that the viruses — all three are respiratory viruses —  are simply playing catchup. 

“They spread the same way and along with lots of other viruses, and you tend to see an increase in them during the cold months,” says Timothy Brewer, MD, professor of medicine and epidemiology at UCLA.

The increase in all three viruses “is almost predictable at this point in the pandemic,” says Dean Blumberg, MD, a professor and chief of pediatric infectious diseases at the University of California Davis Health. “All the respiratory viruses are out of whack.” 

Last year, RSV cases were up, too, and began to appear very early, he says, in the summer instead of in the cooler months. Flu also appeared early in 2021, as it has this year. 

That contrasts with the flu season of 2020-2021, when COVID precautions were nearly universal, and cases were down. At UC Davis, “we didn’t have one pediatric admission due to influenza in the 2020-2021 [flu] season,” Blumberg says. 

The number of pediatric flu deaths usually range from 37 to 199 per year, according to CDC records. But in the 2020-2021 season, the CDC recorded one pediatric flu death in the U.S.

Both children and adults have had less contact with others the past 2 seasons, Blumberg says, “and they don’t get the immunity they got with those infections [previously]. That’s why we are seeing out-of-season, early season [viruses].” 

Eventually, he says, the cases of flu and RSV will return to previous levels. “It could be as soon as next year,” Blumberg says. And COVID-19, hopefully, will become like influenza, he says.

“RSV has always come around in the fall and winter,” says Elizabeth Murray, DO, a pediatric emergency medicine doctor at the University of Rochester Medical Center and a spokesperson for the American Academy of Pediatrics. This year, children are back in school and for the most part not masking, she says. “It’s a perfect storm for all the germs to spread now. They’ve just been waiting for their opportunity to come back.” 

Self-Care vs. Not

RSV can pose a risk for anyone, but most at risk are children under age 5, especially infants under age 1, and adults over age 65.  There is no vaccine for it. Symptoms include a runny nose, decreased appetite, coughing, sneezing, fever, and wheezing. But in young infants, there may only be decreased activity, crankiness, and breathing issues, the CDC says.

Keep an eye on the breathing if RSV is suspected, Murray tells parents. If your child can’t breathe easily, is unable to lie down comfortably, can’t speak clearly, or is sucking in the chest muscles to breathe, get medical help. Most kids with RSV can stay home and recover, she says, but often will need to be checked by a medical professional.

She advises against getting an oximeter to measure oxygen levels for home use. “They are often not accurate,” she says. If in doubt about how serious your child’s symptoms are, “don’t wait it out,” she says, and don’t hesitate to call 911.

Symptoms of flu, COVID, and RSV can overlap.  But each can involve breathing problems, which can be an emergency. 

“It’s important to seek medical attention for any concerning symptoms, but especially severe shortness of breath or difficulty breathing, as these could signal the need for supplemental oxygen or other emergency interventions,” says Mandy De Vries, a respiratory therapist and director of education at the American Association for Respiratory Care. Inhalation treatment or mechanical ventilation may be needed for severe respiratory issues.

Precautions

To avoid the tripledemic – or any single infection – Timothy Brewer, MD, a professor of medicine and epidemiology at UCLA, suggests some familiar measures: “Stay home if you’re feeling sick. Make sure you are up to date on your vaccinations. Wear a mask indoors.”



Source link