Many families must 'dance' their way to COVID-19 survival
June 26, 2020
Science Daily/University of Birmingham
Researchers have been studying how families plan ahead and make decisions about family care and family consumption for a long time -- but what happens when planning ahead is not possible? When consumers can't plan ahead, they 'dance'.
Marketing managers and academics have been studying how families plan ahead and make decisions about family care and family consumption for a long time -- but what happens when planning ahead is not possible? When consumers can't plan ahead, they 'dance'.
Although there has been a lot of talk about how COVID-19 has 'slowed down' family life, a new study in the Journal of Marketing Management by researchers at the University of Birmingham (UK), University of Melbourne (Australia) and Adolfo Ibanez University (Chile) argues that this is not the case for every family.
Dr Pilar Rojas Gaviria, Lecturer in Marketing at the University of Birmingham, comments: "For many families, life has become more precarious, anxious, and accelerated. Rather than a combination of strategic activities and well-planned decisions, we found that when normality is disrupted abruptly, family care looks more like an intricate improvised 'dance'."
Dr Rojas Gaviria and her colleagues note that when facing unplanned disruptions to family life, such as COVID-19, while some families may enjoy more free time because they are not commuting, others face unprecedented situations, such as disrupted careers, caring for others and suffering from the loss of income.
She comments: "We should avoid assumptions about families being affected in the same way. Many families are struggling with mental health while others are coping well. Many have lost friends or family members, others have not.
"This means that organisations should aim to better understand the needs of individual employees and their families and think about how they can support them by acknowledging that these needs are different and that they evolve through time."
Particularly, Dr. Rojas Gaviria and her colleagues found that families who already deal with more intensive care needs -- such as those who have a family member with a chronic health condition -- must 'dance' their way through unplanned disruptions such as the COVID-19 crisis.
Families strike a balance between day-to-day routines -- resorting to what the researchers call 'grounding' activities -- and other more creative, emotionally-laden and inspirational activities that go well beyond their daily schedules in order to counter massive disruption to their everyday life.
In their study of families living with diabetic children, they discovered how, in the midst of chaos, each family finds its own style to 'dance' through their life constraints by alternating 'grounding' and 'aerial' activities.
They also found that that this process often occurs instinctively and invisibly, and is usually lead by one family member who "orchestrates" resources and talents at hand to help their family develop its 'dance'.
Dr Rojas Gaviria adds: "In keeping that 'dance' going, it is essential for the family to balance 'grounding movements' with 'aerial movements' that soothe, inspire and motivate family members.
"For instance, we saw how, during the COVID-19 lockdown both 'grounding' activities -- such as knitting, gardening and baking -- combined with 'aerial' activities -- like becoming a helping hand in the community, placing rainbows in the family home's windows, supporting local shops, fisheries and farms, or raising funds for the NHS -- to comfort families and help them connect to each other, even from a distance."
Dr. Rojas Gaviria argues that there is an untapped need for public policies and support programmes that can be flexible and adaptable to different moments and different life circumstances and that aim at enhancing the creative competencies of the families.
"The aim should be helping families gather resources for movement (energy, time, focus, hope in the future) instead of telling them how to move by setting very strict rules that not everyone is able to follow. Designing a diverse set of support tools that can be offered for different circumstances and at different moments in time is a challenge for our societal systems," she adds.
https://www.sciencedaily.com/releases/2020/06/200626114745.htm
Estimating COVID-19 spread by looking at past trends of influenza-like illnesses
June 26, 2020
Science Daily/Montana State University
In order to better understand the spread of the novel coronavirus, new research examines trends in visits to outpatient clinics for influenza-like illnesses in March 2020 as compared to previous years.
How many people in the U.S. have had COVID-19? Using a database of information collected after the 2009 H1N1 outbreak, a Montana State University researcher is helping develop a better understanding of the spread of the novel coronavirus.
Alex Washburne, a researcher in the Bozeman Disease Ecology Lab, which is housed in the College of Agriculture's Department of Microbiology and Immunology, published a paper on the subject this week in the journal Science Translational Medicine. The paper uses data from ILINet a database created by the Centers for Disease Control and Prevention in 2010 to count patients who check into medical clinics with influenza-like illnesses, or ILI. That type of data collection for the purpose of identifying trends is known as syndromic surveillance.
Influenza-like illnesses include any number of infections that carry symptoms similar to the seasonal flu -- such as fever, cough and sore throat. Both influenza-like H1N1 and non-influenza diseases like COVID-19 fall into that group. Monitoring trends in ILI clinic visits, Washburne said, could help better understand how quickly and extensively COVID-19 spread during the early days of its appearance in the U.S.
In collaboration with researchers at Pennsylvania State and Cornell universities, Washburne examined the number of ILI visits reported each week over the last decade and compared those historical trends to such visits during March 2020. They identified a surge in March 2020 ILI visits that parallels regional increases in COVID-19 cases.
By examining ILI data alongside the known regional prevalence of COVID-19, Washburne and his collaborators determined that there may have been many cases of the coronavirus disease that weren't initially identified as such.
Washburne and his colleagues estimate that as many as 87% of coronavirus cases were not diagnosed during early March, which could translate to around 8.7 million people based on the excess March ILI visits. The surge in ILI diminished quickly in the latter part of March, leading researchers to conclude that more cases of COVID-19 were being identified since fewer ILI reports were being logged in the database.
"Early on there seems to have been a low case detection rate, but as time went on that changed," said Washburne. "By the last week in March, as more and more testing was going on, that case detection rate increased significantly."
This is good news for scientists seeking to predict and prepare for future epidemics, said Washburne. A baseline has been established through a decade of ILI data collection that allows for the early detection of anomalous surges of ILI that deviate from the annual average.
With much of the research about COVID-19 happening as the pandemic unfolds, Washburne said syndromic surveillance like this shows researchers and the medical community one piece of a larger story. When coupled with COVID-19 testing efforts and serological surveys, which seek to identify the proportion of a population with immunity to an illness, this type of data collection and analysis can illuminate a piece of the puzzle that helps outline our understanding of coronavirus as a whole, he said, while also offering insight for future potential epidemics.
Washburne also said that syndromic surveillance using tools like ILINet could be applied in areas where widespread testing is too expensive.
"For communities that may not have the capacity for more large-scale testing, this may be able to help give them a picture of the movement of their epidemic in time and space," he said. "That way they can know when to implement actions like mask wearing and social distancing measures."
The practice of collecting data ahead of a potential outbreak is an investment in future public health, Washburne said. This research into COVID-19 wouldn't have been possible without the creation of the database after H1N1, so continuing to expanding the baseline data collected for other illnesses could be crucial in navigating future pandemics.
"All these different methods can be used to cross-validate each other," he said. "We know if our other methods don't work optimally, we have additional resources. Things like this can really help us be better prepared in the future."
https://www.sciencedaily.com/releases/2020/06/200626092732.htm
EMS calls have dropped 26 percent nationwide in U.S. since the start of the pandemic
June 26, 2020
Science Daily/University at Buffalo
Since early March and the start of the COVID-19 pandemic in the United States, 911 calls for emergency medical services have dropped by 26.1 percent compared to the past two years.
But the study also found that EMS-attended deaths have doubled, indicating that when EMS calls were made, they often involved a far more serious emergency.
"The public health implications of these findings are alarming," said E. Brooke Lerner, PhD, first author on the paper and professor and vice chair for research in the Department of Emergency Medicine in the Jacobs School of Medicine and Biomedical Sciences at UB.
"When people are making fewer 911 calls but those calls are about far more severe emergencies, it means that people with urgent conditions are likely not getting the emergency care they need in a timely way," she said. "The result is increased morbidity and mortality resulting from conditions not directly related to exposure to SARS-CoV2."
This finding covered the six-week period that began on March 2, and this trend persisted through the end of May.
Delaying care
"The doubling of deaths and cardiac arrests during this relatively short period of time, from March through May, demonstrates that people who need emergency health care may be delaying care such that their lives are actually in jeopardy," said Lerner.
Lerner pointed to two possible causes: fear of contracting the virus at health care facilities and the impulse to not burden health care facilities with non-COVID-19 issues.
"This may mean that future consideration needs to be given to how we message the risks associated with seeking medical care during a pandemic," said Lerner. "At the same time that we are stressing how to stay safe from COVID-19, it may also be necessary to stress how important it is to continue to seek care for serious conditions unrelated to the novel coronavirus." Lerner added that the findings echo those of studies in other countries, such as Italy, where there was an increase in heart attack fatalities during the height of the pandemic there.
A persistent trend
"The fact that this trend persists even as the pandemic in some areas has started to lessen in severity shows that the fear of accessing health care has continued," Lerner said.
One positive, unsurprising finding was that the rate of 911 calls related to injuries declined for the obvious reason that during times when regions were shutdown, there were fewer opportunities for driving and recreation-related injuries.
The study also revealed significant issues related to the financial viability of EMS in this type of environment.
"The financial strain on EMS agencies will have long-term ramifications for maintaining this important safety net for our communities, especially those agencies whose revenue is based solely on patient transports," said Lerner.
The study consisted of a comparative, retrospective analysis of standardized patient care records that are submitted by more than 10,000 EMS agencies across 47 states and territories nearly in real-time. Those data are submitted to the National Emergency Medical Services Information System (NEMSIS) database, which stores EMS data nationwide.
The study was published online June 17 in Academic Emergency Medicine. Co-authors are Craig D. Newgard, MD, of Oregon Health and Science University, and N. Clay Mann, MD, of the University of Utah School of Medicine.
The work was supported by the National Highway Traffic Safety Administration, Office of Emergency Medical Services and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
https://www.sciencedaily.com/releases/2020/06/200626092735.htm
New study looks at post-COVID-19 emerging disease in children
June 25, 2020
Science Daily/Radiological Society of North America
In recent weeks, a multisystem hyperinflammatory condition has emerged in children in association with prior exposure or infection to SARS-CoV-2. A new case series published in the journal Radiology examines the spectrum of imaging findings in children with the post-COVID-19 inflammatory condition known in the U.S. as Multisystem Inflammatory Syndrome in Children (MIS-C).
The array of findings includes airway inflammation and rapid development of pulmonary edema, coronary artery aneurysms, and extensive intra-abdominal inflammatory changes.
In April 2020, Evelina London Children's Hospital in London, U.K., experienced a surge of children with a multi-system hyperinflammatory syndrome. The children had a variety of symptoms, including fever, headaches, abdominal pain, rash and conjunctivitis. Clinical features and lab findings shared some similarities to those of Kawasaki disease -- which causes inflammation in the walls of blood vessels -- Kawasaki-disease shock syndrome or toxic-shock syndrome, although atypical and more severe.
"Our hospital saw an unprecedented cluster of children presenting with MIS-C, a new hyperinflammatory syndrome in children related to the current COVID-19 pandemic -- the recognition of which led to a national alert," said the study's lead author, Shema Hameed, M.B.B.S., consultant pediatric radiologist at Evelina London Children's Hospital.
For the study, researchers performed a retrospective review of clinical, laboratory and imaging findings of the first 35 children under age 17 who were admitted to the pediatric hospital that met the case definition for MIS-C. The children were admitted from April 14 to May 9, 2020, and included 27 boys and eight girls, with a median age of 11 years old.
The most common clinical presentation was fever, found in 33 (94%) of the children, gastrointestinal symptoms including abdominal pain, vomiting and diarrhea in 30 (86%) of the children, rash (13 or 37%) and conjunctivitis (9 or 26%). Twenty-one children (60%) were in shock. Clinical status was severe enough to warrant management in the pediatric intensive care unit in 24 of 35 children (69%), of which 7 (20%) required mechanical ventilation and 20 (57%) inotropic support.
Two children required extracorporeal membrane oxygenation (ECMO) due to severe myocardial dysfunction. Lab tests revealed that all of the children had abnormal white blood cell counts.
The study identified a pattern of imaging findings in post COVID-19 MIS-C, including airway inflammation, rapidly progressive pulmonary edema, coronary artery aneurysms and extensive abdominal inflammatory changes within the right iliac fossa.
All 35 children underwent chest X-ray due to fever, sepsis or features of multisystem inflammation. Nineteen X-rays were abnormal, the most common finding being that of bronchial wall thickening.
The predominant findings on chest CT were basal consolidation, or part of the lung filling with fluid; and collapsed lung with pleural effusions, or build-up of fluid in the outer membranes of the lungs.
Abdominal ultrasound findings included inflammatory changes within the right iliac fossa, with mesenteric fat stranding, lymphadenopathy and bowel wall thickening, as well as free fluid in the pelvis.
"As pediatric radiologists, we were interested in the emerging pattern of imaging findings that we observed in these children," Dr. Hameed said. "Our intention is to bring these findings to the attention of the wider radiological community."
The authors advise that future studies should include a larger group of patients, ideally utilizing multi-center databases to assess the radiological findings alongside the complex clinical course of these young patients.
https://www.sciencedaily.com/releases/2020/06/200625140719.htm
Superbug impact on the gut
June 25, 2020
Science Daily/Monash University
Monash University researchers have discovered that the devastating bacterial superbug Clostridioides difficile hijacks the human wound healing system in order to cause serious and persistent disease, opening up the development of new therapies to treat the disease.
Clostridioides difficile is the most common hospital-acquired disease and causes persistent and life-threatening gut infections -- particularly in elderly and immunocompromised patients.
The infection is very difficult to treat, and often repeatedly reoccurs in patients even after they have been given powerful and debilitating antibiotics for many months. C. difficile is also highly resistant to antibiotics, which greatly complicates treatment.
A team based in the Monash Biomedicine Discovery Institute (BDI) found that C. difficile massively activates a human enzyme called plasminogen in order to destroy gut tissue and to help spread the infection throughout the patient. Ordinarily, plasminogen, and its active form plasmin, is deployed in a highly controlled fashion to break down scar tissue and help wounds heal.
"The results were a huge surprise, and revealed that the severe damage caused to the gut by C. difficile was actually caused by a human enzyme rather than a bacterial toxin," said study co-leader and infectious disease expert Prof Dena Lyras.
Given their findings, the researchers decided to investigate whether potent antibodies developed by the team and that inhibited the plasminogen / plasmin system could be used to treat the disease.
"We found that an antibody that prevented plasminogen from being activated dramatically stalled the progress of infection and tissue damage," said first author Milena Awad.
The researchers now aim to commercialise their antibodies in order to treat a range of bacterial and inflammatory diseases.
An advantage of targeting a human protein in an infectious disease is that resistance to the therapy is far less likely to occur.
"The antibody could have broad utility, since the plasminogen / plasmin system is dysregulated in a range of different serious inflammatory and infectious diseases -- for example, the plasminogen system most likely is a driver of the devastating lung damage seen in COVID-19," said study co-leader and structural biologist Prof James Whisstock.
https://www.sciencedaily.com/releases/2020/06/200625102524.htm
Bacterial predator could help reduce COVID-19 deaths
June 24, 2020
Science Daily/University of Birmingham
A type of virus that preys on bacteria could be harnessed to combat bacterial infections in patients whose immune systems have been weakened by the SARS-CoV-2 virus that causes the COVID-19 disease, according to an expert at the University of Birmingham and the Cancer Registry of Norway.
Called bacteriophages, these viruses are harmless to humans and can be used to target and eliminate specific bacteria. They are of interest to scientists as a potential alternative to antibiotic treatments.
In a new systematic review, published in the journal Phage: Therapy, Applications and Research, two strategies are proposed, where bacteriophages could be used to treat bacterial infections in some patients with COVID-19.
In the first approach, bacteriophages would be used to target secondary bacterial infections in patients' respiratory systems. These secondary infections are a possible cause of the high mortality rate, particularly among elderly patients. The aim is to use the bacteriophages to reduce the number of bacteria and limit their spread, giving the patients' immune systems more time to produce antibodies against SARS-CoV-2.
Dr Marcin Wojewodzic, a Marie Skłodowska-Curie Research Fellow in the School of Biosciences at the University of Birmingham and now researcher at the Cancer Registry of Norway, is the author of the study. He says: "By introducing bacteriophages, it may be possible to buy precious time for the patients' immune systems and it also offers a different, or complementary strategy to the standard antibiotic therapies."
Professor Martha R.J. Clokie, a Professor of Microbiology at the University of Leicester and Editor-in-Chief of PHAGE journal explains why this work is important: "In the same way that we are used to the concept of 'friendly bacteria' we can harness 'friendly viruses' or 'phages' to help us target and kill secondary bacterial infections caused by a weakened immune system following viral attack from viruses such as COVID-19."
Dr Antal Martinecz, an expert in computational pharmacology at the Arctic University of Norway who advised on the manuscript says: "This is not only a different strategy to the standard antibiotic therapies but, more importantly, it is exciting news relating to the problem of bacterial resistance itself."
In the second treatment strategy, the researcher suggests that synthetically altered bacteriophages could be used to manufacture antibodies against the SARS-CoV-2 virus which could then be administered to patients via a nasal or oral spray. These bacteriophage-generated antibodies could be produced rapidly and inexpensively using existing technology.
"If this strategy works, it will hopefully buy time to enable a patient to produce their own specific antibodies against the SARS-CoV-2 virus and thus reduce the damage caused by an excessive immunological reaction," says Dr Wojewodzic.
Professor Martha R.J. Clokie's research focuses on the identification and development of bacteriophages that kill pathogens in an effort to develop new antimicrobials: "We could also exploit our knowledge of phages to engineer them to generate novel and inexpensive antibodies to target COVID-19. This clearly written article covers both aspects of phage biology and outlines how we might use these friendly viruses for good purpose."
Dr Wojewodzic is calling for clinical trials to test these two approaches.
"This pandemic has shown us the power viruses have to cause harm. However, by using beneficial viruses as an indirect weapon against the SARS-CoV-2 virus and other pathogens, we can harness that power for a positive purpose and use it to save lives. The beauty of nature is that while it can kill us, it can also come to our rescue." adds Dr Wojewodzic.
"It's clear that no single intervention will eliminate COVID-19. In order to make progress we need to approach the problem from as many different angles and disciplines as possible." concludes Dr Wojewodzic.
https://www.sciencedaily.com/releases/2020/06/200624103234.htm
Far-UVC light safely kills airborne coronaviruses
June 24, 2020
Science Daily/Columbia University Irving Medical Center
A type of ultraviolet light called far-UVC -- which is safe to use around people -- kills more than 99.9 percent of airborne coronaviruses, a new study has found.
More than 99.9% of seasonal coronaviruses present in airborne droplets were killed when exposed to a particular wavelength of ultraviolet light that is safe to use around humans, a new study at Columbia University Irving Medical Center has found.
"Based on our results, continuous airborne disinfection with far-UVC light at the current regulatory limit could greatly reduce the level of airborne virus in indoor environments occupied by people," says the study's lead author David Brenner, PhD, Higgins Professor of Radiation Biophysics at Columbia University Vagelos College of Physicians and Surgeons and director of the Center for Radiological Research at Columbia University Irving Medical Center.
The research was published today in Scientific Reports.
Background
Conventional germicidal UVC light (254 nm wavelength) can be used to disinfect unoccupied spaces such as empty hospital rooms or empty subway cars, but direct exposure to these conventional UV lamps is not possible in occupied public spaces, as this could be a health hazard.
To continuously and safely disinfect occupied indoor areas, researchers at Columbia University Irving Medical Center have been investigating far-UVC light (222 nm wavelength). Far-UVC light cannot penetrate the tear layer of the eye or the outer dead-cell layer of skin so it cannot reach or damage living cells in the body.
The researchers had previously shown that far-UVC light can safely kill airborne influenza viruses.
The new paper extends their research to seasonal coronaviruses, which are structurally similar to the SARS-CoV-2 virus that causes COVID-19.
Study details
In the study, the researchers used a misting device to aerosolize two common coronaviruses. The aerosols containing coronavirus were then flowed through the air in front of a far-UVC lamp. After exposure to far-UVC light, the researchers tested to see how many of the viruses were still alive.
The researchers found that more than 99.9% of the exposed virus had been killed by a very low exposure to far-UVC light.
Based on their results, the researchers estimate that continuous exposure to far-UVC light at the current regulatory limit would kill 90% of airborne viruses in about 8 minutes, 95% in about 11 minutes, 99% in about 16 minutes, and 99.9% in about 25 minutes.
Using far-UVC light in occupied indoor spaces
The sensitivity of the coronaviruses to far-UVC light suggests that it may be feasible and safe to use overhead far-UVC lamps in occupied indoor public places to markedly reduce the risk of person-to-person transmission of coronaviruses, as well as other viruses such as influenza.
Ongoing studies in SARS-CoV-2
In a separate ongoing study, the researchers are testing the efficacy of far-UVC light against airborne SARS-CoV-2. Preliminary data suggest that far-UVC light is just as effective at killing SARS-CoV-2.
"Far-UVC light doesn't really discriminate between coronavirus types, so we expected that it would kill SARS-CoV-2 in just the same way," Brenner says. "Since SARS-CoV-2 is largely spread via droplets and aerosols that are coughed and sneezed into the air it's important to have a tool that can safely inactivate the virus while it's in the air, particularly while people are around."
Brenner continues, "Because it's safe to use in occupied spaces like hospitals, buses, planes, trains, train stations, schools, restaurants, offices, theaters, gyms, and anywhere that people gather indoors, far-UVC light could be used in combination with other measures, like wearing face masks and washing hands, to limit the transmission of SARS-CoV-2 and other viruses."
More information
The paper is titled, "Far-UVC light (222-nm) efficiently and safely inactivates airborne coronaviruses."
https://www.sciencedaily.com/releases/2020/06/200624172050.htm
Initial COVID-19 infection rate may be 80 times greater than originally reported
June 22, 2020
Science Daily/Penn State
Many epidemiologists believe that the initial COVID-19 infection rate was undercounted due to testing issues, asymptomatic and alternatively symptomatic individuals, and a failure to identify early cases.
Now, a new study from Penn State estimates that the number of early COVID-19 cases in the U.S. may have been more than 80 times greater and doubled nearly twice as fast as originally believed.
In a paper published today (June 22) in the journal Science Translational Medicine, researchers estimated the detection rate of symptomatic COVID-19 cases using the Centers for Disease Control and Prevention's influenza-like illnesses (ILI) surveillance data over a three week period in March 2020.
"We analyzed each state's ILI cases to estimate the number that could not be attributed to influenza and were in excess of seasonal baseline levels," said Justin Silverman, assistant professor in Penn State's College of Information Sciences and Technology and Department of Medicine. "When you subtract these out, you're left with what we're calling excess ILI -- cases that can't be explained by either influenza or the typical seasonal variation of respiratory pathogens."
The researchers found that the excess ILI showed a nearly perfect correlation with the spread of COVID-19 around the country.
Said Silverman, "This suggests that ILI data is capturing COVID cases, and there appears to be a much greater undiagnosed population than originally thought."
Remarkably, the size of the observed surge of excess ILI corresponds to more than 8.7 million new cases during the last three weeks of March, compared to the roughly 100,000 cases that were officially reported during the same time period.
"At first I couldn't believe our estimates were correct," said Silverman. "But we realized that deaths across the U.S. had been doubling every three days and that our estimate of the infection rate was consistent with three-day doubling since the first observed case was reported in Washington state on January 15."
The researchers also used this process to estimate infection rates for each state, noting that states showing higher per capita rates of infection also had higher per capita rates of a surge in excess ILI. Their estimates showed rates much higher than initially reported but closer to those found once states began completing antibody testing.
In New York, for example, the researchers' model suggested that at least 9% of the state's entire population was infected by the end of March. After the state conducted antibody testing on 3,000 residents, they found a 13.9% infection rate, or 2.7 million New Yorkers.
Excess ILI appears to have peaked in mid-March as, the researchers suggest, fewer patients with mild symptoms sought care and states implemented interventions which led to lower transmission rates. Nearly half of U.S. states were under stay-at-home orders by March 28.
The findings suggest an alternative way of thinking about the COVID-19 pandemic.
"Our results suggest that the overwhelming effects of COVID-19 may have less to do with the virus' lethality and more to do with how quickly it was able to spread through communities initially," Silverman explained. "A lower fatality rate coupled with a higher prevalence of disease and rapid growth of regional epidemics provides an alternative explanation of the large number of deaths and overcrowding of hospitals we have seen in certain areas of the world."
https://www.sciencedaily.com/releases/2020/06/200622141143.htm
A second COVID-19 wave could be avoided if social distancing and the use of face masks are maintained
Science Daily/June 22, 2020
Barcelona Institute for Global Health (ISGlobal)
A model developed by ISGlobal shows that deconfinement must be gradual and that individual behaviour is a key factor.
Individual behaviour has a significant effect on preventing a large second wave of COVID-19 infections. In fact, maintaining social distancing and other interventions such as the use of face masks and hand hygiene could remove the need for future lockdowns, according to a modelling study performed by the Barcelona Institute for Global Health (ISGlobal), an institution supported by the "la Caixa" Foundation. The findings, published in Nature Human Behaviour, also show that, in countries that have not yet reached the peak of active cases, lockdowns must remain in place for at least 60 days and deconfinement must be gradual in order to decrease the risk of second waves.
Several countries that initially imposed strict lockdown measures to limit the spread of SARS-CoV-2 are in the process of lifting them. However, how and when to ease the restrictions is a difficult decision -- a delicate balance between the need to reactivate the economy and the risk of a second wave of infections that could overwhelm healthcare systems. "The problem is that assessing this risk is difficult, given the lack of reliable information on the actual number of people infected or the extent of immunity developed among the population," explains Xavier Rodó, head of ISGlobal's Climate and Health programme. In this study, Rodó's team present projections based on a model that divides the population into seven groups: susceptible, quarantined, exposed, infectious not detected, reported infectious and confined, recovered and death. It also allows to simulate both the degree of population confinement and the different post-confinement strategies.
"Our model is different because it considers the return of confined people to the susceptible population to estimate the effect of deconfinement, and it includes people's behaviours and risk perception as modulating factors," explains Xavier Rodó. "This model can be particularly useful for countries where the peak of cases has not yet been reached, such as those in the Southern hemisphere. It would allow to evaluate control policies and minimise the number of cases and fatalities caused by the virus" explains co-author and ISGlobal researcher Leonardo López.
The use of face masks, hand hygiene and 'shelter in place' mandates have already demonstrated benefits. The aim of this study was to quantitatively evaluate their relevance as containment strategies. The results clearly show that the length of the first confinement will affect the timing and magnitude of subsequent waves, and that gradual deconfinement strategies always result in a lower number of infections and deaths, when compared to a very fast deconfinement process.
In Spain, where the deconfinement was fast for half of the population and gradual for the rest, individual behaviour will be key for reducing or avoiding a second wave. "If we manage to reduce transmission rate by 30% through the use of face masks, hand hygiene and social distancing, we can considerably reduce the magnitude of the next wave. Reducing transmission rate by 50% could avoid it completely," says Rodó.
The results show that, even in countries that do not have the resources to test and trace all cases and contacts, social empowerment through the use of masks, hand hygiene and social distancing, is key to stopping viral transmission.
Simulations also show that loss of immunity to the virus will have significant effects on the spacing between epidemic waves -- if immunity has a long duration (one year instead of a few months), then the time between the epidemic waves will double.
The model considered total lockdowns and used data available until May 25, but did not take into account a possible effect of temperatures on viral transmission.
https://www.sciencedaily.com/releases/2020/06/200622132943.htm
COVID-19 lockdown reveals human impact on wildlife
June 22, 2020
Science Daily/Max-Planck-Gesellschaft
In an article published in Nature Ecology & Evolutiontoday (22 June), the leaders of a new global initiative explain how research during this devastating health crisis can inspire innovative strategies for sharing space on this increasingly crowded planet, with benefits for both wildlife and humans.
Many countries around the world went into lockdown to control the spread of Covid-19. Brought about by the most tragic circumstances, this period of unusually reduced human mobility, which the article's authors coined "anthropause," can provide invaluable insights into human-wildlife interactions.
There have been countless posts on social media over the past few months reporting unusual wildlife encounters. Anecdotal observations, especially from metropolitan areas, suggest that nature has responded to lockdown. There not only seem to be more animals than usual, but there are also some surprising visitors: pumas have been spotted prowling the streets of downtown Santiago, Chile, and dolphins recently showed up in untypically calm waters in the harbour of Trieste, Italy.
For other species, the pandemic may have created new challenges. For example, some urban-dwelling animals, like gulls, rats or monkeys, may struggle to make ends meet without access to human food. In more remote areas, reduced human presence may potentially put endangered species, such as rhinos or raptors, at increased risk of poaching or persecution.
The authors emphasise that society's priority must be to tackle the immense human tragedy and hardship caused by Covid-19. But, they argue that we cannot afford to miss the opportunity to chart, for the first time on a truly global scale, the extent to which modern human mobility affects wildlife.
To address this challenge, researchers recently formed the "COVID-19 Bio-Logging Initiative." This international consortium will investigate animals' movements, behaviour and stress levels, before, during and after Covid-19 lockdown, using data collected with nifty animal-attached electronic devices called "bio-loggers."
The article's lead author, Professor Christian Rutz, a biologist at the University of St Andrews, UK, and President of the International Bio-Logging Society, explains: "All over the world, field biologists have fitted animals with miniature tracking devices. These bio-loggers provide a goldmine of information on animal movement and behaviour, which we can now tap to improve our understanding of human-wildlife interactions, with benefits for all."
The team will integrate results from a wide variety of animals, including fish, birds and mammals, in an attempt to build a global picture of lockdown effects.
Dr Francesca Cagnacci, Senior Researcher at the Edmund Mach Foundation in Trento, Italy, and Principal Investigator of the Euromammals research network, says: "The international research community responded quickly to our recent call for collaboration, offering over 200 datasets for analysis. We are very grateful for this support."
So, what do the scientists hope to learn? Dr Matthias-Claudio Loretto, a Marie Skłodowska-Curie Fellow at the Max Planck Institute of Animal Behavior in Radolfzell, Germany, explains that it will be possible to address previously intractable questions: "We will be able to investigate if the movements of animals in modern landscapes are predominantly affected by built structures, or by the presence of humans. That is a big deal."
These insights will in turn inspire innovative proposals for improving human-wildlife coexistence, according to Professor Martin Wikelski, Director of the Max Planck Institute of Animal Behavior in Radolfzell, Germany. "Nobody is asking for humans to stay in permanent lockdown. But we may discover that relatively minor changes to our lifestyles and transport networks can potentially have significant benefits for both ecosystems and humans."
Coordinated global wildlife research during this period of crisis will provide unforeseen opportunities for humans to forge a mutually beneficial coexistence with other species, and to rediscover how important a healthy environment is for our own well-being.
https://www.sciencedaily.com/releases/2020/06/200622133020.htm
Researchers find resilience, not loneliness in nationwide study of pandemic response
June 22, 2020
Science Daily/Florida State University
Social distancing during the COVID-19 pandemic has not led to an overall increase in loneliness among Americans.
That's the takeaway from a comprehensive, nationwide study by Florida State University College of Medicine researchers who surveyed more than 2,000 people before and during the enactment of stay-at-home policies in response to the COVID-19 pandemic.
The study on how loneliness and perceived support has changed from before to during the pandemic is published in American Psychologist.
"There has been a lot of worry that loneliness would increase dramatically because of the social distancing guidelines and restrictions," said lead author Martina Luchetti, an assistant professor at the College of Medicine. "Contrary to this fear, we found that overall loneliness did not increase. Instead, people felt more supported by others than before the pandemic. Even while physically isolated, the feeling of increased social support and of being in this together may help limit increases in loneliness."
The paper is part of a larger study College of Medicine researchers are doing on COVID-19 to look at changes in mental health during the COVID-19 crisis and how psychological factors contribute to various aspects of response to the pandemic.
The study involved a nationwide panel of adults ages 18 to 98. Participants first completed a survey in early February unrelated to COVID-19, before the virus was widely known to be a threat to the U.S.
As the threat was being realized, researchers contacted participants again for two more surveys -- one in mid-March during the 15-day period to slow the spread based on White House guidelines and another in late April as the guidelines were about to expire. More than 2,000 responses to the surveys were included in the findings.
The study also looked for increased loneliness in specific at-risk groups, finding only modest evidence of a small increase in loneliness among older adults. Older adults reported less loneliness overall compared to younger age groups, despite an increase in loneliness during the acute phase of the outbreak. That increase in feelings of loneliness among older adults was temporary, leveling off after the issuance of stay-at-home orders.
Individuals living alone and those with at least one chronic condition reported feeling lonelier at the outset but did not increase in loneliness after social-distancing measures were implemented.
"Despite a small increase among some individuals, we found overall remarkable resilience in response to COVID-19," said Angelina Sutin, associate professor of Behavioral Sciences and Social Medicine and senior author.
Loneliness already was a known health risk before the pandemic, and it has been linked to increased risks of morbidity and mortality. Surveys have found that 35 percent of adults 45 and older report feeling lonely and 43 percent of those over 60 report experiencing loneliness at least some of the time.
Some studies suggest that loneliness is even more pervasive among younger adults.
"In the context of the coronavirus pandemic, it may be particularly difficult to reconnect with others given the restrictions on in-person social gatherings," Luchetti said. "Even these transient feelings of loneliness can have a negative effect on health, meaning there could be dangerous unintended consequences if loneliness increases in response to the restrictive measures taken as a result of the pandemic."
Yet from the start of the pandemic, there have been anecdotal reports of people calling their family and friends more often and finding creative ways to stay connected. This outpouring of support may have shielded them from potential increases in loneliness.
The pandemic is also something that everybody is going through.
"Just knowing that you are not alone and that everyone is going through the same restrictions and difficulties may be enough in the short term to keep feelings of loneliness down," Sutin said.
https://www.sciencedaily.com/releases/2020/06/200622095016.htm
Clear signs of brain injury with severe COVID-19
June 18, 2020
Science Daily/University of Gothenburg
Certain patients who receive hospital care for coronavirus infection (COVID-19) exhibit clinical and neurochemical signs of brain injury, a University of Gothenburg study shows. In even moderate COVID-19 cases, finding and measuring a blood-based biomarker for brain damage proved to be possible.
Some people infected with the coronavirus SARS-CoV-2 get only mild, cold-like symptoms, while others become severely ill and require hospital treatment. Among the latter, it has become clear that the patients sometimes show obvious signs of the brain not functioning as it should. These cases are not common, but do occur.
In a project at Sahlgrenska Academy, University of Gothenburg, blood samples were taken from 47 patients with mild, moderate and severe COVID-19 in the course of their hospital stay. These samples were analyzed by means of highly sensitive biomarkers for brain injury. The results were compared with those from a healthy control group comprising 33 people matched by age and sex.
Now that the research is being presented in the journal Neurology, it is evident that an increase in one of the biomarkers took place even with moderate COVID-19 -- that is, in patients admitted to hospital but not in need of ventilator support. This marker, known as GFAP (glial fibrillary acidic protein), is normally present in astrocytes, a star-shaped neuron-supportive cell type in the brain, but leaks out in the event of astrocytic injury or overactivation.
The second biomarker investigated was NfL (neurofilament light chain protein), which is normally to be found inside the brain's neuronal outgrowths, which it serves to stabilize, but which leaks out into the blood if they are damaged. Elevated plasma NfL concentrations were found in most of the patients who required ventilator treatment, and there was a marked correlation between how much they rose and the severity of the disease.
"The increase in NfL levels, in particular, over time is greater than we've seen previously in studies connected with intensive care, and this suggests that COVID-19 can in fact directly bring about a brain injury. Whether it's the virus or the immune system that's causing this is unclear at present, and more research is needed," says Henrik Zetterberg, Professor of Neurochemistry, whose research team at Sahlgrenska Academy performed the measurements.
Magnus Gisslén, Professor of Infectious Diseases at Sahlgrenska Academy and chief physician at the Department of Infectious Diseases, Sahlgrenska University Hospital, leads the Academy's clinical research on COVID-19.
In his view, blood tests for biomarkers associated with brain injury could be used for monitoring patients with moderate to severe COVID-19, to reduce the risk of brain injury.
"It would be highly interesting to see whether the NfL increase can be slowed down with new therapies, such as the new dexamethasone treatment that's now been proposed," Gisslén says.
https://www.sciencedaily.com/releases/2020/06/200618111009.htm
COVID-19 affects adolescent and young adults sexual and reproductive health
June 18, 2020
Science Daily/Columbia University's Mailman School of Public Health
Social distancing and limited access to contraceptive and abortion care during the COVID-19 pandemic is affecting the sexual and reproductive health of adolescents and young adults according to a new study by researchers at Columbia University Mailman School of Public Health and Rutgers University. The researchers address how these challenges, as well as peer and romantic relationships, are being navigated. The findings are published in the journal Perspectives on Sexual and Reproductive Health.
Huge changes for adolescents and young adults, include school closures, potentially much more time with family, the interruption of the normal trajectory toward increased independence and, for many, very limited or no physical proximity to sexual and romantic partners.
Even though the pandemic may lead to less opportunities for sex for some young people, disruptions in access to contraception and abortion can be extremely problematic for adolescents and young adults who are still able to be physically close to their partners during the pandemic, note the authors. "The good news is that some services, including obtaining many forms of contraception and receiving testing and treatment for sexually transmitted diseases can be handled through telemedicine," said Leslie Kantor, a professor and chair of the Rutgers Department of Urban Global Public Health. "If telemedicine remains as widely available as it has been during the coronavirus pandemic, access to sexual and reproductive health care may actually improve for young people." However, Kantor and colleagues say that lack of privacy and confidentiality, which many adolescents and young adults are experiencing while living at home with family, can also hinder the ability to get necessary sexual and reproductive healthcare.
In terms of testing for sexually transmitted infections or seeking abortion care, there is not a lot of data specifically on young people. But many states have tried to restrict abortion access by arguing it is not an essential service despite the fact that abortion clearly is essential and needs to be timely. There also have been very concerning declines in vaccinations for all children older than age 2 and the use of the HPV vaccine, which prevents cancer-causing infections and pre-cancers, has plummeted.
LGBTQ youth have also been impacted, although fortunately, many LGBTQ centers quickly moved support groups and other services online. Services such as QChat Space were already using digital platforms to convene and offer support to LGBTQ youth. However, for some youth whose families are less accepting, being quarantined for months can lead to significant tensions and confidentiality concerns, which could make LGBTQ youth more isolated.
While social disruption resulting from the pandemic affects young adults' sense of health and well-being, one positive aspect is that young adults are digital natives familiar with online platforms and social media. "Young people are supposed to be gaining independence at this time in life, so for those who have had to return home after a period of being away, maintaining relationships with friends and romantic partners at a distance may be particularly challenging. Our view that their constant digital connection was negative is now a positive for them at this time," said David Bell, MD, MPH, Columbia Mailman School of Public Health associate professor of Population and Family Health and Pediatrics.
https://www.sciencedaily.com/releases/2020/06/200618124754.htm
COVID-19 threatens the entire nervous system
Neurological symptoms may appear before fever or cough
June 11, 2020
Science Daily/Northwestern University
A new review of neurological symptoms of COVID-19 patients in current scientific literature reveals the disease poses a global threat to the entire nervous system, reports a Northwestern Medicine study published this week in Annals of Neurology.
About half of hospitalized patients have neurological manifestations of COVID-19, which include headache, dizziness, decreased alertness, difficulty concentrating, disorders of smell and taste, seizures, strokes, weakness and muscle pain.
"It's important for the general public and physicians to be aware of this, because a SARS-COV-2 infection may present with neurologic symptoms initially, before any fever, cough or respiratory problems occur," said lead author of the review, Dr. Igor Koralnik, Northwestern Medicine chief of neuro-infectious diseases and global neurology and a professor of neurology at Northwestern University Feinberg School of Medicine.
The review describes the different neurological conditions that may occur in COVID-19 patients and how to diagnose them, as well as likely pathogenic mechanisms.
"This understanding is key to direct appropriate clinical management and treatment," Koralnik said.
The disease may affect the entire nervous system, including the brain, spinal cord and nerves as well as the muscles. There are many different ways COVID-19 can cause neurological dysfunction, he said. Because this disease may affect multiple organs (lung, kidney, heart), the brain may also suffer from lack of oxygenation or from clotting disorders that may lead to ischemic or hemorrhagic strokes. In addition, the virus may cause direct infection of the brain and meninges. Finally, the reaction of the immune system to the infection may cause inflammation that can damage the brain and nerves.
Koralnik and colleagues have formed a Neuro-COVID research team and started a retrospective analysis of all COVID-19 patients hospitalized at Northwestern Medicine to determine the frequency and type of neurological complications, as well as response to treatment.
Since knowledge about the long term outcome of neurologic manifestations of COVID-19 is limited, Koralnik also will follow some of those patients prospectively in his new outpatient Neuro-COVID clinic to determine if neurological problems are temporary or permanent. These studies will provide the foundation on how to diagnose, manage and treat the many neurologic manifestations of COVID-19, he said.
https://www.sciencedaily.com/releases/2020/06/200611152444.htm
Responding to challenges of older adults with COVID-19
June 10, 2020
Science Daily/University of Pennsylvania School of Nursing
Older adults with COVID-19 who survive hospitalizations and return to their homes confront substantial health challenges and an unpredictable future. Early evidence suggests that complex and long-term physical, functional, cognitive, and emotional negative health consequences will be the norm for them. However, the trajectories of health care needs of older adults with COVID-19 in the weeks and months following hospital discharge have yet to be identified.
In an article in the Journal of Aging and Social Policy, three researchers from the University of Pennsylvania School of Nursing (Penn Nursing) explain how the core components of the Transitional Care Model, along with early findings regarding the unique concerns of those with COVID-19, suggest a path for immediate practice and policy responses to caring for this population as they transition from the hospital back to the community.
The Transitional Care Model is a care management strategy proven in multiple National Institutes of Health clinical trials to enhance health and quality of life and reduce health-care costs for diverse subgroups of hospitalized older adults to home. It encompasses comprehensive discharge planning and home follow-up.
"Informed by this evidence-based framework, immediate implementation of targeted federal and state policy solutions would position health and community-based care systems to respond more effectively to the enormous challenges encountered by older adults with COVID-19 throughout transitions from hospital to home," wrote the three authors: Mary D. Naylor, PhD, RN, FAAN, the Marian S. Ware Professor in Gerontology and the Director of the NewCourtland Center for Transitions and Health; Karen B. Hirschman, PhD, MSW, research associate professor; and Kathleen McCauley, PhD, RN, FAAN, FAHA, Professor Emerita of Cardiovascular Nursing.
https://www.sciencedaily.com/releases/2020/06/200610135027.htm
Will lockdown loneliness make us loners?
Reduced social preference in isolated zebrafish is caused by stress and anxiety, not observed anti-social patterns
June 10, 2020
Science Daily/Sainsbury Wellcome Centre
Loneliness affects both mental and physical health, but counterintuitively it can also result in a decreased desire for social interaction. To understand the mechanics of this paradox, researchers investigated social behavior in zebrafish.
Over the past few months at least half of the world's population has been affected by some form of lockdown due to COVID-19, and many of us are experiencing the impact of social isolation. Loneliness affects both mental and physical health, but counterintuitively it can also result in a decreased desire for social interaction. To understand the mechanics of this paradox, UCL researchers based at the Wolfson Institute and the Sainsbury Wellcome Centre investigated social behaviour in zebrafish. Their results are published in eLife.
Most zebrafish demonstrate pro-social behaviour, but approximately 10% are 'loner' fish who are averse to social cues and demonstrate different brain activity than their pro-social siblings. However, even typically social zebrafish avoid social interaction after a period of isolation. PhD students Hande Tunbak and Mireya Vazquez-Prada, Postdoctoral Research Fellow Thomas Ryan, Dr Adam Kampff and Sir Henry Dale Wellcome Fellow Elena Dreosti set out to test whether the brain activity of isolated zebrafish mimics that of loner fish or whether other forces were at play.
To investigate the effects of isolation, the researchers isolated typically social zebrafish from other fish for a period of two days and then compared their brain activity to zebrafish who demonstrated aversion to social interaction without having been isolated. The isolated fish demonstrated sensitivity to stimuli and had increased activity in brain regions related to stress and anxiety. These effects of isolation were quickly overcome when the fish received a drug that reduces anxiety.
The differences between loner fish and their siblings were found mostly in the hypothalamus, the region of the brain responsible for social rewards. The loner fish hypothalamus did not demonstrate the same pattern of activation during social exposure as its typical counterparts, indicating that loner fish do not experience rewards in the same way as typical fish during social interactions.
By contrast, 'lonely' fish -- those that demonstrated typical social behaviour and were isolated -- demonstrated hypersensitivity to stimuli and activation of brain regions associated with stress and anxiety. Lonely fish experienced actively negative outcomes from social interaction whereas loner fish simply did not experience reward.
"A detailed view of the zebrafish brain can provide important clues for all of us currently experiencing the effects of social isolation," says Dr Elena Dreosti. Our understanding of the neural mechanisms of social behaviour are limited, but we do know that zebrafish and humans share a fundamental drive for social interaction that is controlled by similar brain structures. Although human behaviour is much more complex, understanding how this basic social drive arises -- and how it is affected by isolation -- is a necessary step towards understanding the impact of the social environment on human brains and behaviour. The zebrafish, which is completely transparent throughout early development, offers neuroscientists a detailed view of its brain circuitry.
We won't all be loners after lockdown, but we will be anxious upon returning to our normal social lives. As we emerge from lockdown, we should be aware of this new sensitivity and anxiety, but recognise that overcoming it is necessary for returning to a normal, healthy, social existence.
https://www.sciencedaily.com/releases/2020/06/200610112057.htm
COVID-19 loneliness linked to elevated psychiatric symptoms in older adults
Age perception, rather than chronical age, is the driving force behind this newly-discovered connection
June 9, 2020
Science Daily/Bar-Ilan University
A new study has linked COVID-19-based loneliness in older adults with elevated psychiatric symptoms of anxiety, depression, and trauma symptoms that immediately follow exposure to trauma. Notably, the researchers found that the effect of loneliness on psychiatric symptoms was most pronounced among participants who felt subjectively older than their chronological age. On the other hand, participants who felt subjectively younger than their chronological age exhibited no psychiatric symptoms related to loneliness.
Although social distancing is crucial in thwarting the spread of COVID-19, isolation and the ensuing loneliness may be severely detrimental for older adults. A new study conducted by researchers at Bar-Ilan University and the University of Haifa has linked COVID-19-based loneliness in older adults with elevated psychiatric symptoms of anxiety, depression, and trauma symptoms that immediately follow exposure to trauma. The findings were recently published in the American Journal of Geriatric Psychiatry.
The study focused on older adults, a sector of the population at greater risk for COVID-19 health complications that likely remained in stricter self-isolation than other age groups due to this risk. Notably, the researchers found that the effect of loneliness on psychiatric symptoms was most pronounced among participants who felt subjectively older than their chronological age. On the other hand, participants who felt subjectively younger than their chronological age exhibited no psychiatric symptoms related to loneliness.
"The way older adults perceive old age and their own aging may be more important to their coping and wellbeing than their chronological age," said Prof. Amit Shrira, from the Gerontology Program at the Interdisciplinary Department of Social Sciences at Bar-Ilan University, who conducted the study with Prof. Ehud Bodner and Dr. Yaakov Hoffman, of Bar-Ilan, and Prof. Yuval Palgi from the University of Haifa.
The findings may assist in identifying older adults at high risk for developing psychiatric symptoms due to COVID-19-related loneliness. In addition, they can guide the development of suitable interventions aimed at lowering perception of age in order to mitigate the negative impact of such loneliness and create a protective factor to prevent such a link. The data should also be helpful in advancing preparatory measures for a future pandemic.
What can be done to relieve the emotional burden of isolation among the elderly? Shrira, a clinical psychologist by training, recommends providing ongoing assistance and communication while adhering to relevant health guidelines. Regular conversations with family members, volunteers and even strangers can prevent the onset of deeper loneliness and the sense that no one is willing to hear their pain. Allowing them to share their experience and wisdom helps them feel more valuable. For those coping with feelings of boredom and emptiness during isolation, Shrira suggests that reading, listening to music, solving puzzles, cooking and baking, physical exercise (even the most minimal) and other leisure activities can refresh the normal, monotonous routine.
https://www.sciencedaily.com/releases/2020/06/200609111056.htm
Ischemic stroke rates decrease during COVID-19 pandemic
June 9, 2020
Science Daily/Michigan Medicine - University of Michigan
A new research letter reveals fewer people have been admitted to stroke centers in Michigan and northwest Ohio since the onslaught of the COVID-19 pandemic, and significantly fewer patients received a mechanical thrombectomy for their ischemic stroke.
The authors call COVID-19's influence on other critical illnesses like stroke a bystander effect. That's because time is of the essence for patients with stroke, but not everyone is getting to a comprehensive stroke center for needed care right now.
In the letter, researchers from Michigan Medicine with colleagues across the Michigan Stroke Treatment Improvement Collaborative reported a significant reduction in ischemic stroke admissions in March when compared both to February of this year (17.8%) and to March of 2019 . Similarly, rates of a procedure for ischemic stroke, mechanical thrombectomy, significantly declined this March compared to February and compared to March of 2019.
"A combination of patient fears, stringent patient transfer criteria, and health system strains may have contributed to lower ischemic stroke admissions as well as the near disappearance of thrombectomy procedures," the authors write.
The differences were most pointed in ischemic stroke and quantity of thrombectomy procedures, authors say, while there was less of a change compared to past months for hemorrhagic stroke.
https://www.sciencedaily.com/releases/2020/06/200609095025.htm
Coronavirus linked to stroke in otherwise healthy young people
June 4, 2020
Science Daily/Thomas Jefferson University
Young patients with no risk factors for stroke may have an increased risk if they have contracted COVID-19, whether or not they are showing symptoms of the disease. Surgeons at Thomas Jefferson University and collaborators analyzed patients presenting with stroke from March 20th until April 10th at their institutions. The strokes they observed were unlike what they usually see.
"We were seeing patients in their 30s, 40s and 50s with massive strokes, the kind that we typically see in patients in their 70s and 80s," says Pascal Jabbour, MD, Chief of the Division of Neurovascular Surgery and Endovascular Surgery in the Vickie & Jack Farber Institute for Neuroscience -- Jefferson Health. He is a senior author of a study published in the journal Neurosurgery June 4th, that examines and characterizes strokes of patients who tested positive for COVID-19, done in collaboration with surgeons from NYU Langone Medical Center in New York.
"Although we have to stress that our observations are preliminary, and based on observations from 14 patients, what we have observed is worrying," says Dr. Jabbour. "Young people, who may not know they have the coronavirus, are developing clots that cause major stroke."
The researchers, including first author Ahmad Sweid, MD, examined 14 patients who had come into their Neurointerventional room for stroke. Eight patients were male, six were female, 50%, did not know they had the coronavirus, while the remainder were already being treated for other symptoms of the disease when they developed stroke.
Some of the paper's major points:
Patients with signs of stroke were delaying coming to the hospital for fear of getting the coronavirus. There's a small window of time in which strokes are treatable, so delays can be life threatening.
The mortality rate in these covid-19 stroke patients is 42.8%. The typical mortality from stroke is around 5 to 10%.
42% of the stroke coronavirus positive patients studied were under the age of 50. Most strokes, over 75% of all strokes in the US, occur in people over the age of 65.
The incidence of coronavirus in the stroke population was 31.5%, according to this sample of patients.
Patients observed had stroke in large vessels, in both hemispheres of the brain, and in both arteries and veins of the brain -- all of these observations are unusual in stroke patients.
Why is the coronavirus, which was assumed to be a disease of the lungs, causing blood clots that lead to a higher incidence of stroke? Researchers have shown that the coronavirus enters human cells via a very specific access point -- a protein on human cells called ACE2. But the coronavirus latches onto this protein and uses it to as a gateway into the cell, where the virus can replicate. Not all cells have the same amount of ACE2. This protein is very abundant on cells that line blood vessels, the heart, kidney, and of course, the lungs. Dr. Jabbour and colleagues speculate that the virus may be interfering with this receptor's normal function, which controls blood flow in the brain, in addition to using it as an entry point to the cell.
Another possibility is that the inflammation of the blood vessels causing vasculitis with injury to the cells lining the lumen of the vessel, called endothelium and causing micro thrombosis in small vessels.
"Our observations, though preliminary, can serve as a warning for medical personnel on the front lines, and for all of those at home," says Dr. Jabbour. "Stroke is occurring in people who don't know they have COVID-19, as well as those who feel sick from their infections. We need to be vigilant and respond q uickly to signs of stroke."
https://www.sciencedaily.com/releases/2020/06/200604095600.htm
Patients with ARDS, COVID-19 face significant financial effects in recovery
Long hospitalizations lead to large medical bills, with serious physical and emotional consequences for those recovering from critical illness
June 3, 2020
Science Daily/Michigan Medicine - University of Michigan
Researchers have been investigating the downstream effects of acute respiratory distress syndrome, or ARDS, for years. As the COVID-19 pandemic rages on, their work has relevance for hundreds of thousands of new patients.
It begins with shortness of breath. And for approximately one third of patients, acute respiratory distress syndrome, or ARDS, ends in death. For those who survive, their lives are often turned upside-down. Michigan Medicine researchers have been investigating the downstream effects of ARDS for years. As the COVID-19 pandemic rages on, their work has relevance for hundreds of thousands of new patients.
"The way COVID-19 kills patients is by depriving them from oxygen," says Theodore (Jack) Iwashyna, M.D., professor of critical care medicine. "But only a third or fewer of COVID-19 patients who develop respiratory failure die. Most survive, and we need research that helps them not just survive but really heal."
A team led by Iwashyna wanted to look more closely at how being hospitalized for ARDS affected people months after they were discharged. They interviewed dozens of patients from around the nation. "As we knew from past research, people had new disabilities ranging from general fatigue and weakness to where they couldn't remember things," says Katrina Hauschildt of the U-M department of sociology and first author on the study. "A lot of people had emotional difficulties coming to terms with just how sick they had been -- a kind of PTSD from being in the ICU."
"What I didn't expect," says Iwashyna, "was the lasting chaos into which surviving respiratory failure threw some of our patients and their families. Patients described problems coming not just from medical bills -- although there were plenty of those -- but also from losing their jobs and losing their insurance." Given the magnitude of recession hitting at the same time as patients are trying to recover from COVID-19, Iwashyna and Hauschildt are worried this could be devastating for many families.
One 55-year old man described having to give up his small business because he could not work after getting out of the intensive care unit (ICU). "I had to sell my business. I'm on disability now...I owned a fire prevention company...We used to clean the kitchen exhaust systems in restaurants throughout the state. Degreased the restaurants, like their exhaust hoods in the kitchen and on the roof...Yeah, I sold everything."
The team found that many respiratory failure patients experience what is known as financial toxicity, defined as the financial burdens and related distress of medical care. In turn, this financial toxicity led to additional negative effects on their physical and emotional recovery.
With hospitalization for ARDS often resulting in weeks of high intensity care, patients end up with medical bills ranging from tens of thousands to, in some cases, millions of dollars, and the proportion covered by insurance varied substantially.
One 49-year old male survivor of ARDS told the study team "I barely make it, or my bills are pending like electricity, things and other stuff." Said another 55-year old woman "I had to pay my rent, my food and medicines and all that so I was a little bit short ... They were kind of difficult to pay after the hospital ... Because I had to get more medicines and all that."
The team reported several consequences of hospitalization including emotional distress related to insurance issues and unpaid bills, reduced physical well-being due to the inability to receive follow-up care due to cost, an increased reliance on family and friends to help cover expenses and other material hardships. Said one patient: "In the next couple of months, I may end up being homeless because of the financial aspect of it."
While these cases may seem extreme, they were not rare. And many patients described having to make hard choices about whether they could afford rehabilitation -- and stopping early when their coverage ran out, even though they were not yet recovered. A 51-year old man told the study team "[Physical therapy] was very short, a couple weeks maybe; then it was over, and I just laid around basically. My insurance did not cover any more, so they had to cut me."
Another patient, a 61-year-old woman, described not having the equipment when she tried to go home: "I could pick one item that I wanted," of the hospital bed, wheelchair, and walker she needed, "because the insurance would only pay for one item."
Hauschildt says the study outlines the need for doctors to be more aware of the financial toxicity faced by survivors of ARDS, including those recovering from COVID-19. "One of the biggest things any doctor involved in follow up care can do is anticipate that patients might have real financial burdens and know what resources are available so they can help," she adds.
However, she notes, what's available is really up to policy makers. For example, the study found that patients who were already on public insurance before their illness reported less of an out-of-pocket financial impact. "Communities that put a safety net in place for ARDS and COVID-19 survivors will ultimately have better healing and recovery. People who heal are able to return to work and care for others and their communities; people who don't aren't."
This work was supported by the National Institutes of Health, National Heart, Lung and Blood Institute as part of the Prevention and Early Treatment of Acute Lung Injury (PETAL) Network. The patients who participated in these interviews gave their consent for their words to be quoted, and were all about nine months after having had moderate to severe ARDS.
https://www.sciencedaily.com/releases/2020/06/200603132559.htm