In early April 2022, about two dozen children and their families gathered beneath the redwoods in a regional park near Oakland, Calif. They sat with a physician, Dr. Nooshin Razani, beneath the branches of the ancient giants, breathing the fresh air and discussing the phenomenon of fairy rings—when a mama tree is cut down, the baby trees grow up in a circle surrounding the stump of the parent tree. These families are taking part in a program Razani runs at the University of California San Francisco Benioff Children’s Hospital Oakland. The program, called the Center for Nature and Health, takes pediatric patients who are dealing with conditions like anxiety, autism, obesity, or developmental issues—and who live in areas without much nature nearby—into local parks on excursions with park staff each month. The program is part of a growing trend of so-called “park prescriptions,” which have increased in popularity over the last decade along with research into the health effects of spending time in nature. In these programs, physicians strongly encourage patients young and old to spend more time outside to improve their mental and physical health. “It’s pretty clear that it’s good for you,” says Razani. Research suggests living near green space and recreating in nature can improve mental health and reduce the risks of certain physical health conditions, like heart disease. Scientists are still trying to figure out why, but the leading theory is that spending time in nature reduces stress, a state that’s tied to many health problems. Of course, no doctor is advising patients to spend a day at the park instead of prescribing needed anti-anxiety medications, for instance. Nature is not a cure for health issues—and park prescriptions aren’t meant to be used instead of prescriptions for medications. But people can harness real health benefits from their nearest patch of nature. A history of park prescriptionsNature prescriptions come in many forms, but these types of programs all provide a way for doctors and other healthcare professionals to encourage their patients to spend time in nature. In Walk with a Doc, started by a cardiologist in 2005, health care providers lead strolls in their community; the walks have expanded to more than 500 places around the world. ParkRx, which became one of the first park-prescription programs in the U.S. when it launched in 2013, provides health care practitioners with guides, toolkits, and case studies to help coax their patients outdoors. PaRx in Canada, which officially launched in 2020, was inspired by these programs. The PaRx website provides copious evidence for the health effects of nature and fact sheets for physicians. PaRx also created a virtual nature prescription that doctors can include in a patient’s electronic health record. Already, more than 5,000 healthcare professionals use the program. Nature prescribing has traction overseas as well. Doctors in Scotland started writing nature prescriptions for patients in 2017 in collaboration with the Royal Society for the Protection of Birds Scotland and the National Health Service (NHS). During the pandemic, the NHS also created a referral network to connect patients with nature-based activities, like walking and community gardening. How nature improves healthEveryone’s health could benefit from a closer connection to nature. But not everybody has equal access. Wealthier neighborhoods tend to have more green space than poorer neighborhoods. That’s partly why Razani’s program focuses on children who do not have adequate green space close to home. Often, these are the populations who need the healing benefits of nature the most. “The end condition the clinician is seeing may vary, from obesity and anxiety,” she says, but two important upstream reasons for these conditions are “stress and lack of access to outdoor space.” When the body is stressed, it undergoes physiological changes, says Mat White, a health and environmental psychologist at the University of Vienna in Austria. Stress stimulates the release of the stress hormone cortisol, which in turn raises your blood pressure and heart rate. Chronically elevated levels of stress are connected to anxiety and depression, he notes. Stress has also been connected to heart disease, obesity, and other negative health outcomes. Scientists think that having positive experiences in nature can help alleviate stress and reduce cognitive fatigue, thereby improving health. “The major theories in the field currently coalesce around the idea of stress reduction,” White says. These theories are based on research that started gaining traction around 2010, experts in the field say. Many studies have found correlations between spending time in nature and improved mental or physical health. “We know there’s a robust relationship between mental health and nature exposure,” says Matthew Browning, founding director of the Virtual Reality and Nature Lab at Clemson University who studies the link between the natural world and human health. There’s also a relationship between long-term exposure to nature and reduced risk of cardiovascular disease and death from any cause, he says. One major early study in the field, published in 2008 in the Lancet, found that people in England living in greener areas had lower rates of death from circulatory diseases and from any cause. “Physical environments which promote good health may be important in the fight to reduce socioeconomic health inequalities,” the authors wrote in the study. People who live in greener areas also tend to have lower health care costs, says Browning. In a study published in the May 2022 issue of the journal Environment International, Browning and his colleagues examined the total health-care costs of 5 million people in Northern California over a decade and compared those costs with the amount of green space or trees around each person’s home, determined through satellite data. Living closer to green areas was correlated with lower health care costs, and the link persisted regardless of other factors that can affect health outcomes, like income, education, occupation, and housing conditions. When it comes to how nature exposure helps our stressed-out brains, researchers have two main theories, says Gregory Bratman, director of the environment and well-being lab at the University of Washington. The first, known in scientific circles as the Stress Reduction Theory, is that exposure to many forms of nature engages the parasympathetic nervous system, which is responsible for rest and digestion and encourages stress recovery. (It’s nicknamed the “rest and digest” system.) The other, the Attention Restoration Theory, suggests that nature engages people’s “soft fascination,” says Bratman. This gives our directed attention, which we use to focus, time to replenish, he says. Much of the research has focused just on the visual aspects of nature—seeing the green of trees or grass, or the blue of a river or ocean. But “nature experiences are multi-sensory,” notes Bratman. Practitioners of shinrin-yoku (or “forest bathing”) in Japan theorize that the scent and experience of breathing in the compounds that trees exude into the air could impact immune function, says Bratman. Sound is another key sense that may indicate safety or danger, allowing relaxation or exacerbating stress—and soothing nature sounds fit firmly in the first camp, says Rachel Buxton, a conservation scientist at Carleton University in Canada, who studies soundscapes, seabird ecology, and ecological restoration. Future researchScientists still don’t know everything about how nature affects health. Many of the studies that find a relationship between the two just look at trends in the general population—not within specific groups, like people with anxiety or depression, says White. Establishing the direct effects of nature on certain conditions would involve ethically complex experiments on small groups of patients, he notes. Because of these complications, scientists don’t have much high-quality evidence as to how nature could affect those people who, theoretically, are in most need of a park prescription. It’s also possible that pressuring someone to spend more time in nature might reduce some of the benefits of the visit, says White. In a study published in 2020, White and his colleagues found that feeling social pressure to visit nature was associated with a higher likelihood to get outside, but also with less personal motivation, less happiness during the visit, and higher anxiety. As soon as you tell someone to do something, “there’s a chance it undermines people’s intrinsic enjoyment,” says White. Many important questions about how to maximize a nature prescription remain unanswered. “We don’t really know how much time people need to spend in nature, [or] what types of nature,” says Browning. The quality of nature someone is exposed to is also likely important, but researchers are not quite sure what that means. Is a manicured park with turf grass and a ballfield enough, or do people benefit more when they go out in the woods—somewhere rich in biodiversity? What’s more, the type of nature someone finds relaxing could be highly individual, based perhaps on their familiarity with a particular landscape, says Browning. Scientists are working to fill in these knowledge gaps. Razani, for example, recently received a $1.2 million grant to study the effects of her nature intervention on anxiety in children. And the scientific literature is constantly growing in this area, says Ulrika Stigsdotter, a professor of landscape architecture and planning at the University of Copenhagen in Denmark, who focuses on evidence-based health design for outdoor spaces. Some of that research revolves around how outdoor spaces can be better designed specifically for nature therapy, Stigsdotter notes. If researchers hope to use nature-based treatments to improve the health of specific patient groups, like those with anxiety or depression, the setting really matters. The design of a garden or landscape needs to fit who will be using it, she says: Someone with cancer may respond to certain garden designs differently than someone struggling with depression or someone else who recently moved to a retirement facility. “The treatment program depends on the context,” she says. In the general population, it’s also important not to overstate the effects of nature, says White. “These effects of green and blue space are small” for most people, says White, particularly compared to other factors that affect our health like relationships, job satisfaction, and financial stability. “They’re marginal effects, but they apply to millions of people. So the overall public health benefit is huge, but small for any given individual.” Harnessing these health impacts across entire populations will necessarily mean expanding access. A prescription to get outside can’t address the issues surrounding access to green space. It can’t expand green space in neighborhoods that lack them, or guarantee that vulnerable people feel comfortable going to these green spaces, or combat all the stress and illness people face. “If we had healthy ecosystems [available to] all income levels, we wouldn’t need to take excursions into nature,” says Razani. Still, Razani has seen the power of her program in action. She’s seen a little boy with developmental issues come alive learning about trees, impressing the park naturalist with his deep knowledge. She’s watched another child with autism and anxiety became calm, engaged, and confident while exploring a regional park. The adults involved in the program transform too, she says. One mother, a survivor of domestic abuse, brought her daughters and eventually started leading nature outings herself for other survivors. The more researchers learn about the stress-reducing powers of nature, “what public health people have always been saying—that health starts outside the clinic—is just becoming more and more apparent,” says Razani. from https://ift.tt/EigO6MT Check out https://takiaisfobia.blogspot.com/
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After Marianne Sarcich underwent treatment for breast cancer in 2016, she called an acupuncturist in hopes of easing her cancer-related anxiety—but made sure to be upfront. “I told her right away that I didn’t think this would work, I didn’t believe in it, but I was desperate,” she says. “Absolutely nothing else was helping. I only considered acupuncture to knock it off the list of possibilities.” To her shock, it helped. Over a few months of sessions, she felt the tightness of anxiety began to loosen, and Sarcich began considering other complementary options she’d dismissed previously. She was curious about breathwork; reiki, which is a form of energy healing; mindfulness; sound baths; and yoga. All of them ended up helping her side effects in some way, she says. “As these efforts layered on top of each other, it was a huge relief,” she says. These complementary therapies weren’t treating her cancer—nor did she expect them to—but they helped relieve her anxiety and improve her mood during her arduous treatments. Sarcich joined the patient advocate committee for the Society for Integrative Oncology, which recommends evidence-based holistic therapies to complement FDA-approved treatments for cancer. She also started a 1,000-member peer support group for people with cancer who are interested in complementary therapies. “If something works to address common issues in cancer care like pain, anxiety, mobility problems, depression, and fatigue,” she says, “you grab onto it, and you help others do the same.” A shift toward complementary therapiesComplementary and alternative medicine (CAM) has become increasingly popular in the U.S., and among cancer patients specifically, over the past few decades. People with cancer might use complementary therapies alongside standard medical care—or, in the case of alternative medicine, instead of it. Little evidence exists to support the efficacy of either complementary medicine or alternative medicine to treat cancer (and replacing standard care with alternative treatments can be life-threatening.) But some practices, when used alongside conventional medicine, may help ease some of the unpleasant side effects of cancer treatment, according to the National Cancer Institute (NCI), in a practice known as integrative medicine. A growing number of comprehensive cancer centers are offering integrative medicine, and in 2018, for the first time, the American Society of Clinical Oncology (ASCO) endorsed the Society for Integrative Oncology’s evidence-based guidelines recommending certain integrative therapies during and after breast cancer treatment. Each complementary therapy—whether meditation, hypnosis, yoga, tai chi, acupuncture, cannabis, supplements, chiropractic, reflexology, nutritional therapy, aromatherapy, energy healing, massage, music therapy, dance, or one of the many others—has a different level of evidence behind it, according to NCI, and people with cancer should discuss them with their health care provider before starting any. One study published in JAMA Oncology in 2019, using data from 2012, suggests that about 33% of cancer patients in the U.S. use CAM. The real number is likely much higher—probably around 80%, says Dr. Steve Vasilev, medical director of integrative gynecologic oncology at Providence Saint John’s Health Center and professor at Saint John’s Cancer Institute in California. “When I started practicing 30 years ago, patients were asking about fad therapies like snake venom,” he says. “But now, there’s much more interest in evidence-based therapy like acupuncture or nutritional changes. Fortunately, we now have more data that these really can be helpful.” Upsides and downsidesOne of the most significant upsides to complementary therapy is that it helps the patient feel empowered, says Dr. Lakshmi Rajdev, chief of hematology and oncology at Lenox Hill Hospital in New York. Being diagnosed with and treated for cancer can be overwhelming and stressful, and many people feel swept along in the health care system, she says. Choosing complementary options can help people feel in control, which is psychologically important. “Data supports the use of these complementary therapies in reducing stress and improving coping skills, which both benefit treatment overall,” says Rajdev. “They may not change the way the disease progresses, but they do help patients deal with their illness, and that’s hugely important.” Another major benefit is that they can reduce treatment side effects, especially those that affect quality of life, like depression, nausea, headaches, and pain. With ASCO’s endorsement and based on existing evidence, the Society for Integrative Oncology recommends meditation, music therapy, and yoga for anxiety, depression, and stress reduction among people undergoing breast cancer treatment, along with massage for improving mood and acupuncture and acupressure for reducing nausea and vomiting after chemotherapy. Cancer treatment has also improved recently, which can make complementary therapies appear to be more effective than they used to, adds Dr. Jack Jacoub, an oncologist and medical director of MemorialCare Cancer Institute at Orange Coast Medical Center in California. “Cancer therapy is dramatically different than it was even five or 10 years ago,” he says. “There are still side effects, but we’re moving away from chemo and into targeted therapies that come with less nausea and pain. That means complementary therapies don’t have to be as intense to work. With minor muscle tightness, for example, maybe just a few sessions of massage can be helpful.” One challenge is that some therapies, such as acupuncture, may take weeks or months to result in meaningful mental and physical shifts, Vasilev says. A few months can be significant for someone with cancer, especially when they’re struggling through intense symptoms like nausea and anxiety. The bigger potential downside is interference with conventional treatments, which is why patients should always tell their health care providers if they are using any therapies outside of what they’re prescribed. The JAMA Oncology study found that among the people with cancer who used CAM therapies, 29% did not tell their doctors, which is potentially dangerous. Interference with cancer treatments mainly occurs with supplements, herbs, and vitamins, Rajdev says. Even though these may be naturally derived, some have been found to reduce the efficacy of chemotherapy. “Nearly every patient asks me about supplements because they want to boost their immune system, and they tend to get deluged with advice from friends and family members about what to take,” Rajdev says. “The best advice here is to wait until after treatment for those, and focus instead on complementary therapies that don’t have potential interactions with chemo or pain medications.” Usually, exercise is the most effective non-medical therapy to add to cancer treatment, she says. Ample evidence suggests that regular activity can significantly mitigate cancer treatment effects, so doing yoga, or even just walking more, can provide a safe immune boost. The dangers of alternative medicineRather than integrating complementary therapies into a conventional cancer treatment plan, which might include typical treatments like radiation, surgery, and chemotherapy, a patient pursuing “alternative medicine” would do these therapies instead of standard medical treatment. Alternative medicine has little, if any, evidence of efficacy and may cause harm. In some cases, using these therapies in place of medical strategies could worsen your condition, says Jacoub. “It’s a natural reaction to search for other answers, especially if you’re suspicious of the health care system or you’ve had negative experiences,” he says. “Cost may be another issue, where you’re concerned about how much cancer care will entail, so you want to try an alternative therapy first. Unfortunately, there is simply no compelling evidence that any of these therapies work for standalone cancer care, and they may cause you to delay treatment.” A notable example is Apple co-founder Steve Jobs, who was diagnosed with pancreatic cancer in 2003 when he was 48. He initially decided to reject conventional treatments and instead used dietary changes, botanical formulations, juicing, and acupuncture, but he shifted his opinion nine months later and opted for surgery, followed by targeted immunotherapy treatment. He died seven years later, and experts say it’s impossible to know if that delay shortened his life or whether those alternative therapies had any benefits. However, Jobs’ biographer Walter Isaacson later noted that the tech icon came to regret his decision to delay surgery and subsequent treatment. Despite the risk and lack of evidence, the lure of alternative medicine persists. According to a 2018 survey conducted by the American Society of Clinical Oncology, about 40% of Americans believe cancer can be cured through alternative therapies alone—a statistic the American Cancer Society calls alarming, since research suggests people who use alternative therapies in place of standard cancer treatments have much higher mortality rates. Getting startedStanding at the precipice of cancer treatment can be terrifying. Complementary therapies may help you navigate forward, especially since they provide a much-needed sense of control, Sarcich says. “There is a sense that you need to do something, because if you feel powerless in the midst of all this, it can be terrible,” she says. As long as it’s safe, “Why not try everything? It’s likely you’ll find a few options that will stick, and that you’ll actually love, even when you didn’t think that would be the case.” If your chosen therapies aren’t potentially interfering with cancer treatment, there are usually only upsides to choices like art therapy, yoga, reiki, or massage, adds Rajdev. “The data on interventions like these is compelling, and I’m a believer in some of these since I’ve seen them help my patients,” she says. “The first step is to talk with your oncologist and make a plan together.” from https://ift.tt/6eBgDwz Check out https://takiaisfobia.blogspot.com/ Almost 60% of the U.S. population—and 75% of U.S. children—have evidence in their blood suggesting a past infection with the virus that causes COVID-19, according to new research from scientists at the U.S. Centers for Disease Control and Prevention (CDC) that looks at data from September 2021 to February 2022. By that estimate, most people in the U.S.—almost 200 million—have had COVID-19 as of February. That far exceeds the 80.8 million cases officially tallied by the CDC as of April 26. “We know that the reported cases are just the tip of the iceberg,” said Dr. Kristie Clarke, co-lead for the CDC’s COVID-19 Epidemiology and Surveillance Taskforce Seroprevalence Team, during a press briefing on April 26. Cases can go undetected if people don’t develop symptoms, don’t get tested, or use at-home rapid tests that aren’t reported to public-health officials. Forthcoming CDC research estimates there may actually be three people infected for every case officially reported during the Omicron wave, Clarke added, suggesting that millions of cases were missed as the highly contagious variant spread. In the CDC’s new study, researchers used data on antibodies—proteins the body generates to fight off an infection—to better understand how many people in the U.S. previously had COVID-19. Antibodies made to fight off SARS-CoV-2 (the virus that causes COVID-19) are distinct from those produced by vaccines, so testing for these proteins can help determine if someone was previously infected, even unknowingly. Every few weeks starting in September, researchers analyzed tens of thousands of blood samples from people across the U.S. that were submitted for clinical testing. (The report didn’t specify why most people’s tests were submitted for testing, though it notes that people whose doctors specifically ordered SARS-CoV-2 antibody testing were excluded to avoid skewing the data.) Using those findings, the CDC estimated how much of the total U.S. population had antibodies—and thus had a prior COVID-19 infection—at each point in time. Antibody prevalence shot up during the winter Omicron surge in the U.S., which peaked in mid-January at almost a million new recorded cases per day. As of December 2021, almost 34% of the U.S. population had COVID-19 antibodies, the CDC estimated. By February 2022, after Omicron had torn through much of the U.S. population, an estimated 58% of Americans had antibodies that suggested a prior infection. Roughly 75% of kids 17 and younger, who are less likely to be vaccinated than adults, had SARS-CoV-2 antibodies by February, according to the CDC’s research. “While those who are under the age of 5 are not yet eligible for vaccination, the best way to protect them is to make sure that they are surrounded by people who are taking preventive measures like staying up to date with their vaccines,” Clarke said. The antibody prevalence estimates in the report aren’t perfect, the CDC researchers say. The analyzed blood samples were all submitted for clinical testing, so people who had access and reason to seek care are probably overrepresented in the study group. It’s also impossible to tell from this method whether someone has been infected multiple times. Still, if anything, the estimates are probably too low rather than too high, the researchers note in the study. While antibodies generated to fight off an infection do provide some future immunity to the virus, the CDC researchers warn that they are not a replacement for vaccination. Just as immunity from the COVID-19 vaccines wanes over time and may not offer complete protection against disease, the same is true for infection-derived immunity. “Vaccination remains the safest strategy for preventing complications from SARS-CoV-2 infection, including hospitalization among children and adults,” the agency’s researchers write in their report. from https://ift.tt/2a9CsFN Check out https://takiaisfobia.blogspot.com/ On April 13, 2020 I spoke at a press conference stating that COVID-19 social mitigation measures would be our “new normal” until we had vaccines. By the end of December 2020, safe and effective COVID-19 vaccines became available in the U.S. in limited supply. Now in April 2022, the COVID-19 vaccine supply in the U.S. is bountiful, with vaccines FDA-approved for those 5 years and older. We also now have new medications that can prevent and treat COVID-19. Compared to the early days of the pandemic, COVID-19 is now preventable, treatable, and controllable. But just as we adapted before, we need to adapt again. It is now for us to make individual choices to keep ourselves and others healthy and safe. It is for us to know about and use the many available COVID-19 control tools. Despite major advances in COVID-19 care and prevention over the past two years, we remain in the midst of a serious pandemic. In the US, there are about 30,000 new cases, 1,500 new hospitalizations, and 400 new deaths per day per due to COVID-19. We face the continued evolution of COVID-19 to a more contagious virus that appears in unpredictable waves of infection. We face a response to COVID-19 that is varied and at times contentious. We face opposition to vaccination. We face a public increasingly tired of COVID-19 mitigation measures. We face erosion of trust in public health and health leaders. We also recognize that with a polarized public, attaining unified local responses may be difficult, but we also can see the destructiveness of community infighting. We face continued legal challenges to COVID-19 control measures that are influencing the public health response and limiting CDC authority and action. Federal mandates that large businesses vaccinate their employees have been overturned at the Supreme Court. The recent reintroduction of a mask mandate in Philadelphia is being legally challenged. Less than a week after the CDC extended the mask mandate for travel in response to rising Omicron B2 variant infections, a federal judge vacated the travel mask mandate. These legal rulings means that the authority of the CDC and departments of health are being limited. Like the virus, we need to recognize that how we are responding to COVID-19 has evolved. The April 2022, the new normal means that individuals, businesses, schools, and communities, will shoulder an increasing responsibility for controlling COVID-19. The new normal is that “recommendation” will replace “mandate.” The new normal is that we work together in conjunction with public health to protect each other and ourselves. The new normal does not mean that COVID-19 is over yet. First, vaccinated or not, it is our duty not to infect others. If one has COVID-19, we need to isolate. We need to know the symptoms of COVID-19 and get tested when we feel ill. Because up to 30% of individuals with COVID-19 may not have symptoms yet can spread to others, testing is especially important if one is going to be around medically vulnerable individuals, or in closed, crowded settings where there is increased risk of spread. Over the counter COVID-19 tests, which have excellent performance when used serially continue to need to be made widely available. Second, we need to recognize the importance, safety and efficacy of COVID-19 vaccinations and booster shots for adults and children. Severe COVID-19 infection overwhelmingly now occurs in unvaccinated individuals. More than a third of COVID-19 vaccine-eligible individuals in the U.S. are not vaccinated and misinformation about COVID-19 vaccines have contributed to this problem. . Third, we need to recognize those who are most vulnerable to the adverse effects of the virus and make sure that these individuals remain protected. We also need to realize that individuals without medical conditions can get severe COVID-19, too. This protection comes in the form of vaccination and booster shots. We need to make sure that appropriate medical preventative therapies are used for those who are medically vulnerable. Evusheld is a new combination monoclonal antibody treatment that markedly reduces one’s chance of getting COVID-19 if you are immunocompromised. However, only about 30% of available Evusheld doses have been used. Fourth, whether vaccinated or not, we need to make sure that when somebody gets COVID-19 that they can get treated with antiviral agents. The medications include Paxlovid or Molnupiravir, and monoclonal antibodies. Test-to-treat programs need to be publicized and medication availability expanded. Fifth, we need to realize that the way we track and publicly report COVID-19 infections in communities may be outdated. With there being so many home tests, coupled with an absence of a standardized home testing reporting, we do not know the true numbers of those with COVID-19. Public health officials along with the medical community will need to find and present this information in a unique way. Wastewater testing is one potential strategy as is random surveillance testing of those in the community or testing those seen in healthcare settings. Six, we need to continue to rely on basic COVID-19 preventative measures. COVID-19 is much less transmissible outdoors than indoors and spreads the greatest in closed, crowded spaces. Proper indoor ventilation needs to become the new normal of our indoor life. Seven, face masks also have roles in COVID-19 mitigation, as the chance of becoming infected with or spreading COVID-19 is reduced if individuals wear a well-fitting, high-quality face mask. But face mask effectiveness may vary with variant. Face mask use can be facilitated by making high quality masks freely and widely available. We also must recognize how contentious the face mask issue has become and ask ourselves what their role is in layered mitigation strategies. For example, focusing on ventilation and COVID-19 screening alone may be sufficient to control COVID-19 spread without face mask use. The new normal means that we also need to be respectful of personal, business or community choices to wear or not wear a face mask. Eight, we need the medical community to continue to stand up and be an authoritative source of information. Medicine has been long based on facts and data and public health measures. Increasingly we hear “talk to your trusted healthcare provider.” The medical community has an obligation to call out misstatements and set the facts straight. The medical community needs to step-up to counter false narratives and offer vaccines and boosters to those in their care. The medical community needs to play an even greater role in prescribing the new and effective COVID-19 therapeutics for this preventable and treatable disease. Barring further severe waves of infection, our collective response will be transitioning to individual persons, businesses, or local organizations. We now have vaccines, medications, and strategies to prevent, treat, and control COVID-19. As before, public health will need to continue its critical role in this pandemic and ensure that COVID-19 control tools and therapeutics are available. Two years into this pandemic, it is for us to know how to and act to keep ourselves and others healthy and safe. from https://ift.tt/zNX237L Check out https://takiaisfobia.blogspot.com/ (Washington D.C.) — President Joe Biden’s administration is taking steps to expand availability of the life-saving COVID-19 antiviral treatment Paxlovid, as it seeks to reassure doctors that there is ample supply for people at high risk of severe illness or death from the virus. Paxlovid, produced by Pfizer, was first approved in December. Supply of the regimen was initially very limited, but as COVID-19 cases across the country have fallen and manufacturing has increased it is now far more abundant. The White House is now moving to raise awareness of the pill and taking steps to make it easier to access. The White House said Tuesday it is stepping up outreach to doctors, letting them know they shouldn’t think twice about prescribing the pill to eligible patients. It is also announcing that the drug will now be distributed directly to pharmacies, in addition to existing distribution channels run by states. That is expected to boost the number of sites from 20,000 to more than 30,000 next week and eventually to 40,000 locations. The administration believes the pharmacy channel, which it used to boost availability of COVID-19 vaccines more than a year ago, will similarly make the antiviral pills more available to people. “The bottom line is that we want to make this therapeutic available to all Americans,” Dr. Ashish Jha, the White House COVID-19 response coordinator, said Tuesday on CNN. Paxlovid, when administered within five days of symptoms appearing, has been proven to bring about a 90% reduction in hospitalizations and deaths among patients most likely to get severe disease. About 350 Americans are now dying each day from the coronavirus, down from more than 2,600 during the height of the Omicron wave earlier this year. The U.S. has ordered enough supply of the pills for 20 million people, which is estimated to last for several more months. The administration has warned that subsequent deliveries are dependent on Congress approving additional COVID-19 response funding. The Food and Drug Administration authorized Pfizer’s drug for adults and children age 12 or older with a positive COVID-19 test and early symptoms who face the highest risk of severe outcomes. That includes older people and those with conditions like obesity and heart disease, though the drug is not recommended for patients with severe kidney or liver problems. The administration is also working to expand the number of test-to-treat sites that provide a one-stop shop for those with COVID-19 to get tested for the virus, consult with a medical professional if they’re positive and fill a prescription for Paxlovid on site. Currently there are 2,200 locations nationwide, and the administration hopes support from the Department of Health and Human Services, the Federal Emergency Management Agency and pharmacy companies will enable more sites to come online in the coming weeks. from https://ift.tt/5ToMzjU Check out https://takiaisfobia.blogspot.com/ It’s a challenging time for parents anxiously awaiting the arrival of COVID-19 vaccinations for children under the age of 5. In a report published by Politico April 21, sources with insider knowledge warned that a vaccine may not be available for the youngest age group until late June. And after a federal judge struck down a mask mandate for public transportation on April 18—leading some plane passengers to remove their masks mid-flight—some parents expressed frustration that many people seem to forget that the littlest children still can’t be protected through vaccination. At the same time, many pediatric infectious disease specialists say there are several reasons that parents should feel reassured, even before a vaccine arrives. First and foremost: the risks of severe disease in children are still low relative to adults, and parents can layer on precautions to keep their kids safer. What do we know about COVID-19 risks for children under 5?Even though they’re still unvaccinated, children under 5 years old face low risk of severe disease after getting COVID-19. Since the beginning of the pandemic, 468 children 4 and under have died from COVID-19 in the U.S. according to Centers of Disease Control and Prevention (CDC) data as of April 24. In rare but serious cases, some children have been known to develop Multisystem Inflammatory Syndrome—a potentially deadly condition in which organs like the heart, lungs and brain can become inflamed. But these numbers, relative to population size, represent a minuscule risk, especially compared to that seen among the elderly and those with underlying conditions. Further, these small risks aren’t equal for all children. According to Dr. Sean O’Leary, vice chair of the American Academy of Pediatrics committee on infectious disease, babies under 6 months tend to be at higher risk for respiratory illnesses, and children with preexisting conditions, such as chronic lung disease, may be more vulnerable than healthy children. It’s too soon to tell if the latest variant causing rising cases in the U.S.—BA.2—will be especially dangerous for children under 5, says O’Leary. However, BA.2 seems to be at least 30% more transmissible than Omicron—which itself was more transmissible than previous variants that circulated in the U.S. “We are seeing cases rise, [though] they’re not rising as quickly as they did with Omicron. But it’s a little bit hard to predict where things are going to go from here,” says O’Leary. Some good news for this springFor all these risks, there is some “good news” about the current state of the pandemic, says O’Leary. Although cases are rising, the U.S. isn’t seeing a major surge yet, he says. It also helps, he says, that the weather is now getting warmer in the U.S.—people will have more of an opportunity to gather outside. And while children under 5 are too young to be vaccinated, that does not mean that their immune systems are completely naive to the virus. CDC data shows that, among this age group, more and more children have evidence of antibodies created by the body in response to SARS-CoV-2—suggesting a previous infection. Although prior infections don’t offer as much protection as vaccination, or vaccination plus infection, “the more immunity there is in a community, the fewer infections overall,” says O’Leary. However, he cautions that such protection should not be taken for granted. “We had a lot more infections with Omicron; seroprevalence has gone up for COVID—that’s not in question,” he says. “What is in question is exactly what that means, for both this BA.2 variant, and then also for future variants, in terms of protection.” How can parents keep kids under five safe?Even if there is no big surge over the next few months, that doesn’t mean parents should let their guard down. “We may not see rampant infection right now, but we may continue to see circulating virus in our communities for the foreseeable future,” says Dr. Ibukun Kalu, a pediatric infectious disease physician at Duke University Hospital. Unless the entire family remains alone and inside at all times, it may be impossible to take your child’s risk down to zero. However, combining different methods to reduce risk provides layers of protection. For one thing, says O’Leary, “outdoors is generally safer than indoors, smaller groups are generally safer than larger groups. If you’re in indoor spaces, being masked is generally safer than not being masked.” Further, just because the youngest children can’t get vaccinated yet doesn’t mean you should forget vaccination entirely. Older family members can help to protect kids under the age of 5 by getting vaccinated and boosted themselves. Research has even found that mothers who get vaccinated while they’re pregnant can transfer some immunity to their unborn child. For babies under 6 months, says O’Leary, “the best thing you can do…is one, mom gets vaccinated during pregnancy or before, and two, everyone that’s around that baby is vaccinated.” COVID-19 also isn’t the only disease you should be worrying about. A vaccine is available for kids over the age of 6 months for influenza—which can be deadly for young children. Many children have also fallen behind on other vaccines, which protect kids from diseases that, like measles, can be even more dangerous for children than COVID-19. “We’re holding our breath, because [measles] rates went down as a result of the pandemic [precautions],” says O’Leary. But a surge “certainly could happen as travel loosens up. There’s plenty of measles around the world right now. Kalu says that parents should be thinking about ways to protect their children not just from COVID-19, but from other infections. Especially for little kids, that includes teaching them to wash their hands, keeping the environment clean, and keeping children home when they’re feeling sick. “Those are things that work for a stomach virus, and for COVID-19,” says Kalu. from https://ift.tt/M3gVDAf Check out https://takiaisfobia.blogspot.com/ When the Affordable Care Act passed a decade ago, many women rejoiced: the law required most insurers to fully cover birth control, with no out-of-pocket costs whatsoever. But a decade later, the promise of free contraception remains out of reach for many people. The reason is buried in the fine print. The law requires insurers to cover, with no copay, at least one form of each of the 18 Food and Drug Administration-approved birth control methods, such as pills, intrauterine devices (IUDs), patches, and rings. If patients have a medical reason for needing a contraceptive that is not fully covered by their plan, insurers must provide an “expedient exceptions process” that allows the patient to get that contraceptive covered. In theory, almost anyone with private insurance should be able to easily access whatever type of birth control they and their provider decides is best for them. But in reality, insurers have refused to fully cover many newer contraceptives, arguing that they already cover an older version in the same category. Patients who want or need those uncovered contraceptives are shunted, advocates say, into lengthy, cumbersome prior authorization processes and often denied coverage or slapped with unexpected costs. At the heart of the issue is a standoff between two extraordinarily powerful industry forces—Big Pharma vs. Big Insurance—which collectively spent tens of millions of dollars last year lobbying the federal government over this and a multitude of other issues. Drug manufacturers argue that insurers, by refusing to cover newer products, are discouraging innovation. Insurers, for their part, say that they offer enough varieties of contraception to fully comply with the ACA—and that without coverage limits or federal action to control drug prices, insurance plans would become unaffordable. Meanwhile, patient advocates say regular Americans are trapped in the middle, unable to access the free contraception that the law is supposed to guarantee. Congressional Democrats have taken a side. They are pushing the Biden Administration to issue more specific guidance about the exceptions process and level penalties against insurers that don’t comply—especially as reproductive health care in the U.S. could soon change if the Supreme Court dismantles the national right to abortion this spring. “The folks that are not able to get the birth control they need are potentially either going without it or going with a method that doesn’t meet their needs,” says Mara Gandal-Powers, director of birth control access and senior counsel for reproductive rights and health at the National Women’s Law Center. “And that is just not the point of this part of the law. The point is … to help people prevent pregnancy when they don’t want to be getting pregnant.” Patients struggle to access contraceptionLast fall, a group of Democratic House committee chairs and then Senators Patty Murray and Ron Wyden sent letters to the Department of Health and Human Services (HHS), Department of Labor and Department of Treasury. In January, the three agencies responded with a FAQ reminding insurers of the ACA’s rules, and warning them that the agencies were “actively investigating” complaints and may take further enforcement action. Then, in February, a group of 34 Democratic Senators sent another letter urging the agencies to develop guidelines for a clear contraceptive exceptions process. Last month, another group of more than 100 House Democrats sent yet another letter, urging more enforcement action and asking the agencies to help make the public aware of the ACA requirement. Patient advocates say that while they applaud the prolific letter-writing and the agencies’ FAQ, it’s not enough: it’s clear that women across the country are still getting charged for birth control, or having their contraception outright denied. The National Women’s Law Center runs a hotline where people can get help appealing coverage denials, and it is still seeing reports roll in, Gandal-Powers says. In many cases, patients prefer one type of birth control over another because they have fewer side effects, are safer or more effective, advocates say. About 45% of pregnancies in the U.S. are unintended, and providers note that contraceptives are more likely to be successful at preventing pregnancy if individuals can take them correctly and tolerate any side effects. “It is really important to find the contraception that meets your needs. Otherwise you’re not going to take it,” says Beth Battaglino, a maternal–fetal medicine nurse and CEO of patient advocacy group HealthyWomen. It’s not clear how widespread the problem is, although millions of women may be affected. A report from the nonpartisan Kaiser Family Foundation last year found that 21% of women with private insurance were still paying some out-of-pocket costs for contraception, and researchers say that violations can have a significant impact on patients. Reports collected by the National Women’s Law Center show that in some cases, patients who could only use a specific kind of birth control for medical reasons found their plan did not cover it at no cost, and did not offer a clear exceptions process, leaving the patients to pay hundreds or thousands of dollars out of pocket. Other complaints said women were charged thousands of dollars for services necessary to administer their contraception. Additional patient reports separately shared with TIME showed pharmacy benefit managers requiring patients to complete what’s called step therapy, a process in which a patient must try and fail on other drugs before an insurer will cover the requested drug. One letter from CVS Caremark reviewed by TIME told a patient they must try and fail with three other types of birth control before getting their preferred contraceptive covered. Another letter from Express Scripts reviewed by TIME said the patient would only get coverage after they tried and failed at least five other contraceptive agents. Advocates note that this is not only time consuming and unpleasant for patients, but that the stakes of an unintended pregnancy are higher now for many women around the country. The Supreme Court is expected to reshape the right to abortion in a case this term, and already conservative states have curtailed abortion access ahead of the Court’s decision. Murray, the chair of the Senate’s Health, Education, Labor, and Pensions Committee, says she’s been “hyper vigilant” as states have sought to restrict access to reproductive health care. “This is frightening that in 2022, women in this country have to say, ‘Am I going to be able to get the birth control I need? Am I going to be able to decide when and where and how I’m going to have a family?’” Murray tells TIME. She added that insurers should have been complying with the ACA “from day one,” and she hopes that federal agencies will take further action soon. “I really believe since we are seeing such egregious behavior they need to take the next step, put out comprehensive guidance and then have robust enforcement. That’s the only way that insurers will comply with this law.” HHS and DOL both told TIME they are still actively investigating complaints. Those under the Centers for Medicare and Medicaid Services (CMS) could take six to 12 months, according to an agency spokesperson. “CMS takes complaints regarding contraceptive coverage seriously and is committed to robust enforcement to ensure that insurers and plans comply with the law,” the spokesperson said. Does limiting coverage hurt innovation?While the federal investigations into insurers’ decisions continue, advocates and pharmaceutical companies say the future of new birth control products could hang in the balance. “I am concerned that if we don’t see these new products get coverage that’s going to impact how companies think about contraceptive technologies and development over the next decade or 15 years,” Gandal-Powers says. Some research has shown that when insurance coverage for drugs or vaccines expands, that can lead to more investment in new products. A NBER working paper published in 2020 offered a similar conclusion: when pharmacy benefit managers, which control prescription drug coverage for insurers, began excluding newly approved drugs for coverage around 2012, there was a relative decline in investment in new drugs in the classes that were at greatest risk of being excluded. That behavior makes economic sense, says Leila Agha, an assistant professor of economics at Dartmouth College and lead author of the paper. “The amount of investment in research and development for new pharmaceutical drugs seems to depend on how profitable those drugs are expected to be. And the profitability of the new drug is going to in turn depend on how many consumers they can expect to purchase it at what price,” she says. “So if you make a drug more expensive by moving it up to a less favorable or less generous tier of your prescription drug plan, or if you exclude it from your prescription drug coverage altogether, it’s reasonable to expect that that drug would then have lower sales, and an expectation of that might affect innovation.” Insurers’ decision to exclude certain contraceptives puts those manufacturers in a tough spot. Agile Therapeutics, which makes Twirla, a new, low-dose contraceptive patch, acknowledged financial struggles on its fourth quarter and full year 2021 earnings call last month. Chairman and CEO Al Altomari told investors that the Biden administration’s FAQ in January was a good sign and that if insurers change how they are complying with the ACA rules that could help more Twirla prescriptions go through. Evofem Biosciences, which makes Phexxi, a new non-hormonal contraceptive gel, had a similar message on its call. “I don’t want to seem delusional and say, ‘Oh, we don’t think it’s a huge issue.’ But our leadership of our sales team was at our corporate office this week, and we had a very serious come to Jesus about how difficult this is,” CEO Saundra Pelletier said during her call in March. She added that while they hope the situation will improve next year, the company’s pharmaceutical reps have been offering to help providers fill out insurers’ prior authorization forms so that they can get through the lengthy exception process if they do want to prescribe Phexxi. The drug makers have launched lobbying efforts, too. Evofem spent $240,000 lobbying on “federal health policies pertaining to coverage for contraceptive services” and “access to contraception” last year, while Agile spent $120,000 on the topic and TherapeuticsMD which makes Annovera, a newer vaginal ring, spent $80,000. Insurers try to control health costsFor their part, health insurers say they follow the law and are not doing anything wrong in limiting which contraceptives are covered at no cost. “Plans cover at least one option without cost sharing—and often much more—in each of the 18 FDA designated categories,” said Kristine Grow, a spokeswoman for America’s Health Insurance Plans (AHIP). “Coverage with some cost sharing, is not the same as not covered – your coverage is still saving you money.” Grow added that it can take time for new contraceptives to be covered because formularies are typically developed several months before each benefit year. James Chambers, a researcher at the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center, says that insurers have no choice but to limit what drugs are covered. If they don’t, costs would be unmanageable—and those costs would be passed down to consumers. “Health plans have to behave in this way in some regard, because if it was simply a free market, the health system would just explode in terms of the cost of these therapies,” he says. The U.S. spends more on health care than any other wealthy nation, and efforts to reform prescription drug prices have so far been stalled in Congress. Chambers, who has studied variation in how insurers cover specialty drugs, says ideally the insurance companies would always make their decisions about what to cover in ways that are evidenced based and prioritize patients. But of course, the reality is complicated. It’s difficult to determine the actual impact of reducing pharmaceutical innovation, researchers say. And even arguments about cost can be complex. Rep. Jackie Speier, co-chair of the Democratic Women’s Caucus, tells TIME that “contraception saves the insurers money.” “When you have contraception, you don’t get pregnant unintentionally, and you don’t have the costs associated with prenatal care and maternity care,” Speier says. “So it’s to their advantage to make sure that women have access to contraception.” But insurance companies are often focused on more immediate costs, says Steve Lieberman, a health care policy expert at the USC-Brookings Schaeffer Initiative for Health Policy. Insurers have no guarantee a patient is going to stay on the same plan for years, so there’s little incentive for them to consider long-term savings or innovation in drugs that might help lower costs down the line. “Health plans’ interest is lowering the costs as much as they can for medically necessary drugs. And it’s not their concern whether those reimbursements are sufficient to incentivize investors to develop the next generation of drugs,” he says. Lieberman also notes that if a particular drug is truly innovative and different enough from other products on the market, manufacturers can command high prices and insurers will usually cover it. “The drug companies have better weapons than the health insurers,” he says. Still, while these forces play out, advocates and lawmakers say patients are caught needing access to their birth control. “You’re not going to control costs on the backs of women,” Speier says. “You’re going to comply with the law. You don’t have the choice to require a copay for women accessing contraception. So either fix it, or we’ll come back with a sledgehammer if we need to. Hopefully, it won’t be required.” from https://ift.tt/HTv57lJ Check out https://takiaisfobia.blogspot.com/ If you stockpiled at-home COVID-19 tests during the great Omicron shortage, you may want to do a little research before using your diagnostics. Like food and medications, rapid COVID-19 tests expire—but figuring out when they go bad isn’t always as easy as glancing at the box. Here’s what to know about the expiration dates on at-home COVID-19 tests. When does my COVID-19 test expire?The components of COVID-19 test kits can degrade over time, potentially affecting the diagnostic’s performance and accuracy, according to the U.S. Food and Drug Administration (FDA). Figuring out exactly how long a product lasts takes time, though. To know if a test performs well after two years, for example, the manufacturer would logically need at least two years of data. Since rapid COVID-19 tests are relatively new products, companies are collecting much of that data in real time—meaning their expiration dates can and do change. The FDA sets expiration dates conservatively and then adjusts as needed. To start, at-home COVID-19 tests are typically authorized with expiration dates of four to six months after they’re made, the FDA says. But the agency can extend that window as new study results are available. That dynamic system means the date stamped on your test’s box may not be its current expiration date. In January, the FDA extended the recommended shelf life of Abbott’s BinaxNOW test kits from 12 to 15 months, based on data from the company. CareStart tests distributed through the federal government’s free testing program can also be used for three months longer than their marked expiration dates, according to COVID.gov. The California Department of Public Health went a step further in March, saying that, until further notice, consumers can use any at-home test beyond its expiration date as long as the “control” line shows up normally. (Your test kit should include guidance about the control line.) Officials from Washington State’s health department have also acknowledged that using technically expired but functional tests may be necessary in some cases. To get the latest information about your tests, check the FDA’s website for updates about antigen tests and molecular tests. You may have to calculate the new expiration date yourself, using the lot number or date of manufacture stamped on the package. Can I use a test even if it has expired?If you’re used to ignoring food expiration dates, you may be inclined to do the same with COVID-19 tests. But—even though some people interpret the dates more liberally—the FDA says not to use expired kits. Dr. Ulysses Wu, system director of infectious diseases at Connecticut’s Hartford HealthCare, agrees it’s best to be cautious, because you may not get accurate results if you use an expired test. “You’re more likely to have false negatives rather than false positives, but that false negative could give a false sense of security when you actually are positive for COVID,” he says. Since diagnostic expiration dates are a “moving target,” it’s possible that your test actually lasts longer than the box suggests. But, Wu says, “I would just follow [the latest] expiration date and if you really have a concern or you don’t want to throw it away, you can always call the company.” How should I store my home COVID tests?Time isn’t the only thing that can affect the quality of a COVID-19 test. Moisture and extreme temperatures can also impair its accuracy, Wu says. He recommends keeping medical supplies in a cool, dark place, like a kitchen cabinet, to keep them stable. Despite the name, your bathroom medicine cabinet is not a good place to store drugs and diagnostics because the room often gets hot and humid, Wu adds. Extreme cold is also something to avoid. When the U.S. government first began distributing free at-home test kits this past winter, some people were concerned that the liquid reagents used in the diagnostic process might freeze during delivery. While the FDA says that’s not something to be too worried about, tests are meant to be used in environments kept between 59°F and 86°F. So if yours gets cold in transit, you should allow it to warm up (while in the unopened box) for a couple hours before swabbing. And though it may be tempting after recent supply-chain issues, Wu discourages keeping a huge stockpile of tests on hand. It’s good to have a few around in case someone in your house is exposed to the virus or develops symptoms, but there’s no need to buy a lifetime supply at once, he says—both because they may expire before you can use them, and because it makes it harder for others to get the supplies they need. from https://ift.tt/uocN3jZ Check out https://takiaisfobia.blogspot.com/ A U.K. patient with a severely weakened immune system had COVID-19 for almost a year and a half, scientists reported, underscoring the importance of protecting vulnerable people from the coronavirus. There’s no way to know for sure whether it was the longest-lasting COVID-19 infection because not everyone gets tested, especially on a regular basis like this case. But at 505 days, “it certainly seems to be the longest reported infection,” said Dr. Luke Blagdon Snell, an infectious disease expert at the Guy’s & St. Thomas’ NHS Foundation Trust. Snell’s team plans to present several “persistent” COVID-19 cases at an infectious diseases meeting in Portugal this weekend. Their study investigated which mutations arise—and whether variants evolve—in people with super long infections. It involved nine patients who tested positive for the virus for at least eight weeks. All had weakened immune systems from organ transplants, HIV, cancer or treatment for other illnesses. None were identified for privacy reasons. Repeated tests showed their infections lingered for an average of 73 days. Two had the virus for more than a year. Previously, researchers said, the longest-known case that was confirmed with a PCR test lasted 335 days. Persistent COVID-19 is rare and different from Long COVID. “In Long COVID, it’s generally assumed the virus has been cleared from your body but the symptoms persist,” Snell said. “With persistent infection, it represents ongoing, active replication of the virus.” Each time researchers tested patients, they analyzed the genetic code of the virus to make sure it was the same strain and that people didn’t get COVID-19 more than once. Still, genetic sequencing showed that the virus changed over time, mutating as it adapted. The mutations were similar to the ones that later showed up in widespread variants, Snell said, although none of the patients spawned new mutants that became variants of concern. There’s also no evidence they spread the virus to others. The person with the longest known infection tested positive in early 2020, was treated with the antiviral drug remdesivir and died sometime in 2021. Researchers declined to name the cause of death and said the person had several other illnesses. Five patients survived. Two cleared the infection without treatment, two cleared it after treatment and one still has COVID-19. At the last follow-up earlier this year, that patient’s infection had lasted 412 days. Researchers hope more treatments will be developed to help people with persistent infections beat the virus. “We do need to be mindful that there are some people who are more susceptible to these problems like persistent infection and severe disease,” Snell said. Although persistent infections are rare, experts said there are many people with compromised immune systems who remain at risk of severe COVID-19 and who are trying to stay safe after governments lifted restrictions and masks started coming off. And it’s not always easy to know who they are, said Dr. Wesley Long, a pathologist at Houston Methodist in Texas, who was not part of the research. “Masking in crowds is a considerate thing to do and a way we can protect others,” he said. from https://ift.tt/yo29k8N Check out https://takiaisfobia.blogspot.com/ By official counts, fewer people are being diagnosed with COVID-19 right now than at almost any other point during the pandemic. There were an average of 40,000 new cases per day as of April 19, compared to more than 800,000 per day at the height of the U.S. Omicron wave. But official counts are increasingly misleading. More Americans than ever are testing positive on at-home tests—the results of which are rarely reported to public-health authorities, and are thus missing from official tallies. Public-health experts worry that case numbers are now an unreliable way to judge the state of the pandemic, and that there are countless more infections than statistics show. Under the CARES Act, COVID-19 testing sites are required to report results to public-health departments. The results of proctored remote tests—which are sometimes required for activities including travel and involve a health professional supervising the test over video—are usually reported, too. But individuals aren’t required to report the results of their standard home tests. Some state health departments, like those in Colorado and Washington, collect self-reported data. Others, like Massachusetts, defer to local health departments. But in many places, there’s no established system. The CDC recommends that people share their positive results with their health care provider, who may in turn recommend a laboratory test to confirm the result and add it to official tallies. But many people don’t tell their doctors they’ve had a positive rapid test—25% of American adults don’t even have a primary care doctor, according to one study—and some doctors don’t bother recommending a secondary test. About 30% of people who tested positive for COVID-19 via a DIY diagnostic did not get a confirmatory test and thus probably weren’t counted, according to a January survey from the COVID States Project. That may help explain why overall laboratory testing volume declined from more than 2 million tests per day in January to around half a million per day in mid-April—along with the closure of some mass testing sites, the end of free testing programs for people who are uninsured, and the nationwide relaxation of pandemic precautions. In some respects, it’s surprising that so many people do get another test after getting a positive result at home. David Lazer, co-author of the COVID States Project survey and a professor of political and computer sciences at Northeastern University, says he was surprised by his group’s findings; he expected more than 30% of people to skip the secondary test. At this point in the pandemic, he suspects that the real number is higher, since people are increasingly comfortable with at-home tests and it’s growing harder to find free testing sites. “There’s every reason to believe that the missingness is much, much larger now than it was in January,” Lazer says. That’s a problem, health experts agree. Along with wastewater surveillance and hospitalization rates, testing data is one of the major ways public health officials track the virus’ spread and look for potential surges and hotspots. Agencies including the CDC have said measures like mask mandates can be applied fluidly depending on current transmission patterns in a given area. But if health officials don’t have an accurate picture of where the virus is spreading, they won’t be able to use appropriate mitigation strategies. A national reporting system for home-test data could help solve that problem—but the question is how to make one work, and whether it’s the best use of increasingly strained public-health resources. The mixed blessing of home testsDr. Michael Mina, chief science officer at the remote testing company eMed, has long argued that rapid tests are crucial to controlling the pandemic. Quickly swabbing before travel or social events, for example, can prevent people from unknowingly infecting others. It’s great that people are finally using self-tests regularly, Mina says, but it’s time to better track the resulting data. “Two years ago, I was pushing for at-home tests regardless of reporting, out of this massive urgency and need” for better prevention tools, he says. “Now, we’ve had two years to catch up.” The need for better tracking is clear. During the Omicron wave, about 20% of people in the U.S. who had COVID-like symptoms used an at-home test, according to CDC data. Now, people are testing at home more than ever. For the first time during the pandemic, more people tested positive on at-home tests than other types of tests during the week ending April 16, according to new data from researchers at Boston Children’s Hospital and survey company Momentive (which has not yet been published in a peer-reviewed journal). About 58% of the positive cases reported by the 474,000 people surveyed were picked up by an at-home test. That’s better for individuals because it’s convenient, says John Brownstein, chief innovation officer at Boston Children’s Hospital. “But it’s not better for public health, because public-health data relies on detailed reporting.” Many at-home test kits include a way to voluntarily report results to the manufacturer, often by downloading an app; the company may then choose to share the results with public-health officials. But few people use that option. Through a pilot program run by the CDC and the U.S. National Institutes of Health, more than 1.4 million DIY tests were distributed to households in Tennessee and Michigan in 2021—but fewer than 10,000 test results were later logged in a companion app, according to an article in Health Affairs. Similarly, only about 5,700 people have reported a positive result through Washington State’s hotline since August 2021, a health department representative told TIME. That, too, represents a tiny fraction of the tests taken during that time frame; during the peak of the Omicron surge, the state was recording thousands of cases every day. The search for a better systemIt would be technologically easy for the CDC or another U.S. government agency to build a website where users could quickly log their at-home diagnoses. Brownstein’s research group already runs such a website to “put the ‘public’ back in public health,” he says. Crowdsourcing data benefits individuals as well as researchers, because “you get a disease weather map, where you can understand what’s going on and make decisions for yourself and your family.” But using that approach to inform federal statistics is risky, Lazer says, because a couple of “bad apples” could choose to falsely report many cases and skew the data. And without knowing how many total tests have been taken, it’s hard to know the significance of the few results that are reported, Mina says. (Brownstein, however, thinks there’s value in a national surveillance site, even without 100% participation. “Not many people [write Amazon reviews], but there are enough people who are willing to give you a sense of the value of a product,” he says.) For more people to opt in to a reporting system, they would need a reason beyond being a “Good Samaritan,” Mina says. His company, eMed, is trying to incentivize self-reporting. After someone uses an eMed-compatible home test, the company generates a lab report that is shared with public-health departments. That also benefits the individual, Mina says, because they can use the report to be cleared for travel, work, or school if they’re negative. If they’re positive, they have proof of that result and will be connected by telemedicine to a doctor who can prescribe treatment. Those may be better motivators for the average person than simply contributing to statistics, Mina says. Public-health officials should also take advantage of existing tools by working with diagnostics companies to make their self-reporting systems easier and more accessible, Brownstein says. Instead of downloading an app, for example, people could send in their results via text message. Another option, Lazer says, would be to conduct repeated, large surveys of American households, asking if anyone in the home recently tested positive for COVID-19 and, if so, on which type of test. A problem bigger than self testsTo Beth Blauer, executive director of the Centers for Civic Impact at Johns Hopkins University and an expert on government data systems, the data problem in the U.S. involves more than at-home tests. Two years into the pandemic, states still don’t have a standardized way of collecting and assessing the test results they get from testing sites, which means federal case and testing data is flawed even before considering the missing data from unlogged rapid tests, she says. The situation is especially bad now that some public testing sites are shutting down and uninsured people can no longer get tested for free, Blauer adds. Some people might test at home instead, but many won’t. Data show that home testing is most common among those who are fairly young, white, highly educated, and wealthy—perhaps unsurprising, given that each test costs about $10. Many people, especially those from underserved communities, simply won’t get tested if they can’t get a free diagnostic through work, school, or a convenient public test site, Blauer says, which means many cases will never be detected. “If COVID has taught us anything, it’s that we have to be much more agile in the way that we dial up and dial down public-health interventions,” Blauer says. “As we dilute that data, it becomes harder and harder to be agile.” Finding ways to include at-home test data in official case counts could make a dent in that problem. But that will only work if everyone has access to at-home tests and knows what to do with the information they reveal, says Benjamin Rader, a graduate research fellow at Boston Children’s Hospital. “When we try to create a comprehensive surveillance system, it’s imperative that we make sure we’re reaching everyone in society,” Rader says. “We need to make sure we’re doing things to target everyone and not miss pockets of the U.S.” from https://ift.tt/5qHbR8c Check out https://takiaisfobia.blogspot.com/ |
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