The last time most of us gave any thought to antibodies was probably in high school biology, but we’re getting a crash refresher course thanks to COVID-19. They are, after all, the key to our best defenses against SARS-CoV-2, the virus that’s caused the global pandemic. People who have been infected likely rely on antibodies to recover, and antibodies are what vaccines are designed to produce. Or at least that’s what infectious-disease and public-health experts assume for now. Because SARS-CoV-2 is such a new virus, even the world’s best authorities aren’t yet sure what it will take to build proper and lasting immunity against it. But antibodies are a good bet, since people who get infected and recover from disease generate them both to block viruses or bacteria from infecting cells and to mark them for destruction by an army of immune cells. Lab studies also show that throwing some of those antibodies from recovered patients into lab cultures with the virus seems to neutralize it—a strong sign that these antibodies at least play a part in a good immune response. That’s the reason that on Aug. 23, the Food and Drug Administration (FDA) granted emergency use authorization (EUA) for convalescent plasma to treat COVID-19 patients, as it has for another experimental therapy, remdesivir. The decision allows doctors to transfuse plasma donated from recovered COVID-19 patients into currently sick patients in the hopes that some of the immune response against the virus can be transferred as well. The decision was a bit of an about-face, since just days before, the EUA was put on hold after leading infectious-disease and public-health experts, including National Institutes of Health (NIH) director Dr. Francis Collins and White House Coronavirus Task Force member Dr. Anthony Fauci, said that while the early data from critically ill patients who were transfused with convalescent plasma were encouraging, they were not strong enough to justify EUA—yet. They called for more data from ongoing studies to ensure the safety and efficacy of the treatment. Other doctors, however, who are currently taking part in those trials, believe the EUA is justified. A Mayo Clinic–led trial that is collecting data for the National Convalescent Plasma Study of more than 35,000 patients from 2,800 hospitals who received convalescent plasma through the FDA’s expanded use program showed that people who were transfused with convalescent plasma within three days of their diagnosis had lower mortality rates after 30 days compared with those who received the plasma later, and that people transfused with plasma containing higher levels of antibodies also enjoyed lower mortality rates one month later compared with those receiving plasma with lower concentrations of antibodies. That program allows patients—generally the sickest ones—to receive the transfusions on an experimental basis if no other treatment options are available. “I think there is a crucial role for convalescent plasma right now,” says Dr. James Musser, chair of pathology and genomic medicine at Houston Methodist Research Institute and Houston Methodist Hospital, whose team has transfused several hundred COVID-19 patients so far. He and others also point to a more than century-long history of success in transferring some type of passive immunity from a recovered patient to a sick one, a technique dating back to the 1918 influenza pandemic, when plasma from recovered patients was used to treat those newly infected. In the years since, the practice has proved itself against other emerging infectious diseases, including other coronavirus diseases like SARS and MERS, as well as Ebola. “There is a very rich literature that is well documented over the years,” says Musser. “Importantly, there is a theoretical reason to think it may work, and pretty good justification that it is probably safe as well.” Prior to the issuance of the EUA, doctors could use the therapy only if their patients were enrolled in a clinical trial studying the treatment, if they applied for special investigational use of the therapy, or if their hospital is one of the approximately 2,800 participating in the expanded-use program through the National Convalescent Plasma Study. The decision should provide more patients in hospitals around the country the opportunity to receive the treatment. But one issue with the National Convalescent Plasma Study data—which Collins and Fauci note—is that all of the participants were transfused with plasma from recovered patients, and there is no control group. So, the NIH is also supporting a number of studies comparing antibodies from convalescent plasma with a placebo—including trials focused on treating severely ill patients, as well as those targeting people who are infected but aren’t hospitalized to see if the therapy can potentially prevent their infections from getting that far. The defensive immune cells in plasma are an attractive target not only for doctors who are desperate for anything to treat their sickest patients, but also for researchers who are eager to mine them for possible drug treatments against COVID-19. Even beyond exploring how plasma from recovered patients can be transfused into sick patients to help them, researchers are also aggressively analyzing this convalescent plasma to isolate the most potent and efficient antibodies and potentially turn them into a treatment that can not only control the disease but maybe even prevent it if given to patients at the right time after their infection. If they work in preventing some cases of COVID-19, antibody-based therapies could serve as a bridge for protecting populations until a vaccine is approved and distributed. Limited manufacturing capacity and the finite pool of recovered-patient donors make it nearly impossible to produce enough antibody therapies to protect the world’s population at the moment. And even after vaccines are available, they may not provide 100% protection, so antibodies could play an important role in filling any gaps in immunity. Given convalescent plasma’s track record in treating other infectious diseases in the past, doctors are hoping they’ll have similar success in using it to control COVID-19. “There is not a therapy right now for anyone who is starting to get a [COVID-19] infection,” says Dr. Davey Smith, chief of infectious diseases and global public health at University of California, San Diego, who is overseeing one of the studies looking at outpatients in the U.S. “We have no way to stop it. That’s the reason for the trial.” How Convalescent-Plasma Therapy WorksSo far, early results are mixed on how helpful it is to transfuse sick patients with plasma from recovered patients. One of the first studies, in which 103 patients with severe or life-threatening disease were treated in Wuhan, China, from February 2020 to April 2020, showed little difference in mortality between those receiving the plasma and those not treated, although among severely ill patients, the plasma recipients were 23% more likely to improve over 28 days than those not receiving plasma. But the study was stopped early as cases began to wane in the country. The early results from the Mayo-led analysis, however, are more encouraging—as are those from another recent study of 136 patients treated in Houston from March to July. In that trial, those randomly assigned to receive convalescent-plasma transfusions had lower mortality after 28 days compared with those not receiving the plasma; transfusion within 72 hours of admission to the hospital showed the most dramatic effect on mortality rate. The seemingly contradictory data could be due to a number of factors, the most important of which is the fact that each person is capable of making hundreds of trillions of antibodies to various viruses and bacteria and other pathogens they may encounter. At any given time, our immune systems are busy churning out billions of antibodies, largely based on what bugs we’re currently encountering and which bugs we’ve battled in the past. Some people are able to make strong antibodies against SARS-CoV-2, while others may produce slightly less potent ones, and how effective the transfusions are depends on how potent the antibodies happen to be. So which ones are the best for targeting SARS-CoV-2? The idea behind convalescent plasma is that you don’t actually have to know. Instead, you assume that if someone has recovered from the infection, then their plasma is awash with enough of the right antibodies to take care of the virus. That’s presumably what helped Phil Towse. On April 24, the 68-year-old was at work as a detention officer in the Harris County Sheriff’s office near Katy, Texas, when he started feeling feverish. He got tested the following day, and three days later he learned he was positive for COVID-19. His concerned daughter bought an oximeter to measure his oxygen levels, and when they dropped enough that he could no longer think clearly, his wife took him to the emergency room. Towse wasn’t aware, but the doctors learned he already had pneumonia in both lungs. “I was really close to being put on a ventilator,” he says. “I was a sick dude.” Towse was treated at Houston Methodist West, which is part of the Houston Methodist system, where doctors had been carefully watching the surge in cases that had recently overwhelmed health care teams in New York City, and were preparing for a similar wave. So, “we decided to move forward aggressively with the convalescent-plasma approach,” says Musser. “Like everybody else, we realized there really weren’t good alternatives available at that time.” On March 28, Musser and his team performed the first two COVID-19 convalescent-plasma transfusions at an academic center in the country. He and his team worked hard to educate and recruit donors from the area who had recovered from COVID-19, including Daniel Knight, a Houston attorney. Knight’s COVID-19 experience began in the middle of March with a sore throat that he attributed to allergies. A couple of days later, he developed a fever and started coughing. At the advice of his doctor—who is on the faculty at Houston Methodist Hospital—Knight got a COVID-19 test and immediately isolated himself from his wife and two children in a room above the garage, even before getting the results back. That caution paid off, since it took another two weeks before he received the results. “I was really sick for five or six days with all the symptoms of COVID-19,” he says, including fever, coughing, a rapid heart rate and shortness of breath. Knight was fortunate, however, in that he never got sick enough to need hospitalization, and after he recovered, he decided to donate his plasma. By that time, Houston was in the middle of a peak in cases, and “it was all hands on deck,” says Knight. “Anything I could do to help—I was going to give until I ran out of blood or they told me you can’t give any more. It was really an easy choice for me to donate because I could very easily have been one of those people who was in the ICU. I could have been one of those people who was on a ventilator.” Towse benefited from donors like Knight; soon after his wife brought him to the emergency room, doctors informed them that he was a good candidate for the plasma treatment. “One of the things that swayed our decision to try it was that we read that in order to qualify for the plasma treatment, you had to either already be so sick that they were afraid you weren’t going to make it, or that you were trending on that path,” says Towse’s wife Cathye Jo. “There weren’t a lot of other options.” At 3 a.m. on May 4, Towse was roused by the nursing staff and transfused with plasma that had been donated by someone who had recovered from their infection and was a blood-type match for him. The next day, he says, “I sure did feel better.” Three days later, he was discharged. His doctors will never know exactly which antibodies from his donor contributed to his recovery but it’s enough to know that they likely did. That’s the advantage of plasma—it’s rich in a number of different antibody cells that likely find different ways to block or thwart SARS-CoV-2 from attaching to healthy cells in the body and infecting them. So far, more than 72,000 people with COVID-19 have been transfused with convalescent plasma, and studies are ongoing to monitor how effective the antibodies were in batting the virus. Most data from the past few months of the pandemic have come from severely ill patients like Towse, including those who are on ventilators in the ICU. Musser is overseeing the trial of convalescent plasma at Houston Methodist that first reported the reduction in mortality among plasma recipients. There are two critical hints from that study, as well as others, that could guide how convalescent-plasma therapy could be used in coming months, as schools and businesses reopen and health officials brace for more cases. In Musser’s study, people receiving plasma with higher concentrations of antibodies against SARS-CoV-2 enjoyed greater and more rapid improvement in their health. “That’s the good stuff that we have been using now for almost a month in almost all of our patients,” he says. Scientists are working on ways to identify superdonors who produce the most potent antibodies with a relatively simple lab test. “It makes sense to preselect donors based on the presence of good antibodies that can prevent the virus from docking on cells,” says Rudolf Valenta, a professor of immunopathology at Medical University of Vienna, who has developed such an assay for research use in his country. Doctors are also keeping a close eye on the amount of antibodies that donors produce. After donating 17 times, Knight was told his antibody levels were still good, but that the hospital now had enough volunteers who had recovered more recently and were willing to provide their plasma. Also important is when the plasma is transfused. Musser learned that people receiving the transfusions within three days of being hospitalized tended to do better than those who were transfused later in their illness. That’s why the NIH is funding studies of convalescent plasma for people who have been recently diagnosed with COVID-19. In those trials, patients are randomly assigned to receive a transfusion of convalescent plasma or a placebo solution within three or four days of their diagnosis. Experts believe that intervening early to prevent the virus from infecting healthy cells will help people to avoid some of the more serious consequences of the disease as it progresses, including respiratory problems and injury to the lungs. Those late-stage effects are due to the body’s aggressive immune response to the infection, so avoiding activation of this revved up response by controlling the infection early might protect more patients from the more serious effects of the disease. “We think this study is situated to give the greatest opportunity to see an effect,” says Dr. Clifton Callaway, professor of emergency medicine at the University of Pittsburgh, and one of the principal investigators for the 50-site trial. “We believe that in the first week of symptoms’ appearing, patients have probably not developed their own antibodies, so that’s the time when getting a transfusion of somebody else’s antibodies has the greatest potential benefit. We also think that early in the illness is the best opportunity to change the course of illness and prevent it from becoming severe. We’d like to catch it before it gets bad.” Beyond Convalescent PlasmaConvalescent plasma, while useful, is still far from a panacea. For one thing, not all recovered patients make the same number of antibodies, or even the same types of antibodies, and those that pump out higher levels of antibodies are more sought-after as donors than those with lower levels. Some antibodies are also known to actually help viruses infect cells rather than block them, as a way to ensure viruses are destroyed by pathogen-devouring immune cells. One recent study showed that as many as 20% of patients who recovered from COVID-19 harbored these types of antibodies. While most experts believe that’s unlikely that these would negate the benefit of antibody-based therapies, they are watching for this effect in ongoing studies. In addition, says Callaway, “Plasma is precious. It requires donors, it requires people to have the disease and to recover. More desirable would be to have something we can make in the lab and put into a vial.” For decades now, scientists in the pharmaceutical industry have perfected developing and manufacturing monoclonal antibodies, which are antibodies specifically made to target a single part of an offending pathogen or even a tumor in cancer patients. Monoclonal antibodies have transformed cancer care, leading to remarkable improvements in survival rates in patients with breast, lung and skin cancers, among others, and have also proved to be formidable foes against infectious diseases such as rabies and Ebola. So once COVID-19 began its invasion of the human population last winter, researchers began investigating ways to target SARS-CoV-2 with monoclonal antibodies as well. “The hope is that we can nail down which type of monoclonal antibodies or cocktails of antibodies could do the same job as what we hope plasma will do,” says Callaway. Plasma from recovered patients is the logical starting point for this search, and that’s where Carl Hansen and his team at AbCellera, a biotech company in Vancouver, began last spring. And they hit the antibody lottery. AbCellera’s scientists specialize in developing monoclonal antibodies. In late February they received samples of plasma from the first recovered COVID-19 patients in North America, most of whom were from the West Coast. The team screened 6 million cells from one of these early patients and found about 500 unique antibodies against SARS-CoV-2. The researchers then mapped out where and how these antibodies attach to the virus, and isolated a single antibody that, in the lab, powerfully blocked SARS-CoV-2’s ability to bind to human cells. That early luck may pay big dividends in a highly anticipated human trial. AbCellera partnered with pharmaceutical giant Eli Lilly to test its monoclonal antibody, dubbed Ly-CoV-555, in a multicenter study sponsored by the NIH that began recruiting around 200 participants in June and is expected to conclude in November. Ly-CoV-555 is just one of a handful of specific antibodies that are currently being put to the test to treat COVID-19. And some scientists see potential for antibodies to prevent the disease as well. Because antibodies block the SARS-CoV-2 virus from infecting cells, it’s reasonable to test whether the right antibodies could be useful in preventing people from getting sick in the first place. The NIH agrees, and is sponsoring biotech company Regeneron’s study of a pair of antibodies to see if they can both prevent and treat disease; about 2,000 asymptomatic people who are part of households where a member tested positive will be randomly assigned to receive the two-antibody combination or a placebo. And the NIH is also sponsoring a study of Eli Lilly’s Ly-CoV-555 antibody as a preventive treatment in nursing homes. Once a resident or staff member in a nursing home tests positive, scientists will randomly assign the remaining residents and staff at the facility to receive either the antibody treatment or placebo to see if there is any difference in infection rates between the groups. “We and others have found that we can create a very potent antibody [in Ly-CoV-555] that completely blocks the virus’s ability to enter cells via the spike protein,” says Dr. Dan Skovronsky, chief scientific officer at Eil Lilly. In tests with monkeys, the antibody prevented the animals from getting massive infections. “That’s great news for the monkeys and possibly good news for humans,” he says. Researchers expect to have the first preliminary results from the study in September. If it turns out that antibodies are an effective preventative, they could significantly reduce the number of new infections and help to stop the spread of COVID-19. And if the studies of antibody use early in people’s disease also proves successful, that could help to thwart transmission as well; if more people have their infections under control, then they are less likely to spread it to others. That’s an idea borrowed from the HIV field, in which doctors increasingly rely on “treatment as prevention” to bring viral load down to levels where it can’t spread as easily by contact. Even if and when there is a vaccine to protect people against SARS-CoV-2 infection, antibody-based treatments may still be needed as part of a robust disease-fighting plan, says Callaway. “I believe there is a good chance that people will still pop up with illness, even with a vaccine,” he says. “Therapies like monoclonal antibodies or convalescent plasma are important for patients who develop illness despite a vaccination campaign and who are at risk of getting severe disease.” For Towse, it doesn’t matter how antibodies actually do their job, just that, in his case, he believes they did. Grateful for his recovery, he is planning to donate his own plasma to potentially help others. “It’s a no brainer for me to give,” he says. “I could have been on a ventilator, and that just scares the hell out of me. We’ve got to get [the pandemic] under control and find some way to take care of this. And I think this plasma is the way to go.” from https://ift.tt/3aSXsO9 Check out https://takiaisfobia.blogspot.com/
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Preliminary research released Monday suggests it’s possible to get COVID-19 twice—but experts say the news is not as concerning as that headline may seem. The new research, which was accepted for publication in the journal Clinical Infectious Diseases, details the case of a 33-year-old man living in Hong Kong. He first tested positive for COVID-19 in late March and developed symptoms including cough, sore throat, fever and headache. He made a full recovery, but again tested positive for COVID-19 while traveling home from Europe in mid-August. This time, he did not have any symptoms. The Hong Kong-based researchers behind the study say the man’s case is the first proven example of reinfection with SARS-CoV-2, the virus that causes COVID-19. There have been other documented cases of patients who tested positive for COVID-19 multiple times, but it has not been clear whether they’re truly reinfected or if some of the virus’ genetic material lingers within the body, leading to repeated positive tests. Viral sequencing, however, showed the Hong Kong patient was infected by two different strains of SARS-CoV-2, which suggests he indeed got sick twice. But in some ways, the case is actually encouraging, says Akiko Iwasaki, a professor of immunobiology at the Yale School of Medicine who was not involved in the study. “There’s no need to panic over this reinfection news,” Iwasaki says. “Even though he got reinfected…this is a good example of how immunity should work in a person.” By that, Iwasaki means that the man’s first infection likely protected him enough that he did not develop symptoms during his second infection. There’s no guarantee all patients’ immune systems will react that way, Iwasaki says, but it’s still a promising sign. It’s hard to draw sweeping conclusions from one case of apparent reinfection, says Angela Rasmussen, a virologist at Columbia University’s Mailman School of Public Health. (She also notes the paper was circulated without the researchers’ raw data, which makes it hard to assess the science.) One potential red flag is that the researchers found that the Hong Kong patient did not test positive for antibodies—proteins the body dispatches to fight an infection, and which may help prevent future infections—after his first bout of COVID-19. (According to the study, the patient did develop antibodies after his second positive test.) It’s possible that the first time he got sick, he was tested too early to detect antibodies, or that they were present at low levels missed by the test, the study notes. But if he truly did not develop any antibodies, his case may be an anomaly rather than an example, since most patients do develop at least some antibodies, Rasmussen says. Studies have shown that antibody levels decrease quickly in the months after a coronavirus infection, but researchers still don’t know how well, or for how long, COVID-19 antibodies provide immunity. Unfortunately, the Hong Kong patient’s case doesn’t help clear that up. “We still can’t make conclusions about people who do” test positive for antibodies, Rasmussen says. It’s also not clear whether the man was contagious during his second brush with coronavirus. The amount of virus in his system suggested he could pass it to others, but there’s no evidence as to whether he did. That’s an important question, Iwasaki says. If reinfected patients are contagious even if they’re asymptomatic, herd immunity—the point at which enough of a population is immune to a disease to slow its spread—would be difficult to achieve without a vaccine. The study is an important starting point for understanding coronavirus reinfection, but it will take more data to make any broad conclusions. “There’s been more than 24 million cases reported to date,” the World Health Organization’s Maria Van Kerkhove said at a briefing Monday. “And we need to look at something like [the possibility for reinfection] at a population level.” If reinfection does turn out to be common, Rasmussen says, it could be an argument for vaccinating even those who have recovered from COVID-19. But right now, it’s difficult to apply the paper’s findings at scale—beyond urging everyone, whether they’ve had COVID-19 or not, to wear a mask and continue practicing social distancing. from https://ift.tt/32phFYl Check out https://takiaisfobia.blogspot.com/ Five months after coronavirus took root in the U.S., face masks remain one of the most controversial and confusing parts of the pandemic. Changing public-health messaging hasn’t helped. In March, when personal protective equipment (PPE) was running short, top U.S. public-health officials told Americans that the general public did not need masks because they don’t fully block respiratory particles that spread COVID-19, such as those in a sick person’s cough or sneeze. Most masks are best at preventing particles from getting into the air where others might inhale them, so, at first, the U.S. Centers for Disease Control and Prevention (CDC) recommended that only sick people wear them. But as research progressed, studies showed compelling evidence that even asymptomatic people could infect others with coronavirus—which meant anyone could be unknowingly contagious, and everyone should be trying not to breathe on other people. As science evolved—and a dire PPE shortage eased—the CDC revised its guidance to suggest that everyone wear fabric masks in public. President Donald Trump has also sent mixed messages on masks. He has called wearing masks “patriotic,” but has also opted not to wear them during public appearances or require them at his rallies. Other politicians have also resisted mandates on mask wearing—Georgia Governor Brian Kemp even sued Atlanta Mayor Keisha Lance Bottoms after she required them in public. (He later dropped the lawsuit.) As a result, many people are understandably confused about how masks work and when they should be worn. The science continues to evolve, but here are experts’ latest recommendations about masks and coronavirus. How can I make homemade masks more effective?“The more layers, the better,” says Raina MacIntyre, an infectious disease expert from the University of New South Wales who has studied mask efficacy. In a recent study, MacIntyre and her colleagues recommend a minimum of three layers of fabric. (That said, any face covering is better than none. If all you’ve got is a bandana or t-shirt, wear that.) While the layers closest to your face can be something soft, like cotton, the outer layer should be a water-resistant fabric, like polyester, that can repel droplets. “There’s an easy way to test any fabric,” MacIntyre says. “Take a piece of fabric and drop one drop of water on it and see what happens.” If it soaks in, it’s not repellent enough for the outer layer. If it beads up, you’re in business. Fit is also important. You can easily breathe in germs if there are gaps between the edges of your mask and your face, MacIntyre says. For that reason, she recommends a face mask over a face shield, which is typically open at the bottom. Finally, your nose should be inside your mask at all times, says Ben Abbott, an environmental sciences professor at Utah’s Brigham Young University who recently compiled a guide to masks. “The droplets are produced as you breathe out of your nose just as easily as when you breathe out of your mouth,” he says. But aren’t medical masks better?N95 masks, the fitted respirators doctors wear when caring for contagious patients, are better than cloth masks at blocking viral particles from coming in. Cloth masks offer some protection via a physical barrier—which gets more effective with more layers—but N95s offer better filtration. However, the general public is urged not to buy N95 masks so there are enough for health care workers and the highest-risk individuals. Studies do show that multi-layered cloth masks are about as good as surgical masks at containing the spray of respiratory particles when the wearer sneezes, coughs or talks. That means if everyone wore a cloth mask in public, there would be far less virus circulating and a much lower chance of anyone getting sick. “My mask protects you, your mask protects me,” Abbott says. Do I need a filter?You’ve probably seen advertisements for disposable filters that fit between the layers of a face mask to block viral particles. They may add a little extra protection, but MacIntyre says they’re probably not necessary as long as you wear a multi-layer mask and keep your distance from others. (Using one every day would also add up to a lot of waste and cost, she adds.) If you decide to buy one, “You really need to make sure the filter goes across the whole area of the mask,” MacIntyre says. “The air will flow down the path of least resistance,” so if you’re only using a small filter, air will just move around it. Experts recommend filters made of polypropylene, a plastic-derived material that carries an electrostatic charge that can help it trap incoming and outgoing particles. In a pinch, a few layers of tissue or paper towel could even add a little extra filtration, according to a recent study. When should I wear a mask?Research increasingly suggests coronavirus can spread via tiny respiratory particles that hang suspended in the air for minutes and even hours, in addition to direct contact with droplets from a sick person’s cough or sneeze. Airborne spread is particularly likely in indoor environments that aren’t well-ventilated. “It’s pretty clear now that the indoor [transmission] risk is much higher than outdoor risk,” since viral particles dissipate better in fresh air, Abbott says. That means you should be wearing a mask any time you’re inside with other people—an increasingly likely situation as people go back to school and workplaces. Even if you’re in your own section of a shared office, respiratory particles may circulate throughout the whole space depending on how well it’s ventilated, so it’s safest for everyone to wear a mask all day, Abbott says. (For proof that masks work inside, look to a Missouri hair salon where two stylists with coronavirus didn’t pass it to any of their 140 customers thanks to face masks.) Even if you’re outside, Abbott says you should be masked any time you can’t maintain at least a six-foot distance from others. And yes, you need a mask even if you think you’re not sick. “You’re actually most contagious in the days prior to showing any symptoms,” Abbott says. “That’s why it’s so important for a large portion of the population to be wearing masks. If you wait until you have symptoms, it’s too late.” What about when I’m exercising?If you’re working out in an indoor gym, you absolutely need to wear a mask, Abbott says. If you’re exercising outdoors (and alone) in an uncrowded area, it’s probably safe to take the mask off. You’re unlikely to spread or catch the virus if you quickly pass someone else on a walk, run or bike ride, he says. Should I wear it at home?Realistically, most people aren’t going to wear masks at home. But if you live with someone at high risk of getting severe coronavirus (like an elderly or chronically ill person) or who works in a high-risk environment (like a hospital), it may not be a bad idea, MacIntyre says. And remember, coronavirus spreads easily within households. Housemates have probably been exposed to each other’s germs, so it doesn’t do much good when, for example, one partner wears a mask in public and the other doesn’t, Abbott says. How should I wash my mask?You can throw cloth masks in the washing machine with your regular laundry, MacIntyre says. Just make sure to use high heat and wash your mask after every use. MacIntyre recommends keeping at least two on hand so one is always clean. Are there valid medical reasons not to wear a mask?For the vast majority of people, wearing a fabric mask is safe and beneficial. The worst side effects most people can expect are a little discomfort, acne and “a false sense of security” that causes them to ease up on social distancing and other precautions, Abbott says. Masks may exacerbate breathing problems for those who have issues with it under normal circumstances, such as patients with advanced emphysema or severe asthma, MacIntyre says. But that’s not a free pass to walk around bare-faced. “If you’ve got a condition that makes it more difficult for you to wear a mask, you just need to use other techniques to minimize the amount of time you need to wear a mask,” such as ordering food and supplies online to cut down on time spent in public, MacIntyre says. And though face shields aren’t as effective as face masks, MacIntyre says they are still a decent backup for people who truly cannot wear a mask. from https://ift.tt/32lDcRt Check out https://takiaisfobia.blogspot.com/ For months now, many have been baffled by how the United States, among the richest and most technologically capable countries on Earth, could lead the world in both confirmed cases of COVID-19 and resulting deaths. Fingers have been pointed in many directions, from listless political leadership to intractable cultural attitudes. But there is another factor that arguably made the U.S. a sitting duck for viral catastrophe: the country’s 328 million residents are scattered across its many states, districts and territories, each with their own approach to viral containment. We aren’t battling one epidemic—we’re battling more than 50 of them. More than one observer has compared the country’s battle against the coronavirus to a game of Whack-a-Mole—every time the curve appears to flatten in one state, it arcs in others, like a hurricane with no sense of direction or fatigue. To visualize this phenomenon geographically, TIME traced the wandering eye of this infectious storm by calculating, for each day back to late February, the epidemic’s midpoint—the precise location in the U.S. from which half of all new reported cases were to the west and half were to the east, and likewise for the north and south (what demographers call the median center of population). Here’s what it looks like: As expected, the domestic trajectory of Hurricane COVID begins in the upper Northwest. That’s where the first confirmed U.S. case was reported, on Jan. 20 in Snohomish County, Wash., just a few weeks after the virus emerged in Wuhan, China. After a period of relatively slow growth in February, the “eye” begins its push south into California, weeks before the Grand Princess docked in the Port of Oakland on March 9 with 103 infected passengers aboard. At the same time, cases were growing rapidly in the tri-state area of New York, New Jersey and Connecticut, likely after travelers brought the disease there from Europe, opening a second theater of combat. “The virus had begun multiple assaults into the U.S.,” as two of my colleagues wrote of these spikes on opposite coasts. While the rate of new cases in the west began to stabilize, the tightly-packed areas around New York City experienced surges that rapidly drew the eye of the COVID hurricane across the country. The eye then hovered around the New York region until mid-April. It’s remarkable to see the median longitude (the vertical line) so close to this hotspot, as it means that, on many days, the tri-state area essentially had as many new cases as the entire rest of the nation to the west and south. Next, a surge in and around Chicago, combined with an eventual flattening of the curve in New York, drew the line west through mid-May, when a precipitous spike in Los Angeles began to tug the median latitude southward. By this time, some states, like Virginia, were beginning to ponder a tempered reopening of public spaces like beaches and parks by Memorial Day. Come June, many regions in the south that had not yet seen the worst of the pandemic began reopening--in retrospect, prematurely. Soon, Texas, Arizona and Florida were the new hotspots, drawing the center south and west as Southern California also continued to suffer. In late June through mid-July, the eye was caught in a tug-of-war centered in Arkansas amid rising cases in the Carolinas. It’s important to note that the location of our center point does not illustrate a surge of cases in that particular spot. Instead, it’s the theoretical halfway point that evenly divides the total number of new infections in both directions. Arkansas, for example, was relatively stable when it represented the geographic center of the epidemic, reporting an average of about 20 cases per 100,000 residents a day, significantly lower than several neighboring states. Now, with COVID-19 on the decline across much of the deep south, the eye is heading back north, inching toward the Heartland as cases rise in parts of the midwest. Where the eye eventually settles, however, is far less relevant than the still-distant hope that the virus stops spreading altogether. from https://ift.tt/3aZmGuw Check out https://takiaisfobia.blogspot.com/ (WASHINGTON) — President Donald Trump on Sunday announced emergency authorization to treat COVID-19 patients with convalescent plasma — a move he called “a breakthrough,” one of his top health officials called “promising” and other health experts said needs more study before it’s celebrated. The announcement came after White House officials complained there were politically motivated delays by the Food and Drug Administration in approving a vaccine and therapeutics for the disease that has upended Trump’s reelection chances. On the eve of the Republican National Convention, Trump put himself at the center of the FDA’s announcement of the authorization at a news conference Sunday evening. The authorization makes it easier for some patients to obtain the treatment but is not the same as full FDA approval. The blood plasma, taken from patients who have recovered from the coronavirus and rich in antibodies, may provide benefits to those battling the disease. But the evidence so far has not been conclusive about whether it works, when to administer it and what dose is needed. In a letter describing the emergency authorization, the chief scientist for the FDA, Denise Hinton, said: “COVID-19 convalescent plasma should not be considered a new standard of care for the treatment of patients with COVID-19. Additional data will be forthcoming from other analyses and ongoing, well-controlled clinical trials in the coming months.” But Trump had made clear to aides that he was eager to showcase good news in the battle against the virus, and the timing allowed him to head into his convention with momentum. He and aides billed it as a “major” development and used the White House briefing room to make the announcement. Trump also displayed some rare discipline in the evening news conference, sticking to his talking points, deferring to the head of the FDA, Stephen Hahn, and only taking three questions from reporters. The White House had grown agitated with the pace of the plasma approval. The accusations of an FDA slowdown, which were presented without evidence, were just the latest assault from Trump’s team on what he refers to as the “deep state” bureaucracy. White House chief of staff Mark Meadows did not deal in specifics, but said that “we’ve looked at a number of people that are not being as diligent as they should be in terms of getting to the bottom of it.” “This president is about cutting red tape,” Meadows said in an interview Sunday on “This Week” on ABC. “He had to make sure that they felt the heat. If they don’t see the light, they need to feel the heat because the American people are suffering.” During Sunday’s 18-minute press conference, Trump said he thought there had been a “logjam” at the FDA over granting the emergency authorization. He alleged there are people at the FDA “that can see things being held up … and that’s for political reasons.” Dr. Joshua Sharfstein said the statement, and Hahn’s silence while Trump said it, “was disgraceful.” “The FDA commissioner basically allowed the president to mischaracterize the decision and attack the integrity of FDA employees. I was horrified,” said Sharfstein, a vice dean at John Hopkins University’s school of public health who was a top FDA official during the Obama administration. “This is a promising therapy that has not been fully established,” he said The push on Sunday came a day after Trump tweeted sharp criticism on the process to treat the virus, which has killed more than 175,000 Americans and imperiled his reelection chances. The White House has sunk vast resources into an expedited process to develop a vaccine, and Trump aides have been banking on it being an “October surprise” that could help the president make up ground in the polls. “The deep state, or whoever, over at the FDA is making it very difficult for drug companies to get people in order to test the vaccines and therapeutics,” Trump tweeted. He continued: “Obviously, they are hoping to delay the answer until after November 3rd. Must focus on speed, and saving lives!” Earlier this month, Mayo Clinic researchers reported a strong hint that blood plasma from COVID-19 survivors helps other infected patients recover. But it wasn’t considered proof. More than 70,000 patients in the U.S. have been given convalescent plasma, a century-old approach to fend off flu and measles before vaccines. It’s a go-to tactic when new diseases come along, and history suggests it works against some, but not all, infections. The Mayo Clinic reported preliminary data from 35,000 coronavirus patients treated with plasma, and said there were fewer deaths among people given plasma within three days of diagnosis, and also among those given plasma containing the highest levels of virus-fighting antibodies. But it wasn’t a formal study. The patients were treated in different ways in hospitals around the country as part of an FDA program designed to speed access to the experimental therapy. That “expanded access” program tracks what happens to the recipients, but it cannot prove the plasma — and not other care they received — was the real reason for improvement. Administration officials, in a call with reporters Sunday, discussed a benefit for patients who were within three days of admission to a hospital and were not on a respirator, and were given ‘high-titer’ convalescent plasma containing higher concentrations of antibodies. They were then compared to similar patients who were given lower-titer plasma. The findings suggest deaths were 35% lower in the high-titer group. There’s been little data on how effective it is or whether it must be administered fairly early in an illness to make a significant difference, said Dr. William Schaffner, an infectious diseases expert at Vanderbilt University. Aiming to ward off a possible a run on convalescent plasma after the announcement, government officials have been working to obtain plasma and to team with corporate partners and nonprofit organizations to generate interest among previously infected patients to donate. Hahn, who called the development “promising,” said Trump did not speak to him about the timing of the announcement. He said “this has been in the works for several weeks.” But some health experts were skeptical. Benjamin Corb, of the American Society for Biochemistry and Molecular Biology, called it “conspicuous timing.” “President Trump is once again putting his political goals ahead of the health and well-being of the American public,” Corb said. Rigorous studies are under way around the country, comparing similar patients randomly assigned to get plasma or a dummy infusion in addition to regular care. But those studies have been difficult to finish as the virus waxes and wanes in different cities. Also, some patients have requested plasma rather than agreeing to a study that might give them a placebo instead. Former FDA commissioner Dr. Scott Gottlieb dismissed the suggestion of a slowdown. “I firmly reject the idea they would slow-walk anything or accelerate anything based on any political consideration or any consideration other than what is best for the public health and a real sense of mission to patients,” Gottlieb told CBS’s “Face the Nation.” Trump, in news conferences, “has made all kinds of therapeutic suggestions” that have not proven to be supported by science — and are even dangerous, Schaffner said. That includes statements about the possible value of treating COVID-19 patients with ultraviolet light and disinfectant. Trump reportedly also recently became enthusiastic about oleandrin, a plant extract derived from a toxic shrub that scientists immediately warned against. But the president is perhaps best known for his early and ardent embrace of the malaria drugs hydroxychloroquine and chloroquine. Earlier this month, Hahn emphasized that routine evaluation procedures will remain in place to evaluate COVID vaccine candidates. “I think this administration has put more pressure on the Food and Drug Administration than I can remember” ever happening in the past, Schaffner said. “Everybody is just a little bit nervous,” he said. ___ Stobbe reported from New York. from https://ift.tt/3grTwoO Check out https://takiaisfobia.blogspot.com/ People often talk about COVID-19 testing like it means only one thing. But in reality, the U.S. Food and Drug Administration (FDA) has so far granted emergency-use authorization to more than 200 different tests meant to detect a current or past infection from SARS-CoV-2, the virus that causes COVID-19. Most recently, the agency made headlines for approving the first such test that uses saliva samples, the aptly named SalivaDirect test out of the Yale School of Public Health. These COVID-19 tests fall into three main categories: PCR, antigen and antibody. Dr. Aneesh Mehta, chief of infectious diseases services at Emory University Hospital in Atlanta, Ga., broke down the differences between them—and what to keep in mind if you decide to get tested. PCR testsThe majority of COVID-19 testing happening in the U.S. right now uses polymerase chain reaction (PCR) technology. These tests detect disease by looking for traces of the virus’ genetic material on a sample most often collected via a nose or throat swab. The U.S. Centers for Disease Control and Prevention (CDC) considers PCR tests the “gold standard” of COVID-19 testing, but, like all tests, they’re not perfect. Studies have suggested as many as 30% of COVID-19 PCR test results are inaccurate. (For comparison, the CDC in 2018 estimated that rapid flu tests have about the same rate of incorrect results.) With COVID-19 tests, false negatives seem to be much more common than false positives—so if you get a positive result, you very likely do have the virus. If you get a negative result but have coronavirus symptoms or recently encountered someone sick with the virus, you should still self-isolate until symptoms subside. False negatives can happen if health professionals do not go deep enough into the nose or throat to collect a good sample. The timing of the test matters, too. Infections can be missed if testing happens too soon after exposure, research shows. The reverse is also possible. “Sometimes after the virus has been killed off, there’s still a lot of [genetic material] left over in the body,” Mehta says. This can cause someone to test positive even if they’re not actively sick. Getting tested roughly five days after a possible exposure seems to be the sweet spot. Running a PCR test and reading its results requires specific equipment and chemicals (known as reagents) that are in short supply, which is partially why the U.S. has hit such a testing backlog. To try to cut down on wait times, several companies have developed tests that can detect a virus’ genetic material in minutes, but some--like the Abbott ID NOW test used in the White House—have high reported rates of false negatives. These rapid tests aren’t readily available to most of the American public yet, but some experts argue they could serve a valuable purpose despite their questionable accuracy. Fast tests could significantly ramp up testing capacity, feasibly catching more cases of COVID-19 than our current testing strategy, despite the accuracy issues. Saliva testsCoronavirus saliva tests are a new type of PCR diagnostic for COVID-19. Saliva testing “does depend on standard PCR technology, and it does require some manual labor in order to move it through the steps of the test,” Mehta says. But collecting spit is less invasive than a nose or throat swab and easier to do at home or without medical training, Mehta says. SalivaDirect, the test from Yale, also does not require proprietary chemical reagents or test tubes, which its developers hope will help ease supply and access issues. Early Yale research conducted by testing professional basketball players suggests the saliva test is about as accurate as a traditional nasal PCR test, but Mehta says “we need to more broadly test it” to see if that finding holds true. Antigen testsAntigen tests can turn around results in minutes—but speed comes with tradeoffs. Like PCR tests, antigen tests usually require a nose or throat swab. But unlike PCR tests, which look for genetic material from the SARS-CoV-2 virus, antigen tests look for proteins that live on the virus’ surface. This process is a little less labor-intensive than PCR testing, since there isn’t as much chemistry involved, but it’s also less sensitive. Mehta says that opens the door for possible false positives (if the test picks up on proteins that look similar to those from SARS-CoV-2) or negatives (if it misses proteins entirely). False positives are rare with antigen tests, but as many as half of negative results are reportedly inaccurate. If you test negative but are showing symptoms or have had a risky exposure, your doctor may order a PCR test to confirm the result. While antigen testing is becoming more common in the U.S., only a few such tests have been approved by the FDA so far. Much like with rapid genetic tests, some experts argue that fast-moving antigen tests could help ease testing bottlenecks enough to compensate for their reduced accuracy. Antibody testsUnlike the other tests listed here, antibody tests aren’t meant to pick up on current infection with SARS-CoV-2. Rather, they search the blood for antibodies, proteins the body makes in response to an infection that may provide immunity against the same disease in the future. These tests look for SARS-CoV-2-specific antibodies to see if you’ve previously had coronavirus. Right now, antibody tests can’t do much except satisfy curiosity. For one thing, Mehta says, false results are fairly common. Even if the results are accurate, scientists do not yet know how well or for how long coronavirus antibodies protect someone from a future case of COVID-19. A positive antibody test result does not mean you can’t get COVID-19 again, at least as far as current science suggests. Wide-scale antibody testing is useful for researchers, since it could inform estimates about how many people have actually had COVID-19 and help scientists learn more about if or how antibodies bestow immunity to coronavirus. “From the research perspective, there’s a lot of information we can get from antibody testing if we collect it over time,” Mehta says. But in terms of actionable information for individuals, antibody tests don’t reveal much at this point. “Just because we can detect antibodies does not necessarily mean you’re fully protected from acquiring that infection,” Mehta says. “Continue to take all the same precautions that everyone else is taking.” from https://ift.tt/3aHQrQc Check out https://takiaisfobia.blogspot.com/ Douglas Brooks served as the head of the White House Office of National AIDS Policy during the Obama Administration as the first openly gay, HIV-positive African American to hold the job. He focused on addressing the health needs of those at higher risk of HIV infection, and is now executive director of community engagement at the biopharmaceutical company Gilead Sciences. Dr. Otis Brawley was chief medical and scientific officer of the American Cancer Society before becoming a professor of oncology at Johns Hopkins, where he oversees a research effort exploring disparities in cancer rates and outcomes. Over a Zoom call, the two discussed the systemic factors behind racial inequities in health and how COVID-19 may serve as a catalyst for addressing them. Dr. Otis Brawley: It’s a combination of racism as well as socio-economic deprivation that causes people to not do as well. It starts out at birth and involves what we eat, what our habits are, what our living conditions are, and involves prevention of disease, which I think is not stressed enough, as well as access to care to get treated once diagnosed. We have a lot of data to show that people who are poor are going to have more high-calorie diets, and it causes increased amounts of obesity. People who are poor are not going to be able to have access to doctors for counseling about prevention of disease. If you look at the major chronic diseases, cancer, cardiovascular disease, diabetes, they’re all caused by a combination of smoking, consuming too many calories, not enough exercise and obesity. Those are the causes of cancer, diabetes and cardiovascular disease, which are the major chronic diseases and habits that come along with poverty and with the deprivation due to racism. Douglas Brooks: Otis, you mentioned racism. Often when we hear racism, we think of this as an act of one person or But what we also have to look at is that many of these people, especially Black people, are living in overly crowded homes and buildings. They leave those overly crowded homes and buildings and get on overly crowded public transportation, go to overly crowded workplaces. We can’t ignore those systemic issues that also exacerbate COVID-19 and other health disparities. OB: When I was at the National Cancer Institute in the 1990s, we started a campaign trying to encourage people But the end result was people were hurt. DB: Leadership is important. But it’s defining leadership in ways that make sense for the community. So what do I mean by that? In some places, it may absolutely be that the leader in the community is the guy who owns the barbershop, or the leader in the community is the woman who is looking out for everybody’s kids if they’re going to and from school. We have to be flexible enough in our thinking to understand how we make investments in those communities in ways that are both sustainable and that are realistic. OB: I agree with you. I think the long-term investment should also be in good schools. We need more educated people who can get engaged in the community. We don’t need to reform health care. We need to transform health care. We need to change how we provide it. We need to change how we consume it. DB: Back in April, Tony Fauci said that some of the data [on COVID-19] had started coming in around the significant disparities among Black and Latinx members of our country. And he said, Look, we’re going to find a cure. We’re going to end coronavirus. But once we’ve done that, we have to come back and look at these disparities that continue to impact the African-American community. It felt like a call to action, quite frankly. [I] reach[ed] out to Daniel Dawes, who is the new director of the Satcher Health Leadership Institute at Morehouse School of Medicine. So with Morehouse we are building a platform to, in real time, capture not only the COVID-19 disparities, but disparities around mental health, behavioral health, diabetes and asthma. We want to overlay these on the COVID-19 data, and then use the data with partners like academic institutions, policymakers and folks like us in the private sector, to see how we can make a difference and change the laws and policies in our country to address structural racism. I’m a social worker by training, and the very painful aspect of subtle racism is that childhood should be spent dreaming about what one can be with zero barriers in one’s mind. When a child is in a home, in a family, where people are having to struggle and fight barriers every single day, that opportunity to dream is just not as available. You can’t get change made without being able to both tell the story and show the data to make a difference. OB: If I were health care czar, what I would try to do is make sure that every person in the United States has a health coach. This will be someone who they would meet with perhaps three or four times a year, from birth all the way through the rest of life, and be an adviser on how to stay healthy and discuss what things you need to be doing, and what habits you are starting to get into that are not good for your health. We could prevent a lot of disease. I’m always a little bit optimistic. That’s why I get up out of bed every day and keep doing this. I do think that ultimately we will get people to realize there is a problem. It may not be fixed in the next generation. But I do think we’re going to get better and better. In my field of cancer, I actually get to see the mortality rates for Blacks. For prostate, breast, lung, colorectal—all the major cancers, the mortality rates are actually going down. So I can tell you I’ve got data to prove we are doing good, and the disparities are lessening. But the disparities are going to be here for a long, long time. DB: If I didn’t think we could make a difference—truly make a difference—I probably couldn’t pull myself out of bed. What I think is different about now is the intersection of COVID-19 that has us all at home, and watching TV. The horrific murders that everyone witnessed—good people in our country saw those movements, those actions and marches across the country. And that energy, I think it’s all coming together to see these disparities. I feel more hopeful about our country writ large, but more hopeful about health care and about the economy, about racism and injustice, inequity, than I have in a very, very long time. Because I think good people just didn’t know. They’re not evil, hateful people. They are just people who are going about their lives and didn’t know. Now they do. Moderated by Alice Park from https://ift.tt/34hbhVy Check out https://takiaisfobia.blogspot.com/ You Might Not Catch Coronavirus On an Airplane. But Air Travel Is Still Probably Spreading COVID-198/19/2020 It’s a very good time to be a domestic jet-setter on a budget. JetBlue’s fall sale, which took place in early August, featured tickets as low as $20 for trips between New York City and Detroit or Los Angeles to Las Vegas. Alaska Airlines recently offered a buy-one-get-one sale, a deal more familiar to Payless shoe shoppers than air travelers. United Airlines passengers could recently book themselves a round-trip from Newark, N,J. to Ft. Myers, Fla.—a major viral hotspot—for as little as $6, before taxes and fees hiked the price to a staggering—wait for it—$27. All of this, of course, assumes that you’re willing to risk exposure to COVID-19, a virus that has killed more than 170,000 Americans as of this week. These deals exist because of a variety of reasons that have combined to send the U.S. aviation industry into bizarro mode. First and foremost, airlines are hurting badly. Air travel is down about 66%, judging by the number of people who passed through Transportation Security Administration checkpoints on Aug. 16 compared to the same number from a year prior; the four biggest U.S. airlines lost a combined $10 billion between April and June, the Associated Press reports. Second, many airlines have only survived and avoided mass layoffs because they took pandemic-specific grants and loans from the federal government as part of the CARES Act, passed in March. Airlines that took that money are forbidden from mass layoffs until October; a fall bloodbath is likely. Finally, the airlines that took those loans also agreed to maintain a certain level of service regardless of passenger demand, and carriers figure that if they have to fly some routes anyway, they might as well try to make some money in the process, even if it’s just $6. (The government has since relaxed at least some of those service requirements.) Airlines across the U.S. have made a big deal of what they’re doing to keep individual passengers safe while aboard their aircraft. All the major carriers require passengers to wear masks, some aren’t selling middle seats, and they are cleaning more thoroughly and more often. And at least some experts say it’s safe for individuals to fly without fear of contracting COVID-19 on an airplane, in part because cabin air is continually refreshed (that said, many epidemiologists say they, personally, don’t feel comfortable taking the risk of flying right now). But so far, the U.S. aviation industry has said little about the macro-level threat of people spreading the virus around the country via air travel—the business of offering cheap tickets during a global pandemic is one thing, the ethics are another. COVID-19 came to the U.S. on airplanes, and the global viral picture would surely look different if it weren’t for modern air travel, which lets a person reach San Francisco or Seattle from Wuhan, China in the blink of an eye relative to, say, a steamship. “The chance that any specific individual who boards a plane is sat next to an infected host and contracts the virus is low,” says Dr. Robin Thompson, a mathematical epidemiologist at Oxford University who has researched air travel’s role in viral outbreaks. “However, when many individuals travel, the probability that some infections occur—and the risk that the virus is transported between countries by any of those individuals—is no longer negligible.” Similarly, the ability to fly from one corner of the U.S. to another in mere hours is also a public health threat, as travelers can unknowingly bring the virus from hotspots to areas where it’s more under control, potentially sparking a new outbreak. An Aug. 18 ProPublica report based on anonymized location data found that, of 26,000 smartphones identified on the Las Vegas strip in a four-day period in mid-July, some of those same devices were later spotted in every contiguous U.S. state but Hawaii, underscoring air travel’s unique capability to spread people—and thus a contagion like COVID-19—around the country at great speed and ease. It’s too early to say for sure how air travel is fueling domestic viral spread in the U.S. relative to other methods of transportation. But states near one another tend to have similar COVID-19 situations, meaning the risk of an infected person sparking a new outbreak by driving to a neighboring state is probably much lower than the risk of doing so by that person flying across the country. Meanwhile, while U.S. airlines are offering round-trip flights to viral hotspots for less than the cost of an Uber to the airport, foreign carriers are dramatically reducing service to cities with known outbreaks—flights to Auckland, New Zealand, for instance, were scaled back in mid-August after a new outbreak there of fewer than 100 cases. “This U.S. government, unlike governments around the world, has basically set it up so that airlines, and most other businesses, are engaged in a free-for-all,” says Brian Sumers, senior aviation business editor at Skift, a travel industry news site. “It’s all about the economy, and nobody’s thinking about the social or ethical ramifications of decisions about airline capacity.” Absent government requirements to do so, it’s unreasonable to expect U.S. airlines to trim their service in the interest of public health. They are corporate enterprises beholden to shareholders, and while it makes good business sense for them to focus on individual passenger safety to convince people it’s safe for them to fly again, there’s little incentive for them to care all that much about big-picture public health. The airlines are fighting for their lives, after all, and it’s important to keep in mind that they support at least 10 million jobs, according to Airlines for America, a trade group. “Their businesses have been decimated, they’re just trying to survive, they have all these airplanes, they want to make some money, and if the best way that they can make a little bit of money is to offer $27 round-trip fares to Florida, they’re going to do it,” says Sumers. Furthermore, the CARES Act’s service requirements were set early in the U.S. outbreak. The viral landscape has changed since then, and, in some cases, airlines are more or less mandated to fly to what have since become viral hotspots. But what is reasonable is for airlines to rethink the wisdom of offering cheap-as-chips flights during a deadly pandemic that shows few signs of ebbing. Moreover, the U.S. aviation industry, which has gotten only limited pandemic guidance from the federal government, “needs some kind of safe-travel protocol,” says Henry Harteveldt, a travel industry analyst and president of Atmosphere Research Group. He points to countries like France, which is requiring inbound international passengers to be tested for COVID-19. Of course, mass passenger testing is harder to do for domestic U.S. travelers, given their sheer volume; nearly 800 million people flew within the U.S. in 2018, compared to just over 200 million international passengers. And like so many other problems presented by the pandemic, this one, too, comes back to testing—with delays mounting across the country and results all but useless by the time they arrive, there’s simply no way to ensure that everybody getting on board an airplane right now is truly free of the virus. Many U.S. airlines are requiring passengers to self-certify their health, but there’s no guarantee people will be honest about their condition. “As long as people are not required to prove that they’re in good health before they travel, there’s a risk that someone could get on a plane, and perhaps not infect anybody on that plane, but infect somebody at the destination,” says Harteveldt. from https://ift.tt/3aBYePE Check out https://takiaisfobia.blogspot.com/ Jon Paul was leery entering his first wildfire camp of the year late last month to fight three lightning-caused fires scorching parts of a Northern California forest that hadn’t burned in 40 years. The 54-year-old engine captain from southern Oregon knew from experience that these crowded, grimy camps can be breeding grounds for norovirus and a respiratory illness that firefighters call the “camp crud” in a normal year. He wondered what COVID-19 would do in the tent cities where hundreds of men and women eat, sleep, wash and spend their downtime between shifts. Paul thought about his immunocompromised wife and his 84-year-old mother back home. Then he joined the approximately 1,300 people spread across the Modoc National Forest who would provide a major test for the COVID-prevention measures that had been developed for wildland firefighters. “We’re still first responders and we have that responsibility to go and deal with these emergencies,” he says. “I don’t scare easy, but I’m very wary and concerned about my surroundings. I’m still going to work and do my job.” Paul is one of thousands of firefighters from across the U.S. battling dozens of wildfires burning throughout the West. It’s an inherently dangerous job that now carries the additional risk of COVID-19 transmission. Any outbreak that ripples through a camp could easily sideline crews and spread the virus across multiple fires—and back to communities across the country—as personnel transfer in and out of “hot zones” and return home. Though most firefighters are young and fit, some will inevitably fall ill in these remote makeshift communities of shared showers and portable toilets, where medical care can be limited. The pollutants in the smoke they breathe daily also make them more susceptible to COVID-19 and can worsen the effects of the disease, according to the U.S. Centers for Disease Control and Prevention. Also, a single suspected or positive case in a camp will mean many other firefighters will need to be quarantined, unable to work. The worst-case scenario is that multiple outbreaks could hamstring the nation’s ability to respond as wildfire season peaks in August, the hottest month and driest month of the year in the Western U.S. The number of acres burned so far this year is below the 10-year average, but the fire outlook for August is above average in nine states, according to the National Interagency Fire Center. Twenty-two large fires ignited on Aug. 17 alone after lightning storms passed through the Northwest, and two days later, California declared a state of emergency due to uncontrolled wildfires. A study published this month by researchers at Colorado State University and the U.S. Forest Service’s Rocky Mountain Research Station concluded that COVID-19 outbreaks “could be a serious threat to the firefighting mission” and urged vigilant social distancing and screening measures in the camps. “If simultaneous fires incurred outbreaks, the entire wildland response system could be stressed substantially, with a large portion of the workforce quarantined,” the study’s authors wrote. This spring, the National Wildfire Coordinating Group’s Fire Management Board wrote—and has since been updating—protocols to prevent the spread of COVID-19 in fire camps, based on CDC guidelines:
The guidelines do not include routine testing of newly arrived firefighters—a practice used for athletes at training camps and students returning to college campuses. The Fire Management Board’s Wildland Fire Medical and Public Health Advisory Team wrote in a July 2 memo that it “does not recommend utilizing universal COVID-19 laboratory testing as a standalone risk mitigation or screening measure among wildland firefighters.” Rather, the group recommends testing an individual and directly exposed co-workers, saying that approach is in line with CDC guidance. The lack of testing capacity and long turnaround times are factors, according to Forest Service spokesperson Dan Hottle. (The exception is Alaska, where firefighters are tested upon arrival at the airport and are quarantined in a hotel while awaiting results, which come in 24 hours, Hottle says.) Fire crews responding to early season fires in the spring had some problems adjusting to the new protocols, according to assessments written by fire leaders and compiled by the Wildland Fire Lessons Learned Center. Shawn Faiella, superintendent of the interagency “hotshot crew” – so named because they work the most challenging, or “hottest” parts of wildfires — based at Montana’s Lolo National Forest, questioned the need to wear masks inside vehicles and the safety of bringing extra vehicles to space out firefighters traveling to a blaze. Parking extra vehicles at the scene of a fire is difficult in tight forest dirt roads—and would be dangerous if evacuations are necessary, he wrote. “It’s damn tough to take these practices to the fire line,” Faiella wrote after his team responded to a 40-acre Montana fire in April. One recommendation that fire managers say has been particularly effective is the “module of one” concept requiring crews to eat and sleep together in isolation for the entire fire season. “Whoever came up with it, it is working,” says Mike Goicoechea, the Montana-based incident commander for the Forest Service’s Northern Region Type 1 team, which manages the nation’s largest and most complex wildfires and natural disasters. “Somebody may test positive, and you end up having to take that module out of service for 14 days. But the nice part is you’re not taking out a whole camp.… It’s just that module.” There is no single system that is tracking the total number of positive COVID-19 cases among wildland firefighters among the various federal, state, local and tribal agencies. Each fire agency has its own method, says Jessica Gardetto, a spokesperson for the Bureau of Land Management and the National Interagency Fire Center in Idaho. The largest wildland firefighting agency in the U.S. is the Agriculture Department’s Forest Service, with 10,000 firefighters. Another major agency is the Department of the Interior, which had more than 3,500 full-time fire employees last year. As of the first week of August, 111 Forest Service firefighters and 40 BLM firefighters (who work underneath the broader Interior Department agency) had tested positive for COVID-19, according to officials for the respective agencies. “Considering we’ve now been experiencing fire activity for several months, this number is surprisingly low if you think about the thousands of fire personnel who’ve been suppressing wildfires this summer,” Gardetto says. Goicoechea and his Montana team traveled north of Tucson, Arizona, on June 22 to manage a rapidly spreading fire in the Santa Catalina Mountains that required 1,200 responders at its peak. Within two days of the team’s arrival, his managers were overwhelmed by calls from firefighters worried or with questions about preventing the spread of COVID-19 or carrying the virus home to their families. In an unusual move, Goicoechea called upon a Montana physician—and former National Park Service ranger with wildfire experience—Dr. Harry Sibold to join the team. Physicians are rarely, if ever, part of a wildfire camp’s medical team, Goicoechea says. Sibold gave regular coronavirus updates during morning briefings, consulted with local health officials, soothed firefighters worried about bringing the virus home to their families and advised fire managers on how to handle scenarios that might come up. But Sibold says he wasn’t optimistic at the beginning about keeping the coronavirus in check in a large camp in Pima County, which has the second-highest number of confirmed cases in Arizona, at the time a national COVID-19 hot spot. “I quite firmly expected that we might have two or three outbreaks,” he says. There were no positive cases during the team’s two-week deployment, just three or four cases where a firefighter showed symptoms but tested negative for the virus. After the Montana team returned home, nine firefighters at the Arizona fire from other units tested positive, Goicoechea says. Contact tracers notified the Montana team, some of whom were tested. All tests returned negative. “I can’t say enough about having that doctor to help,” Goicoechea says, suggesting other teams might consider doing the same. “We’re not the experts in a pandemic. We’re the experts with fire.” That early success will be tested as the number of fires increase across the West, along with the number of firefighters responding to them. There were more than 15,000 firefighters and support personnel assigned to fires across the nation as of mid-August, and the success of those COVID-19 prevention protocols depend largely upon them. Paul, the Oregon firefighter, says that the guidelines were followed closely in camp, but less so out on the fire line. It also appeared to him that younger firefighters were less likely to follow the masking and social-distancing rules than the veterans like him. That worries him it wouldn’t take much to spark an outbreak that could sideline crews and cripple the ability to respond to a fire. “We’re outside, so it definitely helps with mitigation and makes it simpler to social distance,” Paul says. “But I think if there’s a mistake made, it could happen.” KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente. from https://ift.tt/32l909l Check out https://takiaisfobia.blogspot.com/ Kayla Brim laughed when she learned it could take 10 days to get her COVID-19 test results back. “I thought, ‘Okay, well, within 10 days I should be fine,’” she remembers. That was on July 2. More than a month later, Brim is still far from fine. Prior to the pandemic, the 28-year-old from Caldwell, Idaho, juggled homeschooling her two kids with her work as a makeup artist—she was supposed to open her own salon in July. Now, she suffers daily from shortness of breath, exhaustion, excruciating headaches, brain fog, neuropathy, high blood pressure and loss of taste and smell. She feels like “a little old lady,” completely knocked out by simple tasks like making lunch for her children. She’s working just enough to help pay the bills and the lease on her empty salon, but she has no idea when she’ll be able to work full-time again, and no idea how she and her husband will manage financially if she can’t. “Half of my day is spent trying to sleep, and the other half of it is trying to pretend like I’m okay—and I don’t know when I’ll be okay,” Brim says. This is “long-haul” COVID-19. Even young, healthy people can become long-haulers (as many call themselves), left unable to work, lead a normal life or, some days, get out of bed. The consequences for each individual can be devastating—and at scale, they’re staggering. Over time, long-haul coronavirus may force hundreds of thousands of people out of work and into doctor’s offices, shouldering the double burden of lost wages and hefty medical bills for the indeterminate future. To treat them, the health care system may have to stretch already-thin resources to the breaking point. It’s going to be “an impending tsunami of patients…on top of all the [usual] chronic care that we do,” says Dr. Zijian Chen, medical director of the Center for Post-COVID Care at New York City’s Mount Sinai Health System, one of the country’s only clinics devoted to caring for patients in the aftermath of coronavirus infection. “At some point it becomes very unsustainable—meaning, the system will collapse.” When most people think of COVID-19, they imagine two possibilities: a flu-like illness that clears on its own, or a life-threatening condition that requires ventilation and a hospital stay. It’s not hard to see how the latter scenario leads to long-term damage. Mechanical ventilation is incredibly hard on the lungs, and days or weeks spent sedated in a hospital bed can sap physical and mental strength. In a small study published in 2011, nearly all the participants who needed intensive treatment for a severe lung injury reported decreased physical ability and quality of life five years after leaving the hospital. Some took years to return to work. Hospitalized coronavirus patients may face a similar fate. But with COVID-19, it’s not just the sickest who face a long road back. A July 24 report from the U.S. Centers for Disease Control and Prevention (CDC) found that, out of about 300 non-hospitalized but symptomatic COVID-19 patients, 35% were still experiencing symptoms like coughing, shortness of breath and fatigue up to three weeks after diagnosis. (By contrast, more than 90% of non-hospitalized influenza patients fully recover within two weeks.) Recovery from COVID-19 can be a drawn-out process for patients of all ages, genders and prior levels of health, “potentially leading to prolonged absence from work, studies, or other activities,” the report noted. The CDC’s surveyors only checked up on people a few weeks after they tested positive for coronavirus, but emerging evidence suggests a large subset of patients are sick for months, not just weeks, on end. Dr. Michael Peluso, who is studying long-term COVID-19 outcomes at the University of California, San Francisco, says about 20% of his research participants are still sick between one and four months after diagnosis. The implications of that problem are enormous. If even 10% of the more than 5 million (and counting) confirmed COVID-19 patients in the U.S. suffer symptoms that last this long, half a million people are already or could soon become chronically ill for the foreseeable future. When Mount Sinai opened its Post-COVID Center in May, the hospital advertised it as the first in the country; since then, a handful of others have opened in states including Colorado, Indiana and Illinois. Mount Sinai’s clinic was modeled after the practice the hospital opened to treat survivors of the 9/11 terrorist attacks. “It’s very similar. It’s a new group, and they need special care,” Chen says. The biggest difference, he says, is the size of the group. Significantly more people have survived COVID-19 than were directly affected by 9/11. Mount Sinai has only scratched the surface of that demand, treating about 300 people so far. The wait time for new patients extends into October. The challenge for doctors like Chen is that nobody really knows why long-haul COVID-19 happens, let alone how to treat it. Other viral diseases with long-term symptoms, such as HIV/AIDS, offer some clues, but every day in the clinic is essentially uncharted territory. One hypothesis is that the virus persists in the body in some form, causing continuing problems. Another is that coronavirus pushes the immune system into overdrive, and it stays revving even after the acute infection passes. But at this point, it’s not clear which theory, if either, is right, or why certain patients recover in days and others suffer for months, Peluso says. Plus, just as there’s huge variation in acute COVID-19 symptoms, not all long-term patients have the same issues. A researcher from the Indiana University School of Medicine in July surveyed 1,500 long-haulers from Survivor Corps, an online COVID-19 support group. They reported almost 100 distinct symptoms, from anxiety and fatigue to muscle cramps and breathing problems. A JAMA Cardiology study published in July suggested many recently recovered patients had lingering heart abnormalities, with inflammation the most common. Some long-term COVID-19 patients have abnormal test results or damage to a specific organ, giving doctors clues as to how they should be treated. But for others, there’s no obvious reason for their suffering, making treatment an educated guessing game. “We don’t know why they [still] have symptoms. We don’t know if our techniques are working,” Chen says. “We don’t know if they’re going to get back to 100%, or 90%, or 80%.” With little evidence, some doctors turn coronavirus long-haulers away or try to convince them their symptoms are psychological. Marcus Tomoff, a 28-year-old in Tampa, Fla. who is in his second month of debilitating fatigue, back and chest pain, nausea and anxiety after a bout of coronavirus, says he hasn’t been taken seriously by friends or even his doctors. “Several times I’ve cried in front of my doctors and they say, ‘You need to deal with this, you’re young,’” he says. The haphazard testing system in the U.S. has further complicated patients’ searches for care. Mount Sinai’s Post-COVID Center, for example, only accepts patients who tested positive for COVID-19 or its antibodies, and Chen fears potential patients who couldn’t get tested or got false-negative results may be falling through the cracks. The best he can do right now is refer them to specialists and hope they find a doctor who can help. For 46-year-old Andrea Ceresa, getting better is a full-time job—minus the paycheck. Ceresa had to stop working as a New Jersey dental office manager after she got sick in mid-April with what she and her doctors believe was COVID-19. (She tested negative for the virus and its antibodies, but her doctors think they were false negatives.) More than 100 days later, she’s in regular contact with her primary care physician, an integrative care doctor and a rotating cast of specialists who she hopes can treat her lingering gastrointestinal problems, hearing and vision issues, weight and hair loss, heart palpitations, migraines, brain fog, neuropathy, fatigue, nausea and anxiety. She can’t get into post-COVID programs without a positive test result, so she’s cobbling together her own care team. Ceresa has paid for her own health insurance through the federal COBRA program since she stopped working, which has put her in a precarious financial state. “I have a stack of bills and I just am starting to open them now,” she says. “I’m definitely, at this point, going to be in the hole thousands of dollars. I’m collecting unemployment. I know I’m going to have to go on disability.” Even then, she says, it may not be enough to pay her bills. There may soon be a lot of patients like Ceresa, says Dr. Bhakti Patel, a pulmonologist at University of Chicago Medicine who studies the long-term effects of critical care. Patel says patients with long-term issues after surviving coronavirus may face a number of obstacles. Patients who remain too sick to return to work (or who are unemployed due to the economic climate) may lose employer-sponsored health insurance at the moment they need it most. Younger patients who do not qualify for Medicare but need public insurance will likely be funneled toward Medicaid, which Patel says is “already over-stretched.” The services long-haul coronavirus patients may need—like physical therapy and mental health care—can be difficult to access, especially via public insurance networks like Medicaid, Patel says. That bottleneck will only get worse if more people need public aid. As patients with an emerging disease, long-haulers also need “an intensity of outpatient care and expertise,” that goes beyond what the average primary care physician can offer, Peluso says. Very few doctors are experienced in treating long-haul symptoms—and even among those who are, “experienced” is a relative term. “This wasn’t a specialty three months ago,” says Chen. People who can’t get into a dedicated post-COVID program may need to try a slew of specialists before they find one who can help, an expensive and tiring game of trial-and-error. (That’s assuming patients can get appointments with specialists like pulmonologists and neurologists, who are often few and far between outside of densely populated areas.) The sickest long-haul patients may also require pricey and difficult-to-access rehab or in-home care, on top of other medical costs. If a family member has to give up work to become a caregiver, that can also have serious economic consequences. Some long-haulers will likely have to file for disability benefits, a byzantine system of its own that’s at risk of becoming overwhelmed. From 2008 to 2017, only about a third of people who applied for disabled-worker benefits in the U.S. were initially approved, according to Social Security Administration (SSA) data. It can be especially difficult for patients without a clear diagnosis or cause of illness, since SSA requires claimants to provide “objective medical evidence” of an impairment. With few other resources available, thousands of long-haulers have sought help from virtual support groups like Survivor Corps and Body Politic, where members talk about their symptoms and celebrate signs of recovery. Programs like COVID Bootcamp 101, an online rehab series run by the nonprofit Pulmonary Wellness Foundation, are also trying to fill gaps in care. The scientific community is doing its best to catch up, but Chen says the government may need to help develop long-term solutions that address the economic consequences of long-term coronavirus symptoms, like a medical safety net program (as it has done for HIV/AIDS patients) or financial assistance for COVID-19 patients (as it did for 9/11 survivors). Without clear answers about what happens next, all doctors can offer the public is yet another plea to take coronavirus seriously—because right now, the only surefire way not to become a long-hauler is to not get COVID-19 at all. That doesn’t help people like Ceresa, though. After more than 100 days of feeling sick, Cersa says she’s still “baffled” this happened to her, an active and healthy woman who’s been a vegan for decades. She stayed home all April except for a couple trips to the grocery store and still had her life destroyed by the virus. She can’t work, sing in her band or plan her wedding after getting engaged a few weeks before the pandemic hit. She tries to comfort herself by thinking about ways it could be worse—it could be cancer—but the truth is, things are bad. “You try to be hopeful and think somehow, miraculously, you’re going to be better, and it doesn’t happen,” she says. “I can’t imagine living like this for another day, let alone the rest of my life.” At this point, no one knows if she’ll have to. from https://ift.tt/31ZLiPK Check out https://takiaisfobia.blogspot.com/ |
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