Saturday, May 30, 2020

What will happen when COVID-19 pandemic and flu season meet?

As if the COVID-19 pandemic isn't scary enough, the flu season is not far away. How severe will the flu season be as it converges with the COVID-19 outbreak? What can we do to prepare?
Dr. Benjamin Singer, a Northwestern Medicine pulmonologist who treats COVID-19 patients in the intensive care unit, outlines the best defense against influenza, which also may protect against coronavirus.
In an editorial that will be published May 29 in the journal Science Advances, Singer, an assistant professor of pulmonary and critical care and biochemistry and molecular genetics at Northwestern University Feinberg School of Medicine, examines the epidemiology and biology of SARS-CoV-2 and influenza to help inform preparation strategies for the upcoming flu season.
He outlines the following four factors that could determine the severity of the upcoming flu season:
1. Transmission: Social distancing policies designed to limit the spread of COVID-19 are also effective against the flu. If COVID-19 cases begin to spike in the fall of 2020, re-tightening social distancing measures could help mitigate early spread of the flu to flatten the curves for both viruses.
2. Vaccination: As we await vaccine trials for COVID-19, we should plan to increase rates of vaccination against the flu, particularly among older adults who are more susceptible to both the flu and COVID-19.
3. Co-infection: We need widespread availability of rapid diagnostics for COVID-19 and other respiratory pathogens because co-infection with another respiratory pathogen, including the flu, occurred in more than 20% of COVID-19-positive patients who presented with a respiratory viral syndrome early in the pandemic.
4. Disparities: The COVID-19 pandemic has highlighted unconscionable disparities among African Americans, Latinx and Native Americans so we must galvanize public health efforts aimed to limit viral spread, increase vaccination rates, deploy rapid diagnostics and expand other health care services for vulnerable populations, including communities of color, the poor and older adults.
The Centers for Disease Control and Prevention estimated that the 2019-2020 seasonal influenza epidemic resulted in tens of millions of cases and tens of thousands of deaths.
"Even in non-pandemic years, the flu and other causes of pneumonia represent the eighth-leading cause of death in the United States, and respiratory viruses are the most commonly identified pathogens among hospitalized patients with community-acquired pneumonia," Singer said.

Tuesday, May 26, 2020

WHO suspends hydroxychloroquine trial as COVID-19 treatment

The World Health Organization said Monday it had temporarily suspended clinical trials of hydroxychloriquine as a potential treatment for COVID-19 being carried out across a range of countries as a precautionary measure.
The decision came after publication last week of a study in The Lancet which indicated that using the drug on COVID-19 patients could increase their chances of dying, WHO chief Tedros Adhanom Ghebreyesus told a virtual press conference.
Tedros said that the executive group of the so-called Solidarity Trial, in which hundreds of hospitals across several countries have enrolled patients to test several possible treatments for the novel coronavirus, had as a precaution suspended trials using that drug.
"The Executive Group has implemented a temporary pause of the hydroxychloroquine arm within the Solidarity Trial while the safety data is reviewed by the Data Safety Monitoring Board," Tedros said.
"The other arms of the trial are continuing," he stressed.
Hydroxychloroquine is normally used to treat arthritis but pronouncement from public figures including US President Donald Trump—who announced last week he is taking the drug—has prompted governments to bulk buy the medicine.
Brazil's health minister also recommended last week using hydroxychloroquine, as well as the anti-malarial chloroquine, to treat even mild COVID-19 cases.
The Lancet study found that both drugs can produce potentially serious side effects, particularly heart arrhythmia.
And neither drug benefitted patients hospitalised with COVID-19, according to a Lancet study, which looked at the records of 96,000 patients across hundreds of hospitals.
Tedros stressed Monday that the two drugs "are accepted as generally safe for use in patients with autoimmune diseases or malaria."
WHO chief scientist Soumya Swaminathan told Monday's briefing that the WHO-backed Solidarity Trial had been looking only at the effects of hydroxychloroquine and not chloroquine.
The decision on suspending enrolment for trials using hydroxychloroquine was "a temporary measure", she said.
"We're just acting by precaution," WHO emergencies chief Michael Ryan agreed.
'Dangerous assumption'?
The COVID-19 pandemic, which began late last year in China, has killed nearly 350,000 people worldwide and infected almost 5.5 million, according to an AFP tally using official sources.
While there is still no approved treatment or vaccine for the novel coronavirus, drastic measures that at one point saw half of humanity under lockdown have pushed down transmission rates in a number of countries.
As many nations begin to gradually lift restrictions, the WHO on Monday stressed the need to keep up with physical distancing measures and to scale up efforts to test and detect cases.
"All countries need to remain on high alert," WHO expert Maria Van Kerkhove said, stressing that "even countries that have seen a decline in cases must remain ready."
She warned that studies using antibody tests to determine how many people have been infected and might have some level of immunity "indicate that a large proportion of the population remains susceptible."
"The virus will take the opportunity to amplify if it can," she said.
Ryan agreed, urging countries to "continue to put in place ... a comprehensive strategy to ensure that we continue on a downward trajectory and that we don't have an immediate second peak."
He warned against the idea that the pandemic might move in natural seasonal waves, stressing that the reason transmission is going down in a number of countries was the drastic measures put in place.
"My concern right now is that people might be assuming that the current rapid infections represents a natural seasonality," he said.
"Making an assumption that it is on a downward trajectory, and the next danger point is sometime in October or November, I think that would be a dangerous assumption."
"If we take the pressure off the virus then the virus can bounce back," he said.

Thursday, May 21, 2020

Social isolation linked to more severe COVID-19 outbreaks

Regions of Italy with higher family fragmentation and a high number of residential nursing homes experienced the highest rate of COVID-19 infections in people over age 80, according to a new study published May 21, 2020 in the open-access journal PLOS ONE by Giuseppe Liotta of the University of Rome, Italy, and colleagues.
Italy has been one of the countries most affected by the COVID-19 pandemic. Researchers have speculated that this is due to Italy's age demographics as well as the connectedness of the older and younger generations and high rate of intergenerational contact. If true, this would suggest that regions with larger households would have more severe COVID-19 outbreaks in older adults.
In the new study, researchers used publicly available data published by each Italian administrative region as well as daily situation reports on COVID-19 published by the Italian Ministry of Health and spanning February 28 through March 31, 2020. All household and population data was extracted between April 1 and 7, 2020.
Across Italian regions, the COVID-19 incidence rate ranged from 0.27% to 4.09% of the population being affected. The mean number of household members ranged from 2.02 to 2.58; the percentage of one member households ranged from 28.5 to 40.9; and percentage of COVID-19 cases that occurred in people over age 80 ranged from 4.3 to 23.6. A model that reflected the percent of the population over age 80, days since 50 cases were registered, percentage of nursing home beds in the total population, and mean number of household members was best able to predict the COVID-19 incidence among older people in each region, with an adjusted R-squared value of 0.695 (p<0.001). A lower mean number of household members and higher number of nursing home beds was associated with more COVID-19 cases in older adults. The study was limited by the fact that age-specific infection rates were not available and the number of COVID-19 tests varied enormously by regions.
The authors add: "Variables associated with social isolation are risk factors forincrease in the proportion of cases in Italian patients aged >80 yearsamong the total number of cases." Professor Liotta also notes that "nursing homes bed rate is one of the determinants of SARS-CoV-2 infection rate among the individuals aged>80 in Italy."
More information: Liotta G, Marazzi MC, Orlando S, Palombi L (2020) Is social connectedness a risk factor for the spreading of COVID-19 among older adults? The Italian paradox. PLoS ONE 15(5): e0233329. doi.org/10.1371/journal.pone.0233329
Journal information: PLoS ONE

Wednesday, May 20, 2020

Garter snakes are surprisingly social, forming ‘friendships’ with fellow serpents

Snakes should be good at social distancing, at least according to what we know about reptiles: Most are solitary creatures that come together to mate and hibernate, but not much else. Not so garter snakes, the harmless serpents that live throughout North America and part of Central America. Researchers have discovered that garter snakes not only prefer to hang out together, but also seem to have "friends" with whom they spend much of their time.
"Snakes are really difficult to study due to their secretive nature," says University of Witwatersrand herpetologist Graham Alexander, who was not involved with the research. This new study and others, he adds, are lifting that veil of secrecy and "revealing snakes to be cognitive beings."
To learn how socializing affects individual animals, comparative psychologist Noam Miller and his graduate student Morgan Skinner at Wilfrid Laurier University have started to study a wide range of species, figuring that different animals may have different ways of interacting in groups. Because few researchers had looked at snakes, Skinner decided to test 40 young eastern garter snakes (Thamnophis sirtalis sirtalis) to assess their personalities and social preferences.
He placed sets of 10 snakes, each with a colored dot on its head, in a walled enclosure less than 1 meter per side. A camera kept track of the snakes' movements. Twice a day, Skinner photographed the snakes' groupings, removed the reptiles, cleaned the enclosure to erase any odors, and put the snakes back in different positions. The cameras then tracked whether the same groups re-formed.
They did, with snakes gathering in groups of three to eight in one of the enclosure's four shelters—small boxes, with a forward-facing opening. Those groups often consisted of the same individuals, suggesting the snakes form cliques, Skinner and Miller reported last month in Behavioral Ecology and Sociobiology. Their social structures "are in some ways surprisingly similar to those of mammals, including humans," Skinner says.
Skinner and Miller also tested each snake's personality. They measured a snake's "boldness" by putting it alone in a shelter. They then measured the amount of time the snake spent outside the safety of the shelter. Some were bold—spending a lot of time exploring the enclosure—and others were shy and stuck to the shelter.
When the snakes were in a group, they tended to do what the group did, regardless of their own personality. Overall, snakes spent about 94% of the time in a shelter. Animals with more snakes in their shelter were less likely to leave.
There are benefits to being social, particularly for younger snakes, Miller explains. For instance, a group retains heat and moisture better than an individual. Also, if a predator attacks, each individual in a group has a better chance to get away than one that is alone. Snakes can also get information from one another—when one snake sees another out exploring, it gets the signal that it's safe to go out, for example.
There have been other hints of social behavior in snakes. Harvey Lillywhite, a physiological ecologist at the University of Florida, and his students have noticed male and female cottonmouth snakes pairing off for long periods and foraging together. Pit vipers and African pythons care for their young. Herpetologist Melissa Amarello, executive director of the nonprofit Advocates for Snake Preservation, has observed communal dens and parental care in rattlesnakes. "Social behavior is not limited to a single site, single species, or even [single] family of snakes," she says.
Lillywhite cautions that the new results might not hold true in the wild, and that they might even have been different had a different enclosure design been used. Nevertheless, he says, the results are "a significant beginning," adding, "social behaviors of reptiles generally—and snakes in particular—are more complex and likely meaningful than we had thought."
Knowing that snakes have comrades, Miller says, could help efforts in their conservation: Often species that are relocated to safe habitats leave, frustrating conservationists. But if they know snakes prefer to hang out in groups, transferring whole groups or pretreating a new location with the species' scents might encourage the transplants to stick around the new location.

Sunday, May 17, 2020

More than one of four most viewed videos about corona contain misleading information: study reveals

More than one in four of the most viewed COVID-19 videos on YouTube in spoken English contains misleading or inaccurate information, reveals the first study of its kind, published online in BMJ Global Health.
Public health misinformation on COVID-19 is reaching far more people than in previous pandemics and has considerable potential for harm, warn the researchers.
While good quality accurate information put out by government bodies and experts is widely available on YouTube, it's often hard to understand and lacks popular appeal, so doesn't have the reach it needs, they add.
Published research shows that YouTube has been both a useful and misleading source of information in previous public health crises, such as the swine flu (HIN1) pandemic and the Ebola and Zika outbreaks.
But social media use has changed since these studies were published, added to which not all of them used validated measuring tools, say the researchers.
To try and provide a more current assessment of the accuracy and quality of information on coronavirus and COVID-19 on YouTube, the researchers searched the digital platform for the most widely viewed and relevant videos as of 21 March 2020.
After excluding those that were duplicates, in languages other than English, lasted more than an hour, or didn't contain audio or visual content, around half of the initial number (69 out of 150; 46%) were eligible for analysis.
The reliability and quality of the content of each one was assessed using validated scoring systems: mDISCERN and mJAMA. And the usefulness of content for the average viewer was assessed using a COVID-19 specific score (CSS), modelled on similar systems developed for use in other public health emergencies.
A CSS point was awarded for exclusively factual information on each of the following: viral spread; typical symptoms; prevention; possible treatments; and epidemiology.
Professional and government agency videos scored significantly higher for accuracy, usability, and quality across all measures than any of the other sources, but didn't feature prominently among viewing figures.
The number of views for the 69 videos included in the analysis added up to 257, 804,146.
Network news accounted for the largest proportion of views (29%), followed by consumers (22%); entertainment news (21%); internet news (12%); professionals (7%); newspapers (5%); educational bodies (2%); and government agencies (2%).
Nearly 50 of the videos (72.5%) contained only factual information. But more than one in four (19; 27.5%) contained misleading or inaccurate information, representing 62,042,609 views or around a quarter (24%) of the total.
Among the 19 misleading videos, around a third came from entertainment news, with network and internet news sources each accounting for around a quarter. Consumer videos made up 13% of the total.
Misleading or inaccurate information included CSS criteria—for example, the belief that pharmaceutical companies already have a cure, but refuse to sell it, or that certain countries have stronger strains of coronavirus; inappropriate recommendations for the general public; racist and discriminatory remarks; and conspiracy theories.
"This is particularly alarming, when considering the immense viewership of these videos," write the researchers.
"Evidently, while the power of social media lies in the sheer volume and diversity of information being generated and spread, it has significant potential for harm," they add.
They acknowledge that they relied on information gathered in just one day, and included only English language content. But the video views in their study far surpass those reported in other YouTube studies on pandemics or public health emergencies, they point out.
"The education and engagement of the public is paramount in the management of this pandemic by ensuring public understanding of, and therefore adherence with, public health measures," they insist.
Given the power of social media in shaping public understanding and behaviour, "YouTube is a powerful, untapped educational tool that should be better mobilised by health professionals," they suggest.
"Many existing marketing strategies are static, in the form of published guidelines, statistical reports and infographics and may not be as appealing or accessible to the general public," they point out.
Public health and government bodies would do well to collaborate with entertainment news and social media influencers to jazz up their digital content and engage a much wider audience to counter the misinformation circulating during this pandemic, they recommend.
More information: YouTube as a source of information on COVID-19: a pandemic of misinformation, BMJ Global HealthDOI: 10.1136/bmjgh-2020-002604

Tuesday, May 12, 2020

Study:U.S. social distancing stabilized, but did not reduce, spread of COVID-19

statistical analysis of all 50 states and Washington, D.C., found that social distancing measures effectively slowed the spread of coronavirus on the whole, but did not reduce the number of new infections per day.
"All the social distancing was clearly helping, but it merely stabilized the process," said Aaron Wagner, professor of electrical and computer engineering and first author of "Social Distancing Has Merely Stabilized COVID-19 in the U.S.," which posted April 30 on the preprint server medRxiv.
"When you're on a plateau and you start relaxing social distancing, you expect the number of new infections to start accelerating," Wagner said. "The virus probably won't spread as fast as it did pre-intervention, but you expect it to accelerate nonetheless."
The analysis, conducted by a team of data scientists, engineers and public health experts at Cornell and the University of Rochester, found that it took roughly 12 days for the impact of social distancing measures to become apparent, because of the virus's incubation period and the wait for test results.
Among other factors, their model considered the doubling rate—the amount of time it took in a given state for the number of coronavirus cases to double—both before and after social distancing began.
"We did not find evidence that any state was in the contracting zone," Wagner said.
The researchers found a surprising consistency across the country.
"There's a lot of talk in the news about this patchwork of responses among the states, and it's easy to get the impression, incorrectly, that the states are all over the place and doing totally different things," Wagner said. "What we found when we were doing this research was that, in terms of the policies we considered, there was not that much difference in terms of what was closed and when."
They considered the closure of K-12 schools and restaurants as their benchmark for the start of social distancing. Forty-one states, they found, closed schools between March 16 and March 19. "You end up with a very clear before and after," Wagner said.
All but three states—North Dakota, South Dakota and Nebraska—showed that social distancing significantly impacted the doubling rate. Those are three of the four states that saw the slowest spread of coronavirus in the nation. New York, New Jersey and Michigan—among the hardest-hit states—showed the starkest change after measures were imposed.
But although the spread of coronavirus began flattening across the country by early April, the social distancing measures did not cause the number of daily new infections to decline, the researchers found.
"Our findings don't show much rationale for substantial relaxation of social distancing, in the absence of other measures," Wagner said. "We don't have a lot of wiggle room."
Additional steps such as contact tracing, increased testing or stricter quarantining could also have an impact, he added, as will the fact that the infection rate will inevitably drop as more people contract the virus, leaving fewer susceptible.
The research was among the first efforts of the new Greater Data Science Cooperative Institute, funded by the National Science Foundation. The institute, a collaboration between researchers at Cornell and the University of Rochester, is focused on using data science applications to solve problems in medicine and health.
"Our institute primarily focuses on the mathematical foundations of data science, but we study those to see them have applications in the real world," said David Matteson, Cornell associate professor of statistics and data science and principal investigator of the data science collaboration.
"This was a time where the methodology we'd worked on was directly applicable to this situation," said Matteson, also a co-author of the social distancing paper. "Early in a crisis like this, raw and messy data is maybe the most informative thing that we have."
The interdisciplinary approach was key to conducting this research, Wagner said.
"Certainly traditional statistics was needed, to run the interrupted time series analysis and so on; the public health expertise was crucial in interpreting the data; and leveraging the underlying dynamics of the spread is a very engineering way of looking at things," he said. "This paper wouldn't have been possible without all three of those viewpoints."
More information: Aaron B. Wagner et al. Social Distancing Has Merely Stabilized COVID-19 in the US, medRxiv (2020). DOI: 10.1101/2020.04.27.20081836
Provided by Cornell University

Sunday, May 10, 2020

The taste of Re-opening Churches and Restaurants in German

The waiters are wearing masks and there's no singing in Church, but some Germans got a taste of normal life at the weekend as restaurants and places of worship reopened after weeks of coronavirus restrictions.
Germany - Covid-19 - Immigration update
In the northeastern state of Mecklenburg-Western Pomerania, residents took advantage of the sunny weather to flock to their favourite eateries and cafes for the first time since mid-March.
The state on the Baltic coast, which has Germany's lowest infection numbers, became the first in the country to reopen restaurants on Saturday.
For the hospitality sector, the restart hasn't come a moment too soon.
"Economically, it has been a disaster for us," said Thomas Hildebrand, manager of Cafe Prag in the state's picturesque capital of Schwerin.
Other states are set to follow with restaurants, cafes and hotels reopening across Germany in the coming days and weeks.
But dining experiences will be different in the age of the corona.
"Our employees must wear masks and our customers must respect social distancing," Hildebrand told AFP, his own mask hanging around his neck.
Staff are also following other hygiene rules "such as disinfecting tables, no common usage of certain utensils", he said.
"We're trying to put this in place, it's new for us. But we are happy to be able to reopen."
Chancellor Angela Merkel recently said Germany had passed the "first phase" of the pandemic, allowing for a gradual return to normal—even if a spike in cases since then has revived concern about the country's infection rate.
'Very moving'
Under Germany's federal system, each of its 16 states makes its own decisions on how to emerge from lockdown.
Most shops are already open again, and children are slowly returning to classrooms. Even Bundesliga football matches are set to resume.
Religious services are starting up again too. On Sunday, Berlin Cathedral held its first Mass since the lockdown.
"The service was like a fresh start, it was very moving," Susanne Romberg said on her way out of the imposing building.
But here too, the  made its presence felt.
Worshippers had to sign in upon arrival, greeted by a clerk behind a plexiglass screen.
They were asked to wear masks and disinfect their hands at the door.
On the pews, little notices reminded people to keep their distance.
In line with rules agreed by places of worship across Germany, there was no singing to prevent the spread of the virus through droplets from an infected person's mouth.
Despite the changes, Klaus Nitzsche, 66, said he had enjoyed the service.
"It was really nice to experience the service together again," he said.
The online Masses he had been following for the past two months "can't compare", he said.

Friday, May 8, 2020

Risk of death from stroke in UK dropped by 24%

The risk for death and disability after a stroke fell significantly between 2000 and 2015 in the United Kingdom, according to a study recently published in PLOS Medicine.New scheme saving lives of stroke patients in Iran - Tehran Times
Hatem A. Wafa, from King's College London, and colleagues estimated time trends in mortality and functional dependence by  subtype during a 16-year period (between 2000 and 2015) using data from the South London Stroke Register. The analysis included 3,128 patients with first-ever ischemic .
The researchers found that between 2000 to 2003 and 2012 to 2015, the adjusted overall mortality decreased by 24 percent (hazard ratio [HR] per year, 0.976). Both men and women saw mortality reductions, as did white and black populations. However, these  reductions were only significant in cardio-embolism strokes (HR per year, 0.972) and in patients aged ≥55 years (HR per year, 0.975). Within 30 days and one year after an ischemic stroke, case-fatality rates declined by 38 percent (rate ratio [RR] per year, 0.962) and 37 percent (RR per year, 0.963), respectively. There was an independent association noted between recent ischemic stroke and a 23 percent reduced risk for functional dependence at three months after onset (RR per year, 0.983).
"We think the change is due to improvements to the way we treat stroke, such as higher admission rates to hospital, increased use of computed tomography and Magnetic resonance imaging scans, and more frequent treatment with thrombolytic and anticoagulant medications in the acute phase of stroke," a coauthor said in a statement.

Friday, May 1, 2020

Blood Test Can Detect Cancers in Previously Undiagnosed Women

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Researchers have shown for the first time that a blood test can be used safely to detect multiple types of cancer in women with no previous signs of the disease.
In a clinical trial of 9,911 women with no evidence or history of cancer, the blood test or "liquid biopsy" detected 26 of the 96 cancer cases identified during the trial. Scientists uncovered an additional 24 cancers among the group using traditional screening methods like mammography, according to the study published April 28 in Science.
Among the 26 women who had their cancers first detected by the blood test, 65% were diagnosed at an early stage of their cancer. Twelve of the women are now in remission after treatment, and eight remain in treatment or have their cancer stabilized nine months after their diagnosis.
"The study suggests that a multi-cancer blood test can be complementary and additive to standard of care screening and may be a good strategy for increasing early detection of cancer," said Anne Marie Lennon of Johns Hopkins University School of Medicine.
Breast, lung, thyroid and colorectal cancers were among the 10 types of cancers detected by the blood test screening. In all, 16 types of cancers were identified in the study participants. The researchers enrolled only women because they wanted to be sure ovarian and uterine cancers were sufficiently represented the study.

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Ovarian cancer, like several other malignancies detected in the study such as lymphomas, lacks a traditional screening test like those used for breast and colorectal cancer. Patients respond better to surgery, radiation and immunotherapy if cancers are caught when they are small and confined to one area of the body, however, so clinicians have turned to blood tests as a way to find multiple cancers at an early stage.
The multi-cancer blood test used in the current study is an earlier version of the CancerSEEK liquid biopsy system described by Lennon and her colleagues in 2018 in Science. It detects cancer by looking for pieces of tumor DNA and measuring levels of cancer-related proteins in circulating blood.
Women who had signs of cancer detected in their first blood test had a second blood test to confirm that that the abnormal result was consistent. After a committee examined their tests and medical records to rule out any non-cancer reason for the abnormal blood tests, women received a full-body diagnostic PET-CT scan to confirm the cancer's presence.
The scan also helped the clinicians fill in the details about the cancer, said Johns Hopkins researcher Nickolas Papadopoulos. "For example, we could detect a lung cancer, tell in which lobe of which lung the cancer was located, the size of the cancer and if there were metastatic lesions present. Blood tests alone are not able to provide this type of precise information."

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The blood test screening did not lead to a significant number of unnecessary procedures, the researchers concluded. Only 1% of the women had false positive blood tests that sent them on to further screening with the PET-CT scan, and 0.22% of the study's participants with a false positive blood test had an invasive diagnostic procedure like surgery.
The study also followed women after their first blood test to see if they might be less likely to go for traditional cancer screenings if their liquid biopsy turned up no signs of cancer. Instead, the researchers found that the group of women were undergoing mammograms at about the same rates as before the study.
This finding was gratifying to the researchers, they said, as they noted that the liquid biopsy should complement but not replace traditional screening,Such earlier detection has the capacity to substantially reduce suffering and death from many cancer types.