Thursday, July 23, 2020

Bacterial vaginosis well explained

Image result for vaginosisBacterial vaginosis, also known as vaginal bacteriosis, is the most common cause of vaginal infection for women of childbearing age.
It frequently develops after sexual intercourse with a new partner, and it is rare for a woman to have it if she has never had sexual intercourse.
Bacterial vaginosis (BV) also increases the risk of developing a sexually transmitted infection (STI). However, BV is not considered an STI.
BV is the vaginal infection most likely to affect women between the ages of 15 and 44 years.

Fast facts about bacterial vaginitis

  • Bacterial vaginitis (BV) is the most common vaginal infection among women aged 15 to 44 years.
  • Symptoms, if they appear, may include itching and a gray, watery discharge with a “fishy” smell.
  • Untreated BV can lead to serious complications.
  • Treatment is normally with antibiotics.
  • Some home remedies are suggested, but anyone with symptoms should see a doctor.

Symptoms

doctor hand with gloves holding petri dish with bacteriaShare on Pinterest
An imbalance in vaginal bacteria can lead to bacterial vaginosis.
BV may be present without symptoms, but if symptoms occur, they include vaginal discharge, burning, and itching.
Vaginal discharge may:
  • be watery and thin
  • be gray or white in color
  • have a strong and unpleasant smell, often described as fishy
Less commonly, there may be:
  • a burning sensation during urination
  • itching around the outside of the vagina
Between 50 and 75 percent of women with BV have no symptoms. BV alone is not considered harmful, but complications can arise.

Complications

Complications that have been linked to BV include a higher risk of:
  • HIV infection, as BV increases susceptibility to the virus
  • STIs, such as the herpes simplex virus, chlamydiagonorrhea, and human papilloma virus (HPV)
  • post-surgical infection, for example, after a termination or a hysterectomy
Possible complications of BV during pregnancy include:
  • early, or preterm, delivery
  • loss of pregnancy
  • the amniotic sac breaking open too early
  • postpartum endometritis, an irritation or inflammation of the lining of the uterus after delivery
  • tubal factor infertility, caused by damage to the fallopian tubes, which connect the ovaries to the uterus
  • chorioamnionitis, an inflammation of the membranes surrounding the fetus, known as the chorion and the amnion
Chorioamnionitis significantly increases the chance of an early delivery. If the newborn survives, they have a higher risk of cerebral palsy.
In-vitro fertilization (IVF) may be less likely to succeed if a woman has BV.
BV also increases the risk of pelvic inflammatory disease (PID), an infection and inflammation of the upper female genital tract that can have severe consequences, including infertility.

Causes

BV is caused by an imbalance of naturally occurring bacterial flora, the usual bacteria found in a woman’s vagina. Why this happens is not clear.
It is different from candidiasis, a yeast infection, or Trichomonas vaginalis (T. vaginalis), or trichomoniasis, also known as trich. These are not caused by bacteria

The role of bacteria

All parts of the body have bacteria, but some are beneficial while others are harmful. When there are too many harmful bacteria, problems can arise.
The vagina contains mostly “good” bacteria and some harmful bacteria. BV occurs when the harmful bacteria grow in numbers.
A vagina should contain bacteria called lactobacilli. These bacteria produce lactic acid, making the vagina slightly acidic. This prevents other bacteria from growing there.
Lower levels of lactobacilli may cause the vagina to become less acidic. If the vagina is not as acidic as it should be, this can give other bacteria the chance to grow and thrive. However, exactly how these harmful bacteria are linked with BV is not known.

Risk factors

Any woman can develop BV, but some behaviors or activities can increase the risk.
These include:
  • douching, or using water or a medicated solution to clean the vagina
  • having a bath with antiseptic liquids
  • having a new sex partner
  • having multiple sex partners
  • using perfumed bubble baths, vaginal deodorants, and some scented soaps
  • smoking
  • washing underwear with strong detergents
BV cannot be caught from toilet seats, bedding, swimming pools, or touching objects.

Treatment

BV often clears up without treatment, but women with signs and symptoms should seek treatment to avoid complications.
Treatment may not be needed if there are no symptoms. Sometimes BV can appear and disappear for no apparent reason.
If there is an abnormal vaginal discharge, it is important to see a doctor as soon as possible. A doctor can diagnose BV and rule out other infections, such as gonorrhea or trich.
Untreated BV can also lead to complications, especially during pregnancy.
Some doctors recommend giving BV treatment to all women who will be undergoing a hysterectomy or termination, before the procedure, regardless of symptoms.
Male partners do not usually need treatment, but they can spread BV between female sex partners.

Antibiotic medication

Antibiotics are effective in up to 90 percent of cases, but BV often comes back again within a few weeks.
Metronidazole is the most common antibiotic for BV.
[woman taking pill]Share on Pinterest
Oral antibiotics are normally effective against BV.
It is available in the following forms:
  • Tablets: Taken orally, twice daily for 7 days. It is seen as the most effective treatment, and the preferred treatment if the woman is breastfeeding or pregnant.
  • A single tablet: Taken orally as a one-time dose. BV is more likely to return with this treatment, compared with the 7-day tablet course.
  • Gel: Applied to the vagina once daily, for 5 days.
Metronidazole reacts with alcohol. The combination can make the patient feel very ill. Individuals taking metronidazole should not consume alcohol for at least 48 hours afterward.
Clindamycin is an alternative antibiotic. It may be used if metronidazole is not effective, or if the infection recurs.
When taking clindamycin, barrier contraception methods, such as latex condoms, diaphragms, and caps may be less effective.
Tinidazole is another antibiotic that is sometimes used to treat BV if metronidazole does not work or if BV recurs. It is taken by mouth as a single dose. Alcohol must be avoided when taking this medication.
If the following happens, further tests will be needed:
  • symptoms persist
  • symptoms go away but come back
  • the patient is pregnant
If symptoms resolve after completing a course of antibiotics, the woman will not have to be tested for BV again.

Recurring symptoms

Around 30 percent of women whose symptoms disappear with treatment will have a recurrence within 3 months, and 50 percent will have a recurrence within 6 months.
This may be treated with a 7-day course of oral or vaginal metronidazole or clindamycin. If the previous treatment was by mouth, vaginal treatment might work better the second time, and if the first treatment was vaginal, the follow-up treatment should be by mouth.
If more than three episodes occur within 12 months, the doctor may prescribe a vaginal metronidazole gel to use twice a week for 3 to 6 months.

Diagnosis

The doctor may be able to diagnose BV from a description of symptoms and a physical examination. They will look out for an unpleasant smell and a thin, white or gray discharge.
If the patient is sexually active and there is a chance that an STI is present, the doctor may order some diagnostic tests.
A swab or small plastic loop can be used to collect sample cells from the vaginal wall. The pH balance of the vagina may also be measured, to assess acidity levels.

Home remedies

No over-the-counter medication is approved for BV, but there is anecdotal evidence that probiotics can help treat BV.
review of studies, published in January 2014, concludes:
Although the results of different studies are controversial, most studies have been in favor of the probiotics in the prevention or treatment of BV, and no adverse effects have been reported. Therefore, it may be helpful to recommend daily consumption of probiotic products to improve public health among women.”
However, more research is needed to confirm its effectiveness.
Some other home remedies have been suggested, but, since BV can lead to serious complications, anyone with symptoms should see a doctor.

Tuesday, July 21, 2020

Kidney cancer well explained (2020 updated)




What you should know!!!
Kidney, or renal, cancer refers to any type of cancer that involves the kidney. Older age, obesity, smoking, and high blood pressure increase the risk of developing kidney cancer.


The kidneys are part of the urinary system, which eliminates waste and excess fluid and electrolytes from the blood. They also control the production of red blood cells and regulate blood pressure.


Kidney cancers mainly originate in two parts of the kidney, the renal tubule and the renal pelvis. A cancer that starts outside the kidney and metastasizes to the kidney is not normally called kidney cancer.


Kidney cancer is one of the 10 most common cancers, affecting about 1 in every 63 people over a lifetime. It occurs more frequently among adults aged between 50 and 80 years.


Worldwide, North America has the highest rate of kidney cancer, but in developing countries, the incidence has been steadily increasing over the last three decades. This increase may be linked to a parallel rise in obesity rates, or it could be due to improved detection and diagnosis.


Symptoms

Growing rates of kidney cancer may be linked to a rise in obesity.


Symptoms do not usually appear in the early stages of kidney cancer.


In the later stages, the person may experience:


Ø blood in the urine


Ø a lump or mass in the back, near the kidneys


Less often, there may be:





Ø a continuous pain in the side, near the kidneys


Ø a lump in the abdomen


Ø anemia


Ø constant fever and night sweats


Ø tiredness or fatigue


Ø weight loss and loss of appetite









Other conditions can lead to similar symptoms, so it is important to see a physician if any of these occur.


Managment

Treatment options depend on several factors, including the patient's general health, the type and stage of kidney cancer, and the patient's own preferences. 


Most kidney cancers are treated first by surgery. A person can function with just one kidney, so removing a kidney is an option. 


Nephrectomy involves removing the kidney, the nearby adrenal gland, a border of healthy tissue, and the adjacent lymph nodes. The surgery can be done laparoscopically, through small incisions. 


If the tumor is less than 1.5 inches, or 4 centimetres across, the surgeon may remove only part of the kidney in a partial nephrectomy. 


If the cancer has spread outside the kidney, surgery may not cure it, but it can ease pain and make other non-surgical treatments more effective. 


In nephron-sparing surgery, the tumor, but not the kidney, is surgically removed. This may be an option during the early stage of kidney cancer, or if the patient has only one kidney. 


A patient who is unwell or frail may not be able to undergo surgery. In this case, a number of nonsurgical treatment options are possible. 


It is important to get as much information as possible and to talk to a doctor or counselor about what to expect.


Embolization aims to block the flow of blood to the tumor. The surgeon inserts a small tube known as a catheter into the groin. X-ray images guide the catheter into the blood supply for the kidney. A special material passes through the catheter into the blood vessel, blocking the blood supply to the kidney and starving the tumor of oxygen and nutrients. This causes the tumor to shrink. 


Cryoablation involves inserting one or more special needles, known as cryoprobes, through small incisions into the tumor. An imaging scan guides the process. A gas in the needles freezes the cells around the tip of each needle. Another gas warms thaws the tissue, and then the cells are refrozen. This freeze-thaw cycle kills the cancer cells. 


Some pain may occur after the procedure, and, rarely, some bleeding, infection, and damage to the tissue close to the tumor. 


Advanced or recurrent kidney cancer treatment is for kidney cancer that comes back, or kidney cancer that has spread out of the kidney. 


Surgery aims to remove as much of the tumor as possible. 


In biological therapy, or immunotherapy, drugs use the body's own immune system to fight cancer. Examples are interferon and interleukin-2. Both are synthetic versions of chemicals that our bodies make. Side effects include nausea, vomiting, chills, elevated body temperature, and loss of appetite. 


In targeted therapy, medicines interrupt the functions that cancer needs to survive, such as the blood supply. 


Targeted therapies include: 

Ø Sunitinib, or Sutent


Ø Sorafenib, or Nexavar


Ø Bevacizumab


Ø Temsirolimus


Radiation therapy cannot usually cure kidney cancer, but it may help reduce the spread and the severity of symptoms. Patients typically undergo a few minutes of treatment daily for a number of days. Radiation therapy that is used to control rather than to cure a cancer tends to have less severe side effects. 


Side effects can include fatigue, nausea, and vomiting. 


Complementary treatments may include taking certain vitamins alongside regular treatment. This should first be discussed with a physician. Some people have found that alternative treatments can relieve symptoms, but these can be unhelpful or hazardous, and should first be discussed with the medical team. 






Stages 











One way of staging kidney cancer is a four-stage system


Stage 1: The tumor is under 2.8 inches, or 7 centimeters in diameter and it is limited to the kidney. 


Stage 2: The tumor is greater than 2.8 inches, or 7 centimeters, in diameter, and it is still limited to the kidney. 


Stage 3: The cancer is any size but has spread beyond the kidney to at least one other location. It may have reached the adrenal gland, nearby blood vessels, a lymph node, or the fat that surrounds the kidney. 


Stage 4: The cancer has spread beyond the fatty tissue around the kidney, it affects at least one lymph node, or it has spread to other organs.










Some causes

Cancer starts when there is a change in the structure of DNA in cells. A genetic mutation causes cells to grow uncontrollably eventually producing tumor cells. 


Untreated, cancer grows and spreads, usually through the lymphatic system, a series of nodes or glands that exist throughout the body. 


Renal cell carcinoma typically starts in the cells that line the tiny tubes of the nephron. Tumors normally grow as a single mass, but sometimes, more than one tumor can grow in one kidney, and sometimes in both kidneys. 


Transitional cell carcinoma develops in the tissue that forms the tubes that connect the kidneys to the bladder. This type of cancer can begin in the ureters and also in the bladder itself. 


Wilms' tumor is a childhood kidney cancer caused by the loss or inactivation of a tumor suppressor gene called QT1 on chromosome 11. Tumor suppressor genes generally suppress tumor growth and control cell growth. 


Putting up kidney cancer

When a person finds out they have cancer or another serious illness, they may experience feelings of grief, stress, anxiety and depression. Talking to a well-qualified counselor may help.


It is important to get as much information as possible. Members of the medical team will provide details about the diagnosis, available options, and their effectiveness.


The patient should eat a healthy diet with plenty of fruits and vegetables, sleep at least 7.5 hours each day, and get enough exercise, within the limits set by the physician. This will maximize the benefits of any treatment.


Allow friends and family to help. They can provide practical assistance and support the patient's mental, emotional, spiritual, and, ultimately, physical health.


How you could avoid it

Measures to reduce the risk of developing kidney and other cancers include:


A healthy lifestyle can help reduce the risk of kidney cancer. 
not smoking 
eating plenty of fruit and vegetables 
exercising regularly 
keeping the body weight within normal limits for your height, sex, and age 
getting at least 7 hours good quality continuous sleep every 24 hours 
maintaining a healthy blood pressure 
avoiding toxic chemicals 


Kinds of kidney cancer

Renal cell carcinoma the most common,


Other types are:
Ø urothelial cell carcinoma of the renal pelvis


Ø squamous cell carcinoma


Ø juxtaglomerular cell tumor, or reninoma


Ø angiomyolipoma


Ø renal oncocytoma


Ø Bellini duct carcinoma


Ø clear-cell sarcoma of the kidney


Ø mesoblastic nephroma


Ø Wilms' tumor, usually diagnosed in children under 5 years of age


Ø mixed epithelial stromal tumor





Rarely, potentially cancerous tumors that usually originate in other parts of the body can start off in the kidneys. These include clear cell adenocarcinoma, transitional cell carcinoma, inverted papilloma, renal lymphoma, teratoma, carcinosarcoma, and carcinoid tumor of the renal pelvis.


Most cancers that originate in the renal tubule are renal cell carcinoma and clear cell adenocarcinoma. Those that originate in the renal pelvis are transitional cell carcinoma.


Risk factors

Risk factors for renal cell carcinoma, the most common type of kidney cancers, include:


Kidney disease that needs dialysis may increase the risk of renal cancer.





Ø Age: The risk increases significantly after the age of 60 years


Ø Sex: For every two women who get kidney cancer, 3 men will do so


Ø Obesity: People with obesity have a significantly higher risk


Ø Smoking: Regular tobacco smokers have a much higher risk, but the risk drops when the person quits


Ø Hypertension, or high blood pressure: The higher risk may be due to the hypertension itself, or it may be due to anti-hypertensive medications


Ø Smoking, obesity, and hypertension account for around 50 percent of all renal cell carcinomas


Ø Workers who are exposed to chemicals, such as asbestos, trichloroethylene, and cadmium, are more likely to develop renal cell carcinoma





Asbestos was widely used in the past in construction. Cadmium is a metal used in batteries. Trichloroethylene is an industrial solvent used to strip paint from metals.


Patients receiving long-term dialysis for chronic kidney failure are more likely to develop renal cell carcinoma. This may be due to kidney disease rather than the dialysis itself.


Patients who have received a kidney transplant and are taking immunosuppressant medications have a higher risk of developing renal cell carcinoma. The use of medications such as phenacetin, a pain reliever, has been linked to a higher risk of kidney cancer, and the use of diuretics may contribute.


Von Hippel-Lindau disease is a genetic condition that increases the risk of several kinds of tumors, including renal cell carcinoma. In hereditary papillary renal cell carcinoma, multiple papillary tumors develop in both kidneys. Other diseases that increase the risk include Birt-Hogg-Dube syndrome and hereditary leiomyoma-renal cell carcinoma.


Diagnosis



The doctor will look at the patient's symptoms and order some tests.

Ø Blood and urine tests can rule out other possible causes of symptoms such as kidney stones or an infection


Ø An ultrasound scan can help the doctor identify any change in the shape of the kidney that could be caused by a tumor


Ø A CT scan normally involves the patient drinking a dye first


Ø An image-guided biopsy involves using a needle to remove a small sample of kidney tissue for examination under a microscope for cancer cells





Additional tests for transitional cell cancer include:

Excretory urogram: A dye is injected into a vein in the patient's arm. The kidneys and urinary system process the dye, and this may enable any signs of cancer to show up on an X-ray.


Cystoscopy: A long narrow tube with a special lens and light at the end is inserted into the urethra, to provide an image inside the patient's bladder. A biopsy may be taken at the same time.


Sunday, July 12, 2020

CDC-Characteristics of Persons Who Died with COVID-19 — United States

During January 1, 2020–May 18, 2020, approximately 1.3 million cases of coronavirus disease 2019 (COVID-19) and 83,000 COVID-19–associated deaths were reported in the United States (1). Understanding the demographic and clinical characteristics of decedents could inform medical and public health interventions focused on preventing COVID-19–associated mortality. This report describes decedents with laboratory-confirmed infection with SARS-CoV-2, the virus that causes COVID-19, using data from 1) the standardized CDC case-report form (case-based surveillance) (https://www.cdc.gov/coronavirus/2019-ncov/php/reporting-pui.html) and 2) supplementary data (supplemental surveillance), such as underlying medical conditions and location of death, obtained through collaboration between CDC and 16 public health jurisdictions (15 states and New York City).


Case-based surveillance

Demographic and clinical data about COVID-19 cases are reported to CDC from 50 states, the District of Columbia, New York City, and U.S. territories using a standardized case-report form (case-based surveillance) or in aggregate. Data on 52,166 deaths from 47 jurisdictions among persons with laboratory-confirmed COVID-19 were reported individually to CDC via case-based surveillance during February 12–May 18, 2020. Among the 52,166 decedents, 55.4% were male, 79.6% were aged ≥65 years, 13.8% were Hispanic/Latino (Hispanic), 21.0% were black, 40.3% were white, 3.9% were Asian, 0.3% were American Indian/Alaska Native (AI/AN), 0.1% were Native Hawaiian or other Pacific Islander (NHPI), 2.6% were multiracial or other race, and race/ethnicity was unknown for 18.0%. (Table 1). Median decedent age was 78 years (interquartile range (IQR) = 67–87 years). Because information about underlying medical conditions was missing for the majority of these decedents (30,725; 58.9%), data regarding medical conditions were not analyzed further using the case-based surveillance data set. Because most decedents reported to the supplementary data program were also reported to case-based surveillance, no statistical comparisons of the decedent characteristics between the data sets were made.


Supplemental surveillance

To collect more complete data on race/ethnicity, selected underlying medical conditions* by age, and clinical course, CDC solicited supplementary information from medical charts and death certificates of decedents with laboratory-confirmed COVID-19 from state, territorial, and local public health departments. The supplementary data request also sought information on locations of death, which is not collected routinely on the CDC case-report form. Among 56 public health departments contacted by CDC, 16† provided supple­mentary data on 10,647 COVID-19 deaths that occurred during February 12–April 24, 2020.

Among the 10,647 COVID-19 decedents for whom supple­mentary data were collected, 60.6% were male, 74.8% were aged ≥65 years, 24.4% were Hispanic, 24.9% were black, 35.0% were white, 6.3% were Asian, 0.1% were AI/AN, 0.1% were NHPI, 2.9% were multiracial or other race, and race/ethnicity was unknown for 6.3% (Table 1). Decedent age varied by race and ethnicity; median age was 71 years (IQR = 59–81 years) among Hispanic decedents, 72 years (IQR = 62–81 years) among all nonwhite, non-Hispanic decedents, and 81 years (IQR = 71–88 years) among white decedents. The percentages of Hispanic (34.9%) and nonwhite (29.5%) decedents who were aged <65 years were more than twice those of white decedents (13.2%) (Figure).

At least one underlying medical condition was reported for 8,134 (76.4%) of decedents for whom sup­plementary data were collected, including 83.1% of decedents aged <65 years. Overall, the most common underlying medical conditions were cardiovascular disease (60.9%), diabetes mellitus (39.5%), chronic kidney disease (20.8%), and chronic lung disease (19.2%) (Table 2). Among decedents aged <65 years, 83.1% had one or more underlying medical conditions. Among decedents aged ≥85 years, 69.5% had one or more underlying medical conditions. Diabetes was more common among decedents aged <65 years (49.6%) than among those aged ≥85 years (25.9%).

Among decedents for whom supplementary data were reported, 8,976 (84.3%) were hospitalized. Among 3,021 (28.4%) with dates of illness onset and death reported, the median interval from illness onset to death was 10 days (IQR = 6–15 days); among 7,794 decedents with hospital admission and death dates, the median interval from hospital admission to death was 5 days (IQR = 3–8 days). Among the decedents, 62.0% died in hospitals. By age group, the largest percentage who died in the emergency department (6.8%) or at home (1.0%) was aged <65 years (combined total = 7.8%), and decreased with increasing age group, whereas the percentage who died in long-term care facilities increased with increasing age and was highest among decedents aged ≥85 years (12.6%).

Among the decedents during February 12–April 24, 2020, for whom supplementary information was provided, 9,997 (93.9%) resided in New York City, New Jersey, or the state of Washington, three areas with early widespread circulation of SARS-CoV-2; the median age among decedents in these three jurisdictions was 75 years, (IQR = 64–84 years). The median age among decedents residing in the other 13 jurisdictions was similar (78 years, [IQR = 68–85 years]).


Discussion

Using national case-based surveillance and supplementary data reported from 16 jurisdictions, characteristics of >10,000 decedents with laboratory-confirmed COVID-19 were described. More than one third of Hispanic decedents (34.9%) and nearly one third (29.5%) of nonwhite decedents were aged <65 years, but only 13.2% of white decedents were aged <65 years. Consistent with reports describing the characteristics of deaths in persons with COVID-19 in the United States and China (2–5), approximately three fourths of decedents had one or more underlying medical conditions reported (76.4%) or were aged ≥65 years (74.8%). Among reported underlying medical conditions, cardiovascular disease and diabetes were the most common. Diabetes prevalence among decedents aged <65 years (49.6%) was substantially higher than that reported in an analysis of hospitalized COVID-19 patients aged <65 years (35%) and persons aged <65 years in the general population (<20%) (5–7). Among decedents aged <65 years, 7.8% died in an emergency department or at home; these out-of-hospital deaths might reflect lack of health care access, delays in seeking care, or diagnostic delays. Health communications campaigns could encourage patients, particularly those with underlying medical conditions, to seek medical care earlier in their illnesses. Additionally, health care providers should be encouraged to consider the possibility of severe disease among younger persons who are Hispanic, nonwhite, or have underlying medical conditions. More prompt diagnoses could facilitate earlier implementation of supportive care to minimize morbidity among individuals and earlier isolation of contagious persons to protect communities from SARS-CoV-2 transmission.

The relatively high percentages of Hispanic and nonwhite decedents aged <65 years were notable. The median age of nonwhite persons (31 years) in the United States is lower than that of white persons (44 years); these differences might help explain the higher proportions of Hispanic and nonwhite decedents among those aged <65 years. The median ages among Hispanic and nonwhite decedents (71 and 72 years, respectively) were 9–10 years lower than that of white decedents (81 years). However, the percentage of Hispanic decedents aged <65 years (33.9%) exceeded the percentage of Hispanic persons aged <65 years in the U.S. population (20%); the percentage of nonwhite COVID-19 decedents aged <65 years (40.2%) also exceeded the overall percentage of nonwhite decedents aged <65 years (23%) in the U.S. population (8). Further study is needed to understand the reasons for these differences. It is possible that rates of SARS-CoV-2 transmission are higher among Hispanic and nonwhite persons aged <65 years than among white persons; one potential contributing factor is higher percentages of Hispanic and nonwhite persons engaged in occupations (e.g., service industry) or essential activities that preclude physical distancing (9). It is also possible that the COVID-19 pandemic disproportionately affected communities of younger, nonwhite persons during the study period (10). Although these data did not permit assessment of interactions between race/ethnicity, underlying medical conditions, and nonbiologic factors, further studies to understand and address these racial/ethnic differences are needed to inform targeted efforts to prevent COVID-19 mortality.

The findings in this report are subject to at least five limitations. First, despite >90% completeness for age and race/ethnicity variables in the supplementary data set, the proportion of missing data for some variables, such as underlying medical conditions, clinical course, and race/ethnicity in case-based surveillance, and location of death, was higher than that for other variables; accordingly, the proportions reported for these variables should be considered minimum proportions rather than robust estimates. Second, reporting practices varied by jurisdiction, and several states bundled underlying medical conditions into organ system–specific categories (e.g., hypertension was included as cardiovascular disease) or did not code specifically for a given condition (e.g., immunosuppression was only specifically coded in 10 of the jurisdictions). These differences in reporting structure precluded evaluations of specific conditions other than diabetes using the entire data set. Third, generalizability of the findings from either data set to all deaths among persons with COVID-19, either within the individual jurisdictions or across the United States, is unknown; COVID-19 testing practices for decedents might differ among jurisdictions. Fourth, information from the supplementary data set provides additional insight into decedent demographic and clinical characteristics; however, these data are a convenience sample from 16 public health jurisdictions. Therefore, because the age-race structure of the underlying population is not known, age-standardized mortality rates could not be calculated. Although more than 90% of decedents resided in just three jurisdictions, and most are represented in case-based surveillance, they represent a subset of deaths reported during this period. Therefore, neither calculations of mortality rates nor statistical comparisons between the demographic characteristics of the decedents with available supplementary data and those from case-based surveillance were possible. Finally, these data were collected during a period before dexamethasone was shown to reduce deaths among ventilated patients; implementation of dexamethasone and other therapeutics, as well as shifts in the ages of patients and geographic locations of cases might affect the generalizability of these data to the current period.China denies 'cover-up' after Wuhan COVID-19 deaths rise 50 ...

Despite these limitations, this report provides more detailed demographic and clinical information on a subset of approximately 10,000 decedents with laboratory-confirmed COVID-19. Most decedents were aged >65 years and had underlying medical conditions. Compared with white decedents, more Hispanic and nonwhite decedents were aged <65 years. Additional studies are needed to elucidate associations between age, race/ethnicity, SARS-CoV-2 infection, disease severity, underlying medical conditions (especially diabetes), socioeconomic status (e.g., poverty and access to health care), behavioral factors (e.g., ability to comply with mitigation recommendations and maintain essential work responsibilities), and out-of-hospital deaths. Regional and state level efforts to examine the roles of these factors in SARS-CoV-2 transmission and COVID-19-associated deaths could lead to targeted, community-level, mortality prevention initiatives. Examples include health communication campaigns targeted towards Hispanics and nonwhite persons aged <65 years. These campaigns could encourage social distancing and the need for wearing cloth face coverings in public settings. In addition, health care providers should be encouraged to consider the possibility of disease progression, particularly in Hispanic and nonwhite persons aged <65 years and persons of any race/ethnicity, regardless of age, with underlying medical conditions, especially diabetes.