Showing posts with label COVID-19. Show all posts

Saturday, 14 November 2020

The Medical Minute: Overcoming pandemic fatigue

The Medical Minute: Overcoming pandemic fatigue:

After nine months of social distancing, masking and quarantining, many people are experiencing pandemic fatigue.

Newswise — The sharp rise in COVID-19 cases throughout Pennsylvania and across the United States makes continued vigilance with established safety efforts essential to helping slow the virus’s spread. Yet after nine months of social distancing, masking and quarantining, many are experiencing pandemic fatigue. Whether it manifests as anxiety, exhaustion or defiance, it’s important to recognize and address it for the sake of our physical and emotional health.

A long and uncertain pandemic

Health care providers on the frontlines of the COVID battle have seen how approaches to treatment and prevention have evolved, sometimes seemingly overnight, often resulting in a sense of uncertainty, anxiety or even doubt with the public.

“It’s been like drinking out of a firehose,” said Dr. Jonathan Nunez, an internal medicine physician at Penn State Health Milton S. Hershey Medical Center, reflecting on the last several months of the pandemic. “Every day we’ve learned something new.”

One of the most significant evolutions he has witnessed — one that may have played a role in some people’s continued unwillingness to mask properly — is guidance on face coverings for the general public.

“At first, we were told that only health care workers needed to wear a mask,” Nunez said. “But since those early days, there's been a lot of evidence overall that wearing masks may definitely slow the spread of the virus and help people from transmitting it to others, especially if they’re asymptomatic.”

Another theory from early in the pandemic was that the warmer weather over the summer would potentially halt the virus, as it does with other seasonal respiratory diseases. “Super spreader events in the form of outdoor gatherings showed that this unfortunately wasn’t the case for COVID,” Nunez said.

Nunez advises that anyone considering in-person activities like dining out or shopping make sure that everyone in the establishment is abiding by the rules. “Are they wearing masks, covering the whole face, sitting six feet apart?” he asked, adding that even with these measures, “there is no absolute decreased risk.” He prefers creative solutions to social gatherings. “Most of my inspiration has come from the internal medicine residents. They've been able to continue their game nights — virtually.”

Minding your mental health

The relentless pace of the pandemic and the resulting social distancing restrictions have been exhausting and stressful, explains Dr. Julie Graziane, a psychiatrist at the Milton S. Hershey Medical Center. “But there are things that we can do to help mitigate a lot of those stressful emotions,” she said.

Graziane suggests an emotional reframing of quarantines and social distancing restrictions. “Don’t think of them as things we’re being forced to follow, but rather as actions we're freely choosing to do to help others,” she said. “We shift it into an altruistic action as we do these things to help our loved one, our neighbor, even the stranger in the community that we care about.”

The colder weather and fewer hours of daylight can add to the emotional burden of that COVID causes.

“We’ve been watchful with mental health as individuals experience significant emotional stress during the pandemic,” Graziane said. “And we’re especially concerned as we head into the winter months that play a role in some people’s depression.”

One significant stressor from COVID that Graziane points to is the disruption to routines, such as getting the kids on the bus in the mornings or driving to work. She recommends establishing new routines.

“Have a regular awake time or regular sleep time, and regular meal times,” Graziane said. “Then take some time during the day to check in with yourself, how you're feeling about the day, the situation. Incorporating healthy activities like exercise and mindfulness, and then pleasurable activities.”

Reflecting on what was important to them and provided meaning to their lives prior to the pandemic can help people find strength and purpose as quarantines continue, Graziane said. “And don’t be afraid to reach out for help. If you feel like you're struggling with getting through this, talk to someone such as a loved one, a physician, a counselor or a friend.”

Nunez stresses that we take the time to check in with others. “Maybe someone you know is struggling and just because you don’t ask, they don’t mention it,” he said. “We’re all going through this. We are not alone.”

Hopeful while remaining vigilant

While recent news that an effective vaccine is expected to come to market soon points to an eventual end to the pandemic and its social restrictions, both Graziane and Nunez stress that the general population is still perhaps months away from being able to receive the two-part vaccination.

“For now, we must remain ever vigilant,” Graziane said.

That includes celebrating the holidays very differently this year.

“I think what’s important this holiday season is remembering that we’re trying to stay healthy and we’re also really trying to keep others healthy,” said Nunez, “especially our patients who are vulnerable and at risk for severe complications of the disease.”

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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Sunday, 18 October 2020

How I'm Turning The Coronavirus Crisis Into A Winter Of Personal Contentment

Living Through COVID-19

Give a shoutout to cheng feng on social or copy the text below to attribute.

“There’s no such thing as bad weather, just the wrong clothing, so get yourself a sexy raincoat and live a little,” Billy Connolly once said.

As we all face the prospect of a long cold winter trying to deal with the ongoing Coronavirus crisis and the collateral damage of economic uncertainty, we need to find ways of taking the sourest of lemons and try to find ways of turning them into lemonade.

With uncertainty comes a need to think positively and with agility. So rather than just hunkering down indoors over the winter, if possible let’s turn a Covid winter of discontent into a winter of contentment. The winter of the great outdoors.

“I refuse to get downhearted and beaten by this virus. I will play by the rules, but I will adapt.”

Let’s walk together, maximise the opportunities for outdoor socialising, create winter gardens, visit outdoor cafes and pubs with heaters and rugs, drink warm cider and mulled wine. Let’s try and use the winter season to turn this mess on its head with some positive intent.

I refuse to get downhearted and beaten by this virus. I will play by the rules, but I will adapt. I will continue to enjoy my life, meet my friends and family, even if it means that I meet them in the wind and rain. The virus will only defeat our spirit, if we choose to let it.

So as the days get shorter and the Covid restrictions look likely to continue right through the winter, it would be easier to just stay indoors and hunker down for winter, but it’s actually the ideal time to get outside and get moving – both in an urban or rural environment.

“Let’s start a muddy boots campaign. Let’s explore the great outdoors. Let’s have a winter of contentment rather than a winter of discontent.”

Considering the likely indoor restrictions due to Covid, there should be a huge campaign to get the public exercising and socialising outdoors this winter – whatever the weather.

I’m going to try and have the best winter ever. I’m going to run in the rain and walk in the mud. I’m going to get a warm and sexy raincoat and get all windswept and interesting.

Let’s start a muddy boots campaign. Let’s explore the great outdoors. Let’s have a winter of contentment rather than a winter of discontent.

Many people spend workdays indoors under fluorescent lights of computers during the working day and then the glow of television screens in the evening.

This has been exasperated during the Covid-19 lockdown restrictions. Going outside takes away the sedentary nature of staring at a screen, adds natural vitamin D and gets us our required levels of exercise.

Also, in terms of Covid, being outside in open spaces reduces the risk of infection. Respiratory viruses get more diluted in air and get dispersed by wind, so the risk of virus transmission would be lower than indoors.

Going outdoors during daylight can also do wonders for boosting our immune system and protecting us from illness. Taking time in the great outdoors activates a group of mental functions that include our ability to learn new things, to process information and to pay attention. It creates mental wellbeing through mindfulness.

In a 2018 report from University of East Anglia it was revealed that “exposure to greenspace reduces the risk of type II diabetes, cardiovascular disease, premature death, preterm birth, stress, and high blood pressure”. Populations with higher levels of greenspace exposure are also more likely to report good overall health, according to global data in the report involving more than 290 million people.

Alfresco living benefits all ages. According to Harvard Medical School, a study published in 2008 found that “children with ADHD scored higher on a test of concentration after a walk through a park than after a walk through a residential neighbourhood or downtown area”.

So as Billy Connolly advised, get yourself a sexy raincoat, go outside and live a little. The time is now to create a winter of outdoor contentment, even in these discombobulating and worrying times.

James Melville is a freelance writer.

Got a unique opinion on a news story that will help cut through the noise? We want to hear from you. Find out what we’re looking for here and pitch us on ukopinion@huffpost.com.

Sunday, 19 July 2020

Coronavirus May Be a Blood Vessel Disease, Which Explains Everything

Pandemic

We know a lot about the dangers of COVID-19 by now but this is an interesting revelation and sounds absolutely in line with the terrible havoc this disease has caused on so many patients.

Many of the infection’s bizarre symptoms have one thing in common

Dana G Smith

May 29 · 8 min read

In April, blood clots emerged as one of the many mysterious symptoms attributed to Covid-19, a disease that had initially been thought to largely affect the lungs in the form of pneumonia. Quickly after came reports of young people dying due to coronavirus-related strokes. Next it was Covid toes — painful red or purple digits.

What do all of these symptoms have in common? An impairment in blood circulation. Add in the fact that 40% of deaths from Covid-19 are related to cardiovascular complications, and the disease starts to look like a vascular infection instead of a purely respiratory one.

Months into the pandemic, there is now a growing body of evidence to support the theory that the novel coronavirus can infect blood vessels, which could explain not only the high prevalence of blood clots, strokes, and heart attacks, but also provide an answer for the diverse set of head-to-toe symptoms that have emerged.

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“All these Covid-associated complications were a mystery. We see blood clotting, we see kidney damage, we see inflammation of the heart, we see stroke, we see encephalitis [swelling of the brain],” says William Li, MD, president of the Angiogenesis Foundation. “A whole myriad of seemingly unconnected phenomena that you do not normally see with SARS or H1N1 or, frankly, most infectious diseases.”

“If you start to put all of the data together that’s emerging, it turns out that this virus is probably a vasculotropic virus, meaning that it affects the [blood vessels],” says Mandeep Mehra, MD, medical director of the Brigham and Women’s Hospital Heart and Vascular Center.

In a paper published in April in the scientific journal The Lancet, Mehra and a team of scientists discovered that the SARS-CoV-2 virus can infect the endothelial cells that line the inside of blood vessels. Endothelial cells protect the cardiovascular system, and they release proteins that influence everything from blood clotting to the immune response. In the paper, the scientists showed damage to endothelial cells in the lungs, heart, kidneys, liver, and intestines in people with Covid-19.

“The concept that’s emerging is that this is not a respiratory illness alone, this is a respiratory illness to start with, but it is actually a vascular illness that kills people through its involvement of the vasculature,” says Mehra.

A respiratory virus infecting blood cells and circulating through the body is virtually unheard of.

A one-of-a-kind respiratory virus

SARS-CoV-2 is thought to enter the body through ACE2 receptors present on the surface of cells that line the respiratory tract in the nose and throat. Once in the lungs, the virus appears to move from the alveoli, the air sacs in the lung, into the blood vessels, which are also rich in ACE2 receptors.

“[The virus] enters the lung, it destroys the lung tissue, and people start coughing. The destruction of the lung tissue breaks open some blood vessels,” Mehra explains. “Then it starts to infect endothelial cell after endothelial cell, creates a local immune response, and inflames the endothelium.”

A respiratory virus infecting blood vessel cells and circulating through the body is virtually unheard of. Influenza viruses like H1N1 are not known to do this, and the original SARS virus, a sister coronavirus to the current infection, did not spread past the lung. Other types of viruses, such as Ebola or Dengue, can damage endothelial cells, but they are very different from viruses that typically infect the lungs.

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Benhur Lee, MD, a professor of microbiology at the Icahn School of Medicine at Mount Sinai, says the difference between SARS and SARS-CoV-2 likely stems from an extra protein each of the viruses requires to activate and spread. Although both viruses dock onto cells through ACE2 receptors, another protein is needed to crack open the virus so its genetic material can get into the infected cell. The additional protein the original SARS virus requires is only present in lung tissue, but the protein for SARS-CoV-2 to activate is present in all cells, especially endothelial cells.

“In SARS1, the protein that’s required to cleave it is likely present only in the lung environment, so that’s where it can replicate. To my knowledge, it doesn’t really go systemic,” Lee says. “[SARS-CoV-2] is cleaved by a protein called furin, and that’s a big danger because furin is present in all our cells, it’s ubiquitous.”

Endothelial damage could explain the virus’ weird symptoms

An infection of the blood vessels would explain many of the weird tendencies of the novel coronavirus, like the high rates of blood clots. Endothelial cells help regulate clot formation by sending out proteins that turn the coagulation system on or off. The cells also help ensure that blood flows smoothly and doesn’t get caught on any rough edges on the blood vessel walls.

“The endothelial cell layer is in part responsible for [clot] regulation, it inhibits clot formation through a variety of ways,” says Sanjum Sethi, MD, MPH, an interventional cardiologist at Columbia University Irving Medical Center. “If that’s disrupted, you could see why that may potentially promote clot formation.”

Endothelial damage might account for the high rates of cardiovascular damage and seemingly spontaneous heart attacks in people with Covid-19, too. Damage to endothelial cells causes inflammation in the blood vessels, and that can cause any plaque that’s accumulated to rupture, causing a heart attack. This means anyone who has plaque in their blood vessels that might normally have remained stable or been controlled with medication is suddenly at a much higher risk for a heart attack.

“Inflammation and endothelial dysfunction promote plaque rupture,” Sethi says. “Endothelial dysfunction is linked towards worse heart outcomes, in particular myocardial infarction or heart attack.”

Blood vessel damage could also explain why people with pre-existing conditions like high blood pressure, high cholesterol, diabetes, and heart disease are at a higher risk for severe complications from a virus that’s supposed to just infect the lungs. All of those diseases cause endothelial cell dysfunction, and the additional damage and inflammation in the blood vessels caused by the infection could push them over the edge and cause serious problems.

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The theory could even solve the mystery of why ventilation often isn’t enough to help many Covid-19 patients breathe better. Moving air into the lungs, which ventilators help with, is only one part of the equation. The exchange of oxygen and carbon dioxide in the blood is just as important to provide the rest of the body with oxygen, and that process relies on functioning blood vessels in the lungs.

“If you have blood clots within the blood vessels that are required for complete oxygen exchange, even if you’re moving air in and out of the airways, [if] the circulation is blocked, the full benefits of mechanical ventilatory support are somewhat thwarted,” says Li.

A new paper published last week in the New England Journal of Medicine, on which Li is a co-author, found widespread evidence of blood clots and infection in the endothelial cells in the lungs of people who died from Covid-19. This was in stark contrast to people who died from H1N1, who had nine times fewer blood clots in the lungs. Even the structure of the blood vessels was different in the Covid-19 lungs, with many more new branches that likely formed after the original blood vessels were damaged.

“We saw blood clots everywhere,” Li says. “We were observing virus particles filling up the endothelial cell like filling up a gumball machine. The endothelial cell swells and the cell membrane starts to break down, and now you have a layer of injured endothelium.”

Finally, infection of the blood vessels may be how the virus travels through the body and infects other organs — something that’s atypical of respiratory infections.

“Endothelial cells connect the entire circulation [system], 60,000 miles worth of blood vessels throughout our body,” says Li. “Is this one way that Covid-19 can impact the brain, the heart, the Covid toe? Does SARS-CoV-2 traffic itself through the endothelial cells or get into the bloodstream this way? We don’t know the answer to that.”

In another paper that looked at nearly 9,000 people with Covid-19, Mehra showed that the use of statins and ACE inhibitors were linked to higher rates of survival.

If Covid-19 is a vascular disease, the best antiviral therapy might not be antiviral therapy

An alternative theory is that the blood clotting and symptoms in other organs are caused by inflammation in the body due to an over-reactive immune response — the so-called cytokine storm. This inflammatory reaction can occur in other respiratory illnesses and severe cases of pneumonia, which is why the initial reports of blood clots, heart complications, and neurological symptoms didn’t sound the alarm bells. However, the magnitude of the problems seen with Covid-19 appear to go beyond the inflammation experienced in other respiratory infections.

“There is some increased propensity, we think, of clotting happening with these [other] viruses. I think inflammation in general promotes that,” Sethi says. “Is this over and above or unique for SARS-CoV-2, or is that just because [the infection] is just that much more severe? I think those are all really good questions that unfortunately we don’t have the answer to yet.”

Anecdotally, Sethi says the number of requests he received as the director of the pulmonary embolism response team, which deals with blood clots in the lungs, in April 2020 was two to three times the number in April 2019. The question he’s now trying to answer is whether that’s because there were simply more patients at the hospital during that month, the peak of the pandemic, or if Covid-19 patients really do have a higher risk for blood clots.

“I suspect from what we see and what our preliminary data show is that this virus has an additional risk factor for blood clots, but I can’t prove that yet,” Sethi says.

The good news is that if Covid-19 is a vascular disease, there are existing drugs that can help protect against endothelial cell damage. In another New England Journal of Medicine paper that looked at nearly 9,000 people with Covid-19, Mehra showed that the use of statins and ACE inhibitors were linked to higher rates of survival. Statins reduce the risk of heart attacks not only by lowering cholesterol or preventing plaque, they also stabilize existing plaque, meaning they’re less likely to rupture if someone is on the drugs.

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“It turns out that both statins and ACE inhibitors are extremely protective on vascular dysfunction,” Mehra says. “Most of their benefit in the continuum of cardiovascular illness — be it high blood pressure, be it stroke, be it heart attack, be it arrhythmia, be it heart failure — in any situation the mechanism by which they protect the cardiovascular system starts with their ability to stabilize the endothelial cells.”

Mehra continues, “What we’re saying is that maybe the best antiviral therapy is not actually an antiviral therapy. The best therapy might actually be a drug that stabilizes the vascular endothelial. We’re building a drastically different concept.”

Update: The New England Journal of Medicine paper investigating the effect of statins and ACE inhibitors on Covid-19 mortality rates has been retracted because of concerns over the quality of the data.

Elemental

Your life, sourced by science.

Written by

Dana G Smith

Senior Writer for Elemental @ Medium covering health, science, and the science of wellness | dsmith@medium.com @smithdanag

Saturday, 18 July 2020

How Nasal Breathing Keeps You Healthier

It may feel unnatural at first, but it’s the best thing for your body

Nasal Breathing

Allison Hirschlag

Jul 14 · 6 min read

reathing easily has always been a vital part of well-being. Thanks to the pandemic, however, this simple biological function has been compromised for many infected people, and remains threatened for everyone else who’s susceptible to getting Covid-19.

But what if changing the way you breathe could potentially help protect you from the very thing that threatens your ability to breathe? That’s one theory some experts are suggesting. It has to do with the simple physiology of the nose, and the chemical compound nitric oxide (NO).

Aside from filtering, warming, and humidifying the air you breathe, the nose is your first line of defense against allergens and pathogens. The mucus and cilia inside are designed to block these outside invaders from going farther down the respiratory tract and making you sick. And NO, which is what the sinuses release when you breathe through your nose, is a vasodilator, meaning it relaxes the blood vessels and lowers blood pressure.

Doctors have been giving NO gas to people long before Covid-19 to help improve lung function in critically ill people suffering from adult respiratory distress syndrome (ARDS), according to Albert Rizzo, MD, Chief Medical Officer for the American Lung Association. There are currently 11 clinical trials in the U.S. and Canada testing whether administering NO can improve recovery time of people with Covid-19 by boosting oxygen levels. The gas may also help fight respiratory tract infections like Covid-19 by inactivating viruses and inhibiting their replication.

Several studies, including one from 2004 that focused on the effects of inhaling NO on the SARS coronavirus, have shown that the compound has antiviral properties. A recent analysis of 45 relevant studies supports this oxygenation boosting effect that North American researchers are trying to demonstrate. It also notes that naturally produced NO from nasal breathing seems to have similar antiviral effects. For example, one discussed study found that humans who exhale more NO have fewer common cold symptoms, which suggests that nasally-produced NO may help protect humans from other respiratory viruses like Covid-19.

“Your lungs do have to work harder at accessing the oxygen in the air that you’re breathing in through your mouth versus your nose.”

Conversely, habitual mouth breathing may actually increase susceptibility to the virus as well as its level of severity, according to the May analysis. It states that mouth breathing during sleep may worsen the symptoms of Covid-19, just as it worsens other respiratory illnesses like the common cold and the flu.

“You do lose some of the benefit of the filtering mechanisms and potentially some of the triggering of the immune system that might be triggered by particles that go through the membranes of the nose,” says Rizzo.

People tend to breathe more through their mouths when they’re stressed or their body is working hard, because it feels like you’re getting more air that way. However, according to Zara Patel, MD, a rhinologist and otolaryngologist at Stanford Medicine, the lungs can’t utilize this air as effectively, because it’s not warmed or humidified as it is when you breathe through your nose.

“Your lungs do have to work harder at accessing the oxygen in the air that you’re breathing in through your mouth versus your nose,” says Patel.

We’re all guilty of occasional mouth breathing, but a number of people are habitual mouth breathers out of necessity, due to an obstruction, abnormal sinuses, or chronic sinus congestion, to name a few potential conditions. According to Patel, some individuals are relatively uninhibited by habitual mouth breathing, but others end up developing side effects that range from uncomfortable to potentially detrimental.

Some of the milder effects include difficulty falling and staying asleep, dry mouth and throat, gum disease, bad breath, and snoring. The more long-term potential effects are changes in jaw shape and position and chronic respiratory problems such as sleep apnea, which can lead to pulmonary and cardiovascular complications down the road. “Your blood pressure, specifically in your pulmonary arteries, tends to go up over time if you have untreated sleep apnea, and that can lead to increased stress on your cardiovascular and pulmonary systems,” says Patel.

Author and journalist James Nestor became familiar with some of these effects within days of voluntarily plugging his nose as part of experimental research for his book, Breath: The New Science of a Lost Art. With the help of Jayakar Nayak, MD, an otolaryngologist at the Sinus Center at Stanford University who also runs a sinus research lab, Nestor conducted an informal study to find out what happens to the body when you only breathe through your mouth for an extended period of time.

“I said, ‘that’s going to be absolute torture for you, but I’m happy to do it,’” recalls Nayak. Aside from helping him block his nose comfortably using clips, Nayak monitored Nestor’s vitals regularly. “He wanted to make it as scientifically valid as possible,” says Nayak.

The experiment was initially supposed to last a month. Nestor could only make it 10 days.

Humans were designed to breathe through our noses, and Patel and Rizzo agree, nasal breathing is better than mouth breathing due to its filtration system and immune response.

“My blood pressure went up 20 points in the first day or two,” recalls Nestor. “I went from not snoring at all or snoring just a couple minutes throughout the night to snoring four hours a night.” According to Nestor, he eventually developed sleep apnea to the point where his blood/O2 levels hit 90–91% (the normal range is 95–100%). He even developed a nasal infection. A friend who did the experiment with him experienced nearly identical effects.

What was perhaps most interesting about the informal study was what happened when Nestor and his friend resumed nasal breathing. According to Nestor, almost immediately, their sleep apnea and snoring dissipated, and was completely gone within four days.

Humans were designed to breathe through our noses, and Patel and Rizzo agree, nasal breathing is better than mouth breathing due to its filtration system and immune response. However, over the centuries, perinasal sinuses and noses have shrunk, leading to more and more nasal breathing problems. For example, over 25 million Americans suffer from sleep apnea. That said, even though some nasal obstructions require surgical intervention, for the majority of people, there are steps to take to make nasal breathing easier.

These steps depend on whether you’re dealing with a blocked nose or simply a habit of mouth breathing. If the latter, start by becoming more aware of your breath. “It’s a conscious effort that you have to make in order to retrain what might have been a bad habit that you developed,” says Rizzo.

If you have chronic sinus congestion, Patel says to start by regularly flushing your nose with saline spray, which can be found at most drug stores. This helps moisten the nasal cavities and flushes out dust and other allergens. You can pair it with an inhaled decongestant spray if needed, but Patel cautions against just grabbing something over the counter, as some sprays have proven to be harmful over time, and instead advises consulting an ENT before buying. An ENT can also help you identify the source of your congestion, like a particular allergy, so the congestion can be treated more efficiently.

For people who think they have sleep apnea, Patel recommends participating in a sleep study (which you can do in the comfort of your own home), and if the results indicate sleep apnea, investing in a CPAP (Continuous Positive Airway Pressure) machine, which helps normalize breathing by opening up airways and even reducing inflammation in the nose.

Once the underlying cause of mouth breathing is rectified, you can try to more consciously breathe through your nose until it becomes second nature. “Mouth breathers should be encouraged to take a sip of water every hour and challenged to close their mouth afterwards,” as a nasal breathing practice says Joi Lucas, MD, a pediatric pulmonologist at Lakeland Regional Hospital in Florida. She also recommends setting an alarm as a reminder, and practicing slow, deep nasal breathing exercises periodically.

Nasal breathing will not ward off viruses like Covid-19 on its own, but it is one of your body’s built-in defense mechanisms against them. It should also just make you feel better all around. Considering the state of things, there’s no better time to make it a habit.

Elemental

Your life, sourced by science.

Written by

Allison Hirschlag

Writer of varying attitudes. Words at WaPo, Scientific American, Cosmo, Audubon, Weather,

Friday, 10 July 2020

Asthma Does Not Seem to Increase the Severity of COVID-19

Asthma Does Not Seem to Increase the Severity of COVID-19:

Asthma does not appear to increase the risk for a person contracting COVID-19 or influence its severity, according to a team of Rutgers researchers.

“Older age and conditions such as heart disease, high blood pressure, chronic obstructive pulmonary disease, diabetes and obesity are reported risk factors for the development and progression of COVID-19,” said Reynold A. Panettieri Jr., a pulmonary critical care physician and director of the Rutgers Institute for Translational Medicine and Science and co-author of a paper published in the Journal of Allergy and Clinical Immunology. “However, people with asthma — even those with diminished lung function who are being treated to manage asthmatic inflammation — seem to be no worse affected by SARS-CoV-2 than a non-asthmatic person. There is limited data as to why this is the case — if it is physiological or a result of the treatment to manage the inflammation.”
Panettieri discusses what we know about asthma and inflammation and the important questions that still need to be answered.

How might awareness of SARS-CoV-2 affect the health of people with asthma?
Since the news has focused our attention on the effects of COVID-19 on people in vulnerable populations, those with asthma may become hyper-vigilant about personal hygiene and social distancing. Social distancing could improve asthma control since people who are self-quarantined are also not as exposed to seasonal triggers that include allergens or respiratory viruses. There is also evidence that people are being more attentive to taking their asthma medication during the pandemic, which can contribute to overall health.

What effect might of inhaled steroids have on COVID-19 outcomes?
Inhaled corticosteroids, which are commonly used to protect against asthma attacks, also may reduce the virus’ ability to establish an infection. However, studies have shown that steroids may decrease the body’s immune response and worsen the inflammatory response. Steroids also have been shown to delay the clearing of the SARS and MERS virus — similar to SARS-CoV-2 — from the respiratory tract and thus may worsen COVID-19 outcomes. Future studies should address whether inhaled steroids in patients with asthma or allergies increase or decrease the risks of SARS-CoV-2 infection, and whether these effects are different depending on the steroid type.
In what way does age play a role in how asthma patients react to exposure to the virus?
A person’s susceptibility to and severity of COVID-19 infection increases with age. However, since asthma sufferers tend to be younger than those with reported high-risk conditions, age-adjusted studies could help us better understand if age is a factor in explaining why asthma patients may not be at greater risk for infection.

Children and young adults with asthma suffer mainly from allergic inflammation, while older adults who experience the same type of airway inflammation can also suffer from eosinophilic asthma — a more severe form. In these cases, people experience abnormally high levels of a type of white blood cell that helps the body fight infection, which can cause inflammation in the airways, sinuses, nasal passages and lower respiratory tract, potentially making them more at risk for a serious case of COVID-19.

In addition, an enzyme attached to the cell membranes in the lungs, arteries, heart, kidney and intestines that has been shown to be an entry point for SARS-CoV-2 into cells is increased in response to the virus. This enzyme is also thought to be beneficial in clearing other respiratory viruses, especially in children. How this enzyme affects the ability of SARS-CoV-2 to infect people with asthma is still unclear.

How might conditions in addition to asthma affect a person’s risk of infection?
Asthma tends to be associated with far fewer other conditions than chronic obstructive pulmonary disease or cardiovascular disease. If SARS-CoV-2 is a disease that causes dysfunction in the cells that line blood vessels throughout the body, then diabetes, heart disease, obesity and other diseases associated with this condition may make people more susceptible to the virus than those who are asthmatic. However, older people with asthma who also have high blood pressure, diabetes or heart disease may have similar instances of COVID-19 as non-asthmatics with those conditions.

Monday, 8 June 2020

The Secret Weapon Against Pandemics

The coronavirus pandemic won't be the last crisis to test public health systems worldwide, says physician and health policy leader Georges C. Benjamin. He details what's needed to lead us out of the pandemic and prevent future ones -- including a robust governmental health entity equipped with updated technology and well-trained staff -- and explains how citizens, businesses and political leaders can do their part to put public health first. (This virtual conversation, hosted by science curator David Biello and head of TED Chris Anderson, was recorded on May 20, 2020.) This talk was presented at an official TED conference, and was featured by our editors on the home page.

About the speakers Georges C. Benjamin · Executive Director, American Public Health Association One of the United States' most influential physician leaders, Georges C. Benjamin speaks passionately about the health issues that have the most impact on our nation today.

David Biello · TED science curator, author David Biello is TED's science curator and the author of "The Unnatural World: The Race to Remake Civilization in Earth's Newest Age." Chris Anderson · Head of TED After a long career in journalism and publishing,

Chris Anderson became the curator of the TED Conference in 2002 and has developed it as a platform for identifying and disseminating ideas worth spreading.

Friday, 1 May 2020

How to Talk to Children about Death During the COVID-19 Pandemic

How to Talk to Children about Death During the COVID-19 Pandemic:

Newswise: How to Talk to Children about Death During the COVID-19 Pandemic

David Schonfeld, MD, directs the National Center for School Crisis and Bereavement at Children's Hospital Los Angeles

Newswise — As the COVID-19 death toll in the United States climbs dramtically, parents and caregivers need to shy away from their protective instincts and prepare themselves for some open and candid conversations with grieving children about death. “For children to cope, adults need to help them understand that death is permanent and irreversible,” says David Schonfeld, MD, Director of the National Center for School Crisis and Bereavement at Children’s Hospital Los Angeles. “Kids need simple and straightforward answers, and an opportunity to share their feelings.”
At some point in their lives, all kids are going to experience the loss of a grandparent, a loved one, a friend, or hear about the death of a famous athlete or celebrity in the news media. “When that happens, kids generally want to talk about it; they want to engage parents in conversation. They want to understand it,” Schonfeld says. He adds that even very young children can understand death. “Research suggests that most children come to understand the concepts of death by 5 to 7 years of age; children at even younger ages can also understand death, especially after experiencing a personal loss.”
The pandemic raises its own set unique challenges for parents, given that families are self-quarantining, subject to safer at home orders, and normal routines, like school and work, have been disrupted.
“Social distancing measures, including lengthy school closures, increases the social isolation of grieving children, and makes it difficult to get support for your children,” says Schonfeld. “During the pandemic, families may find it very difficult to meet basic needs such as obtaining food, preparing meals, or providing supervision after the death of a parent or other caregiver, especially when the surviving adults are grieving and feeling overwhelmed by the pandemic.”
The usual outpouring of assistance, support, and companionship that would normally be provided by extended family, friends, neighbors, and members of the school community in the immediate aftermath of a death may not occur – funerals may need to be postponed and family and friends unable to visit, Schonfeld says.
Critical to the healing process will be helping children understand more about the current pandemic. “After the death of someone close, children often become more concerned about their health and that of others they care about,” he says. “The ability to reassure children that others close to them are healthy and not at risk of dying becomes challenging, even if the initial death was unrelated to the pandemic or any infectious disease. It becomes important to help children deal with their fears and concerns about the pandemic, in addition to any grief they may be experiencing after a personal loss.”
Schonfeld identifies four important concepts about death that are vital to understand for any child of any age.
1. Death is irreversible.
Children need to know that when people die, they don’t come back to life. It’s important to speak in clear, simple terms when explaining that death is permanent.
“We tend to make comments like, the person has ‘gone far away’ or is ‘up on the clouds,” which suggests the person will return,” says Dr. Schonfeld. “So, children may wait for the person to return or resent it when the person doesn’t return. They need to understand it’s irreversible so they can begin the mourning process.”
Schonfeld says that for very young kids using the phrase “all gone,” can help them understand that the person will not come back.
2. After death, all life functions end completely.
Make sure children understand that after death, all life functions stop working completely; the person’s body is not working any longer and the person doesn’t think or feel. Otherwise, children may worry that the person who died is still in pain or sad.
Schonfeld suggests explaining to children, “’When a person dies, his or her body stops working and it doesn’t start working again. So, the person doesn’t feel pain, is not hungry, is not scared.’ You can state it very simply.”
3. Death is inevitable.
Children need to understand that all living things eventually die.
When talking to children about death, Dr. Schonfeld says it’s tempting for a parent to say “Oh, I’ll never die” or “I’ll always be there,” but that can lead to confusion for kids. “If kids think that some people are immortal, it may mean that people who do die were chosen to die perhaps because they did something wrong.”
Teaching kids that all living creatures die is something that can be broached easily in nature. “Kids see examples [of death] all the time, like if you find a dead bird or there’s a spider that dies,” says Schonfeld. These are opportunities in everyday life to discuss the basic concepts of death with kids in a way that shows it’s a part of the lifecycle, and it can be done before they experience any personal loss.
3. Explain the cause of death.
While it’s not necessary to share too many details of a person’s death, providing children with an explanation of how or why a person died will make it less likely for kids to feel scared or guilty.
“Kids need an understanding of the physical reason why someone died,” says Schonfeld. “Guilt is also an extremely common reaction to loss. Kids may think, ‘I did something wrong and that’s why someone I loved died. Then that means I can just never do that again, and it shouldn’t happen again.’”
Although children may not say they feel guilty, Dr. Schonfeld advises that it’s a good idea to address that feeling when talking about death. “I always presume the guilt may be there, so I reassure children that there wasn’t anything that they should have done or could have done that would have changed the outcome.”
General Tips:

Speak clearly and plainly to kids. Don’t use euphemisms.

“It’s important that we use simple terminology and avoid jargon,” says Schonfeld. “The only reason that some expressions are felt to be comforting is they don’t really address what’s happened. But that’s just confusing for kids.”
Check back in with children to see if you’ve been clear; ask the child what he or she has understood about what you’ve said.

Ask children how they feel.

Give them many opportunities to talk about their emotions and different ways to express themselves, such as through drawing or painting.

Allow children to have their feelings.

“There is a tendency to try to cheer people up when they are grieving,” says Schonfeld. “When people witness grief, it makes them uncomfortable, so they want the person to stop demonstrating their distress. But we can’t really help kids cope if we don’t give them permission to express those feelings.”

Model ways to cope with grief.

“Allow your child to own their feelings, and then share a little bit about your feelings and how you have coped with loss,” advises Schonfeld. “You can say, ‘I remember hearing about this [death or tragedy] and I felt very [sad]. What I did was I talked to your mom about it and that made me feel better.’

“You’re sharing coping strategies like talking to people you care about or remembering a positive memory of the person who died,” says Schonfeld. “We need to demonstrate that we have the same authentic feelings and show kids some of the strategies we use to cope with those feelings.”

Understand that every child grieves differently.

Young children don’t sustain intense feelings of grief for long periods, so they may cry or yell, then go play. This is typical for grieving children.
Teenagers may express grief as sadness or anger. This is also quite common

Teens still need to be parented.

Teens tend to turn to their peers to talk about important topics—but during challenging times like grieving a death, teens really do need parent presence and discussion. “They may be reluctant to talk about it because it’s uncomfortable, or they may not want to burden their parents by upsetting them and raising the topic,” says Schonfeld. “But they still need an explanation of what happened, and support.”

Schonfeld also advises parents not to forget that teenagers are still children; although they are more mature and responsible than younger kids, adolescents should not be the primary support system for grieving parents. “Adults need to look for outside support for themselves,” says Dr. Schonfeld.

Grief changes over time.

“When someone dies, you lose that person and that is the primary loss. But you also lose everything the person could have done or might have done for you in the future; those are all the secondary losses,” says Schonfeld. “Young kids who lose someone significant don’t appreciate the secondary losses right away. As they get older, kids grow into realizing all that they have lost. That’s relevant because it doesn’t matter how well you explain [a death] to a child at age 5 or 10, there will be more questions when they are older, 15, 20 or 25.

Additional resources:
--The National Center for School Crisis and Bereavement has a COVID-19 Pandemic Resources webpage that includes a 15-minute presentation for parents on how to talk to and support children during a pandemic.

--Many children’s bereavement programs across the country are quickly adapting to the pandemic by providing virtual groups and/or individual support. Contact the organizations in your area to see how they can assist. Check the National Bereavement Resource Guide: State by State Bereavement Listing complied by New York Life and eluna for a list of bereavement organizations in your state to identify local support for bereaved children and their families.

--Reach out to your pediatrician or mental health professionals by email or phone to obtain additional support. Ask your children’s teacher to connect you with school mental health professionals who can talk with you by phone while schools are closed.

--For further information on how to provide support to grieving children during the pandemic, visit the COVID-19 Pandemic Resources webpage of the National Center for School Crisis and Bereavement. You can also download a free booklet: After a Loved One Dies – How children grieve and how parents and other adults can support them developed by the Coalition to Support Grieving Students.

Friday, 17 April 2020

Making the Most of Your Groceries During the Coronavirus Pandemic

Making the Most of Your Groceries During the Coronavirus Pandemic:

Tara Harman, RDN, has tips on how to stretch your groceries while saving money.

14-Apr-2020 4:00 PM EDT, by University of Alabama at Birmingham

Newswise: Making the Most of Your Groceries During the Coronavirus Pandemic

UAB

Chicken Salad Sandwich Recipe

Newswise — BIRMINGHAM, Ala. – The coronavirus pandemic is causing more Americans to buy groceries and eat from home, but what happens when you are running short on essential items or your budget begins to dwindle?

Fortunately, Tara Harman, RDN, an instructor with the University of Alabama at Birmingham’s Department of Nutrition Sciences, has tips on how to stretch your groceries while saving money.
“It’s hard for anyone to change their usual grocery shopping and food habits in a flash, but COVID-19 is forcing all of us to reconsider how and what we’re eating,” Harman said. “If you’re on a tight budget, buying in bulk so you’re taking fewer trips to the grocery store might seem like an impossible or simply unreasonable ask.”

But, Harman says preparing a shopping list in advance that balances non-perishable (canned or frozen) and perishable food items (dairy products and fresh produce) and aims to repurpose ingredients for multiple meals can help.

“For example, rather than relying on deli cuts of meat to make sandwiches during the day, consider buying less perishable — and also less expensive — foods like canned white meat chicken to make chicken salad for sandwiches,” she said. “Dry chicken salad is the worst, so rather than forgoing mayonnaise to save money, purchase whole milk yogurt instead.”

Harman says yogurt is versatile, and she recommends serving it for breakfast or a snack.
“Still in the spirit of less perishable, less expensive items, you can top it with sliced peaches from a can to add a little more flavor and nutrition,” Harman said.

Harman adds that buying primarily non-perishable food items is an affordable way to build meals for an entire week, especially during this pandemic. But, by adding in some perishable, fresh food items with these shelf-stable staples, you create a healthy balance that satisfies both food cravings and budget concerns.

Coronavirus COVID-19 Nutrition Grocery Shopping