Ohio couple dies of coronavirus minutes apart, family says: ‘Our hearts are shattered’

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Dick and Shirley Meek, married for over 70 years, were holding hands as they died within minutes of each other due to the novel coronavirus. Their favorite music played gently in the background.

“It was a beautiful passing,” reads an obituary from Fischer Funeral Home. “Theirs was a love story for the ages. They had a fairytale ending…Our hearts are shattered, but we are at peace knowing that they are together forever.”

The Ohio couple, aged 89 and 87, died on Jan. 16 about one week after they tested positive for coronavirus and were admitted to Riverside Hospital in Columbus, per local news outlet WBNS. They were scheduled to receive the vaccine three days later.

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MICHIGAN COUPLE DIES OF CORONAVIRUS SECONDS APART

“Mom passed first,” said Debbie Howell, a daughter to the couple. “They were holding hands. The nurse put mom’s head on my dad’s shoulder and she said to dad ‘Dick it’s OK to let go now. Shirley’s waiting for you’ and he passed within minutes.”

Howell and her sisters Vicki Harper and Kelly Meek told WBNS precautions were eased to celebrate the couple’s 70th wedding anniversary on Dec. 22, and then the pair developed colds. After their conditions quickly deteriorated at the hospital, and no treatment options were left, the hospital staff agreed to let the couple share a room so they could be with one another.

The obituary describes the couple as childhood sweethearts, who led lives of love and passion.

“Theirs was a life of adventure – from sky diving to zip-lining, their bucket list was amazing!! Having devout love for family, they still always made time for each other. They met every single day, no matter where they were in the world, at 3:00 for a date and a toast to each other,” the obituary reads.

“We have years of warm memories of holiday parties, backyard cookouts, vacations, birthdays, days on the beach, annual Meek Family Game Show nights, making silly family videos, water skiing and boating, love, laughter and togetherness. Our life together with them as inspiration was a wild and crazy ride!!”

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The daughters shared the couple’s story to urge others to stay safe amid the virus.

Dick, or Edwin Richard, Meek had served in the U.S. Air Force as a Sergeant and was a carpenter, while Shirley worked 25 years at Burger Chef and was a great cook and homemaker, per the obituary.

They are survived by five children, 13 grandchildren, 28 great-grandchildren as well as nieces and nephews.

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‘Some Evidence’ That New U.K. COVID Strain May Be More Deadly but Data Is 'Not Yet Strong'

Leaders in the United Kingdom are warning that there is "some evidence" that the new, highly contagious COVID-19 strain that has reached the U.S. may be more lethal than previously thought.

When the strain first emerged in the U.K. at the end of 2020, Prime Minister Boris Johnson said that it appeared to spread more quickly than other COVID-19 variants but was not more severe or deadly. Speaking Friday, though, Johnson said that new research is showing that it "may be more deadly," though he emphasized that "both vaccines we're currently using [from Pfizer and AstraZeneca] remain effective both against the old variant and this new variant."

"In addition to spreading more quickly, it also now appears that there is some evidence that the new variant — the variant that was first identified in London and the south east — may be associated with a higher degree of mortality," Johnson said in a news conference, according to BBC News.

However, the U.K.'s chief scientific advisor, Patrick Vallance, cautioned at the news conference that the data on this is "not yet strong."

"I want to stress that there's a lot of uncertainty around these numbers and we need more work to get a precise handle on it, but it obviously is a concern that this has an increase in mortality as well as an increase in transmissibility," Vallance said.

Researchers in the U.K. had previously said that the strain, labeled as B.1.1.7, appears to spread about 30 to 70% faster than other COVID-19 variants, but when they looked at the death rates from hospitals those infected with the variant were no more likely to die than other COVID-19 patients.

This new research looked at anyone in the U.K. who was infected with the B.1.1.7 variant, whether or not they went to the hospital, and found that it led to around 30% more deaths.

"If you took … a man in their 60s, the average risk is that for 1,000 people who got infected, roughly 10 would be expected to unfortunately die with the virus. With the new variant, for 1,000 people infected roughly 13 or 14 people might be expected to die," Vallance said.

Johnson instituted a lockdown in the U.K. just before Christmas, after the strain led to a soaring rate of infection in the country. The first case with the B.1.1.7 was found in the U.S. shortly after, and as of Jan. 20 the Centers for Disease Control has identified 144 cases nationwide, however officials at the federal health agency believe that the actual number of cases is higher and growing.

The CDC said Jan. 15 that it expects the strain to become the dominant COVID-19 variant by March, potentially driving infections and deaths higher at a time when they are already well out of control in the U.S.

As of Jan. 22, more than 24,688,100 Americans have tested positive for COVID-19, and at least 410,336 people have died from the virus, according to The New York Times. In the U.K., cases are now on the decline following the lockdown, but deaths have increased by 71% in the last two weeks, with a record-breaking 1,820 deaths on Jan. 20. As of Jan. 22, more than 3,543,600 people in the U.K. have tested positive for COVID-19, and at least 94,580 have died.

As information about the coronavirus pandemic rapidly changes, PEOPLE is committed to providing the most recent data in our coverage. Some of the information in this story may have changed after publication. For the latest on COVID-19, readers are encouraged to use online resources from the CDC, WHO and local public health departments. PEOPLE has partnered with GoFundMe to raise money for the COVID-19 Relief Fund, a GoFundMe.org fundraiser to support everything from frontline responders to families in need, as well as organizations helping communities. For more information or to donate, click here.

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Meghan Trainor Reveals Another Pregnancy Complication at 36 Weeks

Pregnancy isn’t easy for anyone, and right now, no one knows that better than Meghan Trainor. The Grammy winner recently revealed on Instagram that at 36 weeks pregnant, her baby is in a breech position. But she’s doing what she can to remedy the situation.

Trainor shared a beautiful pregnancy photo in which she looked like nothing less than a fertility goddess in the flesh with an update in the caption.

“Preggo update: Baby is breech again at 36 weeks so I’ve been laying upside down on my couch every day lol,” she wrote. “Other than that, we are doing amazing and we’re ready to meet this baby!!!! Also nowadays I don’t look anything like this but damn we looked good this day🤣 big thanks to the team!! 💚”

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A post shared by Meghan Trainor (@meghan_trainor)

 

According to the American College of Obstetricians and Gynecologists, by 36-37 weeks, most babies turn on their own into a head-down position. When babies remain feet or bottom down, it’s referred to as breech position and can result in delivery complications or a switch from a vaginal birth plan to a surgical one. In some cases, an obstetrician can manually rotate the baby but if that’s not successful, a C-section is usually recommended.

Earlier in her pregnancy, Trainor was diagnosed with gestational diabetes, which affects 2-10 percent of pregnancies each year. Gestational diabetes (GD) is caused when the body can’t synthesize enough insulin, which results in high blood sugar. If it goes unmanaged, GD can cause premature birth and other pregnancy complications.

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A post shared by Meghan Trainor (@meghan_trainor)

Trainor, who will be a first-time mom, has been candid about her difficult pregnancy. She spoke with the Today show in December 2020 and described her diagnosis and management plan. “Got a little little tiny bump in the road — I got diagnosed with gestational diabetes, but it’s manageable and it’s OK and I’m healthy and the baby’s healthy,” Trainor explained in an interview with NBC’s Joe Fryer. “I just have to really pay attention to everything I eat. It’s nice to learn so much about food and health and nice to hear that so many women experienced this.”

Celebrate the beauty of different breastfeeding journeys through these photographs.

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Harnessing the power of machine learning to improve urology care

Harnessing the power of machine learning to improve urology care

Urodynamics—a group of tests that evaluate how well the body collects, and then releases, urine—can be crucial for diagnosing urologic problems, particularly in children with spinal cord defects and other neurologic conditions. While urodynamics can provide clinicians with a rich set of data, the interpretation of these tests remains unstandardized. That can make it challenging for urologists to reliably read and analyze the results, says Hsin-Hsiao Scott Wang, MD, MPH, MBAn, a urologist in the Urodynamics Program at Boston Children’s Hospital.

To address this issue, Wang and his colleagues have developed a predictive model based on machine learning algorithms. This approach promises to improve physicians’ ability to accurately identify detrusor overactivity (DO), a urodynamics finding in which the bladder’s detrusor muscle contracts uncontrollably. Drawing from an archive of 799 urodynamics studies performed at Boston Children’s between 2013 and 2019, they identified five representative patterns of DO. They then created an algorithm and evaluated its performance in predicting DO.

Their results, published November 18, 2020, in Neurourology and Urodynamics, show that this predictive model had great performance with area under the curve over 0.8 and an overall accuracy of 81.35 percent, a sensitivity of 76.92 percent, and a specificity of detecting DO events of 81.41 percent. “We hope this can serve as the cornerstone and basis for future research marrying artificial intelligence (AI) and urodynamics,” says Wang.

Personalizing UTI workups in children

Machine learning also shows promise for helping to personalize the evaluation and treatment of children with urinary tract infections (UTIs). Children with febrile UTIs are at increased risk for anatomical abnormalities, including vesicoureteral reflux (VUR), which in turn is associated with recurrent pyelonephritis and renal scarring. However, it can be challenging to determine which children with UTIs should undergo further evaluation with a voiding cystourethrogram.

For a July 2019 study, Wang and his colleagues in Boston Children’s Department of Urology developed and applied a predictive model to data from 500 pediatric UTI patients. They found that this model predicted recurrent UTIs associated with VUR with very robust performance. The novel machine learning algorithm has the potential to further personalize the treatment of children with an initial UTI and identify those most likely to benefit from further evaluation. The model is now available as a free app called PredictVUR. Preliminary analysis shows that this model has helped tremendously for patient counsel and shared decision making in UTI children management.

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100-year-old World War II veteran becomes 1 millionth Florida senior citizen to receive coronavirus vaccine

A 100-year-old World War II veteran becomes the 1 millionth senior to receive the coronavirus vaccine in Florida, live on

A 100-year-old World War II veteran from Florida became the state’s one-millionth senior citizen to receive the coroonavirus vaccine Friday on “Fox & Friends.”

With Gov. Ron DeSantis looking on, Henry Sayler got the life-saving shot on live television. Nearly two-thirds of the state’s shots thus far have gone to senior citizens.

“I didn’t feel a thing,” he said after receiving the vaccination. “I just want to say how happy we are to live in the No. 1 state in the union and have the No. 1 governor in the union.”

Sayler is also a former GOP state senator who counts astronaut Buzz Aldrin and pilot Charles Lindbergh among his acquaintances.

“He’s an American hero,” DeSantis said, adding Sayler still had a good physique for someone his age.

“This is a handsome individual, and people know it.”

The Republican governor touted Florida’s prioritization of the state’s large senior population but called for the federal government to send more vaccines than it has on a weekly basis.

The Fox & Friends hosts, which included veteran Pete Hegseth, thanked Sayler for his lifetime of service.

Fox News meteorologist Janice Dean, who has quarreled with Democratic New York Gov. Andrew Cuomo over his handling of the coronavirus vaccine with regard to seniors, was visibly moved after Sayler received the shot.

“Amazing,” Dean said. “Seniors first.”

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The Biden administration has set a goal of injecting 100 million Americans in the first 100 days, which would be roughly the current rate the country is on of 1 million per day.

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When will the world be vaccinated against COVID-19?

COVID-19

The global effort to find vaccines for COVID-19 has been incredibly successful, with multiple vaccines demonstrating high efficacy in clinical trials less than a year after the disease was discovered.

But it will take several years to manufacture and distribute enough vaccine doses to cover the almost eight billion people on earth.

Current estimates are that it will probably take well into 2023-24 for everyone who needs a vaccine to receive one.

So how should the global community prioritize the distribution of vaccines to give us the best chance of ending the pandemic and saving lives?

Decisions on how to prioritize vaccine doses have to balance the needs in each country, and the world.

COVID-19 vaccines will have the biggest impact on reducing strain on our health services, and reducing restrictions on other parts of society, if we use them to protect the most vulnerable first.

It’s a bit like if you had a family gathering of nine relatives, but you only have three doses of a vaccine now, you’re expecting three more in six months and three more next year. You’d have to decide who to vaccinate first, second and third.

You would probably give it to your grandparents first, because they would be most at risk of dying from COVID-19.

Once they’ve had it, you could see them with much less risk of hurting them.

But what if you had a sibling with asthma? Or those most likely to be traveling around who might bring it into the house from outside?


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The World Health Organization have a recommended priority order starting with health care workers, the oldest (who are most at risk of serious illness and death) and those who are vulnerable due to other health conditions. Most countries are basing their response on this. As more vaccine doses become available, it will be possible to work down by age and vulnerability range. We may also need to review recommendations taking into account new virus variants and outbreaks that occur due to them

It’s a tricky decision for which there is no way to make everyone happy, but most countries now have a clear plan in place.

The global perspective

It’s vital that we think globally as well as nationally when distributing the vaccine. Without worldwide measures, COVID-19 could remain active, and continue to spread.

A virus often mutates and creates new strains as it spreads. We have seen this play out in recent weeks, with two highly transmissible new strains being found in the UK and South Africa, increasing the number of patient cases. Although mutations will always occur, by limiting the presence of the virus worldwide we can reduce both the spread of all strains, and help reduce the risk of new strains forming that could further threaten the global population.

We need to quickly distribute the vaccines to the most vulnerable people, everywhere, and then to the remaining population. If some countries hoard the vaccines, doses will be less available to others.

COVAX is a global initiative that’s been designed to help create global vaccine access. Its aim is to provide 2 billion doses by the end of 2021, with the aim of providing coverage to at least 20% of the population in 195 countries across the world, from X to Y to Z. COVAX needs support from governments around the world to provide critical funds to make sure its work can continue.

Economic recovery is predicted to take much longer if we don’t distribute the vaccines around the world, because we cannot have a healthy global economy if there is still a risk of COVID-19 spreading. By using the vaccines fairly, it’s estimated we could see economic benefits of up to $466 billion in the next five years.

The good news

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Trump’s Pardons Included Health Care Execs Behind Massive Frauds

At the last minute, President Donald Trump granted pardons to several individuals convicted in huge Medicare swindles that prosecutors alleged often harmed or endangered elderly and infirm patients while fleecing taxpayers.

“These aren’t just technical financial crimes. These were major, major crimes,” said Louis Saccoccio, chief executive officer of the National Health Care Anti-Fraud Association, an advocacy group.

The list of some 200 Trump pardons or commutations, most issued as he vacated the White House this week, included at least seven doctors or health care entrepreneurs who ran discredited health care enterprises, from nursing homes to pain clinics. One is a former doctor and California hospital owner embroiled in a massive workers’ compensation kickback scheme that prosecutors alleged prompted more than 14,000 dubious spinal surgeries. Another was in prison after prosecutors accused him of ripping off more than $1 billion from Medicare and Medicaid through nursing homes and other senior care facilities, among the largest frauds in U.S. history.

“All of us are shaking our heads with these insurance fraud criminals just walking free,” said Matthew Smith, executive director of the Coalition Against Insurance Fraud. The White House argued all deserved a second chance. One man was said to have devoted himself to prayer, while another planned to resume charity work or other community service. Others won clemency at the request of prominent Republican ex-attorneys general or others who argued their crimes were victimless or said critical errors by prosecutors had led to improper convictions.

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Trump commuted the sentence of former nursing home magnate Philip Esformes in late December. He was serving a 20-year sentence for bilking $1 billion from Medicare and Medicaid. An FBI agent called him “a man driven by almost unbounded greed.” Prosecutors said that Esformes used proceeds from his crimes to make a series of “extravagant purchases, including luxury automobiles and a $360,000 watch.”

Esformes also bribed the basketball coach at the University of Pennsylvania “in exchange for his assistance in gaining admission for his son into the university,” according to prosecutors.

Fraud investigators had cheered the conviction. In 2019, the National Health Care Anti-Fraud Association gave its annual award to the team responsible for making the case. Saccoccio said that such cases are complex and that investigators sometimes spend years and put their “heart and soul” into them. “They get a conviction and then they see this happen. It has to be somewhat demoralizing.”

Tim McCormack, a Maine lawyer who represented a whistleblower in a 2007 kickback case involving Esformes, said these cases “are not just about stealing money.”

“This is about betraying their duty to their patients. This is about using their vulnerable, sick and trusting patients as an ATM to line their already rich pockets,” he said. He added: “These pardons send the message that if you are rich and connected and powerful enough, then you are above the law.”

The Trump White House saw things much differently.

“While in prison, Mr. Esformes, who is 52, has been devoted to prayer and repentance and is in declining health,” the White House pardon statement said.

The White House said the action was backed by former Attorneys General Edwin Meese and Michael Mukasey, while Ken Starr, one of Trump’s lawyers in his first impeachment trial, filed briefs in support of his appeal claiming prosecutorial misconduct related to violating attorney-client privilege.

Trump also commuted the sentence of Salomon Melgen, a Florida eye doctor who had served four years in federal prison for fraud. That case also ensnared U.S. Sen. Robert Menendez (D-N.J.), who was acquitted in the case and helped seek the action for his friend, according to the White House.

Prosecutors had accused Melgen of endangering patients with needless injections to treat macular degeneration and other unnecessary medical care, describing his actions as “truly horrific” and “barbaric and inhumane,” according to a court filing.

Melgen “not only defrauded the Medicare program of tens of millions of dollars, but he abused his patients — who were elderly, infirm, and often disabled — in the process,” prosecutors wrote.

Prosecutors said the scheme raked in “a staggering amount of money.” Between 2008 and 2013, Medicare paid the solo practitioner about $100 million. He took in an additional $10 million from Medicaid, the government health care program for low-income people, $62 million from private insurance, and approximately $3 million in patients’ payments, prosecutors said.

In commuting Melgen’s sentence, Trump cited support from Menendez and U.S. Rep. Mario Diaz-Balart (R-Fla.). “Numerous patients and friends testify to his generosity in treating all patients, especially those unable to pay or unable to afford healthcare insurance,” the statement said.

In a statement, Melgen, 66, thanked Trump and said his decision ended “a serious miscarriage of justice.”

“Throughout this ordeal, I have come to realize the very deep flaws in our justice system and how people are at the complete mercy of prosecutors and judges. As of today, I am committed to fighting for unjustly incarcerated people,” Melgen said. He denied harming any patients.

Faustino Bernadett, a former California anesthesiologist and hospital owner, received a full pardon. He had been sentenced to 15 months in prison in connection with a scheme that paid kickbacks to doctors for admitting patients to Pacific Hospital of Long Beach for spinal surgery and other treatments.

“As a physician himself, defendant knew that exchanging thousands of dollars in kickbacks in return for spinal surgery services was illegal and unethical,” prosecutors wrote.

Many of the spinal surgery patients “were injured workers covered by workers’ compensation insurance. Those patient-victims were often blue-collar workers who were especially vulnerable as a result of their injuries,” according to prosecutors.

The White House said the conviction “was the only major blemish” on the doctor’s record. While Bernadett failed to report the kickback scheme, “he was not part of the underlying scheme itself,” according to the White House.

The White House also said Bernadett was involved in numerous charitable activities, including “helping protect his community from COVID-19.” “President Trump determined that it is in the interests of justice and Dr. Bernadett’s community that he may continue his volunteer and charitable work,” the White House statement read.

Others who received pardons or commutations included Sholam Weiss, who was said to have been issued the longest sentence ever for a white collar crime — 835 years. “Mr. Weiss was convicted of racketeering, wire fraud, money laundering, and obstruction of justice, for which he has already served over 18 years and paid substantial restitution. He is 66 years old and suffers from chronic health conditions,” according to the White House.

John Davis, the former CEO of Comprehensive Pain Specialists, the Tennessee-based chain of pain management clinics, had spent four months in prison. Federal prosecutors charged Davis with accepting more than $750,000 in illegal bribes and kickbacks in a scheme that billed Medicare $4.6 million for durable medical equipment.

Trump’s pardon statement cited support from country singer Luke Bryan, said to be a friend of Davis’.

These treatments “involved sticking needles in their eyes, burning their retinas with a laser, and injecting dyes into their bloodstream.”

“Notably, no one suffered financially as a result of his crime and he has no other criminal record,” the White House statement reads.

“Prior to his conviction, Mr. Davis was well known in his community as an active supporter of local charities. He is described as hardworking and deeply committed to his family and country. Mr. Davis and his wife have been married for 15 years, and he is the father of three young children.”

CPS was the subject of a November 2017 investigation by KHN that scrutinized its Medicare billings for urine drug testing. Medicare paid the company at least $11 million for urine screenings and related tests in 2014, when five of CPS’ medical professionals stood among the nation’s top such Medicare billers.

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Global demand for cancer surgery set to grow by almost 5 million procedures within 20 years

cancer

Demand for cancer surgery is expected to increase from 9.1 million to 13.8 million procedures over the next twenty years, requiring a huge increase in the workforce including nearly 200,000 additional surgeons and 87,000 anaesthetists globally. With access to post-operative care strongly linked to lower mortality, improving care systems worldwide must be a priority in order to reduce disproportionate number of deaths following complications.

The findings of the two studies, published in The Lancet and The Lancet Oncology, highlight an urgent need to improve cancer surgery provision in low- and middle income countries, while also scaling-up their workforces in order to cope with increasing demand. Until now, a lack of data examining outcomes of cancer surgery in different income settings, and an absence of evidence-based estimates of future demand, had limited efforts to improve cancer care globally.

Cancer is a leading cause of death and disability globally, and exerts substantial economic impacts, with recent evidence suggesting a disproportionate burden of disease in LMICs. With more than half of cancer patients predicted to require surgery at some stage, it is a pivotal component of multidisciplinary care globally and plays a key role in preventing deaths. A 2015 study estimated that US$6.2 trillion in global GDP could be lost by 2030 if surgical cancer systems are not improved.

While the new studies did not assess impacts of COVID-19, the authors acknowledge that the delivery of high-quality post-operative care is more challenging during the pandemic.

Increasing future demand

The Article in The Lancet Oncology journal is a modelling study of global demand for cancer surgery and estimated surgical and anaesthesia workforce requirements between 2018 and 2040.

Using best-practice guidelines, patient characteristics and cancer stage data, the authors calculated the proportion of newly diagnosed cancer cases requiring surgery in 183 countries. To predict future surgery demand, they applied these rates to GLOBACAN cancer incidence predictions from 2018 to 2040.

The team’s analysis estimates that the number of cancer cases requiring surgery globally each year will rise from 9.1 million to 13.8 million (52%, an increase of 4.7 million) from 2018 to 2040. The greatest relative increase will occur in 34 low-income countries, where the number of cases requiring surgery is expected to more than double by 2040 (314,355 cases to 650,164, 107%).

Current and future surgical and anaesthesia workforces needed for the optimal delivery of cancer surgery services were also predicted using staffing estimates based on optimal surgical use in high-income countries as a benchmark for global requirements. To evaluate staffing gaps, the optimal estimated workforce (median workforce of 44 high-income countries) was compared with numbers of surgeons and anaesthetists in each country.

The authors estimate there is currently a global shortage of 199,000 (56%) surgeons and 87,000 (51%) anaesthetists (current workforce of 766,000 surgeons and 372,000 anaesthetists, compared with 965,000 and 459,000 optimal workforce, respectively, estimated by the team’s model). The gap is estimated to be greatest in low-income countries, where the current surgeon availability is 22,000 fewer than the model estimated optimal number of 28,000 surgeons. The current number of anaesthetists in low-income countries falls 11,000 below the model estimated demand of 13,000 anaesthetists.

In recognition of the rising global demand for cancer surgery, estimates were calculated for the optimal surgical and anaesthesia workforces needed in 2040. Extrapolating 2018 data, taking account of predicted future cancer incidence burden in each country, revealed that the surgical workforce will need to increase from 965,000 in 2018 to 1,416,000 (47% increase) in 2040. The anaesthetist workforce would need to rise from 459,000 in 2018 to 674,000 (47% increase) in 2040.

The greatest relative increase in optimal workforce requirements from 2018 to 2040 will occur in low-income countries, where surgeon numbers are required to rise from 28,210 to 58,219 by 2040 (106%). Anaesthetist numbers will also need to increase from 13,000 to 28,000 by 2040 (115%).

However, to match the current benchmark of high-income countries, the actual number of surgeons in low-income countries would need to increase almost 400% (increase from 6,000 to 28,000), and anaesthetists by nearly 550% (increase from 2,000 to 13,000), of their baseline values. This is because the current workforce in these countries is already substantially smaller than in high-income countries.

Dr. Sathira Perera, from the University of New South Wales, Australia, said: “Our analysis has revealed that, in relative terms, low-income countries will bear the brunt of increased future demand for cancer surgery, bringing with it a need to substantially increase numbers of surgeons and anaesthetists. These findings highlight a need to act quickly to ensure that increasing workforce requirements in low-income countries are adequately planned for. There needs to be an increased focus on the application of cost-effective models of care, along with government endorsement of scientific evidence to mobilise resources for expanding services.”

Estimates in the study relied on several assumptions. Predictions of future cancer rates were based on 2018 estimates, however, country-level changes—such as economic developments or altered capacity to screen for early diagnosis—could alter cancer incidence and therefore surgical demand and workforce requirements. Observed gaps in the workforce could also be narrower than the actual gaps in practice, as predictions were conservative because they only considered initial surgical encounters and did not account for any follow-up interactions.

Cancer surgery outcomes

The Article in The Lancet is an observational study exploring global variation in post-operative complications and deaths following surgery for three common cancers.

Deaths among gastric cancer patients were nearly four times higher in low/lower middle-income countries (33 deaths among 326 patients, 3.72 odds of death) than high-income countries (27 deaths among 702 patients).

Patients with colorectal cancer in low/lower middle-income countries were also more than four times more likely to die (63 deaths among 905 patients, 4.59 odds of death), compared with those in high-income countries (94 deaths among 4,142 patients). Those in upper middle-income countries were two times as likely to die (47 deaths among 1,102 patients, 2.06 odds of death) as patients in high-income countries.

No difference in 30-day mortality was seen following breast cancer surgery.

Similar rates of complications were observed in patients across all income groups, however those in low/lower middle-income countries were six times more likely to die within 30 days of a major complication (96 deaths among 133 patients, 6.15 odds of death), compared with patients in high-income countries (121 deaths among 693 patients). Patients in upper middle-countries were almost four times as likely to die (58 deaths among 151 patients, 3.89 odds of death) as those in high-income countries.

Patients in upper middle-income and low/lower middle-income countries tended to present with more advanced disease compared with those in high-income countries, however researchers found that cancer stage alone explained little of the variation in mortality or post-operative complications.

Between April 2018 and January 2019, researchers enrolled 15,958 patients from 428 hospitals in 82 countries undergoing surgery for breast, colorectal or gastric cancer. 57% of patients were from high-income countries (9,106 patients), with 17% from upper middle-income countries (2,721 patients), and 26% from low/lower middle-income countries (4,131 patients). 53% (8,406) of patients underwent surgery for breast cancer, 39% (6,215) for colorectal cancer, and 8% (1,337) for gastric cancer.

Assessing hospital facilities and practices across the different income groups revealed that hospitals in upper middle-income and low/lower middle-income countries were less likely to have post-operative care infrastructure (such as designated post-operative recovery areas and consistently available critical care facilities) and cancer care pathways (such as oncology services). Further analysis revealed that the absence of post-operative care infrastructure was associated with more deaths in low/lower middle-income countries (7 to 10 more deaths per 100 major complications) and upper middle-income countries (5 to 8 more deaths per 100 major complications).

Professor Ewen Harrison, of the University of Edinburgh, UK, said: “Our study is the first to provide in-depth data globally on complications and deaths in patients within 30 days of cancer surgery. The association between having post-operative care and lower mortality rates following major complications indicates a need to improve care systems to detect and intervene when complications occur. Increasing this capacity to rescue patients from complications could help reduce deaths following cancer surgery in low- and middle-income countries.

“High quality all-round surgical care requires appropriate recovery and ward space, a sufficient number of well-trained staff, the use of early warning systems, and ready access to imaging, operating theatre space, and critical care facilities. While in this study it wasn’t possible to assess cancer patients’ full healthcare journey, we did identify several parts of the surgical health system, as well as patient-level risk factors, which could warrant further study and intervention.”

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Study finds genetic clues to pneumonia risk and COVID-19 disparities

pneumonia

Researchers at Vanderbilt University Medical Center and colleagues have identified genetic factors that increase the risk for developing pneumonia and its severe, life-threatening consequences.

Their findings, published recently in the American Journal of Human Genetics, may aid efforts to identify patients with COVID-19 at greatest risk for pneumonia, and enable earlier interventions to prevent severe illness and death.

Despite the increasing availability of COVID-19 vaccines, it will take months to inoculate enough people to bring the pandemic under control, experts predict. In the meantime, thousands of Americans are hospitalized and die from COVID-19 each day.

“This study is so important because we performed analyses separately in participants of Caucasian ancestry as well as African ancestry to identify genetic risk factors contributing to pneumonia susceptibility and severity,” said Jennifer “Piper” Below, Ph.D., associate professor of Medicine and the paper’s corresponding author.

“Combined with systemic racism and socioeconomic factors that have been reported by others, these genetic risk differences may contribute to some of the disparities we observe in COVID-19 outcomes,” Below said.

The researchers conducted genome-wide association studies (GWAS) of more than 85,000 patients whose genetic information is stored in VUMC’s BioVU biobank and which has been linked to “de-identified” electronic health records stripped of personal identifying information. GWAS can identify associations between genetic variations and disease.

With colleagues from the University of North Carolina at Chapel Hill, the University of Texas MD Anderson Cancer Center in Houston, and the Icahn School of Medicine at Mount Sinai in New York, the VUMC researchers identified nearly 9,000 cases of pneumonia in patients of European ancestry, and 1,710 cases in patients of African ancestry.

The strongest pneumonia association in patients of European ancestry was the gene that causes cystic fibrosis (CF). This disease produces abnormally thick mucus leading to chronic infections and progressive respiratory failure.

In patients of African ancestry, the strongest pneumonia association was the mutation that causes sickle cell disease (SCD), a red blood cell disorder that increases the risk for pneumonia, influenza and acute respiratory infections.

Children with CF and SCD are at particular risk for severe disease if they contract COVID-19.

The researchers found that “carriers” who are unaffected by CF yet carry a copy of the CF gene had a heightened susceptibility to pneumonia, and those who are unaffected by SCD yet carry a copy of the SCD mutation were at increased risk for severe pneumonia.

Further studies will be needed to determine whether these carriers also bear “a silent, heightened risk for poor outcomes from COVID-19,” the researchers said.

To identify other genetic variations that increase pneumonia risk, they removed patients with CF and SCD from their analysis, repeated the GWAS, and used another technique called PrediXcan, which correlates gene expression data with traits and diseases in the electronic health record.

This time they found a pneumonia-associated variation in a gene called R3HCC1L in patients of European ancestry, and one near a gene called UQCRFS1 in patients of African ancestry. The molecular function of R3HCC1L is unclear, but deletion of the UQCRFS1 in mice disrupts part of their infection-fighting immune response.

“Although our understanding about the genetic mechanism of pneumonia is still limited, this study identified the novel candidate genes, R3HCC1L and UQCRFS1, and offered an insight for further host genetic studies of COVID-19,” said the paper’s first author, Hung-Hsin Chen, Ph.D., MS, a postdoctoral fellow in Below’s lab.

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5 Reasons to Wear a Mask Even After You’re Vaccinated

As an emergency physician, Dr. Eugenia South was in the first group of people to receive a covid vaccine. She received her second dose last week  — even before President-elect Joe Biden.

Yet South said she’s in no rush to throw away her face mask.

“I honestly don’t think I’ll ever go without a mask at work again,” said South, faculty director of the Urban Health Lab at the University of Pennsylvania in Philadelphia. “I don’t think I’ll ever feel safe doing that.”

And although covid vaccines are highly effective, South plans to continue wearing her mask outside the hospital as well.

Health experts say there are good reasons to follow her example.

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“Masks and social distancing will need to continue into the foreseeable future — until we have some level of herd immunity,” said Dr. Preeti Malani, chief health officer at the University of Michigan. “Masks and distancing are here to stay.”

Malani and other health experts explained five reasons Americans should hold on to their masks:

1. No vaccine is 100% effective.

Large clinical trials found that two doses of the Moderna and Pfizer-BioNTech vaccines prevented 95% of illnesses caused by the coronavirus. While those results are impressive, 1 in 20 people are left unprotected, said Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention.

Malani notes that vaccines were tested in controlled clinical trials at top medical centers, under optimal conditions.

In the real world, vaccines are usually slightly less effective. Scientists use specific terms to describe the phenomenon. They refer to the protection offered by vaccines in clinical trials as “efficacy,” while the actual immunity seen in a vaccinated population is “effectiveness.”

The effectiveness of covid vaccines could be affected by the way they’re handled, Malani said. The genetic material used in mRNA vaccines — made with messenger RNA from the coronavirus — is so fragile that it has to be carefully stored and transported.

Any variation from the CDC’s strict guidance could influence how well vaccines work, Malani said.

2. Vaccines don’t provide immediate protection.

No vaccine is effective right away, Malani said. It takes about two weeks for the immune system to make the antibodies that block viral infections.

Covid vaccines will take a little longer than other inoculations, such as the flu shot, because both the Moderna and Pfizer products require two doses. The Pfizer shots are given three weeks apart; the  Moderna shots, four weeks apart.

In other words, full protection won’t arrive until five or six weeks after the first shot. So, a person vaccinated on New Year’s Day won’t be fully protected until Valentine’s Day.

3. Covid vaccines may not prevent you from spreading the virus.

Vaccines can provide two levels of protection. The measles vaccine prevents viruses from causing infection, so vaccinated people don’t spread the infection or develop symptoms.

Most other vaccines — including flu shots — prevent people from becoming sick but not from becoming infected or passing the virus to others, said Dr. Paul Offit, who advises the National Institutes of Health and Food and Drug Administration on covid vaccines.

While covid vaccines clearly prevent illness, researchers need more time to figure out whether they prevent transmission, too, said Phoenix-based epidemiologist Saskia Popescu, an assistant professor in the biodefense program at George Mason University’s Schar School of Policy and Government.

“We don’t yet know if the vaccine protects against infection, or only against illness,” said Frieden, now CEO of Resolve to Save Lives, a global public health initiative. “In other words, a vaccinated person might still be able to spread the virus, even if they don’t feel sick.”

Until researchers can answer that question, Frieden said, wearing masks is the safest way for vaccinated people to protect those around them.

4. Masks protect people with compromised immune systems.

People with cancer are at particular risk from covid. Studies show they’re more likely  than others to become infected and die from the virus, but may not be protected by vaccines, said Dr. Gary Lyman, a professor at Fred Hutchinson Cancer Research Center.

Cancer patients are vulnerable in multiple ways. People with lung cancer are less able to fight off pneumonia, while those undergoing chemotherapy or radiation treatment have weakened immune systems. Leukemia and lymphoma attack immune cells directly, which makes it harder for patients to fight off the virus.

Doctors don’t know much about how people with cancer will respond to vaccines, because they were excluded from randomized trials, Lyman said. Only a handful of study participants were diagnosed with cancer after enrolling. Among those people, covid vaccines protected only 76%.

Although the vaccines appear safe, “prior studies with other vaccines raise concerns that immunosuppressed patients, including cancer patients, may not mount as great an immune response as healthy patients,” Lyman said. “For now, we should assume that patients with cancer may not experience the 95% efficacy.”

Some people aren’t able to be vaccinated.

While most people with allergies can receive covid vaccines safely, the CDC advises those who have had severe allergic reactions to vaccine ingredients, including polyethylene glycol, to avoid vaccination. The agency also warns people who have had dangerous allergic reactions to a first vaccine dose to skip the second.

Lyman encourages people to continue wearing masks to protect those with cancer and others who won’t be fully protected.

5. Masks protect against any strain of the coronavirus, in spite of genetic mutations.

Global health leaders are extremely concerned about new genetic variants of the coronavirus, which appear to be at least 50% more contagious than the original.

So far, studies suggest vaccines will still work against these new strains.

One thing is clear: Public health measures — such as avoiding crowds, physical distancing and masks — reduce the risk of contracting all strains of the coronavirus, as well as other respiratory diseases, Frieden said. For example, the number of flu cases worldwide has been dramatically lower since countries began asking citizens to stay home and wear masks.

“Masks will remain effective,” Malani said. “But careful and consistent use will be essential.”

The best hope for ending the pandemic isn’t to choose between masks, physical distancing and vaccines, Offit said, but to combine them. “The three approaches work best as a team,” he said.

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