Experts describe types of rashes associated with MIS-C

CHOP experts describe types of rashes associated with MIS-C

In April 2020, pediatricians began recognizing a puzzling syndrome in children involving hyperinflammation that results in an array of symptoms, including fever, gastrointestinal distress and rash. The syndrome, thought to be a post-infectious complication of SARS-CoV-2 infection, was given the name Multisystem Inflammatory Syndrome Children, or MIS-C. However, diagnosing the condition has posed challenges, as many of its symptoms, including rash, are common in many other pediatric infections.

In a study published in Open Forum Infectious Diseases, researchers at Children’s Hospital of Philadelphia (CHOP) describe the array of rashes seen in MIS-C patients at their hospital through late July 2020, providing photos and information that could help doctors diagnose future cases.

“We hope the information provided in this research letter will help general pediatricians and emergency department physicians who may wonder if a patient with a fever requires a more extensive examination,” said Audrey Odom John, MD, Ph.D., Chief of the Division of Pediatric Infectious Diseases at CHOP and senior author of the paper. “Given that some rashes associated with MIS-C are distinctive, we also imagine these images could help many parents who are looking for signs that their child needs prompt evaluation.”

The research team analyzed the MIS-C-associated rashes of seven patients seen at CHOP. Although the researchers did not observe a single, defining rash associated with COVID-19, there were several types of rashes that were common in these patients, both in appearance and location.

In terms of rash location, all patients in the study developed a rash on their lower body, and five of the seven patients had a rash on their inner thighs. Rashes on the chest and upper extremities were also common, occurring in four out of seven patients.

More than half of the patients presented with small-to-medium annular plaques, which look like dime-size circles, on their chest and back. More than half of the patients in the study also developed purpura, tiny red spots, often in the center of the dime-like annular plaques.

While some patients did develop a cherry-red rash on the bottoms of their feet and palms of their hands, this sort of rash was seen in less than half of the patients in the study. Rashes on the face were uncommon, and the rashes rarely itched.

Source: Read Full Article

National experts stress importance of COVID-19 vaccination for Black community

Importance of COVID-19 Vaccination for Black Community Stressed by National Experts including Dr. Cato T. Laurencin

This week in the New York Times a national group of leading Black health experts shined a light on the critical importance of the Black community receiving the COVID-19 vaccination. Amongst the 60 elected members of the National Academy of Medicine were UConn Health Surgeon-Scientist Dr. Cato T. Laurencin and other top experts bringing the critical issue to the national forefront urging the Black community to protect themselves and get vaccinated once available.

Read UConn Today’s Q & A on this important awareness topic with Laurencin who chairs the National Academies Roundtable on Black Men and Black Women in Science, Engineering and Medicine, and serves as the Albert and Wilda Van Dusen Distinguished Endowed Professor of Orthopaedic Surgery at UConn Health and University Professor at UConn.

Q: Are Blacks contracting the COVID-19 virus at higher rates?

A: Our research data show that yes, Blacks not only have higher rates of contracting COVID-19, but also are dying of COVID-19 at high rates. Our team at the University of Connecticut published the first paper in the peer-reviewed literature presenting data showing higher rates of cases and deaths involving COVID-19 in Blacks. Our paper is entitled The COVID-19 Pandemic: A Call to Action to Identify and Address Racial and Ethnic Health Disparities. Since the latest data show that Blacks are continuing to die from high rates of COVID-19, a team of Black members of the National Academy of Medicine are hoping as trusted, reputable medical faces in the community we have a positive impact on the Black community making the choice to get vaccinated.

Q: How may racism in the healthcare system influence medical mistrust in the Black Community?

A: Racism in the healthcare system, whether it be called conscious bias, unconscious bias, stereotyping, or prejudice, contributes to healthcare disparities and high rates of morbidity and deaths among the Black population, and is a driver of mistrust. In order to build trust within the Black community, The National Academies Roundtable on Black Men and Black Women in Science, Engineering and Medicine suggests increasing the number of Black men and women in Medicine and Science. In 2018, the National Academies produced the landmark proceedings entitled An American Crisis: The Growing Absence of Black Men in Medicine and Science.

Q: How do we address medical mistrust right now and urge the Black community to get vaccinated?

A: Established in 2019, the Roundtable on Black Men and Black Women in Science, Engineering and Medicine convenes a broad array of stakeholders to tackle various issues facing the Black community. As a trusted source of information, Roundtable leadership and the COVID-19 Action Group of the Roundtable recorded an informational webinar video focused on addressing common questions and concerns around vaccine hesitation in the Black community. The hope is that this video will be a key resource for the Black community to learn more about the importance of being vaccinated.

Q: Where do we go from here?

Source: Read Full Article

WHO experts discuss AstraZeneca Covid vaccine


The World Health Organization’s vaccine experts were deciding Monday on their usage recommendations for the AstraZeneca-Oxford COVID-19 vaccine—including for older adults.

The 15-member Strategic Advisory Group of Experts on Immunization (SAGE) was spending the day in a virtual extraordinary meeting discussing the two-shot vaccine.

The WHO said the recommendations on who it should and should not be used for would be made public later this week.

The regulatory authorities in several European nations have not authorised the vaccine for use among the over-65s—by far the most vulnerable age group for serious COVID-19 disease.

According to the SAGE meeting’s agenda, “assessment of the critical evidence, including data and draft recommendations related to vaccine use in older adults” will form a key part of Monday’s talks.

The meeting will also discuss recent evidence on new coronavirus variants of concern.

South Africa said Sunday it would suspend the start of its COVID-19 vaccinations with the AstraZeneca jab after a study showed the drug failed to prevent mild and moderate cases of the virus variant that has appeared in the country.

AstraZeneca to present findings

During Monday’s SAGE meeting, AstraZeneca was due to make a 25-minute presentation about the safety and efficacy data on the jab, also known as AZD1222, plus results from the three phases of human testing, from the first jabs to mass trials.

The UK-Swedish pharmaceuticals giant was also to discuss risk management plans and other implementation considerations, before facing questions.

The meeting was also to get an outline of ongoing and planned studies.

The SAGE working group was then to present evidence including data and draft recommendations relating to the vaccine’s use in older adults.

The four-and-a-half-hour meeting was due to wrap up with a presentation of the remaining draft recommendations.

In a separate process, the UN health agency is also set to decide on February 15 whether to give the vaccine emergency use listing for the versions produced in India and South Korea.

If granted, doses from those sites could start to be distributed to some of the world’s poorest countries via Covax, the global vaccine procurement and distribution pool.

Many low-income countries are relying entirely on the AstraZeneca jab to start immunising their most vulnerable populations, but cannot receive their first doses until the WHO grants emergency authorisation.

SAGE advice

SAGE advises the WHO on overall global policies and strategies, ranging from vaccines and technology, research and development, to delivery of immunisation and its links with other health interventions.

Chaired by Mexican doctor Alejandro Cravioto, the group is comprised of 15 experts from around the world representing a broad range of expertise.

SAGE has already issued advice on the usage of the Pfizer-BioNTech and the Moderna vaccines.

So far, the WHO has only given emergency use listing to the Pfizer jab, though several other manufacturers have started the evaluation process, including AstraZeneca and Moderna.

Covax is almost entirely dependent on the AstraZeneca jab in its first wave of distribution.

Some 145 countries are set to receive 337.2 million doses—enough to immunise 3.3 percent of their collective population by mid-2021. Of those, 336 million are AstraZeneca vials.

The first Covax deliveries are expected to take place in late February.

Source: Read Full Article

Experts tap into behavioral research to promote COVID-19 vaccination in the US


As the first doses of COVID-19 vaccines are being rolled out, it is still unclear whether enough Americans are willing to be vaccinated to allow the nation to return to normalcy. Many believe a key part of the equation lies in how effective vaccine communication teams are at convincing the public to get vaccinated. And the key to effective communication tactics in promoting the vaccines may lie in demonstrated behavioral economics and consumer behavior theory, experts say.

“The country has made an incredible investment in fast-tracking SARS-CoV-2 vaccines from conception to market, which would make it even more tragic if we fail to curtail the virus simply because Americans are hesitant to be vaccinated,” says Stacy Wood, an expert on how consumers respond to change and innovation, and first author of a paper published in the New England Journal of Medicine titled “Beyond Politics—Promoting COVID-19 Vaccination in the U.S.” Wood is a professor of marketing and executive director of the Consumer Innovation Collaborative at the NC State Poole College of Management

Recent surveys indicate that the proportion of the U.S. population willing to be vaccinated has fluctuated in recent months—from a high of 72 percent in May, to 51 percent in September and increasing slightly to 60 percent in November. Of those respondents who indicated that they probably or definitely would not get the vaccine, less than half said they might be open to vaccination once others start getting it and more information becomes available.

Since Anthony Fauci has said that at least 80% of the population will need to be vaccinated to get the country back to normalcy, Wood notes that this means it will be necessary to get 100% follow-through from those who are more likely to get the vaccine and 100% conversion of those who are unlikely now but willing to keep an open mind. That’s a daunting prospect.

To address this challenge, Wood and her colleague Kevin Schulman of Stanford drew on their expertise in behavioral economics and consumer research to develop 12 strategies that could, collectively, create an effective vaccine-promotion effort.

Proposed strategies include:

  • Use Analogy: Many attitudes toward the current pandemic are responses to complex medical information. Analogies are short-cuts to conceptual understanding. Saying “the war against COVID” is a term rich in meaning-coming together, making sacrifices, doing tough things, and emerging on the other side with new improvements and inventions in hand. Or one can explain that mRNA vaccines are not weak doses of the virus, but instead are “instruction manuals” that teach the immune system how to defend itself.
  • Increase Observability: Studies have shown consumers’ ability to observe others’ choices can increase an innovation’s rate of adoption. Distributing tokens, such as Livestrong-style bracelets or stickers, or digital badges, such as social media profile frames, may prove to be effective in increasing consumer buy-in. They can even be specific to different populations (e.g. stickers that say “COVID-19 Frontline Hero—I’m Vaccinated!” or “America Honors Her Veterans—I’m Vaccinated!”)
  • Leverage Natural Scarcity: In consumer markets, scarcity often signals exclusivity and prompts greater interest or desirability. Communicators should frame early access to vaccines as a mark of honor or respect for people we want to protect, such as the elderly, teachers or essential workers. Leveraging scarcity, especially as the vaccine is slowly rolled out, may help to counteract many individuals’ natural hesitancy to “go first.”
  • Promote Compromise Options: Consider coffee shops that offer three serving sizes and typically sell more of the middle option. This decision rule-of-thumb is based on choice preferences for “compromise” or middle options. When it comes to the vaccine, communicators should not make vaccination seem like an either-or decision, but rather should frame it as three options where vaccination is in the middle. For instance, options could include allowing people to get the shot now, signing up for a later date, or not getting it at all. Or all three options could include the vaccine—such as get the shot now and donate plasma, simply get the shot now, or get the shot later. The key is to avoid depicting vaccination as the most extreme action in a range of choices.

Source: Read Full Article

Dental experts discover biological imbalance is the link between gum and kidney disease

An imbalance of the body’s oxygen producing free radicals and its antioxidant cells could be the reason why gum disease and chronic kidney disease affect each other, a new study led by the University of Birmingham has found.

Periodontitis—or gum disease—is a common, inflammatory disease which causes bleeding gums, wobbly or drifting teeth and can eventually result in tooth loss.

Previous studies have shown a link between the severe oral inflammation caused by gum disease and chronic kidney disease (CKD) which demonstrated that those with worse inflammation of the gums have worse kidney function.

Previous research also showed that patients with CKD and periodontitis experience a drop in survival rates, similar in magnitude to if they had diabetes instead of gum inflammation, suggesting that gum inflammation may casually affect kidney function.

In this latest study, led by researchers at the University of Birmingham, over 700 patients with chronic kidney disease were examined using detailed oral and full-body examinations including blood samples. The aim was to test the hypothesis that periodontal inflammation and kidney function affect each other and to establish the underlying mechanism that may facilitate this.

Results showed that just a 10% increase in gum inflammation reduces kidney function by 3%. In this group of patients, a 3% worsening in kidney function would translate to an increase in the risk of kidney failure over a 5 year period from 32%-34%. Results also showed that a 10% reduction in kidney function increases periodontal inflammation by 25%.

In contrast to current beliefs that inflammation is the link between periodontitis and other systemic diseases, researchers found for the first time, that in this group of patients, the effect was caused by a biological process called ‘oxidative stress’—or, an imbalance between reactive oxygen species and the body’s antioxidant capacity which damages tissues on a cellular level.

Lead author Dr. Praveen Sharma, from the Periodontal Research Group at the University of Birmingham’s School of Dentistry, said, “This is the first paper to quantify the casual effect of periodontitis on kidney function and vice-versa as well as the first to elucidate the pathways involved.

“It showed that even a modest reduction in gum inflammation can benefit renal function. Given the relative ease of achieving a 10% reduction in gum inflammation, through simple measures like correct brushing techniques and cleaning between the teeth, these results are very interesting.

Source: Read Full Article

India experts find traces of lead, nickel in patients’ blood

Indian health officials have found traces of nickel and lead in a few blood samples taken from hundreds of patients who have been hospitalized by a mysterious illness in a southern state, officials said.

The Andhra Pradesh state government said in a statement Tuesday night that investigations by experts from the All India Institute of Medical Sciences have not been able to ascertain the source of excessive nickel and lead particulate matter in the patients’ blood.

Reports from other tests by experts at the Indian Institute of Chemical Technology, including toxicology reports and blood cultures, are being awaited, the statement said.

Health officials and experts are still baffled by how the heavy metals got into the patients’ blood, and whether they are the cause of the mysterious illness that has left over 585 people hospitalized and one person dead in Andhra Pradesh. The illness was first detected Saturday evening in Eluru, an ancient city famous for its handwoven products.

People with the illness started convulsing without any warning, said Geeta Prasadini, a state health official.

Andhra Pradesh Chief Minister Y.S. Jaganmohan Reddy held a virtual meeting Wednesday with officials who included experts from India’s top scientific institutes. Reddy said 502 of the people with the illness have been discharged after showing improvement.

The patients showed symptoms ranging from nausea and anxiety to loss of consciousness.

What is confounding experts is that there doesn’t seem to be any common link among the hundreds of people who have fallen sick. All of the patients have tested negative for the coronavirus and other viral diseases such as dengue, chikungunya and herpes. The patients aren’t related to each other and don’t all live in the same area. They’re from different age groups, including about 70 children, but very few are elderly.

Initially, contaminated water was suspected. But the chief minister’s office confirmed that people who don’t use the municipal water supply have also fallen ill, and that initial tests of water samples didn’t reveal any harmful chemicals.

A 45-year-old man who goes by the single name Sridhar was hospitalized with symptoms resembling epilepsy and died Sunday evening, doctors said. Prasadini said his autopsy didn’t shed any light on the cause of death.

Source: Read Full Article

Millions will need mental health help in the wake of coronavirus, experts warn

We’re on the brink of a major crisis of mental health, a new report warns.

Around 8.5 million adults and 1.5 million children in England will need mental health support in the wake of the coronavirus pandemic, predicts new analysis from the Centre For Mental Health, which consulted experts from NHS England and NHS trusts.

They warn that many will have lost jobs, lost loved ones, or will be dealing with the long-term effects of having Covid-19.

Add in the general rise of issues such as health anxiety and agoraphobia due to Covid-19, and it’s clear to see that we’re heading for trouble.

The reports suggests that while two-thirds of people will already have existing mental illness and may be receiving support, others will need help for the first time, creating an even greater strain on mental health care by the NHS.

Visit our live blog for the latest updates Coronavirus news live

That’s without considering the mental impact of coronavirus on NHS staff, who the report suggests will need treatment for issues such as post-traumatic distress, high psychological distress, and burnout.

The report says: ‘Among people who have not experienced mental ill health prior to the pandemic, demand for services is forecast at 1.33 million people for moderate-severe anxiety and 1.82 million for moderate to severe depression.’

From the total number of people needing support, researchers estimate more than 230,000 NHS workers may need treatment, including for post-traumatic distress (36,996), high psychological distress (120,372) and burnout (81,499).

Among patients recovering from severe Covid-19, an estimated 630 will need mental health support for anxiety, 454 for depression and 354 for PTSD, according to the report.

Meanwhile, 36,000 people who lost loved ones will need treatment, with depression being the most common condition.

At present unemployment levels, which could rise, around 30,000 people who lost their job will need support for major depression.

And of the 1.5 million children estimated to need support, 458,922 will need help for depression and 407,623 for anxiety.

Children who have lost parents to Covid-19 will also require help, plus those who suffered other mental distress during lockdown.

Nick O’Shea, the chief economist at the Centre For Mental Health, who led the research, said: ‘The numbers are stark. Covid-19 is a disaster for every country that has been badly affected, and the consequences for our mental health are just as severe.

‘The challenge of meeting the mental health needs arising out of the pandemic may be as great as the many difficulties of responding to the virus.

‘So it must be taken as seriously. We must prepare now for what lies ahead.’

The team behind the report want to prepare us for the looming crisis ahead and make sure that plans are put in place to identify people who need mental health support and ensure they receive the right care quickly.

‘Unresolved mental health needs can escalate to crisis point without effective early help,’ Nick added.

‘We cannot afford to wait and see or to leave it until after the pandemic has subsided.’

Centre For Mental Health chief executive Sarah Hughes said: ‘We have identified the risks and the unequal impacts of Covid-19 on both mental and physical health

‘The extent of the crisis is becoming clearer every day.

‘There is a rising tide of distress that will over time require effective and compassionate care and support.

‘The Government and the NHS must act now. We must not leave the nation’s mental health to chance.’

Need support? Contact the Samaritans

For emotional support you can call the Samaritans 24-hour helpline on 116 123, email [email protected], visit a Samaritans branch in person or go to the Samaritans website.

Do you have a story to share?

Get in touch by emailing [email protected]

Source: Read Full Article

New virus cases decline in the US and experts credit masks

The number of Americans newly diagnosed with the coronavirus is falling—a development experts credit at least partly to increased wearing of masks—even as the outbreak continues to claim nearly 1,000 lives in the U.S. each day.

About 43,000 new cases have been reported daily over the past two weeks across the country, down 21 percent since early August, according to data compiled by Johns Hopkins University. While the U.S., India and Brazil still have the highest numbers of new cases in the world, the trend down is encouraging.

“It’s profoundly hopeful news,” said Dr. Monica Gandhi, an infectious-diseases expert at the University of California, San Francisco, who credits the American public’s growing understanding of how the virus spreads, more mask-wearing and, possibly, an increasing level of immunity.

“Hopefully all those factors are coming into play to get this virus under control in this country that’s really been battered by the pandemic,” she said.

The virus is blamed for more than 5.7 million confirmed infections and about 178,000 deaths in the U.S. Worldwide, the death toll is put at more than 810,000, with about 23.7 million cases.

Jeffrey Shaman, a public health expert at Columbia University, said he is skeptical enough people are immune to significantly slow the spread. But he agreed that changes in Americans’ behavior could well be making a difference, recalling the impact that people’s actions had in containing Ebola in West Africa several years ago.

“Ebola stopped for reasons we didn’t anticipate at the time. It was so horrifying that people stopped touching each other,” Shaman said. Something similar may be happening with the coronavirus, he said.

“I know I don’t have nearly the number of contacts that I used to,” Shaman said. “But if we relax that, if we get complacent, will we just see another outbreak?”

The decline in newly reported cases in the U.S. comes even as deaths from the virus remain alarmingly high. Over the past two weeks, state officials have reported an average of 965 deaths a day from COVID-19, down from 1,051 a day in early August.

The percentage of those testing positive for the disease has also declined over the past two weeks, from 7.3% to 6.1%. But that comes as the total number of tests administered has fallen from its August peak of more than 820,000 daily, leveling off in recent weeks at about 690,000 a day.

It’s not clear what will happen to case numbers as more school districts bring students back to classrooms and colleges reopen their campuses. In recent weeks, schools including the University of North Carolina and Notre Dame have moved instruction online after outbreaks on their campuses.

Officials at the University of Tennessee at Knoxville said Monday that four students are facing disciplinary proceedings after three hosted off-campus parties with no mask or other distancing and another left isolation to meet with others despite testing positive for the virus.

Source: Read Full Article

Experts make weak recommendation for remdesivir in severe COVID-19

In The BMJ today, a panel of international experts make a weak recommendation for the use of remdesivir in patients with severe covid-19, and strongly support continued enrolment of patients into ongoing clinical trials of remdesivir.

Their advice is part of The BMJ‘s Rapid Recommendations initiative—to produce rapid and trustworthy guidelines for clinical practice based on new evidence to help doctors make better decisions with their patients.

The antiviral medication remdesivir has received worldwide attention as a potentially effective treatment for severe covid-19 and is already being used in clinical practice.

Today’s recommendation is based on a new evidence review comparing the effects of several drug treatments for covid-19 up to 20 July 2020.

It shows that remdesivir may be effective in reducing recovery time in patients with severe covid-19, although the certainty of the evidence is low. But remdesivir probably has no important effect on the need for mechanical ventilation and may have little or no effect on length of hospital stay.

The authors stress that “the effectiveness of most interventions is uncertain because most of the randomised controlled trials so far have been small and have important study limitations.”

After thoroughly reviewing this evidence, the expert panel says that most patients with severe covid-19 would likely choose treatment with remdesivir given the potential reduction in time to clinical improvement.

But given the low certainty evidence, and allowing for different patient perspectives, values, and preferences, they issued a weak recommendation with strong support for continued recruitment in trials.

They suggest that future research should focus on areas such as optimal dose and duration of therapy, and whether there are specific groups of patients most likely to benefit from remdesivir.

The authors also sound a note of caution about the potential opportunity cost of using remdesivir while the evidence base is still uncertain. As a relatively costly drug that is given intravenously, use of remdesivir may divert funds, time, attention, and workforce away from other potentially worthwhile treatments.

The study that today’s recommendation is based on is called a living systematic review.

In a linked editorial, The BMJ editors explain that living systematic reviews are useful in fast moving research areas such as covid-19 because they allow authors to update previously vetted and peer reviewed evidence summaries as new information becomes available.

Source: Read Full Article