If we spent the cost of COVID-19 on pandemic preparations it would have lasted 500 years

COVID-19 has taken advantage of a world in disorder, causing catastrophic health, social, and economic consequences and irreparable harm to humanity. The virus has killed close to a million people and many more may die as a result of its impact on health systems, food supplies, and the economy. The financial cost will be in the trillions.

This will not be the last global health emergency. The world simply cannot afford to be unprepared again, warns the Global Preparedness Monitoring Board (GPMB) in its second report “A World in Disorder,” released today.

Last year, the GPMB warned that the world was unprepared for the very real likelihood of a deadly pandemic spreading around the globe, killing millions of people, disrupting economies, and destabilizing national security. The Board called for urgent action to break the cycle of panic and neglect that has characterized the response to global health crises in the past.

In its new report, the GPMB provides a harsh assessment of the global COVID-19 response, calling it “a collective failure to take pandemic prevention, preparedness, and response seriously and prioritize it accordingly.” In many countries, leaders have struggled to take early decisive action based on science, evidence and best practice. This lack of accountability by leaders has led to a profound and deepening deficit in trust that is hampering response efforts.

“Transparency and accountability are essential in responding to the COVID-19 pandemic,” said Elhadj As Sy, co-Chair of the GPMB. “Trust is the foundation of government-community relationships for better health but that trust dissipates when governments and leaders do not deliver on their commitments.”

Responsible leadership and good citizenship have been key determinants of COVID-19’s impact, the report finds—systems are only as effective as the people who use them.

The report also finds that, while COVID-19 has demonstrated that the world is deeply interconnected through economics, trade, information, and travel, one of the greatest challenges of the pandemic has been faltering multilateral cooperation. Leadership by the G7, G20, and multilateral organizations has been hampered by geopolitical tensions. The Board calls on leaders to renew their commitment to the multilateral system and strengthen WHO as an impartial and independent international organization. Weakening and undermining the multilateral action will have serious consequences on global health security, it warns. No-one is safe until all are safe.


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“Viruses don’t respect borders. The only way out of this devastating pandemic is along the path of collective action, which demands a strong and effective multilateral system,” said H.E. Dr. Gro Harlem Brundtland, co-chair of the GPMB. “The UN system, which includes the WHO, was created after World War II and has helped make the world a better place for billions of people. It needs to be defended, strengthened, and revitalized, not attacked and undermined.”

The report highlights how the devastating social and economic impact of pandemics, especially for the vulnerable and disadvantaged, is often underestimated and ignored. COVID-19’s long-term socioeconomic impacts are predicted to last for decades, with the World Bank’s conservative scenario estimating a US$ 10 trillion earning loss over time for the younger generation as a result of pandemic-related educational deficits.

COVID-19 has demonstrated the importance of protecting lives and livelihoods and widening our understanding of preparedness to make education, social, and economic sectors pandemic proof. “A World in Disorder” reveals that the return on investment for pandemic preparedness is immense. It would take 500 years to spend as much on preparedness as the world is currently losing due to COVID-19.

“The pandemic has shown the fragility of not only our health systems, but also our global economy. The impact of COVID-19 has been huge in the world and particularly in my region, the Americas, with a sharp increase in health, social and economic inequities,” said Jeannette Vega, GPMB member and Chief Medical Innovation and Technology Officer, La Red de Salud UC-Christus, Chile. “Let’s hope that this time we finally learn the lesson and invest in preparedness and public goods for health to avoid similar tragedies in the future.”

The report highlights the actions that must be taken to end the COVID-19 pandemic and avoid the next catastrophe—to bring order out of chaos. It calls for responsible leadership, engaged citizenship, strong and agile systems for health security, sustained investment, and robust global governance for preparedness.

“A World in Disorder” identifies the specific commitments and actions leaders and citizens must take—boldly, decisively, and immediately. These include sustainable and predictable financing for global and national health security, and a call to hold a UN Summit on Global Health Security to develop an international framework for health emergency preparedness and response.

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Only 25% of older Australians have an advance care plan. Coronavirus makes it even more important

Older adults and those with chronic health conditions share an increased risk of experiencing severe symptoms if they contract COVID-19.

But they’re not a homogeneous group. In the event they become very sick, one person may want all available treatment, even if this includes intensive care and an extended period of rehabilitation. Another may prefer to avoid life-sustaining but highly invasive medical interventions.

If either of these people became suddenly unwell, how likely is it health professionals would know their wishes? Understanding a person’s wishes in advance makes it easier for the health-care system to provide care that matches the person’s preferences.

Yet research shows only 25% of older Australian adults accessing health and aged-care facilities have documented their wishes for future care through advance care planning.

What is advance care planning?

Advance care planning is about discussing your goals for future care, in case of a time when you’re unable to communicate or make your own decisions. It works best when it includes health professionals, family members and other significant people (for example, a spiritual advisor).

A competent adult can specify their preferences for future health care in an advance care directive, or nominate a substitute decision-maker to make health-care decisions on their behalf.

The goal is even if a person is too unwell to make decisions, health-care professionals can still respect their preferences.

Why is advance care planning important during COVID-19?

In a recent paper, my colleagues and I make the case for incorporating advance care planning into the COVID-19 response.

First, it allows us to better prepare for any unexpected surges and reduce the need for rationing of medical resources in this event.

The recent outbreak of COVID-19 in Victoria has severely impacted aged-care settings and the broader community, and reignited concerns about the health-care system’s capacity to cope with local outbreaks.

Much debate about ethical decision-making has focused on the “rationing” scenario, in which outbreaks overwhelm health-care resources and some people are refused treatment.

However, we shouldn’t put our ethics hat on only when the truck gets close to the cliff. Ethics and evidence should inform all decision-making in the COVID-19 response, including taking all sensible steps to avoid a rationing scenario.

If future surges in demand push health-care systems beyond capacity, it will be too late to have advance care planning discussions with people at the time of their admission to hospital.

The public health response to prevent and control outbreaks is of course crucial. Beyond this, advance care planning can ensure those who wish to refuse certain treatments have communicated this, and are not inadvertently “competing” with others for scarce health-care resources.

This is not about abandoning people or an excuse to provide less care. Advance care planning must always be a voluntary process, aimed at respecting a person’s informed preferences.

Importantly, routine care delivery is more complicated in the COVID-19 context, and respecting a person’s preferences can require preparation. For example, a person’s wish to receive care at home may depend on supplies of consumables and personal protective equipment, visiting rosters and backups in case family members or care staff need to quarantine.

Finally, it’s a matter of respecting human rights. Advance care planning enables a person to exercise some level of control over their care, even while highly dependent.

How can we boost the uptake of advance care planning?

In terms of policy, the Australian health sector’s emergency response plan for COVID-19 does indicate aged-care providers should encourage advance care planning among residents.

But the plan should be updated to incorporate a more strategic approach to increasing advance care planning across primary care, hospital and community settings—not just aged care.

Health professionals, including primary care, allied health and aged-care workers, can all help patients and family members understand their condition and options for future treatment, and encourage further discussion about advance care planning.

Lawyers, trained community volunteers, health promotion units and mass media strategies can also play a role in encouraging the broader community to discuss their wishes with family members and health professionals, in non-acute community settings.

The COVID-19 pandemic has stimulated changes in attitudes and accepted practices across the board. We should leverage this to promote increased uptake of advance care planning.

Notably, telehealth technology enables advance care planning discussions from a distance, and new legislation in some states allows remote witnessing of legal documents.

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Bacteria in the gut have a direct line to the brain

With its 100 million neurons, the gut has earned a reputation as the body’s “second brain”—corresponding with the real brain to manage things like intestinal muscle activity and enzyme secretions. A growing community of scientists are now seeking to understand how gut neurons interact with their brain counterparts, and how failures in this process may lead to disease.

Now, new research shows that gut bacteria play a direct role in these neuronal communications, determining the pace of intestinal motility. The research, conducted in mice and published in Nature, suggests a remarkable degree of communication between our nervous system and the microbiota. It may also have implications for treating gastrointestinal conditions.

“We describe how microbes can regulate a neuronal circuit that starts in the gut, goes to the brain, and comes back to the gut,” says Rockefeller’s Daniel Mucida, associate professor and head of the Laboratory of Mucosal Immunology. “Some of the neurons within this circuit are associated with irritable bowel syndrome, so it is possible that dysregulation of this circuit predisposes to IBS.”

The work was led by Paul A. Muller, a former graduate student in the Mucida lab.

How microbes control motility

To understand how the central nervous system senses microbes within the intestines, Mucida and his colleagues analyzed gut-connected neurons in mice that lacked microbes entirely, so-called germ-free mice that are raised from birth in an isolated environment, and given only food and water that has been thoroughly sterilized. They found that some gut-connected neurons are more active in the germ-free mice than in controls and express high levels of a gene called cFos, which is a marker for neuronal activity.

This increase in neuronal activity, in turn, causes food to move more slowly than usual through the digestive tract of the mice. When the researchers treated the germ-free mice with a drug that silences these gut neurons, they saw intestinal motility speed up.

It’s unclear how the neurons sense the presence of gut microbes, but Mucida and his colleagues found hints that the key may be a set of compounds known as short-chain fatty acids, which are made by gut bacteria. They found that lower levels of these fatty acids within the guts of mice were associated with greater activity of the gut-connected neurons. And when they boosted the animal’s gut levels of these compounds, the activity of their gut neurons decreased. Other microbial compounds and gut hormones that change with the microbiota were also found to regulate neuronal activity, suggesting additional players in this circuit.

Neurons in control

Further experiments revealed a conundrum, however. The scientists saw that the particular type of gut-connected neurons activated by the absence of microbes did not extend to the exposed surface of the intestines, suggesting that they cannot sense the fatty acid levels directly.

So Mucida and his colleagues decided to trace the circuit backwards and found a set of brainstem neurons that show increased activity in the germ-free mice. When the researchers manipulated control mice to specifically activate these same neurons, they saw an increase in the activity of the gut neurons and a decrease in intestinal motility.

The researchers continued to work backwards, next focusing their attention on the sensory neurons that send signals from the intestines to the brainstem. Their experiments revealed these sensory neurons extended to the interface of areas of the intestine that are exposed to high-levels of microbial compounds, including fatty acids. They turned off these neurons, to mimic what happens in germ-free mice that lack the fatty acids, or associated gut signals, and observed activated neurons in the brainstem, as well as activation of the gut neurons that control intestinal motility.

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Neurons are genetically programmed to have long lives

When our neurons—the principle cells of the brain—die, so do we.

Most neurons are created during embryonic development and have no “backup” after birth. Researchers have generally believed that their survival is determined nearly extrinsically, or by outside forces, such as the tissues and cells that neurons supply with nerve cells.

A research team led by Sika Zheng, a biomedical scientist at the University of California, Riverside, has challenged this notion and reports the continuous survival of neurons is also intrinsically programmed during development.

The study, published in the journal Neuron, identifies a mechanism the researchers say is triggered at neuron birth to intrinsically decrease a general form of cell death—or “apoptosis”—specifically in neurons. When this genetic regulation is stopped, continuous neuronal survival is disrupted and leads to the death of the animal.

An organism’s survival, brain function, and fitness are dependent upon the survival of its neurons. In higher organisms, neurons control breathing, feeding, sensation, motion, memory, emotion, and cognition. They can die of many unnatural causes, such as neurodegenerative diseases, injury, infection, and trauma. Neurons are long-lived cells, but the genetic controls that enable their longevity are unknown.

Zheng’s team now reports the central piece of the mechanism involved is a small piece of genetic sequence in Bak1, a pro-apoptotic gene whose activation leads to apoptosis. Bak1 expression is turned off when this small piece of genetic sequence, termed microexon, is spliced in the final Bak1 gene product. Exons are sequences that make up messenger RNA.

“Apoptosis is a pathway that controls cell turnover and tissue homeostasis in all metazoans,” explained Zheng, an associate professor of biomedical sciences. “Most non-neural cells readily engage in apoptosis in response to intrinsic and extrinsic stress. But this cellular suicidal program needs to be reined in for neurons so that they live for many years. We now show how genetic attenuation of neuronal apoptosis takes place.”

Zheng’s team identified the Bak1 microexon through a large-scale analysis of expression data from human tissues, mouse tissues, human developing brains, mouse developing forebrains, and mouse developing midbrains. The team first compared neural tissues with non-neural tissues in both humans and mice to identify neural-specific exons. Then, they found cortical neurons reduce their sensitivity to apoptosis as early as neuron birth. They also found apoptosis is gradually reduced during neuronal development before neurons make connections or innervate other cells, suggesting factors other than extrinsic signals can play a role.

“We show neurons transform how they regulate cell death during development,” Zheng said. “This is to ensure neuronal longevity, which is needed to maintain the integrity of neural circuits for brain functions.”

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Cassie Shows Off Postpartum Body, But We Wish She Didn't Have To

Since having daughter Frankie in December, singer and model Cassie has not the most prolific of new celebrity moms on social media. But on Monday, she took to her Instagram Stories with an admission that we think might explain her absence. She seems to have gone back and forth with accepting her postpartum body.

“I haven’t posted anything like this in a while, but I’m very proud of myself,” wrote Cassie, who married trainer and bull-rider Alex Fine last year, shortly after ending her 10-plus-year relationship with Diddy. “The female body is truly an amazing thing. I didn’t rush to lose weight after having Frankie in December, but when I was ready to, I struggled with it for some months.”

After spending her career modeling and performing, we imagine it was difficult for Cassie not to feel she was in the same physical shape as she had been in for most of her life. Pregnancy and childbirth take a toll on the body — changing everything from lung capacity to bone density — and it’s not necessarily realistic to expect that once the baby is finally outside your body that you can get it “back” just by exercising and dieting a lot.

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♐️♍️

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But we very much wish that no new parent felt that this is something they have to do. If we could live in a world in which women weren’t compelled to show off how they lost the baby weight — or even feel the need to explain that doing so is taking some time — we might all be a little healthier and happier.

For her part, Cassie said she realized she needed to be easier on herself.

“I stopped putting so much pressure on myself and with less stress and healthier habits,” she wrote. “This is me today 7 months postpartum. Feeling really good, I’m healthy and working on my strength. Love your body!”

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Day dreaming ✨

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Congratulations to Cassie for feeling good and being proud of herself, truly. Everyone else reading this, please know that you absolutely do not need to have abs like that seven months after having a baby, or ever. Do postpartum workouts and eat right so that you have the strength and endurance to care for your child and do everything else that makes your life fulfilling, not so that you have that extra line down your middle when you wear a bikini.

Cassie has managed to spend her career going by just one name. We wonder if her daughter or any of these celebrity kids with unique names will have the same privilege.

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Naked mole rats have tumor-fighting immune systems

Could naked mole rats help cure cancer? Scientists discover the rodents have special tumor-fighting immune systems

  • Until recently, it was believed naked mole-rats had healthy cells that were resistant to being converted into cancer cells
  • Researchers injected the cells with cancer-causing genes that usually cause tumors in mice 
  • The genes that cause cancer in other rodent cells also caused naked mole-rat cells to become cancerous
  • This suggests the cells and molecules that surround naked mole rat cells prevent other cells from turning into tumors

Naked mole-rats have special tumor-fighting immune systems that make them resistant to cancer, a new study suggests.

It was previously believed that the animals had cells that were resistant to being converted into cancer cells.

But researchers have now discovered that the environment of the naked mole-rat’s body prevents the cancer from developing, not a feature of the rodent’s cells that prevent them from becoming cancerous. 

The team, from the University of Cambridge, says understanding naked mole-rats’ resistance to cancer can help us understanding the early stages of cancer and how to treat it.  

A new study has found that  the cells and molecules that surround naked mole rat cells prevent other cells from turning into tumors (file image)

Naked mole-rats, also known sand puppies, are burrowing rodents that are native to parts of East Africa.

They have other unique traits such as not being able to feel certain types of pain and being able to survive for along time with low levels of oxygen.  

It can live a long time for an animal of its size, up to 32 years, and is highly resistant to cancer and its related tumors. 

Until recently, it was believed naked mole-rats almost never got cancer because their healthy cells were impervious to being converted into cancer cells. 

But now, it’s believed that the rodents’ bodies can actually stop cancer cells from multiplying and spreading.

For the study, published in the journal Nature, the team looked at 79 different cell lines grown from five different types of tissues.

They grew the cells of the intestines, kidneys, lungs, pancreases and skin of 11 individual naked mole-rats. 

Next, researchers infected the cells with altered viruses so that the cells would develop cancer-causing genes. 

The genes caused cancerous tumors when injected in mice and rats cells.

However, the genetically altered naked mole rat cells also began to copy itself and spread. 

‘To our surprise, the infected naked mole-rat cells began to multiply and rapidly form colonies in the lab,’ said lead researcher Dr Fazal Hadi, a professor from the Cancer Research UK Cambridge Center.

‘We knew from this accelerated growth that they had become cancerous.’   

This means the genes that cause cancer in other rodent cells also caused naked mole-rat cells to become cancerous. 

This finding suggests that the cells and molecules that surround other naked mole rat cells prevent them from turning into tumors. 

‘The results were a surprise to us and have completely transformed our understanding of cancer resistance in naked mole-rats,’ said co-senior author Dr Walid Khaled a professor in the department of pharmacology at the University of Cambridge.  

‘If we can understand what’s special about these animals’ immune systems and how they protect them from cancer, we may be able to develop interventions to prevent the disease in people.’  

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Everything Gigi Hadid and Her Family Members Have Said About Her Pregnancy

Model mom-to-be! Gigi Hadid confirmed that in April that she is expecting her and Zayn Malik’s first child and has been opening up about her pregnancy ever since.

“Gigi is pregnant and she and Zayn are so in love,” a source told Us Weekly exclusively at the time. “She’s always wanted to start a family with Zayn.”

Later that same month, another insider revealed, “Gigi has been telling her close friends and family about her pregnancy news and was trying to keep it low-key. She has been so grateful for all the well-wishes and congratulations she’s received. She’s so excited to be a mom and so happy to be pregnant and to be embarking on this new journey of motherhood, especially with Zayn by her side.”

As for Malik, 27, the former One Direction member “couldn’t be more thrilled.”

The couple’s baby news came three months after Us confirmed that they are dating again after previously calling it quits.

“They got back together very recently,” the insider shared with Us in January. “They have been trying to make it work for three months but it has been slow and steady.”

Hadid, 25, and the “Dusk Till Dawn” singer were first linked in November 2015. Following their first breakup nearly three years later, they briefly reunited before splitting again in January 2019. The model went on to date Bachelorette’s Tyler Cameron.

“I am excited for her,” the former reality star, 27, told ESPN West following his ex-girlfriend’s pregnancy reveal. “I am happy for her. She is going to be the most incredible mother. She’s a caring, sweet person and she’s going to be amazing.”

The general contractor went on to tell Us exclusively in May: “I’m stoked for her. … She comes from a great family, so I’m very excited for her.”

Keep scrolling to read what Hadid and her family members have said about the Los Angeles native’s pregnancy, from cravings to fashion shows.

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Study shows patients with hemorrhagic brain disease have disordered gut microbiomes

A new study shows that people with a rare genetic disease that causes bleeding in the brain have gut microbiomes distinct from those without the disease. Moreover, it is the molecules produced by this bacterial imbalance that cause lesions to form in the brains of these patients.

The results are the first in any human neurovascular disease. They have implications both for treating the disease and in examining other neurovascular diseases that could be affected by a person’s gut microbiome.

The study was led by investigators at University of Chicago Medicine and published May 27 in Nature Communications. It examined the gut bacteria of patients with cavernous angioma (CA), a disease where blood vessel abnormalities develop in the brain and cause strokes, seizures and serious neurologic complications. The disease is caused by a genetic mutation in the lesion —which may be inherited or occurs sporadically—and its severity and course vary widely among patients.

UChicago is a leader in studying this disease. It has been designated as a cavernous angioma center of excellence and treats patients with the condition from all over the world.

Investigators had hints that the disease could be affected by the gut microbiome: Senior author Issam Awad, MD, the John Harper Seeley Professor of Neurosurgery and Director of Neurovascular Surgery at UChicago Medicine, was a partner in a previous study in mice, which showed that the cells that lined the blood vessels of the brain reacted to the animals’ gut bacteria.

“The implications of that were very big,” he said. “But we didn’t know if this concept of a unique microbiome that favors the development of lesions would be true in human beings.”

To find out, UChicago researchers—working with investigators at the University of California San Francisco, University of New Mexico, University of Pennsylvania, and the Angioma Alliance patient support group—collected stool samples from more than 120 CA patients.

The samples were then analyzed for their bacterial content and compared with samples from the general population. The CA samples showed significantly higher amounts of gram-negative bacteria and less gram-positive bacteria. The researchers identified a combination of three common bacterial species, whose relative abundance can distinguish CA patients from control patients without CA lesions, with high sensitivity and specificity.

The CA samples also showed an imbalanced network of bacteria that was much more disordered than the general population’s bacterial network. “The CA patients from all the different collection sites had the same distinctive microbiome, regardless of whether they had inherited the mutation or had a sporadic lesion, and regardless of the number of lesions they had,” Awad said. The investigators further showed that the bacterial imbalance in patients with CA produces lipopolysaccharide (LPS) molecules, which travel through the bloodstream to the brain and attach to the brain’s blood vessel lining, facilitating lesion development. “All this evidence pointed to the microbiome as a cause of lesions rather than an effect,” Awad said.

The investigators also collected blood from several CA patients and used advanced computational machine learning to identify the combination of molecular signals associated with the disease. Those with CA had significantly different LPS-related related blood biomarkers and inflammatory molecules. The result was essentially a smart, personalized test for each CA patient. “By looking at both bacteria combinations and the blood biomarkers, we were able to measure just how aggressive the disease was in each patient,” said Sean Polster, MD, a neurosurgery resident at UChicago Medicine and first author on the paper. Polster spent two years of his neurosurgery residency coordinating the study among the different institutions.

The researchers are beginning to think about how these results affect treatment. Earlier studies in mice showed that those fed emulsifiers—which are often used as preservatives in processed foods—had more bleeding in the brain, likely due to the way they disrupted the gut’s bacterial network. The researchers now tell patients to avoid these preservatives.

Though antibiotics and probiotics might seem like natural courses of treatment, they could change the bacterial balance in ways that lead to bigger problems. “This is more complicated than it appears,” said Awad. However, he tells CA patients who have infections caused by gram-negative bacteria (such as urinary tract infections or prostatitis) to have them treated right away to avoid more potential brain lesions.

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Most physicians have seen false-negative COVID-19 test results

(HealthDay)—Most physicians believe they have seen false-negative results for a COVID-19 diagnostic test, according to the results of a recent survey.

Sermo, a social platform for physicians, has been conducting a weekly international poll. In week 7, conducted from May 3 to 5, 2020, 4,476 physicians offered their perspectives regarding false negatives and reinfection rates.

According to the results of the recent poll, more than eight in 10 physicians report they have seen some degree of false-negative test results, including 96 percent of “supertreaters” in an intensive care unit setting (physicians who have treated more than 20 COVID-19 patients) who believe they have seen COVID-19 tests produce a false negative. Just over one-third of hospital-based respondents believe that more than 20 percent of the tests have produced false negatives. Relatedly, four in 10 physicians report seeing at least one false positive. Nearly one in 10 physicians believe they have seen a patient with a reinfection, with higher rates among physicians working internationally (5 percent saw reinfections in the United States versus 15 percent in Italy and Spain and 14 percent in China).

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