How can I get over my needle phobia?

How can I get over my needle phobia? BECKY MCCALL is so scared of jabs they make her faint – and that’s surprisingly common

It’s a wonderfully welcome sight: pictures of people having their Covid vaccinations. But I’m afraid I can’t share in the joy.

In fact I can barely look at one without shuddering, as I’m overcome by a mix of panic and nausea. It’s not that I don’t support the vaccine plan – quite the opposite. 

As a science writer, I know how safe and effective the jabs are. There’s just one problem: I can’t bear needles.

The last time I was jabbed by one, during a blood test about five years ago, I had to have it lying down and almost fainted.

I know it sounds melodramatic, but I’m far from alone. One in ten of the population suffers needle phobia to some degree.

Mild phobics will flinch or look away at the sight of a needle, and make a huge fuss, but still be able to have a jab.

It’s a wonderfully welcome sight: pictures of people having their Covid vaccinations. But I’m afraid I can’t share in the joy, writes BECKY MCCALL

In severe cases, sufferers can be plagued by nightmares and even avoid leaving the house for fear of encountering something needle-like.   

Others, like me, suffer a phenomenon called vasovagal syncope, a not-uncommon nervous-system over-reaction to harmless triggers, such as the sight of blood.

The condition is an extreme manifestation of needle-phobia. The stress of having a jab causes a cascade of hormones to be released in the body and a sudden drop in blood pressure.

This can cause nausea and even loss of consciousness, as the change in blood pressure means there is suddenly too little blood reaching the brain.

Social media went into overdrive last month when a nurse in Tennessee fainted while receiving the Covid vaccine on live TV.

And it was shocking to see – I looked away when she had the actual jab, but watched the all too familiar aftermath.

One moment she’s fine, the next she slumps off her chair as worried onlookers rush to help.

There were some wild suggestions that she died as the result of a fatal reaction. In fact, it was vasovagal syncope.

The nurse, Tiffany Dover, later admitted she often faints when having injections. Vasovagal syncope can also be triggered by mild pain – and she said she also faints when she stubs her toe.

I’m not sure when my own phobia began, but the reactions seem to have become more extreme as I’ve got older. It’s linked to the fact that the sight (or even idea) of blood makes me squirm.

One in ten of the British population suffers needle phobia to some degree. Pictured: Stock image

If one of my children – aged six and ten – bashes a knee, it’s my partner who steps in to put on the plaster. If they’ve got a loose tooth, I just can’t look. It’s too gory.

Needles, by their nature, cause a little bit of bleeding, hence my aversion. I used to suffer terrible nosebleeds as a child which would make me faint. I think this is why blood makes me feel anxious.

The first time I passed out was about 15 years ago, after having a travel vaccine prior to a work trip to Panama. Since then I’ve avoided injections or blood tests unless strictly necessary – and have to have them lying down.

I also spend weeks worrying beforehand, and often cancel and then rebook. It’s all rather over the top, and I don’t want to be like this. I hope, at some point soon, to have the Covid vaccine – although at 49 I’ve got a while to wait.

And I’d like to be able, if not to enjoy the experience, at least not to have to be carried out on a stretcher afterwards.

The NHS-backed approach to overcoming fear of needles, I have discovered, is called applied tension. It’s a technique to raise the blood pressure, and so avoid fainting, which you have to practise three times a day for a week before the injection. 

Sitting somewhere comfortable, you clench all the muscles in your arms, upper body and legs and hold the tension for about 15 seconds, or until your face begins to feel warm, then relax for 30 seconds. This is repeated five times.

Another technique is ‘breathing for relaxation’, which the NHS suggests doing in the five days running up to an injection.

Sitting upright, put your hand on your stomach and take long, slow, gentle breaths in through the nose, and out through the mouth. Do this five times, three times a day.

Another tried-and-tested technique is to make what’s known as a ‘fear ladder’. On a blank page, write a list of situations involving the thing you’re scared of, then give each a score out of ten.

For me, a one out of ten might be thinking about having an injection, while a three would be hearing an anecdote about someone having an injection and how much it hurt and bled.

A ten out of ten would be a masked nursed lunging at me with a knitting-needle-sized hypodermic.

Phobics are advised to pick the least scary thing on their fear ladder and prepare to face it after five days of doing the tension training and breathing exercises. Once that’s done, either repeat this or move on to a slightly scarier one.

I decided to give it a go by watching a YouTube video of someone having an injection – I’d say a five out of ten on my fear ladder.

After a day of doing my exercises, I log in, search ‘phlebotomy’ (bloodletting) and pick a video. As it starts, I have butterflies in my stomach. 

First we see an arm and a nurse explaining the technique – a tourniquet is applied, a syringe prepped, a large needle inserted into a vein and blood drawn.

My nerves seemed to hold steady. Although I felt a little fidgety and uncomfortable, it was fine even as the plunger was pulled back, filling the syringe with blood.

Later I speak to Anxiety UK psychotherapist Michelle Mould, who has treated dozens of needle phobics. Most of these phobias, she says, develop in childhood – kids hate injections because they hurt.

But if a hysterical child is held down or the situation is otherwise mismanaged, such as with a parent becoming visibly upset, it can make things worse.

These experiences can haunt us into adulthood.

And those who don’t like needles, like me, with a phobia, will avoid them more than most. So we never learn not to fear them.

Mould offers sessions of cognitive behavioural therapy, during which the aim is to try to get them to change how they think about injections.

She tells me to focus on the good outcomes (I’ll get vaccinated, so I won’t get Covid), rather than irrational worries (that I’ll bleed to death while writhing in agony).

This rings true to me as, paradoxically, I don’t mind having injections at the dentist. I’ve also had two caesareans, with epidurals, and that didn’t bother me either.

I suppose, in my irrational mind, the benefits of the injections in those cases – not feeling the pain of the dentist’s drill or having a baby – outweigh everything else.

Mould says: ‘We think ourselves into phobias and extreme reactions, so we can think our way out of them.’

And so, when I do get that letter inviting me to go for my Covid jab, I know just what I need to start doing…

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Synced brains: How to bond with your kids – according to neuroscience

Synced brains: how to bond with your kids – according to neuroscience

Many people across the world are still living under tough restrictions or lockdowns because of the pandemic, staying home as much as possible. This means that a lot of parents are spending more time than ever with their children. But how do you turn that time into a deeper relationship?

New research, simultaneously measuring brain activity of parents and children, offers some insights.

To effectively interact with others, we must establish an emotional connection as well as swiftly and accurately infer each other’s goals and intentions. Research shows that this works best if we coordinate our behaviour and bodily responses. Luckily, we have a natural tendency to get in sync with others. For example, we automatically imitate one another –- with classical examples including laughing and yawning –- and engage in complex patterns of coordinated eye gaze or touch.

We even socially synchronise our physiology, for example, through the alignment of our heartbeats and hormone secretion (such as cortisol and oxytocin). When we bond with others, it is as if our entire body engages in a “social dance”.

Socially dancing with others enables us to more easily feel what they are feeling and think what they are thinking. This process, called bio-behavioural synchrony, helps us to more strongly connect with one another. During childhood, being in sync with others is also vital for social, emotional and cognitive development.

Brain-to-brain synchrony

Researchers have recently started testing what happens in the brain when two people interact in this way. Using functional near-infrared spectroscopy (fNIRS) “hyperscanning”, brain activity can be measured while people are doing various tasks and wearing a cap linked up with optical sensors. This is done for each participant, and brain activity is then compared. Synchrony arises when there are aligned decreases and increases in the same brain area at roughly the same time.

Studies using this approach with adults have shown that brain activity also tends to become coordinated during interactions. Also, brain-to-brain synchrony was found to be higher in romantic partners compared with friends or strangers.

But what about parents and children? Our new research reveals that brain-to-brain synchrony is also increased when both mums and dads interact with their children, especially when they play or solve problems, such as puzzles, together. Tellingly, the stronger the brain-to-brain synchrony, the more problems parents and children can solve. We have also found increased brain-to-brain synchrony in mums and their kids when they talk to each other.

Engaging in activities with one’s children, such as solving problems through play or simply having a conversation, should therefore always be seen by parents as opportunities to strengthen the parent-child bond and help their children develop vital social, emotional and cognitive skills.

Mums and dads

Brain-to-brain synchrony has been observed to be stronger for children interacting with their parents than with an unknown adult. Although this shows that the parent-child relationship is special in terms of coordinated brains—probably reflecting their closer emotional bond—it does not yet reveal much about the relationships’ underlying qualities. When we looked more closely at how brain-to-brain synchrony between parents and their children related to interaction and relationship quality, we found several additional clues. Interestingly, these clues differed somewhat between mums and dads.

We saw stronger brain-to-brain synchrony during both puzzle solving and conversation if mums and kids took more turns, meaning that they performed the task or spoke alternately—or in succession. The same was true when children were able to more strongly engage in the task instead of being led by their mothers, and so given more autonomy.

Conversely, synchrony diminished during puzzle solving when mothers reported being stressed. In such moments, taking a short break and engaging in self-care may be beneficial for both mothers and children.

In father-child pairs, however, we did not find any links between brain-to-brain synchrony and turn-taking, child autonomy or stress. In turn, we saw higher synchrony in those pairs where dads indicated that being involved in childcare is important for child development and rewarding for themselves.

Take-home message

It seems that brain-to-brain synchrony between mums and dads and their children can be achieved by different means. One possible explanation may be that mother-child interactions are marked by more rhythm and structure, whereas father-child interactions may be somewhat jerkier and energetic. Such different experiences enable children to successfully and simultaneously interact with different types of caregivers and practice a variety of social, emotional and cognitive skills.

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How much money could you save in a year by giving up smoking?

how much money could you save by giving up smoking?

There are many reasons to give up smoking (your health being the big one).

Sometimes, though, only cold, hard cash provides enough motivation to make a change.

So it’s worth noting, we reckon, that you really can save quite a bit of money by ditching your regular cigarettes.

If you’re buying just a pack of Silk Cut for £13.40 a week, for example, ditching that habit will save you £698 in a year.

Think about what treats you could buy yourself with that extra cash?

If you’re smoking more than a pack a week, the amount of money you could stash away only increases – along with all the other benefits of quitting the cigs.

You can work out exactly how much you could save by ditching smoking with our handy calculator below.

Then please do use that as motivation to finally quit. It’s well worth it.

(Please note, if the calculator isn’t showing up in this article, try opening the link in a new tab on your phone or laptop)

How much could you save by giving up smoking?

Benefits of quitting smoking:

Beyond saving money, here are a few more benefits you can gain by ditching cigarettes:

  • Improved lung capacity – meaning easier breathing
  • More energy
  • A boosted immune system
  • Exercise becomes easier
  • Lower stress levels
  • Better sex
  • Improved fertility
  • Boosted smell and taste
  • Younger-looking skin
  • Whiter teeth
  • Longer life
  • Reduced risk of lung cancer

If you want more tips and tricks on saving money, as well as chat about cash and alerts on deals and discounts, join our Facebook Group, Money Pot.

Do you have a story to share?

Get in touch by emailing [email protected]

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How can we help victims of torture?

Post-traumatic stress disorder, or PTSD, affects many people who are exposed to extreme situations, such as torture. Recent research suggests that chronic pain may make it more difficult to treat trauma.

“Trauma-focused therapy is effective for many patients with PTSD, enabling them to talk through the trauma they experienced,” according to Iselin Solerød Dibaj, a psychologist at Oslo University Hospital.

However, not everyone benefits equally from this form of therapy.

“Torture victims who struggle with both chronic pain and PTSD unfortunately often reap less benefit from ordinary treatment,” says Dibaj.

The Red Cross estimates that between 10,000 and 35,000 people with a refugee background who have come to Norway have experienced torture, reflecting the great need for effective treatment in this country as well.

“Torture is one of the most extreme abuses a person can experience. Physical and mental pain is inflicted with the intention of breaking a person down or obtaining information,” says Håkon Stenmark, a specialist in clinical psychology at RVTS Midt, a regional resource centre for violence, traumatic stress and suicide prevention in central Norway.

“Mental health therapists find it difficult to provide effective help to victims of torture. They are pushing to increase their knowledge and find more effective methods,” says Stenmark.

Now Dibaj and Stenmark, along with Professor Leif Edward Ottesen Kennair and Joar Øveraas Halvorsen, a specialist in clinical psychology and Ph.D. at the Regional Unit for Trauma Treatment at St. Olavs Hospital, have published an article in the journal Torture about treating this patient group.

Professor Kennair, from the Norwegian University of Science and Technology, has been a supervisor and the driving force behind the research project that might lead to better treatment of torture victims.

“Exposure therapy” involves delving into patients’ memories and trying to talk through the trauma.

“But trauma-focused treatment for torture victims has been criticized in several clinical and academic settings for being too concerned with the traumas and not taking context into account, such as social, political and historical factors,” says Dibaj.

Dibaj says they understand this criticism, at the same time as they do not want to write off a trauma treatment for this group that has documented effectiveness in other patient groups.

Other trauma-exposed groups in recent years have shown evidence that chronic pain and PTSD mutually contribute to reinforcing the other condition. One disorder can trigger the other, ensuring that neither disappears.

“So people with both disorders have worse treatment results with both the trauma condition and the chronic pain than if they only had one disorder,” says Kennair.

Having both disorders also brings with it a number of additional challenges that therapists do not address specifically and purposefully in either trauma treatment or pain treatment.

“So we’re questioning whether these factors are partly to blame for the trauma treatment being less effective for victims of torture,” Kennair says.

Effective trauma treatment is largely about experiencing mastery and learning new ways to deal with painful memories.

“But if the patient experiences unmanageable pain, without the tools to deal with it, he or she risks not having this experience. The patient might then drop out or not be willing to delve into the memories,” says Dibaj.

In the same way, pain treatment with the physiotherapist rarely works directly with trauma memories. Thus, this therapy can fall into the same trap—that the patient doesn’t dare to do the rehabilitative exercises for fear of re-experiencing the trauma.

“We’re criticizing the current ‘gold standard trauma therapies’ for not working purposefully and specifically enough with important maintenance mechanisms for patients who have both pain and PTSD,” says Dibaj.

But these patients might actually achieve better outcomes if the therapists worked with the pain and trauma simultaneously.

“In other words, psychologists and physiotherapists should collaborate more in treating these patients,” Dibaj says.

“We also have to remember that torture is such an extreme and unique experience that we can’t just conclude that the pain problems in these patients are the same as we see in other patients with the same problem,” says Dibaj.

Norway has ratified the UN Convention against Torture. It states that people who have been subjected to torture have the right to rehabilitation. In a report from earlier this year, the Red Cross found the services offered to torture victims in Norway to be fragmented and highly person-dependent.

“At the same time, those of us working in the health care services are obliged to offer evidence-based treatment and equal health services,” says Halvorsen.

This means that patients with PTSD need to be offered the form of treatment that currently seems to have the best documented effect. This guideline applies regardless of background. The treatment has to be adapted to each individual patient.

“International guidelines for the rehabilitation of torture victims recommend interdisciplinary, specialized follow-up of these patients. However, studies show that even patients who receive such multi-faceted treatment experience only modest effects. We simply need to gain more knowledge about how we can help this group,” says Dibaj.

“We’ve been pointing out that Norway lacks specialized rehabilitation services for victims of torture for a long time. But since we still have limited knowledge of what characterizes effective rehabilitation for this group, funding and implementing clinical studies need to become an integral part of a specialized rehabilitation program,” Halvorsen says.

But why do some people suffer from PTSD?

“From an evolutionary perspective, we can understand the function of both pain and anxiety. These are alarm systems that signal us that something could potentially pose a danger to us. These signals cause us to avoid that situation. This can be adaptive in the short term, so that we steer clear of potential harm,” says Dibaj.

With PTSD and/or chronic pain, our alarm system is overactive and fires a series of false alarms about danger.

Avoidance normally decreases when the acute danger is over, but with PTSD and/or chronic pain, our alarm system is overactive and fires a series of false alarms about danger.

“If we respond to these alarms as a real danger and avoid what’s triggering the alarm, we risk making the alarm system more sensitive,” Dibaj says.

“Research indicates that post-traumatic cognitions or thoughts—that is, thoughts that come up after experiencing a trauma—play an important role in developing and prolonging post-traumatic distress. Examples of this kind of post-traumatic cognition might be, ‘The world is a dangerous place’ or ‘I’m a broken person,'” says Halvorsen.

Both PTSD and chronic pain are characterized by numerous such false alarms. The affected person might have flashbacks, for example, where something dangerous from the past is perceived as dangerous now. Victims can also experience pain signals without connecting them to something actually being wrong in their body.

“Torture is designed to create this form of distress and, especially in recent times, to create pain that doesn’t result in visible scars,” says Dibaj.

Many victims of torture experience that completely normal movements trigger their alarm system. This naturally leads to less physical activity and also makes a lot of people afraid to move. This condition is called kinesiophobia, when normal activities can lead to severe pain and re-experiencing the trauma.

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How immunity boosting experiment saved couch potato when he got Covid

A couch potato took part in a TV experiment on boosting immunity – and when he got Covid, it saved him

  • The Truth About Boosting Your Immune System, airs on the BBC on Wednesday
  • Six volunteers will undergo a crash course to turn around their immune systems
  • Exercise-phobic David Richard came down with Covid during the experiment
  • But his symptoms were mild after he took part in the strict exercise regime

It is a perennial health question that has never seemed more relevant: just how can we boost our immune system and give ourselves the best fighting chance against infection?

Thousands of books, articles and blogs have been written on the subject (unsurprisingly, more than ever in the past 12 months), making audacious claims about specific regimes, diets and superfoods, which, they claim, will stave off illness and help us recover faster if we do succumb.

Meanwhile, chemist and supermarket shelves heave with products aimed at ‘supporting the immune system’ and other sufficiently vague yet intriguing promises. The problem is, there’s barely a jot of evidence for any of it.

Now, a timely BBC documentary has put some of the best-known immune-boosting theories to the test and found that, in just six weeks, a few simple lifestyle changes can make a significant difference, giving our body the tools it needs to defeat the common cold and flu. And, yes, perhaps even Covid.

The Truth About… Boosting Your Immune System, which airs on Wednesday, features six volunteers who undergo a six-week crash course designed to turn around their underperforming immune systems.

David Richards is one of the participants in the BBC’s experimental documentary, The Truth About Boosting Your Immune System

Each was picked as they’d admitted to having unhealthy lifestyles, such as boozing, eating too much junk food and doing little or no exercise – and suffering regular coughs and colds.

Blood tests at the start of the experiment confirmed that their immune systems were not functioning as well as they could be. Their new regime was nothing too unusual: a varied, balanced diet, high in fibre (yes, lots of fruit and veg), regular exercise and a good sleep pattern.

At the end of the programme, the participants not only felt better, but further blood tests proved their disease-fighting immune responses had become stronger.

Immunologist Professor Sheena Cruickshank, at the University of Manchester, helped oversee the experiment. She says: ‘The rapid response seen was pretty surprising. Their blood tests revealed the plan led to an increase in cells that produce disease-fighting antibodies.’

The programme also reveals other, perhaps less obvious ways to help boost immunity, from massages to cold showers, which have immediate benefits.

Our immune system is just that – a network of organs, glands, cells and compounds throughout the body, which protect us from attack by viruses, bacteria, parasites and other pathogens. As we age, levels of some immune-system cells naturally wane, which is why we tend to become more vulnerable to infections of all kinds.

But age isn’t the only factor – lifestyle plays a big part too. Alcohol, for instance, seems to have a wholly negative impact, even in relatively small amounts. Clinicians have long known that heavy drinking in the long term is associated with a raised risk of immune-related illness, such a pneumonia, slow recovery from illness and poor healing of wounds. 

But, in fact, the effects can be near-instantaneous. When it enters the gut, alcohol alters the make-up of our gut microbiome – the trillions of microorganisms that live in our gut which play an important role in immunity.

This, in turn, damages immune cells in the blood, including our lymphocytes, which are responsible for sending out antibodies.

Antibodies play a vital role in immunity, attacking and destroying invaders such as viruses.

In an experiment, with blood samples taken before and after drinking, presenter Dr Ronx Ikharia, an emergency medicine specialist, downs three glasses of prosecco and finds it is enough to bring down levels of lymphocyte cells by as much as 50 per cent. 

This could reduce the effectiveness of the body’s immune response – and for this reason Prof Cruickshank says people should avoid alcohol around the time of having the Covid jab.

David Lloyd, 38, pictured doing a dance routine with his daughter for exercise, also took part in the experiment

‘You need to have your immune system working tip-top to have a good response to the vaccine, so if you’re drinking the night before, or shortly afterwards, that’s not going to help.’

Alcohol isn’t the only vice that can impact the body’s immune response either. As the volunteers, all recruited from Crewe, find out, their choices in food and exercise are a major factors too.

Salesman David Lloyd, 38, admits he could be taking better care of his body. ‘I like a bit of McDonald’s, KFC, you know, fast food,’ he says. When asked whether he would class his approach to exercise as relaxed, moderate or vigorous, David quips: ‘What’s exercise?’

Meanwhile, Ruth Minshull, 47, a personal assistant, says her lifestyle has become increasingly sedentary. She says: ‘My diet has got worse, and I wouldn’t even say I do a little exercise these days. I do no exercise, truthfully.’

And couch potato Nadiya Remtulla, 45, a car-leasing manager, suffers from constant colds.

At the start of the six-week experiment, blood samples are taken from the volunteers and measured for the number of two key sets of immune cells – neutrophils and lymphocytes. 

Neutrophils are fast-responding immune cells that attack pathogens that can cause diseases as soon as they enter the body, while lymphocytes help the immune system ‘learn’ about different types of foreign invaders, and send out antibodies to fight them off.

If the levels of neutrophils in the blood are too high, it suggests that the body’s immune system is over-active – sending out cells to fight infection when it is not there. Low levels of lymphocytes suggest that the body’s ability to defend itself is impaired. In five out of six of the volunteers, test showed neutrophil levels were high, while lymphocyte levels were low.

According to Prof Cruickshank, the consequences could become serious. ‘Over time, if the immune system is out of balance, you’ll start to feel more run down. You’ll become more susceptible to infection, such as colds, and infections will stay longer.’ Prof Cruickshank warns: ‘These people could suffer more severe Covid illness.’

The good news is that it’s reversible. Prof Cruickshank’s first step for the participants is to change what they eat. Their new diet is one that aims to build ‘gut diversity’ – the variety within the make-up of the organisms that live in the gut and form part of the immune system. Studies show a diet high in meat, saturated fats and sugar can, as alcohol does, create imbalances in the kinds of bacteria in the gut.

And, as with alcohol, this can lead to weakened or abnormally behaving immune system cells in the blood. Meanwhile, diets rich in fibre – vegetables, wholegrains, beans, pulses such as lentils and cereals – can support good gut diversity, promote the development of antibody-producing lymphocytes, and help balance immune cells in the blood.

To illustrate, an analysis of salesman David Lloyd’s gut bacteria, using a stool test, revealed a shockingly low level of diversity.

Immunologist Professor Sheena Cruickshank, at the University of Manchester, helped oversee the experiment

‘All the participants ate very low-fibre diets, with few fruit or veg,’ says Prof Cruickshank.

‘We put them on a fibre-rich diet, not necessarily designed to make them lose weight, but to expose them to a wider group of foods.’

The volunteers replaced high-sugar snacks such as biscuits and chocolate bars with nuts, and had large helpings of vegetables with all their meals.

Personal assistant Ruth admits her meals often consist mainly of cheese and bread, so, like many of the volunteers, she found the new regime ‘a big change’. But they all found something to enjoy. Biscuit fan Nadiya now loves eating figs.

The volunteers were also given fitness trackers and asked to do either 75 minutes of vigorous exercise or 150 minutes of moderate exercise each week.

Scientists believe that exercise boosts our immune system because it helps regulate the flow of immune cells around the body. As our blood flow increases with the heart rate, immune cells move more rapidly into our veins and are able to roam the body at the higher rate and in higher numbers.

A British study in 2011 found that people who did aerobic exercises five or more days a week were 40 per cent less likely to have a cold, over three months, than those who did one day of exercise a week.

‘Exercise is absolutely brilliant for your immune system,’ says Prof Cruickshank. ‘A good bit of moderate exercise really helps stimulate your immune system to help it work optimally.’

On top of that, the volunteers were instructed to stick to a good sleep schedule – with at least eight hours a night suggested. While asleep, humans produce more lymphocytes than they do while awake. This is because hormones such as adrenaline, which keep us alert, inhibit lymphocyte production. When we are asleep we produce less of these hormones.

One study which followed a group of volunteers for two weeks found those who slept less than seven hours a night were almost three times more likely to develop a cold than those who get more than eight.

While diet, exercise and sleep are the most important areas to focus on to help your body fight off infection, there are other ways to boost your immune system.

In the programme, Dr Ronx learns that stress, in the short term at least, can help bolster our defences. Long-term stress is generally considered harmful – for the same reason a lack of sleep damages the immune system. Stress hormones impact the body’s ability to produce lymphocytes. But, a short, sharp dose of stress has its benefits.

Massages and cold showers can boost your immunity, but you should go teetotal the week of your jab, according to experts

When we perceive danger, it triggers the release of a cascade of hormones and other compounds in the body that make us more alert and ready for physical action.

It also stimulates the production of neutrophils and other basic fighter cells – an evolutionary explanation is that, should we be wounded, which opens the body to potential infection, it would help better protect us.

DURING another experiment, arachnophobe Dr Ronx is asked to hold a tarantula, and blood tests are taken before and after to see if there is a difference in the levels of immune cells. The results are conclusive. There is a ten per cent increase in Dr Ronx’s white blood cells following that frightening experience.

This sort of change would effectively make the body better at fighting off an infection – for a few hours at least. Despite this, few will be prepared to scare themselves silly in a bid to avoid getting the odd cold, or even Covid. But research shows the ‘fright’ doesn’t need to be quite so extreme to be effective.

A Netherlands study found that, over a period of a year, people who had a normal shower and then for the final 30 seconds switched it to cold, were 30 per cent less likely to have sick days from work. Scientists believe this is linked to the body’s stress response.

Dr Ronx also finds out there are relaxing ways to boost the immune system too. In studies of people with HIV – a virus that attacks the immune system – massage appeared to increase the number of lymphocyte cells in patients’ blood. Scientists theorise this is because massage stimulates nerves in the skin that connect to glands which produce certain types of lymphocytes. Through stimulation, these glands release lots of lymphocytes into the blood.

Once again, Dr Ronx puts this to the test, undergoing an intense hour-long massage. It turns out Ronx is a ‘super responder’, with 20 per cent increase in lymphocytes in the blood. Dr Ronx adds: ‘Next time you ask your partner for a foot rub, tell them you’re not being self-indulgent – you’re simply trying to improve your immune system.’

Six weeks after beginning their immune-boosting regime, the volunteers get their results, and for one of them the programme may have had a more dramatic consequence than first intended.

Exercise-phobic David Richard, 48, came down with Covid during the experiment.

Asthmatic and overweight, David was sure that his symptoms would be serious: ‘I’m aware of people my age, who are fitter than me, who have ended up in hospital on the oxygen.’

But, to his surprise, David’s symptoms were mild. He had committed to 150 minutes of moderate exercise a week – including (virtual) dance classes, and brisk walking. And though Dr Ronx and Prof Cruickshank were unable to run a blood test on David because of Covid, he’s sure the regime helped make the difference. ‘I’m convinced that what I’ve done helped me fight this off.’

The rest of the volunteers underwent a lood test to take another look at their neutrophil and lymphocyte levels and the results were staggering. In all but one of them, there was a drop in neutrophils to more normal levels, and a rise in antibody-producing lymphocytes.

And the participant who had no change suffered a cold during the experience, which Prof Cruickshank believes is the reason: ‘A cold can leave your immune cells out of kilter, temporarily. But that’s the immune system doing what it’s designed to do.’

She adds: ‘It was amazing to see these changes in just six weeks.

‘The group adapted well to living healthier lifestyles and their bodies will thank them for it, if they stick to it. Many of them lost weight along the way, too. People take for granted the value of the immune system. The human body is a collection of cells that needs caring for, and the activities we do on a daily basis make a difference.’

  • The Truth About… Boosting Your Immune System is on BBC1 on Wednesday at 9pm

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How and When You’ll Actually Get the COVID Vaccine

Two pharmaceutical companies say they’re ready to begin vaccinating people before the end of December, if their vaccines are authorized by the Food and Drug Administration. What does that mean?

The two companies have applied to the FDA for emergency use authorization of their Covid-19 vaccines immediately.

The FDA will meet on December 10 to discuss approval of the Pfizer/BioNTech vaccine and a week later on December 17 for Moderna’s. But the vaccines may not be widely available to the public until at least April 2021, although the companies have started sending doses for potential distribution already. Last Friday, the first large shipment of the Pfizer/BioNTech vaccine arrived in Chicago and Moderna’s CEO believes they can begin vaccinations by December 21.

But hold onto your masks: we will have a very, very small fraction of the doses we need and, unless you are a healthcare worker or in a higher risk group, you probably won’t be able to get one for a while.

In the best case scenario, only 22.5 million people in the United States will be vaccinated by the end of the year—Moderna says it has 20 million doses and Pfizer 25 million, and both vaccines require two shots to work.

Who gets the vaccine first?

Today, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted for the CDC to recommend that healthcare workers and residents of long-term care facilities should get the vaccine first.

That decision follows the recommendation of experts, such as the National Academies of Sciences, Engineering, and Medicine and the Johns Hopkins Center for Health Security.

Since there will be so few vaccines at first, the question is how to distribute with the maximum impact. The answer was to protect the healthcare workers who are likely to be exposed to the virus and essential to stop it as well as the residents of long-term care facilities where the virus has been merciless.

Nearly one in four coronavirus deaths is linked to a long-term care facility, and the surge of cases in the Midwest is largely due to cases among already vulnerable, older people in close-contact environments.

But a recommendation is just a recommendation, and states are not obligated to obey the CDC.

And just because healthcare workers are waved to the front of the line doesn’t mean they will take the vaccine, unless required by their employer. Only 63% of healthcare workers said they would get the vaccine, according to a CDC survey, reminiscent of the low swine flu vaccination rates for health workers back in 2009.

Even if everyone in this group wanted one, there wouldn’t be enough in December anyway: there are 21 million healthcare workers and 3 million residents of long-term care facilities, meaning it will be January before we have enough vaccines for this first group.

How many people need to get the vaccine for it to have an effect on the pandemic?

The very good news is that both vaccines appear to work very well—Moderna’s is 94.1% effective at preventing the disease and the Pfizer vaccine is 95%. And when people in the study did get the virus, Moderna’s was 100% effective at preventing severe disease.

The very bad news is that a vaccine is no good unless it is actually in people’s bodies, and the vaccine needs to be in a lot of people’s bodies.

Most experts say we need to reach 60 to 70 percent immunity to break coronavirus transmission, and at most, only 10% of the population has coronavirus antibodies right now (and who knows how long they last or who those people are).

This becomes a math problem: at the very least, a 95% effective vaccine needs to be given to 63% of the population to raise the immunity by 60 percent (0.95 times 0.63).

That’s about 207 million people. And don’t forget, they need two doses each. And we don’t yet know if people will need a seasonal booster like the flu shot.

So how long before the sign at your drugstore says “COVID vaccines are available”?

The optimistic answer is by April. That’s according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Alex Azar, the Health and Human Services Secretary, also expects vaccines to be generally available by the spring.

But there’s reason to be pessimistic. Vaccines won’t be widely available unless we solve manufacturing and distribution problems that have been characterized as logistical nightmares more than once. There are bottlenecks in vials and syringes and facilities that can seal the vaccine into sterile containers, according to a report earlier this month from the US Government Accountability Office. And while Moderna’s vaccine can be thawed and stored for a month in a regular refrigerator, the Pfizer vaccine needs to be kept at -70 degrees Celsius (-94 Fahrenheit), while most freezers only get to about -20 degrees Celsius. The wait on a freezer that can keep the Pfizer vaccine is currently six weeks. And the shots need to be cold throughout their journey: there need to be planes and trucks equipped to carry these vaccines at super low temperatures, meaning lots and lots of dry ice.

The path from the pharma factory to your arm goes like this: manufacturers make them and ship them to a distributor, then a distributor ships them to where you’d go to get the shots, such as a hospital or pharmacy. From here, things look a lot more clear.

As part of Operation Warp Speed, the CDC partnered with McKesson Corporation to distribute vaccines, while Pfizer has set up a distribution campaign of its own.

And earlier this month, the Department of Health and Human Services announced a partnership with nineteen pharmacy chains, including CVS, Walgreens, and WalMart. That covers 60 percent of the nation’s pharmacies, according to HHS.

So, after we make hundreds of millions of doses of vaccines, produce an equal amount of vials and syringes, make and pack them with dry ice, equip trucks and planes to move them from A to B to C, purchase enough below-Antartic cold freezers and put them in hospitals across the nation, then it’s smooth sailing. In other words: don’t throw away your masks. It’s going to be a while.

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This Is How Many People Really Have Blue Eyes

As it turns out, your eye color may have landed you in one of the most exclusive groups in the world. Though blue is the second-most-common color in humans, only eight to 10 percent of the population can boast about their baby blues. As you might have guessed, brown eyes take the top spot. 

Blue eyes are the most common in Europe, and specifically in Scandinavia. And while they are undoubtedly pretty rare, their green-eyed counterparts are even rarer, accounting for only two percent of the population. Those with hazel and amber eyes account for approximately five percent of the population. Less than one percent of the population have gray eyes (per World Atlas).

Over the years, the percentage of humans with blue eyes has decreased considerably, so those sporting baby blues should count themselves lucky — especially when they find out more about the happy genetic accident that occurred to create the unique eye color.

Blue eyes are the result of a genetic mutation

Approximately 10,000 years ago, someone living in Europe was the first person to experience the mutation that causes blue eyes (per World Atlas). Essentially, the mutation resulted in a switch that turned off the genetic mechanism that causes people to have brown eyes. This particular individual is the ancestor of all those with blue eyes today.

A person’s eye color is determined by several genes that control the melanin production in an iris. Since these genes are passed on by your parents, it’s more likely than not that you’ll share their eye color (per Healthline).

Though blue eyes account for nearly 90 percent of the population in many Scandinavian countries, the number of people with blue eyes in the United States has been decreasing over the past century or so, per a study published in the Annals of Human Biology. Between 1905 and 1951, researchers at Loyola University Chicago found that the number of blue-eyed Caucasian babies in the United States dropped an astonishing 25 percent.

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How can the world allocate COVID-19 vaccines fairly?

SARS-CoV-2 emerged with a bang, appearing out of nowhere and spreading with lightning speed. It affects the body in ways similar to other respiratory illnesses, yet also differently. It forced countries to take drastic actions—mask-wearing, social distancing, shutting down economies—never before seen or most recently experienced a century ago. Now, just a year after the world first heard about a novel coronavirus in Wuhan Province, China, vaccines that very effectively combat COVID-19 already exist.

Yet with vaccine approval, even the limited kind dictated by an Emergency Use Authorization (EUA) like the one the United States just issued for the Pfizer-BioNTech vaccine, the question of distribution remains. The answer is not straightforward, with a seemingly unending set of decisions necessary before the shots actually reach individuals.

At the broadest level, how do international dose allocations look? From there, how does each country circulate its stock? In the U.S., that means to 64 jurisdictions, most of them states. Jurisdictions then distribute to health systems or nursing homes or whichever facilities top their list, and those places independently decide who moves to the front. And on and on down the line. Without digging too deep, it’s easy to see the monumental task at hand for those deciding how to spread out what is, at present, a scant resource.

As of this writing, COVAX, an initiative jointly run by the World Health Organization (WHO) and several other global organizations, recommended proportional allocation to start, meaning each of more than 180 participating countries—which does not currently include the U.S.—would get vaccine doses for 3% of its population, prioritizing essential health workers. In the U.S. in early December, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) published a “final” framework that also put health care workers first but did not account for elderly populations in the same way previous versions had.

Both sets of guidance barely skim the surface with regard to equity, a fact that troubles Penn experts like bioethicist Harald Schmidt and behavioral scientist Alison Buttenheim.

“We know that this disease has disproportionately burdened some groups,” says Buttenheim of Penn Nursing. Black and Latinx individuals have been hospitalized at nearly five times the rate of non-Hispanic whites, according to CDC data, and Black individuals are twice as likely to die from COVID-19 as non-Hispanic whites. “We also know that these groups are the least likely to report being excited about getting a vaccine,” she adds. “Initially, we’re going to have scarce supply, and there’s a worry that this will all contribute to worsening disparities and inequities.”

It doesn’t have to be that way, says Schmidt of Penn Medicine. “None of this is a foregone conclusion, but I think the next few weeks will be critical for how all of this will play out.”

Vaccine numbers

In mid-November, drug maker Moderna announced that its vaccine to combat COVID-19 was 94.5% effective. That came just days after Pfizer and partner BioNTech made similar efficacy claims about theirs. Both use messenger RNA to order the body to initiate a defense against COVID-19, a technique developed by Penn’s Drew Weissman and Katalin Kariko, who has since moved to BioNTech.

The fact that one vaccine is already being distributed, with a second likely authorized soon and a third, from AstraZeneca and Oxford University, close behind, is incredible to Paul Offit. He directs the Vaccine Education Center at the Children’s Hospital of Philadelphia (CHOP) and is a Penn Medicine professor of vaccinology.

“In less than a year we’ve made a vaccine,” he says. “It’s a technological breakthrough. A tour de force. It’s amazing, especially given the level of disdain for science in this Administration.”

If all goes accordingly, the companies making the three frontrunner vaccines expect to produce a combined 5.3 billion doses in 2021. The Pfizer-BioNTech and Moderna vaccines each require two shots. Should the AstraZeneca vaccine require just one, that means potential immunization for some 3.1 billion people next year, about 40% of the world’s population. The U.S. may secure enough to vaccinate around 45 million Americans by the end of January 2021, just shy of 14% of the population. And none of that accounts for 10 other coronavirus vaccines already in Phase 3 clinical trials.

Global allocation

These numbers may sound large, but it’s still unclear who falls into which bucket, says Matthew McCoy, an assistant professor in Penn Medicine’s Department of Medical Ethics and Health Policy.

When COVID vaccines were more theoretical than not, the WHO arm tasked with guiding the organization—called SAGE or the Strategic Advisory Group of Experts on Immunization—highlighted several ethical principles to govern allocation. “They said that any distribution of vaccines should advance human well-being and honor global equity, national equity, reciprocity, and legitimacy,” says McCoy, whose work focuses on bioethics and public policy. “But COVAX has decided to take a much more straightforward approach.” That is, proportional allocation based on population size.

“That means that in the first push, countries will get vaccine doses for 3% of their population with priority for health care workers. The next goal is vaccine for up to 20% of the population with priority for people who are at higher risk for death or serious illness from the virus,” he says. “After that, COVAX plans to start accounting for each country’s risk profile, trying to prioritize those countries the hardest hit by the virus, either in terms of health or economic impact.”

Though Penn philosopher Kok-Chor Tan believes this approach trumps vaccine nationalism, whereby countries hoard doses to protect their own populations, “literal equality isn’t properly sensitive to variations on the ground,” he says. “It’s not attuned to the way the pandemic is actually impacting different countries.”

To address that, Tan, McCoy, and others, including Penn Vice Provost for Global Initiatives Ezekiel Emanuel, proposed in September what they called the Fair Priority Model, shared in the journal Science. It’s a three-phase plan for worldwide distribution of what was, at the time, a COVID vaccine in the abstract.

“Our proposal said that in the first phase, you allocate according to a country’s needs,” says Tan, who studies human rights and global justice. “Distribute with the aim of minimizing premature death due to COVID-19. It’s not equal allocation but rather equitable allocation.” The second phase addresses those same issues, plus tries to reduce what the researchers called “serious economic and social deprivations” like school and nonessential business closures. The third and final phase moves to reduce community transmission.

Tan says he finds the Fair Priority Model ethically superior to the WHO’s proposal. But, in an imperfect world, the two models can work together, he adds. In a forthcoming American Journal of Public Health paper, Emanuel and Tan (with three other co-authors) explain that the Fair Priority Model can supplement the WHO’s scheme by specifying when exceptions to equal allocation are ethically required.

Now that vaccine distribution has begun in many places, the ethics question becomes even more urgent, Tan says. “It’s real. It’s no longer something in the future. But even though we’re on the horizon of some actual vaccines, the amount available in the initial delivery is going to be limited.”

In other words, it’s not a one-and-done situation, McCoy says. “The vaccine is going to arrive in batches and these questions will continue to arise. We need to continue to think about ways to optimize allocation,” a scenario made more challenging because COVAX has little authority over how countries divvy up doses within their borders.

U.S. distribution

For the United States, the branches on that decision tree span all 50 states, plus a handful of large cities, affiliated islands, and territories. Yet despite their independence, these places aren’t making decisions in a vacuum.

Much like SAGE’s guidance to the WHO, a panel of experts convened by the National Academies of Sciences, Engineering, and Medicine provided advice at the request of the CDC and the National Institutes of Health. Buttenheim, scientific director of Penn’s Center for Health Incentives and Behavioral Economics, was on that committee.

After two months of weekly video meetings, listening to and reading expert testimony, and public hearings, the group published the “Framework for Equitable Allocation of COVID-19 Vaccine” in September. Buttenheim led the chapter about vaccine demand.

“The framework strives to allocate what we know will be scarce supply in a way that is fair and equitable and mitigates disease. Having to say who should be in line first and why is hard,” she says. “We wanted to make sure the framework at the very least did not exacerbate, and ideally would address, disparities and inequities in health care.”

To address this, the committee suggested a four-phased approach that, in part, prioritized such populations by focusing on groups in which they are disproportionately represented, Buttenheim explains. For example, front-line health workers at high risk—included in the committee’s first phase—likely captures nurses and respiratory therapists and custodial staff, groups that traditionally skew female and include a higher proportion of racial minorities.

Beyond that, the committee recommended the federal government set aside 10% of its total allocation to redistribute to jurisdictions with greater vulnerability, identified through use of a vulnerability index tool. “We made an argument that if a state or city has a higher proportion of people affected by the disease,” she says, “they should get a larger vaccine allocation based on that and distribute it onward with that same focus.”

Of course, the National Academies framework isn’t law; it’s guidance for ACIP, the CDC’s advisory committee, which then offers recommendations to the federal government. According to Schmidt, the latest word from ACIP did not incorporate a disadvantage index.

“That raises this question, what happens to social inequity?” he says. “It’s there but not with the same high salience as in the Academies’ report. If we want to take social justice seriously, it’s not smart to allocate according to population. Politically, that might be the easiest thing to do but if we’re just doing things that are easy, we’ll again disadvantage racial and ethnic minorities. We’re all set up again to say these groups are just not as important.”

Jurisdiction plans

The final verdict hasn’t yet been read, however. Jurisdictions create and carry out their own distribution plans, initial drafts for which they submitted to the CDC in November. They filed close-to-final versions by Dec. 4.

Schmidt, Buttenheim, and a group of Penn students, with colleagues from Harvard, Georgetown, and CHOP analyzed the proposals with an eye toward equity. They found that 18 states plan to use a disadvantage index in some capacity. “That’s pretty encouraging,” Schmidt says. “ACIP has not recommended this but regardless, states are looking into it. California developed its own index. Tennessee goes on the record saying, “We’ll reserve 10% of our vaccine allocation.'”

Buttenheim is equally heartened. “The strong default here would be proportional allocation,” she says. “It’s impressive that any states are even signaling use of a vulnerability index.”

Important to note is a CDC rule regarding COVID vaccines: No jurisdiction will receive more until it uses up its first batch. To secure additional doses quicker, states may be incentivized to offer vaccines to people they know will take them—groups that don’t necessarily overlap with the disadvantaged populations that, from an ethical standpoint, Schmidt and others believe deserve priority.

Here, the researchers stress the need for transparency and open communication.

“You don’t just show up with a new vaccine and have immediate buy-in,” Buttenheim says. “A lot of groups have been really mistreated in medical research. We need to unpack the distrust people feel. It can take many forms.” Maybe it’s suspicion around the medical industrial complex or the research that led to the vaccines. Maybe it’s disinterest in doing something that feels experimental. “We need to figure out if it helps when people can get vaccinated at familiar locations they know and trust, rather than just at a centralized clinic or large health system,” she adds.

An ever-changing situation

As the situation evolves, those entities offering vaccines must progress with it to ensure the world eventually reaches herd immunity, when enough people are immune such that COVID-19 can no longer spread unchecked. It’s the only way to truly stop the virus from circling the globe again and again, Offit says.

“There’s never been an example in the history of humankind of a pathogen eliminating itself by inducing immunity in a population. That has never happened, and it never will,” he says. “The only way to do this is with a vaccine. Vaccines induce herd immunity. Natural infection never does.”

Some places like the United Kingdom and Canada have already begun distributing a COVID vaccine. And in the U.S., with the EUA around the Pfizer vaccine—and another expected for Moderna soon—Americans have started getting it, too.

Even as the world moves into this new pandemic phase, so many questions remain. Do these vaccines prevent those who receive them from infecting others? How long does immunity last? What happens if the virus mutates? On the distribution side, how do countries ensure that their most vulnerable—people who, in many instances, have historically been overlooked or mistreated—get the vaccination? How do countries prevent exacerbating persistent inequities? There’s plenty more work to do.

“The first quarter or half of 2021 is a pretty narrow window,” Buttenheim says. “We’re going to have to get it right. We don’t want to blow this amazing opportunity.”

Excluded groups

Children and pregnant women have mostly been left out of COVID vaccine trials to date

Despite extensive clinical trials conducted on the frontrunner COVID-19 vaccines—Moderna’s had 30,000 participants, Pfizer-BioNTech had almost 44,000—they did not initially include children younger than 18 or pregnant women (save for those who became pregnant partway through the trial).

Both companies have since started testing children as young as 12, and AstraZeneca has said its trial will go as young as age 5. But even so, that group isn’t likely to get a vaccine soon, says Steven Joffe, a pediatric oncologist and bioethicist with the Perelman School of Medicine.

“Acknowledging that there will be some children with chronic illnesses, most kids don’t need to be at the front of the line,” he says. “Before they get the vaccines, it’s going to be really important to get pediatric data.”

Those should hopefully become available in the next six to eight months, says Paul Offit of Penn Medicine and the Children’s Hospital of Philadelphia. “Children were obviously not a priority group,” he adds, “but I do think they need to be vaccinated.”

Although COVID vaccine trials also excluded pregnant women, as is typically the case, about two dozen or so inadvertently ended up participating, Offit says. They will be followed closely to ensure no harmful effects on the pregnancy or child.

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Latinos are especially reluctant to get flu shots – how a small clinic in Indiana found ways to overcome that

Every year, tens of millions of Americans avoid the flu vaccine. During the 2019-2020 flu season, fewer than half of U.S. adults got the shot.

The Latino population is more reluctant than most other groups to get the flu vaccine and often pays a high price with their health. An analysis by the Centers for Disease Control and Prevention of 10 flu seasons showed the Latino community had the third highest flu-related hospitalization rates of any demographic group.

As professors and researchers who study public health, we want to know why the Latino population, in particular, is so wary of the vaccine.

Here are a few reasons: Latinos worry about whether the shot is safe. They wonder if it works. They question whether it’s actually needed. Confidence in the vaccine is a major predictor of influenza vaccination among Latina women.

Getting a flu shot not only stops the spread of the flu. It might also be an indicator of who is willing to get a COVID-19 vaccine—and conversely, who is not, and why. So it is more important than ever to understand why large groups of people are reluctant to get vaccinated—and what might be done to earn their trust. We think our experience at a clinic in rural Indiana might shed some light on this important issue.

Historically low rates, despite high rewards

Reports from the 2019-2020 influenza season say that 38% of Latino adults were immunized, compared to 41% of Blacks, 42% of American Indian or Alaska Natives, 52% of Asians and 53% of whites. However, when children are included in the calculation rates, numbers for Latinos go up; Latino children are typically immunized with greater frequency than their parents.

Those receiving the shot have fewer lost work and school days. They reduce the risk of seeking medical intervention by 40% to 60%. That includes visits to crowded emergency rooms. In communities with known influenza virus circulation, vaccinations decreased pediatric hospitalizations by 41%. For adults, vaccines reduce the likelihood of admission to an intensive care unit by 82%.

Those with the lowest influenza vaccine rates are also disproportionately affected by COVID-19. Since both illnesses show some of the same symptoms, testing is needed to distinguish one disease from the other. This will divert health care personnel from other tasks. Hospitals already crowded with COVID-19 patients will be asked to make room for those with severe influenza.

This is particularly important this year, as health care providers scramble to prevent the possible “twindemics” of influenza and COVID-19. Even during normal times, the Latino community may be at increased risk of exposure to the flu virus; many have jobs in crowded work environments, like meat packing plants, warehouses and agriculture enterprises.

A rural community steps up

The Family Health Clinic in Monon, Indiana, a rural community in White County, Indiana, has worked to build trust with the local Latino population by taking some relatively simple steps. The clinic, recognized by the U.S. government as a place that provides high-quality care to a traditionally underserved population, is staffed by nurse practitioners. Partnering with the Purdue University School of Nursing, the Family Health Clinic serves a clientele that is 52% Latino.

One important part of gaining trust was in making sure the staff were bilingual. Other strategies the clinic used to establish relationships with the Latino population included sponsoring community activities and inviting Latino participation on the clinic board. Perhaps of most importance was generating a reputation for providing a secure, affordable and respectful place for excellent health care in a setting where staff listened to and responded to questions about vaccines.

Brenda Andrade is one of the many who recently received her influenza shot there. She has five children, ranging in age from four months to nine years. Andrade was willing to receive a shot because she wanted to “make sure her family is protected.”

Two more local residents, Juan and Elidia Miranda, also made the flu shot a priority. “We’ve gotten colds every so often, but not influenza,” said Juan Miranda. After talking with clinic staff, they realized the benefits of staying healthy for themselves and their families.

Community health centers like the Monon clinic have long been a trusted source of care for those who don’t otherwise have health care access. They are more than equipped to handle the reasons often given by Latinos as to why they don’t get the shot. But will this willingness to receive the flu vaccine from a trusted source translate to receiving the COVID-19 vaccine when it’s available?

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How mathematics can help us understand tumor growth

In daily life, we unfortunately have become used to seeing images of tumors and melanomas. You may have noticed that they’re are not entirely symmetric. This asymmetry is useful to doctors in their diagnoses, but why are they asymmetric?

Instinctively, we think that symmetric objects are most often found in nature, but perhaps assymetry is even more common. To complicate things, the same object may sometimes be symmetric and sometimes not. Take soap bubbles for example. When they are small, they seem perfectly symmetric, but when we increase their radius, we see that symmetry is broken: the soap bubble is not perfectly round anymore. This phenomenon is due to the presence of physical effects such as wind and gravity. Therefore, we may affirm that the final shape of the soap bubble is caused by several factors, and the effect of each of those cannot be ignored.

The same happens for cancer growth: the asymmetric shape is due to different biological phenomena. To understand what those phenomena are is still at the center of ongoing research in biology and medicine. Mathematics may give a valuable insight on different aspects of tumor growth. By constructing mathematical models and investigating their solutions, we distinguish between various possible aspects in the mechanisms of tumor growth. This may be useful in developing effective treatments and providing biologists and doctors with complementary information.

Can we model how a tumor grows?

The shape of a tumor is the result of several interactions between tumor cells, healthy cells, molecules and other tissues. To mathematically describe its evolution from a global point of view, one can use a “diffusion equation.” Diffusion equations are good mathematical tools in such a context because they allow to describe the global effects of a physical process which takes place on a much smaller scale.

In general, the process at small scale is diffusion: a net movement of any object (for instance atoms or molecules) from a region of high concentration to a region of lower concentration. One example of such behavior can be the evolution of the temperature (or heat) in a room. We know, by experience, that if we heat one small part of our room, soon the heat will spread over to the rest of it. Nowadays we know that this thermal equilibrium is reached because the atoms and molecules composing the air are moving randomly and disorderly. This motion, called Brownian motion, is named after Robert Brown, an English botanist who first described it in 1827 while observing the movement of pollen particles in water. Interestingly, diffusion equations in mathematics were already studied independently since 1822, when Joseph Fourier introduced his landmark heat equation.

However, the connection between the small scale (Brownian motion) and the global effect of thermal equilibrium was only pointed out by Albert Einstein and Marian Smoluchowski in 1905.

Different types of diffusion and different models

Einstein described a particular type of diffusion, nowadays called the “linear diffusion.” It is characterized by its “mean squared displacement,” an average of how much the particles move in time. The “mean squared displacement” is linear in time, meaning that, on average, if we wait 5 units in time, the particles will move of √5 units in space. The linearity here is between the quantity of time and the square of the quantity of space.

This is not the only possible diffusion and other types have been used and studied, their classification often depending on this notion of “mean squared displacement”. For instance, in the “superdiffusion,” the particles are allowed to “make jumps” (nowadays called Lévy walks) and so to move more in space. This behavior is not only common for molecules but has been observed in animals. For example, it describes well the the foraging strategies of an Albatros. We may notice the differences between the trajectories of a Brownian motion and those of the albatros. In the former the particle stays close to its initial position while in the latter the albatros makes long movements (Lévy jumps).

One of the main advantages in mathematics is that, often, similar techniques and concepts can be adapted to describe different situations in nature. This is the case of parabolic equations, which are a generalization of the above diffusion equations, and are used to model a big variety of phenomena such as the oscillation of prices of the stock market or the evolution of a material undergoing a phase transition, for example the melting of ice into water. The common feature in the phenomena described by parabolic equations is always the description of a global effect arising from a process on a smaller scale.

The shape of a tumor

Assuming that every cell is (more or less) moving randomly we may describe the evolution of the cell density in space (number of cells per volume unit) by a diffusion equation. However, we will not obtain an asymmetric evolution by considering only the cell density. Indeed, a feature of diffusion equations is exactly to make the evolution more symmetric, in an effect similar to the thermal equilibrium explained above.

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