Less than half of people in England understand current lockdown rules

Under half (45%) of people in England report having a “broad understanding” of the current lockdown rules, compared to 90% across the UK during the strict lockdown period, finds UCL’s COVID-19 Social Study.

Levels in Scotland and Wales have also fallen but are higher than those in England, with reported levels of understanding at 75% and 61% respectively. Complete understanding has fallen even further, with only 14% of adults in England reporting understanding the rules completely as lockdown eased, compared to 18% in Wales and 27% in Scotland.

Launched in the week before lockdown started, this ongoing study is funded by the Nuffield Foundation with additional support from Wellcome and UK Research and Innovation (UKRI). It is the UK’s largest study into how adults are feeling about the lockdown, government advice and overall wellbeing and mental health with over 70,000 participants who have been followed across the last 19 weeks.

Access to healthcare has also fallen during the lockdown, with one in 10 people across the UK reporting being unable to see or speak with a GP about their physical health, one in 20 unable to speak to a professional about their mental health, and one in five not telling a GP about symptoms of an illness when they usually would have done (even when appointments to see GPs were available). Groups who faced the most barriers included younger adults, women, individuals from BAME backgrounds, and people with physical and mental health conditions.

People with a diagnosed mental health condition were significantly more likely to have not spoken to a mental health professional when they usually would have done, with a fifth reported not being able to access professional mental health support during lockdown.

Lead author, Dr. Daisy Fancourt (UCL Epidemiology & Health Care) said: “Our study shows that as lockdown measures have eased at different rates in each nation of the UK, levels of understanding around what is and isn’t permissible have dropped, especially amongst younger adults. This could possibly reflect difficulties in applying the rules to more complex life scenarios amongst younger adults, or may be reflective of the different amounts of time spent following the news on COVID-19 amongst different age groups. The general drop-off in understanding could be due to unclear messaging from the government, or a reduction in interest and engagement from people, especially with the cessation of the daily Downing Street coronavirus briefing in late June.”

Depression and anxiety levels, life satisfaction, and happiness have all shown improvements across every socio-demographic subgroup examined, and loneliness levels have also decreased further, showing the first clear pattern of decrease in 19 weeks. However there has been little change in people reporting major or minor stress due to catching COVID-19, unemployment, finance, or getting food.

Cheryl Lloyd, education program head at the Nuffield Foundation said: “With concerns growing over a second wave of COVID-19 it is concerning that many people in England report not understanding the current government guidance. As another Nuffield-funded study by the Reuters Institute has shown, people are less likely to access news about COVID-19 on a daily basis now that lockdown has eased. With the rules changing regularly, this may be a factor in the public not understanding the government guidance.”

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Excessive drinking responsible for 255 deaths per day in U.S.

(HealthDay)—Excessive drinking was responsible for an average of 255 deaths per day in the United States during 2011 to 2015, according to research published in the July 31 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

Marissa B. Esser, Ph.D., from the CDC in Atlanta, and colleagues estimated national and state average annual alcohol-attributable deaths and years of potential life lost (YPLL) during 2011 to 2015, including deaths from one’s own excessive drinking and from others’ drinking.

An average of 93,296 alcohol-attributable deaths (255 per day) and 2.7 million YPLL (29 years of life lost per death, on average) were identified in the United States each year. The researchers found that 54.7 percent of all alcohol-attributable deaths were caused by chronic conditions and 56.0 percent involved adults aged 35 to 64 years. Per 100,000 population, age-adjusted alcohol-attributable deaths ranged from 20.3 in New Jersey and New York to 52.3 in New Mexico. Per 100,000 population, YPLL varied from 613.8 in New York to 1,651.7 in New Mexico.

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Experts make weak recommendation for remdesivir in severe COVID-19

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

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

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

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

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

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

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

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

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

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

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

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

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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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In nation’s 2 largest metros, Blacks and Latinos are more likely to die from COVID-19

A study published today by the UCLA Latino Policy and Politics Initiative found that Latino and Black residents of Los Angeles County and New York City are roughly twice as likely as white residents to die from COVID-19. The research also revealed that high-poverty neighborhoods in both regions have the highest rates of COVID-19 cases and COVID-19–related deaths.

Sonja Diaz, founding director of the policy initiative, said two significant reasons for those trends are that low-income Black and Latino people in both regions tend to have a greater need to work outside of the home and a greater reliance on public transportation, both of which put them at a greater risk for exposure to the coronavirus.

“We are now seven months into the pandemic, and we are starting to have clear information about the disproportionate health and economic impacts that communities of color are facing,” Diaz said. “It’s time to address the specific ways that COVID-19 hurts Latino and Black families and to protect our most vulnerable communities as the virus surges across the nation.”

In Los Angeles County, the age-adjusted death rate was 54 per 100,000 for Latino residents and 46 per 100,000 for Black residents, compared to 23 per 100,000 for white residents; in New York City, the age-adjusted death rates were 247 per 100,000 for Latino residents, 237 per 100,000 for Black residents and 120 per 100,000 for white residents.

The authors recommend that six measures be implemented immediately in cities with large populations of vulnerable communities:

  • Increase testing for low-income communities of color.
  • Provide access to health services and healthy food in low-income communities.
  • Add protections on public transportation, including providing hand sanitizing stations and free masks.
  • Expand access to health care and paid sick leave for essential workers.
  • Increase access to telehealth for low-income residents and the uninsured to bridge the lack of medical care.
  • Ensure that accurate race and ethnicity information is being collected so that elected officials and public health experts can understand the impact of COVID-19 in communities of color.

The researchers analyzed data from Los Angeles County and New York City, two areas that have been hard-hit during the pandemic and are home to large Latino and Black populations. They found that residents who didn’t have health insurance, lived in overcrowded housing conditions and had limited access to the Internet will encounter inequitable access to health care during the pandemic.

In addition, the authors found that people between the ages of 18 and 40 have the highest rate of infection in Los Angeles County; in New York, people over age 45 are most affected. Men in both regions have higher rates of infection than women.

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Florida overtakes NY State in coronavirus cases, adds 9,300

Florida surpassed New York over the weekend as the state with the second-most coronavirus cases in the U.S., as more than 9,300 new cases were reported in the Sunshine State on Sunday, accompanied by an additional 78 new deaths.

Florida’s 423,855 coronavirus cases as of Sunday were surpassed only by California’s 453,659 cases. With 39.5 million residents, California has almost double the population of Florida’s 21.4 million inhabitants. California is the nation’s most populous state, followed by Texas, Florida and New York.

New York, once the epicenter of the virus in the U.S., had 411,736 coronavirus cases. The state has 19.4 million residents.

There were 9,344 new cases reported in Florida on Sunday. The number of new cases was lower than other days last week, but caseloads released on Sundays tend to be smaller because of the lack of workers entering data or in labs testing samples.

The statewide median age of coronavirus patients in Florida was 40.

Almost 3.4 million Floridians have been tested for the virus. The new cases tested over the weekend had a positive rate of 11%, according to the Florida Department of Health.

The state health department recorded 781 COVID-19 deaths over the past week for an average of 126 deaths per day on Sunday, down slightly from Saturday’s weekly average of 127 deaths per day. Florida had 5,972 total deaths as of Sunday, according to the Florida Department of Health.

Florida also had 8,951 coronavirus-related hospitalizations as of Sunday.


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Adults with Alzheimer’s risk factors show subtle alterations in brain networks despite normal cognition

Researchers at McGill University and the Douglas Mental Health University Institute, in collaboration with the StoP-AD Center, have published a new paper in the Journal of Alzheimer’s Disease, examining how a known genetic risk factor for late-onset Alzheimer’s disease (AD) influences memory and brain function in cognitively intact older adults with a family history of AD.

For their study, the researchers looked at a specific gene, called apolipoprotein E (APOE), which has three allelic variants: e2, e3 and e4. Of these genetic variants, previous studies have shown adults with a single APOE e4 (+APOEe4) gene are at higher risk of developing AD. In this study, Drs. Sheida Rabipour, Maria Natasha Rajah and collaborators used functional magnetic resonance imaging (fMRI) to explore whether having a +APOEe4 genotype altered brain activity during memory task performance in older adults who may be at risk of developing AD.

“It turns out that the +APOEe4 variant, most strongly associated with AD development, doesn’t directly affect memory performance or brain activity in cognitively intact older adults,” explains Dr. Rabipour, a postdoctoral researcher in the lab of Dr. Rajah, and the study’s first author. “Rather, +APOEe4 seems to influence the brain regions and systems that older at-risk adults activate to support successfully remembering past events.”

Specifically, older adults with +APOEe4 use different brain regions, such as the parietal cortex, to support successful memory encoding, compared to adults without this genetic risk factor. In contrast, older adults without the APOEe4 genetic risk for AD use traditional memory-related brain regions, such as the medial temporal lobes and prefrontal cortex, to support successful memory encoding. The findings suggest that the role of +APOEe4, when examined over and above the influence of family history, is subtle, and affects the correlation between brain activity and memory performance.

Drawing on existing cohort for data

To complete their study, the researchers examined the influence of +APOEe4 in 165 healthy older adults from the PREVENT-AD cohort, factoring out age and family history, which are also important risk factors for AD. The team used a powerful multivariate analytical approach, enabling them to objectively disentangle people’s general sense of familiarity from specific recollection of an event and its associated context.

“We used a robust data-driven method that does not focus on any particular brain region, but rather examines the whole brain patterns of activity across the different stages and processes required to complete the memory task we designed,” says Dr. Rabipour.

The team was able to identify a distinct relationship between performance and brain activity patterns for recognition memory, even in cognitively normal older adults, based on +APOEe4 genotype. “In other words, even though all our participants were cognitively normal and performed well on the memory task, we were still able to detect a difference in the brain systems supporting memory function based on having a copy of +APOEe4,” notes Dr. Rabipour.

Moving forward

The findings of the study show that there are differences in the relationships between recognition and associated brain activity patterns based on genetic risk for AD and that these differences are measurable even in cognitively normal older adults, when accounting for family history of AD. Additionally they show that the tasks used to measure memory performance are important to consider when examining the nuances between different types of memory and how they may be affected by AD risk factors. Finally, the results suggest that family history and APOE genotype should be considered separately when examining AD risk.

“Understanding the ways in which different genotypes influence—or don’t influence—behavior and brain activity has important implications on the way we design treatments for AD-related memory impairments as well as our approach to preventing and delaying AD development,” explains Dr. Rabipour. “Using our task, we were also able to support a leading theory that memory systems for general familiarity are distinct from those that underlie detailed recollection of a past event. This could imply different approaches to diagnosing and treating conditions that impact one memory system compared to the other and may also help develop tools or strategies to enhance these types of memory as we age.”

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Pin-prick blood test used to test for radiation exposure in mice

A team of researchers at The Ohio State University has developed a pin-prick-type blood test for measuring the amount of radiation exposure in mice. In their paper published in the journal Science Translational Medicine, the group describes building on previous work to develop the test, and how well it worked in lab mice.

As the researchers note, accidental or intentional nuclear explosions remain a threat today, despite a reduction in the arms race between superpowers. Thus, research continues on ways to treat people who are impacted by such events. People close to such an event will not likely need medical care, for obvious reasons—but for those who are far enough away to survive, a need exists to measure their radiation exposure as quickly as possible. The current method is called a dicentric chromosome assay—it involves looking for DNA damage, and sadly, can take up to three or four days to return results. People who have been exposed to dangerous levels of radiation need treatment right away because they can experience damage to their GI tract and bone marrow. In this new effort, the researchers looked for a way to return the same degree of accuracy more quickly.

The work built on the results of an effort by the same team back in 2013 in which they isolated two non-coding kinds of RNA molecules that might be useful for treating radiation exposure: miR-150-5p and miR-23a-3p. Both exist in the blood and are easily measurable. The researchers found that miR-150-5p was very sensitive to radiation exposure, while miR-23a-3p was not. This led them to conduct experiments with the molecules and test mice.

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Vascular development may be at risk in autism

A Canadian collaboration led by Dr. Baptiste Lacoste has undertaken the first ever in-depth study of vasculature in the autistic brain. The product of four years of work, a paper published today in Nature Neuroscience lays out several lines of novel evidence that strongly implicate defects in endothelial cells—the lining of blood vessels—in autism.

Dr. Lacoste, a scientist at The Ottawa Hospital and an assistant professor in the University of Ottawa’s Faculty of Medicine and Brain and Mind Research institute, heads a lab that specializes in neurovascular interactions in health and disease. In collaboration with researchers at McGill University, Laval University, and the National Research Council of Canada, Dr. Lacoste’s team used a mouse model with one of the most common genetic mutations found in autism spectrum disorder—16p11.2 deletion, or “16p” for short.

The team, in which Dr. Lacoste’s graduate student Julie Ouellette and research associate Dr. Xavier Toussay played prominent roles, also used cells derived from the tissue of human autistic adults who carry the 16p mutation.

Nerves and blood vessels not in synch

“If you imagine you have a luxury car—a Ferrari—and it’s beautiful, sitting in your garage. But if you don’t put gas in the tank, the car won’t drive,” says Dr. Lacoste. “It’s exactly the same with the brain. It’s the most complex organ, but if you don’t have blood supply, the brain just doesn’t work properly.”

Normally, when brain cells light up, blood rushes to the active brain region, a phenomenon called ‘neurovascular coupling’. But when neurons of mice with the 16p deletion are stimulated, this study found that vascular responses in those brain regions were delayed and weaker.

This disconnect—or ‘neurovascular uncoupling’—was shown to originate in the blood vessels themselves: Arteries isolated from these mice and kept alive in a medium also showed a weak and sluggish response to chemicals that induce dilation of blood vessels. The team further isolated the source of the deficit in the endothelium, as opposed to the other cell types, such as muscle cells, that surround blood vessels.

Difficulties in development

Dr. Lacoste’s work further shows that problems with blood vessels begin very early in life for those who carry the 16p deletion. In a petri dish, both human-derived and mouse endothelial cells with the mutation were unable to sprout the extensions that normally connect blood vessels to each other, allowing the vascular network to expand and grow. Endothelial cells in the brains of newborn autistic mice had the same problem.

By adolescence, the mice still showed reduced vascular density in their brains. Interestingly, in contrast to the problems in the circulatory system, the researchers found that the neurons in the brains of these young mice appeared to be surprisingly well organized.

As the mice grew, other cells in the brain compensated for their dysfunctional endothelial cells, so that by adulthood they had developed a full network of blood vessels. However, as the researchers’ previous experiments showed, these blood vessels remained dysfunctional in adult mice.

“It’s a bit like if a plumber comes to your house and does a bad job installing the pipes,” says Dr. Lacoste. “You will have trouble getting the right water pressure in your sink from then on.”

Blood vessels and autistic behavior

When a person or mouse carries a 16p mutation, that genetic difference is replicated in every cell in their body. This makes it harder to pin down the cause of systemic developmental differences.

To address this difficulty, Dr. Lacoste’s team generated mice that only expressed the mutation in their endothelial cells—so-called “conditional mutants”. These mice showed similar deficits in their vascular development as whole-body mutants.

Remarkably, although every other cell in their brain and body was genetically normal, these conditional mutants displayed some behavioral signs of autism: hyperactivity, stereotypic movements, and motor learning impairment.

This indicated that the problems in the blood vessels contributed to neuronal dysfunction, which in turn led to the outward signs and symptoms of autism.

Further avenues of inquiry

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Face masks mandatory in northeast Spain amid virus uptick

Authorities in northeast Spain will start fining individuals who do not wear face masks 100 euros ($113) starting Thursday when the use of masks becomes mandatory in Barcelona and the surrounding Catalonia region following a resurgence of the coronavirus.

Spain ended a nationwide lockdown in mid-June after restrictions on movement and public activity succeeded in reining in the country’s virus outbreak after it had pushed the healthcare system to the breaking point and killed thousands of people.

But with most restrictions lifted and some people not following social-distancing rules, the number of confirmed new cases reported daily in Spain has begun to creep up. Confirmed cases doubled between Tuesday and Wednesday amid dozens of small outbreaks.

The biggest increase was in the Catalonia region, with 52 new confirmed cases in a 24-hour period and nearly 2,000 in the past two weeks.

A number of the 500 recent confirmed cases in a rural county around the city of Lleida have been tied to the summer fruit harvest, which draws in migrant day laborers who often work and live in poor conditions. Regional authorities locked down the area on Saturday and have linked 11 of 15 outbreaks there to farm work.

Health authorities warn that the area’s hospitals are already filling up. An inflatable emergency ward has been installed at the gates of a local hospital, a grim reminder of the makeshift medical facilities and morgues set up in Spain when it was among the world’s leading virus hot spots in the spring.

“We are not saturated now, but we could be in the next few days if we don’t reinforce our medical staff and start transferring patients,” regional health official Ramón Sentís said Wednesday.

Masks are mandatory in shared indoor spaces and also outdoors when distance can’t be maintained throughout Spain. Catalonia, which has a population of 7.5 million, is the first region to extend the requirement to situations when people are able to remain 1.5 meters (5 feet) from one another.

The move comes after a notable drop in face mask use in the streets and adherence to social distancing rules.

A county in the northwest Galicia region that is home to 71,000 residents also has been closed off, while masks are now mandatory in a town in the central north Basque Country region. Both Galicia and the Basque Country have regional elections scheduled for Sunday.



The uptick in cases comes as Spain is hoping to salvage its critical tourism industry by encouraging Spaniards to take vacations inside the country and sending the message to foreigners that Spain is a safe place to visit despite the pandemic. Spain had a pandemic death toll of more than 28,390 as of Wednesday.

Neighboring Portugal, which had done well in controlling the virus, is also concerned about an increase in new virus cases in the capital of Lisbon.

Portugal’s Health Ministry on Wednesday reported 443 new cases, 74% of them in the Lisbon metropolitan area.

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