Coronavirus therapeutics 'more complicated' than vaccine, expert says

WHO warns of surge in coronavirus cases in Europe

EEurope is seeing more weekly coronavirus cases than it did in March’s peak; Amy Kellogg reports.

Editors of a highly respected medical journal discussed on Wednesday "Operation Warp Speed" and the government's response to COVID-19, focusing mostly on therapeutics.

"Operation Warp Speed" is the U.S. government's plan to quickly ramp up the development and production of vaccines, therapeutics and diagnostics.

“Therapeutics are, in a way, more complicated than vaccines," said Dr. Eric Rubin, editor-in-chief of the New England Journal of Medicine (NEJM). “There are a limited number of approaches to vaccination and a similarly limited number of endpoints, but for therapeutics, there is an enormously wide range of targets and goals.”

Rubin explained that therapeutics can take a number of approaches, like trying to target the virus, target the host or target the interface between the host and the virus, all possibly leading to different consequences. Researchers can opt for small synthetic molecules or large biological macromolecules, also leading to different development paths, he said.

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“Therapeutics are, in a way, more complicated than vaccines," said Dr. Eric Rubin, editor-in-chief of the New England Journal of Medicine (NEJM)." 
(iStock)

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“The development time from discovery all the way to a useful drug is even longer than in vaccines, it’s often extending for decades," he said.

Rubin said "Operation Warp Speed" set three criteria for supported therapeutics: the candidate has to be ready for clinical testing this fall, there must be strong preclinical data supporting its use, and any candidate chosen must be deliverable at scale by the end of 2020.

Rubin said the criteria “strictly limit” the potential candidates. However, antibody-based therapies were said to have several advantages due to their well-understood development and production processes, in addition to their relatively known safety margins.

It was noted that small molecules like the experimental antiviral remdesivir and dexamethasone were previously shown to have some success. While the former can benefit patients earlier on in infection, the latter showed to lower the fatality rate of patients with more severe disease.

While remdesivir may benefit patients earlier on in infection, dexamethasone showed to lower the fatality rate of patients with more severe disease. 
(iStock)

“Dexamethasone sets a very high bar because it’s cheap and widely available and most of the other things that we’re talking about are antibodies or expensive small molecules so they’ll have to do better than dexamethasone in order to be widely adopted," Rubin said.

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These small molecules were said to have unique properties, and it’s difficult to generalize between them, even within the same chemical class. Each drug has its own pharmacology, subject to investigation and safety testing.

Rubin explained that “often times, it’s very difficult to guess what the issues are going to be for a small molecule as opposed to some of the, for example, antibodies, so there are often not very good guesses about potential toxicities before you get into people.”

Dr. Lindsey Baden, deputy editor of NEJM and co-principal investigator for Moderna’s Phase 3 trial, is involved with "Operation Warp Speed." Baden questioned how to bring out the best in the U.S. government, industry and academia to create a fast, appropriate response to the global health crisis.

“It’s a real balance because we don’t want to get lost in for-profit considerations but we also need responses that are temporally appropriate, so speed, and how to do things quickly in response to this pandemic that is spreading so fast,” Baden said. “It’s something that the different communities haven’t always thought about together that this crisis forced us to [do]

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"I think the speed with which this response is occurring on the biomedical side is encouraging in many ways despite some failings in our response," Baden added.

Finally, Baden addressed the question on the minds of many: How can drug developers speed along these clinical trials without risking safety in the end product?

“There are ways to take risks in manufacturing that are financial that don’t engender safety risks in the studies and those financial risks have to be thought about in the manufacturing side and the delivery side, that I would argue are appropriate risks in this setting," Baden said, elaborating on the nations' daily new case and death count, which is around 36,000 and 750, respectively, per the AP.

He said shaving off a week, month or just a day "has significant potential implications," given the widespread disease.

Click here to listen to the NEJM interview.

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Researchers succeed with a more inclusive approach to heart transplants

Doctors at Yale New Haven Hospital used a more aggressive selection process to more than quadruple the number of heart transplants performed there while maintaining positive patient outcomes, according to a new study.

The findings suggest that a more inclusive approach to selecting donor hearts and transplant recipients can enable hospitals to successfully treat more patients in need of transplants. The study appears online Sept. 18 in the journal JAMA Network Open.

The study looked at short-term patient outcomes for two groups: 49 patients who received heart transplants from 2014 to 2018, and 58 patients who had their heart transplants in the year after the hospital adopted a more aggressive selection process for donor recipients (2018-2019).

The more aggressive selection process significantly shortened the waiting period for heart patients, from 242 days to 41 days, the researchers said. Importantly, patients’ survival rate at 180 days after the transplant remained nearly unchanged.

The expansion of heart transplant procedures at the hospital, in September 2018, coincided with the implementation of the new United Network for Organ Sharing (UNOS) donor heart allocation system in the United States.

“I think this is the takeaway for other centers—that such a change in the approach could create opportunities for patients in need while maintaining outcomes in the short term,” said Makoto Mori, M.D., a surgical resident at Yale and first author of the study.

The senior author of the study was Harlan Krumholz, M.D., the Harold H. Hines Jr. Professor of Medicine (cardiology) and director of Yale’s Center for Outcomes Research and Evaluation.

In practical terms, the expansion of heart transplant procedures at Yale New Haven Hospital meant accepting hearts from older donors with additional medical conditions, as well as accepting transplant recipients with more severe illnesses.

Yale New Haven Hospital also changed the surgical leadership of its advanced heart failure program, hired a dedicated procurement surgeon and an additional transplant coordinator, and increased the involvement of surgical attending physicians.

The researchers noted that Yale’s increase in heart transplant cases was significantly larger than the volume change seen at other heart transplant centers in the same region during the same period, including Hartford Hospital, Tufts Medical Center, Brigham and Women’s Hospital, and Massachusetts General Hospital.

“We used a multidisciplinary approach and made strategic changes in donor and recipient selection, which allowed us to increase the number of heart transplants performed and therefore help more patients with advanced heart failure in a safe and an effective manner,” said co-author Arnar Geirsson, M.D., chief of cardiac surgery at Yale New Haven Hospital.

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Winter may bring a lot more coronavirus cases, new research finds

Early in the coronavirus pandemic, scientists speculated that warm summer air would dampen its spread.

Then as the virus spread rapidly around the world, racking up more than 27 million cases in the spring and summer, the seasonal impact largely fell out of the public conversation.

But researchers at Johns Hopkins University are coming out with new research that suggests rising temperatures do moderate the spread of the virus—and a big new wave of cases could be coming with the cooler fall air.

“We have made significant inroads in this pandemic, and we can say a lot of that is because of social interventions,” said Dr. Adam Kaplin, assistant Hopkins professor of psychiatry and behavioral sciences and the lead researcher.

The warm weather served as a tail wind for those efforts, he said.

“In the fall and colder months we are going to hit a head wind in the other direction and that will make control much more difficult,” Kaplin said.

The findings were so striking that Kaplin took the unusual step of discussing the work while the research still was under review for publication in a scientific journal.

Maryland and other states, as well as other countries, have been easing restrictions with a drop in cases of COVID-19, the disease caused by the coronavirus. But Kaplin said cases could spike with more virus-friendly cool air even with the same restrictions.

The findings of seasonal variation are not new. The flu, the common cold and other coronaviruses typically moderate during warmer months. This could be due to the direct effects of heat on viruses and because fewer people congregate indoors.

Other recent studies or models on the pandemic coronavirus, from the University of Maryland to Harvard and Princeton universities, have found at least some impact from temperature changes or projected that there would be effects even if they weren’t obvious yet.

A paper published in the Journal of the American Medical Association by the Maryland researchers found, for example, the virus acted in a way “consistent with the behavior of a seasonal respiratory virus,” spreading along with temperature and humidity levels. The College Park researchers said it would be possible to develop a weather model to predict places most likely at higher risk for spread.

Rachel Baker from the Princeton Environmental Institute downplayed how much the weather was a factor, instead pointing to the importance of other measures such as wearing masks and physical distancing.

“I think it is possible that upcoming wintertime conditions could increase transmission, particularly in locations with more severe winters,” she said. “However, if we have effective control measures in place, we should be able to limit large secondary outbreaks.”

Baker said studies suggest the effects would be more clear over time. For now, a lot of the studies face challenges, such as differences in how cases are reported around the world.

Dr. Michael Ryan, executive director of the World Health Organization’s Health Emergencies Programme, was even less sure there would be a visible impact from temperature changes.

“This virus has demonstrated no seasonal pattern as such so far,” he said during an Aug. 10 news conference.

But other studies have raised concerns that a cold winter will lead to more cases if steps aren’t taken now to tamp down cases and keep them low.

That includes Dr. David Rubin at the Children’s Hospital of Philadelphia’s PolicyLab, which has incorporated weather into models it regularly produces. (The model suggests a slight uptick in Baltimore in the fall due to various factors including students returning to college campuses.)

The PolicyLab’s own weather study found a narrow range of springlike temperatures were the safest, 60-65 degrees. The researchers hypothesize that colder weather may facilitate more virus transmission but warmer weather may encourage more social gatherings conducive to spread.

The study, published in July in JAMA Network Open, also found distancing measures were the most effective means of controlling the virus no matter the temperature.

“There is a reason the meatpacking industry was hit so hard by this pandemic,” Rubin said. “They do live in congregate housing, but they also work in freezers. … We need to start now and get a good control of the virus so we don’t go into winter already in a surge.”

Kaplin at Hopkins agreed that measures taken now will matter.

A psychiatrist, Kaplin doesn’t normally do weather-related research, but wanted to sound early alarms to get the public’s attention while there is still time.

The issue became clear to him while in Brazil for his wedding in February, a summer month. He noticed a lower rate of viral transmission compared with the infection rate in the United States during a winter month.

Kaplin enlisted statistician colleagues and used data collected by other Hopkins researchers for their public coronavirus dashboard as well as available government weather data. The researchers got information from 50 countries that had reporting early in their outbreaks, before controls such as mask-wearing and physical distancing. The researchers accounted for population and land area in their calculations and looked for a pattern.

They found from January to April, places such as Singapore with average temperatures in the 80s had much lower rates of viral spread than places such as Turkey with average temperatures in the 20s.

Kaplin didn’t want to weigh in on specific actions to get ahead of another big wave of cases. But he said policymakers likely would have to consider tougher restrictions when the temperature drops just to maintain the same level of spread.

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

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

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

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

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

What is advance care planning?

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

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

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

Why is advance care planning important during COVID-19?

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

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

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

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

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

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

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

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

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

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

How can we boost the uptake of advance care planning?

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

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

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

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

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

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

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Kailyn Lowry and More Celebs Who Welcomed Babies in 2020

The next generation! Celebrity parents from Cameron Diaz to John David Duggar gained adorable mini family members in 2020.

The actress and Benji Madden shared their surprise baby news on Instagram in January, writing in a joint Instagram statement: “Happy New Year from the Maddens! We are so happy, blessed and grateful to begin this new decade by announcing the birth of our daughter, Raddix Madden. She has completely captured our hearts and completed our family. While we are overjoyed to share this news, we also feel a strong instinct to protect our little one’s privacy. So we won’t be posting pictures or sharing any more details, other than the fact that she is really really cute!! Some would even say RAD. From our family to all of yours, we’re sending our love and best wishes for a Happy New Year and Happy New Decade.”

A source told Us Weekly exclusively at the time that the couple “went through so much” ahead of their baby girl’s arrival. “Cameron feels like this baby is truly a miracle,” the insider shared. “They just can’t believe their little miracle is finally here. They’ve spent the last five years hoping for this, and it surpassed all of their expectations.”

As for Duggar, the Counting On star welcomed his first child, Grace Annette, with his wife, Abbie Duggar (née Burnett) the following week on January 7. “Our lives have changed forever with the arrival of our baby girl,” the reality stars told Us exclusively. “She is a beautiful gift from God. We are so blessed the Lord has given her to us. It’s still surreal to know that we are really parents but it’s a great new adventure that we are excited to take on together.”

Annette arrived weighing 7 pounds and 2 ounces, measuring 20.75 inches long.

Keep scrolling to see more stars’ infants, from Twilight’s Jackson Rathbone and his wife, Sheila Rathbone, to Today’s Dylan Dreyer and her husband, Brian Fichera.

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Researchers use social media data to learn more about COVID-19 ‘long-haulers’

A Georgia State University researcher is mining social media data to document the experiences of so-called “long-haulers,” people who remain sick long after being diagnosed with COVID-19.

Experts know little about the clinical course of COVID-19. In the early days of the pandemic, clinicians did not believe coronavirus symptoms could persist past two or three weeks. Patients tended to either recover quickly or die from the infection. In late July, the Centers for Disease Control and Prevention published a report acknowledging that in a third of patients—even young adults with no preexisting conditions—COVID-19 can result in prolonged illness.

Juan Banda, assistant professor of computer science at Georgia State, has amassed one of the world’s largest publicly available datasets of COVID-19 Twitter chatter, made up of more than 602 million individual Tweets. Collaborating with researchers from Oxford University and Harvard Medical School, he used the dataset to identify common symptoms shared by long-haulers, some of whom take months to recover. The work is important because clinical reports documenting long-term symptoms of COVID-19 are not accessible to the public.

“Clinical data is not easily available, and it does not always capture detailed follow-up of the patients,” Banda said. “However, those patients are sharing their experiences on social media, allowing us to study the progression of the disease based on self-reported experiences.”

The researchers analyzed Tweets that were published in May—more than 60 days after the start of the pandemic—through July. The 10 most commonly mentioned symptoms were malaise and fatigue, labored breathing, tachycardia or heart palpitations, chest pain, insomnia/sleep disorders, cough, headache and joint pain or fever.

Some of the most serious reported health impacts for long-haulers were acute respiratory failure and acute organ injury, including kidney injury in 20 percent of patients and damage to the heart muscle in 20 to 30 percent of patients. Consequently, long-haulers may be likely to develop chronic conditions such as chronic kidney disease, heart failure and chronic obstructive pulmonary disease.

Banda and his colleagues chose to make the preliminary study public through the pre-print website medRxiv to aid the global push to learn more about the clinical manifestations of COVID-19.

“We have demonstrated that researchers can leverage social media data, specifically from Twitter, to conduct long-term studies of self-reported symptoms,” Banda said.

The work is part of a massive research project to collect and track social media chatter related to COVID-19. Banda’s team at Georgia State began collecting Tweets dedicated to coronavirus on March 10 and continue to collect nearly 4.5 million Tweets each day. Banda has also used the dataset to investigate the spread of misinformation relating to COVID-19 in various geographic areas. The dataset, which you can find here, is publicly available as a resource for the global research community.

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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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Gigi Hadid Reveals a Bit of Her Bump & Why You Won't See More

During her pregnancy, Gigi Hadid is learning one of the first harsh rules about motherhood: Some people will care more about your child more than they do about all the other amazing things you create. Case in point, in preparing to promote Gigi Journal Part II, an art book she created with V Magazine, she wound up receiving tons of fan questions about showing off her baby bump, yet again.

“I’m so grateful for the positive comments and the questions and wanting just to know that we’re all good and safe and everything’s going great and I love you guys,” Hadid said on Wednesday in a long Instagram Live post to unveil the book.

“Obviously, I think a lot of people are confused why I’m not sharing more, but I’m pregnant through a pandemic,” she explained. “Obviously, my pregnancy is not the most important thing going on in the world. That’s a reason that I felt that it’s not really something that I need to share apart from with my family and friends. Obviously, a lot of people have lost lives due to coronavirus that was in the beginning of quarantine and still happening. And then we moved obviously into the reemergence of the [Black Lives Matter] movement, and I thought that our presence on social media should be used for that.”

This is a very mature, selfless way of explaining Hadid’s lack of pregnancy updates. Mine would have been more like, “I’ll post if I want to, so mind your own business,” only with more expletives. (Reason #798 Hadid is a social media star and I am not.)

But beyond the fact that the world is on fire and there are more important things to discuss than the shape of one model’s belly, Hadid also does want to maintain a bit of privacy during this very special time.

“I have been taking a lot of pictures of my bump and sending it to friends and family,” she said. “And it’s been really cute and exciting, and I’m trying to document it well because I’ve heard a lot of people say, make sure you don’t miss it. And I will be sharing stuff like that in the future. I just am not rushed to do it, and I feel like right now, I just want to experience it.”

Hadid spends her entire life presenting an image of herself for public consumption, so it’s pretty understanding if she wants a break from all that.

“I just don’t want to worry about waking up every day during my pregnancy and worry about having to like look cute or post something,” she went on.

We’ll always have the Bella twins for pregnancy bump pics.

Still, she made one tiny concession for curious fans who just want to see evidence of the life growing inside her. After she had previously explained about not looking pregnant on Instagram videos taking from the front, she discussed her love of loose, linen clothing, particularly the set from Holiday she was wearing. Then she unbuttoned the bottom of her shirt.

“OK, there’s my belly, y’all,” she said, revealing the top of her bump and leaving the rest out of view of the camera. “It’s there. It’s just that from the front, it’s different. … I’m taking my time with sharing my pregnancy, and you guys will see it when you see it.”

With that, she continued on with her original purpose, to show off Gigi’s Journal. Because, for real, can we please let a mom-to-be also have her career?

If Gigi and Zayn don’t have a name picked out yet, maybe they can get inspo from these wacky celebrity baby names.

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Why people of color are suffering more from COVID-19

The statistics are shocking. As of mid-June, Black Americans have been hospitalized or died from COVID-19 at a rate about five times that of white Americans, according to the U.S. Centers for Disease Control. Other people of color have experienced much higher hospitalization and death rates than whites as well.

A recent report indicated that if people of color had experienced the same mortality rate as whites, as of late May, more than 14,000 Black Americans would still be alive, along with 1,200 Latino Americans and 400 indigenous Americans.

Tufts experts in public health and community health said they are not surprised by these numbers. “Even prior to the COVID-19 pandemic, we were already in a public health crisis,” said Adolfo Cuevas, an assistant professor of community health in the School of Arts and Sciences. “More than half of Black individuals have a chronic health condition” such as diabetes or high blood pressure, he said, which predisposes people to suffer from the COVID-19 virus. “The racial difference is striking already.”

Ndidiamaka Amutah-Onukagha, an associate professor of public health at the School of Medicine, said, “I think the mortality and morbidity that we’re seeing in COVID-19 is directly related to decades of systemic racism and the impact of racism on communities of color. Racism plays out in the rationing of equipment for people who are testing positive for COVID and even in back room decisions about who is eligible to get tests.”

A number of factors contribute to the health disparities highlighted by COVID-19. Black Americans are more likely to be essential workers, who must work and interact with other people—delivery drivers, grocery store employees, transit workers. They also are disproportionately low-wage workers, unable to afford to not work, said Amutah-Onukagha.

“They don’t have the luxury of working from home and shifting their livelihood to a virtual environment,” she said. “They are still going to have to deal with people face to face.”

Blacks also shoulder a higher burden of chronic disease, with up to 40 percent higher rates of high blood pressure and up to 60 percent higher rates of diabetes than white Americans, she said. Both conditions are increase risk for serious illness from COVID-19, according to the CDC.

Cuevas, whose research focuses on obesity, noted that about 40 percent of individuals nationally has the condition, a risk factor for increasing complications from the coronavirus. But about half of Black Americans have obesity compared to about 40 percent of whites. “So, the racial difference was already alarming,” he said. “What COVID-19 basically has done is exacerbate these racial disparities even more.”

Stress is a risk factor, too. “We know that when you put people in racially charged situations, their blood pressure goes up and their cortisol levels goes up,” said Amutah-Onukagha, who has done research on maternal health among women of color. Cortisol is the body’s main stress hormone, and heightened levels of it increase the frequency of preterm birth, low birth weight, and infants and mothers dying, she said.

The body’s physiologic response to stress “is really having an impact front and center for African Americans,” said Amutah-Onukagha.

Cuevas, who trained as a psychologist, agreed that stress has a physical and emotional effect. “Racial and ethnic minorities report experiencing a wide range of stressors day-to-day—financial strain, relationship problems, discrimination,” he said. “That accumulates over time to adversely affect both the mental and physical health of the individual.”

Add that to the lack of access to health care and to healthy foods and vegetables—and living in communities that are high in environmental toxins and pollutants—”it becomes a really bad soup that contributes to high rates of all these diseases,” he said.

Living conditions matter, too. “Black and brown populations, who have already been suffering from chronic conditions, live in areas that do not facilitate social distancing,” said Cuevas. That in turn causes the virus to spread at a quicker rate and suffer disproportionately from the virus.

Many of the current living conditions arose out of discriminatory policies from the past, Cuevas said. He pointed to government-supported neighborhood redlining from the 1930s to the 1960s—a practice that kept Black communities from building wealth

“Even after the 1960s laws prohibiting redlining, the effects of these practices persist,” he said. “The systematic denial of services limited people’s opportunities to get decent jobs and education, which some scholars suggest led to an overrepresentation of Black people in poverty and working menial labor jobs, which are two factors preventing many from staying at home.”

Likewise, it’s more difficult for people to practice social distancing in these neighborhoods, because residents tend to live in small apartments and with a sizable number of other individuals, he said. “Once you place more of the historical perspective into it, all of these health disparities make a lot more sense.”

Overcoming all these systemic deficits, which lead to health disparities that are especially vivid with the COVID-19 pandemic, is vital—and difficult, Amutah-Onukagha and Cuevas said.

“There is an opportunity here for community health scientists and elected officials to really change the social and public health landscape of the United States,” Cuevas said. “There needs to be real radical change to actualize equal opportunity for all. As community health scientists and elected officials, we must continue to highlight and address the social determinants of health disparities. As citizens, we must engage in local civic and political action to achieve equity near us.”

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Teenagers: Less alcohol and cigarettes, more Cannabis

New data on the addictive behaviour of young people show positive developments, especially in the case of cigarettes: The Smoking rate of 12 – to 25-Year-old is on the lowest level in nearly 50 years. The number of young people who use Cannabis is on the rise.

Since the year 1973, the Federal centre for health education (BzgA) every year surveys on the Smoking behaviour, alcohol and cannabis use in the 12 – to 25-Year-olds in Germany. "The Figures in the smoke are more than erfreulich", Daniela Ludwig says, drug Commissioner of the Federal government. The proportion of young people between 12 and 17 years who smoke, with 5.6 percent to a new historic low. In the age group of 18 – to 25-Year-old Smoking with 21.2 percent as few as never before since the beginning of the BZgA-survey series. "To list just watch, we need to pipe the development of the consumption of E-products and water, even if currently there is no further consumption increases sind", Prof. Dr. med says. Heidrun Thaiss, Director of the BZgA.

Binge drinking is still on Trend

Even with alcohol, there are positive developments: at Least once a week alcohol 9.5 per cent of the surveyed 12 – to 17-Year-olds (2004: 21.2 percent) and 32.9 percent of 18 – to 25-Year-olds (2004: 43.6%) drink. Of concern, however, is that overall, too many young people drinking to alcohol intoxication. "This is in particular in the youth age dangerous. Here are increased common prevention is commitment erforderlich", so Thaiss. Over the years, the Trend of the noise is considered a drink, however, also declined.

Young people Smoking weed and more

Only the consumption of Cannabis, an increase is observed. "We see with concern. Cannabis is by far the most consumed illegal substance. This is of particular concern, since the consumption in adolescence linked with specific risks for growing organism ist", Thaiss says. Young people to educate about the health consequences of Cannabis, the government has a new prevention campaign "Drugcom" launched. "The launch of the social media, followed by new national prevention, with a focus on school. This prevention comes at just the right Zeitpunkt", so Ludwig.

NK