Long-term survival after heart attack could hinge on where you live

Having a heart attack before your 50th birthday is bad enough. But new research shows if you also live in a poor neighborhood, your chances of dying within a decade of that heart attack are higher.

“This tells us that we need to focus not just on a patient’s medical problems, but on the whole person, on where they live and the resources they have that will allow them to thrive,” said the study’s lead investigator, Dr. Adam Berman, a cardiology fellow at Brigham and Women’s Hospital in Boston, a teaching affiliate of Harvard Medical School.

Berman and his team divided 2,097 people who had heart attacks before age 50 into three groups based on where they lived. They ranked home addresses using the area deprivation index, a measure of socioeconomic status that includes income, education, employment and housing quality. The study found the more disadvantaged a person’s neighborhood, the higher the chances they would die within 11 years of a first heart attack.

The research was presented recently at the American Heart Association’s virtual Scientific Sessions. It is considered preliminary until published in a peer-reviewed journal.

Prior research shows people in disadvantaged neighborhoods are less able to afford medications, are exposed to greater amounts of pollution, and have less access to healthy foods and other resources that could improve their health, Berman said. These social determinants of health have been shown to increase the risk of heart disease and stroke.

“It is likely that a variety of neighborhood and personal socioeconomic factors contribute to the underlying mechanisms that drive this association between where someone lives and their chances of dying,” he said. “We have to focus on all of those aspects in the care of our patients, particularly after they have a heart attack, and particularly in those who are young.”

Overall, the number of people in the United States having heart attacks has been declining, but for younger adults, heart attacks appear to have been increasing over the past decade. And for Black adults in their 30s and 40s, heart attacks are more common and more deadly than among young white adults, prior research shows.

The new study found those who lived in the most disadvantaged neighborhoods were more likely to be Black or Hispanic, have public or no health insurance, and experience higher rates of heart-related risk factors.

But the study included a relatively small number of women—nearly 80% of participants were men. That’s a problem, given the high rate of heart disease among Black women, said Dr. Tiffany Powell-Wiley, chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory at the National Heart, Lung, and Blood Institute. Nearly half of all adult Black women have some type of heart disease. They are more likely to die of heart disease—and at a younger age—than their white peers.

“We need to know what this looks like across genders,” said Powell-Wiley, who was not involved in the study. “I think it’s particularly important because we know that African American women have a higher risk of premature cardiovascular mortality, and so we would want to see that they are included in data that looks at this relationship.”

Overall, though, the health challenges aren’t only tied to limited resources, she said.

“There is some data showing mortality is related to the physiological stress of living in these environments. I think that’s where the science really needs to go. We need to really dig into the mechanisms by which social and environmental stressors get under the skin and lead to cardiovascular events.”

For example, Powell-Wiley said, “if you live in these neighborhoods, you’re more likely to be someone who experiences racism and discrimination, and these are layers of things that are affecting you.”

Figuring out how to alleviate those stressors is the hard part, Berman and Powell-Wiley agreed.

“Now we have to find ways to fix it empirically,” Berman said. “We have to test to see what happens if we improve healthy food access to a whole community, or if we can eliminate the cost of medications for a population. That’s the really hard part. How do we fix it in a way that’s meaningful and feasible on a medical system level?”

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Family tragedy has Mindy Kaling speaking out on pancreatic cancer

(HealthDay)—When actor, writer and producer Mindy Kaling’s mom was fighting pancreatic cancer, it was the biggest struggle the family had ever experienced.

Swati Chokalingam, a Boston-area obstetrician/gynecologist and Kaling’s mom, died in 2012 after getting a stage 4 diagnosis eight months earlier.

Now Kaling is raising awareness for the Pancreatic Cancer Action Network (PanCAN) as official brand ambassador for this November’s annual Pancreatic Cancer Awareness Month campaign.

“I think it would make my mother so happy to know that I’m doing something to help other families who are going through what my family went through because it was the greatest trial of our lives,” Kaling said.

Kaling is featured in 30- and 60-second public service announcements (PSAs) and a digital campaign, highlighting the urgent need for funding to support pancreatic cancer research.

Pancreatic cancer is the third-leading cause of cancer-related deaths in the United States, PanCAN said in a news release. Its overall five-year survival rate is low at just 10%. PanCAN estimates that of the more than 57,000 people diagnosed with the disease in 2020, about 47,000 will die. Three prominent figures who died of the disease just this year were “Jeopardy!” host Alex Trebek, Supreme Court Justice Ruth Bader Ginsburg and U.S. Representative John Lewis.

Chokalingam experienced symptoms including backache, weight loss and the yellowing of her eyes from the disease, Kaling recalled.

“I remember at that time, that really felt like the moment in my life where I had to become a real grown up,” Kaling said. “And I had to be strong because she couldn’t see me weak or broken by the news—I wanted to give her hope.”

PanCAN leads research initiatives working to transform pancreatic cancer outcomes through early detection and new treatment approaches. Since 2003, the organization has invested $126 million in pancreatic cancer research. This year, it will invest $23 million toward its research initiatives. PanCAN is able to do this through donor support. Funding for pancreatic cancer research programs and services has been reduced significantly due to the COVID-19 pandemic.

“We are so grateful to Mindy for her ongoing generosity and support and her vulnerability in sharing her story with us this November. She’ll undoubtedly bring more urgency and attention to this deadly disease that is in critical need of additional research and funding,” said Julie Fleshman, PanCAN’s president and CEO.

“Pancreatic cancer patients can’t afford to wait. Every dollar donated through this month’s campaign can make a difference and goes to support PanCAN’s programs and services including essential research that will lead to early detection and better treatment options,” Fleshman added.

Since her mother’s death, Kaling has supported PanCAN and its mission to fund pancreatic cancer research.

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Coronavirus surge in California blamed on indoor gatherings, travel

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As California officials impose the latest coronavirus restrictions, one county official said travel and indoor gatherings are driving the surge in cases.

Daily cases in California have doubled in the last 10 days, representing “the fastest increase California has seen since the beginning of this pandemic,” Gov. Gavin Newsom said at a briefing Monday. Last week, California topped 1 million coronavirus cases. 

Newsom's latest restrictions, which took effect on Tuesday, put 41 of the state’s 51 counties in the strictest of the four-tier system for reopening that is based on virus cases and infection rates. Newsom said 13 counties were in the strictest tier last week.

Some counties even jumped multiple tiers as cases surged and despite the new restrictions.


Dr. Teresa Frankovich, health officer for Humboldt County, which is in the so-called “red tier," just one away from the strictest tier, detailed the restrictions to county residents on Monday, saying the recent increases are to blame on travel and gatherings of people. 

“This is travel where you're going to visit friends and family, staying in households, having close contact unmasked, sharing vehicles," Frankovich said. “I really want to be clear to people that if we want to be able to keep our schools operational, to keep our business community operational, we have to stop the gathering.”

"That's a particularly difficult challenge at the holiday season but it's essential to protect our families and our community," Frankovich continued. 


The Centers for Disease Control and Prevention has already come out with some evidence supporting the idea that virus transmission at home is common. In a recent report, the CDC assessed 101 households in Nashville, Tenn., and Marshfield, Wis., from April to September. More than half (53%) of all household contacts were infected and “secondary infections occurred rapidly, with approximately 75% of infections identified within five days of the primary patient’s getting sick, the health agency wrote.

Fox News' Bradford Betz contributed to this report


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Telemedicine Is Keeping Kids’ Asthma Care on Track: Study

FRIDAY, Nov. 13, 2020 — The use of telemedicine led to an increase in the number of inner-city kids in Los Angeles who kept asthma-related doctor appointments during the coronavirus pandemic, new research shows.

The researchers examined “show rates” — how often parents kept an appointment for their children instead of not showing up — over the first four months of the pandemic.

Allergists who run a school-based mobile asthma program in Los Angeles called the LAC+USC Breathmobile have regular patients they work with. When schools closed due to the pandemic, face-to-face appointments were converted to virtual visits.

“Not only did kids show up for appointments, but their show rates were also significantly higher than during the same period in 2019,” study author Dr. Kenny Kwong said in an American College of Allergy, Asthma and Immunology (ACAAI) news release.

More than 90% of patients’ asthma was well-controlled during the period of telemedicine visits. This rate was comparable to before the pandemic, according to the study authors.

Compared to in-person visits, time spent with each patient rose between 32% and 62% during virtual visits, Kwong and study co-author Dr. Lyne Scott noted.

“Kids with asthma need treatment that is consistent and specialized to their individual needs,” Scott said.

“It’s reassuring and encouraging that the quality of care young patients, including those in underserved populations, received via virtual access kept their asthma under control,” Scott added.

The study shows that quality of care can be maintained when health care providers use new methods of treatment that improve access and convenience for patients, the allergists said.

The findings were scheduled for presentation Friday at the virtual meeting of the ACAAI. Research presented at meetings should be considered preliminary until published in a peer-reviewed journal.

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Mike Caussin Wasn't 'Comfortable' With Jana Kramer Showing Kids on Social

Warming up to the idea. Mike Caussin initially was not on board with Jana Kramer sharing their two kids’ lives on social media.

Kristin Cavallari, Jay Cutler and More Former Couples Crushing Coparenting

“I wasn’t completely comfortable at the beginning, but I became comfortable with sharing the kids so much,” the former professional football player, 33, said during the Monday, November 9, episode of their “Whine Down” podcast. “But then I was on board with it, and we never really discussed my reservations around it. But I’m all for it, and that’s our decision as a couple.”

The Virginia native, who shares daughter Jolie, 4, and son Jace, 23 months, with the One Tree Hill alum, 36, added that if they got divorced, seeing the little ones on social media would “crush” him. Caussin noted that another man being in the photos would be a “big” deal.

Khloe Kardashian, Jana Kramer and More Clap Back at Parenting Police

The conversation came up while he and Kramer discussed Brian Austin Green and Megan Fox’s recent drama after the Jennifer’s Body star, 34, called out her estranged husband, 47, for posting pictures of their three kids — Noah, 8, Bodhi, 6, and Journey, 4 — via Instagram.

“I know you love your kids,” the Tennessee native commented on one of the BH90210 star’s social media uploads earlier this month. “But I don’t know why you can’t stop using them to posture via Instagram. You’re so intoxicated with feeding the pervasive narrative that I’m an absent mother, and you are the perennial, eternally dedicated dad of the year. You have them half of the time. Congratulations you truly are a remarkable human! Why do you need the internet to echo back to you what should be inexhaustibly evident in the way your children love you?”

Caussin noted that “the easiest way to take a jab at your partner is using the kids,” while Kramer urged Green and Fox to put them first in the future.

“There’s so much bitterness and hostility that unfortunately the kids get thrown into it and that’s really unfortunate,” the “Beautiful Lies” diner said. “But hopefully, I know a lot of parents that have been able to do a coparenting therapy after divorce and it’s really helpful for them because they can talk about all these things.”

The Dancing With the Stars alum revealed that she used their daughter to hurt Caussin during their 2016 separation, explaining, “Shoot, I did it. I was like, ‘You can’t see Jolie until I’m done with DWTS. … That’s not healthy for the kids. But you’re just so angry that it makes sense that you might not be acting in the best frame of mind and you forget that you need to put your kids first. You feel like you’re putting your kids first but it’s also, you’re so angry at your partner too.”

Jana Kramer and Mike Caussin: A Timeline of Their Highs and Lows

She and the former NFL player briefly split following a cheating scandal, reuniting after Caussin sought treatment for his sex addiction. Kramer gave birth to their second child in November 2018 and exclusively told Us Weekly the following year that they plan to tell the little ones about Caussin’s struggles.

“I definitely think that’s going to be hard, because unfortunately, when they’re old enough, they’re going to Google,” the singer said in April 2019. “I personally would like for them to hear it from us first before they Google. They’ll never know specifics. That’s something that we’re not going to go, ‘Oh, your dad cheated.’ That’s not healthy for anyone to know. So it’s just, ‘Yes, this is your father’s addiction, but look at where we’re at now.’”

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Hospital on alert for 'election stress disorder' influx

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With no clear winner in 2020’s presidential race and potential lawsuits over ballot counting only threatening to further delay officials from declaring a winner, at least one hospital in California is gearing up for an influx of patients suffering from “election stress disorder.”

“We’ve asked the staff to be extra aware for those patients that are presenting with symptoms that could represent an acute heart attack or an acute neurologic disease like a stroke,” Dr. Paul Silka, emergency department medical director at Regional Medical Center in San Jose, told KTVU.

Silka, who told the news outlet that the staff is preparing based on trends seen in Florida following the 2016 election, said the hospital could see an increase of about 25 extra patients a day due to election stress.

“There’s great evidence that emotions, high-stress events: soccer games, Super Bowl, earthquakes can trigger hormonal release,” Silka told the news outlet.

Other experts have said the election is no different, especially with the amount of social media and news coverage dedicated to this year’s contentious race potentially acting as a trigger. Mental health concerns have already been at the forefront for many physicians do to the ongoing coronavirus pandemic.

A particularly stressful or anxious event could potentially lead to a panic attack, which could be a frightening experience for someone, especially for those who haven’t previously experienced it.

“A panic attack is your body feeling like there is an imminent danger, but in this case it is a misread,” Coral Seco, LMHC at Family Recovery Specialists, a Delphi Behavioral Health Group facility, told Fox News. “Signs of a panic attack can be: increase in heart rate, your muscles contract/stiffen up, nausea, dizziness/disorientation, hot flashes, not having a sense of reality, or pain going up your arms.”

Seco said it’s important to recognize what the signs feel like and to practice self-care in instances or on days when you know you may be more overwhelmed.

“Panic attacks can come out of nowhere and tend to be a disabling component of anxiety,” Seco said.

Excessive fears or worrying, fatigue or insomnia, as well as an inability to focus, irritability, changes to weight, and a lack of motivation, are also signs to watch for when it comes to mental health, Dr. Barbara Nosal, PhD, LMFT, LADC, and chief clinical officer at Newport Institute, previously told Fox News.

“If feelings of depression are impacting physical health and other areas of life, talking with family and friends may help,” Nosal said. “The best approach is to speak with a professional.”

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An epidemiologist explains the new CDC guidance on 15 minutes of SARS-CoV-2 exposure and what it means for you

The Centers for Disease Control and Prevention has new guidance clarifying what exactly “close contact” means when it comes to transmission of SARS-CoV-2, the virus that causes COVID-19.

The previous guidance suggested that a close contact occurred when a person was within six feet of an infectious individual for 15 consecutive minutes. Now, the CDC is acknowledging that even brief contact can lead to transmission. Specifically, the new guidance suggests that those spending a total of 15 minutes of contact with an infectious person over the course of a 24-hour period should be considered in close contact.

Despite the change, most public health professionals have been clear for months that there is nothing magic about six feet. In the same way, there is nothing magic about 15 minutes. These should be used as rough estimates to indicate the types of contact that are relatively higher risk.

This new guidance, then, is an important recognition of the ease with which this virus can spread. It is not a dramatic reversal of CDC guidance, like those related to masks and the back-and-forth on testing of asymptomatic individuals.

This change reflects new evidence that has emerged. This change is an example of how science works. As an epidemiologist who studies respiratory virus transmission, I actually don’t think this change will greatly impact how we live our lives during the pandemic, but it does represent continued evidence of how easily this virus spreads.

Why the change?

The new advice comes on the heels of an outbreak investigation published in the CDC’s Morbidity and Mortality Weekly Report. The investigation found that a prison employee in Vermont was infected, most likely during a series of brief contacts with infected but asymptomatic inmates.

The inmates were waiting on test results in a quarantine unit. The employee reported no close contacts outside of work and they hadn’t traveled outside the state. At the time Vermont was experiencing low levels of community spread. The outbreak investigation used video evidence from surveillance cameras in the prison to document the short interactions. Each interaction lasted about a minute, and in total the employee was in close contact with the infected inmates for about 17 minutes over the course of an eight-hour shift. For at least some of those interactions, the infected inmates weren’t wearing masks.

Documenting infectious contact is hard for respiratory viruses. After all, we can’t see the virus moving through the air. The video footage in this case represents pretty robust evidence. And so the CDC is recognizing the possibility that shorter interactions carry some risk.

This change is also an acknowledgment that the previous definition makes at least one explicit assumption that may not be true. The major assumption of the old rule is that there is a threshold effect of exposure. That is, once you’ve been exposed to a certain amount of virus (15 minutes’ worth), your risk of disease increases. The flip side of this assumption is that at levels below that threshold your risk remains low. That is why we’ve seen some schools mistakenly moving students around at 14-minute intervals.

The new guidance suggests that there is more of a dose-response relationship between viral exposure and risk of disease. Which is to say, the more virus you are exposed to, the higher your risk, even if the exposure doesn’t happen all at once.

What does it mean?

While I don’t think this update will result in big changes, one thing it does do is expand the pool of people for contact tracing. In the ideal scenario, this change could mean that we catch more cases early after exposure. Those people can then begin to quarantine before they become infectious and spread it on to others.

Take, for example, the upcoming holidays. Having family over for Thanksgiving typically means sharing a meal, and likely spending several hours in close contact with others. That is still a risk, especially since those without symptoms can spread the disease.

The people who attend that gathering would all have been considered close contacts before, and they still are. But now, brief interactions that add up over time—for example, with a server at a restaurant—will be considered close contact.

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Bushfires and COVID take their toll on new moms and babies

Almost seven in 10 pregnant women and new mothers (65%) in the ACT and southeast New South Wales say they were severely exposed to bushfire smoke in our recent summer.

Almost nine in 10 (85%) said they isolated themselves and their family at some point this year due to the COVID-19 pandemic.

These are early results of the Mother and Child 2020 (MC2020) survey being conducted by researchers from The Australian National University (ANU), University of Canberra and University of Wollongong, in partnership with Canberra Health Services and NSW Health.

The MC2020 study is examining the effects of this year’s bushfires and COVID-19 on the health and wellbeing of pregnant women and their babies. Mid-way through the survey, 750 women have participated.

The researchers are urging more women to enroll to increase the strength of the study findings. They are encouraging mothers from Aboriginal, Torres Strait Islander and multicultural communities to share their experiences.

The survey highlights the challenges women and their babies faced throughout the bushfires and pandemic as well as their adaptability and resilience in both the short and longer term.

Lead ANU researcher Professor Christopher Nolan said the results will be used to form a series of recommendations on how to improve our health system and emergency responses during major crises. “We need to listen to the experiences of these mothers and look at the challenges they faced during the bushfires and pandemic. Understanding these challenges is the only way we can look to improve these systems in the future,” Professor Nolan said. “We are very grateful for the women who have already joined the study.”

Ms Namita Mittal gave birth to twins during the lockdown and says that balancing looking after her newborn babies, helping her daughter do school from home and handling the pandemic without her family’s support caused her a great deal of anxiety. “None of my family could fly to visit me from India. Having a family member come to stay with you 24/7 to help with the babies is important to me and different from hiring help. There was extra work for me to do and not having that family support was the main thing that caused me anxiety,” Ms Mittal said.

“When my daughter was born my mum came, so I had no experience of how to handle everything myself. Recovering from a cesarean section with two newborns and one child doing school from home, I was really anxious having to do this without my mum.”

Dr Amita Bansal, from ANU, said mothers and babies have been disproportionately affected, and the long-term impact of bushfires, bushfire smoke and COVID-19 on the health of mothers and their babies is unknown.

“If a majority of women felt that exposure to smoke was severe, this may influence their stress levels. Isolation from COVID-19 most likely will add to this stress. Pregnancy itself is an overwhelming period for many women, and any additional stress can be detrimental for health of the mother and her child.”

Dr Bansal said it is important researchers get results that more accurately reflect the population to better prepare our emergency response and health care systems in the future.

“We want to hear the unheard, uncover the unknowns and best represent our diversity, so that we can better inform clinical practice and make policies that are more inclusive; inclusive of our women and children, and inclusive of our diverse perspectives and community,” she said.

“Through our study, we want to uncover if our multicultural community was indeed disproportionately impacted, so that we can improve our clinical practices and policies to reduce health disparities between ethnic groups.”

The survey is available to anyone who was pregnant or had a baby no older than three months on 1 February 2020 or became pregnant by 30 April 2020 in Canberra and Southeastern New South Wales.

The four-part survey asks mothers a series of questions about how the bushfires and pandemic impacted their pregnancy care, birthing and early months of having a new baby, including on their own mental and physical health, as well as the health of their baby.

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Ineffective regulation on discharge from hospital in England leaves patients at risk

Regulators have failed to properly address patient safety on discharge from hospital in England, leaving the physical wellbeing and dignity of patients continuously at risk at a time when they should be returning safely home, finds new research.

The research, “Leaving hospital: A step too far for risk-based regulation?” investigates the reasons for the lack of effective regulations from a legal standpoint. It was published in the journal, Medical Law Review and was funded by the National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre (GM PSTRC) which is a partnership between The University of Manchester and Salford Royal hospital.

Victoria Moore, who led the research, is from the centre’s Safer Care Systems and Transitions theme, and said: “Being discharged from hospital can be a dangerous time for patients, but this is an area that regulators haven’t recognized as a group and as such haven’t paid much attention to. This leaves patients vulnerable. My research investigates why this is the case. The answer lies in the regulatory approach that dominates regulation within the NHS.”

Risk-based regulation is the regulatory approach underpinning health and social care regulations in England. To be successful, this approach requires the risk to patient safety to be appropriately identified, fully understood and prioritized by all regulators involved.

Victoria continued: “Within healthcare regulation in England there are a number of regulators, so it is virtually impossible for all of them to have a unified understanding of the risk posed by discharge. This has resulted in a lack of action by any one regulator.”

The research identifies that in hospital discharge, there are three main weaknesses in risk-based regulation and these have been created by the sheer number of regulators involved.

The first is when identifying risk, as regulators don’t possess a complete overview of all relevant information. This is because of the limited information-sharing mechanisms between the regulators. Therefore, judgements have to be made about what information to share and with which regulator. This is problematic given that successful risk-based regulation is heavily dependent upon the availability of sufficient information to identify risks and inform decision-making.

The number of statutory regulators and the limited nature of information-sharing leads to a second important weakness; it’s virtually impossible for all regulators to have a unified understanding of the risks posed by discharge from hospital. Risks will be understood based on the nature of information available, which will vary due to the number of regulators involved.

Finally, the research explains that successful risk-based regulation relies on being able to correctly prioritize risk. This can only happen if regulators have gathered enough information and all understand and agree the regulatory aims.

Victoria concludes, “The combination of the three weaknesses I’ve identified in my research means the risk posed to the safety of patients on discharge from hospital is neither uniformly recognized by the statutory regulators within the English NHS, nor sufficiently addressed. Professional regulators in particular appear to have a poor awareness of the risk and their role in addressing it. Until regulators can accurately identify this risk, build a unified understanding of its causes and consequences, and prioritize it appropriately, this unacceptable status quo will remain.”

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Leaders in US, Europe divided on response to surging virus

Virus cases are surging across Europe and many U.S. states, but responses by leaders are miles apart, with officials in Ireland, France and elsewhere imposing curfews and restricting gatherings even as some U.S. governors resist mask mandates or more aggressive measures.

The stark contrasts in efforts to contain infections come as outbreaks on both sides of the Atlantic raise similar alarms, including shrinking availability of hospital beds and rising deaths.

Governors of states including Tennessee, Oklahoma, Nebraska and North Dakota are all facing calls from doctors and public health officials to require masks.

In Utah, a spike in cases since school reopened has created a dynamic that Republican Gov. Gary Herbert has called “unsustainable.”

But schools remain open and Herbert, who has been pressured by an outspoken contingent of residents opposed to masks, has resisted a statewide mandate. Instead, he announced last week that they would be required only in six counties with the highest infection rates, while leaving it to others to make their own rules. Meanwhile, many hospitals are being pushed to the breaking point.

“We are not just managing COVID. We are also managing heart attacks and strokes and respiratory failure and all those other things that need ICU-level care,” said Dr. Kencee Graves, chief medical officer for inpatient care at the University of Utah Health hospital in Salt Lake City. The hospital’s intensive care unit was filled by the end of last week, forcing the reopening of a backup intensive care unit.

“The sooner we take care of each other, wear masks, physically distance, the sooner we can have some gatherings in a safe way,” Graves said.

In Oklahoma, where the number of people hospitalized for the virus has reached record levels, doctors have called on officials to do more.

“We need face mask mandates to protect more of our Oklahoma citizens,” Dr. George Monks, the president of the Oklahoma State Medical Association, said in a tweet Sunday.

But Gov. Kevin Stitt has said repeatedly he has no plans to do so, citing concerns about how such a mandate would be enforced.

Oklahoma health officials reported a record high of 821 people hospitalized Tuesday with the virus or under investigation for the infection. Wyoming also reported a record high number of patients hospitalized for the virus.

New virus cases in the U.S. have surged in recent weeks from a daily average of about 42,000 in early October to about 58,000—the highest level since late July, according to Johns Hopkins University.

In one of the most troubling outbreaks, 10 residents of a nursing home in northwest Kansas have died from the virus, health officials said. All 62 residents of the Andbe Home in Norton County, as well as an unspecified number of employees, have tested positive for the infection.

The surge in new cases prompted a change of heart Monday from the mayor of North Dakota’s largest city, in favor of a mask mandate.

Tim Mahoney, who in addition to being Fargo’s mayor is also a general surgeon, has been largely supportive of Republican Gov. Doug Burgum’s approach of leaving management of the virus to local officials.

Mahoney, himself, cast the deciding vote against a mask mandate at a recent meeting of city officials. But with North Dakota leading the nation in new cases and up to one in four city residents now testing positive, Mahoney said a statewide change is in order.

The dynamic contrasts sharply with Europe, where national officials are battling a similar spike with measures including new lockdowns and smart phone apps that track the virus’ spread.

In Ireland, Prime Minister Micheal Martin announced a lockdown starting at midnight Wednesday that will close all non-essential stores, limit restaurants to carryout service and require people to stay within three miles (five kilometers) of their homes, while banning visits to other households.

It marks a near-return to restrictions imposed by the government in March, although schools, construction sites and manufacturing industries will remain open. If people comply with the restrictions, which will be in place until Dec. 1, the country will be able to celebrate Christmas “in a meaningful way,” Martin said.

But as cases surge, some decisions by European leaders to impose new restrictions are facing stiff opposition at the local level. After a tense faceoff, Britain’s government said Tuesday it had failed to reach agreement with Greater Manchester Mayor Andy Burnham, who has rejected tough new measures without money to support the workers and businesses that will be most affected.

Britain’s Communities Secretary Robert Jenrick expressed disappointment with Burnham, saying the mayor “has been unwilling to take the action that is required to get the spread of the virus under control.” Prime Minister Boris Johnson said Tuesday he would impose the restrictions, drawing criticism from Burnham.

“It cannot be right to close people’s place of work, to shut somebody’s business, without giving them proper support,” Burnham said. He said Manchester had sought 90 million pounds ($117 million) from the national government to help people get through the winter. It was unclear how much the city would receive.

In the Netherlands, which has one of the highest infection rates in Europe, a judge in The Hague rejected an appeal by more than 60 Dutch bars and restaurants to overturn a government four-week closure order.

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