Study Examines Effect of Cancer Treatment on COVID-19 Mortality

TUESDAY, Sept. 22, 2020 — Cancer patients treated one to three months prior to COVID-19 diagnosis and those treated with chemoimmunotherapy have the highest 30-day mortality, according to a study presented at the annual meeting of the European Society for Medical Oncology, held virtually from Sept. 19 to 21.

Trisha M. Wise-Draper, M.D., Ph.D., from the University of Cincinnati Cancer Center, and colleagues examined outcomes related to systemic cancer treatment within one year of laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. Data were analyzed for 3,920 patients as of July 31, 2020.

The researchers found that 42 percent of the patients received systemic anticancer treatment within 12 months and 159 distinct medications were administered. Patients treated within one to three months prior to COVID-19 had the highest rates of COVID-19-associated complications; all-cause mortality was 26 percent in this group. By most recent treatment type, 30-day mortality was 20, 18, 17, 29, 20, and 11 percent for chemotherapy, immunotherapy, chemoradiotherapy, chemoimmunotherapy, targeted therapy, and endocrine therapy, respectively. The standardized incidence ratio for mortality was lowest for endocrine treatments and highest for chemoimmunotherapy or chemotherapy less than two weeks before COVID-19 diagnosis. Targeted agents within three to 12 months also had a high standardized incidence ratio. Mortality was 14 percent for patients untreated in the year prior to COVID-19 diagnosis.

“Targeted therapies, especially those causing immune cell depletion, used one to three months before [the diagnosis of] COVID-19, are associated with very high mortality, up to 50 percent,” Wise-Draper said in a statement.

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Canadian province announces new COVID-19 restrictions on gatherings

The Quebec government on Sunday announced new restrictions on gatherings in order to prevent a second wave of COVID-19 infections.

The number of people allowed in “rented halls, places of worship, festive events weddings” will drop from 250 to 50 from Monday, said Health Minister Christian Dube.

In three of the regions in the province—including the cities of Montreal and Quebec City, which have increased to an “orange” alert level—such gatherings are limited to 25 people, Dube told a press conference.

The restrictions do not apply to theaters or cinemas, where social distancing is easier to implement, he added.

“The contagion has increased in three socio-sanitary regions,” Dube told reporters. “The number of cases is increasing and our ability to take care of the sick is decreasing.”

“We ask that you keep contact to a minimum and avoid visiting each other… Avoid family dinners, dinners with friends and parties.”

Canada has seen an increase in the number of coronavirus cases over recent weeks. Quebec and neighboring Ontario, the hardest-hit provinces, have clamped down on large gatherings and private parties.

Ontario expanded restrictions on private gatherings—already in effect in Toronto and Ottawa—to cover the entire province on Sunday. Gatherings are now limited to 10 people indoors and 25 outdoors.

People who organize parties that exceed those limits are subject to a minimum fine of Can$10,000 (US$7,587).

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Risk gene for Alzheimer’s has early effects on the brain

A genetic predisposition to late-onset Alzheimer’s disease affects how the brains of young adults cope with certain memory tasks. Researchers from the German Center for Neurodegenerative Diseases (DZNE) and the Ruhr-Universität Bochum report on this in the scientific journal Current Biology. Their findings are based on studies with magnetic resonance imaging in individuals at the age of about 20 years. The scientists suspect that the observed effects could be related to very early disease processes.

The causes for Alzheimer’s in old age are only poorly understood. It is believed that the disease is caused by an unfavorable interaction of lifestyle, external factors and genetic risks. The greatest genetic risk factor for late-onset Alzheimer’s disease stems from inherited mutations affecting “Apolipoprotein E” (ApoE), a protein relevant for fat metabolism and neurons. Three variants of the ApoE gene are known. The most common form is associated with an average risk for Alzheimer’s. One of the two rarer variants stands for an increased risk, and the other for a reduced risk.

“We were interested in finding out whether and how the different gene variants affect brain function. That is why we examined the brains of young adults in the scanner while they had to solve a task that challenged their memory,” explained Dr. Hweeling Lee, who led the current study at the DZNE in Bonn.

Distinguishing similar events

The group of study participants comprised of 82 young men and women. They were on average 20 years old, and all of them were university students considered to be cognitively healthy. According to their genotype for ApoE, 33 of them had an average, 34 an increased and 15 a reduced risk of developing Alzheimer’s disease at a late age. During the study in the brain scanner, all individuals were presented with more than 150 successive images displayed on a monitor. These were everyday objects such as a hammer, a pineapple or a cat. Some pictures were repeated after a while, but sometimes the position of the displayed objects on the screen had changed. The study participants had to identify whether an object was “new” or had been shown before—and if so, whether its position had shifted.

“We tested the ability to distinguish similar events from one another. This is called pattern separation,” said Hweeling Lee. “In everyday life, for example, it’s a matter of remembering whether a key has been placed in the left or right drawer of a dresser, or where the car was parked in a parking garage. We simulated such situations in a simplified way by changing the position of the depicted objects.”

High-resolution through modern technology

Simultaneously to this experiment, the brain activity of the volunteers was recorded using a technique called “functional magnetic resonance imaging”. Focus was on the hippocampus, an area only a few cubic centimeters in size, which can be found once in each brain hemisphere. The hippocampus is considered the switchboard of memory. It also belongs to those sections of the brain in which first damages occur in Alzheimer’s disease.

When measuring brain activity, the scanner was able to show its full potential: It was an “ultra-high field tomograph” with a magnetic field strength of seven Tesla. Such devices can achieve a better resolution than brain scanners usually used in medical examinations. This enabled the researchers to record brain activity in various sub-fields of the hippocampus with high precision. “Up to now, there were no comparable studies with such level of detail in ApoE genotyped participants. This is a unique feature of our research,” said Hweeling Lee.

No differences in memory performance

There were no differences between the three groups of subjects with regard to their ability for pattern separation. “All study participants performed similarly well in the memory test. It did not matter whether they had an increased, reduced or average risk for Alzheimer’s disease. Such results are certainly to be expected in young healthy people,” said Nikolai Axmacher, Professor of Neuropsychology at the Ruhr-Universität Bochum, who was also involved in the current study. “However, there were differences in brain activity. The different groups of study participants activated the various subfields of the hippocampus in different ways and to varying degrees. Their brains thus reacted differently to the memory task. In fact, we saw differences in brain activation not only between people with average and increased risk, but also between individuals with average and reduced risk.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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A primer on viruses, vaccines and therapies

Since the novel coronavirus SARS-Cov-2 emerged late last year, it has been virtually impossible to consume any news without encountering stories about the virus and how it spreads, potential treatments, and the development of new vaccines.

This deluge of news can be overwhelming, especially for those who aren’t well-versed in virology or immunology. To help equip people to interpret the new information we learn about SARS-Cov-2 every day, Arup Chakraborty, the Robert T. Haslam Professor in Chemical Engineering at MIT, and Andrey Shaw at Genentech sat down early in the pandemic to write a slim book containing an overview of viruses and how they emerge to cause pandemics. The book also explains how our immune system fights viruses, the science of epidemiological models, and how vaccines and therapies work.

The resulting book, “Viruses, Pandemics, and Immunity,” provides important context for anyone who wants to better understand the complexities of the COVID-19 outbreak, as well as past and possible future pandemics, Chakraborty says. The book also provides an outline for creating a more pandemic-resilient world.

“People who read the book will now have a conceptual framework and facts to think about how viruses emerge to cause infectious diseases, how they spread, how we combat them naturally, and how we can combat them with vaccines and therapeutics,” says Chakraborty, who is also a professor of physics and of chemistry, a member of MIT’s Institute for Medical Engineering and Science, and a member of the Ragon Institute of MGH, MIT, and Harvard. “It will give them the framework that they need to debate and consider the current issues, and how we might build a more pandemic-resilient world.”

“It’s very difficult for the public to really get an understanding of the whole picture, and so that’s what our attempt was here,” Shaw says. “We felt that it was important to lay out the scientific framework so that people could make their own decisions about what is going on.”

The book, which was illustrated by Philip J.S. Stork of Oregon Health and Science University, was published by the MIT Press as an ebook on Sept. 8 and will be published as a paperback in February.

Historical perspective

Pandemics have played major roles in the course of human history, especially since humans began living together in closer quarters following the development of agriculture more than 10,000 years ago. Periodic outbreaks of bubonic plague, smallpox, yellow fever, influenza, and other infectious diseases have taken a huge toll on human populations.

During the 20th century, humankind made great strides against infectious disease, due to three major factors: improvements in sanitation, the discovery of antibiotics, and the development of vaccines against many deadly diseases. Because of those advances, many people, especially those living in developed countries, tended to think of major disease outbreaks as a thing of the past.

“This pandemic has reminded us that infectious diseases are an existential threat to humankind and have always been,” Chakraborty says.

As he and Shaw outline in their book, viruses, especially RNA viruses, are well-suited to cause pandemics. One reason for this is that RNA viruses are much more prone to make mistakes in copying their genetic material than DNA viruses are. This allows them to occasionally generate mutations that allow them to jump between species. The SARS-Cov-2 virus is believed to have done just that, likely jumping from bats to humans.

While humans have not previously encountered this particular virus, our immune system does have myriad defenses that can help fend off viral infection. These defenses fall into two main branches—innate and adaptive immunity.

The innate immune system is constantly on the lookout for foreign invaders. Upon encountering viral particles, it deploys a variety of cellular responses that can control the virus. The innate immune system also sends out a distress signal that attracts the specialized cells of the adaptive immune system. These cells, such as “killer T cells,” can launch a response tailored specifically for a particular virus or any pathogen. However, this response takes longer to develop. Once a pathogen has been vanquished, memory T cells, B cells, and antibodies specific to that pathogen continue to circulate, providing immunity to future infection.

Medical advances

While the human body has its own defenses against infection, these don’t always get the job done. Technological advances, especially vaccination, have proven to be a major weapon against infectious disease. The first modern vaccine, which was developed in 1796 to prevent smallpox, consisted of a virus called cowpox, which doesn’t harm humans but is similar enough to smallpox to provoke an immune response against the disease. The term vaccine comes from the Latin word “vaccinus,” meaning “of or from cows.”

The book describes the many types of vaccines, including attenuated vaccines, which consist of a weakened form of a virus or bacterium; vaccines that consist of killed pathogens; and subunit vaccines, which contain just a fragment of a pathogen.

One promising new type of subunit vaccine is RNA vaccines, which are made from RNA that encodes a viral protein. A major advantage of this type of vaccine is that they can be designed very quickly—one pharmaceutical company, Moderna, was able to start phase 1 clinical trials of an RNA vaccine against SARS-Cov-2 just over two months after the virus’ genetic sequence was published. That vaccine is now in phase 3 clinical trials, while dozens more, many based on other strategies, are also in development.

Because we don’t know yet which approaches will work the best for COVID-19, “it is wonderful that many vaccine ideas are being pursued in parallel,” the authors write in their chapter on vaccine development.

One factor that makes the authors optimistic about a SARS-Cov-2 vaccine is that the virus does not mutate rapidly, unlike other RNA viruses such as HIV and influenza. “It may not be so difficult to make a vaccine against it, especially with the extraordinary efforts people are putting into it,” Chakraborty says. He adds that the lessons learned from these intense efforts, and current research on vaccines against highly mutable pathogens, could lead to future advances that make possible vaccines against more difficult viruses such as HIV, which has no effective vaccine even after many decades of research, as well as vaccines against novel mutable viruses that may emerge in the future.

Antiviral drugs have also proven successful against some diseases, such as HIV and hepatitis C. These drugs can target many different stages of the viral life cycle. Some prevent viruses from binding to cell receptors that let them enter cells, while others, such as the reverse transcriptase inhibitors used to treat HIV, prevent the virus from replicating inside cells.

Because it takes so long to develop a new antiviral drug, scientists often try repurposing old drugs when a new virus emerges. Recently the U.S. Food and Drug Administration granted emergency-use authorization for remdesivir, a drug that is believed to interfere with viral replication, to treat COVID-19. Dexamethasone, a corticosteroid that helps reduce inflammation, has also been shown to improve symptoms in some patients.

“When COVID-19 first burst onto the scene, many physicians were really unprepared to treat this. But as the months have passed, we’ve become much more familiar with what’s going on, and we have a better idea how to treat these problems,” Shaw says.

The road ahead

In addition to offering the general public a better understanding of the scientific principles behind viruses, immunity, vaccines, therapies, and epidemiology, Chakraborty and Shaw hope to inspire young people to pursue careers related to those topics. They also hope that the book will help people in policymaking positions to gain a better understanding of the science behind pandemics, to aid them in making decisions that will help combat COVID-19 and potential future disease outbreaks.

“The authors provide a readily accessible introduction to viruses, a class of tiny human pathogens of surprising potential to cause transmissible, sometimes fatal, disease. They speak from a deep understanding of the viruses and the body’s response to viral infections. A great book for people who want to understand why viruses are such a challenge to human life,” says David Baltimore, president emeritus and professor of biology at Caltech, and winner of the 1975 Nobel Prize in Medicine.

Chakraborty and Shaw believe there are many ways to make the world more resilient to future pandemics, including improving early diagnostics, surveillance, and epidemiological modeling; creating more targeted approaches to the development of vaccines and antiviral drugs; making vaccine manufacturing more flexible; and making living spaces, workplaces, and hospitals safer. Success in these areas will require partnerships between government, the pharmaceutical industry and academia, with investments by the government to stimulate the necessary advances, the authors say.

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How the hand gesture for talking on the phone has changed

Daniel Alvarado’s TikTok post has done the circuit, making headlines on HuffPost, Fox News, and BuzzFeed. When something hits platforms that diverse, you know something’s up. And that’s because Alvarado’s video (via TikTok), which has racked up more than 307,000 likes to date, encapsulates something we’ve all been whispering about since 2007, when smartphones started taking over our lives (via Science Node).  

There’s a name for humanity’s collective addiction to smartphones. It’s called nomophobia (via HelpGuide). Like other addictions, it’s linked to increased anxiety, stress, sleep problems, and even narcissism. And now there’s a hand gesture, too. It’s there to remind us that the smartphone has permanently changed the world we live in today. Alvarado’s video proved it. 

How do you signal with your hands that you’re talking on the phone? If you raise your hand to your cheek, extending your pinky and your thumb, you’re a Baby Boomer. Or, perhaps you’re Gen X. Maybe you’re even an older Millennial. You grew up in an age where you fought with your siblings for the privilege to use your corded, banana-shaped phone to leave a voice message on your crush’s answering machine. A voice message, imagine. 

How Gen Z makes the hand gesture for talking on the phone

How does Gen Z — a generation so addicted to technology that they risk personal safety — signal that they’re on the phone? They do what Alvarado’s kids did on his TikTok video. They lift a hand, palm flat, to their ears, as if they were talking on a smartphone. But wait, that’s not all. As BuzzFeed observed, kids these days have no idea why you’d need to “hang up” a phone either. “Mind-blowing,” says Alvarado. And really, it is. 

It’s not just about generational shifts in communications that are leaving everyone over 25 years old feeling like they’re in the Paleolithic age. (If a Gen Z tried to signal to a Baby Boomer, “hey, call me,” all they’d likely get in response is, “does your face hurt, darling?”) No, Alvarez’s video signals something much more mind-boggling: a shift to a world where our everyday, physical lives are defined by the applications we’ve installed onto a small, flat rectangle with Wi-Fi and Bluetooth capabilities. Not everybody’s been asked along for the ride. 

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Easy to overdose on paracetamol if you’re selenium deficient, says research

A lack of the mineral selenium in the diet puts people at risk of paracetamol overdose, even when the painkiller is taken at levels claimed to be safe on the packaging, according to collaborative research emerging from the University of Bath and Southwest University in China.

Paracetamol (also called Tylenol) is best known for relieving mild pain and fever, and is a leading cause of liver failure when taken at dangerous levels. For adults, the recommended maximum daily dosage is 4g (amounting to two 500mg tablets taken four times). However, the team from Bath and Chongqing has found that the micronutrient selenium affects the speed at which the painkiller is flushed from the body. As a result, taking 4g of the medication in a given day can be dangerous for people with low levels of selenium in their bodies.

“People with a selenium deficiency can struggle to eliminate the drug fast enough to keep their livers healthy,” explained Dr. Charareh Pourzand who led the collaborative research from the University of Bath’s Department of Pharmacy and Pharmacology. “They can overdose even when they follow dosage guidelines.”

A huge amount of Paracetamol is consumed around the world, with an average person in the UK popping 70 tablets (or 35 grams) every year. Dr. Pourzand said: “For most people, paracetamol is safe up to the stated dose. But if you are frail, malnourished or elderly, your levels of selenium are likely to be somewhat depleted, and for these people I think it’s a bad idea to take paracetamol at the maximum level currently considered safe.”

It is thought that insufficient selenium intake affects up to 1 billion people worldwide—or one in seven of the globe’s population. It may be tempting to boost selenium levels through supplements, but based on the results of this study, Dr. Pourzand advises against this course of action, as an excess of the micronutrient can be just as dangerous to the body as a deficiency.

“There is a rather limited dose range for the beneficial effects of selenium,” she said. “Both mild selenium deprivation in the body and excess supplementation increase the severity of liver injury after you’ve taken paracetamol.”

She added: “This study shows that the link between selenium status in the diet and paracetamol toxicity is very important. I hope people pay attention to these findings, given everyone has paracetamol in their home. And now with people falling ill with COVID-19, paracetamol is being taken more than ever.”

Selenium helps maintain a healthy redox balance in the body within antioxidant enzymes called selenoproteins (selenium-containing proteins). Redox balance describes the mechanism by which each cell maintains a subtle balance between antioxidant and pro-oxidant levels (where some atoms gain electrons and others lose them, becoming free radicals). When the body’s selenium levels fall out of the beneficial range, antioxidant enzyme activities are decreased and too many free radicals are formed in liver—the main organ where paracetamol is metabolized. This results in damage both to an individual’s DNA and to their proteins.

Dr. Pourzand emphasizes the importance of a good diet in keeping selenium levels within the recommended range. “A healthy, balanced diet is especially important if you take paracetamol on a regular basis, for instance for chronic pain,” she said.

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Immunization programs yield high ‘return on investment,’ saving hundreds of billions of dollars

Immunization programs offered in low- and middle-income countries provide a high “return on investment” in terms of the economic costs of diseases that are prevented and the values of lives that would have been lost, according to a new study led by scientists at the International Vaccine Access Center based at Johns Hopkins Bloomberg School of Public Health.

The researchers, who report their findings in the August issue of Health Affairs, analyzed recent data on immunization programs aimed at preventing 10 infectious diseases in 94 low- and middle-income countries. The research team generated estimates for the economic cost of illnesses and broader losses due to disability and premature death that would occur without the programs, comparing those costs to the costs of the programs themselves.

Using a model that factors in treatment costs, lost wages, and productivity losses, the researchers estimate that the costs averted by implementing these immunization programs will amount to $681.9 billion for 2011-20 and $828.5 billion for the next decade. This estimated net benefit is about 26 times the immunization programs’ costs during 2011-20, and about 20 times their costs for the next ten years, 2021-30.

A second analysis based on the imputed monetary values of lives that will be saved by the immunization programs suggested net-benefit vs. cost ratios for the two decades of more than 50 to 1.

“This analysis shows that immunization programs now have and will continue to have a high return on investment,” says study senior author Bryan Patenaude, ScD, an assistant professor in the Bloomberg School’s Department of International Health. “It also helps put immunization program investments in perspective alongside investments such as education programs and infrastructure investments that might not otherwise seem comparable.”

The new study was conducted under the auspices the Decade of Vaccine Economics project based at the Bloomberg School’s International Vaccine Access Center. DOVE’s research provides economic evidence on vaccines that can be used by organizations such as Gavi, the international public health organization that sponsors immunization programs in low- and middle-income countries worldwide.

“The goal here was to show the return on ‘investment’ in economic or monetary terms, not just in terms of health impact,” says Patenaude. “Framing health investments in economic terms can help organizations and governments compare them to other social investments in an explicit and concrete way.”

For their analysis, the researchers analyzed Gavi’s data and other available data on the costs of immunization programs in 94 low- and middle-income countries against the meningitis-causing Haemophilus influenzae type b and Neisseria meningitidis serotype A; the pneumonia-causing Streptococcus pneumoniae; hepatitis B virus; human papillomavirus; Japanese encephalitis virus; measles virus; rotavirus; rubella virus (German measles); and yellow fever virus.

In the analysis, the costs of these programs will amount to an estimated $25.2 billion for 2011-20 and $39.9 billion in 2021-30 for the 94 low- and middle-income countries. Gavi hosts immunization programs, or has done so in the recent past, in most of the countries covered by the analysis.

The researchers compared these estimated costs to the estimated economic costs of illnesses in the scenario in which there were no immunizations against these pathogens. To do this they used two models. The first was a Cost of Illness model with estimates for cost items such as treatment of disease, lost caregiver wages, and productivity loss due to disability or premature death. The COI model yielded the estimated averted costs of $681.9 billion for 2011-20 and $828.5 billion for the following decade.

The second model, a Value of Statistical Life (VSL) model, was based on the estimated value of a saved life—a calculation derived from estimates of people’s willingness to spend money to reduce their risk of death. Based on this model the averted costs will be $1.31 trillion and $2.1 trillion for the two decades, respectively.

The estimated return on investment, the ratio between the net savings obtained by the programs and their cost, was therefore, for the 2011-20 decade, 26.1 using the COI model and 51.0 using the VSL model. For the 2021-30 decade, those figures were 19.8 and 52.2, respectively.

“Obviously, regardless of the approach you take to estimate benefits, immunization programs are a great value in terms of return on investment and have significant benefits over time,” says Patenaude.

The researchers bundled the estimates for the 10 pathogens together because Gavi typically offers programs with similarly bundled immunizations. But the investigators noted that measles virus was the largest driver of estimated disease-related costs.

“With some countries transitioning away from donor support, these findings can be used to advocate for sustained immunization financing,” says Elizabeth Watts, research associate at the International Vaccine Access Center and co-first author of the study.

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This hack puts an end to sun glare on your laptop

With the weather finally getting warmer and many people working from home, it’s the optimal time to drag your laptop outside and sit in the garden answering emails (or on the balcony, or the stoop, or whatever outside space you have access to). Although working out in the sunshine definitely makes the day go quicker, as well as providing the requisite vitamin D we’re all craving right now, even the most expensive and high-tech laptop isn’t equipped for so much bright light.

The main issue with working outside in the sun is the natural glare on the screen, which can make it hard to see anything you’re trying to work on or read. Thankfully, the denizens of social media have devised an ingenious solution to this problem — and the good news is it’s affordable, easy to do, and doesn’t require even a modicum of IT expertise to pull off.

End sun glare on your laptop with a box

As reported by Metro, an intrepid LinkedIn user named Tom Wood posted a photo working from his own garden with a cardboard box propped up protectively around his laptop. “When you are working from home and want to enjoy the sunshine, yet can’t see your laptop screen because of the sun! Get yourself the latest technological breakthrough….. The Cardboard Box,” he quipped.

The hack was a massive hit online with one Twitter user gushing, “To whoever it was who posted this laptop box cover invention, the Delahoy family would like to say thank you,” alongside a shot of a woman happily working away on a balcony with a box propped up to block the glare. The original post has been liked more than 50,000 times with comments flooding in commending Wood for his genius.  

Still, it’s worth keeping an eye on the temperature of your laptop, even if you employ this nifty trick. As House Beautiful advises, most models will be fine up to about 30 degrees Celsius (around 86 degrees Fahrenheit) but, beyond that, you’re risking causing damage to your hard drive. Even with your box propped up, always be mindful and ensure your laptop isn’t overheating to avoid damaging it.

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Stop Shaming Russell Wilson for Being a Good Stepdad on Baby Future's Birthday

The saga between Ciara, husband Russell Wilson, and her ex-fiancé Future is something of a soap opera — at least that’s the way fans have often reacted to their public comments about each other. Which is fine; side with whichever famous person you like. But we’re not huge fans of what’s going on today, after all three took to social media to celebrate “Baby” Future’s sixth birthday.

People are riled up about Wilson’s post in particular, a super gushy note to his stepson: “You are my daily inspiration. My best friend…Full of Love, Joy, and Grace. I thank Jesus every day for who you are & being able to lead & guide you. Your future is forever endless and I pray you swim into every opportunity and obstacle in life with this much Love and Enthusiasm. Happy 6th Birthday Future! Daddy loves you!”

That’s a bit more effusive than the note Future wrote to his son on Twitter: “Happy Birthday FUTURE. Love u FOREVER twin.”

We highly doubt a 6-year-old is looking to social media for birthday messages from their parents. The little guy is doing just fine, getting extra family time during lockdown with his baby sister, stepdad, and mom Ciara, who’s currently pregnant with another baby boy.

Twitter, on the other hand, is on fire about these posts. Wilson calling himself Baby Future’s “Daddy” is the main issue, reminding us of the way Wilson appeared to have taken over that role quite early in the boy’s life. Future and Ciara split when their son was just a few months old, reportedly because of his cheating. By spring of 2015, she was making public appearances with Wilson, and soon the NFL pro was photographed bonding with Baby Future. Dad Future was none too happy with this.

“If I was a kid, and my mama had a dude pushing me, I would’ve jumped out the stroller and slapped the s— out of him,” the rapper told Power 105. “You never do that in our community. You don’t ever bring a man around your son. How you know this dude for a few months and you bring him around your kid? Who does that? Nobody does that.”

Thus began a back-and-forth between the three that has gone on for years and even involved Ciara suing her ex for slander and libel at one point. Last year, Future said things were cool between him and Wilson.

“I don’t have nothing against him, and I’m happy for them,” he said on his FREEBANDZ RADIO show, per People.

It’s in that context that we’re seeing this current birthday debate bubble up on Twitter. As Future fans question Wilson’s wording.

“You outta pocket,” @TreyDolo_ wrote.

“Russell is so phony and a clout chaser,” @harbor_msv said.  “Like stop trying to take subliminal shots at Baby Future’s dad. He was right about you. And where was this energy for Baby Sienna?”

But a vast majority of people on the platform are applauding Wilson for being such a loving stepfather.

“Anyone who thinks Russell is doing ‘too much’ by loving on Baby Future like he’s his own son seek help, Jesus, and therapy immediately,” Kaiah tweeted.

“Baby Future is super blessed,” Torie wrote. “Didn’t Future say he’s not able to be around all of his kids that much bc of his career? So baby future gets 3 successful parents and parents that are physically there. That’s cool to me.”

We hope that one day, when Baby Future is old enough to read social media, that this last statement is an accepted fact. Like all children, he deserves all the parental love available to him, regardless of what Twitter thinks.

Maybe one day, we’ll add Ciara and Future to this list of famous exes who are actually quite good at co-parenting.

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