Behind Each of More Than 300,000 Lives Lost: A Name, a Caregiver, a Family, a Story

More than 300,000 people have died from COVID-19 in the United States.

It is the latest sign of a generational tragedy — one still unfolding in every corner of the country — that leaves in its wake an expanse of grief that cannot be captured in a string of statistics.

“The numbers do not reflect that these were people,” said Brian Walter, of New York City, whose 80-year-old father, John, died from COVID-19. “Everyone lost was a father or a mother, they had kids, they had family, they left people behind.”

There is no analogue in recent U.S history to the scale of death brought on by the coronavirus, which now runs unchecked in countless towns, cities and states.

“We’re seeing some of the most deadly days in American history,” said Dr. Craig Spencer, director of Global Health in Emergency Medicine at NewYork-Presbyterian/Columbia University Medical Center.

During the past two weeks, COVID-19 was the leading cause of death in the U.S., outpacing even heart disease and cancer.

“That should be absolutely stunning,” Spencer said. And yet the most deadly days of the pandemic may be to come, epidemiologists predict.

Even with a rapid rollout of vaccines, the U.S. may reach a total of more than half a million deaths by spring, said Ali Mokdad of the Institute for Health Metrics and Evaluation at the University of Washington.

Some of those deaths could still be averted. If everyone simply began wearing face masks, more than 50,000 lives could be saved, IHME’s model shows. And physical distancing could make a difference too.

No other country has come close to the calamitous death toll in the U.S. And the disease has amplified entrenched inequalities. Blacks and Hispanics/Latinos are nearly three times more likely to die from COVID-19 than whites.

“I’m really amazed at how we have this sense of apathy,” said Dr. Gbenga Ogedegbe, a professor of medicine and population health at New York University Grossman School of Medicine. He said there’s evidence that socioeconomic factors, not underlying health problems, explain the disproportionate share of deaths.

The disease, he said, reveals “the chronic neglect of Black and brown communities” in this country.

Though the numbers are numbing, for bereaved families and for front-line workers who care for people in their dying moments, every life is precious.

Here are reflections from people who’ve witnessed this loss — how they are processing the grief and what they wish the rest of America understood.

‘There Are Things We Can Do to Still Make a Difference’

Darrell Owens, a doctor of nursing practice in Seattle, was startled to learn recently that he had signed more death certificates for COVID-19 than anyone else in Washington.

Owens runs the palliative care program at the University of Washington Medical Center-Northwest, where he has treated COVID patients since the early spring.

“I’m feeling much more anger and frustration than I did before because much of what we’re dealing with now was preventable,” Owens said.

“We’re all in this great big storm, but some people are in a yacht and some people are on a cruise ship and some people are on a raft,” he added. “We’re not all in this together.”

Owens still finds moments of grace and meaning as he cares for the dying.

“The other day, there was a lady I was taking care of who’d come from a local nursing home and it was very clear that she was nearing the end,” Owens said. “I just picked up her hand. I sat there. I held her hand for about 25 minutes until she took her last breath.”

He stepped out of the room and called the patient’s daughter.

“It made such a difference for her that her mom was not alone,” he said. “What an incredible gift that she gave me and that I was able to give her daughter. So there are things that we can do to still make a difference.”

‘It’s Not a Joke. It’s Not a Hoax.’

Since his father died of COVID-19 in the spring, Brian Walter of Queens, New York, has helped run a support group on Facebook for people who’ve lost family and friends to COVID-19.

It’s helped him grieve his father John, whom he describes as a very loving man dedicated to his autistic grandson and to running a youth program for teenagers.

“It’s been lifesaving in a lot of ways,” Walter said. “Together, we face a lot of issues since we are grieving in isolation. But at the same time, we’re also dealing with people that openly tell us that this is not a real condition, that this is not a real issue.”

Some in their group admit they denied the severity of the virus and shunned precautions until it was too late.

“It’s not a joke. It’s not a hoax, and you will not understand how horrible this is until it enters your family and takes away someone,” he said.

All of this complicates the grief, but it has also led Walter and others in his group to speak out and share their stories, so that numbers don’t obscure the actual people who were leading full lives before dying from COVID-19.

“I know what it’s like to have to say goodbye to somebody over a Zoom call and to not have a funeral,” Walter said.

‘300,000 Stories That Got Shut Down Too Quickly’

Martha Phillips, an ER nurse who took assignments in New York and Texas in the spring and summer, said there is one patient who has become almost a stand-in for the grief of the many whose deaths she witnessed.

It was the very last COVID patient she cared for in Houston.

“I reached down to just adjust her oxygen tubing just a little bit,” Phillips recalled. “And she looks up at me and she sees me through my goggles and my mask and my shield and meets my eyes and she goes, ‘Do you think I’m going to get better?’”

“What do you say to someone who’s not ready to die? Who has so much to live for, but got this and now they’re trapped?”

Two months later, Phillips discovered the woman’s obituary online.

“That one was the hardest,” she said. “But there’s 300,000 people who had time left that was stolen from them; 300,000 stories that got shut down too quickly.”

‘This Is Worse Than Being in War’

ER physician Dr. Cleavon Gilman, a veteran of the Iraq War, said it’s still hard to communicate the brutality of a disease that kills people in the privacy of a hospital wing.

When Gilman was in New York City during the spring surge, he never imagined the U.S. would be losing thousands of people each day to COVID-19 so many months later.

“That 300,000 Americans would be dead and life would go on and people would not have empathy for their fellow Americans,” he said. “I can tell you this is worse than being in war.”

The enemy is invisible, he said, the war zone is everywhere, and many refuse to take the most simple actions to combat the virus, even as morgues fill up in their own community.

Throughout the pandemic, Gilman, who is now working in Yuma, Arizona, has shared photos and stories of people who’ve died from COVID-19 each day on social media.  “It’s really important to honor them,” he said.

This story is from a reporting partnership with NPR and KHN. 

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New trial finds arthritis drug tocilizumab no better than standard care for severe COVID-19

COVID-19, coronavirus

Adding the arthritis drug tocilizumab to standard care for patients in hospital with severe or critical COVID-19 is no better than standard care alone in improving clinical outcomes at 15 days, finds a new trial published by The BMJ today.

There was an increased number of deaths at 15 days in patients receiving tocilizumab, resulting in the trial being stopped early.

Today’s results contradict earlier observational studies suggesting a benefit of tocilizumab. However, observational effects are limited by a high risk that they may be due to other unknown (confounding) factors—and some studies have not yet been peer reviewed or published in a medical journal.

A randomised trial assessing tocilizumab in critically ill patients with COVID-19 (REMAP-CAP) published as a preprint earlier this month, found a beneficial effect of the drug on days free from organ support within 21 days and mortality. Reasons for these apparently contradictory effects, for example differences between patients’ characteristics, need to be assessed in future analysis, say the researchers.

Tocilizumab blocks a specific part of the immune system (interleukin 6) that can go into overdrive in some patients with COVID-19. Doctors think this might help lessen the body’s inflammatory response to the virus and avert some of the more dire consequences of the disease, but its effects are not well defined.

To test this theory, researchers based in Brazil conducted a randomised controlled trial comparing tocilizumab plus standard care with standard care alone in patients admitted to hospital with severe or critical COVID-19.

Their findings are based on 129 relatively young adults (average age 57 years) with confirmed COVID-19 at nine hospitals in Brazil between 8 May and 17 July 2020.

Patients were receiving supplemental oxygen or mechanical ventilation and had abnormal levels of at least two chemicals linked to inflammation in their blood.

Patients were randomly divided into two groups: 65 received tocilizumab plus standard care and 64 received standard care alone.

Other potentially important factors, such as underlying conditions and use of other medication, were taken into account and all patients were monitored for 15 days.

By day 15, 18 (28%) patients in the tocilizumab group and 13 (20%) in the standard care group were receiving mechanical ventilation or died.

Death at 15 days occurred in 11 (17%) patients in the tocilizumab group compared with 2 (3%) in the standard care group.

The increased number of deaths in the tocilizumab group raised safety concerns and the trial was stopped early. In both groups, deaths were attributed to COVID-19 related acute respiratory failure or multiple organ dysfunction.

The researchers point to some limitations including the small sample size, which affects the chances of detecting a true effect. However, results were consistent after adjusting for levels of respiratory support needed by patients at the start of the trial, suggesting that the findings withstand scrutiny.

As such, the researchers conclude that in patients with severe or critical COVID-19, “tocilizumab plus standard care was not superior to standard care alone in improving clinical status at 15 days and might increase mortality.”

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Minorities value, perceive, and experience professionalism differently than their peers

Marginalized groups of people value professionalism more—and are more likely to leave a job at an institution due to issues of professionalism—compared to their white, male counterparts, according to a Penn Medicine study of staff, faculty, and students who were affiliated with a large, academic health system in 2015 and 2017. The findings, published today in JAMA Network Open, suggest that health care institutions must reevaluate and redefine professionalism standards in order to successfully make the culture of academic medicine more inclusive and to improve the retention of minorities and women.

This study is one of a series of research projects launched at Penn Medicine, under the leadership of Vice Dean Eve J. Higginbotham, MD, SM, as part of Office of Inclusion and Diversity’s mission to chart Penn Medicine’s course toward inclusivity for all groups.

“What does it actually mean to operationalize an anti-racist, inclusive workplace? It means understanding the factors in an environment that allow women and minorities to thrive in your organization,” said Jaya Aysola, MD, MPH, assistant dean of Inclusion and Diversity at the Perelman School of Medicine and executive director at the Penn Medicine Center for Health Equity Advancement. “We wanted to look at the ways that marginalized groups perceive and experience professionalism, so that we could move toward standardizing policies in a way that is really inclusive for all. Recruiting female and minority students and employees is not enough if an organization cannot retain them.”

Professionalism has been implemented as a core competency for medical education to govern how physicians conduct themselves in public, be it with patients or with each other. However, the medical field lacks a concise, unifying, and operational definition of professionalism, and the word is often misused or overused. Moreover, the historic definition of professionalism has largely centered around white, heterosexual male identity, and therefore the current understanding of what is deemed professional can often be non-inclusive or discriminatory. For instance, because of these cultural norms, the way that certain groups dress, speak, eat, or wear their hair might be deemed unprofessional.

The study authors wanted to examine perceptions and experiences of professionalism among faculty, trainees, staff, and students, in order to better understand, and then perhaps reevaluate, how professionalism standards are applied to different groups.

In the first part of the study, the researchers analyzed answers collected from the Diversity Engagement Survey, which is administered by Datastar, from February to April 2015. The dataset included 3,506 respondents—faculty, trainees, staff, and students—from two Philadelphia-area health systems and four medical/health professional schools.

On the survey, respondents were asked to rate their responses (from strongly agree to strongly disagree) to three statements related to professionalism: (1) “I have considered changing jobs due to inappropriate, disruptive, or unprofessional behavior by a coworker or supervisor.” (2) “I value institutional initiatives, policies, and/or educational resources related to professional behavior in the workplace.” (3) “My institution supports a culture of professionalism.”

In response to the statement “I value institutional initiatives, policies, and/or educational resources related to professional behavior,” 52 percent of women and 54 percent of

Black individuals agreed or strongly agreed, compared to 45 percent of male and 49 percent of white respondents.

Respondents who self-identified as female, LGBTQ, non-Hispanic Black individuals, when compared with white, heterosexual men, were also statistically significantly more likely to report considering changing jobs because of “unprofessional” behavior. No statistically significant adjusted differences were found among respondents who agreed with the statement “My institution supports a culture of professionalism.”

Aysola said that she suspects the greater value women and underrepresented minority groups place on professionalism may stem from what they perceive to be lacking in their work environment, as well as gaps that they perceive between institutional values and their lived experiences.

To probe that hypothesis further, the research team also analyzed responses to the open-ended question: “Tell us a time that you felt valued or devalued, or welcomed or not welcomed by your organization.” The researchers solicited narratives via email in 2017 from faculty, trainees, staff, and students across the organizations studied. They then analyzed 52 narratives pertaining to professionalism.

Many narrators who self-identified as members of marginalized populations expressed infringement on their professional boundaries during interactions at work or learning environments.

The infringements reported ranged from microaggressions to blatant racism, sexism, xenophobia, and homophobia. Other narratives stated that professional standards were applied differently to certain groups, and those groups perceived that they were subject to greater scrutiny. Experiences cited ranged from facing differential disciplinary practices and feeling unwelcomed, to experiencing pressure to conform and being asked questions about childbearing, living situations, and tattoos.

A consistent theme throughout the stories was that the respondents from underrepresented groups felt they were subjected to greater scrutiny, while simultaneously reporting greater infringements over their professionalism boundaries.

“The narratives that we collected reveal disparities in how we assess professionalism, with minorities and women reporting a microscope over their behaviors.” Aysola said. “A common theme was that being different was not perceived as being a good ‘fit,’ forcing individuals to alter their authentic selves to feel included.'”

These findings, according to Aysola, underscore the need to revisit the professionalism standards, which govern the practice of medicine and the engagement between members of the medical profession. These standards, she said, must be informed by diverse perspectives, in order to be more inclusive. They also must be operationalized in a way that ensures behaviors are subject to equal scrutiny, irrespective of the culture or background of the individual, she added.

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More than half of American adults with advanced MS report mistreatment by caregivers

Four in 10 people with advanced multiple sclerosis, or MS, are emotionally abused by someone responsible for caring for them, reports a study led by the University of California, Riverside.

Further, the study finds one quarter are financially exploited, one in six are neglected, one in nine are battered, and one in 12 are sexually assaulted by a caregiver.

“We knew we would find some level of abuse and neglect, but we were surprised by how prevalent it is,” said Dr. Elizabeth Morrison-Banks, a health sciences clinical professor at the UC Riverside School of Medicine, who led the study. “The findings of this study represent a collective cry for help from so many families affected by multiple sclerosis across the United States.”

MS is an autoimmune disease that affects more than 2.3 million people worldwide. This chronic, degenerative neurological condition periodically shutters communication between the brain and other parts of the body, resulting in symptoms that include numbness and tingling in the arms and legs, as well as blindness and paralysis.

“MS affects people in different ways,” Morrison-Banks said. “Some people live with MS for many years but with milder symptoms, and they may remain completely self-sufficient and never require a caregiver. Others are less fortunate and develop neurological disability that can make them vulnerable to abuse and neglect if they are unable to move around independently, take care of their own finances, or get away from the situation when family conflict escalates. These problems are compounded if the person with MS and family lack financial resources.”

Morrison-Banks explained that for families who are struggling economically, relying on a paid caregiver is often not an option, and family caregivers have to step in to fill the breach.

“Some family caregivers are also working full time, caring for children or other family members, and sometimes dealing with health issues of their own,” she said. “All of these challenges can increase risk of mistreatment. I want to emphasize that the majority of family caregivers do not mistreat those they care for, even in situations that can be very challenging. Nonetheless, it is important to recognize the risk factors for mistreatment of people with disabilities, and do what we can to identify, mitigate, and prevent abuse and neglect.”

Study results appear in Multiple Sclerosis and Related Disorders. According to Morrison-Banks and her colleagues, the research paper is the first published survey documenting the nature and extent of caregiver mistreatment of adults with MS in the United States. The research team collaborated with the North American Research Committee on Multiple Sclerosis to conduct a telephone survey of 206 American adults with advanced MS living across the United States.

The preliminary study found nearly 55% of respondents disclosed undergoing some form of mistreatment since they started receiving care from a family member or friend.

The researchers do not fully understand all the risk factors for mistreatment. Their anonymous telephone survey did find, however, that family members who had to be the primary caregiver every day, day in and day out, were at higher risk of mistreating the person with MS. Other risk factors included the person with MS having higher levels of cognitive impairment or fatigue, the caregiver having a mental health diagnosis, alcohol use by the caregiver or by the person with MS, and lower levels of social support within the family.

As a multiple sclerosis specialist, Morrison-Banks has worked for years with many families affected by MS.

“Being a full-time family caregiver for someone with substantial neurological disability often presents significant challenges,” she said. “Many families take these challenges in stride, but others end up in situations of abuse and/or neglect.”

The researchers were surprised to find no published studies documenting how many people with MS have experienced mistreatment.

“We all felt it was important to study this topic in order to help families dealing with advanced MS,” Morrison-Banks said, adding the first step toward addressing the problem is to recognize that people with MS are at high risk of mistreatment.

Community service organizations such as the National Multiple Sclerosis Society, the Multiple Sclerosis Association of America, and in Riverside County a local organization called Act for MS provide support and services for families in need.

“Our study is a good reminder for all that mistreatment is occurring out there for people with MS and other disabling conditions,” Morrison-Banks said. “Health care professionals should maintain a high index of suspicion. We can’t assume that all people with advanced MS are living in safe situations, even if they don’t bring up their concerns on their own.”

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More than half of Americans know someone infected or ill with COVID: Poll

(HealthDay)—More than half of all Americans have been personally affected by COVID-19 at this point in the pandemic, according to a new HealthDay-Harris Poll survey.

The national survey was conducted by The Harris Poll between Oct. 8 and 12. It found that 55% of U.S. adults now say they know someone in their immediate or extended network of family and acquaintances who’s been infected, hospitalized or passed away from COVID-19.

About two in every five people said they’d had even more direct experience with COVID-19, with either themselves or someone very close to them falling ill, being hospitalized or dying.

“By now, we’re all accustomed to regularly seeing the sobering figures for COVID infection and death rates, but these findings translate to something so much bigger in terms of the full and relentless impact of the virus on millions of Americans,” said Robyn Bell Dickson, managing director of The Harris Poll.

These results come in the midst of a COVID-19 resurgence in the United States, with the nation averaging 59,000 new cases a day. There have been more than 8.3 million reported infections, and around 220,000 U.S. deaths caused by COVID-19.

The online poll of 2,021 U.S. adults also found that 39% reported a direct impact on their lives from the pandemic, including:

  • Having personally had COVID-19 (7%) or being hospitalized (4%) from their infection.
  • Residing in a household with someone who had COVID-19 (6%).
  • Having a close friend, family member or loved one who became infected with COVID-19 (34%), was hospitalized (19%), or passed away (13%).

Overall, more than one in 10 adults have a loved one who has passed away due to COVID-19, the survey found.

Shifts in outlook

People who’ve been personally affected by COVID-19 tend to see the pandemic differently from those who’ve so far remained relatively untouched by the virus, the results showed.

Those who have direct experience with COVID-19, either personally or through a loved one, are more likely to be very concerned that they or a loved one will die from COVID-19. Nearly two-thirds (64%) reported this high level of concern, versus 52% of those with no direct experience or whose only experience is through an acquaintance.

Those without direct experience are also likely to be more optimistic that the pandemic will be under control by early 2021, 56% versus 49% of those with direct experience.

Adults whose personal experience of COVID-19 was more severe, with either themselves or a loved one struggling for life in a hospital or dying, were also more likely to agree with these statements:

  • I wish more people took COVID-19 seriously (87%, versus 80%).
  • I am extremely worried about getting COVID-19 (78%, versus 59%).
  • I am very concerned that I or a loved one will die from COVID-19 (73%, versus 53%).

“It makes sense that people who have experience with the disease will carry a different outlook with them, given that at the beginning of 2020 no one knew much at all about the burgeoning threat of coronavirus,” said Lynn Bufka, senior director of practice transformation and quality at the American Psychological Association.

“As people have more experience with COVID, they are finding the messages regarding the pandemic to be more consistent and mapped on to their own experience,” Bufka said.

Anxiety and resilience

The growing number of people who have personal experience with COVID-19 is adding to the uncertainty that already disrupts the daily lives of all Americans, Bufka said.

“Collectively, we’re all faced with this pandemic, not knowing when it will end. We have no way to put some predictions around it and feel comfortable with those predictions,” she added.

“We’re all sitting in a period of uncertainty with the pandemic, with the economic impact of it, and then you layer in other issues like grappling with systemic racism and the political discourse, there are just a lot of things that are elevating our levels of uncertainty,” Bufka continued. “We know that uncertainty is connected to anxiety. It would not be surprising at minimum to see more individuals struggling with anxiety right now, because it’s harder to feel safe, secure and in control when so much feels outside of your control.”

People also are dealing every day with feelings of loss and grief, ranging from things as profound as illness and death down to the simple need for a regular routine, Bufka said.

“Routines help us in so many ways because they make our lives predictable. They make things less uncertain. They also free up our mental space for tackling the things that are novel,” Bufka said.

“If your schedule changes dramatically or if the kinds of decisions you’re having to make vary day to day, that takes mental energy, which is harder to deal with,” she explained. “So we see people struggling with decision making, with handling novel problems, all of that because mentally, cognitively, their attention is taken with what they’re dealing with in the pandemic.”

It’s also becoming harder to expect help from those around you, she suggested.

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Same-gender couples interact better than heterosexual couples: study

Same-gender couples have higher-quality interactions with one another than heterosexual couples in Southern California, a new UC Riverside study finds.

The study also holds that couples with two men have the smallest social networks.

Researcher Megan Robbins says the recently published study is the first to compare same- and different-sex couples’ social networks and daily interactions with one another.

Past research shows that same-gender couples enjoy strengths including appreciation of individual differences, positive emotions, and effective communication. But research hasn’t compared the quality of their daily interactions—inside and outside the couple dynamic—to those of heterosexual couples.

“The comparison is important because there is so much research linking the quality of romantic relationships and other social ties to health and well-being, yet it is unclear if this applies similarly or differently to people in same-gender romantic relationships because they have been historically excluded from past research,” said Robbins, who is an associate professor of psychology at UCR. Reasons for potential differences include the stigma sexual minorities face, and also their resilience.

For the study, Robbins and her team recruited same-gender and different-gender couples throughout Southern California. The couples had to be in a married or “married-like” committed relationship; living together for at least a year; and have no physical or mental health conditions that impeded their daily functioning.

Among those who applied to be in the study, 78 couples were found to be eligible, 77 of which provided enough data to be used. Twenty-four of the couples were woman-woman; 20 were man-man, and 33 were man-woman.

Participants met with the researchers on two separate Fridays, a month apart, completing surveys. They received text or email prompts several times in the days following the in-person meetings. In the text/email prompts, participants were asked whether they had an interaction with their partner, a family member, or a friend in the past 10 minutes, then asked to rate the quality of the social interaction using a five-point scale—one being unpleasant; three, neutral; five, pleasant.

In terms of social networks, the study found couples in man-man relationships had smaller social networks than woman-woman and man-woman couples. On the other end of the results spectrum, women in relationships with men were most likely to have the largest social networks.

Robbins said the finding is consistent with previous research showing men with men experience the least acceptance among family members.

“We hypothesized that one model for how the social life of people in same-gender couples might differ from those in different-gender couples was a honing model, where people in same-gender couples reduce their social networks down to only those people who are supportive. We found some support for this by learning that the men with men had the smallest social networks in our sample,” Robbins said.

The quality of interactions with families was reported to be greatest by same-gender couples. There was no difference for interaction quality with friends.

In terms of the quality of interactions with their partners, the study found same-gendered relationships had better-quality interactions than found in different-gendered relationships.

Robbins said that may be due to greater similarity between partners when they share a gender identity, and greater equality within the couple, compared to people in different-sex couples.

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Insomnia, sleeping less than six hours may increase risk of cognitive impairment

Middle-aged adults who report symptoms of insomnia and are sleeping less than six hours a night may be at increased risk of cognitive impairment, according to a study by Penn State College of Medicine researchers. The results may help health care professionals understand which patients who report insomnia are at increased risk for developing dementia.

Insomnia is characterized by reports of difficulty falling asleep, difficulty staying asleep, or waking up too early and not being able to get back to sleep. When these symptoms occur at least three nights a week and for at least three months, it is considered a chronic disorder. Researchers found that adults who reported insomnia and obtained less than six hours of measured sleep in the laboratory were two times more likely to have cognitive impairment than people with the same insomnia complaints who got six or more hours of sleep in the lab. The study results were published in the journal Sleep on Sept. 24.

According to Julio Fernandez-Mendoza, associate professor of psychiatry and behavioral health and sleep specialist at Penn State Health Sleep Research and Treatment Center, about 25% of the adult general population reports insomnia symptoms and another 10% suffers from chronic insomnia. He said that being able to distinguish which of these individuals are at risk for further adverse health conditions is critical.

“This study reinforces the need to objectively measure the sleep of adults who complain of insomnia,” Fernandez-Mendoza said. In previous research, the team found that adults with insomnia who obtained less than six hours of sleep were at risk for various cardiometabolic conditions, including hypertension, diabetes, heart disease or stroke and mental health problems, such as depression.

“These new results demonstrate that these middle-aged adults also have an increased risk of cognitive impairment, which can be an early indicator of future dementia in a significant proportion of them,” Fernandez-Mendoza said.

Researchers examined data from the Penn State Adult Cohort, a randomly-selected, population-based sample of 1,741 adults who had one measured night of sleep. Before having their sleep measured in a sound, light and temperature-controlled room, participants completed a clinical history, physical exam and questionnaire to identify self-reported sleep disorders, physical health conditions, mental health problems and substance use. They also were evaluated for cognitive impairment before sleeping in the laboratory, including receiving tests that assessed attention, memory, language and other measures.

Fernandez-Mendoza and colleagues found that adults who reported insomnia symptoms or chronic insomnia and slept less than six hours in the lab were two times more likely to have cognitive impairment when compared to good sleepers. They also found that this association was particularly strong for adults with coexisting cardiometabolic conditions and cognitive impairment, which may be an indicator of vascular cognitive impairment—a condition where poor cardiovascular health results in impaired brain function.

Adults who reported insomnia but who slept six or more hours in the lab were not at risk of cognitive impairment when compared to good sleepers. The research team accounted for potential differences in sociodemographic factors—including age, sex, race, ethnicity, years of education—and the presence of physical and mental health problems, including sleep apnea, as well as substance use, such as smoking and alcohol intake.

Fernandez-Mendoza said that only having one measured night of sleep limited the study’s conclusion to in-lab sleep studies and cautioned that these data do not prove causality. Nevertheless, they further show that insomnia, cognitive impairment and cardiometabolic conditions, like high blood pressure, diabetes and heart disease, often tend to co-occur in adults who get less than six hours of sleep in the lab but not in those who can sleep six hours or more, he highlighted.

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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]

CORONAVIRUS CAUSING 'PERSISTENT FATIGUE' IN MORE THAN HALF OF RECOVERED PATIENTS, STUDY FINDS

"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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Fewer kids may be carrying coronavirus without symptoms than believed, study says

(HealthDay)—Are infected-but-healthy children major “silent spreaders” of the new coronavirus? New research out of northern Italy, once a COVID-19 hotspot, suggests they might not be.

Rigorous COVID-19 testing of children and adults admitted to a hospital in Milan for reasons other than coronavirus found that just over 1% of kids tested positive for SARS-CoV-2, compared to more than 9% of adults.

That suggests a very low rate of asymptomatic infection among children, and does “not support the hypothesis that children are at higher risk of carrying SARS-CoV-2 asymptomatically than adults,” the researchers reported in the Sept. 14 online edition of JAMA Pediatrics.

One U.S. expert in infectious disease found the report encouraging.

“Since the start of the pandemic it has been very difficult to determine what the actual role of children in the spread of the virus is,” said Dr. Amesh Adalja, senior scholar at the Center for Health Security at Johns Hopkins University, in Baltimore.

“It is becoming clear that they do not amplify this virus the way they do influenza when it comes to community spread,” Adalja said.

In the new study, physicians led by Dr. Carlo Agostoni, of the Ca’Granda Foundation Maggiore Polyclinic Hospital in Milan, conducted two sets of nasal swab tests, up to two days apart, on 214 newly admitted patients.

Eighty-three of these new admissions were children and 131 were adults. All were admitted to the hospital in March and April, at the height of northern Italy’s COVID-19 outbreak. However, all of the patients were admitted for reasons unconnected to COVID-19, and none had shown any symptoms of the illness.

So how many were secretly carrying the virus nonetheless? Based on the swab tests, only 1.2% of the pediatric patients turned up positive for infection, compared to 9.2% of adults.

The low rate of carriage among kids in a city with a burgeoning number of COVID-19 cases suggests “that [children’s] role as facilitators of the spreading of SARS-CoV-2 infection could be reconsidered,” the study authors wrote.

Still, the researchers stressed that this is a small sample from just one hospital, so the findings shouldn’t be considered definitive.

And of course community outbreaks of COVID-19 tied to asymptomatic but infected children are happening in the United States. On Friday, researchers from the U.S. Centers for Disease Control and Prevention issued a report on a cluster of cases originating from two Salt Lake City day care facilities. The report found that 12 youngsters infected with coronavirus (only three showed any symptoms) enrolled at two day care centers easily passed SARS-CoV-2 to at least 12 family members, one of whom ended up hospitalized.

So as millions of children head back to school, uncertainty as to their role in the spread of COVID-19 continues, Adalja said.

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Less than half of people in England understand current lockdown rules

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

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

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

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

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

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

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

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

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