H5N1

‘It’s no different from New York’: Urban centers nationwide gird for catastrophic COVID-19 outbreak

Via The Washington Post: ‘It’s no different from New York’: Urban centers nationwide gird for catastrophic virus outbreak. Excerpt:

In Chicago, the Army Corps of Engineers was preparing to erect 2,500 patient quarters throughout three of the cavernous halls at McCormick Place, the largest convention center in North America.  

In Detroit, a major hospital system was readying a letter for patients and their families outlining how scarce ventilators would be allocated, saying those with the best chance of survival would get priority. 

And in Albany, Ga., a hospital executive was straining to send patients to other hospitals as the number of deaths doubled in a matter of days at the largest medical center in the southwestern part of the state.  

While it ravages New York and metastasizes throughout much of the Northeast, the coronavirus is also quickly bearing down on new hot spots, sending doctors and first responders scrambling to prepare for the onslaught.  

Still unable to conduct widespread testing, and fearful as the federal government fails to marshal critical supplies, officials in Boston, Detroit, Chicago, Atlanta, Milwaukee and Los Angeles are watching caseloads climb and taking extraordinary measures to prepare, all the while hoping that aggressive social-distancing measures might ward off the most dismal projections. 

“I’m worried that New York might not be the worst-case scenario when you think about other states that have even older and less-healthy populations, and fewer hospital beds available,” said Retsef Levi, a professor of operations management at the Massachusetts Institute of Technology who has developed modeling tools designed to help public officials prepare for the spread of the novel virus and the disease it causes, covid-19.  

Deborah Birx, the White House’s coronavirus response coordinator, said this week that the task force was anticipating challenges in parts of the country where the numbers had yet to rise as steeply as they have in the outbreak’s existing epicenters, namely New York and New Orleans, as well as Washington state, which reported the country’s first death from covid-19 last month.  

She pointed in particular to Illinois’ Cook County, which includes Chicago, as well as Wayne County in Michigan, which includes Detroit. 

The virus is spreading inland “following intense introductions into coastal areas,” said Joseph Eisenberg, professor and chair of the epidemiology department the University of Michigan’s School of Public Health.  

International comparisons are scarce, he said, given the size of the United States compared with Italy or South Korea, and the reluctance here to enlist the “fairly draconian methods” used to contain the outbreak in China. 

“Without sealing off borders, even just a few cases can seed transmission to a new state,” Eisenberg said. “Because Chicago and Detroit are important hubs, there also could have been introduction at various points in time, with the intensity now building.”  

The danger is already being felt on the ground, where the rapid spread of infection in major metropolitan centers is driving up the numbers in Illinois and Michigan, which by Friday had reported 3,026 cases and 3,657 cases, respectively. The MIT modeling suggests that Northwestern Memorial Hospital, a premier center in Chicago, will be overrun once the infection rate reaches 3 percent — the figure reported in Italian cities as they began testing more consistently. At that level, the hospital, which is among those weighing a do-not-resuscitate policy for infected patients, would have about 1½ patients per intensive care unit bed.

The state of US health, 1990-2016

Via JAMA: The State of US Health, 1990-2016: Burden of Diseases, Injuries, and Risk Factors Among US States. Key points and abstract:

Key Points 

Question  How have the levels and trends of burden of diseases, injuries, and risk factors in the United States changed from 1990 to 2016 by state?  

Findings  This study, involving examination of 333 causes and 84 risk factors, demonstrated that health in the United States improved from 1990 to 2016, although the drivers of mortality and morbidity have changed in some states, with specific risk factors such as drug use disorders, high body mass index (BMI), and alcohol use disorders being associated with adverse outcomes. In 5 states, the probability of death between ages 20 and 55 years has increased more than 10% between 1990 and 2016.  

Meaning  Differences in health outcomes and drivers of morbidity and mortality at the state level indicate the need for greater investment in preventive and medical care across the life course. The intersection of risk, mortality, and morbidity in particular geographic areas needs to be further explored at the state level. 

Abstract 

Introduction  Several studies have measured health outcomes in the United States, but none have provided a comprehensive assessment of patterns of health by state. 

Objective  To use the results of the Global Burden of Disease Study (GBD) to report trends in the burden of diseases, injuries, and risk factors at the state level from 1990 to 2016.  

Design and Setting  A systematic analysis of published studies and available data sources estimates the burden of disease by age, sex, geography, and year.  

Main Outcomes and Measures  Prevalence, incidence, mortality, life expectancy, healthy life expectancy (HALE), years of life lost (YLLs) due to premature mortality, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 333 causes and 84 risk factors with 95% uncertainty intervals (UIs) were computed. 

Results  Between 1990 and 2016, overall death rates in the United States declined from 745.2 (95% UI, 740.6 to 749.8) per 100 000 persons to 578.0 (95% UI, 569.4 to 587.1) per 100 000 persons. The probability of death among adults aged 20 to 55 years declined in 31 states and Washington, DC from 1990 to 2016. 

In 2016, Hawaii had the highest life expectancy at birth (81.3 years) and Mississippi had the lowest (74.7 years), a 6.6-year difference. Minnesota had the highest HALE at birth (70.3 years), and West Virginia had the lowest (63.8 years), a 6.5-year difference. 

The leading causes of DALYs in the United States for 1990 and 2016 were ischemic heart disease and lung cancer, while the third leading cause in 1990 was low back pain, and the third leading cause in 2016 was chronic obstructive pulmonary disease. 

Opioid use disorders moved from the 11th leading cause of DALYs in 1990 to the 7th leading cause in 2016, representing a 74.5% (95% UI, 42.8% to 93.9%) change. In 2016, each of the following 6 risks individually accounted for more than 5% of risk-attributable DALYs: tobacco consumption, high body mass index (BMI), poor diet, alcohol and drug use, high fasting plasma glucose, and high blood pressure. 

Across all US states, the top risk factors in terms of attributable DALYs were due to 1 of the 3 following causes: tobacco consumption (32 states), high BMI (10 states), or alcohol and drug use (8 states). 

Conclusions and Relevance  There are wide differences in the burden of disease at the state level. Specific diseases and risk factors, such as drug use disorders, high BMI, poor diet, high fasting plasma glucose level, and alcohol use disorders are increasing and warrant increased attention. These data can be used to inform national health priorities for research, clinical care, and policy.

See also today's article in The Atlantic discussing this new study in some detail.

670,000 deaths a year the cost of China's reliance on coal

Via the South China Morning Post: 670,000 deaths a year the cost of China's reliance on coal. Excerpt:

Smog caused by coal consumption killed an estimated 670,000 people in China in 2012, according to a study by researchers that tries to put a price tag on the environmental and social costs of the heavy reliance on the fuel. 

Damage to the environment and health added up to 260 yuan (HK$330)[US$42.50] for each tonne produced and used in 2012, said Teng Fei , an associate professor at Tsinghua University. 

The 260 yuan is made up of two parts: the health cost and the environmental damage caused by mining and transporting coal. 

"With existing environmental fees and taxes of between 30 to 50 yuan for each tonne of coal, the country's current pricing system has largely failed to reflect the true costs," Teng said. 

Tiny particulate pollutants, especially those smaller than 2.5 micrograms (known as PM2.5), were linked to 670,000 premature deaths from four diseases - strokes, lung cancer, coronary heart disease and chronic obstructive pulmonary disease - in China in 2012, Teng said. 

That translated to an external cost of 166 yuan for each tonne of coal consumed. Authorities levied only about 5 yuan as a pollution fee per tonne of coal used by consumers including power companies and iron, steel and cement producers. 

Mining and transport add 94 yuan per tonne, including through damage to groundwater resources, subsidence, deaths and occupational diseases. 

Beijing is considering replacing pollution charges with more stringent environmental protection taxes, but progress on legislation has been slow.

WHO: Seven million premature deaths annually linked to air pollution

WHO has published a horrifying news release: 7 million premature deaths annually linked to air pollution. Excerpt:

In new estimates released today, WHO reports that in 2012 around 7 million people died - one in eight of total global deaths – as a result of air pollution exposure. This finding more than doubles previous estimates and confirms that air pollution is now the world’s largest single environmental health risk. Reducing air pollution could save millions of lives. 

New estimates 

In particular, the new data reveal a stronger link between both indoor and outdoor air pollution exposure and cardiovascular diseases, such as strokes and ischaemic heart disease, as well as between air pollution and cancer. This is in addition to air pollution’s role in the development of respiratory diseases, including acute respiratory infections and chronic obstructive pulmonary diseases. 

The new estimates are not only based on more knowledge about the diseases caused by air pollution, but also upon better assessment of human exposure to air pollutants through the use of improved measurements and technology. This has enabled scientists to make a more detailed analysis of health risks from a wider demographic spread that now includes rural as well as urban areas. 

Regionally, low- and middle-income countries in the WHO South-East Asia and Western Pacific Regions had the largest air pollution-related burden in 2012, with a total of 3.3 million deaths linked to indoor air pollution and 2.6 million deaths related to outdoor air pollution.

Seven million deaths a year mean 19,178 per day and 799 per hour: 13 per minute.

Coal burning and tuberculosis make COPD a common condition for non-smokers in China

Via China Medical News: Coal burning and tuberculosis make COPD a common condition for non-smokers in China. Click through for the full post and links. Excerpt:

In western countries chronic obstructive pulmonary disease is seen as predominantly a disease of smokers - and the only way to halt its progression is to stop smoking.  

In China however, thousands of non-smokers shows signs of non-reversible airways obstruction - and the reasons seem to be the country's ubiquitous use of dirty coal for cooking and heating. A study of 300,000 Chinese adults who have never smoked has found that one in twenty (5%) have COPD, with the condition more common in women than in men. 

The main factors associated with COPD were low income, lack of education, living in a rural area and a prior history of tuberculosis.   However, another major factor was cooking with coal.