H5N1

Why are women more prone to long Covid?

Via The Guardian: Why are women more prone to long Covid? Excerpt:

In June 2020, as the first reports of long Covid began to filter through the medical community, doctors attempting to grapple with this mysterious malaise began to notice an unusual trend. While acute cases of Covid-19 – particularly those hospitalised with the disease – tended to be mostly male and over 50, long Covid sufferers were, by contrast, both relatively young and overwhelmingly female. 

Early reports of long Covid at a Paris hospital between May and July 2020 suggested that the average age was around 40, and women afflicted by the longer-term effects of Covid-19 outnumbered men by four to one. 

Over the past 12 months, a similar gender skew has become apparent around the world. From long Covid patients monitored by hospitals in Bangladesh and Russia to the Covid Symptom Tracker app, from the UK-wide Phosp-Covid study assessing the longer-term impact of Covid-19, to the medical notes of specialist post-Covid care clinics across both the US and the UK, a picture has steadily emerged of young to middle-aged women being disproportionately vulnerable. 

Dr Sarah Jolley, who runs the UCHealth post-Covid care clinic in Aurora, Colorado, told the Observer that about 60% of her patients have been women. In Sweden, Karolinska Institute researcher Dr Petter Brodin, who leads the long Covid arm of the Covid Human Genetic Effort global consortium, suspects that the overall proportion of female long Covid patients may be even higher, potentially 70-80%. 

“This pattern has been seen in other post-infectious syndromes,” says Dr Melissa Heightman, who runs the UCLH post-Covid care clinic in north London. “Around 66% of our patients have been women. A lot of them were in full-time jobs, have young children, and now more than a quarter of them are completely unable to work because they’re so unwell. Economically, it’s a bit of a catastrophe.” 

As Heightman points out, this is not a new trend when it comes to infectious diseases, rather one which has historically been neglected. Women are known to be up to four times more likely to get ME/CFS (myalgic encephalomyelitis, or chronic fatigue syndrome), a condition believed to have infectious origins in the majority of cases, while studies have also shown that patients with chronic Lyme disease are significantly more likely to be female.

But despite this, there have been relatively few attempts to drill down into why this is the case. Instead, because these conditions predominantly affect women, they have more often been dismissed as being psychological in origin. Over the years, both ME/CFS and chronic Lyme disease have been ridiculed by sectors of the medical community as forms of hypochondria. 

“In general, there’s not as much research money and attention on conditions that primarily affect women,” says Julie Nusbaum, an assistant professor at NYU Long Island School of Medicine. “That’s just a general disparity in medical research. I think certain biases persist that when women present with a lot of body aches or pains, there’s more often an emotional or personality component to it than medical origin.” 

Worryingly, signs of these age-old biases have crept in over the past year with long Covid. There are anecdotal reports of female patients complaining that their persistent symptoms have been dismissed or attributed to anxiety. Dr Janet Scott, an infectious diseases specialist at the University of Glasgow, says that there remains a school of thought within the academic community that the long Covid gender skew may simply be an artefact of women being more likely to report symptoms than men. 

“I don’t buy it myself,” says Scott. “I think it plays into the narrative of, ‘Don’t worry about long Covid, it’s just a bunch of hysterical, middle-aged women.’” 

But Scott and other scientists around the world are trying to delve into the different factors which make women more prone to developing long Covid. Understanding them could be crucial to shedding a light on this mysterious condition in general, as well as other illnesses which can be triggered by an infection.

High and rising working-age mortality in the US: A report from the National Academies of Sciences, Engineering, and Medicine

Via JAMA Network: High and Rising Working-Age Mortality in the US: A Report From the National Academies of Sciences, Engineering, and Medicine. Excerpt:

Life expectancy has increased in the US and in the world for the past century. In 2010, life expectancy plateaued in the US while continuing to increase in other high-income nations. In the US, life expectancy declined for 3 consecutive years (2015-2017) due primarily to an increase in mortality among working-age adults (those aged 25-64 years). Although the increase in mortality was first described among White middle-aged adults, mortality is now increasing among young and middle-aged adults and in all racial groups. 

This increase in premature death, claiming lives during the prime working ages, has important implications for individuals, families, communities, employers, and the nation. 

A new report from a National Academies of Sciences, Engineering, and Medicine committee studied mortality data from 1990 to 2017 by cause of death, age, sex, race/ethnicity, socioeconomic status, and geography. It found that average working-age mortality rates decreased after 2010 in 16 high-income countries but increased in the US. 

Three causes of death were identified as chiefly responsible: (1) drug poisoning and alcohol-induced causes, (2) suicide, and (3) cardiometabolic diseases. The first category includes mortality from mental and behavioral disorders, which often involve drugs or alcohol. Cardiometabolic diseases include endocrine, nutritional, and metabolic diseases (eg, diabetes, obesity); hypertensive heart disease; and ischemic heart disease and other diseases of the circulatory system (eg, arrhythmia, cardiomyopathy, heart failure). 

Mortality among working-age adults increased from other causes (eg, liver cancer, neurological diseases, homicides, transportation injuries), but none individually made large contributions to the overall trend.

Stark racial disparities persist in vaccinations, state-level CDC data shows

Thanks to Lauren Weber for alerting me to this report in Kaiser Health News: Stark Racial Disparities Persist in Vaccinations, State-Level CDC Data Shows. Excerpt:

Black Americans’ covid-19 vaccination rates are still lagging months into the nation’s campaign, while Hispanics are closing the gap and Native Americans show the highest rates overall, according to federal data obtained by KHN. This story also ran on CNN. It can be republished for free. 

The data, provided by the Centers for Disease Control and Prevention in response to a public records request, gives a sweeping national look at the race and ethnicity of vaccinated people on a state-by-state basis. Yet nearly half of those vaccination records are missing race or ethnicity information. 

KHN’s analysis shows that only 22% of Black Americans have gotten a shot, and Black rates still trail those of whites in almost every state.  

Targeted efforts have raised vaccination rates among other minority groups. Hispanics in eight states, the District of Columbia and Puerto Rico are now vaccinated at higher rates than non-Hispanic whites. Yet 29% of Hispanics are vaccinated nationally, compared with 33% of whites. 

While 45% of Native Americans have received at least one dose, stark differences exist depending on where they live. And Asian vaccination rates are high in most states, with 41% getting a shot. 

The analysis underscores how vaccine disparities have improved as availability has opened up and Biden administration officials have attempted to prioritize equitable distribution. Still, gaps persist even as minority groups have suffered much higher mortality rates from the pandemic than whites and are at risk of infection as states move to reopen and lift mask mandates.

Postoperative outcomes for Indigenous Peoples in Canada: A systematic review

Via CMAJ: Postoperative outcomes for Indigenous Peoples in Canada: a systematic review. The abstract:

Background: Substantial health inequities exist for Indigenous Peoples in Canada. The remote and distributed population of Canada presents unique challenges for access to and use of surgery. To date, the surgical outcome data for Indigenous Peoples in Canada have not been synthesized. 

Methods: We searched 4 databases to identify studies comparing surgical outcomes and utilization rates of adults of First Nations, Inuit or Métis identity with non-Indigenous people in Canada. Independent reviewers completed all stages in duplicate. Our primary outcome was mortality; secondary outcomes included utilization rates of surgical procedures, complications and hospital length of stay. We performed meta-analysis of the primary outcome using random effects models. We assessed risk of bias using the ROBINS-I tool. 

Results: Twenty-eight studies were reviewed involving 1 976 258 participants (10.2% Indigenous). No studies specifically addressed Inuit or Métis populations. Four studies, including 7 cohorts, contributed adjusted mortality data for 7135 participants (5.2% Indigenous); Indigenous Peoples had a 30% higher rate of death after surgery than non-Indigenous patients (pooled hazard ratio 1.30, 95% CI 1.09–1.54; I2 = 81%). Complications were also higher for Indigenous Peoples, including infectious complications (adjusted OR 1.63, 95% CI 1.13–2.34) and pneumonia (OR 2.24, 95% CI 1.58–3.19). Rates of various surgical procedures were lower, including rates of renal transplant, joint replacement, cardiac surgery and cesarean delivery. 

Interpretation: The currently available data on postoperative outcomes and surgery utilization rates for Indigenous Peoples in Canada are limited and of poor quality. Available data suggest that Indigenous Peoples have higher rates of death and adverse events after surgery, while also encountering barriers accessing surgical procedures. These findings suggest a need for substantial re-evaluation of surgical care for Indigenous Peoples in Canada to ensure equitable access and to improve outcomes.

Rich countries close their eyes to the global Covid surge at their own peril

Via The Guardian, an op-ed by Laura Spinney: Rich countries close their eyes to the global Covid surge at their own peril. Excerpt:

Is there one pandemic, or two? That was a question being asked a year ago, when wealthy countries accounting for only 15% of the global population had 80% of the Covid deaths. Could it be that the rich world was more vulnerable, somehow, because its populations were older, or more individualistic, or had forgotten to be scared of infectious disease? 

Even then, some were warning that the worst was yet to come, once the disease took hold in poorer countries. World Bank analysts Philip Schellekens and Diego Sourrouille, for example, predicted a “massive shift” in disease burden to the developing world. Just in terms of demography, they said, you’d expect those countries to account for around 70% of deaths. As things stand they account for a little over half of it, which is probably an underestimate due to variations in data quality – and the pandemic is far from over. 

Last week saw more than 5.8 million new cases of Covid globally, the highest number yet. More than 3 million people have now died from Covid, according to the World Health Organization (WHO), which also reports that infections and hospitalisations in those aged 25 to 59 are increasing at an alarming rate. “It took nine months to reach 1 million deaths, four months to reach 2 million, and three months to reach 3 million,” WHO director general, Tedros Adhanom Ghebreyesus, said last week. 

The sharpest upticks in recent weeks have been seen in south-east Asia – driven in large part by India – and the eastern Mediterranean and western Pacific regions, but the situation is also very bad in Latin America. People who migrated to Brazil in search of work are now reported to be fleeing the humanitarian catastrophe that is unfolding there. 

Infection rates are still high in many wealthy countries – including the US and much of Europe – but the mood is more upbeat: as vaccines roll out, many people feel the worst is behind them. Some US states have rashly lifted their mask mandates. The British government gave the most optimistic signal it could think of earlier this month, when it reopened pubs. 

And Covid-19 is slipping down the headlines, reflecting not just fatigue at having to respect the rules, but fatigue at the very mention of the disease. Fear concentrates the mind, but fear is dissipating; we’d rather read about Tory sleaze, or the doomed European Super League. 

Again, you could be forgiven for asking, is there one pandemic or two? Only now the question has an entirely different meaning. The tables have turned. 

In reality, there was only ever one pandemic. We tend to think of it in terms of national impacts and responses, at best regional ones, but for it to make sense you have to stand back and look at it globally. For all its idiosyncrasies, Covid will stay true to type in at least one way: like pandemics throughout history, it will hammer the poorest hardest.

Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: A comprehensive analysis

Via The Lancet Global Health: Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: a comprehensive analysis. The summary:

Background 

COVID-19 spread rapidly in Brazil despite the country's well established health and social protection systems. Understanding the relationships between health-system preparedness, responses to COVID-19, and the pattern of spread of the epidemic is particularly important in a country marked by wide inequalities in socioeconomic characteristics (eg, housing and employment status) and other health risks (age structure and burden of chronic disease). 

Methods 

From several publicly available sources in Brazil, we obtained data on health risk factors for severe COVID-19 (proportion of the population with chronic disease and proportion aged ≥60 years), socioeconomic vulnerability (proportions of the population with housing vulnerability or without formal work), health-system capacity (numbers of intensive care unit beds and physicians), coverage of health and social assistance, deaths from COVID-19, and state-level responses of government in terms of physical distancing policies. We also obtained data on the proportion of the population staying at home, based on locational data, as a measure of physical distancing adherence. 

We developed a socioeconomic vulnerability index (SVI) based on household characteristics and the Human Development Index. Data were analysed at the state and municipal levels. Descriptive statistics and correlations between state-level indicators were used to characterise the relationship between the availability of health-care resources and socioeconomic characteristics and the spread of the epidemic and the response of governments and populations in terms of new investments, legislation, and physical distancing. We used linear regressions on a municipality-by-month dataset from February to October, 2020, to characterise the dynamics of COVID-19 deaths and response to the epidemic across municipalities. 

Findings 

The initial spread of COVID-19 was mostly affected by patterns of socioeconomic vulnerability as measured by the SVI rather than population age structure and prevalence of health risk factors. The states with a high (greater than median) SVI were able to expand hospital capacity, to enact stringent COVID-19-related legislation, and to increase physical distancing adherence in the population, although not sufficiently to prevent higher COVID-19 mortality during the initial phase of the epidemic compared with states with a low SVI. 

Death rates accelerated until June, 2020, particularly in municipalities with the highest socioeconomic vulnerability. Throughout the following months, however, differences in policy response converged in municipalities with lower and higher SVIs, while physical distancing remained relatively higher and death rates became relatively lower in the municipalities with the highest SVIs compared with those with lower SVIs. 

Interpretation 

In Brazil, existing socioeconomic inequalities, rather than age, health status, and other risk factors for COVID-19, have affected the course of the epidemic, with a disproportionate adverse burden on states and municipalities with high socioeconomic vulnerability. Local government responses and population behaviour in the states and municipalities with higher socioeconomic vulnerability have helped to contain the effects of the epidemic. 

Targeted policies and actions are needed to protect those with the greatest socioeconomic vulnerability. This experience could be relevant in other low-income and middle-income countries where socioeconomic vulnerability varies greatly.

COVID-19 vaccines in high-risk ethnic groups

Via The Lancet: COVID-19 vaccines in high-risk ethnic groups.

Black, Asian, and minority ethnic communities worldwide have a disproportionate risk of severe COVID-19. In the UK, as of May 19, 2020, 36% of critically ill patients with COVID-19 requiring intensive care were from Black, Asian, or minority ethnic groups.1 According to Public Health England, the mortality risk from COVID-19, after accounting for sex, age, deprivation score, and geographical region, is double in Bangladeshi people and up to 50% higher in Black and south Asian people compared with White British people. This finding contrasts with age-adjusted all-cause mortality from previous years, which was lower in Asian and Black people than in White British people. These data imply that COVID-19 has more serious effects in Black and Asian people. 

The ethnic groups most affected by COVID-19 are under-represented in the COVID-19 vaccine trial data published so far. Despite efforts to encourage participation from Black, Asian, and minority ethnic groups, of the 552 participants in the phase 2/3 Oxford–AstraZeneca trial (based in Southampton and Oxford, UK), only one participant was Black and 19 were Asian. Large-scale trials also have a smaller proportion of minority groups compared with the populations sampled (appendix).

Black, Asian, and minority ethnic individuals are under-represented in research. However, the ongoing pandemic necessitates that access to trials and vaccinations shifts from being equal to being equitable. Study recruitment and participation designs should improve diversity in ethnic groups to maximise the validity of results to the populations concerned. Age and sex are routinely considered in recruitment design—the same should now apply to ethnicity. 

In the context of a pandemic that has higher infection and mortality risks in certain ethnic groups, it is important that these specific groups are adequately represented in vaccine trials to evaluate both immunogenicity and efficacy.

'Onions don't cure COVID-19': University of Guelph student combatting misinformation

Via CTV News: 'Onions Don't Cure COVID-19': University of Guelph student combatting COVID-19 misinformation.

GUELPH -- A University of Guelph student has created a website that helps debunk myths, conspiracies, and general misinformation around COVID-19…like how onions aren't the cure. 

The aptly named onionsdontcurecovid.com is part of a campaign started by Lauren Chang to help guide people through misconceptions about the virus. 

The site uses a series of infographics and videos to help share factual and credible information taken from Canadian Public Health surrounding COVID-19. 

"Our aim is not to look at these things and laugh at the people that may be believing it," said Chang. "This is why we encourage people to look at what the information is telling them to do, and as long as it doesn't hurt you and you're able to do it while following public health guidelines, I don't see a problem with it." 

She adds that, while everyone is able to benefit from the site, it's mostly geared towards immigrant communities. 

"Immigrant communities specifically have the problem of having linguistic barriers that deter them from accessing information from more traditional news sources or public health, which are usually only in English or French," said Chang. 

With the help from some other students, the information on the website is translated into 10 different languages. 

"It has specific reach to Chinese communities, Asian communities, and people from different cultural backgrounds and experiences," said Guelph student Pooja Sankar. "That's something that's really great about it." 

Chang says the site is constantly being updated as information about COVID-19 is constantly evolving. 

She is currently planning for her next campaign focused on vaccine education.

Covid-19 vaccine websites violate disability laws, create inequity for the blind

Via KHN, Lauren Weber and Hannah Recht write: Covid Vaccine Websites Violate Disability Laws, Create Inequity for the Blind. Excerpt:

Many covid vaccination registration and information websites at the federal, state and local levels violate disability rights laws, hindering the ability of blind people to sign up for a potentially lifesaving vaccine, a KHN investigation has found. 

Across the country, people who use special software to make the web accessible have been unable to sign up for the vaccines or obtain vital information about covid-19 because many government websites lack required accessibility features. At least 7.6 million people in the U.S. over age 16 have a visual disability. 

WebAIM, a nonprofit web accessibility organization, checked covid vaccine websites gathered by KHN from all 50 states and the District of Columbia. On Jan. 27, it found accessibility issues on nearly all of 94 webpages, which included general vaccine information, lists of vaccine providers and registration forms. 

In at least seven states, blind residents said they were unable to register for the vaccine through their state or local governments without help. Phone alternatives, when available, have been beset with their own issues, such as long hold times and not being available at all hours like websites. 

Even the federal Centers for Disease Control and Prevention’s Vaccine Administration Management System, which a small number of states and counties opted to use after its rocky rollout, has been inaccessible for blind users. 

Those problems violate the Rehabilitation Act of 1973, which established the right to communications in an accessible format, multiple legal experts and disability advocates said. The federal Americans with Disabilities Act, a civil rights law that prohibits governments and private businesses from discriminating based on disability, further enshrined this protection in 1990.

Deadly Donald Trump and 40 years of health failures

The Tyee has published my article: Deadly Donald Trump and 40 Years of Health Failures. Excerpt:

Four years ago, in the early weeks of Donald Trump’s presidency, I wrote an article describing him as an Ebola-level global health threat.

That was obviously a gross under-estimate. And Ebola was the wrong comparison. The outbreak that began in 2013 in West Africa, the worst in history, took about 11,000 lives. (Another outbreak has just started in Guinea, but now it can be fought with experienced health care workers and vaccine.) 

Compared to the lives Trump is responsible for shortening or ending, Ebola was a rounding error. In a recent article, science writer Laurie Garrett charged him with pandemicide. But COVID-19 is only one factor in the deaths caused by Trump and a 40-year attack on American public health. 

Soon after I wrote my 2017 article, The Lancet, a major British medical journal, established one of its commissions. Unlike its other commissions that look at the impact of this or that disease, this one was to focus on the impact of Trump and his policies. 

That commission has now published “Public policy and health in the Trump era,” an indictment not only of Trump but of the 40 years of neoliberal policies begun by Ronald Reagan. It may take another 40 years to repair the damage.