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About 47% of US adults have at least one underlying medical condition that may put them at a higher risk for severe Covid-19 outcomes, according to a new CDC report published Thursday.

Older adults and those with chronic obstructive pulmonary disease, heart disease, diabetes, chronic kidney disease, and obesity are at higher risk for severe COVID-19–associated illness.

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What is added by this report?

The median model-based estimate of the prevalence of any of five underlying medical conditions associated with increased risk for severe COVID-19–associated illness among U.S. adults was 47.2% among 3,142 U.S. counties. The estimated number of persons with these conditions followed population distributions, but prevalence was higher in more rural counties.

What are the implications for public health practice?

The findings can help local decision-makers identify areas at higher risk for severe COVID-19 illness in their jurisdictions and guide resource allocation and implementation of community mitigation strategies.

Risk for severe coronavirus disease 2019 (COVID-19)–associated illness (illness requiring hospitalization, intensive care unit [ICU] admission, mechanical ventilation, or resulting in death) increases with increasing age as well as presence of underlying medical conditions that have shown strong and consistent evidence, including chronic obstructive pulmonary disease, cardiovascular disease, diabetes, chronic kidney disease, and obesity (14). Identifying and describing the prevalence of these conditions at the local level can help guide decision-making and efforts to prevent or control severe COVID-19–associated illness. Below state-level estimates, there is a lack of standardized publicly available data on underlying medical conditions that increase the risk for severe COVID-19–associated illness. A small area estimation approach was used to estimate county-level prevalence of selected conditions associated with severe COVID-19 disease among U.S. adults aged ≥18 years (5,6) using self-reported data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and U.S. Census population data. The median prevalence of any underlying medical condition in residents among 3,142 counties in all 50 states and the District of Columbia (DC) was 47.2% (range = 22.0%–66.2%); counties with the highest prevalence were concentrated in the Southeast and Appalachian region. Whereas the estimated number of persons with any underlying medical condition was higher in population-dense metropolitan areas, overall prevalence was higher in rural nonmetropolitan areas. These data can provide important local-level information about the estimated number and proportion of persons with certain underlying medical conditions to help guide decisions regarding additional resource investment, and mitigation and prevention measures to slow the spread of COVID-19.

BRFSS is an annual, random-digit–dialed landline and mobile telephone survey of noninstitutionalized U.S. adults aged ≥18 years in all 50 states, DC, and U.S. territories. BRFSS collects self-reported information on selected health behaviors and conditions. Overall, 437,500 persons participated in the 2018 BRFSS survey, with a median weighted response rate of 49.9%.*

The underlying medical conditions included in these prevalence estimates were selected using the subset of the list of conditions with the strongest and most consistent evidence of association with higher risk for severe COVID-19–associated illness on CDC’s website as of June 25, 2020 (2) and for which questions on the BRFSS aligned. These included chronic obstructive pulmonary disease (COPD), heart conditions, diabetes mellitus, chronic kidney disease (CKD), and obesity (defined as body mass index [BMI] of ≥30 kg per m2). Conditions from the list of those with mixed and limited evidence§ of association with increased risk for severe COVID-19 illness were not included (2). An analysis of U.S. COVID-19 patient surveillance data found that hospitalizations were six times higher, ICU admissions five times higher, and deaths 12 times higher among patients with underlying medical conditions, compared with those without (4); however, that analysis included a narrower definition of obesity (BMI ≥40 kg per m2), and some, but not all conditions in both the strongest and most consistent evidence and mixed and limited evidence lists.

BRFSS respondents were classified as having an underlying medical condition if they answered “yes” to any of the following questions: “Have you ever been told by a doctor, nurse, or other health professional that you have COPD, emphysema, or chronic bronchitis; heart disease (angina or coronary heart disease, heart attack, or myocardial infarction); diabetes; or chronic kidney disease?” Respondent-reported height and weight were used to calculate BMI; respondents with BMI ≥30 kg per m2 were considered to have obesity. A created variable captured persons having any of these conditions.

Nationwide estimates of underlying medical conditions were weighted to adjust for survey design. For county-level prevalence, estimates of each and of any condition were generated using a multilevel regression and poststratification approach (5) for 3,142 counties in all 50 states and DC. This approach has been validated in comparison with direct BRFSS survey estimates and local surveys for multiple chronic disease measures at state and county levels (5,6). Briefly, a multilevel regression model was constructed for each outcome using individual-level age, gender, race/ethnicity,** and educational-level†† data from the 2018 BRFSS, and data on county-level percentage of the adult population living at <150% of the poverty level from the 2014–2018 American Community Survey (ACS), a survey sent to about 3.5 million addresses each month that asks about topics not included on the decennial census, including education and employment. The model parameters were applied to 2018 Census county-level population estimates by age, gender, and race/ethnicity to calculate the predicted probability of each outcome. Because the U.S. Census Bureau does not provide county-level population data for education level by age, sex, and race/ethnicity, a bootstrapping approach§§ was used to impute it. The estimated prevalence was obtained by multiplying the probability by the total population by county. Model-based estimates for any condition were validated by comparing them with the weighted direct survey estimates from counties with sample size ≥500 (213) in BRFSS; the Pearson correlation coefficient was 0.89. The county-level estimates of having any underlying medical condition were categorized into six county urban/rural classifications using CDC’s National Center for Health Statistics definitions (large central metro/city, large fringe metro/suburb, medium metro, small metro, micropolitan, noncore/rural) (7). The overall weighted direct survey estimates were conducted using SUDAAN (version 11; RTI International), and other analyses were conducted using SAS (version 9.4; SAS Institute).

The nationwide prevalence of any of the five underlying medical conditions among adults aged ≥18 years was 40.7% (95% confidence interval [CI] = 40.4%–41.0%) (Table 1). The overall weighted prevalences of these conditions were 30.9% (obesity), 11.4% (diabetes), 6.9% (COPD), 6.8% (heart disease), and 3.1% (CKD).

TABLE 1. Nationwide and model-based county-level (n = 3,142) estimates of prevalence and number of adults aged ≥18 years with selected underlying medical conditions that might increase risk for severe COVID-19–associated illness — United States, 2018Return to your place in the text
Selected underlying medical condition*Nationwide prevalence % (95% CI)Median county prevalence§ % (range)Median county no. of adults (range)
Any40.7 (40.4, 41.0)47.2 (22.0–66.2)9,743 (41–2,877,316)
Obesity (BMI ≥30 kg/m2)30.9 (30.6, 31.2)35.4 (15.2– 49.9)7,174 (25–2,097,906)
Diabetes mellitus11.4 (11.2, 11.6)12.8 (6.1–25.6)2,742 (11–952,335)
COPD6.9 (6.7, 7.0)8.9 (3.5–19.9)1,962 (7–434, 075)
Heart disease6.8 (6.7, 7.0)8.6 (3.5–15.1)1, 811 (7–434,790)
Chronic kidney disease3.1 (3.0, 3.3)3.4 (1.8–6.2)717 (3–237,766)

Abbreviations: BMI = body mass index; CI = confidence interval; COPD = chronic obstructive pulmonary disease; COVID-19 = coronavirus disease 2019.
* Diabetes mellitus includes both type 1 and type 2 diabetes. COPD includes emphysema and chronic bronchitis. Heart disease includes angina or coronary heart disease, and heart attack or myocardial infarction.
 Weighted direct estimates from the Behavioral Risk Factor Surveillance System, 2018.
§ Prevalence and number of adults estimated for 3,142 counties using a multilevel regression and poststratification approach applied to 2018 Behavioral Risk Factor Surveillance System data.

 

Among 3,142 counties, the median estimated (modeled) county prevalence of any underlying medical condition was 47.2% (range = 22.0%–66.2%); obesity, 35.4% (range = 15.2%–49.9%); diabetes, 12.8% (range = 6.1%–25.6%); COPD, 8.9% (range = 3.5%–19.9%); heart disease, 8.6% (range = 3.5%–15.1%); and CKD, 3.4% (range = 1.8%–6.2%) (Table 1).

Counties with the highest prevalences of any condition were concentrated in Southeastern states, particularly in Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Tennessee, and West Virginia, as well as some counties in Oklahoma, South Dakota, Texas, and northern Michigan, among others (Figure) (Supplementary Table, https://stacks.cdc.gov/view/cdc/90519). The estimated number of adults with any condition generally followed the population distribution, with higher estimated numbers of persons with any underlying medical conditions in more highly populated areas.

FIGUREModel-based estimates of U.S. prevalence (A) and number (B) of adults aged ≥18 years with any selected underlying medical condition,* by county — United States, 2018

The figure is map showing model-based estimates of U.S. prevalence (A) and number (B) of adults aged ≥18 years with any selected underlying medical condition, by county, in the United States, in 2018.

* Selected underlying conditions include chronic obstructive pulmonary disease, emphysema, or chronic bronchitis; heart disease (angina or coronary heart disease, heart attack, or myocardial infarction); diabetes; chronic kidney disease; or obesity (body mass index ≥30 kg/m2).

The estimated median prevalence of any condition generally increased with increasing rurality, ranging from 39.4% in large central metro counties to 48.8% in noncore counties (Table 2); the estimated median number of persons with any underlying condition ranged from 4,300 in noncore counties to 301,744 in large central metro counties.

TABLE 2. Model-based estimates of prevalence and number of persons aged ≥18 years with any select underlying medical condition, by urban/rural county classification — United States, 2018Return to your place in the text
County classification*No. of countiesMedian county prevalence % (range)Median county no. of persons (range)
Metropolitan
Large central metro6839.4 (23.9–48.1)301,744 (43,770–2,877,316)
Large fringe metro§36843.9 (26.4–56.9)34,221 (1,611–725,284)
Medium metro37245.5 (22.0–61.7)33,687 (659–332,209)
Small metro**35845.8 (27.8–62.2)26,683 (41–87,153)
Nonmetropolitan
Micropolitan††64147.8 (24.3–64.6)13,979 (176–59,820)
Noncore§§1,33548.8 (26.8–66.2)4,300 (47–29,469)

* Based on 2013 Urban-Rural Classification Scheme for Counties from the National Center for Health Statistics, CDC.
 Large central metro counties in metropolitan statistical areas (MSAs) of 1 million population that 1) contain the entire population of the largest principal city of the MSA, or 2) are completely contained within the largest principal city of the MSA, or 3) contain ≥250,000 residents of any principal city in the MSA.
§ Large fringe metro counties in MSA of ≥1 million population that do not qualify as large central.
 Medium metro counties in MSA of 250,000–999,999 population.
** Small metro counties are counties in MSAs of <250,000 population.
†† Micropolitan counties in MSAs.
§§ Noncore counties not in MSAs.

Discussion

Three recent studies have reported that underlying medical conditions are highly prevalent among U.S. COVID-19 patients requiring hospitalization and ICU admission (3,4,8). In this report, the median county prevalence of any of five underlying medical conditions that increase the risk for severe COVID-19–associated illness was 47.2%, and prevalences were higher in counties in the southeastern United States and in more rural counties. These county level estimates can be used together with data on hospitalizations, ICU admissions, and ventilator use among COVID-19 patients with underlying conditions when planning for mitigation efforts and additional resource investment, including hospital beds, staffing, ventilators, and other medical supplies that might be needed to treat persons with underlying medical conditions, should they become ill with COVID-19.

The percentage of the population (prevalence) and the estimated numbers of adults with underlying medical conditions provide information for planning and have implications for health care resource utilization. Areas with comparatively lower prevalences but large populations, such as metropolitan areas, might still have large numbers of persons with underlying medical conditions at increased risk for severe COVID-19 illness. Conversely, areas with smaller populations but a comparatively higher prevalence of persons with underlying medical conditions might also have substantial need for additional resources to treat severe COVID-19 illness. Health care in rural counties is often underresourced,¶¶ and rural communities might have limited access to adequate care, which could further increase risk for poor COVID-19–associated outcomes. Prevalence estimates help highlight counties with a higher relative need for resources, whereas estimates of numbers of persons with underlying medical conditions help identify overall need by county; both can help decision-makers predict resource needs and develop resource allocation plans.

The findings in this report are subject to at least five limitations. First, estimates were based on BRFSS data and subject to survey biases such as nonresponse, social desirability, and recall and knowledge of having a particular condition. Second, BRFSS data do not include all underlying medical conditions that might increase risk for severe COVID-19 illness, such as sickle cell disease, or information on organ transplant or disease severity. Third, some of the underlying medical conditions included in BRFSS might not exactly capture those conditions with the strongest and most consistent evidence such as specific heart conditions (e.g., cardiomyopathies and heart failure) or specific type of diabetes. Further, because COVID-19 is a novel disease and information regarding risk factors for severe illness is evolving, additional underlying medical conditions might be added in the future (as an example, cancer was added to the list after these analyses were conducted). Fourth, BRFSS data are collected for noninstitutionalized civilian persons and exclude populations that might be particularly vulnerable to severe COVID-19 illness, including those living in long-term care facilities and incarcerated populations, and might therefore not be representative for those groups. Finally, these estimates might be imprecise because of the multilevel regression modeling process and county-level population estimation.

These findings can be used by state and local decision-makers to help identify areas at higher risk for severe COVID-19–associated illness because of underlying medical conditions and guide resource allocation and implementation of prevention and mitigation strategies. Future analyses could include weighting the contribution of each underlying medical condition according to the risk for severe COVID-19–associated outcomes, as well as identifying and incorporating other aspects of vulnerability to both infection and severe outcomes to better estimate the number of persons at increased risk for COVID-19. These findings highlight the prevalence of underlying medical conditions at the local (county) level that are important causes of morbidity and mortality on their own and increase risk for severe COVID-19–associated illness. These findings also emphasize the importance of prevention efforts to reduce the prevalence of these underlying medical conditions and their risk factors such as smoking, unhealthy diet, and lack of physical activity.

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D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a game changer.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

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Covid-19 and the heart: two new studies offer insights

Since the coronavirus pandemic first began, evidence has emerged showing that Covid-19 can damage more than the lungs.

The disease caused by the novel coronavirus can harm other organs in the body — including the heart — and now two separate studies, published in the journal JAMA Cardiology on Monday, provide more insight into how Covid-19 may have a prolonged impact on heart health in those who have recovered from illness and may have caused cardiac infection in those who died.

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“We’ve understood for a few months now that Covid-19 is not only a respiratory infection but a multi-system infection,” said cardiologist Dr. Nieca Goldberg, medical director of the NYU Women’s Heart Program and senior adviser for women’s health strategy at NYU Langone Health in New York, who was not involved in either study.

“There is an acute inflammatory response, increased blood clotting and cardiac involvement. And the cardiac involvement can either be due to direct involvement of the heart muscle by the infection and its inflammatory response. It could be due to blood clots that are formed, causing an obstruction of arteries,” Goldberg said.

“Sometimes people have very fast heart rates that can, over time, weaken the heart muscle, reduce the heart muscle function. So there are multiple ways during this infection that it can involve the heart.”

 

Inflammation of the heart

One of the JAMA Cardiology studies found that, among 100 adults who recently recovered from Covid, 78% showed some type of cardiac involvement in MRI scans and 60% had ongoing inflammation in the heart.

The study included patients ages 45 to 53 who were from the University Hospital Frankfurt Covid-19 Registry in Germany. They were recruited for the study between April and June. Most of the patients — 67– recovered at home, with the severity of their illness ranging from some being asymptomatic to having moderate symptoms.

The researchers used cardiac magnetic resonance imaging, blood tests and biopsy of heart tissue. Those data were compared with a group of 50 healthy volunteers and 57 volunteers with some underlying health conditions or risk factors.

© NIAID-RML his scanning electron microscope image shows SARS-CoV-2 (yellow)—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S., emerging from the surface of cells (pink) cultured in the lab. Credit: NIAID-RML

The MRI data revealed that people infected with coronavirus had some sort of heart involvement regardless of any preexisting conditions, the severity or course of their infection, the time from their original diagnosis or the presence of any specific heart-related symptoms.

The most common heart-related abnormality in the Covid-19 patients was myocardial inflammation or abnormal inflammation of the heart muscle, which can weaken it.

This type of inflammation, also called myocarditis, is usually caused by a viral infection, Goldberg said, adding that she was not surprised by these study results.

“What they’re saying in this study is that you can identify myocardial involvement or heart involvement by magnetic resonance imaging,” Goldberg said.

The study has some limitations. More research is needed to determine whether similar findings would emerge among a larger group of patients, those younger than 18 and those currently battling coronavirus infection instead of just recovering from it.

“These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19,” the researchers wrote.

‘This infection does not follow one path’

In the other JAMA Cardiology study, an analysis of autopsies found that coronavirus could be identified in the heart tissue of Covid-19 patients who died.

The study included data from 39 autopsy cases from Germany between April 8 and April 18. The patients, ages 78 to 89, had tested positive for Covid-19 and the researchers analyzed heart tissue from their autopsies.

The researchers found that 16 of the patients had virus in their heart tissue, but did not show signs of unusual sudden inflammation in the heart or myocarditis. It’s not clear what this means, the researchers said.

The sample of autopsy cases was small and the “elderly age of the patients might have influenced the results,” the researchers wrote. More research is needed whether similar findings would emerge among a younger group of patients.

“I think both of these studies are important,” Goldberg said.

“One pretty much shows that the MRI scan can help diagnose the myocardial injury that occurs due to Covid and it was confirmed on biopsy,” she said. “The autopsy study showed us something else that’s interesting — that you can have viral presence but not the acute inflammatory process. So this infection does not follow one path.”

‘An increasingly complex puzzle’

Both studies “add to an increasingly complex puzzle” when it comes to the novel coronavirus named SARS-CoV-2, Dr. Dave Montgomery, founding cardiologist at the PREvent Clinic in Sandy Springs, Georgia, said in an email on Tuesday.

“Taken together the studies support that SARS-CoV-2 does not have to cause clinical myocarditis in order to find the virus in large numbers and the inflammatory response in myocardial tissue. In other words, one can have no or mild symptoms of heart involvement in order to actually cause damage,” said Montgomery, who was not involved in the studies.

“Viruses in general have a way of making their way to organs that are quite remote from the original site of infection. SARS-CoV-2 is no different in this regard,” he said. “What is different is that this virus seems to preferentially affect cardiac cells and the surrounding cells. These studies suggest that the heart can be infected with no clear signs. Personally, in my practice, we have seen similar signs of inflammation, including pericardial effusions,” or fluid around the sac of the heart.

Dr. Clyde Yancy of Northwestern University Feinberg School of Medicine and Dr. Gregg Fonarow of the University of California, Los Angeles, co-authored an editorial that accompanied the two new studies in the journal JAMA Cardiology on Monday.

“We see the plot thickening and we are inclined to raise a new and very evident concern that cardiomyopathy and heart failure related to COVID-19 may potentially evolve as the natural history of this infection becomes clearer,” Yancy and Fonarow wrote in the editorial.

“We wish not to generate additional anxiety but rather to incite other investigators to carefully examine existing and prospectively collect new data in other populations to con- firm or refute these findings,” they wrote.

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Experts say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA effects throughout the entire body is the solution to the challenges COVID-19 poses to people with underlying medical conditions. It helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a game changer.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

Reduce unwanted doctor visits, recommended and ranked top by experts!

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Actor Jonathan Adams Shares How COVID-19 Disproportionately Affects Black Americans

Actor Jonathan Adams is focused on staying healthy during the COVID-19 pandemic and he wants fellow Black Americans to stay safe, too.  The novel coronavirus has disproportionately affected Black Americans at a higher rate than other races. 

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New data shows Black and Latinx U.S. residents are three times as likely to get coronavirus, compared to their white neighbors. They’re also nearly twice as likely to die from the disease.

Adams, known for playing Chuck Larabee, Tim Allen’s neighbor on ABC’s “Last Man Standing,” has been talking with his family and friends about the pandemic, including with his sister, who is a nurse

“All I can say is that it’s incredibly oppressive and very frightening,” said Adams, who wears masks and tries to stay healthy overall. He exercises every other day, including taking long walks with his dogs.

Socioeconomic issue

Adams says many essential workers like nurses, restaurant workers, bus drivers, and others, are people of color.

“It’s not necessarily a racial thing but I think it’s more a socioeconomic issue that we’re facing,” he said. “And we’re seeing a disparity in the fact that a lot of Black people, and a lot of Latinos as well, don’t have the white collar jobs that we can stay at home and do from home, do from a computer.”

In fact, 2018 Census data shows 43 percent of black and Latinx workers work in service and production jobs, which typically can’t be done remotely.

Black in America

It’s an emotionally challenging time in the United States

“There’s a lot of tension that comes along with just simply being black in America,” said Adams. “And I think that a lot of why we have hypertension is because of the tension of just trying to live in your own skin.”

The American Heart Association says Black Americans have one of the highest rates of hypertension in the world. While people with the condition are encouraged to relax, Adams says that’s hard to do.

“How can you relax when you’re under this constant pressure?” asked Adams, who calls the combined timing of COVID-19 and Black Lives Matter “a perfect storm.”

He’s ready for open conversations about these tough topics.

“Honestly, I think everything starts at home, and everything starts with your own family,” Adams said. “It all begins with someone you know, or even a small group of people having those arguments and discussions about this. We just need to hammer it out.”

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Why Use D'OXYVA?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

physician-recommended easy to use daily

Why Use D'OXYVA?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

Reduce unwanted doctor visits, recommended and ranked top by experts!

Posted on Leave a comment

The Coronavirus Pandemic Originated in Live-Animal Markets/Illegal Wildlife Trade and Leading Biotech Company, Circularity Healthcare, is Looking to Stop it for Good

Read me the article

Circularity Healthcare is partnering with EndPandemics.earth to help prevent future pandemics by ending the commercial trade in wild animals, expanding wild habitats, and protecting livelihoods.

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Circularity announced a long-term collaboration with EndPandemics on June 16th, 2020 that, in line with Circularity Healthcare’s mission to provide real and affordable healthcare solutions, will create a global alliance to protect and regenerate nature and to help prevent future pandemics by ending the commercial trade in wild animals, expanding wild habitats, and protecting livelihoods. Contributions will not only protect global health and save wildlife, but also safeguard global biodiversity, enhance sustainable agriculture, and mitigate climate change.

Circularity Healthcare will also be donating its products to every member of this charity’s network to help them stay healthy and safe amid the current COVID-19 pandemic. This includes the D’OXYVA Start Health Set.

“Partnering with one of the world’s biotech leaders in proprietary circulatory health and noninvasive delivery technologies that actually helps to save the lives of those infected by pandemic diseases, was a no-brainer for EndPandemics. In our partnership with Circularity Healthcare, we are both looking forward to making a true impact across the globe to address disease surveillance gaps and prevent future outbreaks,” says Michael Mitchell, chairman at EndPandemics.

As the coronavirus pandemic continues to spread worldwide, companies must plan ahead and take necessary steps that will help them protect their employees, keep their business on track, and even prepare for the worst—business disruption. Most have revisited policies, considered new innovations and platforms, and canceled events that require mass gatherings – and yet many still require assistance.

As shops, restaurants, and bars across the nation and around the world continue to be shut down to help flatten the curve and slow the spread of coronavirus, many workers were sent home. For most, if not for all of these workers, that means uncertainty as to when they will see a paycheck again.

Given the current pandemic the world is facing, preventing future breakouts must be a global priority and for those who want to help it can be hard to know where and how to start.

“There are so many ways to help, and sometimes it gets very confusing, as there are so many charities to choose from, but during these hard times, all kinds of giving makes a difference,” says Jennifer Rose Boadilla-Pelaez, Circularity Healthcare’s Senior Sales and Marketing Manager, Creative Director. She continues by stating, “the direction that Circularity Healthcare decided to go in is with an extensive donation and outreach partnership with EndPandemics that will have a long-lasting, global impact on how we approach tackling and preventing current and future pandemics head-on, and for that we are grateful.”

If you are interested in learning more about Circularity Healthcare’s and EndPandemic’s partnership learn more here, or if you’d like to join the mission and donate, learn more here.

About EndPandemics
EndPandemics is a dynamic global alliance of organizations—representing conservation, climate, health, finance, security, agroforestry, business, technology, and communications—who have launched a global campaign to reduce the risks of pandemics by addressing the root cause of all zoonotic outbreaks: rampant wildlife trade and the destruction of wild habitats.

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Why Use D'OXYVA?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

physician-recommended easy to use daily

Why Use D'OXYVA?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

Reduce unwanted doctor visits, recommended and ranked top by experts!

Posted on Leave a comment

Months of Trial and Error in the ICU Offer Clues on How to Save Covid Patients

Faced with an unmanageable influx of coronavirus patients at Columbia University Irving Medical Center’s step-down unit, an intermediate care ward, Jelic made an unorthodox decision: she asked those struggling to breathe to roll onto their bellies while they waited for intubation to mechanically ventilate their inflamed lungs.

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It wasn’t a random guess. Laying patients in the stomach-down prone position is known to improve oxygenation in sedated, intubated patients with acute respiratory distress syndrome. But there was no guarantee the same would hold true for wakeful Covid patients who were gasping for air.

“We had to buy time,” Jelic, who is also an associate professor of medicine at Columbia University, recalled in an interview. “I remember, the first three patients really had a dramatic improvement in their oxygenation.”

In the absence of a cure, doctors like Jelic were left relying in part on trial and error, but months into the most destructive pandemic in a century, their collective experience is starting to build a framework of how best to cope with coronavirus patients.

As many as 1,000 Covid-related research papers are being released daily ahead of peer review and publication, according to Soumya Swaminathan, the World Health Organization’s chief scientist. “Our goal is to see that the learnings from science are as quickly as possible channeled into impacts for patients and communities,” she told reporters in Geneva on Thursday.

‘How You Do It’

The collective experience may be showing results. U.S. deaths, which often ranged between 2,000 and 3,000 a day in April and May, have mostly remained below 1,000 and in the low hundreds since the beginning of June.

The WHO is collating data from countries to identify crucial elements that reduce mortality. These include how health systems triage Covid-19 patients, how they protect those vulnerable to more serious complications, and the speed with which they provide intensive care.

The goal is to create a tool box that will enable doctors to provide better care for the full range of patients with Covid-19, which has turned out to be more than just a respiratory disease, said Sylvie Briand, the WHO’s director for global infectious hazard preparedness.

“It’s not only what you do — sometimes at this level there is no difference — but it’s how you do it,” Briand said in an interview.

Better Practiced

Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, also credits better experience with medicines.

“Whenever you’re in an outbreak, there are two things about treatment that contribute to improvement,” he said. “Not only do you get better in practice, but you get better because of new treatments.”

In April, Gilead Sciences Inc.’s antiviral remdesivir, now approved with the brand name Veklury, was shown to speed recovery time. Last month, the inexpensive corticosteroid dexamethasone was found to reduce deaths by one-third among patients receiving mechanical ventilation. Doctors are also routinely administering heparin and other anticoagulants to prevent dangerous blood clots from forming in the veins of the critically ill.

Although the “awake proning” approach Jelic and colleagues tried hasn’t been properly studied yet in a large clinical trial, it points to a cheap and simple way overwhelmed health centers may be able to help severely ill patients. Their research, published in a June 17 letter to the Journal of the American Medical Association, indicated that it reduced the probability patients would need intubation. The journal also published an invited commentary subtitled “necessity is the mother of invention.”

“I couldn’t agree more with the title,” Jelic said. “I have never seen this much strain on our ICU resources.”

Laying on the stomach improves blood circulation in the upper portion of the lung, she said, increasing the volume of oxygen and carbon dioxide that can be exchanged. It also decreases pressure around the lung, and can help clear secretions from the airways, studies show.

While combination treatments — the HIV medications ritonavir and lopinavir, and the antimalarial drugs hydroxychloroquine and chloroquine with the antibiotic azithromycin — failed to reduce death in hospitalized Covid-19 patients, there’s optimism for others. These include antibody-based therapies and blood products from survivors.

‘Cytokine Storm’

The antiflammatory infusion infliximab, sold by Johnson & Johnson and Merck & Co. as Remicade, is being studied at Tufts Medical Center in Boston as a way of circumventing the major cause of lethal complications in a subset of Covid-19 patients: A damaging immune response, sometimes referred to as a cytokine storm, that usually occurs in the second week of illness.

Infliximab blocks tumor necrosis factor-alpha, a cell-signaling protein or “cytokine” that plays a key role in driving the immune system to exhaustion in response to infections, said Paul Mathew, a Tufts cancer specialist, who’s leading the study. The medicine may also help avert life-threatening blood-clotting problems that can occur in Covid patients.

“Little by little, we discovered new signs and symptoms of the disease,” said the WHO’s Briand. “Now we know that there is really a lot of possibilities for this virus to attack the human body.”

These range from a sudden lack of smell to a multi-system inflammatory syndrome in children — features that have become more apparent with more than 11 million Covid cases worldwide. Others include clotting-related disorders that can be benign skin lesions on the feet, sometimes called “Covid toe,” or potentially lethal strokes.

The more Covid patients Jarrod Mosier sees in his hospital’s intensive care unit in Tucson, Arizona, the more he says he’s convinced that saving lives comes down to protecting the lungs of those with acute respiratory distress syndrome, or ARDS, caused by pulmonary inflammation. Most patients need breathing support, but too little or too much air pressure and volume can damage the lungs further.

“I look at all of those things and tinker with the ventilator for a good while everyday to try to find that balance,” said Mosier, who is also an associate professor of emergency medicine and medicine at the University of Arizona. “To me, that is the thing that will save the most lives in this disease — just excellent critical care management of ARDS.”

Mosier said he’s hoping it results in better patient survival. “I think that’s the case, but it’s very hard to answer that question when you’re in the thick of it,” he said. “Some days I think we’re actually getting pretty good at this. And other days I think, ‘This is demoralizing.’”

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HOW D'OXYVA CAN HELP?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

Reduce unwanted doctor visits, recommended and ranked top by experts!

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FDA says a coronavirus vaccine would have to be at least 50% effective to be approved

The FDA has issued emergency approval for a vaccine only once, for an experimental anthrax vaccine in 2005. The FDA had originally declined to issue an emergency use authorization, but the Department of Defense pushed for one due to concerns over possible anthrax attacks against U.S. military forces. 

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Vaccine-associated enhanced respiratory disease

A clear concern in the FDA’s guidance for the coronavirus vaccine is whether vaccine candidates might cause enhanced respiratory disease —not only failing to decrease the severity of COVID-19, but causing it to get worse. 

While rare, data from animal studies in some vaccine candidates for other coronaviruses, such as SARS-CoV and MERS-CoV, has raised concerns regarding COVID-19, the FDA said.

Infecting healthy people to test a vaccine

The FDA also said challenge trials could be considered to test COVID-19 vaccines. In those trials, healthy people are intentionally infected to see if the vaccine keeps them from getting COVID-19.

That might be necessary if there were so little SARS-CoV-2 virus circulating that it was no longer possible to study whether a vaccine was effective.  If there’s no chance people who’ve gotten test injections could get infected, it wouldn’t be possible to test whether the vaccine works.

US coronavirus map: Tracking the outbreak

The agency made clear in its document that challenge trials are not ideal. “Many issues, including logistical, human subject protection, ethical, and scientific issues, would need to be satisfactorily addressed,” it said. 

Side effects, public trust could undermine vaccine

There are several possible downsides to issuing a vaccine prematurely.

Side effects and bad outcomes may be rare enough that they appear only when many people receive the vaccine, or after enough time has passed for them to appear. That could give fuel to anti-vaccine groups that claim without evidence that vaccines are harmful.

Some people could be scared away from the vaccine if they don’t believe it has been properly and thoroughly tested. If people won’t take the vaccine, it doesn’t matter how soon it’s available.

Paul Offit, a vaccine expert at the University of Pennsylvania, has spoken of the possibility that a vaccine could be unveiled as an “October surprise” and the harm that could cause. The FDA’s guidance made him less concerned, he said.

“I think this is all very reassuring,” he said. “Now all they have to do is follow their own guidelines.

physician-recommended easy to use daily

HOW D'OXYVA CAN HELP?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

physician-recommended easy to use daily

HOW D'OXYVA CAN HELP?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

Reduce unwanted doctor visits, recommended and ranked top by experts!

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This coronavirus mutation has taken over the world. Scientists are trying to understand why.

When the first coronavirus cases in Chicago appeared in January, they bore the same genetic signatures as a germ that emerged in China weeks before. But as Egon Ozer, an infectious-disease specialist at the Northwestern University Feinberg School of Medicine, examined the genetic structure of virus samples from local patients, he noticed something different.

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A change in the virus was appearing again and again. This mutation, associated with outbreaks in Europe and New York, eventually took over the city. By May, it was found in 95 percent of all the genomes Ozer sequenced. 

At a glance, the mutation seemed trivial. About 1,300 amino acids serve as building blocks for a protein on the surface of the virus. In the mutant virus, the genetic instructions for just one of those amino acids — number 614 — switched in the new variant from a “D” (shorthand for aspartic acid) to a “G” (short for glycine).

But the location was significant, because the switch occurred in the part of the genome that codes for the all-important “spike protein” — the protruding structure that gives the coronavirus its crownlike profile and allows it to enter human cells the way a burglar picks a lock.

And its ubiquity is undeniable. Of the approximately 50,000 genomes of the new virus that researchers worldwide have uploaded to a shared database, about 70 percent carry the mutation, officially designated D614G but known more familiarly to scientists as “G.”

“G” hasn’t just dominated the outbreak in Chicago — it has taken over the world. Now scientists are racing to figure out what it means.

At least four laboratory experiments suggest that the mutation makes the virus more infectious, although none of that work has been peer-reviewed. Another unpublished study led by scientists at Los Alamos National Laboratory asserts that patients with the G variant actually have more virus in their bodies, making them more likely to spread it to others.

The mutation doesn’t appear to make people sicker, but a growing number of scientists worry that it has made the virus more contagious.

“The epidemiological study and our data together really explain why the [G variant’s] spread in Europe and the U.S. was really fast,” said Hyeryun Choe, a virologist at Scripps Research and a lead author of an unpublished study on the G variant’s enhanced infectiousness in laboratory cell cultures. “This is not just accidental.”

But there may be other explanations for the G variant’s dominance: biases in where genetic data are being collected, quirks of timing that gave the mutated virus an early foothold in susceptible populations.

“The bottom line is, we haven’t seen anything definitive yet,” said Jeremy Luban, a virologist at the University of Massachusetts Medical School.

The scramble to unravel this mutation mystery embodies the challenges of science during the coronavirus pandemic. With millions of people infected and thousands dying every day around the world, researchers must strike a high-stakes balance between getting information out quickly and making sure that it’s right.

A better lock pick

SARS-CoV-2, the novel coronavirus that causes the disease covid-19, can be thought of as an extremely destructive burglar. Unable to live or reproduce on its own, it breaks into human cells and co-opts their biological machinery to make thousands of copies of itself. That leaves a trail of damaged tissue and triggers an immune system response that for some people can be disastrous.

This replication process is messy. Even though it has a “proofreading” mechanism for copying its genome, the coronavirus frequently makes mistakes, or mutations. The vast majority of mutations have no effect on the behavior of the virus.

But since the virus’s genome was first sequenced in January, scientists have been on the lookout for changes that are meaningful. And few genetic mutations could be more significant than ones that affect the spike protein — the virus’s most powerful tool.

This protein attaches to a receptor on respiratory cells called ACE2, which opens the cell and lets the virus slip inside. The more effective the spike protein, the more easily the virus can break into the bodies of its hosts. Even when the original variant of the virus emerged in Wuhan, China, it was obvious that the spike protein on SARS-CoV-2 was already quite effective.

But it could have been even better, said Choe, who has studied spike proteins and the way they bind to the ACE2 receptor since the severe acute respiratory syndrome outbreak in 2003.

The spike protein for SARS-CoV-2 has two parts that don’t always hold together well. In the version of the virus that arose in China, Choe said, the outer part — which the virus needs to attach to a human receptor — frequently broke off. Equipped with this faulty lock pick, the virus had a harder time invading host cells.

“I think this mutation happened to compensate,” Choe said.

Studying both versions of the gene using a proxy virus in a petri dish of human cells, Choe and her colleagues found that viruses with the G variant had more spike proteins, and the outer parts of those proteins were less likely to break off. This made the virus approximately 10 times more infectious in the lab experiment.

The mutation does not seem to lead to worse outcomes in patients. Nor did it alter the virus’s response to antibodies from patients who had the D variant, Choe said, suggesting that vaccines being developed based on the original version of the virus will be effective against the new strain.

Choe has uploaded a manuscript describing this study to the website BioRxiv, where scientists can post “preprint” research that has not yet been peer reviewed. She has also submitted the paper to an academic journal, which has not yet published it.

The distinctive infectiousness of the G strain is so strong that scientists have been drawn to the mutation even when they weren’t looking for it.

Neville Sanjana, a geneticist at the New York Genome Center and New York University, was trying to figure out which genes enable SARS-CoV-2 to infiltrate human cells. But in experiments based on a gene sequence taken from an early case of the virus in Wuhan, he struggled to get that form of the virus to infect cells. Then the team switched to a model virus based on the G variant.

“We were shocked,” Sanjana said. “Voilà! It was just this huge increase in viral transduction.” They repeated the experiment in many types of cells, and every time the variant was many times more infectious.

Their findings, published as a preprint on BioRxiv, generally matched what Choe and other laboratory scientists were seeing.

But the New York team offers a different explanation as to why the variant is so infectious. Whereas Choe’s study proposes that the mutation made the spike protein more stable, Sanjana said experiments in the past two weeks, not yet made public, suggest that the improvement is actually in the infection process. He hypothesized that the G variant is more efficient at beginning the process of invading the human cell and taking over its reproductive machinery.

Luban, who has also been experimenting with the D614G mutation, has been drawn to a third possibility: His experiments suggest that the mutation allows the spike protein to change shape as it attaches to the ACE2 receptor, improving its ability to fuse to the host cell.

Different approaches to making their model virus might explain these discrepancies, Luban said. “But it’s quite clear that something is going on.”

Unanswered questions

Although these experiments are compelling, they’re not conclusive, said Kristian Andersen, a Scripps virologist not involved in any of the studies. The scientists need to figure out why they’ve identified different mechanisms for the same effect. All the studies still have to pass peer review, and they have to be reproduced using the real version of the virus.

Even then, Andersen said, it will be too soon to say that the G variant transmits faster among people.

Cell culture experiments have been wrong before, noted Anderson Brito, a computational biologist at Yale University. Early experiments with hydroxychloroquine, a malaria drug, hinted that it was effective at fighting the coronavirus in a petri dish. The drug was touted by President Trump, and the Food and Drug Administration authorized it for emergency use in hospitalized covid-19 patients. But that authorization was withdrawn this month after evidence showed that the drug was “unlikely to be effective” against the virus and posed potential safety risks.

So far, the biggest study of transmission has come from Bette Korber, a computational biologist at Los Alamos National Laboratory who built one of the world’s biggest viral genome databases for tracking HIV. In late April, she and colleagues at Duke University and the University of Sheffield in Britain released a draft of their work arguing that the mutation boosts transmission of the virus.

Analyzing sequences from more than two dozen regions across the world, they found that most places where the original virus was dominant before March were eventually taken over by the mutated version. This switch was especially apparent in the United States: Ninety-six percent of early sequences here belonged to the D variant, but by the end of March, almost 70 percent of sequences carried the G amino acid instead.

The British researchers also found evidence that people with the G variant had more viral particles in their bodies. Although this higher viral load didn’t seem to make people sicker, it might explain the G variant’s rapid spread, the scientists wrote. People with more virus to shed are more likely to infect others.

The Los Alamos draft drew intense scrutiny when it was released in the spring, and many researchers remain skeptical of its conclusions.

“There are so many biases in the data set here that you can’t control for and you might not know exist,” Andersen said. In a time when as many as 90 percent of U.S. infections are still undetected and countries with limited public health infrastructure are struggling to keep up with surging cases, a shortage of data means “we can’t answer all the questions we want to answer.”

Pardis Sabeti, a computational biologist at Harvard University and the Broad Institute, noted that the vast majority of sequenced genomes come from Europe, where the G variant first emerged, and the United States, where infections thought to have been introduced by travelers from Europe spread undetected for weeks before the country shut down. This could at least partly explain why it appears so dominant.

The mutation’s success might also be a “founder effect,” she said. Arriving in a place like Northern Italy — where the vast majority of sequenced infections are caused by the G variant — it found easy purchase in an older and largely unprepared population, which then unwittingly spread it far and wide.

Scientists may be able to rule out these alternative explanations with more rigorous statistical analyses or a controlled experiment in an animal population. And as studies on the D614G mutation accumulate, researchers are starting to be convinced of its significance.

“I think that slowly we’re beginning to come to a consensus,” said Judd Hultquist, a virologist at Northwestern University.

Solving the mystery of the D614G mutation won’t make much of a difference in the short term, Andersen said. “We were unable to deal with D,” he said. “If G transmits even better, we’re going to be unable to deal with that one.”

But it’s still essential to understand how the genome influences the behavior of the virus, scientists say. Identifying emerging mutations allows researchers to track their spread. Knowing what genes affect how the virus transmits enables public health officials to tailor their efforts to contain it. Once therapeutics and vaccines are distributed on a large scale, having a baseline understanding of the genome will help pinpoint when drug resistance starts to evolve.

“Understanding how transmissions are happening won’t be a magic bullet, but it will help us respond better,” Sabeti said. “This is a race against time.”

physician-recommended easy to use daily

Why Use D'OXYVA?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

physician-recommended easy to use daily

Why Use D'OXYVA?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

Reduce unwanted doctor visits, recommended and ranked top by experts!

Posted on Leave a comment

Scientists just beginning to understand the many health problems caused by COVID-19

CHICAGO – Scientists are only starting to grasp the vast array of health problems caused by the novel coronavirus, some of which may have lingering effects on patients and health systems for years to come, according to doctors and infectious disease experts.

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Besides the respiratory issues that leave patients gasping for breath, the virus that causes COVID-19 attacks many organ systems, in some cases causing catastrophic damage.

“We thought this was only a respiratory virus. Turns out, it goes after the pancreas. It goes after the heart. It goes after the liver, the brain, the kidney and other organs. We didn’t appreciate that in the beginning,” said Dr. Eric Topol, a cardiologist and director of the Scripps Research Translational Institute in La Jolla, California.

In addition to respiratory distress, patients with COVID-19 can experience blood clotting disorders that can lead to strokes, and extreme inflammation that attacks multiple organ systems. The virus can also cause neurological complications that range from headache, dizziness and loss of taste or smell to seizures and confusion.

And recovery can be slow, incomplete and costly, with a huge impact on quality of life.

The broad and diverse manifestations of COVID-19 are somewhat unique, said Dr. Sadiya Khan, a cardiologist at Northwestern Medicine in Chicago.

With influenza, people with underlying heart conditions are also at higher risk of complications, Khan said. What is surprising about this virus is the extent of the complications occurring outside the lungs.

Khan believes there will be a huge healthcare expenditure and burden for individuals who have survived COVID-19.

LENGTHY REHAB FOR MANY

Patients who were in the intensive care unit or on a ventilator for weeks will need to spend extensive time in rehab to regain mobility and strength.

“It can take up to seven days for every one day that you’re hospitalized to recover that type of strength,” Khan said. “It’s harder the older you are, and you may never get back to the same level of function.”

While much of the focus has been on the minority of patients who experience severe disease, doctors increasingly are looking to the needs of patients who were not sick enough to require hospitalization, but are still suffering months after first becoming infected.

Studies are just getting underway to understand the long-term effects of infection, Jay Butler, deputy director of infectious diseases at the U.S. Centers for Disease Control and Prevention, told reporters in a telephone briefing on Thursday.

“We hear anecdotal reports of people who have persistent fatigue, shortness of breath,” Butler said. “How long that will last is hard to say.”

While coronavirus symptoms typically resolve in two or three weeks, an estimated 1 in 10 experience prolonged symptoms, Dr. Helen Salisbury of the University of Oxford wrote in the British Medical Journal on Tuesday.

Salisbury said many of her patients have normal chest X-rays and no sign of inflammation, but they are still not back to normal.

“If you previously ran 5k three times a week and now feel breathless after a single flight of stairs, or if you cough incessantly and are too exhausted to return to work, then the fear that you may never regain your previous health is very real,” she wrote.

Dr. Igor Koralnik, chief of neuro-infectious diseases at Northwestern Medicine, reviewed current scientific literature and found about half of patients hospitalized with COVID-19 had neurological complications, such as dizziness, decreased alertness, difficulty concentrating, disorders of smell and taste, seizures, strokes, weakness and muscle pain.

Koralnik, whose findings were published in the Annals of Neurology, has started an outpatient clinic for COVID-19 patients to study whether these neurological problems are temporary or permanent.

Khan sees parallels with HIV, the virus that causes AIDS. Much of the early focus was on deaths.

“In recent years, we’ve been very focused on the cardiovascular complications of HIV survivorship,” Khan said.

physician-recommended easy to use daily

HOW D'OXYVA CAN HELP?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

physician-recommended easy to use daily

HOW D'OXYVA CAN HELP?

Expert say D’OXYVA can help COVID-19 patients find relief. Preliminary medical data shows people with pre-existing conditions including diabetes may experience serious complications from COVID-19.

D’OXYVA helps by delivering transdermal ultra-purified medical gas directly to the blood stream delivering major outcomes for well over 90% of users.

Experts call D’OXYVA a gamechanger.

“Studies with D’OXYVA have shown unmatched results in noninvasive woundcare,” Dr. Michael McGlamry.

Anyone with an underlying condition should know this option is available.

Reduce unwanted doctor visits, recommended and ranked top by experts!

Posted on Leave a comment

Circularity Healthcare Joins Springer Publishing Company, Daily Nurse, and Minority Nurse In Recognizing Nurses and Giving Back

In these uncertain times, we must recognize and promote our nurses on the frontlines of the COVID-19 pandemic. Circularity Healthcare is finding ways to share in recognizing those who deserve recognition.

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“We’ve been on the lookout for publishers we can partner with who have the same goal as ours; that is, to help our front liners. In our participation with Springer Publishing’s Nurses’ Week 2020, we want to spread the message that D’OXYVA is readily available for them to keep them protected by boosting their immune system and by providing armor against infection,” said Jennifer Boadilla-Pelaez, Circularity Healthcare’s Senior Sales and Marketing Manager and Creative Director.

Last May, Springer Publishing Company launched its Nurses’ Week 2020 issue to help support and recognize nurses who are leading via change. In this special issue presented by Springer Publishing Company, Daily Nurse, and Minority Nurse, we’ll hear from frontline nurses, nurse researchers, and nurse educators to learn how they lead during the COVID-19 pandemic.

Circularity showed their support by securing a 2-page advertorial for this issue and showcased how to help front liners stay healthy during these uncertain times via its latest article discussing a new clinical trial involving Circularity’s already FDA-approved drug and IDE device D’OXYVA®, which could significantly increase the recovery rate for COVID-19 patients with underlying health conditions and save lives! Circularity has also been calling out all doctors and nurses that Circularity is accepting D’OXYVA donation requests.

(Read the full issue here: https://dailynurse.com/nurses-week-2020-special-issue/)

20% of all proceeds will be donated to the GLO GOOD Foundation, who have joined with the Society of Nurse Scientists Innovators Entrepreneurs and Leaders (SONSIEL) to launch an urgent call-to-action to move personal protective equipment (PPE) supplies, including vital respirator masks, to frontline health-care providers for COVID-19 patients.

About Springer Publishing

Springer Publishing is an award-winning publisher of health-care and behavioral sciences content, featuring books, apps, journals, and digital products. With an acute understanding of how educators teach, how practitioners work, and how students learn, we design our digital and print products for optimal outcomes for learners, patients, and clients. We’ve been proudly educating people in the health-care and helping professions for over 70 years.

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Why COVID-19 kills some people and spares others. Here’s what scientists are finding

The novel coronavirus causing COVID-19 seems to hit some people harder than others, with some people experiencing only mild symptoms and others being hospitalized and requiring ventilation. Though scientists at first thought age was the dominant factor, with young people avoiding the worst outcomes, new research has revealed a suite of features impacting disease severity. These influences could explain why some perfectly healthy 20-year-old with the disease is in dire straits, while an older 70-year-old dodges the need for critical interventions.

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Underlying health conditions are thought to be an important factor influencing disease severity. Indeed, a study of more than 1.3 million COVID-19 cases in the United States, published June 15 in the journal Morbidity and Mortality Weekly Report, found that rates of hospitalizations were six times higher and rates of death were 12 times higher among COVID-19 patients with underlying conditions, compared with patients without underlying conditions. The most commonly reported underlying conditions were heart disease, diabetes and chronic lung disease.

In general, risk factors for more severe COVID-19 outcomes include:

About 8 out of 10 deaths associated with COVID-19 in the U.S. have occurred in adults ages 65 and older, according to the U.S. Centers for Disease Control and Prevention (CDC). The risk of dying from the infection, and the likelihood of requiring hospitalization or intensive medical care, increases significantly with age. For instance, adults ages 65-84 make up an estimated 4-11% of COVID-19 deaths in the U.S, while adults ages 85 and above make up 10-27%.

The trend may be due, in part, to the fact that many elderly people have chronic medical conditions, such as heart disease and diabetes, that can exacerbate the symptoms of COVID-19, according to the CDC. The ability of the immune system to fight off pathogens also declines with age, leaving elderly people vulnerable to severe viral infections, Stat News reported.

Diabetes mellitus — a group of diseases that result in harmful high blood sugar levels — also seems to be linked to risk of more severe COVID-19 infections.

The most common form in the U.S. is type 2 diabetes, which occurs when the body’s cells don’t respond to the hormone insulin. As a result, the sugar that would otherwise move from the bloodstream into cells to be used as energy just builds up in the bloodstream. (When the pancreas makes little to no insulin in the first place, the condition is called type 1 diabetes.)

In a review of 13 relevant studies, scientists found that people with diabetes were nearly 3.7 times more likely to have a critical case of COVID-19 or to die from the disease compared with COVID-19 patients without any underlying health conditions (including diabetes, hypertension, heart disease or respiratory disease), they reported online April 23 in the Journal of Infection.

Even so, scientists don’t know whether diabetes is directly increasing severity or whether other health conditions that seem to tag along with diabetes, including cardiovascular and kidney conditions, are to blame.

That fits with what researchers have seen with other infections and diabetes. For instance, flu and pneumonia are more common and more serious in older individuals with type 2 diabetes, scientists reported online April 9 in the journal Diabetes Research and Clinical Practice. In a literature search of relevant studies looking at the link between COVID-19 and diabetes, the authors of that paper found a few possible mechanisms to explain why a person with diabetes might fare worse when infected with COVID-19. These mechanisms include: “Chronic inflammation, increased coagulation activity, immune response impairment and potential direct pancreatic damage by SARS-CoV-2.”

Related: 13 coronavirus myths busted by science

Mounting research has shown the progression of type 2 diabetes is tied to changes in the body’s immune system. This link could also play a role in poorer outcomes in a person with diabetes exposed to SARS-CoV-2, the virus that causes COVID-19.

No research has looked at this particular virus and immune response in patients with diabetes; however, in a study published in 2018 in the Journal of Diabetes Research, scientists found through a review of past research that patients with obesity or diabetes showed immune systems that were out of whack, with an impairment of white blood cells called Natural Killer (NK) cells and B cells, both of which help the body fight off infections. The research also showed that these patients had an increase in the production of inflammatory molecules called cytokines. When the immune system secretes too many cytokines,a so-called “cytokine storm” can erupt and damage the body’s organs. Some research has suggested that cytokine storms may be responsible for causing serious complications in people with COVID-19, Live Science previously reported. Overall, type 2 diabetes has been linked with impairment of the very system in the body that helps to fight off infections like COVID-19 and could explain why a person with diabetes is at high risk for a severe infection.

Not all people with type 2 diabetes are at the same risk, though: A study published May 1 in the journal Cell Metabolism found that people with diabetes who keep their blood sugar levels in a tighter range were much less likely to have a severe disease course than those with more fluctuations in their blood sugar levels.

People with type 1 diabetes (T1D) are also at elevated risk of adverse outcomes, a small study published in Diabetes Care suggests. The study, coordinated by T1D Exchange — a nonprofit research organization focused on therapies for those with type 1 diabetes — found that of 64 people with either COVID-19 or COVID-19-like symptoms, two died. Nearly 4 in 10 people had to be treated in a hospital. And nearly a third experienced diabetic ketoacidosis — a potentially deadly condition in which the body experiences a shortage of insulin and blood sugar levels rise dangerously high. The average patient was about 21 years old, suggesting that risks could be potentially higher for older age groups.

People with conditions that affect the cardiovascular system, such as heart disease and hypertension, generally suffer worse complications from COVID-19 than those with no preexisting conditions, according to the American Heart Association. That said, historically healthy people can also suffer heart damage from the viral infection.

The first reported coronavirus death in the U.S., for instance, occurred when the virus somehow damaged a woman’s heart muscle, eventually causing it to burst, Live Science reported. The 57-year-old maintained good health and exercised regularly before becoming infected, and she reportedly had a healthy heart of “normal size and weight.” A study of COVID-19 patients in Wuhan, China, found that more than 1 in 5 patients developed heart damage — some of the sampled patients had existing heart conditions, and some did not.

In seeing these patterns emerge, scientists developed several theories as to why COVID-19 might hurt both damaged hearts and healthy ones, according to a Live Science report.

In one scenario, by attacking the lungs directly, the virus might deplete the body’s supply of oxygen to the point that the heart must work harder to pump oxygenated blood through the body. The virus might also attack the heart directly, as cardiac tissue contains angiotensin-converting enzyme 2 (ACE2) — a molecule that the virus plugs into to infect cells. In some individuals, COVID-19 can also kickstart an overblown immune response known as a cytokine storm, wherein the body becomes severely inflamed and the heart could suffer damage as a result.

People who smoke cigarettes may be prone to severe COVID-19 infections, meaning they face a heightened risk of developing pneumonia, suffering organ damage and requiring breathing support. A study of more than 1,000 patients in China, published in the New England Journal of Medicine, illustrates this trend: 12.3% of current smokers included in the study were admitted to an ICU, were placed on a ventilator or died, as compared with 4.7% of nonsmokers. Cigarette smoke might render the body vulnerable to the coronavirus in several ways, according to a recent Live Science report. At baseline, smokers may be vulnerable to catching viral infections because smoke exposure dampens the immune system over time, damages tissues of the respiratory tract and triggers chronic inflammation. Smoking is also associated with a multitude of medical conditions, such as emphysema and atherosclerosis, which could exacerbate the symptoms of COVID-19. A recent study, posted March 31 to the preprint database bioRxiv, proposed a more speculative explanation as to why COVID-19 hits smokers harder. The preliminary research has not yet been peer-reviewed, but early interpretations of the data suggest that smoke exposure increases the number of ACE2 receptors in the lungs — the receptor that SARS-CoV-2 plugs into to infect cells. Many of the receptors appear on so-called goblet and club cells, which secrete a mucus-like fluid to protect respiratory tissues from pathogens, debris and toxins. It’s well-established that these cells grow in number the longer a person smokes, but scientists don’t know whether the subsequent boost in ACE2 receptors directly translates to worse COVID-19 symptoms. What’s more, it’s unknown whether high ACE2 levels are relatively unique to smokers, or common among people with chronic lung conditions.
Several early studies have suggested a link between obesity and more severe COVID-19 disease in people. One study, which analyzed a group of COVID-19 patients who were younger than the age of 60 in New York City, found that those who were obese were twice as likely as non-obese individuals to be hospitalized and were 1.8 times as likely to be admitted into critical care. “This has important and practical implications” in a country like the U.S. where nearly 40% of adults are obese, the authors wrote in the study, which was accepted into the journal Clinical Infectious Diseases but not yet peer-reviewed or published. Similarly, another preliminary study that hasn’t yet been peer-reviewed found that the two biggest risk factors for being hospitalized from the coronavirus are age and obesity. This study, published in medRxiv looked at data from thousands of COVID-19 patients in New York City, but studies from other cities around the world found similar results, as reported by The New York Times. A preliminary study from Shenzhen, China, which also hasn’t been peer-reviewed, found that obese COVID-19 patients were more than twice as likely to develop severe pneumonia as compared with patients who were normal weight, according to the report published as a preprint online in the journal The Lancet Infectious Diseases. Those who were overweight, but not obese, had an 86% higher risk of developing severe pneumonia than did people of “normal” weight, the authors reported. Another study, accepted into the journal Obesity and peer-reviewed, found that nearly half of 124 COVID-19 patients admitted to an intensive care unit in Lille, France, were obese. It’s not clear why obesity is linked to more hospitalizations and more severe COVID-19 disease, but there are several possibilities, the authors wrote in the study. Obesity is generally thought of as a risk factor for severe infection. For example, those who are obese had longer and more severe disease during the swine flu epidemic, the authors wrote. Obese patients might also have reduced lung capacity or increased inflammation in the body. A greater number of inflammatory molecules circulating in the body might cause harmful immune responses and lead to severe disease.

Blood type seems to be a predictor of how susceptible a person is to contracting SARS-CoV-2, though scientists haven’t found a link between blood type per se and severity of disease.

Jiao Zhao, of The Southern University of Science and Technology, Shenzhen, and colleagues looked at blood types of 2,173 patients with COVID-19 in three hospitals in Wuhan, China, as well as blood types of more than 23,000 non-COVID-19 individuals in Wuhan and Shenzhen. They found that individuals with blood types in the A group (A-positive, A-negative and AB-positive, AB-negative) were at a higher risk of contracting the disease compared with non-A-group types. People with O blood types (O-negative and O-positive) had a lower risk of getting the infection compared with non-O blood types, the scientists wrote in the preprint database medRxiv on March 27; the study has yet to be reviewed by peers in the field.

In a more recent study of blood type and COVID-19, published online April 11 to medRxiv, scientists looked at 1,559 people tested for SARS-CoV-2 at New York Presbyterian hospital; of those, 682 tested positive. Individuals with A blood types (A-positive and A-negative) were 33% more likely to test positive than other blood types and both O-negative and O-positive blood types were less likely to test positive than other blood groups. (There’s a 95% chance that the increase in risk ranges from 7% to 67% more likely.) Though only 68 individuals with an AB blood type were included, the results showed this group was also less likely than others to test positive for COVID-19.
The researchers considered associations between blood type and risk factors for COVID-19, including age, sex, whether a person was overweight, other underlying health conditions such as diabetes mellitus, hypertension, pulmonary diseases and cardiovascular diseases. Some of these factors are linked to blood type, they found, with a link between diabetes and B and A-negative blood types, between overweight status and O-positive blood groups, for instance, among others. When they accounted for these links, the researchers still found an association between blood type and COVID-19 susceptibility. When the researchers pooled their data with the research by Zhao and colleagues out of China, they found similar results as well as a significant drop in positive COVID-19 cases among blood type B individuals.

Why blood type might increase or decrease a person’s risk of getting SARS-CoV-2 is not known. A person’s blood type indicates what kind of certain antigens cover the surfaces of their blood cells; These antigens produce certain antibodies to help fight off a pathogen. Past research has suggested that at least in the SARS coronavirus (SARS-CoV), anti-A antibodies helped to inhibit the virus; that could be the same mechanism with SARS-CoV-2, helping blood group O individuals to keep out the virus, according to Zhao’s team.

Many medical conditions can worsen the symptoms of COVID-19, but why do historically healthy people sometimes fall dangerously ill or die from the virus? Scientists suspect that certain genetic factors may leave some people especially susceptible to the disease, and many research groups aim to pinpoint exactly where those vulnerabilities lie in our genetic code.

In one scenario, the genes that instruct cells to build ACE2 receptors may differ between people who contract severe infections and those who hardly develop any symptoms at all, Science magazine reported. Alternatively, differences may lie in genes that help rally the immune system against invasive pathogens, according to a recent Live Science report.

For instance, a study published April 17 in the Journal of Virology suggests that specific combinations of human leukocyte antigen (HLA) genes, which train immune cells to recognize germs, may be protective against SARS-CoV-2, while other combinations leave the body open to attack. HLAs represent just one cog in our immune system machinery, though, so their relative influence over COVID-19 infection remains unclear. Additionally, the Journal of Virology study only used computer models to simulate HLA activity against the coronavirus; clinical and genetic data from COVID-19 patients would be needed to flesh out the role of HLAs in real-life immune responses.

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