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When ICUs Near Capacity, COVID Patients' Risk for Death Nearly Doubles


WEDNESDAY, Jan. 20, 2021 (HealthDay News) -- When intensive care units are swamped with COVID-19 patients, death rates may climb, a new study finds.

Looking at data from 88 U.S. Department of Veterans Affairs (VA) hospitals, researchers found a pattern: COVID-19 patients were nearly twice as likely to die during periods when ICUs were dealing with a surge of patients with the illness.

The results, experts said, do not necessarily mean that a busy ICU puts COVID-19 patients at greater risk.

The study looked at numbers of patients, and not the actual care they received, said Dr. Lewis Kaplan, president of the Society of Critical Care Medicine and a professor of surgery at the University of Pennsylvania, in Philadelphia.

One hospital may have a busy ICU, but be able to expand its capacity and recruit doctors with critical-care training who do not normally work in the unit. Another hospital, Kaplan said, might have fewer COVID-19 patients, but relatively less experience caring for patients who need ventilators.

Kaplan, who was not involved in the study, said the issue is complicated, and not all hospitals would be affected by COVID-19 surges the same way. And since the researchers looked only at VA hospitals, he noted, it's unclear whether the findings extend to other medical centers.

Kaplan stressed that as COVID-19 cases and hospitalizations continue to soar across the United States, people should not delay needed care.

"This shouldn't make people afraid to go to the hospital," he said. "If you're sick, we're here for you."

At the same time, the findings underscore the importance of people doing everything they can to avoid contracting COVID-19.

According to study author Dr. Dawn Bravata, of the Richard L. Roudebush VA Medical Center, in Indianapolis, "What's important is that the public should socially distance to avoid infection. The data show that mortality [death] increases during periods of peak ICU demand. Therefore, the more the public can do to avoid infection, the better."

For the study, published online Jan. 19 in JAMA Network Open, Bravata's team looked at data on patients treated for COVID-19 at 88 VA hospitals between March and August 2020. The vast majority were men, and their average age was 68.

The investigators found that among ICU patients, those treated during a time of "peak" ICU demand were almost twice as likely to die as those treated during relatively quiet times, when the unit was seeing no more than 25% of its peak number of COVID-19 patients.

Bravata agreed that the findings leave many questions open.

For one, she said, the study did not look at the degree to which hospitals "augmented ICU capacity" during the pandemic, and how that related to death rates. It's also unclear how "patient characteristics" might have played a role.

Bravata pointed out that over time, death rates among COVID-19 patients varied considerably, with a high of 25% in April, to just under 13% in July and August.

"COVID-19 patient characteristics, such as age and disease severity, have also varied over time," Bravata said.

"Future studies," she added, "are needed to examine how much of the variation in mortality is due to patient factors versus facility factors."

Patient factors could indeed be a contributor, said Dr. Luis Ostrosky, a professor of infectious diseases at McGovern Medical School at UTHealth in Houston.

For one, he noted, people might hesitate to head to the hospital during local COVID-19 surges. "Maybe some patients are getting to us when they're sicker," Ostrosky speculated.

But while all the answers are not in, the findings reflect what doctors are seeing on the ground, according to Ostrosky, who is also a fellow with the Infectious Diseases Society of America.

"COVID patients do best when they're cared for by a team with the best resources," he said. If local ICUs are full, and those resources are strained, that can make for care that is "not ideal," Ostrosky added.

"In the early days of the pandemic," he pointed out, "we always talked about 'flattening the curve.'"

That means slowing down infection rates in the community, so that seriously ill people are not flooding hospitals all at once.

"The idea is to turn it into a manageable stream," Ostrosky said.

That "flatten the curve" mantra, he added, is as important as ever.


More information

Harvard Medical School has advice on slowing the spread of COVID-19.

SOURCES: Dawn Bravata, MD, physician scientist, VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, and professor, medicine, Indiana University School of Medicine, Indianapolis; Lewis Kaplan, MD, president, Society of Critical Care Medicine, Mount Prospect, Ill., and professor, surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia; Luis Ostrosky, MD, professor, infectious diseases, McGovern Medical School at UTHealth, Houston, and fellow, Infectious Diseases Society of America, Arlington, Va.; JAMA Network Open, Jan. 19, 2021, online

COVID-19 Ups Complication Risks During Childbirth


WEDNESDAY, Jan. 20, 2021 (HealthDay News) -- Women who have COVID-19 during childbirth are more likely to face complications than moms-to-be without the coronavirus, researchers say.

Fortunately, the absolute risk for complications for any one woman is very low (less than 1%). But the relative risks for problems -- such as clotting and early labor -- are significant, the new study found.

Still, "the findings here, truly, are that among women who are hospitalized for childbirth and who were diagnosed with COVID, adverse events are incredibly low. That should provide a lot of reassurance to women who are hoping to become pregnant during this period, or who are pregnant," said study co-author Dr. Karola Jering, from the cardiovascular medicine division at Brigham and Women's Hospital in Boston.

Over eight months in 2020, she and her colleagues collected data on more than 400,000 mothers-to-be, nearly 6,400 of whom were infected with COVID-19.

Among the COVID-19 patients, the researchers found the relative risk of developing any type of blood clot was nearly five times higher than for those without the virus, and nearly four times higher for venous thromboembolism, clots in the veins.

These women were also far more likely to need intensive care or a ventilator, the researchers found.

Those who had the virus were:

  • 7% more likely to need a C-section.
  • 19% more likely to have preterm labor.
  • 17% more likely to have a preterm delivery.
  • 21% more likely to have preeclampsia.

There's little a pregnant woman can do to reduce these risks beyond not being infected, Jering said.

"The problem, of course, is that right now we mostly have supportive care for patients who have COVID, in general. And of the things that have been tested for treatment of patients with COVID, most of them have not been tested in pregnant women," said co-author Dr. Scott Solomon, also from Brigham and Women's.

But Jering said pregnant women are given the other drugs often given to COVID-19 patients, including blood thinners to prevent clots.

In sum, the study findings were positive, Jering stressed. Among the pregnant women with COVID-19 who gave birth, 99% were discharged home, 3% needed intensive care and 1% needed mechanical ventilation. Less than 1% died in the hospital.

Jering said that these findings should reassure women who have COVID-19 that, although complications can occur, most women will have a normal pregnancy and delivery.

Dr. Eran Bornstein is vice-chair of obstetrics and gynecology at Lenox Hill Hospital in New York City. He said, "Overall, these findings are important. They provide further support to prior observations regarding risk factors for COVID-19 during pregnancy as well as for pregnancy complications."

As previous research has shown, Hispanic and Black mothers were at greater risk of having the coronavirus, Bornstein noted. Young age, diabetes and obesity were also risk factors.

"This is important, as it emphasizes the impact sociodemographic factors and health conditions have on the likelihood of having COVID-19 in pregnancy," Bornstein said.

The report was published online Jan. 15 in JAMA Internal Medicine.

More information

For more on pregnancy and COVID-19, see the U.S. Centers for Disease Control and Prevention.

SOURCES: Karola Jering, MD, division of cardiovascular medicine, Brigham and Women's Hospital, Boston; Scott Solomon, MD, division of cardiovascular medicine, Brigham and Women's Hospital, Boston; Eran Bornstein, MD, vice-chair, obstetrics and gynecology, Lenox Hill Hospital, New York City; JAMA Internal Medicine, Jan. 15, 2021, online

Now That Psychiatric Care Has Gone Online, Many Patients Want It to Stay There

WEDNESDAY, Jan. 20, 2021 (HealthDay News) -- Only a year ago, Michigan Medicine psychiatrists were trying to recruit patients to give telepsychiatry a try, with very little success.

The psychiatrists worked with people by video only 26 times in six months, while 30,000 visits happened in person. But that changed quickly when the coronavirus pandemic forced closures in the area in late March.

Now, not only have patients seeking help with mental health issues been working through their emotions and experiences by video and phone for months -- many would like to keep those options, a new study shows.

"Telepsychiatry is an interesting tool for various reasons in terms of providing early access to care, connecting patients in rural areas or who live far away from clinics to be able to get good evidence-based care," said study author Dr. Jennifer Severe, a psychiatrist who helped launch a test of telehealth initiatives at the University of Michigan's outpatient psychiatry clinic.

"Even patients who are closer, based on life burden and expectation, they might not be able to keep up with their appointments, so telehealth actually offers a way to remain connected with care, regardless of how busy people's lives might be," Severe said.

For the study, published recently in the journal JMIR Formative Research, researchers surveyed 244 patients or parents of minor patients in summer 2020. The patients had mental health appointments in the first weeks of the pandemic shutdown.

Most of the survey participants had their own or their child's first pandemic-time appointment through a video call. A minority of patients, 13.5%, started telepsychiatry with phone visits. That group was more likely to be older than 45.

Nearly all of the study participants who had a telepsychiatry visit said it went as well as expected or better.

About half (46.7%) said they were likely to continue with telepsychiatry even after in-person visits were available again. Those who had appointments by phone instead of video were much less likely to want to continue remote mental health care in the future.

"The excitement is there, but we need to make sure that we have a way to keep up with the demand," Severe said.

This data could help inform the decisions of health insurers and government agencies who will make decisions about whether and how to pay mental health care providers for future virtual care, Severe said.

To improve access, while the survey was ongoing, senior study author Dr. Mary Carol Blazek led development of a program called Geriatric Education for Telehealth Access, or GET Access, to help older patients.

The study didn't cover the issue of no-shows and appointment cancellations, but those have been reduced substantially, according to Michigan Medicine.

Phone and video visits within established patient-mental health provider relationships are equally effective, Severe said.

However, for first visits, the therapists typically try to avoid using the phone because it can reduce communication cues and limits observing facial expressions, interaction and movement, which can help evaluate mental health status. Sometimes physical exams can be required to assess a patient's balance and mobility, as well as check for medication side effects.

"Sometimes communication might be difficult. Sometimes you might need to do a physical exam. There might be a lack of important physical exam approaches and communication techniques that might be missing," Severe said. "So, that's one reason I will say telehealth might not be for everyone."

Severe hopes to see more of a blended approach after the pandemic, where a patient may do a face-to-face visit, followed by a couple of telehealth visits, and then return for another face-to-face visit.

During the pandemic, telehealth has been responsible for saving small mental health practices while also continuing to help patients, said Vaile Wright, senior director of health care innovation for the American Psychological Association.

"The evidence is pretty strong. People are having mental health difficulties, much more so than in the past and, thankfully, they are seeking out treatment," Wright added. "I think telehealth makes it possible for them to do so safely."

For some people, it may be harder to connect in a virtual environment. For others, it may make it easier because they don't have to get time off work, figure out child care or travel to the office.

Issues to consider are ensuring that patients understand the online platform, have adequate internet accessibility and have adequate privacy in their homes to have a mental health appointment. Backup safety plans also need to be considered, Wright said.

"What happens if somebody is in a crisis? When they're in your office [you] have a system in place, but when they're not, maybe [you're] not even sure where they're located exactly, that can make it challenging," Wright said. "So, ensuring that you've got those sorts of backups in place is important."

More information

The U.S. Centers for Disease Control and Prevention has more about mental health.

SOURCES: Jennifer Severe, MD, clinical assistant professor, department of psychiatry, University of Michigan, Ann Arbor; Vaile Wright, senior director, health care innovation, American Psychological Association, Washington, D.C.; JMIR Formative Research, Dec. 22, 2020

Tips for Parents of Kids With Diabetes

WEDNESDAY, Jan. 20, 2021 (HealthDay News) -- Kids with diabetes can lead full, fun lives, but they have special needs. Here's what parents should know.

Diabetes is common among American children. More than 205,000 kids and teens have the disease, and cases are rising.

Age makes a difference in the type of diabetes a child is likely to have.

"Most children younger than age 10 with diabetes have type 1," said Dr. Santhosh Eapen, a pediatric endocrinologist at K. Hovnanian Children's Hospital in Neptune, N.J. "The condition occurs when the body stops making the hormone insulin," Eapen explained in a Hackensack Meridian Health news release.

The number of U.S. children and teens with type 2 diabetes increased by 30% between 2001 and 2009, with cases growing among youth aged 10 and older. "With type 2 diabetes, the body produces insulin but doesn't use it properly," Eapen said.

Symptoms

The first symptoms of type 1 diabetes include weight loss, fatigue, blurry vision and frequent urination. Early type 2 symptoms can resemble those of type 1. But sometimes patients with type 2 diabetes don't have any signs.

Risk factors for type 2 diabetes include not getting enough physical activity, being overweight and having a family history of diabetes. Early screening can allow treatment to begin and prevent or delay diabetes-related problems.

Kids with diabetes need care from different health specialists. A child can see a doctor, diabetes educator, dietitian and psychologist. "Children with diabetes will need regular follow-up with their health care team. A typical interval for visits would be every three months," Eapen said.

Physical activity

Physical activity is important because it helps insulin work better and helps keep blood sugar levels under control. "Children with diabetes should be active for an hour every day," Eapen said.

Federal law protects kids with diabetes in public and private schools. These children have the right to take part in school and get the health care necessary to stay healthy. For example, they may need to have diabetes supplies in their backpack.

"Living with diabetes can be challenging. But with extra support from loved ones, children with diabetes can still enjoy all the things that make childhood memorable," Eapen said.

More information

For more on kids and diabetes, visit the U.S. National Library of Medicine.

SOURCE: Hackensack Meridian Health, news release, Jan. 19, 2021

AHA News: COVID-19 Registries Offer Lessons Beyond the Coronavirus

WEDNESDAY, Jan. 20, 2021 (American Heart Association News) -- As the U.S. marks one year since the arrival of SARS-CoV-2, the coronavirus has made history in epic and terrible ways. But it also sparked innovative and inspiring science, say researchers who raced to establish registries of COVID-19 patients.

Their efforts have elements of a medical drama, with mysteries to unravel, lives on the line and obstacles to gathering even basic details. Researchers were forced to adapt quickly and collaborate creatively.

And beyond answering urgent questions about the disease, leaders of those efforts say what they learned might change the way such work is done in years to come.

Dr. James de Lemos, a professor of medicine at UT Southwestern Medical Center in Dallas who helped create one such registry, said the crisis helped researchers cut through red tape and led them to adapt new technologies in ways that would have developed much more slowly without the pandemic.

Registries are a basic scientific tool. The usual work of setting one up takes years. Even then, the projects done from a registry usually involve a handful of investigators working on one or two projects at a time with a centralized corps of statisticians, he said. But as COVID-19 cases exploded across the country last year, "we had to do something different to shorten the time window from idea to discovery."

De Lemos calls it "burst science," a burst of speed or creativity from many players. "We democratized the process, which allowed us to basically put scientific discovery in many more hands."

The need to work quickly and in entirely new ways was also part of the process for Dr. Monika Safford, chief of the Division of General Internal Medicine at Weill Cornell Medicine in New York City. The first U.S. coronavirus case was confirmed last Jan. 20, and by mid-February, "I recognized that we were going to be in deep trouble because we weren't taking the public health measures that needed to be taken," she said.

Chaos followed as virus cases spiked and doctors struggled with shortages of protective gear, hospital and intensive care beds, and even personnel; limits on testing; and a lack of information on treatment. Safford called it a "resource-scarce environment combined with knowledge scarcity. I couldn't do anything about the resource scarcity. But I could do something about the knowledge scarcity."

That something: build a registry, with the goal of answering doctors' most burning clinical questions.

Getting even basic details from patients was a challenge, as gear shortages limited who could get close to patients. Technology came to the rescue, making it possible to link attending doctors with medical students, who weren't allowed on-site but could review and collect data from medical charts. Graduate and undergraduate students at Cornell University's campus in Ithaca, New York, and elsewhere crunched statistics.

The registry quickly provided crucial details that helped physicians predict who was most likely to need intensive care. Eventually, it gathered data on more than 4,000 patients. The team published last April in the New England Journal of Medicine what Safford said was the first front-line report on COVID-19 patients in the United States. Among other things, it suggested obesity made a patient more likely to need a ventilator.

"We got that published within just about six weeks of the first patient coming to our front door," she said. "And that's the kind of speed that we should be shooting for."

Many COVID-19 registries are up and running. Some gather information on groups such as health care workers or college athletes; others focus on specific diseases. The one de Lemos co-leads, the American Heart Association's COVID-19 Cardiovascular Disease Registry, focuses on cardiac issues. It launched last April and currently includes more than 32,000 patients from 110 sites.

The effort made use of a technology platform developed by the AHA that centralizes data, standardizes tools and allows multiple teams to collaborate through cloud computing.

Even before the pandemic, scientists had been exploring such tools. But the demand for information motivated everyone to make it work as quickly as possible, he said.

Preliminary research from the registry showed rates of heart attack, heart failure and stroke in COVID-19 patients were lower than expected, de Lemos said. But data published last November in the AHA journal Circulation pointed to a higher risk for obese patients, particularly in younger people. Other research highlighted how COVID-19 has disproportionately harmed Black and Hispanic communities.

De Lemos and Safford both say studies from their registries will lead to further insights on the disease. "There's a lot more coming soon," de Lemos said.

For him, building a registry has helped him and his colleagues practice ways of being creative, of "thinking on your feet, and recognizing that you have to be flexible and adaptable," de Lemos said.

He thinks time will show that "in many areas, COVID is going to have forced or accelerated transformations." Or, put in terms he said any "This Is Spinal Tap" fan could appreciate, "I think we've kind of turned things (up) to 11."

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email editor@heart.org.

By Michael Merschel

Dental Practices Rebound as U.S. Dentists Look Forward to COVID Vaccine

WEDNESDAY, Jan. 20, 2021 (HealthDay News) -- The coronavirus pandemic hit dental practices hard early in 2020, as COVID-19 fears kept millions of Americans from seeking routine oral health care.

But as dental offices have ratcheted up their safety measures, more patients have steadily been returning for checkups and more, according to recent polls conducted by the American Dental Association Health Policy Institute (HPI).

In fact, by Dec. 14 the average patient volume at U.S. dental offices had resurged to 78% of pre-coronavirus levels according to the poll, which involved 2,700 dentists nationwide.

One such dentist agreed that his industry -- and patients -- have been hit hard by the COVID-19 pandemic.

"Health economists in the U.S. often use the dental industry as an indicator of the country's economic health, and dental workers accounted for over one-third of the health care jobs lost in the U.S. during the COVID pandemic," noted Dr. David Hirsch. He's senior vice president and chair of dental medicine at Northwell Health in New Hyde Park, N.Y.

"Many individuals have delayed important dental care or avoided the dentist because of their own fears about contracting the virus in the dental office," Hirsch said, and the consequences could be dire. "This means serious and life-threatening diseases like oral cancers may go undetected," he noted.

Dentists and dental hygienists had justifiable fears of catching the new coronavirus.

"Dentistry is one of the highest-risk professions for coronavirus exposure, since our work is primarily focused inside patients' mouths and many of our procedures generate aerosols, which are a primary source of coronavirus transmission," Hirsch explained.

In addition, "about half of the current dental workforce is at or near retirement age, which puts them at increased risk for COVID-19 complications," he said.

But hope is in sight as dentists are being included in the first wave of recipients for COVID-19 vaccines. Most dentists are eager to roll up their sleeves.

According to a news release from the American Dental Association, the HPI poll found that "64% of dentists said it is extremely important to get vaccinated, and another 20% answered it is very important. In addition, the majority believe they should get vaccinated as soon as the vaccine is available to them. Older dentists, dentists in large group practices, and specialists find vaccination to be particularly important."

All of this should get Americans back to tending to their oral health, Hirsch said.

Added to office safety protocols already in place, "getting vaccines to all dental providers will increase doctors' and patients' confidence in returning to their usual routines," he said.

Some dental offices are even joining in the vaccination effort by administering shots to qualified patients. For example, California Governor Gavin Newsom announced in early January that dentists would be added to the list of health care professionals eligible to dispense the vaccine.

"All hands on deck -- the more we can administer this vaccine, the better," Dr. Judee Tippett-Whyte, the president of the California Dental Association, told ABC News.

More information

Find out more about COVID-19 safety measures in place at dental offices at the American Dental Association.

SOURCES: David Hirsch, MD, DDS, senior vice president and chair, dental medicine, Northwell Health, New Hyde Park, N.Y.; American Dental Association, news release, Jan. 5, 2021

America Sees COVID Death Tally Top 400,000, While New Variants Worry Scientists

WEDNESDAY, Jan. 20, 2021 (HealthDay News) -- The tragic milestone was reached before a COVID-19 memorial service began in the nation's capital Tuesday evening: More than 400,000 Americans have now died from the new coronavirus.

"To heal, we must remember," President-elect Joe Biden said during the lighted vigil for coronavirus victims at the Lincoln Memorial. "And it's hard sometimes to remember. But that's how we heal. It's important to do that as a nation. That's why we're here today."

His words came as a chaotic U.S. vaccine rollout seeks to gather steam amid the discovery of new COVID-19 variants that might eventually threaten the efficacy of those vaccines.

Most troubling is a variant that first surfaced in South Africa but hasn't yet been spotted in the United States. A new lab study suggests someone might be able to get infected with the South African variant even if they've had COVID-19 before or have been vaccinated.

"I think we should be alarmed," senior study author Penny Moore, an associate professor at the National Institute for Communicable Diseases in South Africa, told CNN. Her team's results were published on the preprint server BioRxiv, and have not been peer-reviewed yet.

"Based on Penny's data, it's likely that the vaccine is going to be somewhat less effective, but how much less effective we don't know," David Montefiori, a virologist at Duke University Medical Center, told CNN. "This is the first time I've been concerned about a variant partially evading the immune response and partially evading the vaccine."

Both experts stressed that people should still get the vaccine. It's extremely effective against other forms of the virus, and they think it likely will still give some level of protection against the new variant.

In the study, Moore and her colleagues took blood from 44 people who'd already had COVID-19. Nearly all of their cases were confirmed to have occurred prior to September, before the variant was spotted in South Africa.

The researchers then looked to see whether their antibodies would fight off the new variant.

For about half of the 44 people, their antibodies were powerless against the new variant.

"We saw a knockout," Moore said. "It was a scary result."

For the other half, the antibody response was weakened, but not totally knocked out.

The analysis showed that the strongest antibody response was from those who had suffered more severe cases of COVID-19. The culprits were mutations in two different parts of the spikes that sit atop the coronavirus. The vaccines work by targeting those spikes.

"It was a two-armed escape from the immune system," Moore told CNN.

Her team is now gathering blood from people who've been vaccinated to see if their antibodies can fight off the new variant.

"I think the data on people with prior infection raises all kinds of red flags for the vaccines," she said. "We have to test it to find out."

Still, it may not be time to panic: Montefiori thinks the vaccine will likely take a hit -- but probably not a huge one.

"We have to remember, the Pfizer and Moderna vaccines are 95% effective -- that's an extraordinary level of efficacy," Montefiori said. "If it reduces to 90, 80, 70% effective, that is still very, very good and likely to have a major impact on the pandemic."

Biden details massive vaccination effort

President-elect Joe Biden has unveiled an ambitious national vaccination plan that will deliver coronavirus vaccines to far more people and invoke a wartime law to boost vaccine production.

He pledged to ramp up vaccination availability in pharmacies, build mobile clinics to get vaccines to underserved rural and urban communities and encourage states to expand vaccine eligibility to people 65 and older, The New York Times reported. Biden also vowed to make racial equity a priority in fighting a virus that has disproportionately infected and killed minorities.

"Our plan is as clear as it is bold: get more people vaccinated for free, create more places for them to get vaccinated, mobilize more medical teams to get the shots in people's arms, increase supply and get it out the door as soon as possible," he said. "You have my word… we will manage the hell out of this operation."

But Biden faces a stark reality: With only two federally authorized vaccines in circulation, supplies will likely be limited for the next several months.

Even if Biden invokes the Korean War-era Defense Production Act, it may take some time to ease vaccine shortages. The law has been invoked already, to important but limited effect, the Times reported. Biden has promised to build mass vaccination sites and develop new programs to serve high-risk people, including the developmentally disabled and those in jail. But those promises will only be achieved if there are vaccines available.

"It won't mean that everyone in this group will get vaccinated immediately, as the supply is not where it needs to be," Biden conceded. But as new doses become available, he promised, "we'll reach more people who need them."

The vaccine distribution plan comes one day after Biden proposed a $1.9 trillion pandemic "rescue" package that includes $20 billion for the vaccine effort. Biden has said repeatedly that he intends to get "100 million COVID vaccine shots into the arms of the American people" by his 100th day in office.

As of Wednesday, nearly 15.7 million Americans had been vaccinated while over 31 million doses have been distributed, according to the U.S. Centers for Disease Control and Prevention. Just over 2 million people have received their second shot.

A global scourge

By Wednesday, the U.S. coronavirus case count passed 24.3 million while the death toll passed 401,800, according to a Times tally. On Wednesday, the top five states for coronavirus infections were: California with nearly 3.1 million cases; Texas with almost 2.2 million cases; Florida with nearly 1.6 million cases; New York with close to 1.3 million cases; and Illinois with almost 1.1 million cases.

Curbing the spread of the coronavirus in the rest of the world remains challenging.

In India, the coronavirus case count was over 10.6 million by Wednesday, a Johns Hopkins University tally showed. Brazil had nearly 8.6 million cases and over 211,400 deaths as of Wednesday, the Hopkins tally showed.

Worldwide, the number of reported infections passed 96.3 million on Wednesday, with over 2 million deaths recorded, according to the Hopkins tally.

More information

The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.


SOURCES: CNN; The New York Times

Health Highlights: Jan. 20, 2021


NYC May Run Out of COVID-19 Vaccines

New York City's COVID-19 vaccination rate has outpaced its supply of vaccine, and the city could run out of doses in the next few days, Mayor Bill de Blasio said Tuesday.

"If we don't get more vaccine quickly, a new supply of vaccine, we will have to cancel appointments and no longer give shots," he said during a media briefing, CBS News reported.

"At the rate we are going we will begin to run out on Thursday… we will have literally nothing left to give as of Friday," de Blasio warned.

The mayor asked the federal government to send more vaccine as soon as possible, CBS News reported.

More than 220,000 people in the city were vaccinated last week -- one every 3 seconds -- and the city could vaccinate 300,000 more this week if it had enough vaccine, according to de Blasio.

He said that 53,000 doses arrived Tuesday, giving the city only 116,000 doses for the week ahead, CBS News reported.



Dr. Rachel Levine Nominated as U.S. Assistant Health Secretary

Dr. Rachel Levine, a transgender woman, has been nominated by President-elect Joe Biden to serve as assistant secretary for health at the U.S. Department of Health and Human Services.

If confirmed by the Senate, Levine would be the first openly transgender federal official in a Senate-confirmed role, according to Biden's transition team, CBS News reported.

Levine is the secretary of health for Pennsylvania and is currently leading the state's response to COVID-19 pandemic.

"Dr. Rachel Levine will bring the steady leadership and essential expertise we need to get people through this pandemic — no matter their zip code, race, religion, sexual orientation, gender identity, or disability — and meet the public health needs of our country in this critical moment and beyond," Biden said in a statement, CBS News reported.

"She is a historic and deeply qualified choice to help lead our administration's health efforts," Biden said.

Are Pricey Air Ambulance Rides Really Saving More Lives?

WEDNESDAY, Jan. 20, 2021 (HealthDay News) -- Air ambulance service is pricey, but promises lifesaving speed by providing rapid straight-line helicopter transport for critically ill patients.

But a new study out of Denmark questions whether that expensive haste winds up saving more lives.

Researchers found no statistically significant difference in the death rate between people transported by ground ambulance or helicopter, according to findings published recently in JAMA Network Open.

That remained true even when researchers only looked at people with critical illness or injuries. They, too, died at statistically similar rates.

Examining deaths and illnesses for critically ill patients, the Danish researchers "found there's not a lot of statistical difference in the overall mortality [deaths] between ground and air, according to this study," said Dr. Michael Abernethy, chief flight physician with the University of Wisconsin School of Medicine and Public Health in Madison.

If these findings pan out, it would mean people are getting socked with huge bills for helicopter transport that didn't necessarily increase their odds of survival.

Nearly 3 out of 4 air ambulance patients are at risk of being hit with a surprise bill of up to $20,000 per ride because the transport provider isn't "in network" with their insurance, according to an earlier May 2020 study in the journal Health Affairs.

For the new study, researchers led by Dr. Karen Alstrup, from Prehospital Emergency Services in Aarhus, Denmark, reviewed 10,618 patients transported by either ground or air between 2014 and 2018, comparing outcomes in both groups.

Denmark is about 17,400 square miles, roughly the size of Vermont and Massachusetts combined, with a population of 5.8 million. The country is served by three medical helicopters.

In the study, 9,480 people were flown by helicopter and 1,138 transported by ground. That included 2,260 patients with critical illness or injury who were flown and 315 who were driven to a hospital.

About 23% of patients flown by helicopter died within one year of transport, compared with 24% of those driven in an ambulance, researchers found.

Among the critically ill, 25% died within one year of air transport versus 27% with ground transport.

These findings run counter to prior studies, which have found that transport by helicopter increases a person's chances of survival, the Danish researchers noted.

But Abernethy -- who wrote an editorial accompanying the study -- argues that the Danish researchers did create a fair comparison of air and ground transport, because in that country both modes offer a similar level of medical care from trained personnel.

Further, the researchers used weather to randomize who received air transport, adding to the validity of their findings. Bad weather forced some to travel by ground, even when air transport would have been preferred, Abernethy noted.

It's hard to say how these observations in Denmark might apply to the United States, which offers dramatically varying quality of air and ground ambulance transport depending on where you live, said Abernethy and Dr. Jonathan Berkowitz, medical director of Northwell Health's Center for Emergency Services in New Hyde Park, N.Y.

"Health care systems vary enormously," Berkowitz said. "I would have to do a deep dive, but I would not surprised if local considerations diminished the generalizability of this study to us. Their existing algorithms for selecting transport, types of providers on teams and pattern of illness could all impact this."

Abernethy noted that helicopter and ground EMS units can vary considerably in terms of training -- both with the aviators and the medical staff.

"In some cases you are delivering a higher level of medical care, and some cases you absolutely aren't," Abernethy said. "You can't make the blanket statement that the helicopter crews are always better trained and have more experience than the ground crews. The ground crew may have higher medical training and more expertise than the medical crew on the helicopter."

Some parts of the country also are oversaturated with air transport options, particularly where insurance reimbursement is more generous, he added.

"There are some areas of the country that are so oversaturated, they'll have two or even three different flight programs sitting at the same airport, and night and day difference between their aviation capabilities and their medical capabilities," Abernethy said.

Berkowitz said he'd like to see more comparison studies that look at outcomes other than death -- for example, neurological status, length of stay in an intensive care unit, or how long it takes a person to be discharged from the hospital.

"There is more that we don't know on these issues than what we do know," Berkowitz said.

More information

The Brookings Institute has more on air ambulance charges.

SOURCES: Michael Abernethy, MD, chief flight physician, University of Wisconsin School of Medicine and Public Health, Madison; Jonathan Berkowitz, MD, medical director, Northwell Health Center for Emergency Services, New Hyde Park, N.Y.; JAMA Network Open, Jan. 11, 2021

Stressed Out By the News? Here's Tips to Help Cope

WEDNESDAY, Jan. 20, 2021 (HealthDay News) -- Be kind to your heart and health and turn off the news, doctors say.

Northwestern University experts suggest checking in on current events a couple of times a day and no more. Constant updates can fuel anxiety and depression, they warn.

"As a practicing preventive cardiologist, one of the most common risk factors for heart disease that I am seeing this year is stress," said Dr. Sadiya Khan, assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine in Chicago. "I know we can all agree it has been an extremely stressful year for all in every aspect of our lives, including stress related to the pandemic and associated health, financial and political events."

Constant news updates pile on layer upon layer of stress, according to Dr. Aderonke Pederson, a psychiatrist at Northwestern Medicine.

"That cumulative stress can translate into increased risks of heart problems, diabetes and more," she said. "Mental illnesses like depression and anxiety, especially when untreated, can increase your risk for chronic health conditions like diabetes, cardiac events and heart disease and can complicate symptoms of asthma. So, there's a feedback loop of mental health conditions and physical health conditions."

The doctors offered several coping strategies, including getting a good night's sleep and calming your mind a couple hours before bedtime with a light-hearted book, journaling, playing a game or taking a warm bath.

"To reduce the consequences of stress, try to focus on heart-healthy behaviors that can reduce your risk, such as exercising, enjoying a healthy diet and finding ways to maintain a positive attitude," Khan said. "If you already have risk factors for heart disease, it's important to check in with your doctor to make sure stress is not making it worse."

Pederson noted that these issues are multiplied for Black people, who have been especially hard-hit by the COVID-19 pandemic.

"Discrimination exacerbates the risk of mental and physical health issues," she said. "African-Americans are less likely to be offered services and treatments for mental health issues, experience stigma related to mental health and tend to delay seeking care, so it's a multi-fold problem."

The doctors recommend checking in on family members who might be feeling overwhelmed and encouraging them to seek help from support groups or primary care providers who can refer them for mental health services.

"I often tell my patients to tell me every negative thing that's happened," Pederson said. "This focuses on their resiliency and helps them process their experiences. Being kind and patient with ourselves and taking stock of all the things we've survived will help us as we move forward."

She said it's vital to accept what you can't control and stay hopeful.

"While there is a lot of chaos, there are still positives, such as the vaccine, which will soon be available to many individuals," Pederson said.

More information

The U.S. Centers for Disease Control and Prevention offers these tips for coping with stress during the COVID-19 pandemic.


SOURCE: Northwestern University, news release, Jan. 15, 2021

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