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Pandemic Opportunity to Fix US Housing, Healthcare, Economic Problems

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  • As the delta wave of COVID begins to subside, we can see glaring holes in our nation’s resilience.
  • Whether the pandemic takes us back to the status quo or triggers reforms depends on the story the nation tells itself about what happened.
  • The pandemic was a disaster. It doesn’t have to be a missed opportunity, either.
  • Dr. Joshua M. Sharfstein is Professor of Health Policy and Management Practice at the Johns Hopkins Bloomberg School of Public Health
  • This is a split opinion. The thoughts expressed are those of the author.

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As the delta wave of the COVID pandemic begins to subside, people in the United States are dying for life to return to normal.

But it is still unclear how the new normal will differ from our pre-pandemic world. We now know that there are better ways to do things – from flexible work to telemedicine. We can also see glaring gaps in our country’s preparedness and resilience, including profound public health underfunding, enormous racial and ethnic disparities in housing, education and employment, and poor access to health care in many rural communities. Now is a golden opportunity to address these issues.

That is at least one lesson in history, which is full of examples of reforms that were actually unthinkable after a crisis. But change doesn’t happen automatically. For every example of a national event that casts a long shadow over politics, there is a counterexample of an event that barely touched the national agenda.

Whether the pandemic will bring us back to the status quo or spark fundamental reforms may depend largely on the story the nation tells about the events.

Who is trusted to tell the story?

The story told initially depends on who has the credibility to be the storyteller.

In 1937, a fatal batch of a drug called Elixir Sulfanilamide killed more than 100 people. A small federal agency called the Food and Drug Administration (FDA) jumped into action and garnered public recognition by dispatching inspectors across the country to track down the remaining doses. The agency then wrote a full report explaining why the public was so vulnerable to dangerous drugs. Congress responded by passing the landmark Food, Drug, and Cosmetic Act, which for the first time in history requires drugs to be reviewed and approved prior to commercialization.

In 1976, however, a very different scenario developed. The Centers for Disease Control and Prevention (CDC) launched a campaign to immunize every “man, woman, and child” in the country against a new strain of influenza. But the feared “swine flu” pandemic never came; Worse, the vaccine was associated with some rare but serious neurological side effects. The CDC’s reputation, tarnished by harsh reporting, could do little to halt a decline in confidence in vaccines.

What story is being told?

A good story attracts attention and tells not only the tragedies that occurred, but also the heroes that prevented further damage.

In 1961, a new sedative called thalidomide caused thousands of serious birth defects in Europe – but very few in the United States because the FDA refused to approve the drug. Tennessee Senator Estes Kefauver sensed an opportunity and encouraged journalists to tell the story like a single heroic drug critic, Dr. Frances Kelsey, who saved thousands of American babies from tragedy. Kelsey subsequently appeared in all of the major national magazines and newspapers and on all major television news programs.

In contrast, the more than 12,000 deaths in the US from the H1N1 pandemic in 2009 did not result in a serious national review of what went right and wrong in the response. A desire to return to normal and move on undermined serious considerations about much-needed investments in infection risk preparedness.

What kind of energy does the story generate?

Stories that inform are important; Stories that inspire people to act are the ones that lead to the most significant reforms.

The 2017 rampage from a hotel room in Las Vegas killed 60 people and injured 411. However, this terrible tragedy resulted in few reforms. Media attention and political debates focused on the narrow issue of bumpers, which were banned by the Justice Department in 2018 and then reintroduced by an appeals court in 2021.

Less than six months later, a shooting at Stoneman Douglas High School in Parkland, Florida killed 17 people and injured 17 others. Despite local election officials predicting that “nothing” would happen because “we’ve seen this show before,” gunfire survivors attacked the gun lobby for blocking even the most sensible reforms. Young people mobilized across the country and across the country. Despite years of blocking similar regulations, Florida lawmakers quickly passed important laws that include background checks, a waiting period, and a new program to remove weapons from people who are considered extremely at risk for their use. These laws have now been passed in 19 states and the District of Columbia.

What will change after COVID-19?

This scenario is easy to imagine: the deep polarization of the nation leaves little room for storytelling or teaching. Harassed and demoralized, public health leaders and authorities are unable to gain enough trust or respect to play an important role in determining a way forward. When cases recede, policymakers fall back into their regular routines and the public welcomes a return to normal.

And yet. An alternative scenario is also conceivable. First, a source of authority emerges, such as a non-partisan national commission or body. His research not only covers why the US failed to get the best COVID responses in the world, but also why the US had one of the most unequal and divisive pandemic experiences ever.

Second, a compelling story of what happened caught the nation’s attention. Millions of Americans understand what could have been done differently and what could have been done differently to avoid unnecessary loss of life.

Third, and finally, the story gets people moving. The window of opportunity for reform may be short and obstacles of all kinds are likely to block the path to reform. Still, proponents will have a chance to advance their arguments: The pandemic was a disaster. It doesn’t have to be a missed opportunity, either.

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Early Omicron Reports Say Illness May Be Less Severe

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JOHANNESBURG – The Covid-19 virus is spreading faster than ever in South Africa, the country’s president said on Monday, an indication of how the new Omicron variant is fueling the pandemic, but there are early signs that Omicron is causing less serious diseases than other forms of the virus.

Researchers at a large Pretoria hospital complex reported that their patients with the coronavirus are much less sick than those they treated before, and that other hospitals are seeing the same trends. In fact, most of their infected patients were admitted for other reasons and had no Covid symptoms.

However, scientists cautioned against placing too much emphasis on potential good news of lesser severity or bad news such as early evidence that previous coronavirus infection offers Omicron little immunity. The variant was only discovered last month, and more study is needed before experts can say much about it with confidence. Additionally, the real effects of coronavirus aren’t always immediately felt as hospital admissions and deaths often lag well behind the first outbreaks.

Dr. Emily S. Gurley, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, said of the signs the variant is less severe, “It wouldn’t be shocking if that were true, but I’m not sure we do can still conclude. “.”

In the absence of more detailed information, governments have responded to Omicron with severe restrictions on international travel and new vaccination regulations. World leaders who have been accused of reacting too slowly or weakly at the start of the pandemic would like to be viewed as measures, although some experts doubt the travel restrictions are an overreaction.

The variant has spread rapidly and has so far been detected in more than 30 countries on six continents. Health officials and researchers say it could be the most contagious form of the virus to date, and that it could soon displace the Delta variant, which emerged as the predominant form last year. This has fueled fears that a world eager to overcome two years of pandemic hardship could slip into yet another cycle of disease, lockdown, and economic suffering.

In Europe as well as in South Africa there are first signs that Omicron cases can be relatively mild, albeit easily ill.

In the UK, the government said Monday that the number of Omicron cases there had risen to 336, two and a half times as many as on Friday. Denmark reported 261 cases, quadrupling the number on Friday, and local media has reported that a holiday lunch for high school students may have been a superspread event with dozens of people catching the new variant.

The UK and Denmark are doing an unusually large amount of genomic sequencing of virus samples to distinguish one variant from another and detect changes, suggesting that many Omicron cases in other countries simply go undetected.

On Monday, the United States required international travelers arriving in the country to show evidence of a negative coronavirus test, which was done no more than 24 hours before their flight, a standard that can be difficult to meet. Previously, fully vaccinated travelers could show negative test results up to 72 hours before departure.

China, a key part of the global travel and tourism industry, announced that it would keep international flights at 2.2 percent pre-Covid levels during the winter in order to maintain its zero-covid approach. The issuance of new passports has been almost completely stopped since August, arriving travelers have to be quarantined for 14 days and extensive papers and several virus tests have to be presented.

In South Africa, where scientists say Omicron is already dominant, the pandemic is picking up again. A month ago, South Africa had fewer than 300 new virus cases a day; on Friday and Saturday there were more than 16,000. It fell slightly on Sunday and Monday, but this may be due to a reporting delay often seen on weekends.

“As the country enters a fourth wave of Covid-19 infections, we are experiencing an infection rate that we have not seen since the beginning of the pandemic,” wrote President Cyril Ramaphosa in an open letter to the country. He added: “Almost a quarter of all Covid-19 tests are now positive. Compare that with two weeks ago, when the proportion of positive tests was around 2 percent. “

A report released this weekend by doctors at the Steve Biko Academic and Tshwane District Hospital Complex in Pretoria, South Africa’s administrative capital, offers the strongest support yet for a more hopeful view of Omicron, despite its author, Dr. Fareed Abdullah, Reasons Cited Be careful with conclusions.

Updated

Dec. 2/6/2021, 6:55 p.m. ET

Dr. Abdullah, director of the HIV / AIDS and Tuberculosis Research Bureau at the South African Medical Research Council, examined the 42 coronavirus patients who were hospitalized last Thursday and found that 29 of them, 70 percent, were breathing ordinary air. Of the 13 who used supplemental oxygen, four had it for non-Covid-related reasons.

Only one of the 42 patients was in the intensive care unit, in line with numbers released last week by the National Institute for Communicable Diseases, which showed that despite the surge in infections, only 106 patients were in the intensive care unit in the past two weeks .

Most patients were admitted “for diagnoses unrelated to Covid-19,” the report said, and their infection “is an incidental finding in these patients and is largely driven by hospital policy that requires testing of all patients”. It is said that two other large hospitals in Gauteng Province, which include Pretoria and Johannesburg, had an even lower percentage of infected patients who needed oxygen.

Dr. Abdullah said in an interview that he went to a Covid station and found a scene unrecognizable from earlier phases of the pandemic when it was full of the buzzing and beeping of oxygen devices.

The Coronavirus Pandemic: Important Things You Should Know

“Out of 17 patients, four received oxygen,” he said. “For me, it’s not in a Covid ward, it’s like a normal ward.”

Dr. Johns Hopkins’ Gurley noted that the severity of the disease reflects not only the variant, but who it infects. Two years into the pandemic, far more people have some immunity to the virus through vaccination, natural infection, or both, and this could lead to milder cases.

“We don’t know how to read the genetic sequences to tell exactly how this variant will develop,” she said. “We are now getting more information from South Africa, a particular population with a particular profile of pre-existing immunity.”

Dr. Maria D. van Kerkhove, the World Health Organization’s technical director for Covid, told CBS News on Sunday that even if a smaller percentage of Omicron cases were found to be severe, it means a larger number of cases could make up for it more hospitalizations and deaths.

Dr. Abdullah also examined all 166 patients with the coronavirus admitted to the Biko-Tshwane complex between November 14 and November 29, and found that their average hospital stay was just 2.8 days and less than 7 percent died . Over the past 18 months, the mean length of stay for these patients was 8.5 days, and 17 percent died. Shorter stays would take the pressure off the hospitals.

Eighty percent of the 166 patients were under 50 years of age, and similar numbers were reported across Gauteng – a sharp contrast to previous cohorts of hospitalized Covid patients who were usually older. This could be because South Africa has a relatively high vaccination rate in people over 50 and a low one in younger people, but one of the big unknowns at Omicron is whether existing vaccines offer strong protection against it.

Part of the caution in interpreting Dr. Abdullah’s report is that the numbers are small, the results haven’t been peer-reviewed, and he doesn’t know how many of the patients had Omicron, unlike other variants of the coronavirus – although the government reported last week that they already had three Accounted for quarter of the virus samples in South Africa.

Dr. Abdullah acknowledged these drawbacks, noting that there could be a delay between the first appearance of Omicron and an increase in serious illness and death. But despite the huge increase in cases, the number of Covid deaths in South Africa has not yet increased.

Lynsey Chutel reported from Johannesburg, Richard Pérez-Peña and Emily Anthes from New York. Coverage was contributed by Megan Specia, Isabella Kwai, Sui-Lee Wee, Juston Jones and Jenny Gross.

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Miller awarded prestigious grant to research policy impacts, health disparities

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Contact: Sarah Nicholas

Gabe Miller (Photo by Robby Lozano)

STARKVILLE, Miss. — A Mississippi State Sociology faculty member is awarded a prestigious Robert Wood Johnson Foundation grant to study how policy affects the health outcomes of members of the LGBT community and other marginalized groups.

Gabe H. Miller, assistant professor of sociology and faculty member in MSU’s African American Studies program, has received the $ 248,431 two-year scholarship from the Robert Wood Johnson Foundation, the nation’s largest philanthropy devoted exclusively to health. The scholarship is part of the RWJF’s Health Equity Scholars for Action initiative. Since 1972, the organization has supported research and programs targeting America’s most pressing health problems – from substance abuse to improving access to quality health care. More information can be found at https://www.rwjf.org/en/how-we-work/building-a-culture-of-health.html

Miller’s Prize is awarded for his proposal “Investigating the Effects of Political and Political Determinants of Health on the Health Outcomes of Lesbian, Gay, Bisexual and Transgender People”. He said he would use his research to guide policymakers towards data-driven policies promoting the health, wellbeing and equal opportunities of the population, and to work on building a “health culture,” which is a core theme at RWJF.

“Racism, homophobia and transphobia affect the health of people of color and LGBT people through discrimination, stigma and minority stress,” said Miller, noting that LGBT people are at greater risk for depression, anxiety, post-traumatic stress disorder, alcohol problems and suicide psychiatric difficulties.

“An intersectional approach to health advocates considering how systems of inequality combine or overlap to produce different health outcomes based on where individuals fall across multiple structures of inequality,” Miller said.

“I will examine the effects of more than 40 different LGBT protections in all 50 states from 2013-2020 to examine how those protections at the federal level affect mental health, physical health, chronic illness, access to health and people’s health behaviors affect LGBT populations. Additionally, I will examine whether these guidelines have different implications when we consider the racial and sexual orientation overlap, ”he said.

Deputy Dean of Research Giselle Thibaudeau said: “Given our commitment to health equity, the MSU is fortunate to have Dr. To have Miller’s passion and expertise in the health inequalities of marginalized communities. We are proud of the recognition and funding of his research by the RWJF. More importantly, we are very proud and hopeful of the impact of Dr. Miller’s efforts on these communities and health equality in general are. “

Born in Texas, he has been a faculty member since 2020 and received his Ph.D. in Sociology from Texas A&M University. His research and teaching interests at MSU include medical sociology and health disparities.

As part of the MSU’s College of Arts and Sciences, the Sociology Department is available at www.sociology.msstate.edu. Further information on the African American Studies course can be found at www.aas.msstate.edu.

MSU is the premier university in Mississippi, available online at www.msstate.edu.

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The link between cytokine storms and cardiovascular problems in COVID-19 patients

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Increased inflammation from cytokine storms has led to several heart complications in infections with coronavirus disease 2019 (COVID-19). But to treat these cardiovascular problems, doctors need to better understand the relationship between cytokine storms and cardiovascular proteins.

New research suggests that the Th1, Th2, and Th17 inflammatory pathways are involved in the overproduction of cardiovascular proteins in COVID-19 infections. Th1 cytokines have an established role as mediators against viral infections. Th2 and Th17 inflammatory pathways are signals during a severe autoimmune reaction.

The results can help clinicians select effective treatment regimens for patients with cardiac complications. They suggest using immunomodulators to reduce cardiovascular inflammation and prevent the immune system’s ability to fight the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Study: Th1, Th2 and Th17 inflammatory pathways correlate synergistically with cardiometabolic processes. A case study on COVID-19. Image source: Corona Borealis Studio / Shutterstock

The study was recently published on the preprint server bioRxiv *, while the article is being peer-reviewed.

Cytokine levels in T helper cell signaling pathways

The researchers compared the cytokines in patients who were or were infected with SARS-CoV-2. In COVID-19 cases, an increasing trend in protein expression was seen in most Th1 and Th17 mediators (and in more than half of Th2 mediators). Protein levels rose from non-severe infections to patients who died from COVID-19 illness. Deceased COVID-19 patients had significantly high Th1, Th2, and Th17 levels. Patients with non-COVID respiratory infections did not show increasing trends in protein expression in inflammatory pathways.

Relationship between cardiometabolic protein and COVID-19 disease severity

In the second research phase, every existing relationship between cardiometabolic protein and COVID-19 infection was examined. Of the 335 cardiometabolic proteins examined, around 35 were strongly linked to the severity of COVID-19 disease. In addition, all 35 proteins were expressed at significantly increased levels in patients who died of COVID-19 disease. Ten cardiometabolic proteins were highly expressed in intubated patients with COVID-19 compared to patients with mild disease.

Cytokine storms contribute to COVID-19-related heart complications

Next, the research team tested its hypothesis that Th1, Th2, and Th17 cytokines are involved in altering cardiometabolic proteins. They grouped immune markers for each pathway and analyzed their frequency of expression for each cardiometabolic protein present in patients with COVID-19 infection.

The results showed 186 links between cytokines and cardiometabolic proteins expressed in COVID-19 infection. In particular, a synergistic effect between the immune pathways and proteins of Th1, Th2 and Th17 was observed.

The research stated that

Most of the compounds on our networks were positive compounds, suggesting that increased production of cytokines stimulates the overall production of cardiometabolic proteins. “

Of the 35 cardiometabolic proteins correlated with severe COVID-19 infection, 31 were predictive factors for cytokine storms. In fact, 20 of the 31 proteins have also been linked to cardiovascular inflammation and high blood pressure in other research studies. The 20 proteins were most strongly associated with IFNGR1 of the Th1 pathway. In the TH2 pathway, the most common association was with CCL11 and CCL7. In the Th17 pathway, the 20 cardiovascular markers were strongly linked to the cytokines PI3, LCN2 and IL6.

Study restrictions and future directions

The study used limited OLINK assay analysis to identify associations between immune mediators in inflammatory pathways and cardiometabolic proteins. An alternative technique that may have provided more descriptive and accurate results is whole genome sequencing.

A second limitation is that due to the many unknowns surrounding SARS-CoV-2 at the beginning of the pandemic, many COVID-19 cases were initially misdiagnosed. Incorrect diagnoses can alter the predictive power of cardiovascular markers with the severity of COVID-19.

Future research is needed to examine the relationship between helper T cells and heart inflammation. This should focus on a more detailed comparison between the cardiovascular and immune pathways and their interaction with viral infections beyond SARS-CoV-2.

Further studies examining the relationships between two systems could provide a complete picture of the immune-cardiovascular interaction in disease and health.

*Important NOTE

bioRxiv publishes preliminary scientific reports that have not been peer reviewed and therefore should not be considered conclusive, that guide clinical practice / health-related behavior or should be treated as established information.

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