A 28 year old male, type 1 diabetic usually requires an average of 110 units of insulin daily. However, since getting Covid-19 infection three months ago, his requirements have gone up to nearly double. Hba1c is also slightly increased. Fortunately, he has never suffered from complications of hyperglycaemia as he is very well educated and understands how to control his blood glucose quite well. This is not his first Covid-19 infection, he has had two previous infections and both times his insulin requirements went back to normal within 2-3 weeks. Is there anything that can be done to help his control?

Dear Colleagues!

Have You noticed remarkable changes after Covid-era? I know there other modifying factors, too, wars next and far to us, globalisation, new rules etc , but Covid made a strong fingerprint on all of us, 

Have your and coworkers and patients attitude, feelings or healthcare indicators changed? 

We meet more younger ones and older patients with highrisk comorbidity requiring polihistiric attitude in mean stream internal medicine, neurology and psychiatry, more emergency occurances and more difficoult social problems .

I feel all around exhaustion, anxiety, the loss of presumed safty.

What about You?

Best regards

For patients with active lupus nephritis, obinutuzumab, a humanized type II anti-CD20 monoclonal antibody plus standard therapy is more efficacious for providing a complete renal response than standard therapy alone, according to a study published online Feb. 7 in the New England Journal of Medicine. The research was published to coincide with the International Society of Nephrology annual World Congress of Nephrology, held from Feb. 6 to 9 in New Delhi.

Richard A. Furie, M.D., from Northwell Health in Great Neck, New York, and colleagues randomly assigned adults with biopsy-proven active lupus nephritis to receive obinutuzumab in one of two dose schedules or placebo (135 and 136 participants, respectively). In addition, all patients received standard therapy with mycophenolate mofetil plus oral prednisone. The primary end point was a complete renal response at week 76, defined by a urinary protein-to-creatinine ratio of less than 0.5, an estimated glomerular filtration rate of at least 85 percent of the baseline value, and no intercurrent event.

The researchers found that 46.4 and 33.1 percent of patients in the obinutuzumab and placebo groups had a complete renal response at week 76. More patients in the obinutuzumab group than the placebo group had a complete renal response at week 76 with a prednisone dose of 7.5 mg per day or lower between weeks 64 and 76 (42.7 versus 30.9 percent). A urinary protein-to-creatinine ratio lower than 0.8 without an intercurrent event was more common in the obinutuzumab group than the placebo group (55.5 versus 41.9 percent). There were no unexpected safety signals noted. More serious adverse events occurred with obinutuzumab than with placebo, and the adverse events reported were mainly infections and events related to COVID-19.

"These findings, and those from the NOBILITY trial, support the hypothesis that deep B-cell depletion with obinutuzumab is an effective treatment for patients with lupus nephritis," the authors write.

Several authors disclosed ties to biopharmaceutical companies, including F. Hoffmann-La Roche, which manufactures obinutuzumab and funded the study.

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Diabetes mellitus type 1 (DM1) is associated with lower probability of incident cardiovascular events than type 2 (DM2), according to a study published online Feb. 12 in the Journal of the Society for Cardiovascular Angiography & Interventions.

Andrew M. Goldsweig, M.D., from Baystate Medical Center in Springfield, Massachusetts, and colleagues compared the prevalence of incident cardiovascular events including myocardial infarction, percutaneous coronary intervention, coronary artery bypass grafting, stroke, carotid revascularization, limb ischemia, and peripheral revascularization among DM1 and DM2 patients (aged 46 to 75 years) receiving care at outpatient facilities with primary care and/or endocrinology, enrolled in the National Cardiovascular Data Registry Veradigm Metabolic Registry 2017 to 2022.

The study population included 5,823 and 156,204 DM1 and DM2 patients, respectively, with a total of 758,643 visits. The researchers found that DM1 patients were younger and had fewer comorbidities. There were 11,096 incident cardiovascular events, with a prevalence ratio of 0.63 for events associated with DM1 versus DM2. The prevalence ratio was 0.66 after adjustment for age. DM1 was associated with less myocardial infarction, percutaneous coronary intervention, stroke, and limb ischemia than DM2 when analyzed by separate cardiovascular events. Across all 10-year age categories, overall cardiovascular event probability was lower in DM1 than DM2 in both female and male patients, before and during/after the COVID-19 pandemic, and after adjustment for comorbidities, hemoglobin A1c, and serum creatinine.

"Although these findings represent good news for DM1 patients, further research is necessary specifically in DM1 patients to prevent and treat cardiovascular events," the authors write.

One author disclosed ties to the life science industry.

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In the United States, the COVID-19 pandemic was associated with increased odds of leaving the emergency department before medically advised (BMA), according to a study published in the April issue of the American Journal of Emergency Medicine.

Yahya Alnashri, M.D., M.P.H., from Prince Sattam bin Abdulaziz University in Al-Kharj, Saudi Arabia, and colleagues conducted a cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey from 2016 to 2021 to examine factors associated with leaving BMA from emergency departments.

Overall, 5.9 million (0.8 percent) of 721.0 million emergency department visits resulted in leaving BMA. The researchers found that the odds of leaving BMA were increased in association with public or no insurance coverage (Medicare, Medicaid/CHIP/state-based, uninsured/self-pay: adjusted odds ratios, 1.74, 1.86, and 1.51, respectively), alcohol or substance use disorders (adjusted odds ratio, 2.19), arrival by ambulance (adjusted odds ratio, 1.68), and being male (adjusted odds ratio, 1.32). Lower odds of leaving BMA were seen in association with hospital admissions and trauma or overdose-related visits (adjusted odds ratios, 0.11 and 0.54, respectively). Significantly increased odds of leaving BMA were seen in association with the COVID-19 pandemic (adjusted odds ratio, 1.44), with an overall increase of 53.6 percent in BMA-related emergency department visits post-March 2020 versus previous years.

"These findings highlight the need for targeted interventions to improve patient-provider communication and ED triage efficiency, especially in resource-constrained facilities serving lower-income individuals," the authors write.

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Postpandemic hospital occupancy is higher than prepandemic and is expected to continue increasing without changes in the hospitalization rate or staffed hospital bed supply, according to a research letter published online Feb. 19 in JAMA Network Open.

Richard K. Leuchter, M.D., from the David Geffen School of Medicine at UCLA in Los Angeles, and colleagues repurposed the COVID-19 dashboard to describe several possible U.S. hospital bed occupancy scenarios arising from an aging population over the next decade.

The researchers found that the mean U.S. hospital occupancy was 63.9 percent from 2009 to 2019 compared with 75.3 percent in May 2023 to April 2024, the year following the end of the COVID-19 public health emergency (PHE). There was a decline seen in the number of staffed hospital beds, from a prepandemic steady state of 802,000 to a post-PHE steady state of 674,000; the mean daily census steady state remained at about 510,000. Substantial state-to-state variation was seen in the post-PHE hospital occupancy steady state. With the aging population, total annual hospitalizations were projected to increase from 36,174,000 in 2025 to 40,177,000 in 2035 without changes in the hospitalization rate or staffed hospital bed supply, corresponding to a national hospital occupancy of about 85 percent by 2032 and by 2035 for adult beds and adult and pediatric beds combined, respectively.

"Experts in developed countries have posited that a national hospital occupancy of 85 percent constitutes a hospital bed shortage (a conservative estimate); our findings show that the U.S. could reach this dangerous threshold as soon as 2032, with some states at much higher risk than others," the authors write.

One author serves on the board of directors of M3 Inc.

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New York Attorney General Letitia James filed a major lawsuit yesterday, accusing 13 e-cigarette companies of illegally selling flavored vapes and targeting young kids through deceptive marketing.

The 192-page complaint claims the companies -- Puff Bar, Evo Brands, PVG2, Demand Vape, Magellan, Happy Distro, Midwest Goods, Pod Juice, Safa Goods, Mi-One, Mylé, MVH I and Price Point -- violated New York's ban on flavored vapes, which studies show are preferred by young users, The Washington Post reported.

“The vaping industry is taking a page out of Big Tobacco’s playbook: they’re making nicotine seem cool, getting kids hooked, and creating a massive public health crisis in the process,” James said in a statement.

“For too long, these companies have disregarded our laws in order to profit off of our young people,” she added.

The lawsuit seeks hundreds of millions of dollars in penalties and restitution for the companies’ public health impact. This includes fines for violating federal and state laws, recovery of revenue from illegal vape sales and the creation of a fund to address the youth vaping crisis in New York.

The attorney general’s office describes these penalties as a “conservative estimate,” given the widespread impact of youth vaping.

The lawsuit claims companies marketed flavors like “Strawberry Donut” and “Tropical Rainbow Blast” using bright packaging and social media influencers to appeal to teens.

One example cited was a Puff Bar ad during COVID-19 lockdowns, promoting vapes as “the perfect escape from back-to-back zoom calls [and] parental texts," The Post reported.

The complaint also alleges that companies have used illegal shipping methods to supply retailers and that many retailers are concentrated around public middle and high schools.

The Vapor Technology Association, a trade group, dismissed the lawsuit’s claims as “false.”

“The facts are that since President Donald Trump raised the age to buy all tobacco products in 2019, youth vaping has dropped to the lowest level in over a decade,” Tony Abboud, the association's executive director, said.

"This suit is the latest example of why President Trump needs to take bold and decisive action to end the government law-fare against the flavored vaping industry,” Abboud added.

Despite the decline, e-cigarettes remain the most commonly used tobacco product among U.S. middle and high school students, according to the U.S. Centers for Disease Control and Prevention (CDC).

In 2024, 1.6 million students (6%) reported e-cigarette use. What's more, 87.6% of those used flavored e-cigarettes.

But, a federal survey released last fall found youth e-cigarette use has decreased nearly 70% since its peak in 2019.

Anti-tobacco advocates warn that nicotine exposure harms developing brains and can lead to addiction, often alongside traditional cigarette use.

“At every turn, each Defendant’s New York-touching commercial conduct in the Flavored E-Cigarette industry undercuts New York’s efforts and law -- which must be now enforced to protect the public,” the lawsuit says.

“By first dodging all of New York’s regulatory safeguards, then making these products as cheap as possible and as abundantly available as possible in our communities, each Defendant cashes in without regard to the lasting harm they cause,” the complaint says.

More information

Johns Hopkins Medicine has more on the dangers of vaping.

SOURCES: The Washington Post, media report, Feb. 20, 2025; Office of the New York State Attorney General, news release, Feb. 20, 2025; U.S. Centers for Disease Control and Prevention, Oct. 17, 2024

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For patients with previously untreated chronic lymphocytic leukemia (CLL), fixed-duration acalabrutinib-venetoclax with or without obinutuzumab significantly prolongs progression-free survival compared with chemoimmunotherapy, according to a study published online Feb. 5 in the New England Journal of Medicine.

Jennifer R. Brown, M.D., from Dana-Farber Cancer Institute in Boston, and colleagues conducted a phase 3, open-label trial involving patients with CLL aged 18 years or older with an Eastern Cooperative Oncology Group performance-status score of 0 to 2, who did not have a 17p deletion or TP53 mutation. Patients were randomly assigned to receive acalabrutinib-venetoclax, acalabrutinib-venetoclax-obinutuzumab, or chemoimmunotherapy with the investigator's choice of fludarabine-cyclophosphamide-rituximab or bendamustine-rituximab (291, 286, and 290 [143 and 147], respectively).

The researchers found that at a median follow-up of 40.8 months, the estimated 36-month progression-free survival was 76.5, 83.1, and 66.5 percent with acalabrutinib-venetoclax, acalabrutinib-venetoclax-obinutuzumab, and chemoimmunotherapy, respectively (hazard ratio for disease progression or death, 0.65 [P = 0.004], for acalabrutinib-venetoclax versus chemoimmunotherapy; P < 0.001 for acalabrutinib-venetoclax-obinutuzumab versus chemoimmunotherapy). The estimated 36-month overall survival was 94.1, 87.7, and 85.9 percent with acalabrutinib-venetoclax, acalabrutinib-venetoclax-obinutuzumab, and chemoimmunotherapy, respectively. The most common adverse event of clinical interest of grade 3 or higher was neutropenia, which was reported in 32.3, 46.1, and 43.2 percent in the three groups, respectively. Ten, 25, and 21 patients died from COVID-19 in the three groups, respectively.

"Continued follow-up will be essential to clarify which patients would be most suitable for acalabrutinib-venetoclax and which for acalabrutinib-venetoclax-obinutuzumab," the authors write.

Several authors disclosed ties to the biopharmaceutical industry, including AstraZeneca, which funded the study.

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The Trump administration changed course on Tuesday, deciding to keep the government's free COVID test program running, just minutes before the website, COVIDtests.gov, was set to shut down.

Earlier that day, The Washington Post reported that officials were preparing to end the program and possibly destroy tens of millions of unused tests worth more than a half-billion dollars.

But 12 minutes before the shutdown, Andrew Nixon, a spokesman for the Department of Health and Human Services (HHS), announced the site would remain active.

“With COVID-19 infections decreasing after a winter peak, we are in the process of regular discussions on closing this round of the COVID-19 test ordering program. At this point, the program is still open, and we will share additional updates as needed,” he said in a statement.

Internal documents showed that HHS officials had been debating two options: Disposing of more than 160 million COVID tests, or continuing to ship them to U.S. households. The stockpile is maintained by the Administration for Strategic Preparedness and Response (ASPR).

Only a small fraction of the tests had expired, and tens of thousands were still being ordered daily, Dawn O’Connell, an ASPR chief under the Biden administration, told The Post.

“It’s expensive to stockpile these tests,” she said. “Destruction costs a significant amount of money, but hanging on to them costs a significant amount of money.”

The reversal followed concerns from public health experts about losing a valuable tool during flu season and future COVID surges.

In his first days back in office, President Donald Trump rescinded many of former President Joe Biden’s COVID-related executive orders, including one aimed at expanding national testing strategy.

“The virus is not posing a major public health threat now,” said Dr. Ashish Jha, who led the White House COVID response from March 2022 to April 2023 under Biden.

Jha, now the dean of Brown University School of Public Health, told The Post that trashing the tests “feels like an act of self-destruction here. It’s going to be expensive. And it takes away a tool that the administration would want to use in the scenario that we get a highly immune-evasive variant."

While COVID cases have decreased after the winter peak, experts warn that free testing remains critical to control infection.

“Destroying an asset that was paid for by the American people, that doesn’t make any sense,” said Dr. Tom Inglesby, who was White House national coordinator for COVID testing from the end of 2021 to April 2022. He's now the director of the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.

In the event of a resurgence, “we need to be able to figure out who is sick, who is not sick, who needs medicine, who is, in fact, contagious, who may be someone who’s vulnerable," Inglesby told The Post. "These diagnostics really help you make really good decisions, help families make good decisions about how to stay healthy.”

ASPR has distributed more than 2 billion free tests since January 2020, including 900 million sent directly to households through COVIDtests.gov, in partnership with the U.S. Postal Service.

The program has been paused and restarted many times, including seven shutdowns since its launch.

Most recently, it was paused in March 2024 and reopened in September right before the winter respiratory illness season.

More information

The U.S. Food and Drug Administration has more on at-home over-the-counter COVID tests.

SOURCE: The Washington Post, media report, Feb. 18, 2025

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President Donald Trump signed an executive order withholding funding from schools and universities that require students to be vaccinated against COVID.

The move is part of Trump's larger efforts to roll back vaccine mandates, despite studies showing that they help increase vaccination rates and reduce COVID deaths, according to a report from The New York Times.

The impact of the Feb. 14 order is unclear, as no states require K-12 students to get the COVID vaccine.

The advocacy group No College Mandates noted that only 15 colleges still required students to be vaccinated as of late last year.

But Trump's order aligns with a larger anti-vaccine sentiment:

• 21 states have already banned COVID vaccine mandates for students.

• Some Republican lawmakers are pushing for broader bans, including a Montana proposal to block mRNA vaccines and an Idaho ban on local health departments offering any COVID vaccines.

The U.S. Centers for Disease Control and Prevention (CDC) maintains that COVID vaccines are safe for children -- and while young people are less likely to suffer severe illness, the virus has still harmed many kids.

Research shows that vaccine rules in schools helped more students get vaccinated and may have slowed the spread of COVID.

But some studies have also found that these rules made some people less trusting of public health guidelines, turning the issue into a political debate instead.

Trump’s latest executive order represents a shift from his first term, when his administration led the rapid development of COVID vaccines.

Those early vaccine rollouts saved an estimated 140,000 lives, The Times reported.

The new policy follows Trump's recent move to reinstate more 8,000 troops who were discharged from the military for refusing the COVID vaccine.

The order only applies to COVID vaccines, leaving state-level requirements for measles, mumps, polio, and other childhood vaccines in place.

States still allow vaccine exemptions for medical, religious or personal reasons.

It’s unclear whether the order will affect medical schools, some of which require COVID vaccinations for students.

More information

The U.S. Centers for Disease Control and Prevention has more on staying up to date with COVID vaccines.

SOURCE: The New York Times, media report, Feb. 14, 2025

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There was a notable decrease in common ophthalmic procedures among Medicare beneficiaries during the first year of the COVID-19 pandemic, according to a study published online Feb. 6 in JAMA Ophthalmology.

Raziyeh Mahmoudzadeh, M.D., from the Virginia Commonwealth University in Richmond, and colleagues estimated changes in the rates of the 10 most prevalent ophthalmic procedures among Medicare beneficiaries during the COVID-19 pandemic in a retrospective U.S. cross-sectional study. The analyses included 3,879,533 procedure entries in 2019 and 3,181,439 entries in 2020.

The researchers found that from 2019 to 2020, there was a −17.9 percent overall decrease in the rates of the 10 ophthalmic procedures. The largest reduction was seen for laser peripheral iridotomy, while the smallest decrease was seen for eye drug injections (−43.6 and −1.5 percent, respectively). There was a reduction of −23.0 percent in cataract surgery. Regionally, the greatest reductions in cataract surgery occurred in the Northeast (−27.9 percent).

"Our results demonstrated an overall decrease of 17.9 percent in the rates of the 10 most prevalent ophthalmic procedures during the pandemic," the authors write. "This reduction appears less substantial compared with other fields of medicine, like ear nose and throat, where up to 98 percent reduction in volume of surgical procedures was reported."

One author disclosed financial ties to Regeneron, Astellas, Apellis, and Allergan.

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A federal judge has ordered the U.S. Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) to restore access to public health websites that were removed or modified in response to a Trump administration executive order on gender.

The order, issued Feb. 11 by U.S. District Judge John Bates, grants a temporary restraining order requested by Doctors for America, a nonprofit group that sued the administration over the website removals.

The affected sites, some of which have been online for decades, contain public health information on HIV prevention, youth health risks, fertility treatments and more.

The ruling states that the two health agencies removed the sites without explanation and likely violated federal law.

“By removing long relied upon medical resources without explanation, it is likely that … each agency failed to ‘examine the relevant data and articulate a satisfactory explanation for its action,’” Bates wrote.

He ordered the CDC and FDA to restore access by the day's end Tuesday, a process that staff members were scrambling to complete.

“It was a double waste for us because we took them offline, put some of them back, edited others and now are putting it back again,” a federal health official who wanted to remain anonymous told The Washington Post.

The removed sites included:

• The CDC's guidelines for HIV and PrEP, a medication that reduces the risk of contracting AIDS.

• The CDC's Social Vulnerability Index -- which was key to identifying high-risk hot spots during COVID.

• FDA databases that track diversity in clinical trials.

• The National Assisted Reproductive Technologies Surveillance System, which monitors fertility treatment success rates.

• Information on youth health risks.

Some researchers also reported that scientific studies on racial health disparities were removed, The Washington Post reported.

Lucia Leone, an associate professor of community health and health behavior at the University of Buffalo, said in a social media post that a 2017 study she co-authored on food access in low-income communities was taken down, likely because it contained the word “diverse."

Physicians and researchers were alarmed about the removals.

“Restoring access to this vital data is welcome news, if it happens," Dr. Steven Woolf, director emeritus and professor of family medicine and population health at Virginia Commonwealth University, told The Washington Post. “But this list doesn’t cover everything that has gone missing.”

Some doctors who treat HIV patients said they were already struggling without the CDC’s HIV and PrEP guidelines.

“We recently had an outbreak of chlamydia at the high school where I work and are actively meeting with school leadership to address increasing our efforts around STI testing and prevention,” Dr. Stephanie Liou, who screens students for sexually transmitted infections and prescribes PrEP, said in a court declaration. “Without these crucial CDC resources, I am not able to do my job to help address this urgent situation that is affecting our youth.”

Dr. Reshma Ramachandran, assistant professor at the Yale School of Medicine, said the CDC’s contraceptive guidance for providers was also removed, The Washington Post reported.

“I take care of female patients of reproductive age, many of whom have other medical conditions making it imperative to select the appropriate contraceptive that would not interfere with their existing comorbidities and other medications,” Ramachandran explained.

The lawsuit argues that the CDC and FDA violated federal law by failing to follow correct procedures for removing public information.

The Justice Department, defending the Trump administration, claimed Doctors for America lacked legal standing to challenge the actions. It said the sites could still be accessed through an online archive called the Wayback Machine, The Washington Post reported.

“The doctors just prefer not to search," Justice Department attorney James Harlow argued in a legal filing. "But one’s ‘desire’ for information from a preferred government source and in a preferred format does not establish informational injury when the content is otherwise obtainable.”

Bates' 21-page opinion rejected that argument, ruling that the health agencies’ actions would harm “everyday Americans, and most acutely, underprivileged Americans, seeking health care."

“If those doctors cannot provide these individuals the care they need (and deserve) within the scheduled and often limited time frame, there is a chance that some individuals will not receive treatment, including for severe, life-threatening conditions,” Bates wrote.

More information

Read the full memorandum opinion here.

SOURCES: The Washington Post, media report, Feb. 11, 2025; Memorandum opinion, Doctors for America v. Office of Personnel Management et al., Feb. 11, 2025

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Post-COVID condition (PCC) continues to affect children, and 80 percent of those currently experiencing PCC have activity limitation, according to a research letter published online Feb. 3 in JAMA Pediatrics.

Nicole D. Ford, Ph.D., M.P.H., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues used data from the 2023 National Health Interview Survey to estimate the prevalence of ever and current PCC in U.S. children aged 0 to 17 years and activity limitations among children currently experiencing PCC.

The analytic sample included 7,585 unweighted and 71,027,000 weighted children. The researchers found that about 1.4 percent of children had ever experienced PCC and an estimated 0.4 percent were currently experiencing PCC at the time of interview in 2023. The prevalence of ever and currently experiencing PCC increased with older age (2.3 and 0.8 percent at age 12 to 17 years). With decreasing family income, the prevalence of ever experiencing PCC increased (<100 percent income-to-poverty ratio, 2.6 percent). Compared with non-Hispanic Black children and children from another or multiple races, the prevalence of ever experiencing PCC was higher among Hispanic and non-Hispanic White children. There was variation in the prevalence of ever experiencing PCC by health insurance. Eighty percent of children currently experiencing PCC had any activity limitation compared with the period before they had COVID-19.

"The large proportion of children experiencing PCC with any activity limitation highlights the need to examine the severity of activity limitation, functional outcomes, and days lost from school," the authors write.

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From 2011 to 2023, there was an increase in early adult mortality in the United States, with further acceleration seen during the COVID-19 pandemic, according to a research letter published online Jan. 31 in JAMA Network Open.

Elizabeth Wrigley-Field, Ph.D., from the University of Minnesota in Minneapolis, and colleagues calculated monthly mortality rates using cause-specific death counts for adults aged 25 to 44 years between 1999 and 2023.

The study analyzed 3,392,364 deaths among the full U.S. population aged 25 to 44 years from 1999 to 2023. Compared with extrapolations of pre-2011 trends, mortality increases across most causes of death produced substantial excess deaths. In 2019, early adult excess mortality was 34.6 percent higher than expected, with further acceleration during the COVID-19 pandemic. All-cause excess mortality was nearly three times higher in 2021 than 2019 (116.2 versus 41.7 deaths per 100,000 population). Excess mortality decreased in 2023 to approximately midway between 2019 and 2021 levels (79.1 deaths per 100,000 population). In 2023, early adult mortality was 70.0 percent higher than it would have been had pre-2011 trends continued, with 71,124 excess deaths. In 2023, drug poisoning, residual natural cause category, transport-related deaths, alcohol-related deaths, and homicide accounted for almost three-quarters of early adult excess mortality (31.8, 16.0, 14.1, 8.5, and 8.2 percent, respectively).

"Increases in early adult mortality can signal population risks that may become more pronounced as these cohorts age. These results suggest the possibility of a worsening mortality crisis unless these trends are reversed," the authors write.

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with more rapid progression of coronary artery lesion-based plaque volume, according to a study published online Feb. 4 in Radiology.

Neng Dai, M.D., from Fudan University in Shanghai, and colleagues examined the impact of SARS-CoV-2 infection on coronary inflammation and plaques using coronary computed tomography angiography. Lesions of patients with and without SARS-CoV-2 infection were compared in terms of the quantitative total and compositional percent atheroma volume (PAV) and annualized PAV change, presence of high-risk plaque, and attenuation of lesion-specific pericoronary adipose tissue (PCAT) at baseline and follow-up.

Data were included for 2,108 coronary artery lesions in 690 patients with SARS-CoV-2 infection and 480 lesions in 113 patients without SARS-CoV-2 infection. The researchers found that lesions in patients with SARS-CoV-2 infection demonstrated more rapid progression of overall PAV (0.90 versus 0.62 percent per year) and noncalcified PAV (0.78 versus 0.42 percent per year) compared with lesions in patients without SARS-CoV-2 infection. Despite similar prevalence at baseline, lesions in patients with SARS-CoV-2 infection had a higher incidence of becoming high-risk plaque (21.0 versus 15.8 percent) and higher incidence of PCAT attenuation of –70.1 Hounsfield units or higher (27.1 versus 19.8 percent). A higher risk for target lesion failure was seen in lesions in patients with COVID-19 (10.4 versus 3.1 percent; adjusted hazard ratio, 2.90).

"Our findings suggest that SARS-CoV-2 infection may exacerbate cardiovascular risk by accelerating the advancement of susceptible plaque types and coronary inflammation, thus offering a potential mechanistic rationale for the link between prior SARS-CoV-2 infection and adverse clinical events," the authors write.

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When it comes to the potential of H5N1 avian flu, otherwise known as bird flu, picking up mutations that might lead to human-to-human spread, that "train has already left the station," warns one infectious disease expert.

If and when bird flu -- already widespread in cattle, cats and other mammals -- gains the ability to transmit between people, the best Americans can hope for is to "control the speed of the train" with vaccines, masks and treatment, said Dr. Peter Chin-Hong. He's a professor of medicine at the University of San Francisco.

Speaking with HealthDay, Chin-Hong stressed that both rapid surveillance and reporting on any new cases of H5N1 that arise are crucial. So the recent silencing of communications from the U.S. Centers for Disease Control and Prevention (CDC) by the Trump administration is worrisome.

"It's not that people won't get the information eventually if it's serious, it's the rapidity of information that I'm worried about," Chin-Hong said.

He compared the recent CDC gag order to a dysfunctional smoke alarm.

"You hope the fire isn't going to come, but if it comes, there will be a delay before you feel it," Chin-Hong said. "Time means lives when we're talking about infectious diseases that really don't know any borders."

As the UCSF expert explained, the current strain of bird flu has been circulating through avian species for about 30 years. It has only occasionally infected people -- usually those who've had extended close contact with birds, such as poultry farm workers.

However, viruses are built to mutate and find new hosts.

That's what's been happening with alarming rapidity in recent years, with more cases of mammals -- such as seals, cattle, cats, dogs and pigs -- coming down with bird flu.

Just one mutation

Over the past year, especially, there's been an uptick of cases among American people, including the recent death of an already frail patient in Louisiana.

In most human cases, H5N1 was thought to have been contracted from close contact with an infected animal.

Unfortunately, human-to-human transmission may only require a few new genetic tweaks by the virus, Chin-Hong warned.

"I think the length of the road before [we see] a mutation that allows easier entry into our lungs is much shorter than people think," he said.

One recent study "looked at the amount of mutations needed before that can occur, and it was very, very short, just one mutation," Chin-Hong noted. "[That] doesn't mean that this mutation will be picked up, but what it means to me is that it's not that far away."

He explained that H5N1 can also interact with "regular" seasonal flu viruses.

"We have a lot of influenza going around and influenza is engineered to really swap genes with each other and they can pick up tricks," Chin-Hong told HealthDay. "And some of those tricks include getting the combination to enter our bodies, which it is not so great at doing right now."

In the relatively few U.S. cases of human bird flu so far recorded, symptoms have typically been mild -- congestion, pink eye and other transitory effects. But if H5N1 mutated so that it could pass easily between people, "all of this may change," Chin-Hong said.

"You might get 'inside' disease, and that includes shortness of breath and you may have other organ involvement," he said.

Vaccines, masks, treatments

Chin-Hong stressed that societies are in a better position to fight mutated H1N1 than they were with COVID-19.

"We're in a very different place from the early days of COVID because we have a test, we have vaccines," he said.

The United States currently has a stockpile of 4.5 million H5N1 vaccines, based on older mutations.

"I think that the stockpiled vaccines would mitigate the effects probably by preventing serious disease, hospitalization and death," Chin-Hong said.

But 4.5 million vaccines would run out very quickly, especially when two doses might be needed to protect each recipient.

"It's a good start and it will be a good way to protect probably frontline workers in the event that we need to," Chin-Hong said, but production of any vaccine would need to be scaled up enormously in a potentially short period of time.

Other forms of prevention would be key, too, such as handwashing and widespread use of N95 masks, he said.

A handful of influenza treatments appear to be somewhat effective against H5N1, including oseltamivir (Tamiflu). "We may also need to stockpile more Tamiflu," Chin-Hong said.

A hobbled CDC and FDA

Key to all of this will be a coordinated effort by key government players, however.

Central to that effort is the CDC, which at the present moment seems hamstrung, Chin-Hong said.

"The CDC is generally the conductor of the orchestra" when it comes to safeguarding public health, he said. "And right now, different parts of the orchestra are playing their own music. And, you know, I think that's that's what we suffered from in the early days of COVID, too."

The potential appointment of anti-vaccine activist Robert F. Kennedy Jr. to head the Department of Health and Human Services (which oversees both the CDC and the Food and Drug Administration) also has Chin-Hong "worried."

"I'm concerned about, you know, any barriers at the FDA level" when it comes to areas such as vaccine research and distribution, he said.

"I know that humans are resourceful and will come up with the science, but the devil is always in the details, and implementing the science is often even more important than the science itself," Chin-Hong concluded.

More information

Find out more about H5N1 avian flu at the World Health Organization.

SOURCE: HealthDay interview, Peter Chin-Hong, MD, professor of medicine, University of California San Francisco

Copyright © 2020 HealthDay. All rights reserved.

From 2020 to 2021, there was a 34 percent increase in firearm-related hospitalizations, according to a research letter published online Jan. 27 in JAMA Network Open.

Raymond A. Jean, M.D., from the University of Michigan in Ann Arbor, and colleagues examined trends in firearm-related hospitalization rates. The analysis included data from the Healthcare Cost and Utilization Project National Inpatient Sample (2015 to 2021).

The researchers identified 159,215 weighted hospitalizations for firearm-related injury during the study period. There was a steady decline in discharges from 2015 to 2019 that was forecasted to continue by the seasonal autoregressive integrated moving average model. From 2020 to 2021, models estimated 39,212 hospitalizations, but the actual observed number was 52,480 (observed-to-expected ratio, 1.34). There were disproportionate increases in hospitalizations among patients younger than 18 years (observed-to-expected ratio, 1.44), Medicaid-enrolled patients (observed-to-expected ratio, 1.46), and Black patients (observed-to-expected ratio, 1.41) compared with historical trends. 

"While attention has been given to the impact of the initial COVID-19 lockdown on admissions for acute medical conditions, the pandemic's overall effect on trauma-related conditions is much less clear," the authors write. "Despite these limitations, these results confirm a pervasive and troubling phenomenon and suggest the need for urgent policy efforts to mitigate gun harm."

Abstract/Full Text

Copyright © 2020 HealthDay. All rights reserved.

As a bird flu outbreak escalates across the U.S., the Trump administration has paused the release of key public health studies, stalling research that could provide insight into how the virus spreads to animals and people.

The blocked studies were supposed to be published in the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR), a respected journal that has reported on health threats since 1952.

One of the studies examines whether veterinarians working with cattle have unknowingly been infected, and another explores whether people may have passed the virus to pet cats, according to CNN.

These reports could help scientists track and prevent future infections.

But a new memo from the Department of Health and Human Services (HHS) has placed an “immediate pause” on communications. Approval is now required from a presidential appointee before publishing, according to the memo.

“This idea that science cannot continue until there’s a political lens over it is unprecedented,” Dr. Anne Schuchat, a former principal deputy director at the CDC, told CNN. “I hope it’s going to be very short-lived, but if it’s not short-lived, it’s censorship.”

Public health experts warn that delaying research on bird flu could put veterinarians, farmworkers and the public at greater risk.

One study, slated to be published last week in the MMWR, looked at cases in Michigan where dairy workers may have transmitted bird flu to their pet cats.

Dr. Jennifer Morse, medical director at the Mid-Michigan District Health Department and a scientist on the pending study, told CNN she got a note from a colleague last week saying that “there are delays in our publication — outside of our control.”

And this isn't the first time the government has disrupted CDC reports.

During President Donald Trump's first term, CNN noted, White House officials interfered with scientific studies on COVID-19.

“What’s happening now is quite different than what we experienced in covid, because there wasn’t a stop in the MMWR and other scientific manuscripts,” Schuchat told CNN.

CDC insiders say the pause will last until at least Feb. 6, though it’s unclear if publishing will resume as scheduled.

The bird flu has infected at least 67 people in the U.S., and claimed the life of one person in Louisiana earlier this year.

It's affected more than 148 million birds and heightened concern about human transmission.

“Maintaining open lines of communication and continuing research with our federal partners is critical as we fight this outbreak.” Dr. Fred Gingrich, executive director of the American Association of Bovine Practitioners, a group for veterinarians specializing in cattle medicine, told CNN.

Schuchat hopes efforts to spin or influence scientific reports won’t happen again.

“The MMWR cannot become a political instrument,” she concluded in a report published by CNN.

More information

The U.S. Centers for Disease Control and Prevention has more on the current situation of bird flu.

SOURCE: CNN, media report, Jan. 30, 2025; U.S. Centers for Disease Control and Prevention

Copyright © 2020 HealthDay. All rights reserved.