How can we prevent the spread of SARS-CoV-2 in children?

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. Visit our coronavirus hub and follow our live updates page for the most recent information on the COVID-19 pandemic.

The rise in cases of COVID-19 among children in the U.S. is primarily linked to the Delta variant. Cases are rising especially quickly in communities with low rates of COVID-19 vaccinations.

Although the Centers for Disease Control and Prevention (CDC)Trusted Source recommend universal indoor masking and physical distancing in schools, mask-wearing is optional in North Dakota and Ohio.

Rapidly increasing infection rates among children and teachers have forced many schools in the U.S. to halt in-person learning and turn to hybrid models of education. This comes despite 175 pediatric disease experts agreeing earlier this year that elementary schools could open full-time for in-person instruction.

Although children generally have milder COVID-19 symptomsTrusted Source than adults, the fact that few studies have investigated how the disease affects children means that many questions remain unanswered. For example, why are so many children being hospitalized with COVID-19? Which children are most at risk? And what can parents and authorities do so that children can return to school safely?

To answer these questions and more, Medical News Today spoke with seven doctors and researchers who specialize in pediatrics and infectious diseases and have worked directly with children with COVID-19.

Why are COVID-19 hospitalizations among children increasing?
The Delta variant of COVID-19 is more than two timesTrusted Source as contagious as previous variants. Alongside school reopenings, this may partially explain the increase in pediatric hospitalizations due to COVID-19.

“The Delta variant that is circulating widely is more contagious, and children are getting infected more often than previously during the pandemic,” Michael L. Chang, M.D., director of pediatric antimicrobial stewardship for McGovern Medical School and Children’s Memorial Hermann Hospital in Texas, told MNT. “Also, across the country, mitigation measures such as masks, reduced occupancy indoors, physical distancing, etc., all ended around the same time.”

“Now, you have a more contagious variant with fewer mitigation measures in place. With the rising number of cases, unfortunately, you will see more hospitalizations. As an example, if 2% of children need hospitalization, then it’s a big difference between 2% of 10,000 cases vs. 2% of 100,000 cases,” he added.

Another reason for rising COVID-19 hospitalizations among children may be that those under the age of 12 years cannot get the vaccination yet.

“Vaccines remain effective at preventing severe illness, hospitalization, and death from [SARS-CoV-2] infection, even Delta strain infection,” Kristin Moffitt, M.D., an infectious disease expert at Boston Children’s Hospital, MA, told MNT. “This is consistent with reports that the overwhelming majority of hospitalizations and deaths during the recent surge are occurring in unvaccinated individuals.”

“Since children under 12 aren’t yet able to be vaccinated, and many adolescents and young adults remain unvaccinated relative to older individuals, this age group is making up a bigger proportion of those at risk for severe illness based on their unvaccinated status,” she added.

Dr. Karen Ravin, M.D., chief of infectious diseases at Nemours Children’s Hospital in Delaware, agreed. “Children under 12 years of age make up a substantial proportion of the unvaccinated population in the U.S., so they are the population at highest risk,” she said. “Early in the pandemic, schools were closed, and children had a lower risk of exposure in the community. Contrast this to now, schools are open for in-person instruction […] so children are at greater risk for being exposed, becoming infected, and, unfortunately, being hospitalized.”

“Early in the pandemic, those over 65 accounted for more severe disease and hospitalization. Now that this age group has a higher percentage of vaccinated persons, the disease burden will be seen in the younger, unvaccinated population,” noted Dr. Adriana Cadilla, an infectious diseases pediatric specialist at Nemours Children’s Hospital in Orlando, FL. “[In Florida,] there has been over a four-fold increase in child [SARS-CoV-2] infections in the past month,” Dr. Cadilla added.

Gut bacteria influence brain development

Extremely premature infants are at a high risk for brain damage. Researchers have now found possible targets for the early treatment of such damage outside the brain: Bacteria in the gut of premature infants may play a key role. The research team found that the overgrowth of the gastrointestinal tract with the bacterium Klebsiella is associated with an increased presence of certain immune cells and the development of neurological damage in premature babies.

Complex interplay: the gut-immune-brain axis

The early development of the gut, the brain and the immune system are closely interrelated. Researchers refer to this as the gut-immune-brain axis. Bacteria in the gut cooperate with the immune system, which in turn monitors gut microbes and develops appropriate responses to them. In addition, the gut is in contact with the brain via the vagus nerve as well as via the immune system. “We investigated the role this axis plays in the brain development of extreme preterm infants,” says the first author of the study, David Seki. “The microorganisms of the gut microbiome — which is a vital collection of hundreds of species of bacteria, fungi, viruses and other microbes — are in equilibrium in healthy people. However, especially in premature babies, whose immune system and microbiome have not been able to develop fully, shifts are quite likely to occur. These shifts may result in negative effects on the brain,” explains the microbiologist and immunologist.

Patterns in the microbiome provide clues to brain damage

“In fact, we have been able to identify certain patterns in the microbiome and immune response that are clearly linked to the progression and severity of brain injury,” adds David Berry, microbiologist and head of the research group at the Centre for Microbiology and Environmental Systems Science (CMESS) at the University of Vienna as well as Operational Director of the Joint Microbiome Facility of the Medical University of Vienna and University of Vienna. “Crucially, such patterns often show up prior to changes in the brain. This suggests a critical time window during which brain damage of extremely premature infants may be prevented from worsening or even avoided.”

Comprehensive study of the development of extremely premature infants

Starting points for the development of appropriate therapies are provided by the biomarkers that the interdisciplinary team was able to identify. “Our data show that excessive growth of the bacterium Klebsiella and the associated elevated ??-T-cell levels can apparently exacerbate brain damage,” explains Lukas Wisgrill, Neonatologist from the Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics at the Department of Pediatric and Adolescent Medicine at the Medical University of Vienna. “We were able to track down these patterns because, for a very specific group of newborns, for the first time we explored in detail how the gut microbiome, the immune system and the brain develop and how they interact in this process,” he adds. The study monitored a total of 60 premature infants, born before 28 weeks gestation and weighing less than 1 kilogram, for several weeks or even months. Using state-of-the-art methods — the team examined the microbiome using 16S rRNA gene sequencing, among other methods — the researchers analysed blood and stool samples, brain wave recordings (e.g. aEEG) and MRI images of the infants’ brains.

Research continues with two studies

The study, which is an inter-university clusterproject under the joint leadership by Angelika Berger (Medical University of Vienna) and David Berry (University of Vienna), is the starting point for a research project that will investigate the microbiome and its significance for the neurological development of prematurely born children even more thoroughly. In addition, the researchers will continue to follow the children of the initial study. “How the children’s motoric and cognitive skills develop only becomes apparent over several years,” explains Angelika Berger. “We aim to understand how this very early development of the gut-immune-brain axis plays out in the long term. ” The most important cooperation partners for the project are already on board: “The children’s parents have supported us in the study with great interest and openness,” says David Seki. “Ultimately, this is the only reason we were able to gain these important insights. We are very grateful for that.”

Can Lighter-Weight Mesh Cut Pain in Open Ventral Hernia Repair?

While offering similar clinical benefits at 1 year, a medium-weight polypropylene mesh was no better for pain control than a heavy-weight mesh in patients who underwent open retromuscular ventral hernia repair, a randomized multicenter trial showed.

In fact, for the more than 300 patients in the trial, the two meshes resulted in identical pain scores — on the NIH’s Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Short Form 3a — at 30 days and 1 year (46.3 and 30.7, respectively), reported David Krpata, MD, of the Cleveland Clinic Center for Abdominal Core Health in Ohio, and colleagues.

Median hernia-specific quality of life (HerQLes) scores did not significantly differ between the medium-weight and heavy-weight mesh groups at 30 days (43.3 vs 45.0 out of 100, respectively; P=0.58) and at 1 year (90.0 vs 86.7, P=0.41), the authors wrote in JAMA Surgery.

“Although we found the absence of any patient-perceived benefits favoring medium-weight mesh surprising, we still find it reassuring that heavy-weight mesh can be used in this context,” the researchers wrote.

“We have been told for years that mesh has been ‘over engineered’ and reducing the weight of the material would lead to improved outcomes and reduced pain over time,” Krpata told MedPage Today. “However, we just didn’t see that.”

“These results need to be taken in the clinical context in which they have been studied,” said Krpata. “Meaning that this addresses mesh weight for open ventral hernia repair where mesh is being placed outside of the abdominal cavity and under the muscle of the abdominal wall, as opposed to minimally invasive repairs with the mesh placed in the abdominal cavity.”

A wide variety of polypropylene mesh devices for hernia repair are marketed without optimal use indications, Krpata and colleagues explained. While the risk for hernia recurrence is reduced with heavy-weight meshes — which have a strength up to 10 times an abdominal wall — these meshes also carry long-term complications such as chronic pain.

“The mesh you are choosing and the selection is a deeply personal choice to the surgeon and patient,” said Michael Meara, MD, of the Ohio State University Wexner Medical Center in Columbus, who was not involved in this study.

“I think the biggest thing to note is that 1 year is a relatively short follow-up,” Meara told MedPage Today. “Longer-term studies will really provide more stable results.”

From March 2017 to April 2019, Krpata and colleagues randomized 350 patients who were undergoing open ventral hernia repair 1:1 to either the medium-weight (n=177) or heavy-weight mesh (n=173).

Patients were blinded to their mesh density, and were undergoing repairs involving surgical incision of 20 cm or less. The main outcome assessed pain using the PROMIS Pain Intensity Short Form 3a. HerQLes scores were generated from a patient survey. Medium-weight mesh density was defined as 40 to 60 g/m2 and heavy-weight mesh was over 75 g/m2.

Mean patient age was 59 and average body mass index (BMI) was 32; half of the participants were women, with baseline characteristics well-balanced between arms. Many of the patients were hypertensive and/or had diabetes, and more than half reported a history of recurrent hernias. Most patients had hernia repair incisions of nearly 15 cm wide. Myofascial advancement flaps were used for all patients.

“I’m selective based on my patient’s BMI,” said Meara. For those with a BMI of 32-35 or higher, a heavy-weight mesh would be preferable, he said. “I think like most studies, you don’t come out of this with an easy decision — both are reasonable and further study is needed.”

The analysis had limitations, the researchers acknowledged, and the results are generalizable to retromuscular mesh placement, but not intraperitoneal placement. Also, chronic pain syndromes were not evaluated.

Potential role of ‘junk DNA’ sequence in aging, cancer

The human body is essentially made up of trillions of living cells. It ages as its cells age, which happens when those cells eventually stop replicating and dividing. Scientists have long known that genes influence how cells age and how long humans live, but how that works exactly remains unclear. Findings from a new study led by researchers at Washington State University have solved a small piece of that puzzle, bringing scientists one step closer to solving the mystery of aging.

A research team headed by Jiyue Zhu, a professor in the College of Pharmacy and Pharmaceutical Sciences, recently identified a DNA region known as VNTR2-1 that appears to drive the activity of the telomerase gene, which has been shown to prevent aging in certain types of cells. The study was published in the journal Proceedings of the National Academy of Sciences (PNAS).

The telomerase gene controls the activity of the telomerase enzyme, which helps produce telomeres, the caps at the end of each strand of DNA that protect the chromosomes within our cells. In normal cells, the length of telomeres gets a little bit shorter every time cells duplicate their DNA before they divide. When telomeres get too short, cells can no longer reproduce, causing them to age and die. However, in certain cell types — including reproductive cells and cancer cells — the activity of the telomerase gene ensures that telomeres are reset to the same length when DNA is copied. This is essentially what restarts the aging clock in new offspring but is also the reason why cancer cells can continue to multiply and form tumors.

Knowing how the telomerase gene is regulated and activated and why it is only active in certain types of cells could someday be the key to understanding how humans age, as well as how to stop the spread of cancer. That is why Zhu has focused the past 20 years of his career as a scientist solely on the study of this gene.

Zhu said that his team’s latest finding that VNTR2-1 helps to drive the activity of the telomerase gene is especially notable because of the type of DNA sequence it represents.

“Almost 50% of our genome consists of repetitive DNA that does not code for protein,” Zhu said. “These DNA sequences tend to be considered as ‘junk DNA’ or dark matters in our genome, and they are difficult to study. Our study describes that one of those units actually has a function in that it enhances the activity of the telomerase gene.”

Their finding is based on a series of experiments that found that deleting the DNA sequence from cancer cells — both in a human cell line and in mice — caused telomeres to shorten, cells to age, and tumors to stop growing. Subsequently, they conducted a study that looked at the length of the sequence in DNA samples taken from Caucasian and African American centenarians and control participants in the Georgia Centenarian Study, a study that followed a group of people aged 100 or above between 1988 and 2008. The researchers found that the length of the sequence ranged from as short as 53 repeats — or copies — of the DNA to as long as 160 repeats.

“It varies a lot, and our study actually shows that the telomerase gene is more active in people with a longer sequence,” Zhu said.

Since very short sequences were found only in African American participants, they looked more closely at that group and found that there were relatively few centenarians with a short VNTR2-1 sequence as compared to control participants. However, Zhu said it was worth noting that having a shorter sequence does not necessarily mean your lifespan will be shorter, because it means the telomerase gene is less active and your telomere length may be shorter, which could make you less likely to develop cancer.

“Our findings are telling us that this VNTR2-1 sequence contributes to the genetic diversity of how we age and how we get cancer,” Zhu said. “We know that oncogenes — or cancer genes — and tumor suppressor genes don’t account for all the reasons why we get cancer. Our research shows that the picture is a lot more complicated than a mutation of an oncogene and makes a strong case for expanding our research to look more closely at this so-called junk DNA.”

Zhu noted that since African Americans have been in the United States for generations, many of them have Caucasian ancestors from whom they may have inherited some of this sequence. So as a next step, he and his team hope to be able to study the sequence in an African population.

In addition to Zhu, authors on the paper include co-first authors Tao Xu and De Cheng and others at Washington State University, as well as their collaborators at Northeast Forestry University in China; Pennsylvania State University; and North Carolina State University.

Funding for this study came from the National Institutes of Health’s National Institute of General Medical Sciences, the Melanoma Research Alliance, and the Health Sciences and Services Authority of Spokane County.

Plant-Based Diets Gain Steam, Major Companies Getting on Board

This is not a real surprise, given the growth in popularity of plant-based eating during the COVID-19 pandemic.

Plant-based food sales were up 27% in 2020, topping $7 billion, according to the Plant Based Foods Association.

“In 2020, 57% of all U.S. households purchased plant-based foods (that’s over 71 million households), up from 53% in 2019,” the association says.
The spike in popularity is largely due to weight issues many people had during lockdown, says Neal Barnard, MD, president of the Physicians Committee for Responsible Medicine and an adjunct professor at George Washington University School of Medicine.

“Many people gained weight during the pandemic,” he says.

They were stuck at home with the refrigerator or pantry nearby. For some, weight gain led to change.

“They were looking to get healthy. In addition, they had time to read and look at health information, which they might have been neglecting before,” Barnard says

Major companies are taking heed.

McDonald’s announced a new plant-based line in 2020. The first item being debuted is a plant-based burger called the McPlant. The company teamed up with Beyond Meat to make its plant-based patty, which the restaurant chain says will be cooked on a separate grill and with separate utensils from its meat-based products.

McDonald’s tested the McPlant in a limited number of restaurants in Sweden and Denmark beginning early this year. The company recently announced that the McPlant will be tested in select restaurants in the U.K. and Ireland starting at the end of September.

Vegan cheese and vegan sandwich sauce options will also be available, according to the company.

McDonald’s has not announced plans to test the McPlant in U.S. markets.

In August, Chipotle launched a limited-edition organic protein option, Plant-Based Chorizo, which is being tested in Denver and Indianapolis, confirms Stephanie Perdue, vice president of brand marketing at Chipotle.

“Plant-based lifestyles have continued to accelerate in popularity, so we see a massive opportunity to bring more vegetables to the center of the plate like we’re doing with Plant-Based Chorizo,” she says.

Taco Bell has been in the plant game for years. The company has over 30 vegetarian menu options. Its most recent plant-based venture is also a partnership with Beyond Meat.

“Taco Bell remains excited about teaming up with Beyond Meat to create a new, innovative plant-based protein, something not quite yet seen in the industry. Details on specific timing and market(s) to come,” Taco Bell says.

Major retailers are also jumping on board. In the spring, Target unveiled a plant-based line called Good & Gather Plant Based.

The line includes items like plant-based creamers and meat alternatives, with all items under $8 and most under $5.

Major grocery store chains, too, are showcasing not-meat alternatives. In many, including Kroger, Beyond Meat and Impossible Burger products are in the meat section, right next to ground beef, steaks and chicken.

And traditional meat producers are getting in on the game, as well. Hormel, Tyson, Smithfield and Perdue all have their own plant-based products, as the big firms look to capture both sides of the growing market.

Companies debuting plant-based products is a great trend, says Barnard.

“They’re doing it because there’s consumer demand, but from the health standpoint, it’s a good change,” he says.

“These products don’t have cholesterol, animal fat, hormones in them, which, say, cow’s milk does.”

How Plant-Based ‘Meat’ May Help You and Save the Environment

The explosion in the plant-based food market has many advocates hoping the plethora of new products will be part of a food revolution that aims to improve our health and save our planet.
Unless you’ve been living under a rock somewhere — or just quarantined for the pandemic — you’ve probably attempted to switch to a plant-based diet yourself or know someone who has.

Vegetarianism and veganism are wildly popular — one survey estimated the number of vegans increased 300% from 2004 to 2019 — and the diets and lifestyles are so much easier now with new plant-based products springing up all over the market.

In 2020, plant-based food sales were up 27%, with sales over $7 billion, according to the Plant Based Foods Association.

Impossible Foods, a company that produces plant-based meat alternatives, has thrived during the COVID-19 pandemic.

At the start of the crisis in 2020, the Impossible Burger was available in around 150 retail stores, according to Dennis Woodside, president of Impossible Foods.

“By the end of 2020, it was available in about 17,000 stores in all 50 states, a more than 100 times increase in 2020 alone,” he says.

Today, the Impossible Burger is sold in more than 22,000 restaurants and grocery stores, including major grocery chains like Kroger, Walmart, and Trader Joe’s, Woodside says.

Along with the health benefits that come with switching from animal meat to plant-based meat, people are also becoming more aware of the environmental benefits, he says.

“Animal agriculture is a leading contributor of greenhouse gas emissions globally,” Woodside says. “Our mission is to reduce the impact of climate change by skipping animals entirely and making the same meat, fish, and dairy products people love — from plants.”

Animal-based foods are responsible for 57% of the total global greenhouse gas emissions from agriculture, compared to just 29% for plant-based crops, according to a new report in Scientific American.

One way to reduce this impact is by creating plant-based meats that outshine animal meat in terms of taste, texture, and appearance, says Woodside.

His company has a goal to replace animal agriculture by 2035.

All Hands on Deck
The Eat-Lancet Commission on Food, Planet, Health brought together 37 scientists from 16 countries to study the best global diet to sustain our environment and feed close to 10 billion people by the year 2050.

Over 2 billion people around the world are overweight or obese, according to the commission. But at the same time, more than 820 million people are going hungry every day.

“Global consumption of fruits, vegetables, nuts and legumes will have to double,” the commission reported. “Consumption of foods such as red meat and sugar will have to be reduced by more than 50%.”

“A diet rich in plant-based foods and with fewer animal-source foods confers both improved health and environmental benefits.”

Food production plays a huge role in the destruction of the planet, the report states.

One way to fight this is to use more of our agricultural land to grow nutritious, plant-based foods instead of animal feed and livestock.

“The raising of animals is, first of all, very inefficient, so we take up a lot of land,” says John A. McDougall, MD, author of The Starch Solution and co-founder of the McDougall Program, a diet and lifestyle guide. “You can get 20 times as many calories from potatoes as you can from beef on the same acre of land.”

Knowing that your diet choices help protect our environment is one of the most exciting parts of going plant-based, says Sharon Palmer, an author and registered dietitian who specializes in plant-based nutrition and sustainability.

You can feel good about your place on the planet,” she says. “That your diet creates the lowest environmental footprint (carbon, water, pollution, land use) compared to other diet patterns, and doesn’t contribute to the suffering of animals.”

The fact that plant-based eating helps sustain the planet is not spoken out about enough, McDougall says.

“People who are intensively interested in climate change pretty much ignore the practical implications of the fact that changing the western diet to a vegan diet could be so beneficial,” he says.

McDougall says he approaches the climate crisis with the same attitude he has when helping patients heal their bodies through following a plant-based diet.

“My new patient is planet Earth,” he says. “Once we get the public, the world, switched to a plant-based diet that’s not so abusive to the planet, the planet will heal.”

“The time has come for all hands on deck.”

“All hands” also includes farmers. The American Farm Bureau, one of the country’s largest advocacy groups for the agricultural industry, has joined with environmental groups to form the Food and Agriculture Climate Alliance. Its goal is to influence climate policy while giving farmers and the agricultural industry a seat at the table.

The inclusion of the Farm Bureau in the effort will be watched closely by climate activists, as the organization for years has fought even the idea that humans are responsible for change in climate, according to Inside Climate News.

Communities of Color Go Plant-Based
Minorities have greatly embraced plant-based eating, with Blacks being the fastest-growing demographic becoming vegan, The Washington Post reported.

A 2020 Gallup poll also found that 31% of non-white Americans ate less meat, compared to 19% of white Americans, the previous year.

Next Stop Vegan is a plant-based restaurant that serves food with Latin flavors, including traditional Hispanic dishes, with locations in the Bronx and Washington Heights in New York City.

Blenlly Mena, founder and CEO, says she was inspired to open the restaurant to change the stigma surrounding vegan food, especially in minority communities.

“There are several misconceptions in our communities that include healthy food being inaccessible, boring, or bland,” she says.

“Black beans and brown rice can also make great burger patties, yes jackfruit can be delicious and a great addition to that next BBQ, and our typical Hispanic dishes, with only a few modifications, can be amazingly delicious,” she says.

Many customers say that transitioning to veganism completely transformed their lives, Mena says.

“We also welcome those that have their doubts and questions, because it’s an opportunity for us to educate them, and yes, why not blow their minds,” she says.

Making the Switch
Many people mistakenly think that going plant-based means you have to be an expert in the kitchen or spend money on pricey designer plant meats, says Palmer, the author and dietitian.

“It can be so easy,” she says. “Canned beans, peanut butter, simmered lentils, brown rice, oatmeal, seasonal fruit, tons of veggies (frozen, canned, fresh).”

Another major reason people struggle, or quit, after trying a plant-based diet is not being prepared, says Palmer.

“You can’t just all of the sudden eat plant-based without some preparation, such as stocking your pantry and fridge regularly, knowing what your go-to foods will be, understanding what dishes and meals you will rely on, and where you can find products in your community,” she says.

McDougall promotes a diet of mostly starches, like potatoes, rice, and beans, along with vegetables, fruits, healthy fats in moderation, and no animal products or added oils.

Human beings are “starchivores,” he says.

“Most people who ever walked this earth consumed a diet based on starches. Mayans and Aztecs in Central America were known as ‘people of the corn.’ Incas in South America ate potatoes.”

Asian civilization was shaped around cultivating the crop we know today as rice, according to a study in Nature.

Neal Barnard, MD, president of the Physicians Committee for Responsible Medicine and an adjunct faculty member at George Washington University School of Medicine, runs the Barnard Medical Center, a primary care clinic in Washington, DC.

He says he always recommends a vegan diet to patients, especially those who have serious health conditions like obesity, diabetes, and hypertension.

Many patients make the switch by following a simple process, Barnard says.

Step one, patients are told to make a list of their favorite foods that don’t have animal products.

“The patient comes back in a week and they’ve written down breakfast, like oatmeal with cinnamon and raisins,” Barnard says. “Lunch, chili instead of meat chili. Dinner, spaghetti with marinara sauce.”

The next step is for patients to eat from their list for 3 weeks straight.

“After 3 weeks, if they’ve actually done it, two things have happened,” Barnard says. “Physically, they’re changing, they’re losing weight, their blood sugar is down, their cholesterol is down, their energy is better, their digestion is better. But apart from the physical changes, their mindset is dramatically different,” he says.

If you are new to plant-based eating, approach it as you would learning a new language, says Julieanna Hever, an author and registered dietitian who specializes in plant-based nutrition.

“You learn a few words, you get a new ingredient that you’ve never tried, maybe some jackfruit,” she says.

“You’re starting to build this whole new repertoire of words and paragraphs,” she says. “But there’s a transition period. You have to get familiar and comfortable, and with time, it gets easier and easier. And then you become fluent.”

Plant-Based Made Easy
More plant-based options make life simpler for vegetarians and vegans, especially when grabbing a quick bite on the run.

Toni Okamoto is the founder of Plant-Based on a Budget, a website and meal plan that aims to show that plant-based eating can be simple and cost-friendly.

The plant-based market has come a long way, she says.

“My friends and I would take turns driving 2 hours to buy 5-pound bags of Daiya (the only way you could purchase it) to split,” says Okamoto, referring to a Canadian company that specializes in dairy alternative foods like cheese. “Now, there are so many varieties of vegan cheese that are widely accessible.”

“When I became vegan in 2007, the thought of walking into a fast-food restaurant and getting a meat-like burger made without animals was a fantasy,” she says. “Today, that fantasy has come true!”

“I buy a lot of plant-based products like hummus and vegetables, but I also appreciate and enjoy accessible options, like Beyond Meat burgers from fast-food restaurants like Carl’s Jr., as well as MorningStar Farms ‘chicken’ nuggets from Walmart,” Okamato says.

But you shouldn’t overdo it on products that are vegan, but not necessarily healthy. For example, while the new McDonald’s McPlant burger has a slightly better nutritional profile than the restaurant chain’s Quarter Pounder with Cheese, it’s still not health food.

“I’d be thrilled for people to just enjoy more bean-and-rice burritos, lentil soup, and other plant-based foods,” Okamoto says. “But a lot of people seem to want that meat experience. This new generation of plant-based meat does a great job of giving it to them without the need to use animals.”

Plant-Based Treat Foods
When browsing plant-based items at your local grocery store, it’s always a good idea to opt for items with the least saturated fat, Barnard says.

You should approach plant-based junk food with the same mindset as you would junk food that’s not plant-based, says Hever.

“Because ‘anything you can eat, I can eat vegan,’ like vegan cookies and burgers, there are all of these different options,” she says. “People are eating that and thinking they are healthy. There is a health halo over it vs. treating them like treat foods, as they should be.”

One worrisome part of the rise in highly processed plant-based products is that negative health effects can cloud the benefits of plant-based eating, Hever says. For example, while “beef” from Impossible Burger and its competitor Beyond Meat have no cholesterol, they are similar to real beef in calories, fat, and saturated fat. And both have almost 5 times as much sodium.

“I’m seeing for the first time in my practice, over the last 3, 4, 5 years, people who have been vegan coming to me with the same health issues as their omnivore counterparts,” she says.

“I’m concerned about that in terms of what’s going to happen in the scientific literature when we start lumping all the vegans together and not discerning what their actual diet consists of,” Hever says. “You can eat healthier or can eat less healthy, but it just kind of gets lumped in, and it can change the data.”

Compassion: The Missing Ingredient
The Minimalist Vegan is a digital lifestyle brand that explores the concept of living with “less stuff and more compassion.” The blog features articles like “15 Practical Steps to a Zero-Waste Kitchen” and “Is Fishing Ethical? Assessing the Cruelty of the Fishing Industry.”

Its YouTube channel shows you how to make dishes like vegan baked ziti.

Michael Ofei co-founded the brand with his wife Maša in 2015. The couple, based in Australia, transitioned to veganism the year before.

“In August 2014, we watched the documentary Earthlings, exploring animal exploitation across domestication, food, fashion, testing, and entertainment,” Ofei says.

“After watching the film, we decided to become vegan on the spot and haven’t looked back since.”

As plant-based eating continues to get more popular, movements surrounding topics like animal rights and environmental sustainability can gain steam and create systemic change, he says.

There’s already been a rise in new, innovative vegan beauty supplies, personal care items, and fashion hitting the shelves, he says.

“For instance, folks make sustainable cruelty-free leather from mushrooms, apple skins, pineapple, wine, and cork,” Ofei says.

Compassion for all, both humans and non-humans, is Ofei’s ultimate hope for the future of veganism and plant-based eating.

“As a society, we’re fighting for equality across all marginalized groups, including age, race, religion, disability, sexual orientation, class, indigenous heritage, and gender,” he says.

“I hope over time, we can expand our views of equality to also include animals.”

4 Important Things to Know About Your Pelvic Floor

If you’re pregnant or have had a baby, you’ve likely heard all about your pelvic floor, the muscles that support your pelvic organs (think: your bladder and uterus)-not to mention all of the ways childbirth can wreak havoc on them (baby coming down the birth canal, anyone?). But mamas aren’t the only ones who should care about these crucial muscles.

“As a urogynecologist, I see a lot of women who have pelvic floor issues who have not been pregnant,” says Lauren Rascoff, M.D., an assistant professor and urogynecologist at the University of Colorado.

And being fit doesn’t make you immune from these issues. While everything from hormonal dysfunction to certain diseases (endometriosis and PCOS, for example) or an infection can play a role in pelvic floor disorders, high-impact exercise (running, for example) and heavy weightlifting (CrossFit), both of which put significant force on your pelvic floor, can increase your risk of problems and pelvic floor dysfunction. That’s when the pelvic floor muscles themselves are either overactive or underactive, explains Rachel Gelman, D.P.T., a pelvic floor clinical specialist in San Francisco. And if you’re not using these muscles correctly-maybe you have posture issues or live a sedentary lifestyle-you could be at risk for dysfunction, and in turn, a disorder.

In fact, about one in four women in this country could suffer from what’s known as a pelvic floor disorder, a group of conditions that negatively impact the pelvic floor muscles and can cause symptoms including urinary incontinence, a lack of bladder control, straining with bowel movements, pelvic pain, and even pelvic organ prolapse.

The problem? Many women don’t know where to start when it comes to learning how to take control of the muscles. Fortunately, it’s easier than you think. And once you’re acquainted with your PF, you’ll boost core strength, send nagging symptoms packing, and build a stronger body fit for your everyday activities.

Here, what experts want you to know about these precious muscles.

1. Bladder Leaks and Pains Are Nothing to be Ashamed Of
“Bladder leaks are common,” says Lauren Peterson, D.P.T., owner and clinical director of FYZICAL Therapy & Balance Centers of Oklahoma City. While they’re common, Peterson notes that leakage is usually a sign that your pelvic floor muscles need attention.

Same goes for pelvic pain. “Sex should not be painful. It should not be difficult to insert and use a tampon,” says Peterson. Many times, simply learning how to activate your pelvic floor muscles (more on that later) is enough to help, too. (Related: 8 Reasons Why You Could Have Pain During Sex)

The problem with pelvic floor issues is that you might not get the answers you’re looking for from a traditional doctor. “Some research shows that health care providers don’t ask questions relating to pelvic floor dysfunction (pain with sex or urinary incontinence),” says Gelman. “Many patients don’t feel comfortable bringing it up if a provider doesn’t ask.”

Here’s why you should: Clinical practice guidelines by the American College of Physicians indicate that first line of treatment for urinary incontinence should be pelvic floor muscle and bladder training. But Cynthia Neville, D.P.T., national director of pelvic health and wellness at FYZICAL Therapy & Balance Centers, says that in her experience, many physicians treat pelvic floor disorders with medication (think: for bladder leakage and incontinence, constipation, or pain).

If your doc doesn’t give you much insight or you want a second opinion? Do some research on a local pelvic floor specialist (you can find one here) who can help you to understand and train your pelvic floor, so you can learn how to strengthen or relax the muscles. (Related: Pelvic Floor Exercises Every Woman Should Do)

2. You Might Not Be Doing a Kegel Correctly
If someone told you to do a kegel, could you? Some women can, but research finds that other times, women don’t respond to verbal instruction alone. That’s where a pelvic floor physical therapist comes in. Through both manual work and devices that stimulate your pelvic floor muscles providing biofeedback, a pelvic floor physical therapist can help you understand how to work these muscles. A full exam can also help ensure that you are strengthening the muscles that are weak and releasing the muscles that are over-tight, explains Peterson.

Just remember: “Kegels are not appropriate for all women with over-tightening pelvic floor muscles until they know how to let go of them properly,” she says. “Continuing to tighten overtightened muscles will likely worsen their symptoms.”

BTW: A correct Kegel involves three things, says Isa Herrera, M.S.P.T., C.S.C.S., founder of PelvicPainRelief.com: The perineal body (the area between your anus and vagina) should move up and in, your anus should contract, and your clitoris should “nod.” “They should all happen at the same time in a neutral pelvis position.” (Related: The 6 Best Kegel Balls for Better Sex)

Also, when you kegel, you want to be working your deep ab muscles, the transverse abdominal muscles-and avoid contracting your glutes. Not using your abdominal muscles enough or gripping your butt muscles can cause many women pelvic floor muscle dysfunction, she says. It means you’re not allowing your pelvic floor muscles to properly function.

3. More Importantly, Kegels Aren’t for Everyone
As mentioned above, not *everyone* needs to strengthen their pelvic floor with kegels. “Many people need to focus on learning to relax their pelvic floor,” says Gelman. “The pelvic floor is like any other muscle and it can be overworked. If you hold a 20-pound weight in a biceps curl for too long, the muscle will fatigue and may start the hurt.” If your PF muscles are tight-aka hypertonic-you might feel pelvic pain, pain during sex, or urinary or bowel incontinence. (Related: 8 Reasons Why You Could Have Pain During Sex)

“For these people, my favorite stretch is Happy Baby,” says Peterson. (Lie on your back with your feet in the air and your soles together.) If that’s too extreme, start with your legs on the ground and your soles together, she suggests. Learning how to do proper diaphragmatic breathing, or belly breathing, is also one of the first steps a therapist might teach you if you have tight pelvic floor muscles. “There are often many other stretches I give to people with tight pelvic floor disorders that are specific to that patient’s case,” says Peterson.

And it’s not just the areas you might immediately think of, she adds. “Often times the backs of the legs (hamstrings), the front of the hips (hip flexors), buttocks (gluteal), and deep rotator muscles all need stretching and strengthening. It is also important that the hip muscles and abdominal muscles surrounding the entire pelvis are truly ‘healthy’ muscles, meaning they are both strong and flexible.”

4. Good Bowel Movements Matter
If you’re all backed up or find yourself straining on the toilet, that’s something to mention to your doc, too. Constipation and pushing with bowel movements can put a lot of pressure on the pelvic floor. Over time this can lead to dysfunction, says Gelman.

A healthy diet with plenty of fiber and good hydration are both important to keep bowels healthy. You might want to even reconsider how you go. Being in a squat-like position puts the pelvic floor in the best position for No. 2, she notes. Put a step stool under your feet or consider a product like the Squatty Potty.

Top Reason for Teen Spine Injuries: Not Wearing Seat Belts

Two-thirds of spinal fractures suffered by American children and teens occur in car crashes when they aren’t wearing seat belts, a new study finds.

Researchers analyzed data on more than 34,500 U.S. patients younger than 18 who suffered spinal fractures between 2009 and 2014. Teens aged 15 to 17 accounted for about 63% of the spinal fractures, two-thirds of which occurred in motor vehicle accidents.

These findings show that around the time teens get their drivers’ licenses, young drivers and passengers are at highest risk for spinal fractures in car crashes, according to the authors of the study published online recently in the journal Spine.

The investigators also found a strong link between not buckling up while in the car and increased risk of spinal fractures.

“Nearly two-thirds of pediatric spinal fractures sustained in [motor vehicle accidents] occurred in children who did not use belts,” Dr. Vishal Sarwahi, from Cohen Children’s Medical Center, in New Hyde Park, N.Y., and colleagues wrote in a journal news release.

Spinal fractures in children and teens were associated with a 3% death rate, with many deaths occurring in unrestrained drivers and passengers, the researchers noted.

Another study finding was that the risk of severe or multiple injuries and death was more than twice as high (nearly 71%) when children and teens didn’t wear seat belts than when they did (29%).

Wearing seat belts was associated with lower rates of multiple vertebral fractures, other types of fractures in addition to spinal fracture, head and brain injuries, and a more than 20% lower risk of death in car crashes.

The researchers also found that 58% of the young spinal fracture patients were male, and that spinal fractures were most common in the South (38%), likely because a lack of public transportation results in more vehicles on the road.

The percentage of U.S. drivers wearing seat belts has risen steadily over the years, but teens and young adults remain less likely to use them, the study authors noted.

The findings highlight the need to take steps to increase seat belt use by younger drivers and passengers, such as targeted approaches using technology and media awareness campaigns, the researchers suggested.

“Ensuring our new, young drivers wear protective devices can greatly reduce morbidity/mortality associated with [motor vehicle accidents] and can help save lives, and spines,” the research team concluded.

Number of Gender-Diverse Teens Grows

The number of American children who identify as a gender other than male or female appears to be increasing, a new study in the journal Pediatrics reports.

In 2017, a CDC survey asked high school students if they considered themselves to be transgender and found 1.8% said yes. But a doctor at the University of Pittsburg Medical Center wondered if the way the CDC survey was structured didn’t capture all kids who were “gender diverse.”

Kacie Kidd, MD, instead turned to a diverse Pittsburg public high school and asked more than 3,000 students two questions:

“What is your sex (or, your sex assigned at birth, on your birth certificate)?”
“Which of the following best describes you (select all that apply)?”
The available options were “girl,” “boy,” “trans girl,” “trans boy,” genderqueer,” “nonbinary,” and “another identity.”

The study says 9.2% of kids responded that they were gender diverse in some way.

The results of the study come as singer Demi Lovato came out as nonbinary and uses the pronouns “they” and “them.”

“This has come after a lot of healing & self-reflective work,” Lovato said on Twitter. “I’m still learning & coming into myself & I don’t claim to be an expert or a spokesperson.”

Finding people on and off the binary definition of gender is not difficult in any society, Jules Gill-Peterson, PhD, associate professor of English and gender, sexuality, and women’s studies at the University of Pittsburgh, told CNN.

“Regardless of what kind of sex and gender system existed in a particular society at a given time, there are pretty much consistently always folks who stray from those norms,” Gill-Peterson said. In many of those cultures, “It’s culturally sanctioned and celebrated for certain people to live lives differently than what we might call the gender they were assigned at birth.”

‘Black fungus’ and COVID-19: Myths and facts

The human body is not the usual habitat for fungi that belong to the order Mucorales, which includes species typically found in soil, dust, decomposing vegetation, and animal dung.

Our immune system is usually more than a match for the fungi, but an “unholy trinity” of diabetes, COVID-19, and steroid treatment can weaken a person’s immunity to such an extent that these microorganisms can gain a foothold.

Diabetes not only increases a person’s risk of severe COVID-19 but also provides conditions in which fungal infections can thrive. To make matters worse, both COVID-19 and the steroid dexamethasone, which intensive care doctors use to treat it, suppress immunity.

The ensuing infection, known as mucormycosis or zygomycosis, spreads rapidly from the nose and sinuses to the face, jaw, eyes, and brain.

On May 26, 2021, there were 11,717 confirmed cases of mucormycosis in India, which has more peopleTrusted Source living with diabetes than any other country in the world, except China.

Even before the pandemic, the prevalence of mucormycosis may have been 70 times higher in India than the overall figure for the rest of the world.

The fungus blocks blood flow, which killsTrusted Source infected tissue, and it is this dead, or necrotic, tissue that causes the characteristic black discoloration of people’s skin, rather than the fungus itself.

Nonetheless, the term “black fungus” seems to have stuck.

Prof. Malcolm Richardson, a professor of medical mycology at the University of Manchester in the United Kingdom, told Medical News Today that the name is “totally inappropriate.”

“The agents of mucormycosis — Rhizopus oryzae, for example — are hyaline (transparent),” he wrote in an email.

“From a mycological point of view, the term ‘black fungus’ (or ‘black yeasts’) is restricted to fungi called dematiaceous, which have melanin in their cell walls. Many people have tried to correct this on Twitter but to no avail.”

He said the media in India were now using the similarly misleading terms “white fungus” and “yellow fungus” to describe supposed variants of mucormycosis.

Fatality rates
Without immediate treatment with an antifungal medication and a surgery to remove necrotic tissue, mucormycosis is often fatal.

Before the pandemic, the Centers for Disease Control and Prevention (CDC) reported an overall mortality rate of 54%Trusted Source.

A 2021 systematic review of all COVID-19-related cases published in the scientific literature found 101 cases: 82 of them in India and 19 from the rest of the world. Among these cases, 31% were fatal.

Dr. Awadhesh Kumar Singh and his co-authors report that around 60% of all the cases occurred during an active SARS-CoV-2 infection and that 40% occurred after recovery.

In total, 80% of the patients had diabetes, and 76% had been treated with corticosteroids.

Myths about transmission
Several theories about the source of mucormycosis infections are circulating on social media, many of them unfounded.

Person-to-person transmission
Crucially, mucormycosis cannot be transmitted from person to person, so there is no need for people to isolate — unless, of course, they have an ongoing SARS-CoV-2 infection.

Rather, the source of infection is environmental, from airborne spores produced by the fungi.

Fungi growing in water, oxygen cylinders, humidifiers
Some media pundits have concluded that the fungi must be growing in dirty water in hospital oxygen cylinders or humidifiers. However, there is no evidence that this can occur, and mycologists have pointed out that fungi cannot produce spores in fluid.

What is more, the pure oxygen stored in cylinders is likely to be detrimental to the growth of microorganisms of all kinds.

Face masks harbor black fungus
This is a myth. There is no evidence that face masks can harbor the fungi.

Onions are to blame
Another popular theory is that the black mold sometimes seen on onions in refrigerators is Mucorales fungus and, therefore, a potential source of infection.

As we have seen, the species in question are not black. In fact, the black mold found on onions and garlic is usually the fungus Aspergillus niger.

In a 2019 paper, Prof. Richardson and his co-author explain that Mucorales fungi grow on moldy bread, decaying fruit and vegetables, crop debris, soil, compost, and animal excreta.

He points out that they have a high moisture requirement and are unlikely to survive on common building materials, such as wood, painted surfaces, and ceramic tiles. He concludes:

“All of these observations suggest that house residents are not generally exposed to zygomycetes in their home environment, apart from mould-contaminated food items, such as bread and fruit.”

Knowledge is power. Get our free daily newsletter.
Dig deeper into the health topics you care about most. Subscribe to our facts-first newsletter today.

Possible routes of transmission
Published evidence points to several potential sources of the infection in hospitals, but it does not mention oxygen tanks, humidifiers, or face masks.

Two studies — published in 2014Trusted Source and 2016, respectively — implicate hospital linens from poorly managed laundries as a source.

A 2009 review of research into hospital outbreaks identifies ventilation systems, wooden tongue depressors, adhesive bandages, and ostomy bags as other possible sources of infection.

Pathologists at the University of Kentucky in Lexington reportTrusted Source that another possible transmission route is the inhalation of spores in dust from nearby building works, or contaminated air-conditioning filters.

They also highlight the importance of infection through the skin, for example via burns, catheter insertion sites, needlestick injuries, insect bites, and stings.

Proven treatments
A video doing the rounds on social media proposes that a concoction of mustard oil, potash alum, rock salt, and turmeric can cure mucormycosis.

In reality, the only proven treatments are surgery to remove necrotic tissue, and the antifungal amphotericin B. However, India now faces severe shortages of the drug.

Just as importantly, doctors are advised to address the underlying causes of impaired immunity, especially poorly managed diabetes and overzealous use of corticosteroids.

In their recent review, Dr. Singh and his colleagues conclude:

“An unholy trinity of diabetes, rampant use of corticosteroid in a background of COVID-19 appears to increase mucormycosis. All efforts should be made to maintain optimal glucose and only judicious use of corticosteroids in patients with COVID-19.”