People with SARS-CoV-2 antibodies may have low risk of future infection, study finds

People who have had evidence of a prior infection with SARS-CoV-2, the virus that causes COVID-19, appear to be well protected against being reinfected with the virus, at least for a few months, according to a newly published study from the National Cancer Institute (NCI). This finding may explain why reinfection appears to be relatively rare, and it could have important public health implications, including decisions about returning to physical workplaces, school attendance, the prioritization of vaccine distribution, and other activities.

For the study, researchers at NCI, part of the National Institutes of Health, collaborated with two health care data analytics companies (HealthVerity and Aetion, Inc.) and five commercial laboratories. The findings were published on Feb. 24 in JAMA Internal Medicine.

“While cancer research and cancer care remain?the?primary?focus of NCI’s work, we were eager to lend our expertise in serological sciences to help address the global COVID-19 pandemic, at the request of Congress,” said NCI Director Norman E. “Ned” Sharpless, M.D., who was one of the coauthors on the study. “We hope that these results, in combination with those of other studies, will inform future public health efforts and help in setting policy.”

“The data from this study suggest that people who have a positive result from a commercial antibody test appear to have substantial immunity to SARS-CoV-2, which means they may be at lower risk for future infection,” said Lynne Penberthy, M.D., M.P.H., associate director of NCI’s Surveillance Research Program, who led the study. “Additional research is needed to understand how long this protection lasts, who may have limited protection, and how patient characteristics, such as comorbid conditions, may impact protection. We are nevertheless encouraged by this early finding.”

Antibody tests — also known as serology tests — detect serum antibodies, which are immune system proteins made in response to a specific foreign substance or infectious agent, such as SARS-CoV-2.

This study was launched in an effort to better understand whether, and to what degree, detectable antibodies against SARS-CoV-2 protect people from reinfection with the virus. Working with HealthVerity and Aetion, NCI aggregated and analyzed patient information collected from multiple sources, including five commercial labs (including Quest Diagnostics and Labcorp), electronic medical records, and private insurers. This was done in a way that protects the privacy of an individual’s health information and is compliant with relevant patient privacy laws.

The researchers ultimately obtained antibody test results for more than 3 million people who had a SARS-CoV-2 antibody test between Jan. 1 and Aug. 23, 2020. This represented more than 50% of the commercial SARS-CoV-2 antibody tests conducted in the United States during that time. Nearly 12% of these tests were antibody positive; most of the remaining tests were negative, and less than 1% were inconclusive.

About 11% of the seropositive individuals and 9.5% of the seronegative individuals later received a nucleic acid amplification test (NAAT) — sometimes referred to as a PCR test — for SARS-CoV-2. The research team looked at what fraction of individuals in each group subsequently had a positive NAAT result, which may indicate a new infection. The study team reviewed NAAT results at several intervals: 0-30 days, 31-60 days, 61-90 days, and >90 days because some people who have recovered from a SARS-CoV-2 infection can still shed viral material (RNA) for up to three months (although they likely do not remain infectious during that entire period).

The team found that, during each interval, between 3% and 4% of the seronegative individuals had a positive NAAT test. But among those who had originally been seropositive, the NAAT test positivity rate declined over time. When the researchers looked at test results 90 or more days after the initial antibody test (when any coronavirus detected by NAAT is likely to reflect a new infection rather than continued virus shedding from the original infection), only about 0.3% of those who had been seropositive had a positive NAAT result — about one-tenth the rate in those who had been seronegative.

Although these results support the idea that having antibodies against SARS-CoV-2 is associated with protection from future infection, the authors note important limitations to this study. In particular, the findings come from a scientific interpretation of real-world data, which are subject to biases that may be better controlled for in a clinical trial. For example, it is not known why people who had tested antibody positive went on to have a PCR test. In addition, the duration of protection is unknown; studies with longer follow-up time are needed to determine if protection wanes over time.

To continue to comprehensively address this important research question, NCI is supporting clinical studies that monitor infection rates in large populations of people whose antibody status is known. These are known as “seroprotection” studies. NCI is also sponsoring ongoing studies using real-world data to assess the longer-term effect of antibody positivity on subsequent infection rates.

This research is part of a $306 million effort that NCI has taken on at the request of Congress to develop, validate, improve, and implement serological testing and associated technologies applicable to COVID-19. Through this appropriation, NCI is working with the Department of Health and Human Services; the National Institute of Allergy and Infectious Diseases, another part of NIH; and other government agencies to apply its expertise and advanced research capabilities to respond to this pandemic, including efforts to rigorously characterize the performance of serology assays.

Drug Might Relieve Low Back Pain in Whole New Way

A new nonopioid pain reliever could be welcome news for people who have difficult-to-treat back pain.

Tanezumab is what’s called a monoclonal antibody. And it might offer extended relief from chronic lower back pain, a large, new study finds. However, a serious side effect remains a concern.

Tanezumab works differently from other treatments, as it blocks nerve growth factor, a protein that causes pain, researchers say.

“It appears that we are on the cusp of developing new drugs, which treat chronic pain by turning down the sensitivity of the nervous system, which is a whole new way of approaching the problem of chronic pain,” said lead researcher Dr. John Markman. He’s a professor of neurosurgery and neurology at the University of Rochester School of Medicine in New York.

“This is very important because we haven’t really had drugs with a new way of affecting chronic pain developed in maybe 100 years,” Markman said.

This phase 3 trial was funded by drugmakers Pfizer and Eli Lilly and Co. Twelve-hundred patients were randomly assigned to one of two doses of tanezumab or placebo. Another 600 patients received the opioid tramadol.

The higher dose of tanezumab reduced pain and also improved function, the researchers said.

Currently, opioid painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are the only medications for chronic lower back pain. But opioids can be addictive, and NSAIDs can cause serious gastrointestinal bleeding.

If these drugs don’t work, the alternative is spinal fusion surgery, and that’s not always effective, Markman said.

Tanezumab is given by injection about every two months. It has none of the side effects of opioids or NSAIDs.

It does, however, have one very serious side effect that affects up to more than 2% of patients. The drug has been linked to joint deterioration that may require joint replacement.

This concern is the major focus of the U.S. Food and Drug Administration’s current review of the drug as a treatment for chronic pain from severe osteoarthritis, Markman said.

Masks and Summer Heat: Expert Tips

Dr. Teresa Murray Amato rode the subway into Manhattan from Queens the other day and found that summertime and face masks aren’t an easy fit.

“It was a warm day. I definitely felt it was a little hot,” said Amato, director of emergency medicine at Long Island Jewish Forest Hills in Queens, N.Y.

Despite her discomfort, Amato resisted the urge to remove her mask — and she recommends that you do the same.

COVID-19 continues to spread even in the humid heat of summer, so it’s important to keep wearing masks and maintaining social distancing to prevent transmission, said Dr. Waleed Javaid, director of infection prevention and control at Mount Sinai Downtown in New York City.

At least 10 states — Alabama, Arkansas, California, Florida, Nevada, North Carolina, Oklahoma, South Carolina, Tennessee and Texas — reached record levels of hospitalized COVID-19 patients on Sunday, the Washington Post has reported.

This was the risk of reopening, but public health officials have said it’s worth it if people wear masks.

Evidence has shown that masks can reduce transmission of the new coronavirus, if everyone wears one, Amato said.

Summer heat may make your mask feel stifling, but you should keep wearing it if you’re near other people or in enclosed spaces, she said.

“Even though we know it’s going to be a little uncomfortable, I really think the benefits outweigh the discomfort of being a little warm while wearing your mask,” Amato said.

Keeping both your mouth and nose covered is important. Folks struggling with their mask in the heat might try switching to a lightweight one that’s more breathable.

At this point, surgical masks are in good enough supply that people who are uncomfortable with a cloth face covering might consider buying a box, Amato said. Even grocery stores are carrying them now.

“A light surgical mask probably does the trick with the least amount of discomfort,” she said.

Sweat is another problem. If your mask becomes damp with sweat, its ability to screen out coronavirus is diminished, Amato and Javaid said.

Read more…

Do You Need to Wear Gloves at the Grocery Store?

Our experience with food has changed dramatically in a matter of a few weeks (along with everything else in life) because of COVID-19. We’re cooking at home more than ever before, and grocery shopping has become one of the few essential errands we leave the house for. Armed with our long shopping list and a face mask, we head out wondering if there’s anything else we can do to protect ourselves.

One question that keeps coming up is – Should you wear gloves at the grocery store?

The short answer is no. You do not need any kind of gloves at the grocery store.

Gloves will not protect you. If you touch a contaminated surface, the virus can transfer to your glove just like it could transfer to your fingers, so there’s no added protection from the gloves. If you touch your mouth or nose with the glove, you can pass the virus to yourself. And taking the gloves off after shopping is an especially vulnerable moment, as you can easily transfer any germs on the gloves to your hands and face if you’re not careful.

The reality is you’re much more likely to catch the coronavirus from the respiratory droplets of a person talking or sneezing near you rather than from an item you touch at the store – that’s why physical distancing is so important. To protect yourself at the grocery store, wear a cloth face mask and keep a minimum 6-foot distance from others. Plan your grocery trip so you can get in an out quickly during quiet times to minimize contact with others.

Gloves do not replace hand hygiene. Given that gloves don’t protect you from the virus, wearing gloves doesn’t save you time from hand washing. You still have to keep up with hand hygiene. That’s the most important way to remove the virus from your hands.

To protect yourself, you’ll want to use hand sanitizer as you enter and exit the grocery store and wipe down your shopping cart handle with a disinfectant. When you get home, wash your hands well with soap and water for 20 seconds. And clean any other items that might be dirty, like your phone and reusable grocery bags.

Gloves do not protect others. As you move about the grocery store, the gloves can get dirty from whatever you touch and transfer it along to others – just as your fingers would.

To protect others, touch as little as possible while you’re out. Don’t pick up produce and then put it back down.

Save the medical gloves. Medical gloves are meant for protection when you’re in high risk situations, like if you’re exposed to bodily fluids like blood, mucous, vomit and urine. The gloves protect patients, caregivers, and health care workers all day long from tasks at home like washing the laundry of a person sick with COVID-19, to tests and procedures at the hospital. For grocery shopping, the gloves don’t add benefit and aren’t necessary. Given medical gloves are in short supply, just as medical face masks are, please use gloves wisely.

6 Essentials for an Effective Face Mask

At some point, all of us will have to leave our homes and venture into public places. For now, it may be the grocery store or the doctor’s office, but later as social distancing measures slowly ease, we may actually be able to get a haircut or return to the office for work. The new normal will be different – seating will be spaced far apart, there will be plenty of clear barriers to protect workers, and you will likely be wearing a face mask.

In many places, you are already required to wear a cloth face covering, and it makes good sense. According to Dr. Anthony Fauci between 25% to 50% of people can be infectious and spread the virus without symptoms. It is easily transmitted by respiratory droplets simply by speaking or laughing, along with coughing or sneezing.

Of course, a cloth face mask is not foolproof protection from COVID-19, but it is much better than no mask. It is another important layer to physical distancing when used in combination with 6 foot spacing from others and hand hygiene. Unfortunately, there aren’t enough N95 or other medical masks in the U.S. for everyone. We need to save those masks for people on the frontline caring for those sick with COVID-19.

Not surprisingly, the cloth face mask market is increasing exponentially to meet demand, and the science behind what makes a good cloth face mask is inching along slowly. It is difficult to know what qualities to prioritize when searching for a face mask.

Here is what we know about what makes a good cloth face mask:

Sew or no-sew: Either sew or no-sew options are fine when used correctly. Do what’s reasonable for you. If you’re in a rush, go with a no-sew option. If you’re crafty, make your own mask at home. Or, order your masks locally or online. Choose mask designs recommended by reliable sources like the CDC. Another option is to check your local hospital’s website. Many are posting patterns with precise instructions to make masks they’ll accept as donations.

Fabric: The best cloth masks will use at least 2 layers of a tightly woven cotton fabric. Look for a high thread count. This acts as a filter blocking respiratory droplets while still allowing you to breathe comfortable.

Filter: Some will have a space to slip in a filter for an added layer of protection. The CDC recommends adding coffee filters to homemade masks. Online I’ve seen many filter options pop-up as people experiment with products in their home. These include cutouts from reusable fabric grocery bags made of polypropylene non-woven fibers, nylon fabric from pantyhose, paper towels, kitchen towels, bra pads, denim, and canvas to name a few.

We do not have much science to go on, so common sense is critical here. Is the filter worth adding when you consider safety and usability? The filter needs to be dense enough to block tiny, moist particles while also being breathable and comfortable. Are you inadvertently breathing something toxic? For example, some HEPA (high-efficiency particulate air) filters can have fiberglass, which would be very dangerous to inhale. Definitely do your own research to keep up with new information.

Fit: You need to be able to breathe comfortably with the mask on so that you do not have to slip it off while you’re in public to take a breath. The face mask must have a snug fit from nose to under the chin and back towards the ears. It’s useless if there are gaps that allow the air in. There are face masks available that come in different sizes. Also, you don’t want to have to fiddle with the mask, for example if it’s stiff, and potentially contaminate your fingers touching the outside layer of the mask. If you feel like you can’t breathe comfortably with your mask, don’t use it, and talk to your doctor about other face covering options.

Ease of use: Once you find a face mask you like, it’s only as good as how you use it. Make sure you can easily untie or remove the loops from your face and pull the mask away from your face without being contaminated by touching the front of the mask. Infinity scarves are not a good option for masks because they’re difficult to cleanly take on and off.

Plan your outings knowing you should not slip the mask on and off to eat or talk on the phone. If you’re exercising outdoors, you may not be able to tolerate a mask when you breathe hard. In that case, choose your exercise location carefully to make sure you can keep a physical distance from others and be safe.

Durability: You will need to wash the cloth mask after each use, so look for reviews online that comment on the masks wear and tear. If the mask loses shape, you will not be able to use it. If you are adding a filter, cleaning it will depend on what kind of filter you use. A coffee filter should be thrown away after each use. Also, the fabric should be pre-washed so that you don’t need to worry about shrinkage.

When you wear a cloth face mask, it shows you care about your own health and the health of others. It signals to others to be respectful of physical distancing measures and keep a 6-foot distance from you. A cloth face covering is also a subtle reminder that the professional masks are for those on the front line. With all the cool colors and patterns out now, you can even make it a style statement.

Coronavirus 2020 Outbreak: Latest Updates

April 15, 7:26 p.m.

Industry leaders meeting with President Donald Trump before Wednesday’s White House Coronavirus Task Force briefing told him that more testing is needed before reopening the country. Public health officials, state and local leaders have been asking for more testing as a way to know who is infected and then to find out who has immunity. Trump is seeking guidance from the leaders on plans to loosen restrictions due to the virus.

At the briefing, Trump said he plans to speak to governors on Thursday “and we will have some information on some openings. I would say we have 20 states, but probably 29, that are in really good shape. We miss sports, we miss everything. We want to get our country open again. ”

Deborah Birx, MD, the coronavirus task force response coordinator, said social distancing has to continue despite some progress in reducing the spread of the coronavirus. Birx said they will look at states and metropolitan areas individually as they come up with the new guidelines, which are expected to be announced Thursday.

25 FEMA Workers Have Contracted COVID-19

April 15, 3:51 p.m.

More than two dozen employees for the Federal Emergency Management Agency have tested positive for coronavirus, according to NBC News. Sources told the network Tuesday that employees were “dropping like flies” and unable to work.
Expanded Coverage

At least one of the 25 workers was in the agency’s main response center for the COVID-19 outbreak, NBC said, and several workers were placed into quarantine. FEMA is the lead agency coordinating the coronavirus response, and the National Response Coordination Center in Washington, D.C., is the main facility where the federal government is managing the pandemic.

The employee tested positive on Monday, according to Politico, and FEMA employees at the center left at the end of the day. The agency started deep cleaning the facility based on CDC guidelines, the news publication reported.

FEMA conducted contact tracing to determine if the employee had contact with members of the White House Coronavirus Task Force in recent days, and reported that the employee and others who were in contact with the employee didn’t come within 6 feet of the task force, according to The Associated Press.

On Tuesday, a FEMA spokesperson confirmed that 25 employees tested positive but didn’t indicate how many response center workers were included in the group, NBC News reported. The spokesperson also didn’t respond to questions about the response center’s protective gear policies such as wearing masks and gloves but said the agency is taking “every precaution recommended by the CDC.”

“The health and safety of the workforce, including our interagency partners and members of the White House Coronavirus Task force, is a top priority for the Federal Emergency Management Agency as we continue to lead the federal operations in response to the pandemic,” the FEMA spokesperson wrote in an email to NBC. “Like many large employers, FEMA has employees who have tested positive.”

More Than 9,000 Health Care Workers Have Contracted COVID-19

April 15, 11:01 a.m.

More than 9,200 U.S. doctors, nurses, and other health care professionals had contracted the coronavirus, and 27 had died by the end of last week, the CDC reported Tuesday.

The numbers are likely an underestimation, the CDC said. The data comes from the 315,000 total cases reported to the CDC between Feb. 12 and April 9. Of those, only 16% listed an occupation. For instance, the 9,200 cases make up 3% of the 315,000 reported cases where job information was reported, but in states with more complete reporting of occupation, health care workers accounted for 11% of cases.

Health care workers with mild or no symptoms may not have been tested as well.

“It is critical to make every effort to ensure the health and safety of this essential national workforce of approximately 18 million [health care professionals], both at work and in the community,” according to a statement from the CDC’s COVID-19 Response Team, published in the CDC Morbidity and Mortality Weekly Report.

According to the data, the average age of the health care workers who tested positive for the new coronavirus was 42, and about 73% were women. More than a third reported at least one other health condition.

In addition, 723 health care workers were hospitalized, and 184 were placed in intensive care. Although most of the health care workers weren’t hospitalized, severe outcomes were reported for all ages.

Among the 27 who died, 10 were age 65 or older. This should be considered when retired health care workers are encouraged to help with a COVID-19 surge, the report stated, which could mean using retired workers for telemedicine, administrative assignments, or non-coronavirus cases.

As more COVID-19 hospitalizations and deaths occur, the number of health care professionals who test positive and die will likely increase as well, according to the report. “Additional measures” could reduce the risk of transmitting the virus, such as screening health care workers for fever and symptoms at the beginning of their shifts, prioritizing them for testing, and discouraging them from working while ill. Reporting more details about COVID-19 cases would help the CDC to draw better conclusions and create better guidelines, too.

“Improving surveillance through routine reporting of occupation and industry not only benefits [health care professionals], but all workers during the COVID-19 pandemic,” the CDC response team wrote.

First Case of Coronavirus Spreading From a Corpse Reported in Thailand

April 14, 4:05 p.m.

A medical professional in Thailand was infected with the new coronavirus while working with a corpse, apparently the first known case of the virus spreading from a dead body, according to letter in a medical journal.

The medical professional, only identified as a “forensic practitioner” in Bangkok, died from the coronavirus, said a letter published in the Journal of Forensic and Legal Medicine.

“According to our best knowledge, this is the first report on COVID-19 infection and death among medical personnel in a Forensic Medicine unit,” said the letter written by Won Sriwijitalai of the RVT Medical Center in Bangkok, and Viroj Wiwanitkit of Hainan Medical University in Haikou, China.

They wrote that pathology/forensic units might want to adopt the disinfection procedures used in operating rooms. Workers in forensic departments are already wearing protective devices such as gloves, goggles, and masks, they wrote.

Angelique Corthals, a professor of pathology at City University of New York, told BuzzFeed that medical examiners, morgue technicians, and people working in funeral homes need to take special care. “It’s a real concern,” she said.

The letter in the medical journal said forensic medical professionals have a low chance of coming in contact with patients who have the new coronavirus, but “they can have contact with biological samples and corpses.”

The letter writers said nobody knows how many corpses contaminated with coronavirus exist because dead bodies are not routinely examined for the virus in Thailand.

Thailand has not been hit hard by coronavirus — Johns Hopkins University reports about 2,600 cases and 40 deaths — but was one of the first countries outside of China to report a case.

People Pay Attention to Social Distancing Orders, CDC Says

April 14, 1:20 p.m.

A CDC report says it appears the public listens when the government orders social distancing to reduce the spread of the coronavirus.

Using location tracking data on mobile devices, the CDC said people in San Francisco, Seattle, New York, and New Orleans started moving around less after different levels of government ordered sheltering in place, banned gatherings of a certain size, and shut down schools.

“Community mobility in all four locations declined from Feb. 26, 2020 to April 1, 2020, decreasing with each policy issued and as case counts increased,” the CDC said. “This report suggests that public policy measures are an important tool to support social distancing and provides some very early indications that these measures might help slow the spread of COVID-19.”

The CDC said it measured “community mobility” using publicly available information from SafeGraph, a company that aggregates location data from mobile devices like smartphones and tablets. The data shows whether a device “leaves home” by traveling more than 150 meters (492 feet) from the place it normally spends the night.

In all four cities, about 80% of the people tracked were leaving home on Feb. 26, the CDC said. By April 1, the percentage of people leaving home had dropped to 42% in New York City, 47% in San Francisco, 52% in Seattle, and 61% in New Orleans.

It looks like a confluence of government actions, not just one thing, persuaded the public to pay attention.

“Overall, across the four areas, emergency declarations (the first policies issued) did not result in a sustained change in mobility; however, declines in mobility occurred after implementation of combinations of policies (such as limits on gatherings or school closures) and after the White House 15 Days to Slow the Spread guidelines were implemented,” the CDC said.

San Francisco, Seattle, New York, and New Orleans all had heavy outbreaks of the coronavirus. The CDC said it studied 3.6% to 6.4% of the mobile devices in the cities.

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Preparing for Coronavirus: Dos and Don’ts

With cases in 42 states and the District of Columbia, coronavirus (and COVID-19, the disease it causes) is spreading rapidly in the United States. Here’s what you need to know to protect yourself right now:

Dos and Don’ts for Everyone

DO wash your hands for at least 20 seconds, several times a day. Use soap and water or a hand sanitizer with at least 60% alcohol:

Before cooking or eating
After using the bathroom
After blowing your nose, coughing, or sneezing

DON’T touch your eyes, nose, and mouth. If you have somehow come into contact with the virus, touching your face can help it enter your body.

DO learn the symptoms, which are similar to flu:

Shortness of breath
Most cases do not start with a runny nose.

DON’T wear a mask unless you’re sick. Masks help protect others from catching the virus, but wearing one when you’re healthy won’t do much. Demand has been so high worldwide that shortages have begun. Leave the masks for people who really need them, like the sick or health care professionals.

DO consider taking extra precautions and staying out of public places if you’re over 60 years old, or have a condition, as you have a higher risk of developing the disease. Note that as of now, the highest-risk groups appear to be seniors and people with preexisting conditions like heart disease, chronic respiratory diseases, and diabetes.

DON’T travel if you have a fever. If you get sick on flight, tell crew immediately. When you get home, contact a health professional.

DO reconsider travel to affected countries, especially if you have underlying conditions. For people in a higher-risk group — seniors and people with preexisting conditions — the agency suggests postponing nonessential travel. It also suggests everyone avoid cruises. Find the latest advisories here.

DON’T panic. At this point, public health officials still say the risk of becoming infected with COVID-19 is low. Taking proper precautions — wash your hands! — and making preparations are the best things you can do.

DO get ready to hunker down. The World Health Organization has now declared COVID-19 to be a pandemic. If someone in your home gets sick, local authorities may want you to be quarantined for up to 14 days. Make sure you have enough shelf-stable food to last that long, as well as prescription medications for anyone in the family, other health supplies such as over-the-counter pain relievers, and disinfectants to clean household surfaces.

A government web site also suggests keeping a 2-week supply of food and water in the case of a pandemic and having copies of electronic health records.

DO practice “social distancing”: Avoid large gatherings and crowds in poorly-ventilated spaces, and try to stay at three to six feet away from anyone who’s coughing or sneezing.

DON’T skip the flu shot. The symptoms of COVID-19 and flu overlap enough that it can complicate diagnosis. If you’ve had a flu shot, you’re less likely to catch the flu or have a case serious enough to require treatment.

DO prioritize your health. Now is not the time to burn the candle at both ends, skip workouts, or ignore a healthy diet—that can weaken your immune system.

DON’T avoid toys or products from Asia. Although the virus can live on surfaces for hours and possibly several days, it’s unlikely to survive the process of being moved from place to place in different temperatures and conditions.

DO check in on high-risk neighbors: older adults and people with serious chronic medical conditions. Monitor their food and medical supplies, and make sure they have people or organizations who can help if they get sick.

Dos and Don’ts When You Don’t Feel Well

DO seek help early if you have a fever, cough, and a hard time breathing. But don’t just drop into the nearest urgent care clinic. Call your doctor to find out the protocol first, to make sure you won’t spread the disease to others.

DON’T go out except to see your doctor, after calling first. And if you do have to go out, avoid public transportation, taxis, and ride-sharing.

DO cough or sneeze into the crook of your elbow or a tissue, and dispose of the tissue immediately in a covered bin. (You should be doing this whether or not you suspect COVID-19 — you don’t want to spread a common cold, either.)

DON’T hang out with your family or pets if you suspect you have the virus. In order to protect them, eat and sleep separately from them, try to stay in one room, and use a separate bathroom if possible. Yes, pets are included in the recommendations. There has been one report of a dog testing positive in Hong Kong for the virus. But officials there said they are not sure the dog is actually infected. The CDC says experts don’t know for sure whether pets can catch it.

DO wear a mask properly around others if you suspect you may have the virus — the mask itself can be a source of infection if you don’t follow the guidelines. The World Health Organization has videos on when and how to use a mask.

DON’T reach for antibiotics. If you happen to have some lying around from a previous illness, you may be tempted. But antibiotics work only on illnesses caused by bacteria, and the coronavirus is — you guessed it — a virus.

DO make sure someone in your home knows how to clean properly. Studies suggest that coronaviruses can live on surfaces for a few hours or up to several days. To reduce the chance of spreading COVID-19, wear disposable gloves to clean surfaces regularly with soap and water, followed by a disinfectant to kill the virus. Effective options include a bleach solution of 5 tablespoons per gallon/4 teaspoons per quart of water, solutions with at least 70% alcohol, or one of the EPA-approved items on this list.

Researchers Weigh Benefits, Risks of PPIs

Reviewed by Brunilda Nazario, MD on July 31, 2019

July 31, 2019 — Rebecca Hill thought she was having a heart attack. The 59-year-old Tennessee native, now living in Wasilla, AK, went straight to the ER.

“They did some tests and found out that I had reflux,” she says. “I’ve gone through very many PPIs to try to keep mine under control.”

She was 34. Since then, Hill has used most of the prescription PPIs available and several over-the-counter versions. She hasn’t had any side effects.

But not everyone has such positive experiences. PPIs, or proton pump inhibitors, are among the most common prescription drugs and are used to treat acid reflux, heartburn, indigestion, gastroesophageal reflux disease (GERD), and stomach ulcers. They include omeprazole, lansoprazole, esomeprazole, pantoprazole and rabeprazole, PPIs work by cutting the amount of acid the stomach makes.

There are numerous case studies of the popular prescription drugs causing myriad health problems. But research results are mixed. Some studies have warned of doctors being too quick to prescribe PPIs and patients staying on them for too long. Others have found little reason for concern.

LeighAnn Miller of Knoxville, TN, was on PPIs for years without any problems.
I had initially taken Prilosec probably about 10 years ago,” she says. “It was prescribed by my primary care physician. I Just had some random heartburn and he prescribed it to me, I took it, didn’t have any issues.”

The symptoms got better 3 years later, so she stopped taking it. But the symptoms came back last July, and she was prescribed a different PPI. This time, her experience was much different.

“I began to have what appeared to be bug bites on my forearm,” says Miller, 35. “And at first, it was just a few, then it began to multiply. … I was covered in a rash from head to toe with the exception of my face for 6 months. It did not resolve completely until March.”

She stopped taking the medication as soon as the symptoms began. After several visits to dermatologists and a rheumatologist, after extensive bloodwork and a battery of tests including a biopsy, everything came back normal. Miller says she and her rheumatologist did some research and found that it could be drug-induced lupus.

According to the Lupus Foundation of America, there is a possible but not definitive link between the condition and PPIs in some people.

The experience has soured Miller on PPIs. “I’m not saying that there are not benefits to these medications, but I do think that there is more risk involved than there is benefit.”

A Very Common Drug
Just how risky it is to take these popular drugs has become a source of debate.

While the benefits to patients are undeniable, the drugs’ safety has come into sharp focus, with studies and researchers both defending and questioning the drugs’ benefits, dangers, and widespread use.

In the last few years, thousands of lawsuits have been filed, with patients claiming side effects including kidney disease and bone fractures. According to Drug Watch, a consumer advocacy group, one of the first cases is set for trial in September 2020.

A study published in May in The BMJ, a British medical journal, looked at death rates associated with PPIs.

According to lead investigator Ziyad Al-Aly, MD, an assistant professor of medicine at Washington University School of Medicine in St. Louis, the study focused on 157,000 veterans who were prescribed PPIs for the first time, following them for 10 years.
“There is a very significant body of evidence that suggests that these drugs (PPIs), when used for a long period of time, especially when they are not medically indicated, are associated with serious side effects and also associated with increased dying from specific causes — namely dying from heart disease, kidney disease, and stomach cancer.”

“There may be other risks as well,” Al-Aly continued, “But, it is important to mention in this context that PPIs are not all evil drugs. They’re also beneficial drugs when used appropriately in the right patient and for the indicated duration of time. In the right patients, these drugs actually also save lives.”

Paul Moayyedi, MD, a professor of gastroenterology at McMaster University in Ontario, Canada, says his new research on PPIs, published in early June in the American Gastroenterology Association’s journal Gastroenterology, found no need for worry.

His study was a large trial of 17,598 people whom researchers followed for 3 years. They found no evidence to support claims that PPIs cause serious diseases like chronic kidney disease, pneumonia, diabetes, and dementia.

One group was put on a PPI, and the other was given a placebo. Moayyedi says they found similar rates “of everything” between the two groups, “The rates of heart disease, stroke, pneumonia, fracture, chronic renal disease, and dementia were very similar between the two groups. Cancer rates were also similar, and all cause mortality was almost identical between the two groups.”

Moayyedi says most of the studies of PPIs are observational and therefore less reliable. They only look to understand causes and effects of these medications. But studies like his test the impact of the drugs on patients against those simply given a placebo.

“In other words, they look at people who are on PPI and people who are not on PPI … and see what happens to them over time,” he says. “These have shown increases in risk of diseases such as pneumonia, fractures. However, on average, patients in these databases who are on PPI are sicker than those who are not, and sicker people get other illnesses.”

His message to patients: “There is no harm that we can see so far.”

Folasade May, MD, director of quality improvement in gastroenterology at UCLA Health, is working on a study of the overuse of PPIs. She feels more research is needed. It’s the only way, she says, to test whether a specific medication leads to a specific outcome.

“The reason why these questions and these studies are important is that there are millions of people on PPIs,” she says. “When a medication is this common, even rare adverse effects can impact a lot of individuals. And that’s why it’s important for scientists — those in the laboratory and those that conduct human studies — to expand our knowledge on if and how PPIs are affecting our bodies in ways that we don’t want them to.”

The Consumer Healthcare Products Association represents leading manufacturers and marketers of over-the-counter medicines. In a statement to WebMD, it stands by the safety of these drugs based on years of data and use.
“More than 60 authors from 29 countries recently published results from a large randomized clinical trial confirming the safety of PPIs. Addressing a number of less rigorous studies which have raised concerns that PPIs may be associated with various health risks, the Authors concluded, ‘It is reassuring that there was no evidence for harm for most of these events other than an excess of enteric [intestinal] infections.’ ” According to the American Gastroenterological Association, which published the study in its official journal, this “new research puts safety concerns to rest.”

For 20 years, John Pandolfino, MD, has been prescribing PPIs to his patients. The division chief of gastroenterology and hepatology at Northwestern University told WebMD he’s never had a patient complain about side effects.

“In the grand scheme of things, I do think PPIs are safe, but there are studies that suggest an association between PPIs and some adverse outcomes. However, I think we have to be careful when we look at those particular studies so as to not over exaggerate the cause-and-effect potential, but also to not completely discount them.

“We know that patients that take PPIs are inherently sicker than those who do not take PPIs, and this confounder may bias studies and explain many of these associations.”

Pandolfino thinks doctors who prescribe these medicines must be more vigilant in their follow-up.

“I think this is an important conversation to be having because right now, we’re seeing new studies every week about PPIs. And since they are very similar studies, we see the same results and the same potential bias in the outcomes. This is a wake-up call for all of us to do a better job of educating patients about the risks and benefits of medicines, because all medicines have risks.”

Risks that patients are trying to process as they make decisions about whether to remain on these drugs — or not.

As Melanoma Rises, Doctors Challenge Some Early Testing

May 6, 2019 — As melanoma cases continue to rise sharply, Americans are being urged to get screened early for this deadliest of skin cancers. But some dermatologists question whether screening people without symptoms has resulted in overdiagnosing melanoma, bringing unnecessary anxiety and treatments.

They note that while the number of invasive melanoma cases diagnosed in the U.S. doubled from 1982 to 2011 and continue to rise, death rates have only dropped slightly. From 2007 to 2016, deaths from melanoma decreased by 2% in adults 50 and older and by 4% in people younger than 50.

“A huge increase in diagnosed melanomas should be associated with a steep decline in mortality,” says Ade Adamson, MD, a dermatologist and assistant professor at Dell Medical School at the University of Texas at Austin. “This is a very delicate discussion in my field because we want to believe so badly that screening healthy people and early detection is going to save lives, regardless of the cancer.”

Adamson says advances in technology contribute to overdiagnoses, including skin scanning tools that pick up tiny changes the eye can’t see. He says it is difficult, sometimes impossible, for a doctor or pathologist to tell a malignant melanoma lesion from a benign mole in the earliest stages of skin cancer.

He says the United States Preventive Services Task Force — a group of independent experts that use evidence to guide decision making — cites overdiagnosis as one of the reasons it doesn’t endorse routine skin cancer screening. The task force said it didn’t have enough data to determine if screening helps save lives. This recommendation is for people without a history or skin cancer who do not have any suspicious moles or other spots.

“The potential for harm clearly exists,” according to a statement the task force released in 2016, although “current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults.”

It says potential harms include misdiagnosis, overdiagnosis, cosmetic effects from biopsy (where a doctor removes a small amount of tissue to examine it for cancer cells), and overtreatment. For instance, surgical removal of moles can leave scars, and medications can have side effects.

A Controversial Topic

Overdiagnosis is controversial in the field of dermatology, where the prevailing wisdom is that greater exposure to ultraviolet (UV) radiation from the sun and tanning salons has led to higher melanoma rates over the years. Dermatology organizations urge Americans to use sunscreen, avoid tanning salons, and regularly get screened for skin cancer, especially if they sunburn easily or have a family history of the disease.

Since 1985, the American Academy of Dermatology has offered free skin cancer screening clinics around the country in May, which is melanoma awareness month.

A spokesman for the academy, Joel Cohen, MD, says the rise in melanoma cases may be related to better technology in the field that helps detect cancer early, screening programs that find melanoma early, and public education campaigns about how to recognize the early signs of skin cancer. When caught early, melanoma doesn’t have to be a death sentence, he says.

“Early diagnosis is absolutely essential when it comes to melanoma,” says Cohen, director of AboutSkin Dermatology in Greenwood Village, CO. “When we catch something tiny, believe me, it’s something to celebrate about. You’ve actually given this person a chance at life.”

Five-year survival rates for people whose melanoma is detected early is 92%, according to data provided by the American Society of Clinical Oncology. If the cancer has spread to other part of the body, that rate drops to 23%.

A recent study examined the American Academy of Dermatology’s SPOTme skin cancer screening program from 1986 to 2014. It said the data suggest that the program “detected thousands of skin cancers that may have gone undetected or experienced a delay in detection.”

It also said that people who went on to be diagnosed with skin cancer were more likely to be uninsured.

‘We’re Ramping Up Health Anxiety’

David J. Elpern, MD, a dermatologist in Williamstown, MA., says that overdiagnosis — not exposure to the sun — has contributed to rising melanoma rates. He believes dermatologists are finding more cases of melanoma early because of “diagnostic drift,” a growing tendency to diagnose and treat benign lesions as malignant cancers.

“You’re picking up tumors that probably never would have amounted to anything,” says Elpern, who has spoken out about changes in the field of dermatology that promote care that’s wasteful and not needed.

Overdiagnosis is not without consequences, he says. Once a patient is labeled with cancer, they’re launched into the health care system, where they’re subjected to excessive and expensive treatments, including biopsies, that are profitable for dermatologists.

“We’re ramping up health anxiety,” he says. Some dermatologists argue that these lowest-risk conditions shouldn’t be labeled as cancers at all. Instead, they should be watched.

But Stephanie Gardner, MD, a dermatologist in suburban Atlanta, says they are vigilant for a reason.

“Patient education and self-exams, appropriate timing of skin exams by dermatologists, and removal and surveillance of suspicious lesions all help to prevent advanced disease,” she says. “I would much rather be overdiagnosed than have a cancer missed, along with all of those ramifications.”

Prevention Tips

Prevention is the first step to avoid skin cancer. The American Academy of Dermatology urges everyone to take these steps:

  • Seek shade when needed. The sun’s strongest rays are between 10 a.m. and 2 p.m.
  • Wear protective clothing when possible: a wide-brimmed hat, sunglasses, long pants, and long-sleeved shirts.
  • Generously apply a broad-spectrum, water-resistant sunscreen with SPF 30 or higher. Use it whenever you are outside, even on cloudy days.
  • Reapply sunscreen every 2 hours.
  • Avoid tanning beds.
  • Do regular skin self-exams to look for new or suspicious spots on your skin.

People at higher risk of skin cancer include those who have:

  • Light skin
  • Skin that burns or freckles easily
  • Blue or green eyes
  • Blond or red hair
  • Certain types and a large number of moles
  • A family history of skin cancer
  • A personal history of skin cancer

How does bereavement impact the immune system?

Losing a loved one is, of course, incredibly traumatic; it may also shorten lifespan. A recent paper reviews decades’ worth of research into bereavement and its effects on the immune system.

For years, researchers and laypeople alike have noted that when someone loses a partner, their risk of mortality increases significantly.

In days gone by, we might have referred to this as a death from a broken heart.

The phenomenon has been under investigation for decades.

For instance, researchers using data from a Finnish population published their findings in 1987. They found that “For all natural causes, mortality during the first week [following the death of a spouse] was over two-fold, compared to expected rates.”

Another study, published in 1995, concluded that, following the death of a spouse, mortality “was significantly elevated in both men and women.” This elevation was most pronounced 7–12 months after the bereavement.

Although scientists have collected a fair amount of evidence demonstrating this effect, there is less information about the biological mechanism that drives it.

Bereavement and the immune system

Now, a literature review has attempted to tie previous findings together to create a clearer picture of this phenomenon. Specifically, the authors were interested in how bereavement and grief might negatively influence the immune system, thereby increasing mortality risk.

The authors, from the University of Arizona, in Tucson, recently published their paper in the journal Psychosomatic Medicine.

The researchers conducted a systematic review of published research from 1977 to now. In all, 33 studies met the grade to be considered for analysis and the scientists focused on 13, which were of the highest quality.

When asked why they conducted the research, one of the authors, Lindsey Knowles, explained that “There is strong evidence that spousal bereavement increases morbidity and risk for early mortality in widows and widowers; however, we have yet to discover how the stress of bereavement impacts health.”

It was in the late 1970s that scientists started looking to the immune system’s role in increased mortality risk after bereavement.

A paper published in The Lancet in 1977 claims to be the first to measure an abnormality in immune function following bereavement.

A new review of the evidence

Knowles explains that she wanted to create a document that includes “all published data on the association between bereavement and immune function — to establish a knowledge base and suggest specific directions for future research.”

The paper outlines the primary findings from studies that have been carried out to date.

In particular, they identify that people who are bereaved have increased levels of inflammation, faulty immune cell gene expression, and reduced antibody responses to immune challenges.

These changes are all significant when trying to understand why people who are bereaved have a higher risk of death; for instance, scientists already know that chronic inflammation plays a part in a range of conditions, including obesity, heart disease, and diabetes.

The authors also conclude that there is a link between the psychological impacts of bereavement — such as grief and depression — and how severely bereavement impacts immune function.

A study published in 1994, for instance, found that, overall, individuals who had been bereaved did not have significant differences in their immune profiles. However, those who also met the diagnostic criteria for depression did have impaired immune function.

This type of research is important; there is still an air of mystery around the topic, so any new insight is vital. Scientists know that grief increases the risk of an earlier death, so understanding what is happening on a physiological basis could help guide how doctors treat these people in the future.

Another of the paper’s authors, associate professor Mary-Frances O’Connor, explains how, “Someday, clinicians may be able to track changes in patients’ immunity and prevent medical complications after this difficult experience.”

When asked about the contribution that this paper lends to the field, O’Connor says:

“This systematic review gives researchers a resource to read all that research in one place, with a modern perspective on how the field has changed and a visual model to help move the field forward in a more organized way.”

Although this line of inquiry has a long history, there are still many gaps that scientists need to fill with fresh research.

As the authors explain, there is a great need for large longitudinal studies; for instance, if researchers could assess an individual’s immune profile before bereavement occurs and throughout the aftermath, this would provide a much-needed depth of information. Of course, this approach would require a great many resources.

Hopefully, this review will ignite a fascination in the next generation of researchers who are destined to tackle this topic.