How serious is Covid-19?
Covid-19 is a highly infectious disease. However, a large proportion of those infected or tested positive either do not develop any symptom or have mild or moderate symptoms. Nearly all people with mild to moderate symptoms recover with supportive care. It can be serious or severe for high-risk populations such as the elderly and those with pre-existing health conditions. However, it is difficult to predict who can develop severe disease. Therefore, everyone should follow preventive measures.
Who is at risk of developing severe illness?
This is not possible to assess with certainty. However, the elderly and anyone with pre-existing health conditions (such as high blood pressure, heart disease, lung disease, cancer or diabetes) appear to develop serious illness more often than others. There is emerging scientific evidence that people with comorbidities are up to twelve times at higher risk of death due to Covid-19 and up to six times more likely to be hospitalised. Men in all age groups are at higher risk than women. Clearly, reducing comorbidities and improving one’s health is key to battling Covid-19. The experience of clinical settings in India indicates that people with two or more comorbidities in any combination, such as diabetes and kidney disease or hypertension and chronic lung disease, are at higher risk of serious diseases. In India, there are an estimated 55 million people with heart diseases and 70 million people with diabetes, which makes all of them high-risk.
Are men at higher risk in comparison to women and if yes, why?
The epidemiological data on Covid-19 cases from different parts of the world as well as India has shown that proportionately more men have tested positive for Covid-19 than women. Of all the Covid-19 deaths in India, 70 per cent of the deaths have been in men. This indicates that men are at a higher risk of suffering from moderate to severe disease. The reasons are not fully understood, and knowledge is evolving. Most likely, it is due to the way in which the immune system of men and women reacts. Researchers have found that in Covid-19, the immune response of men is mostly through cytokines and chemokine (the protective chemicals released by the immune system). The cytokine-based response, while being protective, can be harmful in excess, and results in severe disease, a phenomenon more commonly seen in men. In women, the immune response against Covid-19 is predominantly driven by T-cells. The T-cell-dependent response is more balanced and nuanced. There is more evidence emerging that oestrogen (a hormone in women) may have some protective role against the moderate to severe disease.
There is recent evidence that there could be a post-Covid-19 syndrome in children. How serious is this?
This is still being evaluated. It has been reported from multiple places in the US and is seen in individuals who sort of recovered and then they have a fever, hyper-inflammatory syndrome which affects the skin, intestines, and also results in cardiac dysfunction. Many of these patients require ICU care to support blood pressure. This is a syndrome that has been called multisystem inflammatory syndrome in children (MIS-C) and a case definition has been developed. This is a new disease and knowledge is still evolving. It mimics another similar childhood disease known as the Kawasaki disease.
Can a person be reinfected with Covid-19?
There are not many reports that we can classically categorize under reinfection as of now. To classify any case as reinfection, the genomic sequence of the virus from both episodes should be conducted. There have been only a few such cases of reinfections verified based on genomic sequence out of the 45 million cases reported till the end of October 2020. Based on this information, it is too early to make any conclusive reference. As the pandemic progresses and more and more people recover we may come to know how much of a problem reinfection is.
Does air pollution increase the chance of Covid-19 infection?
There have been studies which have indicated that increased air pollution or PM2.5 level is associated with increase in the morbidity and mortality by 10–17 per cent.2 Pollution causes airway inflammation and predisposes one to infection. More specifically, increase in air pollution results in higher number of cases of chronic respiratory and cardiac diseases such as asthma and chronic bronchitis. These conditions already burden the respiratory and cardiac system of an individual. Thereafter, if a person get Covid-19 infection, it is likely that the already burdened immune system and the inflammation caused by pollution in the system of that individual may not be able to fully handle the disease. Therefore, air pollution is likely to affect the moderate to severe cases of the disease. Studies have reported that the mitigation of air pollution can reduce Covid-19 mortality but can also help in reducing the future mortality.
I keep hearing about mutation in SARS-CoV-2. What does it mean for the severity of disease?
The mutation is a minor change in viral genomic sequence. All viruses mutate which helps them to adapt to continue to infect the human host. SARS-CoV-2 is fairly stable, yet there have been around 15,000 mutations which have been reported till September 2020. But most of these mutations have been in non-significant section of the viruses. There is no evidence that mutations in the various parts of SARS-CoV-2 would alter its ability to cause disease. Current evidence also does not suggest that any significant mutation has occurred to make the vaccines being developed ineffective.
What do we know about the risk of transmission from a confined space?
The study in the journal Science had found that people using long-distance or long-duration shared transport had a high risk of transmission. In fact, this risk was found to be higher than the risk of transmission to those living in the same household. These findings have implications on the use of long-distance mode of travel such as buses and trains.
Are there things I should not do to protect myself from Covid-19?
The key is to follow CABs at all times. A few harmful behaviours like the following should ideally be avoided:
• Smoking (it is the best time to quit smoking).
• Wearing multiple masks (handling of these masks can be challenging and put you at additional risk).
• Taking antibiotics (this is a viral infection, antibiotics do not work).
Is there any special protocol to follow for washing fruits and vegetables?
Wash them thoroughly as you would do otherwise, with clean water. Do not use detergent or other harmful materials on fruits and vegetables. Wash your hands properly after washing fruits and vegetables and avoid touching your face while washing fruits and vegetables.
Can I catch Covid-19 from my pet?
It is a disease transmitted from human-to-human through droplet infection as well as through surface contact. Though there have been a few cases of transmission reported from domestic animals to humans, the details on additional factors are not available for those settings. Studies have found that cats and dogs can get the virus from human beings. Researchers have cautioned against the over-interpretation of these findings. As of now, limited evidence suggests that animals do not contribute to wider spread of infection.
Can Covid-19 be transmitted by houseflies and mosquitoes?
There is no evidence that Covid-19 can be transmitted through houseflies and mosquitoes.
Can Covid-19 spread from shoes?
Evidence available till now indicates that the likelihood of Covid-19 being spread through shoes and then infecting others is low. As a precautionary measure, families with infants and young children should store shoes where children cannot reach them.
Can Covid-19 spread from food? How safe is food ordered from outside?
There is currently no confirmed case of Covid-19 transmitted through food or food packaging. Packaged food and food items are unlikely to transmit the virus. There is no evidence to suggest that Covid-19 is transmitted through food and water. However, considering that the containers we use may hold and transmit the virus to others, it is essential that we remain cautious. Anyone with suspected symptoms like cough and cold should avoid cooking food for others. One should properly clean the surface of the packaged food as a precaution.
Is it safe to receive a courier package?
Yes. Evidence says that the likelihood of an infected person contaminating commercial goods is low. The risk of catching Covid-19 from a package that has moved through, travelled and been exposed to different conditions and temperatures is low. The outer surface of the package should be properly cleaned.
Should one shower after returning from every public place, mall or a hospital?
It is not necessary to shower every time after returning from public places. However, this should be looked at on a case-to-case basis and the risk one poses to family members. If there are high-risk members, it may help to change clothes and take a shower. Every visit to the hospital does not mandate a shower on return but it can be done as a precautionary measure. However, healthcare workers who spend long hours in hospital and potential cases may consider changing clothes and taking a shower on return.
Excerpts from the book, ‘Till We Win’ (Penguin). Dr Chandrakant Lahariya is a medical doctor and leading public policy and health systems expert. Dr Gagandeep Kang is a noted infectious-disease researcher. Dr Randeep Guleria is director of the All India Institute of Medical Sciences, New Delhi. The authors have made an attempt to cite the most updated and reliable sources including peer-reviewed medical journals.
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Illness related messages significant motivators for exercise
Fitness apps that emphasize illness- or death-related messaging are more likely to be effective in motivating participation than are social stigma, obesity, or financial cost messaging, according to a recent study led by researchers at the University of Waterloo.
The study, ‘The Relationship between Perceived Health Message Motivation and Social Cognitive Beliefs in Persuasive Health Communication’, was published in the journal MDPI (Multidisciplinary Digital Publishing Institute) and was authored by Oyibo, with Julita Vassileva, a Persuasive System Design professor at the University of Saskatchewan, assisting with the data collection.
Previous studies, especially on smoking cessation and risky sexual behaviour, found that messages related to mortality could be a barrier to acknowledging health risks, but the study found this is the opposite for fitness apps.
The study asked 669 research participants to indicate how persuasive these five types of messages were in terms of motivating them to work out at home with a fitness app, to uncover their effectiveness, connection with social-cognitive beliefs such as self-regulation (goal setting), self-efficacy, and outcome expectation, and seeing what role male/female gender played.
“I did not expect only illness- and death-related messages to be significant and motivational,” said Kiemute Oyibo, a postdoctoral fellow at the University of Waterloo’s School of Public Health Sciences.
Oyibo added, “Not only were illness- and death-related messages motivational, they had a significant relationship with self-regulatory belief and outcome expectation, and there was no significant difference between males and females.”
Oyibo said he had expected obesity-related messages (such as “one in four Canadians has clinical obesity”) to be motivational and have a significant relationship with self-regulatory belief, given that obesity is associated with the leading causes of global mortality.
“This study is important because it helps us – especially designers of health apps – understand the types of messages that individuals, regardless of gender, are likely to be motivated by in persuasive health communication, and that are likely to influence individuals’ social-cognitive beliefs about exercise,” Oyibo said.
Researchers find why people remember stressful experiences better
Researchers have analysed the reasons why stressful experiences are usually remembered more easily than neutral experiences.
When the brain stores memories of objects, it creates a characteristic pattern of activity for each of them. Stress changes such memory traces. The findings of the study were published in the journal ‘Current Biology’.
The research team, headed by Anne Bierbrauer, Professor Oliver Wolf and Professor Nikolai Axmacher from the RUB Institute of Cognitive Neuroscience, put people in stressful situations during simulated job interviews and then recorded their memory of objects from these interviews.Using functional magnetic resonance imaging, they analysed brain activity while the participants saw the objects again. Memories of objects from stressful situations seem to rely on similar brain activity as memories of the stress trigger itself.
The neuroscientists at RUB would like to understand the reasons for this phenomenon. Earlier studies and theoretical considerations had led to different predictions about how memories of stressful experiences differ from neutral ones: “One idea was that very different memory representation might have been the key to more powerful memories; on the other hand, there were indications that stress memories have resembled each other more closely,” explained Anne Bierbrauer.
The current study provides evidence for the second theory. Unlike in many laboratory studies, the researchers set out to record the memory trace of a real event in their experiments, using the so-called Trier Social Stress Test for this purpose.
During the job interview simulation, the committee used a number of everyday objects; for example, one of the committee members took a sip from a coffee cup. The control group was confronted with the same objects, but the participants were not subjected to any stress.
One day later, the researchers showed the objects to participants in both groups while recording brain activity in a magnetic resonance imaging scanner. The stressed participants remembered the objects better than members of the control group.
The researchers analysed primarily the brain activity in the amygdala, a region whose main functions include emotional learning. They compared the neuronal traces of objects that had been used by the committee members in the stress situation with those of objects that hadn’t been used.
The result was: the memory traces of objects that had been used resembled each other more closely than those of objects that hadn’t been used. This was not the case in the control group. In other words, the brain representations of the objects from stressful situations were very closely linked, and they were thus clearly set apart from other experiences.
“The committee members triggered the stress in the interview situation. Accordingly, it seems that the link between the objects and the stress triggers was crucial for the enhanced memory,” concluded Nikolai Axmacher.
The findings obtained argue against the theory that stronger memories are triggered by memory representations that differ from each other as much as possible — at least when it comes to emotional or stressful memories.Rather, the mechanism that reinforces emotional memories appears to be rooted in the fact that the important aspects of the episode are linked at the neural level and become more closely related to the stress trigger.
REACTIVATING MEMORIES DURING SLEEP IMPROVES MOTOR SKILLS
According to the findings of new research, practice makes one perfect, but sleep helps, too. Learning and executing a new motor skill can be enhanced if a person can get additional memory processing during sleep.
The findings of the study were published in the journal JNeurosci. Researchers at Northwestern University compared how well participants performed a challenging motor task with and without the extra processing during sleep. The participants played a computer game using a myoelectric computer interface, which enabled them to move a cursor by activating specific arm muscles.
Each command to move the cursor in a particular direction was paired with a unique sound; after practising, the participants played the game blindfolded and moved the cursor based on the sound cue alone.
After completing a test round, the participants took a 90-minute nap. The researchers played half of the sound cues during the nap, reactivating the motor memories associated with each cue. After the nap, the participants performed the motions cued during sleep better than the uncued ones.
It took less time to move the cursor, the cursor travelled a more direct route, and fewer superfluous muscles were activated.
These results show people can improve the performance of new motor skills by reactivating memories during sleep. This approach could be a way to enhance rehabilitation for stroke or other neurological disorders.
TELEHEALTH SCREENING OF SOME INFANTS MIGHT AID IN EARLY AUTISM SUPPORT
Telehealth evaluation could help improve access to care for infants with an elevated likelihood of autism, suggests a new UC Davis MIND Institute research.
The study, published recently in Autism, found that telehealth approaches in the first year of life could help families facing barriers to care such as geographic distance and long waitlists and aid in early diagnosis and intervention. “The goal is not to diagnose infants with autism,” said Meagan Talbott, an assistant professional researcher in the Department of Psychiatry and Behavioral Sciences and a MIND Institute faculty member. “It is to provide a developmental evaluation to help bridge the gap that we know parents face when they first notice symptoms until their children ultimately receive an autism diagnosis.”
Talbott notes that many families seeking early evaluations for autism face long provider waitlists, must often travel to centres with appropriate expertise and are frequently told by providers to “wait and see.”
Since specialized services for autism are generally tied to having a formal diagnosis, there are usually years between when parents first have questions and when they can access services.
“This results in significant stress for families and delayed support to infants and their caregivers. We hope this study shows one way that we can help improve families’ access to early evaluations and early services and support them,” said Talbott.
Developmental evaluations via telehealth
The study involved 41 infants, ages 6-12 months, whose parents had concerns about social communication or autism. They were recruited nationally in three cohorts. One-quarter of the infants had siblings with autism.
Talbott’s team used the TEDI (Telehealth Evaluation of Development for Infants), a protocol for conducting behavioural assessments that they previously developed. It uses a parent-coaching model to engage parents and infants in a specific set of interactions such as peek-a-boo, playing with toys and reading a book over 45-90 minutes. The examiner scored social communication, play, imitation and other developmental domains. Parents also filled out a series of questionnaires. All families were also sent a small kit of toys needed for the assessment, including blocks, a soft book, rattles, a small blanket and bubbles.
The majority of infants demonstrated an elevated likelihood of autism on both the parent-reported questionnaires and examiner-rated behaviour. This included decreased communication skills and delayed achievement of developmental milestones. Caregivers’ ratings of the usefulness of the TEDI evaluation were very positive.
The findings may also help to expand infant autism research beyond sibling studies, which have dominated the field. “We hope developing these tools for telehealth will help us to expand infant research beyond the sibling context and help us to understand early development in other groups,” explained Talbott.
What’s next for telehealth evaluation?
“My vision is that in the future if a family has a concern about their infant’s development, we could incorporate a telehealth evaluation like this as a second-level screener to help families figure out whether pursuing a full autism diagnostic assessment makes sense for their infant,” Talbott explained. “We’re very lucky in Sacramento that we have the MIND Institute, but there are many places where families are pretty far from somebody who has our level of expertise.”
The research team will soon start working with community members, families, paediatricians and other providers involved in early autism intervention to find out how developmental evaluation and monitoring via telehealth may fit into the existing care system. In the future, they hope to develop additional online programs to pair with these evaluations to further support families during this early period.
Talbott’s work started before the COVID-19 pandemic, but she noted it was nice to have already done the telehealth legwork.
“The pandemic illustrated how critically important telehealth can be,” Talbott said.
MATERNAL CHOLESTEROL DURING PREGNANCY LINKED WITH HEART ATTACK
A study has suggested that high maternal cholesterol in pregnancy is associated with more serious heart attacks in young adult offspring.
The research was published in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).
“Cholesterol is not routinely measured during pregnancy in most countries so there are few studies on its association with the health of offspring,” said study author Dr. Francesco Cacciatore of the University of Naples Federico II, Italy.
“More research is needed to verify our findings. If confirmed, this association would indicate that high cholesterol in pregnancy should be considered a warning sign and women should be encouraged to exercise and reduce their cholesterol intake. In addition, affected children could be provided dietary and lifestyle guidance aimed at preventing heart disease later in life,” he continued.
The retrospective study included 310 patients who were admitted to the hospital between 1991 and 2019. Of those, 89 patients were admitted with a heart attack, and 221 controls were hospitalised for other reasons. For all 310 participants, data were obtained on the mother’s cholesterol during the first and second trimester of pregnancy with that individual.
The average age of the 89 heart attack patients was 47 years and 84 per cent were men. Patients were classified as having a severe or non-severe heart attack according to: 1) the number of coronary arteries involved (severe attack = involving three arteries); 2) pump function of the heart (severe attack = left ventricular ejection fraction 35 per cent or less); 3) peak levels of creatinine kinase (CK) and CK-MB enzymes, with higher levels indicating more extensive heart damage (severe attack = CK-peak above 1200 mg/dL or CK-MB peak above 200 mg/dL).
The heart attack was considered severe when at least one of the criteria were met.
Maternal cholesterol during pregnancy was significantly correlated with each measure of heart attack severity (number of vessels, ejection fraction, CK and CK-MB).
The researchers analysed the association between maternal cholesterol during pregnancy and heart attack severity after adjusting for age, sex, body mass index (BMI), number of cardiovascular risk factors (obesity, smoking, high blood pressure, family history of heart disease, or high cholesterol, diabetes, prior angina), and serum cholesterol measured after hospitalisation for the heart attack.
Maternal cholesterol during pregnancy predicted heart attack severity independently of age, sex, BMI, number of risk factors, and serum cholesterol after hospitalisation, with an odds ratio of 1.382 (95 per cent confidence interval 1.046-1.825; p=0.023).
In a second analysis including all 310 patients, the researchers examined the association between maternal cholesterol during pregnancy and atherosclerosis in adult offspring. Because no measurements of atherosclerosis were available for most controls, two surrogate measures were used. These were: 1) a number of cardiovascular risk factors; and 2) a number of cardiovascular risk factors plus clinical manifestations such as heart attack or stroke.
Pregnant mothers’ cholesterol level was significantly correlated with both measures of atherosclerosis risk, even after adjusting for age, sex, and cardiovascular risk factors.
Dr. Cacciatore said, “Our observations suggest that a mother’s cholesterol level during pregnancy impacts the developmental programming of offspring and heart attack severity in adulthood. However, the study does not establish causality, nor does it allow us to estimate how much maternal cholesterol may contribute to heart attack severity.”
He concluded, “Prospective studies are needed to better evaluate the magnitude by which maternal cholesterol may influence the development of atherosclerosis in offspring and the combined effect of risk factors throughout the life.”
STUDY FINDS LIVING NEAR OIL, GAS WELLS INCREASES AIR POLLUTION EXPOSURE
Stanford researchers have observed higher levels of air pollutants within 2.5 miles of oil and gas wells, likely worsening negative health outcomes for residents.
The findings of the study were published in the journal ‘Science of The Total Environment’.
The scientists analysed local air quality measurements in combination with atmospheric data and found that oil and gas wells are emitting toxic particulate matter (PM2.5), carbon monoxide, nitrous oxide, ozone and volatile organic compounds (VOCs). The findings will help researchers determine how proximity to oil and gas wells may increase the risk of adverse health outcomes, including preterm birth, asthma and heart disease.
“In California, Black and Latino communities face some of the highest pollutions from oil and gas wells. If we care about environmental justice and making sure every kid has a chance to be healthy, we should care about this. What’s novel about our study is that we’ve done this at a population, state-wide scale using the same methods as public health studies,” said lead author David Gonzalez, who conducted research for the study in Stanford’s Emmett Interdisciplinary Program in Environment and Resources (E-IPER).
The findings align with other smaller-scale studies that have measured emissions from a handful of wells. At least two million Californians live within one mile of an active oil or gas well.
“It’s really hard to show air quality impacts of an activity like oil and gas production at a population scale, but that’s the scale we need to be able to infer health impacts,” said senior study author Marshall Burke, an associate professor of Earth system science at Stanford’s School of Earth, Energy and Environmental Sciences (Stanford Earth).
The research has revealed that when a new well is being drilled or reaches 100 barrels of production per day, the deadly particle pollution known as PM2.5 increases by two micrograms per cubic meter about a mile away from the site.
A recent study published in ‘Science Advances’ found that long-term exposure to one additional microgram per meter cubed of PM2.5 increases the risk of death from COVID-19 by 11 per cent.
“We started in 2006 because that’s when local agencies started reporting PM2.5 concentrations. We’re very concerned about the particulate matter because it’s a leading global killer,” said Gonzalez.
The team evaluated about 38,000 wells that were being drilled and 90,000 wells in production between 2006 and 2019. They developed an econometric model incorporating over a million daily observations from 314 air monitors in combination with global wind direction information from the National Oceanic and Atmospheric Administration (NOAA) to determine if the pollutants were coming from the wells. They analysed locations with air quality data of before and after a well was drilled.
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