Heart attack in chest pain patients may be predicted with the help of new blood markers: Study - The Daily Guardian
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Heart attack in chest pain patients may be predicted with the help of new blood markers: Study

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Researchers identified telltale markers in the blood of heart attack patients that distinguished them from patients suffering chest pain with other causes.

The study published in the open-access journal Frontiers in Cardiovascular Medicine. With the findings of this novel study, researchers hope that the results will lead to new diagnostic tests for heart attacks. If you have ever suffered chest pain, the possibility of a heart attack may have popped into your head. While chest pain is an important symptom of heart attacks, there are a variety of other conditions that can cause similar symptoms, and many of them are not serious. If a patient presents with chest pain at the hospital, doctors need to quickly determine if a heart attack is a culprit. Early treatment is important in limiting the damage that occurs.

At present, this may involve coronary angiography, where a catheter is placed into the blood vessels of the heart. While effective, angiography is invasive, and not something you would like to undergo if unnecessary. Also, in busy or poorly resourced hospitals, angiography may not always be available in time. Another test involves taking a blood sample to check for proteins that indicate damage to the heart muscle. However, these markers are sometimes unreliable and can be elevated by other conditions.

These issues inspired these researchers to look for new markers in the blood that form a unique fingerprint for a heart attack. They turned to small molecules called metabolites that are produced during biochemical processes within our bodies.

“We analysed circulating metabolites in blood plasma samples from cardiac chest pain patients, including heart attack cases and other cardiac chest pain cases, to identify potential markers for heart attack diagnosis and early warning,” explained Dr Xiangqing Kong of the First Affiliated Hospital of Nanjing Medical University, corresponding author on the paper. “Such markers could help confirm heart attack promptly when angiography is unavailable.”

The researchers collected blood samples from 146 patients who presented at the hospital with chest pain and 84 healthy volunteers. Of the 146 chest pain patients, 85 were later confirmed to have suffered a heart attack and the remainder had chest pain from other causes.

Strikingly, on analysing the samples, the researchers found an array of metabolites that were present in different amounts, and the differences were significant enough that they could successfully distinguish between the samples from heart attack patients, those with non-heart attack-related chest pain and the healthy volunteers. Three metabolites showed particular promise as diagnostic markers. “Even after accounting for other cardiac risk factors such as hypertension, smoking and diabetes history, the metabolites deoxyuridine, homoserine and methionine scored highly as potential diagnostic and risk markers of heart attack,” explained Dr Jiye Aa of the China Pharmaceutical University, another author on the paper.

In reality, a suspected heart attack patient will likely undergo various tests before a heart attack is confirmed but expanding the available arsenal of reliable tests will be useful for doctors in narrowing things down quickly. The researchers plan to conduct further research to assess why and how these biomarkers are involved in heart attacks. 

WITH ANI INPUTS

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HOW PHYSIOTHERAPY AND ACUPUNCTURE CAN HELP IN ARTHRITIS TREATMENT

Dr K. Shanmugam

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A chronic musculoskeletal or auto-immune condition, arthritis is a group of diseases that affects the joints, the spine and other parts of the musculoskeletal system. Arthritis is among the leading causes of disability worldwide that impact the quality of life as well as productivity of millions of people. While arthritis is associated primarily with ageing and auto-immune conditions, in recent years, lifestyle factors such as increased rate of obesity, lack of physical activity and unhealthy diets have contributed to its rise.

Arthritis is commonly divided into two forms: osteoarthritis, which is primarily age-related or injury-related wear and tear of the joints and rheumatoid arthritis, which is a systemic auto-immune form of the disease prevalent in different age groups. According to WHO estimates, as many as 9.6% of men and 18.0% of women aged over 60 years have symptomatic osteoarthritis. Similarly, the incidence of rheumatoid arthritis varies between 0.3% to 1% .

NEED FOR THE INTEGRATED TREATMENT APPROACH

Whichever the type, arthritis is a chronic disorder that majorly affects the mobility of patients and needs medical intervention to slow its progression and minimize damage to joint cartilage and bones. Arthritis is a debilitating condition that interferes with millions of people’s daily lives, preventing them from fulfilling their true potential.

Lifestyle changes, weight loss, the routine form of exercises, and consumption of a healthy diet and anti-inflammatory diet are critical interventions to reduce disease progression and improve quality of life.

Conventional treatment of arthritis involves a combination or drugs such as analgesics, NSAIDs (non-steroidal anti-inflammatory drugs), steroids, and immunosuppressants. In patients with a rapid progression of the disease or debilitating pain, these drugs help reduce the inflammation and reduce the disease’s progression. However, chemical-based drugs come with potentially serious side effects.

Alternative drugless therapies and naturopathic interventions can help patients improve their quality of life while reducing harmful drugs’ dosage in the long run. When naturopathic interventions are made early on in the disease cycle, they prove to be the most beneficial and may even help some patients avoid harmful drugs altogether.

Therefore, it is important to develop a treatment approach for arthritis that can enable patients to benefit from naturopathy and modern medicine. Naturopathic interventions also help patients lose weight, an important element in controlling joint degeneration.

ACUPUNCTURE FOR ARTHRITIS

Acupuncture is a traditional Chinese medicine practice that believes that life energy known as ‘qi’ (Chee) flows through the body along different meridians. The human body has 20 such meridians. When the flow of energy through these channels is blocked or imbalances human body experiences pain. There are more than 2000 acupuncture points that connect to meridians. Stimulating those points with needles corrects the flow of energy in the body and alleviates pain.

Modern medicine may not recognize the concepts of acupuncture, but acupuncture has been used as an alternative treatment method for the disease for a long time. Many patients who have failed to benefit from conventional medicine turn to acupuncture treatment and find relief.

Acupuncture, through the insertion of very fine needles on the pressure points, stimulates the brain to release natural pain killers called endorphins and stress hormone cortisol. The stimulation helps reduce pain and control inflammation. Research has shown that acupuncture helps in relieving stiffness and pain in arthritis patients along with promoting joint mobility and preventing cartilage breakdown.

A study published in the journal Evidence-Based Complementary Alternative Medicine in 2018 examined a series of cross-sectional studies to review the benefits of acupuncture for arthritis patients. The study found that acupuncture itself or when combined with other treatment modalities, offers benefits to patients with rheumatoid arthritis and can improve joint function and quality of life without any adverse effects. The study concluded that acupuncture seemed to have anti-inflammatory, antioxidative well immunomodulatory effects on patients, thereby ushering in the benefits .

PHYSIOTHERAPY FOR ARTHRITIS TREATMENT

Physiotherapy and physical exercise are crucial in keeping joint mobility and muscle strength intact. A physiotherapist will first examine the joints and the symptoms of the patient and then recommend a tailored exercise approach for each patient’s requirements depending upon the condition and severity of the disease.

Physiotherapy helps build muscle strength to support the joints, enabling the use of affected joints along with improving overall mobility. As arthritis progressively impacts joint health, regular physiotherapy helps patients maintain fitness and preserve the ability to perform their quality of daily activities.

In certain cases, physiotherapists may also use few electrotherapy modalities to relieve the pain like hydrotherapy, manual therapy, thermotherapy & cryotherapyin arthritis patients. Thus it helps to increases mobility and relieves the pain while also helping patients with ortho supports such as braces or splints for affected joints to maintain and avoid further worsening of the alignment of the joints.

CONCLUSION

Physiotherapy and acupuncture are slowly gaining acceptance as supplementary treatment methods for arthritis. With an ageing population leading to a higher burden of arthritis, there is bound to the greater need for complementary treatment approaches that help minimize adverse drug effects. When used in tandem with modern medicine, naturopathic interventions such as acupuncture can significantly improve patients’ quality of life and clinical outcomes.

The author is Assistant Chief Medical Officer, Jindal Naturecure Institute.

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Vegetarians have healthier levels of disease markers than meat-eaters: Study

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Vegetarians appear to have a healthier biomarker profile than meat-eaters, and this applies to adults of any age and weight, and is also unaffected by smoking and alcohol consumption, according to a new study in over 166,000 UK adults, being presented at week’s European Congress on Obesity (ECO), held online this year.

Biomarkers can have bad and good health effects, promoting or preventing cancer, cardiovascular and age-related diseases, and other chronic conditions, and have been widely used to assess the effect of diets on health. However, evidence of the metabolic benefits associated with being vegetarian is unclear. To understand whether dietary choice can make a difference to the levels of disease markers in blood and urine, researchers from the University of Glasgow did a cross-sectional study analysing data from 177,723 healthy participants (aged 37-73 years) in the UK Biobank study, who reported no major changes in diet over the last five years.

Participants were categorised as either vegetarian (do not eat red meat, poultry or fish; 4,111 participants) or meat-eaters (166,516 participants) according to their self-reported diet. The researchers examined the association with 19 blood and urine biomarkers related to diabetes, cardiovascular diseases, cancer, liver, bone and joint health, and kidney function.

Even after accounting for potentially influential factors including age, sex, education, ethnicity, obesity, smoking, and alcohol intake, the analysis found that compared to meat-eaters, vegetarians had significantly lower levels of 13 biomarkers, including:

Total cholesterol; low-density lipoprotein (LDL) cholesterol–the so-called ‘bad cholesterol; apolipoprotein A (linked to cardiovascular disease), apolipoprotein B (linked to cardiovascular disease); gamma-glutamyl transferase (GGT) and alanine aminotransferase (AST)–liver function markers indicating inflammation or damage to cells; insulin-like growth factor (IGF-1; a hormone that encourages the growth and proliferation of cancer cells); urate; total protein; and creatinine (a marker of worsening kidney function).

However, vegetarians also had lower levels of beneficial biomarkers including high-density lipoprotein ‘good’ (HDL) cholesterol, and vitamin D and calcium (linked to bone and joint health). In addition, they had a significantly higher level of fats (triglycerides) in the blood and cystatin-C (suggesting a poorer kidney condition).

No link was found for blood sugar levels (HbA1c), systolic blood pressure, aspartate aminotransferase (AST; a marker of damage to liver cells) or C-reactive protein (CRP; inflammatory marker).

“Our findings offer real food for thought”, says Dr Carlos Celis-Morales from the University of Glasgow, UK, who led the research.

“As well as not eating red and processed meat which have been linked to heart diseases and some cancers, people who follow a vegetarian diet tend to consume more vegetables, fruits, and nuts which contain more nutrients, fibre, and other potentially beneficial compounds. These nutritional differences may help explain why vegetarians appear to have lower levels of disease biomarkers that can lead to cell damage and chronic disease.”

Although their study was large, the authors point out that it was observational, so no conclusions can be drawn about direct cause and effect. They also note several limitations: they only tested biomarker samples once for each participant, and biomarkers might fluctuate depending on factors unrelated to diets, such as existing diseases and unmeasured lifestyle factors. They also note that were reliant on participants to report their dietary intake using food frequency questionnaires, which is not always reliable.

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WHY INDIA IS WITNESSING MASSIVE COVID-19 EXPLOSION

WHO’s top scientist Soumya Swaminathan warns that ‘the epidemiological features that we see in India today do indicate that it’s an extremely rapidly spreading variant’.

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With 4,03,738 new Covid-19 cases in the last 24 hours, India continued to report more than four lakh daily coronavirus infections for the fourth day on the trot. With this, the cumulative national tally of the infection went up to 2,22,96,414, the Union Health Ministry informed on Sunday morning. The country saw 3,86,444 fresh recoveries on Saturday, pushing the total number of discharges to 1,83,17,404. At present, India has 37,36,648 active coronavirus cases.

In an interview with AFP, World Health Organization’s chief scientist Soumya Swaminathan warned that “the epidemiological features that we see in India today do indicate that it’s an extremely rapidly spreading variant”. She said that the B.1.617 variant of Covid-19, which was first detected in last October, was clearly a contributing factor to the catastrophe unfolding in her homeland.

“There have been many accelerators that are fed into this,” Swaminathan said, stressing that “a more rapidly spreading virus is one of them”.

The WHO recently listed B.1.617 — which counts several sub-lineages with slightly different mutations and characteristics — as a “variant of interest”. But so far it has stopped short of adding it to its short list of “variant of concern” — a label indicating it is more dangerous than the original version of the virus by being more transmissible, deadly or able to get past vaccine protections.

Several national health authorities, including in the United States and Britain, have meanwhile said they consider B.1.617 a variant of concern, and Swaminathan said she expected the WHO to soon follow suit.

“B 1.617 is likely to be a variant of concern because it has some mutations which increase transmission, and which also potentially could make (it) resistant to antibodies that are generated by vaccination or by natural infection,” Swaminathan was quoted as saying by AFP.

She, however, insisted that the variant alone could not be blamed for the dramatic surge in cases and deaths seen in India, lamenting that the country appeared to have let down its guard down, with “huge social mixing and large gatherings”. But even as many in India felt the crisis was over, dropping mask-wearing and other protection measures, the virus was quietly spreading.

“In a large country like India, you could have transmission at low levels, which is what happened for many months,” she said. “It was endemic (and) probably gradually increasing,” she said, decrying that “those early signs were missed until it reached the point at which it was taking off vertically.”

“At that point it’s very hard to suppress, because it’s then involving tens of thousands of people and it’s multiplying at a rate at which it’s very difficult to stop.”

While India is now trying to scale up vaccination to rein in the outbreak, Swaminathan warned that the jabs alone would not be enough to gain control of the situation. She pointed out that India, the world’s largest vaccine-making nation, had only fully vaccinated around two percent of the 1.3 billion-plus population. “It’s going to take many months if not years to get to the point of 70 to 80 percent coverage,” she told AFP.

With that prospect, Swaminathan stressed that “for the foreseeable future, we need to depend on our tried and tested public health and social measures” to bring down transmission.

The surge in India is frightening not only due to the horrifying number of people who are sick and dying there, but also because the exploding infection numbers dramatically increase the chances of new and more dangerous variants emerging. “The more the virus is replicating and spreading and transmitting, the more chances are that… mutations will develop and adapt,” she told AFP.

With agency inputs

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SUGARY BEVERAGE LINKED TO INCREASED RISK OF COLORECTAL CANCER IN WOMEN UNDER 50: STUDY

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If you are obsessed with sugar-sweetened drinks then you need to think twice before having them regularly.

A new study led by Washington University School of Medicine has found a link between drinking sugar-sweetened beverages and an increased risk of developing colorectal cancer in women under age 50. The findings suggest that heavy consumption of sugary drinks during adolescence (ages 13 to 18) and adulthood can increase the disease risk. The study, published in the journal Gut, provides more support for public health efforts that encourage people to reduce the amount of sugar they consume.

“Colorectal cancer in younger adults remains relatively rare, but the fact that the rates have been increasing over the past three decades — and we don’t understand why — is a major public health concern and a priority in cancer prevention,” said senior author Yin Cao, ScD, an associate professor of surgery and of medicine in the Division of Public Health Sciences at Washington University.

“Due to the increase in colorectal cancer at younger ages, the average age of colorectal cancer diagnosis has gone down from 72 years to 66 years. These cancers are more advanced at diagnosis and have different characteristics compared with cancers from older populations.

“Our lab is funded by the National Cancer Institute (NCI) and the National Comprehensive Cancer Network to identify risk factors, the molecular landscapes, and precision screening strategies for these cancers so that they can be detected earlier and even prevented,” said Cao, who also has a master’s of public health.

“In past work, we have shown that poor diet quality was associated with increased risk of early-onset colorectal cancer precursors, but we have not previously examined specific nutrients or foods.”

Compared with women who drank less than one 8-ounce serving per week of sugar-sweetened beverages, those who drank two or more servings per day had just over twice the risk of developing early-onset colorectal cancer, meaning it was diagnosed before age 50.

The researchers calculated a 16 per cent increase in risk for each 8-ounce serving per day. And from ages 13 to 18, an important time for growth and development, each daily serving was linked to a 32 per cent increased risk of eventually developing colorectal cancer before age 50.

Sugar-sweetened drink consumption has been linked to metabolic health problems, such as type 2 diabetes and obesity, including in children. But less is known about whether such high-sugar beverages could have a role in the increasing incidence of colorectal cancer in younger people. Like early-onset colorectal cancer rates, consumption of such drinks has increased over the past 20 years, with the highest consumption level found among adolescents and young adults ages 20 to 34.

The researchers analyzed data from the Nurses’ Health Study II, a large population study that tracked the health of nearly 116,500 female nurses from 1991 to 2015. Every four years, participants answered surveys that included questions about diet, including the types and estimated amounts of beverages they drank.

Of the total participants, over 41,000 also were asked to recall their beverage habits during their adolescence.

The researchers identified 109 diagnoses of early-onset colorectal cancer among the nearly 116,500 participants.

“Despite the small number of cases, there is still a strong signal to suggest that sugar intake, especially in early life, is playing a role down the road in increasing adulthood colorectal cancer risk before age 50,” said Cao, also a research member of Siteman Cancer Center.

“This study, combined with our past work linking obesity and metabolic conditions to a higher risk of early-onset colorectal cancer, suggests that metabolic problems, such as insulin resistance, may play an important role in the development of this cancer in younger adults.”

With the increasing rates in mind, the American Cancer Society has recently lowered the recommended age for a first screening colonoscopy to 45, down from the previously recommended age 50 for people at average risk. Those with additional risk factors, such as a family history of the disease, should start even earlier, according to the guidelines.

Since the study only included female nurses, most of whom were white, more work is needed to examine this link in people of more diverse races, ethnicities and genders.

While sugar-sweetened beverages were linked to an increased risk of early-onset colorectal cancer, some other drinks — including milk and coffee — were associated with a decreased risk.

This observational study can’t demonstrate that drinking sugary beverages causes this type of cancer or that drinking milk or coffee is protective, but the researchers said that replacing sweetened beverages with unsweetened drinks, such as milk and coffee, is a better choice for long-term health.

“Given this data, we recommend that people avoid sugar-sweetened beverages and instead choose drinks like milk and coffee without sweeteners,” Cao said.

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ORGAN TRANSPLANT RECIPIENTS REMAIN VULNERABLE TO COVID-19 EVEN AFTER SECOND VACCINE DOSE

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Researchers at Johns Hopkins have found that two doses of a vaccine against SARS-CoV-2 — the virus that causes COVID-19 — confers some protection for people who have received solid organ transplants, it’s still not enough to enable them to dispense with COVID safety measures including masks and physical distancing.

The findings that were published in the Journal of the American Medical Association (JAMA). This is a follow-up study to an earlier one published in March in JAMA, in which the researchers reported that only 17 per cent of the participating transplant recipients produced sufficient antibodies after just one dose of a two-dose COVID-19 vaccine regimen.

“While there was an increase in those with detectable antibodies — 54 per cent overall — after the second shot, the number of transplant recipients in our second study whose antibody levels reached high enough levels to ward off a SARS-CoV-2 infection was still well below what’s typically seen in people with healthy immune systems,” says study lead author Brian Boyarsky, M.D., a surgery resident at the Johns Hopkins University School of Medicine.

“Based on our findings, we recommend that transplant recipients and other immunocompromised patients continue to practice strict COVID-19 safety precautions, even after vaccination,” Boyarsky says.

People who receive solid organ transplants (such as hearts, lungs and kidneys) often must take drugs to suppress their immune systems and prevent rejection. Such regimens may interfere with a transplant recipient’s ability to make antibodies to foreign substances, including the protective ones produced in response to vaccines.

The new study evaluated this immunogenic response following the second dose of either of the two messenger RNA (mRNA) vaccines — made by Moderna and Pfizer-BioNTech — for 658 transplant recipients, none of whom had a prior diagnosis of COVID-19. The participants completed their two-dose regimen between Dec. 16, 2020, and March 13, 2021.

In the most recent study, the researchers found that only 98 of the 658 study participants — 15 per cent — had detectable antibodies to SARS-CoV-2 at 21 days after the first vaccine dose. This was comparable to the 17 per cent reported in the March study looking at the immune response after only one vaccine dose.

At 29 days following the second dose, the number of participants with detectable antibodies rose to 357 out of 658 — 54 per cent. After both vaccine doses were administered, 301 out of 658 participants — 46 per cent — had no detectable antibody at all while 259 — 39 per cent — only produced antibodies after the second shot.

The researchers also found that among the participants, the most likely to develop an antibody response were younger, did not take immunosuppressive regimens including anti-metabolite drugs and received the Moderna vaccine. These were similar to the associations seen in the March single-dose study.

“Given these observations, transplant recipients should not assume that two vaccine doses guarantee sufficient immunity against SARS-CoV-2 any more than it did after just one dose,” says study co-author Dorry Segev, M.D., PhD, the Marjory K. and Thomas Pozefsky Professor of Surgery and Epidemiology and director of the Epidemiology Research Group in Organ Transplantation at the Johns Hopkins University School of Medicine.

Segev says that future studies should seek to improve COVID-19 vaccine responses in this population, including additional booster doses or modulating the use of immunosuppressive medications so that sufficient antibody levels are achieved.

In addition to Boyarsky and Segev, the Johns Hopkins Medicine research team includes William Werbel, Robin Avery, Aaron Tobian, Allan Massie and Jacqueline Garonzik-Wang.

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New research analyzes more palatable alternatives to control SARS-CoV-2 spread

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At the beginning of the COVID-19 pandemic, intense social distancing and lockdown measures were the primary weapon in the fight against the spread of SARS-CoV-2, but they came with a monumental societal burden. New research from the Center for the Ecology of Infectious Diseases and the College of Public Health at the University of Georgia explores if there could have been a better way.

Through the findings, published in the journal Proceedings of the Royal Society B, the researchers analyzed more palatable alternatives to the kind of social distancing mandates that threw a wrench at how businesses, schools and even family gatherings work. The alternatives — widespread testing, contact tracing, quarantines, certification for non-infected people and other public health policy measures — can slow the spread when combined together, but only with significant investments and broad public compliance.

“I understand why government leaders quickly enacted strict social distancing mandates as the COVID-19 pandemic was rapidly spreading in 2020,” said lead author John Drake, director of the Center for the Ecology of Infectious Diseases and Distinguished Research Professor in the Odum School of Ecology.

“This was the best that we could do at the time. However, school and workplace closures, gathering limits and shelter-in-place orders have had extreme economic consequences. These are harsh, and we really need to find alternative solutions,” John added.

Drake worked with other researchers to develop two models. One targeted how to find infected people to limit transmission through active case finding (through testing of at-risk individuals), thorough contact tracing when cases arise, and quarantines for people infected and their traced contacts.

The second model focused on a strategy of limiting exposure by certifying healthy individuals.

“Each model was tested independently and in combination with general non-pharmaceutical interventions (NPIs),” said co-author Kyle Dahlin, a postdoctoral associate with the centre.

For this study, those interventions were defined as behavioural or generalized interventions that can be broadly adopted, such as wearing a face mask, hand washing, enhanced sick leave, micro distancing and contactless transactions.

“When we ran the model to evaluate the effectiveness of only using social distancing measures, like workplace closures, after the onset of the first wave, approximately half of the population eventually became infected,” said study co-author Andreas Handel, associate professor of biostatistics and epidemiology in UGA’s College of Public Health who helped design the models.

“When we combined social distancing with general interventions, SARS-CoV-2 transmission was slowed, but not enough for complete suppression.”

When they tested the model that actively looked for infection, they found that active case-finding had to identify approximately 95 per cent of infected persons to stop the viral spread.

When combined with NPIs, like face masks, the fraction of active cases that needed to be located dropped to 80 per cent. Considering that during the first wave of the pandemic in 2020, only 1 per cent to 10 per cent of positive cases were found, such an approach by itself wouldn’t work.

The researchers also determined that adding contact tracing and quarantine to active case finding and general NPIs did not drastically change the model’s success.

The model that targeted healthy people to limit exposure determined that to successfully control viral spread, SARS-CoV-2 test validity had to occur within a very narrow window of seven to 10 days with a waiting time of three days or less, and NPIs had to be strictly adopted. Otherwise, a large outbreak would occur.

Pej Rohani, Regents’ and Georgia Athletic Association Professor of Ecology and Infectious Diseases in the Odum School and College of Veterinary Medicine, said that the models’ conclusions indicated the need for continued research.

“These models are important because infectious disease ecologists and epidemiologists need to understand how SARS-CoV-2 transmission can be reduced using measures that do not have extreme societal consequences,” he said.

The CEID’s research highlighted the importance of a robust and widespread testing program, the general adoption of NPIs like face masks, and targeted measures to globally control the ongoing pandemic. These approaches are still extremely important as vaccines continue to be distributed.

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