Category: Health

“A Clinical Hunch by a Lot of Really Smart People”

(p. A1) Thomas Oxley wasn’t even on call the day he received the page to come to Mount Sinai Beth Israel Hospital in Manhattan. There weren’t enough doctors to treat all the emergency stroke patients, and he was needed in the operating room.

The patient’s chart appeared unremarkable at first glance. He took no medications and had no history of chronic conditions. He had been feeling fine, hanging out at home during the lockdown like the rest of the country, when suddenly, he had trouble talking and moving the right side of his body. Imaging showed a large blockage on the left side of his head.

Oxley gasped when he got to the patient’s age and covid-19 status: 44, positive.

The man was among several recent stroke patients in their 30s to 40s who were all infected with the novel coronavirus. The median age for that type of severe stroke is 74.

As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before. On the monitors, the brain typically shows up as a tangle of black squiggles – “like a can of spaghetti,” he said – that provide a map of blood vessels. A clot shows up as a blank spot. As he used a needlelike device to pull out the clot, he saw new clots forming in real-time around it.

“This is crazy,” he remembers telling his boss.

A SURGE

Reports of strokes in the young and middle-aged – not just at Mount Sinai but in many other hospitals in communities hit hard by the coronavirus – are the latest twist in our evolving understanding of its connected disease, covid-19. Even as the virus has infected nearly 2.8 million people worldwide and killed 195,000 as of Friday, its biological mechanisms continue to elude top scientific minds. Once thought to be a pathogen that primarily attacks the lungs, it has turned out to be a much more formidable foe – impacting nearly every major organ system in the body.

Until recently, there was little hard data on strokes and covid-19.

There was one report out of Wuhan, China, that showed that some hospitalized patients had experienced strokes but many of those were seriously ill and elderly. But the linkage was considered more of “a clinical hunch by a lot of really smart people,” said Sherry H-Y Chou, a University of Pittsburgh Medical Center neurologist and critical care doctor.

Now for the first time, three large U.S. medical centers are preparing to publish data on the stroke phenomenon. The numbers are small, only a few dozen per location, but they provide new insights into what the virus does to our bodies.

For the full story, see:

Ariana Eunjung Cha. “Strokes Are Striking Younger, Symptomless COVID-19 Victims.” The Washington Post (Saturday, April 25, 2020): A1.

(Note: bold in original.)

(Note: some of the above quote may have been continued onto a later page than A1.)

“The Licensing and Rollout” of Ebola Vaccine Was Accelerated

(p. 4) To combat Ebola in Congo, one of the world’s poorest nations, health workers are taking a multifaceted approach.

They have worked to win over communities that were sometimes uncooperative — even hostile.

They have drawn on technological innovations, notably a transparent enclosure known as the cube that allows medical workers to reach in and treat patients suffering from the contagious disease through plastic sleeves.

And they have used vaccines, developed relatively recently, which have made it possible to limit the spread of the epidemic.

. . .

The “cube” was . . . a big trust builder.

With transparent walls and integrated plastic sleeves and gloves, the air-conditioned chambers allowed medical teams to tend to Ebola patients without having to put on cumbersome protective gear. The cubes also allowed patients and their family members to see each other without risk of infection.

People were afraid of the treatment centers, where so many had died. But the cubes won trust for the health care workers, said Augustin Augier, chief executive of the Alliance for International Medical Action, the nonprofit aid group that developed the chambers.

“We asked the community to come and visit so they could see what was actually happening,” Mr. Augier said.

At least 500 patients were fully treated in the cubes, which could be set up in 90 minutes and reused up to 10 times, Mr. Augier, said.

But the key factor in curbing the spread of Ebola was the introduction of powerful vaccines and lifesaving antiviral drugs.

In early November 2018, the W.H.O. accelerated the licensing and rollout of the injectable Ebola vaccine Ervebo, made by the American pharmaceutical company Merck. Preliminary study results showed a 97.5 percent efficacy rate, prompting Congo, along with Burundi, Ghana and Zambia, to license the vaccine for wider distribution.

Nearly 300,000 doses of the vaccine have been administered in Congo, said Dr. Moeti of the W.H.O.

For the full story, see:

Abdi Latif Dahir. “Congo, Fresh From 2-Year Ebola Battle, Eyes New Virus.” The New York Times, First Section (Sunday, April 12, 2020): 4.

(Note: ellipses added.)

(Note: the online version of the story has the date April 11, 2020, and has the title “Congo Was Close to Defeating Ebola. Then One More Case Emerged.”)

For Venturesome Amazon Toilet Paper Shoppers, “Like Sandpaper” Is “Better than Nothing”

(p. B5) Where name-brand products sell out, off-brand products sold by third-party sellers have filled the void. Many of the top search results for toilet paper with regular Prime delivery were novelty rolls with zombies or the faces of politicians like Hillary Clinton.

In early April, Arielle Ogletree and her mother, who live near Tampa, Fla., were almost out of toilet paper when they turned to Amazon. They found a 16-pack of the large commercial toilet paper rolls found in public restrooms for $42. A few days later, it was at their door.

“It was the only one they had, and we figured it would last a while,” Ms. Ogletree said.

The roll, too big for a regular holder, sits awkwardly on their bathroom counter. Though the single ply feels “like sandpaper,” Ms. Ogletree said, it was better than nothing.

For the full story, see:

Karen Weise. “Confusion And Chaos At Amazon.” The New York Times (Saturday, April 18, 2020): B1 & B5.

(Note: the online version of the story has the date April 17, 2020, and has the title “When Even Amazon Is Sold Out of Exploding Kittens.”)

Chinese Doctors Wear Adult Diapers to Avoid Taking Off Their One-Per-Day One-Piece Protective Suit

(p. A1) The coronavirus outbreak has exposed the jarring absence in China of a vibrant civil society — the civic associations like business groups, nonprofit organizations, charities and churches that bring people together without involving the government.

. . .

(p. A10) “The traditional management mechanism of ‘big government’ is no longer efficient, and is even failing,” Duan Zhanjiang, a management consultant, wrote in an article about managing the epidemic. “The government is very busy but not effective.

. . .

The Communist Party has never liked or trusted civil society. It is suspicious of any organization that could potentially pose challenge to its rule, including big private enterprises. It has cracked down on nongovernment organizations like rights groups and charities as well as churches and mosques. The party wants nothing to stand between its government and China’s 1.4 billion people.

Big Chinese corporations and wealthy individuals have been donating, many generously. But they also try to keep low profiles for fear of offending a government that is eager to take credit for any success and quick to suspect outside groups of challenging it.

Those gaps are evident on the front lines of the outbreak, where workers have lacked the proper equipment to keep themselves safe. Doctors and nurses wear disposable raincoats instead of protective gowns. They wear ordinary, and inadequate, surgical masks while conducting dangerous throat swab tests. They wear adult diapers because, once they take off their one-piece protective suits, the suits will have to be thrown away. They get only one per day.

For the full commentary, see:

Li Yuan. “THE NEW NEW WORLD; China Blocks Ally in Virus Fight: Its Own People.” The New York Times (Wednesday, February 19, 2020): A1 & A10.

(Note: ellipses added.)

(Note: the online version of the commentary has the date April 5, 2020, and has the same title “THE NEW NEW WORLD; In Coronavirus Fight, China Sidelines an Ally: Its Own People.”)

“Rage and Despair” Outpace Chinese Communists’ “Army of Censors”

(p. A9) HONG KONG — Under normal circumstances, Patrick Wu, a college student from Anhui Province in China’s east, knows better than to talk to his parents about politics.

Mr. Wu, a senior at a university in Beijing, is a self-described skeptic of the Chinese government. His parents are local government officials.

But recent months have been anything but normal. The coronavirus outbreak, and its political implications, have been all that Mr. Wu, 21, thinks about.

. . .

“Things just got out of control. You could see people dying at home,” Mr. Wu said. “I just felt like more people should know about this, and I should open myself to more conversations about this — at least with my parents, who I can trust.”

His parents, from the start, resisted. “Their first reaction was shock and rejection: ‘How could this happen in Wuhan? It must be fake,’” Mr. Wu recalled.

After they were persuaded that the outbreak was genuine, they rejected that Chinese officials had at first covered it up and questioned how it could have exploded so quickly.

Were people who eat wild animals to blame, they asked after the virus was linked to a Wuhan market that sells wildlife. Or maybe the United States planted the virus, his parents said, considering an unfounded conspiracy theory peddled by a top Chinese government spokesman.

“I think the gap in information is too big, and sometimes I alone can’t fill it,” Mr. Wu said.

Slowly, though, he felt his mother relenting. The sheer number of online posts about the virus outpaced even the government’s army of censors. Rage and despair found their way into his parents’ social media feeds, and when a whistle-blower doctor, Li Wenliang, died of the coronavirus, prompting an online revolt against censorship, it was Mr. Wu’s mother who alerted him to the news.

For the full story, see:

Vivian Wang. “INSIDE THE OUTBREAK; Stuck With His Parents and Sparring Over Politics.” The New York Times (Wednesday, April 1, 2020): A9.

(Note: ellipsis added.)

(Note: the online version of the story has the date March 31, 2020, and has the title “INSIDE THE OUTBREAK; Quarreling in Quarantine and Bridging a Generational Divide.”)

“Two Promising Approaches” for Drugs to Reduce Severe Cases of Covid-19

(p. A19) Americans would have the confidence to return to work, even if the virus is still circulating in the fall, if they knew that a robust screening system is in place to identify and arrest new outbreaks and medication can significantly reduce the chance of becoming severely ill. Kevin Warsh, a former Federal Reserve governor, estimates that such a drug could restore at least $1 trillion in economic activity.

. . .  There are two promising approaches, and both could be available soon if government and private industry do things right.  . . .

One approach involves antiviral drugs that target the virus and block its replication. Think of medicines for treating influenza, HIV or cold sores. The drugs work by blocking the mechanisms that viruses use to replicate.  . . .

The other approach involves antibody drugs, which mimic the function of immune cells. Antibody drugs can be used to fight an infection and to reduce the risk of contracting Covid-19. These medicines may be the best chance for a meaningful near-term success.

Antibody drugs are based on the same scientific principles that make “convalescent plasma” one interim tactic for treating the sickest Covid-19 patients. Doctors are taking blood plasma from patients who have recovered from Covid-19 and infusing it into those who are critically ill. The plasma is laden with antibodies, and the approach shows some promise. The constraint: There isn’t enough plasma from recovered patients to go around.

For the full commentary, see:

Scott Gottlieb. “Bet Big on Treatments for Coronavirus; Antivirals and antibody therapies are showing promise. The FDA needs to step up its pace.” The Wall Street Journal (Monday, April 6, 2020): A19.

(Note: ellipses added.)

(Note: the online version of the commentary has the date April 5, 2020, and has the same title as the print version.)

Seeing Patterns Is Important Knowledge

Collecting, categorizing, and taxonomizing, are early steps toward scientific knowledge, as the example below illustrates. But these activities are often dismissed or ridiculed by members of the scientific establishment.

(p. A23) In the 1970s, Dr. Melzack turned to another problem he had been thinking about for years: pain measurement. At the time, doctors had only very crude instruments, like simply asking people to rate their pain level on a scale from 1 to 10 (a method that is still in use). As a young researcher, Dr. Melzack had worked in a chronic pain clinic and befriended a 70-year-old woman with diabetes.

“She was a highly intelligent person with a good vocabulary, and I began to collect her descriptive words about pain, like ‘burning,’ ‘shooting,’ ‘horrible’ and ‘excruciating,’” he told McGill Reporter in a 2008 interview.

He continued to build his adjective collection by listening to many patients’ descriptions and, working with a statistician, divided them into 20 categories, each describing a particular kind of pain: “tugging,” “pulling” and “wrenching” in one category, for instance, and “pinching,” “pressing” and “gnawing” in another.

This descriptive catalog, published in the journal Pain in 1975, became the McGill Pain Questionnaire. It soon became a standard measure worldwide, deeply enriching the conversations doctors have with their patients, and in many cases helping with diagnosis.

For the full obituary, see:

Benedict Carey. “Ronald Melzack, Cartographer of Pain, Is Dead at 90.” The New York Times (Monday, January 13, 2020): A23.

(Note: the online version of the obituary has the date Jan. 12, 2020, and has the same title as the print version.)

Stop Shaming Those Who Slow Spread of Covid-19 by Wearing Face Masks

The government has been saying that we shouldn’t wear face masks because they won’t do us any good AND we shouldn’t wear face masks because they WILL do good for health professionals. Tucker Carlson slam-dunked this issue at the end of his show on Monday, March 30th. Maybe the widespread voluntary wearing of masks is part of the reason Japan and South Korea have been less affected by covid-19 than the experts expected. It is in our interest to protect our health professionals by sending scarce masks their way. But at the same time, we should allow the incentives (surge-pricing) that will produce a lot more masks for our health professionals and for us too. And we should not shame those in the general population who choose to wear masks.

Those in Their 80s, Ceteris Paribus, Less Likely to Be Offered Bypass Surgery

(p. B6) A U.S. study out Wednesday finds that heart attack patients who turned 80 within the previous two weeks were less likely to get bypass surgery than those who were two weeks shy of that birthday, even though the age difference is less than a month.

Guidelines do not limit the operation after a certain age, but doctors may be mentally classifying people as being “in their 80s” and suddenly much riskier than those “in their 70s,” said the study leader, Dr. Anupam Jena of Harvard Medical School.

. . .

Death rates during the first two months after the heart attack were higher among those over 80, suggesting they might have been harmed by not being offered surgery, Jena said.

For the full story, see:

Marilynn Marchione / The Associated Press. “80 Is Not the New 70: Study Finds That Your Age May Bias Heart Care.” The Omaha World-Herald (Wednesday, February 20, 2020): 3A.

(Note: ellipsis added.)

(Note: the online version of the story has the same date as the print version, and has the title “80 Is Not the New 70: Age May Bias Heart Care, Study Finds.” Where there are slight differences in the wording of the online and print versions, the passages quoted above follow the online version.)

Daylight-Saving Time Is Bad for Brain and for Health

(p. A12) Beth Ann Malow, a professor of neurology at Vanderbilt University Medical Center in Nashville, Tenn., wrote in an opinion piece in JAMA Neurology that switching between daylight-saving time and standard time is bad for the brain. “Going back and forth is ridiculous and disruptive, it makes no sense,” said Dr. Malow, who believes permanent standard time would be healthier for all.

. . .

Muhammad Adeel Rishi, a pulmonologist and sleep physician at the Mayo Clinic Health System in Wisconsin, is the lead author of a daylight-saving time position statement that the American Academy of Sleep Medicine intends to publish this year.

About half-a-dozen studies have found a 5% to 15% increased risk of having a heart attack during the days after shifting to daylight-saving time. “It’s a preventable cause of cardiac injury,” Dr. Rishi said. One study found the opposite effect during the fall, in the days after the transition back to standard time. “So maybe the risk stays high throughout the time when we are on daylight-saving time,” he said.

For the full commentary, see:

Sumathi Reddy. “YOUR HEALTH; Why Daylight-Saving Time Is Bad for You.” The Wall Street Journal (Thursday, March 5, 2020): A12.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date March 4, 2020, and has the title “YOUR HEALTH; Here’s Why Health Experts Want to Stop Daylight-Saving Time.” Where there is a difference in wording in the first quoted paragraph, the online version is used.)

The opinion piece co-authored by Beth Ann Malow, and mentioned above, is:

Malow, Beth A., Olivia J. Veatch, and Kanika Bagai. “Are Daylight Saving Time Changes Bad for the Brain?” JAMA Neurology 77, no. 1 (2020): 9-10.