A beaked whale’s nearly four-hour-long dive sets a new record

To break the record for longest dive by a marine mammal, take a deep breath and jump in the water. Then don’t breathe in again for almost four hours.

Cuvier’s beaked whales (Ziphius cavirostris) are master divers (SN: 08/21/18). The creatures not only hold the record for deepest plunge by a marine mammal — measuring nearly 3,000 meters — but  also for the longest dives. In 2014, scientists documented one dive that lasted just over two hours at 137.5 minutes, setting a record. Another Cuvier’s beaked whale has now shattered that record, going 222 minutes, or three hours and 42 minutes, without coming up for air, researchers report September 23 in the Journal of Experimental Biology.  

To last so long underwater, the mammals may rely on large stores of oxygen and a slow metabolism. Once oxygen runs out, the animals may have the ability to tolerate lactic acid building up in their muscles from anaerobic respiration — a method of generating energy that doesn’t rely on oxygen. “These guys blow our expectations,” says Nicola Quick, an animal behaviorist at Duke University Marine Laboratory in Beaufort, N.C.

Calculations based on a seal’s oxygen stores and diving time limits hinted that the whales should last only about half an hour before running out of oxygen. Seals can exceed their limit about 5 percent of the time, so Quick’s team analyzed 3,680 dives by 23 whales. While most dives lasted around an hour, 5 percent exceeded about 78 minutes, suggesting it takes more than twice as long as thought for the whales to switch to anaerobic respiration.

The researchers expected to find that the whales spend more time at the surface recovering after long dives, but the team did not see a clear pattern. “We know very little about [the whales] at all,” Quick says, “which is interesting and frustrating at once.”

Defying the Family Cycle of Addiction

I am the mother of four, but addiction is my ever-present extra child. My grandparents died of alcoholism. My father-in-law did, too. My 43-year-old brother died of a heroin overdose in May. He became addicted after taking prescribed OxyContin following an appendectomy.

When my 13-year-old daughter needed hernia surgery as my brother was hitting rock bottom, it wasn’t the operation I feared. It was the opiates that would be part of her recovery. A 2018 study in the journal Pediatrics reported “persistent” opiate use by nearly 5 percent of patients age 13 to 21 following surgery, as compared to 0.1 percent in the nonsurgical group.

I wanted to figure out a way to help my daughter through the pain without resorting to using opiates.

Days before my daughter’s operation, our family devised a pain protocol based on what we learned from a popular TEDtalk byJohann Hari, a journalist who believes that people avoid addiction through “bonds and connections.”

He cites a study comparing two groups of rats. One group lived alone in cages, with only food, water and water laced with heroin. Those rats became addicted and quickly died. The other group lived in what Mr. Hari called “Rat Park.” They had treats, activities and interaction with other rats. They chose the plain water over the heroin water. They thrived, despite the presence of an addictive substance.

The message I took from it was that affection and connection might help reduce my daughter’s pain. If we surrounded her with comfort, maybe she wouldn’t need the drugs at all.

Our pain protocol included my daughter’s favorite movies, books and foods. We made a list of relaxing activities that build oxytocin: braiding hair, massage, cuddling and wearing cozy clothes. We listened to her fears. As a distance swimmer she could tolerate discomfort, but she was afraid of the unknown of surgical pain. We agreed to bring home whatever pain medication was prescribed, but to avoid using it if possible.

At the hospital, my daughter changed into a pink cotton gown, dotted with lambs and rainbows. I smoothed her hair as a tech struggled to pin an IV into the back of her hand.

“It hurts, Mommy,” she pleaded. “I’m scared.”

A nurse offered a thimble of liquid Xanax to help ease her anxiety. She looked to me for permission, then nodded her head yes. Moments later I witnessed a powerful transformation from fear to nonchalance. She waved goodbye as a team wheeled her bed around a corner. I thought of previous outpatient procedures my children had faced: tubes in the ears, a meniscus tear. I was never given instructions about alternative pain management and I didn’t think to ask. The difference, now, was that my brother was an addict. What if I gave my children pain pills and they became addicted too?

Three hours later the surgeon breezed through the waiting room doors. The hernia was deeper than expected, he reported, and she would be in considerable pain tomorrow.

In the recovery room, my daughter lay propped up in bed, sucking on a frozen rocket pop. “Mama,” she said drowsily. “I’m all done.” She battled to keep her heavy eyelids open. The ice pop melted upright in her hand.

I thought of my brother, nodding off on a family ski vacation; in a parked car waiting for an oil change; during a children’s egg hunt on Easter Sunday.

While my daughter slept, a discharge nurse told me how to change her dressing and watch for fever. Then she explained how to “stay on top” of the pain with a prescription for 44 Oxycodone tablets. My jaw tightened.

“I don’t want to give this to her,” I said, shaking my head at my own memories.

The busy hallway went silent, except for the alarm of an empty IV drip.

“This is like heroin to me,” I said. “My brother is addicted.”

The nurse looked away. “My daughter too,” she said, and began to cry. “She won’t stop. I had to kick her out.”

We exchanged the mournful words of opiate families: “It’s everywhere.”

“Is this all for me?” she asked quietly. She collapsed, smiling, into the stack of duvets on the sofa.

The anesthesia kept the edge off the initial pain. My daughter dozed while we watched episodes of “MasterChef Junior.” That night, my husband carried her to bed, then I slept beside her, alternating Tylenol and ibuprofen. In the morning, I inquired about her discomfort, hoping she wouldn’t ask for a pill.

“It’s just annoying,” she said.

“Annoying like you’re suffering?” I asked.

“Annoying like can I have ice cream for breakfast?”

“Coming right up,” I said. I offered her our specialty of the house: mint chip and a side of Advil. That day, nestled in our sofa oasis, we nibbled from a wooden bowl of buttered popcorn mixed with M&Ms. While surviving all three “High School Musicals,” I stroked her skin, smoothed her hair and praised her bravery. We played Uno, and worked on a puzzle. Greeting cards and balloon bouquets came in from friends and teachers. The principal called. Not once did she complain of intolerable pain.

She winced gingerly when she wanted to flip sides on the couch. We assisted her so that she wouldn’t use her abdominal muscles.

The discharge nurse had told us that walking would speed recovery, so we pretended her stuffed animals were babies and carried them on laps around the first floor of our house.

By day three, she didn’t even want the over-the-counter medication.

“I’m good,” she said. “I don’t need it.”

I felt a mixture of relief and rage. Why were we sent home with so many pills? Without my brother’s experience, I might have given all of them to her.

Her recovery was so quick that it became hard to keep her quiet. On day four I found her teetering on the back of the sofa, arms wide, like she was walking a tightrope.

“Have you lost your mind?” I snapped. “Get down from there!”

“Mom, I’m training,” she protested. “Pain doesn’t bother me so I’m practicing for the military. I made the sofa into an obstacle course.”

As I tucked her back under a blanket, I thought of the twists, turns and pressures my children will inevitably face in their adult lives. My daughter’s resilience has given me reason to hope. Together we are defying our family heritage.

This article first appeared here at the NYTimes.com
Jennie Burke is a writer who lives in Baltimore
.

How Families Are Keeping Halloween From Turning Into a COVID Nightmare

DENVER — For Laura Stoutingburg and her family, Halloween has always been a monthlong celebration of corn mazes, pumpkin patches and, of course, trick-or-treating in their suburban Denver neighborhood.

However, the COVID-19 pandemic has forced the mother of two to change their plans.

“Traditional trick-or-treating house to house does not feel like a smart choice to me this year,” Stoutingburg said.

Families across the nation are haunted by the same dilemma: How can they safely keep the pandemic from overshadowing Halloween? Can families trick-or-treat and go to haunted houses, or should they opt for lower-risk activities at home?

Health experts say families should err on the side of caution when it comes to trick-or-treating and other traditional fall activities. Much depends on each family’s comfort with taking risks and ensuring they adhere to safety standards and common sense, they said. Masks should be worn by all, even if not part of a costume.

“My kids love going to the farm … to go pumpkin-picking, apple-picking and all those things we do in the fall,” said Dr. Aaron Milstone, a professor of pediatrics and an associate epidemiologist at Johns Hopkins University in Baltimore. But, he added, “if you show up at the pumpkin patch and it’s packed with people, that’s not the right time for you to be there.”

The Centers for Disease Control and Prevention recently released Halloween guidelines that warn against high-risk activities like traditional trick-or-treating, haunted houses and costume parties, as well as hay and tractor rides, among other things. The federal agency is also clear on the need for social distancing, mask-wearing and hand-washing to continue.

Many parents are coming up with creative alternatives for Halloween night. For Stoutingburg, 30, that means hosting a small sleepover with relatives that features pumpkin-carving, cupcake-decorating and a scavenger hunt.

Jody Allard and her family also will forgo their usual tricks and treats. Allard, 42, lives in Seattle and has a rare genetic disease putting her at higher risk for COVID-19. The mother of seven said her family will make new traditions this year.

“We’re going to make a bunch of different fun foods from the Halloween shows they like to watch on the Food Network, and we’re going to watch kid-friendly Halloween movies,” Allard said.

In Lancaster, Pennsylvania, 44-year-old writer Jamie Beth Cohen’s daughter came up with the idea that she and her brother dress up in costumes and trick-or-treat inside their own home, with their parents behind the doors of various rooms, waiting with candy.

“She’s excited to wear a costume without a jacket and get lots of the kind of candy she likes,” Cohen said.

Maya Brown-Zimmerman and her family of six never miss out on trick-or-treating in Cleveland. But they will this year, with Brown-Zimmerman, 35, at higher risk for COVID-19 because of multiple lung diseases. Instead, her family will use their costume money on new Halloween decor, and her four kids, ages 3 to 11, will search for candy at home.

“I’ll hide eggs of candy in the front yard for my little kids,” she said. “After they go to bed, the older kids will have a hunt for eggs in the dark in our backyard with flashlights.”

For families still hoping to trick-or-treat this year, though, what can be done to stay as safe as possible?

The Harvard Global Health Institute created a website to help parents assess their risk level for Halloween activities with a color-coded map of county COVID data. It shows which counties are “lower-risk” zones for COVID (green and yellow), where parents might feel more comfortable allowing their children to trick-or-treat, and which are higher-risk areas (orange and red), where online parties and very small gatherings are recommended instead.

Milstone said families should think less in terms of green versus red zones and more in terms of staying safe no matter what, especially considering asymptomatic carriers.

“Rather than people getting a false sense of security that ‘My area is a low-risk area, so I’m just gonna go and do whatever,’ I would say ideally everyone practices the same safe things,” he said.

Dr. Heather Isaacson, a pediatrician with UCHealth in Longmont, Colorado, said masks must be worn by all and has a simple suggestion for the reluctant: “Decorate those masks and incorporate them into the costumes.”

People who hand out candy also should wear masks, added Dr. Alok Patel, a pediatrician and co-host of the “Nova” and PBS Digital Studios show “Parentalogic.” If trick-or-treaters see candy-givers without masks, he suggested wishing them a “Happy Halloween” and passing them by for the next home.

“If people are outside serving candy without a mask, consider the added risk of potential respiratory droplets flying around, including in the candy bowl,” said Patel.

When it comes to handing out candy, it’s a good idea to maintain as much distance as possible.

“Think outside of the box with ideas like a reverse trick-or-treating, where kids stay home and dress up and neighbors do a parade and throw candy,” said Isaacson. She also recommended creating individual goody bags in place of bowls of treats.

“You could go all out and make candy chutes or a giant spider web with candy trapped in it. In some ways, the physically distanced candy-delivery ideas sound more fun,” said Patel.

As for the candy itself, Milstone isn’t as concerned about wrappers as about hand-washing. The primary message is, “Don’t let your kid eat candy with dirty hands,” he said. That means no eating candy until they’re able to get home to wash properly.

While you could technically sanitize wrappers, said Dr. Rita Nasseri, a Los Angeles physician and mother of three, “the safest solution is to buy your own candy and give your children that as a treat.”

As for teens, who may want more independence, Dr. Sam Dominguez, a pediatrician specializing in infectious diseases and medical director of the microbiology lab at Children’s Hospital Colorado, recommended that small groups of friends get together outside and carve pumpkins or watch a projected movie — while wearing masks, of course.

Nasseri advised something similar, adding that food served buffet-style and communal candy should be avoided.

In Boone County, Missouri, currently experiencing a rapid uptick in COVID-19 cases, Karina Koji said her family will stay home on Halloween night. They plan to dress up in costumes and face masks and give out bags of individually wrapped candies. They’ll also leave candy bags in the driveway for anyone who doesn’t feel comfortable coming up to the door.

“We shouldn’t let the pandemic take Halloween from us,” said Koji, 45. “We’ve all had to give up so much. It’s entirely possible to celebrate this fun holiday while staying healthy and keeping ourselves and others safe.”


This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Colleges’ Opening Fueled 3,000 COVID Cases a Day, Researchers Say

Reopening colleges drove a coronavirus surge of about 3,000 new cases a day in the United States, according to a draft study released Tuesday.

The study, done jointly by researchers at the University of North Carolina-Greensboro, Indiana University, the University of Washington and Davidson College, tracked cellphone data and matched it to reopening schedules at 1,400 schools, along with county infection rates.

“Our study was looking to see whether we could observe increases both in movement and in case count — so case reports in counties and all over the U.S.,” said Ana Bento, an infectious disease expert and assistant professor at Indiana University’s School of Public Health.

“Then we tried to understand if these were different in counties where, of course, there were universities or colleges, and particularly, to see if these increases were larger in magnitude in colleges with face-to-face instruction primarily,” she said.

Nearly 900 of those schools opened primarily with in-person classes, according to the draft study.

The research examines the period from July 15 to Sept. 13. It does not name specific institutions or locations, but researchers found a correlation between schools that attempted in-person instruction and greater disease transmission rates.

Just reopening a university added 1.7 new infections per day per 100,000 people in a county, and teaching classes in person was associated with a 2.4 daily case rise, the study found.

“No such increase is observed in counties with no colleges, closed colleges or those that opened primarily online,” the study says.

Factoring in whether students came from places where disease incidence was high added 1.2 daily cases per 100,000 people.

Daily new case counts nationwide during the study period ranged from a high of 70,000 to a low of 30,000, according to data compiled by The New York Times.

The authors are not calling it a mistake for colleges to have opened, considering the many variables each school faced. But earlier reporting on reopening plans around the country found a welter of chaotic efforts that did not conform to a single standard, suggesting the potential for disaster when students returned.

In fact, numerous reports surfaced around the country showing frightening COVID spikes in college towns, often blamed on partying by students. Even at the University of Illinois, a school lauded for its preparations and robust testing, more than 2,000 cases have been reported on campus since students went back last month. Cases there peaked about a week after classes began and have fallen since then.

The authors are not faulting irresponsible young people, either, since they studied class instruction methods, not behavior off campus, where some students have acted extremely poorly.

“I think that it’s slightly unfair, perhaps, to say, ‘Oh, students are congregating and creating these bad behaviors that lead to outbreaks,’” Bento said. “I think it’s more this idea of when you see a huge influx from all over the country, or from different counties, into a college town that we know had a very low burden of COVID throughout the first months, all of a sudden we have this increased probability of infection, because we have a large community of individuals that were susceptible still.”

Rather than lay blame, she said, the idea of the study was to measure the problem and then use that data to better figure out how to respond, which is the subject of a future study.

“In order for you to open online, hybrid or meet face to face, there needs to be a different combination of strategies that allows you to catch [cases] early so you’re able to control community spread, which is the biggest problem here,” Bento said.

The researchers hope to have that work done relatively soon, well before colleges start spring semesters.

There are some unanswered questions, such as how much of the surge in cases is simply from sick students testing positive when they arrive versus catching COVID-19 after they arrive — and how much students spread the virus to the community or the other way around.

Another is how well specific types of responses mitigated the spread, and whether different local safety measures helped or hurt.

And there is an alarming caveat: The work almost certainly did not capture the full extent of the campus-linked surge.

“While this study estimates around a 3,000 increase in daily cases, we have to take into account that this is actually likely an underestimate, because we still don’t see” people who are asymptomatic, Bento said.


This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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As Fires and Floods Wreak Havoc on Health, New Climate Center Seeks Solutions

For the past month, record-breaking wildfires have torched millions of acres from the Mexican border well into Canada, their smoke producing air so toxic that millions of people remained indoors for days on end while many visited hospitals because of respiratory distress.

Last week, Hurricane Sally left a trail of watery devastation in Mississippi, Alabama and the Florida Panhandle, even as more storms brewed offshore.

All of that on top of the COVID-19 pandemic, which has killed nearly 1 million people worldwide.

The timing couldn’t have been better for the opening this month of the Center for Healthy Climate Solutions at UCLA’s Fielding School of Public Health.

Its mission is to work with policymakers and community groups to help safeguard human health against the ravages of climate change. The center was founded on the premise that the long-feared effects of climate change are already here and must be met with policies not only to slow the warming of the planet but also to help people adapt to its reality.

The center’s co-directors, Dr. Jonathan Fielding and Michael Jerrett, believe the clock is running out and we must quickly reduce the amount of carbon being pumped into the atmosphere to have any hope of preserving a viable planet.

“A lot of the predictions of what could happen with climate change have been wrong. But the predictions have been wrong in that they haven’t been catastrophic enough,” Fielding, a professor of medicine and public health at UCLA and former head of the Los Angeles County Department of Public Health, said in an interview last week.

Jerrett, a professor of environmental health sciences at UCLA’s Fielding School who also participated in the interview, is the principal investigator on a study hypothesizing that long-term exposure to air pollution elevates the risk of severe COVID-19 outcomes. Other studies have yielded similar findings.

The following excerpts of the interview with Fielding and Jerrett were edited for length and clarity:

Q: Could the hazardous air quality from the wildfires burning across much of the West Coast fuel an increase in severe COVID-19 cases and deaths?

Jonathan Fielding: There’s a very good chance of that. There is no doubt the effects of air pollution on the lungs and other organs are substantial and contribute to people with chronic problems being more susceptible to the severe effects of COVID.

Michael Jerrett: When we have wildfire events like this, as people are exposed to these high levels of smoke, we see increases in those indicators of morbidity and mortality. And we’ve seen those effects for several lung diseases that have similarities to COVID, like pneumonia.

Q: How does climate change exacerbate the racial, ethnic and socioeconomic health disparities that are so prevalent in our society?

Fielding: You already have people who have a higher rate and burden of chronic illness. Just look at the rates of obesity, for example, as well as the rate of cardiovascular disease. Those are certainly exacerbated by increased heat and by where people can afford to live. A lot of people can only afford a place that’s going to have a lot of heat islands, it’s not going to be air-conditioned, it might not have much in the way even of public transportation.

Jerrett: If you look through very long periods of time, people who have more resources — whether that’s better social contacts or they’re more highly educated, or have higher incomes, or other factors that put them at a social advantage — have always been able to protect themselves from environmental risks better than people who lack those resources.

Q: Can you explain how wildfires affect mental health?

Jerrett: There’s emerging and increasingly convincing literature that shows air pollution is related to anxiety and depression. It’s thought that the change in the nervous system that seems to be stimulated by air pollution, and perhaps the vascular system changes, can affect brain function and lead people into a more depressive state. … Secondly, the loss of immediate surroundings that people are familiar with: So if you are used to looking out and seeing a beautiful forest, and you walk out and you look in your backyard and you see nothing but smoke, and the whole forest is gone, that can affect mental health.

Q: Can we expect to see pandemics more frequently?

Fielding: What I think most people are missing in discussing this issue is population growth. We’re increasing the interface between humans and other species that have viruses that may not affect them but very severely affect humans. So, that’s one issue. The second issue is that climate change is increasing the area where you have vectors that can thrive. So, for example, we’re going to wind up with mosquitoes that can transmit dengue fever and malaria in the U.S.

Q: You talk about the “health co-benefits” of programs that can help slow climate change while mitigating its impact on public health. What are some examples?

Jerrett: Some of the leading practices in terms of generating benefits involve, say, increasing the green cover. As we increase green cover, we absorb more carbon, so we’re going to reduce the risk of long-term climate change, but you can also have substantial health benefits from that. We know that the introduction of more vegetation generally lowers extreme heat, particularly in disadvantaged neighborhoods where they don’t have a lot of park space or a lot of trees. Another leading practice, where the Europeans are way ahead of us — but we do see signs of improvement across California, in places like Santa Monica — is promoting what’s known as active travel: to get people out of their cars and get them on a bicycle or walking for incidental trips or going to work. We get a benefit in terms of their increased physical activity, and we also reduce the amount of emissions.

Q: Are the climate changes we are already seeing permanent, or can they be halted or even reversed?

Jerrett: We’re already in what I would call a climate crisis. It’s elevating to a climate catastrophe, and that’s going to happen in the next 20 years. We still have a chance to pull back. If we don’t, then we’re going to start seeing massive species die-offs; it’s going to affect the ability of people all over the world to feed themselves. We’re going to have these extraordinary, extreme events like wildfires that are going to dwarf what we’ve seen in the past, and large portions of the planet may become uninhabitable.

Fielding: Here I would draw a parallel to COVID. Even though many of us predicted a pandemic, most people didn’t really believe it, the government didn’t prepare well for it, and we’re learning the same thing with climate change. The difference is we have a way, through vaccination and maybe drugs, to reverse what’s going on with COVID. We don’t know that we have the ability to do that with climate change. You have people politicizing it and calling it a hoax, and that, unfortunately, is very detrimental to what we all want, which is to have a habitable planet.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Battle Rages Inside Hospitals Over How COVID Strikes and Kills

Front-line health care workers are locked in a heated dispute with many infection control specialists and hospital administrators over how the novel coronavirus is spread ― and therefore, what level of protective gear is appropriate.

At issue is the degree to which the virus is airborne ― capable of spreading through tiny aerosol particles lingering in the air ― or primarily transmitted through large, faster-falling droplets from, say, a sneeze or cough. This wonky, seemingly semantic debate has a real-world impact on what sort of protective measures health care companies need to take to protect their patients and workers.

The Centers for Disease Control and Prevention injected confusion into the debate Friday with guidance putting new emphasis on airborne transmission and saying the tiny aerosol particles, as well as larger droplets, are the “main way the virus spreads.” By Monday that language was gone from its website, and the agency explained that it had posted a “draft version of proposed changes” in error and that experts were still working on updating “recommendations regarding airborne transmission.”

Dr. Anthony Fauci, the top U.S. infectious disease expert, addressed the debate head-on in a Sept. 10 webcast for the Harvard Medical School, pointing to scientists specializing in aerosols who argued the CDC had “really gotten it wrong over many, many years.”

“Bottom line is, there’s much more aerosol [transmission] than we thought,” Fauci said.

The topic has been deeply divisive within hospitals, largely because the question of whether an illness spreads by droplets or aerosols drives two different sets of protective practices, touching on everything from airflow within hospital wards to patient isolation to choices of protective gear. Enhanced protections would be expensive and disruptive to a number of industries, but particularly to hospitals, which have fought to keep lower-level “droplet” protections in place.

The hospital administrators and epidemiologists who argue that the virus is mostly droplet-spread cite studies that show it spreads to a small number of people, like a cold or flu. Therefore, N95 respirators and strict patient isolation practices aren’t necessary for routine care of COVID-19 patients, those officials say.

On the other side are many occupational safety experts, aerosol scientists, front-line health care workers and their unions, who are quick to note that the novel coronavirus is far deadlier than the flu ― and argue that the science suggests that high-quality, and costlier, N95 respirators should be required for routine COVID-19 patient care.

The highly protective respirators have been in short supply nationwide and have soared in price, from about $1 to $7 each. Meanwhile, research has shown high rates of asymptomatic virus transmission, putting N95s in high demand among front-line health care workers in virtually every setting.

The debate has come to a head at hospitals from coast to coast, as studies have emerged showing that live virus hangs in COVID-19 patients’ hospital rooms even in the absence of “aerosol-generating” procedures (such as intubations or breathing treatments) and has contributed to outbreaks at a nursing home, shuttle bus and choir practice.

KHN and The Guardian U.S. are examining more than 1,200 health care worker deaths from COVID-19, including many in which their family or colleagues reported they worked with inadequate personal protective gear.

Yet some front-line workers and managers disagree about exactly how and why health care workers are getting sick.

The hospital infection-control and epidemiology leaders cite studies suggesting that many health care workers are contracting the virus outside of work and at rates that mirror what’s happening in their communities.

A group of Penn Medicine epidemiologists in late July characterized research on aerosol transmission as unconvincing and cited “extensive published evidence from across the globe” showing the “overwhelming majority” of coronavirus spread is “via large respiratory droplets.”

Unions, occupational health researchers and aerosol scientists, though, reference another pile of studies showing health care workers have been hit far harder than average people ― and a study that showed active viral particles can drift in the air up to 15 feet from a patient in a hospital room. Such particles can hang in the air for up to three hours.

Backing their concerns, a July 6 letter signed by 239 scientists urged the medical community and World Health Organization to recognize “the potential for airborne spread of Covid-19.”

The letter pointed to studies that say talking, exhaling and coughing emit tiny particles that remain suspended in the air far longer than droplets and “pose a risk of exposure.”

In one ward of a Dutch nursing home with recirculated air, researchers found that 81% of the residents were diagnosed with COVID-19. Half of the workers on the ward ― who all wore surgical masks during patient care but not during breaks ― also tested positive for the virus.

Although researchers couldn’t exclude transmission by another method, the “near-simultaneous detection” of the virus among nearly all the residents pointed to aerosol spread.

The idea that the virus is spread by either droplets or aerosols is an oversimplification, said Dr. Shruti Gohil, associate medical director of epidemiology and infection prevention at the University of California-Irvine School of Medicine.

Gohil said it’s more of a spectrum, with the virus being transmitted by some droplets and some large aerosol particles as well.

One metric people in the hospital infection-control field focus on, though, is how many people one sick person infects. For COVID-19, research has shown that the number is about two ― similar to a cold or the flu. For an unequivocally airborne disease like measles, the number is closer to 12 to 18.

Measles is “what airborne [transmission] looks like,” Gohil said. “If this was truly a primary aerosol-transmissible disease, we’d be in a world of hurt.”

Hospital epidemiologists are also focused on the rate of household spread of the novel coronavirus. With the measles, the risk of an unvaccinated member of a household getting sick is 85%, said Dr. Rachael Lee, a hospital epidemiologist and assistant professor at the University of Alabama-Birmingham. For COVID-19, she said, the risk is closer to 10%.

Though the virus is believed to be spread more by droplets than aerosol particles, Lee said, staffers at UAB University Hospital wear an N95 respirator for an extra layer of protection and because the patients require so many breathing treatments or procedures considered “aerosol-generating.”

Such practices are not universal. At the University of Iowa’s hospital, health care workers use N95s and face shields for aerosol-generating procedures but otherwise use surgical masks and face shields for routine care of COVID patients, said Dr. Daniel Diekema, director of the division of infectious diseases at the university.

He said such “enhanced droplet precautions” are working. Places where workers are correctly using regular medical masks and face shields are finding no significant spread of the disease among staffers, although one such report focused on spread from a single patient.

Elsewhere, patients have also been safe on floors where COVID-19 patients and those without the virus have been placed in adjacent rooms ― a practice those concerned about aerosol spread do not endorse.

“It’s not an airborne disease the way measles or tuberculosis is,” said Dr. Shira Doron, an epidemiologist at Tufts Medical Center in Boston and an assistant professor at Tufts medical school. “We know because we don’t see outbreaks that affect multiple patients on a floor.”

Origin of the Debate

The CDC helped set the stage for the current debate. In March, the agency issued revised guidance essentially saying it was “acceptable” for health care workers to use surgical masks ― instead of N95s ― for routine care. The guidance said respiratory droplets were the most likely source of transmission and recommended N95s only for aerosol-generating procedures.

“The contribution of small respirable particles, sometimes called aerosols or droplet nuclei, to close proximity transmission is currently uncertain. However, airborne transmission from person-to-person over long distances is unlikely,” according to the guidance.

The California Hospital Association sent a letter to the state’s congressional delegation urging the revised guidance be made permanent.

“We need the CDC to clearly, not conditionally, move from airborne to droplet precautions for patients and health care workers,” the letter said. Doing so would enable hospitals to preserve PPE supplies and limit the use of special isolation rooms for COVID patients.

An association spokesperson told KHN that the group wasn’t weighing in on the science, merely pressing for clarity of the rules.

Christopher Friese, professor of nursing, health management and policy at the University of Michigan, is among the experts who think those rules have endangered health care workers.

“We lost a tremendous amount of time and, candidly, lives because the early guidance was to wear N95s only for those specific procedures,” Friese said.

Family members and union leaders from Missouri to Michigan to California have raised concerns about nurses dying of COVID-19 after caring for virus patients without N95 respirators. In such cases, hospitals have said they followed CDC guidance.

Friese echoed some occupational safety experts who suggested stronger guidance from the CDC early on calling the disease airborne might have had an impact ― perhaps pressuring President Donald Trump to invoke the Defense Production Act to boost supplies of N95s so “we might have the supply we need everywhere we need,” Friese said.

Surveys across the country show there’s still a shortage of personal protective equipment at many health care facilities.

The CDC guidance posted Friday would have put pressure on some hospitals to bolster their protective measures, something they have reportedly resisted. It said the virus can spread when a person sings, talks or breathes.

“These particles can be inhaled into the nose, mouth, airways, and lungs and cause infection,” the site said. “This is thought to be the main way the virus spreads.”

By Monday morning, the website was back to saying the virus mainly spreads through droplets, noting that draft language had been posted in error.

The University of Nebraska Medical Center has been taking so-called airborne precautions from the start. There, Dr. James Lawler, a physician and director of the Global Center for Health Security at the university, said his colleagues documented that the virus can drift in the air and live on surfaces at an extensive distance from patients.

He said the hospital tests all admitted patients for the virus and keeps COVID-19 patients apart from the general population. He said they pay close attention to cleaning shared spaces and monitoring airflow within the restricted-access unit. Workers also had N95 respirators or PAPRS, which are fitted hoods with filtered air pumped in.

All of it has added up to a “very low” rate of health care worker infections.

Amid uncertainty about the virus, and as an unprecedented number of health care workers are dying, adopting the “highest possible” forms of protection seems the best course, said Betsy Marville, nurse organizer for the 1199SEIU United Healthcare Workers East union in Florida.

That would mean a departure from CDC guidelines that now say health care workers need an N95 respirator only for “aerosol-generating” procedures, like intubations or other breathing treatments. She said the rule has left the nurses she represents in Florida scrambling for protective gear ― or unprotected ― when patients need such treatments urgently.

“You don’t leave your patient in distress and go looking for a mask,” she said. “That’s crazy.”


This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

What are the Effects of CBD on Menopause Symptoms?

The internet is full of the benefits and dangers of CBD that are often presented side by side. But in between all this, no one should forget the medicinal effects of CBD, especially on women’s health. There is a whole new debate on the safety levels of CBD products for menopausal women. The experts are still working on it but there are so many CBD infused products such as bath salts, lubricants, and vagina suppositories for dryness that people are buying.

Menopause is a difficult stage of every women’s life where her body shows many uncomfortable symptoms and eventually it changes their mood. There are so many products available to ease the symptoms of menopause. Some women take supplements, some go for hormone replacement therapy while a large number of the population relies on conventional remedies, and using CBD for menopause is one of them.

But it is hard to determine if these CBD infused products are safe or not; whether they would ease the menopausal symptoms or not.

Dr. JoAnn V. Pinkerton teaches at the University of Virginia, he says that using CBD for menopause is still an unproven remedy because despite these products being available so easily, there are no clinical trials and safety tests conducted for them. So everyone who is buying these products must know that these CBD infused products are not the first line of treatment for menopause symptoms.

Many medical experts acknowledge the medicinal benefits of CBD but still, it is hard to say that it is completely safe to use. Cannabis or marijuana is a common plant that has certain phytochemicals inside that are well-known for their psychoactive effects. These phytochemicals include tetrahydrocannabinol THC and Cannabidiol (CBD).

THC gives the cannabis plant its traditional “high” effects while CBD is not as psychoactive and doesn’t cause intoxication. This is why CBD-infused products do not make their users high or intoxicated.

There is so much research on CBD oil to show benefits on a number of medical conditions such as epilepsy, pain relief, and addiction treatment. But the information on the benefits of CBD in menopause symptoms is limited.

But there is research-based evidence that suggests the effects of CBD on inflammation and pain. while many women have used these CBD infused products to relieve menopausal symptoms and they are quite happy with their results.

The researchers from the University at Albany collected data on menopausal and postmenopausal women that have used these CBD products to relieve their symptoms within the previous year. The results indicated that a majority of women were satisfied with their experience but these CBD products didn’t relieve “all” symptoms of menopause.

Women shared their most uncomfortable symptoms as muscle pain, irritability, sleeping irregularities, stress, vaginal dryness, bladder problems, etc. using CBD products has relieved many of these problems so CBD does have physiological and psychological benefits on the women.

THC and CBD both are natural anti-inflammatory agents. They ease muscular pain and relieve stress-related disorders. This way they improve the mood and prevents agitation and behavioral changes. Due to its calming effect, the user feels more relaxed and it even regulates the sleeping cycle.

Also read: The Truth Behind Keto Candy for Weight Loss 

But even after all these proven benefits, there is not much to predict if CBD infused products are 100% safe for women. Despite the benefits of CBD for menopause, there remain some risks associated with them.

For example, a study on investigating the effects of CBD on epilepsy revealed that many patients experienced worse side effects of it in the form of reduced appetite, abdominal discomfort, diarrhea, and insomnia. Some of them also showed liver problems.

Also, there is a high chance of CBD interacting with other medicines that a user might be taking; for example anti-depressants and sleeping pills. This gap in the regularity of the CBD-infused products would always remain a big safety concern and could only be solved with safety tests of these products.

The post What are the Effects of CBD on Menopause Symptoms? appeared first on Spark Health MD.

3 ways sobriety made me a better advisor

Addiction Recovery Bulletin

Traditions – 

Sep. 17, 2020 – People rarely, if ever, get sober alone. In sobriety and in business, being part of a group allows you to benefit from the experience, strength and the hope of those around you.

2. What other people think of you is none of your business

As a young advisor, I focused on what I should do and was consumed with what others might think of me. Older people made suggestions about where I should live, how I should dress and where I should go to be seen.

I took their advice but ended up feeling incredibly inauthentic and unhappy.

As I continued in my sobriety, letting go of what others might think reinforced the importance of my job as a planner — to help clients discern and live their dreams rather than living out some idea influenced by what their parents did or what their friends planned to do.

more@Financial-Planning

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‘The Centers’ CEO resigns in Ocala

Addiction Recovery Bulletin

Intriguing –

Sept. 13, 2020 – “Along the way, through each and every one of those mergers and acquisitions, the organization has gotten stronger, has provided a better level of care and we’re able to respond to community needs in a better way,” he said. “We’re able to do more with scale than we would otherwise be able to do.”

Organizations like The Centers and SMA rely largely on funding from the state. Private insurance, Medicaid and Medicare only cover a small portion of services, Norman said.

“Florida, in the nation, sits at 49th in mental health and substance abuse funding. It should be an embarrassment. The only reason we can’t get to 50 is that there is a state out there that gives nothing,” Norman said.

Baracskay took over the agency soon after an aborted attempt to transform itself into a combined mental and primary healthcare organization. The CEO then, Tim Cowart, wanted to offer primary healthcare services to increase the agency’s revenue.

The Centers’ board, in moving away from the effort, felt it distracted from the founding goal of providing mental health and substance abuse programs.

Founded in 1972 as Marion-Citrus Mental Health Center, mental health treatment remains central to the organization’s mission.

more@Ocala

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Struggling addicts turn to telehealth for better or worse

Addiction Recovery Bulletin

Soulless Screens? –

Sept. 14, 2020 – Amid the global pandemic, group gatherings have become nearly impossible. Weddings have been put on hold indefinitely, schools are turning to virtual learning and offices are encouraging employees to work from home until it’s safe to be in close proximity.

Though everyone has been impacted in some way by the new restrictions put in place due to COVID-19, people struggling with addiction have had it especially hard in quarantine. Social isolation, economic despair and a global health crisis have made COVID-19 “the perform storm” for individuals with substance use disorders — and on top of all that, normal outlets like group meetings and therapy no longer exist in the traditional sense because meeting face-to-face is now dangerous.

With nowhere else to go, people living with addiction are turning to online resources like virtual support groups and Zoom therapy until things return to normal. And because of the pandemic, there are far more online resources to leverage: According to a recent study from the University of Michigan Addiction Center, policy shifts have made it much easier for addiction care specialists to pivot to telemedicine.

more@YahooSports

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