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These Are the Long-Term Side Effects of COVID-19

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When the COVID-19 pandemic began, we could rattle off the symptoms from the top of our heads: fever, dry cough, and difficulty breathing. Later, the NHS here in the UK and the Centres For Disease Control and Prevention (CDC) in the US added more symptoms to that list: chills, muscle pain, headache, sore throat, a new loss of taste or smell, and repeated shaking with chills. Nausea and diarrhoea are also listed as signs of the disease.

But as the pandemic continues, doctors are starting to look more closely at not just the first signs of infection, but the long-term side effects that linger even after you’ve recovered. Concern over longer-lasting side effects has even prompted the CDC to begin a large study on patients hospitalised with COVID-19 in order to “describe long-term outcomes and come to a fuller understanding of the overall impact of the coronavirus on the health system,” among other goals. Around 3,000 adult patients will be enrolled.

It will likely take some time for doctors to fully understand how this disease affects our health in the long term. Ahead, read what doctors and survivors are reporting now on the lingering effects of the coronavirus on body and mind.

POPSUGAR aims to give you the most accurate and up-to-date information about the coronavirus, but details and recommendations about this pandemic may have changed since publication. For the latest information on COVID-19, please check out resources from the WHO, the NHS, and GOV.UK..



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Pfizer, BioNTech score deal to supply 120M Covid-19 vaccine doses to Japan

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The entrance to a Pfizer office in Cambridge, Massachusetts

Days after announcing the start of their late-stage clinical trial of a vaccine to prevent Covid-19, a U.S. drugmaker and its German partner are supplying a large number of doses of vaccine to Japan.

New York-based Pfizer and Mainz, Germany-based BioNTech said Friday that they would provide 120 million doses of vaccine from their BNT162 development program, assuming regulatory approval, to Japan’s Ministry of Health, Labor and Welfare, in the first half of 2021. Financial details were not disclosed, and terms were based on timing of delivery and volume of doses, but the companies had signed a deal with the U.S. government to supply 100 million doses of vaccine for $1.95 billion.

The announcement referred only to BNT162, which collectively includes four vaccine candidates. In an email, a Pfizer spokesperson wrote that assuming clinical trial success and regulatory approval, the vaccine in question would be BNT162b2, which is the same vaccine that entered a global Phase IIb/III clinical trial last week. The other lead vaccine candidate is BNT162b1.

Shares of Pfizer were down more than 1.6% on the New York Stock Exchange Friday in late-afternoon trading. Shares of BioNTech were down about 2.5% on the Nasdaq.

“We are deeply honored to work with the Japanese government and to marshal our scientific and manufacturing resources toward our shared goal of bringing millions of doses of a potential Covid-19 vaccine to the Japanese people as quickly as possible,” Pfizer CEO Albert Bourla said in a statement. “In the face of this global health crisis, Pfizer’s purpose – breakthroughs that change patients’ lives – has taken on an even greater urgency.”

The news comes amid the postponement of the 2020 Summer Olympics, which were originally scheduled to take place in Tokyo between July 24 and Aug. 9, but have been postponed until summer 2021 due to the Covid-19 pandemic.

Apart from Pfizer and BioNTech, several other companies are also running late-stage clinical trials of Covid-19 vaccines. These include Moderna’s Phase III trial of mRNA-1273, which like BNT162 is a messenger RNA vaccine, though that study is only taking place in the U.S. China’s Sinovac and British drugmaker AstraZeneca are also running Phase III trials.

Photo: Dominick Reuter, AFP, via Getty Images

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Responsibly reopening in the era of Covid-19: A perspective from CVS Caremark’s CMO

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 As state and local governments move through phased re-openings amid Covid-19, with resurgences in some states, many organizations are trying to decide how best to responsibly return employees. The reality for all employers is that we cannot return to what was before, and a thoughtful, phased approach will be needed. This is probably the case for at least another year or more until our country achieves the gold standard of herd immunity from widespread access to an effective vaccine or exposure.

As a physician, I’ve been wrestling with how to judiciously return our own CVS Health colleagues and protect our frontline professionals through a clinically-driven approach that aligns and evolves in step with the latest guidance from the Centers for Disease Control and Prevention (CDC). I know firsthand that other business leaders are concerned with the same, and that’s why we recently launched a solution, with Covid-19 testing at its core, to help organizations return to and maintain worksites.

Without an effective vaccine or treatment, widespread Covid-19 testing is the next best tool for organizations working to responsibly reopen. This is especially important as the CDC has suggested that up to 40 percent of those with Covid-19 could unknowingly spread the virus before they experience symptoms. Testing helps organizations support effective population health surveillance, facilitate contact tracing and ultimately help reduce the virus’ R0 or reproduction number. But, organizations are asking: Who to test? How? Where? When?

Because every organization has specific population health management needs, flexibility is key. That is why our medical affairs team mapped out clinical protocols, based on the latest science and technology, and aligned with CDC guidance for viral testing, to help guide our own and other organizations. The first crucial step is segmenting an onsite population into clinical cohorts, which become the foundation for guidance and protocols for testing and containing COVID-19. They include:

  1. The symptomatic, who attest to symptoms of the virus while onsite.
  2. The asymptomatic, or those not showing symptoms, but who run a higher risk of exposure and need testing at a higher frequency.
  3. The asymptomatic, but who have suspected or known exposure to Covid-19.
  4. Those who previously tested positive for the virus and had been quarantined but need validation with testing before returning to a worksite or campus.

Based on these cohorts, we can guide on how and where these populations should be tested, which could include either point-of-care testing with rapid results or third-party lab-processed testing with results in a few days, and in addition, organizations should have the flexibility to determine where testing takes place, either onsite or in the community. That flexibility is critical, as no two organizations are alike and it’s clear that a one-size-fits all solution will not work. Further, testing is just one component. Organizations should also consider implementing symptom checking and temperature screening, among other protocols.

For CVS Health, helping employers and universities is our next big area of focus as we continue to increase access to widespread Covid-19 testing, which started first in the community and for vulnerable populations most impacted by the virus. Now more than ever, it’s incumbent on us to use our vast presence in communities across the country to support organizations and the economy.

Photo: KaanC, Getty Images

 

 

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8 Ways to Reduce Risk of Contracting COVID-19 While Traveling to Work

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During the last couple of months, the world had almost come to a stop owing to the COVID-19 outbreak. We need to restart and continue with our daily business and work knowing well that this virus is out there. With offices opening up, we need to consider all safety measures while traveling. Any kind of leniency in following the precautions can make it more likely to be affected by the virus. Once the virus enters your body, it starts to multiply. It is harmful not only for the infected but for the people around the infected person as well. However, avoiding this scenario is possible if one follows all the precautions and safety measures. 

Some best ways to reduce the risk of contracting COVID-19 while traveling or commuting to work are:

#1 Gear-up With Personal Protective Equipment (PPE)

Gear-up With Personal Protective Equipment

Whenever you are going outdoors, ensure that you are geared up with personal protective equipment. These mainly include a face mask and a pair of gloves. Wearing these will keep the most prone parts of your body, that is, hands and mouth, safe from coming in contact with the virus. Have at least a couple of masks and a bunch of disposable gloves ready while commuting to work. Once you are home, make sure that you wash the mask properly in case it is reusable. This will make it ready and safe to wear it the next day. Urge yourself as well as others around you to wear personal protective equipment. It will ensure the safety of everyone present in that area at that time.

#2 Sanitize your hands

Sanitize your hands

Once you have finished traveling and reached the office or your home, make sure that you sanitize your hands thoroughly. This way, if your hands are in contact with the virus, it will not be able to enter your body. Sanitizing will kill the virus before it starts to harm your body. Avoid touching anything when you are in a public place like doorknobs, railings, etc. Since the virus is widely spread, anything around you could be contaminated. For the precautions and peace of mind, keep applying the sanitizer to your hands periodically. Do not forget to wash your hands properly before and after a meal. 

#3 Eat right and safely packed food

Eat right and safely packed food

Avoid eating unpacked and street food while commuting to work. It is preferred to take a lunch box, a water bottle, and other required snacks right from your home. The safest and most reliable food that you can eat is one that is prepared at your home. This is essential because the people who are preparing and serving the food in the restaurants and streets are not reliable and the food isn’t safe to consume. Eating that may increase the risk of contracting the coronavirus. 

On the other hand, if you are traveling, then consume only properly packed food products as far as possible. Even if you are visiting a restaurant, ensure that all the precautions are being taken. Choose places where cooks must are wearing all personal protective equipment. Do not be lenient about the same as consuming contaminated food can lead to serious health consequences. 

#4 Maintain proper distance

Maintain proper distance

When you are traveling or commuting to work, try to maintain a decent distance. Do not stand close to the people if you are using public transportation. Avoid taking public transportation that is too crowded. Always remember that the spread of the virus is quite rapid in a crowd. Stay away from the people who are constantly coughing or sneezing. There are high chances of getting an infection from those people. 

If possible, try to avoid using public transport. It is quite safe to travel or commute to your office through your own vehicle. There is a minimal risk of getting infected when you are using your vehicle. But send your car for a wash and sanitization every week. It will ensure that your vehicle is free from the virus. Do not let an unknown person enter your car for the best precautions and safety measures. 

#5 Avoid touching surfaces

Avoid touching surfaces

Since many people are using public transport regularly, the surfaces there might be contaminated. If you touch any such contaminated surface, there are high chances of the virus entering your body. This is why it is generally suggested to avoid touching surfaces at any public place while traveling. 

If your traveling takes a lot of time, you can disinfect the surface around your seat using a sanitizer. It will make your entire journey safer. Sanitizing the surface should not be done bare-handed. Try using the medium of transportation that regularly sanitizes every surface thoroughly. This will not let your hands, as well as clothes, come in contact with the virus. Therefore, touching any kind of surface while traveling must be strictly avoided to be on the safer side.

#6 Drink only filtered water

Drink only filtered water

There are several cases where people got infected from coronavirus due to contaminated water. Therefore, when you leave your home for the office, make sure you carry a water bottle. Do not drink water that you feel is not purified. If you feel thirsty while traveling and do not have filtered water with you, then always drink water from a packed bottle. 

You may have to spend a bit of money to follow this, but all that money will be worth spending for your better health conditions. Do not hesitate to offer the water if someone around you is thirsty. Ask them to sanitize their hands and then give your water bottle. This will be completely safe and will ensure that humanity is still alive even in such conditions. 

#7 Boost you immunity

Boost you immunity

If you are frequently traveling, then make sure that you get vaccinated periodically. Although there is no vaccine to get cured or to stay safe from the coronavirus yet, you can always introduce some medications and supplements to your body that will improve your immunity. These will make your body free from any kind of infections and viruses. 

#8 Spread awareness

Spread awareness

While traveling, if you see a person sitting or moving around without wearing a mask, you must make him aware of the same. Stand at a safe distance and tell them to wear a mask to make that safe for themselves and others in the surrounding. All the people traveling with you must follow all precautions and safety measures. At present, it is a criminal offense to stay outdoors without wearing a mask. 

Responsible citizens must point out such people and spread awareness. Therefore, spread awareness while traveling or commuting to work. Let the people, who are violating the rules, know the negative health consequences of doing the same. 

Summary

Following the above-discussed ways to reduce the risk of contracting COVID-19 while traveling, may be difficult for you in the beginning but with time, you will get used to it, and soon, all these precautionary measures will become your habit. Just have faith and do your part. However, if you experience any coronavirus symptoms, then do not wait for a moment and get all the tests done. 

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UnitedHealth Group sees profits double due to Covid-19

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At the height of the Covid-19 pandemic, UnitedHealth Group saw its profits double, as patients deferred planned surgeries and avoided going into hospitals.

The insurer released its second quarter financial results on Wednesday. UnitedHealth saw its earnings balloon to $6.63 billion in the quarter ending June 30, up from $3.29 billion during the same period last year. The company chalked up the high profits to the “unprecedented, temporary deferral of care.”

At the lowest point in April, CFO John Rex said inpatient care — including Covid-19 cases — was at about three-quarters of normal levels. In June, this recovered to nearly 95%.

Outpatient care fell to 60% of the baseline during that same period, but has since recovered to about 90%. In an earnings call, Rex told investors that these trends have continued in July, despite several states seeing a spike in Covid-19 cases.

 

Patients expected to return

The company didn’t change its earnings outlook for the end of the year, anticipating costs to increase as patients return for deferred care as well as costs related to Covid-19 testing and treatment.

There’s also a possibility that patients who had missed treatment due to the pandemic might be sicker when they return for care, though Rex said that “isn’t showing up yet.”

“It’s kind of hard to ignore the number of new diagnoses that dropped off. It’s hard to ignore the drop-off in heart attack and stroke,” UnitedHealthcare CEO Dirk McMahon said in an earnings call. “You can imagine it was fear of consumers going to an ER that caused them not to access the health system, so — it may be speculative here — but I think the data that we see suggests that there will be some intensity in the services that people receive.”

As unemployment levels soared in April, insurers were asked if they expected to see a drop off in commercial customers as a result. Some reports have tried to estimate the number of people who will lose employer-sponsored health insurance, with a recent analysis by the Urban Institute pegging that number around 10 million.

So far, UnitedHealth Group hasn’t seen a big impact from this, as more employers have opted for furloughs over layoffs, allowing workers to keep their benefits. Stimulus funding to ensure people keep their jobs has also helped.

“The impact on commercial enrollment hasn’t been as great as we would have otherwise thought based on the unemployment data, just because of the stimulus as well as the furloughs,” CEO David Wichmann said.

 

Public option possibilities

Analysts also asked about the elephant in the room for commercial insurers: growing discussions around universal coverage options. Washington was the first state to jump in with a public option last year, where it contracted with private insurers to offer state-procured plans, effectively serving as an extension of its ACA exchange plans.

Wichmann confirmed that UnitedHealth was a successful bidder to offer plans through this new program, which will cap payments at 160% of Medicare.

“There is kind of a unique program design there that uses, I’ll call it roughly a reference-based pricing, and we’re curious to see how we perform… We actually think this will be a nice test to see what the competitiveness of our business will be,” Wichmann said. “Generally speaking, we’re not a strong supporter of these public option proposals, and primarily because they disrupt current coverage platforms which consumers value and appreciate.”

Washington’s new plans will go into effect in 2021.

Photo credit: JamesBrey, Getty Images

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One preliminary study suggests CBD may help to fight Covid-19

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Lockdown restrictions may be easing worldwide, but COVID-19 remains a real threat. A vaccine is still months away, but research shows that help may come from an unexpected source: cannabidiol, also known as “CBD.”

Following a study conducted at the University of Lethbridge in Alberta, Canada, researchers believe that strong cannabis strains could prove valuable in preventing or treating coronavirus infections.

They have published the results of their study on Preprints, in which they discuss analyzing hundreds of cannabis strains to identify how those with the highest CBD could reduce the coronavirus’s impact on the human body. [Preprint articles have not been peer-reviewed]

With two-thirds of Americans supporting the legalization of cannabis, this revelation is less taboo than it may once have been. But how does the research suggest CBD could help to fight COVID-19 infections, and where does the team believe this research could lead?

CBD’s Power to Combat Coronavirus Infections
University of Lethbridge researchers worked under a research license from Health Canada, the government department overseeing Canada’s federal health policy, to develop more than 800 new cannabis sativa lines and extracts. Cannabis sativa strains are high in CBD, one of cannabis’s core chemicals (alongside THC) with anti-inflammatory properties.

Their study led them to hypothesize that those extracts high in CBD could be leveraged to combat Covid-19 infections by modulating levels of ACE2 (angiotensin-converting enzyme II) in certain “gateway” tissues.

These include lung tissue, oral/nasal mucosa, gastrointestinal tract, kidney, and testes. The researchers believe that modulating ACE2 levels in these areas with CBD could help to decrease people’s susceptibility to Covid-19. As the coronavirus can only enter a human host with a receptor, i.e. ACE2, targeting these could reduce the risk of infection significantly.

“The virus has the capacity to bind to [ACE2], and pull it into the cell, almost like a doorway,” said Dr Igor Kovalchuck, one of the researchers and professor of Biological Sciences at Lethbridge, in an interview with CTV.

“Imagine a cell being a large building,” Dr Kovalchuck continued. “Cannabinoids decrease the number of doors in the building by, say, 70 percent […] the level of entry will be restricted. So, therefore, you have more chance to fight it.”

Harnessing the Medicinal Benefits of CBD
During the Lethbridge study, the team screened the cannabis sativa extracts using artificial 3D models of human intestinal, oral, and airway tissues. The researchers discovered that 13 of the extracts high in CBD were capable of modulating ACE2 effectively.

However, as these extracts are high in CBD but extremely low in THC, people would be unable to experience the high associated with cannabis.

The study has yet to be peer reviewed and verified, but the team believes that these sativa lines could be used to develop such preventive treatments as mouthwashes or “throat-gargle” solutions.

“Given the current dire and evolving epidemiological situation, every possible therapeutic opportunity and avenue must be considered”, the team concluded.

The university study was conducted in partnership with Pathway, a company working to develop cannabis-centric treatments for a number of diseases, and Swysh Inc., an oral health company specializing in cannabinoid-based products.

The increasing awareness of CBD’s effectiveness for pain as well as combating various other issues, including anxiety and arthritis, lends extra credibility to the products that Dr Kovalchuck suggests.

“There’s a lot of documented information about cannabis in cancer, cannabis in inflammation, anxiety, obesity, and whatnot,” Dr Kovalchuck told CTV. “When Covid-19 started, Olga [his wife and co-researcher] had the idea to revisit our data, and see if we can utilize it for Covid.”

However, Olga Kovalchuck stressed, “not any cannabis you would pick up at the store will do the trick.” The strains studied are cultivated for medicinal purposes and are high in CBD but low in THC, unlike the cannabis used for recreational purposes.

If the research is received positively by peers and sparks additional studies into combating COVID-19 with CBD, it could challenge common negative perceptions of cannabis further. However, it’s important to note that this study hasn’t been done on humans.

Gathering further evidence of CBD’s ability to fight COVID-19

Other parties are exploring the potential for treating COVID-19 with cannabis, including Israeli canna-tech company Stero Therapeutics.

This startup was ready to start its research into CBD’s effect on the coronavirus at the height of the global crisis. It planned to start clinical trials with 10 patients, all affected by COVID-19, at Petah Tikva’s Rabin Medical Center.

However, the trials had to be canceled when these patients became unavailable and a number of other medical centers in Israel shut their coronavirus wards down due to a massive reduction in new cases.

The company has switched its focus to Europe, where coronavirus cases remain high and more than 176,000 deaths have been reported as of June 30. Yet the number of cases has increased in Israel again since the trials were called off, which means Stero Therapeutics may be able to resume them locally after all.

Its goal is to determine whether CBD can increase the effectiveness of corticosteroids (a key treatment for autoimmune illnesses) or allow for steroid dosages to reduce while enhancing their effect.

Steroids have been employed in the fight against Covid-19, specifically its effect on acute infections, in which an over-response in the immune system is triggered. Known as a cytokine storm, this causes more damage to the organs (specifically the lungs) than the coronavirus itself.

Stero Therapeutics hopes that its research will demonstrate that CBD can be used to enhance steroids’ effectiveness in treating COVID-19 patients.

The research conducted by Stero Therapeutics and the University of Lethbridge’s team could open the doors to unexpected new ways to prevent, and treat, coronavirus. However, further studies will be required to verify the research and facilitate the creation of CBD-centric solutions suitable for COVID-19 patients.

Whatever the outcome, the need for an effective treatment is urgent. The U.S. government put Operation Warp Speed into effect in May, investing billions into furthering creation and testing of vaccines, but experts have warned against rushing into releasing one with low efficacy.

However, if life is to go on safely and economies are to survive, people may be willing to take the first treatment that arrives, CBD-based or not.

Photo: sorbetto, Getty Images

 

 

 

 

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Can You Get COVID-19 Twice?

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Young Afro American woman standing on city street with protective mask on her face. Virus pandemic and pollution concept.

As thousands of people around the world recover from COVID-19 — and experts warn that there could be a second wave of the novel coronavirus later this year — one big question remains: do those who have been infected have immunity, or is it possible that they could get COVID-19 again?

The answer isn’t clear. According to the Centres For Disease Control in the US, the immune response to COVID-19 “is not yet understood.” Meaning, researchers are still trying to determine whether those who have been exposed develop immunity to the virus and, if so, how long it lasts. Drawing comparisons to a previous outbreak, the CDC explains that “patients with MERS-CoV are unlikely to be reinfected shortly after they recover, but it is not yet known whether similar immune protection will be observed for patients with COVID-19.”

The World Health Organisation takes it one step further, noting that there’s currently no evidence that even those who have confirmed antibodies will be protected from a second infection.

But while you shouldn’t be lulled into a false sense of security, you also shouldn’t panic over headlines suggesting that some COVID-19 patients have tested positive after they recovered. “There are reports of people testing positive twice, even weeks apart,” Natasha Bhuyan, MD, physician and regional director at One Medical, told POPSUGAR. “However, experts don’t think these individuals were reinfected. Instead, it’s possible that viral particles remained in their system. These viral particles are suspected to be ‘inactive,’ meaning the people were not contagious at that point.”

In a recent interview with BBC, WHO’s technical lead Maria Van Kerkhove, MD, similarly called these tests “false positives.” Still, as Dr. Bhuyan went on to explain, “very little is known about individual immunity against COVID-19,” including whether any possible protection would last weeks, months, or years.

Another question that remains unanswered? “We don’t know if immunity to infection means [people] cannot transmit this infection to others,” David Cutler, MD, a family medicine physician at Providence Saint John’s Health Centre in Santa Monica, CA, told POPSUGAR. In other words, by not taking the necessary precautions, you could unknowingly put others at risk. “Repeated susceptibility to COVID-19 is just one of many areas of uncertainty regarding the novel coronavirus which causes this disease,” he said.

Until experts know more or we develop a vaccine that can help us safely achieve herd immunity, continue to follow CDC guidelines, by practicing social distancing, wearing a cloth mask in public, and washing your hands and cleaning surfaces frequently.

POPSUGAR aims to give you the most accurate and up-to-date information about the coronavirus, but details and recommendations about this pandemic may have changed since publication. For the latest information on COVID-19, please check out resources from the WHO, the NHS, and GOV.UK.



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Addressing maternal mental health issues during Covid-19 and beyond

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women's health

Pregnancy is always a time of heightened anxiety, but in the age of global pandemic, women are facing unprecedented stressors. Between 10-20% of women experience postpartum depression/anxiety, and for up to 30% of women, symptoms can actually begin during the pregnancy. Perinatal mood disorders have been associated with worse maternal and neonatal outcomes such as increased rates of preterm birth, decreased rates of breastfeeding, impaired infant bonding, and abnormal infant and child development – many of which come with steeper costs.

Certain risk factors for postpartum mood disorders may be exacerbated by the current pandemic including fear of childbirth, poor social and financial support, stressful life events, and adverse pregnancy outcomes. Additionally, recommended coping techniques including reaching out to family and friends for support, getting out of the house, making time for oneself, and exercising may be difficult to accomplish due to social distancing requirements and stay at home orders. Current treatment and counseling resources may also be more limited than in normal times.

The human and economic costs of untreated maternal mental health issues are meaningful, and these outcomes only stand to be intensified by the added stressors of Covid-19 – concerns about the way the virus will impact prenatal care, hospitals continuing to change their visitation policies, and so many unknowns surrounding the impact of the virus on pregnant women and babies. For some women, higher risks of intimate partner violence compound this situation. With these increased stressors, there is cause for concern that maternal mental health could emerge as a secondary public health crisis, the scope of which we may not realize for years to come.

Adjusting to a new normal for prenatal care
Prenatal care has been transformed in recent months due to the pandemic. While some of these changes, like embracing telemedicine for routine prenatal appointments, are arguably for the better, this certainly provokes anxiety for many women who had a set plan for how their pregnancy and prenatal care would look.

Studies have shown that telemedicine appointments are safe for routine prenatal appointments that don’t require ultrasound, lab work or cervical checks, especially for low-risk pregnancies. A medical study showed that a hybrid of in-person and videoconference prenatal visits for low-risk obstetric patients had similar pregnancy outcomes to the traditional in person visits. The American College of Obstetrics and Gynecology (ACOG) and the Society of Maternal Fetal Medicine have also recommended decreasing the number of ultrasounds to lessen the possible risk of transmission of COVID-19. Patients are now screened for the infection prior to appointments, and visitors are often not allowed in with them even for long-awaited ultrasounds.

Decreased access to typical in-person providers can also lead to increased anxiety for many women. For some patients, this may happen if their in-person provider is called to be a laborist on labor and delivery and for others it could be because their provider themselves is ill with Covid-19. Other women are not yet as comfortable with virtual appointments. Meanwhile other expectant mothers in areas more highly affected by Covid-19 are reluctant to even come into the office for necessary in-person appointments as they fear contracting the virus and what that could mean for their pregnancy. This is problematic, as inconsistent prenatal care has been linked to adverse pregnancy outcomes including low birth weight, preterm labor, and stillbirth. Providers should be aware of these concerns, reassure patients of all of the measures being taken to prevent the spread of infection during in person appointments, and take time to explain to patients the reasoning behind the use of telemedicine for routine appointments.

Concerns about Covid-19’s impact on health outcomes
SARS-CoV-2, the virus that causes Covid-19, has only been in circulation since late November/early December, and not much is known about how this virus affects pregnant women and their unborn children. Early studies have shown that pregnant women are not at higher risk for contracting the virus and do not have a worsened clinical course. However, based on the immunologic changes of pregnancy and observations from other respiratory viruses including influenza, SARS, and MERS, it is possible that pregnant women are at increased risk of developing severe pneumonia from SARS-CoV-2. Initial case series also showed no vertical (mother to baby) transmission, but recent evidence shows that it may be possible, with one case study showing an infant born with positive antibodies to the virus. SARS and MERS, also coronaviruses, were associated with adverse pregnancy outcomes including preterm labor, intrauterine growth restriction, increased risk of NICU admissions, increased risk of miscarriage, and stillbirth.

While it is unclear whether or not Covid-19 infections are associated with adverse pregnancy outcomes (a large trial including infected pregnant women is ongoing), obstetricians are seeing an uptick in second and third-trimester pregnancy losses, and a case study was recently reported in the literature of a second-trimester pregnancy loss caused by a placental infection with SARS-CoV-2 infection. There are still so many unknowns, and it’s this uncertainty that is driving increased anxiety and impacting mental health overall.

Shifting birth plans and adapting to changing hospital policies
Many women have been forced to reevaluate their birth plans, for fear of contracting the virus while in the hospital, as well as concerns about delivering alone due to changing hospital visitation policies. Early on in New York, some hospitals stopped allowing visitors altogether. Thankfully most hospitals are now allowing a single visitor for laboring women, with only a few requiring the support person to leave after delivery. Some hospitals are screening for Covid-19 infection with temperature and symptoms checks while others are choosing to test all pregnant women and their partners. If a support person screens or tests positive, he or she will not be allowed in the delivery room, while if a laboring woman screens or tests positive, the recommendation is separation from the baby after birth to prevent neonatal infection. Women who are fearful of delivering alone or being separated from their baby have sometimes chosen to deliver at an alternate hospital or have not truthfully disclosed when they or their partner have experienced symptoms of coronavirus infection, which can put medical personnel at risk.

Intimate partner violence
For far too many women, the trauma of intimate partner violence intensifies mental health conditions. Intimate partner violence is more common during pregnancy than when a woman is not pregnant, with approximately 324,000 pregnant women in the United States experiencing abuse each year. Often abuse starts for the first time when a woman becomes pregnant. With increased social isolation and fear of coronavirus infection, experts have cause for concern that intimate partner violence is increasing during Covid-19 stay at home orders, as it has during previous pandemics and other natural disasters. Many women are afraid to report abuse to begin with, and with safety nets breaking down, schools closed, and fewer in-person medical appointments, the risks are heightened. Joblessness and financial strain as well as multiple people in a household spending large amounts of time quarantined together increases tension that can lead to increased violence.

Empowering providers with solutions
As the pandemic continues, we as the medical community can take steps to ensure we’re effectively identifying and treating mental health issues, and helping women during this unprecedented time:

  1. Screening – ACOG recommends screening all women during pregnancy for mood disorders and performing comprehensive screening for postpartum depression at the postpartum visit. It is imperative that all pregnant and postpartum women continue to be screened for postpartum depression and mood disorders even when appointments occur virtually and that appropriate resources are available for treatment of mental health disorders. ACOG also recommends screening every woman for intimate partner violence at the first prenatal visit, at least once per trimester, and postpartum. However, during this pandemic increased screening may be warranted.
  2. Referring – Obstetric providers should be referring patients appropriately when screening is positive. A list of mental health providers, intimate partner violence counselors, and shelters in each provider’s area should be readily available, and each provider should be aware of how referrals are being handled during the pandemic.
  3. Listening – Obstetric providers should make time to talk to women at each prenatal appointment, whether in person or remote, about specific concerns or anxieties that they have around the pandemic and be ready to address those concerns. Providers should discuss birth plans with women as due dates near, and discuss new changes in hospital policies surrounding visitors, masks, and COVID-19 testing at the same time reassuring patients that they will be well cared for.
  4. Embracing Telemedicine and Other Virtual Platforms – Newer telemedicine platforms are available to fill in the gaps in between visits and are increasingly covered as a benefit by employers. These can provide mental health counseling, mental health prescriptions, and obstetric education by nurse midwives and obstetricians as well as subspecialists. Some also have a variety of provider types including pediatricians, lactation consultants, physical therapists, and back to work coaches. During the birth, video platforms should be offered to allow additional people (including a doula) to be virtually present in the delivery room if the patient chooses.

Now more than ever, women and families need comprehensive care that supports both physical and mental health. By utilizing all available resources, and tapping into what we know about how best to screen and treat maternal mental health issues, we can help mitigate the risks and preserve the care of our women and families – during the pandemic and beyond.

Photo: damircudic, Getty Images

 

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NEWS

CVS head of specialty pharmacy sees future of healthcare at home after Covid-19

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Mail-order prescriptions are nothing new, but pharmacists have turned to a number of other tools to help patients access their prescriptions during the Covid-19 pandemic.  The head of CVS Health’s specialty pharmacy strategy, Prem Shah, said he expects to see more patients continue receive healthcare at home after the pandemic ends.

Though CVS Health had been building up its arsenal of digital tools before the Covid-19 pandemic, stay-at-home orders forced the pharmacy giant to lean more on them. The company has seen a surge in the use of its support services since the beginning of March.

“We started our journey in the digital space in specialty 5 or 6 years ago,” said Shah, who is executive vice president of specialty and product innovation for CVS Health. “The pandemic has allowed us to really test our capabilities virtually, across the board for the PBM. We quickly realized virtual healthcare and support services were going to be critical with social distancing rules in place.”

For example, the company began offering secure text messaging with a nurse or a pharmacist. CVS Health saw a 30% increase in encounter volume, with some patients asking for help with managing their specialty medication, while others needed help finding supplies beyond the medication itself.

CVS Health also saw an uptick in calls to Accordant nurses, which are trained to help patients with rare conditions. More than a third of the calls were for questions about Covid-19.

Shah said CVS Health had also been working with health plans to help them identify which members face the highest risk from Covid-19, so they could reach out to them and make sure they understood everything that is available to them under their plan.

Looking to the future after the Covid-19 pandemic, Shah expects to see a bigger shakeup in traditional care settings.

“If you were to ask me even three months ago, we would say we have many fragmented sites in which we provide these services,” he said. “One of the things I think you’ll see stick in healthcare… how people think about their healthcare workforce is going to be a little more nimble. You’re not requiring someone to go into a specific setting.”

For example, hospitals have typically been a hub for cancer care. But with the pandemic, CVS Health helped patients that were receiving infusions in a hospital setting transition to in-home care.

“Over time, I think you’ll see care move to patients’ homes,” Shah said.

Telehealth has been another big part of the push to care for patients remotely. But there’s still plenty of room to build on these services.

“The real question with telehealth and these other things has to be how do we improve the quality of care?” Shah said. “The industry needs to push hard, but I do think there’s a better care model.”

Photo credit: Irina_Strelnikova, Getty Images

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WEIGHT LOSS

Nurse Who Survived COVID-19 Shares Jaw-Dropping Photo Of What It Did To His Body

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A nurse from San Francisco is shining a light on the severity of COVID-19 with a shocking photo of the effects it had on his body.

Last week, Mike Schultz shared side-by-side images of himself with his over 40,000 Instagram followers of the dramatic 50-pound weight loss he experienced during an eight-week hospital stay as he was treated for the disease caused by the new coronavirus.

The 43-year-old told Health that in the photo on the left, he’s about 190 pounds. He added that he exercised every day and had no underlying health conditions.

“I weighed myself the other day and I’m down to 140 pounds, and I probably weighed less than that when I first got into rehabilitation,” he told the magazine. “I’ve never been this skinny before in my life.”

Schultz explained to Buzzfeed News the reason he decided to post his now-viral photos. “I wanted to show it can happen to anyone. It doesn’t matter if you’re young or old, have pre-existing conditions or not. It can affect you,” he said.

Schultz told CNN that he contracted the coronavirus in early March, “before any of the restrictions were out” and likely got it while attending Miami’s Winter Music Festival. His DJ boyfriend, Josh Hebblethwaite,was working at the event.

“We knew it was out there,” Schultz told Buzzfeed, noting that no “lockdowns” had been ordered at this point. “We just thought, ‘Well, we gotta wash our hands more and be wary of touching our face.’”

The Miami Herald reported that 38 people who attended the LGBTQ-friendly music festival later got sick, and three men died, 

On March 14, about a week after the festival, Schultz flew to Boston, where Hebblethwaite lives.

He told CNN that when he first arrived in Boston, he had a cough but “it wasn’t really a big deal.” But on March 17, he found himself with a fever of 103 degrees and was having difficulty breathing.

When Schultz arrived at the hospital, he was given a swab test and chest X-rays. He tested positive for the coronavirus and was also diagnosed with pneumonia and severe repertory distress syndrome, per CNN.

Soon after, he was intubated and placed on a ventilator to aid his breathing.

“That was the last time I saw my boyfriend,” Schultz told Health. “I texted him, ‘I’m scared.’ Soon after, I was sedated, and I don’t remember much after that.”

He was on the ventilator for four-and-a-half weeks, according to CNN. He told Buzzfeed that during this time it was like he was “in a coma.”

Schultz said that when he woke up from his ordeal, he believed only a week had passed. “I still had a tracheostomy [tube], I couldn’t talk, and my hands were so weak that my phone felt like it was 100 pounds,” he told Health.

He also noticed he had lost weight, but nothing could prepare him for what happened when he finally saw himself in the mirror. “I didn’t even recognize myself,” he told CNN. “I pretty much cried when I looked in the mirror, I was like ‘Oh my God.’”

Schultz is now slowly recovering.

“I’m doing breathing exercises to get my lung capacity up, and plenty of exercises to stabilize my legs so I can finally walk without doing a penguin shuffle,” he joked to Health.

A HuffPost Guide To Coronavirus



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