Category: Covid-19

International

Alexander Chudik, M. Hashem Pesaran and Alessandro Rebucci

August 23, 2022

Experience in Europe shows that mandatory and voluntary social distancing and economic incentives to increase compliance with emergency measures were critical to bringing the COVID-19 viral reproduction number below 1indicating one infected person passed the virus to fewer than one other person. However, no single factor can account for the realized outcomes.

Among factors considered, we find that vaccine uptake was the most important in reducing effective transmission rates in 2021, though the other factors helped bring infections under control.

The COVID-19 pandemic has claimed millions of lives, brought about costly government interventions to contain it, and caused unprecedented and widespread economic disruption worldwide. The pandemic has now evolved into an endemic infectious disease amid heated debates on the pros and cons of social distancing and other containment policies, notably in China.

In our recent working paper, upon which this article is based, we examine the evolution of virus transmission rates in selected European countries since the start of the pandemic in early 2020. Although the European countries on which we focus had similar patterns of transmission at the beginning of the pandemic, they ended up with quite different outcomes.

We exploit these differences to learn about the key drivers of the effective reproduction numbers. In particular, we consider factors such as voluntary and government-mandated social distancing, economic support to comply with containment policies, vaccination uptake and virus mutations.

A common epidemiological metric to measure the spread of an infectious disease is the effective reproduction number, the R-number. It measures the new infections expected to result from one infected individual.

Over the past couple of years, this metric has been used widely in the popular press when reporting on the pandemic. An R-number above 1 implies the epidemic is expanding (since one new infection results in more than one expected secondary infection), whereas a value below 1 implies that the epidemic is contracting.

The R-number changes over time (and across countries) due to the shrinking share of susceptible individuals because of immunity following recovery (the so-called herd immunity component) or from a change in the underlying effective transmission rate, which in turn can depend on a multitude of factors mitigating viral spread.

Chart 1A shows our estimates of the R-number for Western Europe as an aggregate (red line) together with a model-implied estimate of what the R-number would have been without any contribution from the herd immunity (dotted blue line), which we broadly refer to as the effective transmission rate. This chart documents a lot of variationsix distinct waves (marked by the R-number exceeding 1)during 202021.

These estimates, however, mask often large differences in outcomes (number of new cases, hospitalizations and deaths) across countries, as shown in panels 1B (Spain) and 1C (Poland).

Downloadable chart | Chart data

Using a panel data approach, we exploit both time-series and cross-country variations in the rate of transmissions to identify the relative importance of different factors affecting the evolution the epidemic in Western Europe.

Changes to the transmission rate are governed by many factors, both biological and behavioral, such as mutations; social distancing (voluntary or mandatory); government-mandated mobility restrictions and compliance with mandated measures; and immunity changes due to vaccination.

We focus on five key factors. To proxy mandated social distancing and incentives, we use the aggregate stringency and economic support indexes compiled by the Oxford COVID-19 Government Response Tracker project for the first two factors.

To assess the potential impact of voluntary social distancing, we allow forthreshold effects (the third factor), which captures how the fear of becoming infected, stoked by news of increasing cases, influenced individual precautionary behavior. Vaccine availability and public vaccination uptake became more prominent in 2021. We proxy that development by adding the population share of vaccinated people to our panel regressions as a fourth factor.

Our sample ends in November 2021, before the onset of the dominant omicron variant. To proxy for important virus mutations during our sample period, we add the then-dominant delta variant share of the confirmed sequenced cases as our fifth factor.

We find that all determinants of the transmission rate as proxied by our variables are statistically highly significant and have the expected signs (Chart 2). Before the onset of vaccination, mandated containment policies, incentives to comply with them and voluntary changes in behavior arising from fear of infection were important in bringing down the R-number below 1 over sustained periods.

Downloadable chart | Chart data

Following the widespread use of vaccination and toward the end of our sample period in November 2021, we find that the degree of vaccine uptake is the most important contributor to the decline in the effective transmission rate.

The delta variant in the spring/summer of 2021 contributed to an increase in the R-number by about 1, which is substantial. Our country-specific estimates of the basic reproduction number (defined as the R-number in a fully susceptible population in the absence of any mitigation measures) are surprisingly similar across countries, in a tight range from 5.1 to 5.5, with a pooled estimate of 5.3. These estimates are much larger compared with earlier estimates found in the literature that range between 3.0 and 4.0.

As with most empirical research, our analysis has its limitations due largely to data issues. An elephant in the room is the accuracy of the reported number of infected cases and the measurement of mitigating factors used in our study. Infected cases are generally underreported, possibly by a factor of 2 to about 7, depending on the period and the country involved.

In our estimations, we allowed for underreporting of the number of infected cases and found that the results are robust to different assumptions on the magnitude of underreporting and its changes over time as availability of testing increased.

Our proxy variables are also imperfect measures. In addition, the availability of data and the related choice of using aggregate (country-level) data necessitate keeping regression specifications parsimonious, which means that we cannot separately examine each of the specific containment policies adopted.

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Vaccines Were Key to Curbing COVID-19 in Europe; Other Measures Also Useful - Federal Reserve Bank of Dallas

The S.C. Department of Health and Environmental Control reported more than 10,000 new COVID-19 cases and 13 new deaths related to the virus Aug. 14-20.

New cases reported: 10,052

Total cases in S.C.: 1,661,020

New deaths reported: 13

Total deaths in S.C.: 18,245

Percent of ICU beds filled (with COVID-19 and other patients): 62.2 percent

Percent positive: 21.9 percent

In South Carolina, 60.9 percent of people who are eligible for the vaccine have received at least one dose, and 52.8 percent of eligible residents are considered fully vaccinated against the coronavirus.

These numbers reflect all eligible residents in the state, including young children. The latest data from DHEC shows 22.5 percent of children ages 5-11 have at least one vaccine dose, and 2.7 percent of those under age 5 had received a dose of vaccine.

Of the 552 COVID-19 patients hospitalized as of Aug. 20, 75 were in the ICU and 32 were using ventilators.

"I would say there's never a bad time to get your booster if you're eligible. If you are over the age of 50 and you haven't gotten that second booster, you can still go ahead and get it now." said Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, on whether people should wait for fall booster.

Reach Tom Corwin at 843-214-6584. Follow him on Twitter at @AUG_SciMed.

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SC sees 10000 new cases of COVID-19 and 13 new deaths - Charleston Post Courier

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Medical experts weighed in on the advancement of school COVID-19 mask mandates and other pandemic-related measures for the upcoming academic year, at odds over whether the science makes sense.

Several schools have surprised parents with announcements that they'll keep pandemic-related policies in place in the case of high transmission rates. The BA.5 Omicron subvariant of the virus is surging, but current vaccines continue to offer protection against hospitalization for severe disease and death.

The Desoto, Texas, school district said its mask requirement will remain for the 2022-2023 school year because of the rising number of COVID-19 cases in Dallas County. DeSoto ISD said it won a lawsuit allowing them to enforce the use of masks despite Gov. Gov. Greg Abbotts ban on mask mandates in school.

"The district will continue to require masks to be worn at all schools, sites, activities when the community level in Milwaukee County is rated in the High category as determined by the Centers for Disease Control and Prevention (CDC)," Milwaukee Public Schools recently wrote.

FAIRFAX COUNTY SCHOOL BOARD CRITICIZED FOR BAFFLING, ANTI-SCIENCE MEMO ON MASKING

Gabby Mondelli teaches her fourth grade students at Samuel W. Tucker Elementary School in Alexandria, Virginia, on Thursday, August 19, 2021. (Amanda Andrade-Rhoades/For The Washington Post via Getty Images) (Amanda Andrade-Rhoades/For The Washington Post via Getty Images)

The Fairfax County School Board in Virginia sparked a firestorm by making a similar announcement in a recent email to the school community.

"FCPS requires all students to wear a face covering when indoors (except while actively eating/drinking) on school property (to include the buildings, school buses and other school provided vehicles) when the CDC COVID-19 Community Level for Fairfax County is high," the email read. "The current level for Fairfax County is medium. The Code of Virginia allows parents/legal guardians to elect for their child not to wear a face covering while on school property."

"Parents have been left discouraged, angered and confused by this fear mongering and charade,"Elizabeth McCauley of the Virginia Mavens told Fox News Digital.

Frustrated parents have the backing of experts who say the time for mandates has long expired.

"Children continue to be the most vulnerable to harsh Covid restrictions," Fox News medical contributor Nicole Saphier told Fox News Digital. "The CDC has begun moving towards risk-based recommendations yet they are not speaking out when mask and vaccine mandates are still being instituted. Adults are able to congregate in bars, concerts, airplanes and other settings without masks yet kids, who have proven over and over again to be the lowest risk for severe Covid and over 90% of which have already had Covid, are being forced to mask up."

PUBLIC SCHOOL DISTRICTS IMPLEMENTING COVID RESTRICTIONS MEET FEROCIOUS COMMUNITY PUSHBACK

Saphier suggested a better path forward - one she said won't add to the physical and mental stress already caused by mandated mask wearing.

"They are told to mask-up despite zero reputable data demonstrating clinical benefit of cloth mask wearing in the lowest risk population, most of whom have natural immunity," she continued. "What we do know is that mask wearing can have consequences, physical and emotional. Schools need to move towards risk base mitigation measures and stop enforcing universal mandates. Higher (sic) risk staff and children and really anyone who wants to should be allowed to wear a facemask, however, no one should be forced to. Another asinine policy kids are dealing with is requiring boosters for college students to return in the fall. There is no place for universal mandates, vaccines and masks, at this point of the pandemic."

Ellen Phillips virtually teaches a second grade class for students who are either at home or in a separate classroom as in-person learning resumes with restrictions in place to prevent the spread of coronavirus disease (COVID-19) at Rover Elementary School in Tempe, Arizona, U.S., August 17, 2020. REUTERS/Cheney Orr (REUTERS/Cheney Orr)

VIRGINIA MOM BLASTS SONS' SUSPENSIONS FOR NOT WEARING MASKS: PUNISHED FOR POLITICAL REASONS

But health experts like Dr. Gabrielle Virgo, a Silver Spring, Md., pediatrician, "strongly believe" in continued masking.

"I strongly believe in masking," Virgo told the Washington Post. "We have to be realistic. We will see another new variant. This wont be the end of it. Were not at the point where its acceptable for everybody to be taking off their masks. I tell parents: Be prepared."

Julia Raifman, an assistant professor of health law, policy and management at Boston University, says there's enough evidence to suggest the masking has helped reduce COVID rates.

"We see that each layer of COVID mitigation helps but that none is sufficient to control COVID transmission on its own, especially in surges," Raifman told Fox News Digital. "There are several studies indicating mask mandates are associated with reduced COVID transmission, as well as the logic that COVID spreads through the air and that universal mask policies help people with COVID wear masks and reduce spread.

"I think we have been on a policy pendulum where we had business and school closures at first while we learned more about the virus but then we overswung the other direction, to the point where we have no mitigation. COVID remains harmful to health, education, and the economy, mask mandates remain one of the most impactful mitigation strategies, and we should be prepared to use mask mandates to reduce the harms of new surges," she added.

SCHOOL MENTAL HEALTH CRISIS: 70% SEE RISE IN STUDENTS SEEKING TREATMENT SINCE COVID-19 BEGAN: STUDY

The Berkeley Unified School District announced Friday that it will require masks be worn indoors for students, staff and visitors amid a surge in COVID-19 cases. (Berkeley Unified School District)

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Stanford Medical School Professor Dr. Jay Bhattacharya challenged the belief that mask wearing slows the spread of the virus.

"My position is that there is no high quality evidence such as a randomized trial that supports the notion that child masking slows the spread of Covid," he told Fox News Digital. "The experience of Sweden and other European countries shows that schools can operate normally without mask mandates without placing teachers at any elevated risk relative to them relative to other workers in the community."

Dr. LeRoy Essig, a pulmonary disease doctor at OhioHealth Physician Group in Columbus, Ohio, also advocated against facial coverings, telling Fox News Digital that kids who are learning to speak need to see facial expressions to help in their emotional development as they're learning to form words and sounds. Masked children, he said, also have a hard time seeing their classmates' facial expressions, which he said can cause "emotional segregration."

Some schools have pushed for better ventilation systems to improve air quality, an upgrade that could in some cases delay the return to in-person learning. Bhattacharya argued against that route and was adamant that children deserve a "normal school year."

"There are many long term physical and psychological harms to children from not resuming school unburdened by such non-pharmaceutical interventions, especially now that such a large portion of the population has immunity either from recovery from prior covid infection, the vaccine or both," he said. "Ventilation (sic) upgrades may be useful in some schools, but should not be used a pretext to delay the return to normal schooling. All children deserve a normal school year and covid should not be used as a reason to not provide that for American kids."

"This year, my personal take on it is that certainly kids should be in school," Essig agreed. "I think it's been pretty well established that, trying to do remote learning the quality of education is not up to par. The truancy rates are greater. And many kids obviously don't have the same accountability at home as when they're in school. So they certainly should be in school."

Cortney O'Brien isan Editor at Fox News. Twitter: @obrienc2

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Medical experts weigh in on continued COVID-19 school measures: 'There is no place for universal mandates' - Fox News

Despite the emergence of the latest Omicron subvariants -- BA.2, BA.2.12.1, BA.4, and BA.5 -- Massachusetts observed no significant excess mortality this spring, researchers said.

From February to June 2022, when cases from these subvariants were highest, there were 0.1 excess deaths per 100,000 person-weeks in the state, corresponding to 134 excess deaths (95% CI -921 to 1,189), reported Jeremy Faust, MD, MS, of Brigham and Women's Hospital in Boston and editor-in-chief of MedPage Today, and colleagues.

And this was despite at least 226,857 new cases of COVID-19 during the 18-week stretch, according to their research letter in Lancet Infectious Diseases.

The level of excess mortality represents a 97.3% drop compared with the 8-week initial Omicron wave, during which there were 4.0 excess deaths per 100,000 person-weeks, or 2,239 excess deaths (95% CI 1,746-2,733), and a 92.7% drop compared with the combined 26-week Delta and Delta-to-Omicron transition periods, during which there were 1.5 excess deaths per 100,000 person-weeks, or 2,643 excess deaths (95% CI 1,192-4,094).

"We are finally in a phase now where highly immune populations can start to shoulder COVID-19 waves without the guarantee of excess mortality," Faust told MedPage Today. "Before, a COVID wave meant we knew we would have excess mortality."

However, illness from COVID-19 and associated hospitalizations continue to occur. "It's not all just about excess death," Faust noted.

Rather than the much-discussed "herd immunity," the morbidity levels being back to nearly normal shows "herd safety," he said.

"This spring, so many people walking around had a recent immune-generating event, vaccine, booster, or infection," with 80% of the Massachusetts population being fully vaccinated, he added. "So now we have something to show for that, but we don't know how long it will last."

There have been previous drops in mortality since the pandemic began. The first time there were fewer excess deaths in Massachusetts was during February to June 2021, when vaccines were being rolled out. During that time, "the mean age of newly infected people dropped precipitously and prevalence among people older than 60 years was low," Faust and co-authors wrote.

Conversely, the drop in mortality from late February to June 2022 did not correlate with infections in younger people. In fact, the mean age of newly infected people was higher, suggesting that "in our highly vaccinated state, current levels of immunity are considerable, leaving many, if not most, individuals at high risk with substantial protection against the most severe outcomes of SARS-CoV-2 infection," the authors noted.

For this analysis, Faust and colleagues used population data from 2014 to 2019, as well as weekly mortality data from January 2015 to February 2020 provided by the Massachusetts Registry of Vital Records and Statistics, which was 99% complete for all study weeks. They applied seasonal autoregressive integrated moving averages to project the weekly number of expected deaths for Massachusetts for Feb. 3, 2020 to June 26, 2022.

Faust explained that other states, including but not limited to Alaska, Arkansas, Arizona, California, Hawaii, New Hampshire, New Mexico, Oregon, Vermont, Washington, and West Virginia, are reporting higher rates of excess mortality during the same time period. Data are currently unpublished, as they are incomplete, "but the complete numbers won't be lower," he said.

Ingrid Hein is a staff writer for MedPage Today covering infectious disease. She has been a medical reporter for more than a decade. Follow

Disclosures

Faust reported no conflicts of interest. One co-author reported multiple relationships with government sources and pharmaceutical companies.

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Are We Approaching 'Herd Safety' With COVID-19? - Medpage Today

Three drugs, metformin, ivermectin and fluvoxamine are of limited effectiveness at preventing either hypoxia or hospitalisation or an emergency department visit in patients with COVID-19 according to the findings of a COVID-OUT, a recent randomised, placebo-controlled trial with all three medicines.

Before the introduction of COVID-19 vaccines, research efforts were directed towards repurposing existing medicines to treat the virus. Metformin was one such drug and some work revealed how the drug has an anti-thrombotic effect and was highly effective at inhibiting platelet activation. Moreover, other in vitro work found that metformin inhibited NLRP3 inflammasome activation and interleukin (IL)-1 production in cultured and alveolar macrophages along with inflammasome-independent IL-6 secretion, thus attenuating lipopolysaccharide and COVID-19-induced acute respiratory distress syndrome. Taken together, these data point to a possible role for the drug in the treatment of COVID-19 and which was supported by a retrospective analysis which showed that outpatient metformin use was associated with lower mortality and a trend towards decreased admission for COVID-19. Similarly, a systematic review found that fluvoxamine showed a high probability of being associated with reduced hospitalisation in outpatients with COVID-19. Finally, a Cochrane review concluded that uncertainty remains over the efficacy and safety of ivermectin used to treat or prevent COVID-19.

In trying to gather more evidence for the effectiveness of all three drugs in COVID-19, the COVID-OUT trialists, undertook a randomised, placebo-controlled trial with all three drugs. Eligible patients were non-hospitalised individuals who were enrolled within 3 days of a positive test for the virus and within 7 days of symptom onset. In addition, individuals were either overweight or obese, making them at high risk of severe disease if infected with COVID-19. Metformin was given at a dose of 1500 mg for 14 days (after a period of dose escalation over 6 days), fluvoxamine at a dose of 50 mg twice daily and ivermectin at a dose of 390 to 470 g per kilogram per day for 3 days. The primary event was severe COVID-19 over the 14 days of the trial, defined as a composite of hypoxia (< 93% oxygen saturation), emergency department visit, hospitalisation or death. The main secondary outcomes were the individual components of the composite primary outcome.

Metformin, ivermectin, fluvoxamine and COVID-19 outcomes

A total of 1323 participants with a median age of 46 years (56% female) of whom 52% were vaccinated against COVID-19, were enrolled and randomised to one of the three treatments or placebo. The median body mass index of participants was 30.

The adjusted odds ratio for the primary event with metformin was 0.84 (95% CI 0.66 1.09, p = 0.19), 1.09 (95% CI 0.76 1.45, p = 0.78) for ivermectin and 0.94 (95% CI 0.66 1.36, p = 0.75) for fluvoxamine. There were also no significant differences for each of the three drugs based on the secondary outcomes apart from a reduction in emergency department visits for metformin (odds ratio = 0.84, 95% CI 0.35 0.94) and while this finding was statistically significant, the authors made clear that since this was pre-specified as a secondary outcome, the result warranted further trial evidence.

Participants were also asked to self-rate the severity of daily symptoms during the study and these were not reduced any faster with the three drugs compared to placebo.

The authors concluded that none of the three drugs significantly prevented the primary event compared to placebo although the effect of metformin on emergency department visits warranted further investigation.

CitationBramante CT et al. Randomized Trial of Metformin, Ivermectin, and Fluvoxamine for Covid-19 N Eng J Med 2022

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Three drugs all ineffective for COVID-19 according to RCT - Hospital Healthcare Europe

If your waistline increased during the pandemic, youre not alone. Thats coming up on This Land of Ours.

New data from USDAs Economic Research Service shows that U.S. adults ages 20 and older reported a three percent higher prevalence of obesity during the first year of the COVID-19 pandemic. The study analyzed data from the Centers for Disease Control and Preventions Behavioral Risk Factor Surveillance System from March 13, 2020, to March 18, 2021, compared to a pre-pandemic baseline period of January 1, 2019, to March 12, 2020.

Four behaviors that can influence the risk of obesityexercise, hours of sleep, alcohol use, and cigarette smokingwere also examined to help explain the change in the adult obesity rate during the pandemic. Participation in exercise rose 4.4 percent over the period, and people slept 1.5 percent longer, both associated with reducing obesity. Meanwhile, the number of days in the period of a month in which alcohol was consumed was 2.7 percent higher, and cigarette smoking dropped by four percent.

Listen to Sabrina Halvorsons This Land of Ours program here.

Sabrina HalvorsonNational Correspondent / AgNet Media, Inc.

Sabrina Halvorson is an award-winning journalist, broadcaster, and public speaker who specializes in agriculture. She is a native of Californias agriculture-rich Central Valley.

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Adult Obesity Increased During First Year of COVID-19 Pandemic - - Southeast AgNet

CLEVELAND If youve had COVID-19 more than once, youre certainly not alone. Reinfections are becoming more common.

Viruses are very smart. If they are actively infecting a large swath of our population, there are active mutations that keep on happening in these viruses, said Abhijit Duggal, MD, critical care specialist for Cleveland Clinic. This is something that has been described very well, even before COVID.

Dr. Duggal further explains that once youre infected, your immune system will remember that specific variant. However, if a new one comes along, it may be harder to detect which can lead to reinfection.

He said its very similar to how influenza changes every year.

So, what can someone do to help protect themselves?

Dr. Duggal said all the same precautions still apply, like wearing a mask, social distancing when possible and regularly washing your hands. The same goes for getting vaccinated and boosted.

While the vaccine may not be able to prevent COVID completely, it will help lessen the severity of illness.

When it comes to vaccination, its not just a matter of infection, it is a matter of severity of infection. And that is something that has been shown time and time again through these variants, that if you are vaccinated and boosted appropriately, the risk of severe infection goes down significantly, he said.

Dr. Duggal said theres no telling how many times an individual can get COVID-19, which is why its important to protect yourself.

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Why COVID-19 Reinfections are the New Normal - Cleveland Clinic Newsroom

The majority of people likely infected with the omicron variant of COVID-19 were unaware, according to a study from a medical center in Los Angeles, Calif. Al Bello/Getty Images hide caption

The majority of people likely infected with the omicron variant of COVID-19 were unaware, according to a study from a medical center in Los Angeles, Calif.

The majority of people likely infected with the omicron variant that causes COVID-19 were not aware they contracted the virus, which likely played a role in the rapid spread of omicron, according to a study published this week.

Researchers at Cedars-Sinai, a nonprofit health organization based in Los Angeles, examined the infectious status of individuals during the omicron surge in the U.S.

Omicron was first detected in November 2021 and has become the most dominant strain of COVID-19. Common symptoms are typically less severe than other variants and include cough, headache, fatigue, sore throat and a runny nose, according to the researchers.

The study analyzed 2,479 blood samples from adult employees and patients at Cedars-Sinai Medical Center around the time of the omicron variant surge.

Of the 210 people who likely contracted the omicron variant based on antibodies in their blood 56% percent did not know they had the virus, the researchers found.

They also found that only 10% of those who were unaware reported having any symptoms relating to a common cold or other type of infection.

"We hope people will read these findings and think, 'I was just at a gathering where someone tested positive,' or, 'I just started to feel a little under the weather. Maybe I should get a quick test,'" said Dr. Susan Cheng, one of the authors of the study.

"The better we understand our own risks, the better we will be at protecting the health of the public as well as ourselves," said Cheng, who directs the Institute for Research on Healthy Aging in the Department of Cardiology at Cedars-Sinai's Smidt Heart Institute.

A lack of awareness could be a major factor in the rapid transmission of the virus between individuals, according to the study.

"Our study findings add to evidence that undiagnosed infections can increase transmission of the virus," said Dr. Sandy Y. Joung, first author of the study who serves as an investigator at Cedars-Sinai.

"A low level of infection awareness has likely contributed to the fast spread of Omicron," Young said.

Although awareness among health care employees was slightly higher, the researchers said it remained low overall.

Researchers say further studies are needed, "involving larger numbers of people from diverse ethnicities and communities ... to learn what specific factors are associated with a lack of infection awareness," according to the news release.

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Over half of people infected with the omicron variant didn't know it, a study finds - NPR

Study design

This study was part of a cross-sectional, nationwide, multipurpose, mail survey of Japanese PwMSA from October to December, 2020. The data reflect the effects of the early COVID-19 pandemic, corresponding to 8 to 9months after the global pandemic was declared. Prior to this study, we reported another study of aspects of social services in Japan23, and all 155 participants in the present study were also included in that analysis.

The study received approval from the ethics committee of the Faculty of Health Science of Juntendo University (Approval Number 20-012) and was performed in accordance with the Declaration of Helsinki. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and the American Association for Public Opinion Research (AAPOR) reporting guideline.

The survey was anonymous, and confidentiality of information was assured. Informed consent was obtained from all participants by providing a written explanation of the study and having them return the questionnaire form. Because it was anticipated that certain patients did not want their responses to be included in the study, their return of a letter of intent to refuse to respond was also accepted.

The participants of this study were respondents to a survey of all members of the Japanese spinocerebellar degeneration and MSA patient association (https://scdmsa.tokyo/). This is the largest nonprofit organization patient group in Japan and is composed of volunteers. However, the members may not be the patients themselves, because they may be individuals who agree with the purpose of the association. MSA was self-reported by the patients in this study, but the diagnosis of MSA in Japan is made by specialists according to the common diagnostic criteria specified by the Ministry of Health, Labour and Welfare for registration of designated intractable diseases. The criteria are based on the second consensus statement on the diagnosis of MSA12. It was unlikely that an individual belonging to a patient association of rare diseases would self-report without it being based the correct diagnosis. The exclusion criteria for this study were those who were not PwMSA, and those who refused to respond or had incomplete answers to all the questions related to COVID-19.

Questionnaires were mailed to all members using the address database used to send regular patient association mailings. The relevant questions consisted of original COVID-19-related items and background information items that did not reflect COVID-19. The primary outcome was the effect of the COVID-19 pandemic on ICF functioning. The domains of ICF functioning consisted of body function, activity, and participation, and these definitions were in accordance with the WHO22. The self-perception of ICF functioning during the pandemic was assessed through the patients global impression at the time of response. Participants were asked to rate the impact score on each ICF functioning associated with COVID-19 on a 7-point scale: strongly unaffected=3, moderately unaffected=2, slightly unaffected=1, undecided=0, slightly affected=+1, moderately affected=+2, and strongly affected=+3. Of these, responses 1 to3 were classified as Unaffected, and responses of +1 to+3 score were classified as Affected, with the latter responses defined as COVID-19-related decline of ICF functioning. Thus, if domains of ICF functioning (body function, activity, and participation) were affected, the terms impairment, activity limitation, and participation restriction were used, respectively. The infection status and behavioral effects of COVID-19 were also included in the survey.

Participant were asked about age, sex, disease type, disease duration, and dwelling place (home, long-term care facility, hospitalization), and the multiple system impairment questionnaire (MSIQ), patient health questionnaire-2 (PHQ-2), modified rankin scale (mRS) score, barthel index (BI), life-space assessment (LSA), and EuroQoL (EQ) were examined. Of these, the clinical assessment indices were based on self-reported responses of normal conditions before the COVID-19 pandemic. The MSIQ for comprehensive scoring of the severity of disease-related impairments and the PHQ-2 as a screening tool for depression reflect body function as a baseline. The mRS score was used as a simple indicator of independence level, and the BI was used for comprehensive scoring of basic activities of daily living (ADL) assessment, reflecting activity as a baseline. The LSA was used for comprehensive scoring of the extent of daily living space, and the EQ was used as a global assessment of health-related QOL, and they reflected participation as a baseline.

The MSIQ was developed specifically for this study and was scored on a self-report basis for 22 impairments that may occur in MSA (Online Resource 1). All impairments were described in writing to ensure specific understanding. It consists of a total of 22 items: ataxia, muscle weakness/atrophy, muscle rigidity, spasticity, balance disorder, postural abnormality, decreased endurance, fatigue, pain, numbness, sensory disturbance, tremor, involuntary movements, orthostatic hypotension, poor sleep, respiratory disturbance, speech/dysarthria, dysphagia, visual impairment, urinary impairment, voiding impairment, and cognitive impairment. Each impairment was scored as 0 (no impairment) to 3 (severe impairment). Thus, the maximum score of 66 is the most severe impairment, and a score of 0 is the complete absence of impairments.

The PHQ-2 for depression screening24 is a shortened version of the PHQ-925. It consists of two items with a score of 03 each, with 0 being normal and 6 being the most severe24. The PHQ-2 was used instead of the PHQ-9, which contains a motor-related item26.

The mRS was originally developed as an assessment grade for disability or dependence in the ADL of stroke patients. Today, it is widely used in patients with neurological diseases. The score was rated on a six-point scale from 0 (asymptomatic) to 5 (severe disability)27.

The BI evaluates the performance of basic ADL, such as feeding, personal hygiene, bathing, and dressing on a scale of 0100. A higher number reflects a greater ability to function independently and has the advantage of being applicable to self-assessment and direct administration28. To allow for self-assessment by mail, the content of previous studies was used29.

The LSA is a self-report measure to summarize the distance (five distance levels ranging from room to out of town) and frequency (five frequency levels ranging from not at all to every day) an individual travels in a given period of time. The results are calculated by the LSA score, which is 120 for the most active30.

The EQ is a comprehensive measure of health-related QOL that is used worldwide31. In this study, the official Japanese version of the EQ five-dimension five-level questionnaire (EQ-5D-5L) was used, and an index value was calculated, with 1 the highest and 0 the lowest32.

In summary, to clarify the effect of the COVID-19 pandemic on MSA, ICF functioning during the pandemic was defined as the main outcome, potential predictors of functioning decline were defined as MSIQ, PHQ-2, mRS, BI, LSA, and EQ, and the potential confounders were age, sex, disease duration, and dwelling place.

Descriptive statistics are presented for demographic variables and functional outcomes during the COVID-19 pandemic for PwMSA. Continuous variables are presented as means (standard deviation) and categorical variables as numbers (%). Spearmans product rate correlation coefficients were calculated for the associations between ICF functioning scores related to the COVID-19 pandemic. To compare the affected patients with the unaffected patients on ICF functioning, group comparisons were performed using Students t-test for numerical variables, the MannWhitney U test for ordinal variables, and the 2 test when appropriate for categorical variables. A score of 0 was excluded from the analysis in that domain. Among the data of selected patients, missing values were excluded only for that item.

Univariate logistic regression analyses were performed on the identified variables to assess the potential risk factors for affected functioning domains during the COVID-19 pandemic. The dependent variable was a dummy variable that was set to 0 for unaffected (3 to1) and 1 for affected (+1 to+3) for each functioning domain, and the independent variables were the MSIQ, PHQ-2, mRS, BI, LSA, and EQ. Similar analyses were performed for each domain of ICF functioning (impairment, activity limitation, and participation restriction). The associations between risk factors and outcomes are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Finally, multivariate logistic regression analyses were performed to identify independent risk factors for affected function scores during the COVID-19 pandemic for each domain of ICF functioning. Age, sex, disease duration, and dwelling place were forced into the model as adjustment factors, and a stepwise variable increase method (likelihood ratio) was used with independent variables identified on univariate logistic regression analysis. ORs and 95% CIs are presented after adjustment for confounders, including age, sex, disease duration, and dwelling place. For multivariate analysis only, participants with even one missing value were excluded from the analysis, and only complete data were analyzed.

Data analysis was performed using SPSS statistical software version 27.0 (IBM Corp). The significance level was set at =0.05, and all tests were 2-tailed.

All procedures performed in the study were approved by the ethics committee of the Faculty of Health Science of Juntendo University (approval number 20-012).

Informed consent was obtained from all participants by providing a written explanation of the study and by their return of the questionnaire form.

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COVID-19 pandemic and the international classification of functioning in multiple system atrophy: a cross-sectional, nationwide survey in Japan |...

CLEVELAND, Ohio X-rays find antiviral compounds in common foods, a diabetes drug may help prevent serious COVID-19 symptoms, and researchers uncover how much virus infected people spread.

Cleveland.com brings you the latest COVID-19 news and research for Friday Aug. 19, 2022.

Antiviral compounds found in common foods

Three natural compounds present in foods like green tea, olive oil and red wine are promising new candidates for the development of drugs to fight against the coronavirus, according to research published last week in the journal Communications Biology.

A group of researchers in Germany used high intensity x-rays created at the particle accelerator laboratory PETRA III in Hamburg to determine the precise molecular structure of an enzyme required for the replication of the coronavirus, and screen a library of compounds that bind to it and may prevent it from working.

To do this, they mixed the viral enzyme with over 500 different natural compounds and formed tiny crystals. They then illuminated the crystals with the bright light from the x-rays and used the pattern of light bouncing off the crystal structure to create an image of the enzyme accurate down to the level of individual atoms.

The screening showed that three chemical compounds called phenols bind to the enzyme: hydroxyethylphenol (YRL), isolated for the experiments from the henna tree Lawsonia alba, is a compound present in many foods such as red wine and virgin olive oil and used as an anti-arrhythmia agent. Hydroxybenzaldehyde (HBA) is a known anti-tumor agent and accelerates wound healing. It was isolated from the copperleaf Acalypha torta. Methyldihydroxybenzoate (HE9), isolated from the French marigold Tagetes patula, is an anti-oxidant with anti-inflammatory effect and is found in green tea.

All three compounds are already used as active substances in existing drugs, said Christian Betzel from the University of Hamburg The advantage of these substances is their proven safety, says Betzel,. These compounds naturally occur in many foods. However, drinking green tea will not cure your corona infection. Like it will not heal your wounds or cure your cancer. If and how a corona drug can be developed from these phenols is subject to further studies.

Diabetes drug Metformin may treat COVID-19

Researchers have found that metformin, a commonly prescribed diabetes medication, lowers the odds of emergency department visits, hospitalizations, or death due to COVID-19 by over 40%; and over 50% if prescribed early in onset of symptoms, said a study published Thursday in the New England Journal of Medicine. The study also found no positive effect from treatment with either ivermectin or low-dose fluvoxamine.

1,323 participants, some of whom were vaccinated and some who were not, were randomly assigned to receive one of the three drugs individually, a placebo, or a combination of metformin and fluvoxamine or metformin and ivermectin. During 3 to 14 days of treatment, each volunteer tracked their symptoms, and after 14 days, they completed a survey.

We are pleased to contribute to the body of knowledge around COVID-19 therapies in general, with treatments that are widely available, said Carolyn Bramante, MD, principal investigator of the study and an assistant professor of internal medicine and pediatrics at the University of Minnesota Medical School. Our trial suggests that metformin may reduce the likelihood of needing to go to the emergency room or be hospitalized for COVID-19.

How much virus does a person with COVID-19 exhale?

If youve tested positive for COVID, just how much are you spreading virus to others every time you cough, sneeze or just breathe out? One group of researchers at the University of Maryland School of Public Health aimed to find out. What they discovered was that people infected with the highly transmissible Alpha, Delta and Omicron variants of SARS-CoV-2 expel higher amounts of virus than do those infected with other variants, and some individuals spread significantly more virus than others.

They also found that vaccination does not prevent individuals from spreading the virus either. According to their research, individuals who contract COVID-19 after vaccination, even after a booster dose, still shed virus into the air.

Their preliminary findings, though not yet peer-reviewed, have been published on the site MedRxiv.

For the study, 93 people who were infected with SARS-CoV-2 between mid-2020 and early 2022 faced into a cone-shaped apparatus and sang, shouted, coughed and sneezed for 30 minutes, while an attached machine collected the particles they exhaled. The device, called a Gesundheit-II, separated out the fine aerosolized droplets measuring 5 micrometers or less in diameter, which can linger in the air and leak through cloth and surgical masks.

The participants infections were caused by strains including the Alpha variant, which emerged in late 2020, and the later Delta and Omicron variants. All participants with the latter two strains had been fully vaccinated before catching the virus.

The study authors write that their research underscores the importance on better indoor air quality, air filtration, and masking in minimizing viral transmission.

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Green tea, Metformin, and viral superspreaders: COVID-19 research roundup for Friday August 19 - cleveland.com