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Category Archives: Covid-19

Increase in STIs Among Adolescents Witnessed During COVID-19 Pandemic – Drug Topics

Posted: February 7, 2024 at 6:19 am

In the United States, nearly 1 in 4 female adolescents and young adults test positive for sexually transmitted infections (STIs) annually, a statistic made even more troubling by the fact that these young women often avoid health care due to cost, transportation, and confidentiality concerns. With more than 33% of adolescents reporting no primary care provider, this demographic often relies on emergency departments (EDs) and inpatient (IP) settings for their health care needs.

STI test / jarun011 - stock.adobe.com

With the COVID-19 pandemic having decreased healthcare access in the United States, adolescents at risk for sexually transmitted diseases were further compromised. At the time, health experts warned of adverse outcomes on sexual and reproductive health (SRH) for adolescents.

Recently, a study published in Hospital Pediatrics compared changes in STI diagnoses during adolescent visits at childrens hospitals during the COVID-19 pandemic to diagnoses before the pandemic.1 Investigators conducted the retrospective cohort study using the Pediatric Health Information System database comparing adolescent (aged 11 to 18 years) hospital visits with an STI diagnosis by the International Classification of Diseases, 10th revision, during COVID-19 from 2020 to pre-COVID-19 (2017 through 2019).

A total of 2,747,135 adolescent visits from 44 hospitals in the United States were studied, of which 10,941 resulted in an STI diagnosis. The majority (54.5%) of the STI diagnoses were the primary diagnosis: an STI was the primary diagnosis for 36% of IP visits and 66% of ED visits. Where an STI was a secondary diagnosis, the most common primary diagnoses included urinary tract infections, sepsis, acute vaginitis, and unspecified abdominal pain.

READ MORE: COVID-19 Vaccination Effective at Preventing Long COVID in Children, Adolescents

During the summer of 2020, compared to the pre-COVID-19 period, there was an increase (30.4%) in median inpatient weekly visits overall with an STI diagnosis, as well as an increase in visits in fall 2020 (27.3%). Investigators also acknowledged that other recent studies have shown decreased STI testing and increased STI diagnoses in various clinical settings during COVID-19 periods of 2020.

Our findings may be partially driven by changes in health care utilization (eg, loss of primary care access and school-based sexual education) and increased reliance on nontraditional settings for SRH care, including hospital-based care, noted the authors.

Researchers concluded that as a result of this increase in adolescent inpatient visits with an STI diagnosis in 2020, further work is needed to improve STI care, particularly for this demographic. In the study, the authors noted, Given our findings and recent literature on SRH care of adolescents during COVID-19, efforts are needed to optimize SRH care and offset risk for increased STIsto prepare for future pandemics. To optimize STI testing and treatment, innovative efforts are needed, including virtual and in-person outreach, to increase adolescent access to SRH education and care. These efforts are instrumental to reduce the risk for STIs among adolescents cared for in the hospital with the potential to improve related health outcomesin future health care crises.

READ MORE: COVID-19 Resource Center

This article originally appeared in Contemporary OB/GYN.

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VDH: COVID deaths not seeing decline – Vermont Biz

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by Timothy McQuiston, Vermont Business Magazine COVID-19 cases and hospitalizations remained relatively low last week after a long period of edging higher from last summer through early January. Cases and hospitalizations increased slightly for the week. However, fatalities have not seen a related spike nor decline. Deaths reported by the Vermont Department of Health continue to average about 6 a week, for a pandemic total now of 1,112 as of January 20, 2024 (the most recent data available). Total deaths in January are 23 so far and are nearing a monthly level not seen in a full year.

The VDH reported January 31, 2024, that COVID-19 hospitalizations were up 7 last week to a statewide total of 46. COVID-19 activity remains in the "Low" range, according to the VDH. Reported cases last week were 307, up 32 for the week.

Of the total deaths to date, 895 have been of Vermonters 70 or older. There have been 3 deaths of Vermonters under 30 since the beginning of the pandemic.

CDC states that already an estimated 97% of Americans have some level of immunity, from either vaccination or infection or both, which they said will help keep down new transmission and lessen serious outcomes.

New COVID-19 variant JN.1: Experts explain symptoms, how to spot and treat the new strain

(see data tables below)

Report Timeframe: January 21 to January 27, 2024

The hospitalizations dataset contains day-level data reported from all Vermont hospitals each Tuesday. Reported numbers are subject to correction.

The number of reportable COVID-19 cases is still available in this report, below. Laboratory-confirmed and diagnosed COVID-19 cases and COVID-19 outbreaks must still be reported to the Vermont Department of Health.

There were 4 outbreaks last week, 1 at schools, and 3 at long-term care facilities (LTC). There were 9 outbreaks the week before.

Vermont Department of Health recommendations: Preventing COVID-19 (healthvermont.gov)

Vermont has the second lowest fatality rate in the US (128.7 per 100K; Hawaii 102.5/100K). Mississippi (441.1/100K) and Oklahoma (438.7/100K) have the highest rates. The US average is 294.1/100K (CDC data).

There has been a total of 1,174,626 COVID-related deaths to date in the US (CDC) and 7,023,271 globally (WHO).

Following an analysis of COVID-19 data, the VDH reported in January 2023 a cumulative 86 additional COVID-associated deaths that occurred over the course of the pandemic but had not been previously reported. Most of those deaths occurred in 2022.

COVID-19 Update for the United States

Early Indicators

Test Positivity

% Test Positivity

6.3%

(January 21 to January 27, 2024)

Trend in % Test Positivity

-4.6% in most recent week

Emergency Department Visits

% Diagnosed as COVID-19

2.0%

(January 21 to January 27, 2024)

Trend in % Emergency Department Visits

-11% in most recent week

These early indicators represent a portion of national COVID-19 tests and emergency department visits. Wastewater information also provides early indicators of spread.

Severity Indicators

Hospitalizations

Hospital Admissions

22,636

(January 21 to January 27, 2024)

Trend in Hospital Admissions

-10.9% in most recent week

Deaths

% of All Deaths in U.S. Due to COVID-19

3.6%

(January 21 to January 27, 2024)

Trend in % COVID-19 Deaths

No change in most recent week

Total Hospitalizations

6,771,932

CDC | Test Positivity data through: January 27, 2024; Emergency Department Visit data through: January 27, 2024; Hospitalization data through: January 27, 2024; Death data through: January 27, 2024. Posted: February 2, 2024 12:00 PM ET

The Delta variant took off in August 2021, which resulted in the heaviest number of deaths before vaccines and their boosters helped alleviate serious COVID cases. Multiple Omicron variants are now circulating and appear more virulent than previous variants, but perhaps not more dangerous, according to the CDC.

AP April 5, 2023: WHO downgrades COVID pandemic, says it's no longer a global health emergency

Walk-in vaccination clinics run by the state closed on January 31, 2023. Learn more

Vermonters are reminded that all state COVID testing sites were closed as of June 25, 2022. PCR and take-home tests are available through doctors' offices, pharmacies and via mail from the federal government. The federal government officially ended its pandemic response as of May 11, 2023. See more information BELOW or here: https://www.healthvermont.gov/covid-19/testing.

Starting May 11, 2023, the CDC and Vermont Department of Health will no longer use the COVID-19 Community Level to measure COVID-19 activity in the U.S. and Vermont. Instead, Vermont's statewide COVID-19 level will be measured by the rate of COVID-19 in people being admitted to the hospital, per 100,000 residents.

Focusing on hospitalization data is a better estimate of how COVID-19 is impacting the community now that reported COVID-19 cases represent a smaller proportion of actual infections. This also allows us to compare Vermonts hospitalization levels with other parts of the country.

The Delta variant caused a surge in COVID-related fatalities last fall and into the winter.

The highest concentration of deaths was from September 2021 through February 2022. Overall, December 2020 and January 2022 were the worst months with 72 fatalities each.

The US confirmed its first case of COVID-19 on January 20, 2020.

Vermonters ages 6 months and older are eligible for COVID-19 vaccines. Getting vaccinated against COVID-19 is the safer way to build protection from serious illnesseven for those who have already had COVID-19. Learn more about COVID-19 vaccines (CDC)

COVID-19 vaccines are free and widely available. Anyone can get vaccinated in Vermont, including those who live in another state, are non-U.S. citizens, or who have no insurance. See Vermont's current vaccine rates

Know your rights when getting free vaccines.

You are considered up-to-date if you are over the age of 6 years old and have received a bivalent (updated) COVID-19 vaccine.Learn more about kid vaccines

If you are unable or choose not to get a recommended bivalent mRNA vaccine, you will be up to date if you received the Novavax COVID-19 vaccine doses approved for your age group.

Find more on recommended doses from CDC

COVID Vaccine Information for Health Care Professionals

More on COVID-19 Vaccines (CDC)

Recommended COVID Vaccine Doses (CDC)

Find a COVID-19 vaccine near you.

Image

Use Vaccines.gov to find a location near you, then call or visit the location's website to make an appointment.

Vaccines.gov

Everyone 6 months of age and older is eligible to get a COVID-19 vaccination.Most children are also now eligible for a bivalent dose that offers increased protection against the original strain and omicron variants.

See more on recommended vaccine doses by age group (CDC)

Resources for parents and caregivers

Confident Care for Kids

Tips for Helping Kids Feel Ready for Any Vaccine (Vermont Family Network)

#factsheet

What Families with Children Should Know About COVID-19 Vaccines (translated)

https://www.youtube.com/watch?v=lWcqHOgQIVg&t=5s

Conversations About COVID-19 Vaccines for Children with Vermont Pediatricians (American Academy of Pediatrics)

If you cannot get vaccines through any of the options above, our local health offices

offer immunization clinics by appointment.

Need a ride? If you do not have transportation to get a free COVID-19 vaccine or booster, please contact your local public transportation provider or callVermont Public Transportation Association (VPTA)

at 833-387-7200.

English language learners, or immigrant or refugee community members, who would like to learn about more about vaccine clinics can contact theAssociation of Africans Living in Vermont

(AALV) at 802-985-3106.

If you lost your vaccine card or your information is wrong:

Recommendations for keeping your vaccination card and record up to date

Find more COVID-19 translations

COVID-19 resources for people who are deaf and hard of hearing

Report your COVID-19 test results

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US outpatient care for serious mental health issues declined during COVID-19 – University of Minnesota Twin Cities

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A study today in the Annals of Internal Medicine shows that while telemedicine helped some groups seeking mental health care during the COVID-19 pandemic, Americans with serious mental health symptoms suffered from a decline in in-person outpatient mental health visits that has persisted.

Moreover, this lack of outpatient care for those with significant mental illness was seen mostly in patients with lower incomes and education levels.

In a related study, fewer Swedish teens sought care for mental health issues during COVID-19, but their mental health appeared to improve during the pandemic.

"Thanks to a rapid pivot to telemental health care, there was an overall increase during the pandemic of adults receiving outpatient mental health care in the United States," said Mark Olfson, MD, MPH, of Columbia University, first author of the Annals study, in a university press release.

"However, the percentage of adults with serious psychological distress who received outpatient mental health treatment significantly declined."

The study was based on trends seen in participants in the Medical Expenditure Panel Survey Household Component, given from 2018 to 2021 to 86,658 adults. Respondents were asked how frequently in the previous 30 days they had felt so sad that nothing could cheer them up, nervous, restless or fidgety, hopeless, that everything was an effort, or worthless (all, most, some, a little, or none of the time). Responses were scored from 0 to 4, with a score of 13 or higher defining serious psychological distress, the authors said.

During the study period, the rate of serious psychological distress among adults increased from 3.5% to 4.2%, the authors said, likely due to the pandemic and subsequent lockdowns, stress, job loss, and school disruptions.

The rate of outpatient mental health care increased from 11.2% to 12.4% overall from 2018 to 2021. But the rate decreased from 46.5% to 40.4% among adults with serious psychological distress.

Instead, people with higher education degrees, more moderate ranking of mental illness, and younger adults were more likely to use telemental care. Adults over the age of 45 did not see the same increase in telemental care, nor did those seeking care for bipolar disorder or schizophrenia.

By 2021, the authors wrote, approximately one third of adults who received outpatient mental healthcare had received one or more mental health video visits.

"Several groups also had difficulty accessing telemental health care including older individuals and those with lower incomes and less education," observed Olfson. "These patterns underscore critical challenges to extend the reach and access of telemental health services via easy-to-use and affordable service options."

In a new study from Sweden, researchers show that secondary school students who did distance learning in the pandemic were less likely to seek out mental health services than peers who stayed in person, but overall mental health appeared to improve in this age-group.

During the first months of the pandemic, from mid-March to mid-June 2020, Swedish upper secondary school students (ages 17 to 19) were taught remotely.

Care for psychiatric conditions, particularly depression and anxiety, decreased by 4.4% in this group compared to secondary school students aged 14 to 16 who continued to attend school, and the difference remained 21 months into the pandemic.

Contrary to other studies on school closures, the findings from Sweden suggest that distance learning benefited older teens.

"If young people were not accessing healthcare through normal channels, such as school health services, we should be seeing that they are more likely to seek emergency or unplanned care. Instead, we are seeing the opposite," said study author Helena Svaleryd, PhD, of Uppsala University, in a university press release.

The researchers suggest several possible explanations for this mental illness decrease, including reduced stress, more flexible schedules, reduced social pressure, and a reduction in the perceived demands of academic performance.

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COVID-19 Vaccination in a Patient With Gluten Enteropathy: A Case Report – Cureus

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COVID-19 cases drop, but still lots of flu, RSV cases in Erie County – GoErie.com

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Lives versus livelihoods: The COVID-19 trade-off from an epidemiological-economic perspective – CEPR

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Latin America and the Caribbean (LAC) was the region with the highest COVID-19-related death count worldwide (Msemburi et al. 2023), despite implementing stringent public health and social measures (PHSM). At the same time, these policies caused large short-term economic losses by reducing working hours in a sizable fraction of the labour force. In many cases, these short-term costs, mainly in terms of productivity losses and social isolation, were so high that policymakers and individuals were unable to sustain them. This, in turn, triggered a heated and broadly politicised lives vs livelihood debate (Rothwell and Makridis 2020, Levy Yeyati and Malamus 2020), with wildly dissimilar government responses across the region despite the recognition that most economic losses in output (Levy Yeyati and Filippini 2021b) and human capital (de La Maisonneuve et al. 2023) were persistent, affecting lives in the long run. Yet, the question remained unanswered: what would have been the economic impact of tighter/looser PHSM?

To address this question, we built an integrated epidemiological-economic (epi-econ) model to evaluate, in hindsight, the epidemiological, economic, and social trade-offs involved in the PHSM decision, and calibrated it to four LAC countries Argentina, Brazil, Mexico, and Jamaica in the year with the highest death toll in the region, 2021 (Rubenstein et al. 2023). Our model, available at https://iecs.shinyapps.io/covid-model-v2/, is recursive: the outcome from the epidemiological side block impacts the economic outcomes, and vice versa, by incorporating a novel component: lockdown fatigue (Levy Yeyati and Sartorio 2020), that is, the marginal compliance of the PHSM decreases with the stringency/length of the measures, and the drop of the death count (reflecting psychosocial and economic factors).

In line with the DAEDALUS model (Haw et al. 2022), if the policymaker has an economy-focused approach, PHSM will ease and the mortality rate will likely increase. On the other hand, if the priority is to curb the case curve (a safety-focused approach), the economy will have to endure a highly stringent and lengthy lockdown and a likely sizable decline in GDP. However, the lockdown fatigue limits the capacity of the policymaker to discourage mobility over time, constraining the effectiveness of prolonged PHSM policies.

On the epidemiological side, our model provides a framework in which population dynamics are described in mathematical terms, capturing the number of people in separate compartments and the relationships between those compartments. We use an SVEIR transmission model (Augustovski et al. 2023), augmented with a macroeconomic and social impact model of the PHSM, adjusted for the different vaccination strategies in each country.

Figure 1 The SVEIR transmission model

To improve the transmission dynamics, we incorporate specific age-strata mixing patterns matrices to represent the social interactions and effective contact rates at each of these four settings: home, school, work (including transportation), and community. Modified matrices are derived from a model representing the impact of PHSMs on each stratum (school closures, non-essential business and public transport restrictions, staying at home, shielding the elderly, mandatory masks, etc.)

On the economic side, the model quantifies the GDP loss associated with mobility restrictions, incorporating the interaction of the lockdown measures with the behaviour of the population (lockdown fatigue, estimated as the time-varying degree of compliance with mobility measures).

The main link between the PHSM and the economic impact works through the reduction in working hours. The stringency of the mobility restrictions precludes workers to get to the workplaces, effectively reducing the workings hours and producing an economic loss. We assumed that, prior to the PHSM, workers put an optimal amount of hours into work; with PHSM in place, a share of workers is unable to go to their workplaces, reducing economic output (although we account for the fact that some work can be done remotely) and workplace mobility (in turn, viral spread).

In order to quantify the GDP loss, we need a detailed structure of the economic activity of the country, as more labour-intensive economies will be more exposed to mobility restrictions, and more informality in labour intensive sectors will amplify the GDP loss and the need for fiscal support to attenuate the impact of PHSM on the GDP loss. To map the impact of reduced mobility on GDP, we use sectoral value added and labour shares. Moreover, we calibrated incorporated differences in transitioning into remote working across sectors of the economy and countries.

Lockdown fatigue reflects both the increasing psychosocial burden of isolation, including living conditions, and a growing income need, particular taxing for low-income households and informal workers, leading to a decreasing effectiveness of PHSM policies (Levy Yeyati et al. 2021). We estimate a relationship between mobility restrictions and working hours (compliance) that decreases with the cumulative effective length (length adjusted by intensity) of the PHSM, and increases with recent COVID-related deaths (the fear factor). The results in a non-linear relationship that captures the gap between de-jure and de-facto intensity of mobility restrictions (Figure 2).

Figure 2 Lockdown fatigue: Mobility restriction and de facto reduction

To calibrate the model, we map the sequence of PHSM measures actually implemented at the country level in 2021. This sequence yields both a path for cumulative deaths over the year, and an estimation of the GDP loss. In general, governments imposed stringent measures earlier in 2021 and were able to ease them as the vaccination rates accelerated. These results determine benchmark deaths and GDP losses that are later compared to alternative simulated scenarios.

Figure 3 summarises how the two sides of the model interact. For each decision period, the economic model takes the epidemiological output (number of deaths in the previous seven days) as an input, whereas the epidemiological model takes the economic output (working hours) as an input.

Figure 3 Epi-econ integration

Our primary counterfactual scenario is that governments implement less stringent PHSM measures leading to increased deaths but a more modest GDP loss. Based on these alternative outcomes, we quantify the lives-livelihood trade-off as a sacrifice ratio: changes in GDP losses and COVID-related deaths when PHSM become less stringent. Naturally, we are not interested in comparing GDP with deaths, but rather in illustrating the short-run trade-offs, its determinants (comparing slopes) and the policy choices in each case (Figure 4). In particular, the slopes highlight disparities among countries. A steeper slope indicates that reducing GDP loss by 1% would result in a more substantial increase in the daily deaths a difference that emanates from a complex interplay of economic structures, health systems, and previous COVID-19 waves. More generally, the steeper the slope of the trade-off lines, the more challenging the epidemiological-economic trade-offs.

Figure 4Lives versus livelihoods

The model also looks into the interaction of PHSM and social indicators. In particular, it illustrates the widening poverty gap as the stringency of PHSM policies soften in the counterfactual scenario, converging as restrictions eased toward the end of 2021 (Figure 5).

Figure 5 Poverty rates

While the difference in the impact between high and low-income workers is not significant (Figure 5), the results suggest a lower exposure among higher-income workers, typically in low contact-intensive occupations or with a greater ability to transition to remote working.

Figure 6 Income gap

Finally, regarding gender disparities, the results somewhat challenge conventional expectations. We find no statistically significant difference between the income loss for both men and women, particularly during the initial stricter PHSM periods although the simulations do not take into account the incidence of the increased burden of home work within the household.

Figure 7 Gender gap

In navigating the fraught complexities of pandemic response, policymakers face the daunting task of strategic decision-making (Ferranna et al. 2021), particularly in emerging economies where economic losses are expected to be more persistent. Our model, publicly available and customizable, is a powerful tool for policymakers to assess trade-offs in the context of their unique socio-economic landscapes. In particular, the presence of a steep short-term trade-off between health and economics losses emphasises the relevance of targeted pharmaceutical policies, notably increased vaccination coverage.

The model is not intended to pin down an optimal PHSM schedule, a balancing act (Baldwin 2020) that ultimately depends on policy weights that are bound to differ even between policy makers in the same country. Rather, it offers a first insight on the dynamic relationship between PHSM, public behaviour and outcomes in a policy tool that simulates the costs of alternative PHSM programmes and updates them as data becomes available, a first step for better preparedness in the future.

Augustovski F, A Bardach, A Santoro, F Rodriguez-Cairoli, A Lpez-Osornio, F Argento, M Havela, A Blumenfeld, J Ballivian, G Solioz and A Capula (2023), Cost-effectiveness of COVID-19 vaccination in Latin America and the Caribbean: an analysis in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru, Cost Effective Resource Allocation 21(1): 21.

Baldwin, R (2020), COVID, remobilisation and the stringency possibility corridor: Creating wealth while protecting health, VoxEU.org, April 10.

de la Maisonneuve, C, B gert and D Turner (2023), Quantifying the macroeconomic impact of COVID-19-related school closures on human capital, VoxEU.org, January 24.

Ferrana, M, J P Sevilla and D Bloom (2021), Alternative value frameworks for assessing Covid-19 pandemic policies, VoxEU.org, 2 August.

Haw D, P Christen, G Forchini, S Bajaj and K Hauck (2020), DAEDALUS: An Economic-Epidemiological Model to Optimize Economic Activity While Containing the SARS-CoV-2 Pandemic, Imperial College London.

Levy Yeyati, E and F Filippini (2021a), Pandemic divergence: The social and economic costs of Covid-19, VoxEU.org, May 12.

Levy Yeyati, E and F Filippini (2021b), Social and Economic Impact of COVID-19, The Independent Panel for Pandemic Preparedness and Response, Background paper 13.

Levy Yeyati, E and A Malamud (2020). How to Think About the Lockdown Decision in Latin America, Americas Quarterly,2 April.

Levy Yeyati, E and L Sartorio (2020). Take me out: De facto limits on strict lockdowns in developing countries, Covid Economics 39(2).

Levy Yeyati, E, L Sartorio and P Goldstein (2021), Lockdown fatigue: The declining effectiveness of lockdowns, VoxEU.org, 30 March.

Msemburi W, A Karlinsky, V Knutson, S Aleshin-Guendel, S Chatterji and J Wakefield (2023), The WHO estimates of excess mortality associated with the COVID-19 pandemic, Nature 613(7942): 130-137.

Rothwell, J and C Makridis (2020), The real cost of political polarisation: Evidence from the COVID-19 pandemic, VoxEU.org, 10 July.

Rubinstein, A, F Filippini, A Santoro, E Levy Yeyati, A L Lpez Osornio, A L Bardach, C Cejas, S Bauhoff, F Augustovski, A L PichonRiviere (2023), Lives Versus Livelihoods: The Epidemiological, Social, And Economic Impact Of COVID-19 In Latin America and The Caribbean, Health Affairs 42(12).

Santoro A, A L Osornio, I Williams, M Wachs, C Cejas, M Havela, A Bardach, A Lpez, F Augustovski, A Pichn Riviere and A Rubinstein (2022), Development and application of a dynamic transmission model of health systems preparedness and response to COVID-19 in twenty-six Latin American and Caribbean countries, PLOS Global Public Health 2(3).

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Weatherhead’s Jonathan Ernest notes economic changes of childcare facilities following COVID-19 pandemic – The Daily | Case Western Reserve University

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For childcare facilities, keeping doors open is a juggling act

Crains Cleveland Business:Jonathan Ernest, assistant professor at Weatherhead School of Management, noted thattheeconomics of childcare have changed sincetheCOVID-19 pandemic began. Its not that profitable to be working in or havingachildcare facility right now, he said.

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U.S. adults face distress, unequal mental health care access during the COVID-19 era – News-Medical.Net

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U.S. adults experiencedconsiderablepsychological distress andadverse mental health effectsas a resultof the COVID-19 pandemic according to a study at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center. Based on insurance claims, mental health care provider surveys, and electronic health records the research further revealed a decline in in-person outpatient mental health visitsduring the acute phase of the pandemic. Findings are reported in theAnnals of Internal Medicine.

The trends and patterns we observed in the United States align with reports globally concluding that several mental health problems, including depression, and generalized anxiety disorder, have become more prevalent during than before the pandemic."

Mark Olfson, MD, MPH, Professor of Epidemiology at Columbia Mailman School of Public Health, and Dollard Professor of Psychiatry, Medicine & Law atColumbia University Irving Medical Center

To characterize the psychological distress experienced, determine the level of outpatient mental health care, and describe patterns of in-person versus telemental health care, the researchers studied the responses of adults from the Medical Expenditure Panel Surveys by the Agency for Healthcare Research and Quality Component, a nationally representative survey of over 85,000 people. Psychological distress was measured with a 6-point scale range and outpatient mental health care use was determined via computer-assisted personal interviews.

The rate of serious psychological distress among adults increased from 3.5 percent to 4.2 percent from 2018 to 2021. While outpatient mental health care increased overall as well -- from 11.2 percent to 12.4 percent, the rate among adults with serious psychological distress decreased from 46.5 percent to 40.4 percent. Young adults (aged 18 to 44 years significantly increased outpatient mental health care but this pattern was not observed for the middle-aged (aged 45 to 64 years) and older adults (aged >65 years).Similarly, more employed adults reported outpatient mental health treatment care compared to the unemployed.

In 2021, 33 percent of mental health outpatients received at least one video visit. Thelikelihood of receiving in-person, telephone, or video mental health care varied across sociodemographic groups; percentages of video care were higher for younger adults than for middle-aged or older adults, women compared with men, college graduates compared with adults with less education, the seriously distressed,lower-income, unemployed, and rural patients.

"Thanks to a rapid pivot to telemental health care, there was an overall increase during the pandemic of adults receiving outpatient mental health care in the United States.However, the percentage of adults with serious psychological distress who received outpatient mental health treatment significantly declined.Several groups also had difficulty accessing telemental health care including older individuals and those with lower incomes and less education," observed Olfson. "These patterns underscore critical challenges to extend the reach and access of telemental health services via easy-to-use and affordable service options."

"Increasing our understanding of the patterns we observed in terms of access to outpatient mental health care including in-person, telephone-administered, and internet-administered outpatient mental health services could inform ongoing public policy discussions and clinical interventions," noted Olfson. "Identifying low-cost means of connecting lower-income patients to telemental health should be a priority, as well as increasing public investment to make access to high-speed broadband universal."

"The national profile of adults who receive outpatient mental health care via telemental health the younger adult, the employed, higher-income, and privately insured adults, raises concerns about disparities in access to virtual mental health care," said Olfson."Unless progress is made in reducing these barriers, primary care clinicians will continue to encounter challenges in connecting their older, unemployed, and lower income patients to video-delivered outpatient mental health care."

Co-authors areChandler McClellan and Samuel H. Zuvekas, Agency for Healthcare Research andQuality; Melanie Wall, Columbia Mailman School of Public Health; and Carlos Blanco, National Institute on Drug Abuse.

Source:

Journal reference:

Olfson, M., et al. (2024). Trends in Psychological Distress and Outpatient Mental Health Care of Adults During the COVID-19 Era.Annals of Internal Medicine. doi.org/10.7326/m23-2824.

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U.S. adults face distress, unequal mental health care access during the COVID-19 era - News-Medical.Net

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Simnotrelvir to reduces the symptoms of mild to moderate COVID-19 – 2 Minute Medicine

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1. In this randomized controlled trial, patients experiencing symptomatic coronavirus disease 2019 (COVID-19) saw significant improvement in symptom resolution times compared to the placebo group.

2. Further investigation is needed to specifically delineate the impact of simnotrelvir on older COVID-19 patients.

Evidence Rating Level: 1 (Excellent)

Study Rundown: COVID-19 has been a major public health concern since the initial pandemic occurrence in 2020. Though vaccinations are beneficial, they have not been completely effective at preventing the more recent strains of COVID-19. The new variants have strong immune evasion, thus warranting the search for a new drug affecting these variants. Simnotrelvir (SIM0417), an oral small-molecule antiviral agent targeting the SARS-CoV-2 3CLpro, has been proposed as a treatment. When used against the omicron variant of SARS-CoV-2 in vitro, simnotrelvir showed antiviral activity with acceptable side effects. In this double-blind randomized control trial, patients with mild-to-moderate COVID-19 had shorter-lasting symptoms after receiving simnotrelvir plus ritonavir. In the study, those experiencing respiratory symptoms showed more benefits from Simnotrelvir when compared to the placebo. Those in the treatment group had a decrease in their viral load until day nine when compared to those in the placebo group. The placebo group could have experienced unblinding due to the unique taste of the placebo drug, as it only contained excipients. This study only included younger individuals, so the safety and efficacy of this drug on the elderly remains unclear. Overall, early intervention with simnotrelvir plus ritonavir safely showed reduced length of symptoms in patients with COVID-19.

Click here to read the study in NEJM

In-Depth [randomized controlled trial]: A randomized controlled trial in China examined the effects of simnotrelvir on COVID-19 patients. The eligibility criteria included being 18 or older, having signs or symptoms of COVID-19 within three days before the first dose, having at least one symptom before the first dose, and having a mild or moderate severity of the illness. To determine the severity levels, the Food and Drug Administration provided definitions to help classify the participants in the study. The study provided exclusion criteria, including serious kidney, liver, or heart disease, along with the use or expected use of medications that interfere with cytochrome P-450 3A4. The symptoms of COVID-19 most commonly found in participants were dry throat (76.2%), cough (73.4%), and stuffy or runny nose (55.9%). The simnotrelvir group had a significantly shorter time for symptom resolution (180.1 hours; 95% Confidence Interval [CI], 162.1 to 201.6) than the placebo group did (216.0 hours; 95% CI, 203.4 to 228.1). The fever and systemic symptoms resolution times were similar in both groups. However, the simnotrelvir group experienced significantly faster resolution of respiratory symptoms (-41.4 hours; 95% CI, -70.7 to -13.3). From the time of receiving the first dose until day 29, there was a lower incidence of adverse events in the placebo group than in the simnotrelvir group (21.6% vs. 29.0%). The placebo group experienced two serious adverse events, whereas the simnotrelvir group did not experience any. In summary, this studys results suggest that simnotrelvir plus ritonavir is an effective and safe treatment for COVID-19, resulting in earlier respiratory symptom resolution.

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Simnotrelvir to reduces the symptoms of mild to moderate COVID-19 - 2 Minute Medicine

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Vaccine Effectiveness: Which COVID-19 Shots Offer the Most Protection? – SciTechDaily

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A team of University of Michigan researchers analyzed over 80 studies to assess the effectiveness of COVID-19 vaccine doses beyond the primary series. Their findings, based on 150 million patient observations, support the efficacy of both monovalent and bivalent boosters in preventing severe outcomes and underline the importance of annual vaccine updates.

New research highlighted the significant benefits of monovalent and bivalent COVID-19 boosters in preventing hospitalization and death, advocating for the periodic update of vaccines to match circulating virus variants.

First boosters, second boosters, monovalent, bivalent. Just like the SARS-CoV-2 virus strain, the vaccines to combat the virus are always changingand perhaps confusing.

With the goal of better understanding the variety of vaccines, their effectiveness and taking a look at the methods used globally to study vaccines effectiveness, a group of University of Michigan researchers, led by Sabir Meah and Bhramar Mukherjee, evaluated some 80 studies and 150 million observations from patient datasets across the world to understand the various designs and methods that were used to study effectiveness of COVID-19 vaccine doses following the primary series vaccination.

They then applied all the methods used in those studies to patient data from Michigan Medicine.

Meah is a School of Public Health alumnus with a masters degree in Biostatistics and currently a biostatistician in Urology at Michigan Medicine. Mukherjee is the John D. Kalbfleish Distinguished University Professor of Biostatistics, the Sioban Harlow Collegiate Professor of Public Health, and assistant vice president for research in the Office of the Vice President for Research.

What we have been able to create is a repository of methods that can be applied for future annual vaccines, Mukherjee said. It is important to have robust and reproducible results and reliable estimates of vaccine effectiveness to solidify public trust and fight misinformation.

Their full study is available in Science Advances. Meah explains more.

From the patient data you reviewed, could you explain your findings around bivalent and monovalent boosters?

In our study, we evaluated three different vaccination regimens: 1) the monovalent booster targeting the original strain, 2) the second monovalent booster also with the original formulation, and 3) the new bivalent vaccine updated in fall 2022 to target newer Omicron variants. We saw that all sequential doses provided a substantial benefit in terms of preventing hospitalization and death, and the estimates from the fall 2022 Omicron-specific vaccine dose were stronger from worldwide studies we looked at.

These findings support the practice of periodically updating the COVID-19 vaccines for currently circulating variants. Fortunately, it appears that in the U.S. and many other countries, such as those in the European Union, we will be getting updated COVID-19 vaccines on an annual frequency. The fall 2022 vaccine has already been succeeded by a new updated vaccine in fall 2023, which you can still get now in early 2024, if you havent already, targeting the even newer XBB1.5 Omicron variant.

We expect that our conclusions on the utility of updating vaccines should generalize to any updated COVID-19 vaccine, not just the fall 2022 bivalent vaccine, but additional monitoring and study of the real-world effectiveness of an annual vaccine is still necessary, and we hope that the findings of our research can aid these studies. What we have been able to do is to establish an analytic pipeline where researchers can study the vaccine effectiveness of future annual vaccine formulations.

Could you describe what biostatistics brings to the table on this topic?

Biostatistics and epidemiology provide a toolbox for the complex process of evaluating vaccine effectiveness in scientific observational studies. However, there are quite a number of different approachesboth in study design and methods that researchers have employed in vaccine effectiveness studies conducted all over the world, which is what motivated us to conduct our review of their methodology and results and subsequent case study of these methods using Michigan Medicine data.

Quite fortunately, a key finding of our study was that vaccine effectiveness estimates remain relatively stable and do not depend heavily on choice of methods for the outcomes of hospitalization and mortality. We did not observe this advantageous property for infection outcomes, but hospitalization and death are arguably much more important points of study as we advance further into the endemic stage of the pandemic.

Given what your research says about the power of COVID-19 boosters to prevent severe illness and hospitalization, what would you like this study to convey to the public?

COVID-19 vaccines examined in our study, including the fall 2022 bivalent vaccine, provided strong protection against hospitalization and death. We expect this pattern to continue with additional annual vaccines approved by the FDA, but continued study of future vaccines is warranted, and our findings provide some important points of consideration for these future studies.

Reference: Design and analysis heterogeneity in observational studies of COVID-19 booster effectiveness: A review and case study by Sabir Meah, Xu Shi, Lars G. Fritsche, Maxwell Salvatore, Abram Wagner, Emily T. Martin and Bhramar Mukherjee, 20 December 2023, Science Advances. DOI: 10.1126/sciadv.adj3747

Co-authors: Xu Shi, Lars Fritsche, Maxwell Salvatore, Abram Wagner, Emily Martin, all of U-M. Their cross-discipline collaboration is part of the School of Public Healths IDEAS, Interdisciplinary Discovery, Engagement + Actions for Society initiative.

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