Infecting the mind: Burnout in health care workers during COVID-19

May 13, 2020

Science Daily/Texas A&M University

Doctors and nurses across the country are experiencing occupational burnout and fatigue from the increased stress caused by the COVID-19 pandemic. A team of researchers and medical professionals at Texas A&M University and Houston Methodist Hospital are working together to fight two afflictions: COVID-19 and the mental strain experienced by medical professionals.

In an article recently published in the journal Anesthesia & Analgesia, Dr. Farzan Sasangohar, assistant professor in the Department of Industrial and Systems Engineering and colleagues at Houston Methodist Hospital, outline the effects of fatigue and burnout on intensive care unit (ICU) workers, and the steps that can be taken to mitigate these symptoms.

"The COVID-19 pandemic exacerbated an already existing problem within our health care systems and is exposing the pernicious implications of provider burnout," Sasangohar said.

Health care workers are experiencing added stress from multiple areas. Many of them are working longer shifts and experiencing more loss of life. The lack of personal protective equipment (PPE) and training on how to use new equipment causes many professionals to question if they have been exposed. This leads to fear that they could infect their family and loved ones. In addition to those fears, there is anxiety surrounding job security. To reduce the spread of infection, many states have stopped elective procedures and consequently, many health care professionals have been laid off or had their hours reduced.

Sasangohar and the research team documented four major areas of stress with the goal of identifying mitigation strategies to reduce burnout among these life-saving workers. The four areas identified by the researchers include occupational hazards, national versus locally scaled responses, process inefficiencies and financial instability.

The symptoms

Health care workers need effective PPE readily accessible and available to ensure their safety and that of their patients. Getting the necessary equipment has been challenging due to the low numbers of PPE and ventilators in the U.S. Strategic National Stockpile and delays getting equipment into local areas. This slow response, which has caused some providers to reuse PPE past the point of safety and warranty protections, can contribute to anxiety in providers.

"Minimizing occupational hazard is the most important criteria to assure that our health care workforce is fully equipped and assured to be safe in order to face the battle against this virus," said Dr. Bita Kash, professor of health policy and management in the Texas A&M School of Public Health and director of the Joint Center for Outcomes Research at Houston Methodist Hospital.

The process to secure assistance from federal authorities has been cumbersome and slow for providers. Many requests for additional ventilators and PPE are not being met. These uncertainties about when assistance will arrive has resulted in widespread anxiety among providers.

Process inefficiencies have also contributed to fatigue and burnout due to misinformation or conflicting information given between different specialties. While one subspecialty's professional organization recommends a certain guideline, another specialty could recommend something else, which leads to confusion.

Anxiety and worry about future career prospects and the overall economy can also lead to provider burnout. Elective surgeries have been canceled or delayed, causing financial stress on some physicians. Others not directly affected by financial hardship may be worried about loved ones or their own family and how they will weather a coming economic recession.

Prescription for the future

While this is the first world-wide pandemic in many years, there will be more. Working together, local researchers, health care professionals and government officials can prepare for future pandemics and subsequent waves of the COVID-19 pandemic. Houston Methodist Hospital has already begun learning from this pandemic and making changes to be more resilient in response to the current crisis and prepared for similar crises in the future.

In response to the pandemic, Houston Methodist Hospital adapted their policies and focused on constant and responsive communication from leadership to their employees. Proactive and positive responses have allowed the hospital to adapt quickly during the pandemic and reduce employee stress overall. This success has led to recommendations for future preparations.

The researchers' recommendations to reduce provider burnout and fatigue:

• Pandemic plans should include guidance for relevant industries to quickly transition into producing needed medical supplies

• National and regional disaster mitigation plans to help shorten the time needed to provide necessary equipment and testing

• Provision of adequate numbers of test kits and PPE

• Training on disaster management and response for medical professionals

• Relaxing licensing restrictions for individuals licensed outside their state of residence

• Creating a medical reserve corps of these licensed individuals

• Using wearable sensors to monitor health care workers' mental health and provide simple ways to mitigate anxiety and stress

"There is much to learn from the response to COVID-19," said Sasangohar. "In our approach, we used a multi-disciplinary systems approach to learn not just from failures and shortcomings, but also from successful adaptations and improvised interventions at the individual, team and system levels to improve our resilience."

While ICU workers in Houston have weathered many storms, including Hurricanes Ike and Harvey, the COVID-19 pandemic has brought new challenges to already challenging work. The areas identified by the researchers can help make this work safer, more effective and reduce burnout in these critical roles.

https://www.sciencedaily.com/releases/2020/05/200513143749.htm

Stroke doctors establish best practices to protect against COVID-19

Patients should continue to seek early treatment for a suspected stroke, they advise

May 7, 2020

Science Daily/University of California - Los Angeles Health Sciences

To keep patients and health-care providers safe from COVID-19, while providing urgent treatment to stroke patients, extra precautions must be taken, according to new guidelines published in the journal Stroke.

The guidelines were established by the Society of Vascular & Interventional Neurology (SVIN).

UCLA professor of neurology Dr. David Liebeskind, who is president of SVIN and director of the UCLA Stroke Center, expressed concern that fear of COVID-19 may make patients hesitate to seek treatment in the event of a possible stroke.

"People are passing away or having severe strokes out of the hospital," he said. "There are a lot of people who are not coming in."

Delaying treatment by just 15 minutes can make a world of difference in terms of the patient's recovery. Yet stroke centers around the country report that they are treating fewer patients than usual. To minimize the possibility of transmitting infections among patients in the hospital, the SVIN team developed guidelines based on review of the published research, consensus among practicing neurologists and shared best practices.

"Some of these things are intuitive or straightforward in terms of minimizing exposure and maximizing the use of personal protective equipment," said Dr. Liebeskind. Because stroke patients may be unable to communicate and describe their history or symptoms, he said, every patient should be initially considered to be positive for COVID-19.

According to the guidelines, a definitive diagnosis of COVID-19 should be made as soon as possible, as patients who test negative can decrease the use of protective equipment. Patients who test positive should be placed in isolation in a negative pressure room, when available.

Any tests that do not change the treatment strategy should be delayed or deferred until COVID-19 status is established, the guidelines recommend.

The doctors say that telemedicine can play a monumental role in minimizing the number of people who come in direct exposure to the patient. For an acute stroke or thrombectomy code, one person in protective equipment can be with the patient, while another coordinates care via computer or phone.

Remote tele-stroke technology can also be used to obtain history, perform neurological exams and monitor the patient after the stroke has been treated.

"Telemedicine in neurology has evolved over the last 10 years to meet the needs of a consultation," said Dr. Liebeskind. "In stroke, imaging becomes incredibly important, and that becomes integrated as well. We can do the examination very easily via telemedicine, using a video link at the patient bedside. And, through that same link we can access the imaging information as well. At UCLA, we also have dedicated robots that can travel through the hospital that can do all of this."

A head CT or computerized tomography scan is typically the first test performed in the event of a stroke. A chest CT can be performed at the same time, to check the lungs for COVID-19, if this does not unduly delay stroke treatment. Angiography is another imaging technique that allows doctors to look at the blood vessels.

"The use of specific imaging approaches in planning endovascular therapy, and the decision-making regarding the use of intubation and general anesthesia, is always a case specific medical decision in any clinical environment," Dr. Liebeskind said.

Where possible, conscious sedation can be an alternative to general anesthesia and intubation. This could protect patients from unnecessary intubation and conserves mechanical ventilators, he said.

Finally, after thrombectomy or surgery to remove the blood clot, doctors should consider relocating patients back to primary stroke centers to recover, especially for hospitals overwhelmed with critical care or intensive care unit bed shortages. This can help maintain thrombectomy access, Dr. Liebeskind said.

"Our ability to deliver comprehensive stroke care, including endovascular therapy for acute ischemic stroke, remains an intact valuable resource for patients everywhere," he added.

https://www.sciencedaily.com/releases/2020/05/200507145351.htm

Researchers offer ways to address life under COVID-19

New analysis outlines evidence-based approaches to combat bias and fake news, increase cooperation, and cope with stress and isolation

April 30, 2020

Science Daily/New York University

An international team of researchers has outlined ways to manage different facets of life under the spread of the COVID-19 virus, ranging from how we can combat racially driven bias and fake news to how we can increase cooperation and better manage stress.

Its work, which appears in the journal Nature Human Behaviour, considers research stretching over the past half century to offer insights about how to address current circumstances.

"The COVID-19 pandemic represents a massive, global health crisis," observes Jay Van Bavel, an associate professor in New York University's Department of Psychology, who led the project with Stanford's Robb Willer. "Because the crisis requires large-scale behavior change and poses significant psychological burdens on individuals, insights from the social and behavioral sciences are likely going to be very helpful for optimizing pandemic response."

"This interdisciplinary review points to several ways in which research can be immediately applied to optimize response to this pandemic, but also points to several important gaps that researchers should move quickly to fill in the coming weeks and months," adds Willer, a sociologist.

The analysis, drawn from the expertise of over 40 researchers at more than 20 colleges and universities, focuses on phenomena linked to COVID-19, connecting existing scholarship to potential courses of action in several areas, including the following: "Group Threat," "Fake News and Misinformation," "Social Norms," and "Stress and Coping."

Group Threat

The authors, referring to recent attacks on ethnic Asians in predominantly white countries, note that "Europe's most deadly disease, the bubonic plague of the 14th century, unleashed massive violence, including the murder of Catalans in Sicily, clerics and beggars in some locations, and pogroms against Jews, with over a thousand communities eradicated."

However, they point to research that indicates pandemics may, in fact, present opportunities to reduce religious and ethnic prejudice: "coordinated efforts across individuals, communities, and governments to fight the spread of disease send strong signals of cooperation and shared values, which allow people to re-cast others who were previously considered out-group members as in-group members."

The authors recount cooperative acts currently unfolding: More than 20 countries donated medical supplies to China in February, and China has reciprocated. "Government officials can highlight events like these to improve out-group attitudes," they write, adding that other studies have shown that making people feel safer can reduce prejudice.

Fake News and Misinformation

Fake news and conspiracy theories about COVID-19 have undoubtedly proliferated on social media, but new research has explored social-science based solutions to counter the spread of fake news. Fact-checking and correction offer potential remedies, as does source expertise, bipartisanship in messaging, and messages from "unlikely sources" -- those who benefit from the original misinformation.

But the researchers acknowledge that fact-checking and corrections may not keep up with the vast amount of false information produced in moments of crisis like a pandemic and that approaches beyond debunking are necessary.

In response, they offer what scholars term a "pre-bunking approach," which centers on psychological inoculation. Studies have found that preemptively exposing people to small doses of misinformation techniques (including scenarios about COVID-19) can reduce susceptibility to fake news. Another preventative approach involves subtle prompts that emphasize accuracy (for instance, asking users to judge the veracity of a single neutral headline). Such prompts have been found in prior work to improve the quality of the content users share and could be easily implemented by social media platforms.

"To effectively counter fake news about COVID-19 around the world, governments and social media companies must rigorously develop and test interventions in collaboration with independent behavioral scientists," the authors advocate. "This includes identifying treatments that effectively reduce belief in misinformation, while not undermining belief in accurate information -- a particularly salient concern given evidence that most exposure to and sharing of fake news in the U.S. has been concentrated among relatively small sub-sections of the population."

Social Norms

"How much people change will be influenced by aspects of the social and cultural context," the researchers write. "The fact that people tend to follow social norms and cultural mores can sometimes have undesirable consequences. For example, continuous exposure to news examples of people going out might explain why it was difficult to convince Italians to stay at home after the COVID-19 lockdown of March 11." But they also report that "understanding these features of the social environment, such as social norms, social inequality, culture, and polarization, can help identify risk factors and successful messages and interventions."

Prior studies have found that our decisions are influenced by social norms -- what we perceive others are doing or approve/disapprove of -- and that "informational influence" occurs when people use others' behavior as input for reasonable interpretations and responses. Notably, this effect is stronger when people are uncertain and outcomes are important -- as in during a pandemic.

However, the authors caution that although we are influenced by perceptions of norms, research has shown that our estimates of behavior are frequently inaccurate. For example, people can underestimate the frequency others engage in health-promoting behaviors (e.g., hand washing) and overestimate their unhealthy ones (e.g., not properly covering one's mouth when coughing). In order to most effectively change behaviors by correcting misperceptions, the authors point to the importance of public messages that reinforce health-promoting norms (e.g., social distancing and hand-washing) and not highlighting extreme or uncommon behaviors, such as panic buying or young adults gathering.

Stress and Coping

Public health experts have said that one of the most vital strategies for slowing the spread of COVID-19 is "social distancing" -- a practice that, while beneficial, "clashes with the deep-seated human instinct to connect with others, especially during emotional times," the authors observe. Studies have shown social connection "helps people regulate affect, cope with stress, and remain resilient during difficult times" while other scholarship has revealed that "loneliness and social isolation worsen the burden of stress, and produce deleterious effects on mental, cardiovascular, and immune health."

However, the researchers list ways we can diminish the ill effects of isolation.

One, they advocate replacing the term "social distancing" -- when possible -- with "physical distancing." This change, they say, would "highlight the fact that deep social connection with a broader community is possible even when people are physically apart through the use of technology."

Two, they cite the value of online forums, which have long served as hubs for mutual support -- in particular, among individuals with rare illnesses -- and psychological well-being. Other technologies, such as FaceTime and Zoom, have been found to be valuable in generating empathy and connection.

Van Bavel and Willer recognize potential barriers to these tools for seniors.

"Special attention should be placed on helping older adults -- who might be less familiar with these technologies -- to learn and acclimate to the potential richness of digital connections. COVID-19 will leave many of us confused, anxious, and lonely," they write.

Conclusion

"Urgent action is needed to mitigate the potential devastation of COVID-19, and drawing from existing knowledge can help ensure we are taking constructive steps," Van Bavel says. "In addition, the lessons from past studies should be relevant to future pandemics and other public health crises. Whether policy makers are trying to increase vaccination rates or reduce the harm of climate change, they will be fundamentally facing many of the same issues in the future."

"By applying the knowledge gained from earlier research, we hope that public health experts will be better equipped to communicate effectively and drive behavior change in a manner that yields global benefits," adds Willer.

https://www.sciencedaily.com/releases/2020/04/200430113048.htm

COVID-19: The downside of social distancing

April 24, 2020

Science Daily/Ludwig-Maximilians-Universität München

When faced with danger, humans draw closer together. Social distancing thwarts this impulse. Professor Ophelia Deroy from Ludwigs-Maximilians Universitaet in Munich (LMU) and colleagues argue that this dilemma poses a greater threat to society than overtly antisocial behavior.

The corona crisis presents countries around the globe with what is perhaps the greatest challenge most have faced since the Second World War. For one thing, the virus constitutes a truly global threat. In the absence of a vaccine, our primary defense against it consists in what is now termed 'social distancing' -- minimizing our contacts with others in public spaces. In an essay that appears in the leading journal Current Biology, an interdisciplinary team of authors that includes Professor Ophelia Deroy, who holds a Chair in the Philosophy of Mind at LMU and is affiliated with the Munich Neuroscience Center, underline the dilemma posed by measures designed to promote social distancing. "Hazardous conditions make us more -- not less -- social," Deroy says. "Coping with this contradiction is the biggest challenge we now face."

Seen from this point of view, our current problem lies not in egoistic reactions to the crisis or a refusal to recognize the risks, as images of banks of empty shelves in supermarkets or throngs of strollers in our public parks would have us believe. Deroy and her co-authors Chris Frith (a well-known social neurobiologist based at University College London) and Guillaume Dezecache (a social psychologist at the Université Clermont Auvergne) argue that such scenes are not representative. They emphasize that people instinctively tend to huddle together when faced with an acute danger -- in other words, they actively seek closer social contacts. Studies in the fields of neuroscience, psychology and evolutionary biology have already shown that we are not as egoist as some disciplines think. They continue to produce evidence which demonstrates that threatening situations make us even more cooperative and more likely to be socially supportive than we usually are.

"When people are afraid, they seek safety in numbers. But in the present situation, this impulse increases the risk of infection for all of us. This is the basic evolutionary conundrum that we describe," says Dezecache. The demands now being made by governments to self-isolate and follow social distancing guidelines are fundamentally at odd with our social instincts, and therefore represent a serious challenge for most people. "After all," says Deroy, "social contacts are not an 'extra', which we are at liberty to refuse. They are part of what we call normal." The essay's authors therefore contend that, because social distancing stands in opposition to our natural reaction to impending hazards, our social inclinations -- rather than antisocial reactions to rationally recognized threats -- now risk exacerbating the danger.

How then might we escape from this dilemma? According to Deroy, we need to revise what the Internet can offer. The argument goes as follows. In the pre-pandemic world, the Internet and social media were often looked upon as being decidedly unsocial. But in times like the present, they provide an acceptable and effective alternative to physical contact -- insofar as they enable social interactions in the absence of physical contiguity. Social media make it possible for large numbers of people to reach out virtually to neighbors, relatives, friends and other contacts. "Our innate inclinations are cooperative rather than egoistic. But access to the Internet makes it possible for us to cope with the need for social distancing," says Chris Frith.

"How well, and for how long, our need for social contact can be satisfied by social media remains to be seen," says Deroy. But she and her co-authors do have two important recommendations for policy-makers. First of all, they must acknowledge that the demand for social distancing is not only politically highly unusual : It runs counter to the evolved structure of human cognition. Secondly, nowadays, free access to the Internet is not only a prerequisite for freedom of speech. In the present situation, it is also making a positive contribution to public health. "This is an important message, given that the most vulnerable sections of society are often those who, owing to poverty, age and illness, have few social contacts." https://www.sciencedaily.com/releases/2020/04/200424132539.htm

Job insecurity negatively affects your personality

New research shows that experiencing chronic job insecurity can change your personality for the worse

February 26, 2020

Science Daily/RMIT University

Drawing on Cybernetic Big Five Theory, this study proposes that chronic job insecurity is associated with an increase in neuroticism and decreases in agreeableness and conscientiousness.

The study, published in the Journal of Applied Psychology, found those exposed to job insecurity over more than four years became less emotionally stable, less agreeable, and less conscientious.

Report co-author Dr Lena Wang from RMIT University's School of Management said the study built on a growing evidence base about the negative consequences of job insecurity.

"Traditionally, we've thought about the short-term consequences of job insecurity -- that it hurts your well-being, physical health, sense of self-esteem," Wang said.

"But now we are looking at how that actually changes who you are as a person over time, a long-term consequence that you may not even be aware of."

The study used nationally representative data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey in relation to answers about job security and personality for 1,046 employees over a nine-year period.

It applied a well-established personality framework known as the Big Five, which categorises human personality into five broad traits: emotional stability, agreeableness, conscientiousness, extraversion and openness.

The study results showed that long-term job insecurity negatively affected the first three traits, which relate to a person's tendency to reliably achieve goals, get along with others, and cope with stress.

Wang said the results went against some assumptions about job insecurity.

"Some might believe that insecure work increases productivity because workers will work harder to keep their jobs, but our research suggests this may not be the case if job insecurity persists," Wang said.

"We found that those chronically exposed to job insecurity are in fact more likely to withdraw their effort and shy away from building strong, positive working relationships, which can undermine their productivity in the long run."

Previous research has shown that insecure work -- including labour hire practices, contract and casual work, and underemployment -- is on the rise in Australia and globally.

The HILDA data drew on responses from employees from a broad cross-section of professions and jobs, who were asked about how secure they perceived their jobs to be.

Study lead author Professor Chia-Huei Wu from Leeds University Business School said types of job insecurity might include short-term contracts or casual work, jobs threatened by automation, and positions that could be in line for a redundancy.

Importantly, said Wu, there are ways that employers can support workers who are feeling worried about their jobs.

"This is as much about perceived job insecurity as actual insecure contracts," Wu said.

"Some people simply feel daunted by the changing nature of their roles or fear they'll be replaced by automation.

"But while some existing jobs can be replaced by automation, new jobs will be created.

"So employers have the ability to reduce that perception, for example by investing in professional development, skills and training, or by giving career guidance."

https://www.sciencedaily.com/releases/2020/02/200226151958.htm

Mindfulness combined with hypnotherapy aids highly stressed people

'Novel intervention' may be as effective -- or more so -- as existing treatments

June 15, 2020

Science Daily/Baylor University

A new treatment for stress which combines mindfulness with hypnotherapy has shown positive results in a Baylor University pilot study.

The intervention is called "mindful hypnotherapy."

"Mindfulness is a type of meditation that involves focusing attention on present moment awareness. It can help people cope with stress, but can require months of practice and training," said researcher Gary Elkins, Ph.D., director of the Mind-Body Medicine Research Laboratory at Baylor University. "Hypnosis also involves focusing attention, but it includes mental imagery, relaxation and suggestions for symptom reduction."

Hypnosis interventions are typically brief and have been used in pain and symptom management in clinical practice.

The study's basic premise is that using hypnosis to deliver mindfulness goals could have many advantages, Elkins said.

"Combining mindfulness and hypnotherapy in a single session is a novel intervention that may be equal to or better than existing treatments, with the advantage of being more time-effective, less daunting and easier to use," he said. "This could be a valuable option for treating anxiety and stress reduction."

As a brief intervention, mindful therapy could be widely disseminated and is an innovative new mind-body therapy, he said.

The study is published in the International Journal of Clinical and Experimental Hypnosis.

Elkins noted that while mindfulness by itself can be an effective treatment for stress and anxiety for some people, it typically is provided in eight weekly sessions that last two hours or more each week and include an all-day retreat of eight or more hours. That amount of time -- more than 24 therapy hours -- may be a burden in cost and time for some people. Also, research has not shown that mindfulness-based treatments are consistently superior to standard cognitive behavioral therapy, he said.

For the study of mindful hypnotherapy, the Baylor research team recruited 42 individuals with self-reported high stress. Half took part in an intervention of one-hour weekly individual sessions that included hypnosis inductions and suggestions for greater mindfulness. Participants also were given self-hypnosis audio recordings lasting about 20 minutes, each with suggestions for a hypnotic induction, relaxation and greater mindfulness.

The second group did not take part in the intervention.

Intervention material focused on present-moment awareness, nonjudgmental awareness of the five senses, nonjudgmental awareness of thoughts and feelings, self-hypnosis, compassion for self and others, awareness of personal values and meaning in life and transition to long-term practice of mindful hypnotherapy, Elkins said.

At study's end, the intervention group reported a large decrease in stress and a significant increase in mindfulness. Most were highly satisfied with the number of sessions, the ease of home practice and the clarity of content, Elkins said. The average participant practiced almost every day, and overall satisfaction with the intervention was 8.9 on a scale of 10.

In comparison, those who did not participate in the intervention reported no significant difference between pre- and post-study stress level.

A limitation of the study was its small sample size, Elkins said. Future studies of a larger number of people could be of value, as well as testing mindful hypnotherapy for such concerns as anxiety, depression or chronic pain, he said.

https://www.sciencedaily.com/releases/2020/06/200615184150.htm

'Make physical activity part of children's routine' during lockdown

April 29, 2020

Science Daily/University of Strathclyde

Parents and carers should ensure that physical activity is part of the routine for children and families during the COVID-19 lockdown, according to an international study involving the University of Strathclyde.

The study, detailed in a comment article published in The Lancet Child & Adolescent Health, covers 15 nations. It found that time spent in places such as parks, beaches and community gardens reduced by nearly a third between the week ending 23 February -- before the World Health Organization (WHO) declared a COVID-19 pandemic -- and the week ending 5 April.

Travel by public transport was down by more than half -- 59% -- over the same period.

While these and other restrictions are in keeping with the global effort to halt the spread of COVID-19, the researchers found that they were having the effect of reducing still further what were often already low levels of physical activity in children.

The researchers make a number of recommendations to families, health professionals, teachers and policy-makers on promoting healthy activity, including:

• taking the opportunity to go outdoors, while observing distancing regulations

• incorporating physical activity into children's daily routines -- supported by use of electronic media -- and breaking up extended sedentary periods every 30 to 60 minutes; families should also be encouraged to join in while observing distancing regulations

• keeping children's bedtime and rising time consistent, keeping screens out of the rooms where they sleep and avoiding screen use before bedtime

• health professionals recommending current guidelines to parents, family members and caregivers

• promotion by governments of healthy movement behaviours in children as part of response strategies and public messages

• regular media messages promoting physical activity

Children advocating for their right to a healthy, active life within the COVID-19 restrictions.

Professor John Reilly, of Strathclyde's School of Psychological Sciences & Health, is the sole UK participant in the study.

He said: "The measures against COVID-19 are in place for a very good reason but this reduction in physical activity could be seen as an unintended consequence. Even before the lockdown measures, it was a major problem; our previous research has found that, in Scotland alone, fewer than 20% of children were meeting physical activity guidelines.

"It's important that people make whatever use of their environment they can and take the opportunities they can to keep physical activity going. The vast majority of children have access to outdoor spaces they can still use.

"While we have been fortunate with the weather during lockdown, even screen time can also incorporate activity resources, such as online fitness sessions. Breaks in screen time are also important but one reason physical activity is most needed just now is that school is the place where children most often have it.

"We have found that they are much less active on the non-school days of weekends and holidays; our concern is that they are missing out not only in education but also in activity."

Along with the UK, countries participating in the study were: China; Australia; Chile; South Africa; Morocco; Brazil; Mexico; United States; Russia; Sweden; South Korea; Netherlands, India and Canada.

The study reflects Good Health and Wellbeing, which is among the United Nations' Sustainable Development Goals. The University of Strathclyde is a signatory to the Goals, which the UN has set to pursue justice, peace, good health, responsible use of resources and the eradication of poverty and hunger.

Professor Reilly was also a member of an expert panel which produced WHO guidelines, published in 2019, on childhood physical activity.

https://www.sciencedaily.com/releases/2020/04/200429191851.htm

More than 80 percent of Americans report nation's future is significant source of stress

As protests continue, more than half of black adults say discrimination a significant stressor

June 18, 2020

Science Daily/American Psychological Association

More than 8 in 10 Americans (83%) say the future of our nation is a significant source of stress, according to the American Psychological Association's most recent survey report, Stress in America™ 2020: Stress in The Time of COVID-19, Volume Two. The previous high was 69%, reported in 2018 as part of APA's annual Stress in America survey.

Following protests over racial injustice sparked by the death of George Floyd at the hands of Minneapolis police -- all set against the backdrop of the COVID-19 pandemic -- more than 7 in 10 (72%) Americans say that this is the lowest point in the country's history that they can remember.

The report includes findings from two recent surveys conducted by The Harris Poll on behalf of APA: Wave 2 of the COVID Tracker conducted from May 21 to June 3, 2020, among 3,013 adults age 18+ who reside in the U.S. and an additional poll about the current civil unrest conducted from June 9 to 11, 2020, among 2,058 adults age 18+ who reside in the U.S.

"We are experiencing the collision of three national crises -- the COVID-19 pandemic, economic turmoil and recent, traumatic events related to systemic racism. As a result, the collective mental health of the American public has endured one devasting blow after another, the long-term effects of which many people will struggle with for years to come," said Arthur C. Evans Jr., PhD, APA's chief executive officer. "We don't have to be passive players in mitigating the rapidly increasing stress Americans are facing and its consequences on our health."

The proportion of black Americans who say discrimination is a significant source of stress has increased significantly in the past month, with 55% of black adults saying discrimination is a significant source of stress in Wave 2 of the COVID Tracker. At the beginning of May, only 42% said the same in Wave 1. In the most recent civil unrest poll, more than 7 in 10 Americans (71%) say police violence toward minorities is a significant source of stress. But most Americans (67%) say the current movement against systemic racism and police brutality is going to lead to meaningful change in America.

"America has an ongoing racism pandemic that continues to devastate the lives and livelihoods of our black communities," Evans said. "The majority of Americans are finally coming to terms with the reality people of color have known all too well for all too long and that research has documented: Racism poses a public health threat and the psychological burden is immense. We have a lot of healing to do as a nation. Increased access to psychological supports is one way to move us more in the right direction."

In a continued focus on pandemic-related stress through the COVID Tracker, the report also shows nearly 2 in 3 adults (66%) say the government response to the COVID-19 pandemic is a significant source of stress. Of those, 84% say the federal government response is a significant source of stress, followed by state (72%) and local governments (64%).

Overall, more than 6 in 10 Americans (63%) agree that the thought of the U.S. reopening causes them stress, but just over 7 in 10 adults (72%) say they are confident they can protect themselves from coronavirus once the U.S. reopens. At the same time, 65% say they wish they had more information about what they should do as their community reopens.

Stress in America™ 2020: Stress in the Time of COVID-19, Volume Two is available at: https://www.apa.org/news/press/releases/stress/2020/report-june

Methodology

Wave 2 of the COVID Tracker was conducted online within the United States by The Harris Poll on behalf of the American Psychological Association between May 21 and June 3, 2020, among 3,013 adults age 18+ who reside in the U.S. Interviews were conducted in English and Spanish. Data were weighted to reflect their proportions in the population based on the 2019 Current Population Survey by the U.S. Census Bureau. Weighting variables included age by gender, race/ethnicity, education, region, household income and time spent online. Hispanic adults also were weighted for acculturation taking into account respondents' household language as well as their ability to read and speak in English and Spanish. Country of origin (U.S./non-U.S.) also was included for Hispanic and Asian subgroups. Weighting variables for Gen Z adults (ages 18 to 23) included education, age by gender, race/ethnicity, region, household income and size of household. Propensity score weighting was used to adjust for respondents' propensity to be online.

The Civil Unrest Survey was conducted online within the United States by The Harris Poll on behalf of the American Psychological Association between June 9 and 11, 2020, among 2,058 adults age 18+ who reside in the U.S. Results were weighted for age within gender, region, race/ethnicity, household income, education, marital status and size of household where necessary to align them with their actual proportions in the population. Propensity score weighting was also used to adjust for respondents' propensity to be online.

https://www.sciencedaily.com/releases/2020/06/200618124803.htm

How COVID-19 lockdown has altered sleep in the US and Europe

June 10, 2020

Science Daily/Cell Press

Two new studies show that relaxed school and work schedules and more time spent at home has led people to sleep more on average with less 'social jetlag' as indicated by a reduced shift in sleep timing and duration on work days versus free days. But, at the same time, one of the studies also finds that the pandemic has taken a toll when it comes to self-reported sleep quality.

Stay-at-home orders and "lockdowns" related to the COVID-19 pandemic have had a major impact on the daily lives of people around the world and that includes the way that people sleep, two studies report June 10 in the journal Current Biology. Both studies show that relaxed school and work schedules and more time spent at home has led people to sleep more on average with less "social jetlag" as indicated by a reduced shift in sleep timing and duration on work days versus free days. But, at the same time, one of the studies also finds that the pandemic has taken a toll when it comes to self-reported sleep quality.

"Usually, we would expect a decrease in social jetlag to be associated with reports of improved sleep quality," says sleep researcher and cognitive neuroscientist Christine Blume from the University of Basel's Centre for Chronobiology, Switzerland. "However, in our sample, overall sleep quality decreased. We think that the self-perceived burden, which substantially increased during this unprecedented COVID-19 lockdown, may have outweighed the otherwise beneficial effects of a reduced social jetlag."

In their study, Blume and colleagues including Marlene Schmidt and Christian Cajochen explored the effects of the strictest phase of the COVID-19 lockdown on the relationship between social and biological rhythms as well as sleep during a six-week period from mid-March until end of April 2020 in Austria, Germany, and Switzerland. Their data showed that the lockdown reduced the mismatch between social and biological sleep-wake timing as people began working from home more and sleeping more regular hours from day to day. People also slept about 15 minutes longer each night. However, the self-reported data indicated a perception that sleep quality had declined.

In the other study, Kenneth Wright at the University of Colorado, Boulder's Sleep and Chronobiology Laboratory and colleagues asked similar questions by comparing sleep prior to and during Stay-at-Home orders in 139 university students as they shifted from taking their classes in-person to taking them remotely. As the team reports, nightly sleep duration increased by about 30 minutes during weekdays and 24 minutes on weekends. The timing of sleep also became more regular from day to day, and there was less social jetlag.

Students stayed up about 50 minutes later while staying home during weekdays and about 25 minutes later on weekends. Students that tended to sleep less before the effects of COVID-19 took hold showed the greatest increase in the amount of sleep after they stopped going to in-person classes. After the Stay-at-Home orders went into effect, 92 percent of students got the recommended 7 hours or more of sleep per night, up from 84 percent before.

"Insufficient sleep duration, irregular and late sleep timing, and social jetlag are common in modern society and such poor sleep health behaviors contribute to and worsen major health and safety problems, including heart disease and stroke, weight gain and obesity, diabetes, mood disorders such as depression and anxiety, substance abuse, and impaired immune health, as well as morning sleepiness, cognitive impairment, reduced work productivity, poor school performance and risk of accident/drowsy driving crashes," Wright said. "Our findings provide further evidence that poor sleep behaviors are modifiable in university students. A better understanding of which factors during Stay-at-Home orders contributed to changed sleep health behaviors may help to develop sleep health intervention strategies."

"Not surprisingly, this unprecedented situation of the pandemic and the lockdown increased self-perceived burden and had adverse effects on sleep quality," Blume said. "On a positive note, though, the relaxation of social schedules also led to an improved alignment between external or social factors determining our sleep-wake timing and our body's internal biological signals. This was also associated with overall, more sleep."

From a sleep health perspective, the increase in sleep duration and regularity are welcome changes, say the researchers. For those having trouble with sleep quality, Blume suggests engaging in physical activity under the open sky.

https://www.sciencedaily.com/releases/2020/06/200610112107.htm

Sleep: Now More than Ever

 Sleep: Now More than Ever

Guest Contribution by Susan Doktor 

If you’re getting less sleep these days, you’re not alone. Extensive research demonstrates that depression and anxiety are among the leading causes of sleep problems. And with the advent of the coronavirus pandemic, a corollary anxiety pandemic is fast on its heels. The fear, human separation, and financial uncertainty that have accompanied the virus are taking their toll on our mental health and likely our sleep patterns, too.

But insomnia is hardly a new or uncommon phenomenon. As a nation, the US is getting less sleep now than we were a hundred years ago. Most of us will experience short bouts of it in our lifetimes but some 20% of Americans suffer from chronic sleep disorders that present with insomnia as a primary symptom.

Curing any disorder that causes insomnia is the ultimate goal of sleep specialists. But in the absence of a cure—or when insomnia is the disorder itself—insomnia sufferers can take many steps towards getting a better night’s sleep. Let’s take a look at some of the habits, techniques, and products that can help us fall asleep faster and sleep longer and deeper once we do.

Practice Meditation

Meditation is a simple, safe technique that’s available to everyone. It costs nothing and you can learn how to do it without leaving home. All of the “side effects’ associated with meditation are positive, including reduced inflammation, improved cognition, increased immune function, and more.

Focus on Comfort

Our bodies are dynamic. The sleep-related choices you made and habits you adopted years ago may not be serving you well right now. So take an inventory of your bedtime rituals and “equipment.” Perhaps you’ve been sleeping on the same mattress for a decade. The best mattress for your body may not be the one you’re sleeping on, now that you’ve aged ten years.  

How do you know if it’s time for a change? While many mattresses carry longer warranties, experts recommend replacing your mattress every eight to ten years. Obvious sagging is one clue that your mattress is past its prime. If you suffer from allergies and they get worse at night, your mattress may be the culprit. And in general, if you wake with more pain than you went to sleep with, that’s a good reason to consider buying a new mattress.

If you’ve become a hot sleeper—which can happen due to changes in your age, your health, hormone fluctuations, or the medicines you take—it may be time to look into bedding products designed to keep you cool. Choose natural fibers for your sheets and pillows. You may also want to avoid sleeping on a memory foam mattress, which conforms more closely to your body and traps heat in your bed.

Avoid Substances that Can Disturb Sleep

It’s common sense to avoid using stimulants before going to bed. Coffee and cigarettes fall into that category, as do a host of dangerous illegal substances. But don’t imagine that a glass of wine is going to help you get the shut-eye you need, either. Alcohol may induce drowsiness initially but it disrupts circadian rhythms, prevents you from entering the REM phase of sleeping, and can aggravate breathing problems. Some prescription medications, including those commonly prescribed for hypertension and depression, can also adversely affect sleep. Before taking any medication, ask your physician whether it has the potential to keep you awake and whether you’re better off taking it in the daytime.

Get Some Exercise Every Day

Scientists continue to study the specific benefits that daily (and even occasional) exercise can bestow on insomniacs. Evidence strongly suggests that if you experience sleep apnea or other breathing-related sleep problem, exercise can reduce the severity of your symptoms. But like sleep, exercise has restorative powers of its own. Fit in into your routine and you’ll feel better throughout the day.

Shut it Down

The time we spend engaged with our electronic devices continues to grow. Our work has become more technology-driven. We’re spending more of our leisure time on social media. But the blue light emitted by computer and smartphone screens has been demonstrated to disrupt our sleep cycles, particularly when we’re exposed to it before bed time. You’ll sleep more if you surf less. And don’t just put your phone away. Turn it off. That way the dings that signal your night-owl friends’ Facebook posts won’t wake you either. Whatever it is, it can wait til morning.

Potential harms of chloroquine, hydroxychloroquine and azithromycin for treating COVID-19

April 8, 2020

Science Daily/Canadian Medical Association Journal

Chloroquine, hydroxychloroquine and azithromycin are being used to treat and prevent COVID-19 despite weak evidence for effectiveness, and physicians and patients should be aware of the drugs' potentially serious adverse events, states a review in CMAJ(Canadian Medical Association Journal).

"Physicians and patients should be aware of several rare but potentially life-threatening adverse effects of chloroquine and hydroxychloroquine," says Dr. David Juurlink, Division of Clinical Pharmacology and Toxicology, Sunnybrook Health Sciences Centre, and a senior scientist at ICES.

The review provides an overview of potential harms associated with these drugs as well as their management based on the best available evidence.

Potential adverse effects include:

• Cardiac arrhythmias

• Hypoglycemia

• Neuropsychiatric effects, such as agitation, confusion, hallucinations and paranoia

• Interactions with other drugs

• Metabolic variability (some people metabolize chloroquine and hydroxychloroquine poorly and a small percentage metabolize them rapidly, which affects the response to treatment)

• Overdose (chloroquine and hydroxychloroquine are highly toxic in overdose and can cause seizures, coma and cardiac arrest)

• Drug shortages (patients with autoimmune disorders such as rheumatoid arthritis, lupus and other chronic diseases, who take hydroxychloroquine to treat these conditions could have problems accessing this drug)

The review summarizes the poor quality of evidence suggesting that these treatments might be beneficial in patients with COVID-19 and cautions that it is possible that these treatments could worsen the disease.

"Despite optimism (in some, even enthusiasm) for the potential of chloroquine or hydroxychloroquine in the treatment of COVID-19, little consideration has been given to the possibility that the drugs might negatively influence the course of disease," says Dr. Juurlink. "This is why we need a better evidence base before routinely using these drugs to treat patients with COVID-19."

"Safety considerations with chloroquine, hydroxychloroquine and azithromycin in the management of SARS-CoV-2 infection" is published April 8, 2020.

https://www.sciencedaily.com/releases/2020/04/200408125521.htm

Modeling study estimates impact of relaxing control measures on possible second wave of COVID-19 in China

April 8, 2020

Science Daily/The Lancet

Use of real-time monitoring of COVID-19 transmissibility and severity to fine-tune control strategies offers the best chance to minimize second wave of infection in mainland China, outside Hubei province, researchers say in a new study.

New modelling research, published in The Lancetjournal, suggests that China's aggressive control measures appear to have halted the first wave of COVID-19 in areas outside Hubei province, the epicentre of the epidemic. However, given the substantial risk of the virus being reintroduced from abroad, and with economic activity increasing, real-time monitoring of COVID-19 transmissibility and severity is needed to protect against a possible second wave of infection, researchers say.

The study estimates that in regions outside Hubei, the instantaneous reproductive number of COVID-19 -- the average number of cases generated by a single infected individual during the outbreak -- fell substantially after lock down measures were introduced on January 23, 2020, and has remained below 1 since then -- suggesting that the epidemic has shifted from one that is expanding rapidly to one that is slowly shrinking. (The higher the reproductive number, the more transmissible the virus is and the higher the risk for rapid spread. When the reproductive number falls below one, the epidemic is likely to die out.)

However, mathematical modelling to simulate the impact of relaxing current control measures, suggests that premature lifting of these interventions will likely lead to transmissibility exceeding 1 again, resulting in a second wave of infection.

The findings are critical to countries globally that are in the early phases of lock down because they warn against premature relaxation of strict control measures, researchers say. However, the study did not specifically examine the effect of each intervention, or which one was most effective in containing the spread of the virus.

"While these control measures appear to have reduced the number of infections to very low levels, without herd immunity against COVID-19, cases could easily resurge as businesses, factory operations, and schools gradually resume and increase social mixing, particularly given the increasing risk of imported cases from overseas as COVID-19 continues to spread globally," says Professor Joseph T Wu from the University of Hong Kong who co-led the research.

He continues, "Although control policies such as physical distancing and behavioural change are likely to be maintained for some time, proactively striking a balance between resuming economic activities and keeping the reproductive number below one is likely to be the best strategy until effective vaccines become widely available.

Further analysis suggests that the confirmed case fatality risk (the probability of dying among confirmed cases of COVID-19 as officially reported) outside Hubei was 0.98% -- which is almost six times lower than in Hubei (5.91%) -- and varied substantially among different provinces, based on economic development and availability of health-care resources. Among the ten provinces with the largest number of confirmed cases, case fatality ranged from 0% in prosperous regions like Jiangsu to 1.76% in less developed provinces such as Henan.

"Even in the most prosperous and well-resourced megacities like Beijing and Shanghai, health-care resources are finite, and services will struggle with a sudden increase in demand," says senior author Professor Gabriel M Leung from the University of Hong Kong. "Our findings highlight the importance of ensuring that local health-care systems have adequate staffing and resources to minimise COVID-related deaths."

In December 2019, a novel coronavirus (SARS-CoV-2) emerged in Wuhan city and spread across China. Stringent restrictions on the movement of people and goods were introduced nationwide on January 23. These measures have impacted on people's livelihood and personal liberties, as well as lost economic opportunity. Since February 17, restrictions have been progressively relaxed in several provinces, and factories and offices are gradually reopening.

In the study, researchers analysed local Health Commission data of confirmed COVID-19 cases between mid-January and 29 February, 2020, to estimate the transmissibility and severity of COVID-19 in four major cities -- Beijing, Shanghai, Shenzhen, Wenzhou -- and ten provinces outside Hubei with the highest number of confirmed COVID-19 cases. The number of new daily imported and local cases were used to construct epidemic curves for each location by date of symptom onset, and reporting delays -- time lags between the onset of a disease and the reporting of cases -- were incorporated in the modelling to calculate weekly reproduction numbers. The researchers also modelled the potential impact of relaxing control measures after the first wave of infection for different scenarios with rising reproduction numbers.

The analyses suggest that in regions outside Hubei, control measures should be lifted gradually so that the resulting reproductive number does not exceed 1, or the number of cases will progressively rise over the relaxation period. Moreover, the estimates suggest that once elevated, simply tightening control interventions again would not reduce the burden back to its original level, and would require extra effort to drive the reproductive number below 1 in order to revert to the pre-relaxation level -- likely resulting in both higher health and economic loss.

"We are acutely aware that as economic activity increases across China in the coming weeks, local or imported infection could lead to a resurgence of transmission," says co-lead author Dr Kathy Leung from the University of Hong Kong. "Real-time monitoring of the effect of increased mobility and social mixing on COVID-19 transmissibility could allow policymakers to fine tune control measures to interrupt transmission and minimise the impact of a possible second wave of infections."

Despite these important findings, the study has some limitations, including that the estimated reproductive numbers were based on the reported number of confirmed cases, and the time and dates of symptom onset were unavailable for some provinces and relied on data derived from Shenzhen. Finally, a limited number of simulations for relaxing control measures were done, and did not specify which interventions or public responses to the epidemic might correspond to each of these scenarios.

Writing in a linked Comment, lead author Dr Shunqing Xu (who was not involved in the study) from Huazhong University of Science and Technology in China says: "Case fatality rate (CFR) is one of the important unknowns of COVID-19...Leung and colleagues found the confirmed CFR was correlated with provincial per capita gross domestic product and the availability of hospital beds per 10,000. In Wuhan, the CFR was up to 5.08% by March 28, 2020. The remarkable difference in the CFR between these locations and Wuhan might be attributed to the difference in the degrees of health-care capacity. Therefore, consideration should be given to the variations in health-care capacity when implementing interventions."

https://www.sciencedaily.com/releases/2020/04/200408184717.htm

Link between air pollution and coronavirus mortality in Italy could be possible

April 6, 2020

Science Daily/Aarhus University

A group of scientists has found another small piece in the puzzle of understanding COVID-19. Looking for reasons why the mortality rate is up to 12% in the northern part of Italy and only approx. 4.5% in the rest of the country, they found a probable correlation between air pollution and mortality in two of the worst affected regions in northern Italy.

The world has been hit hard by coronavirus, and health services and authorities everywhere are struggling to reduce the spread, combat the disease and protect the population. Nevertheless, the pandemic will cost lives throughout the world. An environmental researcher from Aarhus University has studied whether there could be a link between the high mortality rate seen in northern Italy, and the level of air pollution in the same region. The short answer is "yes possibly." The long answer is in the article below.

The outbreak of Severe Acute Respiratory Syndrome CoronaVirus2 had its source in the Wuhan Province in China in December 2019. Since then, the coronavirus has spread to the rest of the globe, and the world is now treating patients with the disease that follows virus infection: COVID-19. The course of the disease differs for patients the world over: many experience flu-like symptoms, while many others need hospital treatment for acute respiratory infection that, in some cases, leads to death.

However, what factors affect the course of the disease and the possibilities to combat COVID-19 remains unclear, as long as there is no medical treatment or vaccine. At the moment, there are more questions than answers, and researchers all over the world are therefore working to find new insights into the global pandemic.

At Aarhus University, the environmental scientist Dario Caro from the Department of Environmental Science, and two health researchers, prof. Bruno Frediani and Dr. Edoardo Conticini, from the University of Siena in Italy have found yet another small piece in the puzzle of understanding the deadly disease. They have focused on examining why the mortality rate is up to 12% in the northern part of Italy, while it is only approx. 4.5% in the rest of the country.

They have just published an article entitled "Can Atmospheric pollution be considered as a co-factor in the extremely high level of SARS-CoV-2 lethality in Northern Italy?," in which they demonstrate a probable correlation between air pollution and mortality in two of the worst affected regions in northern Italy: Lombardy and Emilia Romagna.

The research project has been published in the scientific journal Environmental Pollution.

"There are several factors affecting the course of patients' illness, and all over the world we're finding links and explanations of what is important. It's very important to stress that our results are not a counter-argument to the findings already made. At the moment, all new knowledge is valuable for science and the authorities, and I consider our work as a supplement to the pool of knowledge about the factors that are important for the course of patients' illness," says environmental scientist Dario Caro, and clarifies that there are a number of other factors that could possibly play a role in the Italian situation:

"Our considerations must not let us neglect other factors responsible of the high lethality recorded: important co-factors such as the elevated medium age of the Italian population, the wide differences among Italian regional health systems, ICUs capacity and how the infects and deaths has been reported have had a paramount role in the lethality of SARS-CoV-2, presumably also more than pollution itself," he explains.

Different datasets show a link

The two northern Italian regions are among the most air-polluted regions in Europe. The recently published article took its outset in data from the NASA Aura satellite, which has demonstrated very high levels of air pollution across precisely these two regions. The group compared these data with the so-called Air Quality Index; a measurement of air quality developed by the European Environment Agency. The index gathers data from several thousand measuring stations all over Europe, providing a geographical insight into the prevalence of a number of pollutant sources in the EU.

The figures speak for themselves. The population of the northern Italian regions lives in a higher level of air pollution, and this may lead to a number of complications for patients with COVID-19 in the regions, simply because their bodies may have already been weakened by the accumulated exposure to air pollution when they contract the disease.

Dario Caro explains that the situation in the Italian regions has been a challenge for several years, with high levels of air pollution that have accumulated over a long period of time in the population. It is therefore unlikely that there is any reason to imagine that people in Denmark are exposed to the same factors or the same levels of pollution as people in northern Italy, where the authorities have been trying to reduce pollution levels for many years.

"All over the world, we're seeing different approaches from countries' authorities, in countries' general public health outset and in the standards and readiness of different countries' national healthcare systems. But this doesn't explain the prevalence and mortality rates that we're seeing in northern Italy compared with the rest of Italy. This feeds hope that we may have found yet another factor in understanding the high mortality rate of the disease in northern Italy," says Dario Caro.

https://www.sciencedaily.com/releases/2020/04/200406100824.htm

US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality

Study estimates 1 in 7 frontline medical workers may miss work to care for their children when US schools are closed to reduce the spread of COVID-19

April 4, 2020

Science Daily/The Lancet

US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

Using the latest data from the US Census Bureau's Current Population Survey to measure the childcare needs of health-care workers if schools are shut, researchers estimate that nationwide, at least one in seven medical workers may have to miss work to care for their children aged 3-12 years old, even after taking into account childcare provided by non-working adults and older siblings within the same household.

These additional childcare obligations could compromise the ability of the US healthcare system to respond to COVID-19 if alternative childcare arrangements are not made, researchers say.

However, the authors caution that the true impact of school closures on overall deaths from COVID-19 cannot be precisely predicted because of large uncertainties around estimates of transmission and infectivity, and to what extent a decline in the health-care workforce impacts the survival of patients with COVID-19.

"Closing schools comes with many trade-offs, and can create unintentional child-care shortages that put a strain on the health-care system," says Professor Eli Fenichel from Yale University in the USA who co-led the research. "Health-care workers spending less time providing patient care to look after their own children can directly influence the development of an epidemic and the survival of those patients. Understanding these trade-offs is vital when planning the public health response to COVID-19 because if the survival of infected patients is sufficiently sensitive to declines in the healthcare workforce, then school closures could potentially increase deaths from COVID-19." 

Support for mandatory school closures to reduce cases and mortality from COVID-19 comes from experience with influenza, or models that do not include the effect of school closure on the health-care workforce. Few studies have considered the trade-off between case reduction and disease burden and the potential loss of healthcare workers to childcare obligations.

In the study, researchers analysed data on more than 3 million individuals between January 2018 and January 2020 to assess family structure and probable within-household childcare options for health-care workers. They identified those most likely to require additional childcare for children aged 3-12 years old in the event of school closures by type of health-care occupation nationally and across different states, assuming that early childcare for children aged under 2 years remains open. They also modelled potential declines in the health-care workforce during school closures with estimates of case reductions from school closures to identify the point at which more lives are lost from school closures than are saved.

The analyses suggest that around 29% of US health-care workers need to provide care for children aged 3-12 years old. In households without a non-working adult or a sibling aged 13 years or older to provide care, the researchers estimate that 15% of health-care workers will require childcare -- equivalent to around 2.3 million children nationwide -- if schools close. However, the authors note that they were unable to account for health-care workers finding alternative methods of care for their children such as babysitters or friends.

School closures will be especially challenging for nurse practitioners (22% will need childcare), physician's assistants (21%), diagnostic technicians (19%), and physicians and surgeons (16%), as well as nearly 13% of the nursing and home health aids who are single parents and part of the group helping the elderly with infection control in nursing homes, researchers say.

The US states likely to have the greatest unmet childcare needs include South Dakota (21% of health-care workers will need childcare), Oregon (21%), and Missouri (21%). In contrast, Washington DC (9% health-care workers with unmet childcare needs), New Mexico (10%), and New Jersey (11%) are least likely to have health-care worker shortages if schools close.

Further analysis suggests that if the case fatality fraction (the share of people who die out of all those infected) rises from 2% to more than 2.4% when the health-care workforce declines by 15%, school closures could lead to a greater number of deaths than those they prevent. However, there is substantial variation across the country. For example, in South Dakota estimates suggest that the case fatality rate must not increase by more than 1.7% before school closures stop saving lives and start increasing overall mortality, whereas in Washington DC it is 4.1% -- this is due to the low child care obligations in Washington DC relative to South Dakota.

"The US healthcare system appears disproportionately prone to labour shortages from school closures, particularly among those health-care workers providing infection control in nursing homes," says co-lead author Dr Jude Bayham from Colorado State University, USA. "These potential health-care workforce shortages should be a priority when assessing the potential benefits and costs of school closures, and alternative child care arrangements must be part of the school closure plan." 

According to Fenichel, "Closing schools and distancing in general is about bending the curve to stay below hospital capacity and reduce COVID-19 mortality, but how we distance in order to bend the curve can also influence the hospital capacity we need to stay below. We need to account for both."

The authors note some important limitations of the study, including that the authors informed their model based on the influenza virus, to which children are particularly vulnerable -- however, early data on COVID-19 suggests children may be less vulnerable, so the benefits of school closures may be smaller than expected. On the other hand, the authors note that closing schools earlier in an outbreak could prevent more cases and lead to less health-care workers being infected and thus able to treat more patients. The study did not include mortality from other conditions that might occur if the health-care workforce declined, which should be taken into consideration when deciding about closing schools, the authors say.

 https://www.sciencedaily.com/releases/2020/04/200404155613.htm

First study on the health conditions of adults one month into COVID-19 lockdown

Early evidence of people's health conditions after one-month of lockdown in China

April 8, 2020

Science Daily/University of Sydney

A new study provides some of the earliest pieces of evidence that the COVID-19 outbreak affected people mentally as well as physically.

The preliminary results reveal adults in locations more affected by COVID-19 had distress, and lower physical and mental health, and life satisfaction.

Researchers from the University of Adelaide, Tongji University and University of Sydney surveyed 369 adults living in 64 cities in China after they had lived under one-month of confinement measures in February this year.

Led by Dr Stephen Zhang from the University of Adelaide, the study identifies adults with existing health conditions and those who stopped working as most at risk of worse mental and physical health.

"As many parts of the world are only just beginning to go into lockdown, we examined the impact of the one-month long lockdown on people's health, distress and life satisfaction," said Dr Zhang.

"The study offers somewhat of a 'crystal ball' into the mental health of Australian residents once they have been in the lockdown for one month."

More than a quarter of the participants worked at the office during the lockdown period while 38 percent worked from home and 25 percent stopped work due to the outbreak.

Published in Psychiatry Research, the study suggests adults living in locations more affected by COVID-19 reported negative life satisfaction only among adults with chronic medical issues but not for those without existing health issues.

Co-author on the study, Professor Andreas Rauch from the University of Sydney said; "We weren't surprised that adults who stopped working reported worse mental and physical health conditions as well as distress. Work can provide people with a sense of purpose and routine, which is particularly important during this global pandemic."

Study participants who exercised for more than 2.5 hours per day reported worse life satisfaction in more affected locations while those who exercised for half an hour or less during the lockdown reported positive life satisfaction.

"We were really surprised by the findings around exercising hours because it appears to be counter-intuitive," said lead author Dr Zhang.

"It's possible adults who exercised less could better justify or rationalise their inactive lifestyles in more severely affected cities. More research is needed but these early findings suggest we need to pay attention to more physically active individuals, who might be more frustrated by the restrictions."

https://www.sciencedaily.com/releases/2020/04/200408102137.htm

People tune out facts and trust their guts in medical emergencies

April 3, 2020

Science Daily/University of Texas at Arlington

A study conducted by two associate professors of marketing at The University of Texas at Arlington shows that people are more likely to base decisions on anecdotal information instead of facts when they feel anxious and vulnerable.

Traci Freling and Ritesh Saini, both in the College of Business, published "When poignant stories outweigh cold hard facts: A meta-analysis of the anecdotal bias" in Organizational Behavior and Human Decision Processes.

"We found that people are more likely to consider personal anecdotes than fact-based information, especially when it deals with medical emergencies," Freling said. "This has a high importance in the current environment, where everyone is concerned about the coronavirus."

Freling said people are more likely to listen to personal stories instead of facts because emotions run high during medical emergencies like the COVID-19 pandemic.

"They are especially dismissive of facts if the incident is something they personally experienced," Freling said. "Specifically, we show that when an issue is health-related, personally relevant or highly threatening, then decision-making is compromised and people tend to rely on anecdotes."

Freling pointed to the run on toilet paper buying during the COVID-19 pandemic as one example of not basing decisions on facts. This example illustrates how consumers who feel vulnerable to a particular problem may rely more heavily on subjective, anecdotal information instead of objective, statistical facts to make decisions.

Former UTA faculty member Zhiyong Yang, now a professor at the University of North Carolina-Greensboro, and two graduate students contributed to the analysis.

The research also revealed that when emotional engagement is low, statistical evidence weighs more heavily.

"Primarily, when there is low-threat severity or it's a non-health issue, people tend to take cold, hard facts into account rather than personal accounts and stories," Freling said.

Additionally, Saini noted that people make "more fact-based decisions when choosing for others, but become surprisingly irrational when choosing for self."

Elten Briggs, chair of the Department of Marketing, said Freling and Saini's analysis could have implications on decision-making processes for business and industry, especially during medical crises.

"Their research provides guidance on how to craft more influential messaging during times like these, when anxiety is heightened for so many people," Briggs said.

https://www.sciencedaily.com/releases/2020/04/200403131259.htm

Removing the novel coronavirus from the water cycle

Science Daily/University of California - Riverside

Scientists know that coronaviruses, including the SARS-CoV-19 virus responsible for the COVID-19 pandemic, can remain infectious for days -- or even longer -- in sewage and drinking water.

Two researchers, Haizhou Liu, an associate professor of chemical and environmental engineering at the University of California, Riverside; and Professor Vincenzo Naddeo, director of the Sanitary Environmental Engineering Division at the University of Salerno, have called for more testing to determine whether water treatment methods are effective in killing SARS-CoV-19 and coronaviruses in general.

The virus can be transported in microscopic water droplets, or aerosols, which enter the air through evaporation or spray, the researchers wrote in an editorial for Environmental Science: Water Research & Technology, a leading environmental journal of the Royal Society of Chemistry in the United Kingdom.

"The ongoing COVID-19 pandemic highlights the urgent need for a careful evaluation of the fate and control of this contagious virus in the environment," Liu said. "Environmental engineers like us are well positioned to apply our expertise to address these needs with international collaborations to protect public health."

During a 2003 SARS outbreak in Hong Kong, a sewage leak caused a cluster of cases through aerosolization. Though no known cases of COVID-19 have been caused by sewage leaks, the novel coronavirus is closely related to the one that causes SARS, and infection via this route could be possible.

The novel coronavirus could also colonize biofilms that line drinking water systems, making showerheads a possible source of aerosolized transmission. This transmission pathway is thought to be a major source of exposure to the bacteria that causes Legionnaire's disease, for example.

Fortunately, most water treatment routines are thought to kill or remove coronaviruses effectively in both drinking and wastewater. Oxidation with hypochlorous acid or peracetic acid, and inactivation by ultraviolet irradiation, as well as chlorine, are thought to kill coronaviruses. In wastewater treatment plants that use membrane bioreactors, the synergistic effects of beneficial microorganisms and the physical separation of suspended solids filter out viruses concentrated in the sewage sludge.

Liu and Naddeo caution, however, that most of these methods have not been studied for effectiveness specifically on SARS-CoV-19 and other coronaviruses, and they have called for additional research.

They also suggest upgrading existing water and wastewater treatment infrastructure in outbreak hot spots, which possibly receive coronavirus from places such as hospitals, community clinics, and nursing homes. For example, energy-efficient, light-emitting, diode-based, ultraviolet point-of-use systems could disinfect water before it enters the public treatment system.

Potable water-reuse systems, which purify wastewater back into tap water, also need thorough investigation for coronavirus removal, and possibly new regulatory standards for disinfection, the researchers wrote.

The extent to which viruses can colonize biofilms is also not yet known. Biofilms are thin, slimy bacterial growths that line the pipes of many aging drinking water systems. Better monitoring of coronaviruses in biofilms might be necessary to prevent outbreaks.

The surge in household use of bactericides, virucides and disinfectants will probably cause an increase of antibiotic-resistant bacteria in the environment. Treated wastewater discharged into natural waterways demands careful monitoring through the entire water cycle. Liu and Naddeo call on chemists, environmental engineers, microbiologists, and public health specialists to develop multidisciplinary and practical solutions for safe drinking water and healthy aquatic environments.

Lastly, developing countries and some regions within highly developed nations, such as rural and impoverished communities, which lack the basic infrastructure to remove other common contaminants might not be able to remove SARS-CoV-19 either. These places might experience frequent COVID-19 outbreaks that spread easily through globalized trade and travel. Liu and Naddeo suggest governments of developed countries must support and finance water and sanitation systems wherever they are needed.

"It is now clear to all that globalization also introduces new health risks. Where water and sanitation systems are not adequate, the risk of finding novel viruses is very high," Naddeo said. "In a responsible and ideal scenario, the governments of developed countries must support and finance water and sanitation systems in developing countries, in order to also protect the citizens of their own countries."

https://www.sciencedaily.com/releases/2020/04/200403132347.htm

Wearing surgical masks in public could help slow COVID-19 pandemic's advance

Masks may limit the spread diseases including influenza, rhinoviruses and coronaviruses

April 3, 2020

Science Daily/University of Maryland

Surgical masks may help prevent infected people from making others sick with seasonal viruses, including coronaviruses, according to new research that could help settle a fierce debate spanning clinical and cultural norms.

In laboratory experiments, the masks significantly reduced the amounts of various airborne viruses coming from infected patients, measured using the breath-capturing "Gesundheit II machine" developed by Dr. Don Milton, a professor of applied environmental health and a senior author of the study published April 3 in the journal Nature Medicine.

Milton has already conferred with federal and White House health officials on the findings, which closely follow statements this week from the head of the Centers for Disease Control and Prevention saying the agency was reconsidering oft-stated advice that surgical masks aren't a useful precaution outside of medical settings. (The debate takes place at a time when clinicians themselves face dangerously inadequate supplies of masks -- a shortfall other UMD researchers are scrambling to help solve.)

The question of masks has roiled society as well, with some retailers refusing to let employees wear them for fear of sending negative signals to customers, and cases of slurs and even physical attacks in the United States and elsewhere against Asians or Asian Americans who were wearing masks, a measure some consider a necessity during a disease outbreak.

The study, conducted prior to the current pandemic with a student of Milton's colleagues on the Faculty of Medicine at the University of Hong Kong, does not address the question of whether surgical masks protect wearers from infection. It does suggest that masks may limit how much the infected -- who in the case of the novel coronavirus often don't have symptoms -- spread diseases including influenza, rhinoviruses and coronaviruses.

Milton, who runs the Public Health Aerobiology, Virology, and Exhaled Biomarker Laboratory in the School of Public Health, demonstrated in a 2013 study that surgical masks could help limit flu transmission. However, he cautions that the effect may not be as great outside of controlled settings.

Nevertheless, he said, the chance they could help justifies taking a new look at whether all people should be encouraged to wear them when they venture out of their houses to stores or other populated locations during the current COVID-19 lockdown.

"In normal times we'd say that if it wasn't shown statistically significant or the effective in real-world studies, we don't recommend it," he said. "But in the middle of a pandemic, we're desperate. The thinking is that even if it cuts down transmission a little bit, it's worth trying."

Previous studies have shown that coronavirus and other respiratory infections are mostly spread during close contact, which has been interpreted by some infectious disease specialists to mean that the disease could spread only through contact and large droplets, such as from a cough or sneeze -- a message that has often been shared with the public.

"What they don't understand is that is merely a hypothesis," Milton said. The current study (along with earlier ones) shows, by contrast, that tiny, aerosolized droplets can indeed diffuse through the air. That means it may be possible to contract COVID-19 not only by being coughed on, but by simply inhaling the breath of someone nearby who has it, whether they have symptoms or not. Surgical masks, however, catch a lot of the aerosolized virus as it's exhaled, he said.

The study was conducted at the University of Hong Kong as part of the dissertation research of the lead author, Dr. Nancy Leung, who, under the supervision of the co-senior authors Drs. Cowling and Milton, recruited 246 people with suspected respiratory viral infections. Milton's Gesundheit machine compared how much virus they exhaled with and without a surgical mask.

"In 111 people infected by either coronavirus, influenza virus or rhinovirus, masks reduced detectable virus in respiratory droplets and aerosols for seasonal coronaviruses, and in respiratory droplets for influenza virus," Leung said. "In contrast, masks did not reduce the emission of rhinoviruses."

Although the experiment took place before the current pandemic, COVID-19 and seasonal coronaviruses are closely related and may be of similar particle size. The report's other senior author, Professor Benjamin Cowling, division head of epidemiology and biostatistics, School of Public Health, HKUMed, and co-director of the World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, said, "The ability of surgical masks to reduce seasonal coronavirus in respiratory droplets and aerosols implies that such masks can contribute to slowing the spread of (COVID-19) when worn by infected people."

Milton pointed to other measures his research has found is even more effective than masks, such as improving ventilation in public places like grocery stores, or installing UV-C lights near the ceiling that works in conjunction with ceiling fans to pull air upwards and destroy viruses and bacteria.

"Personal protective equipment like N95 masks are not our first line of defense," Milton said. "They are our last desperate thing that we do."

Hong Kong University contributed to this report.

https://www.sciencedaily.com/releases/2020/04/200403132345.htm

Rapid infectious disease shifts in Chinese children and adolescents prior to COVID-19

Science Daily/Murdoch Children’s Research Institute

Deaths of children and adolescents in China due to infectious diseases were becoming rare prior to the covid-19 pandemic, according to a new study.

Quarantinable conditions with high death rates such as cholera and plague had effectively disappeared and many traditional and vaccine-preventable infectious diseases of childhood including diarrhea, measles and rubella became uncommon.

The research, led by the Murdoch Children's Research Institute (MCRI) and Peking University and published in the British Medical Journal, found the leading causes of death from infectious diseases in China had shifted markedly over a 10 year period from rabies and tuberculosis to HIV/AIDS.

But overall deaths from infectious diseases decreased steadily between 2008-2018 from 0.21 per 100,000 population in 2008 to 0.07 per 100,000 in 2017.

MCRI Professor George Patton said until now no study had reported on recent trends in infectious diseases among children and adolescents in China.

The new research analysed national surveillance data across 31 mainland Chinese provinces. It involved 5 million students aged six to 22 years, and involved 44 notifiable infectious diseases.

Study author Yanhui Dong, from Peking University, said China had made 'remarkable progress' in infectious disease control in this age group.

But Dr Dong said while animal-to-human infections like bird flu remained low, the potential for major outbreaks like SARS-CoV-2 remained a very real possibility.

After the SARS outbreak in 2003, China made substantial investments in laboratory testing, surveillance system enhancement, national intervention programs for specific diseases, and collaboration with international partners.

Professor Patton said despite the progress, China faced new challenges in responding to seasonal and unpredictable new infectious diseases in children and adolescents.

Comprehensive national surveillance systems and rapid proactive government responses would be an integral part of future infectious disease control in China and around the world, he said.

"China will need to continue its successful efforts against older infectious diseases of children and adolescents, including measles, tuberculosis, rabies, and scarlet fever and now scale-up vaccination for mumps, seasonal influenza, and hepatitis B," Professor Patton said.

"Along with the rest of the world, China will also need greater vigilance around the highly transmissible seasonal and unpredictable diseases that we have seen in the past two decades including SARS, MERS, novel influenzas, Zika, Ebola and now the new SARS-CoV-2 virus."

Despite expanding the national childhood immunisation program in 2008, the most common infections in early childhood in China were still vaccine preventable diseases and gastrointestinal and enterovirus diseases, such as hand, foot and mouth disease.

Sexually transmitted diseases and bloodborne infections largely affected older adolescents.

Dr Dong said the significant increase of HIV/AIDs and STI's among 15-24 year olds seemed related to high risk sexual behaviours and poor awareness of infection risks.

"There is a pressing need for more school and university-based sex education programs as well as peer education, and access to rapid testing for sexually transmitted infections," Dr Dong said.

Dr Dong said the data especially highlighted the need for prevention programs to pivot towards a different set of risks, which would also require different interventions.

Researchers from the Chinese Centre for Disease Control and Prevention, the University of Melbourne and The Royal Children's Hospital also contributed to the study.

Key findings for the six to 22 year age group in China included:

• Deaths from infectious diseases has decreased between 2008-2018 from 0.21 per 100,000 population in 2008 to 0.07 per 100,000 in 2017

• Quarantinable conditions with high death rates have effectively disappeared

• Zoonotic infections like bird flu remained low but there is potential for major outbreaks

• Notifiable infectious diseases decreased from 280 per 100,000 in 2008 to 162 per 100,000 in 2015, but rose again to 242 per 100,000 in 2017, largely related to mumps and seasonal influenza

• Most vaccine preventable diseases were at low levels, but seasonal variation in mumps, rubella, measles, and influenza suggested these diseases should remain a priority for public policy

• Vectorborne diseases, such as those transmitted by mosquitoes and fleas, have declined

• Gastrointestinal and enterovirus diseases remained constant, but typhoid, paratyphoid, and dysentery continued to decline

• Tuberculosis remained the most common bacterial infection, although cases of scarlet fever doubled between 2008 and 2017

• Sexually transmitted diseases and bloodborne infections increased significantly. By the end of 2018, 149,000 people with newly diagnosed HIV/AIDS had been reported, 95 per cent of which were sexually transmitted. Of these, 16,000 new HIV/AIDS cases were reported among 15-24 year olds

• Children and adolescents in western China continued to carry a disproportionate burden from infectious diseases

https://www.sciencedaily.com/releases/2020/04/200403103957.htm

COVID-19 vaccine candidate shows promise

April 2, 2020

Science Daily/University of Pittsburgh

University of Pittsburgh School of Medicine scientists today announced a potential vaccine against SARS-CoV-2, the new coronavirus causing the COVID-19 pandemic. When tested in mice, the vaccine, delivered through a fingertip-sized patch, produces antibodies specific to SARS-CoV-2 at quantities thought to be sufficient for neutralizing the virus.

The paper appeared today in EBioMedicine, which is published by The Lancet, and is the first study to be published after critique from fellow scientists at outside institutions that describes a candidate vaccine for COVID-19. The researchers were able to act quickly because they had already laid the groundwork during earlier coronavirus epidemics.

"We had previous experience on SARS-CoV in 2003 and MERS-CoV in 2014. These two viruses, which are closely related to SARS-CoV-2, teach us that a particular protein, called a spike protein, is important for inducing immunity against the virus. We knew exactly where to fight this new virus," said co-senior author Andrea Gambotto, M.D., associate professor of surgery at the Pitt School of Medicine. "That's why it's important to fund vaccine research. You never know where the next pandemic will come from."

"Our ability to rapidly develop this vaccine was a result of scientists with expertise in diverse areas of research working together with a common goal," said co-senior author Louis Falo, M.D., Ph.D., professor and chair of dermatology at Pitt's School of Medicine and UPMC.

Compared to the experimental mRNA vaccine candidate that just entered clinical trials, the vaccine described in this paper -- which the authors are calling PittCoVacc, short for Pittsburgh Coronavirus Vaccine -- follows a more established approach, using lab-made pieces of viral protein to build immunity. It's the same way the current flu shots work.

The researchers also used a novel approach to deliver the drug, called a microneedle array, to increase potency. This array is a fingertip-sized patch of 400 tiny needles that delivers the spike protein pieces into the skin, where the immune reaction is strongest. The patch goes on like a Band-Aid and then the needles -- which are made entirely of sugar and the protein pieces -- simply dissolve into the skin.

"We developed this to build on the original scratch method used to deliver the smallpox vaccine to the skin, but as a high-tech version that is more efficient and reproducible patient to patient," Falo said. "And it's actually pretty painless -- it feels kind of like Velcro."

The system also is highly scalable. The protein pieces are manufactured by a "cell factory" -- layers upon layers of cultured cells engineered to express the SARS-CoV-2 spike protein -- that can be stacked further to multiply yield. Purifying the protein also can be done at industrial scale. Mass-producing the microneedle array involves spinning down the protein-sugar mixture into a mold using a centrifuge. Once manufactured, the vaccine can sit at room temperature until it's needed, eliminating the need for refrigeration during transport or storage.

"For most vaccines, you don't need to address scalability to begin with," Gambotto said. "But when you try to develop a vaccine quickly against a pandemic that's the first requirement."

When tested in mice, PittCoVacc generated a surge of antibodies against SARS-CoV-2 within two weeks of the microneedle prick.

Those animals haven't been tracked long term yet, but the researchers point out that mice who got their MERS-CoV vaccine produced a sufficient level of antibodies to neutralize the virus for at least a year, and so far the antibody levels of the SARS-CoV-2 vaccinated animals seem to be following the same trend.

Importantly, the SARS-CoV-2 microneedle vaccine maintains its potency even after being thoroughly sterilized with gamma radiation -- a key step toward making a product that's suitable for use in humans.

The authors are now in the process of applying for an investigational new drug approval from the U.S. Food and Drug Administration in anticipation of starting a phase I human clinical trial in the next few months.

"Testing in patients would typically require at least a year and probably longer," Falo said. "This particular situation is different from anything we've ever seen, so we don't know how long the clinical development process will take. Recently announced revisions to the normal processes suggest we may be able to advance this faster."

https://www.sciencedaily.com/releases/2020/04/200402144508.htm