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

Lessons from the Spanish flu: Early restrictions lowered disease, mortality rates

March 30, 2020

Science Daily/Loyola University Health System

A review of published data and analysis on the Spanish flu, found that cities that adopted early and broad isolation and prevention measures had disease and mortality rates that were 30% to 50% lower than other cities.

Large events are cancelled, restaurants and non-essential businesses are closed, and in many states, residents have been asked to shelter in place, all to limit the spread and impact of the COVID-19 virus. But are strict and early isolation and other preventative mandates really effective in minimizing the spread and impact of a disease outbreak?

Stefan E. Pambuccian, MD, a Loyola Medicine cytologist, surgical pathologist and professor and vice chair of the Department of Pathology and Laboratory Medicine at Loyola University Chicago Stritch School of Medicine, has reviewed published data and research from three papers dating back to the 1918-19 Spanish flu pandemic, which infected one-fifth to one-third of the world's population and killed 50 million people.

According to the data and analysis, cities that adopted early, broad isolation and prevention measures -- closing of schools and churches, banning of mass gatherings, mandated mask wearing, case isolation and disinfection/hygiene measures -- had lower disease and mortality rates. These cities included San Francisco, St. Louis, Milwaukee and Kansas City, which collectively had 30% to 50% lower disease and mortality rates than cities that enacted fewer and later restrictions. One analysis showed that these cities also had greater delays in reaching peak mortality, and the duration of these measures correlated with a reduced total mortality burden.

"The stricter the isolation policies, the lower the mortality rate," says Dr. Pambuccian. He studied the Spanish flu, including prevention measures and outcomes, to help develop standards for staffing and safety in the cytology lab, where infectious diseases like the COVID-19 virus are diagnosed and studied at the cellular level. His broader article appeared online this week in the Journal of the American Society of Cytopathology.

Like today, not everyone in 1918 and 1919 thought the strict measures were appropriate or effective at the time.

An estimated 675,000 people died in the U.S. from the Spanish flu, "and there was skepticism that these policies were actually working," says Dr. Pambuccian. "But they obviously did make a difference."

In 1918, the world was still at war "with overcrowded barracks," and much of the U.S. lived with "poverty, poor nutrition, poor hygiene, household/community-level crowding, and a lack of preparation of the population and decision makers due to cognitive inertia and poor medical and insufficient nursing care," says Dr. Pambuccian.

"Although the world is a much different place than it was 100 years ago, the efficacy of the measures instituted during the 1918-19 pandemic gives us hope that the current measures will also limit the impact of the COVID-19 pandemic."

https://www.sciencedaily.com/releases/2020/03/200330110344.htm

'Feeling obligated' can impact relationships during social distancing

March 19, 2020

Science Daily/Michigan State University

In a time where many are practicing "social distancing" from the outside world, people are relying on their immediate social circles more than usual. Does a sense of obligation -- from checking on parents to running an errand for an elderly neighbor -- benefit or harm a relationship? A Michigan State University study found the sweet spot between keeping people together and dooming a relationship.

"We were looking to find whether obligation is all good or all bad," said William Chopik, assistant professor of psychology at MSU and co-author of the study. "When we started, we found that people were responding to types of obligations in different ways. People distinguished between requests that were massive obligations and requests that were simple. There's this point that obligation crosses over and starts to be harmful for relationships."

According to Jeewon Oh, MSU doctoral student and co-author of the study, obligation is sometimes the "glue that holds relationships together," but it often carries negative connotations.

"We found that some obligations were linked with greater depressive symptoms and slower increases in support from friends over time," Oh said. "However, other obligations were linked with both greater support and less strain from family and friends initially."

Chopik and Oh's findings suggest that there's a distinct point at which obligation pushes individuals to the brink of feeling burdened, which can start to harm their relationships.

"The line in our study is when it crosses over and starts to be either a massive financial burden or something that disrupts your day-to-day life," Chopik said. "While engaging in substantive obligation can benefit others and make someone feel helpful, it is still costly to a person's time, energy and money."

Until now, similar research showed inconsistencies in how obligation impacts relationships, which Chopik attributes to the spectrum of obligation. This spectrum ranges from light obligation, like keeping in touch with a friend, to substantive obligation, like lending that friend a considerable amount of money.

"In a way, major obligations violate the norms of friendships," Chopik said. "Interestingly, you don't see that violation as much in relationships with parents or spouses."

Chopik explained that friendships are viewed as low-investment, fun relationships that make people feel good.

"Our longest lasting friendships continue because we enjoy them. But if obligations pile up, it might compromise how close we feel to our friends," Chopik said. "Because friendships are a relationship of choice, people can distance themselves from friends more easily than other types of relationships when faced with burdensome obligations."

Additionally, substantive obligations may create strain in a friendship as we try to encourage our friends to do the same even when they might not be able to do so, Oh said.

"Although we may feel good when we do things for our friends, and our friends are grateful to us, we may start to feel like we are investing too much in that relationship," Oh said.

On the other end of the spectrum, light obligation creates what Chopik calls a "norm of reciprocity."

"Those light obligations make us feel better, make us happier and make our relationships stronger," Chopik said. "There's a sense that 'we're both in this together and that we've both invested something in the relationship.'"

That's why, among the best relationships, low-level acts of obligation don't feel like obligations at all. Small acts of kindness, which strengthen the bonds of our relationships, are done without any fuss or burden.

Still, some types of relationships can make even minor obligations seem daunting. If someone doesn't have a great relationship with a parent, a quick phone call to check in isn't enjoyable, it's an encumbrance.

"Even for things we would expect family members to do, some in the study did them begrudgingly," Chopik said.

Chopik and Oh's findings reveal a spectrum of obligations as diverse as the relationships one has in life.

"It's the little things you do that can really enhance a friendship, but asking too much of a friend can damage your relationship," Chopik said.

https://www.sciencedaily.com/releases/2020/03/200319125132.htm

The genetic quest to understand COVID-19

Unlocking the genetic code of the novel coronavirus will help us prevent other diseases

March 26, 2020

Science Daily/University of Sydney

How the novel coronavirus that causes COVID-19 made the leap from animals to humans is a puzzle that scientists are trying to solve as humanity comes to grip with the deadly pandemic sweeping the globe.

At the frontline of this scientific work is Professor Edward Holmes, an evolutionary virologist who holds a joint position with the School of Life and Environmental Sciences and the School of Medical Sciences at the University of Sydney.

He has been working closely with scientists in China and around the world to unlock the genetic code of SARS-CoV-2, which is the virus that causes COVID-19, to understand its origins and assist in the race other scientists are engaged in to find an effective vaccine.

Their work will also help in the monitoring and prevention of other viruses that could potentially transfer from wildlife into humans, causing what are known as zoonotic diseases.

Already this year, Professor Holmes has co-authored four papers on the novel coronavirus, including two of the earliest descriptions of the virus (published in Nature and The Lancet).

This week he publishes two more.

Brought forward for early publication on Thursday by Nature after peer review, the first paper identifies a similar coronavirus to the one now infecting humans in the Malayan pangolin population of southern China. Professor Holmes, a co-author, is the only non-China based academic on the paper.

Understanding the evolutionary pathway by which this novel coronavirus has transferred to humans will help us not only combat the current pandemic but assist in identifying future threats from other coronaviruses in other species.

This paper is an important part of solving that puzzle.

Professor Holmes said: "The role that pangolins play in the emergence of SARS-CoV-2 (the cause of COVID-19) is still unclear. However, it is striking is that the pangolin viruses contain some genomic regions that are very closely related to the human virus. The most important of these is the receptor binding domain that dictates how the virus is able to attach and infect human cells."

The paper identifies pangolins as possible intermediate hosts for the novel human virus that has emerged. The authors call for these animals and others to be removed from wet markets in order to prevent zoonotic transmission to humans.

Professor Holmes said: "It is clear that wildlife contains many coronaviruses that could potentially emerge in humans in the future. A crucial lesson from this pandemic to help prevent the next one is that humans must reduce their exposure to wildlife, for example by banning 'wet markets' and the trade in wildlife."

Just last week Nature Medicine published research co-authored by Professor Holmes with scientists from Scripps Research Institute in La Jolla California, the University of Edinburgh, Columbia University in New York and Tulane University, New Orleans.

That paper has dispelled the fanciful idea that the novel coronavirus was a manufactured biological agent.

Using comparative analysis of genomic data, the scientists show that SARS-CoV-2 is not a laboratory construct or a purposefully manipulated virus.

Professor Holmes said: "There is simply no evidence that SARS-CoV-2 -- the cause of COVID-19 -- came out of a lab. In reality, this is the sort of natural disease emergence event that researchers in the field like myself have been warning about for many years."

That paper has quickly become the highest ranked academic study of all time as measured by Altmetric, a company that monitors media coverage of research papers.

"The high Altmetric is a strong indication of the remarkable global interest in this topic," Professor Holmes said.

And today, Professor Holmes publishes a commentary in the journal Cell with his colleague Professor Yong-Zhen Zhang from the Shanghai Public Health Clinical Centre and the School of Life Science at Fudan University, Shanghai.

In that article they outline our current knowledge of what the genomic data reveals about the emergence of SARS-CoV-2 virus and discuss the gaps in our knowledge.

This includes taking samples from the Wuhan wet market where it is believed the virus originated. The paper says that "genome sequences of 'environmental samples' -- likely surfaces -- from the market have now been obtained and phylogenetic analysis reveals that they are very closely related to viruses sampled from the earliest Wuhan patients."

However, Professor Holmes and Professor Zhang are quick to point out that as "not all of the early [COVID-19] cases were market associated, it is possible that the emergence story is more complicated than first suspected."

The paper says that the SARS-CoV-2 virus is likely to become the fifth endemic coronavirus in the human population. It concludes that "coronaviruses clearly have the capacity to jump species boundaries and adapt to new hosts, making it straightforward to predict that more will emerge in the future."

How we respond to that will require more research to assist develop public health policy.

They point to policy and other measures to help prevent other coronaviruses becoming a health danger to humans. These include:

- Surveillance of animal coronaviruses in a variety of mammalian species. It is known that bats carry many coronaviruses, we know little about what other species carry these viruses and which has the potential to emerge in humans. 

- Increase action against the illegal wildlife trade of exotic animals

- Removal of mammalian and perhaps avian wildlife from wet markets

https://www.sciencedaily.com/releases/2020/03/200326144357.htm

Anxious about COVID-19? Stress can have lasting impacts on sperm and future offspring

Study identifies biological mechanism by which stress alters sperm and impacts brain development in next generation

March 23, 2020

Science Daily/University of Maryland School of Medicine

Prolonged fear and anxiety brought on by major stressors, like the coronavirus pandemic, can not only take a toll on a person's mental health, but may also have a lasting impact on a man's sperm composition that could affect his future offspring. That is the finding of a provocative new study published in the journal Nature Communications by researchers at the University of Maryland School of Medicine.

The research outlines a biological mechanism for how a father's experience with stress can influence fetal brain development in the womb. The effects of paternal stress can be transferred to offspring through changes in the extracellular vesicles that then interact with maturing sperm. Extracellular vesicles are small membrane-bound particles that transport proteins, lipids, and nucleic acids between cells. They are produced in large amounts in the reproductive tract and play an integral role in sperm maturation.

"There are so many reasons that reducing stress is beneficial especially now when our stress levels are chronically elevated and will remain so for the next few months," said study corresponding author Tracy Bale, PhD, Professor of Pharmacology and Director of the Center for Epigenetic Research in Child Health & Brain Development at the University of Maryland School of Medicine. "Properly managing stress can not only improve mental health and other stress-related ailments, but it can also help reduce the potential lasting impact on the reproductive system that could impact future generations."

She and her colleagues did not specifically study those who were under stress due to the coronavirus pandemic.

To examine a novel biological role for extracellular vesicles in transferring dad's stress to sperm, the researchers examined extracellular vesicles from mice following treatment with the stress hormone corticosterone. After treatment, the extracellular vesicles showed dramatic changes in their overall size as well as their protein and small RNA content.

When sperm were incubated with these previously "stressed" extracellular vesicles prior to fertilizing an egg, the resulting mouse pups showed significant changes in patterns of early brain development, and as adults these mice were also significantly different than controls for how they responded to stress themselves.

To see if similar differences occurred in human sperm, the researchers recruited students from the University of Pennsylvania to donate sperm each month for six months, and complete questionnaires about their perceived stress state in the preceding month. They found that students who had experienced elevated stress in months prior showed significant changes in the small RNA content of their sperm, while those who had no change in stress levels experienced little or no change. These data confirm a very similar pattern found in the mouse study.

"Our study shows that the baby's brain develops differently if the father experienced a chronic period of stress before conception, but we still do not know the implications of these differences," said Dr. Bale. "Could this prolonged higher level of stress raise the risk for mental health issues in future offspring, or could experiencing stress and managing it well help to promote stress resilience? We don't really know at this point, but our data highlight why further studies are necessary."

The research team did find that stress-induced changes in the male reproductive system take place at least a month after the stress is attenuated and life has resumed its normal patterns. "It appears the body's adaptation to stress is to return to a new baseline," Dr. Bale said, "a post-stress physiological state -- termed allostasis."

This research was funded by the National Institute of Mental Health and included co-authors from the Institute for Genome Sciences at the University of Maryland School of Medicine and the Department of Pharmaceutical Science at the University of Maryland School of Pharmacy, as well as the University of Pennsylvania.

"This research represents a critical step in understanding important mechanisms that underlie the field of intergenerational epigenetics," said UMSOM Dean E. Albert Reece, MD, PhD, MBA, who is also the Executive Vice President for Medical Affairs, University of Maryland, and the John Z. and Akiko K. Bowers Distinguished Professor. "Such knowledge is crucial to identify early interventions to improve reproduction and early childhood development down the road."

While the study did not test stress management interventions to determine what effects they might have on attenuating the changes in sperm composition, Dr. Bale, who goes for regular runs to reduce the stress of the current COVID-19 pandemic, contends that any lifestyle habits that are good for the brain are likely good for the reproductive system.

"It is important to realize that social distancing does not have to mean social isolation, especially with modern technologies available to many of us," said Joshua Gordon, Director of the National Institute of Mental Health in his web message about coping with coronavirus. "Connecting with our friends and loved ones, whether by high tech means or through simple phone calls, can help us maintain ties during stressful days ahead and will give us strength to weather this difficult passage."

The Centers for Disease Control and Prevention has tips on "stress and coping" page on their COVID-19 site that recommends the following to "support yourself":

• Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting.

• Take care of your body. Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep, and avoid alcohol and drugs.

• Make time to unwind. Try to do some other activities you enjoy.

• Connect with others. Talk with people you trust about your concerns and how you are feeling.

https://www.sciencedaily.com/releases/2020/03/200323132410.htm

How to manage cancer care during COVID-19 pandemic

March 18, 2020

Science Daily/National Comprehensive Cancer Network

Experts from the Seattle Cancer Care Alliance (SCCA) -- a Member Institution of the National Comprehensive Cancer Network® (NCCN®) -- are sharing insights and advice on how to continue providing optimal cancer care during the novel coronavirus (COVID-19) pandemic. SCCA includes the Fred Hutchinson Cancer Research Center and the University of Washington, which are located in the epicenter of the COVID-19 outbreak in the United States.

"Responding quickly and confidently to the COVID-19 crisis is the health care challenge of our generation," said co-lead author F. Marc Stewart, MD, Medical Director, SCCA. "Our overarching goal is to keep our cancer patients and staff safe while continuing to provide compassionate, high-quality care under circumstances we've never had to face before. We are working around the clock to develop new guidelines and policies to address situations that we couldn't have imagined several weeks ago. When the pandemic ends, we will all be proud of what we did for our patients and each other in this critical moment for humanity."

"The COVID-19 pandemic is impacting every facet of our global and domestic societies and health care systems in unprecedented fashion," said Robert W. Carlson, MD, Chief Executive Officer, NCCN. "People with cancer appear to be at increased risk of COVID-19, and their outcomes are worse than individuals without cancer. The NCCN Member Institutions are rapidly gaining experience in preventing and managing COVID-19. As is the nature of the NCCN Member Institutions, they are sharing their experience in organizing and managing institutional and care systems responses and best practices in this rapidly evolving global effort."

The article stresses the importance of keeping channels of communication open between administrators and staff, patients, caregivers, and the general public. The authors recommend forming an Incident Command Structure (as illustrated below) to provide early coordination of institution-wide efforts and to rapidly respond to changing information. They highlight the need to remain flexible and ready for unexpected challenges.

Some of the anticipated challenges include:

• Staff shortages due to potential exposure and/or school closings

• Limitations of resources such as hospital beds, mechanical ventilation, and other equipment

• Impact on treatment from travel bans, including reduced access to international donors for allogeneic stem cell transplantation

The authors recommend mitigating some of these concerns through proactive measures that include:

• Providing patient information via handouts, signs, web-based communication, and a dedicated phone line for questions and triage

• Rescheduling "well" visits and elective surgeries, and deferring second opinion consultations (where care is already appropriately established)

• Increasing hours of general hospital operations to reduce the unnecessary use of emergency department resources

• Reinforcing a strict "stay at home when ill" policy and insuring staff have access to testing

• Restricting travel and enabling work-from-home wherever possible

• Prioritizing the use of soap and water over hand gel

• Limiting the number of team members who enter patients' rooms

• Considering lower thresholds for blood transfusions

• Moving some procedures from inpatient to outpatient

• Adopting a no visitor policy with rare exceptions such as end-of-life circumstances

• Having upfront, proactive palliative and end-of-life conversations with cancer patients who may become infected with COVID-19

The article also addresses the importance of self-care within and beyond the medical community. The authors call for the prioritization of measures to protect health and frontline staff and assure a safe work environment in order to prevent provider burnout. Those measures include compensation policies, reassignments to administrative roles for immunocompromised staff, and the creation of a back-up labor pool.

NCCN is also gathering documents and links from the leading cancer centers that comprise the nonprofit alliance, and sharing them all online at NCCN.org/covid-19. These include print outs for patient information, screening tools, visitation policies, and other essential forms. Hospitals worldwide are free to use or adapt these resources immediately. The site will be continuously updated as new resources become available.

Article link at NCCN.org/covid-19.

https://www.sciencedaily.com/releases/2020/03/200318143632.htm

Median incubation period for COVID-19

March 17, 2020

Science Daily/University of Massachusetts Amherst

A new study calculates that the median incubation period for COVID-19 is just over 5 days and that 97.5% of people who develop symptoms will do so within 11.5 days of infection.

A University of Massachusetts Amherst biostatistician who directs the UMass-based Flu Forecasting Center of Excellence was invited by the White House Coronavirus Task Force to participate Wednesday morning in a coronavirus modeling webinar.

The four-hour, virtual gathering will include 20 of the world's leading infectious disease and pandemic forecasting modelers, from researchers at Harvard, Johns Hopkins and the Centers for Disease Control and Prevention (CDC) in the U.S. to those based at institutions in England, Hong Kong, South Africa and the Netherlands.

According to the White House Coronavirus Task Force coordinator Dr. Charles Vitek, "This webinar is designed to highlight for the Task Force what modeling can tell us regarding the potential effects of mitigation measures on the coronavirus outbreak. The unprecedented speed and impact of the nCoV-19 epidemic requires the best-informed public health decision-making we can produce."

Nicholas Reich, associate professor in the School of Public Health and Health Sciences, heads a flu forecasting collaborative that has produced some of the world's most accurate models in recent years. He and postdoctoral researcher Thomas McAndrew have been conducting weekly surveys of more than 20 infectious disease modeling researchers to assess their collective expert opinion on the trajectory of the COVID-19 outbreak in the U.S. The researchers and modeling experts design, build and interpret models to explain and understand infectious disease dynamics and the associated policy implications in human populations.

Reich is co-author of a new study in the Annals of Internal Medicine that calculates that the median incubation period for COVID-19 is just over five days and that 97.5 percent of people who develop symptoms will do so within 11.5 days of infection. The incubation period refers to the time between exposure to the virus and the appearance of the first symptoms.

The study's lead author is UMass Amherst biostatistics doctoral alumnus Stephen Lauer, a former member of the Reich Lab and current postdoctoral researcher at the Johns Hopkins Bloomberg School of Public Health.

The researchers examined 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. They conclude that "the current period of active monitoring recommended by the U.S. Centers for Disease Control and Prevention [14 days] is well supported by the evidence."

https://www.sciencedaily.com/releases/2020/03/200317175438.htm