Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts

April 27, 2020

Beating the COBID-19 Virus in Developing Countries




 
The fight against coronavirus will not be won until every country in the world can control the disease. But not every country has the same ability to protect people.
For low-income countries that struggle with weak health systems, large populations of impoverished people and crowded megacities, "there needs to be a very major adaptation" to the established measures we've been using to fight COVID-19, says Dr. Wafaa El-Sadr, an epidemiologist and director of ICAP, a global health organization at Columbia University. 
The COVID-19 playbook that wealthy nations in Europe, Asia and North America have come to know — stay home as much as possible, keep a six foot distance from others, wash hands often — will be nearly impossible to follow in much of the developing world. 
"I think they're trying, but it's not easy," El-Sadr says. "Ministries of health are working, partnering with international organizations to try to innovate — and hopefully, if the innovation works, it can be scaled up."
Here are some of the solutions now being tried.

Fly in tons of medical gear

Problem: Countries in the developing world face massive shortages of medical gear like personal protective equipment, says Avril Lenoir, executive director of Doctors Without Borders. And the cutback in commercial flights has made it difficult to bring in equipment.
Solution: The U.N. has launched what it's calling "solidarity flights" – hiring charter planes to airlift millions of face masks, face shields, goggles, gloves, gowns and other supplies. On April 14, the U.N. dispatched an Ethiopian Airlines charter flight from Addis Ababa full of COVID-19 gear to transport to countries in need. 
"This is by far the largest single shipment of supplies since the start of the pandemic, and we will ensure that people living in countries with some of the weakest health systems are able to get tested and treated," said Dr. Ahmed Al-Mandhari, WHO regional director for the Eastern Mediterranean in a statement.
Assessment: "In the short run, a program like this is fine so long as we're dealing with an acute event," says El-Sadr. "Without [supplies like] PPE, you're at risk of losing your scarce and precious health workforce — and you want to protect them at any cost."
But hiring chartered flights to deliver any kind of aid – instead of commercial flights – is expensive, says Manuel Fontaine, director of emergency programs at UNICEF. The U.N. is calling on donors to provide $350 million to continue this program; so far, it has received $84 million.

Create safe havens for the sick and elderly

Problem: How do you protect the most vulnerable individuals in crowded cities and refugee camps? And how do you keep infected individuals from spreading the disease?
Solution: Health authorities are trying out a somewhat controversial strategy: separating the sick and those at high risk, moving them from the homes where they might live alone or with an extended family into vacant homes or taking over facilities previously used for other purposes, such as learning centers. The people being targeted include the elderly and those with preexisting health conditions that make them susceptible to COVID-19 — as well as the homeless. 
The strategy has been cited by several health researchers as a practical way to control the spread of disease in densely packed communities. Francesco Checchi of the London School of Tropical Health and Medicine wrote a paper on the subject, and Dr. Paul Spiegel of Johns Hopkins University, in another paper, recommended this as a potential solution in refugee settings.
Assessment: In his paper, Spiegel warns that the strategy of isolating these groups are "novel and untested." And thus far, in parts of the developing world where the strategy has been rolled out, it has had mixed results.
Shah Dedar, an aid worker with the humanitarian group HelpAge, says that religious and community leaders among the Rohingya refugees in Bangladesh don't like the idea of taking the sick or the elderly from the families who might care for them. But "elderly men and women with chronic diseases [who lived alone] were very much keen to the idea and appreciated the initiative," says Dedar.
While HelpAge was able convince local Rohingya leaders to give it a try, Spiegel of Johns Hopkins University says that this may not always be possible. In the case of a severe outbreak, aid workers may have to forcibly separate populations, whether the community approves or not. And he warns that this shielding measure is no guarantee it will keep the virus at bay — it could spread within these facilities, as has happened at some nursing homes in the U.S.
And in Cape Town, South Africa, conditions in a homeless "camp" set up by the government have prompted complaints from the residents about close contact and lack of sanitation — and a call from Doctors Without Borders to shut it down.

Get out of town

Problem: Some citizens are afraid of staying in big cities where social distancing is hard to maintain and outbreaks are more likely to spread.
Solution: Those who have family in ancestral homelands are traveling back to stay in these rural environments – it's happened in countries ranging from Bangladesh to Italy.
Assessment: Both government officials and citizens have criticized this exodus,saying that it puts elderly people in those rural environments at risk if the city dwellers might be contagious yet asymptomatic or presymptomatic.
The other downside of fleeing to these more remote areas, says El-Sadr, is that "health care services are less likely to be available."
That said, El-Sadr notes that this kind of population shift can be a good strategy in an area where transmission within a community has not yet occurred but is deemed likely. This could be a "way that people can have more of an ability to survive, to make a living, get social support [if they are sick], get more access to food, where they can socially distance more readily."

Get the police involved

Problem: Social distancing is hard to enforce in densely populated low-income countries. 
Solution: Many governments around the world have turned to the police to ensure that people stay home — and hand out punishments to those who aren't following the lockdown rules. In India, for example, people who violate the lockdown could face up to a year in prison. Others in the country have faced unusual punishments, such as writing "I am very sorry" 500 times, according to an NPR report
Assessment: Unfortunately, there have been reports of officers using physical violence to keep people in their homes in several countries, including India, Bangladesh and the Philippines. In Kenya, the violence has resulted in public outcry, with citizens calling for more civility from its police force. "This is no way to fight a coronavirus epidemic," tweeted a Kenya-based journalist. 

Reinvent factories so they can make medical equipment

Problem: More supplies to fight COVID-19 are needed.
Solution: Get factories to switch gears and respond to the coronavirus.Kenya's textile industry has pivoted to making masks and protective equipment. The Kitui County Textile Center (KICOTEC) has shifted from sewing chef's whites and school uniforms to turning out face masks and scrubs for healthcare workers. Kenya's state-owned oil company is now making hand sanitizer, which it says it is distributing for free.
In South Africa, the state-owned missile manufacturer Denel, has been working to design and build ventilators, and to convert armored trucks into ambulances. The government has launched an initiative called the National Ventilator Project, which calls for companies to build 10,000 ventilators by the end of June, using locally available parts and materials.
Similar efforts are underway in Nigeria, where the government announced that they're working with car companies to manufacture locally-made ventilators. 
Assessment:
In Kenya, KICOTEC turning out 30,000 surgical masks a day, according to Kenya's Ministry of Health. Kenya's petroleum company has produced more than 80,000 gallons so far, and plans to make at least 600,000 gallons more. 
But WHO projects that countries will need millions of masks, goggles and other supplies to protect healthcare workers and citizens while mounting a response to COVID-19. 
So local manufacturing can only partly fill the gap. But local authorities believe it is critical: "We're trying to build up local capacity to ensure that the critical facilities, the beds and ventilators, respirators could be made available within the country," says Adaeze Oreh, a senior official in Nigeria's Ministry of Health, "So we're not constrained by international travel restrictions, border closures and relying on imports."

Set up handwashing stations

Problem: Public health officials globally stress the importance of frequent hand-washing in the fight against COVID-19. In low- and middle-income countries, however, 35% of people lack regular access to soap and water, according to WHO.
"The health workers say we must wash our hands," said Zukwisa Qezo, a 47-year-old mother of two who lives in the Cape Town township to NPR. "But with what?! The city must bring us soap."
Solution: To improve the ability for people to clean their hands, WHO advises that hand hygiene stations — either with soap and water or with alcohol-based hand sanitizer — to be placed at the entrances of buildings, and in transport hubs such as bus and train stations. The system can be as simple as two buckets — one filled with chlorinated water, and one to catch the wastewater.
Assessment: Public hand-washing stations, which were effective in the fight against Ebola, are being resurrected in countries such as Liberia and Sierra Leone, NPR reports. Doctors Without Borders reports that their volunteers are setting up hand washing points in many of the settings they operate in, including migrant camps in Nigeria and health facilities in Mozambique.

April 12, 2020

Coronavirus Seems to Be Taking Men at Higher Rates Than Women




                          Why is the coronavirus so much more deadly for men than for women ...




As the coronavirus sweeps across the globe, one pattern remains consistent: Men seem harder hit by the virus than women and are more likely to have severe illness or die.
At least in the United States, however, it seems that men are less likely to seek out testing for the virus when they feel sick.
"This is to all of our men out there, no matter what age group: If you have symptoms, you should be tested and make sure that you are tested," Dr. Deborah Birx, the White House's coronavirus response coordinator, said on Thursday.
Data from around 1.5 million tests done in the U.S. show that the majority of people tested, 56%, were women. Of those women, 16% tested positive for the virus. In contrast, only 44% of the tests were done on men. And 23% of them tested positive.
"It gives you an idea about how men often don't present in the health-care delivery system until they have greater symptomatology," said Birx – that is, until they're showing more signs of disease.
That's a concern because experts believe this virus poses more dangers for men, perhaps because of biological differences between men and women.
Sabra Klein, a researcher at the Johns Hopkins Center for Women's Health, Sex, and Gender Differences, began noticing hints of a sex difference in COVID-19 infections back in February as reports began to emerge from China. She knew that an increased risk to men has been observed for other severe coronaviruses that have appeared in the past.
"What I was seeing was a pattern that held true in the SARS outbreak that occurred in Hong Kong," she says, "as well as the ongoing MERS outbreak in the Middle East."
One large study of 44,672 confirmed COVID-19 cases done by the Chinese Center for Disease Control and Prevention, for example, found that the fatality rate was 2.8% for men compared with only 1.7% for women.
While some initially suggested that the much higher rate of cigarette smoking among men in China might be to blame, Klein doubts that explanation.
"What we saw in Wuhan has been replicated in every country around the world where we have accurate reporting," says Klein. "In countries like Spain, where the percentages of males and females who report smoking is not significantly different, we still are seeing this profound male bias in severity of COVID-19."
In Italy, one study of 1,591 cases of critically ill people who were admitted into intensive care units showed that about 82% of them were men.
And a study of people hospitalized in the U.S. for COVID-19 in March similarly found that "males may be disproportionately affected by COVID-19 compared with females."
Public health information from the city of New York, which has one of the world's largest outbreaks, shows that men are more likely to be hospitalized and are nearly twice as likely to die. The city's department of health reports about 39 female deaths per 100,000 people and 71 male deaths per 100,000 people.
Scientists know that, in general, women tend to have greater and more robust immune responses. This can be a double-edged sword; autoimmune diseases are more common in women. But it may mean that women are more protected against novel invading germs.
"My hypothesis would be, maybe females are actually mounting an initial immune response to a greater degree than our male counterparts," says Klein, who has just been awarded funding from the National Institutes of Health to study the biological differences between men and women who are infected with COVID-19.
Studies of HIV and hepatitis C show that women can have a stronger immune reaction to viruses. "There are examples. There are not a lot. And I think part of that is because this has been a grossly understudied area," says Klein.
Women have often been excluded from biomedical research, she explains. Historically, that was meant to protect women of childbearing age who might be pregnant, but over time it became scientific dogma that men and women's bodies, other than their reproductive systems, basically weren't that different.
But sex hormones like testosterone and estrogen seem to be important in modulating the immune response, says Veena Taneja of the Mayo Clinic, who studies differences in male and female immune systems.
What's more, she says, women also have two copies of the X chromosome, while men have only one.
"The X chromosome has lots of immune-response genes," Taneja says.
While women's extra X chromosome is generally silenced, she says, "almost around 10% of those genes, they can be activated. Many of those genes are actually immune-response genes."
That makes it possible, she says, that women get a "double-dose" of protection — although it's still too soon to know exactly how all this might play out in the context of COVID-19.
What is clear, however, is that being male may be a risk factor just like other traits that might make one more vulnerable — for example, being older or having certain medical conditions like asthma or heart disease.
All of this may be why Birx felt compelled to deliver a special message to men during her daily briefing at the White House, saying, "I see a lot of men in the audience today. I just want to remind them about the importance of health care."

April 1, 2020

Can A Mask Help in COVID-19? New CDC Guidelines and Pros and Cons


NYC declares face mask shortage to stop coronavirus price-gouging
 NY  has a shortage on this type of Masks
                                                        




Back when there were only few confirmed cases of coronavirus in the U.S., the Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services and the U.S. Surgeon General all pled with the public urging them not to wear face masks unless they were sick or caring for someone who was sick. 
Today, there are thousands of cases of COVID-19 across America — and a growing movement to encourage mask usage in the U.S., even as health-care professionals grapple a severe shortage of protective equipment, including face masks and gowns as they treat coronavirus patients.
On social media, the #Masks4All campaign was started by Jeremy Howard, a distinguished research scientist at the University of San Francisco and a member of the World Economic Forum’s Global AI Council. The #Masks4All movement doesn’t just push for people to wear masks, but also to make their own face masks at home to ensure that health-care workers have access to supplies. 
In an opinion piece for the Washington Post, Howard said, “The senseless and unscientific push for the general public to avoid wearing masks” should rank among the worst missteps made by policy makers. 
That perspective was echoed by George Gao, director-general of the Chinese Center for Disease Control and Prevention in an interview with Science magazine
“The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks,” Gao said. “This virus is transmitted by droplets and close contact. Droplets play a very important role — you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth,” Gao continued. “Many people have asymptomatic or presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.”
Multiple studies have indicated that people may display few symptoms but have the coronavirus, while others may be contagious before they begin to display symptoms. These asymptomatic individuals have complicated government efforts to contain the spread of the coronavirus across the globe.
Some previous research has concluded that face masks have helped reduce contagion by reducing droplets being sprayed into the air during flu season; another Japanese-based study says this works when paired with vaccination, not an option in this case. This study says N95 medical-grade masks do help filter viruses that are larger than 0.1 micrometers (One micrometer, um, is one millionth of a meter.) The coronavirus is 0.125 um. 
Proponents of face masks also point to the anecdotal evidence from countries in East and Southeast Asia, including South Korea and Taiwan, that have been able to slow the spread of the novel coronavirus and flatten the curve more effectively than in countries like the U.S., Spain and Italy.
Mask usage is more ubiquitous in these countries in general as a hygienic practice even outside of instances of global disease outbreaks. “In all of these countries, all of which were hit hard by the SARS respiratory virus outbreak in 2002 and 2003, everyone is wearing masks in public,” Howard wrote.
Recently, some Western countries have required residents to wear face masks. The Czech Republic, Slovakia and Bosnia-Herzegovina now require people to wear masks in public, while nearby Austria requires their use in grocery stores.
KK Cheng, a public-health expert and professor at the University of Birmingham in the U.K, said he wears a mask when he goes to the supermarket and supports Austria’s decision to mandate masks there.
“I think it’s a good idea because trips to the supermarket are the main exposure to the virus,” especially in areas where they are the only businesses that are open, he said. 
The World Health Organization and the CDC continue to stand by their recommendations from earlier in the coronavirus outbreak. They argue that mask usage should be limited to people who have COVID-19 or may have contracted the illness and their caregivers, including health-care workers. 
“There is no specific evidence to suggest that the wearing of masks by the mass population has any particular benefit,”(???)
— Dr. Michael Ryan, the World Health Organization’s top emergencies expert
 “There is no specific evidence to suggest that the wearing of masks by the mass population has any particular benefit,” Dr. Michael Ryan, WHO’s top emergencies expert, said during a press conference Monday.
Similarly, the CDC still “does not recommend that people who are well wear a face mask to protect themselves from respiratory illnesses, including COVID-19.” (Guidelines Changed today)
“You should only wear a mask if a health-care professional recommends it,” the CDC said in a statement online. “A face mask should be used by people who have COVID-19 and are showing symptoms. This is to protect others from the risk of getting infected.” 
But in a comment published in The Lancet, a medical publication, a group of researchers from Hong Kong argued that the lack of studies proving masks to be effective didn’t mean they weren’t. 
“There is an essential distinction between absence of evidence and evidence of absence,” they wrote. “Face masks are widely used by medical workers as part of droplet precautions when caring for patients with respiratory infections. It would be reasonable to suggest vulnerable individuals avoid crowded areas and use surgical face masks rationally when exposed to high-risk areas.”
While face masks may help protect people, they are hard to come by
In many countries, including the U.S., a shortage of masks has endangered doctors and nurses treating patients with COVID-19. Health-care professionals have warned that they may need to reuse masks as a result, which can reduce their effectiveness. Multiple fashion designers have even lent their services in making masks to combat this shortage. 
“We have a massive global shortage,” Ryan said. “Right now, the people most at risk from this virus are frontline health workers who are exposed to the virus, every second of every day. The thought of them not having masks is horrific. So we have to be very careful.”
A spokesman for the CDC noted that officials could reserve face masks for health-care workers, meaning they are less likely to be available for non-health care. “You may need to improvise a face mask using a scarf or bandana,” the CDC said in a post which was last updated on March 25. (Balaclavas may also provide some protection.)
N95 masks, however, are tighter-fitting than surgical masks and protect against small particles and large droplets, according to the CDC. These types of masks offer the most protection from viruses similar to coronavirus. 
For health-care professionals who cannot be six feet apart from patients with COVID-19, there are few substitutes to N95 masks. Surgical masks, the CDC says, should be worn if N95 masks are “so limited that routinely practiced standards of care for wearing N95 respirators and equivalent or higher level of protection respirators are no longer possible.” 
As a last resort if both surgical and N95 masks aren’t available, the CDC says it “may be necessary” for them to use homemade masks that haven’t been approved by the National Institute for Occupational Safety and Health.
Proponents of face-mask usage have suggested that people fashion their own protective gear. “A homemade DIY mask would be better than nothing,” in terms of limiting transmission of coronavirus, Cheng said.
It’s not clear whether people making masks at home should choose certain materials over others. “If the WHO and other authorities think it’s a good thing for the public to wear masks,” Cheng said health authorities around the world would likely investigate which materials offer the best protection for a DIY mask. 

January 5, 2020

Many Humans Love to Insert Stuff In Their Body Cavities





We Americans as a people are extremely good at shoving things inside ourselves. We are slightly less good at getting them back out without the aid of trained medical personnel. 
For a decade I've been chronicling our country's cavity misadventures, and I've learned several things. First is that it's dangerous to be horny. (The sheer number of sex toys removed in emergency rooms is too high to include on this list, for the most part.) Second is that men are far, far stupider than women when it comes to estimating what will fit and what will be retrievable. This is obvious, but it's nice to have the data to back it up. The third is that the human body is a wondrous thing, but the human imagination is even stronger. 
All reports are taken from the U.S. Consumer Product Safety Commission’s database of emergency room visits, and all descriptions are verbatim. Objects are sorted by orifice, working south:

EAR

  • 2 WIRELESS EARBUDS
  • JEWEL
  • “SISTER PUT LONG SLENDER TOY IN PATIENT'S EAR”
  • METAL PIECE OF SHIRT
  • ROCK SALT
  • BERRY
  • “PATIENT SAYS SHE HAD WAX IN-EAR & ATTEMPTED TO REMOVE WITH TWEEZERS & PIECE OF STRING”
  • PAPER IN BOTH EARS
  • “PLACED THERMOMETER IN-EAR, FELL ON BED”
  • JUICE BOX STRAW
  • PEARL
  • WOOD CHIP
  • MICROCHIP
  • DECORATIVE SEASHELL
  • TOOTH OF COMB
  • ZIP TIE
  • SLIME
  • PLASTIC SPIDER
  • CHRISTMAS ORNAMENT

NOSE

  • 2 RARE EARTH MAGNETS
  • SMALL HEART STICKER
  • 2 BUTTON BATTERIES
  • BATH BEAD
  • CHALK
  • “BUG, TRIED TO REMOVE WITH BOBBY PIN, BOBBY PIN NOW STUCK”
  • CANDY WRAPPER
  • GOOGLY EYE
  • MOTHBALL
  • SUNFLOWER SEED
  • CHRISTMAS ORNAMENT

THROAT

  • FIDGET SPINNER
  • CONDOM
  • “7 NUTS FROM THE CHRISTMAS TREE MOM AND DAD WERE TAKING DOWN”
  • LASER POINTER
  • TAPE DISPENSER
  • DECORATIVE ROCK
  • PIECE OF BED
  • TROPICAL BREEZE DETERGENT POD
  • “SWALLOWED 3 BUTTON BATTERIES LAST PM & THUMBTACK THIS AM B/C 'THEY TASTE GOOD'”
  • FUSE
  • CAPSULE THAT EXPANDS INTO A-FOAM DINOSAUR
  • PLASTIC SWORD
  • “SWALLOWED STAMP INK PAD THAT HE RECEIVED AS A PRIZE AT THE DENTIST'S OFFICE”
  • CLEANING SOLUTION, RAZOR BLADE COVERED IN TOILET PAPER, BROKEN PLASTIC SOAP DISH
  • STUFFED BIRD
  • “ABOUT 10” PUZZLE PIECES
  • “HAD NECKLACE IN MOUTH TRYING TO UNTANGLE IT & ACCIDENTALLY SWALLOWED IT”
  • GLASS CHRISTMAS TREE LIGHT
  • ICE CREAM CUP LID
  • DRILL BIT
  • HEARING AID
  • KEY
  • “SWALLOWED A THUMBTACK THAT SHE THOUGHT WAS A MINT”
  • CHRISTMAS ORNAMENT

PENIS

  • CRAYONS
  • MARKER CAP
  • CHOPSTICK
  • BALLPOINT PEN
  • PIECE OF TOY PLIERS
  • LOLLIPOP STICK
  • COAXIAL CABLE
  • WEDDING RING
  • MAGNETS
  • SCREWDRIVER
  • BOBBY PIN, “UNABLE TO ACHIEVE ERECTION & THOUGHT IT WOULD HELP”

VAGINA

  • TOOTHBRUSH
  • “A METAL AND PLASTIC CONTAINER”
  • TAPE
  • “WAS BEING ARRESTED BY THE POLICE SO SHE TOOK HER CELL PHONE AND HID IT FROM THEM - STUCK IT IN HER VAGINA”
  • PERFUME BOTTLE
  • MAKEUP SPONGE
  • LARGE PIECE OF UNDERWEAR
  • TOY ACTION FIGURE
  • RUBBER BALL
  • “JUMPED OFF COUCH LANDED ON SPOON”

RECTUM

  • “PATIENT STATES: HE STATES SLIPPED IN THE SHOWER AND LANDED ON A METAL AIR FRESHENER CAN AND IT WENT INTO RECTUM”
  • FOLDING KNIFE
  • PLASTIC TOY, “ABOUT 6 INCHES LONG”
  • TOOTHPICK
  • TOOTHBRUSH
  • TOOTHBRUSH HOLDER
  • PLUNGER HANDLE
  • MATTRESS FOAM
  • TWO RAZOR BLADES
  • TWO SMALL VIBRATORS
  • TURKEY BASTER
  • CONDOM WRAPPER
  • COAT HANGER, “PATIENT UNSURE HOW IT GOT THERE”
  • GARDEN HOSE CAP
  • CIGARETTE LIGHTER
  • TOY HOCKEY STICK
  • WATER GUN
  • BAG OF HEROIN
  • COINS
  • EGG TIMER
  • SMALL SHAMPOO BOTTLE
  • LARGE SHAMPOO BOTTLE
  • LIGHT BULB
  • APPLE SAUCE CAN
  • “ACCIDENTALLY GOT A DILDO LODGED IN RECTUM & CUT THE END OF THE DILDO OFF”
  • “STUCK A 4 INCH BUTT PLUG UP RECTUM YESTERDAY, HANDLE BROKE. HE CONTINUED TO PUSH THE TOY IN”
  • “WAS USING PROSTATE MASSAGER & IT GOT 'SUCKED IN'”'
  • CHRISTMAS ORNAMENT
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