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Monthly Archives: July 2020
Fauci has been an example of conscience and courage.
But for rash, foolish irresponsibility, I’d nominate the opposition research paper recently circulated by the White House in an attempt to discredit the National Institute of Allergy and Infectious Diseases’ Anthony S. Fauci. As reported by The Post, the document recounted a number of instances — on community transmission, asymptomatic transmission and mask wearing in particular — where Fauci’s views have shifted over time. As far as I know, this official record is unique: A White House attack on the government’s leading infectious-disease specialist during a raging pandemic. It indicates an administration so far gone in rage, bitterness and paranoia that it can no longer be trusted to preserve American lives.
From a purely political standpoint, it is understandable that the administration would want to divert attention from its covid-19 record. Trump’s policy of reopening at any cost is exacting a mounting cost. Five months into the greatest health crisis of modern U.S. history, there are still serious problems with supply chains for protective equipment. There are still long wait times for testing results in many places. The contact tracing process in many communities remains (as one health expert described it to me) “a joke.” More than 132,000 Americans have died.
Rather than addressing these failures, Trump has chosen to sabotage a public official who admits their existence. Rather than confronting these problems, Trump wants to ensure his whole administration lies about them in unison. The president has surveyed America’s massive spike in new infections and thinks the most urgent matter is . . . message discipline.
It is true that a number of Fauci’s views on the novel coronavirus have evolved (though some of the administration’s charges against him are distorted). But attacking a scientist for making such shifts is to willfully misunderstand the role of science in the fight against disease. We do not trust public health officials during an emerging pandemic because they have fully formed scientific views from the beginning. We trust them because 1) they are making judgments based on the best available information and 2) they have no other motive than the health of the public. If, say, health officials were initially mistaken about the possibility of asymptomatic transmission, it is not failure when they change their views according to better data. It is the nature of the scientific method and the definition of their duty.
In the inch-deep world of politics, amending your view based on new information is a flip-flop. In epidemiology, it is known as, well, epidemiology.
Meanwhile, the president is failing according to both requirements of public trust. Trump is not making judgments based on the best available information. And he clearly has political goals that compete with (and often override) his commitment to public health. The president is hoping against hope that the public will forget about the virus until November, or at least about the federal role in fighting it. To apply a veneer of normalcy, he is holding public events that endanger his staff and his audience and is planning a Republican convention that will double as a petri dish.
It now seems likely that the most decisive moment of the American pandemic took place in mid-April when new cases began to stabilize around 25,000 a day. Even four or six more weeks of firm presidential leadership — urging the tough, sacrificial application of stay-at-home orders — might have reduced the burden of disease to more sustainable levels, as happened in Western Europe. And this would have relieved stress on systems of testing, tracing and treatment.
But Trump’s nerve failed him. Instead of holding firm, he began siding with populist demands for immediate opening, pressuring governors to take precipitous steps and encouraging skepticism about basic public health information and measures. This may well have been the defining moment of the Trump presidency. And he was weak, weak, weak.
It is typical for Trump to shift blame. But in this case, the president has selected his fall guy poorly. Fauci has been an example of conscience and courage in an administration that values neither. When Trump encourages a contrast to his own selfishness and cravenness, he only damages himself.
Does Delirium Cause Long-Term Cognitive Decline?
Analysis has “great implications in the COVID era”
Delirium was linked to long-term cognitive decline in both surgical and nonsurgical patients, a meta-analysis showed.
Patients who experienced an episode of delirium were more than twice as likely to show long-term cognitive decline than patients without delirium (OR 2.30, 95% CI 1.85-2.86), reported Terry Goldberg, PhD, of Columbia University in New York City, and co-authors.
Delirium was associated with long-term cognitive decline with a Hedges g effect size of 0.45 (95% CI 0.34-0.57, P<0.001) in a meta-analysis of 23 observational studies (after one outlier study with an exceptionally high OR was excluded), they wrote in JAMA Neurology. Effect sizes were similar between surgical and nonsurgical groups.
“The connection between delirium and cognitive decline that we observed was highly significant and remarkably consistent,” Goldberg said.
“What we propose is that delirium is not simply a marker for those patients already on a downward trajectory, but may be causative in and of itself,” he told MedPage Today. “This may be especially relevant to COVID patients, many of whom experience delirium in the ICU.”
Delirium is “ubiquitous and spares no age groups or populations, occurring in 20% to 70% of hospitalized patients, with the higher numbers seen in critically ill patients on mechanical ventilation,” said Pratik Pandharipande, MD, co-director of the Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University in Nashville, who wasn’t involved with the meta-analysis.
“This study has great implications in the COVID era,” Pandharipande told MedPage Today. “Mechanically ventilated patients with COVID are at a much higher risk of developing delirium because they are subject to all the major risk factors — deeper levels of sedation, high severity of illness, often older age, and additionally, social isolation due to limited visitation rules in the hospital and the fact that the virus can directly affect the brain and lead to neuroinflammation.”
“The meta-analysis reported here shows a consistent message; all selected studies showed that delirium and longer duration of delirium were associated with cognitive impairment,” Pandharipande continued.
“While it is unclear if delirium causes dementia, there is mounting evidence — and the meta-analysis adds to this — that there are structural brain changes with delirium and this puts you at a worse cognitive trajectory,” he said.
“Incorporating strategies such as the ABCDEF bundle from the Society of Critical Care Medicine into the care of your patients — including mechanically ventilated COVID patients — is likely to reduce delirium and possibly its long-term consequences,” he added.
The meta-analysis included a systematic search of articles from 1965 through 2018. The researchers looked for studies that contrasted patients with and without delirium, had objective continuous or binary measures of cognitive outcome, and had a final time point of 3 months or later after the delirium episode.
Data from 24 observational studies, including 3,562 patients who experienced delirium and 6,987 controls who did not, were used. One study with an OR greater than 41 — an order of magnitude greater than any other study — was excluded from some analyses.
Mean study age was about 75 and mean follow-up after a delirium episode was 2.4 years. On average, men made up about 47% of the study populations. The Confusion Assessment Method (CAM) or CAM–intensive care unit was the most frequent delirium measure used, and the Mini-Mental State Examination was used most frequently as a cognitive outcome.
“In all studies, the group that experienced delirium had worse cognition at the final time point,” Goldberg and co-authors wrote.
Meta-regression did not show differences in cognitive outcomes between surgical and nonsurgical studies, suggesting “the underlying pathophysiological events associated with delirium may be similar and speculatively may be associated with inflammatory processes common to both contexts,” they added.
The researchers also did not find significant differences between cognition treated as a continuous variable based on neurocognitive test scores or as a binary variable based on the presence or absence of dementia.
The I2 measure of between-study variability in g was 0.81. Studies of longer duration yielded greater differences, while those with more covariates, and those without baseline cognitive matching, yielded smaller differences.
The observational studies used in this meta-analysis cannot show that delirium is a causative factor in subsequent cognitive decline, the researchers noted. Differences in cognitive outcome measures and the way dementia was diagnosed may be sources of variability, but meta-regressions did not find significant differences among them in terms of their effect on g, they added.
Importantly, the study could not evaluate delirium in the context of other factors, such as frailty, and unmeasured confounders may have influenced results.
Quest reports longer waits for test results
Quest Diagnostics said its average turnaround time for a COVID-19 test is now at “seven or more days,” up from four to five days at the end of June.
- Its testing backlog is getting worse because of the high demand in parts of the country where infection is spreading, Axios’ Bob Herman writes.
Why it matters: Long backlogs make testing less useful — public health officials need to know what their local situation is like now, not what it was like a week ago. Delays are especially problematic if people who are infected continue to go about their lives while they wait for their results.
Between the lines: Quest told investors Monday that its second-quarter revenue will be down 6%, hovering around $1.83 billion, as coronavirus testing has supplanted other, more lucrative tests that had to be put off.
- But Quest still expects to register a profit of at least $1.33 per share thanks to $65 million of government bailout funds and high volumes of COVID-19 tests.
5.4 million Americans lost health insurance
Roughly 5.4 million adults in the U.S. lost their health insurance from February to May after losing their jobs, according to a new estimate from Families USA, a group that favors the Affordable Care Act.
Why it matters: There are more adults under 65 without insurance in Southern states, which are the same states setting new records for single-day coronavirus infections along with rising hospitalizations, Axios’ Orion Rummler writes.
What they found: 3.9 million adults lost health insurance over one year during the Great Recession, per Families USA’s analysis. It only took four months in this current crisis for an estimated 5.4 million Americans to lose health insurance.
- More than 20% of adults in Georgia, Florida, South Carolina, North Carolina, Mississippi, Oklahoma and Texas were without insurance as of May.
- All of these states have set new records in the past two weeks for their highest number of coronavirus infections in a single day, per data from the COVID Tracking Project.
- 46% of adults who lost coverage due to the pandemic came from five states: Florida, New York, Texas, California and North Carolina.
The backdrop: 21 million Americans were unemployed in May, according to the Bureau of Labor Statistics’ nonfarm payrolls report.
More Republicans say they’re wearing masks
Nearly two-thirds of Americans — and a noticeably increasing number of Republicans — say they’re wearing a face mask whenever they leave the house, according to the Axios-Ipsos Coronavirus Index.
Why it matters: A weakening partisan divide over masks, and a broad-based increase in the number of people wearing them, would be a welcome development as most of the country tries to beat back a rapidly growing outbreak, Axios’ Sam Baker writes.
By the numbers: 62% of those surveyed said they’re wearing a mask “all the time” when they leave the house — up from 53% when we asked the same question two weeks ago.
- The biggest jump was among Republicans: 45% say they’re wearing a mask all the time, up from 35% at the end of June.
- Even though it’s narrowing, there’s still a big partisan divide: 95% of Democrats say they wear a mask some or all of the time outside the house, compared with 74% of Republicans.
Between the lines: These numbers may seem high — do two-thirds of the people you pass on the street have a mask on? But the fact that more people are claiming to wear them is at least a sign that masks are increasingly seen as important.
- Among people who said they wear a mask sometimes, 32% reported that they’ve been denied entry into an establishment because they weren’t wearing one, and 21% said someone else has told them to put one on.
- 15% said they’ve told someone else to put on a mask.
Despite seeing great risk, Americans slow to make major changes to deal with COVID
https://www.ipsos.com/en-us/news-polls/axios-ipsos-coronavirus-index
New Axios-Ipsos Coronavirus Index study finds that social distancing continues to decline except for mask use.
Washington DC, July 14, 2020
Fewer Americans report self-quarantining now than any point since the start of the pandemic according to our latest Axios-Ipsos Coronavirus Index. This corresponds with socializing and commercial activity remaining high, if not quite to pre-pandemic levels. However, more Americans see returning to a pre-coronavirus life as a large risk now than at any time since the high-point of the initial wave in mid-April.
Detailed findings:
1. Despite the surge in cases across the South and West, Americans continue to venture out of the home at higher rates and do not re-embrace major social distancing.
- Fewer than one in five (19%) of Americans report self-quarantining the last week, the lowest level since tracking began at the eve of the outbreak in early March.
- Just under half of Americans (47%) report visiting friends and relatives in the last week, a third (30%) report going out to eat, and about one in six (16%) visited elderly relatives in the last week – all essentially unchanged from levels in mid-June before the current spike in cases.
2. However, as cases surge, Americans are increasingly seeing normal activities as posing large risks.
- A third of Americans (33%) see attending in-person gatherings of friends as a large risk to their health. Additionally, over a third (37%) say dining out, just under a third (30%) say going to a salon, and over a quarter (27%) of Americans working remote or temporarily not working say returning to their normal place of employment is a large risk. All are the highest levels since mid to late May.
- As debate about back-to-school rages, a large majority of parents (71%) say sending their child to school in the fall is a large or moderate risk.
3. Most Americans appear to be embracing mask use as a tool to cope with the coronavirus pandemic.
- As of July, three in five Americans (62%) report wearing a mask at all times when leaving the home with an additional 23% reporting sometimes wearing a mask (85% total). This is the highest level of mask use since tracking began in April.
- Among the approximately two in five (38%) Americans who do not wear a mask at all times when out of the home…
- A third (32%) report not being allowed into an establishment without a mask (about 12% of the total population).
- One in five (21%) report being told to wear a mask by another person (about 8% of the total population), up from 15% at the end of May.
4. As the pandemic continues, public trust in both the federal government and state governments has fallen to a low in this tracking.
- A third of Americans (32%) have a fair amount or great deal of trust in the federal government to look out after the best interests of their family. This is down from 53% in mid-March.
- Just over half (55%) trust their state governments, down from 71% in mid-March. Trust in the state government is lowest in the states currently hit the hardest (47% average cross AZ, FL, GA, and TX).
Washington DC, June 30, 2020
As June ends, the latest wave of the Axios-Ipsos Coronavirus Index finds that American fears of the coronavirus pandemic have resurged to levels last seen during the acute parts of the initial wave. This comes, however, as Americans continue to leave the home more frequently, albeit while taking protective measures.
Detailed Findings:
1. Levels of concerns have returned to levels last seen in early May as the pandemic spreads across the South and West.
- Almost two-thirds (60%) of Americans are very concerned about the coronavirus outbreak, with an additional quarter (24%) somewhat concerned.
- Over three quarters (78%) are at least somewhat concerned about the possibility of getting sick, up 9 points from the beginning of June.
- Three quarters (76%) are concerned about their community re-opening too soon, the highest level in our tracking.
2. Correspondingly, perceptions of risk also continue to increase, particularly views of activities that may bring the respondent into contact with large groups of people.
- Over two-thirds (70%) currently say that returning to their pre-COVID life is a moderate or large risk.
3. Risk aversion may also put a damper on the upcoming Fourth of July holiday with 78% saying attending celebrations is a large or moderate risk.
4. Americans have started curtailing social engagement, however the number engaging in out of home commercial activities remains stable or continues to increase.
- Less than half (45%) of Americans say they visited friends and family in the last week, down from the post-COVID high of 49% last week. Additionally, visiting elderly relatives is flat at 14%.
- However, going out to eat continues to increase, now with 31% of Americans reporting having done so in the last week. Visiting a salon or retail store is flat from last week.
Washington DC, June 23, 2020
Our latest Axios-Ipsos Coronavirus Index finds that Americans are increasingly concerned about coronavirus and seeing ‘regular’ activities as increasingly risky after sentiment moderated earlier in June. This uptick in fears comes as Americans address a possible second wave and reflect on their potential to re-enter social distance quarantines if major warning thresholds are met.
Detailed Findings:
1. American concern with the coronavirus outbreak, while not as widespread as during early April, has increased notably over the past two weeks.
- Currently, 85% of Americans are at least somewhat concerned with the outbreak, including 56% who are extremely or very concerned. This is up from 80% and 48% respectively in early June.
- Concern with communities re-opening too soon (to 71% from 64%) and the possibility of getting sick (to 76% from 69%) are also up 7 percentage points over the last two weeks.
- Eighty-five percent of Americans are concerned about a second wave of the coronavirus, including 59% who are extremely or very concerned.
2. “Normal” activities are seen as increasingly risky by many including doing their job, going to the grocery store, or socializing with friends after multiple weeks of minimizing concerns.
3. Americans continue to report that if a second wave hits their state, they will substantially withdraw to protect their health. They also express that they are watching for a wide range of signals of a second wave indicating it may not be official announcements that trigger a rebound in behavior.
- About four in five Americans say they are likely to stay home and avoid others as much as possible if…
- The CDC issued guidelines for people in their state to stay home.
- Their state’s governor issued guidelines for people to stay home.
- There is a new spike in cases in their state.
- Nearby hospital ICUs report full or near-full capacity.
- Someone they know tests positive for the virus.
- Someone they know is dying from the virus.
4. Social distancing behaviors continue to subside, but geographical differences remain in people’s experiences.
- Half of Americans (49%) visited friends or relatives in the last week, up from 47% last week and 19% in early April. However, in the states with the greatest increase in cases (AZ, FL, SC) socializing with friends has declined from 52% to 44% in the last two weeks.
- The number of Americans working remotely has also begun to decline, this week at 37% of all employed persons from 43% last week.
5. One percent of the U.S. population has tested positive for coronavirus at this point.
- About one in ten Americans have been tested (11%) and about one in ten (9%) of those tested, tested positive, equal to about 1% of the overall population.
Washington DC, June 16, 2020
At the end of our third month of tracking America’s response to the coronavirus pandemic, the Axios-Ipsos Coronavirus Index finds that even while Americans are increasingly engaging with each other outside the home, concerns about a second wave and perceived risks of regular activities mount.
Detailed Findings:
1. More Americans are very concerned about the overall COVID-19 outbreak than last week as a majority express high levels of concern about a second wave of the coronavirus.
- Fifty-four percent of Americans are extremely or very concerned about the outbreak, up from 48% last week, while 56% report being extremely or very concerned about a second wave.
- Sixty-four percent view returning to their pre-COVID life as risky right now, up from 57% last week.
2. If there is a second wave, large majorities of Americans report that they are likely to pull back into more socially distancing behaviors.
- Two-thirds (65%) say they are somewhat or very likely to self-quarantine in the event of a second wave in their state and almost all (85%) report they will take steps to social distance.
- This extends to social interactions – 79% report they are likely to stop gathering with friends or family – and commercial behavior – 73% report they would stop going to non-grocery retail stores.
3. As discussion of a second wave mounts, Americans report seeing many ‘normal’ activities as being more risky than just a week ago.
- The number of Americans who report viewing gatherings of friends and family as risky has climbed 5 percentage points from last week (57% moderate or large risk from 52%).
- Additionally, views of dining in at a restaurant (64% risky from 60%), shopping at a retail store (57% risky from 52%), or going to a barber or salon (58% risky from 54%) have all increased this week.
- Large gatherings remain highly suspect with 89% viewing attending protests and 74% viewing attending Fourth of July celebrations as a risk to their health or well-being.
4. Over a third of Americans know someone who has tested positive for coronavirus.
- While 35% know someone who has tested positive, it remains more prevalent in the Northeast (53%) than other parts of the country.
- Nine percent of Americans report they have been tested for coronavirus in our latest survey. Of those, 6% say they tested positive. This represents about 0.6% of the U.S. population.
Americans aren’t pushing to reopen the schools
Most U.S. parents say it would be risky to send their children back to school in the fall — including a slim majority of Republicans and a staggering nine in 10 Black Americans — in this week’s installment of the Axios-Ipsos Coronavirus Index, Axios’ Margaret Talev reports.
Why it matters: President Trump and Education Secretary Betsy DeVos have threatened to withhold federal funds from schools that don’t reopen. The new findings suggest that this pressure campaign could backfire with many of the voters to whom Trump is trying to appeal ahead of the election.
What they’re saying: “Americans at this point, and parents more specifically, can’t be force-fed policies that go against what they think,” says Cliff Young, president of Ipsos U.S. Public Affairs.
- “You can’t wish away or scare away a virus,” Young says. “And right now, they’re not feeling safe in putting their children back in school.”
- “There’s political risks as well — serious political risks for Trump and Republicans. Because even the Republican base sees a risk in putting kids back into the school in the fall.”
Driving the news: Officials on Monday began announcing decisions impacting schools in some major metro areas, erring on the side of caution in response to health concerns and parents’ anxieties.
- In California, school officials announced that public schools in Los Angeles and San Diego will hold online classes only.
- Gov. Andrew Cuomo said Monday that New York schools will open only if the daily infection rates in their region are below 5% over a 14-day average, and that “we’re not going to use our children as guinea pigs.”
Cartoon – Modern Conference Calling
Cartoon – Conference Call was a Huge Success
HENRY KOTULA 