Studies on long-COVID patients with inflammatory rheumatic diseases (iRD) are scarce and largely inconclusive. Nor is it known whether correctly classifying patients with iRD as long-COVID cases is complicated by persistent symptoms that could be attributed to either disease.
The researchers sought to compare the risk of developing long COVID after Omicron infection in iRD patients enrolled in a prospective cohort study, with age- and sex-matched healthy controls.
As per World Health Organization (WHO) guidelines, long-COVID participants reported persistent symptoms lasting at least eight weeks, within three months of confirmed SARS-CoV-2 infection onset, unexplainable by alternative diagnoses.
Of the 1,974 iRD participating patients and 733 controls, 24% and 30% respectively had an Omicron infection. Questionnaires revealed that more iRD patients than controls fulfilled long COVID criteria -- 21% versus 13%, respectively.
Post-hoc modeling showed that higher body mass index and severity in the acute infection phase were significantly associated with a higher risk of developing long COVID. Fatigue and loss of fitness were the most commonly reported long COVID symptoms in both groups; long-COVID recovery time was similar.
More iRD patients than controls with no history of COVID-19 reported symptoms also observed in long COVID, perhaps due to clinical manifestations of underlying rheumatic diseases.
Other researchers presented data from a prospective cohort study -- called "COVID 19: A pandemic with a long tail" -- that included immune-mediated inflammatory disease (IMID) patients on immunosuppressive therapies. They examined whether post-vaccination anti-spike antibody levels could predict breakthrough infection and COVID-19 outcomes.
A large cohort of 1,051 patients provided post-vaccination samples and responded to follow-up questionnaires after three vaccines. Immunosuppressive medication included tumor necrosis factor inhibitors, methotrexate, interleukin inhibitors, janus kinase inhibitors, and vedolizumab. Hospital records, the Norwegian Patient Registry, and the Norwegian Death Cause Registry provided additional information.
Results showed that while half the patients reported COVID-19, few had life-threatening illness. Patients with the highest post-vaccination anti-spike levels had a lower risk of COVID-19 infection, supporting the benefits of repeated vaccination in IMID patients on immunosuppressive therapies. Comorbidities or ulcerative colitis increased the risk of breakthrough infections.
Researchers concluded that low antibody levels do not greatly increase severe COVID-19 risks, and emphasized positive prognoses for vaccinated IMID patients with Omicron infections.
Other researchers have reported on the safety of COVID-19 vaccines during pregnancy and breastfeeding in women with autoimmune diseases. This international study sought to answer questions about COVID-19 vaccination uptake in people with autoimmune diseases.
Overall, 40 pregnant and 52 breastfeeding patients with autoimmune diseases were identified, with vaccination rates of 100% and 96.2%, respectively. Adverse events were reported more frequently by pregnant patients, but at rates similar to pregnant healthy controls. No differences were observed between breastfeeding patients and healthy controls.
Post-vaccination disease flares were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18% of age- and disease-matched control patients. Disease flares were managed with glucocorticoids; one in five women required initiation or changes in their immunosuppressive treatment.
Researchers hope that these indications of COVID-19 vaccination safety during the antenatal period in women with autoimmune disease will strengthen physician-patient communication and overcome vaccine hesitancy.
"The benefits for the mother and fetus by passive immunization are likely to overweigh the potential risks of adverse events and disease flares," Dr. Laura Andreoli, University of Brescia rheumatology professor, said in a statement.
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Studies on the long-term consequences of COVID-19 (long-COVID) in patients with inflammatory rheumatic diseases (iRD) are scarce. Where available data do exist, they tend to be heterogeneous and largely inconclusive. In addition, it is not known whether correctly classifying patients with iRD as long-COVID cases is complicated by increased background noise due to the occurrence of persistent symptoms that could be attributed to either long-COVID or iRD.
A team in the Netherlands aimed to compare the risk of developing long-COVID after infection with the Omicron variant in iRD patients versus age- and sex-matched healthy controls. Data were collected from participants enrolled in a prospective cohort study. In line with WHO guidelines, long-COVID cases were defined as participants who reported persistent symptoms that lasted at least 8 weeks, started after the onset and within 3 months of a confirmed SARS-CoV-2 infection, and could not be explained by an alternative diagnosis.
A total of 1,974 iRD patients and 733 healthy controls participated, of whom 24% and 30% had an Omicron infection, respectively. Questionnaire data revealed that more patients compared to controls fulfilled long-COVID criteria; 21% versus 13% respectively – but this was attenuated after adjusting for potential confounders.
Post-hoc modeling showed that higher body mass index and worse severity in the acute infection phase were significantly associated with higher odds of developing long-COVID. Fatigue and loss of fitness were the most frequently reported symptoms of long-COVID in both groups, and recovery time from long-COVID was also similar.
Importantly, more iRD patients than healthy controls without a history of COVID-19 reported symptoms that are also observed in long-COVID; this could in part also be explained by clinical manifestations of underlying rheumatic diseases. Based on these findings, the authors concluded that people with iRD are not more susceptible to long-COVID than those in the general population.
In a session, COVID 19: A pandemic with a long tail, Ørbo and colleagues shared new data from Nor-vaC – a prospective cohort study that includes immune-mediated inflammatory disease (IMID) patients on immunosuppressive therapies.1 The group examined whether post-vaccination anti-Spike antibody levels were predictive of breakthrough infection and the clinical outcome of COVID-19.
To do this, they used data from 1,051 patients who provided post-vaccination samples and responded to follow-up questionnaires after three vaccine doses. Immunosuppressive medication included tumor necrosis factor inhibitors, methotrexate, interleukin inhibitors, janus kinase inhibitors, vedolizumab, and other medication. Hospital records, the Norwegian Patient Registry, and the Norwegian Death Cause Registry provided information on hospital admissions and cause of death.
Results showed that – while half of patients reported COVID-19 – few had life-threatening illness. Patients with the highest post-vaccination anti-Spike levels had a lower risk of COVID-19 infection, supporting the role of repeated vaccination in IMID patients on immunosuppressive therapies. The presence of comorbidities or ulcerative colitis increased the risk of breakthrough infections.
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These results underline the good prognosis for Omicron infections in vaccinated IMID patients. Though it is possible that patients who knew they had low anti-Spike levels may have shielded during periods of high transmission, the absence of severe infections and deaths in this large cohort indicates that low antibody levels did not greatly increase risk of severe COVID-19.
Finally, Andreoli and colleagues report on the safety of COVID-19 vaccines during pregnancy and breastfeeding in women with autoimmune diseases, using data from 9,201 participants in the COVAD study. This international study in partnership with patient support groups focused on answering meaningful questions and addressing gaps in the literature about the uptake of COVID-19 vaccination in people living with autoimmune diseases.
Overall, 40 pregnant and 52 breastfeeding patients were identified, with vaccination rates of 100% and 96.2%, respectively. Adverse events of all severities were reported significantly more frequently by pregnant than non-pregnant patients, but there was no difference in comparison with pregnant healthy controls. There was also no difference observed between breastfeeding patients and healthy controls.
Post-vaccination disease flares were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18% of age- and disease-matched control patients. All disease flares were managed with glucocorticoids, and one in five women required initiation or a change in their immunosuppressive treatment.
This study provides the first insights into the safety of COVID-19 vaccination during the antenatal period in women with autoimmune disease. While adverse events were more commonly reported by pregnant patients with autoimmune disease than those breastfeeding, these were no higher than among pregnant healthy controls without an autoimmune disease.
These observations are reassuring, and likely to strengthen physician-patient communication and overcome vaccine hesitancy. "The benefits for the mother and fetus by passive immunization are likely to overweigh the potential risks of adverse events and disease flares," said Laura Andreoli from the University of Brescia in Italy.
A report by Public Health Ontario has confirmed that the first bird to test positive for West Nile Virus (WNV) in Ontario this year was located in the Southwestern Public Health region.
“The identification of a bird positive for West Nile Virus serves as our annual reminder to protect ourselves from mosquitoes,” noted Amy Pavletic, Manager of Environmental Health.
Tips to help protect yourself from mosquito bites include using insect repellent with DEET when you are outdoors, covering up exposed skin, and cleaning up any mosquito breeding sites around the home such as standing water, regularly.
While many individuals who are bitten by an infected mosquito show no symptoms, some may experience mild illness including headache, body ache, fever, nausea, vomiting and rash.
The British Junior Cardiologists' Association (BJCA) and the British Cardiovascular Society (BCS) have issued a joint position statement in a bid to stamp out bullying, harassment, discrimination and other "unacceptable" and "unprofessional" behaviors in the specialty.
The statement, published online in the journal Heart, urges every cardiology team member to call out these behaviors to drive culture change.
Endorsed by 19 organizations affiliated with the BCS, the statement represents a specialty-wide response to the issue.
It comes in the wake of evidence suggesting that these behaviors are common in UK cardiology departments, and may be indicative of longstanding cultural and practice issues, fueled by previous training and unconscious biases, says the statement.
Data from the General Medical Council trainee survey suggest that bullying in cardiology is almost double the average across all medical specialties: 12.3% vs. 6.9%, highlights the statement.
Bullying is associated with poorer performance, a heightened risk of medical error, lost productivity, burn-out and absenteeism. It accounts for half of all stress-related workplace illness, the statement points out.
Inappropriate behavior in cardiology departments has a detrimental ripple effect, including on the recruitment and retention of staff, patient care, and other bystanders, says the statement.
"As such, improving the culture and professional behaviors within UK cardiology departments is of paramount importance," it insists.
The statement sets out examples of inappropriate behavior. These include bullying; sexist, racist, homophobic or belittling language; discrimination; harassment; providing or depriving individuals of opportunities based purely on personal characteristics; outbursts of uncontrolled anger; and unconstructive criticism of performance.
And it highlights the common misconception in the specialty that intimidation helps to 'build character' and is how cardiologists were trained in the past.
"This is an anachronistic and flawed concept: intimidating language or actions do not build character and have substantial negative impacts on those affected. Furthermore, role modeling and learnt behaviors lead to perpetuating the cycle of bullying," it emphasizes.
"While mistakes happen in medicine and may require frank feedback to aid learning, they are not an excuse for intimidating or belittling behavior or language," it adds.
Senior team members should lead by example, and act swiftly to respond to concerns. But every member of the cardiology team has a duty to call out inappropriate behaviors to drive culture change and foster a positive working environment, says the statement.
Informal feedback for one-off episodes may be appropriate, but serious events or repeat offenses warrant escalation through formal channels, it says.
Ignoring such behavior simply helps to perpetuate it, emphasizes the statement, adding that safeguards are needed to protect those who raise concerns from being penalized.
Several strategies are required at the individual, departmental, and national level to improve the culture within UK cardiology, concludes the statement. These are:
For departments and individuals
Set out clear standards and expectations of behavioral norms from all members of the cardiovascular team
Encourage the reporting of inappropriate behaviors
Ensure clear policies, practices and procedures are in place for dealing with inappropriate behavior, iteratively reviewed, and included in induction and staff handbooks
Designate and train a behavior lead with whom concerns can be raised
Consider any episodes of inappropriate behavior in the selection process for promotions and leadership roles
Make routine use of multi-source feedback where evidence of all behaviors can be raised
Provide mandatory training for all on workplace culture; how to give and receive structured feedback; unconscious bias; and cardiology-specific human factors
For universities and national bodies
Develop a positive organizational culture and ensure that similar standards of behavior are expected of members (national bodies)
Establish a transparent cardiology reporting strategy for inappropriate behavior
Incorporate Freedom to Speak Up Guardians into the reporting and responding strategies in NHS Trusts
Include a person tasked with promoting professional standards on committees (national bodies)
Consider incidences of inappropriate behavior when allocating funding and advancement in cardiovascular research (universities and funders)
Include past inappropriate behavior when considering people for roles within their organization, at meetings, or the presentation of awards (national bodies)
Ensure that appropriate mentors and advisors outside of the direct supervisory chain are available to everyone taking part in cardiovascular research (universities)
Develop appropriate training packages to improve accessibility to departments and individuals that are reasonably priced and included in study budgets (national bodies)
"As with clinical standards, professional societies have a role in developing a standard for appropriate behavior and a responsibility to ensure that inappropriate behavior is shown to be unacceptable," says the statement.
BCS President Professor John Greenwood comments: "No-one should be discriminated against at work, bullied, harassed or undermined. In cardiology we have had this pervasive culture for far too long. This statement and its practical recommendations represent a concerted effort to stop bullying in its tracks and put measures in place to stop it happening in the future. We will be taking the statement to our annual conference at the beginning of June to raise awareness and discuss implementation of the recommendations across the UK."
Dr. Christian Fielder Camm, BJCA President, adds, "The detrimental effect of inappropriate workplace behavior can be profound and all those involved in UK cardiology and cardiovascular medicine have a responsibility to face up to this longstanding problem."
"This document is a significant step forward in acknowledging this important issue and providing clear recommendations for individuals, departments, and national bodies to tackle this problem."
More information: Consensus statement: Joint British Societies' position statement on bullying, harassment and discrimination in cardiology, Heart (2023). DOI: 10.1136/heartjnl-2023-322445
Citation: UK cardiology societies issue joint policy statement to stamp out unacceptable behaviors (2023, May 30) retrieved 30 May 2023 from https://ift.tt/mHRE49s
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USAID PREDICT animal sampling in Thailand. (Photo credit: Richard Nyberg)
As the Covid-19 pandemic spread across the globe in January 2020, virus hunters pushed for funding to uncover more “yet-to-be-recognized deadly viruses.” They believed that cataloging viruses in wildlife could help prevent future pandemics.
“In China alone, we sampled >10,000 bats and ~2,000 other mammals, using PREDICT protocols to discover 52 novel SARS related-CoV’s, including the closest relative of the Wuhan nCoV [SARS-CoV-2],” boasts a University of California, Davis letter to Senator Dianne Feinstein requesting federal support for programs like PREDICT, the government’s flagship virus-hunting program.
However, the letter didn’t mention the risks of collecting and studying SARS-related viruses, which have the potential to be lethal or highly transmissible. The U.S. Energy Department,Federal Bureau of Investigation, and theWorld Health Organization now recognize that a research accident with SARS-CoV-2 may have sparked one of the biggest pandemics in history.
Indeed, the entire chain of virus hunting work entails risks that can lead to accidental infection, from handling animals to experiments in the lab. The risks can even extend beyond the program: published virus genetic sequences allow other groups to perform high risk research, and can even give terrorists instructions for bioweapons.
The U.S. Agency for International Development (USAID), which spent hundreds of millions of dollars funding virus-hunting work, is attempting to address biosafety loopholes that existed in previous programs. However, newdocuments obtained by U.S. Right to Know show that their latest precautions center around lab work. The risks involved in handling wildlife and publicly publishing sequences of potential pathogens remain.
Unfortunately, these risks are inherent to virus hunting, calling into question the necessity of such programs, and whether their purported benefits justify the risks of triggering a pandemic.
“The programs pose potentially existential risks and provide no–zero–civilian practical benefits.” says Richard Ebright, a molecular biology professor at Rutgers University. “The only applications are bioweapons-agents discovery and bioweapons-agents threat assessment.”
USAID is currently reviewing DEEP VZN, the government’s newest virus-hunting program, after the White House National Security Council and Office of Science and Technology Policy expressed concerns that data from the program could be exploited by foreign actors to develop bioweapons.
The House Committee on Energy and Commerce also requested an investigation into the risks and benefits of programs like DEEP VZN. The committee expressed concerns that such programs would not be able to predict which viruses pose a threat to human health, and that collecting and studying viruses would increase the chances of an accidental outbreak. A key question in their letter is whether methods safer than field sampling can be used to achieve the program’s goals.
“Logically, it makes sense to inventory threats we have out there and get ahead of it. But in the process of trying to find out how to stop a pandemic, are you creating one?” Senator Lindsey Graham told Josh Rogin of the Washington Post. Sen. Graham wanted to suspend funding for DEEP VZN until the proposed work and safety protocols were more transparent.
“USAID, in consultation with our colleagues across the Administration and with Congress, is undertaking a comprehensive review process to make sure the most rigorous safeguards are in place before field research under DEEP VZN can begin. Because field implementation research has not yet started, there are not further details to share at this time,” wrote USAID in response to questions about DEEP VZN’s safety protocols.
DEEP VZN — short for Discovery & Exploration of Emerging Pathogens Viral Zoonoses — is a 5-year, $125 million USAID project that aims to discover and study novel viruses with pandemic potential. Launched in October of 2021, the program is led by Washington State University in collaboration with the University of Washington, Washington University in St. Louis, PATH, and FHI 360 (Family Health International).
Both PATH and FHI 360 are U.S.-based organizations that aim to address health challenges, primarily in low or middle-income countries.
DEEP VZN follows PREDICT, USAID’s $200 million viral discovery project that lasted from 2009 to 2020. Led by UC Davis, EcoHealth Alliance, and Metabiota, PREDICT sampled more than 160,000 animals and people in over 30 countries looking for virological threats. The program discovered nearly 1,000 novel viruses, including over 100 coronaviruses and a new ebolavirus.
The premise of these projects is simple: Finding and studying deadly pathogens before they spill over from animals to people may allow governments to respond to, predict, or even prevent future pandemics.
Yet somescientistsworry that viral discovery programs like PREDICT and DEEP VZN risk causing the pandemics they aim to prevent, either by exposure in the field, an accident in the lab, or by providing malefactors with the information they need to synthesize a pandemic-ready pathogen.
Concerns ran deep enough that White House National Security Council and Office of Science and Technology Policy officials suggested ending DEEP VZN in December 2021.
New U.S. Right to Know documents give an unprecedented look into DEEP VZN’s safety precautions.
The documents show DEEP VZN is trying to address risks associated with its predecessor PREDICT, but these measures do not assuage critics’ fears that the program could lead to a new pandemic.
The DEEP VZN proposal recognizes that “>80% of novel virus characterization can be performed in the absence of virus isolation.” It was amended to state that “ there will be no isolation of and studies using novel coronaviruses, paramyxoviruses, or filoviruses”, and that they will inactivate all viral samples as soon as possible.
The new precautions also “strictly prohibit Dual-Use Research of Concern with a focus on Gain of Function Research,” research on live animals, and ranking viruses according to their risk of starting a pandemic.
DEEP VZN’s precautions contrast with PREDICT, whose funds were used to isolatenovel coronaviruses, create chimeras, and analyze and publish which viruses posed the greatest risk of infecting humans. PREDICT may not have inactivated about half of its collected samples, and did not expressly prohibit gain-of-function research with newly discovered viruses or dual use research of concern.
The newest safety precautions seem designed to prevent the kind of research some scientists worry could lead to a pandemic.
Yet though the proposal for DEEP VZN appears to prohibit gain-of-function research, the term isn’t clearly defined by the scientific community, and isn’t described in more detail in their proposal.
The definition is murky enough that the NIH did not apply rules restricting gain-of-function research to experiments that constructed chimeric viruses more pathogenic than the parent virus in humanized mice.
“Razor thin” safety margins when handling wildlife
While DEEP VZN’s precautions may mitigate risk in the lab, the risk of exposure in the field remains.
Bites and scratches can cut through gloves, and fluids like blood, urine, and saliva have splattered into researchers’ faces.
Standard safety gear like Tyvek suits may offer inadequate protection. “In our experience Tyvek easily tears and allows exposure to undergarments or skin,” EcoHealth Alliance stated on a January 25th 2017 PREDICT team call.
They also noted that “gloves make handling animals difficult in hot/humid areas due to perspiration…”, which could tempt virus hunters to remove them.
Virus hunters can become infected even if they use all appropriate safety gear and have no obvious exposure to animals or their secretions.
“Workers who collect viral samples in the wild will be exposed to viruses they otherwise would not be exposed to,” said Justin Kinney, an Associate Professor at Cold Spring Harbor Laboratory and co-founder of Biosafety Now, a non-profit that advocates for increased regulations on pathogen research. “There is a risk that some workers could become infected with previously undiscovered viruses, could transmit those viruses to others, and could potentially trigger a new pandemic.”
According to virus hunter and infectious disease specialist Michael Callahan in Politico, “…the margins for personal protection during these expeditions are razor thin. The fact that researchers are not infected every time they do a field collection is a question that continues to stump us.”
However, documents obtained by U.S. Right to Know show that PREDICT thought the risk of infection during sampling was minimal.
“It is highly unlikely that PREDICT team members, as part of their routine activities, are at increased risk of exposure to pathogens from the animals being sampled above the background level of the local community who actively hunt and consume many of the animal species being sampled,” one document reads.
Viral sequences pose information risk
Some scientists and biosafety experts worry that other labs will use viral sequences published by DEEP VZN to perform high-risk experiments, even if DEEP VZN doesn’t.
These concerns are not unfounded, considering novel coronaviruses like swine acute diarrhea syndrome coronavirus (SADS) discovered byPREDICT have been recoveredandstudied outside of the project.
Publishing the sequences of potential pathogens could even give bad actors the “blueprints for an arsenal of plagues,” according to Kevin Esvelt, a biologist and professor at the Massachusetts Institute of Technology.
“Virologists will almost certainly use other funds to resurrect some of the newly identified viruses from knowledge of the viral genomes. And unless stringent new biosafety regulations are adopted by the US and other governments, dangerous gain-of-function experiments will almost certainly be performed on the newly identified viruses that have the greatest potential to trigger a new pandemic,” said Kinney.
Unfortunately, there are barriers to adopting stringent biosafety regulations. No agency is empowered to create and oversee globally-accepted biosafety standards. In the U.S., safety regulations primarily apply to institutions receiving federal funding.
Richard Ebright echoes Kinney and Esvelt.
“Virus-discovery poses information risks by providing information on the sequences and properties of new potential pandemic pathogens,” Ebright said. “Publication of the sequences provides information that can be used by a rogue nation, organization, or individual to construct a new potential pandemic pathogen and release it to cause a pandemic.”
According to Ebright, this does not mean that virus discovery work is safer if the results are classified.
“The work should not be done. Period.” he said.
He further cautioned that research can deviate significantly from what is written in a proposal.
“There almost always are differences, usually large differences, between the research proposed in a grant application and research performed under a funded grant,” he said.
Indeed, DEEP VZN’s proposal states that no viruses will be isolated “at this time,” leaving the possibility open for the future.
Despite potentially catastrophic risks, civilian benefits are ‘very unclear’
In spite of significant time and funds invested in viral discovery, scientists remain split on the benefits of such programs.
Ravindra Gupta, a microbiology professor at the Cambridge Institute for Therapeutic Immunology and Infectious Diseases, says that programs cataloging viruses are essential.
“Many of those viruses may have human benefit, and so it’s critical that we do understand what’s out there,” he stated at the Pathogens Project Conference, referring to the Global Virome Project, a virus-hunting offshoot of PREDICT.
Increased knowledge of mammalian viruses can also help “rapidly contextualize where, how, and why new human viruses originate in wildlife, ” wrote Colin Carlson, an assistant research professor at Georgetown’s Center for Global Health Science and Security.
He described how PREDICT helped categorize SARS-CoV-2 at the beginning of the pandemic.
“PREDICT-funded work has contributed to the sequence libraries (along with rapid isolation of the virus, and global data sharing) that allowed taxonomists to rapidly classify SARS-CoV-2 and propose candidate origins,” he said.
Opponents of viral discovery programs note that they haven’t predicted any pandemics yet, and any benefits can be achieved by safer means.
“Monitoring of virus in humans, livestock, crops, and wastewater poses little or no risk and provides much greater, and much more immediately actionable, practical benefits,” said Ebright.
Any such viruses have already infected humans or are poised to do so. Early detection can prevent widespread transmission without the risk of introducing novel pathogens to human populations.
Prominent virologists have also argued that an easier, cheaper, and more effective way of preventing pandemics is to monitor people, screening those with a predefined set of symptoms. Indeed, the sheer number of viruses, many of which mutate rapidly, make prediction expensive, time consuming, and maybe even impossible.
Finding animal reservoirs of human pathogens can be challenging even during or in response to an actual outbreak.
“It seems all previous efforts around outbreaks have failed,” wrote Andrew Clements, PREDICT’s USAID senior scientific advisor, in a 2018 email discussing whether PREDICT should sample animals to find the reservoir of an Ebola outbreak.
“The benefits of the research that will be funded by DEEP VZN are very unclear.” said Kinney.
Indeed, only one novel PREDICT virus posed a potential threat to humans. This virus was sequenced from a patient rather than an animal, and only spread to a handful of people.
“Although PREDICT almost certainly discovered hundreds of potential zoonoses, their true zoonotic potential is almost impossible to assess, leading to the surprising statistic that the programme only led to one conclusive discovery of a zoonosis, the Bas-Congo virus,” wrote Carlson.
Steven Salzberg, a biomedical engineering professor at Johns Hopkins University, goes further than Kinney, stating that there are no benefits “whatsoever” to programs like DEEP VZN. He also disagrees with claims that PREDICT-funded work may have helped respond to the pandemic, or shed light on COVID’s origins.
“It’s true that we had a few viruses from animals that told us perhaps where it originated (e.g., from bats) – but 3+ years later, we still don’t have an answer to that question. So it’s simply false to say those sequences helped us identify things at the beginning of the pandemic,” said Salzberg.
“The risk-benefit ratio is extremely unfavorable,” said Ebright. “In particular, virus discovery research in wildlife is not needed for, and does not contribute to, the development of vaccines and drugs.”
Cases of human metapneumovirus sharply rose this spring, according to CDC data. Symptoms closely mimic other respiratory viruses like respiratory syncytial virus and the flu, but patients are not typically tested for its presence unless admitted to the ER.
"Since HMPV is a recently recognized respiratory virus, healthcare professionals may not routinely consider or test for HMPV," the CDC says on its website. "However, healthcare professionals should consider HMPV testing during winter and spring, especially when HMPV is commonly circulating."
Even with testing, physicians say it likely would not change the type of care they give to patients who are infected with it, according to CNN. Since there is no vaccine or antiviral treatment for HMPV, physicians are left to mostly treat symptoms.
Here are seven other notes about the prevalent, but lesser known virus:
HMPV primarily spreads through coughing and sneezing.
Between Feb. 18 and April 15, the U.S. had the most consistently high positive test rates for HMPV.
HMPV can progress into bronchitis or pneumonia.
The virus can lead to upper and lower respiratory disease in all ages, but mostly young children or older adults.
HMPV was discovered in 2001.
Increased use of molecular diagnostic testing has helped to track and identify cases.
A majority of children have had an HMPV infection by age 5, according to CNN.
Melanoma Canada's mobile skin cancer screening unit, known as the 'Mole Mobile', will be in Barrie later this week.
It will make a stop at Barrie Nissan, located in the city's south end at 630 Veterans Dr., on Friday (June 2) from 8:15 a.m. until 4 p.m.
Melanoma Canada says the Mole Mobile is the first of its kind in Canada and is visiting cities across the country with long wait-times to see a dermatologist, underserved communities, rural and Indigenous regions to help speed up the time to diagnosis, which is vital to improving outcomes for patients.
Dr. Megan MacGillvray and Dr. Sonya Cook be available to do skin cancer screening as well as talk about the warning signs and sun safety.
Melanoma and skin cancer are one of few cancers with rising incidence rates in Canada and around the world, according to Melanoma Canada. Incidence rates for new melanoma cases have been rising on average 1.4 per cent each year over the last 10 years.
The organization also says Centers for Disease Control and Prevention (CDC) statistics from 2016 show that one in three cancers diagnosed are skin cancers. Skin cancers are the most common type of cancer diagnosed in men over 49 years of age, and are one of the most common cancers diagnosed in youth and young adults. If detected early melanoma and other skin cancers are largely treatable.
Health officials behind the Mole Mobile hope to conduct 25,000 skin checks each summer and help thousands of Canadians get access to care in their communities, while educating them on how to self-screen for melanoma and skin cancers.
The Mole Mobile team will also promote the importance of sun safety which is key to preventing melanoma and other skin cancers.
Friday's event is open to the public, who are welcome for a walk-in skin check.
For more information and the Mole Mobile’s schedule, visit molemobile.ca.
Melanoma Canada is the leading national organization dedicated to the elimination of melanoma and skin cancer. Through patient, caregiver, and physician education and public awareness, our goal is to reduce the incidence of the disease and improve overall patient outcomes.
Melanoma Canada offers patient and caregiver support services to those newly diagnosed, and helps those affected navigate their cancer journey by way of certified patient care specialist and cancer coach, peer-to-peer support programs, and group support services.
Founded in 1925, the Canadian Dermatology Association (CDA) is the national voice of Canada’s certified dermatologists, the physician experts in skin health. The CDA is committed to uniting dermatologists through education and advocacy, fostering a strong, united professional community, and promoting excellent patient care through continued professional development.
Emotionally secure people are empowered, confident and comfortable in their own skin. They walk the world with authenticity and conviction, and do what is meaningful to them.
As a Harvard-trained psychologist, I've found that this sense of self-assuredness makes them better able to navigate conflict and be vulnerable with others, mostly because they aren't looking for external validation.
But takes a lot of work to get there. If you use any of these nine phrases, you're more emotionally secure than most people:
1. "Let me think about that before I respond."
One of the most noticeable characteristics of emotionally secure people is that they articulate themselves well. They choose their responses carefully and aren't impulsive in their reactions.
Similar phrases:
"I'm really frustrated and need some time to myself. I don't want to say something I might regret later."
"I don't have an answer right now. Can we revisit this conversation tomorrow?"
2. "No."
Emotionally secure people feel comfortable setting boundaries. They are clear about what they will and will not do based on their own moral principles, needs and desires.
Similar phrases:
"I'm sorry, but I can't help with that because I have too many other commitments."
"Thank you for the offer, but that's not something I enjoy doing."
3. "I'm not comfortable with that."
They always communicate their needs in a respectful way. This means they state how they feel when someone treats them poorly. If they feel their boundaries are being violated, they'll take action to make changes.
Similar phrases:
"When you say things like that, I feel hurt and angry."
"If you treat me like this, I'm going to step away because it's not healthy for me."
4. "This is who I am, and I'm proud of it."
They are consistent in how they operate in the world. This makes being around them predictable and safe because friends and loved ones know that they are who they say they are.
Similar phrases:
"What you see is what you get."
"You may not like this about me, but I am okay with it."
5. "Am I like that?"
Emotionally secure people are able to consider criticism without lashing out. If they receive negative feedback, they don't take it personally. Instead, they see it as an opportunity for self-improvement.
Similar phrases:
"I didn't realize I do that so often. Thank you for pointing it out."
"Wow, I guess I really do say that phrase a lot."
6. "I will work on that."
In meaningful relationships, emotionally secure people will make an effort to change when necessary. They know that taking action is key to personal growth and strengthening connections.
Similar phrases:
"I hear that this is important to you, so I'll work on being more compassionate when I talk to you."
"I'm not very good at being patient. I'm going to practice being less pushy."
7. "I'm sorry you're struggling. How can I help?"
Their empathic and non-judgmental nature in relationships makes them great at being supportive. They also understand that if someone is having a bad day, it isn't a reflection on them.
Similar phrases:
"You look upset, and I'd like to help."
"I see that this is hard for you, but you have my support."
8. "This matters to me."
Having a solid belief system is key to being emotionally secure because it guides our choices. When a value is violated, emotionally secure people are able to take a stance for what they believe is moral and fair.
Similar phrases:
"I really care about this, even if you don't."
"I don't think you're acting in an ethical way, and I can't watch it happen without standing up for what I believe is humane."
9. "I will try!"
Emotionally secure people have cultivated a sense of inner safety that tells them they will be okay, even if a new effort fails. This allows them to experiment with new things, such as hobbies, friendships, travels and even personal coping strategies.
Similar phrases:
"I'll try that next time."
"I may not be good at this, but I'm willing to give it a shot!"
Dr. Cortney S. Warren, PhD, is a board-certified psychologist and author of "Letting Go of Your Ex." She specializes in marriages, love addiction and breakups, and received her clinical training at Harvard Medical School. She has written nearly 50 peer-reviewed journal articles and delivered more than 75 presentations on the psychology of relationships. Follow her on Twitter @DrCortneyWarren.
Dr. Mehdi Aloosh, Medical Officer of Health for Windsor-Essex County, is pictured in his office at the Windsor-Essex County Health Unit on Thursday, May 25, 2023.Photo by JULIE KOTSIS/Windsor Star
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The new medical officer of health for Windsor-Essex County brings extensive experience in public health, as well as family medicine to his leadership role — along with a keen interest in collaboration.
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“I’m still learning about the organization, about the health in the community,” said Dr. Mehdi Aloosh during an interview in his office at the Windsor-Essex County Health Unit.
Aloosh is settling in to his new job, less than a month after being appointed acting medical officer of health on May 1. He was officially named to the top position just over a week ago.
Born in Iran, Aloosh emigrated to Canada where he trained in epidemiology and medical education with a focus on surgical education at Montreal’s McGill University.
A public health and preventive medicine specialist, Aloosh is also a fellow of the Royal College of Physicians and Surgeons of Canada and a public health physician at Public Health Ontario. He has provided medical consultation on a range of public health issues.
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WINDSOR, ONT., MAY 25, 2023 — Dr. Mehdi Aloosh, Medical Officer of Health for Windsor-Essex County, is pictured in his office at the Windsor-Essex County Health Unit on Thursday, May 25, 2023. JULIE KOTSIS/Windsor Starjpg
He trained in family medicine, as well as public health and preventive medicine at McMaster University where he also works as an assistant professor.
“I worked as a family doctor for a decade,” Aloosh said. “I was very satisfied with family medicine and communication with the patients impacting the health of the individuals.
“At the same time, I was interested into the root causes of diseases and health — what makes people sick and what makes people healthy. So, that was why I switched to public health. I do think they are connected together. To be a good public health physician I think some exposure to the community at the individual level is helpful.”
But in public health, “our patients are not individuals they are population.”
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“So the scope of work is very different,” he said.
Aloosh is setting priorities for his new position while connecting with health care partners and community leaders. He is also working University of Windsor educators to bring research data and innovation to public health work.
There is mandated work all health units must do, such as infectious disease prevention, controlling outbreaks, chronic disease prevention and injury prevention, he said.
“What I see from my experience at the provincial level is that there are issues … not unique to Windsor-Essex County,” Aloosh said. “That’s provincial-wide issues, like sexually transmitted diseases.
“We haven’t seen congenital syphilis for years and now we see that in Windsor-Essex County. We see the rise of chlamydia, gonorrhoea.”
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Other local priorities are dealing with the opioid and mental health crisis, which he believes has grown worse as a result of the pandemic.
Aloosh spoke at his first health unit board meeting about the need to increase HPV vaccination levels in the community to help prevent cervical, anal, penile, head and mouth cancers.
“So, if we would be able to successfully vaccinate our kids and our young generation, we can protect them in the future,” he said. “We can eliminate some of the cancer caused by a virus.”
With a booming economy in Windsor and Essex County, plus many new Canadians — immigrants, refugees, migrant workers — arriving in this region, there are further health care challenges, he said.
“Data shows immigrants are a healthier population because they pass through medical checks,” Aloosh said. “The data also shows after immigration they have their health start to go down.”
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He attributes that decline to a variety of reasons, including language barriers, not knowing how to get health care or no access to a family physician.
Aloosh offered praise to his team at the health unit.
“This is not just the work of a medical officer of health,” he said, adding it takes a team of 300 people working in public health in Windsor Essex County —nurses, health inspectors, clerks, managers, directors — working together.
“I’m here as a consultant and the leader of this organization. The team is very important in accomplishing the work of public health.”
Aloosh is “really excited” about his new role “because I see everyone is thinking about having a better community, a more healthier community,”
“And everyone tries to work to that goal which is what I’m really excited about,” he said.
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Hadassah-University Medical Center in Jerusalem’s Ein Kerem has announced an “unprecedented achievement” in the treatment of multiple myeloma cancer – the second-most-common hematological disease that accounts for one-tenth of all blood cancers and one percent of all types of malignancies.
The innovative treatment against the disease, which has long been considered incurable, was developed after a series of experiments carried out in the hospital’s bone marrow transplant and immunotherapy department in recent years that is headed by Prof. Polina Stepansky.
“We have a waiting list of over 200 patients from Israel and various parts of the world at any given time.”
Polina Stepansky
“Now, in light of the impressive results of CAR-T treatments, it seems that they have many more years to live – and with an excellent quality of life,” Stepansky said.
The treatment is based on genetic engineering technology, which is an effective and groundbreaking solution for patients whose life expectancy was only two years until a few years ago. They have used a genetic engineering technology called CAR-T – Chimeric Antigen Receptor T-Cell Therapy, which boosts the patient’s own immune system to destroy the cancer. Over 90% of the 74 patients treated at Hadassah went into complete remission, the oncologists said.
Hadassah University Medical Center (credit: AVI HAYOUN)
“We have a waiting list of over 200 patients from Israel and various parts of the world at any given time,” she continued. “Due to the complexity of the production and the complexity of the treatment itself, only one patient a week enters the treatment, which is still being conducted as an experiment.”
Asked to comment, Prof. (emeritus) Yechezkel Barenholz, a world leader in oncology research and head of membrane and liposome research lab at the Hebrew University-Hadassah Medical School, said he believed the CAR-T technology is a major achievement that will make the diagnosis much easier and simpler and treatment possible.
The CAR-T cell treatment was developed and produced by Hadassah in collaboration with Prof. Cyrille Cohen, head of the immunology and immunotherapy laboratory at Bar-Ilan University (BIU) in Ramat Gan, achieves excellent results, with 90% of the patients treated so far “We have evidence of a very positive overall response rate with minimal side effects, and they are mild. These are dramatic results,” Stepansky maintained. “This is a huge hope for patients with a disease that has not yet had a cure.”
In the coming months, the experimental treatment will also be provided throughout the US.
What is the blood cancer known as multiple myeloma?
Multiple myeloma is a type of cancer of the bone marrow, which is the spongy tissue at the center of some bones that produces the body’s blood cells. The disease was named multiple myeloma because cancer often affects several areas of the body including the skull, pelvis, ribs and spine. Many times, it is suspected or diagnosed after a routine blood or urine test.
At first, it may not produce any symptoms, but as it develops, myeloma causes a wide variety of problems, including chronic bone pain; weakness, shortness of breath and fatigue resulting from anemia; high levels of calcium in the blood that can trigger symptoms including extreme thirst, stomach pain, needing to urinate frequently, confusion and constipation; weight loss, dizziness, blurred vision, or headaches; repeated infections, bruising and unusual bleeding; weak bones that fracture easily; and kidney problems.
The disease is more common in people over the age of 60; it is usually diagnosed over the age of 70 and rarely under 40; men more than women; and people with a family history of multiple myeloma
Stepansky said that the American company “Immix Bio has acquired a patent license and we are about to open a clinical trial in the US. The plan is to reach commercialization and FDA approval as a drug within a year.
The groundbreaking idea of using immune system cells to fight cancer cells was first born several decades ago at Rehovot’s Weizmann Institute of Science in Prof. Zelig Eshhar's immunology department. The development and promotion of CAR-T treatments whose function is to program the patient’s white blood cells by collecting healthy cells from the immune system has since been led by Stepansky. As part of the treatment, a process is performed to isolate the T cells, which are the active cells in the immune system that can fight tumors by themselves/
This is carried out with by apheresis, which takes donated blood components and separates the red and white blood cells. The process takes two to four hours and is similar to a regular blood donation. Later, the T cells are engineered in the Hadassah laboratory, which was built especially for this purpose according to the strictest international standards in clean rooms. In the next step, a genetic engineering procedure is performed by adding a virus along with a genetic segment that encodes a receptor against the cancer cells. Many engineered cells are then injected into the patient. In the end, the engineered T cells target the tumors and destroy the cancer.
Until now, this treatment has been available only in China and the US at a huge cost of nearly $400,000 per patient treatment, and it is very limited in its availability. Only 20% of those who need to receive it in these countries actually get it,” Stepansky said. “With the development led by the researchers at our Danny Cunniff Leukemia Research Laboratory, we were able to reduce the price dramatically and make the treatment affordable and accessible. Moreover, Hadassah developed a more sophisticated and advanced treatment than that offered in the world. As the first and only institution in Israel that develops, manufactures and delivers treatment Internal CAR-T, Hadassah is actually leading the field that will enable the development of future treatments with CAR T cells for the benefit of patients with other types of cancer,” she concluded.
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Nova Scotia is adding three tick-borne diseases to its list of notifiable diseases and conditions, along with Mpox. (CBC - image credit)
Nova Scotia is adding four diseases — three related to tick bites — to the list of illnesses and conditions that health-care professionals and lab staff must report to Public Health upon observation.
The tick-borne diseases anaplasmosis, babesiosis and Powassan virus, along with mpox, are being added to a list that includes other diseases and conditions such as cholera, Ebola, measles, rabies, shellfish poisoning and typhoid.
Jennifer Heatley, executive director of Public Health, said the most recent additions come because they're viewed as emerging issues. There is also a clause in the Reporting of Notifiable Diseases and Conditions Regulations that requires any unusual incidents of disease to be reported to Public Health.
Mpox, previously known as monkey pox, is something that previously fit the latter category because, although it's a known disease, it had not previously been seen in Canada.
"Now that we know it's here, we don't want to forever rely upon that unusual-incidence category," she said.
"We want to actually build it into the regulations and that helps it be clear for health-care providers what their responsibilities are in terms of reporting."
National Institute of Allergy and Infectious Diseases/The Canadian Press
Heatley said the tick-borne diseases are being added on the advice of epidemiologists and Public Health staff.
"It's something we want to watch for," she said.
"We know that the blacklegged tick population is endemic. It's here to stay. It's not going away. So, I think with that knowledge we want to make sure that we're monitoring the situation."
Shift in focus
Although Lyme disease is most associated with tick bites, Heatley said Public Health is shifting its education away from being specific to Lyme. Instead, it is focusing on tick-borne diseases because the main goal is to help people avoid any kind of tick bite and the symptoms of the respective illnesses are not all the same.
The QEII Health Sciences Centre laboratory is now testing all samples submitted for Lyme disease for anaplasmosis because it was emerging as a disease of unusual occurrence in Nova Scotia, according to a Health Department spokesperson. There have been no reported human cases of Powassan virus.
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