We’ve seen the Alpha, Kappa and Delta variants cross our borders, but it turns out another strain of the virus that causes COVID-19 has reached our shores.
Key points:
The Lambda variant is one of 11 official SARS-CoV-2 variants recognised by the World Health Organization
It was first detected in Peru and has spread to 29 countries, including Australia
A new study that has yet to be peer-reviewed found signs that the variant could be more infectious and harder to tackle with vaccination, but it’s early days
The variant, named Lambda by the World Health Organization (WHO) last month, was detected in an overseas traveller who was in hotel quarantine in New South Wales in April, according to national genomics database AusTrakka.
Some reports suggest the new variant could be fast spreading and difficult to tackle with vaccines. So what sets this variant apart from others and should we be concerned?
In April and May this year, Lambda accounted for over 80 per cent of COVID-19 cases in Peru, with a high proportion of cases also in Chile, Argentina, and Ecuador.
On 14 June, Lambda was listed as a ‘variant of interest’ by the World Health Organization due to its vast spread in South America.
Variants of interest are listed as such because they have the potential to be more infectious and severe, but haven’t yet had the devastating impact of those listed as variants of concern.
On 23 June, Public Health England classified it as a ‘variant under investigation’, after six cases were detected in the UK to date, which were all linked to overseas travel.
What makes it different from other variants?
There are now 11 official SARS-CoV-2 variants listed by the WHO.
All SARS-CoV-2 variants are distinguished from one another by mutations in their spike proteins — the components of the virus that allow it to invade human cells.
For instance, the Delta variant first detected in India has two key spike protein mutations — T478K and L452R — that allow it to infect cells more easily and evade the body’s immune response.
A Chilean team of scientists analysed blood samples from health workers in Santiago who had received two doses of the CoronaVac vaccine developed by Sinovac Biotech in China.
They found the Lambda variant has a mutation called L452Q, which is similar to the L452R mutation seen in the Delta and Epsilon variants.
As the L452R mutation is thought to make Delta and Epsilon more infectious and resilient against vaccination, the team concluded that Lambda’s L452Q mutation might also help it spread far and wide.
While it’s possible that Lambda is indeed more infectious than other variants, it’s too early to know for sure, said Kirsty Short, a virologist at the University of Queensland.
“It’s very preliminary,” said Dr Short, who was not involved in the study.
“It’s a good starting point, but I certainly wouldn’t infer anything from that into the clinic.”
Are vaccines still effective against the Lambda variant?
The study also found signs that Lambda’s unique spike mutations could help it slip past the body’s immune response.
The results of the study suggested that the CoronaVac vaccine produces fewer neutralising antibodies — proteins that defend cells against infections — in response to the Lambda variant.
But according to Paul Griffin, who specialises in infectious diseases and vaccines at the University of Queensland, it’s important to remember that these antibodies are just one aspect of immunity.
“We know that [neutralizing antibodies] only tell a part of the story,” said Dr Griffin, who was not involved in the study.
“If that further immunity remains intact, then even with a reduction in neutralizing antibodies, sometimes that protection can still be enough.”
It’s also worth remembering that different vaccines work in different ways to respond to the virus and its variants.
“You can’t really extrapolate from one vaccine,” Dr Short said.
CoronaVac uses inactive versions of SARS-CoV-2 to kick the immune system into gear.
On the other hand, Pfizer contains a single strand of the genetic code that builds the virus’s spike proteins, while AstraZeneca contains a double-strand.
Dr Griffin said that more traditional inactivated vaccines like CoronaVac have proven to be less effective overall than others.
“As a broad category, the inactivated ones have been a little bit underwhelming, particularly compared to others that have such high rates of efficacy,” said Dr Griffin, who was not involved in the study.
While not much is known about how effective the Pfizer and AstraZeneca vaccines are against Lambda, their response to the Delta variant can offer clues.
A recent study from the UK found that two doses of either Pfizer or AstraZeneca are over 90 per cent effective at preventing hospitalisation due to the Delta variant.
Should Australia be worried?
While there has only been one case of Lambda recorded in hotel quarantine in Australia so far, it’s worth keeping an eye on the emergence and spread of SARS-CoV-2 variants around the world, Dr Short said.
“There’s a reason why it’s a variant that we’re watching and looking into more, but it’s certainly not at a point of panic or anything like that.”
Dr Griffin added that Lambda would need to out-compete Delta to become a major concern. “That’s certainly not what we’re seeing,” he said. But as more people get infected, the more chance the virus has to evolve into new variants, Dr Short said.
The best way to tackle this is to focus on getting more people vaccinated, not just in Australia, but globally. “What this should emphasise to everyone is that we need global effort in the vaccination campaign,” Dr Short said.
We’ve been living in a COVID world for more than 18 months now. At the outset of the pandemic, government agencies and health authorities scrambled to inform people on how to identify symptoms of the virus.
But as the virus has evolved, it seems the most common symptoms have changed too.
Emerging data suggest people infected with the Delta variant — the variant behind most of Australia’s current cases and highly prevalent around the world — are experiencing symptoms different to those we commonly associated with COVID earlier in the pandemic.
Clear explanations about the pandemic from a network of research experts
We’re all different
Humans are dynamic. With our differences come different immune systems. This means the same virus can produce different signs and symptoms in different ways.
A sign is something that’s seen, such as a rash. A symptom is something that’s felt, like a sore throat.
The way a virus causes illness is dependent on two key factors:
viral factors include things like speed of replication, modes of transmission, and so on. Viral factors change as the virus evolves.
host factors are specific to the individual. Age, gender, medications, diet, exercise, health and stress can all affect host factors.
So when we talk about the signs and symptoms of a virus, we’re referring to what is most common. To ascertain this, we have to collect information from individual cases.
It’s important to note this data is not always easy to collect or analyse to ensure there’s no bias. For example, older people may have different symptoms to younger people, and collecting data from patients in a hospital may be different to patients at a GP clinic.
So what are the common signs and symptoms of the Delta variant?
Using a self-reporting system through a mobile app, data from the United Kingdom suggest the most common COVID symptoms may have changed from those we traditionally associated with the virus.
The reports don’t take into account which COVID variant participants are infected with. But given Delta is predominating in the UK at present, it’s a safe bet the symptoms we see here reflect the Delta variant.
While fever and cough have always been common COVID symptoms, and headache and sore throat have traditionally presented for some people, a runny nose was rarely reported in earlier data. Meanwhile, loss of smell, which was originally quite common, now ranks ninth.
There are a few reasons we could be seeing the symptoms evolving in this way. It may be because data were originally coming mainly from patients presenting to hospital who were therefore likely to be sicker. And given the higher rates of vaccination coverage in older age groups, younger people are now accounting for a greater proportion of COVID cases, and they tend to experience milder symptoms.
It could also be because of the evolution of the virus, and the different characteristics (viral factors) of the Delta variant. But why exactly symptoms could be changing remains uncertain.
While we still have more to learn about the Delta variant, this emerging data is important because it shows us that what we might think of as just a mild winter cold — a runny nose and a sore throat — could be a case of COVID-19.
This data highlight the power of public science. At the same time, we need to remember the results haven’t yet been fully analysed or stratified. That is, “host factors” such as age, gender, other illnesses, medications and so on haven’t been accounted for, as they would in a rigorous clinical trial.
And as is the case with all self-reported data, we have to acknowledge there may be some flaws in the results.
Does vaccination affect the symptoms?
Although new viral variants can compromise the effectiveness of vaccines, for Delta, the vaccines available in Australia (Pfizer and AstraZeneca) still appear to offer good protection against symptomatic COVID-19 after two doses.
Importantly, both vaccines have been shown to offer greater than 90% protection from severe disease requiring hospital treatment.
A recent “superspreader” event in New South Wales highlighted the importance of vaccination. Of 30 people who attended this birthday party, reports indicated none of the 24 people who became infected with the Delta variant had been vaccinated. The six vaccinated people at the party did not contract COVID-19.
In some cases infection may still possible after vaccination, but it’s highly likely the viral load will be lower and symptoms much milder than they would without vaccination.
We all have a role to play
Evidence indicating Delta is more infectious compared to the original SARS-CoV-2 and other variants of the virus is building.
It’s important to understand the environment is also changing. People have become more complacent with social distancing, seasons change, vaccination rates vary — all these factors affect the data.
But scientists are becoming more confident the Delta variant represents a more transmissible SARS-CoV-2 strain.
As we face another COVID battle in Australia we’re reminded the war against COVID is not over and we all have a role to play. Get tested if you have any symptoms, even if it’s “just a sniffle”. Get vaccinated as soon as you can and follow public health advice.
By: Lara Herrero Research Leader in Virology and Infectious Disease, Griffith University
While the alpha and beta genera are derived from the bat viral gene pool, the gamma and delta genera are derived from the avian and pig viral gene pools.
Recombination appears to be common among deltacoronaviruses.Recombination occurs frequently in the viral genome region that encodes the host receptor binding protein. Recombination between different viral lineages contributes to the emergence of new viruses capable of interspecies transmission and adaptation to new animal hosts.
Lau SKP, Wong EYM, Tsang CC, Ahmed SS, Au-Yeung RKH, Yuen KY, Wernery U, Woo PCY. Discovery and Sequence Analysis of Four Deltacoronaviruses from Birds in the Middle East Reveal Interspecies Jumping with Recombination as a Potential Mechanism for Avian-to-Avian and Avian-to-Mammalian Transmission. J Virol. 2018 Jul 17;92(15):e00265-18. doi: 10.1128/JVI.00265-18. Print 2018 Aug 1. PMID: 29769348
The official list of Covid-19 symptoms should be expanded as the existing one could “miss many Covid-19 cases”, experts have argued. The UK should follow other countries and include a broader range of symptoms, according to a group of scientists. Classic symptoms of Covid-19, listed on the NHS website, are a high temperature, a new continuous cough and/or a loss or change to a person’s sense of smell or taste.
But the most commonly reported symptoms by people taking part in the Office for National Statistics (ONS) Covid-19 Infection Survey are cough, headache and fatigue. The latest ONS release shows 61% of people who tested positive reported symptoms. Of these, 42% had a cough, 39% reported headache and 38% reported fatigue, according to the ONS.
Muscle ache was reported by a quarter of people and 32% reported having a sore throat. Meanwhile a third reported fever and 21% reported loss of smell and 15% reported loss of taste. A separate study – the Zoe Covid Symptom study – recently reported that a headache, sore throat and runny nose are now the most commonly reported symptoms. These are most likely symptoms of the Delta variant.
Writing in the British Medical Journal (BMJ), Dr Alex Crozier and colleagues – including Professor Calum Semple who is a member of Sage – suggest that limiting testing to only people with fever, cough and a change in taste or smell could “miss or delay identification of many Covid cases”.
They suggest this could “hamper efforts to interrupt transmission” of the virus. The group argue that increasing the symptom list could improve Britain’s pandemic response by expanding the criteria for self-isolation and eligibility for symptomatic testing.
The “narrow” case definition “limits” the early detection of contagious people, which restricts the efforts of the Test and Trace programme, they say. Non-traditional symptoms “often manifest earlier”, they added. The US Centres for Disease Control lists 11 more symptoms than the UK, and the World Health Organisation includes nine more. The testing capabilities are now able to facilitate people with a broader spectrum of symptoms, they added.
They say testing people with a single non-specific symptom could overwhelm capacity in the UK, but “combinations of symptoms could be used to help identify more cases sooner without overwhelming testing capacity”. The authors continue: “The UK’s decision to adopt a narrow case definition was based on ease of communication, avoiding confusion with other infections and preserving testing capacity.
People who had mild symptoms at first can still have long-term problems, says the NHS. The signs of long Covid vary from person to person, but the NHS now lists the following common symptoms: extreme tiredness (fatigue), shortness of breath , chest pain or tightness , problems with memory and concentration (“brain fog”), difficulty sleeping (insomnia), heart palpitations, dizziness , pins and needles ,joint pain, depression and anxiety, tinnitus, earaches, feeling sick, diarrhoea, stomach aches, loss of appetite, a high temperature, cough, headaches, sore throat, changes to sense of smell or taste and rashes.
This situation is now different — testing capacity is high. “Covid-19 is associated with a wide range of symptoms. Many patients do not experience the UK’s official case-defining symptoms, initially, or ever, and other symptoms often manifest earlier. Limiting the symptomatic testing to those with these official symptoms will miss or delay identification of many Covid-19 cases, hampering efforts to interrupt transmission.
“Expanding the clinical case definition of Covid−19, the criteria for self-isolation, and eligibility for symptomatic testing could improve the UK’s pandemic response. The Department of Health and Social Care has been approached for comment by PA Media. We will update this piece if there is a response.
The reason women might be more susceptible to long Covid might lie in differences in how our immune systems work – or that’s what scientists hypothesise, anyway. Research is needed to look into this. In a 2016 review on the differences in immune responses between males and females, professor Sabra Klein, of The Johns Hopkins Bloomberg School of Public Health, and professor Katie Flanagan, of Monash University, said females’ strong immune responses result in faster clearance of pathogens and greater vaccine efficacy compared to males. But it also contributes to females’ increased susceptibility to inflammatory and autoimmune diseases.
Neurological symptoms in many cases are correlated with damage to the brain’s blood supply or encephalitis, which can progress in some cases to acute disseminated encephalomyelitis. Strokes have been reported in younger people without conventional risk factors.
As of September 2020, it was unclear whether these symptoms were due to direct infection of brain cells, or of overstimulation of the immune system. A June 2020 systematic review reported a 6–16% prevalence of vertigo or dizziness, 7–15% for confusion, and 0–2% for ataxia.
Oran, Daniel P., and Eric J. Topol. “Prevalence of Asymptomatic SARS-CoV-2 Infection : A Narrative Review.” Annals of Internal Medicine. vol. 173,5 (2020): 362-367. doi:10.7326/M20-3012 PMID 32491919 Retrieved 14 January 2021.
Part of Dennis Plenker’s daily job is growing cancer. And a variety of different ones, too. Depending on the day and the project, different tumors may burgeon in the petri dishes stocked in the Cold Spring Harbor Laboratory where Plenker works as a research investigator. They might be aggressive breast cancers.
They might be glioblastomas, one of the deadliest brain tumors that rob patients of their ability to speak or read as they crowd out normal cells. Or they might be pancreatic cancers, the fast and vicious slayers that can overtake a healthy person within weeks or even days.
These tiny tumor chunks are transparent and bland—they look like little droplets of hair gel that accidentally plopped into a plastic dish and took hold. But their unassuming appearance is deceptive. If they were still in the human bodies they came from, they would be sucking up nutrients, rapidly growing and dodging the immune system defenses.
But in Plenker’s hands—or rather in the CSHL’s unique facility—these notorious killers don’t kill anyone. Instead, scientists let them grow to devise the most potent ways to kill them. These tumor chunks are called organoids. They are three-dimensional assemblages of malignant growths used to study cancer behavior and vulnerability to chemotherapy and the so-called “targeted drugs”—the next generation therapies.
Scientists used to study tumors at a single-cell level, but because tumors grow as cell clusters in the body, it proved to be inefficient. The three-dimensional structures make a difference. For example, chemo might destroy the tumor’s outer cell layer, but the inner ones can develop resistance, so where single cells may die, a 3D mass will bounce back. Organoids can provide a window into these little-known mechanisms of drug resistance.
They can reveal how normal tissues turn malignant and where the cellular machinery goes off-track to allow that to happen. As their name suggests, organoids are scientists’ windows into organs, whether healthy or stricken with disease. You need to know your enemy to beat it, Plenker says, and cancer organoids offer that opportunity.
Taken from patients currently undergoing cancer treatments, these tumor chunks will reveal their weaknesses so scientists can find the cancers’ Achilles’ heel and devise personalized treatments. “Organoids are essentially patients in a dish,” Plenker says. Only unlike real patients, the organoids can be subjected to all sorts of harsh experiments to zero in on the precise chemo cocktails that destroy them in the best possible way.
And they will likely provide a more realistic scenario than drug tests in mice or rats, as animal models aren’t perfect proxies for humans.
These notorious killers don’t kill anyone. Instead, scientists devise the most potent ways to kill them.
The way that cancer proliferates in the body is hard to reproduce in the lab. Stem-cell research made it possible. After scientists spent a decade understanding how various cells multiply and differentiate into other cell types based on molecular cues and nourishment, they were able to make cells grow and fuse into tissues.
To stick together like bricks in a nicely laid wall, cells need a biological scaffold that scientists call an extracellular matrix or ECM, which in the body is made from collagen and other materials. Today, the same collagen scaffolds can be mimicked with a gooey substance called Matrigel—and then seeded with specific cells, which take root and begin to multiply.
Some tissue types were easy to grow—Columbia University scientists grew viable bones as early as 2010.1 Others, like kidney cells, were trickier. They would grow into immature tissues incapable of performing their job of cleaning and filtering blood. It took scientists time to realize that these cells wanted more than scaffolding and food—they needed to “feel at home,” or be in their natural habitat. Kidney cells needed the feeling of liquid being washed over them, the Harvard University group found, when they first managed to grow functioning kidney tissue in 2018.2
Cancers have their own growth requirements. In the body, they manage to co-opt the organism’s resources, but keeping them happy in a dish means catering to their dietary preferences. Different cancers need different types of molecular chow—growth factors, hormones, oxygen and pH levels, and other nutrients. Pancreatic adenocarcinoma thrives in low-oxygen conditions with poor nutrients.3 Glioblastomas feed on fatty acids.4 These nutrients are delivered to organoids via a specific solution called growth medium, which the lab personnel regularly doles out into the dishes.
Plenker is charged with keeping this murderous menagerie alive and well. He is the one who designs the cancers’ dietary menu, a specific protocol for each type. And while his official title is facility manager and research investigator who works closely with David Tuveson, director of the CSHL’s Cancer Center, he is essentially a cancer custodian, a curator of a unique collection that aims to change the paradigm of cancer treatment.
Plenker’s research area is pancreatic cancer—one of the most notorious killers known. Often diagnosed late and resistant to treatment, it is essentially a death sentence—only 8 to 10 percent of patients remain alive five years after diagnosis. The chemo drugs used to treat it haven’t changed in 40 years, Plenker says. In the past decade, physicians tried combining multiple drugs together with relative success. Identifying winning combos can save lives, or at least prolong them—and that’s what the organoids will help clinicians do better.
In a groundbreaking clinical trial called PASS-01 (for Pancreatic Adenocarcinoma Signature Stratification for Treatment), Plenker’s team collaborates with other American and Canadian colleagues to identify the most effective chemo cocktails and to understand the individual patients’ tumor behaviors, which would lead to more personalized treatments.5
Scientists know the same cancer types behave differently in different patients. Typically, all malignancies have the so-called “driver mutation”— the cancer’s main trigger caused by a mutated gene. But tumors also often have “passenger mutations” that happen in nearby genes. These additional mutated genes can generate various proteins, which may interfere with treatment.
Or not. Scientists call these mutated gene combinations tumor mutational signatures, which can vary from one patient to the next. With some cancers, doctors already know what mutations signatures they may have, but with pancreatic cancer they don’t have good tale-telling signs, or biomarkers. “There aren’t many biomarkers to help clinicians decide which chemo may be better for which patient,” explains oncologist Grainne O’Kane, who treats pancreatic cancer patients at the Princess Margaret Hospital in Toronto, Canada.
That’s the reason O’Kane participates in the PASS-01 trial—it will give doctors a better view into the exact specifics of their patients’ malignancies. As they take their patients’ biopsies, they are sending little cancer snippets to the CSHL to be grown into organoids, which will be subjected to chemo cocktails of various combinations to design more personalized regiments for them.
The hospital treats all patients with the so-called standard of care chemotherapy, which is more of a one-size-fits-all approach. Some patients will respond to it but others won’t, so the goal is to define the second line of chemo defense in a more personalized fashion. “That’s where the biopsies we send to Tuveson’s lab might be useful,” O’Kane says. “They can help us find something to benefit patients after the first line of chemo stopped working.”
Organoids are patients in a dish. Unlike real patients, organoids can be subjected to experiments.
Scientists can try all kinds of combos on the tumorous organoids, which they can’t do in living people. “You can treat 100 organoids with 100 different compounds and see which one works, or which compound does a good job and which ones don’t work at all,” Plenker says. That would also allow scientists to define the precise amount of chemo, so doctors wouldn’t have to over-treat patients with harsh drugs that create sickening side effects. Ultimately, organoids should take a lot of guesswork out of the process.
With about 150 patients’ adenocarcinomas already collected, the team hopes to come up with some answers. O’Kane says her team already has three patients for which they were able to design the more personalized second line of defense chemo, based on what their organoids revealed. They haven’t yet tried it, because the trial has only started recently, but this would be the next step.
“Being able to piece all this information together in real time as patients are moving through their therapies can really improve the outcomes,” O’Kane says. And while they may not be able to save all of those who graciously donated their biopsy snippets to science, it will help build better treatments in the future. “Even if we won’t be able to help these specific patients we’re hoping to use this info in the future clinical trials,” O’Kane says.
Organoids can also help understand how cancer develops. This is particularly true for breast cancers, says Camilla dos Santos, associate professor and a member of the CSHL Cancer Center. She studies the inner life of human mammary glands, more commonly referred to as breasts, and is also part of the cancer custodian crew. The hormonal changes that women go through during pregnancy subsequently modify breast cancer risk, sometimes lowering it and sometimes increasing—a complex interplay of the body’s chemicals.
“We know that women who get pregnant for the first time before they turn 25 years old, have a 30 percent decrease in breast cancer incidents later in life,” dos Santos says. “When they turn 60 or 70, 30 percent of them will not develop cancer.” On the contrary, those who are pregnant past 38 have a 30 to 50 percent increase in developing aggressive breast cancer types. Clearly, some molecular switches are involved, but they are very hard to study within the body. That’s where organoids can provide a window into the surreptitious process.
Using breast organoids, scientists can model the complex life of mammary glands at various stages of a woman’s life. And while most women wouldn’t want their breasts poked and pierced when they are pregnant or breastfeeding, many donate their tissues after breast reduction surgery or prophylactic mastectomy due to high-risk mutations like the BRCA gene.
That’s where organoids shine because scientists can not only grow them, but also give them the pregnancy hormonal cues, which will make cells generate milk, stop lactating, or do it again—and study the complex cellular interactions that take place in real life.
There’s a lot to study. At birth, mammary glands are similar in both genders—just little patches of the mammary epithelium tissue. But when puberty hits, the female glands fill up with the so-called mammary tree—a system of ducts for future milk production, which fully “blooms” in pregnancy.
“When a woman becomes pregnant, the duct tree expands, growing two types of cells—luminal and myoepithelial ones,” explains Zuzana Koledova, assistant professor of Masaryk University in Czech Republic who also uses organoids in her work. When the baby is born, the luminal cells, which line the inside of the ducts, produce the proteins that comprise milk.
The myoepithelial cells reside outside the ducts and work as muscles that squeeze the ducts to push milk out. Dos Santos likens this pregnancy mammary gland growth to the changes of the seasons. The images of sprouting ducts look like blossoming trees in the spring while later they shrivel like plants do in the fall.
The body governs these processes via the molecular machinery of hormones, which stimulate breast cells growth during pregnancy, and later cause them to die out. The two pregnancy-related hormones, prolactin and oxytocin, are responsible for milk production. Prolactin induces the luminal cells to make milk while oxytocin makes the myoepithelial cells contract. Once the baby is weaned, the levels of these hormones drop, causing cells to shrink back to their non-pregnant state.
With organoids scientists can observe these cellular dynamics at work. Koledova’s team had watched breast organoids secrete milk based on biological cues. They even recorded movies of cells pumping tiny milk droplets in the dish they were growing in. Using tiny snippets of donated breast tissue, the team grew the organoids inside the Matrigel matrix in the growth media and then added the two pregnancy hormones into the mix, explains Jakub Sumbal, a mammary gland researcher in Koledova’s group.
As they began to secret proteins that compose milk, the organoids, which looked like little domes inside the dish, changed from translucent to opaque. “At first, you can see through them, but then as they produce these proteins, they kind of darken,” Sumbal says. “And you can see them pushing out these little droplets.”
Cancer patients would no longer have to undergo chemotherapy by trial and error.
Dos Santos’s team, who also did similar work, outlined molecular changes that follow such dish-based hormonal cues in their recent study.6 In response to hormonal messages, cells produce proteins, which they display on their surfaces, like status symbols. During pregnancy the burgeoning cells prepping for milk production display the “proteins flags” that make them look important, attracting nourishment. When it’s time to die, they commit a cellular suicide.
They signal to the bypassing macrophages—immune system cleanup crew—to devour them. “They essentially say ‘come eat me!’ to the macrophages,” dos Santos says. “Because I’m no longer needed.”
The ability to mimic these processes in a dish, allows scientists to study the molecular switches that trigger breast cancer development—or minimize it. Scientists know that cancerous cells can hide from the immune system and even co-opt it into protecting themselves. They do it by displaying their own “do not eat me” protein flags on the surface and avoid destruction.
“Sometimes cancer cells can recruit specific types of immune cells to protect them,” dos Santos says. “They can not only say ‘do not eat me,’ but say ‘come hang out with me’ to the macrophages, and the macrophages will send suppressive signals to the B-cells or T-cells, the body defenders.” It is as if the cancer requests protection—a crew of guardians around it to defend against other cells that would otherwise wipe it out.
Scientists can’t telescope into the body to peek at these interactions, but they now can watch these stealth battles unfolding in a dish. “Right now we are looking at the proteins that are secreted by the organoids—the proteins that go on the surface of the organoids’ cells and what they would communicate to the immune system,” dos Santos says.
“Even when there’s no immune system surrounding them, they would still be doing that.” There’s a way to mimic the immune system, too. Scientists can add B-cells, T-cells, macrophages, and other players into the growth medium and watch the full-blown cellular warfare in action. “That’s the next step in our research,” dos Santos says.
Understanding what hormonal fluxes trigger breast cancer, and how it recruits other cells for safekeeping, can give scientists ideas for pharmaceutical intervention. “We can find drugs that pharmacologically turn off the switches that trigger cancer or interrupt its signaling for protection,” dos Santos says. “That opens novel ways to treat people.”
Can organoid research lead to a new standard of care for cancer patients? That’s the ultimate goal, researchers say. That’s why Plenker works at keeping his collection of cancer glops alive and well and thriving—he calls it a living biobank. And he keeps a stash in the cryogenic freezer, too.
He is also developing protocols that would allow commercial companies to grow organoids the same way chemical industries make reagents or mice suppliers grow rodents for research. A benefit of organoid experiments is they don’t involve animals at all.
Hospitals may one day start growing organoids from their patients’ biopsies to design and test personalized chemo cocktails for them. Once science crosses over to that reality, the entire treatment paradigm will change. Cancer patients won’t have to undergo chemotherapy by trial and error.
Instead their cancer organoids will be subjected to this process—knocked out by a gamut of drug combinations to find the winning one to use in the actual treatment. Plenker notes that once enough data is gathered about the tumors’ mutational signatures, scientists may create a database of tumor “mugshots” matching them to the chemo cocktails that beat them best.
And then just sequencing a biopsy sample would immediately inform oncologists what drug combo the patient needs. “We may be about 10 years away from that,” Plenker says, but for now there’s a lot more research to do. And a lot more cancers to grow.
Lina Zeldovich grew up in a family of Russian scientists, listening to bedtime stories about volcanoes, black holes, and intrepid explorers. She has written for The New York Times, Scientific American, Reader’s Digest, and Audubon Magazine, among other publications, and won four awards for covering the science of poop. Her book, The Other Dark Matter: The Science and Business of Turning Waste into Wealth, will be released in October 2021 by Chicago University Press. You can find her at LinaZeldovich.com and @LinaZeldovich.
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss, and a change in bowel movements. While these symptoms may indicate cancer, they can also have other causes. Over 100 types of cancers affect humans.
These factors act, at least partly, by changing the genes of a cell. Typically, many genetic changes are required before cancer develops. Approximately 5–10% of cancers are due to inherited genetic defects. Cancer can be detected by certain signs and symptoms or screening tests. It is then typically further investigated by medical imaging and confirmed by biopsy.
Most cancers are initially recognized either because of the appearance of signs or symptoms or through screening. Neither of these leads to a definitive diagnosis, which requires the examination of a tissue sample by a pathologist. People with suspected cancer are investigated with medical tests. These commonly include blood tests, X-rays, (contrast) CT scans and endoscopy.
The tissue diagnosis from the biopsy indicates the type of cell that is proliferating, its histological grade, genetic abnormalities and other features. Together, this information is useful to evaluate the prognosis and to choose the best treatment.
Adding protein powder to a glass of milk or a smoothie may seem like a simple way to boost your health. After, all, protein is essential for building and maintaining muscle, bone strength, and numerous body functions. And many older adults don’t consume enough protein because of a reduced appetite.
But be careful: a scoop of chocolate or vanilla protein powder can harbor health risks. “I don’t recommend using protein powders except in a few instances, and only with supervision,” says registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women’s Hospital.
What is protein powder?
Protein powders are powdered forms of protein that come from plants (soybeans, peas, rice, potatoes, or hemp), eggs, or milk (casein or whey protein). The powders may include other ingredients such as added sugars, artificial flavoring, thickeners, vitamins, and minerals. The amount of protein per scoop can vary from 10 to 30 grams. Supplements used for building muscle contain relatively more protein, and supplements used for weight loss contain relatively less.
What are the risks?
There are numerous risks to consider when using a protein powder. Among them:
A protein powder is a dietary supplement. The FDA leaves it up to manufacturers to evaluate the safety and labeling of products. So, there’s no way to know if a protein powder contains what manufacturers claim.
We don’t know the long-term effects. “There are limited data on the possible side effects of high protein intake from supplements,” McManus says.
It may cause digestive distress. “People with dairy allergies or trouble digesting lactose [milk sugar] can experience gastrointestinal discomfort if they use a milk-based protein powder,” McManus points out.
It may be high in added sugars and calories. Some protein powders have little added sugar, and others have a lot (as much as 23 grams per scoop). Some protein powders wind up turning a glass of milk into a drink with more than 1,200 calories. The risk: weight gain and an unhealthy spike in blood sugar. The American Heart Association recommends a limit of 24 grams of added sugar per day for women and 36 grams for men.
A new risk revealed
Earlier this year, a nonprofit group called the Clean Label Project released a report about toxins in protein powders. Researchers screened 134 products for 130 types of toxins and found that many protein powders contained heavy metals (lead, arsenic, cadmium, and mercury), bisphenol-A (BPA, which is used to make plastic), pesticides, or other contaminants with links to cancer and other health conditions. Some toxins were present in significant quantities. For example, one protein powder contained 25 times the allowed limit of BPA.
How could protein powder contain so many contaminants? The Clean Label Project points to manufacturing processes or the existence of toxins in soil (absorbed by plants that are made into protein powders).
Not all of the protein powders that were tested contained elevated levels of toxins. You can see the results at the Clean Label Project’s website (www.cleanlabelproject.org).
Daily protein goals
Aim for the Recommended Dietary Allowance for protein intake: 46 grams per day for women and 56 grams for men. For example:
an egg for breakfast (6 grams)
6 ounces of plain Greek yogurt at lunch (18 grams)
a handful of nuts for a snack (4–7 grams)
a cup of milk (8 grams) and 2 ounces of cooked chicken for dinner (14 grams).
What you should do
McManus says that in certain cases, chemical-free protein powders may be helpful—but only with medical supervision. Such cases could include
difficulty eating or an impaired appetite (as a result of cancer treatment or frailty from older age)
a surgical incision or a pressure wound that is not healing well (your body needs protein to repair cells and make new ones)
a serious condition requiring additional calories and protein in order for you to get better (such as burns).
Otherwise, get protein from whole foods: nuts, seeds, low-fat dairy products (yogurt, milk, cheese), legumes (beans, lentils), fish, poultry, eggs, and lean meat. “You’ll find,” McManus says, “that there are many ways to get protein without turning to a powder.”
Bodybuilding supplements are dietary supplements commonly used by those involved in bodybuilding, weightlifting, mixed martial arts, and athletics for the purpose of facilitating an increase in lean body mass. The intent is to increase muscle, increase body weight, improve athletic performance, and for some sports, to simultaneously decrease percent body fat so as to create better muscle definition.
While many bodybuilding supplements are also consumed by the general public the frequency of use will differ when used specifically by bodybuilders. One meta-analysis concluded that – for athletes participating in resistance exercise training and consuming protein supplements for an average of 13 weeks – total protein intake up to 1.6 g/kg of body weight per day would result in an increase in strength and fat-free mass, but that higher intakes would not further contribute.
In addition to being potentially harmful, some have argued that there is little evidence to indicate any benefit to using bodybuilding protein or amino acid supplements. A 2005 overview concluded that “[i]n view of the lack of compelling evidence to the contrary, no additional dietary protein is suggested for healthy adults undertaking resistance or endurance exercise”.
In dispute of this, a 2017 meta-analysis concluded that for athletes participating in resistance exercise training and consuming protein supplements for an average of 13 weeks, total protein intake up to 1.6 g per kg body weight per day would result in an increase in strength and fat-free mass, i.e. muscle, but that higher intakes would not further contribute. The muscle mass increase was statistically significant but modest – averaging 0.3 for all trials and 1.0 to 2.0 kg, for protein intake ≥ 1.6 g/kg/day.
In these times of post-pandemic financial uncertainty, additional return on investment for medical providers is more welcome than ever. Patient financing — which for the purposes of this article means partnering with an external lender to provide service and procedure payments — can produce not just steady income for a practice, but help ensure that patients won’t have to put off procedures or, worse yet, abandon them altogether.
For example, Toronto Plastic Surgeons provides this facility to its patients through Medicard Patient Financing. There are also veterinary financing services for pets available through Medicard Patient Financing. What are some reasons practitioners might have employed in deciding upon this option?
No More Delays
There are, unfortunately, economic disparities when it comes to accessing healthcare services. Too often, the high-income and privileged have more access to healthcare resources than the medium- and low-income populations. Patient financing can help in reducing this imbalance, because the simple and daunting truth is that many medical problems don’t come announced, and it’s often impossible to plan for their associated expenses. With financing, patients don’t need to wait to get their accounts in order before opting for procedures — the result is, ideally, prompt and less stressful treatment.
Since clients can often better manage their expenses via patient financing, they tend to be more satisfied on the whole. In part this is because they are not stressed and burdened with sudden financial decisions associated with urgent medical procedures. Better yet, they are more likely to stay loyal to a practice if they don’t have to worry as much. Compared to other practices that don’t offer this option, they are more likely to choose the former, which can mean increased business through word of mouth.
Reduced Collection Costs
When you partner with a patient financer, you receive payments on time. It also means that your team won’t spend needless hours and energy trying to collect payments.
Steady Cash Flow and Less Bad Debt
In setting up a conventional payment plan for a patient, your team is taking the responsibility of keeping tabs on payments and collecting them on time. It’s essentially extending a loan to a patient, typically without any interest. However, expenses like bills, payroll and lease/rent go on as usual. This can lead to money tied up in accounts receivable, which will easily and quickly impact a budget. But when you opt for association with a patient financing company, the latter bears the cost of collections, including giving you the option of getting payment upfront.
Association with a financing company with its own marketing arm can help promote a business — making your clinic stand out in comparison to competitors.
Which to Choose?
When it comes to financing models, three predominate. In the first, Self-Funding, you as the healthcare provider are responsible for receivables. From creating a payment schedule to collecting funds to following up with the patient, your team carries out all the tasks. In the Recourse Lending model, you work with a patient financier/lender, which will approve a patient’s loan after the business/practice passes qualifying criteria.
If the patient doesn’t pay, the lending/financing company will recover the losses from you. Among the drawbacks here is that the practice will have to bear the losses and lender’s fees. Lastly, there is the Non-Recourse Lending model. Similar to the second, you work with a lending company. Key differences are that it is the patient who has to pass the underwriting criteria (if the lender doesn’t approve the patient, no funding is provided by them), and that losses are borne by the lender. One disadvantage of this method is that the lenders charge interest from patients; when rates are high, patients might not be interested. Also, patients with a weak credit history might be rejected during the underwriting evaluation.
By : Chris Porteous / Entrepreneur Leadership Network Contributor – High Performance Growth Marketer
Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it.
The fund may be a not-for-profit trust that pays out for healthcare according to common rules established by the members or by some other democratic form. In some countries, the fund is controlled directly by the government or by an agency of the government for the benefit of the entire population. That distinguishes it from other forms of private medical insurance, the rights of access to which are subject to contractual obligations between an insured person (or their sponsor) and an insurance company, which seeks to make a profit by managing the flow of funds between funders and providers of health care services.
When taxation is the primary means of financing health care and sometimes with compulsory insurance, all eligible people receive the same level of cover regardless of their financial circumstances or risk factors.
Most developed countries have partially or fully publicly funded health systems. Most western industrial countries have a system of social insurance based on the principle of social solidarity that covers eligible people from bearing the direct burden of most health care expenditure, funded by taxation during their working life.
Among countries with significant public funding of healthcare there are many different approaches to the funding and provision of medical services. Systems may be funded from general government revenues (as in Canada, United Kingdom, Brazil and India) or through a government social security system (as in Australia, France, Belgium, Japan and Germany) with a separate budget and hypothecated taxes or contributions.
The proportion of the cost of care covered also differs: in Canada, all hospital care is paid for by the government, while in Japan, patients must pay 10 to 30% of the cost of a hospital stay. Services provided by public systems vary. For example, the Belgian government pays the bulk of the fees for dental and eye care, while the Australian government covers eye care but not dental care.
Publicly funded medicine may be administered and provided by the government, as in the Nordic countries, Portugal, Spain, and Italy; in some systems, though, medicine is publicly funded but most hospital providers are private entities, as in Canada. The organization providing public health insurance is not necessarily a public administration, and its budget may be isolated from the main state budget. Some systems do not provide universal healthcare or restrict coverage to public health facilities. Some countries, such as Germany, have multiple public insurance organizations linked by a common legal framework. Some, such as the Netherlands and Switzerland, allow private for-profit insurers to participate.
Woolhandler S, Himmelstein DU (August 1999). “When money is the mission—the high costs of investor-owned care”. N. Engl. J. Med. 341 (6): 444–6. doi:10.1056/NEJM199908053410611. PMID10432332.
An article published recent in in the New England Journal of Medicine reports some astounding research findings which could save millions of lives. Why did you miss it? Because there was zero media coverage (apart from a few specialty medical blogs). Zero. That tells you something. Tells you a lot, actually. So, here are the details.
High blood pressure is the world’s leading killer — and will kill more people, including more young people, than Covid-19 (and, in usual years, more than all other infectious diseases combined). High blood pressure can be prevented, mostly by reducing dietary sodium, and is effectively treated with safe, low-cost medications.
But globally, we’re doing terribly on blood pressure control. Less than 1 in 7 people with high blood pressure, an abysmal 14%, have it controlled. This is, frankly, pathetic — and is killing millions of people a year. It’s the most important health care intervention for adults to save lives, and we get it right less than 1 in 7 times (and, in the United States, with a $4 trillion dollar health care system, we get this right less than half the time, despite it being the intervention that can save more lives than any other health care intervention in the US!)
Elegant studies by University of Oxford scientists prove that, for every 20-point increase in systolic blood pressure (the larger “top” number), the death rate from cardiovascular disease doubles. What’s more, this starts at a blood pressure of 115/75 — way below the usual level at which we treat, or toward which we aim treatment. Adapted from “Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies” in The Lancet. But showing that lower is better didn’t prove that lowering more is better. That’s where the incredibly important Systolic Blood Pressure Intervention Trial (SPRINT) study, begun in 2010, comes in.
It’s one thing to prove (as Oxford’s Dr. Sarah Lewington did) that lower blood pressure correlates with lower risk of death, but quite another to prove that lowering blood pressure more saves more lives. Lower blood pressure reduces the risk of death, but how low do we need to go? That’s what’s big news about the results from the SPRINT study that were just released. They prove that lower IS better — and that setting a blood pressure goal lower than the standard treatment goal prevented many more deaths.
The SPRINT study also showed that, despite more side effects (far less dangerous than heart attack or stroke), intensive blood pressure treatment to reach the lower blood pressure goal is safe — even for older people. More intensive treatment prevented more heart attacks, strokes and deaths.Based on the SPRINT study, many guidelines now recommend that certain high-risk patients with high blood pressure aim for a systolic blood pressure below 130 rather than the standard target of 140. (SPRINT aimed for an even lower target of 120/80.)
But the bigger implication: We need to do much better at getting people to under 140/90. For years, doctors were afraid to lower their patients’ blood pressures to levels they thought would be too low, and potentially dangerous. Now, it’s proven that “overshooting” the goal of 140/90 isn’t just something that won’t hurt the patient — it could well save their life.
The death rate among people treated with a blood pressure goal of under 120/80 was 27% lower than the death rate of people treated to the usual target of 140/90. And for every death prevented, about two heart attacks are prevented in addition to strokes, kidney failure, dementia, and more. Now, it’s also true that interventions other than medication can be important. Reducing sodium, in particular, can reduce blood pressure and other health harms from our overly salty diet. Getting regular physical activity, eating a healthier diet overall, reducing air pollution, and more can make a big difference. But these interventions are best done on a societal, community-wide basis.
That’s why, although we should empower and inform patients, we shouldn’t expect them to be able to withstand the obesogenic, salty, sedentary, polluted environment we live in. And even if we could magically improve our food and overall environment, there would still be a billion people in the world in need of medications to treat their hypertension. Why are we failing to control high blood pressure? One reason is that we’ve made treatment too complicated — far more complicated than it needs to be for optimal results. For the past four years, Resolve to Save Lives has worked with our global partners to identify characteristics of high-performing hypertension control programs throughout the world.
The WHO HEARTS technical package for improving cardiovascular health simplifies hypertension treatment: standard treatment protocols that any health worker can implement, reliable supply of quality-assured medicines, team-based health care, patient-centered services and a strong health information system. This makes it more likely that patients will achieve and maintain blood pressure control. Think about it. A study came out last week that could save millions of lives. There was not a single news article about it. Though this was “just” the final report from a study whose key results had previously been released in advance (because the findings are so important), we have been slow to implement these recommendations. It shows that we still have a lot to learn about what we need to focus on to save the most lives.
Resolve To Save Lives partners with countries which implement WHO’s HEARTS package to lower blood pressure. Sodium reduction and hypertension treatment can prevent 3 million early deaths — every year. Lowering blood pressure can save millions of lives. We know what we need to do, now let’s make it happen.
By: Dr. Tom Frieden / Dr. Tom Frieden, director of the US Centers for Disease Control and Prevention during the Obama administration, when he oversaw responses to the H1N1 influenza, Ebola and Zika epidemics, is President and CEO of Resolve to Save Lives, an initiative of Vital Strategies and Senior Fellow for Global Health at the Council on Foreign Relations. Twitter: @DrTomFrieden.
The pressure in the arteries changes depending on what the heart is doing. When the heart squeezes, pumping blood into the arteries, the pressure increases. When the heart relaxes, the pressure decreases. When blood pressure is measured, the highest pressure (when the heart is squeezing) is called the systolic blood pressure. The lowest pressure (when the heart is relaxing) is called the diastolic blood pressure.
Blood pressure is written as two numbers. For example, in the picture at the right, the person’s systolic blood pressure was 158. Their diastolic blood pressure was 99. This blood pressure is written as 158/99. It is said “158 over 99.”
Hypertension Types
There are two types of hypertension, called “primary” and “secondary.” Primary hypertension means that the hypertension is not caused by any other disease or condition and it gradually develops over time with age. Secondary hypertension means that the hypertension is caused by another disease or conditions. Secondary hypertension tend to result in higher blood pressure than primary hypertension. In most cases (90-95%), hypertension is primary. Only a small amount of hypertension (5-10%) is secondary.
There are various health conditions that leads to secondary hypertension which includes: Obstructive sleep apnea, Kidney problems, Adrenal gland tumors, Thyroid problems, Certain defects you’re born with (congenital) in blood vessels, Certain medications (birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs), Illegal drugs (cocaine and amphetamines)
Arguedas, JA (Jul 8, 2009). Arguedas, Jose Agustin (ed.). “Treatment blood pressure targets for hypertension”. Cochrane Database of Systematic Reviews (3): CD004349. doi:10.1002/14651858.CD004349.pub2. PMID19588353. Unknown parameter |coauthors= ignored (|author= suggested) (help)
Williams, B; Poulter, NR, Brown, MJ, Davis, M, McInnes, GT, Potter, JF, Sever, PS, McG society (March 2004). “Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV”. Journal of Human Hypertension 18 (3): 139–85. doi:10.1038/sj.jhh.1001683. PMID 14973512 Law M, Wald N, Morris J (2003). “Lowering blood pressure to prevent myocardial infarction and stroke: a new preventive strategy”. Health Technol Assess 7 (31): 1–94. PMID 14604498.
َAs the world enters the second year of the coronavirus pandemic, actionable insights are more critical than ever. They’re even being prioritized in the new National Strategy for COVID-19 Response and Pandemic Preparedness alongside executive orders to evaluate progress, monitor outcomes, and support transparency and equity with Americans. As the world rolls out COVID-19 vaccines, the need for accurate and timely vaccination distribution and uptake data is top-of-mind for government leaders, public health organizations, and healthcare providers everywhere.
These metrics are foundational for managing vaccination programs, measuring their effectiveness, and determining our collective progress toward “a blanket of herd immunity,” as described by Dr. Anthony Fauci, director, National Institute of Allergy and Infectious Diseases and chief medical advisor for the Biden Administration.
This is a “wartime effort,” as we’ve heard national leaders state recently, to protect population health—particularly the most vulnerable—as well as to contain the virus as we lower case counts toward zero and to restore Americans’ trust with different discourse. By creating public performance dashboards for more transparency and accountability, and prioritizing a data-driven approach in the efforts and decisions of federal, state and local governments, vaccine management analytics is already the data story of 2021.
Vaccine Management Analytics In The Spotlight
Effective management of any vaccine distribution program requires a holistic picture of the vaccine supply chain, the populations being prioritized, the success rate in reaching those populations, and the strengths and weaknesses of the metrics used to measure progress and performance.
On the path to recovery, government leaders, the public and private sector, and healthcare providers have realized that vaccine administration and management is a complex, evolving process. Expecting we could implement it overnight with a one-size-fits-all approach was unrealistic—some may say foolish—and we must ask some of these important questions as we press forward:
Where is the greatest vaccine reluctance based on rate of spread and case count?
How do we prioritize population groups for immunization and maintain equity?
What level of awareness and understanding exists around vaccine safety and efficacy?
How does vaccine supply match demand?
In which direction are immunizations tracking and impacting COVID spread?
Are vaccine sites known and sufficiently equipped and staffed?
As we create the path to normalcy, with increased access, use and communication with data and analytics, we can elevate our national and local pandemic response and make better vaccine management decisions that have a national and global impact.
For several months, I’ve conversed with government leaders and health officials, considering their concerns and questions and discussing how data analytics can assuage them. With those engagements top-of-mind, I’d like to highlight:
Some effective vaccine management dashboard examples that states are leveraging for their needs and situations
How some states are using data and analytics to achieve positive outcomes
Using Data To Guide COVID-19 Vaccine Management
The national vaccine effort is one of the greatest operational challenges America has faced. As we prioritize data and visual analytics in our response and resolution, our learnings can help frame how we approach future events and crises. The dashboard examples that I’ll share, containing sample data, demonstrate how data informs vaccine management, but the same analytics principles and approach could be applied to management of other national challenges.
Tracking Performance Against Vaccine Goals
Do you need to pivot local attention to track down more vaccines or other treatment supplies? Are mortality rates on the rise, unexpectedly? Is there a certain community that needs increased attention? Do we need additional marketing and public outreach to overcome vaccine reluctance and hesitancy? These questions and more are weighing on the minds and hearts of our leaders and public health officials and can be explored through solutions like a performance management dashboard, shown below.
By tracking performance in this way, it’s easier to take a snapshot of local progress to see if a state will meet, exceed or fall short of vaccine goals. It is also an effective communication tool for governors, mayors or county executives to be transparent with constituents and the public in their briefings and updates.
Furthermore, with increased plans to expand vaccine manufacturing and purchases, and improve national allocation, distribution, administration and tracking, there will be more data for government leaders to capture, monitor and share for a clearer sense of how localized efforts impact national goals, benchmarks and reporting.
Assessing The Readiness Of Facilities To Administer Vaccines
This dashboard reflects the readiness of mass vaccine deployment across cities, counties and states because hospitals, medical clinics, pharmacies and other locations have fulfilled administration requirements.
Monitoring COVID-19 Spread In Communities
With data and analytics, communities can assess resources, know when to order supplies, determine vaccine administration and help leaders understand where to focus their efforts. The sample dashboard below is one example of this, providing a high-level view and giving the option to drill down into certain areas to understand where numbers are higher or lower and determine the best course of action.
Vaccine Management Analytics In Action, Creating Benefit In Local Communities
Each week brings new problems that sometimes compound into more complex problems, so “we can’t take any chances and need to put data to the test,” explained Anthony Young, senior manager, solution engineering, U.S. Public Sector at Tableau Software. After nearly a year of capturing, analyzing and determining where we can gain insights from COVID data, using a data-driven approach with vaccine management will continue to create positive outcomes. For example:
Improved patient engagement and understanding of their vaccination responsibility so they successfully follow through with immunization
Clearer, more direct, and proactive communication with stakeholders
Increased public transparency so people are confident they’re receiving good, truthful data
Improved management of vaccination workflows and operations based on demand and need
More equitable vaccination through better population prioritization
Improved tracking and monitoring with populations of interest
Two government agencies are tracking, analyzing and putting data to work in their own pandemic responses as they focus on keeping citizens informed, engaged safe, and healthy.
The Ohio Department of Health published a dashboard, built by the Department of Administrative Services’ InnovateOhio Platform, to keep citizens informed about current trends, key metrics, and its forecast for how mitigation policies will reduce strain on the healthcare system.
The Lake County Health Department (LCHD) in Northern Illinois is tackling vaccine orchestration as it promotes resident health. Together with partners, LCHD launched Lake County AllVax Portal, an online vaccine registration and management system, as a single source of truth for the community to track inventory status, spot trends, pinpoint catalysts and inform vaccine resource planning.
“Transparency matters, and data and analytics will combat disinformation, providing the source of truth when citizens need it most,” explained Graham Stroman, my colleague and vice president of sales, U.S. State, and Local Government at Tableau Software. Let’s continue to make data analytics a central tool and effective mouthpiece in our COVID-19 efforts as Americans anxiously await a return to normalcy.
Let’s Rise To The Vaccine Management Challenge With Data And Analytics
March 2020 was more than a year ago, and so much has changed. Could we ever imagine that this is where we would be today? New terms are part of our everyday language: contact tracing, flatten the curve and social distancing. Just like putting on shoes and brushing our teeth, hand sanitizing and putting on masks are part of our daily routines.
Problems have grown and compounded, but innovative solutions, powered by data and analytics, have emerged to solve them and support better decision making and action. I urge the public and private sector, our government leaders and public health officials to continue looking for ways to lead with data.
To learn more about vaccine management analytics and how Tableau or other resources can help you visualize key insights to create a data-driven, effective vaccine response, visit the vaccine management resource page on Tableau.com.
From connection through collaboration, Tableau is the most powerful, secure, and flexible end-to-end analytics platform for your data. Elevate people with the power of data. Designed for the individual, but scaled for the enterprise, Tableau is the only business intelligence platform that turns your data into insights that drive action.
“Update on WHO Solidarity Trial – Accelerating a safe and effective COVID-19 vaccine”. World Health Organization. 27 April 2020. Archived from the original on 30 April 2020. Retrieved 2 May 2020. It is vital that we evaluate as many vaccines as possible as we cannot predict how many will turn out to be viable. To increase the chances of success (given the high level of attrition during vaccine development), we must test all candidate vaccines until they fail. [The] WHO is working to ensure that all of them have the chance of being tested at the initial stage of development. The results for the efficacy of each vaccine are expected within three to six months and this evidence, combined with data on safety, will inform decisions about whether it can be used on a wider scale.
Yamey G, Schäferhoff M, Hatchett R, Pate M, Zhao F, McDade KK (May 2020). “Ensuring global access to COVID‑19 vaccines”. Lancet. 395 (10234): 1405–06. doi:10.1016/S0140-6736(20)30763-7. PMC7271264. PMID32243778. CEPI estimates that developing up to three vaccines in the next 12–18 months will require an investment of at least US$2billion. This estimate includes Phase1 clinical trials of eight vaccine candidates, progression of up to six candidates through Phase2 and3 trials, completion of regulatory and quality requirements for at least three vaccines, and enhancing global manufacturing capacity for three vaccines.
The first global study of its kind showed 745,000 people died in 2016 from stroke and heart disease due to long hours.The report found that people living in South East Asia and the Western Pacific region were the most affected.
The WHO also said the trend may worsen due to the coronavirus pandemic.
The research found that working 55 hours or more a week was associated with a 35% higher risk of stroke and a 17% higher risk of dying from heart disease, compared with a working week of 35 to 40 hours.
Often, the deaths occurred much later in life, sometimes decades later, than the long hours were worked.Five weeks ago, a post on LinkedIn from 45-year-old Jonathan Frostick gained widespread publicity as he described how he’d had a wake-up call over long working hours.
The regulatory program manager working for HSBC had just sat down on a Sunday afternoon to prepare for the working week ahead when he felt a tightness in his chest, a throbbing in his throat, jawline and arm, and difficulty breathing.
“I got to the bedroom so I could lie down, and got the attention of my wife who phoned 999,” he said.While recovering from his heart-attack, Mr Frostick decided to restructure his approach to work. “I’m not spending all day on Zoom anymore,” he said.
His post struck a chord with hundreds of readers, who shared their experiences of overwork and the impact on their health.Mr Frostick doesn’t blame his employer for the long hours he was putting in, but one respondent said: “Companies continue to push people to their limits without concern for your personal well-being.”
HSBC said everyone at the bank wished Mr Frostick a full and speedy recovery.”We also recognise the importance of personal health and wellbeing and a good work-life balance. Over the last year we have redoubled our efforts on health and wellbeing.
“The response to this topic shows how much this is on people’s minds and we are encouraging everyone to make their health and wellbeing a top priority.”
While the WHO study did not cover the period of the pandemic, WHO officials said the recent jump in remote working and the economic slowdown may have increased the risks associated with long working hours.
“We have some evidence that shows that when countries go into national lockdown, the number of hours worked increase by about 10%,” WHO technical officer Frank Pega said.
The report said working long hours was estimated to be responsible for about a third of all work-related disease, making it the largest occupational disease burden.
The researchers said that there were two ways longer working hours led to poor health outcomes: firstly through direct physiological responses to stress, and secondly because longer hours meant workers were more likely to adopt health-harming behaviours such as tobacco and alcohol use, less sleep and exercise, and an unhealthy diet.
Andrew Falls, 32, a service engineer based in Leeds, says the long hours at his previous employer took a toll on his mental and physical health.”Fifty to 55 hour weeks were the norm. I was also away from home for weeks on end.”
“Stress, depression, anxiety, it was a cauldron of bad feedback loops,” he says. “I was in a constant state of being run down.”After five years he left the job to retrain as a software engineer. The number of people working long hours was increasing before the pandemic struck, according to the WHO, and was around 9% of the total global population.
In the UK, the Office for National Statistics (ONS) found that people working from home during the pandemic were putting in an average of six hours of unpaid overtime a week. People who did not work from home put in an average of 3.6 hours a week overtime, the ONS said.
The WHO suggests that employers should now take this into account when assessing the occupational health risks of their workers. Capping hours would be beneficial for employers as that had been shown to increase productivity, Mr Pega said. “It’s really a smart choice to not increase long working hours in an economic crisis.”
Cohen, Yehudi (1974). Man in Adaptation: the cultural present. Aldine Transaction. pp. 94–95. ISBN0-202-01109-7. In all, the adults of the Dobe camp worked about two and a half days a week. Because the average working day was about six hours long, the fact emerges that !Kung Bushmen of Dobe, despite their harsh environment, devote from twelve to nineteen hours a week to getting food. Even the hardest working individual in the camp, a man named =oma who went out hunting on sixteen of the 28 days, spent a maximum of 32 hours a week in the food quest.
Ginès i Fabrellas, Anna; Luque Parra, Manuel (January 2016). “WORKING TIME AND FLEXIBILITY IN SPAIN”(PDF) (IUSLabor 1/2016): 54–65. Retrieved 30 April 2020.
As vaccines roll out around the world, the question on everybody’s mind, is what does the journey back to “normal” look like? A new normal won’t return at the flip of a switch. We need to understand what’s happening, and we need trusted data to do that. So what should we be tracking? What metrics do we need to make effective, data-driven decisions? And, how do we know if we’re on the path to normalcy?
We recently spoke with Dr. Sam Scarpino, complex systems scientist, and assistant professor at the Network Science Institute at Northeastern University. With his help, we’ve identified five key variables that can help us measure our progress to a state resembling normalcy. In other words, when data will tell us when and how we can return to a simpler—if not quite normal—life.
1. Vaccine effectiveness
The first variable is, of course, the vaccines themselves. In our conversation, Scarpino shared two important variables regarding vaccine rollout:
Transmission: The amount that vaccines reduce transmission
Deployment: How quickly we can roll out vaccines across the country and internationally
Public and private healthcare organizations will need to track these data at a granular level.
Scarpino also emphasized the need for passive, always-on surveillance for COVID-19 and for genomic variants, like the B.1.1.7 variant in the United Kingdom. “Without these surveillance systems, we’re going to be continually caught off-guard by this disease and the “new normal” will feel a lot less normal,” said Scarpino.
2. Vaccine distribution
Next, we have to consider the huge task of distributing and administering the vaccines. This of course brings production and logistical challenges from mass shipping of perishable products, to scaling delivery to patients within myriad healthcare systems. And most critical of all, prioritizing what groups should be vaccinated first, and managing follow-up to ensure second doses are administered on schedule.
“At this stage, the biggest obstacle is delivery of the vaccines,” shared Scarpino. “Given the lack of a uniform national plan, states and localities are creating their own distribution and vaccination plans. Every state has a different approach, with varying levels of success. As a result, we’re already seeing dreadfully slow uptake. What this means is that we need more federal support for community health organizations administering the vaccine and public health agencies monitoring and coordinating our responses.”
There are also concerns around equal access to vaccinations.
“Communities of color and Native American populations have experienced an increased burden of COVID-19, as a direct result of generations of systemic racism that have impacted health and access to healthcare. As a country, and internationally, we need to engage with individuals in these communities to ensure they have a voice and vote in how vaccines are prioritized.”
3. Vaccine acceptance and uptake
The third key variable is vaccine acceptance and uptake, which is difficult to predict. Vaccine acceptance is about building trust within local communities, especially where vaccine hesitancy is the norm. Uptake, on the other hand, is about vaccinations itself. Is it fast, easy, and accessible? The story of COVID-19 is fundamentally a local story, so what we really need are data insights at the postal code level.
“The first step is a critical and realistic assessment of our failures and successes, which requires data,” shared Scarpino. “If we don’t have detailed enough data around uptake, we can’t see which communities are close to herd-immunity and which are further away. We’ll be in the dark trying to respond to COVID-19 flare-ups.”
4. Testing speed and availability
It’s going to take time to roll out the vaccine. But with focus shifting to the vaccine itself, we can’t forget the importance of testing. We need to address questions like:
How available is on-demand testing?
What are the barriers that prevent people from being tested?
How long do the results take? Hours or days?
With this data, communities can identify hot spots and businesses gain insights they need to reopen, getting us one step closer to normalcy.
Scarpino emphasized that “high-rates of testing, paired with isolation, quarantine, and contact tracing can control COVID-19 even without a vaccine,” based on models and data from countries like Vietnam and Australia. “With the proper non-pharmaceutical interventions, we could potentially reach normalcy in months instead of years,” shared Scarpino.
5. Contact tracing
Finally, even with testing, vaccines, and wide scale public health measures, nothing beats good old fashioned contact tracing.
“Contact tracing—and its vital partner, case investigation to determine the source of infections—remains our best tool for fighting this disease,” shared Scarpino.
Closely monitoring where, when, and by whom one was exposed will help people understand if they are at risk, and take the right precautions, especially if they are asymptomatic. Contact tracing is foundational to the path to normalcy, by making sure that exposed individuals are aware, they can take actions to limit further transmission.
“We’ve seen myriad countries, like Japan, Thailand, Vietnam, Mongolia, China, South Korea, Taiwan, New Zealand, Australia, to name only a few, control this disease with testing, tracing, and isolation,” said Scarpino.
The vaccine also requires multiple doses, so Scarpino noted that “we need effective, and accurate systems, for monitoring uptake and ensuring individuals receive all the necessary rounds of inoculation. If our contact tracing systems aren’t working, we can’t control the disease and we can’t ensure individuals are being vaccinated properly.”
Getting back to “normal” takes all of us
Over the next few months, these factors will drive how quickly or how well things will return to normal for citizens, communities, and the economy.
“What we’ve seen over the past year is that society’s deepest challenges—from racism and its lasting effects, to chronically underfunding public health, or access to affordable healthcare and housing—largely dictated the course of this pandemic,” shared Scarpino.
“We can build a brighter, safer, and more productive future. One that will help us return to normal faster and prevent this from happening again. But it’s going to take all of us, working together and it has to start now.”
For more information, check out the Tableau COVID-19 Data Hub, where you can explore dashboards, find actionable insights, and visualize your own analyses.
From connection through collaboration, Tableau is the most powerful, secure, and flexible end-to-end analytics platform for your data. Elevate people with the power of data. Designed for the individual, but scaled for the enterprise, Tableau is the only business intelligence platform that turns your data into insights that drive action
Peter M. Sandman and Jody Lanard (2005). “Bird Flu: Communicating the Risk”. Pan american Health Organisation / World Health Organisation. p. 5. Retrieved 25 August 2020.
Saggu, A. & Anukoonwattaka, W. (2015). “China’s ‘New Normal’: Challenges Ahead for Asia-Pacific Trade”. United Nations ESCAP. SSRN2628613. Missing or empty |url= (help)
