What We Know About Why Some People Never Get Covid 19

Americans who haven’t had covid-19 are now officially in the minority. A study published this week from the US Centers for Disease Control and Prevention (CDC) found that 58% of randomly selected blood samples from adults contained antibodies indicating that they had previously been infected with the virus; among children, that rate was 75%.

What is different about that minority of people that hasn’t yet gotten infected? Stories abound of close calls, of situations where people are sure they could have (or should have) gotten sick, but somehow dodged infection. Not all the questions are answered yet, but the question of what distinguishes the never-covid cohort is a growing area of research even as the US moves “out of the full-blown” pandemic. Here are the possibilities that scientists are considering to explain why some people haven’t contracted the virus.

They behave differently

We’ve seen it play out time and time again—some people adhere more strictly to protocols known to reduce transmission of the virus, including wearing a mask and getting vaccinated. Some people avoid large public settings and may have even been doing so before the pandemic, says Nicholas Pullen, a biology professor at the University of Northern Colorado. Then again, that doesn’t tell the whole story; as Pullen himself notes: “Ironically, I happen to be one of those ‘never COVIDers’ and I teach in huge classrooms!”

They’ve trained their immune systems

The immune system, as any immunologist or allergist can tell you, is complicated. Though vaccination against covid-19 can make symptoms more mild for some people, it can prevent others from contracting the illness altogether.

Growing evidence suggests that there may be other ways that people are protected against the virus even without specific vaccines against it. Some could have previously been infected with other coronaviruses, which may allow their immune systems to remember and fight similarly shaped viruses. Another study suggests that strong defenses in the innate immune system, barriers and other processes that prevent pathogens from infecting a person’s body, may also prevent infection.

An innate immune system that’s already not functioning as well due to other medical conditions or lifestyle factors such as sleep or diet may put a person at higher risk of getting sick from a pathogen. There’s not single answer here yet, but initial studies are intriguing and may offer avenues for future treatments for covid-19 and other conditions.

They’re genetically different

In the past, studies have found interesting associations between certain genetic variants and people’s susceptibility to communicable diseases such as HIV, tuberculosis, and the flu. Naturally, researchers wondered if such a variant could exist for covid-19. One June 2021 study that was not peer reviewed found an association between a genetic variant and lower risk of contracting covid-19; another large-scale study, focused on couples in which one person got sick while the other didn’t, kicked off in Oct. 2021.

“My speculation is that something will be borne out there, because it has been well observed that resistance embedded in genetic variation is selected in pandemics,” Pullen says. But most experts suspect that even if they are able to identify such a variant with some certainty, it’s likely to be rare. For now, it’s best for those who haven’t gotten covid to assume they’re as susceptible as anyone else. Whatever the reasons some people haven’t yet gotten sick, the best defense remains staying up to date with vaccinations and avoiding contact with the virus.

Source: What we know about why some people never get covid-19 — Quartz

“Being exposed to the SARS-CoV-2 virus doesn’t always result in infection, and we’ve been keen to understand why,” study author Rhia Kundu said in a statement, using the scientific name for the coronavirus. “We found that high levels of pre-existing T cells, created by the body when infected with other human coronaviruses like the common cold, can protect against COVID-19 infection.”

The study, which examined 52 people who lived with someone who contracted the coronavirus, found that those who didn’t get infected had significantly higher levels of T cells from previous common cold coronavirus infections. T cells are part of the immune system and believed to protect the body from infection. “Our study provides the clearest evidence to date that T cells induced by common cold coronaviruses play a protective role against SARS-CoV-2 infection,” study author Ajit Lalvani said in a statement.

Researchers cautioned that the findings should not be relied upon as a protection strategy. “While this is an important discovery, it is only one form of protection, and I would stress that no one should rely on this alone,” Kundu said. “Instead, the best way to protect yourself against COVID-19 is to be fully vaccinated, including getting your booster dose.” And the findings on the subject have been inconsistent, with other studies actually suggesting that previous infection with some coronaviruses have the opposite effect.

A major question that has come from the so-called ‘never COVID’ group is whether genetics plays a role in preventing infection. In fact, the question has spurred a team of international researchers to look for people who are genetically resistant to COVID-19 in the hopes that their findings could improve therapeutics. “What we are doing essentially is that we are testing the hypothesis that some people might not be able to get infected because of their genetic and inborn makeup, meaning that they might be genetically resistant to COVID,” says Spaan, who is a member of the COVID Human Genetic Effort.

The effort has sequenced genetic data from about 700 individuals so far, but enrollment is ongoing and researchers have received thousands of inquiries, according to Spaan. The study has several criteria, including laboratory test confirmation that the person has not had previous COVID-19 infection, intense exposure to the virus without access to personal protective equipment like masks and an unvaccinated status at the time of exposure, among others. So far, the group doesn’t know what the genetic difference could be – or if it even exists at all, though they believe it does.

“We do not know how frequent it is actually occurring,” Spaan says. “Is it like a super rare individual with a very, very rare mutation? Or is that something more common?” But the hypothesis is “embedded in human history,” according to Spaan. “COVID is not quite the first pandemic that we are dealing with,” Spaan says. “Humans have been exposed to viruses and other pathogens across time from the early beginning, and these infections have left an imprint on our genetic makeup.”

Those who haven’t gotten the coronavirus are “very much at risk,” says Murphy of Northwestern University. “I think every unvaccinated person is going to get it before this is over.” Experts stressed that research to determine why some people get COVID-19 while others don’t is still very much underway, and no one should rely on any of the hypotheses for protection. Instead, those who haven’t gotten the coronavirus should continue mitigation measures that have been proven to work, like vaccination and mask-wearing.

“You don’t ever want to have COVID,” Murphy says. “You just don’t know which people are going to get really sick from this and die or who’s going to get long COVID, which is hard to diagnose and difficult to treat and very real.” But with coronavirus cases on the rise and mitigation measures like mask mandates dropping left and right, it’s not an easy task.

COVID19: Face masks could return as cases spike Financial Mirror

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CDC Approves COVID-19 Vaccines For Children Under 5

U.S. health advisers on Saturday recommended COVID-19 vaccines for infants, toddlers and preschoolers — the last group without the shots.The advisers to the Centers for Disease Control and Prevention unanimously decided that coronavirus vaccines should be opened to children as young as 6 months. On Saturday afternoon, CDC Director Rochelle Walensky signed off on the panel’s recommendation.

“Together, with science leading the charge, we have taken another important step forward in our nation’s fight against COVID-19,” Walensky said in a statement. “We know millions of parents and caregivers are eager to get their young children vaccinated, and with today’s decision, they can. I encourage parents and caregivers with questions to talk to their doctor, nurse, or local pharmacist to learn more about the benefits of vaccinations and the importance of protecting their children by getting them vaccinated.”

HHS Secretary Xavier Becerra released a statement calling the CDC’s move a “major milestone.”

“Thanks to the FDA and CDC’s rigorous, comprehensive, and independent review of the data, and their strict commitment to following the science, we are reaching another major milestone in our efforts to protect more children, their families, and our communities as we work to end the pandemic,” Becerra said. “We are following the data and science as we make sure all Americans are eligible and have access to COVID-19 vaccines and boosters to prevent severe disease and save lives. Based on CDC and FDA actions, we now know that vaccination for our children 6 months through 5 years old is safe and effective and we are ready to get millions of children vaccinated.”

The White House also weighed in on the decision in a statement calling the CDC’s decision a “monumental step forward in our nation’s fight against the virus.””For parents all over the country, this is a day of relief and celebration,” President Biden said in the statemente. “As the first country to protect our youngest children with COVID-19 vaccines, my Administration has been planning and preparing for this moment for months, effectively securing doses and offering safe and highly effective mRNA vaccines for all children as young as six months old.

“While the Food and Drug Administration OKs vaccines, it’s the CDC that decides who should get them. The government has been gearing up for the start of the shots early next week, with millions of doses ordered for distribution to doctors, hospitals and community health clinics around the country. Roughly 18 million kids will be eligible, but it remains to be seen how many will ultimately get the vaccines. Less than a third of children ages 5 to 11 have done so since vaccination opened up to them last November.

Two brands — Pfizer and Moderna — got the green light Friday from the FDA. The vaccines use the same technology but are being offered at different dose sizes and number of shots for the youngest kids.

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Pfizer’s vaccine is for 6 months through 4 years. The dose is one-tenth of the adult dose, and three shots are needed. The first two are given three weeks apart, and the last at least two months later. Moderna’s is two shots, each a quarter of its adult dose, given about four weeks apart for kids 6 months through 5. The FDA also approved a third dose, at least a month after the second shot, for kids with immune conditions that make them more vulnerable to serious illness.

Two doses of Moderna appeared to be only about 40% effective at preventing milder infections at a time when the omicron variant was causing most COVID-19 illnesses. Pfizer presented study information suggesting the company saw 80% with its three shots. But the Pfizer data was so limited — and based on such a small number of cases — that experts and federal officials say they don’t feel there is a reliable estimate yet.

Hospitalizations surged during the omicron wave. Since the start of the pandemic, about 480 children under age 5 are counted among the nation’s more than 1 million COVID-19 deaths, federal data show. “It is worth vaccinating, even though the number of deaths are relatively rare, because these deaths are preventable through vaccination,” said Dr. Matthew Daley, a Kaiser Permanente Colorado researcher who sits on the advisory committee.

U.S. officials expect most shots to take place at pediatricians’ offices. Many parents may be more comfortable getting the vaccine for their kids at their regular doctor, White House COVID-19 coordinator Dr. Ashish Jha said. He predicted the pace of vaccination to be far slower than it was for older populations.

Pediatricians, other primary care physicians and children’s hospitals are planning to provide the vaccines. Limited drugstores will offer them for at least some of the under-5 group. U.S. officials expect most shots to take place at pediatricians’ offices. Many parents may be more comfortable getting the vaccine for their kids at their regular doctor, White House COVID-19 coordinator Dr. Ashish Jha said. He predicted the pace of vaccination to be far slower than it was for older populations.

“We’re going see vaccinations ramp up over weeks and even potentially over a couple of months,” Jha said. It’s common for little kids to get more than one vaccine during a doctor’s visit. In studies of the Moderna and Pfizer shots in infants and toddlers, other vaccinations were not given at the same time so there is no data on potential side effects when that happens. But problems have not been identified in older children or adults when COVID-19 shots and other vaccinations were given together, and the CDC is advising that it’s safe for younger children as well.

About three-quarters of children of all ages are estimated to have been infected at some point. For older ages, the CDC has recommended vaccination anyway to lower the chances of reinfection.Experts have noted re-infections among previously infected people and say the highest levels of protection occur in those who were both vaccinated and previously infected. The CDC has said people may consider waiting about three months after an infection to be vaccinated.

Source: CDC approves COVID-19 vaccines for children under 5 | Fox Business

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The World’s Lead Exposure Crisis Explained

Starting in 2014, the impoverished city of Flint, Michigan, experienced the highest-profile lead exposure crisis in recent American history. Lead levels in Flint’s children spiked after the city failed to properly treat a new water source. Eventually, the state of Michigan and city of Flint were forced to agree to a $641 million settlement for residents affected by the lead poisoning, and several state officials, including former Gov. Rick Snyder, were criminally indicted for their role in exposing children to lead.

While estimates differ, a prominent study found that the share of screened Flint children under the age of 5 with high lead levels reached 4.9 percent in 2015, up from 2.4 percent before the problems with lead contamination began. According to the CDC guidance at the time, a level of lead in blood that would be considered high was 5 micrograms per deciliter (µg/dL) (the agency has since lowered the threshold to 3.5 µg/dL).

That said, no level of lead exposure is considered safe, and even exposure well below public health recommendations can be quite harmful. That nearly 5 percent of young children in Flint faced exposure to rates that high is a travesty. As scandalous as the Flint lead crisis is, it’s sobering to know that it may be just the tip of the iceberg globally.

A recent systematic evidence review, widely cited and respected in the field, pooled lead screenings from 34 countries representing two-thirds of the world’s population. The study estimated that 48.5 percent of children in the countries surveyed have blood lead levels above 5 µg/dL.

Let me repeat that: Flint became the symbol of catastrophic lead exposure in the United States. The breakdown of a long-neglected system was so terrible that it led to headlines for months and even became an issue in the 2016 presidential election. Yet children in low- and middle-income countries are, per this estimate, 10 times likelier to have high blood lead levels than children in Flint were at the height of the city’s crisis.

The lead problem is global. It’s catastrophic in scope and hurting children’s ability to learn, earn a living when they grow up, and function in society. Yet lead has gotten comparatively little attention in the global public health space.

Charities globally are spending a total of just $6 million to $10 million a year trying to fight it. For comparison, individuals, foundations, and corporations in the United States alone spent $471 billion on charity in 2020. Childhood lead poisoning is a tragedy — and it is one that would be relatively inexpensive for the world to fix.

What lead does to humans

Lead is soft, plentiful, and easy to mine and manipulate, which is why humans have been harnessing it for various purposes for thousands of years. Ancient Romans used lead for everything from water piping to pots and pans to face powder to paint to wine preservatives.

Today, common uses of lead still include cookware, paint, and piping, along with lead acid batteries (a technology still used for most car batteries, even in hybrids), and plane fuel. For decades, a major use of lead was as an additive to gasoline meant to prevent engine knocking.

While the US started phasing out leaded gasoline for passenger cars in 1973 — and only finished in 1996 — the last country to officially abandon it, Algeria, did so last year. The reason we phased it out is that — as we have known at least since Roman times — lead is extremely bad for humans.

“Lead causes toxicity to multiple organs in the human body,” Philip Landrigan, a doctor and professor at Boston College who conducted key studies on the effects of lead in the 1970s, told me. “In infants and children, the brain is the big target. But we also know very well that adults who were exposed to lead — especially people exposed occupationally [and thus exposed to high amounts] — are at very substantially increased risk of heart disease, hypertension, and stroke.”

Lead exposure can be quite deadly. Some of the best evidence here comes from a recent study examining Nascar’s decision to ban leaded gasoline from its cars in 2007. Overall, mortality among elderly people fell by 1.7 percent in counties with Nascar races after the races stopped using leaded gas. The authors estimate that Nascar and other leaded gas races had caused, on average, about 4,000 premature deaths a year in the US.

The biggest costs of lead, though, are its effects on the brains of children. The developing brain is, in Landrigan’s words, “exquisitely sensitive” to the effects of lead. “It damages neurons; the active cells in the brain that we use for reflexing, running, and jumping, everything,” he explains.

The effects of lead “seem to concentrate in the prefrontal cortex,” Bruce Lanphear, a leading medical researcher on lead’s effects based at Canada’s Simon Fraser University, told me. That part of the brain is smaller in adults who were exposed to lead as children, he added.

Neuroscientists believe the prefrontal cortex plays a key role in executive functioning: the ability of people to choose behaviors in pursuit of conscious goals rather than acting on impulse. “It’s what distinguishes us from other animals, what makes us human,” Lanphear said.

For just about any variable you can imagine related to human behavior and thinking, there is probably research indicating that lead is harmful to it. High lead exposure reduces measured intelligence substantially. “If we compare kids at the lower and higher end [of lead exposure], we saw a 5-8 point IQ difference,” Aaron Reuben, a psychologist at Duke University and lead author on a study looking at a cohort in New Zealand, told me. Higher lead levels are associated with higher rates of ADHD and negative changes in personality.

Reuben says his research has found that kids exposed to lead are “less conscientious, less organized, less meticulous. They’re a little less agreeable; they don’t get along as well with others. They’re more neurotic, meaning they have a higher propensity to feel negative emotions.”

In recent years, some writers have embraced a theory that declining lead exposure (mostly due to the gradual removal of lead from gasoline) was a leading factor in the drastic decline in crime, especially violent crime, in the United States in the 1990s. Whether or not lead explains that specific historical phenomenon, several high-quality studies have found a relationship between high lead exposure and crime and delinquency.

One found that Rhode Island schoolchildren exposed to lead were dramatically likelier to be sent to detention. Another, looking at the introduction of lead pipes in the late 19th century, found that cities with the pipes had considerably higher homicide rates. A third, looking at reductions in lead in gasoline in the late ’70s and early ’80s, found that the phase-out led to a 56 percent decline in violent crime.

This evidence is suggestive, not definitive. A recent meta-analysis argued that when you take into account the likelihood of publication bias (that is, that studies showing a strong effect of lead on crime are likelier to be published than studies finding little effect), the effect size could be quite small and not explain any of the decline in homicide rates in the US.

But the idea that lead has a high social cost does not hinge on a specific narrative about crime. Lead appears to be consistently costly across outcomes from IQ to personality to impulse control to elderly mortality.

“Lead has been really bad and very significant in the history of social behavior,” Jessica Wolpaw Reyes, an economist at Amherst College and author of that last paper, summed it up to me.

Lead exposure is still very common in the developing world

The story of lead exposure in the United States and other rich countries in recent decades has in fact been enormously positive. Yes, there have been disastrous lapses as in Flint, but they stand out precisely because they are such an exception to recent trends.

A recent paper from CDC researchers estimated that from 1976 to 1980, fully 99.8 percent of American children aged 1 to 5 had levels of lead in their blood of over 5 micrograms per deciliter. From 2011 to 2016, the share was down to 1.3 percent. In a major triumph for environmental public health, high-level lead exposure went from the norm to an aberration in just four decades, in large part due to the abandonment of lead in gasoline.

As bad as things are in developing countries today, lead exposure in those nations is much less prevalent than it was in the US 40 years ago — a sign of global progress. That said, lead exposure in developing countries appears to be quite high compared to exposure in rich countries today.

Several experts I spoke to pointed to the 2021 evidence review led by Bret Ericson that I referenced above as the best summary of what we know about how common lead exposure is in low- and middle-income countries. In 34 nations, which together account for over two-thirds of the world’s population, the researchers were able to find blood lead surveys they considered reasonably representative of the country’s children, usually conducted by nonprofits or government agencies.

Overall, those studies estimated that 48.5 percent of children had high lead levels (defined as above 5 ug/dL). Levels of exposure varied greatly, with surveys in a few countries (like Tanzania and Colombia) not finding any children with blood lead levels above 5 ug/dL, and other countries showing huge majorities with levels that high. In Pakistan, for instance, over 70 percent of children had high blood lead levels.

Lead levels this high imply incredible amounts of damage to health and well-being. The Global Burden of Disease study published in the Lancet in 2019 estimated that about 900,000 people die due to lead annually, representing 21.7 million years of healthy life lost. One attempt to quantify the economic costs of lead in low- and middle-income countries estimated that in 2011, the burden was around $977 billion annually, or 1.2 percent of global GDP.

Lead in poor countries comes from everything from batteries to turmeric

While the numbers above give a sense of the lead problem’s scale, they are not definitive. One consistent message I heard from experts is that we simply need a lot more data on lead in low- and middle-income countries.

The Ericson evidence review concluded, “there is a paucity of rigorous data on lead exposure in the general populations of [low- and middle-income countries].” Most countries in Africa, and several in Latin America and Central Asia, did not have data usable for the review.

Lead experts also disagree about what the primary sources of lead exposure in developing countries might be. Pure Earth, the largest nonprofit working on lead contamination in developing countries, has generally focused on reducing exposure from informal recycling of lead-acid car batteries. In many developing countries, such recycling happens in mom-and-pop operations in backyards, with no protection for the recycling workers or neighboring residents from the resulting fumes.

But more recently, Pure Earth has also been working on reducing exposure from cookware and spices. Stanford researchers Jenna Forsyth and Stephen Luby have found that turmeric spice in Bangladesh is very often cut with lead chromate. That’s right: The turmeric that Bangladeshis use for cooking often has lead added to it.

Lead is very heavy, and in lead chromate form, it’s a vibrant yellow, which makes it an easy way to adulterate and amplify the color of turmeric. The problem likely spans beyond just Bangladesh. Consumer Reports has found that even in the US, grocery stores were selling turmeric cut with heavy metals.

Environmental scientists have worried for years about lead exposure from ceramics in Central America, where traditional processes often use lead for glazing. But Pure Earth’s Richard Fuller told me that ceramics in India often contain lead too, and in many low-income countries, aluminum cookware is contaminated as well.

Aluminum pots and pans in these contexts “are generally made in local recycling places where the recyclers are throwing all this scrap metal in,” he said. “It’s almost impossible for them to not get lead in.” In turn, that lead can seep into food cooked using these tools.

But other, smaller organizations focus on different lead sources. Lead Exposure Elimination Project (LEEP), founded in 2020, has mostly focused to date on lead paint. Just as lead can make turmeric more vibrant, it can make yellows and whites in paint more vibrant too. “We decided to start with lead paint because it seemed like a significant source of exposure, and there’s an obvious approach to tackling it, which is regulation,” Lucia Coulter, a medical doctor and LEEP’s co-founder, told me.

Tackling lead paint requires introducing new laws and enforcing old ones. Jerry Toe, an official at Liberia’s Environmental Protection Agency (EPA) who has worked with LEEP on lead paint, told me that while the country had adopted a law banning lead paint in 2004, the Liberian EPA had still not formalized any regulations deriving from it by 2019, when he came to the issue. It took a LEEP study in Malawi for regulators in that country to conduct regular monitoring of lead levels in paints for sale.

Imran Khalid, a researcher at Pakistan’s Sustainable Development Policy Institute and director at the World Wildlife Fund Pakistan, has had a similar experience. “The implementation [of lead regulations] is quite poor,” he told me. “Our environmental laws are primarily lip service.”

Khalid has been working with LEEP on paint sampling studies in which he and other researchers obtain paint from stores and test it for lead. Zafar Fatmi, a professor at Aga Khan University in Karachi, said that in his initial testing, around 40 percent of paints had high levels of lead.

Khalid notes that some high-lead paint comes from major multinationals, which makes enforcement a challenge. “For a country like Pakistan that’s already going to the IMF [International Monetary Fund] again and again” asking for loans, he explains, “people become very hesitant [about criticizing multinationals] when environmental issues come up.”

And there are other possible sources in poor nations as well, including some of the same ones still plaguing rich countries. “A lot of homes in African countries still have lead pipes, and nobody is talking about getting rid of them or what problems they’re creating,” Jerome Nriagu, a professor of environmental health sciences at the University of Michigan and one of the first US researchers to raise alarms about lead in Africa, told me.

An urgent need for more funding and more data

Last year, the effective altruist research group Rethink Priorities released a comprehensive report attempting to assess how many groups were working on lead exposure in poor countries and how much more could be done on the issue. Their answers: Not many are working on this, and those that are could likely use millions of dollars more every year to spend on effective projects.

Pure Earth, formerly known as the Blacksmith Institute, is by far the largest player, but it spends just $4 million to $5 million a year on lead. “Summing estimated budgets of other organizations, we believe that donors spend no more than $10 million annually on lead exposure,” Rethink Priorities’ Jason Schukraft and David Rhys Bernard conclude.

Much of that funding comes from government sources like the US Agency for International Development and the Swedish equivalent Sida. Outside support for nonprofits, there’s not much public evidence that international aid agencies are investing in lead abatement. With some notable exceptions, like the Center for Global Development, groups working on global health have largely ignored the issue.

Ten million dollars a year, tops, is not much money at all to spend fighting global lead poisoning, even with increased investments directed by donors in the effective altruism community toward Pure Earth and LEEP. “It’s a fairly small community, and it’s remarkably small given the scale of the problem and the scale of the impacts,” Pure Earth’s Fuller said.

That helps explain why effective altruist groups like Rethink Priorities and GiveWell have become interested in lead alleviation. It’s a neglected area, where each additional dollar can go a long way. So what else could be done with more money and resources? One simple answer is better research.

When I asked Fuller and his colleague Drew McCartor what additional studies they’d do if they could, they immediately said basic lead exposure surveys in affected countries and basic sourcing analysis to see where lead is coming from in those countries.

We have such poor data on how many people (especially children) are being exposed to lead and on how they’re being exposed to lead, that improving that data could in turn significantly enhance nonprofits’ ability to target interventions effectively.

If, say, lead pipes are a bigger source of exposure in sub-Saharan Africa than previously thought, that would change how Pure Earth and other groups allocate funds; likewise, a finding that lead paint is not a significant source of exposure might change LEEP’s approach.

Rethink Priorities concluded that “existing and potential new NGOs in the area currently have the capacity to productively absorb $5 to $10 million annually in additional money,” and that sums above that amount might be productively usable too.

That’s just not a lot of money in the context of US foundations or even foreign aid budgets — especially for something we know is severely injuring children and killing adults in the developing world.

Dylan Matthews

I joined Vox as one of our first three employees in February 2014, and have been here ever since, writing about everything from furries to foreign aid. Right now I’m particularly interested in global development, anti-poverty efforts in the US and abroad, factory farming and animal welfare, and conflicts about the right way to do philanthropy.

Source: The world’s lead exposure crisis, explained – Vox

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CDC Recommends Cutting Covid Isolation Time To 5 Days For Some Healthcare Workers

With hospitals in some areas struggling with staffing shortfalls amid a nationwide surge of Covid-19 cases, the U.S. Centers for Disease Control revised its guidelines Thursday to recommend that healthcare workers who contract Covid-19 but display mild-to-moderate symptoms and are not moderately or severely immunocompromised can return to work five days after symptoms first appear, down from 10 days previously.

Key Facts

Healthcare workers who contract the virus should also wait until at least 24 hours after their last fever without the use of fever-reducing medications and must wait until symptoms like coughing and shortness of breath have improved, according to the guidelines.

Some hospitals have voluntarily adopted a seven-day isolation period for infected staff, the New York Times reported.

The Centers for Disease Control and Prevention (CDC) advises someone who tests positive to go into isolation for 10 days. Critics say that the policy does not take into account how the pandemic has developed over the last two years.

Omicron is now the dominant strain in the U.S. Although more transmissible than prior variants and amid a spike in breakthrough infections among the fully vaccinated, the strain so far appears to be causing milder symptoms.

The CDC also recommended that hospitals cancel all non-essential procedures and visits if necessary to mitigate staffing shortages. Other new CDC guidelines also revised rules for workers who have higher-risk exposure to Covid-19, such as having their eyes, nose or mouth exposed to material possibly containing the virus, but who are not confirmed to have been infected.

In general, asymptomatic workers who have been exposed to the virus in this way do not require any restriction from work if they have received all recommended vaccine doses, including boosters, the CDC said.

Fauci told CNN reducing the 10-day isolation recommendation would help those without symptoms return to work or school, although added “no decisions” had been made yet.

Key Background

As the spread of the highly transmissible omicron variant raises infection rates across the U.S., hospitals have struggled with worker burnout and understaffing. In Massachusetts, New York and Ohio, the National Guard has been deployed to reinforce overburdened hospital staff, Spectrum News reported. “When it comes to the workforce, it’s fair to say we’re facing a national emergency,” American Hospital Association President Rick Pollack told NPR.

Tangent

Airlines for America, a trade association representing most of the nation’s largest airlines, asked the CDC on Thursday to shorten its quarantine recommendation to five days for fully vaccinated people who have a breakthrough Covid-19 case. A4A CEO Nicholas Calio cited potential worker shortages and operation disruptions amid the omicron coronavirus surge if the quarantine time isn’t reduced.

However, flight attendant union chief Sara Nelson pushed back against the airlines’ call on Thursday, saying it would pose health risks. “Although breakthrough infections are mild, the 10-day isolation is extremely disruptive to people’s lives,” he told Newsweek. “It’s unnecessary if a person is contagious for a significantly shorter period of time,” Adalja noted.

Omicron is the most dominant COVID strain in the U.S., comprising of 73 per cent of new infections last week. But even if proven to have milder systems, there are fears the health care system could be overwhelmed if infections put medical workers out of action.

I cover breaking news for Forbes. Previously, I was editor for The Cordova Times newspaper in Cordova, Alaska. In 2018, I obtained a Master of Journalism

I am a Hawaii-based reporter covering breaking news for Forbes. I graduated from the University of Hawaii with a bachelor’s degree in Journalism and

Source: CDC Recommends Cutting Covid Isolation Time To 5 Days For Some Healthcare Workers

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Psychiatrists Are Uncovering Connections Between Viruses & Mental Health They’re Surprising

Immune responses to viruses like SARS-CoV-2 may affect mental health, and vice versa. Doctors are uncovering exactly how.

When the Covid-19 pandemic hit, one of the biggest questions was: Why do some people get so much sicker than others? It’s a question that has forced researchers to confront some deep mysteries of the human body, and come to conclusions that have startled them.

By the fall of 2020, psychiatrists were reporting that among the many groups who were high risk, people with psychiatric disorders, broadly, seemed to be getting more severe forms of Covid-19 at a higher rate. Katlyn Nemani, an NYU neuropsychiatrist, decided to dig deeper, asking: Just how much more at risk, and which conditions?

In January, she and a group of colleagues published a study of 7,348 Covid-19 patients in New York. One finding was stark: People with a schizophrenia spectrum diagnosis faced more than two and a half times the average person’s risk of dying from Covid-19, even after controlling for the many other factors that affect Covid-19 outcomes, such as cardiovascular disease, diabetes, smoking, obesity, and demographic factors — age, sex, and race.

“That was a pretty shocking finding,” Nemani says. The patients all were hospitalized in the same medical system, in the same region, which implies they weren’t receiving radically different treatments, she says. In sum, it all suggests that the risk was closely linked to the mental illness itself and not to some other variable.

Since then, more studies have come out — as well as metastudies pooling the conclusions of those studies — showing worse Covid-19 outcomes among people with diagnosed mental health disorders including depression, bipolar disorder, and schizophrenia.

Some of this isn’t surprising; a lot of people with mental health issues experience a general increased risk of poor health outcomes. But the pandemic started to shine a brighter light on why, bolstering a hypothesis that’s been accruing evidence in recent years.

It appears that something in the body, something biological associated with these disorders, may be at play. “That suggests there’s a physiologic vulnerability there in these folks,” said Charles Raison, a psychiatrist and researcher at the University of Wisconsin Madison.

A doctor checks on a Covid-19 patient at Providence Cedars-Sinai Tarzana Medical Center in Tarzana, California, on September 2.
Apu Gomes/AFP via Getty Images

It’s not necessarily that people with schizophrenia or mood disorders are more likely to become infected with Covid-19. Rather, once they are infected, “the outcomes are worse,” Nemani says.

Depending on the study and the severity of the mental health diagnosis, people with these conditions are, roughly, between 1.5 and 2 times more likely to die of Covid-19 than average, after adjusting for other risk factors (unadjusted risk is even higher). The level of increased risk, Nemani says, is “on par with what we’re seeing for other well-established risk factors like heart disease and diabetes.”

What’s happening? Why would mental illness make someone more vulnerable to a respiratory disease?

Psychiatrists who study these mental illnesses say the culprit might lie in a connection between mental health and the immune system. They’re finding that mental health stressors could leave people more at risk for infection, and, most provocatively, they suspect that responses in the immune system might even contribute to some mental health issues.

There’s a lot that’s unknown here. But the pandemic is giving researchers a new window into these questions. And the research “might teach us something about how to protect these people from infection going forward,” Nemani says.

How the immune system can impact mental health

In September, the Centers for Disease Control and Prevention updated its list of underlying conditions that put people at higher risk for severe Covid-19, adding mood disorders — like depression and bipolar disorder — and schizophrenia spectrum diagnoses, a group that accounts for around 34 million Americans. It was a recognition of the growing evidence published by Nemani and colleagues across medicine, and prioritizes this group for vaccines and booster shots.

Roger McIntyre, a psychiatrist at the University of Toronto, is one of the co-authors of one of two systematic review studies that the CDC cited in its change. (Nemani is a co-author on the second.) To him, it’s no surprise that mental illness imparts an infection risk. “A thread that has been woven through many of these disorders is immune or inflammatory dysregulation,” McIntyre says.

That is, problems with the immune system tend to coincide with mental health issues. And problems with the immune system can lead people to have worse outcomes when it comes to SARS-CoV 2, the virus that causes Covid-19.

“Most of the time in medicine, it’s hard to have one singular explanation for anything,” he cautions. That’s especially true here in the discussion of why people with certain mental health issues might be more at risk for severe disease. People living with mental illnesses like schizophrenia, bipolar disorder, and major depression tend to have shorter-than-average life spans and worse health overall. They’re more at risk for heart disease and obesity; they smoke at higher rates. All these risk factors put people with these mental health issues — particularly schizophrenia — at higher risk of death from many causes, including severe infections.

The studies that have been conducted to date try to control for these factors, but it’s impossible to control for them all. Other factors like economic insecurity, added isolation brought on by the pandemic, access to diagnostic testing, or behaviors at the individual level that are hard to account for in studies could play a role.

But the scientific literature does find links between mental health and immune system health. The biggest one: Studies have reported that many people with depression, bipolar, and schizophrenia (as well as other mental health issues not highlighted as Covid-19 risk factors by the CDC) have higher levels of inflammation throughout the body.

Inflammation is one of the body’s responses to dealing with dangerous invaders like the SARS-CoV-2 virus. Inflammation is literally a flood of fluids containing immune system cells. They get released from the blood into body tissues to help clear infections. This is why infected areas of the body get swollen.

An engineer shows a model of the coronavirus at the Sinovac Biotech facilities in Beijing in April 2020.
NIcolas Asfouri/AFP via Getty Images

When inflammation is short-lived, it can help clear out an infection. When it is chronic, it can cause problems. It wears on the heart and can contribute to illnesses like diabetes. When it comes to Covid-19, scientists suspect that underlying inflammation — or underlying dysregulation of the immune system — is what causes some patients’ bodies to overreact to the virus, causing the worst symptoms that can land people in hospitals and lead to death.

As Nemani explains, the inflammation tends to increase with the severity of the mental illness. “For people with depression, you see a small increase in systemic inflammation,” Nemani says. It grows higher in people with severe depression, and higher still in people with bipolar and schizophrenia. (All these conditions exist on a continuum, and there are more and less severe versions of each.)

So people with certain mental health issues might have chronic inflammation, and that could lead to poorer outcomes when it comes to Covid-19. The question is, why do they have chronic inflammation in the first place?

Part of the reason may simply be the chronic stress that comes from living with mental health issues, McIntyre and Nemani say. Stress can provoke an inflammatory response, as can a lack of sleep.

But it’s also possible that the immune system has a role to play in generating these diseases. “Beginning in about 2000, we began to show that inflammation can make people depressed,” Raison says. “The best evidence is that there have been a number of studies where inflammatory stimuli [such as drugs known to cause inflammation] of various intensity and durations have been given to people, and they tend to make people feel depressed and exhausted.”

In depression, McIntyre says, scientists often (but not always) find elevated markers of inflammation in the blood. “Now, it may not be the causative role, although it might be,” he says. “It may be the causative role in some people, and it may be playing more of a secondary role in other people.”

This just provokes another question: Why would the immune system change our mood and influence our exhaustion?

McIntyre makes an example of the common cold to explain. “When you have the common cold, I’m not saying you have depression, but what I’m saying is you have a lot of symptoms that look a lot like depression,” he says. “You feel tired, your sleep is disrupted, you lose your appetite. You’re probably not enjoying many things. You’re quite apathetic. Things are bland in your life. That’s the immune system that’s been activated, creating those symptoms. We think that for some people with depression, that can explain your depressive symptoms.”

That is, when your immune system isn’t working properly, it could contribute to, or even possibly generate, depressive symptoms.

A view of Manhattan streets in April 2020, as the coronavirus overwhelmed New York City.
Spencer Platt/Getty Images

Similarly, it’s possible that the immune system plays a role in generating schizophrenia. There’s a theory that viral exposure while in utero is closely tied with developing psychotic illness or schizophrenia later on,” says Ellen Lee, a psychiatrist and researcher with the University of California San Diego. It’s possible that the mother’s immune response during the infection leaves a lasting impact on the child’s brain and immune system. Other studies have suggested that having a prior autoimmune disorder puts a person at risk for schizophrenia. But, Lee stresses, “There’s so much that we don’t fully understand.”

The bigger point, Lee says, is to recognize that schizophrenia is “a whole-body disorder.” “We see inflammation increase in the brain and we see inflammation increase throughout the body.” That leaves people with schizophrenia at risk of a whole host of chronic illnesses. “The inflammation worsens metabolic health, which then in turn usually leads to obesity and worse inflammation,” Lee says. “So it’s all kind of a cycle.”

How infections could precipitate mental health issues

The evidence for this theory — that immune issues can contribute to mental health disorders — is incomplete.

For one, Raison says that while it seems as though inflammation can contribute to depression, “it has not appeared that blocking inflammation is a particularly robust way to either treat or prevent these disorders.” So there’s a big piece of the puzzle missing there. Another missing piece: There are some cases of depression where inflammation does not appear to play a big role, says McIntyre, and there are probably many unrecognized or underrecognized causes or contributors to mental health issues.

Finally, the mental health conditions mentioned in this piece — depression, bipolar, schizophrenia — are not fully understood to begin with. Scientists just generally don’t understand how much biological overlap there is among them. With depression in particular, some scientists suspect it isn’t just one disease, but perhaps many different ones that manifest with similar, overlapping symptoms.

So the big picture is complicated and incomplete.

But if it is true that the immune system can influence the mind and vice versa, it opens up some important, fascinating questions.

For instance: Can getting sick, and the immune system reaction to fighting a virus, provoke changes in mental health? Our bodies get inflamed when we fight off an infection. Could that impact and even possibly cause or contribute to a mood disorder?

Past work suggests it could. An enormous study of the health records of 3.56 million people born between 1945 and 1996 in Denmark showed that a history of infection and autoimmune disorders predicted later diagnosis of mood disorders. More specifically, the study found that the more infections a person had, the more at risk they’d be for mental health issues later on; there could be a causal pathway here. That makes it seem like the infections themselves are a risk factor.

This also might be playing out in the pandemic. “It seems like having Covid puts you at higher risk for psychiatric illness after infection,” Nemani says. A February study of 69 million individual health records, published in The Lancet, found that “the incidence of any psychiatric diagnosis in the 14 to 90 days after Covid-19 diagnosis was 18.1 percent, including 5.8 percent that were a first diagnosis.” (The study made a few comparisons. Covid infections seem to precede more first time mental health diagnoses than breaking a bone, getting a kidney stone or a gallstone, and seem to precede more diagnoses than other infections like the flu.)

Exactly how this unfolds is not fully understood. Some of it might be due to the peculiarities of Covid-19 and how it can infect nervous system tissues, and is possibly a unique symptom of long Covid. (As reported in the Lancet study, Covid-19 patients were around twice as likely to develop a psychiatric illness for the first time compared to a control group of people who were sick with the flu.) But it also could be because many viral infections can nudge people’s mental health in a poor direction.

Consider the common cold example McIntyre laid out above. What if, after getting an infection, the lethargic wasting feeling doesn’t leave? There’s some suspicion that changes to the immune system, wrought by battling the virus, could do that.

Again, this is hardly settled science. But the pandemic presents these psychiatry researchers with an opportunity to ask these questions. When it comes to mental health risk after an infection, “what we’re going to need to do is tease apart what’s due to general stress from the pandemic itself — people losing people that they love, the stress of just getting the diagnosis itself, all of the life changes that came along with it — from the potential immune effects of the virus,” Nemani says.

More questions could be answered, too. “Looking ahead, we might be able to better understand how a viral infection can lead to new onset psychiatric illness,” she says. “If we can better understand that mechanism, we might be able to identify treatment targets that could potentially help treat psychiatric symptoms … and maybe even bolster the immune system of susceptible patients.”

Taking care of mental health can help communities prepare for outbreaks

Despite scientists having an incomplete picture of the science here, they believe it’s still useful to know that mental health issues can be a precursor to infection risk, or vice versa.

Recently, public health researchers at Yale published a study that found a county-level correlation between people’s general mental well-being and confirmed cases of Covid-19. Whereas the meta-reviews mentioned above looked at infection risk for actual diagnoses, this study looked at a more general measure of “poor mental health days.” It’s a self-reported measure that simply has people recall “the number of days that you are kind of feeling down or had some emotional issues,” Yusuf Ransome, the Yale epidemiologist who led the study, says.

In this study, “poor mental health days” is used as a way to take the mean mental health temperature of a region, and it does seem to be correlated to outbreak risk. At this zoomed-out level of analysis, it’s even harder to determine causality. But at least, Ransome says, it suggests that when it comes to the intersection of mental health and infection, we shouldn’t just focus on issues that rise to the level of a diagnosis.

On the left: diagnosed Covid-19 cases between January 22 and October 7, 2020, per 10,000 people. On the right: the average number of days adults had poor mental health.
American Journal of Preventative Medicine

“When we are only focusing on clinical manifestations, we might miss sort of the much more lay version of how people are experiencing mental health,” he says. “We need to look at even the most basic indicators of mental well-being. We don’t necessarily need to have the whole population diagnosed by a clinician for depression to understand the severity of the impact.”

To identify communities where mental health is overall poor, he says, is to potentially target them for interventions and outreach to help deal with future viral outbreaks.

For now, the scientists who research this intersection of mental health and the immune system want the public to know that mental health disorders can be whole-body disorders. They don’t just impact the brain. And for that, they applaud the CDC’s decision to recognize these disorders as being risk factors for severe Covid-19. A lot of people with such disorders are underserved by health care in general.

“People with mental health disorders — especially schizophrenia, severe depression — they don’t receive primary care interventions as often as other people,” Nemani says. “The fact that the CDC updated their high-risk list to include some of these mental health conditions was just, you know, a really great thing that really might help save lives.”

It’s hard to think of any silver linings in the pandemic, but one is the potential to gain knowledge. “We have a single virus at a single point in time, infecting so many people at a scale that we’ve never seen before,” Nemani says.

If scientists can use the pandemic to learn even more about the nature of these mental illnesses and how they interact with the immune system, more future lives could be saved, too.

Source: Can depression worsen Covid-19 and other infections? And can a virus make you depressed? – Vox

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