Mental Health Startup Uses Voice ‘Biomarkers’ To Detect Signs Of Depression And Anxiety

Young female character having a panic attack, an imaginary monster shadow silhouette, mental health issues, psychology

The quick brown fox jumps over the lazy dog,” Rima Seiilova-Olson says slowly and emphatically over Zoom.

The simple sentence holds enormous value for mental health care, she explains, smiling as if to acknowledge that it might be less than obvious how a silly phrase could be so meaningful to a computer programmer and leader of an artificial intelligence startup.

The short saying contains every letter of the alphabet and phoneme in the English language, says Seiilova-Olson, an immigrant from Kazakhstan who is cofounder and chief scientist of Kintsugi Mindful Wellness. Kintsugi believes these sounds offer invaluable insight that can help mental health providers better support people with depression and anxiety.

The Bay Area-based company is building AI software that analyzes short clips of speech to detect depression and anxiety. This so-called voice biomarker software is being integrated into clinical call centers, telehealth services and remote monitoring apps to screen and triage patients reaching out for support, helping providers more quickly and easily assess their needs and respond.

“There’s just not a lot of visibility as to who is severely depressed or anxious.”

Kintsugi CEO and co-founder Grace Chang

Seiilova-Olson, 36, first met co-founder and CEO Grace Chang, 40, a Taiwanese immigrant now based in Berkeley, in 2019 at an open AI hackathon in San Francisco. Surprised to cross paths at a male-dominated event, the women began comparing notes about their respective personal challenges trying to access mental health care:

Seiilova-Olson had struggled to secure a therapist during postpartum depression with her first child, and when Chang had needed her own support, she said it had taken months for anyone from Kaiser to call her back.

“Living in the Bay Area, you can push a button and a car can come to you or food can come to you,” Chang says. “But this was really a challenge.” As engineers, they viewed the dilemma differently than clinicians might.

“We saw this as an infrastructure problem, where you have so many people trying to jam through that front door,” Chang explains. “But there’s just not a lot of visibility as to who is severely depressed or anxious, who is low-to-moderate. And if we could provide this information to those frontline practitioners, then we’d maybe have an opportunity to greatly alleviate that bottleneck.”

Kintsugi was born out of that idea in 2019. It sits in a competitive space of health tech startups like Ellipsis Health and Winter Light Labs that are using voice biomarkers to detect mental health or cognitive issues, built on research showing that certain linguistic patterns and characteristics of a person’s voice can be correlated with psychiatric or neurological conditions.

Kintsugi last year raised $8 million in seed funding led by Acrew Capital, and in February, announced it had closed a $20 million Series A round led by Insight Partners, which valued the company at nearly $85 million, according to PitchBook.

In-person mental health facilities typically use questionnaires to gauge the severity of patients’ anxiety or depression, measures known as PHQ-9 and GAD-7 scores. But during telehealth visits or phone consults — where face-to-face interaction is lost, making it harder to pick up on symptoms — Kintsugi’s technology helps to fill that gap.

Nicha Cumberbatch, assistant director of public health at Spora Health, a provider focused on health equity and people of color, uses Kintsugi’s software to assess women in its all-virtual, doula-led maternal health program, Spora Mommas.

The voice analysis tool, which Spora began using for patient consultations a few weeks ago, has helped Cumberbatch identify women who are, or may be at risk of, experiencing anxiety and depression before, during or after their pregnancies. When a patient starts speaking to a Spora clinician or doula on Zoom, Kintsugi’s AI begins listening to and analyzing her voice.

After processing 20 seconds of speech, the AI will then spit out the patient’s PHQ-9 and GAD-7. The employee can then use that mental health score to decide what additional testing may be needed and how best to advise or direct the patient to resources — like a psychiatrist, cognitive behavioral therapist or obstetrician.

Cumberbatch says Kintsugi’s technology is allowing her to “​​keep a more watchful eye” on her patients “and then move forward with proactive recommendations around mitigating their symptoms.” And while it’s not meant to replace clinicians or formal medical evaluations, she adds, it can be used as a screening tool to “allow us to have a more well-rounded, 360-view of the patient when we don’t have them in front of our face.”

“That technology… [allows] us to have a more well-rounded, 360-view of the patient when we don’t have them in front of our face.”

Nicha Cumberbatch, assistant director of public health at Spora Health

Dr. ​​Jaskanwal Deep Singh Sara, a Mayo Clinic cardiologist who has collaborated with Ellipsis and led research on potential uses of voice biomarkers for cardiology, cautions that while the technology is promising for health care, the field has a long way to go to ensure that it’s accurate, safe and beneficial for patients and clinicians alike.

“It’s not ready for primetime by any stretch of the imagination yet,” Dr. Sara says. Studies in psychiatry, neurology, cardiology and other areas have shown an association between voice biomarkers and various conditions or diseases, but they haven’t shown how this relationship can be used to improve clinical outcomes, he says.

Such research is “not the same as saying, ‘How can we instrumentalize it in clinical practice, and how feasible is it? How effective is it in gauging an individual’s medical trajectory?’” he explains. “If it doesn’t provide any benefits in terms of how we manage them, then the question is: why would you do it?”

He says addressing those questions is “one of many next steps that we have to undertake on this” and that larger clinical trials are needed to answer them. “If it makes health care delivery cheaper or more efficient, or if it improves outcomes for patients, then that’s great,” he adds. “But I think we need to demonstrate that first with clinical trials, and that hasn’t been done.”

To address these issues and validate its software, Kintsugi is conducting clinical studies, including with the University of Arkansas for Medical Sciences, and the National Science Foundation has awarded Kintsugi multiple grants to ramp up its research. The company is also pursuing FDA “de novo” clearance and continuing to build its own dataset to improve its machine learning models.

(Data and insights from Kintsugi’s voice journaling app, as well as conversations with call centers or telehealth providers and clinical collaborations with various hospitals, all become part of an enormous dataset that feeds Kintsugi’s AI.) Seiilova-Olson says this self-generated, unfettered proprietary dataset is what sets Kintsugi apart in the AI health care space — where many technologies are reliant on outside data from electronic health records.

That collection of troves of data on individuals’ speech can be concerning — particularly in the mental health and wellness space, which is widely considered a regulatory Wild West. (These products and services are often not subject to the same laws and stringent standards that govern how licensed clinicians provide formal medical care to patients.)

But Kintsugi’s founders say that patient privacy is protected because what matters for its technology is not what people are saying, but how they are saying it. Patients are also asked for their consent to be recorded and care is not affected by their decision to opt in or opt out, according to the founders.

Kintsugi says it has served an estimated 34,000 patients. The company is currently working with a large health system with 90 hospitals and clinics across 22 states, and they are active in a care management call center that services roughly 20 million calls per year. It is also partnering with Pegasystems, which offers customer service tools for health care and other industries, to help payers and providers handle inbound calls.

Chang says other customers include Fortune 10 enterprise payers, pharmaceutical organizations and digital health applications focused on remote patient monitoring, but that she could not yet share their names. Kintsugi’s clinical partners include Children’s Hospital Colorado, Joe DiMaggio Children’s Hospital in Florida, Chelsea and Westminster Hospital in London and SJD Barcelona Children’s Hospital in Spain, Chang said.

Prentice Tom, Kintsugi’s chief medical officer, adds that it’s working with the University of Arkansas to explore how the tool can be used to possibly identify patients with suicidal ideation, or increased or severe suicide risk, as well as with Loma Linda University, to look at how the technology can be used to spot burnout amongst clinicians.

The team is also looking for ways to expand availability and uses for younger and elderly patients, as well as for maternal and postpartum populations. And beyond patients themselves, it’s perhaps nurses who are benefiting most from Kintsugi’s work, according to the founding team: having a triage tool that helps reduce administrative work or the time spent asking generic questions enables nurses to more seamlessly move patients in their journey.

But Tom, a Harvard-trained emergency medicine physician and former faculty member at Stanford University’s Department of Emergency Medicine, says Kintsugi is now doing far more than addressing infrastructure issues alone. It’s democratizing access to mental health care, Tom said, moving away from a physician-centric paradigm that caters more to people with significant enough depression that they require medical evaluation.

“This tool actually creates a view of mental health in terms of mental wellness,” Tom said, “where everyone has the opportunity to understand where they sit on the spectrum and that actually stratifies treatment options well beyond the current infrastructure.”

I’m a Senior Writer at Forbes covering the intersection of technology and society. Before joining Forbes, I spent three years as a tech reporter at Politico, where I covered

Source: Mental Health Startup Uses Voice ‘Biomarkers’ To Detect Signs Of Depression And Anxiety

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More contents:

How To Tell If You Have a Yeast Infection or UTI

Itching, burning or the constant urge to go — when it comes to problems down there, figuring out what’s wrong can be a tricky task. That’s because many issues that affect the vagina present with symptoms that may seem similar or even overlapping.

This is particularly true when it comes to urinary tract infections and yeast infections, two of the most common to afflict women — about 50% to 60% will experience a UTI at least once in her lifetime, and around 75% of women will experience a yeast infection at some point.

“These conditions can sometimes mirror one another because they both cause vaginal and bladder irritation,” says Jessica Shepherd, M.D., an ob-gyn, women’s health expert, and founder of Sanctum Wellness in Dallas, Texas.

lite9-4-1-1-1-1-3Here’s how to tell the difference between a UTI and a yeast infection so you can get the proper treatment.

Symptoms

UTI symptoms include:

  • A persistent urge to urinate, even if the bladder is empty and not much comes out
  • Incontinence
  • Burning, stinging or discomfort when urinating
  • Abdominal pain or cramping, especially when urinating
  • Cloudy or bloody urine
  • Pelvic pain
  • Pain in the lower back or flank
  • Fever, chills, nausea

Yeast infection symptoms include:

  • Constant itching, burning, or pain when urinating
  • Abnormal discharge (white and cottage cheese-like)
  • Itching or irritation in the vaginal area
  • Vaginal pain or soreness

Causes

UTIs occur when bacteria gets into the vaginal area, giving it the opportunity to travel up to the urethra or bladder where it becomes a full-blown infection and triggers uncomfy symptoms, explains Dr. Shepherd. Women are more likely than men to get one (although men can have a UTI, too) because our urethras (the pathway to the bladder) are shorter, making the bacterial journey easier.

Yeast infections happen when there’s an overgrowth of yeast that disrupts the vagina’s delicate microbiome. “Yeast naturally grows in our vaginas, along with other ‘good’ bacteria, but sometimes these levels can become imbalanced, leading to an infection,” says Staci Tanouye, M.D., a board-certified OB/GYN in Jacksonville, Florida and a Poise partner. “This can be caused by things like taking antibiotics, pregnancy, diabetes or a compromised immune system.”

Treatment

You need antibiotics to get rid of a UTI, so schedule an appointment with your doctor as soon as you notice symptoms. “If left untreated, a UTI could potentially spread to the kidneys, causing pain in the lower back or side, as well as fever, chills, or nausea,” Dr. Shepherd says.

Yeast infections can be treated with antifungal medications, but always talk to your doctor before trying any over-the-counter products, Dr. Tanouye says. Your doctor can help you determine which medication is right for you (there are oral options or suppositories that you insert into the vagina, as well as creams to help alleviate discomfort like itching).

Yeast infections require antifungal medications. These can be prescribed or purchased without a prescription and are available in a variety of treatments. You may take an oral medication, use a topical substance, or even insert a suppository. The duration of treatment varies and can range anywhere from one dose to multiple doses over a week’s time. Just like UTIs, you should take the yeast infection medication for the entire recommended duration to prevent the condition from coming back.

It’s possible that you have recurring UTIs and yeast infections that require a more aggressive treatment. Your doctor will outline these treatments if you experience multiple infections over a short course of time.

Preventing UTIs and yeast infections:

“Lifestyle factors can go a long way in helping you ward off UTIs and yeast infections,” says Dr. Shepherd. Here are some tactics to keep in mind:

  • Stay hydrated. “This can help prevent mild UTIs because fluids help flush bacteria from the urinary tract while decreasing inflammation,” Dr. Tanouye says.
  • Exercise. Being active supports a strong immune system, which is important for you to be able to fight off infections.
  • Ditch tight clothing. “Wear breathable clothing and keep skin dry,” Dr. Tanouye says, and try to change out of damp or sweaty clothing as soon as possible. Yeast thrives in warm, moist environments.
  • Avoid scented products. Feminine perfumes, deodorants, wipes or tampons that are scented may disrupt the makeup of vaginal bacteria, causing infection.
  • Wipe from front to back. This can help prevent you from spreading bacteria (which may cause a UTI) from the rectum to the vagina.
  • Don’t douche. This can disrupt your vagina’s natural bacterial makeup, which may lead to a yeast infection.

UTIs are common, with 10 in 25 women, and 3 in 25 men experiencing a UTI in their lifetime. Women experience UTIs more commonly than men because a woman’s urethra is shorter than a man’s, and closer to the vagina and anus, resulting in more exposure to bacteria.

You may also be more at risk for a UTI if you:

  • are sexually active
  • are pregnant
  • are currently using or have used antibiotics recently
  • are obese
  • have gone through menopause
  • have given birth to multiple children
  • have diabetes
  • have or have had a kidney stone or another blockage in your urinary tract
  • have a weakened immune system

Women experience yeast infections more frequently than men, and 75 percent of women will get a yeast infection in their lifetime. Yeast infections commonly occur in the vagina and vulva, but you can also get a yeast infection on your breast if you’re breast feeding and in other moist areas of the body, like the mouth. A vaginal yeast infection is not a sexually transmitted infection, but in rare occasions you can pass it to your partner during sex.

Your risk of contracting a vaginal yeast infection increases if:

  • you’re between puberty and menopause
  • you’re pregnant
  • you use hormonal birth control
  • you have diabetes and don’t manage high blood sugar effectively
  • you’re using or have recently used antibiotics or steroids
  • you use products in your vaginal area like douches
  • you have a compromised immune system

Source: How to tell if you have a yeast infection or UTI

More contents:

Vaginal yeast infections fact sheet”. womenshealth.gov. December 23, 2014. Archived from the original on 4 March 2015. Retrieved 5 March 2015.

Sexually transmitted diseases treatment guidelines, 2006″. MMWR Recomm Rep. 55 (RR-11): 1–94. PMID 16888612. Archived from the original on 2014-10-20.

Vaginal yeast infection”. MedlinePlus. National Institutes of Health. Archived from the original on 4 April 2015. Retrieved 14 May 2015.

Diagnosis of vaginitis”. Am Fam Physician. 62 (5): 1095–104. PMID 10997533. Archived from the original on 2011-06-06.

Thrush in men and women”. nhs.uk. 2018-01-09. Retrieved 2021-01-16.

Yeast infection (vaginal)”. Mayo Clinic. Archived from the original on 16 May 2015. Retrieved 14 May 2015.

Vaginal Candidiasis | Fungal Diseases | CDC

Treatment of vaginal candidiasis for the prevention of preterm birth: a systematic review and meta-analysis”.

“Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of Amerika

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Symptoms of Dementia and Early Warning Signs

From age 50 on, it’s not unusual to have occasional trouble finding the right word or remembering where you put things.

Dementia Symptoms at a Glance

  • Difficulty with everyday tasks
  • Repetition
  • Communication problems
  • Getting lost
  • Personality changes
  • Confusion about time and place
  • Troubling behavior

But persistent difficulty with memory, cognition and ability to perform everyday tasks might be signs that something more serious is happening to a loved one’s brain.

Dementia isn’t actually a disease, according to the Mayo Clinic. It’s a catch-all term for changes in the brain that cause a loss of functioning that interferes with daily life. Dementia can diminish focus, the ability to pay attention, language skills, problem-solving and visual perception. It also can make it difficult for a person to control his or her emotions and lead to personality changes.

Roughly 6.5 million Americans are living with Alzheimer’s dementia, according to the “2022 Alzheimer’s Disease Facts and Figures” report from the Alzheimer’s Association. Alzheimer’s disease is the leading cause of dementia, accounting for 60 percent to 70 percent of cases, but a range of brain illnesses can lead to the condition (see sidebar, “Diseases that cause dementia”).

Diseases that cause dementia

These conditions are the leading causes of dementia. Many patients have mixed dementia, a combination of two or more types, such as Alzheimer’s and vascular dementia.

Alzheimer’s disease. Alzheimer’s is characterized by amyloid plaques and tangled fibers in the brain and by a loss of connections between nerve cells. Damage initially appears in the hippocampus, an area of the brain involved in memory formation, and gradually spreads.

Vascular dementia. The second most common type of dementia results from damage to the vessels that supply blood to the brain. It tends to affect focus, organization, problem-solving and speed of thinking more noticeably than memory.

Lewy body dementia. Abnormal protein deposits in the brain, called Lewy bodies, affect brain chemistry and lead to problems with behavior, mood, movement and thinking.

Frontotemporal disorders. Degenerative damage to the brain’s frontal and temporal lobes is the most common cause of dementia in people age 65 and younger. Symptoms might include apathy; difficulty communicating, walking or working; emotional changes; and impulsive or inappropriate behaviors.

A loved one showing symptoms of dementia needs to see a medical expert who can conduct tests and come up with a diagnosis. If a loved one has dementia, you’ll want to plan how you will manage that care, especially as the condition progresses.

But it’s also important to rule out other medical conditions with dementia-like symptoms that may disappear with treatment such as infections and side effects of medications.

Dementia symptoms to watch for

Here are some of the warning signs identified by dementia experts and mental health organizations:

• Difficulty with everyday tasks. Everyone makes mistakes, but people with dementia may find it increasingly difficult to do things like keep track of monthly bills or follow a recipe while cooking, the Alzheimer’s Association says. They also may find it hard to concentrate on tasks, take much longer to do them or have trouble finishing them.

• Repetition. Asking a question over and over or telling the same story about a recent event multiple times are common indicators of mild or moderate Alzheimer’s, according to the Cleveland Clinic.

• Communication problems. Observe if a loved one has trouble joining in conversations or following along with them, stops abruptly in the middle of a thought or struggles to think of words or the name of objects.

• Getting lost. People with dementia may have difficulty with visual and spatial abilities. That can manifest itself in problems like getting lost while driving, according to the Mayo Clinic.

• Personality changes. A loved one who begins acting unusually anxious, confused, fearful or suspicious; becomes upset easily; or loses interest in activities and seems depressed is cause for concern.

• Confusion about time and place. Loved ones who forget where they are or can’t remember how they got there should raise alarms. Another worrisome sign is disorientation about time — for example, routinely forgetting what day of the week it is, says Jason Karlawish, M.D., a professor at the University of Pennsylvania’s Perelman School of Medicine and co-director of the Penn Memory Center.
• Troubling behavior. If your family member seems to have increasingly poor judgment when handling money or neglects grooming and cleanliness, pay attention.

Some people who experience memory loss or have difficulty with attention, decision-making language or reasoning may have a condition known as mild cognitive impairment. The condition causes a noticeable decline, but the changes are less severe than with dementia and a person can still perform normal daily activities, according to the Cleveland Clinic.

People with mild cognitive impairment are at an increased risk of developing dementia.

Signs of dementia? Where to find help

When your loved one is displaying troubling symptoms, a trip to a primary care physician is often the first step. But to get a definitive diagnosis, you’ll need to see a specialist such as a neurologist, geriatrician or geriatric psychiatrist.

If you can’t find one, the National Institute on Aging recommends contacting the neurology department of a nearby medical school. Some hospitals also have clinics that focus on dementia.

Ailments can mimic dementia

Any number of treatable conditions can cause dementia-like symptoms. Some of the most common:

• Alcohol abuse
• Anxiety, depression or stress
• Blood clots, brain infections or tumors
• Delirium
• Head injuries
• Kidney, liver or thyroid problems
• Side effects of medication
• Vitamin deficiencies

Source: National Institute on Aging

Specialists will want to know about the patient’s personal and family medical history. A close relative or relatives having had Alzheimer’s is a major risk factor.

Recent research suggests that a prevalence among even members of your extended family can increase your dementia risk. Doctors also will conduct physical and neurological exams to rule out other treatable causes for dementia symptoms.

Some of the methods that doctors use to diagnose dementia:

• Cognitive and neuropsychological tests assess language and math skills, memory, problem-solving and other types of mental functioning.

• Lab tests of blood and other fluids, including checking levels of various chemicals, hormones and vitamins, can help rule out nondementia causes for the symptoms.

• Brain scans such as CT, MRI or PET imaging can spot changes in brain structure and function. These tests also can identify strokes, tumors and other problems that can cause dementia.

• Psychiatric evaluation can determine whether a mental health condition is causing or affecting the symptoms.

• Genetic tests are important, especially if someone is showing symptoms before age 60. The early onset form of Alzheimer’s is strongly linked to a person’s genes, according to the Mayo Clinic. Talk with a genetic counselor before and after getting tested.

Editor’s note: This article was published on October 22, 2019. It has been updated with more recent information.

By: Patrick J. Kiger

Patrick J. Kiger is a contributing writer for AARP. He has written for a wide variety of publications, including the Los Angeles Times Magazine, GQ and Mother Jones, as well as the websites of the Discovery Channel and National Geographic.​​

Source: Symptoms of Dementia and Early Warning Signs

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Critics:

Having trouble with memory can be an early symptom of dementia. The changes are often subtle and tend to involve short-term memory. A person with dementia may be able to remember events that took place years ago, but not what they had for breakfast.

Another early symptom of dementia is difficulty with communicating thoughts. A person with dementia may have a hard time explaining something or finding the right words to express themselves. They may also stop in the middle of a sentence and not know how to continue.

Having a conversation with a person who has dementia can be challenging, and it may take longer than usual for them to express their thoughts or feelings.

A change in mood is also common with dementia. If you have dementia, it may not be easy to recognize this in yourself, but you may notice this change in someone else. Depression, for instance, is common in the early stages of dementia.

Someone who has dementia may also seem more fearful or anxious than they were before. They could get easily upset if their usual daily routine is changed, or if they find themselves in unfamiliar situations.

Apathy, or listlessness, is a common sign in early dementia. A person with dementia may lose interest in hobbies or activities that they used to enjoy doing. They may not want to go out anymore or have fun.They may also lose interest in spending time with friends and family, and they may seem emotionally flat.

Someone in the early stages of dementia may often become confused. They may have trouble remembering faces, knowing what day or month it is, or figuring out where they are. Confusion can occur for a number of reasons and apply to different situations. For example, they may misplace their car keys, forget what comes next in the day, or have difficulty remembering someone they recently met.

But dementia is not one single condition. It’s essentially an umbrella term that covers a wide range of cognitive disorders. This includes Alzheimer’s disease, which accounts for 60 to 80 percent of cases, according to the Alzheimer’s Association…

More contents:

Caregiving for dementia: Helping your loved one stay connected

Healthy lifestyle, not supplements, prevent dementia

Staying Sharp: Take control of your brain health

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Covid Year Three Will Be Better, Experts Agree, Unless Rich Countries Ignore The Pandemic Elsewhere

It was March 2020 when the reality of the Covid-19 pandemic hit home in the U.S. When the NBA suspended its season, it seemed to give permission for other closures and stay-at-home orders, and they quickly followed. At that point, there had only been around 3,000 confirmed cases of the disease and about 60 confirmed Covid deaths.

Fast-forward two years, and the numbers are staggering. According to estimates from Johns Hopkins University, as of Wednesday there have been over 79 million confirmed Covid cases and over 960,000 deaths. Several million have been hospitalized and millions more have reported symptoms that linger for weeks or even months, with unknown consequences moving into the future.

“It’s massively higher than I thought,” says Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco. “Particularly when in November 2020 the announcement came out that we had a vaccine that was 95% effective.”

Amanda Castel, a professor of epidemiology at George Washington University’s Milken Institute School of Public Health, said in an email that she’s also surprised that the pandemic is still going, compared to her initial expectation. “In retrospect, I think I was hopeful that it would be more self-limited, like the SARS pandemic.”

The worst of the pandemic is behind us, experts told Forbes, in part because the first two years provided valuable tools for the continued fight against both Covid and future disease epidemics. Ignoring the pandemic in lower-income countries, they say, could mean new variants making their way back to the U.S.

One lesson the experts didn’t expect to learn was how polarizing the response to the pandemic could be, especially as time went on. “I was surprised and alarmed to see how politically polarized Covid-19 responses have become, with some U.S. states (most recently Florida) promoting public health policies that directly oppose the science (and common sense),” Steffanie Strathdee, associate dean of global health sciences at the University of California, San Diego, said in an email.

The depth and intensity of political anger against public health officials was also jarring, says Castel. “To think that many public health leaders at the local, state and national level received death threats and lawsuits because of the evidence-based guidance they issued is appalling.”

“It’s tragic, because the outcomes of that were that hundreds of thousands of people died, who would not have died, if the response had been less political and more governed by the best science,” Wachter adds.

Wachter also says it’s hard to fathom the size of anti-vaccine sentiment based on what things looked like before the pandemic. “The anti-vax movement was previously pretty small and fringe,” he says. “And it was as likely to come from the left as the right—maybe even more likely to come from the left.”

The worst of the pandemic is (probably) behind us

“Years three and four will, hopefully, see a transition of Covid-19 from an emergent condition to an ongoing public health challenge with significantly less morbidity and mortality,” Anand Parekh, chief medical advisor for the Bipartisan Policy Center, says in an email. But not if it’s left to itself, he’s quick to add. “This would require easy access to prevention, testing and treatment.”

“I think the likeliest path will be a version of where we are now,” says Wachter. “With small surges that will not be overwhelming and be regional, partly related to seasonality, maybe partly related to vaccine status in different regions.”

The biggest unknown about this prediction, of course, is whether a new Covid variant emerges, which Strathdee warns is an increased risk if high-income countries choose to ignore the pandemic in the rest of the world. “If we don’t ensure that new medical advances such as vaccines and therapeutics reach the lower- and middle-income countries, new variants will emerge that threaten us all.”

Long Covid will have a potentially long impact

A potentially bigger challenge than surges of new infections in pandemic year three, says Wachter, are the still mostly unknown impacts of long Covid. If it turns out that, as some preliminary estimates suggest, as many as 10% to 20% of people experience lingering symptoms, “that’s tens of millions of people, and that’ll have an impact on the workforce and that’ll have an impact on economic performance.”

Long Covid will take a potential toll on the healthcare system as well, adds Castel. “Until we learn more about how to prevent and treat long Covid, we can anticipate a large burden on the healthcare system for the near future.”

“The high prevalence of long Covid stands to cause significant disability,” Strathdee says. “which affects both mental and physical health, including quality of life. I don’t think we’ve got a good handle yet on how big this problem may be.”

One major concern, says Wachter, is that unlike most respiratory diseases, early studies are warning that Covid may cause long-term health problems. A recent study said that people with even mild Covid showed more incidents of brain damage compared with those uninfected. Another finding: People infected with Covid have higher rates of heart attack and strokes. “If that turns out to be real, you’re talking about a new risk factor in almost 40% of the population,” he says. “A risk factor that may be as potent, as if people have high blood pressure or if they smoke. And that’s a very big deal.”

The tool kit for the next disease surge

Health experts agree that Covid-19 is likely to be around for a long time, and it’s also not going to be the last pandemic. The past two years, they say, have provided a lot of insight into what needs to be done to prepare for the next deadly disease surge.

When it comes to respiratory viruses like Covid, “We need to keep good-fitting N95 face masks, HEPA filters and good old soap and water,” says Strathdee.

“Masks should have been consistently recommended early on in the pandemic, as other countries did,” Parekh agrees. Castel concurs. “Masks are simple to use, relatively easy to obtain, and have proven to be effective in both protecting the wearer and those around them.”

Another key tool for combating future epidemics is testing, Wachter says. “We clearly made a terrible error early on in not working hard to get good tests out there more quickly,” he says. “And particularly, I think we were very late on home testing, both developing them and distributing them.”

One crucial factor that emerged to combat Covid, says Esther Krofah, executive director of FasterCures and the Center for Public Health at the Milken Institute, was research collaboration between scientists, companies and governments to produce vaccines and therapeutics quickly. That’s something she hopes doesn’t go away. “We need to ensure we build sustainable infrastructure to continue such collaboration,” she says, “and move forward efforts to change the culture in medical research to align with the urgent needs of patients.”

Experts do suggest rethinking one of the most contentious aspects of the pandemic response: school closures. “One of the real lessons learned is the negative impact of school closures on kids,” says Wachter. “And I think it will influence our response the next time.”

“Virtual schooling, while necessary intermittently, will need to be more closely considered in the future taking into account the virus’ epidemiology, risk to students and staff, and considerations for childcare/parental workforce,” says Parekh.

Hospitals need to be better prepared for future surges

Covid-19 hit hospitals extremely hard, overworking doctors and nurses to the point of burnout during pandemic surges, as intensive care units and other departments were pushed to capacity and beyond. This means that hospitals will need to work on building their surge capacity, experts say.

“Stockpiling and distributing critical medical material, deploying surge medical staff and ensuring that healthcare systems through federal grants are exercising their response plans are all critical,” Parekh says.

A major challenge for hospitals, says Wachter, will be getting extra capacity in place without breaking the bank. “Nobody’s going to be able to afford to keep a lot of excess bed capacity available, or a lot of excess nursing and doctor capacity,” he says. However, what hospitals can do is better stockpile equipment and protective clothing for healthcare workers. “The things that are not wildly expensive but you do want to have in the basement.”

In addition to better preparing for surges, hospitals also need to be better at identifying threats early so public health measures can be put in place, says Strathdee. “Public health departments and hospitals need to be better equipped to conduct surveillance, which includes systems for timely reporting.”

Castel encourages closer communication between hospitals and public health officials. “Hospitals are often sentinel sites and the first place that persons infected with these illnesses seek care, therefore they must have the capacity to work closely with public health to assist in the timely detection of emerging infectious diseases.”

Rebuilding trust and fighting apathy is critical

“An effective response to a pandemic requires three things: political leadership, national unity and timely resources,” says Parekh. Those first two have been hard to come by since 2020, with one expert confiding to Forbes their concern that political polarization “has significantly impaired the ability of public health authorities to enact countermeasures in the future.”

Another challenge that health experts have seen during the course of the pandemic isn’t just politics but also apathy. “On May 24, 2020, the New York Times covered its whole front page with a story headlined: ‘U.S. Deaths Near 100,000, An Incalculable Loss.’ It listed names of the dead, as the paper did after 9/11. In December 2020, shortly before vaccines became available, we approached 300,000 dead, though the Times did not (and still has not) run a similar story,” Krofah says. “I’m afraid we have become numb to these numbers.”

Wachter notes that if a new surge of Covid comes in the next few months, it may be hard to galvanize a public response. “Everybody is so cognitively over this,” he says. “And the idea that you would have to hunker down again? It’s going to be awfully hard to convince people to do that.”

Other experts agree that separating politics from public health is going to be essential in order to move forward in combating future epidemics. A crucial aspect of that is rebuilding trust in institutions, repaid in kind with clear communication rooted in science. But it’s also, several say, something that has to happen between people’s everyday interactions with each other.

For Castel, what’s needed is that sense of community seen early in the pandemic when “neighbors volunteered to help older, more vulnerable people get groceries, or to make masks, or to donate food to overworked medical personnel,” she says. “Without this sense of community, we would not be where we are today and I can only hope that if faced with another pandemic, that we would all come together again in a united effort to protect and support each other. “

I’m a senior editor at Forbes covering healthcare, science, and cutting edge technology. 

Source: Covid Year Three Will Be Better, Experts Agree, Unless Rich Countries Ignore The Pandemic Elsewhere

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More contents:

Stool Tests Might Help Spot Early Pancreatic Cancer

Stool tests might provide a useful way to help doctors spot early pancreatic cancer, say researchers.

They have been trialling the concept in a study with 136 volunteers.

The findings, described in the journal Gut, suggest detectable changes involving gut bugs could provide a warning sign that a tumour is present.

Pancreatic cancer often doesn’t cause symptoms in the early stages. That means it is usually more advanced and harder to treat when it is found.

As the cancer grows it may cause vague symptoms, such as indigestion, changes to bowel habit and some tummy or back pain. Some people see their GP several times before being diagnosed.

Currently, fewer than one in 20 of those with the most common form – ductal adenocarcinoma – will survive for five years or more. Earlier detection could improve those odds.

The Spanish team behind the work recruited patients from two hospitals – one in Madrid and the other in Barcelona. Only some of the patients had pancreatic ductal adenocarcinoma, while the others were selected as controls for comparison.

The researchers collected and analysed spit and stool samples from the volunteers to see if there was any discernible difference between the groups.

While the saliva samples drew a blank, the stool ones did show a difference that the team believe could be useful for helping to diagnose pancreatic cancer.

It was a distinct pattern or genomic profile of gut bacteria, fungi and other microbes.

This consistently identified patients with the disease, irrespective of how far it had progressed, suggesting that characteristic microbiome signatures emerge early on and that the stool microbiome might pick up early stage disease, say the researchers.

They recommend more studies – and some are already taking place.

Independent researchers in Germany have validated the findings in a small number of patients, and the test is also being trialled in Japan.

Source: Stool tests might help spot early pancreatic cancer – BBC News

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Critics: By: Samuel Lovett

Stool samples could soon be analyzed to help detect pancreatic cancer after scientists identified microorganisms that appear to place individuals at greater risk of developing the illness. In a study of 136 people, scientists found that 27 different microbes were abundant in the stool samples of those diagnosed with the most common form of pancreatic cancer.

This “microbial profile” consistently identified patients with the disease, irrespective of how far it had progressed, raising hope that a new screening test could be developed to diagnose pancreatic cancer.

Pancreatic cancer is deadly and can be very difficult to treat, with only around one in four people surviving one year or more after diagnosis. Dr Helen Rippon, chief executive of Worldwide Cancer Research, which helped fund the study, said: “This new breakthrough builds on the growing evidence that the microbiome – the collection of microorganisms that live side by side with the cells inside our body – is linked to the development of cancer.

References

“Can pancreatic cancer be prevented?”. American Cancer Society. 11 June 2014. Archived from the original on 13 November 2014. Retrieved 13 November 2014.

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