December 21, 2020 3:21 PM ET
https://www.npr.org/2020/12/21/94629211 ... enied-care
At the start of the coronavirus pandemic, a small group of disability rights advocates found itself in a race against time to save the life of a woman with an intellectual disability.
The woman was taken to the hospital with COVID-19. But the hospital, in a small Oregon town, denied the ventilator she needed. Instead, a doctor, citing her "low quality of life," wanted her to sign a legal form to allow the hospital to deny her care.
Out of that quiet fight in early spring, the advocates — staff at a disability rights legal group, a state lawmaker and a few others — discovered something disturbing: There were many cases in Oregon of health care being rationed to people with disabilities.
At the same moment, across the United States, disability groups and even a civil rights office of the U.S. government were raising a similar warning: that behind closed doors, people with disabilities, as well as elderly people, were in danger of being denied health care.
NPR was looking for cases, too, and heard about the woman in Pendleton while she was in the hospital.
There's no reason that these examples would occur more frequently in Oregon than in other states. But the fight for that anonymous woman with an intellectual disability peeled back the curtain on health care decision-making in Oregon in a way that did not happen in other states.
That activism led to change in Oregon — including anti-discrimination legislation and new statewide policies.
It was late March when the woman with an intellectual disability contracted COVID-19. She struggled to breathe.
In the hospital, a medical provider wrote do-not-resuscitate (DNR) and do-not-intubate orders for the woman. Those are medical instructions to health care providers to withhold potentially painful interventions, like a ventilator or CPR, if a patient stops breathing or the patient's heart stops. The woman was alone in the hospital and did not understand what the doctor and medical staff wanted her to agree to.
In addition, the hospital staff sent word to the woman's group home: Fill out DNRs in advance for your other residents, in case one of them comes to the hospital.
People who worked with the woman were angry that the doctor and the hospital seemed to be discounting the lives of people with disabilities.
Someone tracked down lawyers for help.
The lawyers work for Disability Rights Oregon (DRO), a federally funded legal group that protects the rights of people with disabilities. State Sen. Sara Gelser, who chairs Oregon's Senate Committee on Human Services, was notified too.
January 5, 2021 6:13 PM ET
https://www.npr.org/sections/health-sho ... ing-damage
Early in the pandemic, people with COVID-19 began reporting an odd symptom: the loss of smell and taste.
The reason wasn't congestion. Somehow, the SARS-CoV-2 virus appeared to be affecting nerves that carry information from the nose to the brain.
That worried neurologists.
"We were afraid that SARS CoV-2 was going to invade the brain," says Dr. Gabriel de Erausquin, an investigator at the Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases at the University of Texas Health Science Center at San Antonio.
Their fears proved well-founded — though the damage may come from the body and brain's response to the virus rather than the virus itself.
Many patients who are hospitalized for COVID-19 are discharged with symptoms such as those associated with a brain injury. These include "forgetfulness that impairs their ability to function," de Erausquin says. "They complain about trouble with organizing their tasks, and that entails things such as being able to prepare a meal."
But COVID-19 also appears to produce many other brain-related symptoms ranging from seizures to psychosis, a team reports in the Jan. 5 issue of the journal Alzheimer's & Dementia. The team, which included de Erausquin, says severe COVID-19 may even increase a person's risk of developing Alzheimer's disease.
For many affected patients, brain function improves as they recover. But some are likely to face long-term disability, de Erausquin says.
"Even if the proportion, the rate, is not very high, the absolute number of people who will suffer these consequences is likely to be high," he says, because so many people have been infected.
Scientists are still trying to understand the many ways in which COVID-19 can damage the brain.
It's been clear since early in the pandemic that the infection can lead to blood clots that may cause a stroke. Some patients also suffer brain damage when their lungs can no longer provide enough oxygen.
To understand other, less obvious mechanisms, though, scientists needed brain tissue from patients with COVID-19 who died. And early in the pandemic they couldn't get that tissue, says Dr. Avindra Nath of the National Institute of Neurological Disorders and Stroke.
"Because it was such an infectious organism, people were not conducting autopsies at most places," Nath says. They simply lacked the protective gear that would allow them to remove a brain safely.
That's changing, though, says Nath, who was part of a team that studied brain tissue from 19 COVID-19 patients.
The team saw widespread evidence of inflammation and damage, they reported Dec. 30 in The New England Journal of Medicine.
They also found a possible explanation for the damage.
"What we found was that the very small blood vessels in the brain were leaking," Nath says. "And it wasn't evenly — you would find a small blood vessel here and a small blood vessel there."
The injuries resembled those from a series of tiny strokes occurring in many different areas of the brain, Nath says.
The finding may explain why COVID-19 patients have such a wide range of brain-related symptoms, Nath says, including some related to brain areas that control functions such as heart rate, breathing and blood pressure.
Serra Húnter Fellow, Department of Statistics and Operations Research, Universitat Politècnica de Catalunya-BarcelonaTech, Spain
Are environmental pollution and biodiversity levels associated to the spread and mortality of COVID-19? A four-month global analysis
On March 12th, 2020, the WHO declared COVID-19 as a pandemic. The collective impact of environmental and ecosystem factors, as well as biodiversity, on the spread of COVID-19 and its mortality evolution remain empirically unknown, particularly in regions with a wide ecosystem range. The aim of our study is to assess how those factors impact on the COVID-19 spread and mortality by country. This study compiled a global database merging WHO daily case reports with other publicly available measures from January 21st to May 18th, 2020. We applied spatio-temporal models to identify the influence of biodiversity, temperature, and precipitation and fitted generalized linear mixed models to identify the effects of environmental variables. Additionally, we used count time series to characterize the association between COVID-19 spread and air quality factors. All analyses were adjusted by social demographic, country-income level, and government policy intervention confounders, among 160 countries, globally. Our results reveal a statistically meaningful association between COVID-19 infection and several factors of interest at country and city levels such as the national biodiversity index, air quality, and pollutants elements (PM10, PM2.5, and O3). Particularly, there is a significant relationship of loss of biodiversity, high level of air pollutants, and diminished air quality with COVID-19 infection spread and mortality. Our findings provide an empirical foundation for future studies on the relationship between air quality variables, a country's biodiversity, and COVID-19 transmission and mortality. The relationships measured in this study can be valuable when governments plan environmental and health policies, as alternative strategy to respond to new COVID-19 outbreaks and prevent future crises.
Although this is not directly related to MS, I feel those of you who are interested in following Covid developments will find this man does a very good daily update. If you are concerned that people you know are not taking the issue seriously then this particular update might be of use.
Ann Neurol. 2021 Jan 21.
Objective: This study was undertaken to assess the impact of immunosuppressive and immunomodulatory therapies on the severity of coronavirus disease 2019 (COVID-19) in people with multiple sclerosis (PwMS).
Methods: We retrospectively collected data of PwMS with suspected or confirmed COVID-19. All the patients had complete follow-up to death or recovery. Severe COVID-19 was defined by a 3-level variable: mild disease not requiring hospitalization versus pneumonia or hospitalization versus intensive care unit (ICU) admission or death. We evaluated baseline characteristics and MS therapies associated with severe COVID-19 by multivariate and propensity score (PS)-weighted ordinal logistic models. Sensitivity analyses were run to confirm the results.
Results: Of 844 PwMS with suspected (n = 565) or confirmed (n = 279) COVID-19, 13 (1.54%) died; 11 of them were in a progressive MS phase, and 8 were without any therapy. Thirty-eight (4.5%) were admitted to an ICU; 99 (11.7%) had radiologically documented pneumonia; 96 (11.4%) were hospitalized. After adjusting for region, age, sex, progressive MS course, Expanded Disability Status Scale, disease duration, body mass index, comorbidities, and recent methylprednisolone use, therapy with an anti-CD20 agent (ocrelizumab or rituximab) was significantly associated (odds ratio [OR] = 2.37, 95% confidence interval [CI] = 1.18-4.74, p = 0.015) with increased risk of severe COVID-19. Recent use (<1 month) of methylprednisolone was also associated with a worse outcome (OR = 5.24, 95% CI = 2.20-12.53, p = 0.001). Results were confirmed by the PS-weighted analysis and by all the sensitivity analyses.
Interpretation: This study showed an acceptable level of safety of therapies with a broad array of mechanisms of action. However, some specific elements of risk emerged. These will need to be considered while the COVID-19 pandemic persists.
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