We don’t see a lot about COVID-19 within the mainstream media lately. Persons are bored with excited about it, and the oldsters who generate content material for the mainstream media are bored with writing about it. Greater than drained, I’d say. Fed up is extra prefer it. However a fast take a look at the info is fascinating.
At current, the prevalence of COVID is diminishing. Throughout the week ending August 31, 2.3% of emergency division visits reported optimistic COVID assessments. This was an enormous drop from the ten.2% of ED visits that reported optimistic COVID assessments the earlier week. There was a significant improve in ED visits on account of COVID simply up to now few months, from the low positivity charge of lower than 0.5% reported within the week ending Might ninth of this yr. Because the onset of the pandemic, there have been 139.8 million optimistic COVID-19 emergency division visits.
Total numbers of hospitalizations and deaths have additionally dropped considerably. Listed here are some COVID loss of life figures for comparability:
Week ending 09/14/2024 – 563 deaths on account of COVIDWeek ending 08/31/2024 – 663 deaths on account of COVIDWeek ending 05/18/2024 – 336 deaths on account of COVIDWeek ending 01/27/2024 – 2,131 deaths on account of COVIDWeek ending 01/17/2023 – 3,870 deaths on account of COVIDWeek ending 01/15/2022 – 19,078 deaths on account of COVIDWeek ending 01/19/2021 – 25,974 deaths on account of COVID
In response to my calculator, the latest COVID loss of life charge is about 2.5% of what it was on the pandemic’s peak. It’s not over, nevertheless it actually is method, method down.
Within the US, there have been 111,820,092 confirmed instances of COVID, and 1,219,489 confirmed deaths. Over 95% of the US inhabitants has identifiable COVID antibodies, which reduces the influence when it comes to hospitalizations and deaths. In comparison with COVID in its peak interval, what we’re now’s positively minor. The illness has its ups and downs, however the total trajectory is evident. Basically, COVID is diminishing as a critical risk.
The lengthy COVID story is considerably extra regarding. The CDC has taken its time in defining lengthy COVID. They’ve settled on three months because the time span that defines lengthy COVID – if signs persist three months or longer, the sickness qualifies as lengthy COVID. The prevalence of lengthy COVID in adults over the age of 18 declined very barely, from about 7.5% in June of 2022 to about 6% in the identical interval in 2023, and has not modified since 2023. These percentages will not be percentages of the overall inhabitants, however of the inhabitants that was recognized with COVID – in different phrases, since 2023 about 6% of individuals initially recognized with COVID went on to develop lengthy COVID. In response to the CDC, the individuals more than likely to be affected by lengthy COVID are ladies, Hispanics, hospitalized people, individuals with underlying well being situations, and the unvaccinated. In adults reporting earlier episodes of COVID, the prevalence of lengthy COVID is far increased. It reached 18.9% again in 2022 and has not modified a lot since that point.
Simply a few months in the past, we have been reluctantly pressured to cross on the knowledge that Paxlovid doesn’t do a lot to alleviate the signs of lengthy COVID.
The parade of variants continues. As of August 31, there have been 26 variants in circulation within the US. The variant at present inflicting probably the most infections is designated as KP.3.1.1, which is related to 42.2% of COVID instances that come to the eye of the healthcare system and are topic to blood assessments. That is actually a small fraction of all of the COVID instances for the reason that starting of the pandemic, however that proportion is probably going an correct reflection of the present prevalence of that variant within the total inhabitants. All of those present variants are within the Omicron class.
Talking as Doc Gumshoe, I’m reluctant to stake a agency place on the present COVID outlook. Sure, hospitalizations and deaths are method down, however every new variant appears to be extremely infective. Vaccines and former infections increase mobile immunity and are efficient safety in opposition to critical sickness, however will not be that protecting in opposition to preliminary an infection. My spouse and I put on masks solely once we suppose we have to. On the films or the theater we put on masks, additionally at any healthcare amenities we go to. Will this be the way in which it’s for the remainder of the twenty first century? We actually hope not, nevertheless it’s laborious to know.
Some however not all antidepressants could lead to weight acquire
This was based mostly on a examine that analyzed information from greater than 183,000 individuals between the ages of 20 and 80, with a mean age of 48 years. Most topics have been obese or overweight at the beginning of the examine. The vast majority of the topics have been ladies. The researchers analyzed members’ digital well being information and physique mass index. They gauged weight acquire or loss at common intervals of six, twelve, and twenty-four months, after individuals began taking antidepressants. (Petimar J. Remedy-induced Weight Change Throughout Frequent Antidepressant Therapies. Ann Intern Med 2024 Aug; 177(8);993-10030
In reference to this examine Dr. Roy Perlis, affiliate chief of psychiatric analysis at Massachusetts Basic Hospital, identified that it is very important perceive that weight acquire is a key cause that individuals would possibly cease taking antidepressants, even when the antidepressants are working nicely, and likewise that some individuals could also be reluctant to begin taking antidepressants even when they really feel depressed or anxious, as a result of they’re conscious that weight acquire is a possible aspect impact and they’re extra involved about weight acquire than about their emotions of melancholy or nervousness.
The examine particularly in contrast one antidepressant, sertraline (Zoloft, now marketed by Viatris, previously marketed by Upjohn and Pfizer) with a number of different antidepressants – escitalopram (Lexapro, from Forest), paroxetine (Paxil, from GlaxoSmithKline), duloxetin (Cymbalta, from Eli Lilly). citalopram (Celexa, additionally from Forest). fluoxetine (Prozac, additionally from Eli Lilly), venlaxafine (Effexor, from Pfizer), and bupropion (Wellbutrin, a drug with conflicting information regarding totally different generic variations, and whose manufacture and distribution entails many various companies).
The largest weight beneficial properties have been related to escitalopram and paroxetine. Every of those was linked with a 1.4 pound weight acquire at 6 months. For escitalopam, the load acquire rose to three.6 kilos at 24 months, and for paroxetine it reached 2.9 kilos at 24 months. Sertraline was related to a small weight acquire, simply 0.5 kilos, on the 6 month mark, however the weight acquire elevated to three.2 kilos on the 24 month marker. Citalopram, fluoxetine, and venlaxafine have been a lot in the identical vary as sertraline. The one drug that was related to any weight reduction in any respect was bupropion, simply 0.25 kilos at 6 months. However that development switched instructions at 24 months, when bupropion was related to a mean weight acquire of 1.2 kilos.
The examine’s writer factors out that weight acquire and weight reduction could be related to melancholy itself. Some people can truly shed some pounds because of melancholy, which may make individuals lose their urge for food. Maybe when individuals begin taking an antidepressant, their urge for food improves, they usually regain the load they’d misplaced.
The examine was observational, that means it can not show that antidepressants trigger weight modifications, solely that they have been linked with them. It wasn’t a randomized, managed trial and the members taking antidepressants weren’t in comparison with a management group not taking the medicines.
Additional limitations of the examine have been identified by the authors. One was that solely about one third of the topics have been taking their prescribed antidepressant remedy simply six months after the examine began, which makes it tough (if not unimaginable) to hyperlink later weight modifications with a particular drug. And, in fact, the examine was not randomized, so the authors couldn’t inform if the variations within the weight outcomes have been due principally to the variations between the medicines or different variations between the examine topics.
I’m in accord with the underlying precept of the examine, particularly that the topic of weight acquire related to antidepressants is unquestionably vital. Extra weight and weight problems is a big well being concern within the US and across the globe, and likewise, for a lot of individuals, weight management borders on an obsession. And big numbers of individuals take antidepressants. The CDC reported that in 2025 to 2018, 13.2% of American adults used antidepressants – about twice as many ladies (17.7%) as males (8.4%). And girls are reportedly extra involved about weight acquire than males. Thus, the topic that this examine was addressing is of concern to an important many people.
However when it comes to outcomes that involved people would possibly act on, the examine got here up relatively brief. The examine seems to have been designed in such a method as to give you a bonus for sertraline, however no such benefit emerged. The one antidepressant that demonstrated any weight reduction was bupropion, after which solely on the six-month interval.
It’s laborious to say if there was any total conclusion rising from the examine. I grant the authors’ good intentions. It might clearly be worthwhile to puzzle out which – if any – of the out there antidepressants had no hostile results in any respect when it comes to weight acquire. The examine didn’t accomplish this, and it appears seemingly that assembly that exact goal is unrealistic. The most effective I can say is, “Good strive!”
Ought to all individuals aged 70 or older take statins?
Regardless of acknowledged skepticism on whether or not statins do extra good than hurt, the consensus is that individuals over 40 who’ve any of a number of cardiovascular danger elements can cut back their danger of main hostile cardiovascular occasions by taking statins. About 47 million people within the US take a day by day statin capsule. It has been instructed that excess of these 47 million individuals are the truth is at main coronary heart assault danger. In response to the CDC, 86 million People have elevated ldl cholesterol, and about 121 million have coronary heart illness. In response to cardiovascular practitioners, these people would all profit from statin remedy.
However now it’s being instructed that each one people 70 years previous or older would profit from statins, no matter whether or not they had any particular cardiovascular danger elements.
This was based mostly on an observational examine by which researchers analyzed information from the UK Biobank and Whitehall II research in additional than 20,000 adults 70 years and older with or with out earlier heart problems. This information was then utilized in a heart problems simulation mannequin to estimate their coronary heart illness danger, survival charge, quality-adjusted life years, and healthcare prices with and with out lifetime customary or increased depth statin remedy. (Mihaylova B, et al. Coronary heart 2024;0:1–10. doi:10.1136/heartjnl-2024-324052)
On evaluation, the researchers discovered that members who continued with customary statin remedy for his or her lifetime elevated their quality-adjusted life years by 0.24 – 0.70 years and people on higher-intensity statin remedy raised their quality-adjusted life years by one other 0.04 – 0.13 years.
The examine’s lead writer, Borislava Mihaylova, DPhil, College of Oxford, stated “The results of statin remedy reported right here throughout individuals 70 years of age and older are, as anticipated, a bit smaller however sizeable. These outcomes full the image of seemingly substantial well being advantages with statin remedy throughout the continuum of age and danger ranges within the inhabitants.”
A query inescapably arises: are these small will increase in life expectancy well worth the elevated dangers that accompany statin remedy? It seems to me that the utmost profit, on common, is a bit lower than one “quality-adjusted” yr of elevated life. Some people will get greater than that and a few will get much less.
However we now have to think about the trade-off. The checklist of attainable statin unwanted effects is lengthy and regarding, viz: headache, nausea, dizziness, gastrointestinal bloating, diarrhea, constipation, muscle or joint ache, confusion, reminiscence loss, kidney harm, liver harm, muscle breakdown (rhabdomyolysis), elevated blood sugar and sort 2 diabetes.
Of those, rhabdomyolysis might be the one of many biggest concern. This situation impacts about 26,000 individuals within the US. It’s typically unusual, and unusual amongst individuals taking statins – about 1.5 in 100,000 statin customers develop rhabdomyolysis. This might account for fewer than a thousand of the rhabdomyolysis instances within the US. Typically, rhabdomyolysis is a results of overexertion or trauma and ends in a breakdown of muscle fiber. The poisonous parts of the muscle fiber can enter the circulation and trigger kidney harm.
By itself, the chance of rhabdomyolysis shouldn’t be sufficient to dissuade an individual from statin remedy if the guts illness dangers have been vital, specifically, elevated ldl cholesterol. Nonetheless, in an individual with no particular cardiovascular dangers, the advantages of statin remedy look doubtful. Talking for myself, I’m not the least disposed to begin statin remedy within the doubtful hope of gaining a small fraction of a further yr of life.
In case you didn’t discover, the examine inhabitants included each individuals with and with out recognized cardiovascular danger elements. Within the US, as I identified above, the variety of individuals with elevated ldl cholesterol is nearly double the quantity at present taking statins. If the UK proportion is analogous, it’s attainable (and even seemingly) that the statins conferred that profit solely to the examine members who truly had cardiovascular danger elements, and to not the topics with none danger elements. Why wouldn’t it be in any other case? Why would statins, which decrease cardiovascular danger by lowering ldl cholesterol transport, carry any profit to people whose levels of cholesterol have been regular? In any case, as we now have a number of occasions identified in previous discussions, ldl cholesterol at regular ranges is a vital physiologic issue. If ranges are within the regular vary, why would there be any profit in bringing these ranges decrease?
My skepticism extends not solely to the outcomes of the examine, however to the motives of the examine within the first place. Had been the authors on the lookout for a cause to prescribe statin remedy to an ever-increasing fraction of the inhabitants? The funding for the analysis got here from the UK Nationwide Institute of Care and Well being Analysis, so it wasn’t a pharmaceutical firm seeking to increase gross sales of its statin.
I must repeat what I stated at first of this dialogue, that statin remedy gives very vital advantages to individuals with coronary heart illness dangers. The examine underneath dialogue was meant to find out whether or not statin remedy supplied comparable advantages to people who didn’t have these coronary heart illness dangers. In my view, this examine didn’t accomplish that goal.
A notable AI accomplishment
AI can do many issues, together with issues associated to healthcare. AI can give you compounds that, based mostly on their configuration, have the potential to be employed as useful medication. Whether or not AI can confirm the efficacy of those potential compounds, in truly having useful results when utilized in people, must be decided on a case-by-case foundation. There are estimated to be about 20 million natural compounds, any of which is likely to be priceless as medication. If AI may not less than determine the possibles out of this large group, it could be a significant step in the proper course
The NY Occasions just lately reported what I’d decide to be a notable, and extremely promising, AI accomplishment. A person with amyotrophic lateral sclerosis (ALS), which was referred to as Lou Gehrig’s illness, had completely misplaced his capability to make use of his voice. He couldn’t make a single sound, a lot much less utter a phrase or participate in a dialog.
Physicians on the College of California, Davis, have been capable of assemble a three-dimensional printed mannequin of his mind and use it as a option to decide the place to implant electrodes that linked the affected person’s mind with a pc. Then they sank 4 electrode arrays into his mind’s outer layer. Every array had 64 spikes and seemed like a tiny mattress of nails. Every spike detected impulses from the neurons that fired when the affected person tried to type a phrase by transferring his tongue, lips, or jaw. The pc was capable of translate these makes an attempt into sounds.
Quickly after implantation, the machine – implants plus the pc, termed a neuroprosthesis – was capable of acknowledge a 50 phrase vocabulary with 99.6% accuracy. Right here’s how the article within the New England Journal of Medication summarized the outcomes of the remedy:
“Twenty-five days after surgical procedure, on the primary day of system use and following half-hour of assortment of cortical recordings and processing whereas the participant tried to talk, the neuroprosthesis achieved 99.6% accuracy with a 50-word vocabulary. On the second day, after 1.4 extra hours of system coaching, the neuroprosthesis achieved 90.2% accuracy utilizing a 125,000-word vocabulary. With additional coaching information, the neuroprosthesis sustained 97.5% accuracy for self-paced conversations for over 248 cumulative hours over 8.4 months after surgical implantation.
“In a person with ALS and extreme dysarthria, an intracortical speech neuroprosthesis reached a degree of efficiency appropriate to revive naturalistic communication after temporary coaching.” (N Engl J Med. 2024 Aug 15; 391(7): 609–618. doi: 10.1056/NEJMoa2314132)
I’m conscious that plenty of individuals view AI as a critical and looming risk to human existence. If machines can do all that, why do we want people? The instance above is a transparent indication of why we do want people. It was people who found out that AI would possibly represent a solution to that affected person’s extremely regarding drawback. AI can course of the mind scans and give you the place precisely to implant the electrodes, however a human has to instruct it to take action. And it’s an entire lot extra sensible and handy to have a human being truly implant the electrodes. We’re not antiquated and ineffective – not but, anyway!
Everyone knows that hypertension – hypertension, as it’s identified to the healthcare world and a lot of the remainder of the world as nicely – is a transparent and regarding well being danger. After we go to any medical practitioner, virtually all the time the primary issues the nurse does is examine our top, weight, and blood stress. It feels routine and virtually trivial. In case your blood stress is a bit excessive on that preliminary studying, likelihood is the nurse, or the doctor, will examine it once more. It’s vital to do the blood stress measurement accurately.
Right here’s what the Harvard Well being Letter says about taking your personal blood stress.
“Whether or not you’re on the physician’s workplace or checking your personal blood stress, it’s vital to take sure steps to get correct readings. Don’t drink a caffeinated beverage or smoke throughout the half-hour earlier than the take a look at. Sit quietly for 5 minutes earlier than the take a look at begins. Throughout the measurement, sit in a chair along with your toes on the ground and your arm supported so your elbow is at about coronary heart degree. The inflatable a part of the cuff ought to utterly cowl not less than 80% of your higher arm, and the cuff ought to be positioned on naked pores and skin, not over a shirt. Don’t discuss throughout the measurement. Have your blood stress measured twice, with a short break in between. If the readings are totally different by 5 factors or extra, have it achieved a 3rd time.It’s a good suggestion to have your blood stress measured in each arms not less than as soon as, for the reason that studying in a single arm could also be increased (normally the proper, since there’s extra direct blood circulation from the guts on that aspect). The upper quantity ought to be used to make remedy choices.”
Why did Harvard Well being suppose it was a good suggestion to publish these directions? My guess is, as a result of many extra individuals are actually doing their very own blood stress readings. There was a time when an individual would have his/her blood stress checked solely within the context of a healthcare go to of some type. However these days, easy dwelling blood stress measuring units are extensively (and inexpensively) out there. Errors in utilizing these units, in addition to attainable defects within the units themselves, may simply result in faulty readings, and faulty readings – whether or not on the excessive or low aspect – may have dangerous penalties. Maybe the Harvard Well being directions will make an actual distinction in lowering the frequency of incorrect blood stress readings, and, additionally maybe, result in improved well being outcomes.
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The subsequent time I put fingers to the keyboard (in my capability as Doc Gumshoe, anyway) I’m going to check out urinary tract infections. These are the commonest infections within the US, and they’re much greater than a nuisance.
As I’ve stated many occasions, I welcome your feedback – hold them coming! Additionally, please let me know of any areas within the healthcare orbit that I ought to scrutinize.
Be nicely, and thanks once more! Finest, Michael Jorrin (aka Doc Gumshoe)
[ed note: Michael Jorrin, who I dubbed “Doc Gumshoe” many years ago, is a longtime medical writer (not a doctor) and shares his commentary with Gumshoe readers once or twice a month. He does not generally write about the investment prospects of topics he covers, but has agreed to our trading restrictions. Past Doc Gumshoe columns are available here.]
