We don’t see a lot about COVID-19 within the mainstream media nowadays. Individuals are uninterested in excited about it, and the oldsters who generate content material for the mainstream media are uninterested in writing about it. Greater than drained, I might say. Fed up is extra prefer it. However a fast have a look at the information is fascinating.
At current, the prevalence of COVID is diminishing. In the course of the week ending August 31, 2.3% of emergency division visits reported constructive COVID exams. This was an enormous drop from the ten.2% of ED visits that reported constructive COVID exams the earlier week. There was a significant enhance in ED visits on account of COVID simply prior to now few months, from the low positivity price of lower than 0.5% reported within the week ending Might ninth of this 12 months. Because the onset of the pandemic, there have been 139.8 million constructive COVID-19 emergency division visits.
Total numbers of hospitalizations and deaths have additionally dropped considerably. Listed below are some COVID demise 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 line with my calculator, the latest COVID demise price is about 2.5% of what it was on the pandemic’s peak. It’s not over, nevertheless it actually is means, means 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 affect when it comes to hospitalizations and deaths. In comparison with COVID in its peak interval, what we’re taking a look at now could be undoubtedly minor. The illness has its ups and downs, however the total trajectory is obvious. Normally, COVID is diminishing as a severe menace.
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 identified with COVID – in different phrases, since 2023 about 6% of individuals initially identified with COVID went on to develop lengthy COVID. In line with the CDC, the individuals most definitely to be affected by lengthy COVID are ladies, Hispanics, hospitalized people, individuals with underlying well being circumstances, and the unvaccinated. In adults reporting earlier episodes of COVID, the prevalence of lengthy COVID is way greater. 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 data 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 the moment 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 exams. That is actually a small fraction of all of the COVID instances for the reason that starting of the pandemic, however that share 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 means down, however every new variant appears to be extremely infective. Vaccines and former infections increase mobile immunity and are efficient safety in opposition to severe sickness, however will not be that protecting in opposition to preliminary an infection. My spouse and I put on masks solely after we suppose we have to. On the films or the theater we put on masks, additionally at any healthcare services 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 exhausting to know.
Some however not all antidepressants could end in weight acquire
This was primarily based on a examine that analyzed information from greater than 183,000 individuals between the ages of 20 and 80, with a median age of 48 years. Most topics have been obese or overweight firstly of the examine. Nearly all of the themes have been ladies. The researchers analyzed individuals’ digital well being data and physique mass index. They gauged weight acquire or loss at common intervals of six, twelve, and twenty-four months, after folks began taking antidepressants. (Petimar J. Medicine-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 Common Hospital, identified that it is very important perceive that weight acquire is a key cause that folks may cease taking antidepressants, even when the antidepressants are working effectively, and likewise that some folks 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 facet impact and they’re extra involved about weight acquire than about their emotions of melancholy or anxiousness.
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 includes many alternative corporations).
The largest weight positive factors 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 burden 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 pattern switched instructions at 24 months, when bupropion was related to a median weight acquire of 1.2 kilos.
The examine’s writer factors out that weight acquire and weight reduction might be related to melancholy itself. Some people can truly shed weight on account of melancholy, which may make folks lose their urge for food. Maybe when folks begin taking an antidepressant, their urge for food improves, they usually regain the burden they’d misplaced.
The examine was observational, that means it can’t show that antidepressants trigger weight adjustments, solely that they have been linked with them. It wasn’t a randomized, managed trial and the individuals taking antidepressants weren’t in comparison with a management group not taking the drugs.
Additional limitations of the examine have been identified by the authors. One was that solely about one third of the themes have been taking their prescribed antidepressant remedy simply six months after the examine began, which makes it troublesome (if not unimaginable) to hyperlink later weight adjustments with a particular drug. And, after all, 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 drugs or different variations between the examine topics.
I’m in accord with the underlying precept of the examine, specifically that the topic of weight acquire related to antidepressants is certainly essential. 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 ladies are reportedly extra involved about weight acquire than males. Thus, the topic that this examine was addressing is of concern to an ideal many people.
However when it comes to outcomes that involved people may act on, the examine got here up reasonably quick. The examine seems to have been designed in such a means 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 exhausting to say if there was any total conclusion rising from the examine. I grant the authors’ good intentions. It will clearly be worthwhile to puzzle out which – if any – of the out there antidepressants had no opposed results in any respect when it comes to weight acquire. The examine didn’t accomplish this, and it appears seemingly that assembly that individual 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 components can cut back their danger of main opposed cardiovascular occasions by taking statins. About 47 million people within the US take a day by day statin capsule. It has been prompt that way over these 47 million individuals are in truth at main coronary heart assault danger. In line with the CDC, 86 million Individuals have elevated ldl cholesterol, and about 121 million have coronary heart illness. In line with cardiovascular practitioners, these people would all profit from statin remedy.
However now it’s being prompt that each one people 70 years previous or older would profit from statins, no matter whether or not they had any particular cardiovascular danger components.
This was primarily based 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 price, quality-adjusted life years, and healthcare prices with and with out lifetime normal or greater 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 individuals who continued with normal 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 consequences of statin remedy reported right here throughout folks 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 definitely worth the elevated dangers that accompany statin remedy? It seems to be to me that the utmost profit, on common, is a bit lower than one “quality-adjusted” 12 months of elevated life. Some people will get greater than that and a few will get much less.
However we’ve to contemplate the trade-off. The listing of doable statin unintended effects is lengthy and regarding, viz: headache, nausea, dizziness, gastrointestinal bloating, diarrhea, constipation, muscle or joint ache, confusion, reminiscence loss, kidney injury, liver injury, muscle breakdown (rhabdomyolysis), elevated blood sugar and kind 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 usually 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 leads to a breakdown of muscle fiber. The poisonous parts of the muscle fiber can enter the circulation and trigger kidney injury.
By itself, the danger of rhabdomyolysis shouldn’t be sufficient to dissuade an individual from statin remedy if the center 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 12 months of life.
In case you didn’t discover, the examine inhabitants included each individuals with and with out identified cardiovascular danger components. Within the US, as I identified above, the variety of folks with elevated ldl cholesterol is sort of double the quantity at the moment taking statins. If the UK proportion is comparable, it’s doable (and even seemingly) that the statins conferred that profit solely to the examine individuals who truly had cardiovascular danger components, and to not the themes with none danger components. Why would it not be in any other case? Why would statins, which decrease cardiovascular danger by lowering ldl cholesterol transport, convey any profit to people whose levels of cholesterol have been regular? In spite of everything, as we’ve 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. Have 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 trying to increase gross sales of its statin.
I have to repeat what I stated at first of this dialogue, that statin remedy offers very vital advantages to individuals with coronary heart illness dangers. The examine below dialogue was meant to find out whether or not statin remedy supplied related advantages to people who didn’t have these coronary heart illness dangers. For my part, 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, primarily based on their configuration, have the potential to be employed as helpful medication. Whether or not AI can confirm the efficacy of those potential compounds, in truly having helpful 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 perhaps helpful as medication. If AI might a minimum of determine the possibles out of this big group, it will be a significant step in the proper route
The NY Instances lately reported what I might choose to be a notable, and extremely promising, AI accomplishment. A person with amyotrophic lateral sclerosis (ALS), which was often called Lou Gehrig’s illness, had completely misplaced his means 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 in a position to 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 regarded like a tiny mattress of nails. Every spike detected impulses from the neurons that fired when the affected person tried to kind a phrase by shifting his tongue, lips, or jaw. The pc was in a position to translate these makes an attempt into sounds.
Quickly after implantation, the gadget – implants plus the pc, termed a neuroprosthesis – was in a position to acknowledge a 50 phrase vocabulary with 99.6% accuracy. Right here’s how the article within the New England Journal of Drugs 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 further 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 stage 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 a lot of folks view AI as a severe and looming menace 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 discovered that AI may represent a solution to that affected person’s extremely regarding downside. 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 a complete 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 many of the remainder of the world as effectively – is a transparent and regarding well being danger. After we go to any medical practitioner, nearly at all times the primary issues the nurse does is examine our peak, weight, and blood stress. It feels routine and nearly 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 essential to do the blood stress measurement accurately.
Right here’s what the Harvard Well being Letter says about taking your individual blood stress.
“Whether or not you’re on the physician’s workplace or checking your individual blood stress, it’s essential 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. In the course of 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 stage. The inflatable a part of the cuff ought to utterly cowl a minimum of 80% of your higher arm, and the cuff must be positioned on naked pores and skin, not over a shirt. Don’t speak throughout the measurement. Have your blood stress measured twice, with a quick break in between. If the readings are totally different by 5 factors or extra, have it performed a 3rd time.It’s a good suggestion to have your blood stress measured in each arms a minimum of as soon as, for the reason that studying in a single arm could also be greater (normally the proper, since there’s extra direct blood circulation from the center on that facet). The upper quantity must be used to make remedy selections.”
Why did Harvard Well being suppose it was a good suggestion to submit these directions? My guess is, as a result of many extra folks 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 form. However these days, easy dwelling blood stress measuring gadgets are broadly (and inexpensively) out there. Errors in utilizing these gadgets, in addition to doable defects within the gadgets themselves, might simply result in faulty readings, and faulty readings – whether or not on the excessive or low facet – might 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 following 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 – maintain them coming! Additionally, please let me know of any areas within the healthcare orbit that I ought to scrutinize.
Be effectively, and thanks once more! Greatest, 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.]
