The new study found that the pandemic didn’t lead to increases in postpartum depression or anxiety diagnoses. But it did prompt a 15% increase in the number of privately insured new moms filling prescriptions for antianxiety medications like Valium, Xanax, Ativan and Klonopin.

The researchers didn’t find an increase in SSRI prescriptions, though.

SSRIs, or selective serotonin reuptake inhibitors, are the gold standard for treating both depression and anxiety disorders. But these drugs, which include medications like Zoloft, Prozac and Lexapro, take time to work.

Benzodiazepines, also known as benzos, are sometimes used as a stopgap during the month or two it takes for an SSRI to start working. But they aren’t a substitute for SSRIs. And they carry significant risks of dependence and abuse.

“What concerns me the most is not what we found but what we didn’t find,” said Grace Bagwell Adams, lead author of the study and an associate professor in UGA’s College of Public Health. “You can’t tell me there wasn’t more depression and anxiety in this population during the pandemic. And historically, even pre-COVID, postpartum depression and anxiety has always been underdiagnosed. But we didn’t find an increase in diagnoses.”

Postpartum depression, anxiety largely underdiagnosed. The pandemic didn’t help.

One in 10 women experience postpartum depression or anxiety in the first six months after giving birth. The majority aren’t properly diagnosed and don’t receive treatment for the conditions.

The researchers analyzed data from more than 518,000 privately insured postpartum women from January 2016 through December 2020. Despite reported increases in anxiety and depression across the board after the onset of the pandemic, the researchers found no evidence of an increase in diagnoses of postpartum depression or postpartum anxiety.

This suggests that the underdiagnosis and undertreatment of these conditions was exacerbated by the pandemic-induced health care crisis, the researchers said.

Many insurers only cover one postpartum visit, typically at about six weeks after giving birth. Health care providers are supposed to screen for depression and anxiety at these visits.

But during COVID, it’s likely that many women didn’t have that appointment, Bagwell Adams said. Or if they did, it may have taken place via telehealth, which isn’t always ideal for discussing difficult mental health challenges.

“One of the top causes of maternal mortality is suicide,” Bagwell Adams said. “When these women don’t get diagnosed and they don’t receive proper treatment, they die. And it’s not that postpartum women didn’t see their doctor in time. It’s that they aren’t being listened to.”

Benzos aren’t a substitute for SSRIs when it comes to depression

After the birth of her son during the pandemic, Bagwell Adams experienced that lack of communication firsthand at her postpartum checkup.

“We had a chat, and I told him I was basically crippled by anxiety and depression,” she said. “He was like, ‘Let’s get you something to help calm you down.’ I thought he was going to send me home with an SSRI.”

Instead, her doctor prescribed a benzo.

As someone who’s dealt with anxiety for years, Bagwell Adams knew that wasn’t going to cut it. After some back and forth with her doctor, she was prescribed Lexapro. But many patients wouldn’t know to push back like she did.

“The thing I get really worried about it is that this is what we found for the cream of the crop in terms of insurance coverage,” Bagwell Adams said. “The women in this sample have private insurance. This is the best-case scenario for the United States, and that doesn’t look good.”

Combining opioids with benzos likely increased. That combination can be deadly.

Another concerning side effect of increased benzo prescriptions is interactions with other medications, particularly opioids.

More than seven out of every 10 women who give birth via C-section and one in four who deliver vaginally are prescribed opioids for pain management. And previous research shows that opioid prescriptions for postpartum women increased during the COVID-19 pandemic.

But combining opioids with benzos can be deadly. And the likelihood that some of the women who filled benzodiazepine prescriptions were simultaneously taking pain medications is high, the researchers said.

“For me, this study highlights more questions than answers,” Bagwell Adams said. “There’s something bigger happening here that is really disconcerting when it comes to treating women in general and postpartum women in particular.”

Published in Archives of Women’s Health, the study was funded in part by a grant from the National Institute on Drug Abuse. Co-authors include Emily Lawler and Amanda Abraham, from UGA’s School of Public and International Affairs; Shelby Steuart, a doctoral graduate of UGA’s School of Public and International Affairs who is now a postdoctoral researcher at the University of Chicago, and Hailemichael Shone, of Indiana University.

The study, published in JRSM Open, analysed data from over 1,000 people in England and Wales who logged their symptoms on an app between November 2020 and March 2022.

Pain, including headache, joint pain and stomach pain, was the most common symptom, reported by 26.5% of participants.

The other most common symptoms were neuropsychological issues such as anxiety and depression (18.4%), fatigue (14.3%), and dyspnoea (shortness of breath) (7.4%). The analysis found that the intensity of symptoms, particularly pain, increased by 3.3% on average each month since initial registration.

The study also examined the impact of demographic factors on the severity of symptoms, revealing significant disparities among different groups. Older individuals were found to experience much higher symptom intensity, with those aged 68-77 reporting 32.8% more severe symptoms, and those aged 78-87 experiencing an 86% increase in symptom intensity compared to the 18-27 age group.

Gender differences were also pronounced, with women reporting 9.2% more intense symptoms, including pain, than men. Ethnicity further influenced symptom severity, as non-white individuals with long Covid reported 23.5% more intense symptoms, including pain, compared to white individuals.

The study also explored the relationship between education levels and symptom severity. Individuals with higher education qualifications (NVQ level 3, 4, and 5 – equivalent to A-levels or higher education) experienced significantly less severe symptoms, including pain, with reductions of 27.7%, 62.8%, and 44.7% for NVQ levels 3, 4 and 5 respectively, compared to those with lower education levels (NVQ level 1-2 – equivalent to GCSEs).

Socioeconomic status, as measured by the Index of Multiple Deprivation (IMD), also influenced symptom intensity. Participants from less deprived areas reported less intense symptoms than those from the most deprived areas. However, the number of symptoms did not significantly vary with socioeconomic status, suggesting that while deprivation may exacerbate symptom intensity, it does not necessarily lead to a broader range of symptoms.

Lead author Dr David Sunkersing (UCL Institute of Health Informatics) said: “Our study highlights pain as a predominant self-reported symptom in long Covid, but it also shows how demographic factors appear to play a significant role in symptom severity.

“With ongoing occurrences of Covid-19 (e.g., LB.1, or D-FLiRT variants), the potential for more long Covid cases remains a pressing concern. Our findings can help shape targeted interventions and support strategies for those most at risk.”

In the paper, the researchers called for sustained support for long Covid clinics and the development of treatment strategies that prioritise pain management, alongside other prevalent symptoms like neuropsychological issues and fatigue.

Given the significant impact of demographic factors on symptom severity, the study underscored the need for healthcare policies that addressed these disparities, ensuring equitable care for all individuals affected by long Covid, the researchers said.

Study limitations included a lack of information on other health conditions participants may have had and a lack of information about health history. The researchers cautioned that the study may have excluded individuals with very severe Covid and those facing technological or socioeconomic barriers in accessing a smartphone app.

The study was led by the UCL Institute of Health Informatics and the Department of Primary Care and Population Health at UCL in collaboration with the software developer, Living With Ltd.

Those who experienced loneliness were among the most impacted.

“During the pandemic, loneliness almost tripled the risk of depression in older adults with diabetes,” says clinical pharmacist and first author ZhiDi Deng. “This not only highlights the impact of quarantines and lock-downs on individuals’ mental health. It also shows us that there is room for improvement on how we can better deliver services to older adults with diabetes in future public health crises.”

Although not as severely impacted as those with a history of depression, one in eight older adults with diabetes who had no history of depression prior to the pandemic were depressed in the autumn of 2020. “The pandemic has taken a significant toll on the mental health of everyone, particularly older adults with chronic conditions such as diabetes,” says co-author Grace Li, a research assistant at the University of Toronto’s Institute for Life Course and Aging (ILCA). “It’s important for primary health providers to be vigilant for signs of depression among their older patients, even those who were doing well in the past.”

The researchers identified several other factors that were associated with a higher risk of depression among those with diabetes, such as being female, having functional limitations or chronic pain, and experiencing family conflict.

They also reported some unexpected findings. The researchers found that those who were separated, divorced, or widowed had lower odds of recurrent depression during the pandemic than those who were married or in common-law relationships. “This is different from research conducted before the pandemic that indicated married individuals usually are less depressed,” said co-author Dorina Cadar, Senior Lecturer in Neuroepidemiology and Dementia at the Centre for Dementia Studies at Brighton and Sussex Medical School and the director of the Cognitive Epidemiology, Dementia, and Ageing Research lab. “We hypothesized that participants who were married during the pandemic experienced worse mental health because the need to stay for extended periods of time in close living proximity during the lockdowns or quarantine could possibly exacerbate any relationship conflicts. Our findings indicate that those who were experiencing family conflict during the pandemic had more than triple the risk of depression during the pandemic.”

The second unexpected finding was that those with higher income prior to the pandemic had a greater risk of depression during the pandemic than those who were poorer.  In pre-pandemic research, higher income is associated with a lower prevalence of depression.

“We hypothesized that this finding may have been influenced by the generous response of the Canadian government with the Canadian Emergency Response Benefit (CERB), which may have had a protective impact on the mental health of low-income Canadians. CERB provided Canadians who lost employment during the pandemic with a $2000 monthly income. For some low-income individuals and households, this would actually increase their monthly income, thereby reducing financial-related stress among this population,” said co-author Maria Rowsell, a research assistant at the University of Toronto’s ILCA.

The study was conducted using data from the Canadian Longitudinal Study on Aging (CLSA) surveys. The CLSA is a large national longitudinal study involving older Canadians with diabetes. This study identified 2,730 individuals with diabetes in the CLSA sample. In this group, 1,757 individuals had no pre-pandemic history of depression, and 973 had a pre-pandemic history of depression. The study was published online this month in the journal Archives of Gerontology and Geriatrics Plus.

“The long-term implications of the pandemic extend far beyond physical health,” said senior author Professor Esme Fuller-Thomson of the University of Toronto’s Factor-Inwentash Faculty of Social Work and Director of the ILCA. “It is important to improve access to mental health services for people with diabetes, particularly during periods of increased stress. Interventions that have shown promising results to support the mental health of individuals with comorbid depression and diabetes include cognitive behavioural therapy and psychoeducation.  We need to improve access to these important services.”

“It was surprising to me that the prevalence was that high,” says Torri Metz, MD, vice chair of research of obstetrics and gynecology at University of Utah Health, who co-led the nationwide study. “This is something that does continue to affect otherwise reasonably healthy and young populations.”

Intersecting risks

Prior research had shown that COVID affects pregnant people in uniquely risky ways. A COVID infection during pregnancy is more likely to lead to hospitalization or death, compared to an infection outside of pregnancy. COVID also increases the risk of pregnancy-related complications such as preterm birth or stillbirth. But until this study, the risk to pregnant people of developing long COVID was unknown.

The researchers enrolled more than 1500 people nationwide who had been sick with COVID for the first time while pregnant, and assessed self-reported long COVID symptoms at least six months after infection. As part of the National Institutes of Health RECOVER project, a massive nationwide collaboration to understand and treat long COVID, the large size of the study established solid associations and provided a picture of risk that was accurate for pregnant people across demographic groups.

The researchers found that 9.3% of people who contracted COVID during pregnancy went on to experience long-term symptoms. Some of the most common long COVID symptoms participants experienced were fatigue, gastrointestinal issues, and feeling drained or exhausted by routine activities.

“This is a critical study as pregnancy and the post-partum period are one of the most vulnerable times in an individual’s life,” said David Goff, M.D., Ph.D., division director for the Division of Cardiovascular Sciences at the NIH’s National Heart, Lung, and Blood Institute. “By better understanding how individual characteristics interact with SARS-CoV-2 infection during pregnancy and lead to an increased risk of long COVID, this study yields important insights to potentially develop targeted interventions for this population.”

Because the symptoms of long COVID can overlap with the symptoms of pregnancy itself, Metz says that it’s especially important for obstetricians to be vigilant for them. “I doubt most obstetric clinicians are as aware of long COVID as perhaps we should be,” Metz says. “But people are having these symptoms, and we need to make sure that we’re not forgetting that these could be long-term manifestations of their SARS-CoV-2 infection.”

To ensure that the reported long COVID symptoms weren’t symptoms of pregnancy, the researchers did a secondary analysis that was restricted to people who reported symptoms more than 12 weeks after giving birth. The estimated risk of long COVID remained similar, confirming the initial findings.

Metz says that while the rate of long COVID observed was surprisingly high, it could underestimate the actual risk of long COVID for pregnant people. On average, people reported whether or not they had symptoms of long COVID 10 months after their initial infection, which means that the study could have missed people whose symptoms resolved earlier.

Several factors were associated with an increased risk of long COVID. People with anxiety or depression prior to their infection, as well as people with obesity, were more likely to experience lasting symptoms. Self-reported financial hardship was also associated with higher rates of long COVID, although the study could not determine whether financial difficulties were a cause or a consequence of extended symptoms.

“Our results highlight that people who were pregnant when they got COVID may have significant long-term symptoms after pregnancy, like fatigue even after simple activities that they did before the infection,” says senior author Vanessa Jacoby, MD, MAS, director of the Clinical and Translational Science Institute at UCSF, and a professor of obstetrics, gynecology, and reproductive sciences as well as Associate Vice Chancellor for Clinical Research. “We encourage people to speak with their healthcare provider about persistent symptoms to connect with appropriate support and care,” she says.

A continued concern

Previous estimates of long COVID rates following infection in the general population range from 10% to over 20%, putting the researchers’ results on the lower end of the risk spectrum. Metz says that this could be because pregnant people’s immune systems tend to react less strongly to infection. This puts pregnant people at higher risk of severe symptoms during the infection, but may put them at lower risk of long-term organ damage that can lead to persistent symptoms. Pregnant people tend to be overall younger and healthier than other populations, which could also contribute to the difference.

But the high prevalence of long COVID, including in pregnant populations, emphasizes that health practitioners should keep an eye out for its symptoms, Metz says. “We need to have this on our radar as we’re seeing patients. It’s something we really don’t want to miss. And we want to get people referred to appropriate specialists who treat long COVID.”

U of U Health’s Long COVID Clinic specializes in caring for patients with prolonged symptoms of COVID-19. Learn more about the clinic here.

About RECOVER: The National Institutes of Health Researching COVID to Enhance Recovery (NIH RECOVER) Initiative brings together clinicians, scientists, caregivers, patients, and community members to understand, diagnose, and treat long COVID. RECOVER has created one of the largest and most diverse groups of Long COVID study participants in the world. In addition, RECOVER clinical trials are testing potential interventions across five symptom focus areas. For more information, please visit recoverCOVID.org.

This research was published as “Post–Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After Infection During Pregnancy” in Obstetrics and Gynecology.

The study was funded by the National Institutes of Health (NIH) Agreements OTA OT2HL161847, OT2HL161841 and OT2HL156812 as part of the Researching COVID to Enhance Recovery (RECOVER) Research Initiative.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Being able to get an appointment at GP surgeries and to see the same doctor improves patient health, is a more cost-effective use of healthcare resources, and is popular.

A new study, led by the University of Leicester, analysed data across 6,010 English practices between 2018 and 2022, using continuity data from the General Practice Patient Survey which showed that fewer patients both had and were able to see a preferred doctor in their practices.

The national average dropped from 29.3 per cent to 19 per cent of patients in just four years, with the decline steepening following the COVID-19 lockdown. Although the decline occurred across all types of practices, differences between practices widened over this period.

The study examined a range of factors related to both patients and their practices in order to determine whether any were linked to the rate at which continuity was declining. These included the percentage of patients with White ethnicity, the numbers of GPs and nurses per 10,000 patients, and the percentage of patients reporting being able to get a same day appointment, as well as the practice’s deprivation score and region in England.

Dr Steven Levene from the Department of Population Health Sciences at the University, who led the study, said: “Our study showed slower declines in continuity in practices with more doctors and with higher percentages of patients seen on the same day as booking. However, continuity declined more quickly in practices where continuity had previously been better, where there were higher percentages of patients of White ethnicity, or practices located in many areas outside of London.”

The rate of declining continuity was not associated with deprivation, whether the practice was urban or rural, practice size, nurse numbers, NHS contract type or NHS practice funding.

The study has now been published in the journal Annals of Family Medicine.

Dr Levene said: “Patients who can regularly see the same doctor usually have increased satisfaction with their care, while avoiding having to repeat their medical history leads to a more efficient use of time and resources.

“The surge in demand following lockdown and the backlog of work have resulted in higher workloads in already overstretched practices: not only are patients finding it harder to get an appointment, but this is less likely to be with their regular practitioner. Not surprisingly, public satisfaction with the NHS is at a record low and improving access to a GP appointment is the top reported priority for patients (British Social Attitudes survey).

“The number of qualified GPs has remained relatively static whilst the population continues to grow. Despite more GPs being trained, a recent poll of GPs revealed many are struggling to find an NHS GP post; yet an established NHS scheme to support practices financially to expand their workforce excludes doctors.

“The disappearance of continuity of care should not be inevitable. By prompt effective nationwide action to help practices provide enough appointments and prioritise continuity more within appointment systems, and to remedy shortages of GPs in many practices, the NHS might be able to halt and then reverse this worrying trend. Continuity of care matters – to patients, to the better delivery of healthcare, and to the health of the country.”

Children are generally more susceptible than adults to respiratory infections such as the common cold, and yet, for unknown reasons, the SARS-CoV-2 virus tends to cause less severe symptoms in children than in adults, resulting in lower rates of hospitalization and death during the COVID-19 pandemic. The innate immune system provides the first line of defense against viruses and bacteria, quickly producing a variety of anti-viral and proinflammatory proteins to fend off infection while the body develops other, more targeted, immune responses such as antibodies. Studies have shown that, compared with adults, the innate immune system is more active in the nasal passages of children and might therefore be better at blocking the early stages of SARS-CoV-2 infection. But the reason for this increased activity is unknown.

“Prior work suggested that heightened nasal innate immunity in children was due to intrinsic biological mechanisms inherent to their age,” says Ellen F. Foxman, associate professor of Laboratory Medicine and Immunobiology at Yale School of Medicine and the senior author of the new JEM study. “But we thought it could also be due to the high burden of respiratory viruses and bacterial infections in children.”

To investigate whether frequent respiratory infections are responsible for elevating nasal innate immunity in children, Foxman and colleagues re-analyzed more than 600 nasal swabs originally taken during the pandemic from pediatric patients about to undergo elective surgery or emergency room evaluation. Initially tested only for the presence of SARS-CoV-2, Foxman and colleagues re-screened the samples for 19 different respiratory viruses and bacteria, as well as measuring the levels of antiviral and inflammatory proteins produced by the innate immune system.

The researchers found that many children—even those without any symptoms—were infected with respiratory pathogens other than SARS-CoV-2. This was especially true for younger children, with viruses or infection-causing bacteria being detected in around 50% of asymptomatic patients under five years old. Children with higher levels of respiratory pathogens showed higher levels of nasal innate immune activity, regardless of whether they were toddlers or teenagers.

To further investigate the relationship between respiratory infections and nasal innate immunity, Foxman’s team compared nasal swabs taken from healthy one-year-olds at both a routine well-child checkup and a follow-up appointment one to two weeks later. Over half of the children tested positive for a respiratory virus on one of their two visits to the pediatrician, indicating that they had either acquired or cleared an infection in the intervening period. In almost every case, the child’s innate immune activity was higher at the time they were infected and lower at the time when they were virus free.

“This reveals that nasal antiviral defenses are not continually on high alert in young children but are activated in response to acquisition of a respiratory virus, even when that virus is not causing symptoms,” says Foxman.

Taken together, the study’s results indicate that the innate immune system is often highly activated in the nasal passages of children because they are frequently infected with relatively benign pathogens, such as the rhinoviruses responsible for the common cold. Foxman speculates that young children have more infections with common seasonal viruses than adults because they have less immunological protection from prior exposures (such as antibodies). However, since SARS-CoV-2 was a new virus to the human population, neither adults nor children had prior protection when the COVID-19 pandemic began. In this situation, activation of generalized antiviral defenses in children by other infections may have helped to fight off the initial stages of SARS-CoV-2 infection, leading to less severe outcomes in children compared with adults.

“We have identified respiratory viruses and bacteria as key drivers of the enhanced nasal innate immunity in children,” Foxman says. “Our results compel further study of how seasonal respiratory viruses and nasal bacteria impact disease severity of COVID-19 and pediatric immune responses in general.”

Watkins et al. 2024. J. Exp. Med. https://rupress.org/jem/article-lookup/doi/10.1084/jem.20230911?PR

IMAGE: THE NEW STUDY SUGGESTS THAT, BY FREQUENTLY ACTIVATING THE ANTIVIRAL AND PROINFLAMMATORY INNATE IMMUNE RESPONSE, COMMON RESPIRATORY VIRUS AND BACTERIAL INFECTIONS MAY HAVE HELPED TO PROTECT CHILDREN FROM SARS-COV-2.

view more CREDIT: ©2024 WATKINS ET AL. ORIGINALLY PUBLISHED IN <EM>JOURNAL OF EXPERIMENTAL MEDICINE</EM>. HTTPS://DOI.ORG/10.1084/JEM.20230911

In a new paper published in Science and co-authored by Duncan J. Watts of the University of Pennsylvania, the researchers introduce a new methodology for measuring social media content’s causal impact at scale. They show that misleading content from mainstream news sources — rather than outright misinformation or “fake news” — was the primary driver of vaccine hesitancy on Facebook.

A new approach to estimating impact

“Misinformation has been correlated with many societal challenges, but there’s not a lot of research showing that exposure to misinformation actually causes harm,” explained Allen.

During the COVID-19 pandemic, for example, the spread of misinformation related to the virus and vaccine received significant public attention. However, existing research has, for the most part, only established correlations between vaccine refusal and factors such as sharing misinformation online — and largely overlooked the role of “vaccine-skeptical” content, which was potentially misleading but not flagged as misinformation by Facebook fact-checkers.

To address that gap, the researchers first asked a key question: What would be necessary for misinformation or any other type of content to have far-reaching impacts?

“To change behavior at scale, content has to not only be persuasive enough to convince people not to get the vaccine, but also widely seen,” Allen said. “Potential harm results from the combination of persuasion and exposure.”

To quantify content’s persuasive ability, the researchers conducted randomized experiments in which they showed thousands of survey participants the headlines from 130 vaccine-related stories — including both mainstream content and known misinformation — and tested how those headlines impacted their intentions to get vaccinated against COVID-19. Researchers also asked a separate group of respondents to rate the headlines across various attributes, including plausibility and political leaning. One factor reliably predicted impacts on vaccination intentions: the extent to which a headline suggested that the vaccine was harmful to a person’s health.

Using the “wisdom of crowds” and natural language processing AI tools, Allen and her co-authors extrapolated those survey results to predict the persuasive power of all 13,206 vaccine-related URLs that were widely viewed on Facebook in the first three months of the vaccine rollout. By combining these predictions with data from Facebook showing the number of users who viewed each URL, the researchers could predict each headline’s overall impact — the number of people it might have persuaded not to get the vaccine. The results were surprising.

The underestimated power of exposure

Contrary to popular perceptions, the researchers estimated that vaccine-skeptical content reduced vaccination intentions 46 times more than misinformation flagged by fact-checkers.

The reason? Even though flagged misinformation was more harmful when seen, it had relatively low reach. In total, the vaccine-related headlines in the Facebook data set received 2.7 billion views — but content flagged as misinformation received just 0.3% of those views, and content from domains rated as low-credibility received 5.1%.

“Even though the outright false content reduced vaccination intentions the most when viewed, comparatively few people saw it,” explained Rand. “Essentially, that means there’s this class of gray-area content that is less harmful per exposure but is seen far more often —and thus more impactful overall — that has been largely overlooked by both academics and social media companies.”

Notably, several of the most impactful URLs within the data set were articles from mainstream sources that cast doubt on the vaccine’s safety. For instance, the most-viewed was an article — from a well-regarded mainstream news source — suggesting that a medical doctor died two weeks after receiving the COVID-19 vaccine. This single headline received 54.9 million views — more than six times the combined views of all flagged misinformation.

While the body of this article did acknowledge the uncertainty of the doctor’s cause of death, its “clickbait” headline was highly suggestive and implied that the vaccine was likely responsible. That’s significant since the vast majority of viewers on social media likely never click out to read past the headline.

How journalists and social media platforms can help

According to Rand, one implication of this work is that media outlets need to take more care with their headlines, even if that means they aren’t as attention-grabbing.

“When you are writing a headline, you should not just be asking yourself if it’s false or not,” he said. “You should be asking yourself if the headline is likely to cause inaccurate perceptions.”

For platforms, added Allen, the research also points to the need for more nuanced moderation — across all subjects, not just public health.

“Content moderation focuses on identifying the most egregiously false information — but that may not be an effective way of identifying the most overall harmful content,” she says. “Platforms  should also prioritize reviewing content from the people or organizations with the largest numbers of followers while balancing freedom of expression. We need to invest in more research and creative solutions in this space – for example, crowdsourced moderation tools like X’s Community Notes.”

“Content moderation decisions can be really difficult because of the inherent tension between wanting to mitigate harm and allowing people to express themselves,” Rand said. “Our paper introduces a framework to help balance that trade-off by allowing tech companies to actually quantify potential harm.”

And the trade-offs could be large. An exploratory analysis by the authors found that if Facebook users hadn’t been exposed to this vaccine-skeptical content, as many as 3 million more Americans could have been vaccinated.

“We can’t just ignore this gray area-content,” Allen concluded. “Lives could have been saved.”

The coronavirus spike protein (SP) attaches to host cells at glycans on the cell surface, including red blood cells (RBCs), platelets and endothelial cells.  This is a feature common to all coronaviruses. However, some e.g. the common cold viruses express a glycan-cleaving enzyme and so are able to detach. SARS, SARS-CoV-2 and MERS viruses have no glycan-cleaving enzyme and all virulent. After linking to human cells in this way the virus is able to slide over to the ACE-receptor and gain entry.  Much research effort was focused on preventing virus entry and reproduction – via the ACE2 receptor. This effectively diverted attention from other aspects of virus behaviour, in particular the SP.

It had been assumed that the SP itself was harmless because it cannot reproduce.  For this reason, it was thought to be a suitable antigen.  However, SP has other effects – RBCs coated with SP, as described, aggregate in clumps, leading to microvascular occlusion and clot formation. This is consistent with the clinical observations that microvascular clots and poor oxygenation were common in severely ill Covid patients and a prominent feature of the morbidity of Covid-19.

Of note – the authors of this study also point out that the Omicron SP was found to have 10 times the haemagglutinating activity of SP from previous variants.  They therefore advocate suspension of the use of Omicron-based COVID-19 vaccines. As these underwent no human testing and have significantly reduced efficacy compared with previous vaccines, they offer no benefits and only the reverse.

There is a further implication of SP coated RBCs; measurements of SP in plasma will be low – and misleading – because most of it is attached to cells (RBCs) which are removed by definition before plasma is tested. Whole blood measurement shows that SP persists for up to 187 days after CV19 vaccination, the authors note.

Clearly, what was needed was therapeutic strategies for early treatment that combined anti-viral agents with pro-active measures to reduce RBC aggregation.

Early in the pandemic clinicians in the field had already reported positive effects – in particular, rapid resolution of Covid-19 hypoxia –  with ivermectin, hydroxychloroquine and fluvoxamine. The latter two agents have significant activity in reducing RBC and platelet aggregation. Ivermectin, which binds with high affinity to multiple sites on the SP, is associated with rapid increases in oxygen saturation and clinical improvement. This was described to Medical Update Online by Dr Jackie Stone in 2021

In view of the persistence of SP in the bloodstream and its association with ‘long Covid’, there is a clear therapeutic basis for long term treatment with ivermectin, hydroxychloroquine or fluvoxamine. These are all cheap, generic drugs.

The figure below summarises these observations together with relevant supporting information.

This paper has been written by a team of authors with outstanding academic credentials and contains a wealth of thought-provoking detail. Given the current/recent upsurge of Covid vaccine associated thrombotic events it is important reading for clinicians and policy-makers.

“The pandemic gave us a unique opportunity to see how wide-spread mitigation measures like social distancing and bar/restaurant closures may have affected alcohol consumption,” said lead author Kasey Creswell, associate professor of psychology at Carnegie Mellon University. “We focused on young adults who were engaging in heavy drinking before the onset of the pandemic, and we followed them over time to see if there were any pandemic-related changes to their alcohol consumption and alcohol problems.”

Unlike most prior studies of drinking habits during the pandemic, this study prospectively examined the drinking patterns of 234 heavy-drinking young adults ages 21 to 29 years from before to well after the onset of the pandemic. Prior to the pandemic, these individuals had to report binge drinking at least four times in the past month, defined as consuming 5 or more drinks per occasion (for males) and 4 or more drinks per occasion (for females). The team gathered data every six months from February 2018 to March 2022.

Results showed that these young adults significantly reduced how much and how often they were drinking from before to after the onset of the pandemic. Notably, they decreased their monthly alcohol consumption by nearly 13 drinks, and they also reported significantly fewer alcohol-related problems. Notably, these reductions in alcohol use and alcohol problems were still evident up to two years after the start of the pandemic.

According to Creswell, the results may in part be explained by the environment. Alcohol was still available to these young adults during the pandemic, but the context in which they were drinking likely changed pretty drastically for most of them. Due to pandemic restrictions, they weren’t able to drink with friends at parties or in bars, contexts that are usually associated with heavy alcohol use in young adults. The study authors highlight the impact of social settings in problematic alcohol use.

“Alcohol is a social drug,” said Aidan Wright, the Phil F. Jenkins Research Professor of Depression at the Eisenberg Family Depression Center and professor of psychology at the University of Michigan. Wright is a contributing author on this study. “These results highlight the social nature of drinking and speak to the importance of the social context in driving drinking behavior.”

The study also found significant decreases in negative emotions during the pandemic but did not find any change in the use of alcohol as a coping mechanism during the pandemic. The results for men and women followed similar patterns.

“Although there are overall trends that show declining patterns in drinking, it doesn’t mean that people did not have high periods of drinking,” said Wright. “The averages hide a lot of information, smearing over a lot of different trajectories that people took.”

Of note, solitary drinking did increase during the pandemic, with participants reporting a 4% increase in this habit. Creswell’s previous research has associated solitary drinking with an increased risk of developing alcohol problems. Creswell acknowledges the increase in solitary drinking in this study remained fairly muted, considering the constraints in accessing alcohol in social settings due to pandemic-related mitigation measures.

“Drinking to cope is the main reason young people engage in solitary drinking,” said Creswell. “But in this study, we actually saw a decrease in drinking to cope motives along with decreases in negative affectivity, so we think this increase in solitary drinking is less of a signal of something problematic happening and more a result of pandemic-related restrictions on social drinking settings.”

The study is limited to drinking-age adults (21 years or older) in a primarily white population. The results may not be broadly generalizable to other groups. Creswell notes that future studies are needed to evaluate the effect of the pandemic on alcohol consumption and related problems in different populations.

Alcohol-related problems were assessed in the study using the Alcohol Use Disorder Identification Test and the Brief Young Adult Alcohol Consequences Questionnaire. Negative affect was assessed using the Personality Inventory for DSM-5.

“The pandemic was really hard on a lot of people, but for this group of young adults who were engaging in heavy drinking, the pandemic seems to have had a long-term positive effect.”

“Functional status is an important predictor of longevity and quality of life among older adults, and individuals with diabetes face a higher risk of functional decline than the general population,” said first author Andie MacNeil, a research assistant at the Factor-Inwentash Faculty of Social Work (FIFSW) and the Institute for Life Course and Aging at the University of Toronto. “Because the pandemic exacerbated many risk factors for functional decline, such as social isolation and physical inactivity, we wanted to examine changes in functional status among this population.”

The study’s sample came from the Canadian Longitudinal Study on Aging, a national longitudinal study of older Canadians. Respondents with diabetes were 53% more likely to develop at least one functional limitation during the pandemic compared to respondents without diabetes. Even after taking into account major risk factors for functional decline, such as such as physical activity, obesity, smoking, and other chronic health conditions, older adults with diabetes still faced a 28% higher risk of developing functional limitations.

“It is important for health professionals to encourage their older patients, particularly those with diabetes, to engage in behaviours that can help maintain their functional status, such as regular physical activity,” said co-author Susanna Abraham Cottagiri, doctoral candidate at the School of Medicine at Queens University.”

The study also found that socioeconomic factors were associated with functional limitations among older adults with and without diabetes. When compared to those with an annual household income of $100,000 or more, older adults with diabetes with an income of $20,000 or less had a 5-fold higher risk of developing at least one functional limitation. Even among those without diabetes, those with an income of $20,000 or less had double the risk of developing at least one functional limitation compared to those with an annual income of $100,000 or more.

“While socioeconomic status is an important predictor of functional decline among those both with and without diabetes, the magnitude of this relationship is much greater for respondents with diabetes,” said co-author Ying Jiang, a senior epidemiologist at the Public Health Agency of Canada.

The authors also examined the probabilities of functional limitations across various patient characteristics such as sex, diabetes status, and household income, and then stratified into several risk factors, such as age, physical activity level, smoking status, multimorbidity, and weight. Across various patient profiles, socioeconomic status was a consistent driver of functional status.

Co-author Professor Paul Villeneuve at the Department of Neuroscience and the CHAIM Research Centre, Carleton University, hypothesized the possible reason for this pattern: “People with low socioeconomic status face disproportionate stressors over their lifetime that may adversely impact their physical functioning in older age, such as working more physically demanding jobs, worse nutrition, and living in areas with less greenspace and walkability.”

The researchers hope these findings can be used to inform interventions to promote better physical functioning among middle age and older adults.

“Combining lifestyle approaches that integrate physical activity with nutrition interventions have been shown to improve physical function in older adults with diabetes” said co-author Margaret de Groh, scientific manager at the Public Health Agency of Canada.

“Poverty remains a major barrier to nutrition and food security,” said senior author Professor Esme Fuller-Thomson at the University of Toronto’s FIFSW and director of the Institute for Life Course & Aging. “It is important to think about broader strategies to decrease poverty and improve food access in Canada in order to promote better physical functioning among older adults.”

The study was published this week in the Canadian Journal of Diabetes. The study included 6,045 participants of the Canadian Longitudinal Study on Aging (CLSA) who were free from functional limitations in the 2015-2018 wave of data collection and who provided information on their functional status during the COVID-19 pandemic (September–December 2020). This research was supported, in part, by the Canadian Institutes of Health Research (CIHR) grant #172862 (PI Esme Fuller-Thomson).

What Covid “long haulers” found was that their new illness was not so new. In fact, it resembled other post-viral syndromes: difficult to treat and neglected by science. In riveting and accessible prose, Prior follows an innovative band of patients who took matters into their own hands and researched the disease themselves, thereby flipping the script and illustrating a new paradigm for research. In these unprecedented times, the CDC and the WHO came to them. As Covid continues to circulate, its long-term effects could grow as well, weighing on the healthcare system for decades to come. But, as Prior shows, getting Long Covid treatments right could help revolutionize care for all complex and chronic illnesses.

Ryan Prior is a journalist and former Journalist-in-Residence at the Century Foundation. He covered the COVID-19 pandemic as a features writer for CNN and writes the Patient Revolution column for Psychology Today. He has also written for USA Today, STAT, the Guardian, and the Nation. He directed the documentary Forgotten Plague, is a board member at the ME Action Network, and was a Stanford Medicine ePatient Scholar.

The results, published in Cancer Medicine, describe one of the first large-scale studies to examine the rates of breast cancer diagnoses during the first year of the COVID-19 pandemic; the results also have implications for how physicians and policymakers can address issues that may arise due to the diagnostic delays that occurred during the pandemic, the authors said.

“I think what’s notable is that the drop in breast cancer diagnoses was consistent across all regions of the country, all age groups, and all different races. It was not an isolated event,” said Katharine Yao, MD, FACS, senior author of the study and Chair of the ACS National Accreditation Program for Breast Centers (NAPBC). “The results of this study tell us that during the pandemic, patients weren’t coming in for evaluation of breast findings and for screening mammograms, and that’s very likely why we saw fewer cancers diagnosed in 2020.”

The NCDB, a clinical oncology database jointly operated by the CoC and American Cancer Society, captures approximately 74% of all newly diagnosed cancers in the U.S. Researchers also used U.S. Census data to determine the number of women and men in the general population over the study period. In total, they analyzed data from 1,499,806 patients with stage 0-IV breast cancer across 1,328 CoC sites.

Other Key Study Findings 

• While the researchers found that the decrease was seen for both women and men and across nearly all patient age groups, races, and ethnicities, the decrease was most dramatic for females aged 50–59 years (16.1% decrease) and 60–69 years (17.4% decrease). The authors noted two possible reasons for why these age groups were most vulnerable during the pandemic: Patients older than 50, including the 60-69 age group,  are more likely to be affected by breast cancer compared to younger age groups; additionally, older women are more likely to be screened with mammograms, and therefore may have been more susceptible to screening delays that occurred during the pandemic.
• Hispanic women experienced the sharpest decline from 2019 to 2020 among all races and ethnicities, with an 18.4% decrease. This is consistent with other disparities that Hispanic individuals faced during the pandemic, as research has shown that Hispanic people had higher rates of COVID-19 infection as well as mortality related to COVID-19, the authors noted.
• Women receiving care in the Western U.S. and mid-Atlantic regions experienced the largest declines in 2020, which may reflect the large COVID-19 outbreaks in New York and other mid-Atlantic states, the state of Washington, and California during the study period.

• Though representing less than 1% of breast cancer cases in 2020, the number of breast cancer diagnoses in men declined sharply – by 20% – in 2020 compared to 2019.

The reasons behind these decreases are likely multifactorial, reflecting screening restrictions that occurred in the early months of the pandemic when stay-at-home orders were implemented in several states, as well as the fear of exposure that may have caused some patients to delay care for breast cancer symptoms, the authors noted. Other factors, such as unemployment, may have kept some people away from receiving care even after pandemic restrictions were lifted.

Future Implications for Breast Cancer Care 

“There are so many unknowns. For example, in the next 5 to 10 years, are we going to see worse survival rates or higher recurrence rates because patients weren’t getting their screening mammograms or coming in to be evaluated?” said Dr. Yao, a breast surgeon who also serves as vice chair of research within the department of surgery at NorthShore University in Evanston, Illinois. “We just don’t know.”

Future research is needed to determine when case numbers will return to baseline levels and the consequences of delayed diagnosis and care, particularly among patients and geographic areas that were most severely affected by the pandemic.

“I think it’s important to have this data as a baseline, so that we can look at future data and compare it to what happened in the past,” Dr. Yao said. “To know that, we need to know where we started. And that’s what this study really presents – a starting point.  Looking at years after 2020, we’ll gain a more complete picture and can start to see where the trends lie.”

Disclosures: The authors report no conflicts of interest, including relevant financial interests, activities, relationships, or affiliations.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Citation: Fefferman M, Kuchta K, Wang C. Rates of newly diagnosed breast cancer at Commission on Cancer facilities during the early phase of the COVID-19 pandemic. Cancer Medicine, 2023. DOI: 10.1002/cam4.6874