#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutGuidelines After VaccinationAdvertisementContinue reading the main storySupported byContinue reading the main storyPandemic Raises Concerns About Childhood Lead PoisoningLead screenings for children plummeted last spring, and stay-at-home orders may have increased household exposure to the toxic metal.A worker scraping off lead paint. The C.D.C. estimates that more than 20 million housing units in the United States contain lead-based paint, which was essentially banned in 1978.Credit…Jamie Hooper/AlamyMarch 11, 2021, 5:00 a.m. ETOver the past half-century, public health officials have made enormous progress in protecting American children from lead poisoning and the irreversible neurological damage it can cause. Since the 1970s, the percentage of children with high levels of lead in their blood has plummeted.But in 2020, a new health threat, the coronavirus, endangered these hard-earned gains.When Covid-19 cases spiked last spring, lockdowns and day care closures confined young children to their homes, where lead exposure can be particularly high. The growing national emergency also delayed lead-removal efforts and disrupted routine childhood lead screenings, leaving health officials unable to identify and treat many children living in lead-laden homes.Last month, the Centers for Disease Control and Prevention estimated that in the early months of the pandemic, roughly 10,000 children with elevated levels of lead in their blood may have gone undetected.“Hundreds of thousands of children have missed their essential tests for lead,” said Joseph Courtney, a senior epidemiologist at the C.D.C.’s lead poisoning prevention and environmental health tracking branch, who conducted the analysis. “And it’s something that has potentially permanent lifetime effects.”There is no safe level of exposure to lead, which can disrupt neurological and cognitive development, causing learning disabilities, behavioral problems and developmental delays.The C.D.C. estimates that more than 20 million housing units in the United States contain lead-based paint, which was banned in 1978. When the paint flakes, cracks or peels, the lead mixes with dust, which children can ingest or inhale. Young children, whose brains are still developing, are at particular risk.“The main route of exposure for most children is lead-contaminated dust, from paint getting on their hands or their toys,” said David Jacobs, chief scientist at the National Center for Healthy Housing. “And then normal child behavior at this age is, everything goes in the mouth.”For that reason, many states recommend or require that children of certain ages have their blood tested for lead. (Federal guidelines require that all children who are enrolled in Medicaid receive blood lead level tests at ages one and two.) Doctors typically perform these tests as part of a child’s regular checkup.But when the pandemic hit last March, government officials issued stay-at-home orders, and many medical offices closed. Others started conducting appointments virtually. “You can’t do a blood lead test by telemedicine,” said Dr. Stephanie Yendell, senior epidemiology supervisor at the Minnesota Department of Public Health. “You can’t get a blood sample by video call.”That month in Minnesota, the number of tests for blood lead level fell to 70 percent of what it had been the previous year, Dr. Yendell said. “And then in April, we bottomed out at 43 percent compared to the year before.”In New York City, which was hit by an early wave of Covid-19 cases, childhood lead screenings declined by 88 percent last April.Anecdotal reports of these declines soon made their way to the C.D.C., which asked state and local health officials to share their lead screening data so the agency could conduct a more formal analysis. Thirty-four health departments — representing 32 states, plus New York City and Washington, D.C. — ultimately did so.Paint is the most common cause of childhood lead poisoning, but lead pipes also pose a threat; the longer that water sits stagnant in such pipes, the more lead leeches into it.Credit…Julio Cortez/Associated PressEvery one of those departments reported a drop-off in testing last spring, Dr. Courtney and his colleagues found. Over the first five months of 2020, roughly 500,000 fewer children had their blood lead levels tested in these districts compared with the same period of 2019. The decline was especially steep in March, April and May, when testing levels fell 50 percent compared to the previous year.The Coronavirus Outbreak

AdvertisementContinue reading the main storySupported byContinue reading the main storyVoicesNobody Wants Cancer. But a ‘Big C’ Label Has Surprising Upsides.Classifying a rare blood disorder as a cancer opened new doors for disease investigation, treatment and hope for a cure.Credit…Paper Illustration by Reina Takahashi, photographed by Tony Cenicola/The New York TimesMarch 11, 2021, 5:00 a.m. ETI have a rare blood disorder. When it was diagnosed 25 years ago, it was called an “orphan disease,” meaning the small number of people affected didn’t justify research investments by major pharmaceutical companies.Enter the World Health Organization and its 2008 decision to classify the condition as a blood “cancer.” This opened new doors for disease investigation and understanding. It prompted a growing number of super specialist practitioners, and most important, hope for some 300,000 people living in the United States with what are now called myeloproliferative neoplasms, or MPNs.Nobody likes to hear a cancer diagnosis, particularly for a disease they thought was benign. In fact, when I first saw my blood disorder referred to as a cancer, I wrote to the MPN Research Foundation, a nonprofit research and advocacy group, and suggested they remove the “Big C” word from their website. How, I thought, could they be so misleading?That’s when I discovered I was behind the times. MPNs were indeed reclassified as a malignant condition of the bone marrow, affecting sometimes one, two or all three types of blood cells: white cells, red cells and platelets.The average age people are diagnosed with an MPN is 60-something. My diagnosis came at age 38. For the next 15 years, I was treated for essential thrombocythemia, a type of MPN that caused my bone marrow to produce significantly higher than normal numbers of platelets. The proliferation of platelets put me at risk for dangerous clots and ultimately led to complete blockages of two important veins of the portal system, which carries blood to the liver.The Big C label began to look like good news.Once MPNs were classified as blood cancers — including essential thrombocythemia, polycythemia vera and myelofibrosis — interest grew from research laboratories, major medical centers, and small and mega pharmaceutical companies, which now saw these rare and poorly understood conditions as an opportunity. Perhaps pieces to the MPN puzzle could shed light on more common blood cancers, like leukemia and lymphoma. And perhaps treatments for those widely studied cancers could be used to treat MPNs.“The cancer designation did open up significant new funding opportunities, for example from the National Cancer Institute,” said Barbara Van Husen, board chair of the MPN Research Foundation. “It has definitely accelerated research.” There are more than 200 clinical trials underway for various MPNs, as well as ongoing research into stem cell transplantation, currently the only potential cure for these rare cancers.In my case, for reasons researchers are working to understand, my bone marrow flipped a switch. I was no longer making excessive platelets. Instead I was producing too many red cells and was given a revised diagnosis of polycythemia vera, a distinctly different MPN. I went for regular phlebotomies, the modern version of bloodletting in which pints of my blood were drained into a collection bag to reduce blood volume. Think blood transfusion, reversed.Doctors increased the dose of the 30-year-old chemotherapy drug I had been taking since my blood clots first appeared. The drug is still considered standard of care “if well tolerated.” It effectively adjusted my red counts. Unlike newer, more targeted drugs, however, it does not discriminate, potentially killing off not just red cells but white cells and platelets as well.I continued to live a full and largely unaffected life, though I often suffered symptoms such as debilitating headaches and bone pain.The hallmark fatigue of these blood disorders was not yet on my radar. I hiked. I cycled. I traveled. I was a night owl typically functioning “well” on five to six hours of sleep.Then, in September of 2019, my summer bike rides became an exhausting effort. By October, I was so fatigued that walking up a slightly inclined sidewalk had me leaning on a lamppost to catch my breath. Doctors identified scarring (“fibrosis”) in my bone marrow, elevating my diagnosis once again, to the third evolution of my MPN journey, myelofibrosis.“You’re a poster child for exploring new drug therapies for MPNs,” Dr. Ellen Ritchie, of Weill Cornell Medical Center in Manhattan, recently told me. Just seven months into my participation in a global phase 2 clinical trial for a new combination drug therapy, tests indicated significant, measurable improvement. It appears my disease is beginning to reverse.More than two decades after my first of many bone marrow biopsies, I have more energy than many of the “healthy” people I know.We tend to think of cancer as acute. Get it out quickly, go through treatments, prevent it from spreading. But for those with a chronic cancer like an MPN, there isn’t a distinctive beginning, middle and end. It can be overwhelming, emotionally exhausting, and even as we learn more about the disease, full of uncertainty.“Often, individuals with a chronic illness, like cancer, are more challenged to be hopeful about their future, while also needing to be focused on thriving on a daily basis,” says Laura Kaplan, a licensed clinical social worker whose Connecticut practice helps people navigate serious illness. “It is important for their identity and quality of life to try to keep a good perspective about living with the process of their disease.”For years, I chose not to let my condition define me. I chose not to identify myself as someone living with cancer. I would simply live my life fully, day to day. I would work hard and play hard, enjoy raising my two boys, deal with whatever challenged my health, and keep on moving. That approach continues to serve me well.Ruth Fein Revell, a health and environment writer, serves on a patient advisory board of the MPN Research Foundation.AdvertisementContinue reading the main story

The legalization of cannabis and the arrival of nonmedical fentanyl are fundamentally changing drug markets in North America. A large part of these changes relates to the ability to produce large quantities of the drugs at low costs, which has slashed wholesale prices for both drugs and retail prices for cannabis. A new analysis explores the effects of these changes on use. The analysis concludes that sharp declines in production costs for cannabis and opioids could dramatically reduce the price per dose for consumers in ways that alter patterns of use and dependence.
The analysis, by a researcher at Carnegie Mellon University (CMU), is published in the International Journal of Drug Policy.
“Historical analogies suggest that very large declines in price can have effects on use that go beyond just expanding traditional patterns of consumption,” explains Jonathan Caulkins, professor of operations research and public policy at CMU’s Heinz College, who wrote the analysis. “The overall situation with cannabis and fentanyl may look more different in 2040 compared to today — just as today looks different compared to 2000.”
Caulkins focused on the motivations for use of these drugs, factors that appear ready to change. He also considered market factors, noting that basic relationships among production costs, prices, and consumption have held up in markets over centuries. And he looked at wild cards — cultural, sociological, and political changes that could be equally influential.
Caulkins started with two key economic ideas: First, prices in competitive markets fall to match the marginal cost of production. For example, North American cannabis production costs have decreased as much as 95 percent. Second, when prices fall, consumption rises. This has occurred with cannabis, although as yet, there is no indication that fentanyl production has reduced retail opioid prices — but monitoring retail opioid prices is difficult.
Therefore, falling prices affect consumption, but the effects of precipitous declines may not be simply a larger version of the effects of modest price declines. Among other factors to consider is elasticity of demand, including how the degree of responsiveness to price changes varies from one setting to the next and from one outcome to the next. In short, for many products used widely by society (e.g., lighting and electricity, computers, cigarettes), Caulkins explains, their meaning changed when production costs fell radically.
“Liberalization of cannabis policy and reduced production costs may fundamentally change the place of cannabis in society,” Caulkins notes. Consider, for example, that cannabis operations are listed on the NASDAQ and Toronto stock exchanges, legalization has led to a wide range of products such as edibles and vaping, and advertising for the product has soared. More changes are likely, he suggests.
Significant declines in wholesale opioid prices could also have far-reaching and unexpected effects, Caulkins predicts. Among them: reducing the value of criminal organizations’ cross-border smuggling, making distribution less violent.
“We don’t know what the future holds,” he adds, “but I predict that if someone in 2040 lists the major changes in drug markets, use, and dependence that occurred since 2020, there will be items on that list that pertain to the declines in production costs brought about by cannabis legalization and the spread of synthetic opioids.”
Based on this prediction, Caulkins concludes: “It’s not too soon to invest more in monitoring markets to stay abreast of the diverse ramifications that may flow from these radical reductions in production costs.”

Pregnant women remain at increased risk of severe COVID-19, and their risk of being admitted to intensive care or needing invasive ventilation is higher than non-pregnant reproductive aged women with the virus, an ongoing global study has found.
Pregnant women with COVID-19 are at increased risk of severe COVID-19, particularly if they are from ethnic minority backgrounds, or if they have pre-existing conditions like obesity, high blood pressure and diabetes, concludes the research led by the University of Birmingham and World Health Organization (WHO).
Their research, published today (March 11) in the BMJ, is part of a unique and ongoing living systematic review and meta-analysis of data, which began in April 2020, and follows the researchers’ first publication in the BMJ last August.
This latest publication details the researchers’ analysis of the results of 192 studies — an additional 115 studies than were included in their August publication — into the impact of COVID-19 on pregnant women and their babies.
The review found that one in 10 pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed with confirmed COVID-19. Overall, 339 pregnant women with confirmed COVID-19 died from any cause (0.02% of a total 41,664 women involved in 59 studies). The overall rates of stillbirth and neonatal death are low in women with suspected or confirmed COVID-19, the review found.
The most common clinical symptoms of COVID-19 in pregnant women were fever (40%) and cough (41%), although compared to non-pregnant women of reproductive age, pregnant and recently pregnant women with COVID-19 were more likely to by asymptomatic.
Increased maternal age, high body mass index, non-white ethnicity, and pre-existing comorbidity including chronic hypertension and diabetes were identified as risk factors for pregnant women developing severe COVID-19. While there is emerging evidence from the review that pregnancy specific conditions such as pre-eclampsia and gestational diabetes may be associated with severe covid-19, the authors state that more data are needed to robustly assess the association between pregnancy specific risk factors and COVID-19 related outcomes.
First Author Dr John Allotey, of the University of Birmingham-based WHO Collaborating Centre for Global Women’s Health, said: “Pregnant women should be considered a high risk group, particularly those identified to have risk factors, for severe COVID-19 based on our findings. Mothers should also be reassured that the risks to their babies is very low.”
Professor Shakila Thangaratinam, corresponding author and Co-Director of the WHO Collaborating Centre for Global Women’s Health at the University of Birmingham, added: “In the current situation, where evidence is rapidly produced, our living systematic review — underpinned by robust methods and continually updated at regular intervals — is crucial to address important research questions and to shape healthcare policy and clinical decision-making.
“Pregnant women and healthcare professionals will need to take into account the additional risks faced by pregnant women with COVID-19 in making decisions such as taking-up of vaccines if offered to prevent COVID-19, and plan management in pregnancy.”

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Materials provided by University of Birmingham. Note: Content may be edited for style and length.

During the COVID-19 pandemic, people who recognize the connections they share with others are more likely to wear a mask, follow health guidelines and help people, even at a potential cost to themselves, a new University of Washington study shows.
Indeed, an identification with all humanity, as opposed to identification with a geographic area like a country or town, predicts whether someone will engage in “prosocial” behaviors particular to the pandemic, such as donating their own masks to a hospital or coming to the aid of a sick person.
The study, published March 10 in PLOS ONE, is drawn from about 2,500 responses, from more than 80 countries, to an online, international study launched last April.
Researchers say the findings could have implications for public health messaging during the pandemic: Appealing to individuals’ deep sense of connectedness to others could, for example, encourage some people to get vaccinated, wear masks or follow other public health guidelines.
“We want to understand to what extent people feel connected with and identify with all humanity, and how that can be used to explain the individual differences in how people respond during the COVID-19 pandemic,” said author Rodolfo Cortes Barragan, a postdoctoral researcher at the UW Institute for Learning & Brain Sciences, or I-LABS, who co-led the study with postdoctoral researcher Nigini Oliveira at the Paul G. Allen School for Computer Science and Engineering.
In psychology, “identification with all humanity” is a belief that can be measured and utilized in predicting behavior or informing policy or decision-making. Last spring, as governments around the world were imposing pandemic restrictions, a multidisciplinary team of UW researchers came together to study the implications of how people would respond to pandemic-related ethical dilemmas, and how those responses might be associated with various psychological beliefs.

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Researchers designed an online study, providing different scenarios based in social psychology and game theory, for participants to consider. The team then made the study available in English and five other languages on the virtual lab LabintheWild, which co-author Katharina Reinecke, an associate professor in the Allen School, created for conducting behavioral studies with people around the world.
The scenarios presented participants with situations that could arise during the pandemic and asked people to what extent they would:
Follow the list of World Health Organization health guidelines (which mostly focused on social distancing and hygiene when the study was run between mid-April to mid-June)
Donate masks of their family’s to a hospital short on masks
Drive a person exhibiting obvious symptoms of COVID-19 to the hospital
Go to a grocery store to buy food for a neighboring family
Call an ambulance and wait with a sick person for it to arrive
In addition to demographic details and information about their local pandemic restrictions, such as stay-at-home orders, participants were asked questions to get at the psychology behind their responses: about their own felt identification with their local community, their nation and humanity, in general. For instance, participants were asked, “How much would you say you care (feel upset, want to help) when bad things happen to people all over the world?”
Researchers found that an identification with “all humanity” significantly predicted answers to the five scenarios, well above identifying with country or community, and after controlling for other variables such as gender, age or education level. Its effect was stronger than any other factor, said Barragan, and popped out as a highly significant predictor of people’s tendency to want to help others.
The authors noted that identifying with one’s country, in fact, came in a distant third, behind identification with humanity in general and one’s local community. Strong feelings toward one’s nation, nationalism, can lead to behavior and policies that favor some groups of people over others.

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“There is variability in how people respond to the social aspects of the pandemic. Our research reveals that a crucial aspect of one’s world view — how much people feel connected to others they have never met — predicts people’s cooperation with public health measures and the altruism they feel toward others during the pandemic,” said co-author Andrew Meltzoff, who is co-director of I-LABS and holds the Job and Gertrud Tamaki Endowed Chair in psychology.
Since last spring, of course, much has changed. More than 2.5 million people worldwide have died of COVID-19, vaccines are being administered, and guidance from the U.S. Centers for Disease Control and Prevention, especially regarding masks, has evolved. If a new survey was launched today, Barragan said, the research group would like to include scenarios tuned to the current demands of the pandemic and the way it challenges us to care for others even while we maintain physical distancing.
While surveys, in general, can be prone to what’s known as self-serving bias — the participant answers in ways that they believe will make them “look good” — researchers say that’s not evident here. They point to the sizeable differences between responses that identify with all humanity, and those that identify with community or country, and note there would be little reason for participants to deliberately emphasize one and not the others.
The project is part of a larger multidisciplinary effort by this same UW research team to bring together computer scientists and psychologists interested in decision-making in different cultural contexts, which could inform our understanding of human and machine learning.
An eventual aim of the study is to use tools from artificial intelligence research and online interactions with humans around the world to understand how one’s culture influences social and moral decision-making.
“This project is a wonderful example of how the tools of computer science can be combined with psychological science to understand human moral behaviors, revealing new information for the public good,” said co-author Rajesh Rao, the Hwang Endowed Professor of Computer Science and Engineering at the UW.
For COVID-19 and future humanitarian crises, the ethical dilemmas presented in the study can offer insight into what propels people to help, which can, in turn, inform policy and outreach.
“While it is true that many people don’t seem to be exhibiting helpful behaviors during this pandemic, what our study shows is that there are specific characteristics that predict who is especially likely to engage in such behavior,” Barragan said. “Future work could help people to feel a stronger connection to others, and this could promote more helpful behavior during pandemics.”
Additional co-authors were Koosha Khalvati, a doctoral student in the Allen School and Rechele Brooks, a research scientist with I-LABS.
The study was funded by the UW, the Templeton World Charity Foundation and the National Science Foundation.

#masthead-section-label, #masthead-bar-one { display: none }The Coronavirus OutbreakliveLatest UpdatesMaps and CasesRisk Near YouVaccine RolloutGuidelines After VaccinationAdvertisementContinue reading the main storySupported byContinue reading the main storyU.S. Releases New Covid-19 Guidance for Nursing Homes, Permitting Indoor VisitsThe recommendations are the first revision to the federal government’s nursing home guidance since September.Family members visiting the Life Care Center of Kirkland, Wash. The government’s new guidance arrived as more than three million vaccine doses had been administered in nursing homes, a federal agency said.Credit…Ted S. Warren/Associated PressMarch 10, 2021, 7:20 p.m. ETWASHINGTON — The Biden administration published revised guidelines on Wednesday for nursing home visits during the coronavirus pandemic, allowing guests to go inside to see residents regardless of whether they or the residents have been vaccinated.The recommendations, released by the Centers for Medicare and Medicaid Services with comment from the Centers for Disease Control and Prevention, are the first revision to the federal government’s nursing home guidance since September. And they arrived as more than three million vaccine doses had been administered in nursing homes, the agency said.Federal officials said in the new guidance that outdoor visits were still preferable because of a lower risk of transmission, even when residents and guests have been fully vaccinated.The guidance was also the latest indication that the pandemic in the United States was easing, with coronavirus cases continuing to decrease across the nation, though the seven-day average remains at more than 58,000. The C.D.C. released long-awaited guidance on Monday for Americans who have been fully vaccinated, telling them that it was safe to gather in small groups at home without masks or social distancing.About 62.5 million people have received at least one dose of a Covid-19 vaccine, including about 32.9 million people who have been fully vaccinated by Johnson & Johnson’s single-dose vaccine or the two-dose series made by Pfizer-BioNTech and Moderna.In a statement laying out the reasons for updating the recommendations, Dr. Lee A. Fleisher, the chief medical officer at the Centers for Medicare and Medicaid Services, cited the millions of vaccines administered to nursing home residents and staff and a decline in coronavirus cases in nursing homes.“C.M.S. recognizes the psychological, emotional and physical toll that prolonged isolation and separation from family have taken on nursing home residents and their families,” he said.Earlier in the pandemic, the coronavirus raced through tens of thousands of long-term care facilities in the United States, killing more than 150,000 residents and employees and accounting for more than a third of all virus deaths since late spring. But since the arrival of vaccines, new cases and deaths in nursing homes have fallen steeply, outpacing national declines, according to a New York Times analysis of federal data.The eight pages of recommendations, which are not legally binding, did come with suggested limits, saying that “responsible indoor visitation” should be allowed at all times unless a guest is visiting an unvaccinated resident in a county where the Covid-19 positivity rate is higher than 10 percent and less than 70 percent of residents in the nursing home have been fully vaccinated. The guidance also says to limit visits if residents have Covid-19 or are in quarantine.So-called compassionate care visits — when a resident’s health has severely deteriorated — should be allowed regardless of vaccination status or the county’s positivity rate, the guidance said.When a positive case is identified in a nursing home, visits should be halted and residents and staff tested, the guidance said. Visits can resume in other parts of the facility if there are no positive tests there, but if cases are discovered in other areas, nursing homes should suspend all visits.AdvertisementContinue reading the main story

#masthead-section-label, #masthead-bar-one { display: none }El brote de coronavirusVacunas: lo que debes saberIdentifica las N95 falsasEficacia vs. EfectividadAsí funciona la Sputnik V¿Una vacuna cubana?AdvertisementContinue reading the main storySupported byContinue reading the main storyLas mujeres informan de peores efectos secundarios tras la vacuna para la covidLos hombres y las mujeres suelen responder de forma diferente a muchos tipos de vacunas. Esto se debe probablemente a una mezcla de factores, como las hormonas, los genes y la dosis de las vacunas.Los investigadores de los CDC analizaron los datos de seguridad de 13,7 millones de vacunas para la COVID-19 y descubrieron que el 79,1 por ciento de los efectos secundarios notificados procedían de mujeres, aunque solo el 61,2 por ciento de las vacunas se habían administrado a mujeres.Credit…Mike Kai Chen para The New York Times10 de marzo de 2021 a las 15:51 ETRead in EnglishLa mañana que Shelly Kendeffy recibió su segunda dosis de la vacuna de Moderna contra la COVID-19, se sintió bien. En la tarde, sintió el brazo adolorido y dolor corporal, y para la noche, tenía síntomas parecidos a los de la influenza.“Los dientes me castañeteaban, pero estaba sudando… como empapada y a la vez congelándome”, contó Kendeffy, una paramédica de 44 años de State College, Pensilvania.Al día siguiente, fue a trabajar y preguntó entre sus colegas —ocho hombres y siete mujeres— acerca de su experiencia con las vacunas. Seis de las mujeres tuvieron dolor de cuerpo, escalofríos y fatiga. La única mujer que no tuvo síntomas de influenza estuvo despierta vomitando gran parte de la noche.Los ocho hombres dieron testimonios muy diferentes. Uno tuvo un ligero dolor en el brazo, dolor de cabeza y dolor corporal. Dos hablaron de una ligera fatiga y un poco de dolor muscular. Uno tuvo dolor de cabeza. Y cuatro no experimentaron ningún síntoma.“Yo trabajo con mujeres muy fuertes”, afirmó Kendeffy. Pero dijo: “es evidente que, para nosotras, los efectos secundarios fueron más intensos”. Después de 24 horas, ya se sintió mejor y está muy contenta de haber recibido la vacuna. “No me arrepiento, porque seguro que esto es mejor que la alternativa”, señaló. “Pero tampoco sabía qué esperar”.Las diferencias que Kendeffy observó entre sus colegas están apareciendo en todo el país. En un estudio publicado el mes pasado, los investigadores de los Centros para el Control y la Prevención de Enfermedades (CDC, por su sigla en inglés) analizaron los datos de inocuidad de los primeros 13,7 millones de dosis de vacunas contra la COVID-19 administradas a los estadounidenses. De los efectos secundarios reportados a este organismo, el 79,1 por ciento vino de mujeres, pese a que solo habían aplicado el 61,2 por ciento de las vacunas a personas del sexo femenino.La mayor parte de las insólitas reacciones anafilácticas a las vacunas contra el coronavirus también se han presentado en mujeres. Los investigadores de los CDC informaron que los 19 sujetos que habían sufrido esa reacción a la vacuna de Moderna eran mujeres y que las mujeres representaban 44 de los 47 sujetos que han tenido reacciones anafilácticas a la vacuna de Pfizer.“No me sorprende en absoluto”, señaló Sabra Klein, microbióloga e inmunóloga de la Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins. “La diferencia que se da según el sexo coincide por completo con informes anteriores relacionados con otras vacunas”.En un estudio de 2013, los científicos de los CDC y de otras instituciones descubrieron que cuatro veces más mujeres que hombres entre 20 y 59 años reportaron reacciones alérgicas después de recibir la vacuna de 2009 contra la influenza, pese a que fueron vacunados más hombres que mujeres. En otro estudio, se descubrió que entre 1990 y 2016, las mujeres conformaron el 80 por ciento de todos los casos de reacciones anafilácticas a las vacunas en personas adultas.En general, las mujeres “tienen más reacciones a una diversidad de vacunas”, mencionó Julianne Gee, funcionaria médica en la Oficina de Seguridad de la Inmunización de los CDC. Eso incluye las vacunas contra la influenza que se administran a los adultos, así como algunas que se administran en la infancia, como las vacunas contra la hepatitis B y la de sarampión, rubeóla y paperas (SRP).Sin embargo, la noticia no es tan mala para las mujeres. Casi siempre, los efectos secundarios son leves y de poca duración. Además, estas reacciones físicas son una señal de que la vacuna está surtiendo efecto, de que estás “desarrollando una respuesta inmunitaria muy consistente y es probable que, como consecuencia” estés “protegida”, señaló Klein.Así avanza la vacunación en el mundoTracking Coronavirus Vaccinations Around the WorldMore than 316.6 million vaccine doses have been administered worldwide, equal to 4.1 doses for every 100 people.¿Pero por qué se dan estas diferencias según el sexo? Parte de la respuesta podría ser de comportamientos. Rosemary Morgan, investigadora de salud a nivel internacional de la Escuela de Salud Pública Bloomberg de la Universidad Johns Hopkins dijo que es posible que las mujeres hablen de efectos secundarios más que los hombres incluso cuando sus síntomas sean los mismos. No existe ninguna investigación específica sobre las vacunas que respalde esta aseveración, pero es menos probable que los varones consulten a un médico cuando están enfermos, así que quizás sea menos probable que reporten efectos secundarios, comentó.Sin embargo, no hay duda de que la biología tiene una participación importante. “De muchos modos, la respuesta inmunitaria de las mujeres es distinta a la de los hombres”, señaló Eleanor Fish, inmunóloga de la Universidad de Toronto.Las investigaciones han demostrado que, en comparación con sus contrapartes masculinos, las mujeres y las niñas producen más anticuerpos que combaten las infecciones —en ocasiones hasta el doble— como respuesta a las vacunas contra la influenza, SPR, fiebre amarilla, rabia, así como hepatitis A y B. Gee mencionó que también a menudo desarrollan respuestas más consistentes que vienen de las células inmunitarias llamadas células T. La mayor parte de las veces, estas diferencias son más importantes en adultos jóvenes, lo cual “nos habla de un efecto biológico que tal vez esté relacionado con las hormonas de la reproducción”, señaló.Las hormonas sexuales que incluyen los estrógenos, la progesterona y la testosterona pueden adherirse a la superficie de las células inmunitarias e influir en la manera en que funcionan. Por ejemplo, la exposición a los estrógenos hace que las células inmunitarias produzcan más anticuerpos como repuesta a la vacuna contra la influenza.Además, según Klein, la testosterona “parece ser muy inmunosupresora”. La vacuna contra la influenza tiende a ser menos protectora en los varones que tienen mucha testosterona, en comparación con los que tienen una menor cantidad de esa hormona sexual. Entre otras cosas, la testosterona inhibe la producción de sustancias químicas inmunitarias, conocidas como citoquinas, que realiza el cuerpo.También es posible que las diferencias genéticas entre hombres y mujeres tengan alguna influencia sobre la inmunidad. Muchos genes relacionados con la inmunidad se encuentran en el cromosoma X, del cual las mujeres tienen dos copias y los hombres solo una. Los inmunólogos siempre han creído que solo se encendió un cromosoma X en las mujeres y que el otro estaba inactivo. Pero ahora, las investigaciones demuestran que el 15 por ciento de los genes eluden esta inactivación y se expresan más en las mujeres.Estas fuertes respuestas inmunitarias ayudan a explicar por qué el 80 por ciento de las enfermedades autoinmunes afecta a las mujeres. “Las mujeres poseemos una mayor inmunidad, ya sea hacia nosotras mismas, hacia un antígeno vacunal o hacia un virus”, afirmó Klein.También puede ser importante la cantidad que contiene una dosis de la vacuna. En algunos estudios, se ha demostrado que las mujeres absorben y metabolizan los medicamentos de una manera distinta a la de los varones y que casi siempre requieren menos dosis para que estos surtan el mismo efecto. Pero hasta la década de 1990, en gran parte de los ensayos clínicos para fármacos y vacunas se excluía a las mujeres. “Desde siempre, las dosis recomendadas de los medicamentos se basan en ensayos clínicos en los que los participantes son hombres”, señaló Morgan.Los ensayos clínicos actuales ya incluyen a las mujeres. Pero, según Klein, en los ensayos para las nuevas vacunas contra la covid, no se distinguieron ni se analizaron lo suficiente los efectos secundarios por sexo. Tampoco probaron si una dosis más pequeña podría ser igualmente eficaz para las mujeres y producirles menos efectos secundarios.Hasta que no lo hagan, comentó Klein, los profesionales de la salud deben hablar con las mujeres sobre los efectos secundarios de las vacunas para que no se asusten si los presentan. “Creo que es útil alertar a las mujeres de que quizás tengan más reacciones adversas”, afirmó. “Eso es normal y es probable que sea un reflejo de que su sistema inmunitario está funcionando”.Vacunas contra la COVID-19: respondemos todas tus dudasLos periodistas del Times respondieron a las preguntas de los lectores sobre la vacunación, qué podemos esperar y lo que va a pasar ahora.AdvertisementContinue reading the main story

Aspirin is an established, safe, and low-cost medication in long-standing common use in prevention and treatment of cardiovascular diseases, and in the past a pain relief and fever reducing medication. The use of aspirin was very popular during the 1918 Spanish Influenza pandemic, several decades before in-vitro confirmation of its activity against RNA viruses. Studies showed that aspirin, in addition to its well-known anti-inflammatory effects, could modulate the innate and adaptive immune responses helping the human immune system battle some viral infections.
With this information in mind Israeli researchers hypothesized that pre-infection treatment with low-dose aspirin (75mg) use might have a potential beneficial effect on COVID-19 susceptibility and disease duration. A joint team from Leumit Health Services, Bar-Ilan University, and Barzilai Medical Center conducted an observational epidemiological study, utilizing data from Leumit Health Services, a national health maintenance organization in Israel. Their findings were recently published in The FEBS Journal.
The researchers analyzed data of 10,477 persons who had been tested for COVID-19 during the first COVID-19 wave in Israel from February 1, 2020 to June 30, 2020. Aspirin use to avoid the development of cardiovascular diseases in healthy individuals was associated with a 29% lower likelihood of COVID-19 infection, as compared to aspirin non-users. The proportion of patients treated with aspirin was significantly lower among the COVID-19-positive individuals, as compared to the COVID-19-negative ones. And those subjects who had been treated with aspirin were less associated with the likelihood of COVID-19 infection than those who were not. Moreover, the group observed that the conversion time of SARS-CoV-2 PCR test results from positive to negative among aspirin-using COVID-positive patients was significantly shorter, and the disease duration was two-three days shorter, depending upon the patients’ pre-existing conditions.
“This observation of the possible beneficial effect of low doses of aspirin on COVID-19 infection is preliminary but seems very promising,” says Prof. Eli Magen from the Barzilai Medical Center, who led the study.
Study principal investigator Dr. Eugene Merzon, from Leumit Health Services, emphasizes the importance of repeating the study results using larger samples, and including patients from other hospitals and countries, to verify the results.
Dr. Milana Frenkel-Morgenstern, of the Azrieli Faculty of Medicine of Bar-Ilan University: “The present study sought to better understand the potential favorable effects of aspirin in aiding the human immune system battle COVID-19. We intend to investigate a larger cohort of patients and in randomized clinical trials.”

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A gene therapy for chronic pain could offer a safer, non-addictive alternative to opioids. Researchers at the University of California San Diego developed the new therapy, which works by temporarily repressing a gene involved in sensing pain. It increased pain tolerance in mice, lowered their sensitivity to pain and provided months of pain relief without causing numbness.
The researchers report their findings in a paper published Mar. 10 in Science Translational Medicine.
The gene therapy could be used to treat a broad range of chronic pain conditions, from lower back pain to rare neuropathic pain disorders — conditions for which opioid painkillers are the current standard of care.
“What we have right now does not work,” said first author Ana Moreno, a bioengineering alumna from the UC San Diego Jacobs School of Engineering. Opioids can make people more sensitive to pain over time, leading them to rely on increasingly higher doses. “There’s a desperate need for a treatment that’s effective, long-lasting and non-addictive.”
The idea for such a treatment emerged when Moreno was a Ph.D. student in UC San Diego bioengineering professor Prashant Mali’s lab. Mali had been investigating the possibility of applying CRISPR-based gene therapy approaches to rare as well as common human diseases. Moreno’s project focused on exploring potential therapeutic avenues. One day, she came across a paper about a genetic mutation that causes humans to feel no pain. This mutation inactivates a protein in pain-transmitting neurons in the spinal cord, called NaV1.7. In individuals lacking functional NaV1.7, sensations like touching something hot or sharp do not register as pain. On the other hand, a gene mutation that leads to overexpression of NaV1.7 causes individuals to feel more pain.
When Moreno read this, it clicked. “By targeting this gene, we could alter the pain phenotype,” she said. “What’s also cool is that this gene is only involved in pain. There aren’t any severe side effects observed with this mutation.”
Non-permanent gene therapy

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Moreno had been working on gene repression using the CRISPR gene editing tool as part of her dissertation. Specifically, she was working with a version of CRISPR that uses what’s called “dead” Cas9, which lacks the ability to cut DNA. Instead, it sticks to a gene target and blocks its expression.
Moreno saw an opportunity to use this approach to repress the gene that codes for NaV1.7. She points out an appeal of this approach: “It’s not cutting out any genes, so there are no permanent changes to the genome. You wouldn’t want to permanently lose the ability to feel pain,” she said. “One of the biggest concerns with CRISPR gene editing is off-target effects. Once you cut DNA, that’s it. You can’t go back. With dead Cas9, we’re not doing something irreversible.”
Mali, who is a co-senior author of the study, says that this use of dead Cas9 opens the door to using gene therapy to target common diseases and chronic ailments.
“In some common diseases, the issue is that a gene is being misexpressed. You don’t want to completely shut it down,” he said. “But if you could turn down the dose of that gene, you could bring it to a level where it is not pathogenic. That is what we are doing here. We don’t completely take away the pain phenotype, we dampen it.”
Moreno and Mali co-founded the spinoff company Navega Therapeutics to work on translating this gene therapy approach, which they developed at UC San Diego, into the clinic. They teamed up with Tony Yaksh, an expert in pain systems and a professor of anesthesiology and pharmacology at UC San Diego School of Medicine. Yaksh is a scientific advisor to Navega and co-senior author of the study.

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Early lab studies
The researchers engineered a CRISPR/dead Cas9 system to target and repress the gene that codes for NaV1.7. They administered spinal injections of their system to mice with inflammatory and chemotherapy-induced pain. These mice displayed higher pain thresholds than mice that did not receive the gene therapy; they were slower to withdraw a paw from painful stimuli (heat, cold or pressure) and spent less time licking or shaking it after being hurt.
The treatment was tested at various timepoints. It was still effective after 44 weeks in the mice with inflammatory pain and 15 weeks in those with chemotherapy-induced pain. The length of duration is still being tested, researchers said, and is expected to be long-lasting. Moreover, the treated mice did not lose sensitivity or display any changes in normal motor function.
To validate their results, the researchers performed the same tests using another gene editing tool called zinc finger proteins. It’s an older technique than CRISPR, but it does the same job. Here, the researchers designed zinc fingers that similarly bind to the gene target and block expression of NaV1.7. Spinal injections of the zinc fingers in mice produced the same results as the CRISPR-dead Cas9 system.
“We were excited that both approaches worked,” Mali said. “The beauty about zinc finger proteins is that they are built on the scaffold of a human protein. The CRISPR system is a foreign protein that comes from bacteria, so it could cause an immune response. That’s why we explored zinc fingers as well, so we have an option that might be more translatable to the clinic.”
The researchers say this solution could work for a large number of chronic pain conditions arising from increased expression of NaV1.7, including diabetic polyneuropathy, erythromelalgia, sciatica and osteoarthritis. It could also provide relief for patients undergoing chemotherapy.
And due to its non-permanent effects, this therapeutic platform could address a poorly met need for a large population of patients with long-lasting (weeks to months) but reversible pain conditions, Yaksh said.
“Think of the young athlete or wounded war fighter in which the pain may resolve with wound healing,” he said. “We would not want to permanently remove the ability to sense pain in these people, especially if they have a long life expectancy. This CRISPR/dead Cas9 approach offers this population an alternative therapeutic intervention — that’s a major step in the field of pain management.”
Researchers at UC San Diego and Navega will next work on optimizing both approaches (CRISPR and zinc fingers) for targeting the human gene that codes for NaV1.7. Trials in non-human primates to test for efficacy and toxicity will follow. Researchers expect to file for an IND and to commence human clinical trials in a couple years.
This work was supported by UC San Diego Institutional Funds and the National Institutes of Health (grants R01HG009285, RO1CA222826, RO1GM123313, R43CA239940, R43NS112088, R01NS102432, R01NS099338).
Disclosure: Ana Moreno, Fernando Alemán, Prashant Mali and Tony Yaksh have a financial interest in Navega Therapeutics. The terms of these arrangements have been reviewed and approved by the University of California San Diego in accordance with its conflict of interest policies.

A new systematic review of 65 studies from around the world involves a total of 97,333 health care workers and finds that 1 in 5 have experienced depression, anxiety, and/or PTSD during the ongoing COVID-19 pandemic. Yufei Li, Nathaniel Scherer, and colleagues at the London School of Hygiene & Tropical Medicine, U.K., present these findings in the open-access journal PLOS ONE on March 10.
The pandemic has posed significant challenges for health care workers, with many fearing for their own safety while facing a high workload and limited psychological support. Previous analyses of data from multiple studies have revealed high rates of depression, anxiety, and PTSD among health care workers during the pandemic. However, those reviews did not adequately address the many relevant studies conducted in China, where the first COVID-19 outbreak occurred.
To address that gap, Li, Scherer, and colleagues carried out a systematic search of studies in both English and Chinese that were conducted from December 2019 to August 2020 and addressed prevalence of mental disorders in health care workers. They identified 65 suitable studies from 21 countries, involving a total of 97,333 health care workers.
By pooling and statistically analyzing data from all 65 studies, the researchers estimated that 21.7 percent of the health care workers involved in the studies have experienced depression during the pandemic, 22.1 percent anxiety, and 21.5 percent PTSD. Studies conducted in the Middle East showed the highest pooled rates of depression (34.6 percent) and anxiety (28.9 percent).
These findings suggest that the COVID-19 pandemic has significantly impacted the mental health of health care workers. For comparison, the World Health Organization estimates that 4.4 percent of the entire world population experience depression, and 3.6 percent experience anxiety disorders, including PTSD. However, those estimates were determined through different methods and prior to the pandemic.
Nonetheless, the authors note, the new findings could help inform policy and initiatives to provide urgently needed psychological support to health care workers.
The authors add: “This systematic review and meta-analysis provides, to date, the most comprehensive synthesis of depression, anxiety and PTSD prevalence amongst health care workers during the COVID-19 pandemic, with the unique inclusion of publications in both English and Chinese.”

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