Publisher Health

First-year college students are reporting drinking less alcohol and having fewer episodes of binge drinking four months into the coronavirus pandemic than they were before the pandemic started, according to a study by the University of North Carolina at Chapel Hill.
The study is based on the experiences of 439 Carolina students and reflects how the pandemic affected students’ social lives and stress. Researchers from the Carolina Population Center and the UNC School of Medicine published the study findings August 2 in the Journal of Adolescent Health.
“We found that social factors, like social distancing and reductions in social support from friends, were associated with decreases in alcohol use among first-year students. By contrast, stress-related factors were less important,” said lead study author Jane Cooley Fruehwirth, an associate professor in the UNC-Chapel Hill Department of Economics in the College of Arts & Sciences and a faculty fellow at the Carolina Population Center.
Her collaborators include Ben Gorman, a senior communications and neuroscience major in the College of Arts and Sciences, and Krista Perreira, a professor of social medicine at the UNC School of Medicine and a faculty fellow at the Carolina Population Center. The work builds on their previous research looking at the mental health of first-year college students during the pandemic.
Alcohol Usage Declines
Using survey data, researchers found the prevalence of alcohol use by first-year college students decreased from 54.2% before the pandemic to 46% mid-pandemic. The prevalence of binge drinking dropped from 35.5% before the pandemic to 24.6% mid-pandemic.
“We followed the same group of first-year college students before and after the pandemic began, which allowed us to analyze Covid-related determinants of drinking behaviors while accounting for pre-existing alcohol use and social factors,” says Gorman, who also runs the TEACH Initiative, an organization which conducts near-peer substance use and mental health education in North Carolina high schools.
While the social factors dominated, stress did play a role for some students. Difficulties with distanced learning were associated with increased drinking for students who were already consuming alcohol before the pandemic. Furthermore, 20.5% of students reported using alcohol or other drugs to cope with the pandemic.
“The dominance of social factors suggests that reductions in alcohol use may not be sustained once college students return to campus,” said Fruehwirth. “For students who were already drinking prior to the pandemic, universities can support them by providing ways to help them manage stress, through counseling, student support groups and particularly targeting challenges with distance learning through academic coaching.”
This research was supported by the Carolina Population Center and its National Institutes of Health (NIH)/National Institute of Child Health and Human Development (NICHD) Grant Award Number P2C HD50924 (JF), the Integrating Special Populations/ North Carolina Translational and Clinical Sciences Institute through Grant Award Number UL1TR002489 (KP), the Office of Undergraduate Research and Department of Economics at UNC-CH.
Story Source:
Materials provided by University of North Carolina at Chapel Hill. Note: Content may be edited for style and length.

While the vaccines are effective at preventing serious illness and death, the risk of developing post-Covid health problems after a breakthrough infection isn’t known.While some breakthrough cases among those who are fully vaccinated against Covid-19 are inevitable, they are unlikely to result in hospitalization or death. But one important question about breakthrough infection that remains unanswered is: Can the vaccinated develop so-called long Covid?Long Covid refers to a set of symptoms — such as severe fatigue, brain fog, headache, muscle pain and sleep problems — that can persist for weeks or months after the active infection has ended. The syndrome is poorly understood, but studies suggest that between 10 and 30 percent of adults who catch the virus may experience long Covid, including those who experienced only mild illness or no symptoms at all.But the vast majority of data collected about long Covid has been in the unvaccinated population. The risk of developing long Covid for the fully vaccinated who get infected after vaccination hasn’t been studied.While preliminary research suggests that it is, in fact, possible for a breakthrough case to lead to symptoms that can persist for weeks to months, there are still more questions than answers. What percent of breakthrough cases result in lingering symptoms? How many of those people recover? Are the persistent symptoms after breakthrough infection as severe as those that occur in the unvaccinated?“I just don’t think there is enough data,” said Dr. Zijian Chen, medical director at the Center for Post-Covid Care at Mount Sinai Health System in New York. “It’s too early to tell. The population of people getting sick post vaccination isn’t that high right now, and there’s no good tracking mechanism for these patients.”One recent study of Israeli health care workers published in the New England Journal of Medicine offers a glimpse of the risk of long Covid after a breakthrough infection. Among 1,497 fully vaccinated health care workers, 39 of them — about 2.6 percent — developed breakthrough infections. (All of the workers were believed to be infected after contact with an unvaccinated person, and the study was conducted before the Delta variant became dominant.)While most of the breakthrough cases were mild or asymptomatic, seven out of 36 workers tracked at six weeks (19 percent) still had persistent symptoms. These long Covid symptoms included a mix of prolonged loss of smell, persistent cough, fatigue, weakness, labored breathing or muscle pain.But the study’s authors caution against drawing too many conclusions from the research. The sample size — just seven patients — is small. And the research was designed to study antibody levels in the infected, said Dr. Gili Regev-Yochay, director of the infectious disease epidemiology unit at Sheba Medical Center. It was not designed to study the risk of long Covid after a breakthrough infection, “It was not the scope of this paper,” Dr. Regev-Yochay said. “I don’t think we have an answer to that.”Even so, the fact that one in five of the health care workers who had breakthrough infections still had lingering symptoms after six weeks appears to be the first indication from a peer-reviewed study that long Covid is possible after a breakthrough infection.“People have said to me, ‘You’re fully vaccinated. Why are you being so careful?’” said Dr. Robert M. Wachter, professor and chair of the department of medicine at the University California San Francisco. “I’m still in the camp of I don’t want to get Covid. I don’t want to get a breakthrough infection.”Dr. Wachter said that despite the many limitations of the Israeli study, the data offer more evidence that the vaccinated should keep taking reasonable precautions to avoid the virus.“I’m going to take it at face value that one in five people, six weeks after a breakthrough case, continued to feel crummy,” Dr. Wachter said. “That’s enough to make me want to wear two masks when I go into the grocery store, which is not that burdensome anyway.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}Complicating the study of breakthrough infections is the fact that the U.S. Centers for Disease Control and Prevention only tracks post-vaccination infections that result in hospitalization or death. While the C.D.C. does continue to study breakthrough infections in several large cohorts, the lack of data on all breakthrough cases remains a source of frustration among scientists and patient advocacy groups.“It’s very frustrating not to have data at this point in the pandemic to know what happens to breakthrough cases,” said Akiko Iwasaki, an immunologist at Yale School of Medicine who is conducting studies of long Covid. “If mild breakthrough infection is turning into long Covid, we don’t have a grasp of that number.”Diana Berrent, founder of Survivor Corps, a Facebook group for people affected by Covid-19 that has about 171,000 members, took an informal poll and found 24 people who said they had lingering symptoms after a breakthrough infection. It’s not a scientific sample, and the cases haven’t been validated, but the poll shows the need for more data on breakthrough cases, Ms. Berrent said.“You can’t extrapolate it to the general population, but it’s a very strong signal that the C.D.C. needs to be mandating reporting of every breakthrough case,” Ms. Berrent said. “We can’t know what we’re not counting.”But some experts predict the surge of new cases caused by the spread of the Delta variant will, unfortunately, lead to more breakthrough cases in the coming months. Dr. Chen of Mount Sinai said it will take several months before patients with long Covid from a breakthrough infection are enrolled in studies.“We’re waiting for these patients to show up at our doors,” Dr. Chen said.Despite the lack of data, one thing is clear: Getting vaccinated will reduce the risk of getting infected and getting long Covid, said Athena Akrami, a neuroscientist at University College London who collected and published data from nearly 4,000 long Covid patients after developing long Covid herself after a March 2020 bout with Covid-19“It’s simple math,” said Dr. Akrami. “If you reduce infections, then the likelihood of long Covid will drop automatically.”

Covid made things worse for many people with obsessive-compulsive disorder. But it also came with a silver lining.Most people behave in one or more ways that others may consider peculiar, and I am no exception. I want my clothes to match, from shoes to eyeglasses and everything in between (including underwear — a challenge when packing for a trip). If visitors use my kitchen, they’re asked to put things back exactly where they were found. In arranging my furniture, countertops and wall-hangings, I strive for symmetry. And I label packaged foods with their expiration dates and place them in my pantry in date order.I know I’m not the only one with quirks like these that others may consider “so O.C.D.,” a reference to obsessive-compulsive disorder. But the clinical syndrome, in which people have unbidden recurring thoughts that lead to repetitive habits, is far more than a collection of quirky behaviors. Rather, it is a highly distressing and chronic neuropsychological condition that can trigger serious anxiety and make it difficult to function well in school, at work or at home.For someone with O.C.D., certain circumstances or actions that most people would consider harmless, like touching a doorknob, are believed to have potentially dire consequences that require extreme corrective responses, if not total avoidance. A person may so fear germs, for example, that shaking someone’s hand can compel them to wash their own hand 10, 20 or even 30 times to be sure it’s clean.For many, the Covid-19 pandemic only made things worse. Past research has found a potential correlation between traumatic experience and increased risk of developing O.C.D., as well as worsening symptoms. A person with O.C.D. who already believes dangerous germs lurk everywhere would, understandably, have become paralyzed with anxiety by the spread of the novel coronavirus. And indeed, a Danish study published in October found that the early months of the pandemic resulted in increased anxiety and other symptoms in both newly diagnosed and previously treated O.C.D. patients aged 7 to 21. How serious is O.C.D.?The disorder often runs in families, and different members can be affected to varying degrees. Symptoms of the condition often begin in childhood or adolescence, afflicting an estimated 1 to 2 percent of young people and rising to about one in 40 adults. About half are seriously impaired by the disorder, 35 percent moderately affected and 15 percent mildly affected.It is not hard to see how the disorder can be so disruptive. A person with O.C.D. who is concerned that they may fail to lock the door, for example, may feel compelled to unlock and relock it over and over. Or they may become unduly stressed and anticipate disaster if a strict routine, like switching a light on and off 10 times, is not followed before leaving a room. Some people with O.C.D. are plagued by taboo thoughts about sex or religion or by a fear of harming themselves or others.The comedian Howie Mandel, now 65, told MedPage Today in June that he has suffered from O.C.D. since childhood, but wasn’t officially diagnosed until many years later after spending most of his life “living in a nightmare” and struggling with an obsession about germs. He has been working to help counter the stigma of mental illness and increase public understanding of O.C.D. in hopes that greater awareness of the disorder will foster early recognition and treatment to avert its life-impairing effects.How is O.C.D. treated?“Until the mid-1980s, O.C.D. was considered untreatable,” said Caleb W. Lack, a professor of psychology at the University of Central Oklahoma. But now, he said, there are three evidence-based therapies that may be effective, even for the most severely afflicted: psychotherapy, pharmacology and a technique called transcranial magnetic stimulation, which sends magnetic pulses to specific areas of the brain.Most patients are initially offered a form of cognitive behavioral therapy, called exposure and response prevention. Starting with something least likely to elicit anxiety — for example, showing a used tissue to people with an obsessive fear of contamination — patients are encouraged to resist a compulsive response, like repeated handwashing. Patients are taught to engage in “self-talk,” exploring the often irrational thoughts that are going through their heads, until their anxiety level declines.When they see that no illness has resulted from viewing the tissue, the therapy can progress to a more provocative exposure, like touching the tissue, and so forth, until they overcome their unrealistic fear of contamination. For especially fearful patients, this therapeutic approach is often combined with a medication that counters depression or anxiety.One silver lining of the pandemic is that it may have allowed more people to get treated remotely through online health services. “With telemedicine, we’re able to do very effective treatment for patients, no matter where they may live in relation to the therapist,” Dr. Lack said. “Without ever leaving central Oklahoma, I can see patients in 20 states. Patients don’t have to be within a 30-mile radius of the therapist. Telemedicine is a real game changer for people who won’t or can’t leave home.”For highly impaired O.C.D. patients for whom nothing else has worked, the latest option is transcranial magnetic stimulation, or T.M.S., a noninvasive technique that stimulates nerve cells in the brain and helps to redirect neural circuits that are involved in obsessive thoughts and compulsions.“It’s as if the brain is stuck in a rut, and T.M.S. helps the brain circuitry get on a different path,” Dr. Lack explained. As with exposure and response prevention, he said, T.M.S. uses provocative exposures, but combines them with magnetic stimulation to help the brain more effectively resist the urge to respond.In a study of 167 severely affected O.C.D. patients at 22 clinical sites published in May, 58 percent remained significantly improved after an average of 20 sessions with T.M.S. The Food and Drug Administration has approved the technique for treating O.C.D., though many insurance companies are not yet offering coverage.Where can I get help?Bradley Riemann, a psychologist at Rogers Behavioral Health System in Oconomowoc, Wisc., said his organization, which has 20 locations in nine states, relies on treatment teams that include psychologists, psychiatrists, nurses and social workers to provide both outpatient and inpatient treatment for O.C.D. patients as young as age 6. Too often, Dr. Riemann said, parents inadvertently reinforce the problem by clearing a path so that their child can avoid their obsessive fear and resulting compulsive response. For example, they might routinely open doors for a child fearful of contamination.The nonprofit International O.C.D. Foundation, based in Boston, can help patients and families find therapists and support groups for those struggling with the condition. A message can be left at 617-973-5801.

Robot-assisted surgeries have only modest advantages over other approaches, a large analysis found. Surgical procedures performed with the aid of a robot is sometimes marketed as the “best” form of surgery. But a recent review of 50 randomized controlled trials, testing robot-assisted surgeries against conventional methods for abdominal or pelvic procedures, suggests that while there may be some benefits to robotic surgery, any advantages over other approaches are modest.Robotic surgery is performed by surgeons, not robots. But instead of conventional hand-held tools used in laparoscopic surgery, which involves tiny incisions, and open surgery, in which the surgeon enters the body through a large incision, the doctor uses a machine. The surgeon controls the machine’s tools remotely by using joysticks and foot controls while viewing the surgical site through a high-definition monitor that provides a three-dimensional image of the procedure.Some surgeons believe that these robots allow more precision during the operation, shorter recovery time, and generally better clinical outcomes for patients. But the review found that in many ways, compared outcomes from the robotic and conventional procedures showed little difference. For example, in 39 studies that reported the incidence of complications requiring further surgical interventions, up to 9 percent of conventional laparoscopies led to such problems, but so did as much as 8 percent of robotic operations. In studies of gastrointestinal surgery, life-threatening complications ranged from 0 to 2 percent for robot-assisted surgery, from 0 to 3 percent for laparoscopy and from 1 to 4 percent for open surgeries. The findings were published in Annals of Internal Medicine.For various reasons, sometimes robot-assisted or laparoscopic surgeries do not work, and the surgeon must switch to doing an open operation. Overall, this happened up to 8 percent of the time in robotic operations and as much as 12 percent in laparoscopies. In urologic and gynecologic surgeries, there was almost no difference between robot-assisted operations and laparoscopies in the number of operations that had to be switched to open procedures.Long-term outcomes of at least two years were reported in eight of the reviewed studies, and they found that mortality rates were similar in all three techniques. In up to 3 percent of robotic surgeries and 5 percent of open surgeries, the patient died. There were no deaths in laparoscopic procedures.The researchers did find some time differences between the procedures, however. In short, robot-assisted surgeries generally take longer. In studies of gynecological robotic surgeries, duration ranged as high as 265 minutes, compared with maximums of 226 minutes for laparoscopy and 187 for open procedures. In both urologic and colorectal operations, robot-assisted surgeries were consistently longer than comparable laparoscopic and open operations.The lead author, Dr. Naila H. Dhanani, a surgical resident at UT Health in Houston, said that for a patient, there is no reason to choose robotic surgery over other modes.“Just because something’s new and fancy doesn’t mean it’s the better technique,” she said. “Yes, robotic is safe, we’ve proven that. But we haven’t proven it’s better. There were four studies that showed a benefit with robotic surgery, so that’s quite modest. Forty-six showed no difference at all.”Dr. James A. Eastham, chief of urology at Memorial Sloan Kettering Cancer Center, who was not involved in the study, agreed.“No one would argue with the primary conclusions,” he said. “The intra-operative complication rates and postoperative outcomes are similar regardless of surgical approach. It is far more important to select an experienced surgeon with specialization in a particular field rather than picking a technique.”But there are certainly practical benefits for the surgeon. Operations can last for hours, and in conventional procedures the surgeon has to remain standing, bending, twisting and turning to move the tools into the right position. Not so with a robotic procedure.“There is this ergonomic advantage,” said Dr. Gerard M. Doherty, surgeon-in-chief at Brigham and Women’s Hospital in Boston who had no part in the study. “We move the arms of the robot while sitting comfortably. I have one surgeon who told me it will extend his career by a decade.”But robotic surgery is more expensive than other methods. The initial cost of the machines, the disposable instruments they require, the contracts for servicing the devices and the extra time spent in operating rooms make them so expensive that many hospitals cannot use them. The average initial cost of a robotic setup is about $2 million.Even in large health care centers, robots have their limitations. “We have 64 operating rooms, and only four of them have robots in them,” Dr. Doherty said.One company, Intuitive Surgery, which makes the da Vinci robots, has such a dominant market presence in the United States that they are essentially without competition, and this may be a factor in keeping the prices high. But more competition may be coming.“I’ve seen robots made by other companies,” Dr. Doherty said. “Everyone’s hope is that if someone can bring a new platform in, then prices will come down. But we’ve been saying that for a decade. Intuitive has been pretty aggressive about maintaining their market.”In any case, according to Dr. Eastham, the future of surgery is robotic. “Despite the lack of evidence that robotics is ‘better’ than true laparoscopy or open surgery,” he said, “there is no question that in the U.S., the shift to robotics has already occurred.”

WASHINGTON — The Biden administration admonished the Republican governors of Texas and Florida on Friday for blocking local school districts from requiring masks or taking other measures to protect students from the coronavirus in the coming school year.The secretary of education, Miguel Cardona, sent a pair of letters to the governors and their education commissioners, writing that he was concerned about recent executive actions taken by both governors.Those orders, he wrote, prohibited districts from “voluntarily adopting science-based strategies for preventing the spread of Covid-19 that are aligned with the guidance from the Centers for Disease Control and Prevention,” like universal masking. The letters were made public late Friday.The debate over whether local school districts should be able to require masks has become highly partisan. Republicans have cast mask rules as an infringement on parental rights, while Democrats have said they are a matter of public health.Last week President Biden also sharply criticized Republican governors like Gov. Ron DeSantis of Florida and Gov. Greg Abbott of Texas who had banned mask mandates, saying they “are passing laws and signing orders that forbid people from doing the right thing.”“If you aren’t going to help, at least get out of the way,” Mr. Biden said.In one letter released Friday, Dr. Cardona criticized Governor DeSantis for threatening this week to withhold the salaries of district superintendents or school board members who defied his order.The education secretary noted that the American Rescue Plan Act passed by Congress allocated more than $7 billion to the state for safety measures. None of the money has been made available to local districts, Dr. Cardona wrote, and it could be used to pay the salaries of school officials.“In fact, it appears that Florida has prioritized threatening to withhold state funds from school districts that are working to reopen schools safely rather than protecting students and educators and getting school districts the federal pandemic recovery funds to which they are entitled,” Dr. Cardona wrote.In his letter to Texas officials, Dr. Cardona criticized Governor Abbott’s executive order blocking mask rules in schools as well as other state guidance that makes contract-tracing optional.Dr. Cardona said Governor Abbott’s order “may infringe upon a school district’s authority to adopt policies to protect students and educators as they develop their safe return to in-person instruction plans required by federal law.”The offices of Governor DeSantis and Governor Abbott did not immediately respond to a request for comment.He suggested that the state’s actions might imperil its federal relief funding. The policies, he wrote, appeared to “restrict the development of local health and safety policies and are at odds with the school district planning process,” which are required under the Education Department’s rules for receiving the relief funding.Dr. Cardona said his department’s rules emphasize that districts have discretion over how to use their funding, and that contact tracing, indoor masking policies, and other C.D.C recommendations are permitted and encouraged.Dr. Cardona added that the Biden administration would “continue to closely review and monitor” whether both states were meeting requirements under federal funding laws.Dr. Cardona also expressed support for districts in both states that have defied the governors’ orders.“The Department stands with these dedicated educators who are working to safely reopen schools and maintain safe in-person instruction,” he wrote.

Thousands of COVID-19 cases and deaths in California, Oregon, and Washington between March and December 2020 may be attributable to increases in fine particulate air pollution (PM2.5) from wildfire smoke, according to a new study co-authored by researchers at Harvard T.H. Chan School of Public Health.
The study is the first to quantify the degree to which increases in PM2.5 pollution during the wildfires contributed to excess COVID-19 cases and deaths in the U.S. It was published online August 13, 2021, in Science Advances.
“The year 2020 brought unimaginable challenges in public health, with the convergence of the COVID-19 pandemic and wildfires across the western United States. In this study we are providing evidence that climate change — which increases the frequency and the intensity of wildfires — and the pandemic are a disastrous combination,” said Francesca Dominici, Clarence James Gamble Professor of Biostatistics, Population and Data Science at Harvard Chan School and senior author of the study.
In 2020, at the same time the nation was contending with the COVID-19 pandemic, huge wildfires swept across the western U.S., including some of the largest ever in California and Washington. Wildfires produce high levels of fine particulate matter (PM2.5), which has been linked with a host of negative health outcomes, including premature death, asthma, chronic obstructive pulmonary diseases (COPD), and other respiratory illnesses. In addition, recent studies have found a link between short- and long-term exposure to PM2.5 and COVID-19 cases and deaths.
The researchers — from Harvard Chan School, the John A. Paulson School of Engineering and Applied Sciences at Harvard University, and the Environmental Systems Research Institute in Redlands, Calif. — built and validated a statistical model to quantify the extent to which wildfire smoke may have contributed to excess COVID-19 cases and deaths in California, Oregon, and Washington, three states that bore the brunt of the 2020 wildfires. They looked at the connection between county- and daily-level data on PM2.5 air concentrations from monitoring data, wildfire days from satellite data, and the number of COVID-19 cases and deaths in 92 counties, which represented 95% of the population across the three states. The researchers accounted for factors such as weather, population size, and societal patterns of social distancing and mass gatherings.
The study found that from August 15 to October 15, 2020, when fire activity was greatest, daily levels of PM2.5 during wildfire days were significantly higher than on non-wildfire days, with a median of 31.2 micrograms per cubic meter of air (µg/m3) versus 6.4 (µg/m3). In some counties, the levels of PM2.5 on wildfire days reached extremely high levels. For instance, from September 14 to September 17, 2020, Mono County, Calif., experienced four days in a row with PM2.5 levels higher than 500 µg/m3 as a result of the Creek Fire. Such levels are deemed “hazardous” by the U.S. Environmental Protection Agency.

While some types of RNA viruses cloak themselves to hide inside a cell and create copies of themselves, a “detective enzyme” might be attuned to their whereabouts. A slight variation in their genomic code gives some people’s cells the capacity to produce this sensor.
Many positive-strand RNA viruses share a strategy to avoid detection by a cell’s immune system until they can increase their numbers. Among them are the SARS-CoV-2 virus, flaviviruses such as West Nile and Zika, as well as the picornaviruses behind polio and some heart and brain inflammation.
After invading a cell, these types of viruses take over part of an intracellular membrane, within the system of membranes that form compartments within the cell. The viruses use this modified organelle as a refuge for replicating themselves. Their viral products are thereby shielded from most of the cell’s innate immune sensors.
A new study looks at how a variant of the enzyme, oligoadenylate synthetase 1, targets the hiding spots of these viruses. This isoform of the enzyme is called OAS1 p46. The OAS family of sensors are prompted by interferon to seek out RNA viruses or their locations. This reconnaissance helps the cell defend against the attack.
Although much research has documented the importance of OAS proteins in activating an enzyme that cleaves viral RNA in order to block a variety of different viruses from replicating, little is known about how individual OAS proteins contribute to this breadth of antiviral activity.
Most of a cell’s RNA virus sensors are deployed to detect viruses within the cytosol that is between the nucleus and the outer membrane of the cell. They sense viral RNA that accumulates in the cytosol during infection.

A day after the F.D.A. authorized third doses of the Pfizer-BioNTech and Moderna vaccines for some immunocompromised people, an independent expert panel advising the C.D.C. recommended the move.WASHINGTON — An independent panel advising the Centers for Disease Control and Prevention on Friday recommended third doses of coronavirus vaccine for certain people with weakened immune systems, giving its support to the Food and Drug Administration’s authorization of the extra shots.The F.D.A. on Thursday cleared third doses for people with solid organ transplants and others with similarly weakened immune systems, who face a higher risk of severe bouts of Covid-19.After nearly three hours of presentations and discussion on Friday, the C.D.C. committee, made up of medical experts, voted unanimously to recommend third shots for people in the category who have already received the two-dose vaccines made by Pfizer-BioNTech or Moderna.While the panel’s guidance is nonbinding, it is followed closely by physicians and public health departments. Dr. Rochelle Walensky, the director of the C.D.C., quickly signed off on the recommendation, calling it “an important step in ensuring everyone, including those most vulnerable to Covid-19, can get as much protection as possible from Covid-19 vaccination.”About three percent of Americans have weakened immune systems for a variety of reasons, from a history of cancer to the use of certain medications such as steroids.Dr. Neela D. Goswami, a C.D.C. official, said the group now eligible for third shots could include those with advanced or untreated H.I.V. infections, those who have undergone certain types of stem cell transplants within the past two years and those receiving certain kinds of chemotherapy, among others.Those slated for treatments that weaken the immune system should get a third dose beforehand, Dr. Goswami said. Everyone eligible for a third shot should wait at least 28 days after their second before getting it, according to the C.D.C.Dr. Dorry L. Segev, a transplant surgeon at Johns Hopkins University who has researched the impact of third doses in transplant recipients, praised the C.D.C. for putting out a more detailed guidance on who should receive a third shot.“It is incredibly difficult to come up with clearly delineated criteria for who should be getting” a third shot among those with weakened immune systems, he added.Dr. Jose U. Scher, a rheumatologist at NYU Langone Health who has studied the effect of vaccines on the immunocompromised, said that the C.D.C. vote — and the guidance from its experts — would help patients who had been agonizing over whether to seek out a third shot. Previously, he said, when people tested themselves for antibodies after vaccination and came up empty, “there were no tools for us to respond to that.”“We now know that this population was being left behind,” he said.Immunocompromised people will not need a doctor’s permission or a prescription to get a third shot, C.D.C. officials said. They will need only to attest that they meet the eligibility requirements for an additional dose. Anyone else, including people with chronic medical conditions, like diabetes or asthma, should not be getting third shots at this point, they said.Dr. Scher predicted that this honor-system approach could be messy. “I don’t know if there’s any way of corroborating someone’s claim” of being immunocompromised, he said. Requiring some kind of proof, such as a doctor’s note, would be a better process, he said.The updated F.D.A. authorizations do not apply to immunocompromised people who received the single-dose Johnson & Johnson vaccine. The C.D.C. panel did not offer recommendations on additional shots for that group, which is believed to be small. But the lack of guidance from either the F.D.A. or C.D.C. has left that group in limbo..css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-3btd0c{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:1rem;line-height:1.375rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-3btd0c{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-3btd0c strong{font-weight:600;}.css-3btd0c em{font-style:italic;}.css-w739ur{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-family:nyt-cheltenham,georgia,’times new roman’,times,serif;font-weight:700;font-size:1.375rem;line-height:1.625rem;}@media (min-width:740px){#NYT_BELOW_MAIN_CONTENT_REGION .css-w739ur{font-size:1.6875rem;line-height:1.875rem;}}@media (min-width:740px){.css-w739ur{font-size:1.25rem;line-height:1.4375rem;}}.css-9s9ecg{margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}.css-uf1ume{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-pack:justify;-webkit-justify-content:space-between;-ms-flex-pack:justify;justify-content:space-between;}.css-wxi1cx{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-self:flex-end;-ms-flex-item-align:end;align-self:flex-end;}.css-12vbvwq{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-12vbvwq{padding:20px;width:100%;}}.css-12vbvwq:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-12vbvwq{border:none;padding:10px 0 0;border-top:2px solid #121212;}.css-12vbvwq[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-12vbvwq[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-12vbvwq[data-truncated] .css-5gimkt:after{content:’See more’;}.css-12vbvwq[data-truncated] .css-6mllg9{opacity:1;}.css-qjk116{margin:0 auto;overflow:hidden;}.css-qjk116 strong{font-weight:700;}.css-qjk116 em{font-style:italic;}.css-qjk116 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:visited{color:#326891;-webkit-text-decoration-color:#326891;text-decoration-color:#326891;}.css-qjk116 a:hover{-webkit-text-decoration:none;text-decoration:none;}“We do understand the challenges here, and because of that we will continue to work very diligently to try to have a solution,” Dr. Peter Marks, the F.D.A.’s top vaccine regulator, said at the panel’s meeting. The F.D.A. is waiting on more data that it expects to receive this month, including Johnson & Johnson’s clinical trial data on the safety and efficacy of two doses.Dr. Kathleen Dooling, a C.D.C. official, said that patients who qualify for a third dose should ideally seek out the vaccine they already received, but that they could take the other two-dose vaccine if necessary.Presenting studies that supported giving third doses, Dr. Dooling emphasized that immunocompromised people who receive a third dose should still wear a mask, maintain social distancing with people they do not live with, and avoid crowds and poorly ventilated indoor spaces. She said that people with weakened immune systems had also been shown to be at greater risk of breakthrough infection.But Dr. Dooling said that early studies of how some immunocompromised people responded to third doses made clear that there could be some benefit. One such randomized, placebo-controlled study of more than 100 organ transplant recipients found that patients who received a third shot of Moderna’s vaccine two months after a second dose showed marked increases in antibody levels.Dr. Dooling also cited observational studies of solid-organ transplant recipients and patients on hemodialysis, which showed that people who had no detectable antibody response to their initial two doses did have one after a third dose.Studies have also shown that third doses are safe.The recommendation from the panel, the Advisory Committee on Immunization Practices, comes as health officials grapple with whether people who were vaccinated early in the nation’s inoculation campaign may need booster doses soon, a move that scientists and public health experts argue is not yet supported by data. Officials at the C.D.C. and F.D.A. have been careful to frame the authorization of third doses for people with weakened immune systems as a separate issue.“Other individuals who are fully vaccinated are adequately protected and do not need an additional dose of Covid-19 vaccine at this time,” Dr. Janet Woodcock, the acting F.D.A. commissioner, said in a statement on Thursday announcing the authorization, adding that the agency was “actively engaged in a science-based, rigorous process with our federal partners” to consider whether booster doses may be needed.Some are taking matters into their own hands. Just over a million people who received a two-dose vaccine in the United States have already received a third dose, Dr. Dooling told the C.D.C. panel on Friday.

Last month, three states — Virginia, South Dakota and Connecticut — joined the ranks of more than a dozen others that have legalized marijuana — also known as cannabis — for recreational use. Yet, despite these changing laws and growing social acceptance of the drug, a new study finds that use is still lower among cancer patients.
The study, published today in the journal Cancer by researchers at Virginia Commonwealth University Massey Cancer Center, analyzed data from nearly 20,000 people over a span of four years and found that reports of marijuana use peaked at 9% for cancer patients, compared to 14% among people with no cancer history.
“Even when we looked at whether someone used cannabis over the four years of observation and we control for things like age and race, cancer patients are still not increasing their use over time like the general population,” said study lead author Bernard Fuemmeler, Ph.D., M.P.H., associate director for population science and interim co-leader of the Cancer Prevention and Control research program at VCU Massey Cancer Center. “I would have expected them to have at least mirrored what was happening in the general population.”
This paper drew on data collected between 2013 and 2018 from the Population Assessment of Tobacco and Health (PATH), which tracks a representative sample of Americans to survey smoking behaviors, including both tobacco and marijuana.
For people who never had cancer, rates of marijuana use rose during the four-year PATH study period. This same period saw a wave of recreational marijuana legalization sweep across the nation.
“Because of law enforcement changing, we expect to see changes in attitudes and perceived benefits and harms,” said study co-author Sunny Jung Kim, Ph.D., Harrison Scholar at VCU Massey Cancer Center and assistant professor of health behavior and policy at the VCU School of Medicine. “This work gives us perspective on prevalence of cannabis use among cancer patients and how it has changed over time.”
But why aren’t cancer patients following the same trend as the rest of the population? The odds of a cancer patient using marijuana in the past year were essentially flat between 2013 and 2018.

A study of microbial populations under a prolonged period of starvation by Indiana University professor Jay T. Lennon and his laboratory could help researchers answer questions pertaining to chronic infections, the functioning of bacteria in the environment and the persistence of life itself.
In a paper published online Aug. 12 by the Proceedings of the National Academy of Sciences of the United States of America, Lennon and his colleagues explain their study of about 100 populations of different bacteria in closed systems, which had no access to external food for 1,000 days. The team tracked how long they survived, and almost all of them persisted.
“The larger question of how bacteria survive long periods of energy limitation is relevant to understanding chronic infections in humans and other hosts, and is related to how some pathogens tolerate drugs like antibiotics,” said Lennon, a professor in the Department of Biology in the College of Arts and Sciences.
Many bacterial infections are difficult to treat, in part, because drugs are often designed to target the cellular machinery of metabolically active cells. Energy-limited bacteria often enter a quiescent, or dormant, state that makes them less sensitive to drug treatments, Lennon said. Not only can the pathogens persist under such conditions, the populations can also evolve antibiotic resistance, making the problem worse.
Microbes also play an important role in the environment. The bacteria in the study came from agricultural soils. In those habitats, Lennon said, microbes form symbiotic relationships with plants, and they carry out processes that are essential for the functioning of ecosystems, such as carbon sequestration, nutrient cycling and greenhouse gas emissions.
A major and unresolved question is how billions of microbial cells and thousands of microbial taxa coexist in a single gram of soil, often under harsh environmental conditions. One explanation supported by the research is that microbes seem to be well-adapted to feast-or-famine conditions, where resources can be in short supply for extended periods. This may help explain how complex microbial communities are maintained over time.
In the study, Lennon and his colleagues estimated that bacteria, which are the fastest-reproducing organisms on the planet, can also be extremely long-lived. Lennon and his team, including former Indiana University doctoral student William Shoemaker, estimated that energy-limited bacteria can have lifespans that rival, and in some cases exceed, those of plants and animals. The study used survival analyses to estimate that some populations have extinction times of up to 100,000 years.
“Obviously, these predictions extend far beyond what can be measured,” Lennon said, “but the numbers are consistent with the ages of viable bacteria that have been recovered from ancient materials, such as amber, halite crystals, permafrost and sediments at the bottom of the deepest oceans.”
The persistence of microbes under such conditions likely involves dormancy and other mechanisms that conserve energy. For example, Lennon and colleagues found that the survival of cells in their closed system was sustained by the ability of bacteria to “scavenge” their dead relatives.
Under these lean conditions, where cells must eke out a living on vanishingly small quantities of food, Lennon and his team were curious about the potential for bacteria to evolve. They identified genes that were under negative selection, but also signatures of positive selection, which indicate cryptic growth that allowed new mutations to increase in frequency. This finding suggests that the recycling of dead cells has the potential to fuel adaptive evolution. Such observations are relevant for understanding the constraints on fundamental biological processes given that large swaths of the planet are energy limited.
This work was funded by the National Science Foundation, the U.S. Army Research Office and the National Aeronautics and Space Administration.