Publisher Health

Many Americans increased their alcohol intake during the pandemic, with women and parents of young children disproportionately affected.For most of her life, Andrea Carbone, a 51-year-old paralegal living in Florida, wasn’t a big drinker. But when the pandemic struck, she worried constantly about her job, her health and the safety of her children.While many people were able to work from home last year, Ms. Carbone, was required to go into the office. Some mornings she would cry in her car as she drove along deserted roads and highways to get to her office in downtown Tampa, which looked, she said, “like a ghost town.”As her stress levels soared, so did her alcohol intake. Before the pandemic, Ms. Carbone would have a glass of red wine with dinner most nights. But by May, her intake had climbed substantially. “I noticed I was having a glass of wine as soon as I got home, then a glass with dinner, then we’d sit down to watch TV and I’d have another glass or two,” she said. “By the end of the night I was drinking a bottle.”Ms. Carbone is far from alone. The widespread fear, frustration and social isolation surrounding the tumultuous events of the past year — the pandemic, civil unrest, political upheaval — caused stress levels to skyrocket, with many people increasing their alcohol intake. Women and parents of young children seem to have been hit particularly hard. A nationwide survey commissioned by the American Psychological Association in February found that one in four adults reported drinking more this past year to manage their stress. That rate more than doubled among those who had children between the ages of 5 and 7.Another study published in JAMA Network Open in October found that Americans increased the frequency of their alcohol consumption by 14 percent compared to a year earlier. But the same study found a 41 percent increase in the number of days on which women drank heavily, defined as having four or more drinks in a couple of hours.“Women have disproportionately left the labor force entirely compared to men; they have disproportionately taken on the work around the house, the child care, and the child’s education,” said Michael S. Pollard, the lead author of the JAMA study and a senior sociologist at the RAND Corporation. “So, it stands to reason that women would increase their alcohol use disproportionately as well.”The psychological damage from the past year has caused sharp declines in physical health, including widespread weight gain and disruptions in sleep. Hospitals around the country have reported an increase in admissions for hepatitis, cirrhosis, liver failure and other forms of alcohol-related diseases. Almost no group has been spared.Driftwood Recovery, an addiction and mental health rehabilitation center in Texas, has had so many requests for treatment this past year that it has a two-month waiting list. Vanessa Kennedy, Driftwood’s director of psychology, said that many of her clients are parents who started drinking heavily as they struggled to balance their day jobs with home-schooling and other parental responsibilities.“They’re used to having their kids go off happily to school and having an experienced teacher teach their children while they go to work and focus on performing well and providing financial support for their family,” said Dr. Kennedy. “Their work roles are conflicting with their parenting roles, and it’s been difficult for them to create space and do those things well.”Dr. Kennedy has treated a wide range of patients who turned to excessive drinking this past year. Some lost their jobs or shuttered their businesses, which left them without daily structure and the means to provide for their families. Others were college students who felt socially disconnected when they were sent home to do virtual schooling, or older adults who drank because they were depressed that they could not see their loved ones or hug their grandchildren.Before last year, Gordon Mueller, a retiree who lives in Rochester, N.Y., rarely consumed more than one or two drinks a day. But when the pandemic struck and the economy and stock market stumbled, Mr. Mueller was consumed by anxiety as he followed the news and worried about his retirement account. As Mr. Mueller sheltered in place at home with his wife, his alcohol intake escalated to seven drinks a day: vodka cocktails in the afternoon, wine with dinner, and a whisky nightcap before bed. “We had no idea if we were going to financially get through this thing, let alone get sick and potentially die,” he said. “It was just a lot of fear and boredom. Those were the two emotions.”Ms. Carbone now uses an app to track her alcohol intake and has at least two “dry” days a week.Zack Wittman for The New York TimesBut many people have found novel ways to rein in their drinking. In December, Mr. Mueller turned to Moderation Management, an online community that helps people who want to cut back on their drinking but not necessarily abstain. He started attending Zoom calls with other members and using the organization’s private Facebook group to learn tips and advice to reduce his drinking. Then, in January, he decided to give up alcohol for a while to see how he would feel.“I’m happy to say that I haven’t had a drink this year, and I feel a lot better: I sleep better, and I can get more things done,” he said. “The nice thing about this moderation group is that it’s not an all-or-nothing ‘You can never drink again or you’re a failed alcoholic’ approach.”In Tampa, Ms. Carbone started using a popular app called Cutback Coach, which helps people track their alcohol intake and set goals and reminders so they can develop healthier drinking habits. Using the app, Ms. Carbone makes a plan for how much she will drink each week. The app tracks her daily intake, sends her notifications about her goals, and updates her on her progress, including all the calories she avoided and the money she saved by drinking less. She now has at least two “dry” days per week and has cut her drinking in half.“Seeing the progress that I’ve made makes me feel good and makes me keep doing it,” she said. “I sleep a lot better. I wake up less at night. I wake up feeling less sluggish, less tired, and I’ve been going to the gym more regularly, whereas before I couldn’t drag myself there.”For people who want to reduce their drinking, here are some simple tips that might help.Try PrecommitmentRather than relying on willpower alone, make a plan every Sunday to limit your drinking to a specific amount each day of the week and stick to it. This is a tactic known as precommitment, which Cutback Coach uses to help its thousands of members. The idea behind it is that you increase your chances of success by committing to a plan and restricting your ability to back out later on. Some other examples of precommitment are deciding not to keep junk food in your house and encouraging yourself to exercise by scheduling a workout with a friend. Studies show that precommitment is an effective way to change behavior.Find Social SupportTalk to your spouse, a friend or a family member about your plan to drink less. They can hold you accountable and help you find healthier ways to manage your stress. Make a plan to go for a walk with your friend or partner at the end of the day, for example, instead of opening a bottle. “You might find that you have a buddy who says, ‘why don’t we go play tennis or do something else to unwind after work,’” said Dr. Kennedy. “There are a lot of benefits to trying healthy activities instead of the wine.”Create ObstaclesSet up rules to slow your drinking. Mary Reid, the executive director of Moderation Management, follows a simple rule that helps her avoid drinking heavily: Each glass of wine she drinks has to last at least one hour. “My strongest tool is timing my drinks,” she said. “We always tell new members that we do have stop buttons, but we just ignore them.” Dr. Kennedy at Driftwood employs a similar rule. She tells people to alternate every alcoholic drink they have with a glass of water.Change Your RoutineSome people drink more out of habit than an actual desire for alcohol. Try substituting sparkling water or another beverage for your usual drink. Mr. Mueller used to have a cocktail every night while watching the evening news. But when he cut back on alcohol, he switched to drinking a cup of tea or nonalcoholic beer while watching the news and realized he just needed a beverage to sip. “Now I still have a glass in my hand but it doesn’t have alcohol,” he said. “It’s almost like having a glass in your hand is the habit and not the alcohol.”

“This crisis affects more or less everyone, and poetry can help us process difficult feelings like loss, sadness, anger, lack of hope.”Many, perhaps most, of us have spent this past year struggling to find ways to mourn the losses, weather the stresses and revive the pleasures stolen by the Covid-19 pandemic. We’ve monitored Zoom funerals, weddings, graduations, christenings, bar and bat mitzvahs, alternately laughing and weeping at inanimate screens as we tried to make sense of a world turned upside down.But I wonder how many have turned to poetry as a source of comfort, release, connection, understanding, inspiration and acceptance. This being National Poetry Month, there’s no better time than the present to do so.One person who has long valued poetry as both a personal and professional aid is Dr. Norman Rosenthal, a psychiatrist in Rockville, Md., who pioneered the use of light therapy for seasonal affective disorder. A clinical professor of psychiatry at Georgetown Medical School, Dr. Rosenthal said he has used poems as a therapeutic assistant, with rewarding results among his patients.“I have loved poetry ever since I was able to read, and it has been a personal source of comfort and solace to me at different times in my life,” he told me. “As a therapist, I have collected poems along the way that I thought had the power to heal, inspire or, at the very least, bring joy.”Now anyone can access and benefit from the short poems he has found to be so therapeutic and the soul-restoring messages he has gleaned from them. Dr. Rosenthal has compiled them in a new book, “PoetryRx: How 50 Inspiring Poems Can Heal and Bring Joy to Your Life,” complete with helpful takeaways and discussions of the circumstances under which they were written. (The book will be published next month by Gildan Media.)While we herald vaccines as potential saviors from the threat of a devastating virus, Dr. Rosenthal said, “Poetry can serve as a vaccine for the soul.” In a world that is so marred by loss and deprived of pleasure, he believes poetry can help fill in the gaps, offering a brief retreat from a troubled world and hope for a better future.For Margaret Shryer, a Minnesota great-grandmother, poetry has been like a good friend, a reliable source of inspiration and consolation that has helped her remain sane during the many Covid months mostly confined to her apartment in a senior residence.“Poetry generally picks me up,” she told me. “There’s a nugget of truth in every poem, and I flip through them to find ones that resonate with me and will get me going. I read them aloud. Every time you go back to a poem, you read it with a different set of ears. To people who think they don’t like poetry or understand it, I say ‘What about lyrics? That song you love? That’s poetry.’ Some of the most moving poetry can be found in lyrics.”I used to believe that poetry did not “speak” to me, but I now see how wrong I was. I lived for 44 years with a husband, a lyricist, whose beautifully crafted, heartfelt lyrics touched my every fiber and continue to uplift and inspire me a decade after his death. The special beauty of Dr. Rosenthal’s book for me is his discussion of what each poem is saying, what the poet was likely feeling and often how the poems helped him personally, as when he left his birth family in South Africa for a rewarding career in the United States.Amanda Gorman’s inspired and inspiring poem that stole the show at President Biden’s inauguration in January has shown millions of Americans the emotional and social power of poetry and, I hope, prompted them to use it themselves.On her blog, Diana Raab, a psychologist, poet and author in Santa Barbara, wrote that “poetry can help us feel as if we’re part of a larger picture and not just living in our isolated little world. Writing and reading poetry can be a springboard for growth, healing and transformation. Poets help us see a slice of the world in a way we might not have in the past.”Dr. Rafael Campo, a poet and physician at Harvard Medical School, believes poetry can also help doctors become better providers, fostering empathy with their patients and bearing witness to our common humanity, which he considers essential to healing. As he put it in a TEDxCambridge talk in June 2019, “When we hear rhythmic language and recite poetry, our bodies translate crude sensory data into nuanced knowing — feeling becomes meaning.”According to Dr. Robert S. Carroll, a psychiatrist affiliated with the University of California, Los Angeles, Medical Center, poetry can give people a way to talk about subjects that are taboo, like death and dying, and provide healing, growth and transformation.Referring to the pandemic, Dr. Rosenthal said, “This crisis affects more or less everyone, and poetry can help us process difficult feelings like loss, sadness, anger, lack of hope. Although not everyone has a gift for writing poetry, all of us can benefit from the thoughts so many poets have beautifully expressed.”Indeed, the book’s first section features the poem “One Art” by Elizabeth Bishop, about loss that can comfort those who are suffering. She wrote:Even losing you (the joking voice, a gestureI love) I shan’t have lied. It’s evidentthe art of losing’s not too hard to masterthough it may look like (Write it!) like disaster.“When people are devastated by loss they should be allowed to feel and express their pain,” Dr. Rosenthal said in an interview. “They should be offered support and compassion, not urged to move on. You can’t force closure. If people want closure, they’ll do it in their own time.”Closure was not a state cherished by Edna St. Vincent Millay, who wrote that“Time does not bring relief; you all have liedWho told me time would ease me of my pain!”However, Dr. Rosenthal pointed out that for most people, time does bring relief, despite what his friend Kay Redfield Jamison wrote in her memoir “An Unquiet Mind.” For her, relief “took its own, and not terribly sweet, time in doing so.”Poems, I now realize, thanks to Dr. Rosenthal, can be a literary panacea for the pandemic. They let us know that we are not alone, that others before us have survived devastating loss and desolation and that we can be uplifted by the imagery and cadence of the written and spoken word.

“This crisis affects more or less everyone, and poetry can help us process difficult feelings like loss, sadness, anger, lack of hope.”Many, perhaps most, of us have spent this past year struggling to find ways to mourn the losses, weather the stresses and revive the pleasures stolen by the Covid-19 pandemic. We’ve monitored Zoom funerals, weddings, graduations, christenings, bar and bat mitzvahs, alternately laughing and weeping at inanimate screens as we tried to make sense of a world turned upside down.But I wonder how many have turned to poetry as a source of comfort, release, connection, understanding, inspiration and acceptance. This being National Poetry Month, there’s no better time than the present to do so.One person who has long valued poetry as both a personal and professional aid is Dr. Norman Rosenthal, a psychiatrist in Rockville, Md., who pioneered the use of light therapy for seasonal affective disorder. A clinical professor of psychiatry at Georgetown Medical School, Dr. Rosenthal said he has used poems as a therapeutic assistant, with rewarding results among his patients.“I have loved poetry ever since I was able to read, and it has been a personal source of comfort and solace to me at different times in my life,” he told me. “As a therapist, I have collected poems along the way that I thought had the power to heal, inspire or, at the very least, bring joy.”Now anyone can access and benefit from the short poems he has found to be so therapeutic and the soul-restoring messages he has gleaned from them. Dr. Rosenthal has compiled them in a new book, “PoetryRx: How 50 Inspiring Poems Can Heal and Bring Joy to Your Life,” complete with helpful takeaways and discussions of the circumstances under which they were written. (The book will be published next month by Gildan Media.)While we herald vaccines as potential saviors from the threat of a devastating virus, Dr. Rosenthal said, “Poetry can serve as a vaccine for the soul.” In a world that is so marred by loss and deprived of pleasure, he believes poetry can help fill in the gaps, offering a brief retreat from a troubled world and hope for a better future.For Margaret Shryer, a Minnesota great-grandmother, poetry has been like a good friend, a reliable source of inspiration and consolation that has helped her remain sane during the many Covid months mostly confined to her apartment in a senior residence.“Poetry generally picks me up,” she told me. “There’s a nugget of truth in every poem, and I flip through them to find ones that resonate with me and will get me going. I read them aloud. Every time you go back to a poem, you read it with a different set of ears. To people who think they don’t like poetry or understand it, I say ‘What about lyrics? That song you love? That’s poetry.’ Some of the most moving poetry can be found in lyrics.”I used to believe that poetry did not “speak” to me, but I now see how wrong I was. I lived for 44 years with a husband, a lyricist, whose beautifully crafted, heartfelt lyrics touched my every fiber and continue to uplift and inspire me a decade after his death. The special beauty of Dr. Rosenthal’s book for me is his discussion of what each poem is saying, what the poet was likely feeling and often how the poems helped him personally, as when he left his birth family in South Africa for a rewarding career in the United States.Amanda Gorman’s inspired and inspiring poem that stole the show at President Biden’s inauguration in January has shown millions of Americans the emotional and social power of poetry and, I hope, prompted them to use it themselves.On her blog, Diana Raab, a psychologist, poet and author in Santa Barbara, wrote that “poetry can help us feel as if we’re part of a larger picture and not just living in our isolated little world. Writing and reading poetry can be a springboard for growth, healing and transformation. Poets help us see a slice of the world in a way we might not have in the past.”Dr. Rafael Campo, a poet and physician at Harvard Medical School, believes poetry can also help doctors become better providers, fostering empathy with their patients and bearing witness to our common humanity, which he considers essential to healing. As he put it in a TEDxCambridge talk in June 2019, “When we hear rhythmic language and recite poetry, our bodies translate crude sensory data into nuanced knowing — feeling becomes meaning.”According to Dr. Robert S. Carroll, a psychiatrist affiliated with the University of California, Los Angeles, Medical Center, poetry can give people a way to talk about subjects that are taboo, like death and dying, and provide healing, growth and transformation.Referring to the pandemic, Dr. Rosenthal said, “This crisis affects more or less everyone, and poetry can help us process difficult feelings like loss, sadness, anger, lack of hope. Although not everyone has a gift for writing poetry, all of us can benefit from the thoughts so many poets have beautifully expressed.”Indeed, the book’s first section features the poem “One Art” by Elizabeth Bishop, about loss that can comfort those who are suffering. She wrote:Even losing you (the joking voice, a gestureI love) I shan’t have lied. It’s evidentthe art of losing’s not too hard to masterthough it may look like (Write it!) like disaster.“When people are devastated by loss they should be allowed to feel and express their pain,” Dr. Rosenthal said in an interview. “They should be offered support and compassion, not urged to move on. You can’t force closure. If people want closure, they’ll do it in their own time.”Closure was not a state cherished by Edna St. Vincent Millay, who wrote that“Time does not bring relief; you all have liedWho told me time would ease me of my pain!”However, Dr. Rosenthal pointed out that for most people, time does bring relief, despite what his friend Kay Redfield Jamison wrote in her memoir “An Unquiet Mind.” For her, relief “took its own, and not terribly sweet, time in doing so.”Poems, I now realize, thanks to Dr. Rosenthal, can be a literary panacea for the pandemic. They let us know that we are not alone, that others before us have survived devastating loss and desolation and that we can be uplifted by the imagery and cadence of the written and spoken word.

In powering through discomfort, I became inured to it — until I figured out how to acknowledge what I actually wanted.This article is part of a series on resilience in troubled times — what we can learn about it from history and personal experiences.“You are miserable,” my boss said, as I murmured in faint protest. “Every day you come in here with that grumpy face, and you make me look at it.” Despite the harsh words, her tone was laced with love and concern. And she was right: The job was not a fit.I was a talent agent at a huge Hollywood agency in my 20s, representing emerging comedy actors. My role was to make my clients’ dreams come true. I loved that part — spotting talent, and getting them started on their journeys to fame and fortune — and I’m certain they would tell you now that I was good at it. But that was the only part that worked for me.I didn’t enjoy the stuff that was supposed to be fun. One partner noticed I was spending too little on my expenses, instead of schmoozing. After a movie premiere, I got a talking-to for going straight to my seat instead of walking the red carpet with the cast, a ritual that made me want to evaporate, every time.“There are parts of the job you clearly find icky,” my boss continued, as she watched me curl into a nauseated ball on her love seat. “But you have to think about whether you can tolerate them, in order to enjoy the parts you like.”Mental health professionals like to say that we’re all floating around the world like little rubber bands: We encounter a challenge, which makes us stretch, grow and bounce back. That’s how resilience is meant to work.But that all assumes that hard times end. What if there’s always something else? What if you go through a year as relentless as this last one has been for so many of us: illness, death, home-schooling, job losses, systems crumbling left and right? An entire year of hobbling around with two flat tires but only one spare, praying for an uneventful day or two, until the next tire blows?What happens is that you get used to it — something with which I am all too familiar. Tolerating things I didn’t enjoy was, for a long time, my superpower, one I had cultivated after an eventful childhood. By many metrics my upbringing was blissful: boundless love, laughter, globe-trotting adventures. But I also know change and trauma, having moved over 30 times over three decades, across a childhood punctuated by dramatic loss, including violent conflict in my homeland, Kashmir, and the death of my beloved grandfather. My little rubber band eventually settled, taut and brittle, seemingly forever. In powering through the discomfort of constant change, I became inured to it.Resilience without any waning period, turned into endurance, and I became adept at snuffing out my own vulnerability and discomfort before I even felt it. I grew into someone who could live anywhere, befriend anyone, be anyone, do anything — the harder, the better.And it was these exact qualities that garnered praise. “You don’t have to worry about her,” people told my parents, and everyone swelled with pride. If no one understood me, I’d learn a new language. If my accent was a barrier, then — poof! — all of a sudden, I sounded American. If my bank balance was negative $900 one month, I’d figure out how to reverse it.I chased the high of conquering things that seemed impossible, which led me to the entertainment industry. Cracking the codes to its impenetrable world made me think I was winning, then thriving, until those conversations with my boss began to shatter that perception. I realized I had a dream job — it just wasn’t mine.When she suggested that I could be happier, that I could envision the right life for me and go get it, my mind was blank. I had been ignoring my feelings in favor of crossing off the next goal, through college, law school, a prestigious job. My itinerant childhood wired me to pursue stability above all, but what were my dreams? “Don’t you want to write some books, maybe have a couple kids?” she said, casually, and I froze. It sounded perfect. But the idea of actively seeking happiness was terrifying. What if I failed?I had spent so long buffeted by the waves of external events that once they went quiet I didn’t know what to do. Technically, a lifetime of endurance had convinced that me I was so tough that I could handle anything. But I didn’t want to. So for the first time, I allowed myself to say so. I didn’t know if there was a professional pursuit that might make me happier, but that one was worth seeking.I knew only that my true love was reading, and writers. I knew words on a page made me happy, and I went looking for more of that feeling. The joy I felt discussing ideas, helping mold those ideas into a script, then onscreen, became my new pursuit. It suddenly felt so silly, so luxurious, not to be in pure survival mode — to have made the space to think about what was good for me.I got into producing, and had a baby. But soon I felt that old dissatisfaction creep in again, the one that I was making other people’s dreams come true but not my own. And this time I trusted my feelings enough not to ignore them. This wasn’t the kind of challenge I was meant to power through; it was one that called for looking clearly within myself. The pleasure I derived from work had successfully chipped away at the hard shell of my endurance, and let happiness into the cracks, shining a light on the malaise nudging its way out. But still, I couldn’t admit what I wanted.So I spent some time flailing about, groaning, wishing out loud that the world — someone, anyone — would tell me what to do next. After months of this charade, my husband, a professional writer, steered me into listing five people whose careers I admired. That was easy. “They’re all writers,” he said. “Do you think that means anything?”Reading brought me such transcendent joy, who was I to think I might bring that same joy to other people? It seemed insane, at the time, like deciding to be God. I just couldn’t. “Of course you could,” he said. And the new me, the one who was learning that life could be celebrated rather than just tolerated, decided to try.So I wrote and wrote, thinking: if it’s bad, no one will ever see it; if it’s good, it might change my life. I started with a lot of disjointed, maudlin blog entries. As they became less terrible, I pitched and wrote an advice column for people wanting to break into entertainment. I wrote a short film, funded by my last producing paycheck, and shot it in our home. That got me an agent, and sold my first TV show, and kicked off a screenwriting career. Last year, during the pandemic, I wrote some essays. Those essays allowed me to sell the book I’m writing now.Ever an immigrant, it’s still difficult for me to say out loud that my dreams are taking shape, without my old self disassociating. “Are you insane? If you talk about it, it’ll all crumble away!” the disassociated me screams, even now. She’s maddening, but I ignore her. I have finally figured out what is good for me: to sit in a sunny room, by myself, typing these words. No pushy colleagues. No schmoozing. No stiff upper lip, while I wait for a happier time that might never come.And I’m still tough; this last year has reminded me of that. But my rubber band hasn’t snapped or frayed. I know it’s not stuck, and this won’t last forever. I have some other settings now: content, delighted, disappointed, anxious. One might even call them feelings. Feelings I’m marinating in as I write this book. If it works, it might change my life. If it doesn’t? Well, I’ll bounce back.Priyanka Mattoo is a Los Angeles-based writer and filmmaker. She is working on “Sixteen Kitchens,” a memoir-in-essays from Knopf.

El síndrome MIS-C puede afectar a los menores semanas después de infectarse con el coronavirus. Los expertos, tras publicarse el mayor estudio realizado en Estados Unidos sobre la afección, recomiendan a los pediatras estar atentos.Muchos niños y adolescentes que desarrollaron el misterioso síndrome inflamatorio que puede manifestarse varias semanas después de contraer el coronavirus nunca tuvieron los síntomas clásicos de COVID-19 al momento de su infección, según el estudio de casos más grande hasta ahora en Estados Unidos.El estudio, dirigido por investigadores de los Centros para el Control y la Prevención de Enfermedades (CDC, por su sigla en inglés), encontró que en más de 1000 casos en los que se disponía de información sobre si se habían enfermado por su COVID-19 inicial, el 75 por ciento de los pacientes no experimentaron tales síntomas. Sin embargo, de dos a cinco semanas después, se enfermaron lo suficiente como para ser hospitalizados por la afección, llamada síndrome inflamatorio multisistémico pediátrico (MIS-C, por su sigla en inglés), que puede afectar diversos órganos, especialmente el corazón.El estudio, publicado el 6 de abril en JAMA Pediatrics, afirmó que “se cree que la mayoría de las enfermedades MIS-C son el resultado de casos leves o asintomáticos de COVID-19” seguidos de una respuesta hiperinflamatoria que parece ocurrir cuando los cuerpos de los pacientes han producido su nivel máximo de anticuerpos contra el virus. Los expertos aún no saben por qué algunos jóvenes, y una cantidad menor de adultos, responden de esta manera.“Eso significa que los pediatras de atención primaria deben tener un alto índice de sospecha de esto porque la covid es muy frecuente en la sociedad y los niños a menudo tienen una enfermedad asintomática en su infección inicial de covid”, afirmó Jennifer Blumenthal, intensivista pediátrica y especialista en enfermedades infecciosas pediátricas del Hospital para Niños de Boston, quien no estuvo involucrada en el estudio.Los investigadores evaluaron 1733 de los 2090 casos del síndrome en personas de 20 años o menos que habían sido reportados a los CDC hasta enero.Los resultados muestran que, aunque el síndrome es poco común, puede ser grave. Los datos de los CDC solo incluyeron pacientes que fueron hospitalizados. Más del 90 por ciento de estas personas jóvenes experimentaron síntomas que involucraron al menos cuatro sistemas de órganos y el 58 por ciento necesitó tratamiento en unidades de cuidados intensivos.Muchos experimentaron problemas cardiacos importantes: más de la mitad desarrolló baja presión arterial, el 37 por ciento desarrolló choque cardiogénico y el 31 por ciento experimentó una disfunción cardiaca relacionada con la incapacidad del corazón para bombear de forma adecuada. El estudio afirmó que un porcentaje significativamente mayor de pacientes que no habían tenido síntomas de COVID-19 experimentaron estos problemas cardiacos, en comparación con aquellos que sí tuvieron síntomas iniciales de coronavirus. Un porcentaje mayor de pacientes que al principio fueron asintomáticos también terminaron en unidades de cuidados intensivos (UCI).“Incluso la gran mayoría de los niños con casos graves de MIS-C que estuvieron en la UCI, no tuvieron una enfermedad previa que pudieran reconocer”, afirmó Roberta DeBiasi, jefa del departamento de enfermedades infecciosas del Children’s National Hospital en Washington D. C., quien no participó en la investigación.El estudio proporcionó la imagen demográfica y geográfica más detallada del síndrome hasta la fecha. Alrededor del 34 por ciento de los pacientes eran negros y el 37 por ciento eran hispanos, lo que refleja la forma en que el coronavirus ha afectado desproporcionadamente a los miembros de esas comunidades. A medida que avanzaba la pandemia, escribieron los autores, aumentó la proporción de pacientes de raza blanca, que representaban el 20 por ciento de todos los casos. Las personas de origen asiático representaban poco más del uno por ciento de los pacientes.En general, casi el 58 por ciento de los pacientes eran hombres, pero la proporción no era la misma en todas las edades. En el grupo más joven —recién nacidos hasta los 4 años— el número de niños y niñas era prácticamente igual, y la proporción entre hombres y mujeres aumentaba en los grupos de mayor edad hasta que la proporción llegaba a más de dos en el grupo de 18 a 20 años.La gran mayoría de los pacientes (casi el 86 por ciento) eran menores de 15 años. El estudio reveló que los menores de 5 años tuvieron el menor riesgo de desarrollar complicaciones cardiacas graves y fueron menos propensos a necesitar cuidados intensivos. Los pacientes de 10 años o más tuvieron una probabilidad mucho mayor de desarrollar problemas como choque cardiogénico, presión arterial baja y miocarditis (inflamación del músculo cardiaco).“Creo que es parecido a lo que vimos con la covid, donde los niños mayores parecían tener enfermedades más graves”, dijo DeBiasi. “Y eso se debe a que lo que en realidad enferma a las personas de la covid es su aspecto inflamatorio, así que quizás estos niños mayores, por diversas razones, produjeron más inflamación en la covid inicial o en el MIS-C”.Aun así, un número significativo de los pacientes más jóvenes desarrollaron problemas cardiacos. En el grupo entre recién nacidos hasta niños de 4 años, el 36 por ciento tuvo baja presión arterial, 25 por ciento tuvo choque cardiogénico y el 44 por ciento recibió tratamiento en la UCI.Pacientes de todas las edades en el estudio experimentaron casi la misma incidencia de algunos de los problemas cardiacos menos comunes relacionados con el síndrome, como aneurismas coronarios y acumulación de líquido. Los niños de 14 años o menos fueron más propensos a tener sarpullido y enrojecimiento de los ojos, mientras que los mayores de 14 tuvieron mayores probabilidades de desarrollar dolor en el pecho, dificultad para respirar y tos. Cerca de dos tercios de todos los pacientes se vieron afectados por dolores abdominales y vómito.Se registraron 24 muertes, repartidas en todos los grupos de edad. No hubo información en el estudio sobre si los pacientes tenían afecciones médicas subyacentes, pero los médicos e investigadores informaron que las personas jóvenes con MIS-C por lo general estuvieron previamente sanas y tenían muchas más probabilidades de estar sanas que el número relativamente pequeño de jóvenes que padecieron enfermedades graves de las infecciones iniciales de covid.De los 1075 pacientes de los que se tenía información sobre la enfermedad de covid inicial, solo 265 mostraron síntomas en ese momento. Eran más propensos a ser mayores: su edad promedio fue de 11 años, mientras que la edad promedio de aquellos con infecciones de covid asintomáticas fue de 8. Sin embargo, eso podría deberse a que “los niños más pequeños no pueden expresar sus preocupaciones con la misma eficiencia”, aseguró Blumenthal, quien coescribió una editorial sobre el estudio.“En realidad no sabemos si en efecto hay menos sintomatología en la población muy joven”, concluyó.Tampoco están claras las razones que subyacen al hallazgo del estudio de que en la primera oleada de MIS-C, del 1 de marzo al 1 de julio de 2020, los jóvenes eran más propensos a algunas de las complicaciones cardíacas más graves. DeBiasi dijo que eso no coincidía con la experiencia de su hospital, donde “los niños estaban más enfermos en la segunda ola”.El estudio documentó dos oleadas de casos de MIS-C que siguieron a los aumentos de los casos generales de coronavirus durante un mes o más. “El tercer pico más reciente de la pandemia de COVID-19 parece estar conduciendo a otro pico de MIS-C que quizá implique a comunidades urbanas y rurales”, escribieron los autores.El estudio descubrió que la mayoría de los estados en los que la tasa de casos de MIS-C por población era más alta se encontraban en el noreste, donde se produjo el primer aumento de casos, y en el sur. Por el contrario, la mayoría de los estados con altas tasas de niños con COVID-19 por población, pero con bajas tasas de MIS-C, se encontraban en el Medio Oeste y el Oeste. Aunque la concentración de casos se extendió de las grandes ciudades a los pueblos más pequeños con el tiempo, no fue tan pronunciada como las tendencias generales de la pandemia, dijeron los autores.Blumenthal dijo que ese patrón geográfico podría reflejar que la “comprensión de las complicaciones de la enfermedad” no había alcanzado su prevalencia en las distintas regiones o que muchos estados con tasas más bajas de MIS-C tienen poblaciones menos diversas étnicamente. “También podría tratarse de algo relacionado con la propia covid, aunque no lo sabemos”, dijo. “En este momento, no sabemos nada sobre cómo las variantes afectan necesariamente a los niños”.El estudio representó solo los criterios más estrictos sobre MIS-C, al excluir unos 350 casos notificados que cumplían la definición del síndrome de los CDC pero tenían una prueba de anticuerpos negativa o presentaban principalmente síntomas respiratorios. DeBiasi dijo que también hay muchos casos probables de MIS-C que no se comunican a los CDC porque no cumplen todos los criterios oficiales.“Estos probables niños con MIS-C, en la vida real, son un montón de niños”, dijo. Además, aunque hasta ahora se ha centrado en los casos graves, “hay todo un grupo de niños que en realidad pueden tener MIS-C leve”.Si una comunidad ha experimentado un aumento reciente de coronavirus, entonces “solo porque el niño diga: ‘Nunca he tenido covid o mis padres nunca lo han tenido’, eso no significa que el niño que tienes delante no tenga MIS-C”, dijo DeBiasi. “Si tu ciudad tiene covid, prepárate”.Pam Belluck es una reportera de ciencia y salud cuyos galardones incluyen un Premio Pulitzer compartido en 2015 y el premio Nellie Bly a la mejor historia de primera plana. Es autora de Island Practice, un libro sobre un doctor peculiar. @PamBelluck

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesThe G7 group of wealthy nations must lead a “Herculean mobilisation” to push for global mass vaccination against Covid, former PM Gordon Brown has said.Writing in the Guardian, Mr Brown said £22bn was needed to ensure yearly vaccinations for lower income countries until Covid no longer claims lives.The next G7 summit is due to take place in the UK in June.The UK government said millions of doses had been sent to developing countries under the Covax scheme.The Covax programme, run by the World Health Organization (WHO) and other international groups, aims to ensure vaccines are shared fairly among all nations, rich and poor.The scheme is expected to provide enough jabs to cover more than a quarter of the developing world by the end of this year, but less than 1% of the population of sub-Saharan Africa has been immunised so far, Mr Brown said.”Immunising the west but only a fraction of the developing world is already fuelling allegations of ‘vaccine apartheid’, and will leave Covid-19 spreading, mutating and threatening the lives and livelihoods of us all for years to come,” he wrote.The G7 is made up of the UK, Canada, France, Germany, Italy, Japan, the US and the European Union.The scheme to share vaccines with other countriesG7 pledge billions for Covax vaccine schemeUK pledges surplus Covid vaccines to poorer nationsMr Brown said there was an urgent need for greater action and warned against “unpredictable funding” and “erratic patterns of giving”.”We need to spend now to save lives, and we need to spend tomorrow to carry on vaccinating each year until the disease no longer claims lives,” the former Labour leader said.Deliveries of vaccine supplies under the Covax programme started in February, but there have been criticisms that it has not moved quickly enough.So far, more than 38 million doses have been delivered to around 100 countries under the scheme.The WHO has criticised the “shocking imbalance” in the distribution of coronavirus vaccines between wealthier and poorer nations.Mr Brown said if G7 members commit to funding 60% of the vaccination fund, other wealthy countries will likely follow.The money needed is a “fraction of the trillions” the pandemic is costing, Mr Brown added.He said that if wealthy nations could mobilise the same moral force and urgency that inspired Live Aid in the 1980s and Make Poverty History in 2005, “we can end our reliance on the begging bowl” and establish global systems to deal with the pandemic.However, international aid commitments have been cut in the last year as economies struggle to recover from the impact of the pandemic.The UK government has come under fire for its decision to reduce foreign aid from 0.7% of national income to 0.5% – a move that would save about £4bn a year.A government spokesperson said: “We recognise this is a global crisis requiring global solutions, which is why the UK has been a leading donor to the Covax procurement pool for vaccines. “Millions of doses have been sent to developing countries through the Covax scheme already. With our G7 partners, we will intensify our cooperation on the health response to Covid-19, including the acceleration of global vaccine development and deployment.”COVID VACCINE: When can you get it?NEW VARIANTS: How worrying are they?FACE MASKS: When do I need to wear one?TESTING: How do I get a virus test?GLOBAL TRACKER: Where are the virus hotspots?

SharecloseShare pageCopy linkAbout sharingimage copyrightGetty ImagesChina’s top disease control official has said the efficacy of the country’s Covid vaccines is low, in a rare admission of weakness. In a press conference, Gao Fu added that China was considering mixing vaccines as a way of boosting efficacy. China has developed four different vaccines approved for public use, though some trials abroad had suggested efficacy as low as 50%. Mr Gao later said his comments had been misinterpreted. More than 100 million people in China have received at least one shot of the vaccine. Beijing insists the jabs are effective and said it will grant visas only to foreigners with a Chinese shot.What did Mr Gao say? Gao Fu, head of the Chinese Centres for Disease Control and Prevention, on Saturday said at a conference the current vaccines “don’t have very high rates of protection”.He suggested that the China was considering mixing Covid-19 vaccines, as a way of boosting efficacy. Mr Gao explained that steps to “optimise” the vaccine process could include changing the number of doses and the length of time. He also suggested combining different vaccines for the immunisation process. But he later appeared to backtrack on his comments, telling state media Global Times that “protection rates of all vaccines in the world are sometimes high, and sometimes low”. “How to improve their efficacy is a question that needs to be considered by scientists around the world,” he told the paper. He added that his earlier admission that Chinese vaccines had a low protection rate were a “complete misunderstanding”. Mr Gao’s original and later comments have been largely unreported by Chinese media. His original comments however, attracted some criticism on social media site Weibo, with commenters suggesting that he should “stop talking”. What do we know about Chinese vaccines?With little data released internationally, the effectiveness of the various Chinese vaccines has long been uncertain. China’s Sinovac vaccine for instance has shown in trials in Brazil to be only 50.4% effective, barely over the 50% threshold needed for regulatory approval by the World Health Organisation. What do we know about China’s Covid-19 vaccines?Covid-19: The disinformation tactics used by ChinaCoronavirus – what’s gone wrong in Brazil? Interim results from late-stage trials in Turkey and Indonesia however, have suggested the Sinovac shot to be between 91% and 65% effective. Western vaccines like the ones by BioNTech/Pfizer, Moderna or AstraZeneca all have an efficiency rate of around 90% or higher. How are they different from other vaccines? China’s vaccines though differ significantly from some vaccines, especially those developed by Pfizer and Moderna. Developed in a more traditional way, they are so-called inactivated vaccines which means they use killed viral particles to expose the immune system to the virus without risking a serious disease response.By comparison, the BioNtech/Pfizer and Moderna vaccines are mRNA vaccines. This means part of the coronavirus’ genetic code is injected into the body, training the immune system how to respond.The UK’s AstraZeneca vaccine is yet another type of vaccine where a version of a common cold virus from chimpanzees is modified to contain genetic material shared by the coronavirus. Once injected, it teaches the immune system how to fight the real virus.One significant advantage of the Chinese vaccines is that it can be stored in standard refrigerators at 2-8 degrees Celsius. Moderna’s vaccine needs to be stored at -20C and Pfizer’s vaccine at -70C.China is offering its vaccines around the world and has already shipped millions to countries from Indonesia, Turkey to Paraguay and Brazil.

A personalized cancer vaccine developed with the help of a Mount Sinai computational platform raised no safety concerns and showed potential benefit in patients with different cancers, including lung and bladder, that have a high risk of recurrence, according to results from an investigator-initiated phase I clinical trial presented during the virtual American Association for Cancer Research (AACR) Annual Meeting 2021.
“While immunotherapy has revolutionized the treatment of cancer, the vast majority of patients do not experience a significant clinical response with such treatments,” said study author Thomas Marron, MD, PhD, Assistant Director for Early Phase and Immunotherapy Trials at The Tisch Cancer Institute and Assistant Professor of Medicine (Hematology and Medical Oncology) at the Icahn School of Medicine at Mount Sinai. “Cancer vaccines, which typically combine tumor-specific targets that the immune system can learn to recognize and attack to prevent recurrence of cancer. The vaccine also contains an adjuvant that primes the immune system to maximize the efficacy.”
To generate the personalized cancer vaccine, Dr. Marron and colleagues sequenced each patient’s tumor and germline DNA and tumor RNA. They also identified the patient’s tumor-specific target to help predict whether the patient’s immune system would recognize the vaccine’s targets.
The Mount Sinai computational pipeline, called OpenVax, allows the researchers to identify and prioritize immunogenic targets to synthesize and incorporate into the vaccine.
Following any standard cancer treatment such as surgery for solid tumors or bone marrow transplant for multiple myeloma, patients received 10 doses of the personalized vaccine over a six-month period. The vaccine was given with the immunostimulant, or adjuvant, poly-ICLC, which is “a synthetic, stabilized, double-stranded RNA capable of activating multiple innate immune receptors, making it the optimal adjuvant for inducing immune responses against tumor neoantigens,” said study author Nina Bhardwaj, MD, PhD, Director of the Immunotherapy Program and the Ward-Coleman Chair in Cancer Research at The Tisch Cancer Institute at Mount Sinai.
“Most experimental personalized cancer vaccines are administered in the metastatic setting, but prior research indicates that immunotherapies tend to be more effective in patients who have less cancer spread,” said Dr. Bhardwaj. “We have therefore developed a neoantigen vaccine that is administered after standard-of-care adjuvant therapy, such as surgery in solid tumors and bone marrow transplant in multiple myeloma, when patients have minimal — typically microscopic — residual disease. Our results demonstrate that the OpenVax pipeline is a viable approach to generate a safe, personalized cancer vaccine, which could potentially be used to treat a range of tumor types.”
Before the vaccine, the trial participants statistically had a high chance of disease recurrence. Thirteen patients received the Mount Sinai team’s vaccine: 10 had solid tumor diagnoses and 3 had multiple myeloma.
After a mean follow-up of 880 days, four patients still had no evidence of cancer, four were receiving subsequent lines of therapy, four had died, and one chose not to continue the trial. The vaccine was well tolerated, with roughly one-third of patients developing minor injection-site reactions.
A phase 1 trial’s primary goal is to determine the safety of an experimental treatment, which was achieved in this trial. Researchers also saw early potential benefits of the vaccine after blood tests of one of the patients showed an immune response from the vaccine, and two other patients had robust response to immunotherapy afterward, results that are normal after being exposed to a cancer vaccine.

Early results from a new, pioneering chimeric antigen receptor (CAR) T cell immunotherapy trial led by researchers at the UCLA Jonsson Comprehensive Cancer Center found using a bilateral attack instead of the conventional single-target approach helps minimizes treatment resistance, resulting in long-lasting remission for people with non-Hodgkin’s B-cell lymphoma that has come back or has not responded to treatment.
The new approach, which will be presented at the American Association for Cancer Research Annual Meeting during one of the clinical oral plenary sessions, achieves a more robust defense and helps avoid relapse by simultaneously recognizing two targets — CD19 and CD20 — that are expressed on B-cell lymphoma.
In the small trial, four out of the five patients enrolled demonstrated a complete metabolic response, with minimal toxicity. While the median duration of the response, progression-free survival and overall survival endpoints have not yet been reached, the results are very promising.
“These responses are overall very impressive,” said lead author Sanaz Ghafouri, MD, a hematology/oncology fellow at the David Geffen School of Medicine at UCLA. “We are hopeful that dual targeting CD19/CD20 CARs in naïve memory T-cells will provide patients with relapsed or refractory aggressive B-cell lymphomas, that are otherwise chemotherapy-refractory, a chance at a possible cure or at the very least a lasting long-term remission.”
Patients diagnosed with relapsed or refractory B-cell lymphoma tend to have poor outcomes with second-line therapies. While CAR T cell therapy has been a game-changer for many people with this disease, recurrence is still a common phenomenon — approximately 50% of patients relapse by six months.
“One of the reasons CAR T cell therapy can stop working in patients is because the cancer cells escape from therapy by losing the antigen CD19, which is what the CAR T cells are engineered to target,” said Sarah Larson, MD, assistant professor of hematology/oncology at the David Geffen School of Medicine at UCLA and the principal investigator on the trial. “One way to keep the CAR T cells working is to have more than one antigen to target. So by using both CD19 and CD20, the thought is that it will be more effective and prevent the loss of the antigen, which is known as antigen escape, one of the common mechanisms of resistance.”
The patients enrolled in the trial all had measurable disease after either undergoing two or more lines of therapy for primary mediastinal B-cell lymphoma, or three or more lines of therapy for mantle cell lymphoma or follicular lymphoma. All patients had CD19/CD20 positive B-cell malignancy on tissue biopsies prior to the CAR T therapy.

Giving early-stage pancreatic cancer patients a CD40 immune-stimulating drug helped jumpstart a T cell attack to the notoriously stubborn tumor microenvironment before surgery and other treatments, according to a new study from researchers in the Abramson Cancer Center (ACC) at the University of Pennsylvania. Changing the microenvironment from so-called T cell “poor” to T cell “rich” with a CD40 agonist earlier could help slow eventual progression of the disease and prevent cancer from spreading in more patients.
The data — which included 16 patients treated with the CD40 agonist selicrelumab — was presented today by Katelyn T. Byrne, PhD, an instructor of Medicine in the division of Hematology-Oncology in the Perelman School of Medicine at the University of Pennsylvania, during a plenary session at the American Association for Cancer Research annual meeting.
“Many patients with early-stage disease undergo surgery and adjuvant chemotherapy. But it’s often not enough to slow or stop the cancer,” Byrne said. “Our data supports the idea that you can do interventions up front to activate a targeted immune response at the tumor site — which was unheard of five years ago for pancreatic cancer — even before you take it out.”
The purpose of CD40 agonists is to help “push the gas” on the immune system both by activating antigen-presenting cells, such as dendritic cells, to “prime” T cells and by enhancing immune-independent destruction of the tumor site. The therapies have mostly been investigated in patients with metastatic pancreatic cancer patients in combination with other therapies, such as chemotherapy or other immunotherapies. This is the first time the drug has been shown to drive an immune response in early-stage patients both at the tumor site and systemically — which mirrors what researchers found in their mouse studies.
The phase 1b clinical trial was conducted at four sites, including the ACC, Fred Hutchinson Cancer Research Center at the University of Washington, Case Western Reserve University, and Johns Hopkins University.
Sixteen patients were treated with selicrelumab before surgery. Of those patients, 15 underwent surgery and received adjuvant chemotherapy and a CD40 agonist. Data collected from those patients’ tumors and responses were compared to data from controls (patients who did not receive the CD40 agonist before surgery) treated at Oregon Health and Science University and Dana Farber Cancer Institute.
Multiplex imaging of immune responses revealed major differences between the two groups. Eighty-two percent of tumors in patients who received the CD40 agonist before surgery were T-cell enriched, compared to 37 percent of untreated tumors and 23 percent chemotherapy or chemoradiation-treated tumors. Selicrelumab tumors also had less tumor-associated fibrosis (bundles of tissue that prevent T cells and traditional therapies from penetrating tumors), and antigen-presenting cells known as dendritic cells were more mature.
In the treatment group, disease-free survival was 13.8 months and median overall survival was 23.4 months, with eight patients alive at a median of 20 months after surgery.
“This is a first step in building a backbone for immunotherapy interventions in pancreatic cancer,” Byrne said.
Based on these findings, researchers are now investigating how other therapies combined with CD40 could help strengthen the immune response even further in pancreatic cancer patients before surgery.
“We’re starting to turn the tide,” said Robert H. Vonderheide, MD, DPhil, director of the ACC and senior author. “This latest study adds to growing evidence that therapies such as CD40 before surgery can trigger an immune response in patients, which is the biggest hurdle we’ve faced. We’re excited to see how the next-generation of CD40 trials will take us even closer to better treatments.”