Publisher Health

Bacteria in the mouth may play a role in survival from idiopathic pulmonary fibrosis (IPF), finds a new study led by researchers from the University of Michigan and the University of Virginia.
The findings come from a larger analysis of the role of the lung microbiome and IPF. Working under the hypothesis that treatment with antibiotics could improve outcomes in patients with the disease, the CleanUP-IPF study includes the collection of cheek swabs and other samples to examine changes in bacterial populations.
David O’Dwyer, M.D., Ph.D., of the Division of Pulmonary and Critical Care Medicine at U-M Medical School, partnering with John Kom, M.D. and Imre Noth, M.D., of the University of Virginia and their team, saw an opportunity to also study the role of the oral microbiome in lung disease, as it is now generally accepted that bacteria from the mouth and throat are a major contributor to the lung microbiome.
Using 16S rRNA analysis and other genetic techniques, the team extracted DNA from the cheek swabs to look for clues.
Surprisingly, they found that one bacterial species, Streptococcus mitis, tended to dominate in certain patients with IPF who were not treated with antibiotics. What’s more, those patients had better lung function and less severe disease — and ultimately, were more likely to survive.
To date, research has shown that a more diverse set of bacteria in the lungs and in the gut is reflective of better health. That does not hold true for the mouth, however, noted O’Dwyer. Streptococcus mitis tends to act as a gatekeeper toward other bacterial threats, including those that can cause periodontal disease, he said.
The team notably did not find the same protective relationship between oral Streptococcus mitis and IPF in patients who had received antibiotics. Future studies aim to further determine the various bacterial populations within the oral and lung environment in patients with IPF to understand the link between these microbiomes and disease.

The constant remodeling of the organs of the female reproductive tract during the reproductive cycle leads to fibrosis and chronic inflammation over the years. Scientists from the German Cancer Research Center (DKFZ) have now uncovered these unexpected long-term consequences of female reproductive function in mice. The results have been published in the scientific journal CELL.
The organs of the female reproductive tract undergo extensive remodeling during each menstrual cycle in preparation for ovulation or pregnancy. This process is similar in other female mammals, where it is called the estrous cycle.
Little research has been done into the recurring remodeling and its effects on the affected organs — the ovary, oviducts, uterus, cervix and vagina. Many studies to date have been based purely on microscopic examinations or have only focused on individual organs or the activity of certain genes.
A team led by Ângela Gonçalves and Duncan Odom, both DKFZ, has now systematically investigated the changes in gene activity and morphology in each phase of the estrous cycle in all affected organs in mice — at the level of individual cells and at spatial resolution. The researchers were thus able to compile a cell atlas of the female reproductive tract.
The results show that connective tissue cells, fibroblasts, play a central and very organ-specific role in the remodeling of the reproductive tract by controlling the reorganization of the extracellular matrix and inflammation.
Many physiological reproductive events such as ovulation, menstruation or implantation of the fertilized egg show characteristic signs of inflammation. The molecular signaling pathways and molecules responsible for maintaining this inflammation originate largely from fibroblasts, one of the main sources of pro-inflammatory messengers.
A remarkable feature of the female reproductive tract is its ability to rapidly clear these cyclic inflammations and restore normal reproductive function. Inflammation that does not subside, in conjunction with other signs of ageing, can become chronic and lead to fibrosis.
Based on their findings, the DKFZ researchers developed a model in which the repeated remodeling of the reproductive tract over the reproductive lifespan drives a gradual, age-related development of fibrosis and chronic inflammation. They were able to test this hypothesis directly by switching off the estrous cycle with drugs. This cycle blockade reduced the progression of fibrosis, while other ageing processes continued to occur normally.
“In humans, a higher lifetime number of menstrual cycles is associated with a higher risk of uterine cancer. If chronic inflammation and fibrosis also accumulate with the number of cycles in women, this could be a contributing factor to the increased risk of cancer,” explains Duncan Odom.
Ângela Gonçalves adds: “Our atlas sheds light on how estrous, pregnancy and aging together shape the female reproductive tract. For a long time it was thought that these events leave no traces or scars in the affected organs. Our work reveals the unexpected costs to the female reproductive capacity caused by the constant remodeling of the reproductive tract.”

Published29 minutes agoShareclose panelShare pageCopy linkAbout sharingBy Nick TriggleHealth correspondentWhen Stephen Davies walks around his Lancashire village of Rawtenstall he says the impact of the NHS dentistry crisis is clear for all to see.”There are people walking around with no teeth,” says the 67-year-old. “I notice it amongst my friends. There’s a whole generation of people with no teeth because they can’t get a dentist.” He, like many others, has also been unable to access an NHS dentistry and has had to resort to emergency dental treatment to have 10 teeth pulled out. He ended up taking out a loan to pay for four false teeth.”I’ve paid my National Insurance all my working life and I can’t find a dentist. It’s just not fair.”It is a story that will be familiar across the country. NHS England’s national patient survey last year found just over half of people had tried to access an NHS dentist in the past two years – with nearly a quarter of them unsuccessful.Those who were not registered with a practice already found it the most difficult – chiming with a BBC investigation in 2022 that found nine in 10 NHS dentists were not taking on new adult patients.’I pull out my own teeth’Gary Tierney, 54, from Cambridgeshire, has been without an NHS dentist for four years. He says he has driven to every dentist in the area and they told him they were no longer accepting NHS patients. “No-one wants to take on NHS patients. Most of my upper teeth are gone, I’ve had to pull a few of them myself. Others are just broken and rotting, I can’t afford to go private as the first thing they expect you to do is see the expensive hygienist before they will even look at the problem.”Peter Williams is another person who has been unable to find an NHS dentist. He and his family last saw one in 2019.Image source, Peter Williams”Very soon after our dentist reopened its doors after Covid, we received a letter saying they were no longer treating NHS patients and we would have to take out a private dentistry plan or pay for our treatment.”Despite regularly trying local dentists close to him in West Sussex, he has not been able to find one willing to take on new NHS patients.”They either only accept private patients or their NHS slots are all full.”It is impossible. My children are 19 and 17 and they haven’t had a check-up for four years. I think it is really unfair, particularly on children.”Fruitless 200-mile round tripGeorge Filer, 80, from South Gloucestershire, has found himself in the same position.”I have not seen an NHS dentist now for over four years as our local dentist was taken over and now only accepts private patients.”I have contacted the NHS for a dentist and the nearest one offered was in Basingstoke. A round trip of over 200 miles.”He is not optimistic the government’s new plan, which will see dentists offered extra payments to take on NHS patients, will work.”It won’t go anywhere. Will what the government is proposing be enough to overcome a private patient’s income? I doubt it very much.”The problems have left many resorting to having to pay for treatment privately – or giving up altogether.The patient survey found that of the people who did not try to see an NHS dentist, half had relied on private dentistry or went without because they assumed they would not be able to find one.Tommy Been, 28, from Berkshire, has not been able to find an NHS dentist since 2019 when he moved house.No practices in his area are taking on new NHS patients. The closest dentist doing so is 17 miles away and neither Tommy nor his partner drive, so that option is off the table.In September, Tommy resorted to booking a private appointment because he was suffering with toothache. His consultation and treatment for fillings including one root canal came to £1,720. Tommy could not afford the fee upfront, but has been able to opt for a payment plan to spread the cost.”It’s a large amount of money we can’t afford. With an NHS dentist it would have been maybe a quarter of the price or a little more.”More on this storyMouth-cancer deaths fear over NHS dentist shortagePublished8 November 2023Woman takes 200-mile round trips for NHS dentistPublished14 July 2023Full extent of NHS dentistry shortage revealedPublished8 August 2022Related Internet LinksBritish Dental AssociationHealth and Social Care CommitteeThe BBC is not responsible for the content of external sites.

The survey reflects the life experiences of more than 92,000 transgender and nonbinary Americans.Transgender and nonbinary Americans experience stark rates of unemployment and harassment, according to the largest survey of their life experiences to date. The data reflect a longstanding pattern of discrimination at a time when states across the country have passed laws restricting their health care, bathroom access and participation in sports.The findings come from the U.S. Transgender Survey, which many researchers and policymakers have relied on since a version of it debuted in 2011. The National Center for Transgender Equality, an advocacy group, carried out the latest iteration of the survey in late 2022, garnering responses from more than 92,000 transgender and nonbinary Americans, age 16 and up, from every state in the country.The group released a preliminary analysis of responses to the survey’s 600 questions on Wednesday, with the full report expected later this year.The survey was not given to a random sample of transgender people, so it cannot be interpreted as representative of the transgender population as a whole. It also skewed young, with 43 percent of respondents ages 18 to 24.Still, there were more than three times as many respondents as there were in 2015, the last time the survey was conducted, when 28,000 people participated.“You don’t see data sets like this,” Sandy James, an attorney and the lead researcher of the new survey, said in a press briefing. “Tens of thousands of trans people knew that it was imperative that they make their voices heard.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Published23 minutes agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Nick TriggleHealth correspondentDentists will be offered a £20,000 bonus to work in the areas of England with the poorest access to NHS care.The payment – dubbed a golden hello – will be available to up to 240 dentists, about 1% of the workforce.It is part of a wider plan by the government to improve access to NHS dentistry, and includes top-up payments to all dentists to take on new NHS patients.But dental leaders say the measures do not go far enough.The state of NHS dentistry was recently thrust into the spotlight when hundreds of people queued outside a new dental practice in Bristol to register as NHS patients.And a BBC investigation in 2022 found nine in 10 NHS dental practices across the UK were not accepting new adult patients for treatment on the NHS.It found the lack of NHS appointments had led people to drive hundreds of miles in search of treatment, pull out their own teeth without anaesthesia, or resort to making their own improvised dentures.’Plan will help’While the golden hello is aimed at getting more dentists to work for three years in the so-called dental deserts where there is the poorest access to NHS care, the top-up payments will be crucial to improving access across the board.An extra £15 will be given to dentists on top of the standard payment of £28 for seeing a patient who has not visited a dentist for two years.If the patient needs more complex work, the cash incentive will increase to up to £50.The government hopes the incentives will lead to another 1.5 million treatments being given over the next 12 months.Last year 32.5 million were carried out – but that is still fewer than before the pandemic.Achieving that depends on tempting current dentists into doing more NHS work instead of private work – something the British Dental Association (BDA) does not think is guaranteed.Dentist training posts are in the process of being increased, but that will take some years to start making a significant difference.Image source, Getty ImagesHealth Secretary Victoria Atkins said she recognised how frustrating it was not being able to access an NHS dentist.”I’m determined to deliver faster, simpler and fairer access to NHS dentistry for patients. This plan will help.”To support the proposal, an extra £200m will be invested on top of the £3bn currently spent each year.But the BDA said this did not go far enough, pointing out spending had dropped by £1bn since 2010 once inflation was taken into account.Full extent of NHS dentistry shortage revealedDriving hundreds of miles for dentist ‘unacceptable’Mouth-cancer deaths fear over NHS dentist shortageBDA leader Shawn Charlwood accused ministers of “rearranging the deckchairs”.”This ‘recovery plan’ is not worthy of the title. It won’t halt the exodus from the workforce or offer hope to millions struggling to access care.”Nothing here makes this service fit for the future. “The crisis will remain a burning issue in communities across this country until we get real change.”Louise Ansari, head of Healthwatch England, said there were “major access issues”, which the rising cost of living had also had a big impact on.She the plan was a “good start”, but in the long term more radical solutions were needed.Pulling own teeth outAlongside the cash incentives, the plan includes other steps.Dental teams will travel to schools and nurseries to provide fluoride varnish treatments and supported teeth-brushing. Mobile dental services will also be targeted at rural and coastal areas, while water fluoridation will be expanded to new parts of the country to help prevent tooth decay.It comes after Labour announced its own policy of supervised teeth-brushing for three-to-five-year-olds. The party has also previously said it would offer incentives for new dentists to work in areas with the greatest need.Shadow health secretary Wes Streeting told the BBC: “After 14 years of Conservative neglect, patients are desperately queuing around the block to see a dentist, literally pulling their own teeth out, and tooth decay is the number one reason for six-to-10 year-olds being admitted to hospital. “The Conservatives are only promising to do something about it now there’s an election coming.”More on this storyMouth-cancer deaths fear over NHS dentist shortagePublished8 November 2023Woman takes 200-mile round trips for NHS dentistPublished14 July 2023Full extent of NHS dentistry shortage revealedPublished8 August 2022Related Internet LinksBritish Dental AssociationHealth and Social Care CommitteeThe BBC is not responsible for the content of external sites.

Researchers at the Icahn School of Medicine at Mount Sinai have identified a new approach to controlling bacterial infections.The findings were described in the February 6 online issue of Nature Structural & Molecular Biology.
The team found a way to turn on a vital bacterial defense mechanism to fight and manage bacterial infections. The defense system, called cyclic oligonucleotide-based antiphage signaling system (CBASS), is a natural mechanism used by certain bacteria to protect themselves from viral attacks. Bacteria self-destruct as a means to prevent the spread of virus to other bacterial cells in the population.
“We wanted to see how the bacterial self-killing CBASS system is activated and whether it can be leveraged to limit bacterial infections,” says co-senior author Aneel Aggarwal, PhD, Professor of Pharmacological Sciences at Icahn Mount Sinai. “This is a fresh approach to tackling bacterial infections, a significant concern in hospitals and other settings. It’s essential to find new tools for fighting antibiotic resistance. In the war against superbugs, we need to constantly innovate and expand our toolkit to stay ahead of evolving drug resistance.”
According to a 2019 report by the Centers for Disease Control and Prevention, more than 2.8 million antimicrobial-resistant infections occur in the United States each year, with over 35,000 people dying as a result.
As part of the experiments, the researchers studied how “Cap5,” or CBASS-associated protein 5, is activated for DNA degradation and how it could be used to control bacterial infections through a combination of structural analysis and various biophysical, biochemical, and cellular assays. Cap5 is a key protein that becomes activated by cyclic nucleotides (small signaling molecules) to destroy the bacterial cell’s own DNA.
“In our study, we started by identifying which of the many cyclic nucleotides could activate the effector Cap5 of the CBASS system,” says co-senior author Olga Rechkoblit, PhD, Assistant Professor of Pharmacological Sciences at Icahn Mount Sinai. “Once we figured that out, we looked closely at the structure of Cap5 when it’s bound to these small signaling molecules. Then, with expert help from Daniela Sciaky, PhD, a researcher at Icahn Mount Sinai, we showed that by adding these special molecules to the bacteria’s environment, these molecules could potentially be used to eliminate the bacteria.”
The researchers found that determining the structure of Cap5 with cyclic nucleotides posed a technical challenge, requiring expert help from Dale F. Kreitler, PhD, AMX Beamline Scientist at Brookhaven National Laboratory. It was achieved by using micro-focused synchrotron X-ray radiation at the same facility. Micro-focused synchrotron X-ray radiation is a type of X-ray radiation that is not only produced using a specific type of particle accelerator (synchrotron) but is also carefully concentrated or focused on a tiny area for more detailed imaging or analysis.

Next, the researchers will explore how their discoveries apply to other types of bacteria and assess whether their method can be used to manage infections caused by various harmful bacteria.
The paper is titled “Activation of CBASS-Cap5 endonuclease immune effector by cyclic nucleotides.”
Other authors who contributed to this work are Angeliki Buku, PhD, and Jithesh Kottur, PhD, both with Icahn Mount Sinai.
The work was funded by National Institutes of Health grants R35-GM131780, P41GM111244, KP1605010, P30 GM124165, S10OD021527, GM103310, and by the Simons Foundation grant SF349247.

Daily exposure to chemicals used in the manufacture of plastic food containers and many cosmetics may be tied to nearly 56,600 preterm births in the U.S. in 2018, a new study shows. The resulting medical costs, the authors of the report say, were estimated to reach a minimum of $1.6 billion and as much as $8.1 billion over the lifetime of the children.
For decades, the chemicals, called phthalates, have been shown to interfere with the function of certain hormones, or signaling compounds that circulate in the blood and guide much of the body’s processes. Exposure to these toxins, which is believed to occur as consumer products break down and are ingested, has been linked to obesity, cancer, and fertility issues, among many other health concerns.
Led by researchers at NYU Grossman School of Medicine, the new analysis of phthalate exposure in more than 5,000 American mothers has specifically linked it to increased risk of lower weight and gestational age (the period of time between conception and birth) among newborns. These risk factors, the authors say, are known to at least modestly heighten risk for infant death, interfere with academic performance, and may potentially contribute to heart disease and diabetes. According to their results, roughly 10% of all preterm births that occurred in 2018 could be linked to the chemicals.
“Our findings uncover the tremendous medical and financial burden of preterm births we believe are connected to phthalates, adding to the vast body of evidence that these chemicals present a serious danger to human health,” said study lead author Leonardo Trasande, MD, MPP. “There is a clear opportunity here to lessen these risks by either using safer plastic materials or by reducing the use of plastic altogether whenever possible,” added Trasande, the Jim G. Hendrick, MD, Professor in the Department of Pediatrics at NYU Langone Health.
The study, publishing online Feb. 6 in the journal The Lancet Planetary Health, is believed to be the largest of its kind to date and includes information from a much more racially and ethnically diverse group of women than previous studies on the topic, says Trasande.
For the research, the team analyzed data from the Environmental Influences on Childhood Health Outcomes (ECHO) program, an initiative by the National Institutes of Health to better understand the effects of a wide range of environmental, social, and economic factors on children’s health. The information, which ranged from access to food and the impact of racism and income inequality to toxin exposures, allowed researchers to account for and separate out demographic factors besides phthalates that could influence preterm birth, says Trasande.
To assess prenatal phthalate exposure, the researchers measured levels of 20 different metabolites (the components into which the chemicals break down within the body) in urine samples collected at three points during each subject’s pregnancy. Then, the team looked for associations between these metabolite levels and preterm births. Next, they estimated the resulting monetary costs from intensive-care-unit stays and other related medical bills, and lost worker productivity over a lifetime from lowered IQ points.

Besides examining overall exposure to the toxins, the authors also searched for distinctions between specific phthalates. In particular, they compared di-2-ethylhexyl phthalate (DEHP), a chemical long used to make plastic more flexible, with several newer replacements for DEHP, which has faced heightened scrutiny in recent years.
According to the findings, when grouping mothers based on the amount of DEHP metabolites in their urine, the 10% with the highest levels had a 50% increased risk of giving birth before week 37 of their pregnancy compared with the 10% with the lowest levels. Meanwhile, the risk for preterm birth was doubled for women exposed to the highest quantities of three common DEHP alternatives, di-isodecyl phthalate (DIDP), di-n-octyl phthalate (DnOP), and diisononyl phthalate (DiNP), compared with those who had little to no exposure.
“These results demonstrate the need to regulate phthalates as a class rather than trying to address them one at a time,” said Trasande, a professor in the Department of Population Health at NYU Langone. “Otherwise, investigators are likely going to find the same study results in another few years about the next group of chemicals used as replacements.”
According to Trasande, who is also the director of NYU Langone’s Division of Environmental Pediatrics, the authors next plan to expand their analysis to exposures in other countries and to examine the health effects of preventing phthalate exposure in the first place. California, among a few states, has banned some use of phthalates in consumer products, as have European Union member states.
Trasande cautions that further research is needed to better understand the specific mechanisms behind the link between phthalate exposure and preterm birth.
Funding for the study was provided by National Institutes of Health grants P2CES033423, U2COD023375, U24OD023382, U24OD023319, UH3OD023285, UH3OD023305, UH3OD023251, UH3OD023248, UH3OD023318, UH3OD023271, UH3OD023342, UH3OD023272, and UH3OD023290.

Published27 minutes agoShareclose panelShare pageCopy linkAbout sharingBy Sophie Hutchinson and Aurelia FosterBBC NewsFamilies of children left disabled by an epilepsy drug and women injured by pelvic mesh implants should be given urgent financial help, England’s patient safety commissioner has said.Dr Henrietta Hughes has called on the government to act quickly to help victims of the two health scandals. It follows a review which found lives had been ruined because concerns about some treatments were not listened to.Ministers say they will consider and respond to the recommendations.It is estimated that, since the early 1970s, about 20,000 babies have been born with disabilities after foetal exposure to sodium valproate, which can harm unborn babies if taken in pregnancy. Scientific papers from as early as the 1980s suggested valproate medicines were dangerous to developing babies, yet warnings about the potential effects were not added to some packaging until 2016.Some families affected have been campaigning for decades to raise awareness of the potential effects of the drug, with some calling for compensation and a public inquiry.Dr Hughes was asked by the government to look into a potential compensation scheme for those affected by that scandal, as well as the one involving some 10,000 women who were injured by their pelvic mesh implants – a treatment for pelvic organ prolapse (POP) and incontinence.Some women were left in permanent pain, unable to walk, work or have sex. Figures suggest there were 127,000 mesh implants to treat incontinence and POP between April 2008 and March 2017, but campaigners believe the actual number is higher.Dr Hughes has recommended initial payments of £100,000 to be made to victims of the sodium valproate scandal and £20,000 to be paid to women injured by mesh implants.This should be followed by further payments for some, as well as some non-financial assistance to victims and their families, Dr Hughes said.’Scandal bigger than thalidomide’Dr Henrietta Hughes told the BBC she believed the sodium valproate scandal was “bigger than thalidomide” – referring to the severe birth defects caused by a morning-sickness drug, which was licensed in the 1950s in the UK.”I’ve heard so many heartbreaking stories about the problems they’re having in terms of getting access to the medical care that they need, but also the impact that it’s had on the parents who have had to give up their work, give up their businesses and stay at home and care for their children,” Dr Hughes said.She said many of those born with disabilities – known as foetal valproate syndrome – had been unable to work or look after themselves as adults.She said a redress scheme was “a question of justice” for families who had “been fighting for years or even decades”.Failure to help victims of the scandal would show “a callous disregard for the pain and the suffering” of those harmed, Dr Hughes said.’Guilt’ for taking epilepsy drugEmma Friedmann, whose son Andy was born with foetal valproate syndrome, said she felt guilty about her son’s condition.”It’s the guilt of taking the pills. It’s the guilt of not asking enough questions. It’s the guilt of becoming pregnant. It’s the guilt of believing your doctors… It’s the guilt of not being able to provide for your family.”Andy, now aged 25, is unlikely ever to live independently and is more like a six-year-old, his mother said. Mr Friedman said she was not hopeful she would receive any compensation and that her trust “can never be fixed”.”This is what makes me upset – that these people have known for so long and they are still resisting… doing things.”She said she had found it difficult to cope emotionally, at times. The government now says the drug should not be given to women or girls of childbearing age, except in special circumstances. Even now, about three babies a month are born with developmental disorders and physical abnormalities after foetal exposure to the drug.Hundreds sue NHS over ‘barbaric’ mesh treatment”Severe pain’ from meshA review in 2020 concluded that the suffering caused by pelvic mesh had also been entirely avoidable, caused by failings in the health system and a failure to heed families’ warnings.Dr Hughes told the BBC many women who have been injured by the mesh have suffered, need wheelchairs and have to “pay a fortune” to travel to hospital appointments. “It just adds insult to injury,” she said.Sadie Lambourne, from Yeovil, told the BBC she had lost her independence due to injuries sustained by her mesh implant.She said she was advised by a surgeon to have it fitted to treat incontinence. After a few years, she said she began to suffer severe pain in her lower back and had many infections.”The mesh had eroded through into my bladder, causing all the infection and pain,” she explained.Sadie had to give up working because she could not stand or sit for long periods, and her teenage children now help her shower and get into bed.”I’m not able to be a mum for them,” she said. “We are living hand-to-mouth and we don’t go on holiday.”A redress scheme would mean I don’t need to worry.”If I knew then what I know now, I wouldn’t have had the mesh.”Women’s Health Minister Maria Caulfield said: “Our sympathies remain with those affected by sodium valproate and pelvic mesh and we are focused on improving how the system listens to patients and healthcare professionals, as well as introducing measures to make medicines and devices safer.”More on this storyThe mesh in my body is a ‘ticking time bomb’Published2 March 2023Epilepsy drug GP guidance ‘a massive breakthrough’Published22 February 2023Anger at slow progress over mesh scandalPublished8 July 2021’I didn’t know epilepsy drug would harm my baby’Published2 December 2020Lives ruined as damage seen as ‘women’s problems’Published8 July 2020Epilepsy drug disabilities a ‘scandal’Published22 January 2018We’ve had no help – epilepsy drug victimsPublished26 September 2017Hundreds suing NHS over vaginal implantsPublished18 April 2017Related Internet LinksDepartment of Health and Social Care – GOV.UKNHS EnglandMedicines and Healthcare products Regulatory AgencyThe BBC is not responsible for the content of external sites.

Nearly 1,170,000 people have died from COVID-19 in the United States according to official federal counts, but multiple excess mortality studies suggest that these totals are vastly undercounted. While excess mortality provides an estimation of deaths that likely would not have occurred under normal, non-pandemic conditions, there is still little evidence into whether the SARS-CoV-2 virus contributed to these additional deaths, or whether these deaths were caused by other factors such as healthcare disruptions or socioeconomic challenges.
Now, a new study led by Boston University School of Public Health (BUSPH) and the University of Pennsylvania (UPenn) provides the first concrete data showing that many of these excess deaths were indeed uncounted COVID-19 deaths.
Published in the journal PNAS, the study compared reported COVID-19 deaths to excess deaths due to non-COVID, natural causes, such as diseases and chronic illnesses, and found that increases in non-COVID excess deaths occurred at the same time or in the month prior to increases in reported COVID-19 deaths in most US counties.
Focusing on excess deaths by natural causes rather than all-cause excess death estimates provides a more accurate understanding of the true number of deaths attributable to COVID-19, as it eliminates external causes for mortality, such as intentional or unintentional injuries, for which COVID-19 would not be a contributing factor.
“Our findings show that many COVID-19 deaths went uncounted during the pandemic. Surprisingly, these undercounts persisted well beyond the initial phase of the pandemic,” says study corresponding author Dr. Andrew Stokes, associate professor of global health at BUSPH, who has led numerous studies analyzing excess mortality patterns and drivers during the pandemic.
The temporal correlation between reported COVID-19 deaths and excess deaths reported to non-COVID-19 natural causes offers insight into the causes of these deaths, he says. “We observed peaks in non-COVID-19 excess deaths in the same or prior month as COVID-19 deaths, a pattern consistent with these being unrecognized COVID-19 deaths that were missed due to low community awareness and a lack of COVID-19 testing.”
If the primary explanation for these deaths were healthcare interruptions and delays in care, the non-COVID excess deaths would likely occur after a peak in reported COVID-19 deaths and subsequent interruptions in care, says study lead author Eugenio Paglino, a PhD student studying demography and sociology at UPenn. “However, this pattern was not observed nationally or in any of the geographic subregions we assessed,” Paglino says.

Importantly, these findings also disprove political assertions or public beliefs that have attributed mortality during the pandemic to COVID-19 vaccinations or shelter-in-place policies.
“This work is important because our ability to detect and correctly assign deaths during an epidemic goes to the heart of our understanding of the disease and how we organize our response,” says Dr. Nahid Bhadelia, founding director of the Boston University Center for Emerging Infectious Diseases Policy and Research.
For the study, Dr. Stokes, Dr. Paglino, and colleagues utilized novel statistical methods to analyze monthly data on natural-cause deaths and reported COVID-19 deaths for 3,127 counties over the first 30 months of the pandemic, from March 2020 to August 2022. They estimated that 1.2 million excess natural-cause deaths occurred in US counties during this time period, and found that roughly 163,000 of these deaths did not have COVID-19 listed at all on the death certificates.
Analyzing both temporal and geographical patterns of these deaths, the researchers found that the gap between these non-COVID excess deaths and reported COVID-19 deaths was largest in nonmetropolitan counties, the West, and the South — and that the second year of the pandemic saw almost as as many non-COVID excess deaths in the second year of the pandemic as in the first year, contrary to previous research. Meanwhile, metropolitan areas in New England and the Mid-Atlantic states were the only areas to report more COVID-19 deaths than non-COVID excess deaths.
Many of these geographical differences in death patterns are likely explained by differences in state policies, COVID death protocols, or political biases by local officials that influenced COVID policies. In rural areas, for example, COVID-19 testing was more limited, and political biases or stigma around COVID may have affected whether COVID-19 was listed on a death certificate. Conversely, reported COVID-19 deaths may have exceeded non-COVID excess deaths due to successful mitigation policies that encouraged physical distancing and masking, and likely lowered cases of other respiratory diseases. Certain state protocols, such as in Massachusetts, also enabled death investigators to list COVID-19 as an official cause of death within 60 days of a diagnosis (until March 2022), rather than the 30-day limit in other states.
“Geographic variation in the quality of cause of death reporting not only adversely affected pandemic response in areas where COVID-19 deaths were underreported, but it also reduced the accuracy of our national surveillance data and modeling,” says study coauthor Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation. “Standardizing and improving death investigation and certification should be a public health priority.”
The researchers hope this new data will encourage future analyses using hospitalizations and other local data to continue to parse uncounted COVID-19 deaths from excess natural-cause as well as external deaths.
“This study documents the deadliness of COVID-19 and the effectiveness of public health interventions,” said Kristin Urquiza, who cofounded Marked By COVID, the justice and remembrance movement led by COVID grievers, after losing her father to COVID. “The least we can do to honor those who died is to accurately account for what happened.”
The study was also coauthored by researchers at BUSPH, UPenn, University of Washington School of Public Health, the University of Minnesota, RTI International, the University of California, San Francisco. It was funded by The Robert Wood Johnson Foundation, the National Institute on Aging, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the W.K. Kellogg Foundation, and the Agency for Healthcare Research and Quality.

A groundbreaking study from the University of Pennsylvania School of Nursing (Penn Nursing), recently published in Innovation in Aging, has shown promising results in improving the quality of life (QOL) and sleep quality in individuals living with memory problems. The research delves into the efficacy of a nonpharmacological approach in a trial known as the Healthy Patterns Sleep Program.
Nancy Hodgson, PhD, RN, FAAN, the Claire M. Fagin Leadership Professor in Nursing and Chair of Department of Biobehavioral Health Sciences, led a group of researchers from Penn Nursing, Penn Medicine, Rutgers School of Nursing, and Drexel University’s College of Nursing and Health Professions, in the study involving 209 pairings of community-residing individuals with memory problems and their care partners. Participants were assigned to either the Healthy Patterns Sleep Program, which consisted of one-hour home activity sessions administered over four weeks, or a control group that received sleep hygiene training, plus education on home safety and health promotion. The Healthy Patterns Sleep Program trained care partners in timed daily activities such as reminiscence in the morning, exercise in the afternoon and sensory activities in the evening that can decrease daytime sleepiness and improve nighttime sleep quality.
“The results from this study provide fundamental new knowledge regarding the effects of timing activity participation and can lead to structured, replicable treatment protocols to address sleep disturbances,” said Hodgson. “Overall, the Healthy Patterns program resulted in improved QOL compared to an attention-control group.”
The findings also indicate that, compared to a control group, the four-week Healthy Patterns program improved sleep quality among persons living with memory issues who had depressive symptoms or poor sleep quality. The study indicates the Healthy Patterns Intervention might need a longer dose to induce improvements in other sleep-wake activity metrics.
The study, “Timed Activity to Minimize Sleep Disturbance in People With Cognitive Impairment, is available online. Its significance lies in its confirmation of the effectiveness of behavioral interventions in not only improving quality of life and addressing sleep quality issues in this population, but also potentially reducing care partner burden and overall care costs for persons living at home with memory problems.
Co-authors of this article include Penn Nursing’s Miranda V. McPhillips, PhD, RN; Adriana Perez, PhD, ANP-BC, FAAN; Barbara Riegel, PhD, RN, FAAN, FAHA; Subhash Aryal, PhD, MS; and Sonia Talwar, MBA; Nalaka Gooneratne, MD, MSc (Penn Medicine); Darina V. Petrovsky, PhD, RN (Rutgers); and Laura N Gitlin, PhD, FAAN, FGSA (Drexel). This study was supported by the National Institutes of Health (Grant NR0152260).