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People with dementia are twice as likely to contract Covid, huge study finds

People with dementia had a significantly higher risk of contracting the coronavirus, and they were much more likely to be hospitalized and die from it, than people without dementia, a new study of millions of cases found. medical in the United States.

Their risk could not be fully explained by characteristics common to people with dementia that are known risk factors for Covid-19: old age, living in a nursing home, and conditions such as obesity, l asthma, diabetes and cardiovascular disease. After researchers adjusted for these factors, Americans with dementia were still twice as likely to have contracted Covid-19 at the end of last summer.

“It’s pretty compelling to suggest that there is something about dementia that makes you more vulnerable,” said Dr. Kristine Yaffe, professor of neurology and psychiatry at the University of California at San Francisco, who doesn’t did not participate in the study.

The study found that black people with dementia were almost three times more likely than white people with dementia to be infected with the virus, a finding that experts say most likely reflected the fact that people of color have generally suffered disproportionate damage during the pandemic.

“This study highlights the need to protect patients with dementia, especially those who are black,” the authors wrote.

Maria Carrillo, chief scientist of the Alzheimer’s Association, which heads the journal that published the study, Alzheimer’s and Dementia, said in an interview: “One of the things that comes out of this Covid situation is that we should highlight these disparities. . “

The study was conducted by researchers at Case Western Reserve University who analyzed the electronic health records of 61.9 million people aged 18 and older in the United States from February 1 to August 21, 2020. data, collected by IBM Watson Health Explorys, came from 360 hospitals and 317,000 health care providers in all 50 states and represented one-fifth of the US population, the authors said.

Rong Xu, professor of biomedical informatics at Case Western and lead author of the study, said there had been speculation about whether people with dementia were more prone to infections and damage from Covid-19.

“We thought, ‘We have the data, we can just test this hypothesis,’ Dr Xu said.

The researchers found that out of 15,770 patients with Covid-19 in the records analyzed, 810 of them also had dementia. When researchers adjusted for general demographic factors – age, sex, and race – they found that people with dementia were more than three times more likely to contract Covid-19. When they adjusted for Covid-specific risk factors like nursing home residency and underlying physical conditions, the gap narrowed somewhat, but people with dementia were still twice as likely to ‘be infected.

Experts and study authors said the reasons for this vulnerability could include cognitive and physiological factors.

“People with dementia are more dependent on those around them to ensure safety, to remember to wear a mask, to keep people away through social distancing,” said Dr. Kenneth Langa, professor of medicine at the University of Michigan , who did not participate in the study. “There’s the cognitive impairment and the fact that they’re more socially at risk,” he says.

Dr Yaffe said there could also be an “element of frailty” in people with dementia, including a lack of mobility and muscle tone, which could affect their resilience to infections.

Dr Carrillo noted that the coronavirus infection was associated with an inflammatory response that has been shown to affect blood vessels and other aspects of the circulatory system. Many people with dementia already have vascular disorders, which can be made worse or amplified by Covid-19.

Indeed, the study authors subdivided patients according to the type of dementia listed in the electronic records and found that people designated as having vascular dementia had a greater risk of infection than those designated as having vascular dementia. Alzheimer’s disease or other types.

But Dr Langa and Dr Yaffe warned that there was a significant overlap between types of dementia. Many patients have both Alzheimer’s disease and vascular disease, they said, and physicians who are not specialists may not distinguish the subtypes when providing codes for electronic records.

In examining the risk of hospitalization and death for patients with Covid dementia, the researchers did not adjust demographics such as age or whether they lived in nursing homes or had under-developed medical conditions. underlying. They found that dementia patients with Covid were 2.6 times more likely to have been hospitalized in the first six months of the pandemic than those without dementia. They were 4.4 times more likely to die.

Blacks with Covid-19 and dementia were significantly more likely to be hospitalized than whites with both diseases. The authors did not find a significant difference in the death rate of black-and-white coronavirus patients with dementia, although they wrote that the number of deaths analyzed, 170, may be too small to provide a conclusion. solid about it.

Experts noted that one of the limitations of the study was that researchers did not have access to socio-economic information, which could lead to a better understanding of patients’ risk factors.

Dr Langa also noted that the data only reflected people who interacted with the health system, so it did not include “more isolated and poorer patients who have a harder time getting to homes. doctors”.

Therefore, he said, the study could be “an underestimate of the higher risk of Covid infection for people with dementia.”

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Daily Covid toll in the United States remains huge, but cases drop

The past few weeks in the United States have been the deadliest for the coronavirus pandemic, and residents of most counties remain at extremely high risk of contracting the virus. At the same time, transmission appears to be slowing across the country, with the average number of new cases being 40 percent lower on January 29 than the U.S. peak three weeks earlier.

Other indicators reinforce the current downward trend in cases. Hospitalizations are down significantly from the records in early January. The number of tests per day has also decreased, which may mask the true toll of the virus, but the positivity rate of these tests has also decreased, indicating that the slower spread is real. Still, the average daily death rate reported over the past seven days remains above 3,000, compared to less than 1,000 per day in September and October.

Hospitalizations

Improve.

100,000

October 1st

29 january

-24%

New tests per day

With less testing, more cases are missed.

2 millions

October 1st

29 january

-11%

Positivity rate

Improve.

ten%

October 1st

29 january

-5 pct.

pts.

Note: Tests are presented as seven-day averages. Positive test rates are calculated using cumulative counts for the past seven days and exclude peaks prior to the time period shown. The positivity rate was highest in the spring, when testing capacity was extremely limited.·Source: The Covid monitoring project.

The country’s peaks were extremely high: nearly 1% of the U.S. population tested positive for the virus in the two weeks to January 8 alone. This high starting point means that even after the sharp drop, Covid-19 hospitalizations remain at levels seen in early December, as intensive care units were already nearing capacity in much of the country. They are currently almost twice as high as previous highs in spring and summer.

Experts believe the decrease could mark a turning point in the epidemic after months of rising numbers of cases. But new, more contagious variants threaten to disrupt progress and could even propel case rates to a new high if they prevail, especially if the nationwide vaccine rollout faces obstacles.

Variants discovered in the United Kingdom and South Africa have both been found in the United States. Vaccine makers have said their drugs appear to be less effective against the South African variant. Other variations are also appearing: researchers have discovered a Californian variant, and a Brazilian variant that shares similarities with the South African variant appeared in the United States for the first time.

The variants may have already caused new outbreaks in the UK, Brazil and South Africa, and federal officials have warned that the faster-spreading UK variant could become the dominant variant in the US by now March. But at least for now, their presence in the United States does not appear to have significantly compromised a general downward trend. Although transmission remains dangerously high in most countries, every state is seeing a decrease in new cases. Hospitalizations are also on the decline across the country.

Evolution of new cases and hospitalizations since the peak

Note: Shows data from October 1 to January 29. Observations are presented as seven-day averages. The peaks in the graph reflect the relative peaks during the time period shown. A few states had a higher number of hospitalizations or new cases in the spring or summer.·Sources: New York Times database of national and local health agency reports; the Covid monitoring project.
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CDC Warns New Virus Variant Could Fuel Huge Spikes in Covid Cases

Federal health officials sounded the alarm on Friday that a rapidly spreading and much more contagious variant of the coronavirus is expected to become the main source of infection in the country by March, potentially fueling a new wave of cases and deaths.

In a study released Friday, the Centers for Disease Control and Prevention said its forecast indicated that outbreaks caused by the new variant could lead to a booming pandemic this winter. He called for a doubling of preventive measures, including more intensive vaccination efforts across the country.

The variant is not known to be more fatal or to cause more serious illness. But the dreadful warning – covered by limited data on the prevalence of the variant first identified in Britain – landed in a week when the country’s nascent vaccination campaign was hampered by confusion and limited supply. as demand increased among a growing number of eligible people.

Only 76 cases of the variant have been identified in the United States so far, but the actual number is believed to be higher and is expected to increase in the coming weeks, officials said. They pointed out that current mitigation strategies were effective against the new strain, urging Americans to be vigilant by wearing face masks, keeping a distance of six feet or more from other people, washing their hands frequently, reducing interactions with people outside their home, limiting contact and avoiding contact. crowds.

But spikes in cases threaten to cripple already overwhelmed hospitals and nursing homes in many parts of the country. Some are at or near capacity. Others have faced troubling infection rates among their staff, causing shortages and surging patient numbers.

“I want to stress that we are deeply concerned that this strain is more transmissible and may accelerate epidemics in the United States in the weeks to come,” said Dr. Jay Butler, deputy director of infectious diseases at the CDC. “We are sounding the alarm bells and urging people to realize that the pandemic is not over and that it is by no means time to throw in the towel.”

“We know what is working and we know what to do,” he said.

Covid cases and deaths have broken record after record across the country, with a death maximum of 4,400, announced on Tuesday. At least 3,973 new deaths and 238,390 new cases were reported Thursday, and the country is nearing the 400,000 death mark.

One in 860 Americans died from Covid-19 last year, according to new figures released by the CDC But the burden of deaths has not fallen equally across races, ethnicities and geographies, and we fears that vaccines will not reach the hardest-hit communities, where access to health services is limited and mistrust is rampant.

The new variant, called B 1.1.7, was first identified in Britain, where it quickly became the main source of infections, accounting for up to 60% of new cases diagnosed in London and the surrounding area .

It has since been detected in at least 30 countries, including the United States and Canada. In the United States, it represents less than 0.5% of cases, based on the analysis of a limited number of samples.

Other variants circulating in South Africa and Brazil are also believed to be more contagious, but have not yet been identified in the United States. Japanese authorities said this month that they had detected one of the variants in four passengers from Brazil.

The CDC had announced earlier that from January 26, all air passengers arriving in the United States, regardless of their vaccination status, would be required to show proof of a negative result of a test for the coronavirus. or recovery from Covid.

In the new report, scientists at the CDC modeled how quickly the variant could spread in the United States, assuming that about 10-30% of people have pre-existing immunity to the virus, and an additional 1 million people will be vaccinated every week from this month. .

If the variant is around 50% more contagious, as British data suggests, it will become the predominant source of all infections in the United States by March, according to the model. A slow deployment of vaccinations will hasten this destiny.

The variant differs by approximately 20 mutations from previous versions of the virus, of which at least two mutations may contribute to its greater contagiousness. As of Jan. 13, it had been detected in 76 cases from 12 states, but the actual numbers are likely much higher, Dr Butler said. “The CDC expects these numbers to increase in the coming weeks,” he said.

National and local laboratories have pledged to sequence around 6,000 samples per week, a goal the agency expects to achieve in about three weeks.

Agency officials also warned that standard tests for the virus could miss one of the genes altered in the new variant. This shouldn’t be a problem for most lab tests, they said, but some antigen tests can produce “false negatives,” missing infection cases.

“So far we haven’t found any evidence of this, but we are looking at it more closely,” Dr. Butler said.

It is not yet clear what makes the newer variants more contagious. They share at least one mutation, called N501Y, which is believed to be involved. One possibility, the researchers said, is that the mutation could increase the amount of virus in the nose but not in the lungs – potentially explaining why it’s more contagious, but not more deadly.

A greater amount of virus in the nose means that anyone infected would expel more virus when speaking, singing, coughing or even breathing, said Trevor Bedford, evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle.

“It makes the same situations that are spreading now – people living in the same household, those kinds of unventilated indoor contacts – more likely to spread,” he said.

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Outdoor heaters seem like a huge waste. Are they really?

Heaters can also have an unexpected psychological effect, Dr. Wen says. His research suggests that having “perceived control” over temperature, such as by a nearby radiator, can increase your “thermal acceptability” or the temperature range in which you feel comfortable.

In other words, when used in a place where you don’t control the heat, like a shared office or apartment building with a central thermostat, just knowing you can turn on a heater can make you feel better. make it more tolerant of cooler temperatures.

Having said that, be careful. Although safer than in previous decades, the Consumer Product Safety Commission reports that heaters are involved in approximately 1,700 fires and 80 deaths each year. To reduce these risks, the group suggests keeping heaters three feet from flammable items, plugging them directly into walls, and turning them off before bed.

If you still don’t know what to do, you shouldn’t be losing too much sleep, said Jennifer Amann, director of the buildings program at the American Council for an Energy-Efficient Economy, a nonprofit research organization.

Similar to Dr Bailis’ thoughts on the fireplace versus patio heater debate, Ms Amann said other changes, such as buying LED bulbs, adding insulation, and regularly changing your air filter, could make a bigger difference over time than running or not running a heater.

Dr Wen also stressed the importance of implementing energy efficiency measures, regardless of the heating method chosen. Since homes lose 25-30% of their heat through windows, she said it was imperative to take measures such as weatherstripping, plastic wrap and hanging blinds or curtains.

“Otherwise,” she said, “you’re just efficiently generating heat that comes out the window.”

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Huge turnout in New York on the first day of early voting.

New Yorkers flooded polling stations on Saturday, the first day of early voting in the state, anxious to ensure their ballots are counted given the challenges of holding a contentious presidential election in the midst pandemic.

By 9:30 a.m., shortly before the ballot box opened, more than 300 people had already lined up outside Madison Square Garden, the vast majority of them wearing face masks and doing their best to follow the distancing rules social. Less than 15 minutes later, the lineage had grown by over 100.

Bottom line, Aaron Weston, 50, said he was prepared to wait as long as needed to vote early.

“I didn’t want to let everything that’s going on with the coronavirus stop me from starting over this year – especially when it’s so important,” Mr. Weston said.

There were similar long lines at Barclays Center in Brooklyn, The Armory in Washington Heights, and other major sites in the city.

Saturday was the first time New Yorkers were allowed to vote early in a presidential election, which is expected to produce an all-time high turnout. No less than 3.3 million people out of 4.7 million active voters in New York, or 70%, are expected to vote by mail or in person, according to one estimate.

Recent incidents involving postal votes have led many voters to the polls on Saturday. This week, some voters said they did not believe their votes would be counted if they mailed out ballots. Late last month, the city’s Council of Elections came under fire after as many as 100,000 Brooklyn voters received mail-in ballots with the wrong names and addresses.

In the June primaries, the Election Bureau, a quasi-independent agency controlled by the two main parties, failed to send mail ballots to an unknown number of voters on time. It also took more than six weeks to finalize the results of the main Congressional Democratic primary races due to an influx of mail-in votes.

Recent failures and reports of long lines and queues in other parts of the country, including Georgia and Texas, have raised concerns that New York’s early voting may be marred by problems.

Voters will have until November 1 to vote. The nine-day early voting period aims to increase voter turnout by making voting more convenient. Depending on the day, early voting sites will open as early as 7 a.m. and stay open until 8 p.m., including this weekend and the next day.

Luis Ferré-Sadurní contributed reporting