COVID-19/coronavirus

Deaths from substance abuse spiked among older Americans during pandemic, data shows

Deaths due to substance abuse, particularly of alcohol and opioids, rose sharply among older Americans in 2020, the first year of the coronavirus pandemic, as lockdowns disrupted routines and isolation and fear spread, federal health researchers reported on Wednesday (Source: “Deaths From Substance Abuse Rose Sharply Among Older Americans in 2020,” New York Times, Nov. 30).

Deaths from opioids increased among Americans aged 65 and older by 53% in 2020 over the previous year, the National Center for Health Statistics found. Alcohol-related deaths, which had already been rising for a decade in this age group, rose by 18%.

Alcohol and opioid deaths remained far less common among older people than among those middled-aged and younger, and rates had been rising in all groups for years. But the pronounced uptick surprised government researchers.

Physiological changes that occur with aging leave older adults more vulnerable to the ill effects of alcohol and drugs, as metabolism and excretion of substances slow down, increasing the risk of toxicity. Smaller amounts have bigger effects, researchers have found.


Study finds U.S. political divides may explain reduced racial disparities in COVID deaths

New evidence suggests that the shrinking gap in U.S. COVID-19 racial death disparities is being driven by political division and increasing total deaths — mostly among white people — rather than by decreasing deaths among Black Americans (Source: “Study: US political divide may help explain shrinking racial COVID death gap,” Center for Infectious Disease Research and Policy, University of Minnesota, Nov. 1).

According to a new University of Wisconsin and UCLA study published in PLOS One, Black people still bear a larger COVID-19 death burden than white people, despite a relatively younger population, but suggest that a wider political chasm likely drove more deaths in the latter group as the pandemic evolved.

Researchers examined COVID-19 death disparities since the early months of the pandemic when Black Americans had far higher death rates than their white peers.

Black and Hispanic Americans are much more likely to work in jobs that must be done in person, leading to much higher exposure to the virus. "That didn't change as the racial differences in the mortality rate shifted," lead author Adeline Lo said. "Other factors — like geographical distribution, healthcare access, income equality — that contributed to the initial higher rate of Black deaths didn't go away either."

What did change was that levels of concern about COVID and adherence to protective public health measures (eg, lockdowns, closures, prohibitions on gathering) widened along political lines, with increasing deaths among white Americans. After initially issuing similar state mandates in the first few weeks of the pandemic, within one month, Republican-controlled states began lifting public health restrictions, lessening virus containment and leading white deaths to surpass those of Black people from April to October 2020.


CDC data shows people of color less likely to receive Paxlovid, other COVID treatments

People of color with a COVID-19 diagnosis were much less likely to receive Paxlovid and other treatments than white patients, according to new data from the Centers for Disease Control and Prevention (CDC) (Source: “CDC data: People of color much less likely to receive Paxlovid, other COVID treatments,” The Hill, Oct. 27).
 
The CDC findings are consistent across all age groups and underscore the persistent disparities surrounding access to COVID-19 treatments, especially the antiviral pill Paxlovid. Paxlovid is the most commonly prescribed medication and the preferred outpatient therapeutic for eligible patients, according to the CDC.
 
During a four-month period from April to July 2022, Paxlovid treatment was 36% lower among Black patients relative to white patients and 30% lower among Hispanic patients relative to non-Hispanic patients, according to the study.


Early COVID lockdowns not tied to worse mental health, study finds

New research from the American Psychological Association shows that state restrictions and lockdowns imposed during the first six months of the pandemic were not related to worsening mental health (Source: “Study: Early state lockdowns not tied to worse mental health,” CIDRAP News Scan, Oct. 18).

The study, published in Health Psychology, was based on data collected from a survey of more than 6,500 participants at the start of the pandemic from March 18 to April 18, 2020, and answers were compared with the same survey given to 5,600 of the same participants about 6 months later: from Sept. 26 to Oct. 16, 2020.

Though loneliness and symptoms of distress increased for participants during the first six months of the pandemic, those feelings were not related to state lockdowns, and instead were correlated with knowing someone who had the virus, and consuming pandemic-related media, researchers found.

"There were robust significant relationships between personal direct experiences with the pandemic—that is, knowing someone who got very sick or died or getting sick oneself—and increased global distress, loneliness, and traumatic stress symptoms," the authors concluded.


Federal report finds telehealth fraud during pandemic cost Medicare $128 million

The federal government eased telehealth requirements at the beginning of the COVID-19 pandemic so more Americans could get remote care with fewer obstacles.
 
A report released last week by federal government investigators found that nearly $128 million in telehealth claims submitted during the first year of the pandemic may have been fraudulent (Source: “'Guardrails' needed? Telehealth fraud cost Medicare $128M in first year of COVID pandemic, feds say,” USA Today, Sept. 11).
 
Investigators said less than 1% of the 742,000 Medicare-certified doctors and other providers of telehealth services submitted roughly a half million problematic claims. Yet the billings are concerning enough that government investigators urged the Biden administration to tighten oversight to ensure millions of Americans can access remote care while safeguarding taxpayer dollars.
 
Before 2020, Medicare largely restricted telehealth to people who accessed medical care via video and audio connections set up in rural clinics. Amid the pandemic, Medicare allowed recipients in cities and suburbs to get care remotely, often from their home, via a phone call or a video chat. Medicare also more than doubled the types of services eligible for reimbursement to make it easier for people to get care without the risk of COVID-19 exposure during a visit to a clinic or hospital.


Following COVID missteps, CDC plans major overhaul

Following a series of missteps in the COVID-19 pandemic and monkeypox outbreak, the Centers for Disease Control and Prevention will undergo an “ambitious” overhaul, its director announced Wednesday (Source: “In an effort to address its missteps during Covid, CDC plans an ‘ambitious’ agency overhaul,” STAT News, Aug. 17).

In an email to staff, CDC Director Rochelle Walensky said the renewal effort will focus on making the agency more nimble and responsive to needs that arise in health emergencies. The priority will be to gather data that can be used to rapidly dispense public health guidance, rather than craft scientific papers.

Walensky also said the agency needs to acknowledge the flaws of its response to Covid-19. Those mistakes date to the earliest days of the pandemic, when a test designed by CDC scientists to detect the new disease failed to work on the ground — leaving the country blind to how quickly the SARS-CoV-2 virus was transmitting at a critical juncture when aggressive measures could have slowed Covid’s spread.

“For 75 years, CDC and public health have been preparing for Covid-19, and in our big moment, our performance did not reliably meet expectations,” Walensky said in the email, sent to the agency’s 11,000-person staff.  “My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness.”


Study: Cognitive deficits remain elevated years after COVID infection

COVID survivors remain at higher risk of psychotic disorders, dementia and similar conditions for at least two years, according to a study that highlights the mounting burden of chronic illness left in the pandemic’s wake (Source: “Covid’s Harmful Effects on the Brain Reverberate Years Later,” Bloomberg, Aug. 17).

While anxiety and depression occur more frequently after COVID than other respiratory infections, the risk typically subsides within two months, researchers at the University of Oxford found. In contrast, cognitive deficits known colloquially as “brain fog,” epilepsy, seizures and other longer-term mental and brain health disorders remained elevated 24 months later, according to a large study published Wednesday in the journal Lancet Psychiatry.

The findings, based on the records of more than 1.25 million patients, add to evidence of the virus’s potential to cause profound damage to the central nervous system and exacerbate the global burden of dementia -- which cost an estimated $1.3 trillion in the year the pandemic began. Oxford researchers showed in March that even a mild case is associated with brain shrinkage equivalent to as much as a decade of normal aging. 


In rural areas, COVID hits Black, Hispanic communities hardest, although gap appears to be narrowing

At the peak of the Omicron wave, Covid killed Black Americans in rural areas at a rate roughly 34% higher than it did white people, new research has found, although the gap appears to be narrowing in recent months (Source: “In Rural America, Covid Hits Black and Hispanic People Hardest,” New York Times, July 28).

Across the small towns and farmlands, new research has found, Covid killed Black and Hispanic people at considerably higher rates than it did their white neighbors. Even at the end of the pandemic’s second year, in February 2022, overstretched health systems, poverty, chronic illnesses and lower vaccination rates were forcing nonwhite people to bear the burden of the virus.

In towns and cities of every size, racial gaps in Covid deaths have narrowed. That has been especially true recently, when major gains in populationwide immunity have tempered the kind of pressure on health systems that appears to hurt nonwhite Americans the most.


Faulty oxygen readings added to COVID-19 disparities, study finds

Covid-19 care, including distribution of lifesaving therapies, was significantly delayed for Black and Hispanic patients due to inaccurate oxygen readings from devices that can work poorly in darker-skinned individuals, according to a new study (Source: “Faulty oxygen readings delayed Covid treatments for darker-skinned patients, study finds,” Stat News, May 31).

Widely used pulse oximeters, which measure oxygen levels by assessing the color of the blood, have been under increasing scrutiny for racial bias because they can overestimate blood oxygen levels in darker-skinned individuals and make them appear healthier than they actually are. A 2020 study comparing oxygen levels measured by the devices with readings taken from “gold standard” arterial blood samples found pulse oximeters were three times less likely to detect low oxygen levels in Black patients than in white patients. Two months after that report, the Food and Drug Administration issued a safety communication alerting patients and clinicians that the devices could be erroneous in those with dark skin.

The new study, published in May in JAMA Internal Medicine, found that  the inaccuracies in oxygen measurement occurred at higher rates not only in Black patients, but also in Hispanic and Asian patients, compared to white patients. Those inaccuracies had real-world consequences. The study provided evidence that undetected low oxygen levels led to delays in Black, Hispanic and Asian patients receiving potentially lifesaving therapies such as the drugs remdesivir and dexamethasone, and in many cases, led to patients not receiving treatment at all.


Ohio set for rollout of COVID vaccines for children younger than 5

With federal approval of pediatric COVID-19 vaccines expected soon, vaccine providers in Ohio have begun placing orders for vaccines for children less than 5 years old, and the first deliveries are expected on Monday, state health officials said (Source: “Ohio ready for rollout of pediatric COVID-19 vaccines when approved, state health official says,” Cleveland.com, June 16).

“The one group that has still been waiting has been our youngest children, those less than 5 years of age and now that appears likely to change,” Ohio Department of Health director Dr. Bruce Vanderhoff said Thursday in a press briefing.

The vaccine advisory committee to the U.S. Food and Drug Administration recently voted unanimously to recommend approval of Pfizer’s application for a vaccine for those ages 6 months through 4 years old. Moderna has applied for a COVID-19 vaccine for ages 6 months through 5 years old.

Next, FDA leadership is expected to issue its approval. On Friday and Saturday, the U.S. Centers for Disease Control and Prevention advisory committee will meet to make recommendations for the vaccines’ uses. The CDC director must then approve the committee’s recommendations.