As the coronavirus continues to spread around the world, we don’t yet know either the full scale of the unfolding global health disaster or the cumulative impact economically. But over the past week, as virus hotspots have emerged in South Korea, in Iran, in Italy and elsewhere, and as more and more countries find cases of the disease, we’re beginning to get a sense of the magnitude of what is unfolding.
China has spent two months trying to contain an outbreak. As an authoritarian country it hasn’t shied away from locking down megacities, even cocooning entire residential communities — allowing only one household member out every couple of days to go looking for food. Tens of millions of people are now living a dystopian existence essentially barricaded within their own apartment walls. Yet even with these emergency responses, large numbers have fallen sick and thousands have died. Meanwhile, consumer spending in the world’s second largest economy has all but ground to a halt. Month-on-month car purchases in the country are down by a staggering 92 percent.
South Korea has imposed extraordinary controls in Daegu, a city of roughly 3 million people. Italy has quarantined tens of thousands of people, deploying police and military to stop them from leaving the region that is at the center of that country’s outbreak. In Turkey, on Tuesday, a plane from Iran with a person on board suspected of carrying the virus was met at the airport by health officials and all the passengers were promptly quarantined for two weeks.
Until this week’s stock market swoon, the inevitable economic toll had gotten lost in the panicked coverage of the virus’s spread. When countries shut down rail and air and road routes in and out of regions, when schools are closed, when public gatherings are discouraged or banned, when curfews are imposed, and when nonessential businesses are shuttered, the economic cost is immense.
The intricately interconnected parts of the global trade and supply chain systems are unraveling at warp speed as the disease spreads, and, assuming these lockdowns last, the consequences will likely be economically devastating. If the stock market continues to sink, if factories remain shuttered, and if consumers pull back from spending, over the coming months there could be massive, and unexpected, spikes in unemployment and poverty, even in places not directly experiencing the mass transmission of the virus within their populations.
Trump’s Pollyannaish statements on coronavirus in the U.S. notwithstanding, this country will not, of course, remain inured to the epidemic’s consequences. That belated realization among investors was what triggered this week’s panicked stock market sell-off. Between Friday of last week and the close of business on Tuesday, the Dow Jones shed roughly eight percent of its value. On both Monday and Tuesday, the market dived on a scale reminiscent of the chaotic days during the summer and early autumn of 2008, as the housing crisis morphed into a broader financial crisis.
If the bad news about the virus’s spread continues, that market retraction will also continue over the trading days and weeks ahead, making what happened in the first days of this week only a prelude to a larger and longer crisis. Public health experts at the CDC and in the universities increasingly think it’s only a matter of time before the United States, too, experiences serious outbreaks. Indeed, the announcement late Wednesday afternoon that a Californian who had neither traveled to a hot zone nor been in close contact with someone who had has the virus signifies it is likely already starting to circulate within the U.S. If it is, the impacts will be huge, not just on the country’s overstretched health systems, but on the political and economic infrastructure. It’s not a stretch to imagine global stock market collapses over the coming weeks and a stark contraction of consumer spending and of employment in their wake.
Even if this dislocation doesn’t grow to the cataclysmic scale of the 1918-19 Spanish Flu, the coming months will surely force the U.S. to confront some glaring policy shortcomings — and to do so at speed.
Roughly 28 million Americans lack health insurance. That number has gone up every year of the Trump presidency and will continue to go up so long as current policies are in place that drive immigrants ever further outside the safety net, that encourage states to limit Medicaid access, and that make it harder for individuals to access health care exchanges set up under the Affordable Care Act. It’s pretty much impossible to rein in a pandemic, especially of a disease that is communicable before a sufferer becomes sick enough to visit the ER, with so many people entirely excluded from primary care coverage. Millions more, who do have insurance, are so under-insured and have such high deductibles that, in practice, they too do not visit primary care doctors nearly as often as they should.
So far, the Democratic candidates running for the presidency haven’t linked the virus outbreak to their calls for expanded and more affordable health care coverage. It’s past time for them to do so. With this outbreak, not only does the moral imperative for universal health care grow, but so does the pragmatic rationale: Germs don’t obey class and ethnic and national boundaries. If poor, uninsured people don’t get treated for viral pneumonia in proper facilities, they will spread that disease throughout the community. It will be impossible to bring regional outbreaks under control if huge swathes of the population cannot access doctors either because they are afraid they will be bankrupted by medical bills, or because they are terrified they will render themselves vulnerable to deportation by putting themselves onto medical system and government radars. And the more people remain untreated, the more the virus will spread, creating a cascading effect of health and economic consequences. Economically, it would likely prove to be far less expensive to expand health coverage to everyone now, rather than try to clean up the mess of an epidemic made worse by massive numbers of people being uninsured.
This isn’t an issue that can wait for a long policy debate post-election. In an emergency, policies have to meet new needs at speed. And right now, there’s an unprecedented need to expand the health care umbrella to everyone who lives in the United States.
But that alone is only one part of a much larger puzzle. Forty percent of Americans are only one missed paycheck away from poverty — they have no, or only minimal, savings to fall back on, and no cushion for paying monthly bills such as rent or mortgage, utilities, and car payments in the event of an unexpected economic jolt. If a region in the U.S. were to be locked down in the way that cities have been in China, South Korea, Italy and Iran, a vast number of that region’s residents would be quickly bankrupted, and a large proportion of small businesses that rely on a constant flow of customers would go under. Of course, this isn’t just about individuals; it’s also about the cascading economic impact on entire communities. Prolonged quarantines and lock-downs could devastate already financially on-edge neighborhoods as surely as de-industrialization devastated the Rust Belt and the 2008 housing crisis devastated everywhere from California Central Valley cities such as Stockton to urban regions of Nevada.
Unlike most of our peer nations, in the U.S. there is no legal right to paid sick leave, although the Family and Medical Leave Act does allow for up to 12 weeks of unpaid leave. In practice, the country’s sick leave rules are so ludicrously weak that they provide a strong disincentive for people, even in food processing and restaurants and other industries where germs spread particularly fast, to stay off work when sick. That’s as backward an approach as possible during a pandemic when health officials are urging the precautionary principle be adopted, and asking people to self-quarantine if they think they may have been in contact with a sick person. Again, while candidates such as Bernie Sanders have pushed for paid sick leave, they haven’t, as yet, linked it to the issue of quarantine.
During World War II, Winston Churchill’s government set up an insurance system, under the War Damages Act, in the U.K. to ensure that victims of the blitz who lost homes or businesses to the aerial bombardment wouldn’t be left to sink on their own. The insurance system was paid for out of tax receipts, and was designed so that that the state would cover these losses and large numbers of individuals, and communities heavily hit by the bombing, wouldn’t be left destitute. Surely, in an age of pandemic, of mass quarantines, and of sudden lockdowns, such an insurance system is similarly imperative in the U.S.
Yet, nothing in the Trump administration’s approach suggests it is thinking big-picture. Instead, it has asked Congress to appropriate a relatively paltry $2.5 billion to fight the virus’s spread — and half of that money will come from raiding other existing public health funds. That’s barely one-third of the amount that it is demanding from the Pentagon over the coming months to work on Trump’s border wall. While there seems to be no shortage of funds for the military and for crackdowns on asylum seekers and destitute migrants, the pool of resources isn’t there for a massive effort to buffer the impacts of coronavirus. Nothing suggests the administration would, for example, roll back tax cuts on the wealthy and on corporations to fund a mutual insurance program for its economic victims.
We are on the edge of the unknown, facing the possibility of a pandemic — and accompanying economic dislocation — on a scale not seen for generations. In the face of this, big and bold policy responses will likely be required, and required fast. Unfortunately, the Trump administration doesn’t inspire any confidence that it’s up to this enormous task.
At least five B.C. children died from influenza last month, as mortalities spike
At least five children died last month in British Columbia from influenza as a rise of early season respiratory illnesses added strain to the beleaguered healthcare system.
The figure marks a departure from the average of two to three annual flu deaths among children in the province between 2015 and 2019, data from the BC Coroners Service shows.
“Public health is monitoring the situation closely and is reminding people of the steps they can take to protect themselves, their children and their loved ones against the flu,” the B.C. Centre for Disease Control said in a statement.
“It is important to know that death associated with influenza in previously healthy children continues to be rare.”
The centre said it is aware of a sixth reported flu death among children and youth under 19, but it was not immediately clear why the sixth wasn’t included in the coroners’ figures.
Provincial Health Officer Dr. Bonnie Henry said the children who died included one who was younger than five years old, three who were between five and nine, and two adolescents who were between 15 and 19.
“Early findings indicate some of the children experienced secondary bacterial infections contributing to severe illness, which can be a complication of influenza,” Henry said in a statement Thursday.
The deaths in British Columbia suggest figures could tick up across the country given the common challenges facing health systems this respiratory season. Alberta has also recorded the deaths of two children with influenza so far this season.
Before the COVID-19 pandemic, an average of five to six kids died per flu season across Canada, data collected from 12 hospitals across the country shows.
The national data was collected between 2010 and 2019 by IMPACT, a national surveillance network administered by the Canadian Paediatric Association. It was included in a research paper published in March in “The Lancet Regional Health — Americas” journal that also found no deaths from the flu among children in either 2020 or 2021.
No one from either IMPACT or the B.C. Centre for Disease Control was immediately available for an interview.
On Monday, Henry said that after two years of low flu rates, mostly due to COVID-19 pandemic restrictions, the province is seeing a “dramatic increase” in illness and it arrived sooner than normal.
She urged parents to get their children vaccinated against the flu.
On Thursday, British Columbia’s Health Ministry announced a “blitz” of walk-in flu clinics that will open across the province Friday through Sunday. Flu vaccines are free to all kids aged six months and older in B.C.
The B.C. Centre for Disease Control said getting the shot is particularly important for those at risk of severe outcomes, including those with chronic medical conditions like heart, lung, kidney or liver disorders and diseases, those with conditions that cause difficulty breathing or swallowing, those who need to take Aspirin for long periods of time and those who are very obese.
The BC Coroners Service said its data is preliminary and subject to change while investigations are completed.
The cases include those where influenza was identified as an immediate, pre-existing or underlying cause of death, or as a significant condition.
Henry said updates on pediatric influenza-related deaths will be posted weekly as part of the respiratory surveillance summaries on the B.C. Centre for Disease Control website.
This report by The Canadian Press was first published Dec. 8, 2022.
Cough and cold medication shortage to end next year, pharmacists association says
Parents with sick kids might be able to take a break from crushing adult Tylenol and mixing it with apple sauce if they hurry quickly to a local pharmacy.
A Shopper’s Drug Mart pharmacist The Daily Press spoke with on Tuesday wouldn’t say how much they’d received but advised to hurry while quantities last. A Rexall pharmacist is only selling children’s Tylenol to parents with sick kids, not to those just preparing for a rainy day.
Adam Chappell, owner and pharmacist at Parma Right in The 101 Mall, told The Daily Press he was expecting nine retail-sized bottles of children’s Tylenol last Wednesday, which he also planned to keep behind the counter and limit to one bottle per customer.
The shortage makes it difficult for parents to control fevers in their children, leading to more doctor visits, he said.
“We had more public health measures in place with COVID, so we had 1½ to two years where we really didn’t see much influenza or common cold,” said Chappell, whose independent pharmacy opened in November.
“So now we’re seeing everything all at once because we’re now socializing more. It’s that time of year, so we’re starting to see more influenza, cough and colds and COVID is still circulating. I think it’s a combination of higher use and some lingering logistical issues.”
A children’s drug shortage began in the spring and worsened in the summer when an early onset of flu and respiratory syncytial virus was made worse by COVID-19, which presents as a cold. Parents began stocking up.
When local manufacturers could not keep up with demand, Health Canada arranged to import supply from the United States and Australia, whose first shipment in early November went straight to hospitals, in part because the labels were not bilingual, Postmedia reported.
Health Canada has authorized 500,000 bottles of imported children’s acetaminophen for retail to arrive in December, and domestic supply is starting to recover, Jen Belcher with the Ontario Pharmacists Association told The Daily Press in a telephone interview.
That organization asserts pandemic lockdowns in China are blocking exports of the raw ingredients used for medications, Postmedia reported Nov. 16.
If lockdowns in China continue, however, she conceded it could interrupt the ingredient supply in the long-term. There is also a global reliance on India for the raw ingredients used in over-the-counter medication.
Canadian manufacturers can tap various international suppliers if approved by Health Canada, Belcher said.
Adult Tylenol and Advil remain plentiful.
Chappell recommends that parents speak to their pharmacist to determine a dosage of adult pills based on the child’s weight and symptoms. They can be crushed and added to yogurt, apple sauce or chocolate syrup.
If parents can wait a few days for the package to arrive, they can order a supply for their child from a compounding pharmacist, who is qualified to make custom medications including liquid formulations. There are several compounding pharmacists in Sudbury, but none in Timmins.
“When it comes to cough and cold medication for both adults and children, we’re not seeing an imported supply of those. Those are short and have been for quite some time due to this high level of demand, small amounts have been trickling through the supply chain but it hasn’t been enough to keep up with demand,” said Belcher.
She expects the adult cough and cold medication shortage to end sometime between January and March, 2023, just in time for the end of flu season.
A quick check of the adult cough and cold section of four downtown pharmacies on Tuesday showed partially empty shelves, but there was still a variety of medication to choose from.
Belcher said pharmacists have lots of experience finding alternatives for patients, if necessary.
“While the over-the-counter medications in short supply are the most visible representation of the challenges to our supply chain, pharmacy teams have been managing very high levels of drug shortages, some critical, where there are really few or no alternative options,” she said, adding that up to 20 per cent of the team’s day is spent managing shortages.
Study explores the risk of new-onset diabetes mellitus following SARS-CoV-2 infections
In a recent study posted to the medRxiv* preprint server, researchers evaluated individuals who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and were diagnosed with diabetes mellitus within six months of the onset of coronavirus disease 2019 (COVID-19) to understand the temporal relationship between SARS-CoV-2 infections and diabetes mellitus.
Recent research indicates a potential increase in the new-onset diabetes mellitus diagnoses after SARS-CoV-2 infections. While the causative mechanisms are not clearly understood, various hypotheses suggest the roles of stress-induced hyperglycemia during SARS-CoV-2 infections, changes in the innate immune system, virus-induced damage or changes to the beta cells or vasculature of the pancreas, as well as the side effects of the treatment in the increased incidence of diabetes mellitus diagnoses.
Furthermore, the drastic lifestyle changes brought about by the COVID-19 pandemic have decreased physical activity and increased obesity. The stress induced by the pandemic has also increased endogenous cortisol levels, a known risk factor for diabetes mellitus. Examining the temporal relationship between SARS-CoV-2 infections and new-onset cases of diabetes mellitus will help develop effective screening and therapeutic strategies.
About the study
In the present study, the team conducted a nationwide analysis using electronic health records aggregated in the National COVID Cohort Collaborative (N3C) database in the United States (U.S.). They analyzed all individuals with SARS-CoV-2 infections and type 2 diabetes mellitus between March 2020 and February 2022. Data from the health records for the six months preceding and following the SARS-CoV-2 infections were included to avoid selection and ascertainment bias.
SARS-CoV-2 infections were confirmed based on the International Classification of Diseases, Tenth Revision (ICD-10) code, or laboratory test results. New-onset diabetes mellitus cases were defined as those that did not have an ICD code for diabetes mellitus in their electronic health records before September 2019. The incidence of diabetes mellitus was then analyzed concerning SARS-CoV-2 infections.
The results reported a sharp increase in new-onset diabetes mellitus diagnoses in the 30 days following SARS-CoV-2 infections, with the incidence of new diagnoses decreasing in the post-acute stage up to approximately a year after the infection. Surprisingly, the number of new-onset diabetes mellitus cases in the months following SARS-CoV-2 infections is lower than in the months preceding the infection.
The authors believe that the increase in healthcare interactions brought about due to the COVID-19 pandemic might explain the notable increase in diabetes mellitus diagnoses in the time surrounding SARS-CoV-2 infections. New patients might have been tested for hemoglobin A1C or glucose levels during their first interaction with the healthcare system, the results of which might have then been used to diagnose diabetes mellitus.
Additionally, SARS-CoV-2 infection-induced physiological stress could have triggered diabetes mellitus in high-risk individuals who might have developed the disease later in life without COVID-19.
According to the authors, the overall risk of developing diabetes mellitus has increased, irrespective of SARS-CoV-2 infections, due to the drastic decrease in physical activity, weight gain, and the stress induced by the COVID-19 pandemic. Furthermore, a longer follow-up period might report an increased incidence in new-onset diabetes mellitus cases, with the SARS-CoV-2 infection precipitating disease development in individuals who might not have otherwise developed diabetes.
To summarize, the researchers conducted a cross-sectional, nationwide analysis of individuals in the U.S. to understand the temporal relationship between diagnoses of new-onset diabetes mellitus and SARS-CoV-2 infections. The results reported a spike in diabetes mellitus diagnoses in the one month following SARS-CoV-2 infections, followed by a marked decrease in the number of diagnoses for up to a year after the infection.
The authors believe that the sudden increase in diabetes diagnoses could be due to increased healthcare interactions brought about by the COVID-19 pandemic. The new-onset diabetes mellitus cases could also be a reaction to the physiological stress induced by SARS-CoV-2 infections.
Furthermore, the drastic lifestyle changes brought about by the COVID-19 pandemic might be responsible for the high incidence of diabetes mellitus, irrespective of SARS-CoV-2 infections. However, extensive research is required to understand the epidemiology and mechanisms connecting SARS-CoV-2 infections with new-onset diabetes mellitus.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
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