14 Festive & Healthy Halloween Recipes (Kids Will Love)
Our family loves Halloween! It’s true, in the early days we were trick-or-treating holdouts (all that sugary artificial candy… shudder!). Now that my kids are older and we’ve figured out a healthy balance, times have changed. We just buy candy with better ingredients (and make sure to have non-candy treats too). Reinventing our dinner plan is another way …
On Oct. 22, the Food and Drug Administration (FDA) approved the first drug for treating COVID-19.
Remdesivir, an antiviral medication given intravenously, is now approved for anyone hospitalized with COVID-19. It works by blocking the virus’s ability to make more copies of itself. Earlier this year, the drug had received emergency use authorization (EUA), which falls short of approval but is granted during a public health crisis if there is encouraging data supporting its potential benefits. Approval means the drug’s maker, Gilead, provided more information to the FDA on the medication’s effectiveness and safety than was used to issue the EUA.
“This decision by the FDA is a milestone in the treatment of hospitalized patients with COVID-19,” says Dr. Andre Kalil, professor of internal medicine at University of Nebraska Medical Center who was among the first to treat patients from the Diamond Princess Cruise ship with remdesivir and runs one of the drug’s clinical trials. “Remdesivir shortens the recovery time by 5-7 days, provides 50% faster clinical improvement, prevents patients’ progression to mechanical ventilation, and is associated with a 45% mortality reduction in the first two weeks of disease. These are real and meaningful benefits to our patients.”
The FDA decision is based on three randomized controlled trials that found that people receiving remdesivir shortened their recovery time. While the data did not find a statistically significant benefit in reducing mortality, doctors involved in one of the studies, published in the New England Journal of Medicine (NEJM), reported a trend toward reduced mortality after about a month, especially among people who received the drug early in their infection, as Kalil notes. Patients receiving the drug also needed less additional oxygen and were less likely to progress to severe disease compared to those receiving placebo. The NEJM study was placebo-controlled and supported by the U.S. National Institute of Allergy and Infectious Diseases.
The other two studies, sponsored by Gilead, did not include placebo controls, but compared patients receiving the drug and standard of care to those getting standard of care alone. The drug was effective, and those receiving five days of remdesivir treatment improved as much as those receiving a 10-day course.
The National Institutes of Health now includes remdesivir as part of its recommended treatment strategy for hospitalized COVID-19 patients, and doctors treating patients have said that the drug is one of the reasons that death rates from the disease may have started to drop since the beginning of the pandemic. Other medications and treatment strategies, such as anti-inflammatories and keeping patients on their stomachs to prevent worsening respiratory symptoms, are other likely contributors to the decline in death rates.
The FDA approval comes days after a study from the World Health Organization found no benefit of the drug in reducing early death or in preventing progression to serious disease among nearly 3000 COVID-19 patients. That study, however, did not include a placebo control and compared outcomes to standard of care. It’s also not clear how sick the patients in that study were and therefore how meaningful the results are.
The NEJM study included hints that people who receive the drug earlier in their disease may benefit more, and doctors are already studying whether people with mild symptoms but who don’t need to be hospitalized can be treated with remdesivir on an outpatient basis.
Editor’s note: Second in a series on the impact of COVID-19 on communities of color, and responses aimed at improving health equity. Click hereto read part one.
In early March 2020, as COVID-19 was declared a public health emergency in Boston, Mass General Brigham began to care for a growing number of patients with COVID-19. Even at this early stage in the pandemic, a few things were clear: our data showed that Black, Hispanic, and non-English speaking patients were testing positive and being hospitalized at the highest rates. There were large differences in COVID-19 infection rates among communities. Across the river from Boston, the city of Chelsea began reporting the highest infection rate in Massachusetts. Within Boston, several neighborhoods, including Hyde Park, Roxbury, and Dorchester, exhibited infection rates double or triple the rest of the city. COVID-19 was disproportionately harming minority and vulnerable communities.
Working toward an equitable response to COVID-19
From the start, our work was driven by examining COVID data by race, ethnicity, language, disability, gender, age, and community. As the COVID crisis intensified in Massachusetts, we sought ways to improve health equity and extend support within the communities we serve. We designed and deployed initiatives aimed at our patients, community members, and employees. Below are examples of tools to enhance equity that we found useful.
Communicating with patients
As new COVID care models were established, we worked on access to clinical communication for all patients and their families. There was a particular focus on language, since COVID greatly impacted non-English speaking communities, and on communication for people with disabilities.
We linked COVID operations, such as our nurse hotline and telemedicine platforms, to interpreter services or bilingual staff, supported by patient tip sheets in multiple languages. Interpreters, working virtually through enhanced technology and remote communication, supported patients and families with limited English proficiency.
We collected information on clinical and administrative staff language proficiency, so that multilingual staff could help guide patient care. For example, at two hospitals we established a care model of Spanish-speaking physicians to provide cultural and linguistic support in inpatient and intensive care units that complemented interpreter services.
As all staff and patients began wearing masks, we ensured that deaf or hard-of-hearing patients would be able to communicate with care teams through the use of masks with a clear window, to allow for lip reading.
Providing up-to-date information for patients and employees
Guidance on how to protect yourself from COVID-19 evolved rapidly. Limited English proficiency, limited access to the Internet or to smartphones and computers, and limited tech savvy are barriers to receiving information for many of our patients and employees. We needed to identify ways to ensure that rapidly changing health information was available to everyone.
For our patients, we created COVID education in multiple languages, which was distributed through various modes, including brief videos. We also sent text messages with COVID alerts to more than 100,000 of our patients who live in hot-spot communities, or who were not enrolled in our patient portal.
For our employees, we initially hosted socially-distanced, in-person educational sessions in multiple languages. These sessions provided COVID education and updates on infection control protocol and human resources policies. Our employee educational effort later shifted to a remote model by enrolling 5,500 employees who do not use computers as part of their normal job function (such as environmental services and nutrition and food services staff) into a multilingual texting campaign designed to provide key information.
Expanding equity within communities
Through the COVID pandemic, we were building on our existing presence in, and partnerships with, the communities we serve in eastern Massachusetts in several ways.
Community members lacked necessary supplies to protect themselves from COVID, such as masks. In April, we launched the production of care kits — packages which included masks, hand sanitizer, soap, and patient education materials — and distributed them within our communities at locations such as COVID testing centers, food distribution sites, and housing authorities. To date, more than 175,000 care kits have been distributed, including more than 1.3 million masks.
We also partnered with community leaders to provide COVID education. We identified trusted community leaders to record and release brief educational videos over social media to reinforce wearing masks, social distancing, and washing hands.
Finally, through screening for social determinants of health, it became clear that many of our most vulnerable communities were reporting high rates of food insecurity. We coupled longstanding efforts to address unmet health-related social needs among our patients and communities with our COVID response, by distributing grocery bags and meals at several COVID testing sites.
Looking forward
We made it through the peak of the pandemic in Massachusetts, launching a suite of initiatives to address inequity within Mass General Brigham’s COVID response. However, the battle is by no means over. Now is the time for action. Even in states like Massachusetts, where infections, hospitalizations, and deaths have substantially declined in recent months, we need to ready ourselves for a resurgence — one that is already occurring in parts of the US and Europe. Surveillance and early preparation are key. Increased prevention and mitigation efforts, widespread testing, and identification of emerging hot spots can help curb the impact of a fall and winter resurgence of the virus. Unless we act now, and unless we ramp up efforts aimed at improving health equity, this will once again hit minority communities hardest.
Hi folks, today we’re back for another edition of Ask a Health Coach! Erin is here sharing her strategies for making good health a priority during the pandemic, plus what to do when you feel like you’re putting in a lot of effort without a lot of reward and what she eats in a typical day. Got more questions? Keep them coming in the Mark’s Daily Apple Facebook Group or in the comments below.
Annie asked:
“I love the way I feel when I eat clean, but meal prepping always takes a backseat to all the other things I need to do, especially now that I’m working, parenting, and homeschooling. How do I carve out time to eat healthier?”
You’re not alone in feeling the pressure of doing it all. With all of our waking hours being consumed by work and family responsibilities, making time for the non-essentials like exercise and eating well (which I would argue are essential), seems nearly impossible.1
At first glance, the issue is pretty straightforward, right? There’s not enough time. There are only 24 hours in a day anyway. But here’s the deal, people who feel like they have the least amount of free time, the ones who feel the most overworked, are actually doing it to themselves.
In this study, researchers had 7,000 participants estimate how much time was needed to accommodate their basic needs compared to how much free time they had in their schedules.2 It turns out that their time constraints were an illusion.
The pressure of what we have time for and what we don’t has more to do with the things we assign value to rather than how many hours there are in a day.
That being said, everything we do in life is a choice – what we eat, say, and do, where we spend our energy and our money – they’re all choices. And, as you might guess, there are consequences of those choices.
There’s no doubt that your life is busier than ever right now. You’ve probably never worn more hats in your life, but instead of looking at food as an afterthought, or telling yourself you “don’t have the time,” I suggest you try giving it a little more attention.3 Here’s why.
If you choose not to make meal prepping a priority (or at least keeping healthy food on hand), the consequences might be that you find yourself grabbing snacks throughout the day, ordering less-than-healthy takeout, or not eating enough quality food, which can bring on an afterhours binge. And the consequences of those actions might mean you’re feeling foggy and fatigued day after day, making it even more difficult to do all the things you need to do.
Keep in mind, these are just consequences of your choices.
Also, you mention that you love the way you feel when you eat clean, so, you already know it’s worth it to take good care of yourself. You know how it feels when you can’t stop snacking on goldfish crackers in front of the TV versus the satisfaction you get from sitting down for a well-balanced meal eaten slowly where you enjoy every freaking bite!
While you might not have time to spend hours in the kitchen, how about throwing something in the crockpot before the day begins? Or making a big batch of chili or stew over the weekend. Or roasting a whole chicken and some veggies in the oven.
Again, it comes down to choices and priorities. How great would it be to have more focus throughout the day because you decided to put your health first? How amazing would it be to feel energized into the evening hours instead of feeling drained? By making a simple shift in your priorities, you could see a dramatic swing in how you feel throughout the day.
Adam asked:
“I’m really struggling here. With all the time I spend reading labels and tracking my macros, I’m finding that the effort is becoming greater than the benefit. I’m doing all these things but not really noticing any results. What gives?”
Ah, the sweet reward of bigger biceps or a smaller pant size. You’re not alone in wanting results. That’s why health and fitness is a $4.5 trillion industry.4 But I get it. You’re diligently putting in the work, day after day, and not seeing the outcome you’re looking for.
There could be a few different factors at play here, but one you might want to consider is a phenomenon called discounting, which basically means that the more effort you put into something, the less valuable the reward becomes. In a study published in Cognitive Affective, and Behavioral Neuroscience, researchers had participants do two simple tasks that would be rewarded with a cash prize.5 Sometimes the tasks involved high effort, other times it involved a low amount of effort. They found that the participants who put in more effort responded to the reward with less enthusiasm than those who put in less work.
You can blame the nucleus accumbens for that.6 It’s the part of the brain that’s in charge of the reward circuitand is based on two essential neurotransmitters: dopamine and serotonin. So, in a nutshell, it’s just how we’re wired.
Does that mean you shouldn’t put in the effort? It depends. In general, I don’t subscribe to the typical diet culture where everything is weighed, evaluated, and overanalyzed. I opt for teaching my clients to have an effortless relationship with food where they eat satiating, satisfying, nutrient-dense meals when they’re hungry without micromanaging every detail.
But if you take pleasure out of reading labels and managing your macros as you’re doing, keep doing it. I’ve found that in situations where people actually enjoy the effort they put in, the journey ends up being more rewarding than the destination itself.
“I’ve been following Mark’s diet for several years and I love seeing posts about what he eats during the day. But what does your day look like?”
Let me start by saying that knowing what works for you and your body is nutrition gold. It really is. You can read every nutrition book in the world, follow dozens of “healthy” food bloggers and influencers, and copy Mark’s diet (or mine) to a tee, but since every human is unique — and responds differently to different foods, it’s important to know what works for you.7
For instance, I follow the Primal way of eating fairly closely, as you might expect.8 Most nights you’ll find me with a grilled ribeye and plate of steamed veggies smothered in butter. Maybe a square or two of dark chocolate. But sometimes, I’ll have an evening where I partake in some good old-fashioned carbs and dairy. For me, nothing beats delighting in a few perfectly crispy, salty roasted potatoes accompanied by a thick dollop of rich, organic sour cream.
I know exactly how my body responds to foods like these. And armed with this information, I can choose to treat myself without any fuss or worry. I encourage you to find what works for you too. When you start your day with eggs and bacon do you feel satiated or starving? When you drink coffee are you wired or alert? When you indulge in carbs do you get sleepy or energized? Like I said, everyone’s different and no amount of researching how other people eat will give you the same answers as listening to your own body.
Editor’s note: First in a series on the impact of COVID-19 on communities of color and responses aimed at improving health equity.
By now we’ve read headlines like these all too often: “Communities of Color Devastated by COVID-19.” Way back in March, available data started to show that vulnerable, minority communities were experiencing much higher rates of infection and hospitalization from COVID-19 than their white counterparts. New York City, New Orleans, Chicago, Detroit, Milwaukee, and Boston, where I live and work, all became ground zeros in our nation’s early battle with the pandemic. The numbers were astounding: Blacks and Latinos were four to nine times more likely to be infected by COVID than whites, even in our nation’s top hot spots. Was I surprised? Absolutely not.
A long view on health disparities
I’m originally from Puerto Rico, and grew up in a bilingual, bicultural home where I had a ringside seat to witness how the issues of race, ethnicity, culture, and language barriers intersected with all aspects of society. Currently, I’m a practicing internist at Massachusetts General Hospital (MGH), where I founded the MGH Disparities Solutions Center in 2005, which I led until becoming the Chief Equity and Inclusion Officer for the hospital last year. I’ve studied and developed interventions to address disparities in health and health care for more than two decades. My career has connected me to more than 100 hospitals in 33 states that are actively engaged in efforts to improve quality, eliminate racial and ethnic disparities in care, and achieve health equity. So, addressing disparities in care isn’t just a job for me; it’s my profession and my passion.
History teaches us that disasters — natural or man-made — always disproportionately harm vulnerable and minority populations. Think of Hurricane Katrina in New Orleans. Those with lower socioeconomic status, who were predominately Black, lived in lower-lying areas with limited protections against flooding, including levees that hadn’t been upgraded or reinforced. Multiple factors converged during and after the storm to rain down unprecedented damage and destruction on these communities, compared with white communities with higher socioeconomic status.
A shifting, yet familiar story of health disparities unspools
Fast-forward to the early months of this devastating pandemic. Working alongside many talented colleagues, I led the combined Mass General Brigham and Equity COVID Response efforts at MGH. Hospitals around the country quickly learned that people with chronic conditions such as diabetes, lung disease, and heart disease, and those of advanced age, had a poorer prognosis once infected with COVID-19.
In the United States, these chronic conditions disproportionately affect minority populations. So, minorities entered the pandemic with a long history of health disparities that put them at a disadvantage. Structural racism, discrimination, and the negative impact of the social determinants of health — including lower socioeconomic status, less access to education, hazardous environments — continuously undermine the health and well-being of these communities. This is compounded by minorities having less access to health care, and, when they are able to see a health care provider, often engaging with significant mistrust, or language barriers, that make it difficult to obtain high-quality care.
We quickly saw the importance of effective public health messaging, delivered by trusted messengers. However, in minority communities, where mistrust prevails due to historic racism, and limited English proficiency is common, these messages, and the appropriate messengers, weren’t available.
Multicultural media tried its best. But a lack of physicians of color to deliver key messages, and a lot of messages being delivered in English, created a vacuum in good information. Not surprisingly, this was filled by misinformation. So, many communities didn’t get important information early, shared by someone they could trust and easily understand, and presented in their language. Time lost led to lives lost.
Physical structures of systemic inequities helped drive illnesses and deaths
COVID-19 is a respiratory virus that is easily spread from person to person through droplets, and aerosols produced when people breathe, talk, cough, or even sing. This means proximity increases risk, thus the push to social distance, and more recent mandates about wearing masks. To make matters more complicated, a person can have COVID-19 for 10 to 14 days and be asymptomatic, spreading the virus easily and unknowingly to friends, family, coworkers, and those who stood close by on public transportation.
So, what have we learned since last spring about who is at highest risk for COVID-19? It’s those who live in densely populated areas; those who have multiple and multigenerational households in small living spaces; those deemed essential workers — health care support services, food services, and more — who don’t have the luxury to work from home, have groceries delivered, or socially isolate themselves; and those who depend on public transportation to get to work, and thus can’t travel safely in their car, or afford parking when they get to work.
Minorities aren’t more genetically susceptible to COVID-19. Instead, all of the factors described here are the social conditions in which minorities and vulnerable communities are more likely to live and move around in this world every day. Only by building from this understanding can we hope to shift the narrative, and change the headlines before cases surge this winter.
Preventing lead poisoning at the source: Case Western Reserve University researchers examine implications for lead-safe housing in Cleveland through lens of rental properties and their landlords.
Hi folks, today we’re back for another edition of Ask a Health Coach! Erin is here sharing her strategies for making good health a priority during the pandemic, plus what to do when you feel like you’re putting in a lot of effort without a lot of reward and what she eats in a typical day. Got more questions? Keep them coming in the 
