HealthCareTips blog

“Media fast: The news is like caramel corn – after the first bite you just keep eating. I have been limiting my exposure to the news – actually since Covid started. The media moguls try to get us to hang onto their every word by telling us that each news segment is, “Breaking News.” It’s not all “Breaking News.” It’s their way of training our taste buds to keep coming back for more or to never leave. We need to step away from the TV. You are so right. Our brains, our bodies, our spirits need a break.”

-Great analogy, Barbara.

The post Weekly Link Love — Edition 107 appeared first on Mark's Daily Apple.

The Nightmare Pandemic Economy Joe Biden Is Inheriting, in 5 Charts

When President-elect Joe Biden steps into White House in January, he will inherit two inextricably linked crises: The worsening COVID-19 pandemic and a wide-reaching recession. As U.S. coronavirus cases are spiking to all-time highs, he will be responsible for keeping Americans safe while guiding a fragile economy through recovery.

That’s a tall order—and a somewhat paradoxical one. A fully open economy will most certainly lead to more viral spread and likely result in more deaths, while a closed economy could contain the virus but bring about even more financial hardship. And as the weather cools and fewer people want to dine, drink or otherwise spend time outside, it will become even harder to find the right mix of policies to both curb spread and keep businesses (and their employees) afloat.

Biden has already demonstrated a more hands-on approach to the pandemic than U.S. President Donald Trump. In his first order of business after being projected the winner, the President-elect established a COVID-19 advisory board to guide his thinking and work with state and local health officials. The group, Biden’s transition team says, will develop public-health strategies based on scientific information to “reopen our schools and businesses safely and effectively,” among other goals.

Still, the task at hand will be difficult, to say the least. The following five charts show what Biden and his Vice President-elect, Kamala Harris, are up against as they prepare to take the oaths of office.

1. Americans don’t agree on the best course of action

The coronavirus has affected almost every country around the world. Many have taken an economic hit this year as a result. However, while citizens of other countries generally agree on how to move forward, Americans have a wide ideological divide that could make Biden’s job much harder, as presidents often draw on public support to help push their agendas forward.

A Pew survey conducted over the summer found that, among citizens of economically advanced countries struggling to contain the virus, Americans were the most polarized along party lines in their assessment of their government’s response to the virus and the economy. Furthermore, another Pew poll from October revealed that only 24% of Trump supporters said the coronavirus outbreak was very important to their vote, compared with 82% of Biden supporters. Conversely, 84% of Trump supporters said the economy was very important, versus 66% of Biden supporters.

Biden has pledged to follow the advice of public-health advisors, even if they recommend shutting down businesses. Biden’s supporters may applaud that approach, but he will find it challenging to convince the rest of the country it’s the right way to go—especially Trump’s most ardent loyalists, many of whom have shunned even basic preventative measures, like masks.

2. Lawmakers don’t agree, either

Election Day resulted in a narrower Democratic majority in the House of Representatives, while two Jan. 5 runoff elections in Georgia will determine whether the Senate remains narrowly in Republican control or gets split down the middle, with Harris casting a tie-breaking vote when necessary.

Either way, the congressional situation is a major obstacle for Biden’s agenda, writes TIME’s Abby Vesoulis. As she notes, the President-elect may get only parts of his broad plans—spanning everything from childcare to infrastructure to climate change—through a gridlocked Congress.

On the coronavirus front, Biden has called for federal relief programs—including loans for small businesses, direct payments to working families and student loan forgiveness—to serve as a financial bridge until the virus is under control. He has also proposed employing tens of thousands of COVID-19 contact tracers as a means of both curbing viral spread and chipping away at the high unemployment rate.

Federal relief programs are not new for Biden, who, as vice president to Barack Obama during the height of the Great Recession, helped shepherd a $787 billion stimulus package through Congress in 2009. But back then, he had the benefit of a significant Democratic majority in both chambers, making it easier to put the Obama Administration’s goals into practice.

3. The unemployment crisis is worse than it seems

The overall U.S. unemployment rate is currently 6.9%, which, while better than April’s 14.7%, still means that 10 million pre-pandemic jobs remain M.I.A., according to Nov. 6 data from the Bureau of Labor Statistics (BLS). Economists have said that the jobs that haven’t returned by this point will be the hardest to claw back, in part because they are concentrated in the industries most affected by virus containment measures, like leisure, travel and hospitality.

The Trump-era employment gains may not continue at the same pace under Biden, because prolonged unemployment, especially in a weak labor market, can be harder to fix. People who have been unemployed for six months or more are about twice as likely to drop out of the labor force as to find employment, according to a U.S. Federal Reserve analysis of unemployment trends during the Great Recession. Additionally, the longer a person is out of work, the less consumer purchasing they do, which further slows economic growth.

Alarming BLS data show that long-term unemployment as a share of all unemployment is growing fast. In October, 3.6 million of the 11 million unemployed Americans—or one in three—had been out of work for six months or longer. That’s a ratio not seen since mid-2014, when Biden was VP and the unemployment rate, like today, topped 6%.

The continuing unemployment crisis has led economists to become increasingly pessimistic about when the country might return to pre-pandemic levels. Business and academic economists surveyed by the Wall Street Journal in April predicted the labor market would recover by 2022. But when surveyed again in October, 55% had extended their recovery forecast to 2023 or later.

4. Biden can’t fix the coronavirus or the economy without addressing systemic racism

2020 brought the country’s ongoing struggle with racism to the fore, as police brutality and other forms of violence against Black people led to nationwide Black Lives Matter (BLM) demonstrations. But systemic racism hasn’t been on display just in horrifying viral videos—it has also been apparent as COVID-19 ravaged Black communities in particular.

Systemic racism has made it harder for Black communities to achieve the wealth, access to health care and overall prosperity that white communities enjoy. As a result, Black people in the U.S. are most vulnerable to the virus itself, as well as the economic disruptions it has brought on. A disproportionate share of Black Americans have fallen severely ill from the virus. They are more likely to hold lower-wage, public-facing, front-line worker positions that put them at greater risk of exposure. And they are less likely to have accumulated savings to pay the bills if their jobs disappear. Addressing the pandemic’s health and economic effects requires acknowledging these facts, and acting accordingly.

5. We’re not out of this yet

On Nov. 9, pharmaceutical company Pfizer announced promising results from its vaccine effectiveness trials; other companies are also in late-stage trials. The stock market surged on the news, as investors predicted that the vaccine will suppress case rates and therefore expedite economic recovery.

But that won’t happen immediately, even if the vaccine is highly effective in a biological sense. Public-health strategies will continue to be critical during the time it will take to produce, distribute and widely administer a vaccine. The U.S. Centers for Disease Control and Prevention, which is planning a phased rollout starting with high-risk populations, is anticipating that a limited number of doses will be available at first. If the rollout happens as quickly as President Trump has touted, mass vaccination could take Biden’s entire first term.

Another obstacle: for a vaccine to work, people need to actually receive it—but survey data suggest that many Americans aren’t on board. The chart below, adapted from STAT and The Harris Poll, shows that only about 58% of Americans surveyed in October plan to get a vaccine as soon as one is available—down from 69% in August. The hesitancy is even more pronounced among Black Americans, with only 43% reportedly planning to get vaccinated right away.

It’s hard to say how effective Biden will be in balancing public-health measures with the economic consequences of viral containment. Other countries have shown such a balancing is possible—Germany, South Korea and Japan, for instance, have experienced fewer deaths per capita and less severe economic losses than the U.S., as measured by gross domestic product declines since late 2019.

But it’s not an apples-to-apples comparison. Other nations benefit from a stronger consensus among citizens on the best path forward. Moreover, some have social safety nets that cushion the blows from economic disruptions. And not all countries have the added complication of deep-seated racism that has disproportionately affected minority communities in the U.S.

Still, Biden believes the government needs to do better, and he campaigned on the promise of finding middle ground. In the last pre-election debate, he suggested that health and economic goals are not necessarily in competition—that if the nation is healthy, then the economy will be, too. His challenge now will be channeling that idea into effective policy. Given that states, rather than the national government, have the most power to issue and enforce public-health rules, expect him to start by working with—or, in some cases, perhaps even pressuring—the country’s governors to follow his lead.

How Is Your Inner Critic Holding You Back?

The inner critic undermines our accomplishments, diminishes our self-esteem, and makes us feel inadequate—especially if we’re close to a big change. Read on to learn how to deal with it and move forward.

The post How Is Your Inner Critic Holding You Back? appeared first on Chris Kresser.

Why You May Not Be Able to Get Pfizer’s Frontrunner COVID-19 Vaccine

The freezer in your kitchen likely gets down to temperatures around -20° C (-4° F). “That keeps your ice cream cold, but it doesn’t turn your ice cream into an impenetrable block of ice,” says Paula Cannon, an associate professor of molecular microbiology and immunology at the University of Southern California’s Keck School of Medicine.

Pfizer’s promising COVID-19 vaccine, by contrast, must be stored at about -70° C (-94° F)—a temperature cold enough to harden ice cream into a spoon-breaking block of ice, and that only specialized freezers can produce.

Those cold storage requirements are raising serious questions about who could get the Pfizer vaccine if it’s approved, and when. The reality, experts say, is that the Pfizer vaccine probably won’t be available to everyone, at least not right away. Large medical centers and urban centers are the most likely to have the resources necessary for ultra-cold storage. People without access to these facilities, such as those living in rural areas, nursing homes and developing nations, may have to wait for other vaccines working their way through the development pipeline.

Pfizer’s vaccine candidate, which has not yet been approved by the U.S. Food and Drug Administration but is reportedly 90% effective at preventing COVID-19, uses genetic material called mRNA. If it’s not kept at extremely cold temperatures, mRNA can break down, rendering the vaccine unusable.

If the Pfizer vaccine is kept at -70° C, it can last up to six months. But many hospitals, to say nothing of community medical offices and pharmacies, do not have ultra-cold freezers, which cost around $10,000 up front and are expensive to run because of their high energy usage. Retrofitting existing freezers to reach these temperatures isn’t possible either, Cannon says. “It would be like going from a Fiat car to a Tundra truck”—the technology and energy requirements are simply different.

There may also be shortages of the type of pharmaceutical-grade glass needed to make vials that can withstand such cold temperatures, says Dr. William Moss, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health. New York-based glass company Corning won a $204 million government grant in June specifically so it could increase production of its sturdy glass, which is made without boron.

Distributing the vaccine will also be difficult, since it must remain frozen during shipping. Pfizer has built a storage container that, with the help of dry ice, can keep doses cold for up to 10 days in transit without any additional freezer equipment. Periodically replenishing the containers with dry ice can buy another 15 days, but depending on how often the containers are opened, and for how long, that timeline could be considerably shorter. (Dry ice is also in short supply right now because of the increase in food delivery during the pandemic, combined with the fact that fewer people are driving and buying gas, driving down the ethanol production required to make dry ice.)

Once they’re out of the box, the shots can last for about five days in standard refrigeration. But the boxes hold from 200 to 1,000 vaccine vials, each of which contains about five doses of the shot—more than most doctor’s offices could reasonably expect to use before some doses start to defrost and become useless, as ProPublica recently reported.

A Pfizer spokesperson told TIME that the company “is committed to ensuring everyone has the opportunity to have access to our vaccine working closely with local government.” The spokesperson added that global distribution has gone smoothly during clinical trials, and that portable and under-the-counter-sized ultra-cold freezers are available for smaller vaccination sites.

“We believe all countries will be able to effectively dose patients even with our cold chain requirements,” the spokesperson said.

For mass U.S. distribution, Cannon says the most practical solution may be setting up large, centralized vaccination centers that could rapidly go through doses, rather than trying to get the jab into every doctor’s office and pharmacy nationwide. The U.S. Department of Health and Human Services on Nov. 12 announced it will work with pharmacies nationwide to distributes COVID-19 vaccines for free, but it’s not yet clear which vaccines will be available through that partnership.

Some states are considering large vaccine depots, as indicated by their draft plans for vaccine rollout sent to the CDC, but such centralized hubs require additional staff, equipment and cost that some states can’t afford. Plus, in rural areas, reaching a “centralized” location may still require lengthy travel for some people. The Pfizer vaccine must also be given in two separate doses, which could be a hard sell to people who have to drive hours to get it.

Moss adds that those who need the vaccine most—like the elderly and those with prior health conditions—may be the least able to travel to get one. And distributing an ultra-cold vaccine may be a pipe dream in countries poorer than the U.S., Moss says.

“It would be extremely challenging, if not impossible, to get such a vaccine out to, say, countries and people in Sub-Saharan African and many parts of Asia, where the infrastructure is not what we have in the United States,” he says.

Pat Lennon, who oversees cold-chain storage at the global health nonprofit PATH, says ultra-cold vaccines were distributed during the recent Ebola outbreak in the Democratic Republic of the Congo, but that was an easier feat, since the virus did not spread as widely.

Moss says he’s not overly concerned about distribution challenges, at least right now. Pfizer’s COVID-19 vaccine is one of many currently in development, and “I don’t have any reason to think this Pfzier vaccine is special in such a way that its efficacy is going to be substantially higher than another vaccine,” Moss says. (Time will tell, of course, exactly how the efficacy and availability of the different shots stack up.)

Many of the other vaccine candidates currently going through clinical trials do not have such stringent cold-storage requirements. Pharmaceutical companies Moderna, Johnson & Johnson and AstraZeneca have all said their COVID-19 vaccine candidates could be kept at temperatures of -20° C or above, which should make distribution easier.

Cannon adds that Pfizer and other vaccine makers may refine their formulas over time. Some other vaccines, such as those for measles and yellow fever, are shipped in a freeze-dried format and reconstituted with water before they’re administered. Something similar may be possible for COVID-19 vaccines in the future, Cannon says. The Pfizer spokesperson says the company hopes to release a COVID-19 vaccine that could be stored at temperatures between 2-8° C in 2022.

But for now, people should be prepared to wait awhile before life returns to normal. Even once vaccines are available, it will take time to achieve the widespread inoculation required to stop the virus from spreading unchecked. “I would say a best-case scenario may be toward the end of 2021,” Moss says. “But it’s going to depend on not just vaccine availability and approvals, but the willingness of people to accept the vaccine. There’s a whole other challenge and layer there.”

In the meantime, the best tools are the ones we’ve already got: social distancing, wearing masks and washing your hands.

Birth control and high blood pressure: Which methods are safe for you?

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Three effective forms of birth control contain the hormone estrogen: the birth control patch, combined hormonal birth control pills, and a vaginal ring. Doctors have typically recommended that women avoid birth control with estrogen if they have high blood pressure, which current US guidelines define as 130 mm Hg systolic pressure and 80 mm Hg diastolic pressure, or higher. A recent clinical update in JAMA clarifies whether it’s safe for some women with high blood pressure to use these forms of birth control.

Why does blood pressure matter when choosing birth control?

Birth control containing estrogen can increase blood pressure. When women who have high blood pressure use these birth control methods, they have an increased risk of stroke and heart attack compared with women who do not have high blood pressure. However, their actual chances of having a stroke or a heart attack are still quite low.

When considering birth control options, it’s important to also weigh the possible risks of an unintended pregnancy. A woman who has a history of high blood pressure before she becomes pregnant is more likely to experience

preeclampsia, a pregnancy complication that can affect liver and kidney function and can even lead to eclampsia, or seizures
diabetes during pregnancy
blood clots
heart attack

She’s also at higher risk for problems with fetal growth and preterm birth.

Why are recommendations around blood pressure and birth control being updated?

When US blood pressure guidelines changed in 2017, many more people were diagnosed with high blood pressure. That happened because the new guidelines tightened standards, as follows:

normal blood pressure is less than 120 (systolic)/80 (diastolic) mm Hg
elevated blood pressure is between 120 and 129 mm Hg (systolic) and less than 80 mm Hg (diastolic)
high blood pressure is 130 mm Hg (systolic) and 80 mm Hg (diastolic) or higher.

With these updated definitions, nearly half of American adults have high blood pressure. Black women are at particularly high risk: more than half of Black women over the age of 19 are diagnosed with high blood pressure.

If a woman has high blood pressure, the JAMA update recommends weighing three factors before starting an estrogen-containing birth control: a woman’s age, control of blood pressure, and any other risks for heart disease.

Safe to use birth control containing estrogen: If women are 35 years old or younger, have well controlled blood pressure, and are healthy, estrogen-containing birth control can be used. Be sure to have a health professional check blood pressure within one month of starting this type of birth control. Additionally, routine blood pressure checks are recommended twice a year.
Should avoid birth control containing estrogen: If women are older than 35, even if they have well controlled blood pressure, estrogen-containing birth control should be avoided. Similarly, women of any age who have multiple risk factors for heart disease or who have uncontrolled high blood pressure should not use birth control containing estrogen. These women also should not use the birth control shot (Depo-Provera) because it may increase cholesterol and lead to an increased risk of stroke, according to the review. (This medication contains a different hormone called progestin.)

The JAMA update reviewed evidence based on an older definition of high blood pressure in the context of birth control use. Further research is needed to better understand how different ranges of blood pressure might affect women using birth control that contains estrogen. However, it’s unlikely that these recommendations would change further based on the newer definition of high blood pressure.

Which birth control methods do not contain estrogen?

So, what can women who are unable to use birth control containing estrogen use to prevent pregnancy? The good news is that there are a variety of other birth control methods available, both hormonal and nonhormonal.

The most reliable forms of birth control without estrogen are the copper intrauterine device (IUD), the hormonal IUD, the implant, and sterilization for women or men.
Nonhormonal methods include the copper IUD, condoms for men or women, cervical cap, and diaphragm.
Three progestin-only hormonal methods are safe to use: the minipill, the birth control implant, or the hormonal IUD. However, the birth control shot (Depo-Provera) is not recommended for women who have poorly controlled high blood pressure.

If you do have high blood pressure, exercise and dietary changes remain an important component of maintaining your heart health. Discuss with your doctor which birth control options might be best for you, so that you and your doctor can engage in shared decision-making about your preferences.

See the Harvard Health Birth Control Center for more information on options.

The post Birth control and high blood pressure: Which methods are safe for you? appeared first on Harvard Health Blog.

Quarantine snacking fixer-upper

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The “battle of the bulge” gained a new foe this year: quarantine snacking. Sales of snack foods like cookies and crackers shot up in the early days of lockdowns, and recent consumer surveys are finding that people have changed their eating habits and are snacking more.

We don’t yet have solid evidence that more snacking and consumption of ultra-processed food this year has led to weight gain. While memes of the “quarantine 15” trended on social media earlier this year, only a few small studies have suggested a link between COVID-19-related isolation and weight gain. But you don’t need scientific evidence to know if your waistband is tighter.

Snacking is not just a weight risk

Regular junk food snacking brings many risks. Processed foods are typically filled with loads of unhealthy saturated fats and high amounts of salt, calories, added sugar, and refined (unhealthy) grains.

Eating too much of these foods can lead to increased blood sugar (which raises the risk for diabetes), constipation, or an increased LDL cholesterol level (which boosts the risk for heart disease).

What you can do

If your snacking habits are off the rails, here are some tips to get back on track.

Keep junk food out of the house. Without junk food lying around, you won’t be tempted to eat it.
Plan healthy snacks. Stock your refrigerator and pantry with healthy snack foods such as fat-free Greek yogurt, berries, chopped vegetables, nuts (walnuts, almonds), hummus, or whole wheat crackers. Plan your daily snacks in advance, so you’ll be more likely to snack wisely.
Zero in on hunger. Before snacking, ask yourself whether you’re hungry or just thirsty. A good way to tell: drink an eight-ounce glass of water and then wait 10 to 15 minutes. If you’re still hungry, have a healthy snack.
Know your cravings. Are you hungry, or are you lonely, bored, or stressed? Food won’t fix the problem. Instead, go for a walk around the block, put on some music, or choose another activity that might distract you or boost your mood. If you still want food, eat only a small amount.
Don’t skip meals. This can make you so hungry later in the day that you’re vulnerable to devouring mega-portions of snack food to supply your body with easily digested sugars.
Don’t eat straight from the bag or carton. If you snack on an open bag of crackers or a tub of frozen yogurt, you may eat more than a single serving. Instead, portion out your serving in a dish.
Eat mindfully. Turn off the TV, put down your phone, and pay attention to your snack. Savoring a piece of fine chocolate can be more satisfying than mindlessly gobbling down a whole chocolate bar.
Prepare for snacks away from home. Plan ahead and keep a healthy snack in your bag or car. That way you won’t turn in desperation to calorie-laden cookies or vending machines.

The post Quarantine snacking fixer-upper appeared first on Harvard Health Blog.

12 Influenza Hospitalizations In Ohio: Flu Update

Weekly Link Love — Edition 107

Research of the Week

New Primal Blueprint Podcasts

Media, Schmedia

Interesting Blog Posts

Social Notes

Everything Else

Things I’m Up to and Interested In

Question I’m Asking

Recipe Corner

Time Capsule

Comment of the Week