health Archives - 911³Ô¹Ï /category/health/ Thu, 23 Mar 2023 17:40:43 +0000 en-US hourly 1 Why Thinking Makes Us Feel Tired /why-thinking-makes-us-feel-tired/ Thu, 15 Sep 2022 21:52:13 +0000 /?p=24924 Have you ever wondered why you feel tired at the end of a workday, if all you have done is sit in front of a computer? Numerous studies have shown that using our brain for challenging or stressful tasks drains energy and makes us tired. This happens for multiple reasons. Thinking increases glutamate. A recently

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Have you ever wondered why you feel tired at the end of a workday, if all you have done is sit in front of a computer?

Numerous studies have shown that using our brain for challenging or stressful tasks drains energy and makes us tired.

This happens for multiple reasons.

Thinking increases glutamate.

A recently published in Current Biology found that participants who spent more than six hours working on a mentally taxing assignment had higher levels of glutamate — an important signaling molecule in the brain. Too much glutamate can disrupt brain function.

The scientists thought the effects of cognitive fatigue could be due to metabolic changes in the brain. They enrolled 40 participants and assigned 24 of them to perform a challenging task. For example, watching letters appear on a computer screen every 1.6 seconds and documenting when one matched a letter that had appeared three letters ago. The other 16 participants were asked to perform a similar, but easier task. Both teams worked for just over six hours, with two 10-minute breaks.

Using a technique called magnetic resonance spectroscopy, the researchers measured glutamate levels in the brain’s lateral prefrontal cortex. The prefrontal cortex is the home of cognitive control — the part of the brain that allows people to suppress their impulses. “If you get stung by an insect, you want to scratch,” said Antonius Wiehler of the Paris Brain Institute. “If you’re stopping this reflex, that would be cognitive control.” It’s also the system that humans rely on to choose tempting short-term rewards, such as an unhealthy snack, over long-term gains.

The researchers found that by the end of the day, participants who labored on the more difficult task had accumulated more glutamate in this region of the brain than those who had worked on the easier task. And, given a choice between an immediate cash reward and a larger reward that would come months later, they were more likely to choose the smaller, short-term reward than they were at the start of the day.

In addition to increased glutamate, our brains burn a lot of sugar when they are working hard.

Glucose (a form of sugar) is the primary energy source for every cell in the body. Because the brain is so rich in nerve cells, or neurons, it is the most energy-demanding organ, Brain function such as thinking, memory, and learning are closely linked to glucose levels and how efficiently the brain uses this fuel source. For example, if there’s insufficient glucose in the brain, neurotransmitters, the brain’s chemical messengers, are not produced and communication between neurons breaks down. Additionally, hypoglycemia, a common diabetic complication caused by low blood glucose levels, can lead to loss of energy for brain function. It’s also linked to poor attention and cognitive function.

So, there is a biological reason why I crave something sweet every afternoon! Think of all the “fuel” craved when cramming for a test or working late on a project. Our brains are demanding fuel to keep powering through!

Understanding the science behind our behavior can help us make healthier choices. Try to forego junk food and fuel up with healthier sugar sources like fruit instead. Take regular breaks to clear your head. A few minor changes can make a big difference in your energy levels, cognitive function, and overall health.

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Other Factors In Play With Lockdowns – Mental Health /other-factors-in-play-with-lockdowns-mental-health/ Fri, 15 May 2020 19:54:32 +0000 /?p=8623 It seems like people are becoming polarized over COVID-19 solutions. At times, it feels difficult to have nuanced discussions about the various measures being employed to combat the virus. This is really too bad. We are all in this pandemic together. This is not and will never be a black and white situation. COVID-19 is

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It seems like people are becoming polarized over COVID-19 solutions. At times, it feels difficult to have nuanced discussions about the various measures being employed to combat the virus. This is really too bad. We are all in this pandemic together. This is not and will never be a black and white situation. COVID-19 is a real disease that poses significant risk to some people, yet any societal or individual response carries with it potentially serious repercussions. Every action has a reaction and these reactions should be included in any risk calculations.

That said, I want to share some observations about the COVID-19 lockdown, outside of the disease itself.

Parents are growing increasingly concerned about their children’s mental health. In a recent , parents report nightmares, tantrums, and regressions are just some of the worrisome behaviors their children are exhibiting in the wake of school closures and weeks of stay-at-home orders.

Here’s what I’ve noticed with my own children:

  • In general, my twin 3-year-olds are fine. They miss their school friends, but seem to enjoy the extra time with Mom and Dad. Of late, however, my son constantly brings up “the virus.” If we go for a walk, we are always watching for “the virus.” When he plays by himself, I hear him run from or fight “the virus.” While my wife and I have tried to downplay the disease, it’s obvious others have given him more details or he has overhead discussions about “the virus.” It is difficult to know how much the COVID-19 fear and isolation will impact young kids as they grow up.
  • In many ways, my 6-year-old seems to be blossoming. She is a getting a lot of one-on-one time with Mom and we have learned a lot about her learning style. She appears to be enjoying the extra time with her siblings, especially her older sister. The only thing I have noticed is an increase in nightmares. She now needs to sleep with the lights on and often comes into our bedroom during the night.
  • My 9-year-old is having the hardest time adjusting. Fourth grade is a social age. She definitely misses her friends. At times, she seems lethargic and depressed, not her usual state. She says she often wakes up hoping I will be rushing her to get ready for school. If there is no school in the fall, I am worried.

It seems too that children’s reactions mirror those of their parents. My daughter had a play date scheduled with one of her best friends. On the ride to our home, she became very anxious about being out of her house and we had to bring her home. The child’s mother is extremely worried about COVID-19. On Zoom calls, she is not her usual happy self. Her stress level is palpable.

It is sad that kids are contending with these emotional issues when the virus to them. While the long term mental health impact of COVID-19 is yet unknown, any traumatic childhood experience can have far reaching effects into adulthood. As such, I encourage everyone to be mindful of their pandemic responses when around children.

But it’s not just kids who are suffering. Across the country, suicide and crisis hotlines are reporting record call volumes. , a federal crisis hotline that provides counseling and support to emotionally distressed people during times of natural and human-caused disasters, saw a year over year increase of calls. Pandemic-related stress is also prompting a spike in alcohol and drug use, according to a , with Americans reporting a 55% rise in alcohol consumption and a 36% increase in drug use.

The Internet is currently flooded with memes, like the one the below, about prolific drinking during the pandemic.  

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As funny as the jokes can be, experts have already started to about the secondary effects of COVID-19, including increased rates of addiction, depression, post-traumatic stress disorder, and suicide. A fear, isolation, and unemployment stemming from the virus could result in 75,000 “deaths of despair” years after the worst of the pandemic is over. Deaths of despair include suicide and those related to drug or alcohol abuse. The study, released by Well Being Trust and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, estimated the number of deaths based on the rate of economic recovery, with 75,000 “the most likely” out of a range of approximately 27,000 to 154,000 between the years 2020 and 2029.

I am not a fan of fear mongering, but it is undeniable unemployment and isolation will adversely impact society long after this immediate crisis has passed. That’s why I believe policies intended to reduce the spread of the disease need to factor in the emotional and mental health risks accompanying them. I say this not to be negative, but rather to underscore the importance of understanding the full implications of government-wide mandates.

As I’ve shared in previous blogs, I favor Sweden’s approach to managing the COVID-19 outbreak, which relies heavily on voluntary cooperation with social distancing protocols rather than state imposed restrictions. Here in the U.S., I’m confident that those most at risk from the virus will take the necessary precautions to protect their health without the need for broad compulsory measures that threaten the well-being of low risk individuals and society as a whole.

Stay safe, stay strong!

 

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9+ Out of 10 Chicago & Cook County COVID-19 Victims Had Preexisting Conditions /9-out-of-10-chicago-cook-county-covid-19-victims-had-preexisting-conditions/ Wed, 13 May 2020 18:11:32 +0000 /?p=8565 Nationwide, data repeatedly shows that most people who die from COVID-19 have contributory secondary causes of death. Here in Chicago, where 911³Ô¹Ï is headquartered, 94% of the city’s COVID-19 victims and 92% of all Cook County COVID-19 victims had preexisting medical conditions. The Cook County Medical Examiner’s database shows COVID-19 as the primary cause of

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Nationwide, data repeatedly shows that most people who die from COVID-19 have contributory secondary causes of death. Here in Chicago, where 911³Ô¹Ï is headquartered, 94% of the city’s COVID-19 victims and 92% of all Cook County COVID-19 victims had preexisting medical conditions.

The Cook County Medical Examiner’s shows COVID-19 as the primary cause of death for 2,303 people. Of those, more than 2,112 appear to have at least one underlying condition as a secondary cause of death. There were no secondary causes reported for 191 deaths.

Cook Data 20200509.png

Hypertension affected 1,070 victims or more than 46% of all deaths. Diabetes impacted 973 victims or 42% of the death total. Pulmonary disease was part of 397 deaths or 17%. And 215 of those deaths, about 9%, were accompanied by obesity or morbid obesity. Others had conditions including cancer, cardiovascular disease, or kidney disease. The numbers in the table above equal more than 100% because many victims had more than one preexisting condition.

The Cook County data aligns with  on comorbidity volume. Though the City’s data does not provide the same level of comorbidity detail, it does report that 1,090 of Chicago’s 1,160 COVID-19 victims had underlying conditions. That’s 94%.

As of May 8, the average age of all COVID-19 deaths in Illinois was 74, while the median age of the state’s population is old.  Almost 50% of all Illinois deaths have  long-term care facilities ().

What’s remarkable about the Cook County comorbidity data is just how few young adults have died from COVID-19 in the absence of a preexisting condition. Nobody under 20 has died without one. Only three deaths in the 20-29 age bracket were without a documented comorbidity. And in the 30-39 and 40-49 age brackets, just 26 deaths had no defined underlying causes. Such statistics suggest the odds are slight of anyone young and healthy dying from this disease.

When those numbers are compared against each age bracket’s population percentage, those at risk (and who have very low risk) become more even more clearly defined.

IL Pop by Age.PNG

Illinois residents over the age of 70 account for 8.5% of the state’s population and 63.8% of the deaths. Those under 40-years old account for 54.5% of the population and just 2.2% of the deaths. Put another way, a person over 80 is 706,740% more at risk of dying from COVID-19 than a person under 20.

Understanding who is most at risk (and who is not) is paramount to combating the virus. What Cook County and other comorbidity data across the country indicates is that the risk of death for young and healthy people is considerably lower than people may have originally thought or continue to believe. There are pockets of people (elderly, those with high risk comorbidities) and specific environments (nursing homes, hospitals, jails, congested workplaces like meat processing plants, etc.) warranting stringent infectious disease precautions and concentrated efforts to control the virus’s damage. The young and healthy should take precautions too (proper hand hygiene, immunity-boosting supplements), but there is lower risk to them going about their normal lives.

Stay safe, stay strong!

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Vitamin D Deficiency Increases Risk of COVID-19 Complications /vitamin-d-deficiency-increases-risk-of-covid-19-complications/ Tue, 12 May 2020 22:31:41 +0000 /?p=8567 I previously mentioned the potential of vitamin D to boost immune system defenses against COVID-19. Two recent studies have discovered a strong correlation between severe vitamin D deficiency and complications and/or mortality rates of COVID-19 patients. The first – published in Aging Clinical and Experimental Research – found that COVID-19 infections and deaths were greater

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I previously mentioned the potential of vitamin D to boost immune system defenses against COVID-19. Two recent studies have between severe vitamin D deficiency and complications and/or mortality rates of COVID-19 patients.

The first – published in – found that COVID-19 infections and deaths were greater in countries where people had low vitamin D levels, such as Italy and Spain, compared to northern European countries where average vitamin D levels were higher. British researchers attributed the vitamin D differences to some southern Europeans having darker pigmentation, which reduces vitamin D synthesis, and northern Europeans consuming more cod liver oil and vitamin D supplements.

The appeared in the online journal . Though not yet peer-reviewed, the study’s conclusion was the same: Low vitamin D levels were linked to a hyperactive immune system.

By analyzing publicly available patient data from around the globe, lead researcher and biomedical engineer and his team at Northwestern University discovered a significant correlation between vitamin D levels and cytokine storm — a hyperinflammatory condition caused by an overactive immune system — as well as a correlation between vitamin D deficiency and mortality.

can severely damage lungs and lead to acute respiratory distress syndrome and death in patients,” said Ali Daneshkhah, a postdoctoral research associate in Beckman’s lab and the paper’s first author. “This is what seems to kill a majority of COVID-19 patients, not the destruction of the lungs by the virus itself. It is the complications from the misdirected fire from the immune system.”

As vitamin D enhances people’s innate immune systems as well as prevents them from becoming dangerously overactive, Backman and his team’s findings indicate that having healthy levels of vitamin D could protect patients against severe complications, including death, from COVID-19.

“Our analysis shows that it might be as high as cutting the mortality rate in half,” Backman said. “It will not prevent a patient from contracting the virus, but it may reduce complications and prevent death in those who are infected.”

Clinical trials to see if vitamin D can help infected patients are now underway. Meanwhile, I continue to be a proponent of taking vitamin D, vitamin C, and zinc supplements to protect your health should you contract COVID-19. Being healthy in general is the best thing you can do to protect your immune system.

Stay safe, stay strong!

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Pandemic Response: 1968 vs. Now /pandemic-response-1968-vs-now/ Fri, 08 May 2020 18:33:58 +0000 /?p=8570 I found this American Institute for Economic Research article comparing society’s response to the current COVID-19 crisis to the H3N2 pandemic of 50 years ago both enlightening and discouraging. H3N2 (or the “Hong Kong flu,” as it was more popularly known) occurred between 1968-1970. It arrived in the United States from Hong Kong in September

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I found this American Institute for Economic Research comparing society’s response to the current COVID-19 crisis to the H3N2 pandemic of 50 years ago both enlightening and discouraging.

H3N2 (or the “Hong Kong flu,” as it was more popularly known) occurred between 1968-1970. It arrived in the United States from Hong Kong in , peaking in mid-December through January 1969. It ultimately killed 100,000 people in the U.S., mostly over the age of 65, and one million worldwide.

At that time, the U.S. lifespan was today. The population was much smaller, 200 million as compared to 328 million. Adjusting for population and demographics, it’s probable the pandemic of five decades ago would result in a quarter million deaths today, making it as lethal as COVID-19.

But while the outbreak is shockingly similar in scale, the way society handled it couldn’t be . Stock markets didn’t plummet. Congress passed no legislation. The Federal Reserve didn’t cut interest rates. Not a single governor acted to enforce social distancing, curve flattening (even though hundreds of thousands of people were hospitalized), or crowd banning. No daycares shuttered despite there being more infant deaths from H3N2 than there have been from COVID-19. No for violating stay-at-home orders. Unemployment didn’t skyrocket. There was no worry of or . Despite a New York Times editorial describing the pandemic as “one of the worst in the nation’s history,” only 23 schools and colleges closed, businesses remained open, and Woodstock was still held (although it took place between the first and second waves of the pandemic). Going about daily life in the face of the disease was a deliberate choice.

So what changed between 1968 and now? Dr. Deborah Birx cited fatality estimates from a Imperial College London for the federal government’s drastic restrictions, a model for its veracity. Some theorize there were partisan elements to the government mandated shelter-in-place orders, with political parties using them to achieve objectives unrelated to public health. Certainly, the Vietnam War received far greater media coverage than the virus in a much less invasive way. Today, with a relentless 24-hour news cycle, stories of COVID-19 can dominate. 

I don’t know the answer. But as a urges, I do think there’s value in revisiting the nation’s response to the Hong Kong flu pandemic. Much like the world repeatedly learned and lost the , it seems like the country needs to rediscover how it treated past disease-born hardships so it can make the most well-informed decisions regarding future pandemic measures. As a healthcare leader, I believe I have a duty to bring that knowledge to light. 

Stay safe, stay strong!

 

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Sweden Capital – Close to Herd Immunity /sweden-capital-close-to-herd-immunity/ Mon, 04 May 2020 05:11:07 +0000 /?p=8583 Sweden is confident they see a light at the end of the current pandemic tunnel. One indicator is the country’s capital nearing herd immunity. Anders Tegnell, chief epidemiologist at Sweden’s Public Health Agency, tells USA Today, “We think that up to 25% of people in Stockholm have been exposed to coronavirus and are possibly immune.

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Sweden is confident they see a light at the end of the current pandemic tunnel. One indicator is the country’s capital nearing herd immunity. Anders Tegnell, chief epidemiologist at Sweden’s Public Health Agency, USA Today, “We think that up to 25% of people in Stockholm have been exposed to coronavirus and are possibly immune. A recent survey from one of our hospitals in Stockholm found that 27% of staff there are immune. We think that most of those are immune from transmission in society, not the workplace. We could reach herd immunity in Stockholm within a matter of weeks.”

Sweden, unlike many other nations, has not taken a hardline approach to the COVID-19 pandemic that has resulted in mass economic shutdowns and surging unemployment elsewhere. In the U.S. alone, more than 30 million people are now In contrast, Sweden’s response to the pandemic has largely been “business as usual.” Bars, restaurants, libraries, public pools, and most schools remain open in the nation of 10 million, from critics skeptical of the country’s approach.

The spread of any virus slows dramatically as more people develop the antibodies to fight the virus and are no longer able to spread it. In Stockholm, home to approximately two million residents, achieving herd immunity would account for roughly 20% of the county’s total population. This would certainly slow the spread of COVID-19, though it is far below the herd immunity threshold of 60% to 70% is needed for the virus.

As we head into May, Sweden’s COVID-19 death toll stands just over 2,500, with nearly half of all fatalities occurring in nursing homes, where visits have been banned since March 31. “We have taken reasonable measures without without really hurting health care or schools,” said Tegnell. “We are going for a sustainable strategy; something we can keep doing for months.” As Sweden continues its targeted approach to tackling the pandemic, time will tell if that holds true.

On Wednesday, the World Health Organization (WHO) . “What [Sweden] has done differently is it has very much relied on its relationship with its citizenry and the ability and willingness of its citizens to implement self-distancing and self-regulate,” said Dr. Mike Ryan, the agency’s top emergencies expert. “In that sense, they have implemented public policy through that partnership with the population.”

Making social distancing more a matter of personal responsibility than a government mandate is at the heart of Sweden’s coronavirus strategy. “I think there’s a perception out that Sweden has not put in control measures and just has allowed the disease to spread,” Ryan told reporters. “Nothing can be further from the truth.” In addition to prohibiting nursing home visits, Sweden has banned gatherings of more than 50 people. Citizens were asked to work from home, if possible, and urged those over 70 to self-isolate as a precaution.

I have seen news reports that say Sweden model’s has had terrible results, but I am not clear where that data is coming from. Sweden has a slightly larger population than New York City, with similar exposure levels, but with a far lower death rate. As of April 28, NYC had 12,000 reported deaths out of eight million people whereas Sweden had 2,300 out of 10 million.

I further mapped out some countries vs. their and Sweden’s is not especially high.

Death Rates.jpg

What is different is that Sweden has not done as much self inflicted economic damage nor do they fear a second wave of the virus as much as other countries do when they relax their lockdowns. Both of these things sound amazing.

America has had lockdowns for some time now, and the data is showing that Sweden may not be wrong in taking a less restrictive approach. In a by political scientist Wilfred Reilly, he discusses the lack of empirical evidence to support that lockdowns have been more effective than well-done social-distancing measures to stop the spread of COVID-19. Analyzing data from the , Reilly found that the states that issued more self-regulating social-distancing rules at the pandemic’s onset fared favorably against those states that were quick to issue shelter-in-place orders (even after excluding New York – the extreme outlier of bad results). Comparing the two groups, (minus New York), “the social-distancing states experienced 663 fewer cases per million and 42 fewer deaths per million on average than the lockdown states.”

I am a proponent of the Swedish model for managing this outbreak. Individual freedom and personal responsibility are hallmarks of the American way. People know COVID-19 is serious, but each person’s circumstances are unique. I believe being able to address them as they see fit is better than any “one size fits all” mandate. My own situation has changed dramatically at times throughout this pandemic.  For example, a friends’ child was with my family and I during spring break because his mother was undergoing chemotherapy treatment and his father had to travel for work. After spring break, he stayed with us for two additional weeks, and we had to be very strict with our quarantine to ensure he did not bring anything home to his immunocompromised mother. After he went home, we no longer felt the need for any exceptional virus controls given that we are all lower risk. And if we do get the virus, we figure we are doing our part to create herd immunity to protect those who cannot afford to catch it.

Stay safe, stay strong!

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Teach a Person to Fish /teach-a-person-to-fish/ Thu, 30 Apr 2020 14:09:51 +0000 /?p=8580 When I was entering 4th grade, my parents bought their first house, which was my primary home through high school. Seeing my childhood home on Zillow today, the landscaping is greatly improved, but the front looks much the same. Growing up, I spent a lot of time in the basement. It had the only TV

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When I was entering 4th grade, my parents bought their first house, which was my primary home through high school.

Rose Lane.jpg

Seeing my childhood home on Zillow today, the landscaping is greatly improved, but the front looks much the same. Growing up, I spent a lot of time in the basement. It had the only TV in the house, fake wood panels, cinder block and wood shelves with my parents’ college text books and novels, a laundry room with a 1/2 bath, and whatever stuff my brother and I were playing with at the time.

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Two signs hung on the basement walls. For different reasons, I remember them both vividly.

The one over the bathroom toilet said this:

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As an adult, the message is clear. But growing up, it meant different things to me at different ages.

The other sign was a proverb.

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I read and thought about that proverb often over the years. It is so simple – yet so profound, powerful, and true. That proverb influenced my views on the world and helped me determine how I could make the greatest difference in it.

I noticed over and over, when people did not follow that proverb, long term success proved elusive. Be it economic policy, parenting style, management strategy, relationship attitude, or any other aspect of life, that proverb always provides sage wisdom.

With my children, I believe my job is to help them on their journey to becoming strong and decent people. I let them struggle at times, not because I do not care, but because I do. Learning to become self sufficient is the only way they can become independent. They should want to be with me, not need to be with me. I want them to be more successful and better than I am in every way that matters, including happiness. That drives my parenting style.

I get more joy and satisfaction from knowing 911³Ô¹Ï is providing an outlet for people to “fish” for themselves and their families, than I do from any pride in myself. Providing a great place for people to work, grow, and excel is something I relish.

With charities, I always ask “are they solving the problem permanently (teaching people to fish) or temporarily masking it (giving people a fish)?” Candidly, I struggle to support organizations if they are not working towards a permanent solution to the problem.

Recently, 911³Ô¹Ï team members held an internal fundraiser to support the Greater Chicago Food Depository, the Milwaukee Hunger Task Force, and Feeding America. As a company, 911³Ô¹Ï matched our employees’ generous contributions. With unemployment soaring, food banks are seeing a dramatic increase in demand. For the first time in their lives, many people do not know where their next meal will come from. They are food banks hours before they even open. People are in dire need and the money we donated will help people in the short term.

Food bank lines.jpg

But what about the long term? People are in need because they were “banned from fishing.” As a country, we will not be able to “give a fish” our way out of the economic hardships resulting from COVID-19. The longer the national shutdown continues, the number of people in need will grow while the number of people with resources to assist will dwindle. The pattern needs to be reversed. Every day someone is prevented from fishing, the livelihood of that person, their family, and society overall is jeopardized.

The best thing I can do, and the best thing I feel society can do, is provide people with as much evidence-based information as possible about the virus. That way, when restrictions are lifted, people are knowledgeable and comfortable taking the necessary steps to provide for themselves and their families. From what I’ve observed, the panicdemic surrounding COVID-19 has proven to be far more destructive and dangerous than the pandemic itself. Only knowledge can offset fear of the unknown, which is why I have found such a pressing need to write about and discuss the status of the COVID-19 outbreak. I just want you all to know my perspective as I write these blogs.

Stay safe, stay strong!

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COVID-19 Cases and Deaths Counted Differently By State/Country /covid-19-cases-and-deaths-counted-differently-by-state-country/ Mon, 27 Apr 2020 20:17:47 +0000 /?p=8578 When I look at COVID-19 data, I see very large disparities in the volume of cases and deaths between various countries as well as between states within the U.S. Many factors, including time of the testing ratio, time since outbreak, weather, population density, age of the population, health of the population, government decisions, and personal

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When I look at COVID-19 data, I see very large disparities in the volume of cases and deaths between various countries as well as between states within the U.S.

Many factors, including time of the testing ratio, time since outbreak, weather, population density, age of the population, health of the population, government decisions, and personal choices can impact the virus’s severity in a region.

Another reason why it’s difficult to compare regional severity is the lack of a universal definition of what constitutes a COVID-19 case or cause of death.

The same holds true within America. The Centers for Disease Control and Prevention (CDC) has no clear singular definition of what is or is not a COVID-19 death. published by the CDC on March 4 state:

It is important to emphasize that Coronavirus Disease 2019 or COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death.

The “assumed to have caused” and “contributed” instructions are not standard practices for other diseases. The result is states, and even care facilities, have chosen different methods of documenting COVID-19 deaths. This cannot help but inflate COVID-19 statistics compared to other causes and increase confusion.

During Gov. JB Pritzker’s , Dr. Ngozi Ezike, the Illinois Department of Public Health (IDPH) director, gave the state’s definition of a COVID-19 death. Simply put, it means at the time of death, a person had a COVID-19 diagnosis.

“Technically, even if you died of a clear alternate cause, but you had COVID at the same time, it’s still listed as a COVID death. So, everyone who’s listed as a COVID death doesn’t mean that was the cause of death, but they had COVID at the time of death,” said Ezike.  As an example, she said, “If you were in hospice and had already been given a few weeks to live, and then you also were found to have COVID, that would be counted as a COVID death.”

In some states, like Alabama, the deceased must have tested positive for COVID-19 for the death to be reported as a COVID-19 death. Other states, like New York, allow for more leeway. A death may be reported as a COVID-19 death if the deceased was suspected of having it even if no test was performed. Some states require COVID-19 to be the primary cause of death in order to qualify for state reporting, while others report all cases where COVID-19 was present at the time of death to be COVID-19 deaths. These divergent methods make some region’s infection and death rates undercounted and others overcounted, making it difficult to gauge the disease’s true impact on medical resources and mortality rates. This is especially problematic when death counts influence hospital reimbursements and federal relief.

According to a recent , Alabama officials have ruled that one of every 10 people who died with COVID-19 did not die of COVID-19.

In Colorado, the number of COVID-19 deaths The Colorado Department of Public Health and Environment (CDPHE) said it previously counted deaths of persons who had COVID-19 in its totals, even if COVID-19 was not the cause of death. In one example, the Montezuma County coroner found that a man who had died of acute alcohol poisoning – his blood alcohol level was nearly double the lethal level – had his death classified as COVID-19. In revising its reporting policy, the CDPHE will now distinguish between deaths caused by COVID-19 and deaths where COVID-19 was present. “What the people want to know is not who died with COVID-19, but who died of COVID-19,” .

In states where deaths can be attributed to COVID-19 without confirmed diagnosis, those deaths can be counted in the numerator (people that died from COVID-19), but not in the denominator (people that tested positive for COVID-19) of their death ratios. This is fundamentally flawed math.

When experts look back on this time, I think not standardizing the definition of a COVID-19 death will be considered a significant error on the part of the U.S. and the world in trying to understand and control this pandemic. Overreactions or underreactions are certain given the disparity in methods. Flawed and inconsistent data undermines credibility. It is really important when digesting data to know how it is calculated and to not assume data from one source is actually comparable to another source.

Stay safe, stay strong!

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First U.S. COVID-19 Case Earlier Than Previously Thought /first-covid-19-case-in-united-states-earlier-than-previously-known/ Wed, 22 Apr 2020 17:50:03 +0000 /?p=8574 Two coronavirus-infected people died in Santa Clara County in California on Feb. 6 and Feb. 17, making them the first documented COVID-19 fatalities​ in the United States. Until now, the first fatality was believed to have occurred in Kirkland, Washington on Feb. 29. Across the country, there has been a growing concern that COVID-19 has been

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Two coronavirus-infected people died in Santa Clara County in California on Feb. 6 and Feb. 17, making them the ​ in the United States. Until now, the first fatality was in Kirkland, Washington on Feb. 29.

Across the country, there has been a growing concern that COVID-19 has been in the United States longer than experts first believed.

Earlier this month, physician and Santa Clara County Executive Dr. Jeff Smith said data collected by the Centers for Disease Control and Prevention (CDC), local health departments and others suggest it was “a lot longer than we first believed” — most likely since “back in December.”

Speaking with the , Smith said, “This wasn’t recognized because we were having a severe flu season. Symptoms are very much like the flu. If you got a mild case of COVID, you didn’t really notice. You didn’t even go to the doctor. The doctor maybe didn’t even do it because they presumed it was the flu.”

In Santa Clara County, which had previously reported its first COVID-19 death on March 9, the said it will likely identify more deaths from COVID-19 as the Medical Examiner-Coroner continues to investigate area deaths.

Because COVID-19 symptoms can be slow to appear in infected individuals, and the time from onset of symptoms to death averages three weeks, the patient that died on Feb. 6 would have become infected in January at the latest.

With a by the University of Southern California and the LA Department of Public Health showing that the Los Angeles County COVID-19 outbreak could be up to 55 times bigger than the number of confirmed cases, evidence is quickly mounting that the virus has been here in the U.S. far earlier than was originally suspected. As Dr. Smith noted, in all likelihood since December 2019.

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COVID-19 Outbreak Much Larger Than Confirmed Cases /covid-19-outbreak-is-much-larger-than-confirmed-cases/ Tue, 21 Apr 2020 19:21:16 +0000 /?p=8576 The University of Southern California and the LA Department of Public Health released preliminary study results that found approximately 4.1% of Los Angeles County’s adult population has antibodies to the coronavirus, estimating that between 221,000 adults to 442,000 adults in the county have had the infection. This new estimate is 28 to 55 times higher

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The University of Southern California and the LA Department of Public Health released that found approximately 4.1% of Los Angeles County’s adult population has antibodies to the coronavirus, estimating that between 221,000 adults to 442,000 adults in the county have had the infection.

This new estimate is 28 to 55 times higher than the 7,994 confirmed cases of COVID-19 reported to the county through early April.

This is exciting research. If correct, the data would mean that the county’s than originally thought, instead of the projected 4.5%.

Although not enough people have developed antibodies yet, this is encouraging news for the development of herd immunity. If further studies confirm that the virus is less deadly than originally feared, the more likely it is that certain activities can be resumed sooner than expected for people in low risk categories.

Stay safe, stay strong!

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