The current investigators analyzed national healthcare claims from the US Medicaid program from 2001 to 2010 for 39,582 Medicaid beneficiaries (mean age, 44.5 years; 78.5% women) diagnosed with depression. Patients with alternative indications for anti-psychotic therapy, such as schizophrenia, psychotic depression or bipolar disorder, were excluded.
After a period of at least 3 months of treatment with a single antidepressant, more than half of the patients (56.6%) augmented their treatment with one of these atypical anti-psychotics: quetiapine, risperidone, aripiprazole or olanzapine. The remaining patients (43.4%) added a second antidepressant. The average chlorpromazine-equivalent starting dose for all atypical anti-psychotics was 68 mg/day, which increased to 100 mg/day during follow-up.
A total of 153 patients died during 13,328 person-years of follow-up, including 105 who augmented with an atypical anti-psychotic and 48 who augmented with a second antidepressant.
Compared with those who added a second antidepressant, those who added an anti-psychotic had a 45% increased risk of dying during follow up (adjusted hazard ratio,1.45; 95% CI, 1.02 – 2.06).
Antipsychotic Added to Antidepressant Linked to Higher Mortality – Medscape – Oct 07, 2020. https://www.medscape.com/viewarticle/938707?src=rss#vp_1
Not So Tiny Human Disease Vectors (still kids though)
There is increasing evidence that children and adolescents can efficiently transmit SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1–3). During July–August 2020, four state health departments and CDC investigated a COVID-19 outbreak that occurred during a 3-week family gathering of five households in which an adolescent aged 13 years was the index and suspected primary patient; 11 subsequent cases occurred.
Citation for this article: Schwartz NG, Moorman AC, Makaretz A, et al. Adolescent with COVID-19 as the Source of an Outbreak at a 3-Week Family Gathering — Four States, June–July 2020. MMWR Morb Mortal Wkly Rep. ePub: 5 October 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6940e2
Sorry folks but you probably need to rethink Thanksgiving this year.
Drug-Induced Arrhythmias: A Scientific Statement From the American Heart Association
Abstract
Many widely used medications may cause or exacerbate a variety of arrhythmias. Numerous antiarrhythmic agents, antimicrobial drugs, psychotropic medications, and methadone, as well as a growing list of drugs from other therapeutic classes (neurological drugs, anticancer agents, and many others), can prolong the QT interval and provoke torsades de pointes. Perhaps less familiar to clinicians is the fact that drugs can also trigger other arrhythmias, including bradyarrhythmias, atrial fibrillation/atrial flutter, atrial tachycardia, atrioventricular nodal reentrant tachycardia, monomorphic ventricular tachycardia, and Brugada syndrome. Some drug-induced arrhythmias (bradyarrhythmias, atrial tachycardia, atrioventricular node reentrant tachycardia) are significant predominantly because of their symptoms; others (monomorphic ventricular tachycardia, Brugada syndrome, torsades de pointes) may result in serious consequences, including sudden cardiac death. Mechanisms of arrhythmias are well known for some medications but, in other instances, remain poorly understood. For some drug-induced arrhythmias, particularly torsades de pointes, risk factors are well defined. Modification of risk factors, when possible, is important for prevention and risk reduction. In patients with nonmodifiable risk factors who require a potentially arrhythmia-inducing drug, enhanced electrocardiographic and other monitoring strategies may be beneficial for early detection and treatment. Management of drug-induced arrhythmias includes discontinuation of the offending medication and following treatment guidelines for the specific arrhythmia. In overdose situations, targeted detoxification strategies may be needed. Awareness of drugs that may cause arrhythmias and knowledge of distinct arrhythmias that may be drug-induced are essential for clinicians. Consideration of the possibility that a patient’s arrythmia could be drug-induced is important.
Drug-Induced Arrhythmias: A Scientific Statement From the American Heart Association — https://www.ahajournals.org/doi/10.1161/CIR.0000000000000905
If you go to the original article page you’ll find a link to the full statement in PDF format that includes several lists of the medications that can either cause or exacerbate arrhythmias.
Quote for Today – 10.02.20
“If you told me that somebody who was only testing, not wearing their mask, not distancing, and not taking every other precautionary measure tested positive,” said Saskia Popescu, a University of Arizona epidemiology professor and biodefense expert, “I would say: No shit, Sherlock.”
Why the White House’s testing-only strategy to shield Trump from Covid-19 fell short — https://www.statnews.com/2020/10/02/why-the-white-houses-testing-only-strategy-to-shield-trump-from-covid-19-fell-short/?utm_campaign=rss
Don’t Blame the Kids…(a lot of them went back to college)
During August 2–September 5, 2020, weekly COVID-19 cases among persons aged 18–22 years increased 55% nationally. Increases were greatest in the Northeast (144%) and Midwest (123%). Increases in cases were not solely attributable to increased testing.
Citation: Salvatore PP, Sula E, Coyle JP, et al. Recent Increase in COVID-19 Cases Reported Among Adults Aged 18–22 Years — United States, May 31–September 5, 2020. MMWR Morb Mortal Wkly Rep. ePub: 29 September 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6939e4external icon
Clusterf**k at UNC — The CDC Sanitized Version
The Daily Tar Heel, UNC Chapel Hill’s independent student newspaper, wasn’t holding back in an editorial published Monday, August 17, 2020, criticizing the university’s administration after four COVID-19 clusters were reported on campus. Editor’s note: Letters in the headline were blurred by McClatchy News. The Daily Tar Heel
Read more here: https://www.newsobserver.com/news/coronavirus/article245017180.html
As of Monday, 177 students were in isolation at UNC-Chapel Hill after testing positive for COVID-19, and hundreds more were in quarantine. Through last week, the test positivity rate on campus jumped over 10 percentage points to 13.6 percent. Such a high positivity rate indicates that the virus is spreading through the campus community. (According to the World Health Organization, anything over 5 percent is cause for concern.) There are likely students infected with the virus who aren’t showing symptoms, and they could leave campus without knowing they’re sick.
https://www.theverge.com/2020/8/18/21373482/unc-covid-outbreak-students-home-testing-university
UNC is sending some students back home without testing them for COVID-19
Update 09.29.20 aka The Sanitized CDC version of events:
A North Carolina university experienced a rapid increase in COVID-19 cases and clusters within 2 weeks of opening the campus to students. Student gatherings and congregate living settings, both on and off campus, likely contributed to the rapid spread of COVID-19 in this setting.
The CDC is not naming names. But the NC university not mentioned is pretty obvious.
The Beginning of the End
Airlines want more from the government printing press.
American Airlines was also the airline that blew, incinerated, wasted, and trashed more than any other airline on share buybacks. Buybacks ceased in the second quarter, but from 2013 through Q1 2020, American Airlines incinerated $13.1 billion in cash on share buybacks. That cash would now come in very handy. 2013 was also the year Mr. Parker became CEO of American Airlines. Delta blew, wasted, and incinerated $11.7 billion in cash on share buybacks over the period; Southwest Airlines, $10.9 billion (starting in 2012); and United $8.9 billion. In total, the big four airlines blew, wasted, and incinerated $44.6 billion in cash on share buybacks from 2012 through Q1 2020, and now the airlines want an additional $25 billion bailout, for a total of $50 billion, much of it in forms of grants, from taxpayers (data via YCharts)
Facing Crappiest Recovery Ever, Airlines Demand New $25-Billion Bailout, for $50 Billion Total, after Having Burned $45 Billion on Share Buybacks — https://wolfstreet.com/2020/09/28/facing-crappiest-recovery-ever-airlines-demand-new-25-billion-bailout-for-50-billion-total-after-having-burned-45-billion-on-share-buybacks/
Just. Say. NO.
Changing Age Distribution of the COVID-19 Pandemic — United States, May–August 2020
During June–August 2020, COVID-19 incidence was highest in persons aged 20–29 years, who accounted for >20% of all confirmed cases. Younger adults likely contribute to community transmission of COVID-19. Across the southern United States in June 2020, increases in percentage of positive SARS-CoV-2 test results among adults aged 20–39 years preceded increases among those aged ≥60 years by 4–15 days.
This report provides preliminary evidence that younger adults contributed to community transmission of COVID-19 to older adults. Across the southern United States in June 2020, the increase in SARS-CoV-2 infection among younger adults preceded the increase among older adults by 4–15 days (or approximately one to three incubation periods). Similar observations have been reported by the World Health Organization.*** Further investigation of community transmission dynamics across age groups to identify factors that might be driving infection among younger adults and subsequent transmission to older adults is warranted.
citation for this article: Boehmer TK, DeVies J, Caruso E, et al. Changing Age Distribution of the COVID-19 Pandemic — United States, May–August 2020. MMWR Morb Mortal Wkly Rep. ePub: 23 September 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6939e1external
All I can think of right now are the colleges and universities who have sent infected students back home. No one could have seen this coming said no one with a shred of intelligence!
Higher education committed suicide with its dual racketeering model. First was the college loan racket, in which schools colluded with the federal government to jam too many “customers” through the pipeline who didn’t belong there, and who buried themselves under a lifetime debt obligation they could never escape. The second was the intellectual racket of creating sham fields of study that contaminated all the other “humanities” with poisonous bullshit theory, and eventually even invaded the STEM disciplines. Covid-19 screwed the pooch on all that, scotching the four-year party-hearty in-residence part of the deal. For now, who needs an online class in Contemporary Sexual Transgression ($2000-a-credit) when you can just click on Porn-hub for free? Hundreds of colleges and universities will be going out of business in the years ahead.
James Howard Kunstler — https://kunstler.com/clusterfuck-nation/things-going-by/#more-‘
Africa’s Covid-19 Death Rate
The most widely accepted factor is Africa’s youthful population. Only about 3 per cent of Africans are over the age of 65, the age group in which illness and death from the coronavirus are most common. (By comparison, about 18 per cent of Canada’s population is over the age of 65.)
Africa’s low COVID-19 death rate has multiple causes, WHO says — https://www.theglobeandmail.com/world/article-africas-low-covid-19-death-rate-has-multiple-causes-who-says/
- Case fatality rate of 2.4
- lower testing rates
- youthful population
- 90% of cases in people <65 years of age
- more rural areas, more time outdoors
- strict lock downs early
- poor road network, limited international flights
Covid-19 – Kids Have Better Immune Response, D614G Mutation and I Don’t Want to Live in an Assisted Living Facility
Saturday mornings are my time to catch up on news. Here are a few articles that caught my eye today.
Researchers studied 65 children and 60 adults with COVID-19 at a hospital system in New York City and found the children stayed in the hospital shorter periods of time, needed ventilators less often, and had a lower death rate, according to the study published in Science Translational Medicine. Those findings fell in line with what other scientists had noticed: Children don’t get as sick with coronavirus as adults do. The CDC, for instance, says around eight children per 100,000 were hospitalized with COVID-19, compared to 164.5 adults per 100,000. But scientists are not sure why this happens.
Citation: Children Have Better COVID Immune Response Than Adults – Medscape – Sep 25, 2020 — https://www.medscape.com/viewarticle/938059?src=rss
The virus is mutating and appears to be more infectious.
The study, published as a preprint on the medRxiv server (https://bit.ly/306RWDt), found that nearly all (99.9%) of the strains in the second wave had a mutation, known as D614G, which has been shown to increase the number of “spikes” on the crown-shaped virus, increasing its ability to infect cells.
Citation: Houston Study: More Contagious Coronavirus Strain Now Dominates – Medscape – Sep 24, 2020 — https://www.medscape.com/viewarticle/937975?src=rss
And the first study I’ve stumbled upon on Covid-19 mortality in assisted living facilities.
In North Carolina and Connecticut, for example, the proportions of COVID-19 cases that were fatal across the state were 3.3% and 9.3%, respectively. In assisted living facilities in those states, the fatality rate climbed to 13% and 31.6%. Unlike nursing homes, assisted living communities are not subject to federal regulation and are not required to collect and report data on COVID-19, coauthor Helena Temkin-Greener of the University of Rochester School of Medicine & Dentistry said in a news release
Citation: High COVID-19 Mortality Seen in Assisted-Living Facilities – Medscape – Sep 24, 2020 — https://www.medscape.com/viewarticle/937999?src=rss
We are learning there may be an underlying genetic and immunological basis in cases of severe Covid-19.
The researchers found that more than 10% of people who develop severe COVID-19 have misguided antibodies―autoantibodies―that attack the immune system rather than the virus that causes the disease. Another 3.5% or more of people who develop severe COVID-19 carry a specific kind of genetic mutation that impacts immunity. Consequently, both groups lack effective immune responses that depend on type I interferon, a set of 17 proteins crucial for protecting cells and the body from viruses. Whether these proteins have been neutralized by autoantibodies or―because of a faulty gene―were produced in insufficient amounts or induced an inadequate antiviral response, their absence appears to be a commonality among a subgroup of people who suffer from life-threatening COVID-19 pneumonia.
Scientists discover genetic and immunologic underpinnings of some cases of severe COVID-19 — https://www.nih.gov/news-events/news-releases/scientists-discover-genetic-immunologic-underpinnings-some-cases-severe-covid-19
Finally from my long read of the day is a quote from our Covid-19 rock star in the U.S. I’ve got the full article open in my browser to read later. Enjoy!
You know, you just do it: you tell things the way they are. Sometimes that’s not in agreement with what people would like to hear. But I learnt a long time ago that people will ultimately have sustained respect for you if you give them the information based on science and are not afraid to tell people things they do not want to hear. Whether they act on the things you tell them is beyond my power. The only thing that I can do is analyze the situation, look at the scientific data, and make whatever recommendation they ask me to make. But you can be assured that it will be always based on scientific evidence and data.
Citation: BMJ 2020;370:m3703 — The BMJ interview: Anthony Fauci on covid-19 — https://www.bmj.com/content/370/bmj.m3703
lifeunderwriter.net 
You must be logged in to post a comment.