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Battered by 1st wave, Madrid hospital staff stretched by 2nd

TORREJÓN DE ARDOZ, Spain (AP) — With speed and determination, nurses, doctors and caretakers move in and out of glassed rooms with beds hooked up to tubes, cables and monitors. The cadence of beeps serves as a soundtrack to their workday, underpinned by a constant chatter of voices at half pitch and the snapping of rubber gloves as they’re removed by staff ending their shifts.

It’s another day at the intensive care ward at the Torrejón de Ardoz University Hospital, on the outskirts of the European capital that has so far seen the worst of the second wave of the pandemic. Still, hospital staff count themselves lucky: Despite having had to add nine intensive care beds to the usual 16, the hospital hasn’t had to postpone treatment for any other patients.

Many others in the region have.

Hospitals and their workers have been stretched to their limits again in Madrid, where the surging number of COVID-19 patients in September forced an expansion of critical care beds into gymnasiums and surgery rooms. But as the number of incoming patients started to ease last week, health professionals are dismayed at what they see as official acceptance of a situation that is far from normal.

“It can’t be that we fall into a dynamic of a virus wave followed by a lockdown, and then the next wave in winter and lockdown again in winter,” said Carlos Velayos, an intensivist who has seen a slight decrease in new patients with coronavirus-related symptoms arriving at his Fuenlabrada hospital, also in suburban Madrid.

At the peak of the first wave, ICU wards were given over to haste, desperation and even cluelessness about what to do. Now, a well-oiled machinery saves some lives and loses others to COVID-19, but without the doomsday atmosphere of March and April.

“It’s no longer like being in a war zone field hospital,” said Velayos. “But the reality is that we are working way over our normal capacity. This is a situation that is absolutely exceptional and that we shouldn’t have reached under any scenario.”

As many professionals are still coming to terms with the emotional impact of the first wave, they are now struggling to understand why Spain has not prepared better for new outbreaks of a virus that has left more than 825,000 infected in the country and at least 32,000 deaths.

Treatment has improved, although the time that COVID-19 patients spend under intensive care can still stretch for weeks or even months, taking up desperately-needed hospital resources, said Dr. María José García Navarro, medical director of the Torrejón de Ardoz University Hospital, where 49 patients are now being treated, 35 in normal beds and 14 in ICUs.

“We have learned to quickly identify the symptoms and what treatment to apply, which are the drugs that are useful and which aren’t, even if that narrowed down our options,” García Navarro said. Corticosteroids that were experimented with at the onset of the pandemic have now discarded on behalf of Remdesivir, the

L.A. County reports highest daily COVID-19 case count in 6 weeks

A shopper makes her way past a sign that thanks first responders that rests next to a "Sanitize on the Go," station to keep shoppers safe from coronavirus at the Westfield Santa Anita shopping mall in Arcadia on October 7, 2020. This is the first day customers return to indoor shopping after Los Angeles County eases restrictions and have reopened the malls and the individual stores. <span class="copyright">(Genaro Molina/Los Angeles Times)</span>
A shopper makes her way past a sign that thanks first responders that rests next to a “Sanitize on the Go,” station to keep shoppers safe from coronavirus at the Westfield Santa Anita shopping mall in Arcadia on October 7, 2020. This is the first day customers return to indoor shopping after Los Angeles County eases restrictions and have reopened the malls and the individual stores. (Genaro Molina/Los Angeles Times)

Los Angeles County on Wednesday reported its highest count of daily COVID-19 infections since Aug. 22, highlighting the continued dangers of the virus even as more businesses are opening up.

Health officials have been warning that another coronavirus wave is possible this fall even have numbers of cases and deaths have been declining since a serious summer spike.

Los Angeles County has lagged behind other parts of California in reopening due to its continued high numbers of new cases and deaths. But on Wednesday, indoor shopping centers reopened for the first time in months, with limited capacity.

The doors swung open to disturbing news: Public Health Director Barbara Ferrer announced 1,645 new cases and 30 additional deaths. It’s unclear whether Wednesday’s number signifies a trend or is a one-off linked to a backlog of cases.

“While one day of a high number of cases does not indicate a trend, this is something we need to watch closely,” Ferrer said.

In recent weeks, the county has repeatedly reported less than 800 daily hospitalizations and fewer than 1,000 daily coronavirus cases. And while the average positivity rate has decreased from a summer spike and hit its lowest number since the pandemic began, officials have warned that an ongoing incremental increase in daily case counts could pose a risk of increased transmission.

The numbers underscore the delicate balancing act facing officials, who are trying to carefully reopen the economy without prevent the spike in cases that occurred in the summer. That has caused frustration among some businesses.

For example, Gov. Gavin Newsom on Wednesday said theme parks like Disneyland must remain closed for now despite intense pressure to reopen.

“We’re going to be led by a health-first framework, and we’re going to be stubborn about it,” the governor told reporters. “We don’t anticipate in the immediate term any of these larger theme parks opening until we see more stability in terms of the data.”

County officials reported that the state’s new health equity metric — the positivity rate of a county’s lowest quartile, used to ensure that communities disproportionately affected by the virus progress in step with the county as a whole — did not prevent the county from moving forward. The seven-day average positivity rate for L.A. County is currently 2.8%. For those in the lowest-resourced areas, the number is 4.6%. Both numbers are considered low, and would place the county in Tier 3 if not for the high daily case count.

L.A. County, like others throughout the state, will face a test of time in its ability to maintain

The Washington Post to serve as media partner for National Press Club’s Help The Heroes campaign

The Washington Post to serve as media partner for National Press Club’s Help The Heroes campaign

PR Newswire

WASHINGTON, Oct. 7, 2020

WASHINGTON, Oct. 7, 2020 /PRNewswire/ — The National Press Club announced at a recent news conference that The Washington Post would serve as an official media partner for the Club’s Help The Heroes campaign, a program designed to help front line medical workers at Howard University Hospital and feed the fight against COVID-19 by providing hospital staff with nutritious take-home meals.

The Washington Post to serve as media partner for National Press Club’s Help The Heroes campaign
The Washington Post to serve as media partner for National Press Club’s Help The Heroes campaign

The Washington Post has pledged to contribute advertising support for the campaign, including a full-page ad that ran in today’s newspaper.

“Help The Heroes is all about neighbors helping neighbors in this time of need,” said National Press Club President Michael Freedman. “So we are grateful and honored to have the backing and support of The Washington Post – one of the most respected newspapers in the country and a pillar of the DC community.”

According to a recent article in The Washington Post, hospitals are preparing for a nightmare scenario this fall when flu patients and COVID-19 patients may swamp hospital wards. There is appropriate concern that this will exhaust the staff. “I worry the most about the ability of the workforce to step into the ring again. Adrenaline can only take you so far,” said Dr. Brandan Carr of Mount Sinai Hospital. 

Help The Heroes is funded by donations from corporations, foundations and non-profits. Donations for Help The Heroes go to the National Press Club Journalism Institute, the Club’s affiliated 501c-3. To learn more about Help The Heroes or to make a contribution, please visit: 

Founded in 1908, the National Press Club is The World’s Leading Professional Organization for Journalists with more than 3,000 members. The Club speaks out on press freedom issues and annually recognizes journalists at risk at home and abroad with the John Aubuchon Award for Press Freedom.

PRESS CONTACT: Lindsay Underwood for the National Press Club;


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Reproductive Health Tied to CVD in Women

Pregnancy complications and fertility issues that occur throughout the course of life may increase a woman’s risk of developing cardiovascular disease (CVD) later on in life, according to an umbrella review.

A wide range of female sex-specific reproductive health factors from first menstruation to menopause were associated with increased risk of composite CVD, stroke, ischemic heart disease, and heart failure (HF), reported Krishnarajah Nirantharakumar, MD, of the University of Birmingham in England, and colleagues.

Preeclampsia, gestational diabetes, stillbirth, and preterm birth had the strongest associations with cardiovascular illness later on in life, with women who had history of preeclampsia at four times the risk of developing HF (relative risk 4.19, 95% CI 2.09-8.38), they wrote in The BMJ.

Breastfeeding reduced the risk of poor cardiovascular health. There were also no observed associations between CVD and use of progesterone-only birth control, non-oral hormonal contraceptives, or fertility treatment, according to the authors.

“Our review increases awareness of female sex-specific risk factors for cardiovascular disease among women and health care workers,” Nirantharakumar told MedPage Today in an email. “It calls for multi-disciplinary collaboration between primary care doctors and specialists (obstetricians, gynecologists, cardiologists, and stroke physicians) in the evaluation and follow-up of women with a history of reproductive risk factors for cardiovascular disease.”

Christopher Nau, MD, a maternal-fetal medicine specialist at University Hospitals in Cleveland, said that while this review does not quantify individualized risk, it highlights a wide range of female-specific reproductive health factors that all physicians should pay attention to when screening patients.

“Pregnancy is a window into the long-term health risks for a woman,” Nau, who was not involved in the study, said in an interview. “A lot of issues with women’s reproductive health can have an impact on other parts of their health, and we need to keep that in mind.”

Recent age and sex-specific trends have shown some increases in cardiovascular illness risk among younger age groups, and specifically women, Nirantharakumar said. Although many studies have investigated female sex-specific cardiovascular risk factors, gaps in the current literature make public health implications unclear.

Nirantharakumar and colleagues conducted an umbrella review to synthesize existing systematic reviews and meta-analyses. They searched databases for studies about women, CVD, and risk factors related to fertility and pregnancy occurring from first menstruation to menopause. The group investigated several cardiovascular health outcomes, including ischemic heart disease, coronary artery disease, stroke, HF, composite CVD, and others.

Narrative reviews, literature reviews, genetic studies, duplicate analyses, and reviews that looked into atherosclerosis, venous thromboembolism, and hormone replacement treatment were excluded from the review. The researchers accepted articles published up to August 2019.

There were 32 articles included in the umbrella review, a majority of which were meta-analyses. The studies that investigated fertility outcomes followed patients for a median of 10 years, while those that looked into adverse pregnancy outcomes followed patients for around 7.5 years.

Women with moderate preeclampsia, stillbirth, and preterm birth were more than twice as likely to develop composite CVD. Those who had preeclampsia, gestational

2014 seal flu outbreak illustrates threat of avian flus to mammals

Oct. 7 (UPI) — Scientists have identified the genetic mutations that allowed an avian flu strain to adapt to mammalian transmission, triggering an outbreak among European seals.

In 2014, an avian flu strain spread rapidly among harbor and gray seals in northern Europe, killing roughly a tenth of the population.

For the new study, published Wednesday in the journal Cell Host and Microbe, researchers exposed ferrets to different strains of H10N7, the virus subtype responsible for the 2014 seal flu outbreak.

Scientists found most avian flu strains failed to infect the ferrets, but that seal-adapted strains were successfully transmitted via the air from ferret to ferret.

The study suggests avian flu can regularly and repeatedly acquire mutations that make them more transmissible among mammals.

“Usually, these occasional introductions of avian influenza viruses in seals, like in humans, are ‘dead ends’ because the virus is not transmissible from one individual to another,” first study author Sander Herfst said in a news release.

“However, sometimes these viruses adapt to the new host and acquire the ability to be transmitted between individuals,” said Herft, an assistant professor of molecular virology and virus evolution at Erasmus University Medical Center in the Netherlands.

Researchers suspect the 2014 outbreak, which killed some 2,500 seals, began in western Sweden when one or more seals came into contact with infected birds or virus-laden bird droppings.

“Transmission from seal to seal is likely to have occurred via aerosols or respiratory droplets, most probably whilst the seals are resting on land,” said Herfst. “However, direct contact transmission between seals can also not be excluded because seals are highly social and interact with each other regularly.”

Lab tests showed the same strains found spreading among seals were able to spread among ferrets.

“The seal-adapted virus was efficiently transmitted through the air via aerosols or droplets between ferrets, whereas the avian virus was not,” Herfst said. “These findings suggest that the mutations the avian virus underwent once it took hold within the seal population have allowed it to become transmissible via the air between mammals.”

Comparisons of avian flu strain genomes and mammal-adapted strains revealed changes to the genes responsible for the regulation of hemagglutinin, a protein on the surface of influenza viruses.

Researchers found the mutations caused the virus to prefer to attach to mammal virus receptors in the respiratory tract, rather than to avian receptors.

Because the strains isolated for the study were collected late in the 2014 outbreak, scientists suggest the mutations may have occurred after the virus was already spreading among seals.

“The mutations that we identified are similar to the ones acquired in 1957 in the first year of the H2N2 pandemic in humans,” Herfst said. “In addition, these same mutations were required to render highly pathogenic avian influenza viruses of the H5N1 subtype transmissible via the air between ferrets — a model organism for mammal influenza research.”

The findings suggests influenza strains may regularly adopt mutations that enable spread among mammals, the researchers said.

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Where You Live at 50 Could Determine Life Expectancy

One explanation: “Counties with a higher percentage of residents of color could also have a higher number of segregated neighborhoods and communities,” and segregated communities can concentrate poverty, the report points out, further restricting access to quality schools, safe parks, good jobs, and banks and capital for business development. Chronic stress from systemic racism and discrimination in health care have also put predominantly Black communities at a disadvantage when it comes to life expectancy.

“Evidence is clear that counties with more Black residents are having worse outcomes, and it’s incumbent on all of us to make sure that everyone has the opportunity to live a longer and healthier life,” Tan says.

“Those extra years are another anniversary, potentially another grandchild — that’s what people are missing out on.”

The coronavirus pandemic and life expectancy

Though the data in the report predates the coronavirus pandemic, Tan says COVID-19 — which has taken an especially heavy toll on adults 50 and older — has the potential to further exacerbate life expectancy disparities at midlife.

For example, COVID-19 hospitalization rates for Black, Hispanic and Native Americans is nearly five times as high as for white Americans, according to data from the Centers for Disease Control and Prevention (CDC). Blacks are also over twice as likely to die from a coronavirus infection as whites.

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With Trump Back at Work, Colleagues Face ‘Dangerous Moment’

President Donald Trump is protected at the White House by snipers, sensors, a new 13-foot-tall fence, and a dozens-strong force of Secret Service agents, but none of that managed to keep out the deadly and wily virus that infected him and has killed more than 211,000 Americans.

Nonetheless, the President went back to the Oval Office on Wednesday, less than 48 hours after being released from Walter Reed National Military Medical Hospital and still undergoing aggressive treatment. Medical experts warn that Trump may face a challenging, second-week phase of COVID-19 and could still be contagious.

Trump insisted on working out of the iconic office anyway, and was briefed by aides about the pandemic aid package talks with Congress — which he temporarily cut off in a tweet on Tuesday — and Hurricane Delta’s threat to the Gulf Coast, said White House Deputy Press Secretary Brian Morgenstern. To accommodate the President while he is ill, the Oval Office’s ventilation system was upgraded to change and filter the air more frequently, Chief of Staff Mark Meadows said Wednesday. Staff seeing Trump in person are asked to wear a yellow gown, mask and goggles.

Seven months into the pandemic, there’s a newfound realization among White House staff that they relied too heavily on a rapid testing regime to alert them to COVID-19 in their midst, and didn’t do enough to enforce that masks be worn and distance be kept, measures recommended by federal health officials for months and used in workplaces around the country. Over the course of the last week, it has become clear that the West Wing is part of a COVID-19 hotspot in the nation’s capital, infecting Trump and at least 10 White House officials, with more than 100 believed to have been infected in Capitol Hill offices, and leading senior military officials isolating themselves.

Trump’s decision to leave the main residence of the White House and work from his office was seen by many as another example of the President’s disregard for those around him, his willingness to put his staff at risk, and his unwillingness to be a model for responsible public health recommendations that could stem the spread of the virus. It echoed Trump’s insistence on Sunday evening that a Presidential limousine driver and two Secret Service agents risk being exposed to the virus while riding with him while he waved through the car’s bullet-proof glass to supporters outside Walter Reed hospital.

As the scale of the outbreak has come into focus, the White House leadership has now told the few still working in the cramped West Wing to space themselves apart in meetings and cover their faces, after months of actively discouraging staff from wear masks and not keeping their distance in meetings.

U.S. Service members wear masks and eye protection before President Trump's return to the White House from Walter Reed National Military Medical Center on Oct. 05

U.S. Service members wear masks and eye protection before President Trump’s return to the White House from Walter Reed National Military Medical Center on Oct. 05

Win McNamee—Getty Images

But given President Trump’s publicly stated dislike for masks and social distancing measures,

‘Dangerously incompetent’ politicians must go

The New England Journal of Medicine, one of the most prestigious medical journals in the world, on Wednesday broke with a nearly two-century tradition of avoiding politics to lambast U.S. politicians for their handling of the coronavirus pandemic.

In a first for the journal, the editors called for Americans to vote out leaders who have not done enough to address the pandemic.

“When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent,” the editors wrote. “We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”

While the 35 editors who signed the editorial did not call out President Donald Trump by name, the article is filled with allusions to his actions.

“The response of our nation’s leaders has been consistently inadequate,” they wrote. “The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls.”

The editorial is the latest condemnation of the Trump administration from a respected scientific publication. Last month, Scientific American endorsed Joe Biden for president, the first time the venerable publication has backed a presidential candidate in its 175-year history.

The New England Journal of Medicine editorial, titled “Dying in a Leadership Vacuum,” does not endorse Biden, it offers an unsparing critique of Trump and his administration.

The editors wrote that while Covid-19 is a global crisis, the United States government has “failed at almost every step” to contain the pathogen’s spread.

“This crisis has produced a test of leadership,” they wrote. “With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.”

The U.S. leads the world in the number of confirmed Covid-19 cases and deaths. The country has recorded over 7.3 million infections and more than 208,000 deaths, according to the World Health Organization.

The editorial points to early blunders such as testing shortages and a lack of personal protective equipment for health care workers, but adds that the country continues to fall short today.

“While the absolute numbers of tests have increased substantially, the more useful metric is the number of tests performed per infected person, a rate that puts us far down the international list, below such places as Kazakhstan, Zimbabwe and Ethiopia, countries that cannot boast the biomedical infrastructure or the manufacturing capacity that we have,” they wrote.

The editors called other public health interventions, such as social distancing measures, “lackadaisical at best,” and criticized moves to lift restrictions before the virus’ spread was brought under control.

The editorial also pointed out that mask wearing has been inconsistent across the country, “largely because our leaders have

New England Journal of Medicine editorial takes aim at Trump administration: “This election gives us the power to render judgment”

The New England Journal of Medicine made a rare political move Wednesday, publishing an editorial by dozens of U.S. editors who denounced the Trump administration’s handling of the coronavirus pandemic and said this election “gives us the power to render judgment.” 

The editorial, titled “Dying in a Leadership Vacuum,” does not explicitly endorse former Vice President Joe Biden, but the editors’ message is clear — the current leadership must change.

“Our current leaders have undercut trust in science and in government, causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed ‘opinion leaders’ and charlatans who obscure the truth and facilitate the promulgation of outright lies,” the editorial says. 

“Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences,” the editorial added. “Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment.”

The editorial notes that, while some deaths in the U.S. were inevitable, tens of thousands could have been saved with a better response. 

Meanwhile, President Trump is claiming personal victory over the virus, saying he feels great as he presumably continues to still be shedding the virus. The president said it was a “blessing from God” that he contracted COVID-19, so he can encourage greater access for the experimental drugs he used.

“I feel great. I feel like, perfect,” the president said in a four-minute video posted to Twitter. “I think this was a blessing from God, that I caught it. This was a blessing in disguise. I caught it, I heard about this drug, I said let me take it, it was my suggestion. I said, let me take it. And it was incredible the way it worked, incredible. And I think if I didn’t catch it, we’d be looking at that like a number of other drugs. But it really did a fantastic job. I want to get for you what I got. I’m going to make it free, you’re not going to pay for it.” 

Meanwhile, “isolation carts” have been set up in the West Wing, where staff can pull personal protective equipment in order to interact with the president. 

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Coronavirus Debate Safety: A New Issue Grips the 2020 Race

Mr. Biden and his campaign have for months sought to make the race a referendum on Mr. Trump and, in particular, his stewardship of the virus response. Mr. Biden’s team believes that the president’s conduct around his diagnosis has further highlighted the contrasts between the two campaigns and their approaches to a virus that has killed 211,000 people in the United States and caused staggering economic fallout.

Mr. Trump has mocked masks, held large-scale rallies and minimized the risks of the virus even after contracting it. “Don’t be afraid of Covid,” he tweeted on Monday. After taking a drive with Secret Service agents to greet supporters on Sunday — alarming some medical experts — he returned to the White House from the hospital on Monday and ripped off his mask, even as positive cases among his staff continued to grow.

Mr. Biden had moved to take down negative ads after news of Mr. Trump’s positive test last week, but with the president out of the hospital, the Biden campaign confirmed Wednesday that it was resuming “contrast and negative spots” along with pressing an affirmative case for the former vice president. The president had already resumed his attacks in recent days on Democrats, including Mr. Biden.

Representatives for Mr. Trump’s campaign did not respond to questions about the president’s plans for the debates and around testing.

Former Representative Sean Duffy of Wisconsin, a Republican who has attended Trump rallies during the pandemic, dismissed any idea that Mr. Trump’s approach to the virus set a bad example or was imprudent.

“Everyone’s making choices,” he said. “They assess risk and make choices that are right for them, their families. Some say they are going to wear masks, some choose not to. In a free society, that’s what we allow for.”

Mr. Biden, by contrast, has called for mask mandates and has cast wearing a mask as a patriotic duty. He faced criticism for months — from Republicans and some Democrats — for running an exceptionally cautious campaign with very little in-person campaigning. Even now he is holding only tightly controlled, socially distanced events. But in a stark reversal of campaign activities, it is now Mr. Biden who remains on the trail, while Mr. Trump is at home.

Thomas Kaplan contributed reporting.

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