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Study: Many older Americans with heart failure take 10 or more meds

When older people hospitalized for heart failure are sent home, they are often given a whopping 10 medications to take for a variety of conditions.

But is this “polypharmacy” practice necessary, or does it just place a bigger burden on already frail patients?

It’s not a question so much of the quantity of the medications, but whether the medications patients are taking are the right ones for them, said senior study author Dr. Parag Goyal, a geriatric cardiologist at NewYork-Presbyterian in New York City.

“It’s not just that we’re not starting the right medications, there may be situations where we’re not stopping the wrong medications as well,” Goyal said. “I think we need to look at the medication that older adults with heart failure take in a more holistic fashion.”

For the study, Goyal’s team examined the medical charts of 558 adults aged 65 and older who were hospitalized in the United States between 2003 and 2014.

When admitted, 84% of the patients were taking five or more medications and 42% were taking 10 or more. When discharged, those numbers had risen to 95% of patients prescribed five or more medications and 55% taking 10 or more.

Most of the prescribed medicines were not for the patients’ heart failure or heart conditions, the researchers said.

A larger medication burden increases the risk of adverse drug reactions, which could lead to patients ending up in the hospital, Goyal explained. It can also require more work for the patient, which can have an impact on quality of life.

“It’s a big challenge,” Goyal said. “How exactly do you reconcile the fact that a lot of these medications are meant to prevent events and to help patients feel better with the concept that as the number of medications rise, you might be negatively affecting these parameters?”

The study found that about 90% of older adults with heart failure have at least three other medical conditions. More than 60% have at least five other conditions.

The findings were published online Oct. 13 in the journal Circulation: Heart Failure.

The researchers concluded that there is a need to develop strategies that can alleviate the negative effects of polypharmacy. Among the drugs that may be overused are proton-pump inhibitors, which reduce stomach acid.

There are a host of medications patients may have been taking for years that could be reviewed, Goyal noted.

However, the study suggested that the benefits of medication may outweigh the risks of polypharmacy for people with certain conditions, including chronic obstructive pulmonary disease COPD and diabetes.

Some medications already are multipurpose, including one that treats diabetes and heart failure, said Dr. Gregg Fonarow, chief of the University of California, Los Angeles, division of cardiology.

“That doesn’t mean there are not some medications that are not necessary and could be either reduced or consolidated, but that for patients with heart failure that have a number of other comorbid conditions there are a number of medications that are proven in randomized trials, proven in

Many Older Americans With Heart Failure Take 10 or More Meds | Health News

By Cara Roberts Murez
HealthDay Reporter

(HealthDay)

TUESDAY, Oct. 13, 2020 (HealthDay News) — When older people hospitalized for heart failure are sent home, they are often given a whopping 10 medications to take for a variety of conditions. But is this “polypharmacy” practice necessary, or does it just place a bigger burden on already frail patients?

It’s not a question so much of the quantity of the medications, but whether the medications patients are taking are the right ones for them, said senior study author Dr. Parag Goyal, a geriatric cardiologist at NewYork-Presbyterian in New York City.

“It’s not just that we’re not starting the right medications, there may be situations where we’re not stopping the wrong medications as well,” Goyal said. “I think we need to look at the medication that older adults with heart failure take in a more holistic fashion.”

For the study, Goyal’s team examined the medical charts of 558 adults aged 65 and older who were hospitalized in the United States between 2003 and 2014.

When admitted, 84% of the patients were taking five or more medications and 42% were taking 10 or more. When discharged, those numbers had risen to 95% of patients prescribed five or more medications and 55% taking 10 or more. Most of the prescribed medicines were not for the patients’ heart failure or heart conditions, the researchers said.

A larger medication burden increases the risk of adverse drug reactions, which could lead to patients ending up in the hospital, Goyal explained. It can also require more work for the patient, which can have an impact on quality of life.

“It’s a big challenge,” Goyal said. “How exactly do you reconcile the fact that a lot of these medications are meant to prevent events and to help patients feel better with the concept that as the number of medications rise, you might be negatively affecting these parameters?”

The study found that about 90% of older adults with heart failure have at least three other medical conditions. More than 60% have at least five other conditions.

The findings were published online Oct. 13 in the journal Circulation: Heart Failure.

The researchers concluded that there is a need to develop strategies that can alleviate the negative effects of polypharmacy. Among the drugs that may be overused are proton-pump inhibitors, which reduce stomach acid. There are a host of medications patients may have been taking for years that could be reviewed, Goyal noted.

However, the study suggested that the benefits of medication may outweigh the risks of polypharmacy for people with certain conditions, including chronic obstructive pulmonary disease (COPD) and diabetes.

Some medications already are multipurpose, including one that treats diabetes and heart failure, said Dr. Gregg Fonarow, chief of the University of California, Los Angeles, division of cardiology.

“That doesn’t mean there are not some medications that are not necessary and could be either reduced or consolidated, but that for patients with heart failure that have a number of other comorbid

High-intensity exercise has no effect on mortality rate in older populations, study suggests

High-intensity exercise does not appear to add to risk of mortality among older adults, a new study has found.

INTERMITTENT FASTING MAY CAUSE MUSCLE LOSS MORE THAN WEIGHT LOSS, STUDY SAYS

The research, which was published in The BMJ medical journal on Wednesday, found that HIIT (high-intensity interval training) and MICT (moderate-intensity continuous training) for those aged 70-77 showed no increase in the risk of mortality compared to recommended daily activity.

FITNESS INFLUENCER SHOWS HOW ‘BEFORE AND AFTER’ PHOTOS ARE MANIPULATED

”This study suggests that combined MICT and HIIT has no effect on all-cause mortality compared with recommended physical activity levels,” the study authors from the Norwegian University of Science and Technology in Norway, Newsgram reported.

Participants were splits into a control group, HIIT group and MICT group.

Participants were splits into a control group, HIIT group and MICT group.
(iStock)

GYM-GOER IN TENNESSEE OPENS UP AFTER EMPLOYEE THREATENED TO KICK HER OUT FOR WEARING A SPORTS BRA

The research followed a group of 1,567 men and women – 790 women and 777 men – in Norway over the course of five years.

The participants were put into a control group of 780 that followed Norwegian guidelines for physical activity, which state 30 minutes of moderate physical activity five times a week, MICT group of 387 and a HIIT group of 400. The HIIT group did two weekly high-intensity workout sessions, while the MICT did two moderate-intensity 50 minute workout sessions a week.

At the end of the five year study, the mortality rate for the combined HIIT and MICT group was 4.5%, nearly half the expected outcome of 10%, which is based on the 2% yearly mortality rate for people aged 70-75 according to Norway’s statistics. This supports the researchers expectations from “observational studies [that] have shown that older adults who are physically active have a higher health related quality of life than those who are less physically active,” the report read.

The mortality rate for the two groups compared to the control group, which was 4.7%, suggested no large difference in mortality rate among the exercise styles.

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Though researchers noted before the study 87.5% of participants reported “overall good health,” thus suggesting a possible selection bias that could have influenced results.

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Older men need to hydrate even when they are not thirsty

A new study confirms that older men may lack the bodily cues that help younger men remain hydrated.

Smart thermostats have nothing on our hypothalamus. This is the gland that helps us maintain a healthy body temperature.

When we get too hot, the hypothalamus causes our skin to produce sweat that cools us down as it evaporates. We then become thirsty, and we should drink to replace the water that we lost through sweating.

However, if we sweat too much or do not drink water to replenish our fluids, we can become dehydrated.

Without enough water in the body, we lose the ability to cool ourselves with sweat, and the body can overheat. This increases our chance of experiencing heatstroke and other heat-related damage to our bodies.

As we age, the efficiency of our temperature regulation system declines. Although most research into the effects of dehydration focuses on young adults, a new study in The Journal of Physiology examines its role in the health of older adults.

Older adults may not feel as thirsty as young people and should take care to hydrate when they work or exercise and when the weather is hot.

Researchers from the Human and Environmental Physiology Research Unit at the University of Ottawa in Canada explored the paradoxical risk associated with dehydration later in life.

On the one hand, during exercise, dehydration in older adults does not lead as readily to an increase in body temperature through a reduction in heat loss as it does in younger people.

Although this may seem to be a good thing, the lack of sweat and thirst means that the person loses important cues that suggest that it is time to rehydrate.

Without drinking enough water, dehydration in older adults may persist and quietly increase to dangerous levels.

Scientists have suggested that the reason that older adults feel less thirsty is due to a reduced ability to detect and respond to the level of salt in their blood.

When the balance between water and salt in the blood tips toward salinity, the body of a younger adult responds with feelings of thirst.

The researchers wondered if the same reduced ability to track blood salinity, or “osmolality,” that reduces sensations of thirst may also be the driver behind the less extreme response to dehydration in older adults.

Ten younger men (18–30 years old) and 10 older men (54–67 years old) participated in exercise heat stress tests. The researchers asked them to abstain from consuming alcohol and engaging in strenuous exercise for 24 hours before each session. They also asked them to drink 500 milliliters of water the night before the experiments.

After screening, the men took part in two exercise sessions placed a week apart. At the start of each exercise session, the participants received an intravenous saline solution to increase blood osmolality before entering a heated, whole-body direct-air calorimeter for 1 hour of stationary cycling.

The calorimeter measured the participants’ whole-body evaporative and dry heat loss, and other measurements

Pregnancy rates hit new lows for women 24 and younger, new highs for women 35 and older: study

Pregnancy rates among women aged 24 or younger hit record lows in 2016, while rates for women aged 35 and older reached new highs, according to a new analysis published Thursday by Guttmacher, a sexual and reproductive health research organization.

Meanwhile, abortion rates have also declined for young people over the past 25 years, partially due to a decline in the number of people in that age group who became pregnant.

“Pregnancy rates for young people have reached their lowest recorded levels, and both birth and abortion rates among young people are continuing a longstanding decline over the past two-and-a-half decades,” said Guttmacher Senior Research Associate Isaac Maddow-Zimet.

“Conversely, pregnancy rates among older age groups have reached historic highs, with abortion rates remaining fairly constant.”

Guttmacher’s count of pregnancies includes ones that end in births, abortions, miscarriages and stillbirths.

In 2016, the latest year for which comprehensive data is available, there were 115 pregnancies per 1,000 women between the ages of 20 and 24, according to the report, the lowest levels recorded since the peak in 1990 of 202 pregnancies per 1,000 women in that age group.

Teen pregnancies have once again hit record lows, according to the analysis, with 15 pregnancies per 1,000 women aged 15-17, down from a peak of 75 per 1,000 women in that age group in 1989.

In 2016, there were 60 pregnancies per 1,000 women aged 18-19, from a peak of 175 women per 1,000 in that age group in 1991.

While state trends generally mirror national trends, pregnancy rates in 2016 were higher in young people in the South and Southwest, according to the analysis. For example, Texas, Mississippi, Alabama, Georgia, Florida, and other states had higher than average pregnancy rates among teenagers.

Meanwhile, pregnancy rates for those aged 35-39 and 40 or older reached historic highs. In 2016, there were 73 pregnancies per 1,000 women between the ages of 35 and 39, and 18 per 1,000 women aged 40 or older. 

Pregnancy rates were higher for older age groups in the Northwest and Northeast states, including New York and New Jersey, according to the analysis.

The analysis also found that the abortion rate among young people is also declining, reaching 4 abortions per 1,000 women between the ages of 15 and 17 in 2017; 14 abortions per 1,000 women aged 18 and 19; and 24 abortions per 1,000 women between the ages of 20 and 24.

Among women over age 30, the abortion rate has stayed relatively stable since the late 1970s, at about 14 abortions per 100,000 women between the ages of 30 and 34; 9 abortions per 100,000 women between the ages of 35 and 39; and less than 5 abortions per 100,000 women aged 40 and older. 

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Morrison government to spend $1.6bn funding at-home care for older Australians

Video: Public sector workers ‘very frustrated’ over 0.3 per cent pay increase: Unions NSW (Sky News Australia)

Public sector workers ‘very frustrated’ over 0.3 per cent pay increase: Unions NSW

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The Morrison government says it will fund 23,000 new packages for older Australians waiting to receive at home care, at a cost of $1.6bn.



a person sitting on a bed: Photograph: Yui Mok/PA


© Provided by The Guardian
Photograph: Yui Mok/PA

Tuesday’s budget increases the number of approved home care packages available over the next four years in response to both the aged care royal commission and the Covid-19 pandemic.

The interim report of the royal commission found the government needed to act urgently to reduce waiting times for older Australians seeking in-home support.

For the past two years, more than 100,000 Australians have been on wait lists for approved home care packages, with tens of thousands entering residential care prematurely as a result.

Related: How much will I get from the 2020 federal budget tax cuts? More if you earn over $100,000

The government has been under pressure over its aged care response during the pandemic. There have been more than 670 deaths nationally in aged care facilities, more than 640 of those in Victoria, and older Australians have been left to languish in soiled beds and clothes without proper food and hydration.



The Australian government has announced additional funding for aged care after criticism of its response to the coronavirus pandemic.


© Photograph: Yui Mok/PA
The Australian government has announced additional funding for aged care after criticism of its response to the coronavirus pandemic.

The health minister, Greg Hunt, said on Tuesday there would be an extra $81m for additional staff and training, on top of $101.2m the government announced for this purpose in March.

The health budget comprises $467bn in overall spending over four years, $16.5bn of that makes up the emergency response to the pandemic.

The government says it will increase funding for hospitals by $33.6bn over the new five-year national health reform agreement and provide $5.7bn for mental health, including already announced funding to double the number if Medicare-funded psychology sessions from 10 to 20.

Related: Australian treasurer Josh Frydenberg’s 2020 budget speech – in full

Hunt said the budget would fund the government’s ongoing response to the pandemic and “helps chart the road out”, with aged care “a particular focus”.

Total funding in aged care will be $23.9bn over the forward estimates – an increase of $2.2bn Hunt said – including the $1.6bn for home care packages.

The treasurer, Josh Frydenberg, said on Tuesday night that aged care was “one of the greatest challenges we face in delivering essential services to Australians”.

He said additional responses and funding would be informed by the final report from the royal commission.

“The government will provide a comprehensive response to the final recommendations following receipt of that report,” he said. “This will involve significant additional investment.”

Tuesday’s budget includes $2.3bn in announced funding for investment in Covid-19 treatments and vaccines and funding for the listing of new drugs on the pharmaceutical benefits scheme, including Lynparza for women diagnosed with ovarian

Older, Overweight and Male: Trump’s COVID Risk Factors Make Him Vulnerable | Top News

By Kate Kelland and Ludwig Burger

LONDON/FRANKFURT (Reuters) – U.S. President Donald Trump’s gender, age and weight are all factors that make him more vulnerable to developing severe COVID-19, and give him a notional risk of around 4% of dying from it, health experts said on Friday.

The probability is hard to assess precisely, however, since factors such as overall fitness and activity levels, pre-existing conditions and recent medical research can all make a significant difference.

A working paper by the U.S. National Bureau of Economic Research published in July put an infected but otherwise healthy 70- to 79-year-old’s risk of dying from COVID-19 at 4.6%, regardless of gender.

David Spiegelhalter, a professor of risk and an expert in statistics at Britain’s Cambridge University, cited a COVID-19 survival calculator that put the mortality rate for an otherwise healthy 74-year-old white man with COVID-19 during the peak of the pandemic in Britain earlier this year at 3% to 4%.

That risk would now “presumably be somewhat less”, he said, as doctors around the world have gained experience in treating the disease.

Michael Head, a global health professor at Britain’s University of Southampton, said that “the president’s profile would classify him as vulnerable. He is aged 74, and reportedly overweight”.

Information provided by a White House physician in June puts the 74-year-old president in the obese category, which triples his risk of needing hospital treatment, according to data from the U.S. Centers for Disease Control and Prevention (CDC) released in August.

Even for otherwise healthy 65- to 74-year-olds infected with coronavirus, the mortality risk is 90 times higher than for those aged 18-29, according to the CDC data.

Julian Tang, an expert in respiratory sciences at Leicester University, said that, apart from age and obesity, “other existing medical conditions like diabetes, hypertension, other chronic heart and lung disease can lead to serious COVID-19 disease”.

But Naveed Sattar, a professor of metabolic medicine at the University of Glasgow, noted that Trump has no reported chronic conditions and is reasonably active – he plays golf frequently and appears to walk briskly – which may offset some of the risks.

The CDC data also do not take into account the state-of-the-art care that the president is likely to receive, although medical experts warned Trump’s doctors not to be tempted to treat him differently from any similar patient.

“I would advise them: Do not deviate from your standard protocol – because that’s when mistakes happen and you’re starting to experiment,” said Bharat Pankhania, senior clinical lecturer at Britain’s University of Exeter Medical School.

“This is not a time or place to experiment, just because he happens to be the president.”

A number of possible COVID-19 treatment approaches are currently being tested in late-stage trials, including manufactured antibodies designed to stop the coronavirus from invading cells.

Pankhania said the standard protocol would be to “monitor, and act if required”.

“The usual thing that we need to act on, if required, is oxygen,” he said. “And if a

City of Hope-led study details new strategy to address the barriers that keep older adults out of clinical trials

The study examined what has been done and chartered a roadmap to improve equitable access using the best-available scientific literature on barriers to older adult participation in cancer clinical trials.

A City of Hope-led study revealed little effort has been made to improve older adult representation in clinical trials of new cancer drugs, even when the treatment is aimed at a disease that disproportionately affects this age group.

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William Dale, M.D., Ph.D., director of the Center for Cancer and Aging Research at City of Hope, the study’s senior author. Photo: City of Hope

“There is currently no incentive to establish real-world effectiveness among older adults. Older adults need a seat at the table,” said Mina Sedrak, M.D., M.S., lead author of the study and deputy director of the Center for Cancer and Aging at City of Hope, a world-renowned independent research and treatment center for cancer, diabetes and other life-threatening diseases.

Two in 5 Americans with cancer are age 70 or older, yet fewer than 25% of patients in cancer clinical trials registered with the Food and Drug Administration are in this age group, Sedrak said.

The study was published in the journal CA: A Cancer Journal for Clinicians on Oct. 1. Researchers reviewed 8,691 studies that evaluated barriers which hindered older adults from participating in cancer trials. Twelve articles defined complex, interrelated problems as root causes, including stringent eligibility criteria, physician concern for toxicity, ageism, transportation and caregiver burden.

Only one study implemented an intervention meant to increase enrollment of older adults in trials – and it was not successful. This finding starkly amplifies the lack of effective strategies to improve participation of this underrepresented group in cancer research.

The researchers report that cancer trials must ask appropriate questions tailored or driven by the needs of older adults with cancer and should measure relevant outcomes. Their call to action applies to all oncologists and primary care providers, not just geriatric oncologists, Sedrak said, adding that patients should advocate for themselves.

“Ask your doctor about clinical trial opportunities when you’re diagnosed with cancer and do your own research because there may be an option that you haven’t heard about. It may benefit you, but perhaps your doctor may not have considered you for the investigational trial,” he said.

William Dale, M.D., Ph.D., the study’s senior author and an oncologic geriatrician at City of Hope, said, “We don’t know enough about treating our largest group of cancer patients. In the midst of the COVID-19 pandemic, when enrollment in trials is lower than ever due to isolation and distancing practices, actively including older adults in clinical trials is incredibly important.” Dale is the Arthur M. Coppola Family Chair in Supportive Care Medicine at City of Hope.

City of Hope is a leader in offering older patients appropriate and personalized cancer care, as exemplified by the fact that Dale and his colleagues co-wrote the American Society of Clinical Oncology’s guidelines

Moderna says coronavirus vaccine boosts immune system response in older adults

Biotech company Moderna announced on Tuesday that its coronavirus vaccine candidate elicited immune responses in older adults from a Phase 1 study in levels comparable to those seen in younger adults. The findings were published Tuesday in the New England Journal of Medicine.

The vaccine candidate, dubbed mRNA-1273, “induced consistently high levels” of neutralizing antibody levels in 40 healthy participants across two age cohorts – 56-70 and 71 and over – per the company announcement.

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Biotech company Moderna announced on Tuesday that its coronavirus vaccine candidate elicited immune responses in older adults from a Phase 1 study in levels comparable to those seen in younger adults. (iStock)

Biotech company Moderna announced on Tuesday that its coronavirus vaccine candidate elicited immune responses in older adults from a Phase 1 study in levels comparable to those seen in younger adults. (iStock)

“These interim Phase 1 data suggests that mRNA-1273, our vaccine candidate for the prevention of COVID-19, can generate neutralizing antibodies in older and elderly adults at levels comparable to those in younger adults,” Dr. Tal Zaks, chief medical officer of Moderna, said in the announcement. “Given the increased morbidity and mortality of COVID-19 in older and elderly adults, these data give us optimism in demonstrating mRNA-1273’s protection in this population, which is being evaluated in the Phase 3 COVE study.”

MODERNA SEES ‘POSITIVE’ PHASE I DATA FOR POTENTIAL CORONAVIRUS VACCINE

The data stemmed from a second interim analysis which assessed a two-dose vaccination administered 28 days apart in two dose levels, 25 micrograms (µg) and 100 micrograms, reporting findings one month after the second dose.

“This analysis found that both the 25 µg and 100 µg dose levels were generally well-tolerated in both age cohorts,” per the announcement.

The 100 microgram dose elicited higher antibody levels, “supporting the selection of the 100 µg dose for further study in the Phase 3 trial.” Moderna previously announced plans to use the 100 microgram dose in its late-stage trial, which will enroll up to 30,000 volunteers in the U.S. As of Sept. 25, there were 27,232 participants enrolled, 30% of which were from diverse communities.

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Company officials said the majority of adverse events were mild to moderate, like headache, fatigue and chills, among others.

After the second vaccination, one patient in the 56-70 cohort with the 25 microgram dose experienced a fever, and a second patient in the older cohort and higher dose had fatigue, but officials said “clinical laboratory values of Grade 2 or higher revealed no pattern of concern” and that the patients would be followed through 13 months for a longer assessment.

The findings were said to be confirmed through three live virus assays, and “robust neutralizing activity was observed in all participants 14 days after the second vaccination.”

The U.S. government already struck a deal with Moderna for 100 million doses of the vaccine, with an option to buy an additional 400 million doses.

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Moderna COVID-19 vaccine appears safe, shows signs of working in older adults – study

CHICAGO (Reuters) – Results from an early safety study of Moderna Inc’s coronavirus vaccine candidate in older adults showed that it produced virus-neutralizing antibodies at levels similar to those seen in younger adults, with side effects roughly on par with high-dose flu shots, researchers said on Tuesday.

The study, published in the New England Journal of Medicine, offers a more complete picture of the vaccine’s safety in older adults, a group at increased risk of severe complications from COVID-19.

The findings are reassuring because immunity tends to weaken with age, Dr. Evan Anderson, one of the study’s lead researchers from Emory University in Atlanta, said in a phone interview.

The study was an extension of Moderna’s Phase I safety trial, first conducted in individuals aged 18-55. It tested two doses of Moderna’s vaccine – 25 micrograms and 100 micrograms – in 40 adults aged 56 to 70 and 71 and older.

Overall, the team found that in older adults who received two injections of the 100 microgram dose 28 days apart, the vaccine produced immune responses roughly in line with those seen in younger adults.

Moderna is already testing the higher dose in a large Phase III trial, the final stage before seeking emergency authorization or approval.

Side effects, which included headache, fatigue, body aches, chills and injection site pain, were deemed mainly mild to moderate.

In at least two cases, however, volunteers had severe reactions.

One developed a grade three fever, which is classified as 102.2 degrees Fahrenheit (39°C) or above, after receiving the lower vaccine dose. Another developed fatigue so severe it temporarily prevented daily activities, Anderson said.

Typically, side effects occurred soon after receiving the vaccine and resolved quickly, he said.

“This is similar to what a lot of older adults are going to experience with the high dose influenza vaccine,” Anderson said. “They might feel off or have a fever.”

Norman Hulme, a 65-year-old senior multimedia developer at Emory who took the lower dose of the vaccine, said he felt compelled to take part in the trial after watching first responders in New York and Washington State fight the virus.

“I really had no side effects at all,” said Hulme, who grew up in the New York area.

Hulme said he was aware Moderna’s vaccine employed a new technology, and that there might be a risk in taking it, but said, “somebody had to do it.”

Reporting by Julie Steenhuysen; Editing by Bill Berkrot

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