TheWest Virginia Department of Health and Human Resources (DHHR) reportsas of 10:00 a.m., on September 7, 2020, there have been 461,558 total confirmatory laboratory results receivedfor COVID-19, with 11,575 total cases and 247 deaths.
DHHR has confirmed the death of an 86-year old female fromKanawha County. On this Labor Day, we must remember thoseWest Virginians who have lost their lives, said Bill J. Crouch, DHHR CabinetSecretary. We offer our deepest sympathies to all affected by COVID-19.
CASESPER COUNTY: Barbour (35), Berkeley (831), Boone(157), Braxton (9), Brooke (102), Cabell (589), Calhoun (18), Clay (29),Doddridge (13), Fayette (421), Gilmer (20), Grant (144), Greenbrier (106),Hampshire (93), Hancock (128), Hardy (76), Harrison (301), Jackson (217),Jefferson (389), Kanawha (1,731), Lewis (36), Lincoln (126), Logan (519),Marion (230), Marshall (134), Mason (120), McDowell (74), Mercer (350), Mineral(147), Mingo (280), Monongalia (1,401), Monroe (138), Morgan (41), Nicholas(57), Ohio (297), Pendleton (45), Pleasants (15), Pocahontas (45), Preston (141),Putnam (350), Raleigh (391), Randolph (228), Ritchie (6), Roane (37), Summers(21), Taylor (110), Tucker (12), Tyler (15), Upshur (46), Wayne (298), Webster(7), Wetzel (45), Wirt (8), Wood (324), Wyoming (72).
Pleasenote that delays may be experienced with the reporting of information from thelocal health department to DHHR. As case surveillance continues at the localhealth department level, it may reveal that those tested in a certain countymay not be a resident of that county, or even the state as an individual inquestion may have crossed the state border to be tested.Such is the case of LoganCounty in this report.
Pleasevisit the dashboard located at www.coronavirus.wv.gov for more information.
Forty hours after treating her first coronavirus patient, on March 30, Angela Aston came home to her family with a cough. Gosh, your throat is scratchy, her husband told her. Right away she knew she had likely been infected with Covid-19. As a nurse practitioner, Ms. Aston, 50, was confident she knew how to handle her symptoms, and disappeared to her bedroom to quarantine and rest.
By day 50 of her illness, that confidence had disappeared. In late May, she was still experiencing daily fevers and fatigue. She went to bed each evening worried that her breathing would deteriorate overnight. Particularly frustrating was the difficulty she felt explaining to her colleagues, friends and family that after eight weeks she was still sick.
I felt this stigma like, Ive got this thing nobody wants to be around, Ms. Aston said. It makes you depressed, anxious that its never going to go away. People would say to my husband, Shes not better yet? They start to think youre making it up.
Ms. Aston found psychological comfort in an online support group, founded by the wellness organization Body Politic, where more than 7,000 people share their experiences as Covid-19 long-haulers, whose sicknesses have persisted for months.
Along with sharing their physical symptoms, many in the support group have opened up about how their mental health has suffered because of the disease. Dozens wrote that their months of illness have contributed to anxiety and depression, exacerbated by the difficulties of accessing medical services and disruptions to their work, social and exercise routines.
Early on in the pandemic, a pervasive myth among patients and some health authorities was the idea that Covid-19 was a short-term illness. Only in recent months has more attention been given to long-haulers. In online support groups like Body Politic and Survivor Corps, long-haulers have produced informal surveys and reports to study their course of illness.
Natalie Lambert, a health researcher at Indiana University School of Medicine, recently surveyed more than 1,500 long-haul patients through the Survivor Corps Facebook page and found a number of common psychological symptoms. She found that anxiety was the eighth most common long-haul symptom, cited by more than 700 respondents. Difficulty concentrating was also high on the list, and more than 400 reported feeling sadness.
Dr. Teodor Postolache, a psychiatrist at the University of Maryland School of Medicine, estimates that between one-third and one-half of Covid-19 patients experienced some form of mental health problem including anxiety, depression, fatigue or abnormal sleeping.
Those without Covid-19 infections are also seeing their mental health suffer amid the pandemic. A study published in June by the Centers for Disease Control and Prevention found that symptoms of anxiety and depression nationwide increased significantly during April through June of 2020 compared with the same period last year. This study found that adverse mental health symptoms were disproportionately reported in young adults, Black and Hispanic adults and essential workers. The National Alliance on Mental Illness, a nonprofit organization, has seen a 65 percent increase in people reaching out to its help line for mental health resources since the onset of the pandemic.
The public health response to the Covid-19 pandemic needs to include addressing its mental health consequences, said Mark Czeisler, an author of the C.D.C. study.
Chimre Smith, 38, a middle-school teacher in Baltimore, marked her sixth month of Covid-19 symptoms in September. On March 22 Ms. Smith was on the phone with her therapist when she began to feel a tickle in her throat, which turned into a burn by the evening. Her symptoms became a wheel of misfortune, vacillating daily between nausea, diarrhea and headaches, she said.
Since then, she has gone to the emergency room a dozen times. In mid-April she rewrote her will. A persistent mental fog has made it difficult to put together sentences, she said, whereas before the pandemic she had functioned like a walking thesaurus. When she realized that could not return to teaching seventh and eighth grade English this autumn because of fatigue, she cried.
By the fourth month of her illness, Ms. Smith had contemplated taking her own life. I said, Who in the world would want to live like this? she said. I wanted to jump out of my own body.
Ms. Smith is one of many long-haulers who, like Ms. Aston, said her mental health improved when she joined the online support groups Body Politic and Survivor Corps, where she exchanges tips for managing mental and physical symptoms. Members of these groups supported Ms. Smith in overcoming her thoughts of suicide, she said.
Other Covid-19 patients turned to peers on such groups for reassurance that their symptoms were not imagined. Every single symptom Ive experienced is echoed by dozens of other people, said Angela Vzquez, 33, a Covid-19 patient in Los Angeles. We cant all be collectively hallucinating the same symptoms.
Although social media groups provide validation, there is also some risk. Groups that do not moderate their content can contribute to the spread of misinformation when users share unverified medical advice. (Survivor Corps requires people to link to trustworthy sources, and Body Politic deploys volunteers to moderate posts.) Support group members also sometimes inadvertently reinforce one anothers fears through detailed discussion of their own medical experiences, according to Jo Daniels, a psychologist at the University of Bath and an author of a recent study in the journal American Psychologist on Covid-19 and mental health.
Some long-haulers said that their doctors recommended limiting the time they spent on these groups daily so they could take in information without becoming overwhelmed.
Updated September 4, 2020
Immunologists speculate that long-haulers symptoms might persist because they harbor fragments of viral genes that are not infectious but that trigger violent immune reactions. There is limited knowledge of Covid-19s lingering impact, however, both because the illness is still new and because of broader gaps in understanding the long-term effects of viral infections.
Many long-haulers said their mental health suffered when they faced skepticism about their symptoms from friends, family and even medical providers. Female long-haulers pointed to numerous studies showing that medical providers were more likely to underestimate womens pain levels and misdiagnose their conditions. Ms. Smith said that in her first week of illness, her male doctor suggested she might have a sinus infection rather than Covid-19. Ms. Vzquez was told that her difficulty breathing could be a product of anxiety. Gina Assaf, a consultant in Washington, D.C., who helped write Body Politics report, said that by week six of her Covid-19 course, her doctor asked if her symptoms could be bad allergies.
That felt like gaslighting, Ms. Assaf said. Her friends were dubious of her lingering symptoms. I stopped talking about it with a lot of my friends because it felt like they couldnt understand.
The pandemic has caused mental stress for many in its disruption to social, work and exercise routines. But these interruptions are often worse for long-haulers. Some cut themselves off from community partly because they are sick, but also because they are loathe to explain physical and mental problems that they themselves do not understand. The activities that they normally rely on to relieve stress, such as exercise, are difficult or impossible to undertake. In Dr. Lamberts survey of long-haulers, inability to exercise or be active was the fifth most commonly reported symptom, cited by 916 respondents.
Being unable to work and feeling unproductive can also hinder mental health, according to the National Alliance on Mental Illness. Losing income and health insurance brings its own form of anxiety.
My doctor said the most important thing is to completely de-stress, said Jenna Bitar, 28, a New Yorker who contracted coronavirus and was placed on leave by her employer in March. But how do I avoid stress when I dont even know if Ill be able to afford my medical bills? I dont have a job.
For long-haul Covid-19 patients, one helpful mental health resource is validation from friends, family and colleagues, Dr. Lambert said. She also called for primary care physicians to stay up-to-date on new research so that they could properly inform their patients, and for clinical researchers to continue studying the diseases mental health and cognitive effects.
Dr. Daniels, the University of Bath psychologist, said that researchers should study strategies for improving mental health, given the many people who turn to negative coping mechanisms like substance abuse.
Several long-haulers said they were learning to be gentle with themselves, as they adjusted to a new normal in their work and family lives.
Ive had three OK days, but Im hesitant to share that, because it could go away, Ms. Smith said. Long-haulers will tell you that. We preface every conversation when we feel good with, Ill regret saying this tomorrow.
What are antibodies?
Antibodies are Y-shaped proteins than bind to one's foreign invaders, like viruses, bacteria, fungi and parasites.
At the height of the coronavirus lockdown, President Donald Trump and his top health advisers trumpeted a new test that would help Americans reclaim their lives one that would tell them if they already had the virus and were protected from getting it again.
Their arrival would help get Americans back to work by showing those who might have the wonderful, beautiful immunity, said Trump, a point repeated at the daily briefings last April.
Months later, the U.S. is awash in the tests but the bold predictions about their usefulness have yet to materialize.
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There was definitely a lot of wishful thinking that there was going to be a magical test that was going to save us all, but were not there yet, said Dr. Jennifer Rakeman of New York Citys Public Health Laboratory.
The tests check the blood for antibodies the body makes to fight off an infection. Scientists are still working to figure out how well antibodies for the coronavirus may shield someone from another infection, or how long that protection might last. Some early studies suggested any immunity fades fast; research published last week was more promising, suggesting that antibodies last at least four months after diagnosis and do not fade quickly.
For now, the Centers for Disease Control and Prevention and the American Medical Association explicitly warn that antibody tests should not be used to make decisions about returning workers to the office or students to school, though some labs still promote them for those uses. The CDC recommends everyone even those who were sick and recovered take precautions to prevent getting and spreading the virus.
Experts say it was probably unrealistic to expect answers to key immunity questions early in the outbreak. Those questions have traditionally been answered only through long-term animal or human studies, said Marc Jenkins of the University of Minnesota.
The National Institutes of Health and universities are conducting some of this work, but much of it has taken a back seat to the rapid development of vaccines in the middle of a pandemic.
Everyones impatient and I can see why, Jenkins said. But theres no easy path to this knowledge about immunity.
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Antibody tests are different from the standard nasal swab tests that diagnose active infections. Instead, they use a blood sample or finger-prick of blood to look for signs of a past infection, whether the person was sick or had no symptoms at all. Based on other viruses, experts expect those with coronavirus antibodies to be at least partly immune for several months, if not longer.
Dr. Anthony Fauci and other members of the White House task force said early on it was a reasonable assumption that if you have the antibody, youre protected but added that there wasnt proof.
To get that proof, scientists first run experiments in animals. Human trials come next and can take even longer. Researchers track people who had an infection and developed antibodies to see if they become reinfected. Their antibodies are measured to to gauge the level needed for immunity.
Jenkins and others said it's entirely possible that an effective vaccine will arrive before coronavirus antibody studies are completed, helping answer some of the key questions. Vaccines spur the production of antibodies, and a number of coronavirus vaccines are now being tested around the world.
In the meantime, experts say antibody tests are useful for two things: Large studies in the general population to see how widely the coronavirus has spread, and screening people who may be able to donate their antibody-rich blood plasma, which is used as an experimental treatment for COVID-19.
But those uses were not the focus of White House briefings last spring, which attracted between 8 million and 10 million cable TV viewers daily, according to Nielsen. A spokesperson for the White House coronavirus task force did not provide a response to requests for comment.
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Expecting massive demand, the Food and Drug Administration chose a flood-the-zone strategy, allowing more than 170 tests to launch with little oversight.
At the same time, Trump highlighted his administrations fantastic progress bringing antibody tests to market, some officials were raising concerns. Reports of European governments forced to discard millions of faulty tests raised alarms.
Were going to be very careful to make sure that when we tell you youre likely immune from the disease ... the test really said that, said Admiral Brett Giroir, the administrations testing czar.
The FDA pulled back on its lax policy for antibody tests in May, requiring companies to begin submitting data on accuracy. The FDA has authorized about 40 thus far, while dozens more await review.
Despite the precautions from regulators, some testing companies continue to advertise the tests for workers and others. Big laboratories, including LabCorp and Quest, offer the tests to employers, along with other services like temperature checks.
We are aware of the CDCs guidance," Quest spokeswoman Kimberly Gorode said in a statement. That is why we recommend that employers use antibody testing as part of a holistic approach to bringing their employees back to the office.
LabCorp said in a statement: As knowledge grows there may be benefit in having access to this information."
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At testing sites in New York City in April, doctors with Somos a medical non-profit serving low-income communities told people who tested positive for antibodies that they could safely return to work, although they acknowledged nothing is 100%. In a recent interview, the group's founder, Dr. Ramon Tallaj, defended the testing. He said the workers would have been expected to go back anyway. The antibody tests simply provided one extra layer of protection, he said.
The CDC and state public health agencies continue to use antibody testing to track the spread of the virus in the U.S. So far, in most areas studied, fewer than 5% of the population have antibodies. That's far below the levels that most experts think will be needed for herd immunity against coronavirus, underscoring the need for a vaccine.
For now, Jenkins doesn't recommend spending the money to get tested for antibodies unless a doctor recommends it.
"Even the research community cant really tell you what the result means, Jenkins said.
As the United States braces itself for a likely "second wave" of COVID-19 this fall, many experts are anticipating a spike in cases -- but some say that may not translate into an equally dramatic spike in deaths.
A lot has changed since the pandemic first hit the U.S. earlier this year, when the nation's hospitals were overwhelmed with patients suffering a new, mysterious illness. Fast forward to September, and the pandemic is still surging out of control in many parts of the country, but relatively speaking, fewer patients are dying from the virus.
Now, experts are pointing to several factors to explain why COVID-19 has become, in effect, a slightly less deadly illness: still far deadlier than the flu, but not as lethal as it was in those early days.
Six months into the pandemic, doctors now have more success treating patients with the novel coronavirus -- especially those with severe symptoms -- than they did at the beginning of the year. Adults that are older and more vulnerable to illness are staying home, as the virus is now infecting a greater number of younger people who are less likely to succumb to illness.
"In terms of absolute numbers, we are learning much more about how to treat patients with serious complications compared to at the start of the pandemic," said Dr. John Brownstein, a Harvard Medical School professor and ABC News contributor. "Now that we know more effective protocols and treatments, the number of deaths will likely go down."
A pharmacist doctor works on the basics of the raw materials for investigational of the coronavirus disease (COVID-19) treatment drug "Remdesivir", in Ibn Sina laboratory, at Eva Pharma Facility in Cairo, Egypt June 25, 2020.
There are various techniques and treatments coming into the scene that are helping medical teams move forward.
Dexamethasone, a steroid treatment mainly used to cure lung inflammation, is seeing positive results in COVID-19 patients, especially when used early on.
The Food and Drug Administration has broadened emergency use authorization for an antiviral drug called remdesivir. Studies show the antiviral therapy used to treat hospitalized patients with the virus decreases mortality rates.
In addition to the use of new drugs, doctors also have learned practical tips that can help patients survive. A tactic called "proning" -- simply flipping a patient on their stomach -- lets oxygen run more effectively through the body.
Also, doctors have learned to hold off on placing patients on ventilators right away because they've found less invasive ways to help patients with labored breathing get enough air, according to experts, who also said doctors are now working to assess patients earlier to try to make interventions sooner.
And as doctors continue learning how to save patients in the hospital, public health experts continue learning more effective habits to avoid the spread of COVID-19, especially in vulnerable populations.
"When it comes to infections, there are prevention techniques we know work, including physical distancing, social distancing, mask wearing and mindful hygiene/hand washing," said Dr. Jay Bhatt, an ABC News contributor and former chief medical officer of the American Hospital Association.
"With wider availability of PPE and acceptance of the new normal, we now have supplies to protect people," said Bhatt. "The work by health care deliveries and health systems is key, with strategies and protocols put in place for our health and safety. These behaviors, in turn, help drive down the numbers of deaths."
Ryan Schmutz looks from his dorm at Utah State University Wednesday, Sept. 2, 2020, in Logan, Utah, where he was one of about 300 students quarantined to their rooms this week.
The change in seasons will be important to pay attention to as we keep an eye on infections with people staying indoors come the fall and winter.
"Outdoors there is lower risk for transmission from the greater air movement. The odds of getting sick are lower when you are outside compared to confined spaces like elevators and living in close proximity," said Dr. Simone Wildes, an infectious disease physician at South Shore Health in Massachusetts. "Being in crowded spaces, you are much more likely to spread the virus."
Doctors encourage low-risk people to enjoy the outdoors, while still paying attention to standard protocols and social distancing. "As the fall approaches, you have drier conditions. More people are spending more time indoors, so generally the virus is more efficient," explained Brownstein.
The average age of those infected with coronavirus has declined over the last several months.
We are seeing spikes with younger and less vulnerable populations. Furthermore, special attention has been paid to older populations by sealing off high-risk settings where we see people more susceptible to illness -- like nursing homes.
"Early on, we really focused on the elderly 65+ years of age with underlying conditions," said Wildes. "As we reopen, we see a lot of young people getting the virus. Most young people do not have underlying conditions, so they do a lot better than the older, more susceptible populations."
Again, the time of year plays a role in this shift. "Percentage wise, a rise in cases is being triggered amongst the younger population, because upon returning to school, they are not practicing the same level of social distancing and mask wearing," said Brownstein.
Younger, healthy people are venturing out and are less likely to die from the virus.
But for many public health experts, the relatively lower death rate moving into the fall is the only bright spot in an otherwise gloomy forecast. The Centers for Disease Control is now predicting that within the next four weeks, the virus will have killed between 3,300 and 7,500 Americans, and infected 150,000 to 360,000 others.
This trend is already playing out in North Carolina, where college campuses reopened last month with in-person classes, and at least 3,000 students have tested positive for COVID-19. UNC at Chapel Hill, NC State University and East Carolina University are three schools in particular that have experienced overwhelming spikes.
A major goal from a medical standpoint is to minimize deaths, and as we approach the fall, a big concern coming into play is the intersection between coronavirus and the flu. Wildes stressed that doctors are encouraging everyone to get the flu vaccine to boost their chances of staying healthy this winter. Experts are also encouraging everyone to continue following social distancing measures to prevent as many COVID-19 infections as possible.
There are still many unknowns regarding COVID-19, but one common occurrence among those infected is smell loss. There are many different events that can trigger smell loss, and Dr. Jessica Grayson provides insight as to why this might be happening.
Hyposmia or anosmia, a decreased or complete loss of smell, has been widely reported in patients with COVID-19, often as a symptom noticed early on prior to other symptoms or even as the only symptom present in an otherwise asymptomatic patient.
There have been a significant number of people who have been treated or tested at UAB who have had loss of smell in the setting of their COVID diagnosis, Grayson said. However, given the isolation protocols, most of these have only been diagnosed subjectively.
Grayson, an assistant professor with the UAB Department of Otolaryngology, said post-viral smell loss is the most common reason for loss of smell. Approximately 40 percent of anosmia is due to post-viral causes. More than 200 different viruses can cause alterations in smell and taste due to temporary or long-term injury to the neural structures.
If the nose is congested or full of polyps, then the odorant particulates cannot reach the olfactory fibers, which sense the smell and communicate with the brain, she said. In other instances, the nose looks relatively normal, but there is local inflammation in the olfactory mucosa that leads to adverse effects on smell.
Grayson adds that, apart from COVID-19, some people are born with hyposmia or anosmia. These disorders are typically diagnosed once the person is old enough to communicate that they cannot smell, typically during adolescence. In people suffering with obesity, there is an increased risk of potential smell loss due to benign intracranial hypertension, which causes thinning of the skull base particularly in the region of the cribriform plate because it is already the thinnest region where the olfactory nerves penetrate into the nasal cavity.
Patients with BIH have also been found to suffer from alterations in smell, she said. Trauma, particularly high-velocity head trauma, can cause loss of smell in patients either due to shearing of the olfactory nerves from coup and contrecoup injuries to the head or from direct injury to the olfactory region of the skull base.
Grayson said that surgery in the region of the olfactory mucosa that does not preserve this mucosa can cause smell loss. Tumors arising from the olfactory mucosa, olfactory fibers and anterior cranial fossa can cause smell loss. Neurodegenerative diseases and inflammatory conditions, such as Parkinsons disease and Sjogrens disease, can also negatively affect smell.
Retraining the nose
Although losing the sense of smell can be jarring, Grayson said there are ways to regain that lost sense.
Patients with post-viral smell loss have roughly a 60-80% chance of regaining some of their smell function at one year, Grayson said. However, people with traumatic injuries often do not regain smell.
Smell retraining consists of exposure to certain scents in a repeated nature over many weeks. Patients smell four odor categories flowery, fruity, aromatic and resinous every day for 12 weeks and potentially up to six months.
Studies have shown improvement in smell when patients utilize smell retraining, and some studies have suggested changing the four scents at 12-week intervals, she said. When patients performing smell retraining were compared to patients who were not, there were more patients who had improvement in their sense of smell.
Keen on smelling
Grayson said sense of smell is important for flavoring of food as well as safety reasons.
The ability to smell is important, because if something is burning, the house is on fire, food has gone bad, a gas leak, brakes burning in your car, you need to be able to have that sense, she said. Patients who cannot smell have to have protections in place to prevent bad things from happening, like checking smoke detectors monthly, following expiration dates strictly or having someone else in the home who can smell, or having natural gas detectors.
She said if a person begins to experience a lost sense of smell or taste, COVID-19 testing may be an option.
Right now, if you lose your sense of smell and taste, you can look for COVID testing, if available, she said. However, you can also isolate for 10 days, or 72 hours symptom-free, and follow CDC guidelines.
Grayson said concerned persons can reach out to the Department of Otolaryngology, which can send a smell test.
If we need to do smell retraining based on loss, our team will also get you set up for a follow-up appointment.
This story oriiginally appeared on the University of Alabama at Birminghams UAB News website.
174 students and 1 employee reported they have tested positive for the virus since Friday.
The University of Iowa is reporting new COVID-19 case numbers with 174 students self-reporting they have tested positive since Sept. 4. 1,569 students have tested positive since the beginning of the semester.
One additional employee reported they have tested positive since Sept. 4, for a total of 20 employee cases since the beginning of the semester.
15 students are in quarantine in the residence halls, and 97 are in isolation.
As of Friday, there are 4,356 confirmed positive cases in Johnson County. Iowa City is still listed on the New York Times ranking of metro areas with most COVID-19 cases in the United States in the last two weeks, listed at 13 as of Sept. 7.
Iowa City was listed as the fourth-worst metro in the country on Sept. 4.
The official name for my new heart troubles, as Ive recently been diagnosed, is postural orthostatic tachycardia syndrome, or POTS. The condition, a puzzling dysfunction of both the heart and the nervous system, messes with how the body regulates involuntary functions, including pulse. POTS is known to affect approximately 500,000 people in the U.S., typically young women in their late teens or early 20s. But now, several cardiologists with whom Ive spoken say theyre noticing an unsettling trend. Previously fit and healthy women of all ages who have had COVID-19 are showing up at their offices, complaining of inexplicably racing hearts.
Read: COVID-19 can last for several months.
The more we learn about COVID-19, the stranger its effects appear to be. Beyond its telltale fever and cough, troubling early evidence has been mounting that the disease can damage many organs in the body, including the lungs, the brain, andyes, you guessed itthe heart. An array of cardiac dysfunctions has cropped up, confounding researchers and revealing that COVID-19 is a far more complicated and potentially long-lasting disease than people initially expected. These heart ailments have especially gained attention from sports: Some college football players who have had COVID-19 are sitting out this season with myocarditis, a rare condition that can be fatal if untreated. The Red Sox pitcher Eduardo Rodriguez is doing the same.
In a strange way, I feel lucky. POTS is not life-threateningat least, aside from the risk of head trauma from blacking out. But it is destabilizing, both physically and mentally, to wander around not knowing what my body has in store for me from one minute to the next. Like so many other aspects of this pandemic, this latest syndrome in my parade of illness is mysterious, disruptive, and scarily indefinite.
After my smoothie incident, I called my cousin Emily Wessler, a pediatric cardiologist at Stanford, and asked her what was going on in my body whenever I felt like I was going to pass out. Youre not getting enough blood to the brain, she told me, so the brain says, Shut down! Shut down! Emergency! Shed been reading more and more professional chatter about cases of POTS and other cardiovascular disorders post-COVID, so she urged me to make an appointment with a cardiologist. She added that I also might want to speak with a neurologist. There are a lot of doctors to call if your whole body feels like its malfunctioning, which is not ideal at a time when millions of Americans are losing their health insurance.
I started with a cardiologist. At NYU Langone, Seol Young Han Hwang hooked me up to an EKG that immediately spit out bad news. Sinus tachycardia, it read. Abnormal ECG. In other words, my heart was beating much faster than it should have been, given that I was reclining on an exam table. Han asked me to wear a Holter monitor for a week to trace my hearts vagaries. It showed abrupt daily spikes, during which my heart rate would jump from as low as 51 beats per minute, while at rest, to as high as 163.
"I smell blood," Alexander told fellow staff members on a recent Sunday at Brookdale University Hospital Medical Center in New York City.
The scent hung in the air, something that he had always noticed at the Brooklyn hospital. Lately the smell of blood has been more prevalent, a sign that the gun violence that has gripped the city perhaps has its tightest hold on the communities surrounding his hospital.
"It has a little bit of a metallic smell. And it kind of just lingers with you," said Alexander, 36, who added that on particularly violent days he can't stop smelling blood, even after he's gone home and showered. "You know it when you smell it."
Brookdale, a level two trauma center, has been a lifeline for shooting victims from East New York and Brownsville -- neighborhoods that have been the most ripped apart by gun violence in thet city. And after struggling to help their community survive the Covid-19 outbreak, Alexander and the rest of the staff now find themselves dealing with another crisis.
'Broad daylight, people are getting shot'
Brookdale saw nearly 100 more gunshot victims in June, July and August of this year compared to the same period last year, according to data from the hospital.
There were 149 gunshot victims treated at Brookdale during those three months -- 38 in June, 66 in July, and 45 in August. Last year there were 55 gunshot victims -- 12 in June, 25 in July, and 18 in August.
And while shooting numbers continue to rise to levels not seen in New York City in years, staff at the hospital struggle to save victims, a task that has not only become more frequent but more problematic. It's a strong indicator that the violence isn't stopping.
"What we've noticed recently over the last couple of months is that 9 a.m, 10 a.m., 11 a.m., broad daylight, people are getting shot. People are getting murdered," Alexander said. "You're sometimes like, 'Wow, it's 10 o'clock in the morning. I got up at 5 a.m. to go to work. What time did this person get up to shoot somebody at 10 o'clock? People used to think in the daytime you have some safety."
And it's not just safety during the day that's in peril, Alexander says. He's seeing more and more come in with multiple gunshot wounds, which ultimately makes it harder to save a life.
In July, 81% of the patients who were shot were in critical condition, according to the hospital.
"Normally you'll get someone who was shot twice. Three times maybe. But we're talking about twenty, thirty times. One person," Alexander said. "So we know as physicians that our ability to save that person at that point is almost non-existent. There's just too much damage in too many places to be able to control anything."
New York City's summer explosion of gun violence
Gun violence has tightened its grip on the city as Covid-19 started to get under control. As of Aug. 27 there were 974 shooting incidents across New York City, which is almost twice that of the year prior, which had 527. There were also 1,174 shooting victims while last year there were 602, according to NYPD statistics.
East New York and Brownsville are two neighborhoods that have led the city in shootings. Year to date as of late August there have been 66 shooting incidents in Brownsville, compared to 25 the year before. Shooting victims are also higher, with 77 compared to 43 the year before. In East New York there were 84 victims compared to 50 the previous year. And 65 incidents compared to 41 last year.
And while shootings have skyrocketed in the city, gun arrests are still not yet at last year's pace, though they are climbing back up.
As of Aug. 23 there were 2,062 gun arrests, down from 2,221 from last year.
"Since June 1, the city has just exploded in gun violence," said NYPD Chief Michael LiPetri, chief of crime control strategies.
"We have large groups of people committing quality of life offenses, whether it be gambling street dice, whether it be drinking, that then, unfortunately, turns into violence after the fact. Mainly gang members, committing firearm related violence," said LiPetri, who added that narcotics related shootings are also another driver of the violence.
"There are many many factors and we can't just be focused on one of them," said LiPetri, who said the number of those released from jail was closer to 2,000.
'Regular people' are victims
LiPetri has been outspoken about how crime statistics are about the victims, not about numbers. Dr. Alexander also sees the people beyond the statistics.
"When you say gun violence the majority of people are thinking, oh, a TV gangster or something along those lines," said Alexander. "No. Regular folk. Regular people, 30s, 20s, teenagers, preteens, people less than 10 years old. Those are the people that we see. And the impact of that is profound to say the least."
Dr. Patricia O'Neill, the trauma medical director at Brookdale, said she recently had three gunshot wound victims that she treated. One was shot 10 times. The other had bullets rip into his neck and out through his face. The other serious injury was a teen who was shot only once and had a single bullet that tore through his chest but somehow sat neatly between his heart, aorta and esophagus.
"He was 19 years old and he still had braces," O'Neill said of the victim of the "magic bullet."
"It just sort of made me think he was so young."
But not to be ignored was the vicious cycle of violence spurred by a lack of cooperation and vengeance, she said.
"On these particular shootings people are unwilling to cooperate because they want to go out and take care of it themselves," Clark said. "One incident happens, you have an uncooperative victim so there's no arrest. That means the person that did that shooting is not being held accountable. But what you're also seeing is that the victim now is taking matters into their own hands, getting their own people involved and retaliating, and then you have another victim."
'A real deal miracle'
There are some victims Dr. Alexander will never forget.
There was the woman shot in the back of the head one time and the bullet was lodged in the middle of her brain. Not only was she alive, she was conscious.
"Arms and legs moving. Talking, communicating, blinking their eyes and with you. That is a real deal miracle," Alexander said.
Then there was the overnight shift on New Year's Eve 2019, where he had to break the news to the man's family that he did not survive the shooting. He was told afterward by a detective that his patient was the first homicide of the new year. What he remembers most is choking back tears while the family wailed.
"I told them I'm sorry for their loss," Alexander said. "Unfortunately that probably does sound routine and mundane and repetitive to people listening to this on the outside, but it's probably some of the most sincere words that we share as physicians."
And last month a young man was shot in the stomach, but he had enough wherewithal to brag about his injuries on Instagram.
"You see that from time to time," Alexander said. "They want to Instagram Live or go on Facebook and say, 'Hey I got shot. I'm a gangster.' No, you almost died. And your mother would have been mortified."
From Covid-19 patients to gunshot victims
And while gunshot victims continue to cycle in and out, Alexander tries to make sure he and the rest of the staff, already brutally taxed after dealing with Covid-19 patients, still have enough left in the tank for their patients.
The mere mention of Brookdale Hospital during the height of the Covid-19 outbreak was enough to make Alexander roll his eyes and shoot his head back in disbelief and exasperation. The ICU at Brookdale was overflowing with sick and scared Covid-19 patients only a few months ago: Indeed, East New York and Brownsville were two of hardest hit areas in the city, according to city data.
Patient beds lined the hospital's hallways and refrigerated trucks, designed to be emergency morgue space, were overflowing with victims who could not be saved.
Alexander said he slept four to six hours a night and didn't take a day off from February 20 until April 17.
"Although it was emotionally traumatizing and mentally anguishing it was something that was very different than the public health emergency of gun violence," the doctor said.
"I don't walk into work thinking, 'Oh, I'm going to have thirty people shot today.' I don't walk into work thinking that," Alexander said. "I walk into work thinking I'm going to help people and help those that I need to take care of. I don't know how traumatic that may be for me. Emotionally, mentally, physically, depending on what comes through that door."
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A COVID-19 nasal swab test kit sits on a table Thursday, Aug. 13, 2020, during a clinic held by the St. Clair County Health Department at Yale High School.(Photo: Brian Wells/Times Herald)
The St. Clair County Health Department has reported a possible COVID-19 exposure at a Port Huron Township restaurant.
The department was notified two employees at Bob Evans, 2190 Water St., were confirmed to have the coronavirus, according to a press release.
Residents who visited Bob Evans between Aug. 30 and Sept. 4may have been exposed and are encouraged to self-monitor for symptoms over the next 14 days. Residents should be testedif becoming symptomatic with any of the following: fatigue, cough, fever or chills, shortness of breath or difficulty breathing, new loss of taste or smell, muscle or body aches, headache, nausea or vomiting, congestion or runny nose, sore throat, or diarrhea.
"Take extra precautions to avoid transmitting the virus to others. Individuals may be able to spread the disease for up to 48 hours priors to symptoms and some may remain asymptomatic," the health department said in a statement.
The management of Bob Evans is working closely with health department officials. The establishment has temporarily closed for deep cleaning andCOVID-19 protocols are in place.
The virus spreads through respiratory droplets between people who are in close contact with one another. This generally occurs when an infected person coughs, sneezes or talks. The best way to reduce the spread of COVID-19 and protect others includes:
For more information on testing locations, visit https://www.michigan.gov/coronavirus.
General questions can be directed during regular business hours to the St. Clair County COVID-19 Informational Hotline (810) 966-4163 or covid19@stclaircounty.org. COVID-19 information is also available on the health department website www.scchealth.co or follow @scchdmi on social media.
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Use of inexpensive, readily available steroid drugs to treat people hospitalized with Covid-19 reduced the risk of death by one-third, according to an analysis encompassing seven different clinical trials conducted by the World Health Organization and published Wednesday in the Journal of the American Medical Association.
The positive steroid findings the result of a pooled look at data known as a meta-analysis confirm a similar survival benefit reported in June from a single, large study. Corticosteroids are the first, and so far only, therapy shown to improve the odds of survival for critically ill patients with Covid-19.
Based on the newly published data, the WHO on Wednesday issued new treatment guidelines calling for corticosteroids to become the standard of care for patients with severe and critical Covid-19. Such patients should receive 7-10 days of treatment, a WHO panel said. But it cautioned against use of the steroids in patients with non-severe illness, saying that indiscriminate use of any therapy for COVID-19 would potentially rapidly deplete global resources and deprive patients who may benefit from it most as potentially life-saving therapy.
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The consistent findings of benefit in these studies provide definitive data that corticosteroids should be first-line treatment for critically ill patients with COVID-19, said Hallie Prescott and Todd Rice, professors of medicine at the University of Michigan and Vanderbilt University, respectively, in an accompanying JAMA editorial.
Nahid Bhadelia, medical director of the Special Pathogens Unit at the Boston University School of Medicine, said there has been widespread adoption of steroids in the care of critically ill patients with Covid-19 since the first trial results in June. This is particularly true in many resource-limited countries where I work. This meta-analysis adds further confidence to those results, she added.
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Other groups, including the National Institutes of Health and the Infectious Diseases Society of America, have already issued similar guidelines recommending the use of steroids to treat patients with severe Covid-19.
The new analysis included data on 678 patients randomized to treatment with steroids and 1,025 patients to usual care or a placebo. All of the patients had a confirmed diagnosis of Covid-19 and were admitted to the hospital. Most were on mechanical ventilation. Twenty-nine percent of the patients were women, but a breakdown by race was not disclosed.
After 28 days, 33% of the steroid-treated patients had died, compared to 41% of the patients on usual care or a placebo. In the meta-analysis, the difference in absolute mortality translated into a 34% reduction in the risk of death for those given steroids a statistically significant result.
The survival benefit remained consistent regardless of the type of steroid administered, the dose, or whether patients were receiving mechanical ventilation or supplemental oxygen only, researchers found.
Eighteen percent of patients on steroids reported side effects compared to 23% of patients on usual care or placebo. Adverse events varied across trials but there was no suggestion that the risk of serious adverse events was higher in patients assigned to corticosteroids except for the two smallest trials, in which the total number of serious adverse events was one and three.
Corticosteroids do not directly attack the novel coronavirus. Instead, the drugs work by dampening the activity of a patients immune system to prevent it from attacking the lungs a serious and often fatal condition called acute respiratory distress syndrome, or ARDS.
The first evidence that common steroids could improve the survival of patients with severe Covid-19 came in June when British researchers conducting a large clinical trial called RECOVERY reported that the use of dexamethasone reduced the death rate by 35% in patients requiring ventilation and by 20% in patients who needed oxygen but were not ventilated.
Prior to the public announcement of the RECOVERY trial results, physicians had been reluctant to use steroids to treat severely ill Covid-19 patients due to concerns about side effects. Clinical trials involving other immune-suppressing drugs like IL-6 inhibitors were also yielding disappointing results.
Patrick Vallance, the U.K. governments chief scientific adviser, speaking in June, called the dexamethasone survival benefit from the RECOVERY study tremendous news and a groundbreaking development in our fight against Covid-19. But the findings also hampered efforts to confirm the results. Other randomized and controlled clinical trials investigating the use of steroids at that time were unable to enroll additional patients.
For that reason, the WHOs Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group stepped in to coordinate the meta-analysis of these incomplete but randomized and controlled trials. The analysis was done prospectively, meaning that data and outcomes from the seven individual trials were not known in advance, but were shared for the first time with the WHO team in order to reduce the chance of bias.
Three of the individual clinical trials of steroids were published in JAMA Wednesday, alongside the WHOs meta-analysis.
The efforts of the clinical trial groups for the launch and conduct of high-quality trials in the midst of a pandemic should be acknowledged as an important accomplishment. The agreement among the trialists to share unpublished data with WHO is an example of how science can advance and is critical in the midst of what is likely to be numerous underpowered [randomized controlled trials], write Prescott and Rice in their JAMA editorial.
The WHOs meta-analysis leaves some questions about steroids and Covid-19 unanswered, said Boston Universitys Bhadelia.
It still remains unclear if there is any use in starting [steroids] earlier. Most clinicians, including myself, would not do so with the current data, she said, adding that theyre also uncertain whether to use biomarkers to guide therapy rather than oxygenation only.
One of the concerns about steroids is, given too early in the course of Covid-19, they might hamper the bodys ability to eliminate the virus, leading to worse outcomes. But steroids might also benefit a subset of Covid-19 patients who dont yet need oxygen but have lab tests indicating early signals of their immune system going into overdrive.
It would be interesting to know if co-administration of an antiviral may help reduce viral load while the earlier steroids work on the inflammatory component in that group of people, Bhadelia said. We also need more data around co-infections in the setting of steroid use.
