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High burden propecia 1mg tablets price of antibiotic-resistant Mycoplasma genitalium in symptomatic urethritisMycoplasma genitalium is an aetiological agent of sexually transmitted urethritis. A cohort study investigated M. Genitalium prevalence, antibiotic resistance and association with previous macrolide exposure among 1816 Chinese men who presented with symptomatic urethritis between 2011 propecia 1mg tablets price and 2015. Infection was diagnosed by PCR, and sequencing was used to detect mutations that confer resistance to macrolides and fluoroquinolones.

In 11% of propecia 1mg tablets price men, M. Genitalium was the sole pathogen identified. Nearly 90% propecia 1mg tablets price of infections were resistant to macrolides and fluoroquinolones. Previous macrolide exposure was associated with higher prevalence of resistance (97%).

The findings point to the need for routine propecia 1mg tablets price screening for M. Genitalium in symptomatic men with urethritis. Treatment strategies to overcome antibiotic propecia 1mg tablets price resistance in M. Genitalium are needed.Yang L, Xiaohong S, Wenjing L, et al.

Mycoplasma genitalium propecia 1mg tablets price in symptomatic male urethritis. Macrolide use is associated with increased resistance. Clin Infect Dis 2020;5:805–10. Doi:10.1093/cid/ciz294.A new entry inhibitor propecia 1mg tablets price offers promise for treatment-experienced patients with multidrug-resistant HIVFostemsavir, the prodrug of temsavir, is an attachment inhibitor.

By targeting the gp120 protein on the HIV-1 envelope, it prevents viral interaction with the CD4 receptor. No cross-resistance has been described with other antiretroviral agents, including propecia 1mg tablets price those that target viral entry by other modalities. In the phase III BRIGHTE trial, 371 highly treatment-experienced patients who had exhausted ≥4 classes of antiretrovirals received fostemsavir with an optimised regimen. After 48 weeks, propecia 1mg tablets price 54% of those with 1–2 additional active drugs achieved viral load suppression <40 copies/mL.

Response rates were 38% among patients lacking other active agents. Drug-related adverse events included nausea (4%) and propecia 1mg tablets price diarrhoea (3%). As gp120 substitutions reduced fostemsavir susceptibility in up to 70% of patients with virological failure, fostemsavir offers the most valuable salvage option in partnership with other active drugs.Kozal M, Aberg J, Pialoux G, et al. Fostemsavir in adults with multidrug-resistant HIV-1 propecia 1mg tablets price infection.

N Engl J Med 2020;382:1232–43. Doi. 10.1056/NEJMoa1902493Novel tools to aid identification of hepatitis C in primary careHepatitis C can now be cured with oral antiviral treatment, and improving diagnosis is a key element of elimination strategies.1 A cluster randomised controlled trial in South West England tested performance and cost-effectiveness of an electronic algorithm that identified at-risk patients in primary care according to national recommendations,2 coupled with educational activities and interventions to increase patients’ awareness. Outcomes were testing uptake, diagnosis and referral to specialist care.

Practices in the intervention arm had an increase in all outcome measures, with adjusted risk ratios of 1.59 (1.21–2.08) for uptake, 2.24 (1.47–3.42) for diagnosis and 5.78 (1.60–21.6) for referral. The intervention was highly cost-effective. Electronic algorithms applied to practice systems could enhance testing and diagnosis of hepatitis C in primary care, contributing to global elimination goals.Roberts K, Macleod J, Metcalfe C, et al. Cost-effectiveness of an intervention to increase uptake of hepatitis C virus testing and treatment (HepCATT).

Cluster randomised controlled trial in primary care. BMJ 2020;368:m322. Doi:10.1136/bmj.m322Low completion rates for antiretroviral postexposure prophylaxis (PEP) after sexual assaultA 4-week course of triple-agent postexposure prophylaxis (PEP) is recommended following a high-risk sexual assault.3 4 A retrospective study in Barcelona identified 1695 victims attending an emergency room (ER) between 2006 and 2015. Overall, 883 (52%) started prophylaxis in ER, which was mostly (43%) lopinavir/ritonavir based.

Follow-up appointments were arranged for those living in Catalonia (631, 71.5%), and of these, only 183 (29%) completed treatment. Loss to follow-up was more prevalent in those residing outside Barcelona. PEP non-completion was associated with a low perceived risk, previous assaults, a known aggressor and a positive cocaine test. Side effects were common, occurring in up to 65% of those taking lopinavir/ritonavir and accounting for 15% of all discontinuations.

More tolerable PEP regimens, accessible follow-up and provision of 1-month supply may improve completion rates.Inciarte A, Leal L, Masfarre L, et al. Postexposure prophylaxis for HIV infection in sexual assault victims. HIV Med 2020;21:43–52. Doi:10.1111/hiv.12797.Effective antiretroviral therapy reduces anal high-risk HPV infection and cancer riskAmong people with HIV, effective antiretroviral therapy (ART) is expected to improve control of anal infection with high-risk human papillomavirus (HR-HPV) and reduce the progression of HPV-associated anal lesions.

The magnitude of the effect is not well established. By meta-analysis, people on established ART (vs ART-naive) had a 35% lower prevalence of HR-HPV infection, and those with undetectable viral load (vs detectable viral load) had a 27% and 16% reduced risk of low and high-grade anal lesions, respectively. Sustained virological suppression on ART reduced by 44% the risk of anal cancer. The role of effective ART in reducing anal HR-HPV infection and cancer risks is especially salient given current limitations in anal cancer screening, high rates of anal lesion recurrence and access to vaccination.Kelly H, Chikandiwa A, Alemany Vilches L, et al.

Association of antiretroviral therapy with anal high-risk human papillomavirus, anal intraepithelial neoplasia and anal cancer in people living with HIV. A systematic review and meta-analysis. Lancet HIV. 2020;7:e262–78.

Doi:10.1016/S2352-3018(19)30434-5.The impact of sex work laws and stigma on HIV prevention among female sex workersSex work laws and stigma have been established as structural risk factors for HIV acquisition among female sex workers (FSWs). However, individual-level data assessing these relationships are limited. A study examined individual-level data collected in 2011–2018 from 7259 FSWs across 10 sub-Saharan African countries. An association emerged between HIV prevalence and increasingly punitive and non-protective laws.

HIV prevalence among FSWs was 11.6%, 19.6% and 39.4% in contexts where sex work was partly legalised, not recognised or criminalised, respectively. Stigma measures such as fear of seeking health services, mistreatment in healthcare settings, lack of police protection, blackmail and violence were associated with higher HIV prevalence and more punitive settings. Sex work laws that protect sex workers and reduce structural risks are needed.Lyons CE, Schwartz SR, Murray SM, et al. The role of sex work laws and stigmas in increasing HIV risks among sex workers.

Nat Commun 2020;11:773. Doi:10.1038/s41467-020-14593-6.BackgroundCumbria Sexual Health Services (CSHS) in collaboration with Cumbria Public Health and local authorities have established a COVID-19 contact tracing pathway for Cumbria. The local system was live 10 days prior to the national system on 18 May 2020. It was designed to interface and dovetail with the government’s track and trace programme.Our involvement in this initiative was due to a chance meeting between Professor Matt Phillips, Consultant in Sexual Health and HIV, and the Director of Public Health Cumbria, Colin Cox.

Colin knew that Cumbria needed to act fast to prevent the transmission of COVID-19 and Matt knew that sexual health had the skills to help.ProcessDespite over 90% of the staff from CSHS being redeployed in March 2020, CSHS maintained urgent sexual healthcare for the county and a phone line for advice and guidance. As staff began to return to the service in May 2020 we had capacity to spare seven staff members, whose hours were the equivalent of four full-time staff. We had one system administrator, three healthcare assistants, one nurse, Health Advisor Helen Musker and myself.CSHS were paramount to the speed with which the local system began. Following approval from the Trust’s chief executive officer we had adapted our electronic patient records (EPR) system, developed a standard operating procedure and trained staff, using a stepwise competency model, within just 1 day.In collaboration with the local laboratories we developed methods for the input of positive COVID-19 results into our EPR derivative.

We ensured that labs would be able to cope with the increase in testing and that testing hubs had additional capacity. Testing sites and occupational health were asked to inform patients that if they tested positive they would be contacted by our teams.This initiative involved a multiagency system including local public health (PH) teams, local authority, North Cumbria and Morecambe Bay CCGs, Public Health England (PHE) and the military. If CSHS recognise more than one positive result in the same area/organisation, they flag this with PH at the daily incident management meeting and environmental health officers (EHOs) provide advice and guidance for the organisation. We have had an active role in the contact tracing for clusters in local general practices, providing essential information to PH to enable them to initiate outbreak control and provide accurate advice to the practices.

We are an integral part in recognising cases in large organisations and ensuring prompt action is taken to stem the spread of the disease. The team have provided out-of-hours work to ensure timely and efficient action is taken for all contacts.The local contact tracing pilot has evolved and a database was established by local authorities. Our data fed directly into this from the end of May 2020. This enables the multiagency team to record data in one place, improving recognition of patterns of transmission.DiscussionCumbria is covered by three National Health Service Trusts, which meant accessing data outside of our Trust was challenging and took more time to establish.

There are two CCGs for Cumbria, which meant discussions regarding testing were needed with both North and South CCGs and variations in provision had to be accounted for. There are six boroughs in Cumbria with different teams of EHOs working in each. With so many people involved, not only is there need for large-scale frequent communication across a multisystem team, there is also inevitable duplication of work.Lockdown is easing and sexual health clinics are increasing capacity in a new world of virtual appointments and reduced face-to-face consultations. Staff within the contact tracing team are now balancing their commitments across both teams to maintain their skills and keep abreast of the rapid developments within our service due to COVID-19.

We are currently applying for funding from PH in order to second staff and backfill posts in sexual health.ConclusionCSHS have been able to lend our skills effectively to the local contact tracing efforts. We have expedited the contact tracing in Cumbria and provided crucial information to help contain outbreaks. It has had a positive effect on staff morale within the service and we have gained national recognition for our work. We have developed excellent relationships with our local PH team, PHE, Cumbria Council, EHOs and both CCGs.Cumbria has the infrastructure to meet the demands of a second wave of COVID-19.

The beauty of this model is that if we are faced with a second lockdown, sexual health staff will inevitably be available to help with the increased demand for contact tracing. Our ambition is that this model will be replicated nationally..

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Publisher. Princeton, NJ. Mathematica Aug 27, 2020 Authors Alex Bohl and Michelle Roozeboom-Baker Updates to the sixth edition include information on. Added newly established codes that capture COVID-related treatments delivered in the hospital setting. As COVID-19 disrupts people’s lives and livelihoods and threatens institutions around the world, the need for fast, data-driven solutions to combat the crisis is growing.

This primer is designed to help researchers, data scientists, and others who analyze health care claims or administrative data (herein referred to as “claims”) quickly join the effort to better understand, track, and contain COVID-19. Readers can use this guidance to help them assess data on health care use and costs linked to COVID-19, create models for risk identification, and pinpoint complications that may follow a COVID-19 diagnosis. Related NewsNew findings published this month in two prominent journals provide insight into the characteristics and performance of health systems using the latest data from the Compendium of U.S. Health Systems, created by Mathematica for the Agency for Healthcare Research and Quality (AHRQ).Mathematica and AHRQ researchers reported in Health Affairs that there was substantial consolidation of physicians and hospitals into vertically integrated health systems from 2016 to 2018. This resulted in more than half of physicians and 72 percent of hospitals being affiliated with one of the 637 health systems in the United States.

Among systems operating in both 2016 and 2018 years, the median number of physicians increased by 29 percent, from 285 to 369. This has implications for cost, access, and quality of care.Although most research on health systems suggests that consolidation is associated with higher prices, a new article published in Health Services Research suggests that vertically integrated health systems might provide greater value under payment models that provide incentives to improve value. In this study, the authors found lower costs and similar quality scores from system hospitals compared with non-system hospitals that were participating in Medicare’s Comprehensive Care for Joint Replacement, a mandatory episode payment model.These studies were conducted by researchers at Mathematica, which leads AHRQ’s Coordinating Center for Comparative Health System Performance. This initiative seeks to understand the factors that affect health systems’ use of patient-centered outcomes research in delivering care. Learn more about the Comparative Health System Performance Initiative..

Publisher. Princeton, NJ. Mathematica Aug 27, 2020 Authors Alex Bohl and Michelle Roozeboom-Baker Updates to the sixth edition include information on. Added newly established codes that capture COVID-related treatments delivered in the hospital setting.

As COVID-19 disrupts people’s lives and livelihoods and threatens institutions around the world, the need for fast, data-driven solutions to combat the crisis is growing. This primer is designed to help researchers, data scientists, and others who analyze health care claims or administrative data (herein referred to as “claims”) quickly join the effort to better understand, track, and contain COVID-19. Readers can use this guidance to help them assess data on health care use and costs linked to COVID-19, create models for risk identification, and pinpoint complications that may follow a COVID-19 diagnosis. Related NewsNew findings published this month in two prominent journals provide insight into the characteristics and performance of health systems using the latest data from the Compendium of U.S.

Health Systems, created by Mathematica for the Agency for Healthcare Research and Quality (AHRQ).Mathematica and AHRQ researchers reported in Health Affairs that there was substantial consolidation of physicians and hospitals into vertically integrated health systems from 2016 to 2018. This resulted in more than half of physicians and 72 percent of hospitals being affiliated with one of the 637 health systems in the United States. Among systems operating in both 2016 and 2018 years, the median number of physicians increased by 29 percent, from 285 to 369. This has implications for cost, access, and quality of care.Although most research on health systems suggests that consolidation is associated with higher prices, a new article published in Health Services Research suggests that vertically integrated health systems might provide greater value under payment models that provide incentives to improve value.

In this study, the authors found lower costs and similar quality scores from system hospitals compared with non-system hospitals that were participating in Medicare’s Comprehensive Care for Joint Replacement, a mandatory episode payment model.These studies were conducted by researchers at Mathematica, which leads AHRQ’s Coordinating Center for Comparative Health System Performance. This initiative seeks to understand the factors that affect health systems’ use of patient-centered outcomes research in delivering care. Learn more about the Comparative Health System Performance Initiative..

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COVID-19 has exposed the cracks in the foundation of does propecia lower sperm count America’s rural community health system. These cracks include increased risk of facility closures, loss of services, low investment in public health, maldistribution of health professionals, and payment policies ill-suited to low-volume rural providers.As a result, short-term relief to stabilize rural health systems and long-term strategies to rebuild their foundations are necessary. In this does propecia lower sperm count post, we propose four policy cornerstones on which to rebuild the rural health system. They include new financing and delivery models, community engagement, local health planning, and regionalization of delivery systems.The Cracked FoundationThe cracks in the rural health system’s foundation impair system performance on many levels.

Rural hospitals, clinics, and emergency medical services (EMS) report reduced revenues and utilization. Shortages of personal protective does propecia lower sperm count equipment, testing supplies, and ventilators. And limited COVID-19 surge capacity. The chronic underfunding of rural public health has also dismantled emergency response capacity.

Finally, enhanced payment policies have slowed, but not prevented, rural hospital closures.While these cracks are not new, COVID-19 does propecia lower sperm count has revealed how deep they are. For example, 172 rural hospitals have closed since 2005. Due to chronic underfunding, rural public health departments employ staff with narrower skill does propecia lower sperm count sets and fewer epidemiologists than their urban peers. Low patient utilization and revenues have severely reduced the crisis response capacity of rural health systems.

Rural communities have fewer health resources to respond to COVID-19.Despite concerns about hospital closures, a large percentage of rural residents bypass their local health systems. These bypass patterns reveal tension between the desire to retain local services and the will to sustain these services through utilization and financial support.Weaknesses of Volume-Based Payment PoliciesFee-for-service payment policies fail to address rural providers’ high fixed does propecia lower sperm count costs, inadequate cash reserves, and high reliance on non-emergent care revenues. They also discourage delivery of high-value, low-margin services such as primary care, chronic care, and prevention.To sustain low-volume rural providers, Medicare provides enhanced reimbursement to critical access, sole community, and Medicare-dependent hospitals and Rural Health Clinics. Still, these designation programs rely on fee-for-service payment methods insufficient for does propecia lower sperm count rural providers.

They fail to mitigate the impact of Medicare sequestration and bad debt cuts, low Medicaid and commercial reimbursement, low dependence on inpatient care, and declining rural populations.At the same time, volume-based payment policies in our market-based health system favor the location of services in larger communities and encourage providers to compete for business. This reality does not serve rural areas well, particularly small and isolated areas. A competitive market approach, in the absence of formal health planning, inhibits does propecia lower sperm count coordination, promotes wasteful competition, distributes services inefficiently, and shifts planning from local to corporate levels.Patching the Foundation. Short-Term SolutionsCOVID-19 has widened the cracks in our rural health foundation.

Short-term responses have included financial support as well as regulatory relief to expand telehealth use and increase hospital bed availability. These interventions seek to stabilize rural providers and their ability to respond to community needs does propecia lower sperm count. COVID-19’s impact has also renewed interest in the Rural Hospital Closure Relief Act of 2019 [PDF] (H.R. 5481/S.

3103). The Act would allow additional struggling rural hospitals to become Critical Access Hospitals by restoring state authority to designate necessary providers.After COVID-19, we will face difficult decisions. Some rural providers may close, while many others will be weakened. State and local governments may face growing service demands with fewer resources to meet those demands.Rebuilding the Foundation.

Long Term SolutionsWhile helpful, traditional rural support policies have not fully repaired the foundation of rural community health. Thus, long-term strategies to rebuild, rather than patch, the rural health foundation are needed. In response, we propose the following four policy cornerstones to anchor this approach.Cornerstone 1. New financing and delivery system modelsNew rural financing and delivery system models are needed to:Respond to individual community requirements;Rightsize services;Reduce reliance on utilization and patient volume;Cover the costs of care, including fixed costs;Sustain crisis response capacity;Support public and population health, team-based care, telehealth, and transportation.

AndEnsure access to inpatient, outpatient, specialty, and primary care services.Demonstrations in Maryland, Pennsylvania, and Vermont are testing payment and delivery system models that may inform future rural health system development. Revisiting lessons learned from past state and federal demonstrations can provide additional information to supplement the results of these demonstrations.Cornerstone 2. Community engagementImplementation of rural delivery system models will be less effective unless communities engage in selecting models that meets their needs. Effective community engagement includes cross-sector representation, participation of vulnerable populations, and education on the economics of local health care services.

Community members must understand that health systems are not “public utilities” but resources requiring local utilization and financial support. Effective community engagement seeks to identify and reflect local concerns, values, and priorities. It should also explore why residents bypass local services to seek care outside of the community. Communities will need tools, technical assistance, and resources to support their community engagement processes.Cornerstone 3.

Local health planningCommunity engagement and local health planning are closely aligned. Local health planning processes are not the large-scale programs created under the National Health Planning and Resource Development Act of 1974. Rather, they are local efforts that can leverage the community health needs assessments (CHNAs) required of tax-exempt hospitals or the Mobilizing for Action through Planning and Partnerships (MAPP) process, used by public health agencies for voluntary accreditation. These processes offer a framework to conduct community health planning and engagement focused on health rather than health services.Collaboration between hospitals and local health departments (LDHs) would result in more comprehensive community health assessments.

Maryland, New York, North Carolina, and Ohio encourage collaboration between hospitals and LHDs and/or the alignment of their assessment cycles. New York requires hospitals and LHDs to collaborate on CHNAs, prioritize community issues, and jointly implement initiatives to address health priorities. To maximize their effectiveness, these assessments and planning processes should reflect the health system and health improvement needs of the community.Cornerstone 4. Regionalization of delivery systemsRegionalization of high-cost services complements effective local health planning.

Rural health systems often compete in “medical arms races” for specialty and diagnostic services, resulting in duplication and inefficient resource use. In contrast, regionalization involves “rightsizing” health systems by organizing delivery of essential services locally and high-cost services regionally. The loss of rural obstetrical services is an opportunity to regionalize care by providing pre/postnatal services locally, performing deliveries at designated regional hospitals, and offering transportation to ensure access to regional services.Effective planning and regionalization require local and state-level input on the distribution of rural populations, needs, and services. States can play an important role in encouraging regional health planning.

Texas, for example, funded Regional Health Partnerships (RHPs) under a Medicaid 1115 waiver. RHPs, which include hospitals and LHDs. RHPs must create plans to improve regional access, quality, cost-effectiveness and collaboration. Florida, as another example, established local health councils which are non-profit agencies that conduct regional health planning and implementation activities.Regional health planning can also support coordinated preparedness and response to local and global events.

Minnesota, for example, established eight Health Care Coalitions that collaborate inter-regionally for planning and response purposes. State Offices of Rural Health and other stakeholders can facilitate regional planning by convening health care, public health, and social service partners.With Crisis Comes OpportunityRural America has an exceptional history of resilience, innovation, and collaboration. Recovery from COVID-19 requires new strategies to rebuild the crumbling rural health foundation. The four cornerstones – payment and delivery system reform, community engagement, local health planning, and regionalization – can provide the base for strong and vibrant health systems serving rural America.Tools and resources are needed to support rural communities in taking responsibility for their health systems.

Government and philanthropic organizations can be an important source of funding for development of these resources. We further recommend that states explore opportunities to create regional planning systems to improve the delivery of essential and specialty services in rural areas. While COVID-19 has weakened rural health systems, it also provides an opportunity to pursue a new approach to engage rural communities in planning for and developing sustainable systems of care. John Gale is a Senior Research Associate and the Director of Policy Engagement at the Maine Rural Health Research Center.

His work concentrates on rural delivery systems including Rural Health Clinics. Critical Access Hospitals. And mental health, substance use, primary care, and EMS services. The central focus of his work is on the development of systems of care that overcome the siloes inherent in our health care system and the development of programs and services to support rural providers.

Latest posts by John Gale (see all) Alana KnudsonAlana Knudson, PhD, serves as a Program Area Director in the Public Health Department at NORC at the University of Chicago and is the Director of NORC’s Walsh Center for Rural Health Analysis. Dr. Knudson has over 25 years of experience implementing and directing public health programs, leading health services and policy research projects, and evaluating program effectiveness. Latest posts by Alana Knudson (see all) Shena Popat, MHA, is a Research Scientist in the Walsh Center for Rural Health Analysis at NORC at the University of Chicago.

Ms. Popat has extensive experience working on rural and frontier health program evaluations and policy analysis projects, collaborating with partners and stakeholders to develop policy recommendations for federal agencies. Previously, Ms. Popat served as a manager at a rural critical access hospital.

Ms. Popat received her master’s in health administration from the George Washington University. Latest posts by Shena Popat (see all) Share this:Like this:Like Loading... Listen to this post.

COVID-19 has exposed propecia 1mg tablets price the cracks in the foundation of America’s rural community health system. These cracks include increased risk of facility closures, loss of services, low investment in public health, maldistribution of health professionals, and payment policies ill-suited to low-volume rural providers.As a result, short-term relief to stabilize rural health systems and long-term strategies to rebuild their foundations are necessary. In this post, we propose four policy cornerstones on which to rebuild the rural health system propecia 1mg tablets price.

They include new financing and delivery models, community engagement, local health planning, and regionalization of delivery systems.The Cracked FoundationThe cracks in the rural health system’s foundation impair system performance on many levels. Rural hospitals, clinics, and emergency medical services (EMS) report reduced revenues and utilization. Shortages of propecia 1mg tablets price personal protective equipment, testing supplies, and ventilators.

And limited COVID-19 surge capacity. The chronic underfunding of rural public health has also dismantled emergency response capacity. Finally, enhanced payment policies have slowed, but not prevented, rural hospital closures.While these cracks are not propecia 1mg tablets price new, COVID-19 has revealed how deep they are.

For example, 172 rural hospitals have closed since 2005. Due to chronic underfunding, rural public health departments employ staff propecia 1mg tablets price with narrower skill sets and fewer epidemiologists than their urban peers. Low patient utilization and revenues have severely reduced the crisis response capacity of rural health systems.

Rural communities have fewer health resources to respond to COVID-19.Despite concerns about hospital closures, a large percentage of rural residents bypass their local health systems. These bypass patterns reveal tension between the desire to retain local services and the will to sustain these services through utilization and financial support.Weaknesses of Volume-Based Payment PoliciesFee-for-service payment policies fail to address rural providers’ high fixed costs, inadequate cash reserves, and high reliance propecia 1mg tablets price on non-emergent care revenues. They also discourage delivery of high-value, low-margin services such as primary care, chronic care, and prevention.To sustain low-volume rural providers, Medicare provides enhanced reimbursement to critical access, sole community, and Medicare-dependent hospitals and Rural Health Clinics.

Still, these designation programs rely on fee-for-service payment methods insufficient for rural providers propecia 1mg tablets price. They fail to mitigate the impact of Medicare sequestration and bad debt cuts, low Medicaid and commercial reimbursement, low dependence on inpatient care, and declining rural populations.At the same time, volume-based payment policies in our market-based health system favor the location of services in larger communities and encourage providers to compete for business. This reality does not serve rural areas well, particularly small and isolated areas.

A competitive market approach, in the absence of propecia 1mg tablets price formal health planning, inhibits coordination, promotes wasteful competition, distributes services inefficiently, and shifts planning from local to corporate levels.Patching the Foundation. Short-Term SolutionsCOVID-19 has widened the cracks in our rural health foundation. Short-term responses have included financial support as well as regulatory relief to expand telehealth use and increase hospital bed availability.

These interventions propecia 1mg tablets price seek to stabilize rural providers and their ability to respond to community needs. COVID-19’s impact has also renewed interest in the Rural Hospital Closure Relief Act of 2019 [PDF] (H.R. 5481/S.

3103). The Act would allow additional struggling rural hospitals to become Critical Access Hospitals by restoring state authority to designate necessary providers.After COVID-19, we will face difficult decisions. Some rural providers may close, while many others will be weakened.

State and local governments may face growing service demands with fewer resources to meet those demands.Rebuilding the Foundation. Long Term SolutionsWhile helpful, traditional rural support policies have not fully repaired the foundation of rural community health. Thus, long-term strategies to rebuild, rather than patch, the rural health foundation are needed.

In response, we propose the following four policy cornerstones to anchor this approach.Cornerstone 1. New financing and delivery system modelsNew rural financing and delivery system models are needed to:Respond to individual community requirements;Rightsize services;Reduce reliance on utilization and patient volume;Cover the costs of care, including fixed costs;Sustain crisis response capacity;Support public and population health, team-based care, telehealth, and transportation. AndEnsure access to inpatient, outpatient, specialty, and primary care services.Demonstrations in Maryland, Pennsylvania, and Vermont are testing payment and delivery system models that may inform future rural health system development.

Revisiting lessons learned from past state and federal demonstrations can provide additional information to supplement the results of these demonstrations.Cornerstone 2. Community engagementImplementation of rural delivery system models will be less effective unless communities engage in selecting models that meets their needs. Effective community engagement includes cross-sector representation, participation of vulnerable populations, and education on the economics of local health care services.

Community members must understand that health systems are not “public utilities” but resources requiring local utilization and financial support. Effective community engagement seeks to identify and reflect local concerns, values, and priorities. It should also explore why residents bypass local services to seek care outside of the community.

Communities will need tools, technical assistance, and resources to support their community engagement processes.Cornerstone 3. Local health planningCommunity engagement and local health planning are closely aligned. Local health planning processes are not the large-scale programs created under the National Health Planning and Resource Development Act of 1974.

Rather, they are local efforts that can leverage the community health needs assessments (CHNAs) required of tax-exempt hospitals or the Mobilizing for Action through Planning and Partnerships (MAPP) process, used by public health agencies for voluntary accreditation. These processes offer a framework to conduct community health planning and engagement focused on health rather than health services.Collaboration between hospitals and local health departments (LDHs) would result in more comprehensive community health assessments. Maryland, New York, North Carolina, and Ohio encourage collaboration between hospitals and LHDs and/or the alignment of their assessment cycles.

New York requires hospitals and LHDs to collaborate on CHNAs, prioritize community issues, and jointly implement initiatives to address health priorities. To maximize their effectiveness, these assessments and planning processes should reflect the health system and health improvement needs of the community.Cornerstone 4. Regionalization of delivery systemsRegionalization of high-cost services complements effective local health planning.

Rural health systems often compete in “medical arms races” for specialty and diagnostic services, resulting in duplication and inefficient resource use. In contrast, regionalization involves “rightsizing” health systems by organizing delivery of essential services locally and high-cost services regionally. The loss of rural obstetrical services is an opportunity to regionalize care by providing pre/postnatal services locally, performing deliveries at designated regional hospitals, and offering transportation to ensure access to regional services.Effective planning and regionalization require local and state-level input on the distribution of rural populations, needs, and services.

States can play an important role in encouraging regional health planning. Texas, for example, funded Regional Health Partnerships (RHPs) under a Medicaid 1115 waiver. RHPs, which include hospitals and LHDs.

RHPs must create plans to improve regional access, quality, cost-effectiveness and collaboration. Florida, as another example, established local health councils which are non-profit agencies that conduct regional health planning and implementation activities.Regional health planning can also support coordinated preparedness and response to local and global events. Minnesota, for example, established eight Health Care Coalitions that collaborate inter-regionally for planning and response purposes.

State Offices of Rural Health and other stakeholders can facilitate regional planning by convening health care, public health, and social service partners.With Crisis Comes OpportunityRural America has an exceptional history of resilience, innovation, and collaboration. Recovery from COVID-19 requires new strategies to rebuild the crumbling rural health foundation. The four cornerstones – payment and delivery system reform, community engagement, local health planning, and regionalization – can provide the base for strong and vibrant health systems serving rural America.Tools and resources are needed to support rural communities in taking responsibility for their health systems.

Government and philanthropic organizations can be an important source of funding for development of these resources. We further recommend that states explore opportunities to create regional planning systems to improve the delivery of essential and specialty services in rural areas. While COVID-19 has weakened rural health systems, it also provides an opportunity to pursue a new approach to engage rural communities in planning for and developing sustainable systems of care.

John Gale is a Senior Research Associate and the Director of Policy Engagement at the Maine Rural Health Research Center. His work concentrates on rural delivery systems including Rural Health Clinics. Critical Access Hospitals.

And mental health, substance use, primary care, and EMS services. The central focus of his work is on the development of systems of care that overcome the siloes inherent in our health care system and the development of programs and services to support rural providers. Latest posts by John Gale (see all) Alana KnudsonAlana Knudson, PhD, serves as a Program Area Director in the Public Health Department at NORC at the University of Chicago and is the Director of NORC’s Walsh Center for Rural Health Analysis.

Dr. Knudson has over 25 years of experience implementing and directing public health programs, leading health services and policy research projects, and evaluating program effectiveness. Latest posts by Alana Knudson (see all) Shena Popat, MHA, is a Research Scientist in the Walsh Center for Rural Health Analysis at NORC at the University of Chicago.

Ms. Popat has extensive experience working on rural and frontier health program evaluations and policy analysis projects, collaborating with partners and stakeholders to develop policy recommendations for federal agencies. Previously, Ms.

Popat served as a manager at a rural critical access hospital. Ms. Popat received her master’s in health administration from the George Washington University.

Latest posts by Shena Popat (see all) Share this:Like this:Like Loading... Listen to this post.

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The Royal College of Pathologists stated:“National Pathology Week 2020 kicks off with a special ‘Meet the Presidents’ event on 2 November. Open to all, the event involves both our President and propecia without side effects President-elect who will be discussing why pathology is ‘at the heart of healthcare’ and taking your questions. Members and anyone interested in attending can book their free place here."Other highlights in their programme include:a pathology-themed virtual book group event on 3 November involving an expert panel and the author of our selected book, The Pandemic Century. A History of Global Contagion from the Spanish Flu to Covid-19an online origami workshop on 7 November where scientist-turned-artist, Dr Lizzie Burns, will show you how to fold a ‘beating heart’ out of paper.

Attendees will propecia without side effects also hear from a pathologist about how the heart works and what can go wrong. Bookings for these events open early next week so keep an eye on their website and social media channels. Please also help promote their virtual pub quizzes for medical and biomedical science undergraduates and veterinary science undergraduates by propecia without side effects sharing the event links with any students you know.Help teach your children about biomedical science with these fun activitiesFor National Pathology Week 2019, the IBMS took some of our members to King’s Cross Academy to trial our activity sheets for children. This year, why don't you use the sheets at home with your own children?.

You could even make your own video and tag us when you post it. To give you a head start, here's what we learnt propecia without side effects last year.Use social media to inform the public about your role #AtTheHeartOfHealthcareSocial media can have huge benefits for teaching, CPD, communication and promoting the profession. These days, every phone is a camera and a video recorder, and there's always somebody in the lab with editing or Photoshop skills. Maybe there's that one person who has a big Instagram following, another who is very active in Facebook communities or someone who wants to be the next Tarantino?.

Whatever your skills - your department probably has more reach propecia without side effects than you imagine. Think about how you can inform people about the biomedical science #AtTheHeartOfHealthcare this National Pathology Week and tag us in your posts!. 22 October 2020 Sir Professor Stephen Holgate and Ann Hannah have both been acknowledged in the Queen’s Birthday Honours this propecia without side effects year. Sir Professor Stephen Holgate, Clinical Professor of Immunopharmacology at the University of Southampton and Royal College of Physicians Special Advisor on Air Quality, has been awarded a knighthood.

Ann Hannah, Rapid Response Laboratories Operations and Histology Manager, has been awarded a British Empire Medal. IBMS CEO, Jill Rodney comments:“On behalf of propecia without side effects the IBMS, I would like to extend my congratulations to Ann and Sir Stephen. They have both made outstanding contributions to the biomedical science profession and I am delighted that their achievements have been recognised at such a high level."Sir Stephen Holgate has been awarded a Knighthood for his services to medical research.One of the top specialists in his field, Sir Stephen has devoted his career to understanding lung disease. He is a co-founder of Synairgen – a University of Southampton spin-out company which was established with the aim to understand why patients with lung disease are so vulnerable to respiratory viruses.Through their research, Sir Stephen’s team discovered that those with lung disease have a defect in the production of interferon beta.

The molecule is normally released towards the end of an immune attack, and helps propecia without side effects to reduce inflammation. The team at Synarigen developed an inhalable form of interferon beta, which is effective against asthma, chronic obstructive pulmonary disease and Covid-19.Furthermore, Sir Stephen speaks out about the dangerous impacts of air pollution on human health. In 1026, he chaired a Royal College of Physicians work party which published a prominent report revealing that around 40,000 propecia without side effects deaths in the UK each year can be attributed to air pollution. He continues to put pressure on policymakers about the issues.

More recently, he was a lead author of a report by RCP and The Royal College of Paediatric and Child Health which highlights the dangerous impact of air pollution on the health of children and young people.Sir Stephen commented:“This award came as a complete surprise to me. I am so grateful to the many colleagues whom I have had the pleasure of working with over the last four decades, and without whom propecia without side effects this would never have occurred. I hope it shines a light on the importance of lung disease which, for many years, has not had the recognition it deserves.”Ann Hannah has been awarded a British Empire Medal for her services to pathology in the Covid-19 pandemic. As the Rapid Response Laboratories Operations and Histology Manager, she has been vital in ensuring the delivery of medically-led diagnostics, innovation, value and long-term investment to healthcare.

She has been invaluable in linking Health Services Laboratories with their NHS Trust partner and client hospitals.Ann propecia without side effects commented:I’m still feeling quite overwhelmed, and humbled, to think that I was nominated for this honour from amongst so many deserving colleagues. It may often be said, but It is absolutely true, that we all rely on very many other members of the team to do our job to the best of our ability. It is really amazing to see the level of resilience and commitment that all have shown, and continue to demonstrate, during these continuing challenging times..

23 October 2020 Start planning your promotion of the biomedical science #AtTheHeartOfHealthcare November 2-8 propecia 1mg tablets price is National Pathology Week - the Royal College of Pathologists’ annual week-long celebration of activities and events promoting the disciplines and professions in pathology. We are delighted to support this event, as it provides an excellent opportunity for our members to showcase their roles and specialties in the profession. This year’s theme propecia 1mg tablets price is. At the heart of healthcare - our very own hashtag - so we're doubly pleased to shine a light on this great awareness campaign.

The Royal College of Pathologists stated:“National Pathology Week 2020 kicks off with a special ‘Meet the Presidents’ event on 2 November. Open to all, propecia 1mg tablets price the event involves both our President and President-elect who will be discussing why pathology is ‘at the heart of healthcare’ and taking your questions. Members and anyone interested in attending can book their free place here."Other highlights in their programme include:a pathology-themed virtual book group event on 3 November involving an expert panel and the author of our selected book, The Pandemic Century. A History of Global Contagion from the Spanish Flu to Covid-19an online origami workshop on 7 November where scientist-turned-artist, Dr Lizzie Burns, will show you how to fold a ‘beating heart’ out of paper.

Attendees will also hear from a pathologist about how the heart propecia 1mg tablets price works and what can go wrong. Bookings for these events open early next week so keep an eye on their website and social media channels. Please also help promote their virtual pub quizzes for medical and biomedical science undergraduates and veterinary science undergraduates by sharing the event links with any students you know.Help teach your children about biomedical science with these fun activitiesFor National propecia 1mg tablets price Pathology Week 2019, the IBMS took some of our members to King’s Cross Academy to trial our activity sheets for children. This year, why don't you use the sheets at home with your own children?.

You could even make your own video and tag us when you post it. To give you a head start, here's what we learnt last year.Use social media to inform propecia 1mg tablets price the public about your role #AtTheHeartOfHealthcareSocial media can have huge benefits for teaching, CPD, communication and promoting the profession. These days, every phone is a camera and a video recorder, and there's always somebody in the lab with editing or Photoshop skills. Maybe there's that one person who has a big Instagram following, another who is very active in Facebook communities or someone who wants to be the next Tarantino?.

Whatever your skills - your propecia 1mg tablets price department probably has more reach than you imagine. Think about how you can inform people about the biomedical science #AtTheHeartOfHealthcare this National Pathology Week and tag us in your posts!. 22 October 2020 Sir Professor Stephen Holgate and Ann Hannah have both been acknowledged in propecia 1mg tablets price the Queen’s Birthday Honours this year. Sir Professor Stephen Holgate, Clinical Professor of Immunopharmacology at the University of Southampton and Royal College of Physicians Special Advisor on Air Quality, has been awarded a knighthood.

Ann Hannah, Rapid Response Laboratories Operations and Histology Manager, has been awarded a British Empire Medal. IBMS CEO, Jill Rodney comments:“On propecia 1mg tablets price behalf of the IBMS, I would like to extend my congratulations to Ann and Sir Stephen. They have both made outstanding contributions to the biomedical science profession and I am delighted that their achievements have been recognised at such a high level."Sir Stephen Holgate has been awarded a Knighthood for his services to medical research.One of the top specialists in his field, Sir Stephen has devoted his career to understanding lung disease. He is a co-founder of Synairgen – a University of Southampton spin-out company which was established with the aim to understand why patients with lung disease are so vulnerable to respiratory viruses.Through their research, Sir Stephen’s team discovered that those with lung disease have a defect in the production of interferon beta.

The molecule is normally released towards the propecia 1mg tablets price end of an immune attack, and helps to reduce inflammation. The team at Synarigen developed an inhalable form of interferon beta, which is effective against asthma, chronic obstructive pulmonary disease and Covid-19.Furthermore, Sir Stephen speaks out about the dangerous impacts of air pollution on human health. In 1026, propecia 1mg tablets price he chaired a Royal College of Physicians work party which published a prominent report revealing that around 40,000 deaths in the UK each year can be attributed to air pollution. He continues to put pressure on policymakers about the issues.

More recently, he was a lead author of a report by RCP and The Royal College of Paediatric and Child Health which highlights the dangerous impact of air pollution on the health of children and young people.Sir Stephen commented:“This award came as a complete surprise to me. I am propecia 1mg tablets price so grateful to the many colleagues whom I have had the pleasure of working with over the last four decades, and without whom this would never have occurred. I hope it shines a light on the importance of lung disease which, for many years, has not had the recognition it deserves.”Ann Hannah has been awarded a British Empire Medal for her services to pathology in the Covid-19 pandemic. As the Rapid Response Laboratories Operations and Histology Manager, she has been vital in ensuring the delivery of medically-led diagnostics, innovation, value and long-term investment to healthcare.

She has been invaluable in linking Health Services Laboratories with their NHS Trust partner and client hospitals.Ann commented:I’m still feeling quite overwhelmed, and humbled, to think that I was nominated for this honour from amongst so many deserving propecia 1mg tablets price colleagues. It may often be said, but It is absolutely true, that we all rely on very many other members of the team to do our job to the best of our ability. It is really amazing to see the level of resilience and commitment that all have shown, and continue to demonstrate, during these continuing challenging times..

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SOBRE NOTICIAS can you buy propecia online EN ESPAÑOLNoticias en español es una sección de Kaiser Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que vive en los Estados Unidos. Use Nuestro Contenido can you buy propecia online Este contenido puede usarse de manera gratuita (detalles). Al menos la mitad de los votantes prefiere el enfoque de la atención médica del ex vicepresidente Joe Biden al del presidente Donald Trump, lo que sugiere que la preocupación por reducir los costos y manejar la pandemia podría influir en el resultado de esta elección, según revela una nueva encuesta. Los hallazgos, de la encuesta mensual de KFF, indican que los votantes no confían en las garantías del presidente de que protegerá a las personas con condiciones preexistentes de las compañías de seguros si la Corte Suprema anulara la Ley de Cuidado de Salud a Bajo Precio (ACA).Un mes antes de que el tribunal escuche los argumentos de los can you buy propecia online fiscales generales republicanos y la administración Trump a favor de revocar la ley, la encuesta muestra que el 79% del público no quiere que el Supremo cancele las protecciones de cobertura para los estadounidenses con afecciones preexistentes.

La mayoría de los republicanos, el 66%, dijo que no quiere que se anulen esas garantías.Además de dejar a unos 21 millones de estadounidenses sin seguro, revocar ACA podría permitir a las compañías de seguros cobrar más o negar cobertura a las personas porque tienen condiciones preexistentes, una práctica común antes que se estableciera la ley, y que un análisis del gobierno reveló en 2017 que podría afectar hasta a 133 millones de estadounidenses.Casi 6 de cada 10 personas dijeron que tenían un familiar con una condición preexistente o crónica, como diabetes, hipertensión, o cáncer, y aproximadamente la mitad dijo que les preocupa que un ser querido no pueda pagar la cobertura, o la pierda por completo, si se anulara la ley.La encuesta revela una preferencia sorprendente por Biden sobre Trump cuando se trata de proteger a las personas con condiciones preexistentes, un tema que el 94% de los votantes dijo que ayudaría a decidir por quién votar. Biden tiene can you buy propecia online una ventaja de 20 puntos. Un 56% prefiere su enfoque, contra un 36% para Trump.De hecho, el sondeo muestra una preferencia por Biden en todos los problemas de atención médica que se plantean, incluso entre los mayores de 65 años y en temas que Trump ha dicho que eran sus prioridades mientras estuviera can you buy propecia online en el cargo, lo que indica que los votantes no están satisfechos con el trabajo del presidente para reducir los costos de la atención médica, en particular. El apoyo a los esfuerzos de Trump para reducir el precio de los medicamentos recetados ha disminuido, y los votantes ahora prefieren el enfoque de Biden, del 50% al 43%.La mayoría de los votantes dijeron que prefieren el plan de Biden para lidiar con el brote de COVID-19, 55% a 39%, y para desarrollar y distribuir una vacuna para COVID, 51% a 42%.

Trump ha delegado en gran medida la gestión de la pandemia a los funcionarios can you buy propecia online estatales y locales, al tiempo que prometió que los científicos desafiarían las expectativas y producirían una vacuna antes del día de las elecciones.Cuando se les preguntó qué tema era más importante para decidir por quién votar, la mayoría de los encuestados señaló a la atención médica. El 18% eligió el brote de COVID-19 y el 12% mencionó el cuidado de salud en general. Casi una proporción igual, el can you buy propecia online 29%, optó por la economía.La encuesta se realizó del 7 al 12 de octubre, después del primer debate presidencial y el anuncio de Trump de que había dado positivo para COVID-19. El margen de error es más o menos 3 puntos porcentuales para la muestra completa y 4 puntos porcentuales para los votantes.(KHN es un programa editorialmente independiente de KFF).

Emmarie Huetteman can you buy propecia online. ehuetteman@kff.org, @emmarieDC Related Topics Courts Elections Health Care Costs Noticias En Español The Health can you buy propecia online Law COVID-19 KFF Polls Preexisting ConditionsIn March, Sue Williams-Ward took a new job, with a $1-an-hour raise.The employer, a home health care agency called Together We Can, was paying a premium — $13 an hour — after it started losing aides when COVID-19 safety concerns mounted.Williams-Ward, a 68-year-old Indianapolis native, was a devoted caregiver who bathed, dressed and fed clients as if they were family. She was known to entertain clients with some of her own 26 grandchildren, even inviting her clients along on charitable deliveries of Thanksgiving turkeys and Christmas hams. Explore Our Database KHN can you buy propecia online and The Guardian are tracking health care workers who died from COVID-19 and writing about their lives and what happened in their final days.

Without her, the city’s most vulnerable would have been “lost, alone or mistreated,” said her husband, Royal Davis.Despite her husband’s fears for her health, Williams-Ward reported to work on March 16 at an apartment with three elderly women. One was blind, one was wheelchair-bound, and the third had a severe mental illness can you buy propecia online. None had been diagnosed with COVID-19 but, Williams-Ward confided in Davis, at least one had symptoms of fatigue and shortness of breath, now associated with the virus.Even after a colleague on the night shift developed pneumonia, Williams-Ward tended to her patients — without protective equipment, which she told her husband she’d repeatedly requested from the agency. Together We Can did not respond to multiple phone and email requests for comment about the PPE available to its workers.Still, Davis said, “Sue did all the little, unseen, everyday things that allowed them to maintain their liberty, dignity and freedom.”He said that within three days Williams-Ward was can you buy propecia online coughing, too.

After six weeks in a hospital and weeks can you buy propecia online on a ventilator, she died of COVID-19. Hers is one of more than 1,200 health worker COVID deaths that KHN and The Guardian are investigating, including those of dozens of home health aides.During the pandemic, home health aides have buttressed the U.S. Health care can you buy propecia online system by keeping the most vulnerable patients — seniors, the disabled, the infirm — out of hospitals. Yet even as they’ve put themselves at risk, this workforce of 2.3 million — of whom 9 in 10 are women, nearly two-thirds are minorities and almost one-third are foreign-born — has largely been overlooked.Home health providers scavenged for their own face masks and other protective equipment, blended disinfectant and fabricated sanitizing wipes amid widespread shortages.

They’ve often done it all on poverty wages, without overtime pay, hazard pay, sick can you buy propecia online leave and health insurance. And they’ve gotten sick and died — leaving little to their survivors. Email can you buy propecia online Sign-Up Subscribe to KHN’s free Morning Briefing. Speaking out about their work conditions during the pandemic has can you buy propecia online triggered retaliation by employers, according to representatives of the Service Employees International Union in Massachusetts, California and Virginia.

€œIt’s been shocking, egregious and unethical,” said David Broder, president of SEIU Virginia 512.The pandemic has laid bare deeply ingrained inequities among health workers, as Broder puts it. €œThis is exactly what structural racism looks like today can you buy propecia online in our health care system.”Every worker who spoke with KHN for this article said they felt intimidated by the prospect of voicing their concerns. All have seen colleagues fired for doing so. They agreed to talk candidly about their work environments on the condition their full names not be used.***Tina, a home health provider, said she has faced these challenges in Springfield, Massachusetts, one of the nation’s poorest cities.Like many of her colleagues — 82%, according to a survey by the National Domestic Workers can you buy propecia online Alliance — Tina has lacked protective equipment throughout the pandemic.

Her employer is a family-owned company that gave her one surgical mask and two pairs of latex gloves a week to clean body fluids, change wound dressings and administer medications to incontinent or bedridden clients.When Tina received the company’s do-it-yourself blueprints — to make masks from hole-punched sheets of paper can you buy propecia online towel reinforced with tongue depressors and gloves from garbage bags looped with rubber bands — she balked. €œIt felt like I was in a Third World country,” she said.The home health agencies that Tina and others in this article work for declined to comment on work conditions during the pandemic.In other workplaces — hospitals, mines, factories — employers are responsible for the conditions in which their employees operate. Understanding the plight of home health providers begins with American labor can you buy propecia online law.The Fair Labor Standards Act, which forms the basis of protections in the American workplace, was passed in an era dually marked by President Franklin Delano Roosevelt’s New Deal changes and marred by the barriers of the Jim Crow era. The act excluded domestic care workers — including maids, butlers and home health providers — from protections such as overtime pay, sick leave, hazard pay and insurance.

Likewise, standards set by the Occupational Safety and Health Administration three decades later carved out “domestic household employment activities in private residences.”“A deliberate decision was made to discriminate can you buy propecia online against colored people — mostly women — to unburden distinguished elderly white folks from the responsibility of employment,” said Ruqaiijah Yearby, a law professor at St. Louis University.In 2015, several of these exceptions were eliminated, and protections for health providers became “very well regulated on paper,” said Nina Kohn, a professor specializing in civil rights law at Syracuse University. €œBut the reality is, noncompliance is a norm and the penalties for noncompliance are toothless.”Burkett McInturff, a civil rights lawyer working on behalf of home health workers, said, can you buy propecia online “The law itself is very clear. The problem lies in the ability to hold these companies accountable.”The Occupational Safety and Health can you buy propecia online Administration has “abdicated its responsibility for protecting workers” in the pandemic, said Debbie Berkowitz, director of the National Employment Law Project.

Berkowitz is also a former OSHA chief. In her view, political and financial decisions in recent years can you buy propecia online have hollowed out the agency. It now has the fewest inspectors and conducts the fewest inspections per year in its history.Furthermore, some home health care agencies have classified home health providers as contractors, akin to gig workers such as Uber drivers. This loophole protects them from the responsibilities of employers, said Seema can you buy propecia online Mohapatra, an Indiana University associate professor of law.

Furthermore, she said, “these workers are rarely in a position to question, or advocate or lobby for themselves.”Should workers contract COVID-19, they are unlikely to receive remuneration or damages.Demonstrating causality — that a person caught the coronavirus on the job — for workers’ compensation has been extremely difficult, Berkowitz said. As with other health care jobs, employers have been quick to point out that workers might have caught the virus at the gas station, grocery store or home.Many can you buy propecia online home health providers care for multiple patients, who also bear the consequences of their work conditions. €œIf you think about perfect vectors for transmission, unprotected individuals going from house to house have to can you buy propecia online rank at the top of list,” Kohn said. €œEven if someone didn’t care at all about these workers, we need to fix this to keep Grandma and Grandpa safe.”Nonetheless, caregivers like Samira, in Richmond, Virginia, have little choice but to work.

Samira — who makes $8.25 an hour with one client and $9.44 an hour with another, and owes tens of thousands of dollars in hospital bills from previous work injuries — has no other option but to risk can you buy propecia online getting sick.“I can’t afford not to work. And my clients, they don’t have anybody but me,” she said. €œSo I just pray every day I don’t get it.” can you buy propecia online Eli Cahan. emcahan@stanford.edu, @emcahan Related Topics Aging Health Industry Public Health COVID-19 Home Health Care Lost On The FrontlineCalifornia Healthline correspondent Angela Hart discussed how the coronavirus pandemic has derailed California’s efforts to deal with homelessness on KPBS “Midday Edition” on Oct.

8. KHN Midwest correspondent Lauren Weber discussed the difference between D.O.s and M.D.s with Newsy’s “Morning Rush” on Tuesday. KHN correspondent Anna Almendrala discussed how L.A. County’s enforcement of workplace coronavirus protocols has cut COVID-19 deaths with KPCC’s “Take Two” on Tuesday.

KHN senior correspondent Sarah Jane Tribble discussed rural hospitals and KHN’s “Where It Hurts” podcast with Illinois Public Media’s “The 21st” on Oct. 5 and “Tradeoffs” on Oct. 8. KHN chief Washington correspondent Julie Rovner joined C-SPAN’s “Washington Journal” on Tuesday to discuss the Affordable Care Act case before the Supreme Court next month and what else to expect in the realm of health care after the election.

KHN freelancer Priscilla Blossom discussed Halloween safety tips with KUNC’s “Colorado Edition” on Tuesday. Related Topics California Doctors Homeless Medical EducationTrombonist Jerrell Charleston loves the give-and-take of jazz, the creativity of riffing off other musicians. But as he looked toward his sophomore year at Indiana University, he feared that steps to avoid sharing the coronavirus would also keep students from sharing songs.“Me and a lot of other cats were seriously considering taking a year off and practicing at home,” lamented the 19-year-old jazz studies major from Gary, Indiana.His worries evaporated when he arrived on campus and discovered that music professor Tom Walsh had invented a special mask with a hole and a protective flap to allow musicians to play while masked. Don't Miss A Story Subscribe to KHN’s free Weekly Edition newsletter.

Students also got masks for the ends of their wind instruments, known as bell covers, allowing them to jam in person, albeit 6 feet apart.“It’s amazing to play together,” Charleston said. €œMusic has always been my safe space. It’s what’s in your soul, and you’re sharing that with other people.”Of course, the very act of making music powered by human breath involves blowing air — and possibly virus particles — across a room. One infamous choral practice in Washington state earlier this year led to confirmed diagnoses of COVID-19 in more than half of the 61 attendees.

Two died.So musicians around the country are taking it upon themselves to reduce the risk of COVID-19 without silencing the music. With pantyhose, air filters, magnets, bolts of fabric and a fusion of creativity, those who play wind instruments or sing are improvising masks to keep the band together. Solomon Keim rehearses in protective gear that doesn't mask the sound.(Chris Bergin for KHN) Brayden Wisley practices safe sax-playing. Other tips for musicians.

Play in a big space with good ventilation, and break after 30 minutes to allow the air to clear.(Chris Bergin for KHN) Brendan Sullivan plays trombone while both he and the instrument are masked. It has been recommended that most instrumentalists face the same direction while playing and stay 6 feet apart — with a distance of 9 feet in front and back of trombonists.(Chris Bergin for KHN)A consortium of performing arts groups has commissioned research exploring ways for musicians to play safely. The group’s preliminary report from July recommends instrumentalists wear masks with small slits, use bell covers, face the same direction while playing and stay 6 feet apart for most instruments — with a distance of 9 feet in front and back of trombonists. Other research has shown cotton bell covers on brass instruments reduced airborne particles by an average of 79% compared with playing without one.Jelena Srebric, a University of Maryland engineering researcher involved in the consortium’s study, said it’s also best to play in a big space with good ventilation, and musicians should break after 30 minutes to allow the air to clear.

These rudimentary solutions, she said, promise at least some protection against the virus.“Nothing is 100%. Being alive is a dangerous business,” Srebric said. This “gives some way to engage with music, which is fantastic in this day and age of despair.”Dr. Adam Schwalje, a National Institutes of Health research fellow at the University of Iowa Hospitals and Clinics, is a bassoonist who has written about the COVID risk of wind instruments.

He said a combination of bell covers, social distancing and limited time playing together could be helpful, but the effectiveness of bell covers or masks for musicians to wear while playing is “completely unproven” at this point. Schwalje’s paper said it’s not possible to quantify the risk of playing wind instruments, which involves deep breathing, sometimes forceful exhalation and possible aerosolizing of the mucus in the mouth and nose.Still, early results of research at the universities of Maryland and Colorado are helping to inspire improvisational mask-making and other safety measures, said Mark Spede, national president of the College Band Directors National Association who is helping lead the commissioned research.At Middle Tennessee State University, for example, tuba teacher Chris Combest said his students tie pillowcases over the bells of their instruments, and some wear masks that can be unbuttoned to play. At the University of Iowa, wind players in small ensembles must use bell covers and masks, but they can pull them down when playing as long as they pull them up during rests. Heather Ainsworth-Dobbins said her students at Southern Virginia University use surgical masks with slits cut in them and bell covers made of pantyhose and MERV-13 air filters, similar to what is used on a furnace.Indiana University Jacobs School of Music professor Tom Walsh distributes custom masks he designed that allow students to play their instruments safely as a group.(Chris Bergin for KHN) Skyler Floe tries out his horn's bell cover to much fanfare at Indiana University Jacobs School of Music in Bloomington, Indiana.(Chris Bergin for KHN) Kyle Cantrell's sound carries while reducing the risk of virus transmission.(Chris Bergin for KHN) At Indiana, Walsh sought out whatever research he could find as he designed his tight-fitting cotton musical mask, reinforced with a layer of polypropylene and with adjustable ties in the back.

A flap hangs over the hole, outfitted with two magnets that allow it to close over the instrument. The professor’s mom, Julie Walsh — who made his clothes when he was a kid — has sewn more than 80 of the musical masks for free. The opera program’s costume shop makes bell covers with a layer of fabric over a layer of stiff woven material known as interfacing fabric.Bailey Cates, a freshman trumpet player, said the quality of the sound is about the same with these masks and they make her feel safer.Flutes present unique challenges, partly because flutists blow air across the mouthpiece. Alice Dade, an associate professor of flute at the University of Missouri, said she and her students clip on device called “wind guards” usually used outdoors, then sometimes fit surgical masks over them.Alice Dade, an associate professor at the University of Missouri, recommends using clip-on devices for flutes called “wind guards,” which shield the lip plate of the flute from wind when playing outdoors.

The ventilated design helps limit condensation and interference with the player’s air stream. Amid the pandemic, some flutists now use them with surgical masks on top to curb the spread of the coronavirus.(Alice Dade)Indiana flute student Nathan Rakes uses a specially designed cloth mask with a slit and slips a silk sock on the instrument’s end. Rakes, a sophomore, said the fabric doesn’t affect the sound unless he’s playing a low B note, which he rarely plays.Walsh is a stickler for finding big practice spaces, not playing together for more than half an hour and taking 20-minute breaks. All jazz ensemble musicians, for example, also must stay at least 10 feet apart.“I carry a tape measure everywhere I go,” he said.

€œI feel responsible for our students.”Some K-12 schools are trying similar strategies, said James Weaver, director of performing arts and sports for the National Federation of State High School Associations.His son Cooper, a seventh grade sax player at Plainfield Community Middle School in Indiana, uses a surgical mask with a slit. It sometimes jerks to the side with the vibrations of playing, but Cooper said it “feels good as long as you have it in the right place.” Cooper also helped his dad make a bell cover with fabric and MERV-13 material.While many groups use homemade bell covers, McCormick’s Group in Wheeling, Illinois, has transformed its 25-year-old business of making bell covers to display school colors and insignias into one that is making musicians safer with two-ply covers made of polyester/spandex fabric. CEO Alan Yefsky said his company started reinforcing the covers with the second layer this summer. Sales of the $20 covers have soared.“It’s keeping people employed.

We’re helping keep people safe,” Yefsky said. €œAll of a sudden, we got calls from nationally known symphony organizations.”Other professional musicians take a different tack. Film and television soundtracks are often recorded in separate sessions. Woodwinds and brass players in individual plexiglass cubicles and masked, with distanced string players recording elsewhere.The U.S.

Marine Band in Washington, D.C., practices in small, socially distanced groups, but string instrumentalists are the only ones wearing masks while playing.For both professionals and students, the pandemic has virtually eliminated live audiences in favor of virtual performances. Many musicians say they miss traditional concerts but are not focusing on what they’ve lost.“Creating that sense of community — an island to come together and play — is super important,” said Cates, the Indiana trumpet player. €œPlaying music feels like a mental release for a lot of us. When I’m playing, my mind is off of the pandemic.”Indiana University Jacobs School of Music professor Tom Walsh works with students during rehearsal in Bloomington, Indiana.

The professor’s mom, Julie Walsh — who made his clothes when he was a kid — has sewn more than 80 of the musical masks for free.(Chris Bergin for KHN) Laura Ungar. lungar@kff.org, @laura_ungar Related Topics Public Health COVID-19Use Our Content This story can be republished for free (details). At least half of voters prefer former Vice President Joe Biden’s approach to health care over President Donald Trump’s, suggesting voter concern about lowering costs and managing the pandemic could sway the outcome of this election, a new poll shows.The findings, from KFF’s monthly tracking poll, signal that voters do not trust assurances from the president that he will protect people with preexisting conditions from being penalized by insurance companies if the Supreme Court overturns the Affordable Care Act. (KHN is an editorially independent program of KFF.)Coming a month before the court will hear arguments from Republican attorneys general and the Trump administration that the health law should be overturned, the poll shows 79% of the public does not want the court to cancel coverage protections for Americans with preexisting conditions. A majority of Republicans, 66%, said they do not want those safeguards overturned.In addition to leaving about 21 million Americans uninsured, overturning the ACA could allow insurance companies to charge more or deny coverage to individuals because they have preexisting conditions — a common practice before the law was established, and one that a government analysis said in 2017 could affect as many as 133 million Americans.

Email Sign-Up Subscribe to KHN’s free Morning Briefing. Nearly 6 in 10 people said they have a family member with a preexisting or chronic condition, such as diabetes or cancer, and about half said they worry about a relative being unable to afford coverage, or lose it outright, if the law is overturned.The poll reveals a striking preference for Biden over Trump when it comes to protecting preexisting conditions, an issue that 94% of voters said would help decide who they vote for. Biden has a 20-point advantage, with voters preferring his approach 56% to 36% for Trump.In fact, it shows a preference for Biden on every health care issue posed, including among those age 65 and older and on issues that Trump has said were his priorities while in office — signaling voters are not satisfied with the president’s work to lower health care costs, in particular. Support for Trump’s efforts to lower prescription drug costs has been slipping, with voters now preferring Biden’s approach, 50% to 43%.A majority of voters said they prefer Biden’s plan for dealing with the COVID-19 outbreak, 55% to 39%, and for developing and distributing a vaccine for COVID-19, 51% to 42%.

Trump has largely left it up to state and local officials to manage the outbreak, while promising that scientists would defy expectations and produce a vaccine before Election Day.Asked which issue is most important to deciding whom to vote for, most pointed to health care issues, with 18% choosing the COVID-19 outbreak and 12% saying health care overall. Nearly an equal share, 29%, selected the economy.The survey was conducted Oct. 7-12, after the first presidential debate and Trump’s announcement that he had tested positive for COVID-19. The margin of error is plus or minus 3 percentage points for the full sample and 4 percentage points for voters.

Emmarie Huetteman. ehuetteman@kff.org, @emmarieDC Related Topics Courts Elections Health Care Costs The Health Law COVID-19 KFF Polls Preexisting Conditions.

SOBRE NOTICIAS EN ESPAÑOLNoticias en español es una sección de Kaiser Health News que contiene traducciones de artículos de gran interés para la comunidad hispanohablante, y contenido original enfocado en la población hispana que vive en los Estados propecia 1mg tablets price Unidos. Use Nuestro Contenido propecia 1mg tablets price Este contenido puede usarse de manera gratuita (detalles). Al menos la mitad de los votantes prefiere el enfoque de la atención médica del ex vicepresidente Joe Biden al del presidente Donald Trump, lo que sugiere que la preocupación por reducir los costos y manejar la pandemia podría influir en el resultado de esta elección, según revela una nueva encuesta. Los hallazgos, de la encuesta mensual de KFF, indican que los votantes no confían en las garantías del presidente de que protegerá a las personas con condiciones preexistentes de las compañías de seguros si la Corte Suprema anulara la Ley de Cuidado de Salud a Bajo Precio (ACA).Un mes antes de que el propecia 1mg tablets price tribunal escuche los argumentos de los fiscales generales republicanos y la administración Trump a favor de revocar la ley, la encuesta muestra que el 79% del público no quiere que el Supremo cancele las protecciones de cobertura para los estadounidenses con afecciones preexistentes. La mayoría de los republicanos, el 66%, dijo que no quiere que se anulen esas garantías.Además de dejar a unos 21 millones de estadounidenses sin seguro, revocar ACA podría permitir a las compañías de seguros cobrar más o negar cobertura a las personas porque tienen condiciones preexistentes, una práctica común antes que se estableciera la ley, y que un análisis del gobierno reveló en 2017 que podría afectar hasta a 133 millones de estadounidenses.Casi 6 de cada 10 personas dijeron que tenían un familiar con una condición preexistente o crónica, como diabetes, hipertensión, o cáncer, y aproximadamente la mitad dijo que les preocupa que un ser querido no pueda pagar la cobertura, o la pierda por completo, si se anulara la ley.La encuesta revela una preferencia sorprendente por Biden sobre Trump cuando se trata de proteger a las personas con condiciones preexistentes, un tema que el 94% de los votantes dijo que ayudaría a decidir por quién votar.

Biden tiene una ventaja propecia 1mg tablets price de 20 puntos. Un 56% prefiere su enfoque, contra un 36% para Trump.De hecho, el sondeo muestra una preferencia por Biden en todos los problemas de atención médica que se plantean, incluso entre los mayores de 65 años y en temas que Trump ha dicho que eran sus prioridades mientras estuviera en el cargo, lo que indica que los votantes no están satisfechos con el trabajo propecia 1mg tablets price del presidente para reducir los costos de la atención médica, en particular. El apoyo a los esfuerzos de Trump para reducir el precio de los medicamentos recetados ha disminuido, y los votantes ahora prefieren el enfoque de Biden, del 50% al 43%.La mayoría de los votantes dijeron que prefieren el plan de Biden para lidiar con el brote de COVID-19, 55% a 39%, y para desarrollar y distribuir una vacuna para COVID, 51% a 42%. Trump ha delegado en gran medida la gestión de la pandemia a los funcionarios estatales y locales, al tiempo que prometió que los científicos desafiarían las expectativas propecia 1mg tablets price y producirían una vacuna antes del día de las elecciones.Cuando se les preguntó qué tema era más importante para decidir por quién votar, la mayoría de los encuestados señaló a la atención médica. El 18% eligió el brote de COVID-19 y el 12% mencionó el cuidado de salud en general.

Casi una proporción igual, el 29%, optó por la economía.La propecia 1mg tablets price encuesta se realizó del 7 al 12 de octubre, después del primer debate presidencial y el anuncio de Trump de que había dado positivo para COVID-19. El margen de error es más o menos 3 puntos porcentuales para la muestra completa y 4 puntos porcentuales para los votantes.(KHN es un programa editorialmente independiente de KFF). Emmarie Huetteman propecia 1mg tablets price. ehuetteman@kff.org, @emmarieDC Related Topics Courts Elections Health Care Costs Noticias En Español The Health Law COVID-19 KFF Polls Preexisting ConditionsIn March, Sue Williams-Ward took a new job, with a $1-an-hour raise.The employer, a home health care agency propecia 1mg tablets price called Together We Can, was paying a premium — $13 an hour — after it started losing aides when COVID-19 safety concerns mounted.Williams-Ward, a 68-year-old Indianapolis native, was a devoted caregiver who bathed, dressed and fed clients as if they were family. She was known to entertain clients with some of her own 26 grandchildren, even inviting her clients along on charitable deliveries of Thanksgiving turkeys and Christmas hams.

Explore Our Database KHN and The Guardian are tracking health care workers who died from COVID-19 and writing about their lives and what happened propecia 1mg tablets price in their final days. Without her, the city’s most vulnerable would have been “lost, alone or mistreated,” said her husband, Royal Davis.Despite her husband’s fears for her health, Williams-Ward reported to work on March 16 at an apartment with three elderly women. One was blind, one was wheelchair-bound, and the third had a severe propecia 1mg tablets price mental illness. None had been diagnosed with COVID-19 but, Williams-Ward confided in Davis, at least one had symptoms of fatigue and shortness of breath, now associated with the virus.Even after a colleague on the night shift developed pneumonia, Williams-Ward tended to her patients — without protective equipment, which she told her husband she’d repeatedly requested from the agency. Together We Can did not respond to multiple phone and email requests for comment about the PPE propecia 1mg tablets price available to its workers.Still, Davis said, “Sue did all the little, unseen, everyday things that allowed them to maintain their liberty, dignity and freedom.”He said that within three days Williams-Ward was coughing, too.

After six weeks in a hospital and propecia 1mg tablets price weeks on a ventilator, she died of COVID-19. Hers is one of more than 1,200 health worker COVID deaths that KHN and The Guardian are investigating, including those of dozens of home health aides.During the pandemic, home health aides have buttressed the U.S. Health care system by keeping the most vulnerable propecia 1mg tablets price patients — seniors, the disabled, the infirm — out of hospitals. Yet even as they’ve put themselves at risk, this workforce of 2.3 million — of whom 9 in 10 are women, nearly two-thirds are minorities and almost one-third are foreign-born — has largely been overlooked.Home health providers scavenged for their own face masks and other protective equipment, blended disinfectant and fabricated sanitizing wipes amid widespread shortages. They’ve often done it all on poverty wages, without overtime pay, hazard pay, sick leave and propecia 1mg tablets price health insurance.

And they’ve gotten sick and died — leaving little to their survivors. Email Sign-Up Subscribe to KHN’s free propecia 1mg tablets price Morning Briefing. Speaking out about their work conditions during the pandemic has triggered retaliation by employers, propecia 1mg tablets price according to representatives of the Service Employees International Union in Massachusetts, California and Virginia. €œIt’s been shocking, egregious and unethical,” said David Broder, president of SEIU Virginia 512.The pandemic has laid bare deeply ingrained inequities among health workers, as Broder puts it. €œThis is exactly what structural racism looks like today in our health care system.”Every worker who spoke with KHN for this article said they felt intimidated by the propecia 1mg tablets price prospect of voicing their concerns.

All have seen colleagues fired for doing so. They agreed propecia 1mg tablets price to talk candidly about their work environments on the condition their full names not be used.***Tina, a home health provider, said she has faced these challenges in Springfield, Massachusetts, one of the nation’s poorest cities.Like many of her colleagues — 82%, according to a survey by the National Domestic Workers Alliance — Tina has lacked protective equipment throughout the pandemic. Her employer is a family-owned company that gave her one surgical mask and two pairs propecia 1mg tablets price of latex gloves a week to clean body fluids, change wound dressings and administer medications to incontinent or bedridden clients.When Tina received the company’s do-it-yourself blueprints — to make masks from hole-punched sheets of paper towel reinforced with tongue depressors and gloves from garbage bags looped with rubber bands — she balked. €œIt felt like I was in a Third World country,” she said.The home health agencies that Tina and others in this article work for declined to comment on work conditions during the pandemic.In other workplaces — hospitals, mines, factories — employers are responsible for the conditions in which their employees operate. Understanding the plight of propecia 1mg tablets price home health providers begins with American labor law.The Fair Labor Standards Act, which forms the basis of protections in the American workplace, was passed in an era dually marked by President Franklin Delano Roosevelt’s New Deal changes and marred by the barriers of the Jim Crow era.

The act excluded domestic care workers — including maids, butlers and home health providers — from protections such as overtime pay, sick leave, hazard pay and insurance. Likewise, standards set by the Occupational Safety and Health Administration three decades later carved out “domestic household employment activities in private residences.”“A deliberate decision was made to discriminate against colored people — mostly women — to unburden distinguished elderly white folks from the responsibility of employment,” said Ruqaiijah propecia 1mg tablets price Yearby, a law professor at St. Louis University.In 2015, several of these exceptions were eliminated, and protections for health providers became “very well regulated on paper,” said Nina Kohn, a professor specializing in civil rights law at Syracuse University. €œBut the reality is, noncompliance is a norm and the penalties for noncompliance are toothless.”Burkett McInturff, a civil propecia 1mg tablets price rights lawyer working on behalf of home health workers, said, “The law itself is very clear. The problem lies in the ability to hold these companies accountable.”The Occupational Safety and Health Administration has “abdicated its responsibility for protecting workers” in the pandemic, said Debbie Berkowitz, director of the National Employment propecia 1mg tablets price Law Project.

Berkowitz is also a former OSHA chief. In her view, political and propecia 1mg tablets price financial decisions in recent years have hollowed out the agency. It now has the fewest inspectors and conducts the fewest inspections per year in its history.Furthermore, some home health care agencies have classified home health providers as contractors, akin to gig workers such as Uber drivers. This loophole protects them from the responsibilities of propecia 1mg tablets price employers, said Seema Mohapatra, an Indiana University associate professor of law. Furthermore, she said, “these workers are rarely in a position to question, or advocate or lobby for themselves.”Should workers contract COVID-19, they are unlikely to receive remuneration or damages.Demonstrating causality — that a person caught the coronavirus on the job — for workers’ compensation has been extremely difficult, Berkowitz said.

As with other health care jobs, employers have been quick to point out that workers might have caught the virus at the gas station, grocery store or home.Many home health propecia 1mg tablets price providers care for multiple patients, who also bear the consequences of their work conditions. €œIf you propecia 1mg tablets price think about perfect vectors for transmission, unprotected individuals going from house to house have to rank at the top of list,” Kohn said. €œEven if someone didn’t care at all about these workers, we need to fix this to keep Grandma and Grandpa safe.”Nonetheless, caregivers like Samira, in Richmond, Virginia, have little choice but to work. Samira — who makes $8.25 an hour with one client and $9.44 an hour with another, and owes tens of thousands of dollars in hospital bills from propecia 1mg tablets price previous work injuries — has no other option but to risk getting sick.“I can’t afford not to work. And my clients, they don’t have anybody but me,” she said.

€œSo I just pray every day I propecia 1mg tablets price don’t get it.” Eli Cahan. emcahan@stanford.edu, @emcahan Related Topics Aging Health Industry Public Health COVID-19 Home Health Care Lost On The FrontlineCalifornia Healthline correspondent Angela Hart discussed how the coronavirus pandemic has derailed California’s efforts to deal with homelessness on KPBS “Midday Edition” on Oct. 8. KHN Midwest correspondent Lauren Weber discussed the difference between D.O.s and M.D.s with Newsy’s “Morning Rush” on Tuesday. KHN correspondent Anna Almendrala discussed how L.A.

County’s enforcement of workplace coronavirus protocols has cut COVID-19 deaths with KPCC’s “Take Two” on Tuesday. KHN senior correspondent Sarah Jane Tribble discussed rural hospitals and KHN’s “Where It Hurts” podcast with Illinois Public Media’s “The 21st” on Oct. 5 and “Tradeoffs” on Oct. 8. KHN chief Washington correspondent Julie Rovner joined C-SPAN’s “Washington Journal” on Tuesday to discuss the Affordable Care Act case before the Supreme Court next month and what else to expect in the realm of health care after the election.

KHN freelancer Priscilla Blossom discussed Halloween safety tips with KUNC’s “Colorado Edition” on Tuesday. Related Topics California Doctors Homeless Medical EducationTrombonist Jerrell Charleston loves the give-and-take of jazz, the creativity of riffing off other musicians. But as he looked toward his sophomore year at Indiana University, he feared that steps to avoid sharing the coronavirus would also keep students from sharing songs.“Me and a lot of other cats were seriously considering taking a year off and practicing at home,” lamented the 19-year-old jazz studies major from Gary, Indiana.His worries evaporated when he arrived on campus and discovered that music professor Tom Walsh had invented a special mask with a hole and a protective flap to allow musicians to play while masked. Don't Miss A Story Subscribe to KHN’s free Weekly Edition newsletter. Students also got masks for the ends of their wind instruments, known as bell covers, allowing them to jam in person, albeit 6 feet apart.“It’s amazing to play together,” Charleston said.

€œMusic has always been my safe space. It’s what’s in your soul, and you’re sharing that with other people.”Of course, the very act of making music powered by human breath involves blowing air — and possibly virus particles — across a room. One infamous choral practice in Washington state earlier this year led to confirmed diagnoses of COVID-19 in more than half of the 61 attendees. Two died.So musicians around the country are taking it upon themselves to reduce the risk of COVID-19 without silencing the music. With pantyhose, air filters, magnets, bolts of fabric and a fusion of creativity, those who play wind instruments or sing are improvising masks to keep the band together.

Solomon Keim rehearses in protective gear that doesn't mask the sound.(Chris Bergin for KHN) Brayden Wisley practices safe sax-playing. Other tips for musicians. Play in a big space with good ventilation, and break after 30 minutes to allow the air to clear.(Chris Bergin for KHN) Brendan Sullivan plays trombone while both he and the instrument are masked. It has been recommended that most instrumentalists face the same direction while playing and stay 6 feet apart — with a distance of 9 feet in front and back of trombonists.(Chris Bergin for KHN)A consortium of performing arts groups has commissioned research exploring ways for musicians to play safely. The group’s preliminary report from July recommends instrumentalists wear masks with small slits, use bell covers, face the same direction while playing and stay 6 feet apart for most instruments — with a distance of 9 feet in front and back of trombonists.

Other research has shown cotton bell covers on brass instruments reduced airborne particles by an average of 79% compared with playing without one.Jelena Srebric, a University of Maryland engineering researcher involved in the consortium’s study, said it’s also best to play in a big space with good ventilation, and musicians should break after 30 minutes to allow the air to clear. These rudimentary solutions, she said, promise at least some protection against the virus.“Nothing is 100%. Being alive is a dangerous business,” Srebric said. This “gives some way to engage with music, which is fantastic in this day and age of despair.”Dr. Adam Schwalje, a National Institutes of Health research fellow at the University of Iowa Hospitals and Clinics, is a bassoonist who has written about the COVID risk of wind instruments.

He said a combination of bell covers, social distancing and limited time playing together could be helpful, but the effectiveness of bell covers or masks for musicians to wear while playing is “completely unproven” at this point. Schwalje’s paper said it’s not possible to quantify the risk of playing wind instruments, which involves deep breathing, sometimes forceful exhalation and possible aerosolizing of the mucus in the mouth and nose.Still, early results of research at the universities of Maryland and Colorado are helping to inspire improvisational mask-making and other safety measures, said Mark Spede, national president of the College Band Directors National Association who is helping lead the commissioned research.At Middle Tennessee State University, for example, tuba teacher Chris Combest said his students tie pillowcases over the bells of their instruments, and some wear masks that can be unbuttoned to play. At the University of Iowa, wind players in small ensembles must use bell covers and masks, but they can pull them down when playing as long as they pull them up during rests. Heather Ainsworth-Dobbins said her students at Southern Virginia University use surgical masks with slits cut in them and bell covers made of pantyhose and MERV-13 air filters, similar to what is used on a furnace.Indiana University Jacobs School of Music professor Tom Walsh distributes custom masks he designed that allow students to play their instruments safely as a group.(Chris Bergin for KHN) Skyler Floe tries out his horn's bell cover to much fanfare at Indiana University Jacobs School of Music in Bloomington, Indiana.(Chris Bergin for KHN) Kyle Cantrell's sound carries while reducing the risk of virus transmission.(Chris Bergin for KHN) At Indiana, Walsh sought out whatever research he could find as he designed his tight-fitting cotton musical mask, reinforced with a layer of polypropylene and with adjustable ties in the back. A flap hangs over the hole, outfitted with two magnets that allow it to close over the instrument.

The professor’s mom, Julie Walsh — who made his clothes when he was a kid — has sewn more than 80 of the musical masks for free. The opera program’s costume shop makes bell covers with a layer of fabric over a layer of stiff woven material known as interfacing fabric.Bailey Cates, a freshman trumpet player, said the quality of the sound is about the same with these masks and they make her feel safer.Flutes present unique challenges, partly because flutists blow air across the mouthpiece. Alice Dade, an associate professor of flute at the University of Missouri, said she and her students clip on device called “wind guards” usually used outdoors, then sometimes fit surgical masks over them.Alice Dade, an associate professor at the University of Missouri, recommends using clip-on devices for flutes called “wind guards,” which shield the lip plate of the flute from wind when playing outdoors. The ventilated design helps limit condensation and interference with the player’s air stream. Amid the pandemic, some flutists now use them with surgical masks on top to curb the spread of the coronavirus.(Alice Dade)Indiana flute student Nathan Rakes uses a specially designed cloth mask with a slit and slips a silk sock on the instrument’s end.

Rakes, a sophomore, said the fabric doesn’t affect the sound unless he’s playing a low B note, which he rarely plays.Walsh is a stickler for finding big practice spaces, not playing together for more than half an hour and taking 20-minute breaks. All jazz ensemble musicians, for example, also must stay at least 10 feet apart.“I carry a tape measure everywhere I go,” he said. €œI feel responsible for our students.”Some K-12 schools are trying similar strategies, said James Weaver, director of performing arts and sports for the National Federation of State High School Associations.His son Cooper, a seventh grade sax player at Plainfield Community Middle School in Indiana, uses a surgical mask with a slit. It sometimes jerks to the side with the vibrations of playing, but Cooper said it “feels good as long as you have it in the right place.” Cooper also helped his dad make a bell cover with fabric and MERV-13 material.While many groups use homemade bell covers, McCormick’s Group in Wheeling, Illinois, has transformed its 25-year-old business of making bell covers to display school colors and insignias into one that is making musicians safer with two-ply covers made of polyester/spandex fabric. CEO Alan Yefsky said his company started reinforcing the covers with the second layer this summer.

Sales of the $20 covers have soared.“It’s keeping people employed. We’re helping keep people safe,” Yefsky said. €œAll of a sudden, we got calls from nationally known symphony organizations.”Other professional musicians take a different tack. Film and television soundtracks are often recorded in separate sessions. Woodwinds and brass players in individual plexiglass cubicles and masked, with distanced string players recording elsewhere.The U.S.

Marine Band in Washington, D.C., practices in small, socially distanced groups, but string instrumentalists are the only ones wearing masks while playing.For both professionals and students, the pandemic has virtually eliminated live audiences in favor of virtual performances. Many musicians say they miss traditional concerts but are not focusing on what they’ve lost.“Creating that sense of community — an island to come together and play — is super important,” said Cates, the Indiana trumpet player. €œPlaying music feels like a mental release for a lot of us. When I’m playing, my mind is off of the pandemic.”Indiana University Jacobs School of Music professor Tom Walsh works with students during rehearsal in Bloomington, Indiana. The professor’s mom, Julie Walsh — who made his clothes when he was a kid — has sewn more than 80 of the musical masks for free.(Chris Bergin for KHN) Laura Ungar.

lungar@kff.org, @laura_ungar Related Topics Public Health COVID-19Use Our Content This story can be republished for free (details). At least half of voters prefer former Vice President Joe Biden’s approach to health care over President Donald Trump’s, suggesting voter concern about lowering costs and managing the pandemic could sway the outcome of this election, a new poll shows.The findings, from KFF’s monthly tracking poll, signal that voters do not trust assurances from the president that he will protect people with preexisting conditions from being penalized by insurance companies if the Supreme Court overturns the Affordable Care Act. (KHN is an editorially independent program of KFF.)Coming a month before the court will hear arguments from Republican attorneys general and the Trump administration that the health law should be overturned, the poll shows 79% of the public does not want the court to cancel coverage protections for Americans with preexisting conditions. A majority of Republicans, 66%, said they do not want those safeguards overturned.In addition to leaving about 21 million Americans uninsured, overturning the ACA could allow insurance companies to charge more or deny coverage to individuals because they have preexisting conditions — a common practice before the law was established, and one that a government analysis said in 2017 could affect as many as 133 million Americans. Email Sign-Up Subscribe to KHN’s free Morning Briefing. Nearly 6 in 10 people said they have a family member with a preexisting or chronic condition, such as diabetes or cancer, and about half said they worry about a relative being unable to afford coverage, or lose it outright, if the law is overturned.The poll reveals a striking preference for Biden over Trump when it comes to protecting preexisting conditions, an issue that 94% of voters said would help decide who they vote for.

Biden has a 20-point advantage, with voters preferring his approach 56% to 36% for Trump.In fact, it shows a preference for Biden on every health care issue posed, including among those age 65 and older and on issues that Trump has said were his priorities while in office — signaling voters are not satisfied with the president’s work to lower health care costs, in particular. Support for Trump’s efforts to lower prescription drug costs has been slipping, with voters now preferring Biden’s approach, 50% to 43%.A majority of voters said they prefer Biden’s plan for dealing with the COVID-19 outbreak, 55% to 39%, and for developing and distributing a vaccine for COVID-19, 51% to 42%. Trump has largely left it up to state and local officials to manage the outbreak, while promising that scientists would defy expectations and produce a vaccine before Election Day.Asked which issue is most important to deciding whom to vote for, most pointed to health care issues, with 18% choosing the COVID-19 outbreak and 12% saying health care overall. Nearly an equal share, 29%, selected the economy.The survey was conducted Oct. 7-12, after the first presidential debate and Trump’s announcement that he had tested positive for COVID-19.

The margin of error is plus or minus 3 percentage points for the full sample and 4 percentage points for voters. Emmarie Huetteman. ehuetteman@kff.org, @emmarieDC Related Topics Courts Elections Health Care Costs The Health Law COVID-19 KFF Polls Preexisting Conditions.

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By Robert Preidt HealthDay Reporter FRIDAY, Aug is propecia safe. 28, 2020 (HealthDay News) -- Breastfeeding mothers are unlikely to transmit the new coronavirus to their babies via their milk, researchers say. No cases of an infant contracting COVID-19 from breast milk have been documented, but questions about the potential risk remain. Researchers examined 64 samples of breast milk collected from 18 women across the United States who is propecia safe were infected with the new coronavirus (SARS-CoV-2) that causes COVID-19. One sample tested positive for coronavirus RNA, but follow-up tests showed that the virus couldn't replicate and therefore, couldn't infect the breastfed infant, according to the study recently published online in the Journal of the American Medical Association.

"Detection of viral RNA does not equate to infection. It has to grow and multiply in order to be infectious and we did not is propecia safe find that in any of our samples," said study author Christina Chambers, a professor of pediatrics at the University of California, San Diego. She is also director of the Mommy's Milk Human Milk Research Biorepository. "Our findings suggest breast milk itself is not likely a source of infection for the infant," Chambers said in a UCSD news release. To prevent transmission of the virus while breastfeeding, wearing a mask, hand-washing and sterilizing pumping equipment after each use are recommended.

"We hope is propecia safe our results and future studies will give women the reassurance needed for them to breastfeed. Human milk provides invaluable benefits to mom and baby," said co-author Dr. Grace Aldrovandi, chief of the Division of Infectious Diseases at UCLA Mattel Children's Hospital in Los Angeles. WebMD News from HealthDay Sources SOURCE. University of California, San Diego, news release, Aug.

19, 2020 Copyright © 2013-2020 HealthDay. All rights reserved..

By Robert Preidt HealthDay Reporter FRIDAY, Aug propecia 1mg tablets price. 28, 2020 (HealthDay News) -- Breastfeeding mothers are unlikely to transmit the new coronavirus to their babies via their milk, researchers say. No cases of an infant contracting COVID-19 from breast milk have been documented, but questions about the potential risk remain. Researchers examined 64 samples of breast milk collected from 18 women across the United States who were infected propecia 1mg tablets price with the new coronavirus (SARS-CoV-2) that causes COVID-19.

One sample tested positive for coronavirus RNA, but follow-up tests showed that the virus couldn't replicate and therefore, couldn't infect the breastfed infant, according to the study recently published online in the Journal of the American Medical Association. "Detection of viral RNA does not equate to infection. It has to grow and multiply propecia 1mg tablets price in order to be infectious and we did not find that in any of our samples," said study author Christina Chambers, a professor of pediatrics at the University of California, San Diego. She is also director of the Mommy's Milk Human Milk Research Biorepository.

"Our findings suggest breast milk itself is not likely a source of infection for the infant," Chambers said in a UCSD news release. To prevent transmission of the virus while breastfeeding, wearing a mask, hand-washing and sterilizing pumping equipment after each use are recommended. "We hope our results and future studies will give women the reassurance needed for them to breastfeed propecia 1mg tablets price. Human milk provides invaluable benefits to mom and baby," said co-author Dr.

Grace Aldrovandi, chief of the Division of Infectious Diseases at UCLA Mattel Children's Hospital in Los Angeles. WebMD News from HealthDay propecia 1mg tablets price Sources SOURCE. University of California, San Diego, news release, Aug. 19, 2020 Copyright © 2013-2020 HealthDay.

Can propecia cause weight gain

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As SARS-CoV-2 continues its global spread, it’s possible that one of the pillars of Covid-19 pandemic control — universal facial masking — might can propecia cause weight gain help reduce the severity of disease and ensure that a greater proportion of new infections are asymptomatic. If this hypothesis is borne out, universal masking could become a form of “variolation” that would generate immunity and thereby slow the spread of the virus in the United States and elsewhere, as we await a vaccine.One important reason for population-wide facial masking became apparent in March, when reports started to circulate describing the high rates of SARS-CoV-2 viral shedding from the noses and mouths of patients who were presymptomatic or asymptomatic — shedding rates equivalent to those among symptomatic patients.1 Universal facial masking seemed to be a possible way to prevent transmission from asymptomatic infected people. The Centers for Disease Control and Prevention (CDC) therefore recommended on April 3 that can propecia cause weight gain the public wear cloth face coverings in areas with high rates of community transmission — a recommendation that has been unevenly followed across the United States.Past evidence related to other respiratory viruses indicates that facial masking can also protect the wearer from becoming infected, by blocking viral particles from entering the nose and mouth.2 Epidemiologic investigations conducted around the world — especially in Asian countries that became accustomed to population-wide masking during the 2003 SARS pandemic — have suggested that there is a strong relationship between public masking and pandemic control. Recent data from Boston demonstrate that SARS-CoV-2 infections decreased among health care workers after universal masking was implemented in municipal hospitals in late March.SARS-CoV-2 has the protean ability to cause myriad clinical manifestations, ranging from a complete lack of symptoms to pneumonia, acute respiratory distress syndrome, and death.

Recent virologic, epidemiologic, and ecologic data have led to the hypothesis that facial can propecia cause weight gain masking may also reduce the severity of disease among people who do become infected.3 This possibility is consistent with a long-standing theory of viral pathogenesis, which holds that the severity of disease is proportionate to the viral inoculum received. Since 1938, researchers have explored, primarily in animal models, the concept of the lethal dose of a virus — or the dose at which 50% of exposed hosts die (LD50). With viral infections in which host immune responses can propecia cause weight gain play a predominant role in viral pathogenesis, such as SARS-CoV-2, high doses of viral inoculum can overwhelm and dysregulate innate immune defenses, increasing the severity of disease. Indeed, down-regulating immunopathology is one mechanism by which dexamethasone improves outcomes in severe Covid-19 infection.

As proof of concept of viral inocula influencing disease manifestations, higher doses of administered virus led to more severe manifestations of Covid-19 in a Syrian hamster model of SARS-CoV-2 infection.4If the viral inoculum matters in determining the severity of SARS-CoV-2 infection, an additional hypothesized reason for wearing facial masks would be to reduce the viral inoculum to which the wearer is exposed and the subsequent clinical impact of the disease. Since masks can filter out some virus-containing droplets (with filtering capacity determined can propecia cause weight gain by mask type),2 masking might reduce the inoculum that an exposed person inhales. If this theory bears out, population-wide masking, with any type of mask that increases acceptability and adherence,2 might contribute to increasing the proportion of SARS-CoV-2 infections that are asymptomatic. The typical rate of asymptomatic infection with SARS-CoV-2 was estimated to be 40% by the CDC in mid-July, but can propecia cause weight gain asymptomatic infection rates are reported to be higher than 80% in settings with universal facial masking, which provides observational evidence for this hypothesis.

Countries that have adopted population-wide masking have fared better in terms of rates of severe Covid-related illnesses and death, which, in environments with limited testing, suggests a shift from symptomatic to asymptomatic infections. Another experiment in the Syrian hamster model simulated surgical masking of the animals and showed that with simulated masking, hamsters were less likely to get infected, and if they did get infected, can propecia cause weight gain they either were asymptomatic or had milder symptoms than unmasked hamsters.The most obvious way to spare society the devastating effects of Covid-19 is to promote measures to reduce both transmission and severity of illness. But SARS-CoV-2 is highly transmissible, cannot be contained by syndromic-based surveillance alone,1 and is proving difficult to eradicate, even in regions that implemented strict initial control measures. Efforts to increase testing and containment in the United States have been ongoing and variably successful, owing in part to the recent increase in demand for testing.The hopes for vaccines are pinned not just on infection prevention.

Most vaccine trials include a can propecia cause weight gain secondary outcome of decreasing the severity of illness, since increasing the proportion of cases in which disease is mild or asymptomatic would be a public health victory. Universal masking seems to reduce the rate of new infections. We hypothesize that by reducing the viral inoculum, it would also increase the proportion of infected people who remain asymptomatic.3In an outbreak on a closed Argentinian cruise ship, for example, where passengers were provided can propecia cause weight gain with surgical masks and staff with N95 masks, the rate of asymptomatic infection was 81% (as compared with 20% in earlier cruise ship outbreaks without universal masking). In two recent outbreaks in U.S.

Food-processing plants, where all workers were issued masks each day and were required to wear them, the proportion of asymptomatic infections among the more than 500 people who became infected was 95%, with only 5% in each outbreak experiencing mild-to-moderate symptoms.3 Case-fatality rates in countries with mandatory or enforced population-wide masking have remained low, even with resurgences of cases after lockdowns were lifted.Variolation was a process whereby people who were susceptible to smallpox were inoculated with material taken from a vesicle of a person with smallpox, with the intent of causing a can propecia cause weight gain mild infection and subsequent immunity. Variolation was practiced only until the introduction of the variola vaccine, which ultimately eradicated smallpox. Despite concerns regarding safety, worldwide distribution, and eventual uptake, the world has high hopes for a highly effective SARS-CoV-2 vaccine, and as of early September, 34 can propecia cause weight gain vaccine candidates were in clinical evaluation, with hundreds more in development.While we await the results of vaccine trials, however, any public health measure that could increase the proportion of asymptomatic SARS-CoV-2 infections may both make the infection less deadly and increase population-wide immunity without severe illnesses and deaths. Reinfection with SARS-CoV-2 seems to be rare, despite more than 8 months of circulation worldwide and as suggested by a macaque model.

The scientific community has been clarifying for some time the humoral and cell-mediated components of the adaptive immune response to SARS-CoV-2 and the inadequacy of antibody-based seroprevalence studies to estimate the level of more durable T-cell and memory B-cell immunity to SARS-CoV-2. Promising data have been emerging in recent weeks suggesting that strong cell-mediated immunity results from can propecia cause weight gain even mild or asymptomatic SARS-CoV-2 infection,5 so any public health strategy that could reduce the severity of disease should increase population-wide immunity as well.To test our hypothesis that population-wide masking is one of those strategies, we need further studies comparing the rate of asymptomatic infection in areas with and areas without universal masking. To test the variolation hypothesis, we will need more studies comparing the strength and durability of SARS-CoV-2–specific T-cell immunity between people with asymptomatic infection and those with symptomatic infection, as well as a demonstration of the natural slowing of SARS-CoV-2 spread in areas with a high proportion of asymptomatic infections.Ultimately, combating the pandemic will involve driving down both transmission rates and severity of disease. Increasing evidence suggests that population-wide facial masking might benefit both components of the response.In recent months, epidemiologists in the United States and throughout the world have been asked the same question by clinicians, journalists, and members of the public, “When will we have a vaccine? can propecia cause weight gain.

€ The obvious answer to this question would be, “When a candidate vaccine is demonstrated to be safe, effective, and available. That can be determined only by scientific data, not by a target calendar date.” But we realize that such a response, although accurate, overlooks much of what people are ultimately seeking to understand.The emphasis on “we” reveals can propecia cause weight gain that most people want much more than an estimated vaccine-delivery date. Their inquiry typically involves three concerns. First, when will the public be able to have confidence that available vaccines are safe and effective?.

Second, when can propecia cause weight gain will a vaccine be available to people like them?. And third, when will vaccine uptake be high enough to enable a return to prepandemic conditions?. Often, the inquiry is also assessing can propecia cause weight gain whether the biotech and vaccine companies, government agencies, and medical experts involved in developing, licensing, and recommending use of Covid-19 vaccines realize that the responses they provide now will influence what happens later. There is often a sense that messages regarding Covid-19 vaccines can have problematic framing (e.g., “warp speed”) and make assertions that involve key terms (e.g., “safe” and “effective”) for which experts’ definitions may vary and may differ considerably from those of the general public and key subpopulations.As Covid-19 vaccines move into phase 3 clinical trials, enthusiasm about the innovative and sophisticated technologies being used needs to be replaced by consideration of the actions and messages that will foster trust among clinicians and the public.

Although vast investments have been made in developing safe and effective vaccines, it is important to remember that can propecia cause weight gain it is the act of vaccination itself that prevents harm and saves lives. Considered fully, the question “When will we have a Covid-19 vaccine?. € makes clear the many ways in which efforts related to both the “when” and the “we” can affect vaccination uptake can propecia cause weight gain. Recognizing the significance of both aspects of the question can help public health officials and scientists both to hone current messaging related to Covid-19 vaccines and to build a better foundation for clinicians who will be educating patients and parents about vaccination.The recently released guidelines from the Food and Drug Administration (FDA) on testing of Covid-19 vaccine candidates are scientifically sound and indicate that no compromises will be made when it comes to evaluating safety and efficacy.1 This commitment needs to be stated repeatedly, made apparent during the vaccine testing and approval process, and supported by transparency.

Assurances regarding the warp speed effort to develop a vaccine or to issue emergency use authorizations accelerating availability must make clear the ways in which clinical trials and the review processes used by federal agencies (the FDA, the National Institutes of Health, and the Centers for Disease Control and Prevention [CDC]) will objectively assess the safety and effectiveness of vaccines developed using new platforms. Clinicians and the public should have easy access to user-friendly materials that can propecia cause weight gain reference publicly available studies, data, and presentations related to safety and effectiveness. The FDA’s and CDC’s plans for robust longer-term, postlicensure vaccine safety and monitoring systems will also need to be made visible, particularly to health care professionals, who are essential to the success of these efforts.2The second key part of this question pertains to when a safe and effective Covid-19 vaccine will become available to some, most, or all people who want one. This question has technical and moral components, and the answers on both fronts could foster or can propecia cause weight gain impede public acceptance of a vaccine.

Data from antibody testing suggest that about 90% of people are susceptible to Covid-19. Accepting that 60 to 70% of the population would have to be immune, either as a result of natural infection or vaccination, to achieve community protection (also known can propecia cause weight gain as herd immunity), about 200 million Americans and 5.6 billion people worldwide would need to be immune in order to end the pandemic. The possibility that it may take years to achieve the vaccination coverage necessary for everyone to be protected gives rise to difficult questions about priority groups and domestic and global access.Given public skepticism of government institutions and concerns about politicization of vaccine priorities, the recent establishment of a National Academy of Medicine (NAM) committee to formulate criteria to ensure equitable distribution of initial Covid-19 vaccines and to offer guidance on addressing vaccine hesitancy is an important step. The NAM report should be very helpful to the CDC’s Advisory Committee on Immunization Practices, the group that traditionally develops vaccination recommendations in the United States.

The NAM’s can propecia cause weight gain deliberations about which groups will be prioritized for vaccination involve identifying the societal values that should be considered, and the report will communicate how these values informed its recommendations. Will the people at greatest risk for disease — such as health care workers, nursing home residents, prison inmates and workers, the elderly, people with underlying health conditions, and people from minority and low-income communities — be the first to obtain access?. Alternatively, will the top priority be reducing transmission by prioritizing the public workforce, essential workers, students, and young people who can propecia cause weight gain may be more likely to spread infection asymptomatically?. And how will the United States share vaccine doses with other countries, where infections could ultimately also pose a threat to Americans?.

Releasing expert-committee reports, however, should not be equated with successfully communicating with the public about vaccine candidates and availability.3 In the United States and many other countries, new vaccines and vaccination recommendations are rarely can propecia cause weight gain released with substantial public information and educational resources. Most investments in communication with clinicians and the public happen when uptake of newly recommended vaccines, such as the human papillomavirus vaccine or seasonal influenza vaccine, falls short of goals. Not since the March of Dimes’s polio-vaccination efforts in the 1950s has there been major can propecia cause weight gain investment in public information and advocacy for new vaccines. There is already a flood of misinformation on social media and from antivaccine activists about new vaccines that could be licensed for Covid-19.

If recent surveys suggesting that about half of Americans would accept a Covid-19 vaccine4 are accurate, it will take substantial resources and active, bipartisan political support to achieve the uptake levels needed to reach herd immunity thresholds.5High uptake of Covid-19 vaccines among prioritized groups should also not be assumed. Many people in these groups will want to be vaccinated, but their willingness will be affected by what is said, the way it is said, can propecia cause weight gain and who says it in the months ahead. Providing compelling, evidence-based information using culturally and linguistically appropriate messages and materials is a complex challenge. Having trusted people, such can propecia cause weight gain as public figures, political leaders, entertainment figures, and religious and community leaders, endorse vaccination can be an effective way of persuading the portion of the public that is open to such a recommendation.

Conversely, persuading people who have doubts about or oppose a particular medical recommendation is difficult, requires commitment and engagement, and is often not successful.Finally, surveys suggest that physicians, nurses, and pharmacists remain the most highly trusted professionals in the United States. Extensive, active, and ongoing involvement by clinicians is essential to attaining the high uptake of Covid-19 vaccines that will be needed for society to return to prepandemic conditions can propecia cause weight gain. Nurses and physicians are the most important and influential sources of vaccination information for patients and parents. Throughout the world, health care professionals will need to be well-informed and strong endorsers of Covid-19 vaccination.A more complete answer to the common question is therefore, “We will have a safe and effective Covid-19 vaccine when the research studies, engagement processes, communication, and education efforts undertaken during the clinical trial stage have built trust and result in vaccination recommendations being understood, supported, and accepted by the vast majority of the public, priority and nonpriority groups alike.” Efforts to engage diverse stakeholders and communities in Covid-19 vaccination education strategies, key messages, and materials for clinicians and the public are needed now.In a laboratory setting, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was inoculated into human bronchial epithelial cells.

This inoculation, can propecia cause weight gain which was performed in a biosafety level 3 facility, had a multiplicity of infection (indicating the ratio of virus particles to targeted airway cells) of 3:1. These cells were then examined 96 hours after infection with the use of scanning electron microscopy. An en can propecia cause weight gain face image (Panel A) shows an infected ciliated cell with strands of mucus attached to the cilia tips. At higher magnification, an image (Panel B) shows the structure and density of SARS-CoV-2 virions produced by human airway epithelial cells.

Virus production was approximately 3×106 plaque-forming units per culture, a finding that is consistent with a high number can propecia cause weight gain of virions produced and released per cell.Camille Ehre, Ph.D.Baric and Boucher Laboratories at University of North Carolina School of Medicine, Chapel Hill, NC [email protected]Specificity of SARS-CoV-2 Antibody Assays Both assays measuring pan-Ig antibodies had low numbers of false positives among samples collected in 2017. There were 0 and 1 false positives for the two assays among 472 samples, results that compared favorably with those obtained with the single IgM anti-N and IgG anti-N assays (Table S3). Because of the low prevalence of SARS-CoV-2 infection in Iceland, we required positive results from both pan-Ig antibody assays for a sample to be considered seropositive (see Supplementary Methods in Supplementary Appendix 1). None of the samples collected in early 2020 group were seropositive, which indicates that the virus had not spread can propecia cause weight gain widely in Iceland before February 2020.

SARS-CoV-2 Antibodies among qPCR-Positive Persons Figure 2. Figure 2 can propecia cause weight gain. Antibody Prevalence and Titers among qPCR-Positive Cases as a Function of Time since Diagnosis by qPCR. Shown are can propecia cause weight gain the percentages of samples positive for both pan-Ig antibody assays and the antibody titers.

Red denotes the count or percentage of samples among persons during their hospitalization (249 samples from 48 persons), and blue denotes the count or percentage of samples among persons after they were declared recovered (1853 samples from 1215 persons). Vertical bars can propecia cause weight gain denote 95% confidence intervals. The dashed lines indicated the thresholds for a test to be declared positive. OD denotes optical density, and RBD receptor binding domain.Table 1.

Table 1 can propecia cause weight gain. Prevalence of SARS-CoV-2 Antibodies by Sample Collection as Measured by Two Pan-Ig Antibody Assays. Twenty-five days after diagnosis by qPCR, more than 90% of samples from recovered persons tested can propecia cause weight gain positive with both pan-Ig antibody assays, and the percentage of persons testing positive remained stable thereafter (Figure 2 and Fig. S2).

Hospitalized persons can propecia cause weight gain seroconverted more frequently and quickly after qPCR diagnosis than did nonhospitalized persons (Figure 2 and Fig. S3). Of 1215 persons who had recovered (on the basis of results for the most recently obtained sample from persons for whom we had multiple samples), 1107 were seropositive (91.1%. 95% confidence interval [CI], 89.4 to 92.6) (Table 1 and can propecia cause weight gain Table S4).

Since some diagnoses may have been made on the basis of false positive qPCR results, we determined that 91.1% represents the lower bound of sensitivity of the combined pan-Ig tests for the detection of SARS-CoV-2 antibodies among recovered persons. Table 2 can propecia cause weight gain. Table 2. Results of can propecia cause weight gain Repeated Pan-Ig Antibody Tests among Recovered qPCR-Diagnosed Persons.

Among the 487 recovered persons with two or more samples, 19 (4%) had different pan-Ig antibody test results at different time points (Table 2 and Fig. S4). It is notable that of the 22 persons with an early sample that tested negative for both pan-Ig antibodies, 19 remained negative at the most recent test date (again, for both antibodies). One person tested positive for both pan-Ig antibodies in the first test and negative for both in the most recent test.

The longitudinal changes in antibody levels among recovered persons were consistent with the cross-sectional results (Fig. S5). Antibody levels were higher in the last sample than in the first sample when the antibodies were measured with the two pan-Ig assays, slightly lower than in the first sample when measured with IgG anti-N and IgG anti-S1 assays, and substantially lower than in the first sample when measured with IgM anti-N and IgA anti-S1 assays. IgG anti-N, IgM anti-N, IgG anti-S1, and IgA anti-S1 antibody levels were correlated among the qPCR-positive persons (Figs.

S5 and S6 and Table S5). Antibody levels measured with both pan-Ig antibody assays increased over the first 2 months after qPCR diagnosis and remained at a plateau over the next 2 months of the study. IgM anti-N antibody levels increased rapidly soon after diagnosis and then fell rapidly and were generally not detected after 2 months. IgA anti-S1 antibodies decreased 1 month after diagnosis and remained detectable thereafter.

IgG anti-N and anti-S1 antibody levels increased during the first 6 weeks after diagnosis and then decreased slightly. SARS-CoV-2 Infection in Quarantine Table 3. Table 3. SARS-CoV-2 Infection among Quarantined Persons According to Exposure Type and Presence of Symptoms.

Of the 1797 qPCR-positive Icelanders, 1088 (61%) were in quarantine when SARS-CoV-2 infection was diagnosed by qPCR. We tested for antibodies among 4222 quarantined persons who had not tested qPCR-positive (they had received a negative result by qPCR or had simply not been tested). Of those 4222 quarantined persons, 97 (2.3%. 95% CI, 1.9 to 2.8) were seropositive (Table 1).

Those with household exposure were 5.2 (95% CI, 3.3 to 8.0) times more likely to be seropositive than those with other types of exposure (Table 3). Similarly, a positive result by qPCR for those with household exposure was 5.2 (95% CI, 4.5 to 6.1) times more likely than for those with other types of exposure. When these two sets of results (qPCR-positive and seropositive) were combined, we calculated that 26.6% of quarantined persons with household exposure and 5.0% of quarantined persons without household exposure were infected. Those who had symptoms during quarantine were 3.2 (95% CI, 1.7 to 6.2) times more likely to be seropositive and 18.2 times (95% CI, 14.8 to 22.4) more likely to test positive with qPCR than those without symptoms.

We also tested persons in two regions of Iceland affected by cluster outbreaks. In a SARS-CoV-2 cluster in Vestfirdir, 1.4% of residents were qPCR-positive and 10% of residents were quarantined. We found that none of the 326 persons outside quarantine who had not been tested by qPCR (or who tested negative) were seropositive. In a cluster in Vestmannaeyjar, 2.3% of residents were qPCR-positive and 13% of residents were quarantined.

Of the 447 quarantined persons who had not received a qPCR-positive result, 4 were seropositive (0.9%. 95% CI, 0.3 to 2.1). Of the 663 outside quarantine in Vestmannaeyjar, 3 were seropositive (0.5%. 95% CI, 0.1 to 0.2%).

SARS-CoV-2 Seroprevalence in Iceland None of the serum samples collected from 470 healthy Icelanders between February 18 and March 9, 2020, tested positive for both pan-Ig antibodies, although four were positive for the pan-Ig anti-N assay (0.9%), a finding that suggests that the virus had not spread widely in Iceland before March 9. Of the 18,609 persons tested for SARS-CoV-2 antibodies through contact with the Icelandic health care system for reasons other than Covid-19, 39 were positive for both pan-Ig antibody assays (estimated seroprevalence by weighting the sample on the basis of residence, sex, and 10-year age category, 0.3%. 95% CI, 0.2 to 0.4). There were regional differences in the percentages of qPCR-positive persons across Iceland that were roughly proportional to the percentage of people quarantined (Table S6).

However, after exclusion of the qPCR-positive and quarantined persons, the percentage of persons who tested positive for SARS-CoV-2 antibodies did not correlate with the percentage of those who tested positive by qPCR. The estimated seroprevalence in the random sample collection from Reykjavik (0.4%. 95% CI, 0.3 to 0.6) was similar to that in the Health Care group (0.3%. 95% CI, 0.2 to 0.4) (Table S6).

We calculate that 0.5% of the residents of Iceland have tested positive with qPCR. The 2.3% with SARS-CoV-2 seroconversion among persons in quarantine extrapolates to 0.1% of Icelandic residents. On the basis of this finding and the seroprevalence from the Health Care group, we estimate that 0.9% (95% CI, 0.8 to 0.9) of the population of Iceland has been infected by SARS-CoV-2. Approximately 56% of all SARS-CoV-2 infections were therefore diagnosed by qPCR, 14% occurred in quarantine without having been diagnosed with qPCR, and the remaining 30% of infections occurred outside quarantine and were not detected by qPCR.

Deaths from Covid-19 in Iceland In Iceland, 10 deaths have been attributed to Covid-19, which corresponds to 3 deaths per 100,000 nationwide. Among the qPCR-positive cases, 0.6% (95% CI, 0.3 to 1.0) were fatal. Using the 0.9% prevalence of SARS-CoV-2 infection in Iceland as the denominator, however, we calculate an infection fatality risk of 0.3% (95% CI, 0.2 to 0.6). Stratified by age, the infection fatality risk was substantially lower in those 70 years old or younger (0.1%.

95% CI, 0.0 to 0.3) than in those over 70 years of age (4.4%. 95% CI, 1.9 to 8.4) (Table S7). Age, Sex, Clinical Characteristics, and Antibody Levels Table 4. Table 4.

Association of Existing Conditions and Covid-19 Severity with SARS-CoV-2 Antibody Levels among Recovered Persons. SARS-CoV-2 antibody levels were higher in older people and in those who were hospitalized (Table 4, and Table S8 [described in Supplementary Appendix 1 and available in Supplementary Appendix 2]). Pan-Ig anti–S1-RBD and IgA anti-S1 levels were lower in female persons. Of the preexisting conditions, and after adjustment for multiple testing, we found that body-mass index, smoking status, and use of antiinflammatory medication were associated with SARS-CoV-2 antibody levels.

Body-mass index correlated positively with antibody levels. Smokers and users of antiinflammatory medication had lower antibody levels. With respect to clinical characteristics, antibody levels were most strongly associated with hospitalization and clinical severity, followed by clinical symptoms such as fever, maximum temperature reading, cough, and loss of appetite. Severity of these individual symptoms, with the exception of loss of energy, was associated with higher antibody levels.Trial Population Table 1.

Table 1. Demographic Characteristics of the Participants in the NVX-CoV2373 Trial at Enrollment. The trial was initiated on May 26, 2020. 134 participants underwent randomization between May 27 and June 6, 2020, including 3 participants who were to serve as backups for sentinel dosing and who immediately withdrew from the trial without being vaccinated (Fig.

S1). Of the 131 participants who received injections, 23 received placebo (group A), 25 received 25-μg doses of rSARS-CoV-2 (group B), 29 received 5-μg doses of rSARS-CoV-2 plus Matrix-M1, including three sentinels (group C), 28 received 25-μg doses of rSARS-CoV-2 plus Matrix-M1, including three sentinels (group D), and 26 received a single 25-μg dose of rSARS-CoV-2 plus Matrix-M1 followed by a single dose of placebo (group E). All 131 participants received their first vaccination on day 0, and all but 3 received their second vaccination at least 21 days later. Exceptions include 2 in the placebo group (group A) who withdrew consent (unrelated to any adverse event) and 1 in the 25-μg rSARS-CoV-2 + Matrix-M1 group (group D) who had an unsolicited adverse event (mild cellulitis.

See below). Demographic characteristics of the participants are presented in Table 1. Of note, missing data were infrequent. Safety Outcomes No serious adverse events or adverse events of special interest were reported, and vaccination pause rules were not implemented.

As noted above, one participant did not receive a second vaccination owing to an unsolicited adverse event, mild cellulitis, that was associated with infection after an intravenous cannula placement to address an unrelated mild adverse event that occurred during the second week of follow-up. Second vaccination was withheld because the participant was still recovering and receiving antibiotics. This participant remains in the trial. Figure 2.

Figure 2. Solicited Local and Systemic Adverse Events. The percentage of participants in each vaccine group (groups A, B, C, D, and E) with adverse events according to the maximum FDA toxicity grade (mild, moderate, or severe) during the 7 days after each vaccination is plotted for solicited local (Panel A) and systemic (Panel B) adverse events. There were no grade 4 (life-threatening) events.

Participants who reported 0 events make up the remainder of the 100% calculation (not displayed). Excluded were the three sentinel participants in groups C (5 μg + Matrix-M1, 5 μg + Matrix-M1) and D (25 μg + Matrix-M1, 25 μg + Matrix-M1), who received the trial vaccine in an open-label manner (see Table S7 for complete safety data on all participants).Overall reactogenicity was largely absent or mild, and second vaccinations were neither withheld nor delayed due to reactogenicity. After the first vaccination, local and systemic reactogenicity was absent or mild in the majority of participants (local. 100%, 96%, 89%, 84%, and 88% of participants in groups A, B, C, D, and E, respectively.

Systemic. 91%, 92%, 96%, 68%, and 89%) who were unaware of treatment assignment (Figure 2 and Table S7). Two participants (2%), one each in groups D and E, had severe adverse events (headache, fatigue, and malaise). Two participants, one each in groups A and E, had reactogenicity events (fatigue, malaise, and tenderness) that extended 2 days after day 7.

After the second vaccination, local and systemic reactogenicity were absent or mild in the majority of participants in the five groups (local. 100%, 100%, 65%, 67%, and 100% of participants, respectively. Systemic. 86%, 84%, 73%, 58%, and 96%) who were unaware of treatment assignment.

One participant, in group D, had a severe local event (tenderness), and eight participants, one or two participants in each group, had severe systemic events. The most common severe systemic events were joint pain and fatigue. Only one participant, in group D, had fever (temperature, 38.1°C) after the second vaccination, on day 1 only. No adverse event extended beyond 7 days after the second vaccination.

Of note, the mean duration of reactogenicity events was 2 days or less for both the first vaccination and second vaccination periods. Laboratory abnormalities of grade 2 or higher occurred in 13 participants (10%). 9 after the first vaccination and 4 after the second vaccination (Table S8). Abnormal laboratory values were not associated with any clinical manifestations and showed no worsening with repeat vaccination.

Six participants (5%. Five women and one man) had grade 2 or higher transient reductions in hemoglobin from baseline, with no evidence of hemolysis or microcytic anemia and with resolution within 7 to 21 days. Of the six, two had an absolute hemoglobin value (grade 2) that resolved or stabilized during the testing period. Four participants (3%), including one who had received placebo, had elevated liver enzymes that were noted after the first vaccination and resolved within 7 to 14 days (i.e., before the second vaccination).

Vital signs remained stable immediately after vaccination and at all visits. Unsolicited adverse events (Table S9) were predominantly mild in severity (in 71%, 91%, 83%, 90%, and 82% of participants in groups A, B, C, D, and E, respectively) and were similarly distributed across the groups receiving adjuvanted and unadjuvanted vaccine. There were no reports of severe adverse events. Immunogenicity Outcomes Figure 3.

Figure 3. SARS-CoV-2 Anti-Spike IgG and Neutralizing Antibody Responses. Shown are geometric mean anti-spike IgG enzyme-linked immunosorbent assay (ELISA) unit responses to recombinant severe acute respiratory syndrome coronavirus 2 (rSARS-CoV-2) protein antigens (Panel A) and wild-type SARS-CoV-2 microneutralization assay at an inhibitory concentration greater than 99% (MN IC>99%) titer responses (Panel B) at baseline (day 0), 3 weeks after the first vaccination (day 21), and 2 weeks after the second vaccination (day 35) for the placebo group (group A), the 25-μg unadjuvanted group (group B), the 5-μg and 25-μg adjuvanted groups (groups C and D, respectively), and the 25-μg adjuvanted and placebo group (group E). Diamonds and whisker endpoints represent geometric mean titer values and 95% confidence intervals, respectively.

The Covid-19 human convalescent serum panel includes specimens from PCR-confirmed Covid-19 participants, obtained from Baylor College of Medicine (29 specimens for ELISA and 32 specimens for MN IC>99%), with geometric mean titer values according to Covid-19 severity. The severity of Covid-19 is indicated by the colors of the dots for hospitalized patients (including those in intensive care), symptomatic outpatients (with samples collected in the emergency department), and asymptomatic patients who had been exposed to Covid-19 (with samples collected during contact and exposure assessment). Mean values (in black) for human convalescent serum are depicted next to (and of same color as) the category of Covid-19 patients, with the overall mean shown above the scatter plot (in black). For each trial vaccine group, the mean at day 35 is depicted above the scatterplot.ELISA anti-spike IgG geometric mean ELISA units (GMEUs) ranged from 105 to 116 at day 0.

By day 21, responses had occurred for all adjuvanted regimens (1984, 2626, and 3317 GMEUs for groups C, D, and E, respectively), and geometric mean fold rises (GMFRs) exceeded those induced without adjuvant by a factor of at least 10 (Figure 3 and Table S10). Within 7 days after the second vaccination with adjuvant (day 28. Groups C and D), GMEUs had further increased by a factor of 8 (to 15,319 and 20,429, respectively) over responses seen with the first vaccination, and within 14 days (day 35), responses had more than doubled yet again (to 63,160 and 47,521, respectively), achieving GMFRs that were approximately 100 times greater than those observed with rSARS-CoV-2 alone. A single vaccination with adjuvant achieved GMEU levels similar to those in asymptomatic (exposed) patients with Covid-19 (1661), and a second vaccination with adjuvant achieved GMEU levels that exceeded those in convalescent serum from symptomatic outpatients with Covid-19 (7420) by a factor of at least 6 and rose to levels similar to those in convalescent serum from patients hospitalized with Covid-19 (53,391).

The responses in the two-dose 5-μg and 25-μg adjuvanted vaccine regimens were similar, a finding that highlights the role of adjuvant dose sparing. Neutralizing antibodies were undetectable before vaccination and had patterns of response similar to those of anti-spike antibodies after vaccination with adjuvant (Figure 3 and Table S11). After the first vaccination (day 21), GMFRs were approximately 5 times greater with adjuvant (5.2, 6.3, and 5.9 for groups C, D, and E, respectively) than without adjuvant (1.1). By day 35, second vaccinations with adjuvant induced an increase more than 100 times greater (195 and 165 for groups C and D, respectively) than single vaccinations without adjuvant.

When compared with convalescent serum, second vaccinations with adjuvant resulted in GMT levels approximately 4 times greater (3906 and 3305 for groups C and D, respectively) than those in symptomatic outpatients with Covid-19 (837) and approached the magnitude of levels observed in hospitalized patients with COVID-19 (7457). At day 35, ELISA anti-spike IgG GMEUs and neutralizing antibodies induced by the two-dose 5-μg and 25-μg adjuvanted vaccine regimens were 4 to 6 times greater than the geometric mean convalescent serum measures (8344 and 983, respectively). Figure 4. Figure 4.

Correlation of Anti-Spike IgG and Neutralizing Antibody Responses. Shown are scatter plots of 100% wild-type neutralizing antibody responses and anti-spike IgG ELISA unit responses at 3 weeks after the first vaccination (day 21) and 2 weeks after the second vaccination (day 35) for the two-dose 25-μg unadjuvanted vaccine (group B. Panel A), the combined two-dose 5-μg and 25-μg adjuvanted vaccine (groups C and D, respectively. Panel B), and convalescent serum from patients with Covid-19 (Panel C).

In Panel C, the severity of Covid-19 is indicated by the colors of the dots for hospitalized patients (including those in intensive care), symptomatic outpatients (with samples collected in the emergency department), and asymptomatic patients who had been exposed to Covid-19 (with samples collected during contact and exposure assessment).A strong correlation was observed between neutralizing antibody titers and anti-spike IgG GMEUs with adjuvanted vaccine at day 35 (correlation, 0.95) (Figure 4), a finding that was not observed with unadjuvanted vaccine (correlation, 0.76) but was similar to that of convalescent serum (correlation, 0.96). Two-dose regimens of 5-μg and 25-μg rSARS-CoV-2 plus Matrix-M1 produced similar magnitudes of response, and every participant had seroconversion according to either assay measurement. Reverse cumulative-distribution curves for day 35 are presented in Figure S2. Figure 5.

Figure 5. RSARS-CoV-2 CD4+ T-cell Responses with or without Matrix-M1 Adjuvant. Frequencies of antigen-specific CD4+ T cells producing T helper 1 (Th1) cytokines interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and interleukin-2 and for T helper 2 (Th2) cytokines interleukin-5 and interleukin-13 indicated cytokines from four participants each in the placebo (group A), 25-μg unadjuvanted (group B), 5-μg adjuvanted (group C), and 25-μg adjuvanted (group D) groups at baseline (day 0) and 1 week after the second vaccination (day 28) after stimulation with the recombinant spike protein. €œAny 2Th1” indicates CD4+ T cells that can produce two types of Th1 cytokines at the same time.

€œAll 3 Th1” indicates CD4+ T cells that produce IFN-γ, TNF-α, and interleukin-2 simultaneously. €œBoth Th2” indicates CD4+ T cells that can produce Th2 cytokines interleukin-5 and interleukin-13 at the same time.T-cell responses in 16 participants who were randomly selected from groups A through D, 4 participants per group, showed that adjuvanted regimens induced antigen-specific polyfunctional CD4+ T-cell responses that were reflected in IFN-γ, IL-2, and TNF-α production on spike protein stimulation. A strong bias toward this Th1 phenotype was noted. Th2 responses (as measured by IL-5 and IL-13 cytokines) were minimal (Figure 5)..

As SARS-CoV-2 continues its global spread, it’s possible that one of the pillars of Covid-19 pandemic control — universal facial masking — might help reduce the severity of disease and ensure that a greater proportion of new infections are asymptomatic propecia 1mg tablets price. If this hypothesis is borne out, universal masking could become a form of “variolation” that would generate immunity and thereby slow the spread of the virus in the United States and elsewhere, as we await a vaccine.One important reason for population-wide facial masking became apparent in March, when reports started to circulate describing the high rates of SARS-CoV-2 viral shedding from the noses and mouths of patients who were presymptomatic or asymptomatic — shedding rates equivalent to those among symptomatic patients.1 Universal facial masking seemed to be a possible way to prevent transmission from asymptomatic infected people. The Centers for Disease Control and Prevention (CDC) therefore recommended on April 3 that the public wear cloth face coverings in areas with high rates of community transmission — a recommendation that has been unevenly followed across the United States.Past evidence related to other respiratory viruses indicates that facial masking can also protect the wearer from becoming infected, by blocking viral particles from entering the nose and propecia 1mg tablets price mouth.2 Epidemiologic investigations conducted around the world — especially in Asian countries that became accustomed to population-wide masking during the 2003 SARS pandemic — have suggested that there is a strong relationship between public masking and pandemic control.

Recent data from Boston demonstrate that SARS-CoV-2 infections decreased among health care workers after universal masking was implemented in municipal hospitals in late March.SARS-CoV-2 has the protean ability to cause myriad clinical manifestations, ranging from a complete lack of symptoms to pneumonia, acute respiratory distress syndrome, and death. Recent virologic, epidemiologic, and ecologic data have led to the hypothesis that facial masking may also reduce the severity of disease among people who do become infected.3 This possibility is consistent with a long-standing theory of viral pathogenesis, which holds that the severity of disease is proportionate to the viral inoculum propecia 1mg tablets price received. Since 1938, researchers have explored, primarily in animal models, the concept of the lethal dose of a virus — or the dose at which 50% of exposed hosts die (LD50).

With viral infections in which propecia 1mg tablets price host immune responses play a predominant role in viral pathogenesis, such as SARS-CoV-2, high doses of viral inoculum can overwhelm and dysregulate innate immune defenses, increasing the severity of disease. Indeed, down-regulating immunopathology is one mechanism by which dexamethasone improves outcomes in severe Covid-19 infection. As proof of concept of viral inocula influencing disease manifestations, higher doses of administered virus led to more severe manifestations of Covid-19 in a Syrian hamster model of SARS-CoV-2 infection.4If the viral inoculum matters in determining the severity of SARS-CoV-2 infection, an additional hypothesized reason for wearing facial masks would be to reduce the viral inoculum to which the wearer is exposed and the subsequent clinical impact of the disease.

Since masks can filter out some virus-containing droplets (with filtering capacity determined by mask type),2 masking might propecia 1mg tablets price reduce the inoculum that an exposed person inhales. If this theory bears out, population-wide masking, with any type of mask that increases acceptability and adherence,2 might contribute to increasing the proportion of SARS-CoV-2 infections that are asymptomatic. The typical rate of asymptomatic infection with SARS-CoV-2 was estimated to be 40% by the CDC propecia 1mg tablets price in mid-July, but asymptomatic infection rates are reported to be higher than 80% in settings with universal facial masking, which provides observational evidence for this hypothesis.

Countries that have adopted population-wide masking have fared better in terms of rates of severe Covid-related illnesses and death, which, in environments with limited testing, suggests a shift from symptomatic to asymptomatic infections. Another experiment in the Syrian hamster model simulated surgical masking of the animals and showed that with simulated masking, hamsters were less likely to get infected, and if they did get infected, they either were asymptomatic or propecia 1mg tablets price had milder symptoms than unmasked hamsters.The most obvious way to spare society the devastating effects of Covid-19 is to promote measures to reduce both transmission and severity of illness. But SARS-CoV-2 is highly transmissible, cannot be contained by syndromic-based surveillance alone,1 and is proving difficult to eradicate, even in regions that implemented strict initial control measures.

Efforts to increase testing and containment in the United States have been ongoing and variably successful, owing in part to the recent increase in demand for testing.The hopes for vaccines are pinned not just on infection prevention. Most vaccine trials include a secondary outcome of decreasing the severity of illness, since increasing the proportion of cases in which disease is mild propecia 1mg tablets price or asymptomatic would be a public health victory. Universal masking seems to reduce the rate of new infections.

We hypothesize that by reducing the viral inoculum, it would also increase the proportion of infected people who remain asymptomatic.3In an outbreak on a closed Argentinian propecia 1mg tablets price cruise ship, for example, where passengers were provided with surgical masks and staff with N95 masks, the rate of asymptomatic infection was 81% (as compared with 20% in earlier cruise ship outbreaks without universal masking). In two recent outbreaks in U.S. Food-processing plants, propecia 1mg tablets price where all workers were issued masks each day and were required to wear them, the proportion of asymptomatic infections among the more than 500 people who became infected was 95%, with only 5% in each outbreak experiencing mild-to-moderate symptoms.3 Case-fatality rates in countries with mandatory or enforced population-wide masking have remained low, even with resurgences of cases after lockdowns were lifted.Variolation was a process whereby people who were susceptible to smallpox were inoculated with material taken from a vesicle of a person with smallpox, with the intent of causing a mild infection and subsequent immunity.

Variolation was practiced only until the introduction of the variola vaccine, which ultimately eradicated smallpox. Despite concerns propecia 1mg tablets price regarding safety, worldwide distribution, and eventual uptake, the world has high hopes for a highly effective SARS-CoV-2 vaccine, and as of early September, 34 vaccine candidates were in clinical evaluation, with hundreds more in development.While we await the results of vaccine trials, however, any public health measure that could increase the proportion of asymptomatic SARS-CoV-2 infections may both make the infection less deadly and increase population-wide immunity without severe illnesses and deaths. Reinfection with SARS-CoV-2 seems to be rare, despite more than 8 months of circulation worldwide and as suggested by a macaque model.

The scientific community has been clarifying for some time the humoral and cell-mediated components of the adaptive immune response to SARS-CoV-2 and the inadequacy of antibody-based seroprevalence studies to estimate the level of more durable T-cell and memory B-cell immunity to SARS-CoV-2. Promising data have been emerging in recent weeks suggesting that strong cell-mediated immunity results from even mild or asymptomatic SARS-CoV-2 infection,5 so any public health strategy that could reduce the severity of disease should increase population-wide immunity as well.To test our hypothesis that population-wide masking is one of those strategies, we need further studies comparing the rate of asymptomatic infection in areas with and areas without universal masking propecia 1mg tablets price. To test the variolation hypothesis, we will need more studies comparing the strength and durability of SARS-CoV-2–specific T-cell immunity between people with asymptomatic infection and those with symptomatic infection, as well as a demonstration of the natural slowing of SARS-CoV-2 spread in areas with a high proportion of asymptomatic infections.Ultimately, combating the pandemic will involve driving down both transmission rates and severity of disease.

Increasing evidence suggests that population-wide facial masking might benefit both components of propecia 1mg tablets price the response.In recent months, epidemiologists in the United States and throughout the world have been asked the same question by clinicians, journalists, and members of the public, “When will we have a vaccine?. € The obvious answer to this question would be, “When a candidate vaccine is demonstrated to be safe, effective, and available. That can be determined only by scientific data, not by a target calendar date.” But we realize that such a response, although accurate, overlooks much of propecia 1mg tablets price what people are ultimately seeking to understand.The emphasis on “we” reveals that most people want much more than an estimated vaccine-delivery date.

Their inquiry typically involves three concerns. First, when will the public be able to have confidence that available vaccines are safe and effective?. Second, when will a vaccine be available to people like propecia 1mg tablets price them?.

And third, when will vaccine uptake be high enough to enable a return to prepandemic conditions?. Often, the inquiry is also assessing whether the biotech and vaccine companies, government agencies, and propecia 1mg tablets price medical experts involved in developing, licensing, and recommending use of Covid-19 vaccines realize that the responses they provide now will influence what happens later. There is often a sense that messages regarding Covid-19 vaccines can have problematic framing (e.g., “warp speed”) and make assertions that involve key terms (e.g., “safe” and “effective”) for which experts’ definitions may vary and may differ considerably from those of the general public and key subpopulations.As Covid-19 vaccines move into phase 3 clinical trials, enthusiasm about the innovative and sophisticated technologies being used needs to be replaced by consideration of the actions and messages that will foster trust among clinicians and the public.

Although vast investments have been made in developing safe and effective vaccines, it is important to remember that it propecia 1mg tablets price is the act of vaccination itself that prevents harm and saves lives. Considered fully, the question “When will we have a Covid-19 vaccine?. € makes clear the many propecia 1mg tablets price ways in which efforts related to both the “when” and the “we” can affect vaccination uptake.

Recognizing the significance of both aspects of the question can help public health officials and scientists both to hone current messaging related to Covid-19 vaccines and to build a better foundation for clinicians who will be educating patients and parents about vaccination.The recently released guidelines from the Food and Drug Administration (FDA) on testing of Covid-19 vaccine candidates are scientifically sound and indicate that no compromises will be made when it comes to evaluating safety and efficacy.1 This commitment needs to be stated repeatedly, made apparent during the vaccine testing and approval process, and supported by transparency. Assurances regarding the warp speed effort to develop a vaccine or to issue emergency use authorizations accelerating availability must make clear the ways in which clinical trials and the review processes used by federal agencies (the FDA, the National Institutes of Health, and the Centers for Disease Control and Prevention [CDC]) will objectively assess the safety and effectiveness of vaccines developed using new platforms. Clinicians and the public should have easy access to user-friendly materials that reference publicly available studies, data, and presentations related to safety propecia 1mg tablets price and effectiveness.

The FDA’s and CDC’s plans for robust longer-term, postlicensure vaccine safety and monitoring systems will also need to be made visible, particularly to health care professionals, who are essential to the success of these efforts.2The second key part of this question pertains to when a safe and effective Covid-19 vaccine will become available to some, most, or all people who want one. This question has technical and moral components, propecia 1mg tablets price and the answers on both fronts could foster or impede public acceptance of a vaccine. Data from antibody testing suggest that about 90% of people are susceptible to Covid-19.

Accepting that propecia 1mg tablets price 60 to 70% of the population would have to be immune, either as a result of natural infection or vaccination, to achieve community protection (also known as herd immunity), about 200 million Americans and 5.6 billion people worldwide would need to be immune in order to end the pandemic. The possibility that it may take years to achieve the vaccination coverage necessary for everyone to be protected gives rise to difficult questions about priority groups and domestic and global access.Given public skepticism of government institutions and concerns about politicization of vaccine priorities, the recent establishment of a National Academy of Medicine (NAM) committee to formulate criteria to ensure equitable distribution of initial Covid-19 vaccines and to offer guidance on addressing vaccine hesitancy is an important step. The NAM report should be very helpful to the CDC’s Advisory Committee on Immunization Practices, the group that traditionally develops vaccination recommendations in the United States.

The NAM’s deliberations about which groups will be prioritized for vaccination involve identifying the propecia 1mg tablets price societal values that should be considered, and the report will communicate how these values informed its recommendations. Will the people at greatest risk for disease — such as health care workers, nursing home residents, prison inmates and workers, the elderly, people with underlying health conditions, and people from minority and low-income communities — be the first to obtain access?. Alternatively, will the propecia 1mg tablets price top priority be reducing transmission by prioritizing the public workforce, essential workers, students, and young people who may be more likely to spread infection asymptomatically?.

And how will the United States share vaccine doses with other countries, where infections could ultimately also pose a threat to Americans?. Releasing expert-committee reports, however, should not propecia 1mg tablets price be equated with successfully communicating with the public about vaccine candidates and availability.3 In the United States and many other countries, new vaccines and vaccination recommendations are rarely released with substantial public information and educational resources. Most investments in communication with clinicians and the public happen when uptake of newly recommended vaccines, such as the human papillomavirus vaccine or seasonal influenza vaccine, falls short of goals.

Not since the March of Dimes’s polio-vaccination efforts in the 1950s has there been major investment in public information and propecia 1mg tablets price advocacy for new vaccines. There is already a flood of misinformation on social media and from antivaccine activists about new vaccines that could be licensed for Covid-19. If recent surveys suggesting that about half of Americans would accept a Covid-19 vaccine4 are accurate, it will take substantial resources and active, bipartisan political support to achieve the uptake levels needed to reach herd immunity thresholds.5High uptake of Covid-19 vaccines among prioritized groups should also not be assumed.

Many people in these groups will want to propecia 1mg tablets price be vaccinated, but their willingness will be affected by what is said, the way it is said, and who says it in the months ahead. Providing compelling, evidence-based information using culturally and linguistically appropriate messages and materials is a complex challenge. Having trusted people, such as public figures, political leaders, entertainment figures, propecia 1mg tablets price and religious and community leaders, endorse vaccination can be an effective way of persuading the portion of the public that is open to such a recommendation.

Conversely, persuading people who have doubts about or oppose a particular medical recommendation is difficult, requires commitment and engagement, and is often not successful.Finally, surveys suggest that physicians, nurses, and pharmacists remain the most highly trusted professionals in the United States. Extensive, active, and propecia 1mg tablets price ongoing involvement by clinicians is essential to attaining the high uptake of Covid-19 vaccines that will be needed for society to return to prepandemic conditions. Nurses and physicians are the most important and influential sources of vaccination information for patients and parents.

Throughout the world, health care professionals will need to be well-informed and strong endorsers of Covid-19 vaccination.A more complete answer to the common question is therefore, “We will have a safe and effective Covid-19 vaccine when the research studies, engagement processes, communication, and education efforts undertaken during the clinical trial stage have built trust and result in vaccination recommendations being understood, supported, and accepted by the vast majority of the public, priority and nonpriority groups alike.” Efforts to engage diverse stakeholders and communities in Covid-19 vaccination education strategies, key messages, and materials for clinicians and the public are needed now.In a laboratory setting, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was inoculated into human bronchial epithelial cells. This inoculation, which was performed in a biosafety level 3 facility, had a multiplicity of infection (indicating the ratio of virus particles propecia 1mg tablets price to targeted airway cells) of 3:1. These cells were then examined 96 hours after infection with the use of scanning electron microscopy.

An en face image (Panel A) shows an infected ciliated cell with strands of mucus attached to the cilia propecia 1mg tablets price tips. At higher magnification, an image (Panel B) shows the structure and density of SARS-CoV-2 virions produced by human airway epithelial cells. Virus production was approximately 3×106 plaque-forming units per culture, a finding that is consistent with a high number of virions produced and released per cell.Camille Ehre, Ph.D.Baric and Boucher Laboratories at University of North Carolina School of Medicine, propecia 1mg tablets price Chapel Hill, NC [email protected]Specificity of SARS-CoV-2 Antibody Assays Both assays measuring pan-Ig antibodies had low numbers of false positives among samples collected in 2017.

There were 0 and 1 false positives for the two assays among 472 samples, results that compared favorably with those obtained with the single IgM anti-N and IgG anti-N assays (Table S3). Because of the low prevalence of SARS-CoV-2 infection in Iceland, we required positive results from both pan-Ig antibody assays for a sample to be considered seropositive (see Supplementary Methods in Supplementary Appendix 1). None of the samples collected in early 2020 group were seropositive, which indicates that the virus had propecia 1mg tablets price not spread widely in Iceland before February 2020.

SARS-CoV-2 Antibodies among qPCR-Positive Persons Figure 2. Figure 2 propecia 1mg tablets price. Antibody Prevalence and Titers among qPCR-Positive Cases as a Function of Time since Diagnosis by qPCR.

Shown are the percentages of samples positive for both pan-Ig antibody assays and the antibody titers propecia 1mg tablets price. Red denotes the count or percentage of samples among persons during their hospitalization (249 samples from 48 persons), and blue denotes the count or percentage of samples among persons after they were declared recovered (1853 samples from 1215 persons). Vertical bars propecia 1mg tablets price denote 95% confidence intervals.

The dashed lines indicated the thresholds for a test to be declared positive. OD denotes optical density, and RBD receptor binding domain.Table 1. Table 1 propecia 1mg tablets price.

Prevalence of SARS-CoV-2 Antibodies by Sample Collection as Measured by Two Pan-Ig Antibody Assays. Twenty-five days after diagnosis by qPCR, more than 90% of samples from recovered persons tested positive with both pan-Ig antibody assays, and the percentage of persons testing positive propecia 1mg tablets price remained stable thereafter (Figure 2 and Fig. S2).

Hospitalized persons seroconverted more frequently and quickly after qPCR diagnosis than did propecia 1mg tablets price nonhospitalized persons (Figure 2 and Fig. S3). Of 1215 persons who had recovered (on the basis of results for the most recently obtained sample from persons for whom we had multiple samples), 1107 were seropositive (91.1%.

95% confidence propecia 1mg tablets price interval [CI], 89.4 to 92.6) (Table 1 and Table S4). Since some diagnoses may have been made on the basis of false positive qPCR results, we determined that 91.1% represents the lower bound of sensitivity of the combined pan-Ig tests for the detection of SARS-CoV-2 antibodies among recovered persons. Table 2 propecia 1mg tablets price.

Table 2. Results of Repeated Pan-Ig Antibody propecia 1mg tablets price Tests among Recovered qPCR-Diagnosed Persons. Among the 487 recovered persons with two or more samples, 19 (4%) had different pan-Ig antibody test results at different time points (Table 2 and Fig.

S4). It is notable that of the 22 persons with an early sample that tested negative for both pan-Ig antibodies, 19 remained negative at the most recent test date (again, for both antibodies). One person tested positive for both pan-Ig antibodies in the first test and negative for both in the most recent test.

The longitudinal changes in antibody levels among recovered persons were consistent with the cross-sectional results (Fig. S5). Antibody levels were higher in the last sample than in the first sample when the antibodies were measured with the two pan-Ig assays, slightly lower than in the first sample when measured with IgG anti-N and IgG anti-S1 assays, and substantially lower than in the first sample when measured with IgM anti-N and IgA anti-S1 assays.

IgG anti-N, IgM anti-N, IgG anti-S1, and IgA anti-S1 antibody levels were correlated among the qPCR-positive persons (Figs. S5 and S6 and Table S5). Antibody levels measured with both pan-Ig antibody assays increased over the first 2 months after qPCR diagnosis and remained at a plateau over the next 2 months of the study.

IgM anti-N antibody levels increased rapidly soon after diagnosis and then fell rapidly and were generally not detected after 2 months. IgA anti-S1 antibodies decreased 1 month after diagnosis and remained detectable thereafter. IgG anti-N and anti-S1 antibody levels increased during the first 6 weeks after diagnosis and then decreased slightly.

SARS-CoV-2 Infection in Quarantine Table 3. Table 3. SARS-CoV-2 Infection among Quarantined Persons According to Exposure Type and Presence of Symptoms.

Of the 1797 qPCR-positive Icelanders, 1088 (61%) were in quarantine when SARS-CoV-2 infection was diagnosed by qPCR. We tested for antibodies among 4222 quarantined persons who had not tested qPCR-positive (they had received a negative result by qPCR or had simply not been tested). Of those 4222 quarantined persons, 97 (2.3%.

95% CI, 1.9 to 2.8) were seropositive (Table 1). Those with household exposure were 5.2 (95% CI, 3.3 to 8.0) times more likely to be seropositive than those with other types of exposure (Table 3). Similarly, a positive result by qPCR for those with household exposure was 5.2 (95% CI, 4.5 to 6.1) times more likely than for those with other types of exposure.

When these two sets of results (qPCR-positive and seropositive) were combined, we calculated that 26.6% of quarantined persons with household exposure and 5.0% of quarantined persons without household exposure were infected. Those who had symptoms during quarantine were 3.2 (95% CI, 1.7 to 6.2) times more likely to be seropositive and 18.2 times (95% CI, 14.8 to 22.4) more likely to test positive with qPCR than those without symptoms. We also tested persons in two regions of Iceland affected by cluster outbreaks.

In a SARS-CoV-2 cluster in Vestfirdir, 1.4% of residents were qPCR-positive and 10% of residents were quarantined. We found that none of the 326 persons outside quarantine who had not been tested by qPCR (or who tested negative) were seropositive. In a cluster in Vestmannaeyjar, 2.3% of residents were qPCR-positive and 13% of residents were quarantined.

Of the 447 quarantined persons who had not received a qPCR-positive result, 4 were seropositive (0.9%. 95% CI, 0.3 to 2.1). Of the 663 outside quarantine in Vestmannaeyjar, 3 were seropositive (0.5%.

95% CI, 0.1 to 0.2%). SARS-CoV-2 Seroprevalence in Iceland None of the serum samples collected from 470 healthy Icelanders between February 18 and March 9, 2020, tested positive for both pan-Ig antibodies, although four were positive for the pan-Ig anti-N assay (0.9%), a finding that suggests that the virus had not spread widely in Iceland before March 9. Of the 18,609 persons tested for SARS-CoV-2 antibodies through contact with the Icelandic health care system for reasons other than Covid-19, 39 were positive for both pan-Ig antibody assays (estimated seroprevalence by weighting the sample on the basis of residence, sex, and 10-year age category, 0.3%.

95% CI, 0.2 to 0.4). There were regional differences in the percentages of qPCR-positive persons across Iceland that were roughly proportional to the percentage of people quarantined (Table S6). However, after exclusion of the qPCR-positive and quarantined persons, the percentage of persons who tested positive for SARS-CoV-2 antibodies did not correlate with the percentage of those who tested positive by qPCR.

The estimated seroprevalence in the random sample collection from Reykjavik (0.4%. 95% CI, 0.3 to 0.6) was similar to that in the Health Care group (0.3%. 95% CI, 0.2 to 0.4) (Table S6).

We calculate that 0.5% of the residents of Iceland have tested positive with qPCR. The 2.3% with SARS-CoV-2 seroconversion among persons in quarantine extrapolates to 0.1% of Icelandic residents. On the basis of this finding and the seroprevalence from the Health Care group, we estimate that 0.9% (95% CI, 0.8 to 0.9) of the population of Iceland has been infected by SARS-CoV-2.

Approximately 56% of all SARS-CoV-2 infections were therefore diagnosed by qPCR, 14% occurred in quarantine without having been diagnosed with qPCR, and the remaining 30% of infections occurred outside quarantine and were not detected by qPCR. Deaths from Covid-19 in Iceland In Iceland, 10 deaths have been attributed to Covid-19, which corresponds to 3 deaths per 100,000 nationwide. Among the qPCR-positive cases, 0.6% (95% CI, 0.3 to 1.0) were fatal.

Using the 0.9% prevalence of SARS-CoV-2 infection in Iceland as the denominator, however, we calculate an infection fatality risk of 0.3% (95% CI, 0.2 to 0.6). Stratified by age, the infection fatality risk was substantially lower in those 70 years old or younger (0.1%. 95% CI, 0.0 to 0.3) than in those over 70 years of age (4.4%.

95% CI, 1.9 to 8.4) (Table S7). Age, Sex, Clinical Characteristics, and Antibody Levels Table 4. Table 4.

Association of Existing Conditions and Covid-19 Severity with SARS-CoV-2 Antibody Levels among Recovered Persons. SARS-CoV-2 antibody levels were higher in older people and in those who were hospitalized (Table 4, and Table S8 [described in Supplementary Appendix 1 and available in Supplementary Appendix 2]). Pan-Ig anti–S1-RBD and IgA anti-S1 levels were lower in female persons.

Of the preexisting conditions, and after adjustment for multiple testing, we found that body-mass index, smoking status, and use of antiinflammatory medication were associated with SARS-CoV-2 antibody levels. Body-mass index correlated positively with antibody levels. Smokers and users of antiinflammatory medication had lower antibody levels.

With respect to clinical characteristics, antibody levels were most strongly associated with hospitalization and clinical severity, followed by clinical symptoms such as fever, maximum temperature reading, cough, and loss of appetite. Severity of these individual symptoms, with the exception of loss of energy, was associated with higher antibody levels.Trial Population Table 1. Table 1.

Demographic Characteristics of the Participants in the NVX-CoV2373 Trial at Enrollment. The trial was initiated on May 26, 2020. 134 participants underwent randomization between May 27 and June 6, 2020, including 3 participants who were to serve as backups for sentinel dosing and who immediately withdrew from the trial without being vaccinated (Fig.

S1). Of the 131 participants who received injections, 23 received placebo (group A), 25 received 25-μg doses of rSARS-CoV-2 (group B), 29 received 5-μg doses of rSARS-CoV-2 plus Matrix-M1, including three sentinels (group C), 28 received 25-μg doses of rSARS-CoV-2 plus Matrix-M1, including three sentinels (group D), and 26 received a single 25-μg dose of rSARS-CoV-2 plus Matrix-M1 followed by a single dose of placebo (group E). All 131 participants received their first vaccination on day 0, and all but 3 received their second vaccination at least 21 days later.

Exceptions include 2 in the placebo group (group A) who withdrew consent (unrelated to any adverse event) and 1 in the 25-μg rSARS-CoV-2 + Matrix-M1 group (group D) who had an unsolicited adverse event (mild cellulitis. See below). Demographic characteristics of the participants are presented in Table 1.

Of note, missing data were infrequent. Safety Outcomes No serious adverse events or adverse events of special interest were reported, and vaccination pause rules were not implemented. As noted above, one participant did not receive a second vaccination owing to an unsolicited adverse event, mild cellulitis, that was associated with infection after an intravenous cannula placement to address an unrelated mild adverse event that occurred during the second week of follow-up.

Second vaccination was withheld because the participant was still recovering and receiving antibiotics. This participant remains in the trial. Figure 2.

Figure 2. Solicited Local and Systemic Adverse Events. The percentage of participants in each vaccine group (groups A, B, C, D, and E) with adverse events according to the maximum FDA toxicity grade (mild, moderate, or severe) during the 7 days after each vaccination is plotted for solicited local (Panel A) and systemic (Panel B) adverse events.

There were no grade 4 (life-threatening) events. Participants who reported 0 events make up the remainder of the 100% calculation (not displayed). Excluded were the three sentinel participants in groups C (5 μg + Matrix-M1, 5 μg + Matrix-M1) and D (25 μg + Matrix-M1, 25 μg + Matrix-M1), who received the trial vaccine in an open-label manner (see Table S7 for complete safety data on all participants).Overall reactogenicity was largely absent or mild, and second vaccinations were neither withheld nor delayed due to reactogenicity.

After the first vaccination, local and systemic reactogenicity was absent or mild in the majority of participants (local. 100%, 96%, 89%, 84%, and 88% of participants in groups A, B, C, D, and E, respectively. Systemic.

91%, 92%, 96%, 68%, and 89%) who were unaware of treatment assignment (Figure 2 and Table S7). Two participants (2%), one each in groups D and E, had severe adverse events (headache, fatigue, and malaise). Two participants, one each in groups A and E, had reactogenicity events (fatigue, malaise, and tenderness) that extended 2 days after day 7.

After the second vaccination, local and systemic reactogenicity were absent or mild in the majority of participants in the five groups (local. 100%, 100%, 65%, 67%, and 100% of participants, respectively. Systemic.

86%, 84%, 73%, 58%, and 96%) who were unaware of treatment assignment. One participant, in group D, had a severe local event (tenderness), and eight participants, one or two participants in each group, had severe systemic events. The most common severe systemic events were joint pain and fatigue.

Only one participant, in group D, had fever (temperature, 38.1°C) after the second vaccination, on day 1 only. No adverse event extended beyond 7 days after the second vaccination. Of note, the mean duration of reactogenicity events was 2 days or less for both the first vaccination and second vaccination periods.

Laboratory abnormalities of grade 2 or higher occurred in 13 participants (10%). 9 after the first vaccination and 4 after the second vaccination (Table S8). Abnormal laboratory values were not associated with any clinical manifestations and showed no worsening with repeat vaccination.

Six participants (5%. Five women and one man) had grade 2 or higher transient reductions in hemoglobin from baseline, with no evidence of hemolysis or microcytic anemia and with resolution within 7 to 21 days. Of the six, two had an absolute hemoglobin value (grade 2) that resolved or stabilized during the testing period.

Four participants (3%), including one who had received placebo, had elevated liver enzymes that were noted after the first vaccination and resolved within 7 to 14 days (i.e., before the second vaccination). Vital signs remained stable immediately after vaccination and at all visits. Unsolicited adverse events (Table S9) were predominantly mild in severity (in 71%, 91%, 83%, 90%, and 82% of participants in groups A, B, C, D, and E, respectively) and were similarly distributed across the groups receiving adjuvanted and unadjuvanted vaccine.

There were no reports of severe adverse events. Immunogenicity Outcomes Figure 3. Figure 3.

SARS-CoV-2 Anti-Spike IgG and Neutralizing Antibody Responses. Shown are geometric mean anti-spike IgG enzyme-linked immunosorbent assay (ELISA) unit responses to recombinant severe acute respiratory syndrome coronavirus 2 (rSARS-CoV-2) protein antigens (Panel A) and wild-type SARS-CoV-2 microneutralization assay at an inhibitory concentration greater than 99% (MN IC>99%) titer responses (Panel B) at baseline (day 0), 3 weeks after the first vaccination (day 21), and 2 weeks after the second vaccination (day 35) for the placebo group (group A), the 25-μg unadjuvanted group (group B), the 5-μg and 25-μg adjuvanted groups (groups C and D, respectively), and the 25-μg adjuvanted and placebo group (group E). Diamonds and whisker endpoints represent geometric mean titer values and 95% confidence intervals, respectively.

The Covid-19 human convalescent serum panel includes specimens from PCR-confirmed Covid-19 participants, obtained from Baylor College of Medicine (29 specimens for ELISA and 32 specimens for MN IC>99%), with geometric mean titer values according to Covid-19 severity. The severity of Covid-19 is indicated by the colors of the dots for hospitalized patients (including those in intensive care), symptomatic outpatients (with samples collected in the emergency department), and asymptomatic patients who had been exposed to Covid-19 (with samples collected during contact and exposure assessment). Mean values (in black) for human convalescent serum are depicted next to (and of same color as) the category of Covid-19 patients, with the overall mean shown above the scatter plot (in black).

For each trial vaccine group, the mean at day 35 is depicted above the scatterplot.ELISA anti-spike IgG geometric mean ELISA units (GMEUs) ranged from 105 to 116 at day 0. By day 21, responses had occurred for all adjuvanted regimens (1984, 2626, and 3317 GMEUs for groups C, D, and E, respectively), and geometric mean fold rises (GMFRs) exceeded those induced without adjuvant by a factor of at least 10 (Figure 3 and Table S10). Within 7 days after the second vaccination with adjuvant (day 28.

Groups C and D), GMEUs had further increased by a factor of 8 (to 15,319 and 20,429, respectively) over responses seen with the first vaccination, and within 14 days (day 35), responses had more than doubled yet again (to 63,160 and 47,521, respectively), achieving GMFRs that were approximately 100 times greater than those observed with rSARS-CoV-2 alone. A single vaccination with adjuvant achieved GMEU levels similar to those in asymptomatic (exposed) patients with Covid-19 (1661), and a second vaccination with adjuvant achieved GMEU levels that exceeded those in convalescent serum from symptomatic outpatients with Covid-19 (7420) by a factor of at least 6 and rose to levels similar to those in convalescent serum from patients hospitalized with Covid-19 (53,391). The responses in the two-dose 5-μg and 25-μg adjuvanted vaccine regimens were similar, a finding that highlights the role of adjuvant dose sparing.

Neutralizing antibodies were undetectable before vaccination and had patterns of response similar to those of anti-spike antibodies after vaccination with adjuvant (Figure 3 and Table S11). After the first vaccination (day 21), GMFRs were approximately 5 times greater with adjuvant (5.2, 6.3, and 5.9 for groups C, D, and E, respectively) than without adjuvant (1.1). By day 35, second vaccinations with adjuvant induced an increase more than 100 times greater (195 and 165 for groups C and D, respectively) than single vaccinations without adjuvant.

When compared with convalescent serum, second vaccinations with adjuvant resulted in GMT levels approximately 4 times greater (3906 and 3305 for groups C and D, respectively) than those in symptomatic outpatients with Covid-19 (837) and approached the magnitude of levels observed in hospitalized patients with COVID-19 (7457). At day 35, ELISA anti-spike IgG GMEUs and neutralizing antibodies induced by the two-dose 5-μg and 25-μg adjuvanted vaccine regimens were 4 to 6 times greater than the geometric mean convalescent serum measures (8344 and 983, respectively). Figure 4.

Figure 4. Correlation of Anti-Spike IgG and Neutralizing Antibody Responses. Shown are scatter plots of 100% wild-type neutralizing antibody responses and anti-spike IgG ELISA unit responses at 3 weeks after the first vaccination (day 21) and 2 weeks after the second vaccination (day 35) for the two-dose 25-μg unadjuvanted vaccine (group B.

Panel A), the combined two-dose 5-μg and 25-μg adjuvanted vaccine (groups C and D, respectively. Panel B), and convalescent serum from patients with Covid-19 (Panel C). In Panel C, the severity of Covid-19 is indicated by the colors of the dots for hospitalized patients (including those in intensive care), symptomatic outpatients (with samples collected in the emergency department), and asymptomatic patients who had been exposed to Covid-19 (with samples collected during contact and exposure assessment).A strong correlation was observed between neutralizing antibody titers and anti-spike IgG GMEUs with adjuvanted vaccine at day 35 (correlation, 0.95) (Figure 4), a finding that was not observed with unadjuvanted vaccine (correlation, 0.76) but was similar to that of convalescent serum (correlation, 0.96).

Two-dose regimens of 5-μg and 25-μg rSARS-CoV-2 plus Matrix-M1 produced similar magnitudes of response, and every participant had seroconversion according to either assay measurement. Reverse cumulative-distribution curves for day 35 are presented in Figure S2. Figure 5.

Figure 5. RSARS-CoV-2 CD4+ T-cell Responses with or without Matrix-M1 Adjuvant. Frequencies of antigen-specific CD4+ T cells producing T helper 1 (Th1) cytokines interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and interleukin-2 and for T helper 2 (Th2) cytokines interleukin-5 and interleukin-13 indicated cytokines from four participants each in the placebo (group A), 25-μg unadjuvanted (group B), 5-μg adjuvanted (group C), and 25-μg adjuvanted (group D) groups at baseline (day 0) and 1 week after the second vaccination (day 28) after stimulation with the recombinant spike protein.

€œAny 2Th1” indicates CD4+ T cells that can produce two types of Th1 cytokines at the same time. €œAll 3 Th1” indicates CD4+ T cells that produce IFN-γ, TNF-α, and interleukin-2 simultaneously. €œBoth Th2” indicates CD4+ T cells that can produce Th2 cytokines interleukin-5 and interleukin-13 at the same time.T-cell responses in 16 participants who were randomly selected from groups A through D, 4 participants per group, showed that adjuvanted regimens induced antigen-specific polyfunctional CD4+ T-cell responses that were reflected in IFN-γ, IL-2, and TNF-α production on spike protein stimulation.

A strong bias toward this Th1 phenotype was noted. Th2 responses (as measured by IL-5 and IL-13 cytokines) were minimal (Figure 5)..

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NSW has reported one new case of locally transmitted COVID-19 in the 24 hours to does propecia work for receding hairlines at the temples 8pm last night.Four cases in overseas travellers in hotel quarantine were also diagnosed, bringing the total number of cases in NSW to 4,149.There were 12,985 tests reported to 8pm last night, compared with 14,378 in the previous 24 hours. Confirmed cases (including inte​​rstate residents in NSW health care facilities) 4,149 Deaths (in NSW from confirmed cases) 55 Total tests carried out 2,903,101 Of the five new cases to 8pm last night. four were acquired overseas and are in hotel quarantine one was locally acquired and linked to a known case or cluster.The one new locally acquired case is a close contact of cases linked does propecia work for receding hairlines at the temples to Great Beginnings Childcare Centre in Oran Park, who were reported yesterday. There are now six cases associated with this childcare centre, and 19 in total in the Oran Park community cluster.

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