After 41 years of practice, Mendota Heights doctor finds renewed purpose in virtual medicine

Dr. Carolyn Borow has delivered more than 3,500 babies in her 41 years as a family doctor. But she hasn’t delivered one since the coronavirus pandemic began.

Instead Borow, like many medical professionals, has gone virtual, doing all those appointments about pregnancy complications, sore throats and COVID fears via computer and FaceTime. In fact, the only time she’s been in a hospital recently was when she herself had surgery.

“I am definitely going through baby withdrawal,” said Borow, who works out of Allina Health in West St. Paul and Eagan. “I’d never planned that at some point I’m not going to be doing this. Only a pandemic would keep me from it.”

At a time when a growing number of veteran doctors are suddenly considering retirement, Borow is finding renewed purpose in her work.

A 2020 survey of 2,300 U.S. physicians by the nonprofit Physicians Foundation reported that 37% of doctors said they would like to retire within a year. Many expressed fear for their personal health, including 28% who had “serious concerns” about catching COVID-19.

Borow, though, sees value in her shifting work experience.

“I thank everybody who is making these appointments,” Borow said. “Because it has allowed me to still feel meaningful. Because I had no intention ever of not continuing to serve people.”

Initially, to cut down on coronavirus exposure, Allina limited the number of its doctors going in and out of United Hospital in St. Paul, where Borow has worked. So, Allina hired doctors to serve full time in the hospital.

Secondly, because of her age and medical risks during the COVID crisis, Borow decided to curtail her in-person contact with patients. She went virtual on the fly.

“It was all new to me,” she said of distance doctoring. “But in my motivation to serve people, I just learned it quickly.”

Borow is as busy as ever. An empty nester with a retired husband, she dons her scrubs every morning — in the clinic, she used to wear streets clothes and a lab coat — and sits at an Allina-issued computer in her son’s old bedroom in their Mendota Heights home. Her two cats sometimes scratch at the door. But Borow is diligent and determined, officially working 9 a.m. to 5 p.m. Monday through Friday (actually, two nights until 6) and on-call every other weekend. Of course, that doesn’t include the two or three hours every night of paperwork and the pre-shift prep for her appointments.

She also spends a half-day per week in the clinic signing forms, wearing a mask and shield over her glasses.

With a different virtual patient scheduled every 20 minutes, the doctor is much more punctual than in her days at the clinic, where an assistant could warn an impatient patient that the physician is running late.

“I have openings every day, people can get right in, which was never the case before,” Borow said. “Although before, we could work someone in with double booking.”

She’s now able to see patients

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Another Study Finds COVID Usually Mild in Kids | Health News

By Robert Preidt, HealthDay Reporter

(HealthDay)

MONDAY, Nov. 23, 2020 (HealthDay News) — COVID-19 is mild is most children, a new study says, but certain children have a higher risk of severe illness.

Of more than 135,000 children tested for the new coronavirus (SARS-CoV-2) at seven children’s hospitals in the United States up to September, 4% were found to be infected.

Those most likely to test positive included children from ethnic minorities, teens, those with history of public insurance, and those with certain underlying medical conditions.

Similar risk factors were noted in the 6.7% of infected children who developed severe COVID-19 and were hospitalized with respiratory, cardiovascular or COVID-19-specific symptoms. Of those, 27.6% required intensive care and 9.2% required mechanical ventilation.

Eight of the children who tested positive died, a fatality rate of 0.15%. The risk of death was strongly associated with having numerous complex preexisting medical conditions.

Children with a progressive long-term medical condition were nearly six times more likely to develop severe illness, and the risk was 1.5 to three times higher among Black children, those younger than 1 and older than 12, and those with a history of public insurance.

The researchers also found that Black, Hispanic and Asian children were less likely to get tested, but were two to four times more likely to test positive than white children.

“While the overall risk is low in this group of children, we see significant disparities in those who are testing positive and developing severe disease, which follows what we see in adults,” said study author Hanieh Razzaghi, assistant director of the PEDSnet Data Coordinating Center at Children’s Hospital of Philadelphia.

PEDSnet is national pediatric health network that includes more than 7 million patients.

“Future studies need to evaluate to what extent the higher rate of positive test results reflects different testing strategies across patient groups, as well as different social determinants of risk, like exposure to air pollution and likelihood of family continuing to work at in-person essential jobs,” Razzaghi said in a hospital news release.

“Similarly, it is important to understand differences in the biology of infection that cause different rates of symptoms between patients, so we can best protect children at higher risk,” she added.

The study was published Nov. 23 in the journal JAMA Pediatrics.

SOURCE: Children’s Hospital of Philadelphia, news release, Nov. 23, 2020

Copyright © 2020 HealthDay. All rights reserved.

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Over-45s at greater risk of STIs, new study finds

Middle-aged adults face a greater risk of catching sexually transmitted infections than ever before — because society is unwilling to talk about older people having sex, a new study has found.



a hand holding a baby on a bed: Social stigma was a key barrier to sexual health in the over-45s, researchers said.


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Social stigma was a key barrier to sexual health in the over-45s, researchers said.

Negative attitudes toward sexual health and limited knowledge of the needs of over-45s mean some older people are unaware of the dangers of unprotected sex, researchers from the UK, Belgium and the Netherlands have warned.

Experts associated with the SHIFT sexual health initiative surveyed 800 adults across the south coast of England and northern regions of Belgium and the Netherlands — with some 200 respondents identified as facing socioeconomic disadvantage.

Almost 80% of respondents in the general population group were aged between 45 and 65, while 58% of those considered socioeconomically disadvantaged were aged 45-54.

Researchers said “major changes” in sexual behavior in recent decades have seen rising numbers of sexually active older people — but many barely consider the possibility of STIs.

The most cited reason for not using contraception was that participants deemed themselves to be monogamous, exclusive to one relationship, experts said, followed by participants believing they were not at risk of pregnancy.

“Over-45s at most risk are generally those entering new relationships after a period of monogamy, often post-menopause, when pregnancy is no longer a consideration, but give little thought to STIs,” Ian Tyndall, senior lecturer at Britain’s University of Chichester, one of the project’s partner organizations, said in a statement.

Researchers found that more than 50% of respondents in both the general population and in the socioeconomically disadvantaged group had never been tested for a sexually transmitted infection.

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Stigma and shame were identified as the greatest barriers to adults accessing sexual healthcare services, with many participants indicating that they felt that sexual health was a “dirty” term, discouraging people from seeking regular health checks.

“A big barrier to people accessing services is societal stigma, and assumptions that older people are asexual and that sex is no longer part of their lives. This really limits the awareness of sexual health services among this group,” Tess Hartland, research assistant with the SHIFT project, told CNN.

A “significant number” of survey respondents were also unaware of the risks of sexually transmitted infections, researchers said, while 42% of general respondents in the UK and the Netherlands did not know where their nearest sexual health service was located.

“A lot of services and sexual health promotion is really tailored towards young people,” Hartland told CNN, noting that some people in the over-45 age category may have received limited sexual health education at school, affecting their attitudes today.

Participants also reported that their healthcare professionals, such as doctors and nurses, lacked appropriate sexual health knowledge.

“A lot of respondents preferred to go to their GP or their doctor rather than a specific sexual health service,” Hartland

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Rise in nighttime blood pressure increases heart disease risk, study finds

Nov. 2 (UPI) — People who have high blood pressure at night are at increased risk for heart disease, even if their blood pressure is within normal ranges during the day, according to a study published Monday by the journal Circulation.

A nighttime systolic blood pressure — the “top” number — that is 20 millimeters of mercury — or mm. Hg, the unit of measure for blood pressure — above daytime readings raises a person’s risk for heart disease by 18%, the data showed.

That same rise in nighttime blood pressure also increases a person’s risk for heart failure by 25%, the researchers said.

“Nighttime blood pressure is increasingly being recognized as a predictor of cardiovascular risk,” study co-author Dr. Kazuomi Kario said in a statement.

“This study provides much more in-depth information about the cardiovascular risk associated with high nighttime blood pressure,” said Kario, a professor of cardiovascular medicine at Jichi Medical University in Japan.

Nearly half of all adults in the United States — or 108 million people — have high blood pressure, the Centers for Disease Control and Prevention estimates.

Research suggests that up to 40% of people experience rises in systolic blood pressure at night, whether or not their blood pressure is considered normal or healthy — between 90 mm. Hg and 120 mm. Hg — during the day.

For this study, researchers measured daytime and nighttime systolic blood pressure in 6,359 adults from across Japan between 2009 and 2017, using an at-home, wearable, ambulatory monitor.

Blood pressure was recorded during daily activities and sleep for at least 24-hours at a time, and device data were periodically downloaded at a healthcare clinic, the researchers said.

Nearly half of the study participants were male, and more than half were aged 65 years and older, according to the researchers.

All of the study participants had at least one risk factor for heart disease — although none had been diagnosed with it — and 75% of them were taking blood pressure medications when the study began, the researchers said.

The study participants were instructed to rest or sleep during nighttime hours and maintain their usual daytime activities, and they recorded their daily activities and sleep and wake times in a diary.

Nearly every participant recorded 20 daytime and seven nighttime automated blood pressure measurements.

By the end of the study period, participants experienced a total of 306 cardiovascular events, including 119 strokes, 99 diagnoses of coronary artery disease and 88 diagnoses of heart failure.

Those with a disrupted circadian blood pressure rhythm — or higher blood pressure at night than during the day — had a 48% higher risk for heart disease and were nearly three times as likely to experience heart failure, the data showed.

Circadian rhythms are the body’s natural, internal process that regulates a person’s sleep-wake cycle and repeats with each rotation of the Earth, or roughly every 24 hours, according to the American Heart Association.

Blood pressure typically fluctuates with a pattern that follows the

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A Rapid Virus Test Falters in People Without Symptoms, Study Finds

Mr. Bryant, of Quidel, who received an early copy of the University of Arizona study, praised the results as “very, very good,” citing the Sofia’s ability to root out “people who are infectious.”

Quidel, which is running several studies of its own, does not yet have definitive results that show the Sofia works in people without Covid-19 symptoms. But “based on the data so far, it seems to be applicable to that population,” Mr. Bryant said of his company’s results.

Other experts advised caution.

Although C.T. values do tend to increase as virus levels diminish, exceptions to this trend exist — and there is no universal “magic-number cutoff” for infectiousness, Dr. Dien Bard said.

Failing to grow the coronavirus out of a person’s sample also does not guarantee that individual is not contagious to others, said Omai Garner, the associate director of clinical microbiology in the UCLA Health System, who was not involved in the study.

Several experts noted that the University of Arizona study did not track transmission among its participants, making it impossible to draw conclusions about how, and from whom, the virus spread.

Dr. Harris said that some of the concerns about the Sofia’s accuracy could be overcome with repeat testing. Screened frequently enough with a rapid test, infected people missed by one Sofia would probably be detected with the next, especially if the levels of virus in their bodies were rising, Dr. Harris said. He and his colleagues are now gathering data on University of Arizona athletes, who are tested daily, to investigate this possibility. Quidel has also partnered with the Pac-12 and Big Ten Conferences to conduct daily tests.

People with symptoms or known exposures to the coronavirus should still get the most precise and reliable tests available — those that use P.C.R., said Susan Butler-Wu, a clinical microbiologist at the University of Southern California who was not involved in the study. More data, she added, would be needed to figure out how rapid tests fit into the larger diagnostic landscape.

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Coronavirus transmission at home ‘common,’ over 50% household contacts infected, CDC finds

Coronavirus spread within households is common, and “substantial transmission” occurs from both children and adults, according to a report from the Centers for Disease Control and Prevention (CDC).

Health officials have been warning about virus transmission occurring inside homes. Dr. Deborah Birx, White House coronavirus task force coordinator, for instance, has warned that coronavirus-related closures of public places won’t stop virus spread in this phase of the pandemic, where at-home gatherings are contributing to cases, reported the Chicago Tribune. 

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 Also, Dr. Allison Arwady, commissioner of the Chicago Department of Public Health, has said: “In fact where we see the spread of COVID-19 is where we let down our guard, where we literally let down our mask because we feel comfortable with those we love, but the virus is just looking for opportunities to spread.”

In its latest report, the CDC assessed 101 households in Nashville, Tenn., and Marshfield, Wis., from April to September. The households included 101 index patients (or the believed source of infection) and 191 household contacts. These people took self-samples for the virus everyday for two weeks.

Over half (53%) of all household contacts were infected and “secondary infections occurred rapidly, with approximately 75% of infections identified within 5 days of the index patient’s illness onset,” the health agency wrote.

Younger index patients aged 12 to 17 years infected about 38% of household contacts, according to the data.

CORONAVIRUS IN THE US: STATE-BY-STATE BREAKDOWN

The CDC advises using separate bathrooms and bedrooms, if possible, to reduce virus spread at home, among other measures. (iStock)

The CDC advises using separate bathrooms and bedrooms, if possible, to reduce virus spread at home, among other measures. (iStock)

To lower the risk of virus spread at home, the CDC recommends isolating immediately upon coronavirus-like symptoms, testing positive, or testing due to high-risk exposure, whichever happens first. Also, everyone should wear masks in shared spaces at home.

Members of the same household should use separate bedrooms and bathrooms if possible, the CDC wrote. Finally, a significant number of infected people in the study were asymptomatic, which further emphasizes the importance of isolation, the agency wrote.

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Cardiac MRI contrast agents unlikely to produce adverse reactions, study finds

Oct. 29 (UPI) — Chemicals used to improve images of the heart during MRI scans are unlikely to produce allergic reactions and other side effects in patients who take them, according to a study published Thursday by the journal Radiology: Cardiothoracic Imaging.

In reviewing data from more than 145,000 cardiac MRI scans performed in Europe between 2017 and 2019, well under 1% included reports of side effects or allergic reactions related to the use of contrast agents such as gadolinium, the data showed.

In addition, just 47 of the contrast agent-related adverse reactions included those that were “severe” in nature, such as chest pain, the researchers said.

“Our study demonstrates that the administration of intravenous gadolinium-based contrast agents for cardiac MRI is safe for the overwhelming majority of patients,” study co-author Dr. Johannes Uhlig said in a statement.

Cardiac MRI is used to diagnose a variety of conditions, including aneurysms, blood clots and defects. The imaging method also can help evaluate diseases such as cardiomyopathy and myocarditis, or inflammation of the heart.

The majority of cardiac MRI exams use intravenous gadolinium-based contrast agents to improve visualization of the heart muscle and blood flow, the researchers said.

Contrast agents contain an ion of the heavy metal gadolinium, which is toxic to humans. However, in contrast agents, it is bound in a molecule called a ligand to make it safe, according to Uhlig, a cardiologist at University Medical Center in Goettingen, Germany.

The findings of this study come three years after the European Union enacted new regulations restricting the marketing of linear gadolinium-based contrast agents, he and his colleagues said.

Gadolinium-based contrast agents are classified as either linear — with longer ligands — or macrocyclic — with a cage-shaped ligand that traps the ion inside — based on the type of ligand used, they said.

Studies have shown that trace amounts of the toxic gadolinium ions may remain in the body following repeated gadolinium-based contrast agent use, and linear agents are thought to have a higher likelihood of staying behind compared to macrocyclic ones, according to Uhlig.

The U.S. Food and Drug Administration recommends that physicians consider gadolinium retention when choosing agents to use, he said.

For the new study, Uhlig and his colleagues reviewed data on 154,779 patients who underwent cardiac MRI, with almost 95%, or 145,855, receiving gadolinium-based contrast agents.

Among those who received these agents prior to cardiac MRI, 0.38%, or 556, reported an adverse reaction, with all but 47 being classified as “mild.” Those included allergic reactions such as developing hives and wheezing, the data showed.

The 47 “moderate” or “severe” adverse reactions included chest pain and irregular heartbeat. Adverse events also occurred in cardiac MRIs performed without gadolinium, with 2.6%, or 231, of the 8,924 patients reporting adverse reactions such as anxiety and shortness of breath, the researchers said.

The results underscore the importance of preprocedural assessments to look for contraindications to MRI scanning and use of gadolinium-based contrast agents, as well as the likelihood of adverse

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Immunity to coronavirus lingers for months, study finds

Immunity to Covid-19 infection lingers for at least five months, researchers reported — and probably longer than that.



a man and a woman looking at her cell phone: PERTH, AUSTRALIA - APRIL 20: Registered nurse Heather Hoppe receives a flu vaccination in the trial clinic at Sir Charles Gairdner hospital on April 20, 2020 in Perth, Australia. Healthcare workers in Western Australia are participating in a new trial to test whether an existing tuberculosis vaccine can help reduce their chances of contracting COVID-19. 2000 frontline staff from Fiona Stanley, Sir Charles Gairdner and Perth Children's Hospital are taking part in the research trial, which will see half of participants receiving the existing Bacillus Calmette-Guérin (BCG) vaccine in addition to their flu vaccine, while the other half receive the regular flu shot. The BCG vaccine was originally developed to work against tuberculosis, but it is hoped it might help reduce the chance of contracting coronavirus as well as lessen the severity of symptoms and boost immunity in the long term. The BRACE trial is being led by by the Murdoch Children's Research Institute. (Photo by Paul Kane/Getty Images)


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PERTH, AUSTRALIA – APRIL 20: Registered nurse Heather Hoppe receives a flu vaccination in the trial clinic at Sir Charles Gairdner hospital on April 20, 2020 in Perth, Australia. Healthcare workers in Western Australia are participating in a new trial to test whether an existing tuberculosis vaccine can help reduce their chances of contracting COVID-19. 2000 frontline staff from Fiona Stanley, Sir Charles Gairdner and Perth Children’s Hospital are taking part in the research trial, which will see half of participants receiving the existing Bacillus Calmette-Guérin (BCG) vaccine in addition to their flu vaccine, while the other half receive the regular flu shot. The BCG vaccine was originally developed to work against tuberculosis, but it is hoped it might help reduce the chance of contracting coronavirus as well as lessen the severity of symptoms and boost immunity in the long term. The BRACE trial is being led by by the Murdoch Children’s Research Institute. (Photo by Paul Kane/Getty Images)

While the report may seem confusing and contradictory to a similar report out of Britain this week, it really isn’t. People’s bodies produce an army of immune compounds in response to an infection and some are overwhelming at first, dying off quickly, while others build more slowly.

The new report out Wednesday shows 90% of people who recover from Covid-19 infections keep a stable antibody response.

“While some reports have come out saying antibodies to this virus go away quickly, we have found just the opposite — that more than 90% of people who were mildly or moderately ill produce an antibody response strong enough to neutralize the virus, and the response is maintained for many months,” Florian Krammer, a professor of vaccinology at the Icahn School of Medicine at Mount Sinai, who led the study team, said in a statement.

“This is essential for effective vaccine development.”

The team looked at the antibody responses of more than 30,000 people who tested positive for Covid-19 at Mount Sinai’s Health System between March and October. They characterized their antibody responses as low, moderate or high. More than 90% had moderate to high levels, or titers, of antibodies to the spike protein of the virus — the structure it uses to grapple the cells it infects.

They then closely studied 121 patients who recovered and donated their plasma — once three months after they first developed symptoms, and again five months later.

They did see a drop-off in some antibodies. But others persisted, they reported in the journal Science.

“The serum antibody titer we measured in individuals initially were likely produced by plasmablasts, cells that act as first responders to an invading virus and come together to produce initial bouts of antibodies whose strength soon wanes,” said Dr. Ania Wajnberg, director of Clinical Antibody Testing at the Mount Sinai Hospital.

“The sustained antibody levels that we subsequently observed

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U.K study finds sharp drop in COVID-19 antibodies just months after infection

One of the vexing things about coronaviruses like the common cold is that the immune response they induce is often short-lived. You catch a cold, recover and then catch it again six months later.

New research published Tuesday indicates fading immunity might also occur with the much more serious coronavirus, SARS CoV-2. Imperial College London scientists found that in a random sample of 365,000 adults in the United Kingdom, the presence of COVID-19 antibodies declined in all age groups by 26% from June to September.

The subjects in the REACT2 study, which has not been peer-reviewed, were given finger-prick tests in three rounds over the summer. After the first round, which ended in July, about 60 of 1,000 people in the sample, or 6%, had positive antibodies. By the end of September, that number had fallen to 44 per 1,000 (4.4%).

Age appeared to affect antibody duration. Younger people had higher levels than those over 65, and their antibodies lasted longer.


A faster decline in antibodies was observed in asymptomatic or mildly symptomatic cases than in those with full-blown symptoms, said Professor Wendy Barclay, head of the college’s infectious disease department, in a video call with journalists. Health care workers showed no change in antibody levels, possibly due to continuous on-the-job exposure to the virus.

“On the balance of evidence, I would say, with what we know for other coronaviruses, it would look as if immunity declines away at the same rate as antibodies decline away, and that this is an indication of waning immunity at the population level,” Barclay added.

“We don’t yet know what level of antibody is needed in a person’s blood to prevent reinfection,” she added.

Just a handful of cases of people getting COVID-19 twice have been confirmed. But immunity from the first wave of infections in March and April may only now be starting to dissipate, raising the prospect of more repeat cases, according to epidemiologists.

The findings suggest that those expecting increased infections to result in so-called herd immunity over time could be disappointed.

Herd immunity occurs when enough of a population is immune to a disease, making it unlikely to spread and protecting the rest of the community.

If no vaccine is developed, the portion of the population that would have to recover from COVID-19 in order to achieve herd immunity is estimated at about 70%, or more than 200 million people in the United States, according to the Mayo Clinic.

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Nurses Make Up Most Hospitalized Coronavirus Health Care Workers, CDC Finds | Health News

Most of the health care workers hospitalized with the coronavirus are nurses, according to a new Centers for Disease Control and Prevention report.

The report found that nearly 6% of all patients hospitalized with COVID-19 were health care workers, with 36.3% of those patients being nurses. More than two-thirds, 67.4%, had direct patient contact and more than 4% of the health care workers who were hospitalized died.

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TOPSHOT - A passenger in an outfit (R) poses for a picture as a security guard wearing a facemask as a preventive measure against the Covid-19 coronavirus stands nearby on a last century-style boat, featuring a theatrical drama set between the 1920s and 1930s in Wuhan, in Chinas central Hubei province on September 27, 2020. (Photo by Hector RETAMAL / AFP) (Photo by HECTOR RETAMAL/AFP via Getty Images)

The CDC’s report included medical records from nearly 7,000 coronavirus patients who were in the hospital between March 1 and May 31.

Nearly 90% of health care workers who were hospitalized with the virus had at least one underlying medical condition, with the most common, 73%, being obesity.

According to the report, the median age of the hospitalized health care worker was 49, compared to 62 among the general population. Most health care workers in the hospital with COVID-19 were women, with a large proportion being Black.

Additionally, the report found that the median length of hospitalization among the providers with COVID-19 was four days and 27.5% of providers were admitted to the intensive care unit for a median of six days.

The CDC said the findings were comparable to those reported among health care providers with COVID-19 in China.

In the U.S., nursing-related occupations account for a large proportion of the health care workplace, and in 2019 registered nurses represented approximately one-third of health care providers.

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