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Dentist issues warning after ‘healthy’ dad dies at 37

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The tragic case of a Wirral dad-of-seven who lost his battle with an aggressive form of mouth cancer has led to concerns that thousands of cases are going undiagnosed.

Alan Birch, 37, had 90% of his tongue removed when he was diagnosed with mouth cancer in 2018.

Despite Alan undergoing both radiotherapy and chemotherapy, the cancer returned each time and specialists told his devastated family there was nothing more they could do for him.

The news was even more shocking as Alan, a self-employed plasterer from Moreton, lived a healthy, active lifestyle and did not drink or smoke.

It was after learning of the devastating diagnosis that Alan and his partner of 12 years, Debbie McDonough, decided to get married. The wedding ceremony in February was attended by more than 150 family and friends.

Debbie said at the time: “Usually the cancer he has is curable, but he got it in a very aggressive form. Every time they operated, it came back worse.”



a group of people posing for the camera: Dad-of-seven Alan Birch, pictured with his partner Debbie

© Liverpool Echo
Dad-of-seven Alan Birch, pictured with his partner Debbie

After winning hearts across Merseyside, sadly Alan died a few weeks later in April.

Mouth cancer takes more lives than cervical cancer and testicular cancer combined, with 8,722 new cases reported in the UK last year. This is a 58% increase compared to a decade ago and a 97% rise since 2000.



a man and a woman sitting at a table: Alan Birch and Debbie McDonough on their wedding day in February

© Joe Hague Photography
Alan Birch and Debbie McDonough on their wedding day in February

With the latest figures from the British Dental Association showing that 19 million treatments have been missed due to lockdown, dentists are now concerned about the number of cases of mouth cancer that will have potentially gone undiagnosed this year as a result.

But there is still a lack of awareness and knowledge around this type of cancer – something which dentists are keen to continue to try and rectify.

This comes as new research revealed that 52% of people living in the north-west are unaware their dentist will screen them for mouth cancer during a routine check-up. This figure was highest with those aged between 25-35, increasing to 61%.

What are the latest coronavirus figures for where you live? Find out by adding your postcode.

Dr Catherine Tannahill, dentist and director of clinical dentistry at Portman Dental Care, which carried out the research, said: “As dentists we see first-hand the impact this disease can have, and that’s why we want to ensure people are aware of what the signs and symptoms are, what to do if they spot an issue and what steps they can take to reduce the risk of developing mouth cancer.

“This is now more important than ever before, as thousands of diagnoses may have potentially been missed this year due to dental practices having to close in initial lockdown, and the subsequent backlog of appointments since.

“While this may sound alarming, early diagnosis of mouth cancer leads to a 90% survival rate, which is why it is imperative that people continue visiting their dentist

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health 

AACE Issues ‘Cookbook’ Algorithm to Manage Dyslipidemia

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Dr Yehuda Handelsman

A new algorithm on lipid management and prevention of cardiovascular disease from the American Association of Clinical Endocrinologists* (AACE) and the American College of Endocrinology (ACE) is “a nice cookbook” that many clinicians, especially those who are not lipid experts, will find useful, according to writing committee chair Yehuda Handelsman, MD.

The algorithm, published Oct. 10 in Endocrine Practice as 10 slides, or as part of a more detailed consensus statement, is a companion to the 2017 AACE/ACE guidelines for lipid management and includes more recent information about new therapies.

“What we’re trying to do here is to say, ‘focus on LDL-C, triglycerides, high-risk patients, and lifestyle. Understand all the medications available to you to reduce LDL-C and reduce triglycerides,’ ” Handelsman, of the Metabolic Institute of America, Tarzana, Calif., explained in an interview.

“We touch on lipoprotein(a), which we still don’t have medication for, but it identifies people at high risk, and we need that.”

Clinicians also need to know “that we’ve got some newer drugs in the market that can manage people who have statin intolerance,” Handelsman added.

“We introduced new therapies like icosapent ethyl” (Vascepa, Amarin) for hypertriglyceridemia, “when to use it, and how to use it. Even though it was not part of the 2017 guideline, we gave recommendations based on current data in the algorithm.”



Dr Robert H. Eckel

Although there is no good evidence that lowering triglycerides reduces heart disease, he continued, many experts believe that the target triglyceride level should be less than 150 mg/dL, and the algorithm explains how to treat to this goal.

“Last, and most importantly, I cannot fail to underscore the fact that lifestyle is very important,” he emphasized.

Robert H. Eckel, MD, of the University of Colorado at Denver, Aurora, and president of medicine and science at the American Diabetes Association, who was not involved with this algorithm, said in an interview that the algorithm is important since it offers “the clinician or health care practitioner an approach, a kind of a cookbook or application of the guidelines, for how to manage lipid disorders in patients at risk … It’s geared for the nonexperts too,” he said.

Dyslipidemia Treatment Summarized in 10 Slides

The AACE/ACE algorithm comprises 10 slides, one each for dyslipidemic states, secondary causes of lipid disorders, screening for and assessing lipid disorders and atherosclerotic CVD (ASCVD) risk, ASCVD risk categories and treatment goals, lifestyle recommendations, treating LDL-C to goal, managing statin intolerance and safety, management of hypertriglyceridemia and the role of icosapent ethyl, assessment and management of elevated lipoprotein(a), and profiles of medications for dyslipidemia.

The algorithm defines five ASCVD risk categories and recommends increasingly lower LDL-C, non–HDL-C, and apo B target levels with increasing risk, but the same triglyceride target for all.

First, “treatment of lipid disorders begins with lifestyle therapy to improve nutrition, physical activity, weight, and other factors that affect lipids,” the consensus statement authors stress.

Next, “LDL-C has been, and remains, the main focus of efforts to improve

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health 

COVID rising in southwest Va.; health system issues warning

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RICHMOND, Va. (AP) — Southwest Virginia is seeing a sustained, troubling increase in cases of COVID-19 driven partly by small family gatherings, the governor and top health officials said Wednesday, as one area health system issued a stark warning that its resources were being stretched thin.

“To be quite frank, today our region is in a really bad place in this pandemic,” said Jamie Swift, the chief infection prevention officer for Ballad Health, which serves southwest Virginia, as well as adjacent parts of Tennessee, North Carolina and Kentucky.

Gov. Ralph Northam said at a news conference in Richmond that Virginia overall is among just a handful of U.S. states not reporting large increases in COVID-19 cases. But the seven-day testing percent positivity rate in the region’s westernmost localities is about twice the rate of the rest of the state’s 5.1 % and has been increasing for 15 days, Northam said.

“I strongly urge everyone in the southwest — look at these numbers and step up your precautions,” Northam said.


The governor said there were no immediate plans to introduce new regional restrictions to reduce the spread of the virus, but he said such a move was a possibility if the numbers keep trending up.

Northam and Secretary of Health and Human Resources Dr. Daniel Carey said gatherings of extended family members not living in the same household were contributing to the spread. Virginia has so far reported nearly 177,000 cases of COVID-19 and just over 3,600 deaths since the start of the pandemic, according to health department data.

Dr. Karen Shelton, the director of a health department district that includes much of southwest Virginia, wrote in an email that other factors contributing to what she called a “surge” in cases included: outbreaks at churches, inconsistent mask wearing, in-person schooling, social gatherings of friends and coworkers, and relatively fewer people telecommuting due to less broadband access.

Shelton also said a surge in cases in neighboring Tennessee was contributing.

“Tennessee has fewer regulations and has had events, social gatherings, and sports. Friday night football has continued with fans gathering closely in stands without masks,” she wrote.

Swift, Ballad’s infection prevention officer, said at a news conference that it was “past time” for the area to change its behaviors.

The health system said it had seen a 43% increase in the cases across its region over the past week, 88.5% of its ICU beds were full, and it had 181 team members in quarantine or isolation.

“At this rate, we’re only going to be able to care for COVID-19 patients,” said Ballad’s Chief Operating Officer Eric Deaton.

Dane Poe, the administrator of Lee County, located in the furthest southwest tip of Virginia, said the county has been lucky so far to not have more than a few dozen cases requiring hospitalization. The county’s only hospital closed in 2013.

Still, having to be prepared for the additional hospital trips has further strained the six already-strapped volunteer agencies in the country that provide ambulance services,

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medicine 

Diaceutics Launches World’s First Diagnostic Network for Precision Medicine to Solve Global Cancer Testing Issues

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– Diaceutics today launches world’s first digital platform solution to broken testing ecosystem DXRX – The Diagnostic Network®

– Global pharma companies, labs and diagnostic companies are leveraging the platform with 38 laboratories and diagnostic companies onboarded and two pharma companies piloting the platform

– DXRX provides access to pipeline of global diagnostic testing data on one secure platform and enables industry-wide collaboration to accelerate biomarker test adoption and time to peak therapy prescription from years to months

– Early collaborations are now live on DXRX to address real-world cancer testing issues such as PD-L1 reimbursement in the US, and EQA Provision for NGS testing in EU and Asia

Diaceutics PLC, (AIM: DXRX), today announces the launch of DXRX – The Diagnostic Network® which has been designed to accelerate the end-to-end development and commercialization of precision medicine diagnostics by reducing time to peak biomarker test adoption for cancer testing from years to months. As a solution to today’s broken testing ecosystem, DXRX brings together stakeholders from across the industry to collaborate in a vibrant marketplace to solve real-world testing issues in a secure, standardized way for patients.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20201028005588/en/

Sarah Colgan, Head of Global Marketing at Diaceutics (Photo: Business Wire)

DXRX integrates a pipeline of global diagnostic testing data into one secure platform providing access to transparent, real-time reporting on diagnostic utilization at a local level across multiple therapeutic areas.

Early collaborations between pharma, labs and diagnostic companies are live on the platform’s marketplace with 38 Laboratories and Diagnostic Companies onboarded from across EU, Asia and the US. These collaborations are designed to improve test standardization, reimbursement, regulatory support and External Quality Assessment (EQA). Collaborators today include Synlab, PathGroup (US), SRL Diagnostics (Asia), Fundación Jimenez Díaz, The Royal Marsden NHS Foundation Trust, Istituto Nazionale Tumori Regina Elena Roma and Diatech Pharmacogenetics (EU). Two global pharmaceutical clients are also piloting the technology.

The platform enables pharma clients to monitor and enhance test quality at local level to increase return on investment across multiple brands, and leverage a broad network of local partnership opportunities to implement best-in-class testing for their precision medicine portfolios. DXRX also enables clients to outsource the end-to-end diagnostic development and commercialization process from biomarker discovery to in-market test availability in order to reduce time to market for new therapies.

Furthermore, DXRX also provides users access to a global expert advisory panel of key opinion leaders from the areas of oncology, including lung cancer research and colorectal research; pathology, including tissue pathology and uropathology; molecular diagnostics; digital image analysis; telemedicine and informatics; external quality assessment (EQA); and FDA-expertise.

The end-to-end service offering provided by DXRX is enabled by a growing network of industry leading service providers in 51 countries. They cover precision medicine diagnostics to deliver implementation services such as test standardization, reimbursement, regulatory support and External Quality Assessment (EQA). Recent partnerships include Histocyte Laboratories, Targos Molecular Pathology, EMQN CIC, CPQA-ACP, NordiQC and UKNEQAS ICC & ISH.

An

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health 

AHA News: Study Highlights Heart-Health Issues for Adults Who Were Preemies | Health News

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(HealthDay)

American Heart Association News

MONDAY, Oct. 26, 2020 (American Heart Association News) — Erin Wegener was a tiny baby facing enormous challenges.

Born at 29 weeks’ gestation, she weighed only 1 pound, 14 ounces. Her first three months were lived in the neonatal intensive care unit. Family photos show her covered in gauze, sustained by too many tubes to count. Her entire hand just about fit inside her father’s wedding ring.

Her parents were warned she could face a lifetime of mental and physical challenges. But today, she’s working as a music therapist in the same hospital system in Grand Rapids, Michigan, where she was born.

The doctors’ most dire warnings didn’t come true, and her premature birth has never been much of a factor in her adult life. “I feel very thankful that I have not had a lot of health issues growing up,” she said.

Wegener was born in 1985, just a few years before breakthroughs in treatment allowed many more extremely low birth weight babies to survive. As that wave of children enters adulthood, a new study is revealing details about possible risks to their heart health.

Research published Monday in the American Heart Association journal Hypertension compared cardiovascular health among two groups of Australians born in 1991 and 1992, as they turned 25 years old. The 165 participants in the first group were born extremely preterm (earlier than 28 weeks’ gestation) or with an extremely low birth weight (below 2.2 pounds). The 127 participants in the second group were born at term and at normal weights.

Researchers looked at several factors related to heart health and calculated a cardiovascular health score for each person. Overall, the extremely premature/low birth weight group had a less favorable rating than the term-born group, specifically for blood pressure, exercise capacity, fasting blood glucose (a marker of diabetes) and visceral abdominal fat (“belly fat,” which has been linked to heart disease, cancer and more).

It was known that people born early are prone to such problems, said the study’s lead author Dr. Jeanie Cheong, a professor at the Royal Women’s Hospital in Melbourne, Australia. But the new research sought to tie the risks together for an overall view, she said. “We looked at all these factors cumulatively, rather than individually, thus providing a holistic view to health.”

Her work is part of the ongoing Victorian Infant Collaborative Study, which has been monitoring a group of Australians since their birth in 1991 or 1992. That’s the era when some treatments became widespread – such as corticosteroids for at-risk pregnant women to accelerate lung growth of babies in utero or using wetting-like agents called surfactants to treat immature lungs in premature babies.

Those treatments led to what Cheong called an exponential rise in survival over a short period for preemies. Before the 1970s, the survival rate of extremely preterm babies was below 10%, she said. By the early 1990s, that rate had soared to nearly 70%. It’s now at 87%, according to

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health 

El Paso issues curfew to help curb Covid-19 as cases surge and hospitals reach full capacity

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El Paso County Judge Ricardo Samaniego issued the curfew from 10 p.m. to 5 a.m. starting Sunday night for the next two weeks to help curb the rising rates.

“The purpose of the curfew is to limit mobility in the community,” Samaniego said during a virtual press conference Sunday night, adding that the positivity rate and hospitalizations have exploded in recent weeks. “Currently our hospitals are stretched to capacity,” the judge explained.

The county — which includes the city of El Paso and sits in the southwest border of Texas above Juarez, Mexico — has seen a 160% increase in positivity rate since October 1 and a 300% increase in hospitalizations, the judge said.

“We’ve had significant spikes to the point that our hospital capacity is really tapped. We’re probably at the end of our rope there,” Mayor Dee Margo told CNN’s Ana Cabrera on Newsroom Sunday night. “It’s not good here at all.”

US Department of Health and Human Services (HHS) resources will arrive in Texas this week, including two 35-person Disaster Medical Assistance Teams and a Trauma Critical Car Team, according to a statement from Governor Greg Abbott’s office.

On Sunday, 517 new positive Covid-19 cases were reported in the county for a total of 39,326 confirmed cases, according to the City/County of El Paso Covid-19 website. Three new deaths were also reported for a total of 575 deaths, the website shows.

Curfew imposed to slow spread

Samaniego explained that the curfew was put in place instead of another stay at home order because officials want to minimize the economic impact on businesses and families.

“The curfew is enough to limit the economic consequences on local businesses by allowing the stores to stay open. We carefully thought about the economic impact if we were to impose a full stay at home order like we did at the beginning of this process,” Samaniego explained.

“We know the impact it would have for you not to be able to go to work. So we’re going to do everything possible to continue moving towards the balancing of the economy and making sure that we adhere to public health and everything that is required for us to continue our battle against this very insidious virus,” he added.

Audrey Rodriguez of the Bowling Family YMCA in Northeast El Paso prepares the venue for early voting by putting out social distancing and direction markers from the entrance into the parking lot.

Those who don’t comply with orders could face a fine of $250 for not wearing a mask and $500 for not following the order, Samaniego said.

Mayor Margo said that while there hasn’t been one cause identified for the recent surge, many cases have been attributed to community spread and people letting their guard down.

“We did an analysis for two weeks on 2,404 cases from October 6 through October 20 and what we found is that 37% of our positives were from visiting large big-box stores, 22.5% were restaurants, and 19% were travel to Mexico,” Margo explained, adding that 10% were attributed to parties and reunions, 7.5% were due to gyms and only 4% were due to large gatherings.

The mayor urged people to

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fitness 

Carlo Ancelotti issues James Rodriguez Everton fitness update

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Carlo Ancelotti has revealed Everton will check on James Rodriguez over the next few days following Everton’s loss to Southampton.

The Blues were handed their first defeat of 2020/21, but still stayed top of the league, on Sunday afternoon at St Mary’s as the hosts secured a 2-0 win.

Goals from James Ward-Prowse and Che Adams were enough to seal the points for Ralph Hasenhuttl’s side with Everton playing well below the level they have so far this term.

Towards the end of the game, with the visitors having made all three substitutions, Rodriguez seemed to be struggling as the final minutes played out.

However, his manager doesn’t believe the problem is a big one.

Ancelotti told his post-match press conference: “I think we have to check in the next few days.

Royal Blue: Carlo Ancelotti – James Rodriguez is not definitely out for Southampton

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“He was tired at the end, he felt his muscle a little bit. But I don’t think it’s a big problem.

“It’s true that the game was difficult for everyone.”

Everton lost their for the first time this season on Sunday, ending a run of eight matches unbeaten in all competitions to get 2020/21 off to a flying start.

Ancelotti was disappointed with the defeat, but believes his side shouldn’t be too down-hearted after what has been a tremendous start to the campaign.

“It was not a good day, it was not a good performance,” he added.

“We are here to talk about the first defeat and I think we have to move forward. Of course, we don’t like to lose games, but in football it happens.

“We arrived after a fantastic start and so we have to move forward from this game with the same belief as we had when we arrived here.

“It can happen.

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“I’m disappointed because we lost the game, but I cannot forget what we did until now.

“We did really well honestly and we have to keep going to continue to do well. This is the point, we don’t have to be too disappointed.

“We are still at the top of the table, this is an unbelievable achievement for us. We have to try to stay there.”

Source Article …

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health 

Germany Issues Travel Warnings as COVID Surges in Europe | World News

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By Kirsti Knolle and Inti Landauro

BERLIN/MADRID (Reuters) – Germany warned on Thursday against travel to neighbouring countries, Belgium’s foreign minister went into intensive care and Spain said COVID-19 was “out of control” in many areas, as governments across Europe took action to fight the pandemic.

As German authorities reported more than 10,000 daily cases for the first time, Berlin issued travel warnings for Switzerland, Ireland, Poland, most of Austria and many Italian regions, including the capital Rome.

“The situation overall has become very serious,” Lothar Wieler, of the Robert Koch Institute, Germany’s infectious diseases agency, said in Berlin, adding: “We still have a chance to slow a further spread of the virus.”

After Europe appeared to have gained a measure of control over the epidemic following the dramatic lockdowns of March and April, a surge in cases over recent weeks has put the continent back at the heart of the crisis.

Hospitalisations and deaths across most of Europe have not yet reached the levels of the initial wave early this year, but authorities in many countries worry the situation could rapidly get worse.

More than 5.3 million people in Europe have contracted the disease and over 204,000 have died, according to the European Centre for Disease Prevention and Control (ECDC).

India has had more than 7.7 million cases – the world’s highest tally after the United States with 8.3 million. But elsewhere in Asia, from China to South Korea or New Zealand, draconian lockdowns and rigorous contact tracing have helped contain the disease.

Grappling with the enormous costs of the coronavirus, Europe’s leaders are desperate to avoid a repeat of the blanket lockdowns that shut down their economies in the spring.

But as cases have surged, and health services have come under increasing pressure, they have been forced to impose and expand local restrictions aimed at reducing public gatherings to ever wider areas.

Underlining the reach of the disease, Belgian Foreign Minister Sophie Wilmes went into intensive care on Thursday. German Health Minister Jens Spahn tested positive a day earlier.

“The second wave is a reality,” Spanish Health Minister Salvador Illa said on Thursday. “In many areas of our country, the epidemic is out of control.”

A number of Spanish regions are calling for localised curfews such as those implemented in France and Italy, where Lazio, the region around Rome, has joined Lombardy and Campania around Milan and Naples in imposing overnight curfews.

Amid the growing public alarm, Germany’s statistics office noted that sales of toilet paper rose almost 90% last week from pre-crisis levels with almost equally sharp jumps in sales of disinfectants and soap.

Only Sweden, a European outlier which has relied largely on voluntary measures to promote social distancing, was an exception, declaring senior citizens no longer need to isolate themselves given lower COVID infection rates than in spring.

As the crisis has intensified, much of the public goodwill seen in the first phase of lockdowns has evaporated and central governments have engaged in angry spats

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health 

Healthcare, retirement security seen as top issues for older voters, lawmakers say

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Concerns over healthcare and retirement security will be top of mind for voters over 50 years old in the upcoming election, lawmakers said Tuesday.

“Every fiber of my being believes retirement security is the biggest issue over the next decade, maybe even longer,” Rep. David SchweikertDavid SchweikertThe Hill’s 12:30 Report – Presented by the Walton Family Foundation – Why Pelosi set a 48-hour deadline for a coronavirus relief deal The Hill’s Morning Report – Sponsored by Goldman Sachs – Tipping point week for Trump, Biden, Congress, voters The Hill’s Morning Report – Sponsored by Facebook – Trump combative, Biden earnest during distanced TV duel MORE (R-Ariz.) said during AARP’s “America’s Most Reliable Voter” event, hosted by The Hill. “It’s more than just the retiree and their benefits, it’s also the cost of Medicare — being the primary driver of future debt — and how do we provide better healthcare and change the cost curve?”

Sen. Bob CaseyRobert (Bob) Patrick Casey Senate Democrats call for ramped up Capitol coronavirus testing The Hill’s 12:30 Report – Presented by the Walton Family Foundation – Why Pelosi set a 48-hour deadline for a coronavirus relief deal The Hill’s Morning Report – Sponsored by Goldman Sachs – Tipping point week for Trump, Biden, Congress, voters MORE (D-Pa.), the ranking member of the Senate special committee on aging, explained that voters over the age of 50 always play a key role in elections, but in this particular presidential race, they “may be the vote that decides the election.” He pointed out that older voters were some of the hardest hit by the coronavirus pandemic, and that the virus has “amplified and greatly enhanced those concerns” regarding their health and financial future.

“We know that people across the board were losing health insurance before the pandemic [and] that number has gone a lot higher,” he said. “That affects people in this age category, as well, and there’s also some longer-term retirement financial security issues at play.”

Sen. Debbie StabenowDeborah (Debbie) Ann StabenowDems to focus on issues, not character, at Barrett hearings Lobbying world GOP super PAC announces million ad buy in Michigan Senate race MORE (D-Mich.) further emphasized how “very real” the threat of lack of accessibility to comprehensive healthcare can be to older voters. 

“Healthcare generally is very critical, but when we talk about whether or not we are going to have a real federal plan that gets our arms around the COVID crisis that has rapid testing, that gets a vaccine safely as soon as possible — I think for older people there’s a greater sense of urgency,” she said at Tuesday’s event.

Stabenow, a ranking member on the Senate finance subcommittee on health care, expressed disappointment regarding Republican attempts to reduce access to healthcare via Affordable Care Act repeal and Medicare restraint, which could take away benefits like coverage of pre-existing conditions.

“I don’t know why it’s a partisan divide, healthcare. To me, healthcare is personal, not political,”

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health 

Vaccine storage issues could leave 3B people without access

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GAMPELA, Burkina Faso (AP) — The chain breaks here, in a tiny medical clinic in Burkina Faso that went nearly a year without a working refrigerator.

From factory to syringe, the world’s most promising coronavirus vaccine candidates need non-stop sterile refrigeration to stay potent and safe. But despite enormous strides in equipping developing countries to maintain the vaccine “cold chain,” nearly 3 billion of the world’s 7.8 billion people live where temperature-controlled storage is insufficient for an immunization campaign to bring COVID-19 under control.

The result: Poor people around the world who were among the hardest hit by the virus pandemic are also likely to be the last to recover from it.


The vaccine cold chain hurdle is just the latest disparity of the pandemic weighted against the poor, who more often live and work in crowded conditions that allow the virus to spread, have little access to medical oxygen that is vital to COVID-19 treatment, and whose health systems lack labs, supplies or technicians to carry out large-scale testing.

Maintaining the cold chain for coronavirus vaccines won’t be easy even in the richest of countries, especially when it comes to those that require ultracold temperatures of around minus 70 degrees Celsius (minus 94 F). Investment in infrastructure and cooling technology lags behind the high-speed leap that vaccine development has taken this year due to the virus.

With the pandemic now in its eighth month, logistics experts warn that vast parts of the world lack the refrigeration to administer an effective vaccination program. This includes most of Central Asia, much of India and southeast Asia, Latin America except for the largest countries, and all but a tiny corner of Africa.

The medical clinic outside Burkina Faso’s capital, a dirt-streaked building that serves a population of 11,000, is a microcosm of the obstacles.

After its refrigerator broke last fall, the clinic could no longer keep vaccines against tetanus, yellow fever, tuberculosis and other common diseases on site, nurse Julienne Zoungrana said. Staff instead used motorbikes to fetch vials in insulated carriers from a hospital in Ouagadougou, making a 40-minute round-trip drive on a narrow road that varies between dirt, gravel and pavement.

A mother of two who visits the Gampela clinic says she thinks a coronavirus inoculation program will be challenging in her part of the world. Adama Tapsoba, 24, walks four hours under scorching sun to get her baby his routine immunizations and often waits hours more to see a doctor. A week earlier, her 5-month-old son had missed a scheduled shot because Tapsoba’s daughter was sick and she could only bring one child on foot.

“It will be hard to get a (COIVD-19) vaccine,” Tapsoba said, bouncing her 5-month-old son on her lap outside the clinic. “People will have to wait at the hospital, and they might leave without getting it.”

To uphold the cold chain in developing nations, international organizations have overseen the installation of tens of thousands of solar-powered vaccine refrigerators. Keeping vaccines at stable temperatures from

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