Viral load may predict ventilator need, death risk; coronavirus damages red blood cells



a man in a blue shirt: FILE PHOTO: The coronavirus disease (COVID-19) outbreak in Oldham


© Reuters/PHIL NOBLE
FILE PHOTO: The coronavirus disease (COVID-19) outbreak in Oldham

By Nancy Lapid

(Reuters) – The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Viral load predicts need for ventilator, death risk

When COVID-19 patients are admitted to the hospital because of pneumonia, doctors can estimate their risk of needing mechanical breathing support or dying based on their “viral load” – the amount of virus genetic material obtained by swabbing the back of the nose and throat, a new study suggests. “This risk can be predicted regardless of how sick they are when they are admitted, what other comorbidities they may have, their age or how many days they had symptoms,” coauthor Dr. Ioannis Zacharioudakis of NYU School of Medicine told Reuters. His team studied 314 patients, dividing them into three groups according to viral load upon hospital admission. The group with highest viral levels had 59% higher odds of becoming critically ill or dying than the lowest viral load group. The data, published on Friday in Annals of the American Thoracic Society, “will have practical implications in our ability to judge which patients will benefit the most from early escalation of care, treatment with antivirals and/or inclusion in trials of new therapeutics,” Zacharioudakis said. (https://bit.ly/3oJijtQ)

Coronavirus damages red blood cell membranes

The new coronavirus damages the membranes of oxygen-carrying red blood cells, contributing to the hypoxemia, or low blood concentrations of oxygen, common in COVID-19, researchers have found. Signs of hypoxemia can range from shortness of breath to organ and tissue damage. Studying blood samples from COVID-19 patients and healthy individuals, researchers found the virus did not appear to affect red cells’ ability to pick up oxygen and deliver it throughout the body. But patients had “clear damage” to red cell membranes, in particular to a membrane protein responsible for helping the cell survive injuries. As a result, patients’ red cells might be more vulnerable to so-called oxidative stress and other injury, coauthor Angelo D’Alessandro of the University of Colorado Denver said in an email. Red cells circulate for up to 120 days before the body replaces them with new ones, and they cannot synthesize new components to replace the damaged parts. This might help explain why some COVID-19 symptoms can last for months, D’Alessandro said. (https://bit.ly/3mMBq4A)

Pandemic exacts toll on ER doctors’ mental health

COVID-19 is taking a toll on emergency physicians’ mental health and many are reluctant to seek help, according to poll results reported at the American College of Emergency Physicians (ACEP) annual meeting. Among a nationally representative group of 862 U.S. emergency physicians, 87% reported feeling more stressed since the pandemic began and 72% reported more burnout. More than 80% cited concern for their own health and safety, and the safety of their family and friends, around contracting COVID-19. Nearly half said they are uncomfortable seeking mental health services, 73% said

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We Talked to a Dentist About the Dangerous Teeth Trends Going Viral on TikTok

Many people turn to TikTok to stay up to date on the latest trends, from home improvement hacks to makeup tips. It can even be a resource for wellness and oral hygiene advice.



a close up of a person wearing glasses and looking at the camera: We Talked to a Dentist About the Dangerous Teeth Trends Going Viral on TikTok


© Getty / JGI/JamieGrill / JGI/Jamie Grill
We Talked to a Dentist About the Dangerous Teeth Trends Going Viral on TikTok

But, there are also plenty of dangerous fads that go viral on social media with little transparency about the harmful effects. The disastrous Kylie Jenner lip challenge from a few years ago and the more recent Benadryl challenge are two examples that come to mind.

Lately, TikTok has seen a wave of tooth-related videos that could potentially encourage young people to do irreversible damage to their dental health. We spoke to Dr. Ingrid Murra, DDS, founder of Two Front orthodontic care, about the risks of these concerning trends.

Nail-Glue Vampire Fangs

Some TikTok users are going to extreme lengths to celebrate spooky season this year, prioritizing frightfully realistic costumes over their dental health. The latest DIY look to gain traction on the app involves using nail adhesive, which contains similar ingredients to super glue, to attach vampire fangs to your teeth.

One video with over one million likes documents the moment user @muawk realizes her fake fangs are stuck and appears to hyperventilate as she tries to pull them from her teeth. In a follow-up video, she brushes and flosses frantically until they finally fall off.

According to Dr. Murra, this trend is unsafe because “nail glue can strip off the enamel of your teeth, which can increase the chance of getting cavities and cause sensitivity.” The powerful glue can also damage your gums.

If you do make the mistake of trying the damaging technique at home, Dr. Murra warns against trying to fix it yourself. Not only should your dentist be the one to get you out of the sticky situation, but they can actually safely place fangs on your teeth so you can channel the undead look, risk-free.

Shaving Teeth With a Nail File

Another concerning hack on the app could have even more permanent ramifications. Some users are taking a nail file to their teeth to even them out or make them smaller and filming the process. Once again, this can cause damage to your enamel.

“You risk removing too much enamel and causing sensitivity and increasing the chance of getting cavities,” Dr. Murra said. “Removing enamel is also permanent – unlike hair and nails, teeth don’t grow – so I highly recommend cosmetic changes by your dentist, prosthodontist, or orthodontist.” These professionals will do a more precise job, while being attentive to preserving tooth structure.

Depending on the cosmetic fix you want to make, there are a couple of different procedures a dentist may consider. If your teeth are too long, a dentist can carefully remove parts of your teeth to even them out, whereas if they are too short, they can build a composite to match your tooth shade. Either

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A deadline, then a viral surge and Florida hospitals miss out on pandemic aid

Florida’s caseload surged around the June cutoff date for the high-impact distribution. Between March and June 10, 2,801 people in the state had died from Covid-19 and 67,371 had tested positive for the virus, according to data from the Florida Department of Health.

Two months after the cutoff date, deaths had nearly tripled and the state was coping with an eightfold increase in cases.

Jackson and Shands are among 30 safety net hospitals designated to treat Florida’s poorest and typically uninsured residents. Combined, the hospitals have treated 60 percent of the state’s 46,693 hospitalized Covid-19 patients, but have received a sliver of the funding given to some states that saw fewer infections.

Gainesville-based Shands Hospital lost $160 million in revenue because of the pandemic and has received only $31.4 million in CARES Act aid. The shortfall forced Shands CEO Ed Jimenez to freeze employee raises indefinitely.

“Imagine you’re a nurse, and you take care of Covid patients, and your boss just said you don’t get a raise,” Jimenez said in an interview. “If Florida had gotten its fair share, if the safety nets had gotten their fair share, if my hospital had not been overlooked in the safety net tranche, things would be better.”

“They wouldn’t be great but they’d be better,” Jimenez said.

While Shands received $31.4 million from the Provider Relief Fund’s first phase of general distribution, it received no high-impact aid.

Jackson, which lost more than $78 million in revenue from the pandemic, said it received a combined $108 million from high-impact and general distributions. HHS data shows Jackson received $83.1 million from the high-impact fund.

And both Shands and Jackson got nothing from $14.4 billion set aside for safety net providers because, under HHS rules, both hospitals made too much money.

In Jackson’s case, the federal agency counted revenue from a tax levied by Miami-Dade County that funds the hospital. At Shands, Jimenez was unable to write off $68 million tied to the teaching hospital’s partnership with the University of Florida.

“After that, not a dime,” Jimenez said of the first phase of cash. Sens. Marco Rubio and Rick Scott heard his complaints, he said, but the Republican lawmakers told him there was little they could do.

“At the end of the day, it’s HHS, which is not subject to the will of the Congress or Senate,” JImenez said.

Talks with HHS Deputy Secretary Eric Hargan about updating the distribution rules went nowhere, Migoya said.

“Deputy Secretary Hargan was talking to me about it, and trying to figure out how to help us,” Migoya said. “It still didn’t happen.

“Obviously that was never the intent of the CARES money — that was to make up for lost revenues, but we’re not even close to that,” Migoya said.

When asked about the complaints from Jimenez and Migoya, a HHS spokesperson who would speak only on the condition of anonymity pointed to $20 billion set aside for Phase 3 of the general distribution, which opened for applications Oct.

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Dentist’s Viral TikTok Explains Why You’re Probably Using the Wrong Amount of Toothpaste



a man and a woman looking at the camera: You’re probably using too much toothpaste when brushing your teeth, per one dentist’s viral TikTok. You only need a pea-sized amount for max effectiveness.


© TikTok
You’re probably using too much toothpaste when brushing your teeth, per one dentist’s viral TikTok. You only need a pea-sized amount for max effectiveness.

  • You’re probably using using too much toothpaste when you brush your teeth, according to one dentist’s viral TikTok.
  • People over age 3 only need a pea-sized amount for maximum effectiveness—not a heaping swoop.
  • You also shouldn’t rinse your mouth with water or mouthwash right after brushing.

Ever feel like you’re constantly going through tubes of toothpaste? You might be using too much. According to TikTok’s viral Gao Jye Teh, B.D.S., a dentist based in the U.K., people over age 3 only need a pea-sized amount for maximum effectiveness—not a heaping swoop like ads typically show.

The young dentist shared a TikTok informing the public of the common misconception that garnered six million views. He also shared it to Instagram, writing: “Commercials are lying to you! You don’t need to use that much toothpaste. 🤯” Not only is it wasteful, it doesn’t make your teeth any cleaner.

Dr. Gao says the danger in using excess toothpaste, especially for children, lies in the risk of fluorosis—a cosmetic condition that changes the appearance of tooth enamel when too much fluoride (the cavity-preventing ingredient in toothpaste) is ingested. Fluorosis can present itself as mild discoloration, staining, and even obvious pitting. “Although dental fluorosis can be cosmetically treated, the damage done to the enamel is permanent,” Dr. Gao said in a separate video.

A 2013 to 2016 study from the Centers for Disease Control and Prevention (CDC) confirms Dr. Gao’s warning, citing that children under the age of 3 should only use “a smear” of fluoride paste “the size of a rice grain.”

In a following TikTok, Dr. Gao enlightened the internet with another common dental hygiene mistake. According to him, you shouldn’t rinse your mouth after brushing—not with water or mouthwash. “Flouride in your toothpaste takes time to work,” he wrote. “So spit, don’t rinse!” The comments flooded with concerned brushers. “So I haven’t really brushed my teeth for 14 years?” one person wrote. “I’ve done it all wrong my entire life,” another added.

Dr. Gao recommends waiting at least 20 or 30 minutes after brushing before having a drink of water or swishing mouthwash. Optimally, he suggests using a fluoride rinse later in the day. That way, you’ll get the full benefits of brushing and rinsing.

Some folks who are used to rinsing right away say they’re struggling to make the change. “Ideally, you should use [toothpaste and mouthwash] at separate times,” Dr. Gao replied to one comment. “If you really can’t stand not rinsing, using mouthwash after brushing is better than using water.”

The more you know, right?

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Viral Co-Infections With C. Diff Add Insult to Injury

Gastrointestinal viruses often come along with community-acquired Clostridioides difficile infection (CA-CDI), CDC researchers said.

Adult and pediatric patients with CA-CDI showed 12% prevalence of viral GI pathogens, norovirus being the most common, reported Alice Y. Guh, MD, MPH, of the CDC in Atlanta, reporting in PLoS One.

Assessing 155 patients with stool-confirmed CA-CDI at five cross-country U.S. sites from December 2012 to February 2013, the investigators identified 18 CDI patients with such viruses: 10 norovirus, four adenovirus, three rotavirus, and one sapovirus.

Co-infected patients were more likely than non-co-infected to have nausea or vomiting – 56% versus 31% (P=0.04) – suggesting viral co-pathogens contributed to these symptoms in some.

Paralleling earlier research, no significant differences emerged between the two groups in previous healthcare, medication exposures, or CDI outcomes complications.

An earlier U.S. study of viral co-infections in pediatric patients reported a higher prevalence of 24% and an association with a greater CDI bacterial burden. Again, norovirus was the most common viral pathogen detected. Other countries have reported even higher viral co-infection rates, approaching 70% in some cases.

A 2016 study assessing for additional symptoms such as abdominal pain and gas found CDI patients co-infected with norovirus had more severe gastrointestinal symptoms.

The current study was undertaken by the CDC’s Emerging Infections Program (EIP), which conducts population- and laboratory-based CDI surveillance. The five participating EIP sites were in Georgia, Maryland, Minnesota, New York, and Oregon.

Although primarily healthcare-associated, CDI has been increasingly reported in the community among people with no traditional CDI risk factors. In previous studies, more than 35% of CA-CDI patients reported no recent antibiotic use, while more than 50% reported nausea or vomiting, neither of which is traditionally associated with CDI. These findings raised concerns that other pathogens may be involved.

They speculated that some CA-CDI cases testing positive for a viral pathogen may have been truly co-infected, with the viral pathogen causing nausea or vomiting and CDI causing diarrhea. Alternatively, some of the co-infected cases could have been merely colonized with C. difficile and actively infected solely with a viral pathogen; in many cases identified as co-infections, C. difficile could not be cultured.

“As the use of multiplex molecular panels increases, a greater frequency of co-pathogens might be identified among patients with CDI,” Guh and colleagues wrote, calling for a better understanding of the clinical significance of such findings in order to guide patient management and infection prevention.

Thaddeus Stappenbeck, MD, PhD, of the Cleveland Clinic’s Lerner Research Institute in Ohio, commented to MedPage Today that polymicrobial infection of the intestine is a well-established paradigm in clinical medicine. It affects a small but significant percentage of patients infected with one gut viral or bacterial pathogen who show co-infection with a pathogen from the other class, he said.

“The co-infection seems to create worse symptoms in a subset of these patients but not all,” he told MedPage Today.

“This report provides evidence that C. diff infection shows co-infection with common viral infections at a rate similar

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Rural hospitals in Midwest face viral surge

WESSINGTON SPRINGS, S.D. — Rural parts of the American Midwest that had previously escaped the worst of the coronavirus are now seeing a surge — and hospitals are struggling to keep up.

Counties across Wisconsin, North Dakota, South Dakota and Montana sit among the top in the nation for new cases per capita over the last two weeks, according to Johns Hopkins researchers. In counties with just a few thousand people, the number of cases per capita can soar with even a small outbreak — and the toll hits close to home in tight-knit towns.

As the brunt of the virus has blown into the Upper Midwest and northern Plains, the severity of outbreaks in rural communities has come into focus. Doctors and health officials in small towns worry that infections may overwhelm communities with limited medical resources. And many say they are still running up against attitudes on wearing masks that have hardened along political lines and a false notion that rural areas are immune to widespread infections.

Even as outbreaks threaten to spiral out of control, doctors and health officials said they are struggling to convince people of the seriousness of a virus that took months to arrive in force.

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HERE’S WHAT YOU NEED TO KNOW ABOUT THE VIRUS OUTBREAK:

— Britain’s Space Agency is backing a medical drone delivery service that aims to move virus samples, test kits and protective equipment between hospitals.

— A spike in cases in Europe deals a bitter blow to the economy.

— In Germany, Chancellor Angela Merkel warned of “difficult months” ahead as the nation posted another daily record of new cases Saturday.

— Iran announces its virus death toll has reached 30,000.

— AP PHOTOS: India holds digital fashion week amid pandemic.

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— Follow AP’s pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

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HERE’S WHAT ELSE IS HAPPENING:

ROME — The Vatican says someone who lives in the same Vatican hotel as Pope Francis has tested positive for coronavirus, adding to the 11 cases of COVID-19 among the Swiss Guards who protect him.

The Vatican said Saturday that the resident of the Domus Sanctae Marthae has moved out temporarily and is in isolation, as are all the people who came into direct contact with him.

The hotel serves as a residence for Vatican-based priests as well as visiting clerics and lay people. Francis chose to live there permanently after his 2013 election, shunning the Apostolic Palace, because he said he needed to be around ordinary people. The hotel has a communal dining room and chapel where Francis celebrates Mass each morning.

The Vatican, a tiny city state in the center of Rome, has beefed up its anti-COVID-19 measures amid a resurgence of the outbreak in Italy. Protective masks are required indoors and out, but Francis has largely shunned them even when holding audiences with the public.

At 83 and with part of a lung removed when he was in his 20s due to illness, the pope would be at

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