Several studies have found that smoking cigarettes increases the risk of severe Covid-19 and death
However, until now, scientists haven’t fully understood how this happens
In a new study, UCLA researchers show how cigarette smoke blocks the first line of defence against infections
Since the early days of the pandemic, questions have been raised about the link between smoking and Covid-19, the disease caused by SARS-CoV-2.
In June this year, the World Health Organization stated that, based on existing literature assessing the association between smoking and Covid-19, there was “insufficient information to confirm any link between tobacco or nicotine in the prevention or treatment of Covid-19”.
However, more recent studies have shown that while smokers are not at risk of contracting infection, their risk of severe disease and death, once infected, is higher than that of non-smokers, although the ways that cigarette smoke exposure affects airway cell infection by SARS-CoV-2 have not been very clear.
A new study by scientists at the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research at the University of California has helped understand how this happens by investigating SARS-CoV-2 infection on a cellular and molecular level – using a model of airway tissue created from human cells.
To perform their study, the scientists employed a platform known as an air-liquid interface culture. Essentially, this is grown from human airway stem cells and closely replicates how the airways behave and function in humans.
The airways carry air breathed in through the nose and mouth to the lungs, also functioning as the body’s first line of defence against airborne pathogens, such as viruses, the authors noted.
“Our model replicates the upper part of the airways, which is the first place the virus hits,” said Brigitte Gomperts, a professor of pulmonary medicine and member of the UCLA Jonsson Comprehensive Cancer Center.
“This is the part that produces mucus to trap viruses, bacteria and toxins and contains cells with finger-like projections that beat that mucus up and out of the body.”
This type of model, Gomperts explained, has previously been used to study lung diseases for over a decade and has been shown to mimic the changes in the airway that can be seen in someone that smokes.
‘Smoking cigarettes is like creating holes in these walls’
The air-liquid cultures used in the study were grown from airway stem cells that were taken from the lungs of five young, healthy, non-smoking tissue donors.
To replicate the effects of smoking, the researchers exposed these airway interface cultures to cigarette smoke for three minutes per day over four days.
They then infected the cultures exposed to cigarette smoke (along with identical cultures that had not been exposed) with live SARS-CoV-2 viruses.
The two groups were compared. In the models exposed to smoke, the researchers saw between two and three times more infected cells.
Image source: UCLA Broad Stem Cell Research Center/Cell Stem Cell
A more in-depth analysis led to the conclusion that smoking resulted in more severe infection, at least in part, by blocking the activity of interferons (which play a critical role in the body’s early immune response to fight the virus).
“If you think of the airways like the high walls that protect a castle, smoking cigarettes is like creating holes in these walls,” Gomperts said.
“Smoking reduces the natural defences, and that allows the virus to set in.”
The rise in the use of alcohol-based hand sanitisers has increased the incidence of hand eczema
Hand eczema presents as a red itchy, sometimes burning or even tender, rash
Adequate skincare should, therefore, be prioritised, especially among healthcare workers
When Covid-19 started spreading across the globe, the World Health Organisation (WHO) and the Centers for Disease Control and Prevention recommended that the best way to prevent Covid-19 infection is through physical distancing, wearing cloth masks, as well as frequent and proper handwashing and surface decontamination.
The call for regular handwashing led to an exponential rise in the use of alcohol-based hand sanitisers, which has increased the incidence of hand eczema in healthcare workers as well as the general population.
Two kinds of hand eczema
Hand eczema characteristically presents as a red itchy, sometimes burning or even tender, rash. The rash may be dry with cracked and scaly skin, or wet with blisters, oozing and crusting. Certain individuals, such as those with underlying atopic (a general disposition to develop) eczema, are at greater risk of developing alcohol rub hand eczema due to the inherent impaired barrier function of the skin characterising this condition.
In a study from Hubei province in China, 434 healthcare workers were interviewed, with 321 (74%) reporting that they sanitise their hands more than 10 times per day. Of those healthcare workers, 246 (76.6%) reported symptoms of hand eczema, with the most common being irritant contact hand eczema and less commonly allergic contact hand eczema.
Another study from Milan reported that from 9 March to 4 May 2020 there were 24 new cases of hand eczema in the general population related to the use of alcohol-based sanitisers.
Some of the issues with alcohol-based hand sanitisers include the use of non-standard formulae (meaning that methanol is used instead of ethanol); types of alcohol such as isopropyl alcohol vs. ethanol; as well as varying amounts of alcohol (<60%). The various recipes making the rounds on social media in the early days of lockdown illustrate this point.
“Irritant” contact hand eczema may develop in anyone whose hands are exposed to irritants such as water, soap, or alcohol hand sanitisers. “Allergic” contact hand eczema, on the contrary, will only develop in those who have been primed to develop skin irritation to certain substances such as nickel, latex or colophony (found in adhesives, cosmetics and printing ink).
Debilitating and painful disease
An intact skin usually deters from the development of the latter form of hand eczema. Irritants assist in disrupting the skin barrier, improving the likelihood of developing allergic contact hand eczema.
Alcohol rub hand eczema can become a debilitating and painful disease, resulting in work absenteeism which can severely impair the delivery of essential services. The increased frequency of handwashing and use of alcohol hand sanitiser associated with Covid-19 prevention dramatically increases the likelihood of developing allergic contact hand eczema, which may greatly impact quality of life as well as cause occupational difficulties in the long run.
Apart from the discomfort of dry, itchy skin, the breaks in the skin can serve as a point of entry for Covid-19 because of viral receptors in the blood vessels of the skin. Painful, dry skin could also inadvertently decrease hand hygiene compliance which further increases the risk of disease transmission in these individuals. Prevention is therefore essential.
It has become clear that the Covid-19 pandemic will persist for the foreseeable future. Equally clear has been the gargantuan impact of this viral infection. Therefore, the importance of following protective guidelines, such as outlined by health and government organisations, is undeniable and should be closely adhered to.
The WHO has recommended a 60% alcohol-containing hand sanitiser with 1.45% glycerol as a moisturising agent to protect healthcare workers, and now the frequently sanitising public, from the complications of excessive alcohol hand rub usage. The minimum amount of glycerol required to decrease the risk of hand eczema is not known, although studies have shown that even lower levels than the recommended 1.45% glycerol were effective to protect the skin from excessive drying.
Moisturisers few and far between
Further recommendations include the use of an emollient-containing hand cream immediately after sanitising. Although this is a useful measure to prevent alcohol rub dermatitis, one study showed that only approximately one in five healthcare workers did so after using alcohol hand rub. This figure is highly unlikely to be higher among the general public.
Sanitising stations are located everywhere in hospitals and public areas and have been an important means of combating the spread of Covid-19. However, moisturisers are few and far between, hence the increased incidence of alcohol rub hand eczema during the pandemic.
Adequate skin care could increase hand hygiene compliance and should therefore be prioritised, especially among healthcare workers. Furthermore, preventative measures are critical to allay the next, albeit completely different wave, that of allergic contact hand eczema – another unintended health consequence of Covid-19.
*Dr Suretha Kannenberg is a Consultant Dermatologist in the Division of Dermatology at Stellenbosch University. Sergio Alves and Allison Arendse are 5th-year medical students in the same division. This is a revised version of their article recently published in the South African Medical Journal.
Face masks don’t restrict breathing during exercise, researchers say
This means that they’re harmless and should therefore be worn when exercising
An exception, however, is in cases where people suffer from severe cardiopulmonary disease
Since a face mask is supposed to cover the mouth and nose in order to limit the spread of the new coronavirus, wearing one while exercising is uncomfortable for most people.
However, contrary to previous findings that wearing a mask during exercising impairs oxygen intake – as well as the World Health Organization’s official advice, stating that “people should NOT wear masks while exercising, as masks may reduce the ability to breathe comfortably” – a new study suggests that this isn’t the case.
According to the researchers who looked at the effects of face masks on the cardiorespiratory system (the heart, blood vessels, and lungs) during physical activity, most people should be able to breathe perfectly well with a mask on while exercising, despite it not feeling comfortable.
“There might be a perceived greater effort with activity, but the effects of wearing a mask on the work of breathing, on gases like oxygen and CO2 in blood or other physiological parameters, are small, often too small to be detected,” study author and exercise physiologist, Susan Hopkins from the University of California San Diego (UCSD), said in a news release by the university.
For their study, Hopkins and colleagues reviewed existing scientific literature on the effects of different face masks, including surgical masks, N95 respirators, and cloth face masks, on cardiorespiratory response during physical activity.
Based on their analysis, they said that current evidence suggests while face masks worn by healthy people during exercise result in minimal resistance to airflow, they do not seem to significantly impact lung function and oxygen intake, and are therefore harmless.
They did acknowledge that dyspnea (breathing discomfort) may potentially increase when exercising with a face mask, especially when one is not used to doing so.
“Wearing a face mask can be uncomfortable,” says Hopkins.
“There can be tiny increases in breathing resistance. You may re-inhale warmer, slightly enriched CO2 air. And if you’re exercising, the mask can cause your face to become hot and sweaty.
“But these are sensory perceptions. They do not impact cardiopulmonary function in healthy people.”
Exceptions for certain people
The authors also gave the assurance that their findings apply to both young and old adults, irrespective of gender. However, there is an exception in patients with severe cardiopulmonary disease who have an increased risk of experiencing exertional dyspnea, they cautioned.
“In such cases, these individuals might feel too uncomfortable to exercise, and that should be discussed with their doctor,” Hopkins said.
“However, the fact that these individuals are at great risk should they contract Covid-19 must also be considered.”
The researchers also disclosed that the literature investigating this issue is evolving and that further studies are still needed to support these findings.
The first results for a Covid vaccine are out, with Pfizer and BioNTech reporting 90% efficacy and Moderna reporting almost 95% efficacy based on early data
Despite its promise, cold chain requirements mean this jab wouldn’t be the first choice for countries like South Africa
The vaccine needs to be kept at minus 70 degrees Celsius, well below other vaccines used in South Africa, which poses a huge challenge to its delivery and storage
The world’s first hope for a Covid-19 vaccine – the jab developed by drug companies Pfizer and BioNTech, showing 90% efficacy in preventing Covid-19 in early results, and Moderna’s candidate showing almost 95% efficacy – is highly unlikely to become widely available in South Africa.
This is because Pfizer’s vaccine needs to be stored below freezing temperatures – at minus 70 degrees Celsius — that the country doesn’t have the capacity to do on a large scale. If the shots are kept at temperatures too high or too low, they can spoil and become less effective.
In the United States, large city hospitals are already “rushing to buy the expensive ultra-cold freezers” that cost between R150 000 and R235 000 each, to store the shots, for which Pfizer and BioNTech will apply for an emergency license from the US regulator, the Food and Drug Administration (FDA), later this month, Statnews reports.
And just three days after the announcement of the BNT162b2 vaccine’s first interim results, the European Union signed an agreement with the manufacturers to supply it with 200 million doses and an option to request an additional 100 million doses, “with deliveries anticipated to start by the end of 2020, subject to regulatory approval”.
But South Africa doesn’t have the required ultra-cold freezers to store the vaccine – except for a few at large research institutions such as the National Institute for Communicable Diseases, says director of Vaccines for Africa at the University of Cape Town, Gregory Hussey.
And, along with less well-off rural hospitals in developed countries, the country is unlikely to be able to afford to buy enough of the freezers to be able to make the vaccine available at community health centres or clinics, or pay for the cold chain systems that are necessary to maintain the vaccines.
Most vaccines that are part of South Africa’s immunisation programme have to be kept at temperatures between two and eight degrees Celsius. The country’s system – including vaccine transportation, storage, and monitoring – is therefore not suitable for vaccines that need to be kept below freezing temperatures.
And the Pfizer/BioNTech vaccine is not the only Covid-19 frontrunner that is likely to pose a problem to South Africa. The biotechnology company, Moderna’s mRNA-1273 jab, which released its first results on Monday, needs to be stored at minus 20 degrees Celsius.
Although, the pharmaceutical company released new data on Monday showing that their candidate could be stored at a standard temperature of between two and eight degrees Celsius for up to 30 days – compared to its shelf life of six months when kept frozen. Despite this revised storage temperature, the jab still needs to be shipped and transported at minus 20 degrees Celsius.
Pfizer/BioNTech and Moderna’s vaccine both use mRNA technology. Such vaccines use pieces of man-made genetic material known as messenger ribonucleic acid, or mRNA, that instructs our bodies to produce proteins, in the form of antibodies and killer cells, to fight off SARS-CoV-2, the virus that causes Covid-19.
But the snag is that these two mRNA vaccines need to be kept at extremely low temperatures, or they risk becoming damaged.
And to complicate things even further, mRNA vaccine technology is new – not a single vaccine using mRNA messengers has been licensed for human use up to date.
“I don’t know if we could really even contemplate an mRNA vaccine with our present setup,” explains Barry Schoub, chair of South Africa’s ministerial advisory committee on coronavirus vaccines. “Things may change, but with our present setup, the places where we could actually utilise it would be so limited that it would be a major challenge.”
South Africa’s challenge of keeping vaccines cool
Maintaining a cold chain – where a product must be consistently stored at a low temperature – is important to ensure that vaccines don’t degrade or lose their efficacy. A 2018 paper in the journal Vaccine, showed that although this deterioration did not pose a safety risk to people receiving the vaccine, the jabs offered less protection after being stored at the wrong temperature.
This is a major risk for rural hospitals and clinics or those facilities that lack adequate infrastructure to properly store doses when a Covid vaccine becomes available, according to Hussey, who also serves on the Covid vaccines ministerial advisory committee.
Schoub, who is also a virologist and former director of the National Institute for Communicable Diseases, agrees: “You can’t really store vaccines reliably and sustainably at minus 20 degrees Celsius anywhere outside the bigger cities. Especially if you’re looking at places with a hotter climate, like the Northern Cape or KwaZulu-Natal, even maintaining a freezer at minus 20 is going to be a question mark.”
This means that even with Moderna’s stability at lower temperatures, South Africa’s cold chain system may be unable to handle maintaining the vaccine at its required minus 20 degrees Celsius during transport. Fluctuations in the temperature along the way could cause the jab to become less effective and offer less protection to the person being vaccinated.
But even without taking into account the additional obstacles that will arise with maintaining a vaccine at well below 0 degrees Celsius, just regulating the temperature for our existing vaccines is already a challenge.
An assessment of vaccine management in 18 countries done by the World Health Organisation Regional Office for Africa in 2001 found that “only 47% of the indicators were satisfactorily met for buildings, cold chain equipment, and transport at the national level”.
In the Western Cape, a 2015 study published in Vaccine found that government-managed vaccine supply chains were often unable to manage the temperatures at which vaccines need to be stored, adequately.
The average temperature of health centre fridges in the study ranged from 0.9 to 9.2 degrees Celsius, meaning that the jabs could have potentially been stored at temperatures both too low or too high and been damaged.
Why does 90% efficacy matter?
Despite the delivery challenges of the Pfizer/BioNTech vaccine, its 90% potential efficacy has physicians and scientists, who mostly expected a much lower efficiency, excited.
Although it is only initial data that could still change as the trial progresses, this kind of efficacy puts the jab in the same category as the world’s most effective vaccines, such as the measles shot.
Schoub explains: “If it does turn out to be true then that is a major, giant step forward, but at this stage it’s very difficult to assess how accurate that figure is because it’s still early in the trial.”
A higher efficacy rate means that the jab is able to offer more protection to a population. This is important when it comes to the role of a vaccine in offering immunity to a community.
If only half the people receiving a vaccine are going to be protected, you need to vaccinate a much larger portion of the population in order for it to make a difference and properly contain an outbreak.
But until now, scientists have been skeptical that we would be able to reach the same level when it came to Covid-19.
As Schoub explains, it was speculated that a Covid vaccine would be unlikely to offer the same level of protection as the measles shot because of the differences between the two diseases. While both are spread in a similar manner, through coughs or sneezes, they fundamentally differ in how they affect a person’s body.
Measles is a systemic disease, meaning it affects the whole body, while Covid is initally a pulmonary disease that mainly targets the lungs. In that respect, Covid is more similar to influenza, which is what has been used as the sort of benchmark when it comes to vaccine efficacy, says Schoub.
The distinction in how the disease works matters, because it influences the type of immune response – with measles requiring the production of antibodies in the blood to fight off the measles virus and influenza needing a more complicated immune response through antibodies in respiratory secretions.
The type of immune response needed to fight off influenza is hard to get through vaccinations, with most flu jabs only offering around a 60% chance of protection from the infection.
Most Covid vaccine trials are therefore designed to pick up around 60% efficacy in a vaccine candidate, the director of the American government’s National Institute of Allergy and Infectious Diseases, Anthony Fauci, explained in a Medical Brief webinar in October.
But regardless of whether the Pfizer/BioNTech candidate is suitable for South Africa, the issue of delivering a vaccine is something we need to begin working on now, says Hussey.
He concludes: “There is a huge cost involved in delivering a vaccine, the World Health Organisation has estimated that cost of delivery of vaccines could be up to two or three-fold greater than the cost of the vaccines alone.
“There is also the additional operational costs of conducting immunization campaigns during the Covid-19 pandemic. We have to ensure that the facilities, the staff administering vaccines and the recipients of vaccines are kept ‘Covid safe’. That’s something we need to factor into our planning.”
“Getting the vaccine out to the people who need it is the challenge and we don’t have a great track record in even getting routine vaccines to the communities that need them most.”
The first results for a Covid vaccine are out, with Pfizer and BioNTech reporting 90% efficacy based on early data
Despite its promise, cold chain requirements mean this jab wouldn’t be the first choice for countries like South Africa
The vaccine needs to be kept at minus 70 degrees Celsius, well below other vaccines used in South Africa, which poses a huge challenge to its delivery and storage
The world’s first hope for a Covid-19 vaccine – the jab developed by drug companies Pfizer and BioNTech, showing 90% efficacy in preventing Covid-19 in early results – is highly unlikely to become widely available in South Africa.
This is because the vaccine needs to be stored below freezing temperatures – at minus 70 degrees Celsius – that the country doesn’t have the capacity to do on a large scale. If the shots are kept at temperatures too high or too low, they can spoil and become less effective.
In the United States, large city hospitals are already “rushing to buy the expensive ultra-cold freezers” that cost between R150 000 and R235 000 each, to store the shots, for which Pfizer and BioNTech will apply for an emergency license from the US regulator, the Food and Drug Administration (FDA), later this month, Statnews reports.
And just three days after the announcement of the BNT162b2 vaccine’s first interim results, the European Union signed an agreement with the manufacturers to supply it with 200 million doses and an option to request an additional 100 million doses, “with deliveries anticipated to start by the end of 2020, subject to regulatory approval”.
But South Africa doesn’t have the required ultra-cold freezers to store the vaccine – except for a few at large research institutions such as the National Institute for Communicable Diseases, says director of Vaccines for Africa at the University of Cape Town, Gregory Hussey.
And, along with less well-off rural hospitals in developed countries, the country is unlikely to be able to afford to buy enough of the freezers to be able to make the vaccine available at community health centres or clinics, or pay for the cold chain systems that are necessary to maintain the vaccines.
Most vaccines that are part of South Africa’s immunisation programme have to be kept at temperatures between two and eight degrees Celsius. The country’s system – including vaccine transportation, storage, and monitoring – is therefore not suitable for vaccines that need to be kept below freezing temperatures.
And the Pfizer/BioNTech vaccine is not the only Covid-19 frontrunner that is likely to pose a problem to South Africa. The pharmaceutical company, Moderna’s mRNA-1273 jab, of which the first results are likely to be released before the end of the year, needs to be stored at minus 20 degrees Celsius.
Pfizer/BioNTech and Moderna’s vaccine both use mRNA technology. Such vaccines use pieces of man-made genetic material known as messenger ribonucleic acid, or mRNA, that instructs our bodies to produce proteins, in the form of antibodies and killer cells, to fight off SARS-CoV-2, the virus that causes Covid-19.
But the snag is that these two mRNA vaccines need to be kept at extremely low temperatures, or they risk becoming damaged.
And to complicate things even further, mRNA vaccine technology is new – not a single vaccine using mRNA messengers has been licensed for human use up to date.
“I don’t know if we could really even contemplate an mRNA vaccine with our present setup,” explains Barry Schoub, chair of South Africa’s ministerial advisory committee on coronavirus vaccines. “Things may change, but with our present setup, the places where we could actually utilise it would be so limited that it would be a major challenge.”
South Africa’s challenge of keeping vaccines cool
Maintaining a cold chain — where a product must be consistently stored at a low temperature – is important to ensure that vaccines don’t degrade or lose their efficacy. A 2018 paper in the journal Vaccine, showed that although this deterioration did not pose a safety risk to people receiving the vaccine, the jabs offered less protection after being stored at the wrong temperature.
This is a major risk for rural hospitals and clinics or those facilities that lack adequate infrastructure to properly store doses when a Covid vaccine becomes available, according to Hussey, who also serves on the Covid vaccines ministerial advisory committee.
Schoub, who is also a virologist and former director of the National Institute for Communicable Diseases, agrees: “You can’t really store vaccines reliably and sustainably at minus 20 degrees Celsius anywhere outside the bigger cities. Especially if you’re looking at places with a hotter climate, like the Northern Cape or KwaZulu-Natal, even maintaining a freezer at minus 20 is going to be a question mark.”
But even without taking into account the additional obstacles that will arise with maintaining a vaccine at well below 0 degrees Celsius, just regulating the temperature for our existing vaccines is already a challenge.
An assessment of vaccine management in 18 countries done by the World Health Organisation Regional Office for Africa in 2001 found that “only 47% of the indicators were satisfactorily met for buildings, cold chain equipment, and transport at the national level”.
In the Western Cape, a 2015 study published in Vaccine found that government-managed vaccine supply chains were often unable to manage the temperatures at which vaccines need to be stored, adequately.
The average temperature of health centre fridges in the study ranged from 0.9 to 9.2 degrees Celsius, meaning that the jabs could have potentially been stored at temperatures both too low or too high and been damaged.
Why does 90% efficacy matter?
Despite the delivery challenges of the Pfizer/BioNTech vaccine, its 90% potential efficacy has physicians and scientists, who mostly expected a much lower efficiency, excited.
Although it is only initial data that could still change as the trial progresses, this kind of efficacy puts the jab in the same category as the world’s most effective vaccines, such as the measles shot.
Schoub explains: “If it does turn out to be true then that is a major, giant step forward, but at this stage it’s very difficult to assess how accurate that figure is because it’s still early in the trial.”
A higher efficacy rate means that the jab is able to offer more protection to a population. This is important when it comes to the role of a vaccine in offering immunity to a community.
If only half the people receiving a vaccine are going to be protected, you need to vaccinate a much larger portion of the population in order for it to make a difference and properly contain an outbreak.
But until now, scientists have been skeptical that we would be able to reach the same level when it came to Covid-19.
As Schoub explains, it was speculated that a Covid vaccine would be unlikely to offer the same level of protection as the measles shot because of the differences between the two diseases. While both are spread in a similar manner, through coughs or sneezes, they fundamentally differ in how they affect a person’s body.
Measles is a systemic disease, meaning it affects the whole body, while Covid is initally a pulmonary disease that mainly targets the lungs. In that respect, Covid is more similar to influenza, which is what has been used as the sort of benchmark when it comes to vaccine efficacy, says Schoub.
The distinction in how the disease works matters, because it influences the type of immune response – with measles requiring the production of antibodies in the blood to fight off the measles virus and influenza needing a more complicated immune response through antibodies in respiratory secretions.
The type of immune response needed to fight off influenza is hard to get through vaccinations, with most flu jabs only offering around a 60% chance of protection from the infection.
Most Covid vaccine trials are therefore designed to pick up around 60% efficacy in a vaccine candidate, the director of the American government’s National Institute of Allergy and Infectious Diseases, Anthony Fauci, explained in a Medical Brief webinar in October.
But regardless of whether the Pfizer/BioNTech candidate is suitable for South Africa, the issue of delivering a vaccine is something we need to begin working on now, says Hussey.
He concludes: “There is a huge cost involved in delivering a vaccine, the World Health Organisation has estimated that cost of delivery of vaccines could be up to two or three-fold greater than the cost of the vaccines alone.
“There is also the additional operational costs of conducting immunization campaigns during the Covid-19 pandemic. We have to ensure that the facilities, the staff administering vaccines and the recipients of vaccines are kept ‘Covid safe’. That’s something we need to factor into our planning.”
And even though South Africa is only expecting to get enough Covid vaccines for around 5% of its population by next year, and a large rollout to the general public will likely only come in the next two years, Hussey cautions: “I think getting the vaccine is a simple thing. Getting the vaccine out to the people who need it is the challenge and we don’t have a great track record in even getting routine vaccines to the communities that need them most.”
The average temperature for healthy persons used to be around 37°C
Over the last two centuries, it seems there has been a drop in temperature
Researchers are puzzled as to why this may be the case
In 1868, German physician Carl Wunderlich reported that a healthy body temperature reading was 37°C. Now, almost two centuries later, researchers have noticed that the average body temperature in healthy individuals is declining.
According to a paper compiled by researchers from Stanford University, temperatures of adults in the United States has decreased 0.03°C per decade, which led the authors to believe that people in higher-income countries now have an average body temperature that is 1.6°C lower than in 1868. Researchers attributed this drop in body temperature to reductions in infectious diseases.
Lower temperatures in high-income countries
A more recent study conducted by a group of physicians, anthropologists and local researchers found similar results when studying the Tsimane Amerindians of the Bolivian Amazon.
The existing hypothesis – that people have lower temperatures in high-income countries – led to researchers further hypothesizing that people in lower-income areas would have higher temperatures. The researchers, led by Michael Gurven (professor of anthropology at University of California Santa Barbara), wanted to test the hypothesis in this population.
Why choose the Tsimane?
The Tsimane are indigenous people of lowland Bolivia who have a minimalistic lifestyle, without access to running water and sanitation.
Researchers found that the Tsimane were exposed to many disease-causing agents, “indicated by elevated immune activation biomarkers throughout life”.
The majority of deaths among the Tsimane was due to infection, and they also exhibit endemic polyparasitism (natural infestation by two or more parasites).
They also have a high resting metabolism, which means when they are not moving their bodies they still burn a high number of calories, leading to an increase in temperature. These reasons further led researchers to believe that they would have higher body temperatures.
Predictions contradicted
Body temperatures collected by the Tsimane Health and Life History Project (THLHP) since 2002 were used in the study. Researchers found that contrary to their predictions, there has also been a rapid decrease in average body temperature in the Tsimane population.
According to researchers, during the earliest study period from 2002 to 2006, unadjusted mean BTs for adult women and men were 37.02°C. However, between 2012 to 2018, body temperature dropped by 0.45°C for women and 0.49°C for men.
This drop in temperature happened over two decades, whereas the drop in body temperature in the US population was observed over almost two centuries. Surprisingly, researchers could not find the reasons behind this drop in temperature.
Researchers from the American Museum of Natural History have identified a new “hidden” gene in SARS-CoV-2, the virus that causes Covid-19, and say this may explain why it is so highly infectious.
The discovery of the “overlapping gene”, named ORF3d, could have a significant impact on how we combat the virus, the research team wrote. Overlapping genes (OLGs) are a type of ‘gene within a gene’, effectively concealed in a string of nucleotides, ScienceAlert explains.
“Overlapping genes may be one of an arsenal of ways in which coronaviruses have evolved to replicate efficiently, thwart host immunity, or get themselves transmitted,” said lead author Chase Nelson, a postdoctoral researcher at Academia Sinica in Taiwan and a visiting scientist at the American Museum of Natural History.
“Knowing that overlapping genes exist and how they function may reveal new avenues for coronavirus control, for example through antiviral drugs.”
Their findings were published in the journal eLife.
According to the team’s findings, the newly discovered gene is present in a previously discovered pangolin coronavirus. This, they say, possibly reveals repeated loss or gain of this gene during the evolution of the new coronavirus, as well as related viruses.
The most effective way to stop the spread of a virus is to prevent contact with everyone who is infected. Those who are infected can be isolated and treated if necessary. To determine who they are, it’s necessary to actively look for and manage cases.
During the Covid-19 pandemic, emerging technologies are being repurposed to help trace whoever has been in contact with an infected person.
Some of these technologies, such as the Global Positioning System (GPS), wi-fi and Bluetooth, are not new. GPS has been used to find accident victims at precise geographic locations. Some of the uses of wi-fi are oxygen monitoring devices, smart beds, access to electronic medical records and real-time access to X-rays and magnetic resonance imaging scans.
Now these tools can also help do one of the most important jobs in the pandemic: track and trace. They allow people some movement and economic activity, with the ability to manage their own risk of being exposed to possible infection or spreading any infection.
The South African government recently introduced a mobile application, COVID Alert SA, to help people notify their close contacts if they are infected.
The app is based on smartphone technology enabled by readily available functions developed by Apple or the Google Exposure Notification System. It uses a phone’s signal to generate a random code. The code is then exchanged with other users of the same app within a two metre radius. These codes are stored on the respective devices for two weeks.
Newly elected DA leader John Steenhuisen has come out guns blazing following President Cyril Ramaphosa’s extension of the national state of disaster by another month, to 15 December, in order to keep Covid-19 prevention measures in place.
Ramaphosa made a number of announcements on Wednesday evening.
South Africa will be allowing tourists from all countries across its borders under an upcoming amendment to the Level 1 Covid-19 lockdown regulations, ending the controversial red-list travel system.
Trading hours will also be normalised, “for instance for the sale of alcohol for retail outlets”.
But Steenhuisen said it was “incomprehensible” that the state of disaster has been extended by yet another month.
“Government cannot keep managing South Africa around a single risk when our nation is so imperilled by far greater risks, such as poverty, hunger and unemployment,” the DA leader said in a statement following Ramaphosa’s address.
As the coronavirus pandemic continues around the world, some people are turning to an emerging black market for fake negative test results.
In France, at Paris’ Charles de Gaulle Airport in September, a group of seven people were arrested for selling falsified digital certificates intended to prove negative coronavirus results, the AP reported last week.
The group was discovered following an investigation sparked by a traveler leaving France for Ethiopia. The traveler reportedly had a fake digital certificate that claimed they tested negative for the virus.
The group in Paris was reportedly selling the fake test results for $180 (R2,800) to $360 (R5,600) apiece.
In another case, in late October, a group of travelers in Brazil was found with falsified negative test results in an attempt to enter the Fernando de Noronha island group, the AP reported.
Rather than buying fake test results, the group is accused of altering their own results.
Dr. Michael Osterholm, an influential Covid-19 advisor to President-elect Joe Biden, on Wednesday called for a four- to six-week nationwide lockdown to help drive down infection numbers.
Osterholm, part of Biden’s 13-person Covid-19 advisory panel announced Monday, told Yahoo Finance on Wednesday that the US had a “big pool of money” to help pay for people’s lost wages and get the economy back on track during a lockdown while a vaccine was being rolled out.
Osterholm said a national lockdown would drive the number of new cases down, “like they did in New Zealand and Australia.”
“We could pay for a package right now to cover all of the wages, lost wages for individual workers, for losses to small companies, to medium-sized companies or city, state, county governments. We could do all of that,” he said. “If we did that, then we could lock down for four to six weeks.”
He added: “We could really watch ourselves cruising into the vaccine availability in the first and second quarter of next year while bringing back the economy long before that.”
Over the last seven days, the US has recorded an average of more than 112,000 daily cases. Cases reached an all-time peak of more than 132,000 on Friday.
HEALTH TIPS (as recommended by the NICD and WHO)
• Maintain physical distancing – stay at least one metre away from somebody who is coughing or sneezing
• Practise frequent hand-washing, especially after direct contact with ill people or their environment
• Avoid touching your eyes, nose and mouth, as your hands touch many surfaces and could potentially transfer the virus
• Practise respiratory hygiene – cover your mouth with your bent elbow or tissue when you cough or sneeze. Remember to dispose the tissue immediately after use.
Before Covid-19, one in three South Africans presented with a psychological disorder during their lifetime
Adding to the problem, the pandemic has caused a significant rise in depression, anxiety and trauma symptoms
One of the most insidious barriers to seeking treatment is, however, the silence surrounding mental health
As a mental healthcare provider, I approach the end of every year with some trepidation. As soon as the August winds start to blow in Bloemfontein, we tend to see a distinct increase in our community’s psychological distress. The year 2020 has not spared us this increased burden of suffering.
This year has presented humanity with extreme challenges and our university community has felt this to our core. The latest research indicates that the South African population has been affected by the pandemic in various ways and on various levels but none less severe than our psychological health.
One in three South Africans will present with a psychological disorder during their lifetime (and this was prior to the Covid-19 outbreak), and the effects of the pandemic have caused a significant rise in depression, anxiety and trauma symptoms among South Africans.
In mourning
We are experiencing exceptionally high levels of financial stress due to the impact of the disease and lockdown on our economy. We have endured months of social distancing, fears surrounding our own health and the well-being of our loved ones, our financial safety, managing our children’s home-schooling, adapting to distance-learning and concerns about the academic year being salvaged.
We have had to experience loss after loss. We mourn loved ones, colleagues and acquaintances that have become ill or passed away due to the pandemic. We have mourned the loss of our normal lives. The hugs, handshakes, casually touching someone’s arm, the shows, sporting events, weddings, graduations and braais we took as for granted.
We grieve for a time before sanitising and masks and avoiding contact with our fellow humans were the daily norm. We miss our offices and tearoom banter. We miss being with our students. Amid all of these losses, we know that our rates of gender-based violence, suicide and substance abuse have increased. When people are forced to spend time with others in confined spaces amid increasing financial, health and social stressors, frustration and fear may lead to damaging reactions and dysfunctional coping mechanisms.
World Mental Health Awareness Day on 10 October could not have arrived at a better time. This year the World Health Organization is encouraging investment into mental healthcare across the globe. While this is an essential step in increasing access to mental healthcare services, it is also only one aspect in the use of psychological treatment resources.
One of our most important barriers to providing mental healthcare often lies within us. Mental illness remains one of the most stigmatised conditions in society, even though each one of us will be affected by our own or our loved ones’ mental-health problems at some point during our lives. Some of the common problematic and erroneous beliefs society holds about people who struggle with mental illness is that they are somehow deviant, dangerous, weak or even faking it.
Unfortunately, our healthcare workers are not immune to such prejudicial attitudes and neither are their patients. Self-stigmatisation occurs when we internalise these discriminatory generalisations and fail to access mental healthcare because we believe that we should be stronger, or just pull ourselves together or worry about the impact of receiving a psychiatric diagnosis on our career or our relationships.
Silence one of the most insidious barriers
We fear being judged by our healthcare providers, our employers, colleagues, family and friends. This culminates in a situation where we lead lives of quiet desperation – numbing our distress with distractions and substances and perhaps even work. The silence surrounding mental health is one of the most insidious barriers to accessing treatment – because you cannot be helped if nobody knows you are suffering.
This is the tragedy of suicide, which more frequently than we wish to believe, is the final symptom of depression and severe psychological illness. I have had to assist more patients than I care to recall to work through the trauma and grief of losing a loved one to suicide.
Perhaps one of the most tragic aspects of this is that almost all would sit in utter shock recalling how their loved one had seemed fine. How this came out of the blue. How he or she had never told anyone how difficult life had become for them. How hard it was to get out of bed each morning. How much energy it took to go through the motions of a normal day. How ultimately they were so ill that they believed that they were a burden to their family and friends. How they could see no hope of relief from their pain other than to end their lives. And nobody knew. They were silent in their suffering because of fear of stigma, judgement, rejection or being viewed as a burden.
The surprising gift of the pandemic
Mental illness does not discriminate against anyone. It affects professors, students, support staff and the greater university community equally. Nobody is spared these struggles. This is what we all share, the human experience of life’s seasons which we cannot do alone. When we need the help of more than our resilience, support structure and exercise routine.
This is where the pandemic has brought some unexpected gifts. Prior to March of this year, it was very unusual for psychologists to provide online or telephonic therapy. In fact, many medical aids were uncomfortable covering teletherapy. Once we had no other alternative, however, we all had to adapt. Suddenly I no longer only saw patients who were able to attend sessions at my office. Now I could assist students and doctors who were in lockdown across the country. I could refer patients to the appropriate therapist, irrespective of where they were.
Patients no longer had to negotiate the uncomfortable experience of waiting in a psychologist’s waiting room or being seen leaving an office looking upset or need to take time off work to attend a session. Now patients can access their psychotherapist from the containment and confidentiality of their own space, and we, in turn, are more freely available as we are not bound to a specific venue.
Receiving psychological treatment is becoming as normal a part of well-being as going for a run, or eating healthily or spending time with our social support system. And this is what is going to save lives. The more we normalise the use of psychological services, the less stigma and silencing we will be subjected to.
We survived a pandemic
As a clinical psychologist, I proudly tell my students, colleagues and patients that I have my own psychotherapist without whom I would not be the therapist, colleague, friend and mom I am. There is no shame in owning our vulnerability and reaching out for assistance in order to make meaningful and even enjoyable the few journeys around the sun that we have left.
So this October of 2020 should be the month when we start the conversation about our mental health. And by doing, so we permit those around us to do the same. We have survived a pandemic that changed the world and our daily lives. It’s okay not to be okay.
*Angie Vorster is a Clinical Psychologist at the School of Clinical Medicine, University of the Free State.
Asthma has not proven to be one of the top comorbid diseases for worse Covid-19 outcomes
Researchers have speculated that people with allergy-driven asthma might even have some protection against Covid-19
They, however, found that non-allergic asthma increases the risk of severe Covid-19 by up to 48%
Everyone agrees about the good news – people whose asthma is spurred on by allergies don’t appear to have an increased risk of life-threatening illness if they contract Covid-19.
“Asthma has not risen as one of the top comorbid diseases for worse Covid-19 outcomes,” said Dr Sandhya Khurana, director of the Mary Parkes Center for Asthma, Allergy and Pulmonary Care at the University of Rochester (New York) Medical Center. “We always worry with asthma and viral infections, because they seem to trigger asthma exacerbation unreasonably. But what we’ve seen so far is reassuring.”
But debate continues to swirl regarding the potential severity of Covid infection in people with non-allergic asthma.
Non-allergic asthma
Some studies have suggested that people who have asthma caused by something other than allergies – exercise, stress, air pollution, weather conditions – might have an increased risk of severe Covid-19.
For example, Harvard researchers found that having non-allergic asthma increased the risk of severe Covid-19 by as much as 48%. That conclusion was based on data from 65 000 asthma sufferers presented in the June issue of the Journal of Allergy and Clinical Immunology.
“For those people, I think being more cautious would be good for them,” said senior researcher Liming Liang, an associate professor of statistical genetics at the Harvard T.H. Chan School of Public Health in Boston. “I think the next wave is coming. We’ve got to be more cautious.”
But other experts note that the data involving Covid and non-allergic asthma sufferers is very limited, and any conclusions that these people are at higher risk of severe infection could be flawed.
Their asthma could be caused by other lung ailments that are associated with more serious cases of Covid, for instance, said Dr Mitchell Grayson, chief of allergy and immunology at Nationwide Children’s Hospital in Columbus, Ohio.
A reasonable suspicion
“There have been several studies that have shown that COPD does increase your risk of more severe disease,” he said. “I don’t think these studies have done a good job of excluding COPD in these patients.”
Grayson agrees with Khurana that in the early days of the Covid-19 pandemic, there was much concern that asthma could be a risk factor – a reasonable suspicion, given that the coronavirus attacks the lungs.
But everything that came out of the initial epidemic in China suggested that asthma was not a risk factor for life-threatening Covid, Grayson said, and the data continued to confirm that as the coronavirus spread across the globe.
“It’s not there in the data. If it is there, it’s an extremely small risk. It’s nothing I can see,” he said.
Researchers have speculated that people with allergy-driven asthma might have some protection against Covid, due to the way the coronavirus infects the body.
The SARS-CoV-2 virus that causes Covid-19 enters lung cells by engaging with a type of protein on their surface called an ACE2 receptor, Khurana said.
Not as many ACE2 receptors
“In the setting of an allergic type of inflammation, the expression of the ACE2 receptor appears to be downregulated. It appears to be lower. There’s not as much receptor,” she said.
Because there aren’t as many ACE2 receptors available, people with allergic asthma might not be as vulnerable to severe infection, Khurana said. This theory also could help explain why other chronic diseases appear to increase Covid risk, she added.
“Patients in conditions like diabetes or hypertension, this receptor expression is increased,” Khurana said. “That’s a possible reason why those comorbid diseases are at especially high risk for this infection.”
But that only explains why allergic asthma isn’t a major risk factor for severe Covid, Grayson said. It doesn’t explain why some studies are finding increased risk among people with non-allergic asthma.
Grayson suspects that the purported link between non-allergic asthma and Covid found in these studies is actually a link between a Covid and a host of different lung ailments, especially COPD.
Scratching the surface
“There are studies showing that COPD increases your risk of more severe Covid, not markedly but a little bit, not to the extent of things like hypertension and diabetes and [being] elderly,” he said. “I’m concerned that what they’re calling non-allergic asthma actually is COPD, which would skew their data.”
In Khurana’s view, more study is needed, particularly prospective studies that track people with different types of asthma prior to Covid infection.
“So far, we just don’t know enough to make any conclusions. I think we’re still scratching the surface here and still have a lot to learn,” she said.
In the meantime, it would pay for everyone to protect themselves, Khurana added.
“It’s good practice to observe the recommended guidance on hand hygiene and physical distancing and masking and avoiding any situation where you could be exposed, even though it’s obviously welcome to see that allergic asthma is not as high-risk as some of the other comorbid diseases,” Khurana said.
British researchers monitored infants’ brain activity while they had a painful heel lance to draw blood
It was not possible to determine if infants that were held skin-to-skin by a parent felt less pain
Brain activity was, however, different in the infants that had skin-to-skin contact
Infants may feel less pain when held by a parent with skin-to-skin contact, a new UK study suggests.
“We have found when a baby is held by their parent with skin-on-skin contact, the higher-level brain processing in response to pain is somewhat dampened. The baby’s brain is also using a different pathway to process its response to pain,” said study co-author Lorenzo Fabrizi. He’s with University College London in the department of neuroscience, physiology and pharmacology.
“While we cannot confirm whether the baby actually feels less pain, our findings reinforce the important role of touch between parents and their newborn babies,” Fabrizi said in a college news release.
Painful heel lance
The study included 27 infants, up to about three months old, who were born premature or at term at UCL Hospitals in Britain.
The researchers monitored the infants’ brain activity while they had a painful heel lance to draw blood for testing.
During the procedure, the infants were either held by their mother skin-to-skin; held by their mother with clothing, or lying in a crib or incubator (most of those infants were swaddled).
The infants’ initial brain response to the pain of the heel lance was the same. But as it triggered four to five waves of brain activity, the later waves of brain activity were lower among those babies who were held skin-to-skin.
The dampening of the delayed response to pain in the infants who had skin contact with their mothers “suggests that parental touch impacts the brain’s higher-level processing. The pain might be the same, but how the baby’s brain processes and reacts to that pain depends on their contact with a parent,” said study co-author and pain researcher Rebecca Pillai Riddell.
“Our findings support the notion that holding a newborn baby against your skin is important to their development,” added Pillai Riddell, a professor in the department of psychology at York University in Toronto.
