• With the focus on Covid-19, it is easy to forget that the ‘regular’ seasonal flu can also be dangerous
• The flu can also lead to complications like pneumonia and worsen certain chronic health conditions, including heart disease
• To help prevent the flu, experts say that getting the flu shot is more important than ever 

Amid the Covid-19 pandemic, a new US study serves as a reminder of how severe the seasonal flu can be.

Researchers found that among 90 000 Americans hospitalised with the flu, 12% had a serious heart complication, including heart attack and sudden heart failure. Many ended up in the intensive care unit, and 7% died in the hospital.

The study shows that Covid-19 isn’t alone among viruses that can up the odds for heart events.

The findings also underscore the importance of getting the flu shot – especially this year, experts said.

Flu shot always recommended

“The flu is not ‘just a cold’,” said Dr Kathryn Edwards, a professor at Vanderbilt University School of Medicine in Nashville. “People often don’t appreciate how serious it can be.”

A yearly flu shot is always recommended, she said, especially for people older than 65 and those with certain chronic conditions such as heart disease, diabetes and asthma. They are at heightened risk of flu complications.

This season, flu vaccination is particularly important because of the pandemic, Edwards said. That’s in part to avoid having hospitals overrun by both flu and Covid patients.

Edwards, who was not involved in the study, is also a spokesperson for the Infectious Diseases Society of America.

While the flu usually causes temporary miseries like fever, cough and a sore throat, it can also lead to complications such as pneumonia and other secondary infections. The infection can also worsen certain chronic health conditions, including heart disease.

Body-wide inflammation

But that is not necessarily common knowledge, said Dr Shikha Garg, the senior researcher on the new study.

“I don’t know that these cardiac complications are on people’s radar,” said Garg, of the US Centers for Disease Control and Prevention. “This study shows just how common they are.”

For the study, Garg’s team looked at 90 000 flu hospitalisations in 17 US states between 2010 and 2018. Just under 12% of those patients suffered a heart complication.

Not surprisingly, people with existing heart conditions were at greater risk: 21% of those patients had a cardiac complication – as did 19% of patients with kidney disease and 15% of those with diabetes.

Edwards said the flu may directly trigger heart complications, by spurring body-wide inflammation. If, for example, a person has artery-clogging “plaques”, that inflammation could rupture the plaque and lead to a heart attack.

Of study patients with heart complications, almost one-third landed in the ICU, and 7% died.

No guarantee against the flu

Despite the severity of the flu, Americans frequently skip the annual vaccine. During the 2018–2019 season, the CDC says, between 34% and 56% of adults got the flu shot, with variations by state.

“Everyone age six months and older should be vaccinated,” Edwards said.

The shot is no guarantee against the flu, she added, but it is typically about 50% effective. And even if it does not prevent the infection entirely, Edwards said, it may reduce the severity of the illness.

“We don’t know for sure what’s going to happen in the fall,” Garg said. But since both the new coronavirus and the flu are likely to be in circulation, she added, Americans should be prepared.

Flu vaccine safe

“Now more than ever,” Garg said, people should get the flu shot.

It is possible, Edwards noted, that the efforts in place to battle Covid – from physical distancing to hand-washing to mask-wearing – will take some of the bite out of flu season. But those things do not take the place of vaccination, she said.

Garg agreed. “The flu vaccine is safe, and it’s our most important tool for prevention.”

The findings were published in the Annals of Internal Medicine.

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• Aerosol containment methods may not be protecting health workers against SARS-CoV-2 as touted
• The effectiveness of such devices was never properly tested
• It was found that the aerosol box actually increases exposure to virus particles – by up to five times 

Aerosol boxes meant to protect health care workers when they intubate Covid-19 patients may actually increase their exposure to airborne virus particles, an Australian study warns.

Intubation is done when patients are placed on a ventilator.

Aerosol boxes have been touted as a quick, simple way to protect workers, but their effectiveness and safety were never clinically tested. No international guideline on personal protective equipment has endorsed their use.

Even though experts have raised concern that the devices may put health care workers at risk, they are in use worldwide.

Increased exposure to virus particles

In this study, researchers tested the effectiveness of five aerosol containment methods (aerosol box; sealed box with and without suction; vertical drape; and horizontal drape) compared with no intervention.

Volunteers held a bottle of harmless fluid just under their mouth, and coughed every 30 seconds. Detection devices were used to count different-sized airborne particles and assess particle spread for five minutes.

Compared with using no containment device, exposure to airborne particles of all sizes was higher when an aerosol box was used, the study found.

If Covid-19 particles act the same way as the fluid used in this simulation, the results suggest the aerosol box increases exposure to virus particles – in some cases by a factor of five times or more, according to findings published on in July in the journal Anaesthesia.

The investigation was conducted by a team at Intensive Care and Anaesthesia Specialists at Eastern Health in Melbourne. Peter Chan and Joanna Simpson, who led the effort, said the research team was surprised by the findings.

Minimal to no benefit

“Spikes of airborne particles were clearly seen, coinciding with patient coughing. We believe that these represent particles escaping from the arm access holes in the aerosol box,” the researchers reported.

The race to provide protective equipment has resulted in a variety of devices, but evidence of their safety and effectiveness has been lacking, the study authors said.

“This study demonstrates that devices such as the aerosol box we tested – which is typical of designs used worldwide – confer minimal to no benefit in containing aerosols during an aerosol-generating procedure and may increase rather than decrease airborne particle exposure,” the authors concluded.

In a journal news release, Chan said if the aerosol box were sold as a product and regulated, it would probably need to be recalled immediately due to the potential infection risk for healthcare workers.

“Unfortunately, because these devices have been donated and are not regulated in any way, healthcare workers might be continuing to increase their exposure to Covid-19 while thinking they are protecting themselves,” he added.

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• It’s important for people to consider the message they send with their gifts
• Giving a money-saving gift could be taken to imply that the recipient needs money
• Giving a time-saving gift, on the other hand, implies that the person is busy and in high demand

It may seem like a paradox, but giving someone a gift to help them save money is a sure way to make them hate it.

The reason: It will make the recipient feel inferior to you, researchers say. In contrast, a gift that helps a recipient save time is taken as a compliment.

The findings, from a series of experiments, are outlined in a study recently published in the Journal of the Association for Consumer Research.

Saving time vs. money

“Most of us have this belief that any gift we give is going to be appreciated – but the way a gift is presented can influence how people feel about it,” said study co-author Grant Donnelly, assistant professor of marketing at Ohio State University, in Columbus.

“When you don’t have time, you’re perceived as busy and in high demand. There’s something high-status about that, compared to not having enough money, which is seen as low status,” Donnelly said in a university news release.

In one experiment, the researchers asked 405 people how they felt about receiving a gift they thought was intended to save them either time or money.

Those who received a gift that was intended to save them money were more likely to say it made them feel embarrassed, ashamed and bad, compared to those who received a time-saving gift.

Perspective gap

“They thought the gift-giver was implying they couldn’t take care of themselves and were incompetent because they needed money,” Donnelly said.

The findings show that it’s important for people to consider the message they send with their gifts.

“We can have this perspective gap where we don’t really consider how our gifts are received. It can harm your relationship with the recipient if you’re not careful,” Donnelly said. “It may be best to give a money-saving gift without acknowledging the reason, or to find a way to make it about saving time.”

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• There is some evidence that antibacterial drugs interact with hormonal contraceptives
• This means that women on the Pill should be careful when taking antibiotics
• Researchers recommend that pharmacy inserts of both kinds of drugs should warn patients of the risk

Doctors have long suspected it, but a comprehensive new study provides more evidence that antibiotics can reduce the effectiveness of birth control pills.

That means women who are using both types of drugs at once should take extra precautions to avoid an unintended pregnancy, the study’s British authors say.

The study couldn’t prove cause and effect. However, it “suggests there is an interaction of antibacterial drugs with hormonal contraceptives, which can potentially impair the effectiveness of the contraceptives,” concluded a team led by Dr Robin Ferner of the Institute of Clinical Sciences at the University of Birmingham.

Additional contraception

The findings didn’t surprise one American ob-gyn.

“We have known for a long time that certain antibiotics will affect the metabolism of the oral contraceptive hormones,” said Dr Mitchell Kramer, who directs obstetrics and gynaecology at Northwell Health’s Huntington Hospital in Huntington, New York.

“Therefore, we advise of patients on birth control pills to use additional contraception, such as condoms or spermicidal suppositories/foam, during the duration of taking the antibiotic just as a precaution,” he said.

According to the UK research team, prior studies on interactions between antibiotics and birth control pills had yielded mixed findings.

Seeking clarity, Ferner and his team tracked reports of suspected unwanted drug side effects (called Yellow Cards) that had been reported by health care providers and the public to the UK’s drug and medical devices regulator, the Medicines and Healthcare Products Regulatory Agency.

Unintended pregnancies

Specifically, they compared the number of unintended pregnancies reported in almost 75 000 Yellow Cards for antibiotics in general, about 33 000 for enzyme-inducing drugs, and more than 65 500 other types of drugs.

There were 46 instances of unintended pregnancies in the Yellow Card reports for antibiotics (a rate of 62 per 100 000), 39 in the enzyme-inducing drug reports (119 per 100 000), and six in reports of other drugs.

Compared with the other types of drugs, unintended pregnancies were seven times more common in Yellow Card reports of antibiotics and 13 times more common in reports of enzyme-inducing drugs, which included some antibiotics.

Congenital birth defects were also reported seven times more often in enzyme-inducing drug Yellow Card reports, according to the study, published on 18 August in the journal BMJ Evidence Based Medicine.

Calculating absolute risks from the data wasn’t possible, and the risk will vary from woman to woman, according to her physiological make-up and circumstances, the researchers stressed.

Warnings needed

They agreed that if a woman is taking hormonal contraceptives and an antibiotic, she is “advised to take extra contraceptive precautions when a short course of an antibacterial drugs is added”.

Dr Jennifer Wu is an ob-gyn at Lenox Hill Hospital in New York City. Reading over the study, she said it was well-designed, with “large numbers and good tracking of patients”.

Based on the findings, Wu believes that “doctors and patients need to have careful discussions about new prescriptions and whether they could interfere with birth control pills.

“Pharmacy inserts of antibiotics and the enzyme-inducing drugs should also warn patients as another precaution,” she said.

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• Nausea and vomiting during pregnancy can have a big impact on the lives of sufferers
• Pregnant women may experience nausea and vomiting all day long
• The term ‘morning sickness’ is, therefore, incorrect and can cause confusion

As many expectant mothers can unhappily attest, the nausea and vomiting known as “morning sickness” can occur at any time of the day.

In a new study, British researchers analysed diaries kept by 256 women from the day they learned they were expecting until the 60th day of their pregnancy.

While vomiting was most common between 7 a.m. and 1 p.m., nausea was likely all day long. And many women reported vomiting even into the evening.

The most common hour for nausea and vomiting was 9 a.m. to 10 a.m., when 82% experienced nausea and 29% experienced vomiting.

Significant negative impact

About 94% of the women had one symptom or the other during the study, and 58% experienced both, according to findings published recently in the British Journal of General Practice.

By comparing symptoms across the first seven weeks of pregnancy, the researchers found that the chances of nausea and vomiting rose.

The likelihood of nausea was highest in weeks five through seven, and vomiting in week seven. The study only examined the first seven weeks.

“If a pregnant woman experiences sickness in the afternoon she may feel that this is unusual and wrong, or if she experiences no vomiting but feels nauseous all day she might think she is not covered by the term ‘morning sickness’,” said study author Roger Gadsby. He’s an associate clinical professor at the University of Warwick Medical School in Coventry, UK.

Gadsby also noted that those women who have severe symptoms feel the term trivialises the condition.

“Nausea and vomiting in pregnancy (NVP) can have a significant negative impact on the lives of sufferers,” he pointed out in a university news release.

“It can cause feelings of depression, of being unable to look after the family, and of loss of time from paid work. Very severe NVP, called hyperemesis gravidarm, is the commonest cause of admission to hospital in the first trimester of pregnancy,” Gadsby said.

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