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FAQs on COVID-19 and chronic medical conditions

Serious complications from COVID-19 are most likely to develop in elderly people, as well as those who have weakened immune systems, or who are immunocompromised.

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This illustration was created at the Centers for Disease Control and Prevention (CDC)

Serious complications from COVID-19 are most likely to develop in elderly people, as well as those who have weakened immune systems, or who are immunocompromised, says infectious disease specialist Alan Taege, M.D. from Cleveland Clinic in the U.S.

When people are immunocompromised, their body has a reduced ability to fight off and recover from infections. This could be because they have a certain chronic condition that affects the immune system, or because of certain medications they are taking. For example, some cancer treatments and medications used for autoimmune conditions weaken a person’s immune response, as do medicines that people take after having an organ transplant.

Unfortunately, there is not yet a vaccine that can prevent COVID-19, so we cannot prevent the disease, but there are many things you can do to minimize your risk such as social distancing, frequent handwashing and routinely disinfect surfaces in your home, such as doorknobs, faucet handles and cell phones.

It is especially important for older adults and those with underlying medical conditions to avoid being exposed to the virus in the first place. It’s spread by droplets that come out the nose and mouth of someone who’s infected when they cough or sneeze, so you can get COVID-19 from being in close contact (within about 2 metres) with an infected person who has these symptoms. You might also be able to get it from touching a surface that’s been contaminated with infected droplets.

It is also important to maintain healthy habits, like eating well, getting enough sleep and managing your stress levels, in order to keep your immune system as strong as it can be.

Dr. Taege has answered some of the most common questions about protecting the most vulnerable populations:

Q: Who is most at-risk for getting severely sick from the coronavirus?

A: The coronavirus that causes COVID-19 is new, so we don’t yet understand exactly how it impacts specific groups of high-risk people. But those who are thought to be most susceptible to serious complications of COVID-19 include people who are older than 65, or are taking medications that suppress the immune system or suffer from conditions such as cancer, hypertension. lung disease, diabetes, heart disease or other conditions that compromise the immune system.

Q: Why are people over the age of 65 more at risk?

A: Our immune system naturally becomes weaker as we age, which makes it harder for our bodies to fight off infections.

Q: Should someone who is immunocompromised still go to medical appointments?

A: Call your healthcare provider and ask. Some appointments might be able to be rescheduled, or handled by phone, or if available, virtually through a telemedicine visit or by phone. Healthcare facilities are taking special precautions to protect the health and safety of patients during this time.

Q: Should someone on immunosuppressing medications stop taking them?

A: Do not stop taking your medications without talking to your healthcare provider first. Just as there is risk associated with having a compromised immune system, there is also risk associated with stopping medication suddenly and potentially having disease flares. If you have questions or concerns, or if you become sick, talk with your doctor.

Q: In addition to the advice on hygiene, social distancing and all of the other precautions given to the general public, what extra steps could a vulnerable person take to prepare for a COVID-19 outbreak in the community?

A: Consider the following:

Ask your healthcare provider if it’s possible to get an advance supply of your medications, in case there is an outbreak in your community and you need to stay home for more than a few weeks. You can also ask your healthcare provider or pharmacy if ordering medications online and having them shipped to your home is an option.

Have enough groceries and household supplies on-hand so that you could comfortably stay home for a few weeks if you had to. Many grocers offer online ordering and delivery, which could also help you avoid having to go out.

Talk to your doctor to make sure you are up to date on your recommended vaccinations, such as the pneumonia and flu shots, which can help prevent those serious illnesses. These will not protect you against COVID-19, but they will protect you from other infections that could require you to seek medical care.

Make a plan for who will take care of you if you do get sick.

If you have a chronic condition and live alone, ask family members, friends or neighbors to check on you regularly during an outbreak. Ask them to call or contact you through email or social media.

Q: How can someone help a loved one who is in the high-risk category?

A: You can start by checking in on your love one’s well-being frequently via phone, email or social media. You might also consider:

Offering to pick up groceries or prescriptions and drop them off at your loved one’s doorstep so they do not have to go out.

Learning what medications your loved one is taking, and helping them get extra medication and supplies, if possible.

If your loved one is in a hospital or long-term care facility, check ahead of time to see if they have restrictions on visitation. And never visit when you’re sick.

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Knowing the telltale signs of stroke

Learning stroke symptoms can help disrupt stroke before it disrupts your (or someone else’s) life.

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Here’s what you may not know, but has to be emphasized: Stroke can happen to anyone, happening to over 800,000 people every year in the US alone. And so it goes without saying that knowing the signs of stroke and how to prevent it can help protect you or your loved ones from disabilities caused by stroke.

The National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, created the “Know Stroke” campaign to disrupt stroke and help people in your community who might be at risk of stroke through prevention, treatment and research.

“Seconds are critical when someone is having a stroke,” said Dr. Clinton Wright, vascular neurologist and director of the Division of Clinical Research at NINDS. “It’s important to know the signs.”

Know Stroke

Most strokes happen when the brain stops getting the blood supply it needs to work properly. Without enough blood flow, the brain starts to lose function. Two million brain cells die every minute during stroke, which is why stroke prevention is important. Preventing stroke protects you from developing disabilities that stroke may cause like speech problems, limited movement and memory loss.

Know the Signs of Stroke

Stroke symptoms often appear suddenly and can be easily missed. Treating stroke by getting to a hospital quickly is critical to prevent brain damage. If you see these signs, act F.A.S.T.:

  • Face drooping: One side of the face droops when smiling
  • Arm weakness: If both arms are raised, one drifts down
  • Speech difficulty: Slurred or strange speech
  • Time to call 911: Do not drive yourself or your loved one – call an ambulance immediately if you notice one or more of these signs

Learning these stroke symptoms can help disrupt stroke before it disrupts your (or someone else’s) life. Other signs to look for include sudden numbness, confusion, difficulty seeing, difficulty walking and severe headache, especially one that occurs in a split second, called a thunder-clap headache. Remember stroke is always an emergency that requires fast action and medical treatment.

Know How to Prevent Stroke

Some medical conditions and lifestyle considerations can put you at higher risk for stroke. For example, high blood pressure is the leading cause of stroke. Stroke can be prevented by effectively treating high blood pressure as well as high cholesterol, heart disease, diabetes, smoking and obesity. There are several ways to lower your risk for stroke:

  • Treat high blood pressure
  • Exercise regularly
  • Eat healthy and maintain a healthy weight
  • Manage diabetes
  • Quit smoking
  • Control cholesterol

Doing your best to prevent stroke from happening is the No. 1 way to lower your risk of disabilities caused by stroke. Even if you have had a stroke before, you can still take steps to reduce your risk of more strokes. Treating these risk factors may also reduce the chance of developing age-related dementia. For more information on the connection between stroke risk factors and dementia, visit mindyourrisks.nih.gov.

Know How to Recover from Stroke

As much as prevention helps lower the chances of having a stroke, it can still happen. Rehabilitation therapy is usually started in the hospital within 48 hours after a stroke. Health care workers help stroke patients relearn skills that were lost from the stroke or teach them new ways to compensate for remaining disabilities. Researchers continue to investigate how patients can restore blood flow to the brain and how to protect brain cells after stroke to improve recovery.

Know More

When you know the signs of stroke, you can help prevent a life-changing disability for yourself or someone you care about. You could even save a life. Visit stroke.nih.gov to learn more about stroke risks, prevention and research.

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Acetaminophen reduces sepsis patients’ risk of having organ injury

Intravenous acetaminophen was safe for all the sepsis patients, with no difference in liver injury, low blood pressure, or other adverse events compared to the placebo group. Among secondary outcomes, they also found that organ injury was significantly lower in the acetaminophen group, as was the rate of acute respiratory distress syndrome onset within seven days of hospital admission.

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Intravenous acetaminophen reduced sepsis patients’ risk of having organ injury or developing acute respiratory distress syndrome, a serious condition that allows fluid to leak into the lungs.

This is according to a study, “Phase 2b Randomized Trial of Acetaminophen for Prevention and Treatment of Organ Dysfunction in Critically Ill Sepsis Patients”, that appeared in JAMA.

As FYI: Sepsis is the body’s uncontrolled and extreme response to an infection. In sepsis, red blood cells become injured and die at abnormally high rates, releasing so called “cell-free hemoglobin” into the blood. The body becomes overwhelmed and can’t remove this excess hemoglobin which can lead to organ damage.

While the trial did not improve mortality rates in all patients with sepsis regardless of severity, the researchers found that acetaminophen gave the greatest benefit to the patients most at risk for organ damage. With the therapy, those patients needed less assisted ventilation and experienced a slight, though statistically insignificant, decrease in mortality.

To test the therapeutic potential of acetaminophen more fully in a mid-stage clinical trial, researchers enrolled 447 adults with sepsis and respiratory or circulatory organ dysfunction at 40 US academic hospitals from October 2021 to April 2023.

Patients were randomized to receive either acetaminophen or a placebo intravenously every six hours for five days. The researchers then followed the patients for 28 days to see how they fared. They also completed a special analysis using data only from the patients with levels of cell-free hemoglobin above a certain threshold. The team’s primary interest overall was the number of patients who were able to stay alive with no organ support, such as mechanical ventilation or kidney failure treatment.

Scientists note that identifying high levels of cell-free hemoglobin as a biomarker that could be tested when patients are first admitted to the hospital would be a breakthrough, because it could help quickly determine which patients with sepsis might benefit from acetaminophen therapy.

The researchers found that intravenous acetaminophen was safe for all the sepsis patients, with no difference in liver injury, low blood pressure, or other adverse events compared to the placebo group. Among secondary outcomes, they also found that organ injury was significantly lower in the acetaminophen group, as was the rate of acute respiratory distress syndrome onset within seven days of hospital admission.

When looking more closely at the patients with higher cell-free hemoglobin, the researchers found that just 8% of patients in the acetaminophen group needed assisted ventilation compared to 23% of patients in the placebo group. And after 28 days, 12% of patients in the acetaminophen group had died, compared to 21% in the placebo group, though this finding was not statistically significant.

“While the anticipated effects of acetaminophen therapy were not realized for all sepsis patients, this study shows that it still holds promise for the most critically ill” said James Kiley. “Though, more research is needed to uncover the mechanisms and validate these results.”

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Extreme heat associated with children’s asthma hospital visits

Daytime heat waves were significantly associated with 19 percent higher odds of children’s asthma hospital visits, and longer duration of heat waves doubled the odds of hospital visits. They did not observe any associations for nighttime heat waves.

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For children seeking care at urban pediatric health centers, extreme heat events were associated with increased asthma hospital visits.

This is according to research published at the ATS 2024 International Conference.  

“We found that both daily high heat events and extreme temperatures that lasted several days increased the risk of asthma hospital visits,” said corresponding author Morgan Ye, MPH, research data analyst, Division of Pulmonary and Critical Care Medicine, University of California, San Francisco School of Medicine. “Understanding the impacts of climate-sensitive events such as extreme heat on a vulnerable population is the key to reducing the burden of disease due to climate change.”

For this study, Ye and colleagues looked at 2017-2020 electronic health records from the UCSF Benioff Children’s Hospital Oakland, which included data on asthma hospital visits by patients of the hospital, some of whom are from Benioff Oakland’s Federally Qualified Health Center, and demographics including patients’ zip codes. They used data from the PRISM Climate Group of Oregon State University to determine the timing of daily maximum (daytime heat waves) and minimum (nighttime heat waves) for each zip code. The researchers restricted their analyses to the region’s warm season (June to September). To evaluate the potential range of effects of different heat wave measurements, they used 18 different heat wave definitions, including the 99th, 97.5th and 95th percentile of the total distribution of the study period for one, two or three days.

They designed the study in a way that allowed them to determine the association between each heat wave definition and a hospital visit. They repeated the analysis for Bay Area and Central California zip codes.

The team discovered that daytime heat waves were significantly associated with 19 percent higher odds of children’s asthma hospital visits, and longer duration of heat waves doubled the odds of hospital visits. They did not observe any associations for nighttime heat waves. 

According to Ye, “We continue to see global temperatures rise due to human-generated climate change, and we can expect a rise in health-related issues as we observe longer, more frequent and severe heat waves. Our research suggests that higher temperatures and increased duration of these high heat days are associated with increased risk of hospital visits due to asthma. Children and families with lower adaptation capacity will experience most of the burden. Therefore, it is important to obtain a better understanding of these heat-associated health risks and susceptible populations for future surveillance and targeted interventions.”

The authors note that past research has suggested positive associations between extreme heat and asthma, but findings regarding hospitalizations and emergency room visits have been conflicting. Additionally, many other studies have focused on respiratory hospitalizations and not hospitalizations for asthma, specifically, and have not included or had a focus on children. This study is also unique because it investigated the effect of daily high temperatures but also the effects of persistent extreme temperatures.

This study demonstrates that even milder extreme heat temperatures may significantly impact health. These effects are more pronounced in climate-susceptible populations, including children and those who are medically vulnerable, such as those served by the urban pediatric health center in this study. The authors hope these study results will lead to more equitable health outcomes and reduce racial/ethnic disparities observed in climate-sensitive events.

“These results can be used to inform targeted actions and resources for vulnerable children and alleviate health-related stress during heat waves,” they conclude.

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