COVID-19 amplified America’s devastating health gap. Can we bridge it?
The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
19 November, 2020
Credit: Joe Raedle/Getty Images
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
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<p>In the last 100 years, we've made incredible advances in health care, advances that would be viewed as miraculous to any previous generation. To pick one example, the<a href="https://ourworldindata.org/life-expectancy" target="_blank"> U.S. life expectancy</a> in 1950 was 68.2 years. We've since added 10 years to that average. Social programs have helped the young and elderly, two of the most health-vulnerable populations, receive unprecedented levels of care and attention. And telemedicine has decoupled many Americans' health support and monitoring from brick-and-mortar hospitals, expanding access to care.</p><p>Yet, despite these advances and despite handily<a href="https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/" target="_blank"> outspending other OECD nations on health care</a>, the United States preserves vast health disparities. As James Madara, CEO and executive vice president of the American Medical Association,<a href="https://www.ama-assn.org/about/leadership/america-s-health-care-crisis-much-deeper-covid-19" target="_blank" rel="noopener noreferrer"> </a>wrote on the organization's site: "The U.S. health system that exists today is a hodgepodge of ideas, programs, and regulations that is both extraordinarily expensive and highly inefficient. And despite its size and technological advancements, our health system is beset by tremendous gaps and inequities that favor some groups while unfairly disadvantaging others."</p><p>Our current predicament has its origins in tectonic sociohistorical forces that have shifted and fractured the health care landscape. For those at the peaks, access to superior care, education, resources, and social networks serve to protect their health. For those in the canyons, the ground continues to weather away with each past and ongoing crisis—consider, for example, the disproportionate fallout from<a href="https://diabetes.diabetesjournals.org/content/60/11/2667" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.salon.com/2013/09/29/ronald_reagans_shameful_legacy_violence_the_homeless_mental_illness/" target="_blank" rel="noopener noreferrer">the dissolution of the Mental Health Systems Act</a>.</p><p>Then came COVID-19.</p>
COVID-19 deepens U.S. health disparities
<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.<blockquote>We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights.</blockquote>
Working to close the health gap
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health
<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
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Experts fear Thanksgiving COVID spikes—Can you have your turkey and stay healthy too ?
Experts plead with Americans to keep gatherings limited this Thanksgiving, while families devise new ways to celebrate the holidays.
19 November, 2020
Credit: Lightfield Studios/Adobe Stock
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<p>Like any holiday, Thanksgiving has always had challenges mixed in with the fun. There are maddening travel logistics, crafting a dinner to meet everyone's dietary needs, avoiding your uncle's ceaseless <a href="https://bigthink.com/videos/talking-politics" target="_self">politic-baiting conversation starters</a>, and, of course, finding someone who can muscle through <a href="https://bigthink.com/tag/turkey" target="_self">the post-dinner slumber</a> to tackle the dishes. But this year, families must face an unprecedented challenge: managing family expectations and safety during the pandemic.</p><p>After 2020's contentious news cycle and a <a href="https://www.scientificamerican.com/article/a-running-list-of-record-breaking-natural-disasters-in-2020/" target="_blank">record-breaking number of disasters</a>, Americans want a dollop of normality to go along with their pumpkin pie. Unfortunately, this desire has grown in tandem with <a href="https://coronavirus.jhu.edu/" target="_blank" rel="noopener noreferrer">COVID-19 cases</a>. As of this writing, the United States is climbing its third pandemic peak and has endured more than 11 million cases and nearly 250,000 deaths (more than any other country). According to Johns Hopkins data, last week saw the U.S.'s highest seven-day average at 78,738 cases per day.</p><p>"We're at a point where the epidemic is accelerating across the country. We're right at the beginning of the steep part of the epidemic curve," Dr. Scott Gottlieb, former U.S. Food and Drug Administration commissioner, <a href="https://www.cnbc.com/2020/10/31/us-reports-record-99321-new-covid-cases-as-scientists-warn-of-difficult-winter-.html" target="_blank" rel="noopener noreferrer">said on CNBC</a>. He added, "You'll see cases start to accelerate in the coming weeks. December's probably going to be the toughest month."</p>
The experts agree
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDgyNi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMjU4MTI4OX0.3o3ULs3WhMned31DMmr-mvZdiFYvqo6NxcaxSAh9sjQ/img.jpg?width=980" id="3894b" class="rm-shortcode" data-rm-shortcode-id="105be1aaba5ecf60fd69fa89486833f7" data-rm-shortcode-name="rebelmouse-image" />A graph showing confirmed coronavirus cases from Jan. 3 to Nov. 18, 2020. The third, current peak is the largest so far.
<p>Dr. Gottlieb is just one of many experts who worry that Thanksgiving trips and gatherings will bolster the growth of COVID cases in America. Dr. James Phillips, chief of disaster medicine at George Washington University Hospital, <a href="https://www.cnn.com/2020/11/14/health/us-coronavirus-saturday/index.html" target="_blank">told CNN</a> that he expects cases to spike after Thanksgiving, further stressing the health care system and prompting harsher restrictions. If Americans do not learn from Thanksgiving, he forecasts another spike at Christmas.</p><p>Dr. Iahn Gonsenhauser, chief quality and patient safety officer at The Ohio State University Wexner Medical Center, concurs. As he <a href="https://www.livescience.com/thanksgiving-gathering-safely-coronavirus.html" target="_blank">told Live Science</a><u>:</u> "Most experts would agree that we're expecting to see a spike after Thanksgiving and that's a spike on top of already very discouraging and very scary numbers. By far the safest choice that anybody can make this Thanksgiving holiday and likely stretching into the other winter holidays that are coming up is to host your celebration virtually."</p><p>While many Americans may recognize Dr. Gonsenhauser's advice as sage, it's equally unwelcomed. <a href="https://www.axios.com/us-surgeon-general-pandemic-fatigue-record-covid-929e5cd3-d42a-4bab-b541-5e3d79abe242.html" target="_blank" rel="noopener noreferrer">Pandemic fatigue</a> is depleting the nation's willpower and <a href="https://www.psychologytoday.com/us/blog/license-shine/202009/six-tips-reduce-covid-decision-fatigue" target="_blank" rel="noopener noreferrer">clouding its judgment</a>. Add to that a longing to see family and friends—many of which we may have been separated from for close to a year—and it's easy to see why so many Americans are heading home for the holidays.</p><p>According to a TripAdvisor survey, <a href="https://www.cbsnews.com/news/thanksgiving-holiday-travel-covid-19-surge/" target="_blank" rel="noopener noreferrer">56 percent of Americans plan to travel</a> this Thanksgiving—less than previous years but a substantial amount nonetheless. Airlines are adding more flights to meet the demand, and <a href="https://www.vox.com/21525068/covid-19-airplane-risk-coronavirus-pandemic-airports" target="_blank" rel="noopener noreferrer">more people in airports</a> will increase the likelihood of transmission. Many other Americans will travel by car, popularly seen as the safer option but one that still increases one's risk of exposure at restaurants, gas stations, and public restrooms.</p><p>In response, governors have instated a patchwork of restrictions. They've closed nonessential indoor businesses, limited restaurants to pick-up orders, and made face masks a requirement when out and about. <a href="https://www.govtech.com/em/safety/As-Thanksgiving-Holiday-Looms-Hospitals-Gear-up-for-COVID-Surge-.html" target="_blank" rel="noopener noreferrer">Hospitals have also geared up</a> for an influx of new patients while facing their own holiday challenges. Many are already caring for large swaths of COVID patients while the winter weather is making physical-distancing tactics, such as outdoor tents, more difficult to manage. </p><p>"We don't really want to see mamaw at Thanksgiving and bury her by Christmas," Dr. Mark Horne, president of the Mississippi State Medical Association, <a href="https://apnews.com/article/travel-family-gatherings-coronavirus-pandemic-thanksgiving-holidays-3c759ab924a0d9de27803527ddf36c1c" target="_blank" rel="noopener noreferrer">told the Associated Press</a>. "It's going to happen. You're going to say 'Hi' at Thanksgiving, 'It was so great to see you,' and you're going to either be visiting by FaceTime in the ICU or planning a small funeral before Christmas."</p>To grandmother's house we go?
<p>Even while governors and experts pleaded with families to limit Thanksgiving gatherings to individual households, there has been no uniform, country-wide restrictions put in place. As such, every family must perform a risk calculation to decide how to spend Thanksgiving.</p><p>"[G]iven the fluid and dynamic nature of what's going on right now in the spread and the uptick of infections, I think people should be very careful and prudent about social gatherings, particularly when members of the family might be at a risk because of their age or their underlying condition," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, said on <a href="https://www.cbsnews.com/news/fauci-thanksgiving-covid-different/" target="_blank">CBS Evening News</a>. </p><p>He added, "When you're talking about relatives that are getting on a plane, being exposed in an airport, being exposed in a plane, then walk in the door and say 'Happy Thanksgiving' — that you have to be careful about."</p><p>To help families make their decisions, <a href="https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays/thanksgiving.html" target="_blank" rel="noopener noreferrer">the Centers for Disease Control and Prevention (CDC) has released Thanksgiving considerations</a> to supplement safety alongside local rules and regulations. The agency lists several factors to consider in any risk calculation. These include local levels of COVID-19, potential travel exposure, the number of people attending, the health risks of those attendees, and the duration of the gathering as well as its location.</p><p>If people from outside the household will attend, the CDC recommends the following actions to increase safety and limit viral transmission:</p><ul><li>Ensure everyone wears a mask when not eating or drinking;</li><li>Keep people who do not live together at least 6 feet apart;</li><li>Have people bring their own food, drinks, utensils, etc. No potluck-style dinners;</li><li>Host the gathering outdoors or increase indoor ventilation;</li><li>Keep music levels down to prevent shouting or speaking too loudly;</li><li>Encourage good handwashing; </li><li>Clean and disinfect commonly touched surfaces often.</li></ul><p>You can find more information on the <a href="https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays.html" target="_blank" rel="noopener noreferrer">CDC's Holidays website</a>. It's also worth noting that <a href="https://medical.mit.edu/covid-19-updates/2020/07/how-long-symptom-onset-person-contagious#:~:text=The%20CDC%20identifies%20a%20%E2%80%9Cclose,who%20has%20been%20positively%20diagnosed" target="_blank" rel="noopener noreferrer">a negative result on a COVID-19 test</a> is no guarantee of safety. People can harbor the virus, become infectious to others, show no symptoms, and still render a false positive several days after their initial infection.</p>Staying home for the holidays
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="caf5ae9303d7359a42a37cfc200d83b1"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/yDuHtJCj_Og?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>For families staying physically distanced, there remains the question of how to celebrate Thanksgiving this year. 2020's standard answer has been the Skype or Zoom call. Certainly an option, but one that should be spiced up for the holiday meal.</p><p>You can, for example, integrate your preferred telecommunication app can into shared experiences. Family members can work meal prep together or teach each other their signature dishes. Activities like crafts, decorating, and thankfulness trees can be coordinated by the kids and shared with the family simultaneously. You can cook up the same meal, light the same scented candles, and listen to the same music to create a common sensual environment.</p><p>You can also find telecommunication apps designed to be used alongside specific activities. <a href="https://discord.com/" target="_blank">Discord</a> is a favorite among gamers for video games. Even if battle royales aren't your family's speed, it works perfectly well for <a href="https://bigthink.com/personal-growth/board-games-for-kids" target="_self">board games</a>, and your family's favorite likely has a digital version available. Similarly, <a href="https://www.netflixparty.com/" target="_blank" rel="noopener noreferrer">Netflix's Teleparty</a> provides an online space to watch and chat about movies together. If Black Friday was your family's bonding tradition, try scouring for the savings together online and share a cocktail afterward to toast a successful shop. There is also the platform <a href="https://gather.town/" target="_blank">Gather</a>, which allows for proximity video chatting in a customizable 2D world.</p><p>If your family wishes to disconnect from the binary realm, try beginning a new holiday tradition this Thanksgiving. You can write holiday letters to distant family members. We're talking physical letters, which <a href="https://www.karger.com/Article/Abstract/343131" target="_blank" rel="noopener noreferrer">preliminary research suggests</a> has the salubrious bonus of reducing stress and anxiety for the writer. You can create holiday care packages for friends. And this year especially, the holiday card and photobook traditions will be more appreciated than ever. If you're in a time crunch, emails or texts are also nice.</p><p>For most families, Thanksgiving in 2020 will be unlike any other and will be, for better or worse, one to remember. Thankfully, there are ways to stay safe and healthy—and help others do so, too—while still connecting with loved ones in a meaningful way.</p>
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Using machine learning to track the pandemic’s impact on mental health
Textual analysis of social media posts finds users' anxiety and suicide-risk levels are rising, among other negative trends.
17 November, 2020
Photo by Nick Fewings on Unsplash
Dealing with a global pandemic has taken a toll on the mental health of millions of people.
<p> A team of MIT and Harvard University researchers has shown that they can measure those effects by analyzing the language that people use to express their anxiety online.</p><p>Using machine learning to analyze the text of more than 800,000 Reddit posts, the researchers were able to identify changes in the tone and content of language that people used as the first wave of the Covid-19 pandemic progressed, from January to April of 2020. Their analysis revealed several key changes in conversations about mental health, including an overall increase in discussion about anxiety and suicide.</p><p>"We found that there were these natural clusters that emerged related to suicidality and loneliness, and the amount of posts in these clusters more than doubled during the pandemic as compared to the same months of the preceding year, which is a grave concern," says Daniel Low, a graduate student in the Program in Speech and Hearing Bioscience and Technology at Harvard and MIT and the lead author of the study.</p>
<p>The analysis also revealed varying impacts on people who already suffer from different types of mental illness. The findings could help psychiatrists, or potentially moderators of the Reddit forums that were studied, to better identify and help people whose mental health is suffering, the researchers say.</p><p>"When the mental health needs of so many in our society are inadequately met, even at baseline, we wanted to bring attention to the ways that many people are suffering during this time, in order to amplify and inform the allocation of resources to support them," says Laurie Rumker, a graduate student in the Bioinformatics and Integrative Genomics PhD Program at Harvard and one of the authors of the study.</p><p>Satrajit Ghosh, a principal research scientist at MIT's McGovern Institute for Brain Research, is the senior author of the <a href="https://www.jmir.org/2020/10/e22635" target="_blank">study</a>, which appears in the <em>Journal of Medical Internet Research</em>. Other authors of the paper include Tanya Talkar, a graduate student in the Program in Speech and Hearing Bioscience and Technology at Harvard and MIT; John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center; and Guillermo Cecchi, a principal research staff member at the IBM Thomas J. Watson Research Center.</p>
<h3>A wave of anxiety</h3><p>The new study grew out of the MIT class 6.897/HST.956 (Machine Learning for Healthcare), in MIT's Department of Electrical Engineering and Computer Science. Low, Rumker, and Talkar, who were all taking the course last spring, had done some previous research on using machine learning to detect mental health disorders based on how people speak and what they say. After the Covid-19 pandemic began, they decided to focus their class project on analyzing Reddit forums devoted to different types of mental illness.</p><p>"When Covid hit, we were all curious whether it was affecting certain communities more than others," Low says. "Reddit gives us the opportunity to look at all these subreddits that are specialized support groups. It's a really unique opportunity to see how these different communities were affected differently as the wave was happening, in real-time."</p><p>The researchers analyzed posts from 15 subreddit groups devoted to a variety of mental illnesses, including schizophrenia, depression, and bipolar disorder. They also included a handful of groups devoted to topics not specifically related to mental health, such as personal finance, fitness, and parenting.</p><p>Using several types of natural language processing algorithms, the researchers measured the frequency of words associated with topics such as anxiety, death, isolation, and substance abuse, and grouped posts together based on similarities in the language used. These approaches allowed the researchers to identify similarities between each group's posts after the onset of the pandemic, as well as distinctive differences between groups.</p>
<p>The researchers found that while people in most of the support groups began posting about Covid-19 in March, the group devoted to health anxiety started much earlier, in January. However, as the pandemic progressed, the other mental health groups began to closely resemble the health anxiety group, in terms of the language that was most often used. At the same time, the group devoted to personal finance showed the most negative semantic change from January to April 2020, and significantly increased the use of words related to economic stress and negative sentiment.</p><p>They also discovered that the mental health groups affected the most negatively early in the pandemic were those related to ADHD and eating disorders. The researchers hypothesize that without their usual social support systems in place, due to lockdowns, people suffering from those disorders found it much more difficult to manage their conditions. In those groups, the researchers found posts about hyperfocusing on the news and relapsing back into anorexia-type behaviors since meals were not being monitored by others due to quarantine.</p><p>Using another algorithm, the researchers grouped posts into clusters such as loneliness or substance use, and then tracked how those groups changed as the pandemic progressed. Posts related to suicide more than doubled from pre-pandemic levels, and the groups that became significantly associated with the suicidality cluster during the pandemic were the support groups for borderline personality disorder and post-traumatic stress disorder.</p><p>The researchers also found the introduction of new topics specifically seeking mental health help or social interaction. "The topics within these subreddit support groups were shifting a bit, as people were trying to adapt to a new life and focus on how they can go about getting more help if needed," Talkar says.</p><p>While the authors emphasize that they cannot implicate the pandemic as the sole cause of the observed linguistic changes, they note that there was much more significant change during the period from January to April in 2020 than in the same months in 2019 and 2018, indicating the changes cannot be explained by normal annual trends.</p>
<h3>Mental health resources</h3><p>This type of analysis could help mental health care providers identify segments of the population that are most vulnerable to declines in mental health caused by not only the Covid-19 pandemic but other mental health stressors such as controversial elections or natural disasters, the researchers say.</p><p>Additionally, if applied to Reddit or other social media posts in real-time, this analysis could be used to offer users additional resources, such as guidance to a different support group, information on how to find mental health treatment, or the number for a suicide hotline.</p><p>"Reddit is a very valuable source of support for a lot of people who are suffering from mental health challenges, many of whom may not have formal access to other kinds of mental health support, so there are implications of this work for ways that support within Reddit could be provided," Rumker says.</p><p>The researchers now plan to apply this approach to study whether posts on Reddit and other social media sites can be used to detect mental health disorders. One current project involves screening posts in a social media site for veterans for suicide risk and post-traumatic stress disorder.</p><p>The research was funded by the National Institutes of Health and the McGovern Institute.</p><p>Reprinted with permission of <a target="_blank" href="http://news.mit.edu/" rel="noopener noreferrer">MIT News</a>. Read the <a target="_blank" href="https://news.mit.edu/2020/covid-19-impact-mental-health-1105" rel="noopener noreferrer">original article</a>.</p>
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What ended the Black Death, history's worst pandemic
The bubonic plague ravaged the world for centuries, killing up to 200 million people.
16 November, 2020
Credit: Peter Macdiarmid/Getty Images
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<p>While the world continues to suffer from the onslaught of COVID-19, its toll has yet to approach the grim statistics of history's deadliest pandemic–the Black Death. Also called the Black Plague, this terrible illness afflicted Europe and Asia in the mid-1300s, with new outbreaks over several centuries. It killed about a third of the European population when it began–nearly 20 million people. Over a few years, the total for the extremely contagious plague is estimated to have reached as high as 200 million victims globally. </p><p>The bubonic plague first came to Europe in 1347, aboard 12 trading ships from the Black Sea that docked at the Sicilian port of Messina. Most of the sailors on those ships were either dead or terribly ill, covered in black boils full of blood and pus. By the time the authorities tried to send these ships away, it was too late and the plague started spreading. This was due, in particular, to the fact that the disease did not only transmit through air but also through the bites of infected fleas and rats. These were plentiful in Europe of the time, and a real mainstay aboard ships, which carried the plague from port to port. The illness also spread to livestock like cows and sheep and even chicken.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc4MDc1Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1OTc5NzI0MX0.IbLuKhr8C2W_Ey5x_WurodGweNVQMEz7c6uhzzdOEGg/img.jpg?width=980" id="af530" class="rm-shortcode" data-rm-shortcode-id="4a7cdb7e2e605c63a1df5b8bdda096bc" data-rm-shortcode-name="rebelmouse-image" />
People praying for relief from the bubonic plague, circa 1350. Original Artwork: Designed by E Corbould, lithograph by F Howard.
Credit: Hulton Archive/Getty Images
<p>The disease likely originated in Asia over 2,000 years ago. This ancient pestilence decimated the world on different occasions but none as bad as when it hit in the Middle Ages.</p><p>Caused by the bacterium <a href="https://en.wikipedia.org/wiki/Yersinia_pestis" target="_blank">Yersinia pestis</a>, the plague resulted in terrifying symptoms. As <a href="https://www.history.com/topics/middle-ages/black-death" target="_blank" rel="noopener noreferrer">reported</a> by the History Channel, the Italian poet Giovanni Boccaccio described the afflictions that came with the plague in no uncertain terms: "In men and women alike, at the beginning of the malady, certain swellings, either on the groin or under the armpits…waxed to the bigness of a common apple, others to the size of an egg, some more and some less, and these the vulgar named plague-boils."</p>
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Ambulance men of Florence, Italy, carrying a patient on a stretcher whilst wearing masks to ward off the plague.
Credit: Hulton Archive/Getty Images
<p>Attacking the lymphatic system, the plague also brought with it fever, vomiting, diarrhea, body aches, and pains. Unfortunately, available medieval treatments like bloodletting certainly weren't too pleasant and did little to stem the tide of the Black Death. Neither did the belief of many that the plague was a punishment from God. This resulted in the purging of "heretics" like the massacres of thousands of Jews in 1348 and 1349 and a whole class of self-flagellating people who went from town to town beating themselves in penance.</p><p>What finally ended the Black Death? It went away for periods of time but would come back for a new round during several centuries like its resurgence in London in 1665-1666, when it killed about 100,000 – a quarter of the city's population. The eventual weakening of the pandemic was likely due to the practice of <strong>quarantining</strong> infected people that originated in Venice in the 15th century and is with us to this day. Improved sanitation, personal hygiene, and medical practices also played a role in ultimately slowing the plague's terror march. Still, annually there are about 1,000 to 3,000 cases of the plague even in the modern world.</p>
Plague 101
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Study warns of delayed flu outbreaks after pandemic ends
The positive steps we are taking to prevent disease might have a negative side effect.
13 November, 2020
Credit: Christopher Furlong/Getty Images
- A new study out of Princeton suggests that measures to prevent COVID-19 are also preventing certain other diseases.
- The nature of seasonal diseases means that people who avoid them this year may just be putting it off, leading to a large wave later.
- These estimates don't mean we should be less preventive now, only that we must be sure to take care in the future.
<p> As the United States continues to struggle with the pandemic, the proven effectiveness of face masks to reduce the rate and risk of infection continues to be underutilized. Places that have implemented mask and distancing mandates are seeing generally lower rates of transmission and infection than those without these mandates, as more fully explained <a href="https://www.pnas.org/content/117/26/14857" rel="noopener noreferrer" target="_blank">here</a>, <a href="https://www.eurekalert.org/pub_releases/2020-06/tl-pss060120.php" rel="noopener noreferrer" target="_blank">here</a>, and <a href="https://www.vox.com/science-and-health/21546014/mask-mandates-coronavirus-covid-19" rel="noopener noreferrer" target="_blank">here</a>. <br> <br> However, one of the three iron laws of the cosmos is the law of unintended consequences; no matter what you do, there will be at least one.</p><p> As a study out of Princeton has just shown, this also applies to live-saving mask mandates. Given that many other diseases follow predictable cycles, a team of researchers has shown that the steps we're taking to prevent the spread of COVID-19 now may lead to larger outbreaks of seasonal diseases later. <br> <br> Before we go any further, we want to make it clear that we are not telling you stop wearing a mask, social distancing, or taking all the precautions against catching and spreading COVID. The point of this study and this article is to make people aware of a side effect of these measures so that we can better deal with them later, not to suggest that these measures not be taken. </p>
<iframe width="730" height="430" src="https://www.youtube.com/embed/UFX9oS2kpUA" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> A team of researchers based out of Princeton published a <a href="https://www.pnas.org/content/early/2020/11/06/2013182117" target="_blank" rel="noopener noreferrer">study</a> in the Proceedings of the National Academy of Sciences showing the predictions of a model that estimates the after effects of our current efforts to avoid COVID-19.</p><p>As it turns out, Non-pharmaceutical interventions (NPIs) such as social distancing and wearing masks help prevent more than just COVID-19. Instances of other diseases, such as respiratory syncytial virus (RSV) and the flu, are also lower than they would otherwise be due to people taking these precautions. Cases of RSV may have declined by as much as a 20 percent already. </p><p> This makes a lot of intuitive sense. Your mask doesn't care what kind of virus it keeps you from exhaling towards other people; it stops all of them. If you stay inside to avoid catching a particular disease, you still avoid all of them. This kind of thing has happened before. The precautions taken during the 1918 flu pandemic probably reduced measles cases by a third. <br> <br> However, these diseases come back seasonally and will be there waiting for us when the current pandemic ends. This might be a bit of a problem, as lead author Rachel Baker <a href="https://www.princeton.edu/news/2020/11/09/large-delayed-outbreaks-endemic-diseases-possible-following-covid-19-controls" target="_blank" rel="noopener noreferrer">explained</a>:<br> <br> "While this reduction in cases could be interpreted as a positive side effect of COVID-19 prevention, the reality is much more complex. Our results suggest that susceptibility to these other diseases, such as RSV and flu, could increase while NPIs are in place, resulting in large outbreaks when they begin circulating again."<br> <br> Think of it like this: As fewer and fewer people get these diseases due to our current mask and social distancing tendencies, fewer and fewer people have immunity to them. Immunity to RSV lasts only a few <a href="https://en.wikipedia.org/wiki/Respiratory_syncytial_virus" target="_blank" rel="noopener noreferrer">years</a>. If people who would have gotten it this year don't, they may contract and spread it next year when they aren't working so hard to avoid respiratory infections, along with all the other people who were likely to get it next year anyway for typical reasons. <br> <br> The model is less exact for the flu, given the number of variables affecting how contagious the flu is from year to year, but a similar principle applies. </p><p><br> There is a fair amount of uncertainty to these findings, as the authors admit. Outbreaks in some areas have been better studied than others. The behavior of these seasonal outbreaks is more thoroughly understood in Florida than in Minnesota, for example, and these predictions may not be as applicable there. The models are also highly dependent on what measures we take and when to fight COVID-19, and the worst-case ones rely on a lot of things happening in tandem. </p> So while we can't know exactly what that next flu season will look like, the essential finding of this study is that it is likely to be worse than it otherwise would be, everything else being equal. Various measures, such as getting more people vaccinated against the flu and keeping people home when they are sick with seemingly banal colds, will be necessary in the years to come. Hospitals should also brace for higher than average numbers of people coming in as a result of this.
Why you should still wear a mask
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc3NDYzNS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMzc1ODM1Nn0.UNIHh2X2AtR6fq_fhAwejphFKIOY9J3lGFWgDf-R6oE/img.jpg?width=980" id="d681e" class="rm-shortcode" data-rm-shortcode-id="1dc1e7ee8c2f01ac128b4b48c1675510" data-rm-shortcode-name="rebelmouse-image" />A chart from another study on the effectiveness of masks and lockdowns. The grey line in the bottom two marks when mask mandates were imposed.
Credit: Zhang, Li, Zhang, and Molina
<p><br>Again, before you decide that this means mask mandates are just delaying some kind of reckoning, we can look at the numbers. Several <a href="https://www.nationalgeographic.com/science/2020/07/coronavirus-deadlier-than-many-believed-infection-fatality-rate-cvd/" target="_blank" rel="noopener noreferrer">sources</a> agree <a href="https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm" target="_blank" rel="noopener noreferrer">that</a> the <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu" target="_blank" rel="noopener noreferrer">coronavirus</a> is <a href="https://www.livescience.com/covid-19-vs-flu-deaths-hospitalized-patients.html" target="_blank" rel="noopener noreferrer">deadlier</a> than <a href="https://www.snopes.com/fact-check/flu-kills-more-people-covid-19/" target="_blank" rel="noopener noreferrer">the </a><a href="https://www.snopes.com/fact-check/flu-kills-more-people-covid-19/" target="_blank" rel="noopener noreferrer">flu</a><a href="https://www.snopes.com/fact-check/flu-kills-more-people-covid-19/" target="_blank" rel="noopener noreferrer">.</a> We also don't have a vaccine for it yet, unlike for the flu, and keeping yourself and others from getting sick now remains extremely important for keeping people alive. </p><p> A friend of mine remarked at the beginning of the pandemic that certain events in society leave marks on the people in it, much like growth rings on a tree showing years of drought decades after it occurred. If the findings of this study are accurate, then COVID-19 will leave rings visible in seasonal outbreaks over the next few years alongside the slew of others it will create. <br></p><p>Given what this study shows us and the hard-learned lessons we have about what happens when you don't listen to scientists, maybe we'll do a better job at controlling those potential epidemics.</p>
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