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Morning Rounds Elizabeth Cooney

Former Trump health official says later surge in Covid deaths could have been avoided

A doctor who helped guide the Trump administration’s pandemic response said that most U.S. deaths from Covid-19 could have been avoided. Deborah Birx, one of six health officials who talked to CNN’s Sanjay Gupta in an interview broadcast last night, said a crucial opportunity to prevent soaring deaths was missed. "I look at it this way. The first time we have an excuse," she said. "There were about a hundred thousand deaths that came from that original surge. All of the rest of them, in my mind, could have been mitigated or decreased substantially." After she warned in August that the country was entering a new phase in the pandemic with rising cases, she said Trump called her. "It was very uncomfortable, very direct and very difficult to hear."

Pandemic's mental health toll continues

Disease and death are still inspiring fear and grief. A new national survey tracking anxiety, depression, and people’s need for mental health services found jumps in all three from August through February. Adults reporting symptoms of anxiety or depression during the past seven days climbed from 36% to 42%, as did those who said they needed but did not receive mental health counseling or therapy during the past four weeks, rising from 9% to 12% over those six months. The biggest increases came in people 18 to 29 years old and who hadn’t graduated from high school. And it's not over: In the last 10 days of January, more than 2 in 5 adults reported anxiety or depression during the past seven days, 1 in 4 of whom said they didn’t get the therapy they needed.

How Covid-19 affects the brain

In a chilling new review of how SARS-CoV-2 may do its damage in the brain, researchers list neuropsychiatric impairments that range from loss of taste and smell to “brain fog” to suicidal behavior. Brain damage arises and sometimes persists after the immune response to Covid-19 stirs a cytokine storm that can activate immune cells in the brain, they write, possibly leading to altered learning, memory, neuroplasticity, hallucinations, and nightmares. The virus itself may cross the blood-brain barrier, too, and in the brain stem, could prompt anxiety and autonomic changes such as rapid heart rate, shortness of breath, and sweating. Another theory: Inflammation and blood clotting may combine to cause microstrokes and neuronal damage, with different neuropsychiatric symptoms depending on where in the brain they happen.

Inside STAT: The battle over Talkspace

(alex hogan/STAT)

Late last year, Reno, Nev., Mayor Hillary Schieve proposed a novel idea to meet the mental health needs of her community: The city would spend $1.3 million of expiring coronavirus relief funding on virtual therapy through the app Talkspace, available free to everyone but young children. The plan, however well-intentioned, was not universally well-received. Local therapists, distrustful of Talkspace and frustrated they hadn’t been consulted, were aghast. In many ways, the conflict in Reno underlined the broader tensions between conventional therapy and the cash-flush companies racing to disrupt it. Many therapists are skeptical of the quality of care. But supporters say that apps like Talkspace are effective and fill a gap in the nation’s tattered mental health system. STAT’s Mario Aguilar has more.

Black patients more likely to receive care in hospitals with worse safety records

Black people are more likely than white people to be admitted to hospitals with worse patient safety outcomes, a new analysis reports. For nine of 11 safety indicators such as bloodstream infections and pulmonary embolisms, including 6 of 7 related to surgery, Black patients were significantly less likely to be admitted into hospitals classified as “high quality” based on their records of minimizing patient risk. These racial disparities can’t be attributed to differences in how sick patients were when they arrived at the hospital, nor to racial differences in their health, health behaviors, or health care before being admitted, the authors note: “Differences in the quality of hospitals into which Black and white patients are admitted continue to be a driver of overall disparities.”

JAMA editor sidelined after podcast skeptical of racism in medicine causes stir

JAMA’s top editor has been placed on leave after an outcry from Black physicians over a tweet and podcast questioning structural racism, the Associated Press reports. “No physician is racist, so how can there be structural racism in health care?” the tweet read in part, promoting a podcast that critics called cringeworthy and appalling. JAMA took down the podcast earlier this month and Howard Bauchner, the journal’s editor-in-chief, apologized. But a committee that oversees the journal started an investigation late last week and placed Bauchner on administrative leave, pending the outcome of its inquiry. The podcast, billed as a discussion for skeptics, featured two white doctors: a deputy journal editor who expressed discomfort with the word “racism” and a physician who runs a New York City health system.

Covid-19 cases in the U.S.

Cases yesterday: 43,694
Deaths yesterday
: 506
Vaccine doses distributed, per CDC180,646,465
Total doses administered: 143,462,691

What to read around the web today

  • FDA approves first personalized cell therapy for patients with multiple myeloma. STAT+
  • 'Vaccine passports' are on the way, but developing them won't be easy. Washington Post
  • A volunteer army’s mission: Vaccinate Black people in the rural South. New York Times
  • Analysis: How the U.S. invested in the war on terrorism at the cost of public health. KHN
  • Opinion: Lessons from Nordic countries can accelerate the impact of AI in medicine. STAT+

Thanks for reading! More tomorrow,

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