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Morning Rounds Shraddha Chakradhar

Participant in AstraZeneca Covid-19 vaccine trial had serious neurological symptoms

New details about the individual who triggered a global shutdown of the Phase 3 clinical trial of a Covid-19 vaccine being co-developed by AstraZeneca and the University of Oxford emerged yesterday. The participant was a woman from the U.K. who experienced neurological symptoms consistent with a rare but serious spinal inflammatory disorder called transverse myelitis, AstraZeneca's chief executive Pascal Soriot shared during a call with investors. Although the woman's diagnosis hadn't been confirmed, Soriot said that her condition was improving and that she was expected to be discharged soon. During the call, Soriot also revealed that the vaccine trial had previously been halted in July after another participant experienced neurological symptoms, although it was later diagnosed as multiple sclerosis and unrelated to the Covid-19 vaccine being tested. 

Here's what else is new with the pandemic: 

  • A new Commonwealth Fund survey of nearly 1,300 people further underscores the uneven impact of Covid-19 on vulnerable populations: More than half of Black and Latinx individuals reported some kind of economic challenge, compared to 1 in 5 white people. At the same time, nearly 40% of women reported mental health struggles, compared to 1 in 4 men. 
  • HHS yesterday issued guidance allowing pharmacists to be able to administer a Covid-19 vaccine to anyone age 3 and older when one becomes available. The vaccine has to be FDA-approved, and must be administered according to CDC recommendations. 
  • Researchers in the U.K. have developed a scoring system to better assess a patient's risk of dying from Covid-19. The model, which was developed based on data from more than 35,000 patients with Covid-19, stratifies patients into four risk groups on a scale of 21 points. Those with a score of 9 or higher have a 40% higher risk of death, while that figure increases to 62% with a score of 15 or higher. In a separate analysis, this new system was also more accurately able to determine the risk of death than other scoring methods currently in use. 

Covid-19 vaccine safety a big concern among U.S. adults, new poll finds

The U.S. public is highly concerned about vaccine safety, according to a new Kaiser Family Foundation poll. Of the nearly 1,200 people who were surveyed recently, 62% expressed concerns that the FDA would approve a Covid-19 vaccine under political pressure. At the same time, while a vast majority don't think a vaccine will be ready before early November — a timeline that the CDC recently asked states to prepare for — only about 40% said they would get a vaccine if it was available by then. Slightly more than half of people surveyed had heard of convalescent plasma therapy, which was granted emergency approval by the FDA last month, and the vast majority think more studies need to be done to determine its efficacy. 

ADHD among Black youth could be higher than previously thought

A new review suggests that Black people in the U.S. may be at a higher risk for ADHD than previously thought. The finding counters the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, which mental health experts use to diagnose conditions, and which states that the prevalence of ADHD among Black individuals is lower than the general population. Looking at 21 studies representing data from nearly 155,000 Black individuals, scientists found that the prevalence of ADHD in this population was around 15%. Previous estimates, however, have suggested that ADHD prevalence in the general population could be 2%-12%. Black people are not often included in datasets that calculate ADHD prevalence, which the authors cite as a possible reason why previous estimates seem low. Other factors, including low socioeconomic status and the fact that teachers tend to overreport symptoms among Black youth from low-income backgrounds, could also explain the differences. 

Inside STAT: Covid-19 is taxing the support system of pregnant people recovering from substance use

Peer doula Carrie Diehl, with her 8-month-old daughter, leaves work at Baystate Franklin Medical Center. (ALICE PROUJANSKY FOR STAT)

A lot of a doula's work requires personal contact, from holding newborns to postpartum care for the new mother. For Carrie Diehl of Greenfield, Mass., who works as a peer mentor doula for mothers in recovery from substance use disorder, the Covid-19 pandemic has complicated all of her work. The stress and isolation brought on by Covid-19 mean that those with a history of substance use are at an increased risk of relapse. And unlike before the pandemic, Diehl — who is also a new mother and is 5 years sober from a substance use disorder — has now had to rely on more phone calls, more texts, and the occasional walk with a client. "I’m trying to find a way," Diehl tells STAT contributor Alice Proujansky, "Because it’s not like I can watch the baby over the phone." Read more here. 

Q&A: A framework for clinicians-in-training to prepare for climate change

As massive wildfires, hurricanes, and record-breaking temperatures hit parts of the U.S., a group of doctors is urging medical residency programs to implement standardized curriculum on the health impacts of climate change. They published their proposed framework in a new paper, which includes a breakdown of high-risk populations, including the elderly and low-income families, and a review of the current understanding on how climate impacts health — such as the relationship between air quality and respiratory illness. I spoke with Rebecca Philipsborn, a pediatrician at Emory University School of Medicine and lead author of the paper, to learn more. 

What was the impetus for this framework?  
Right now, we can graduate doctors from medical school and residency programs without any mention of climate change, and yet climate change has been called the greatest threat of our time. 

What does the framework involve?
The way we break it down is: How climate change harms health, how doctors can adapt clinical practice to health conditions and diseases that are worsened by climate change, and how climate change undermines and disrupts health care delivery. One example of this last category is hospital evacuation during extreme weather scenarios or shortages of critical medical supplies during Hurricane Maria in 2017. [The framework] is meant to serve as a template or guide for residency program directors. Talking about air quality from wildfires, for instance, could come during community health rotations, or pulmonary/respiratory rotations or even primary care rotations. 

Read the rest of our conversation here

Age of first period has decreased slightly in the past two decades

The age of menarche — when girls first get their period — has been decreasing in recent years, according to new CDC data. Early menarche could put girls at a higher risk of developing health problems including breast cancer or even mental health conditions such as depression. The new report reveals that between 2013-2017, the average age of menarche was 11.9, down from 12.1 in 1995. Hispanic women had a higher probability of early menarche than white women, as did those whose mothers had a high school diploma or GED compared to those whose mothers had a bachelor's degree. And consistent with previous reporting, girls who started menstruating at an earlier age were also likelier to start having sex at younger ages.

What to read around the web today

  • America is trapped in a pandemic spiral. The Atlantic
  • How common is burnout among physicians? It depends on how it’s defined. STAT
  • Ex-Columbia University gynecologist accused of abusing dozens of patients is indicted. NPR
  • Woodward defends decision to withhold Trump's virus comments. Associated Press
  • The silence and sorrow of miscarriage. JAMA

Thanks for reading! More tomorrow,


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Thursday, September 10, 2020


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