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Morning Rounds Shraddha Chakradhar

For people with type 1 diabetes, CDC Covid guidelines are puzzling

The CDC’s recommendations for who ought to get a Covid-19 vaccine when are causing confusion among people with diabetes: Those with the type 1 form of the disease are lower down on the priority list than those with type 2. People with type 2 will get vaccinated right after health care and other essential workers, as part of Phase 1. But people with type 1 are in Phase 2, even though data show that these people have just as much risk — if not more — of dying from Covid-19 as those with type 2 diabetes. CDC guidelines rank a person with type 2 diabetes as someone “at increased risk” of more severe illness from Covid-19, while those with type 1 diabetes “might be at an increased risk.” Those recommendations differ from the U.K.’s, which place patients with either type of diabetes in the same risk category. STAT’s Elizabeth Cooney has more here

Here’s the latest look at Covid-19 by the numbers

The pandemic is continuing seemingly unabated in the U.S. There were more than 300,000 new infections reported at the end of last week, a new daily record that came right after the single deadliest day — more than 4,000 fatalities — due to Covid-19. The vaccine rollout is also going slowly: According to the CDC, only around 6.6 million people have received the first dose of a vaccine, which is still nearly 13 million short of the 20 million who were to have gotten vaccinations by the end of 2020. The situation in many other parts of the world is also grim. The U.K. recorded 1,325 deaths on Friday — its single deadliest day since the start of the pandemic — as the B.1.1.7 variant continues spreading across parts of the country. And Africa has now surpassed 3 million Covid-19 cases, continuing to raise questions about how soon countries there can get vaccinations. 

Youth who try e-cigarettes may be three times as likely to smoke regular cigarettes

A survey of U.S. youth who were followed for four years finds that those who try e-cigarettes are three times more likely to smoke traditional cigarettes than those who don’t try the devices. The study included data from those who were between the ages of 12-24. Nearly two-thirds of this group had tried tobacco, and by the end of the fourth year, 12% were daily tobacco users. And while the risk was still small, 10% of those who tried e-cigarettes were likely to be daily smokers later, compared to 3% of those who didn’t vape. At the same time, daily smoking was six percentage points less among those who experimented with vaping after they turned 18. 

Inside STAT: A call for hospitals to find ways to allow family visits during the pandemic


Romelia Navarro (right) is comforted by nurse Michele Younkin as she weeps while sitting at the bedside of her dying husband, Antonio, in St. Jude Medical Center's Covid-19 unit in Fullerton, Calif., in July. (JAE C. HONG/AP)

As the U.S. confronts nearly 380,000 Covid-19 deaths, the authors of a new First Opinion argue that hospitals ought to find ways to allow family members to regularly communicate with and visit their loved ones. As members of a palliative care team at Boston’s Brigham and Women’s Hospital, the authors write that they’ve seen the trauma that family separation inflicts on patients and their families, even though hospitals kept families away in an effort to prevent further infections. “The inequitable chaos of the status quo — usually a nurse scrambling to arrange a video chat, often on her or his personal phone — is unacceptable. Nearly 10 months into the pandemic, we should not still be trying to figure this out,” they write. More here.

Most hospitalized for Covid-19 still have symptoms six months later, China study finds

A small study of patients hospitalized with Covid-19 in China finds that the majority of them still had at least one symptom six months after initially falling ill. Experts looked at data from more than 1,700 patients hospitalized between January and May in Wuhan, with follow-up data from June to September last year. More than three-quarters of the patients had at least one symptom at follow-up, with muscle weakness or fatigue as the most common symptom. Sleep difficulties and anxiety or depression were also frequently reported. The study, the largest and longest analysis to date of post-Covid recovery, also found that a subset of patients had antibody levels that were at less than half the levels at initial infection, suggesting that these patients could also have a higher risk of reinfection. 

Black neighborhoods in St. Louis had less Covid-19 testing despite higher hospitalization rates

A study of seven counties in the St. Louis area finds inequitable distribution of Covid-19 testing in majority-Black neighborhoods. Between March and August 2020, more than 400,000 Covid-19 tests were performed in these seven counties, and there were more than 4,000 hospitalizations for the illness. However, fewer than 90,000 tests — or roughly 1 in 5 tests — were conducted in the ZIP codes that accounted for 50% of the hospitalizations, the majority of which were Black neighborhoods. In contrast, more than half the tests were performed in the neighborhoods that only accounted for 25% of hospitalizations, areas that weren’t predominantly Black. And within the same ZIP code, the study found that Black residents had a lower rate of tests per hospitalization than white residents. 

Covid-19 in the U.S.

Cases yesterday: 213,905
Deaths yesterday: 1,814
Vaccine doses distributed, per CDC22,137,350
Number of people who received first dose: 6,688,231

What to read around the web today

  • At elite medical centers, even workers who don’t qualify are vaccinated. The New York Times
  • Throughout history, mass vaccine rollouts have been beset by problems. The Boston Globe
  • Democrats have their best shot yet at letting Medicare negotiate drug prices — but it’s still not a done dealt. STAT+
  • Search for better COVID vaccines confounded by existing rollouts. Nature
  • Clogged phone lines and ethical dilemmas: Texas health providers scramble to roll out vaccine with little state guidance. The Texas Tribune

Thanks for reading! More tomorrow,

Shraddha

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Monday, January 11, 2021

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