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Morning Rounds Shraddha Chakradhar

How to fix the Covid-19 dumpster fire in the U.S.

(Hyacinth Empinado/STAT)

Americans make up fewer than 5% of the world's population, but account for a quarter of the world's Covid-19 cases and deaths. And the U.S. response to the pandemic, to put it simply, "is a raging dumpster fire," writes STAT's Helen Branswell. But getting out of the current predicament is going to take a lot more coordination than the country has shown thus far. A total lockdown like in the early months of the pandemic is not possible again, but neither is an option to throw caution to the wind. STAT asked a number of experts for their thoughts on what we ought to do now: Top infectious disease official Anthony Fauci shared that we ought to turn back the clock and start over, not with lockdowns but with closing bars, banning large gatherings, and encouraging mask wearing outdoors all the time. "I would almost guarantee that we would see a turnaround of the resurgence that we’re seeing now,” he says. Read more here.  

Here's what else is going on with Covid-19: 

  • What could be next for Anthony Fauci, if the White House keeps up with its recent attempts to sideline and discredit him? He could be dismissed from his post as head of the NIAID, writes STAT's Lev Facher, or could even be formally barred from conducting public interviews or briefings. Read more here
  • As California continues to see a surge in Covid-19 cases, Gov. Gavin Newsom announced a sweeping rollback of reopening plans in the state, including indoor closures of restaurants and movie theaters statewide as well as complete shutdown of bars' operations. Los Angeles and San Diego school districts also announced that they will be online-only in the fall. 
  • A new modeling study estimates that deaths from HIV, tuberculosis, and malaria in some low- and middle-income countries could increase due to disruptions in care from the pandemic. HIV deaths could increase by as much as 10% over the next five years, the study finds, while TB deaths could rise by 20% and malaria deaths could go up by 36%. 
  • An Amnesty International report estimates that 3,000 health care workers around the world have died from Covid-19, with the most deaths in Russia, the U.K., and the U.S. This figure likely represents an underestimate given the lack of reporting, the analysis says. The report also outlines serious shortages of protective equipment and the threat of reprisals from employers and members of the public for raising concerns about the coronavirus. 

Premed students call for MCAT to become an online test this season

Students for Ethical Admissions, an organization of premed students in the U.S. and Canada, is calling for the Association of American Medical Colleges to reconsider in-person MCAT testing due to the pandemic. Other standardized tests, including the LSAT and GRE, have moved online this season, while schools such as Stanford have waived the MCAT requirement for this application season. AAMC responded to SEA's initial concerns, emphasizing late last week that online testing would not be possible to "protect the integrity of the exam." But SEA says it has since learned that at least four students — who claim no other outside activity — tested positive for Covid-19 after going to an MCAT testing center. Moving the MCAT online or making it optional this cycle "will mitigate infection rates amongst applicants and demonstrate ... that the medical community will practice what they preach about avoiding gatherings and small, enclosed spaces," an SEA representative tells me. The AAMC confirmed with me yesterday that it will still be requiring in-person testing. 

Goals for ending world hunger are likely to be missed, UN says

World hunger is trending in the wrong direction, according to a new United Nations report. Almost 690 million people — 9% of the world's population — went hungry last year, up by 10 million since 2018 and an increase of 60 million since 2014. The report also estimates that at the current rate, roughly 840 million people would be undernourished by 2030, and that the UN's goal of ending world hunger by that year would also not be met. The prevalence of undernourishment in Africa was twice as high as the global average, while more than half the number of undernourished individuals reside in Asia. Covid-19 is likely to exacerbate the scenario, the report suggests, as early estimates show up to 132 million people will go hungry this year from the effects of the pandemic. 

Inside STAT: How should hospitals respond to bias from patients? Experts offer a playbook

A small STAT survey of physicians in 2017 found that the majority of them reported being at the receiving end of some form of abuse from patients, but hospitals don't usually have policies in place to help providers deal with this problem. Now, new recommendations offer some ways that hospitals can better address incidents of patient bias. Some institutions had refrained from creating their own framework believing that the problem was too complicated to address, experts tell STAT's Alexander Spinelli. But the new guidelines break down the actions to take, asking hospitals to craft policies specifically to address patient bias, to consider the needs of all staff — not just physicians — and to create a system so problems can be reported in a routine way. Read more here

Creating more inclusive care environments to improve LGBTQ individuals' health

Equipping health care practices to be more inclusive of LGBTQ individuals could also improve rates of STI testing. In a new study, researchers describe a program that trained staff at federally funded community centers on the needs of LGBTQ patients, including asking patients' preferred pronouns. Ten centers were included in the study, and an analysis found that after the training, the centers saw a 43% increase in the practice of collecting patients' preferred pronouns and a 300% increase in having liaisons at centers specifically for LGBTQ patients. At the same time, testing for STIs also increased: Rates of testing for HIV nearly doubled, while syphilis, chlamydia, and gonorrhea testing also increased. "[D]eveloping more inclusive and culturally affirming environments can increase LGBT engagement in health care, and eventually lead to better overall health and well-being," the authors write.

Health gap between high- and low-income earners in U.S. is greater than in England

The impact of income inequality on health seems to be greater on those in the U.S. than those in England, according to new research. Scientists looked at data from nearly 13,000 middle-aged adults in the U.S. and England, and calculated the health gap between the top 20% and bottom 20% of income earners in both groups. The gap was significantly greater among U.S. adults in 13 of the 16 measures the study looked at: measures included self-reported assessments such as climbing up flights of stairs as well as physician-diagnosed conditions such as diabetes and cancer. Disparities were greater within the U.S. than within England: 29% of low-income earners in the U.S. had diabetes compared to around 12% of the high earners. At the same time, only about 14% of low-income earners in England had the condition, compared to 6% of the top earners. 

What to read around the web today

  • Pakistan to resume polio campaign as COVID-19 cases decline. Associated Press
  • Connecting donated human lungs to pigs repaired damage to the organs, scientists report. STAT
  • How koalas with an STD could help humanity. The New York Times
  • At college health centers, students battle misdiagnoses and inaccessible care. The Washington Post

One final update for you: More than 200 universities and 17 states are now fighting the new ICE rules for international students. A judge is scheduled to hear the Harvard and MIT case today, and I'll share any news from that in tomorrow's newsletter. 

Thanks for reading!

Shraddha

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Tuesday, July 14, 2020

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