This is default featured slide 1 title

Go to Blogger edit html and find these sentences.Now replace these sentences with your own descriptions.This theme is Bloggerized by Lasantha Bandara - Premiumbloggertemplates.com.

This is default featured slide 2 title

Go to Blogger edit html and find these sentences.Now replace these sentences with your own descriptions.This theme is Bloggerized by Lasantha Bandara - Premiumbloggertemplates.com.

This is default featured slide 3 title

Go to Blogger edit html and find these sentences.Now replace these sentences with your own descriptions.This theme is Bloggerized by Lasantha Bandara - Premiumbloggertemplates.com.

This is default featured slide 4 title

Go to Blogger edit html and find these sentences.Now replace these sentences with your own descriptions.This theme is Bloggerized by Lasantha Bandara - Premiumbloggertemplates.com.

This is default featured slide 5 title

Go to Blogger edit html and find these sentences.Now replace these sentences with your own descriptions.This theme is Bloggerized by Lasantha Bandara - Premiumbloggertemplates.com.

Sunday, May 24, 2020

Protesters hang Beshear in effigy, sparking bipartisan rebuke

Photo by Sarah Ladd, Courier Journal, via Twitter
Protesters hung Gov. Andy Beshear in effigy from a tree across from the governor's mansion and took their demonstration to its front porch, prompting objections from Kentucky politicians of both parties Sunday.

The event started as a Second Amendment rally "but turned into a protest of coronavirus restrictions and Beshear’s administration," reports Sarah Ladd of the Louisville Courier Journal. "As the rally wound down, organizers led the remaining crowd to the governor’s mansion to attempt to hand deliver a request for Beshear to resign. . . . No one came to the door. A few Kentucky state troopers got out of their cars to observe but did not attempt to stop the crowd. It’s not clear if Beshear was at home at the time. The crowd returned to the capitol, at which time an effigy of Beshear was hung from a tree outside the Capitol while 'God Bless the U.S.A.' played over the loudspeaker."

The effigy bore a sign saying "Sic semper tyrannis," Latin for "Thus ever to tyrants," the state motto of Virginia and the words John Wilkes Booth reportedly said after assassinating President Abraham Lincoln in 1865. "After hanging for a short time while people snapped photos," Ladd reports, "it was cut to the ground." But it brought objections from some protesters, and from politicians of both parties.

"I condemn it wholeheartedly," Secretary of State Michael Adams, a Republican, said on Twitter. "The words of John Wilkes Booth have no place in the Party of Lincoln."

State Senate Minority Leader Morgan McGarvey, D-Louisville, called on Republican leaders to "join me in condemning violent threats against any elected official."

Sen. Whitney Westerfield, R-Hopkinsville, who narrowly lost the 2015 attorney general's race to Beshear and has been one of his most frequent critics, replied, "Agreed, @MorganMcGarvey. This awfulness has no place in civil society."

Senate Majority Leader Damon Thayer, R-Georgetown, tweeted, "These actions are reprehensible. I absolutely condemn violence and threats of violence. If you want to protest, do it peacefully and respectfully."

Why wear a mask in public? Because you may have the coronavirus and not know it, and it's highly contagious

President Trump wore a mask on a private tour of a Ford plant Thursday but refuses to do so in public.
By Melissa Patrick
Kentucky Health News

Wearing a mask when out in public is even more important as Kentucky reopens its economy, medical professionals advise. Many Kentuckians are skeptical.

Rebecca Dutch, chair, UK Department
of Molecular and Cellular Biochemistry
(UK Photo by Mark Cornelison)
"It is actually, primarily, so that if you happen to have the virus and you don't know it -- which happens very frequently now -- you're not breathing it out, coughing it out on other people," said Rebecca Dutch of the University of Kentucky, who has spent more than 30 years studying viruses.

"Every person we add into our interactions is someone we might either get it from or pass it to, or take it home to our families," Dutch said. "Remember that the risk is still there, so think carefully about whether what you are doing is something that is a good idea."

Dutch is a professor and the chair of the Department of Molecular and Cellular Biochemistry at UK, and leader of the Covid-19 Unified Research Experts (CURE) Alliance team, which advises on covid-19 patient care and clinical trials at the university.

She said the novel coronavirus has a relatively high infection rate, with each infected person causing three more infections if there are no restrictions on activities and contacts. Emergency restrictions imposed by Gov. Andy Beshear have reduced Kentucky's infection rate to 0.87, according to a model created by the co-founders of Instagram, which displays each state's rate at rt.live. A rate of less than 1 means the virus should eventually stop spreading.

It will be important to watch this number as the state has fewer restrictions and more contacts; Beshear has refused to say how the infection rate drives his decisions, but New York Gov. Mario Cuomo has said a rate of 1.1 or above would be a trigger for him to reimpose restrictions.

As he allowed opening of Kentucky's stores and restaurants, and social gatherings of 10 or fewer people, Beshear used the rhyme "Hands, face and space" to summarize the medical advice: Keep your hands washed; don't touch people not in your immediate family; wear a mask in close quarters; avoid touching your face; keep six feet of separation; and to entertain outside, if at all possible.

"All of these are mechanisms just to try to stop as much spread as we can," said Dutch. "So that is why the governor is now asking people to mask."

The official message also came with a warning that some Kentuckians may have become complacent about their risk of getting the virus. "some may conclude that the danger is not still there, and I’ve got to urge you, the danger is still there. If we take our eye off the ball . . . we could find ourselves in late June paying very dearly for our actions today," Health Commissioner Steven Stack warned May 22.

The most controversial piece of advice is to wear a mask, so Beshear is asking Kentuckians to say on social media posts why they wear one, and to talk to others about it.

"Some people have objected to masks, and the challenging part about that is you can object to a mask on your own personal health, but it is not your own personal health that it is going to impact," Beshear said May 19. "It is other people's health, so it is more about your willingness to protect other people if you are wearing or not wearing one."

The governor regularly points out that masks are recommended by the White House and the Centers for Disease Control and Prevention. At one point he said they shouldn't be a partisan issue.

Kaiser Family Foundation Poll released May 22 found that Democrats are about twice as likely as Republicans to say they wear a mask every time they leave their house: 70% and 37%, respectively. Majorities of each party said they wear a mask "most of the time."

Kaiser Family Foundation chart; click on it to enlarge. More data and poll questions are here
The poll also found that while 72% of Americans think President Trump should wear a mask when meeting with others, only about half of Republicans, 48%, agree. The report says that the partisan difference in largely driven by Republican men.

A pushback on several levels

Trump says he doesn't need to wear a mask because he is tested daily for the virus, but critics say he is missing an opportunity to set an example that would save lives. Thursday, he refused to wear a mask in front of news cameras while touring a Ford plant in Michigan on Thursday, saying "I didn't want to give the press the pleasure of seeing it." He wore a mask when news cameras weren't around, but someone on the tour took a picture of him and it was widely circulated.

Senate Majority Leader Mitch McConnell regularly wears a mask, bit U.S. Sen. Rand Paul, an ophthalmologist, says he won't wear one because he says he has had the disease and is immune. However, experts warn that this hasn't been proven, and there have been reports of people testing positive weeks after they have recovered, and that it is uncertain if they are contagious or not.

Fourth District U.S. Rep. Thomas Massie weighed in on Twitter yesterday, saying "There is no authority in the Constitution that authorizes the government to stick a needle in you against your will, force you to wear a mask, or track your daily movements. Anyone who says you have to right to avoid those things fundamentally misunderstands the 9th" Amendment, which says the Constitution's language "shall not be construed to deny or disparage others retained by the people."

Lexington Herald-Leader photo
And in a move that got national notice, a Manchester convenience store posted a sign banning masks. Alvin's responded to complaints by saying it was a "joke," the Lexington Herald-Leaderreported. Later, it clarified the statement in a Facebook post, saying it would not turn away mask-wearing customers and "It's your choice to wear one or not, not our government's choice for us." Newsweek reports that the sign has since been taken down.

Earlier, Chris Kenning and Sarah Ladd of the Louisville Courier Journal took a look at who was or wasn't wearing masks around Kentucky and found a low percentage of compliance in one of the hardest-hit parts of the state.

Mason Barnes, Judge-Executive of Simpson County, just south of Warren County, which continues to have one of the state's highest infection rates, told the CJ, "I'd say 70 percent to 80 percent of the people are not wearing masks when they're out and about."

Beshear has said Kentuckians will not be cited or arrested for not wearing a mask in public.

So, why should you wear a mask?

The simple answer is because the virus is primarily spread by tiny droplets from infected people, not just coughing and sneezing, but from talking and breathing. A mask can stop the spread of those droplets, especially from people who have the virus but don't know that they do. Stack, the health commissioner, says about one in four Kentuckians who have the virus have no symptoms.

UK HealthCare photo
Dutch, the UK virologist, pointed out that people can be very infectious just before they get symptoms.

She said, "When people can spread it before they know they are sick, we actually have to take extra precautions because we all have to think, 'Oh, I might have this, what do I need to do to protect people when I go out?'"

More than 40% of Kentucky adults are at higher risk of serious illness if infected with the virus because they have heart disease, chronic obstructive pulmonary disease, uncontrolled asthma, diabetes or a body mass index of 40 or more, indicating morbid obesity, according to the Kaiser Family Foundation. It did not include people with another risk factor, cancer, in which Kentucky is a national leader.

The value of wearing a mask is illustrated by a new study, published in The Proceedings of the National Academy of Sciences. It shows how normal speaking can launch thousands of droplets that can remain suspended in the air for eight to 14 minutes, allowing them to be inhaled by others. "There is a substantial probability that normal speaking causes airborne virus transmission in confined environments," the study report says.

The researchers said in a letter to The New England Journal of Medicine that the same experiment, using scattered laser light, found that use of a cloth face mask blocked nearly all droplets emitted when talking.


In addition, the scientific evidence is so strong to support the wearing of masks to slow the spread of the virus that more than 100 prominent health experts have asked governors to require them. They write that the research "strongly suggests that requiring fabric mask use in public places could be amongst the most powerful tools to stop the community spread of covid-19."

So why did the CDC recommend not wearing a mask two months ago? The Mayo Clinic says face masks were not recommended at the start of the pandemic because experts didn't know the extent to which people with covid-19 could spread the virus before symptoms appear, nor was it known that some people have covid-19 but don't have symptoms.

The CDC now recommends the use of reusable cloth masks so that surgical masks and N95 respirator masks, which continue to be in short supply, can be saved for health-care workers.

The CDC guidance says cloth masks should: fit snugly but comfortably against the side of the face; be secured with ties or ear loops; include multiple layers of fabric; allow breathing without restriction; and be able to be laundered and machine-dried without damage or change to shape. It also cautions that they should not be placed on children under age 2, anyone who has trouble breathing, or anyone who would have trouble removing the mask without help. The Mayo Clinic recommends that cloth face coverings be washed after every day of use.

Beshear's "healthy at work" rules require businesses to have employees to wear a cloth mask, unless it is a health or safety hazard to do so, or if they are working alone or in an enclosed space, or if they are working in an area that allows for appropriate social distancing. The order also encourages customers to wear masks, and allows businesses to refuse to serve customers not wearing them.

Dutch urged caution as the state reopens its economy, saying that the "long road ahead of us" will require all of us to make smart choices if we are to slow the spread of this virus, like continuing to practice social distancing and wearing a mask.

"I think it is really critical that people understand that as we are reopening the economy, we've done a good job of slowing down the rate of infections, but the virus is not gone," she said.

She added later, "The best we can do is anything that can just slow down how often people spread this virus from them to someone else, and that's how we win. Hopefully we will do well. We will see."

Saturday, May 23, 2020

No deaths from covid-19 in Ky. for the first time in 1½ months

Kentucky Heath News chart shows that cases trended up this week, but the two-week trendline, a key federal metric used to guide states in reopening their economies, is down.
As news develops about the coronavirus and its covid-19 disease, this item may be updated. Official state guidance is at kycovid19.ky.gov.

“For only the second time in about a month and a half, we have zero new deaths to report,” Gov. Andy Beshear said in his daily coronavirus update, delivered by press release, not in person.

Beshear reported 148 more cases of the coronavirus, for an adjusted total of 8,571. At least 3,102 Kentuckians have recovered from the virus. For additional information, including lists of positive cases and deaths, as well as breakdowns of coronavirus infections by county, race and ethnicity, click here. The list does not include a breakdown of today's new cases.

While a key federal metric for states reopening their economies, a two-week trendline, is down in Kentucky, the state's cases have trended upward this week as Beshear has allowed all retail establishments to reopen, restaurants to reopen at limited capacity, and gatherings of 10 or fewer people, a step he advance to include Memorial Day weekend.

“I am urging Kentuckians to please be safe this weekend,” Beshear said in the press release. “As we recover, we are depending on Kentuckians to take the steps necessary to protect one another this weekend and every day and weekend moving forward.”

About 200 demonstrators gathered on the steps of the state Capitol to call for removal or reduction of restrictions imposed by Beshear. Few masks were in evidence as people stood within six feet of each other, and Republican U.S. Senate candidate Wesley Morgan went around shaking hands.

Four would-be protesters had sought an injunction from a federal judge to block any state enforcement at the event, but District Judge Gregory Van Tatenhove said no Thursday evening, noting that the Beshear administration said the rally could proceed, and the four men hadn't shown that they had suffered harm, the Courier Journal reports.

In other covid-19 news Saturday:
  • The "How Covid-19 Spreads" webpage of the U.S. Centers for Disease Control and Prevention no longer says that the coronavirus spreads easily from contaminated surfaces. A CDC spokeswoman told The Washington Post that the agency made the change after that the revisions were the result of “usability testing” and an internal review. The webpage still says,  “It may be possible that a person can get covid-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads, but we are still learning more about this virus.”
  • President Trump’s move to block travel from Europe in March "triggered chaos and a surge of passengers from the outbreak’s center" before the ban went into effect, the Post reports, noting that "Harrowing scenes of interminable lines and unmasked faces crammed in confined spaces spread across social media." Trump banned travel from China in February, but allowed 48,000 Americans to return, and "Members of the administration’s coronavirus task force were even presented with charts showing that the number of flights arriving from Europe dwarfed the influx from China," the Post reports.

Friday, May 22, 2020

Beshear says virus is declining in Kentucky, but he and health chief warn that might not continue 'if we take our eye off the ball'

Johns Hopkins University chart shows how Kentucky testing is up and positive results are down.
By Al Cross
Kentucky Health News

Gov. Andy Beshear declared for the first time Friday that the coronavirus is declining in Kentucky, but he and his health commissioner warned of a possible resurgence as the Memorial Day weekend began with small gatherings allowed and restaurants opening on a limited basis.

“We now think that we have not just plateaued, but we are actually in a decline in overall numbers of cases, especially when you look at the amount of testing that we’re doing,” Beshear said as he announced 141 new coronavirus cases and five more deaths from covid-19, bringing the state's toll to 391.

“We have proven that when we have adversity like we have had, we are resilient, we take care of each other,” Beshear said at the start of his daily briefing. Looking ahead to the Memorial Day weekend, he said, “It’s about being able to more things that we have done in a while and to make sure we do them responsibly. . . . How we're able to keep our cases down depends on how we do this weekend, and every weekend thereafter.”

Health Commissioner Steven Stack praised Kentuckians for their sacrifice, then issued much more comprehensive warnings.

“This is a time that gets dangerous for us; people get complacent. We can have the tendency to reach the wrong conclusions sometimes,” he said. “The reason we’re not having a much serious crisis right now … is because of what you have done … staying healthy at home these last couple of months.”

Then he warned, “Because we’re not in that trouble some may conclude that the danger is not still there, and I’ve got to urge you, the danger is still there. If we take our eye off the ball . . . we could find ourselves in late June paying very dearly for our actions today.”

Beshear, replying to a question about Memorial Day, said “My chief concern is that we’re so excited to see each other we’ll forget all the rules.”

Primary election: Secretary of State Michael Adams and State Board of Elections Executive Director Jared Dearing appeared at the briefing to urge people planning to vote in the rescheduled June 23 primary to do it by absentee ballot, to avoid long lines at polls, which will be as few as one per county.

GoVoteKy.com, a site for absentee-ballot applications, will be open until midnight June 15. Dearing said it takes about two minutes to apply. Adams said voters can also call, email or fax their county clerk, but the clerks are overrun, "so the best way to be a respectful citizen is to go to the website."

Ballots and postage-paid envelopes will be mailed to applicants, who must mail or otherwise return them by June 23. The deadline to register to vote for the primary, or correct registration information, is 4 p.m. Tuesday, May 26.

Beshear said, "This might be the easiest that it ever is to vote. . . . I would love to see us have a better primary response through this than we normally see" in a primary, when about one in six voters usually cast ballots.

Unemployment: Deputy Workforce Secretary Joshua Benton said 14,000 claims from March and  38,000 from April remain unresolved. He said more reviewers and adjudicators and being hired, and the most experienced adjudicators are being assigned to the March cases.

Benton said the kcc.ky.gov website has been changed to allow employers to submit return-to-work dates for employees, which will stop their unemployment benefits, and to add a dialog box to "streamline email . . . A lot of people are emailing a lot of different staff."

Beshear, asked if people who are told to quarantine themselves because they have had contact with an infected person, didn't answer directly. “We’d contact their employer because their employer should not want them coming back in sick,” he said. “Every business ought to realize that at that point its dangerous for that person to come in.”

In other covid-19 news Friday:
  • Beshear said the five deaths were of an 88-year-old Jefferson County man, a 97-year-old Jefferson County woman, a 74-year-old Barren County man, an 88-year-old Hopkins County woman and a 72-year-old Shelby County woman.
  • He said the fatalities have been 77.6 percent white, 18.7% African American, 2% Asian American, and 1.3% multiracial; and 3% Hispanic and 97% non-Hispanic.
  • Counties with five or more new cases were Jefferson and Warren, 28 each; Kenton, 16; Boone, 11; Fayette, nine; Woodford, six; and Logan and Shelby, five each.
  • Beshear said the state more than 171,338 coronavirus tests have been conducted in Kentucky, and "I still think that number is low," because some negative results are not reported.
  • Asked how the state is reporting viral tests, which determine if someone has the virus, and antibody tests, which see if they've had it but are less accurate, Stack said positive results from antibody tests are counted as probable cases; that number stood at 121 Friday, part of a total case number of 8,426 -- 3,069 of whom have recovered.
  • Beshear's chief of staff, LaTasha Buckner, said the state Capitol would reopen to groups of 10 or fewer visitors, by appointment, on Wednesday, May 27. She said they would be asked, but not required, to wear masks.
  • Beshear said a private funeral for former first lady Phyllis George, with about 40 people, would be held in the Capitol rotunda on Monday and livestreamed on KET. He complimented her children, Lincoln and Pamela Brown, saying they saw "the difficulty in having the same types of services we have had in the past," presumably a public lying in state with visitation.
  • The governor said that on June 29, when he tentatively plans to allow gatherings of 50 or fewer people, he might allow opening of small, "community type" swimming pools "where there is the ability to limit folks to 50 and to enforce the social distancing." He said that would depend on "where the virus is."

Reducing your risk of changes in thinking following surgery

Cognition is an important function of the brain that enables us to acquire and process information, to enhance our understanding of thoughts, experiences, and our senses. Any condition that affects our ability to think, reason, memorize, or be attentive affects our cognitive ability. Some cognitive decline is a normal part of aging, but there are many things you can do to prevent or forestall cognitive changes as you age, including when planning for surgery.

Older adults are having more surgical procedures

As our population ages and medicine and healthcare advances, more older adults are likely to develop serious conditions (like heart problems) and undergo surgical procedures to treat or manage these conditions. Recent surveys suggest that progress in surgical techniques and control of anesthesia has increased surgical procedures in older people, with approximately 30% of all surgeries being conducted in people over the age of 70.

While advances in medicine may help people live longer, older adults are more likely to develop complications due to surgery. Some research suggests approximately one-quarter of those over 75 undergoing major surgery will develop significant cognitive decline, and about half of those people will suffer permanent brain damage.

Why do surgery and anesthesia cause problems with thinking for older adults?

There are degenerative changes in the brain with aging that predispose people to cognitive changes from surgery. Hence, age is a risk factor that needs to be considered when making decisions about surgery. Education level, mental health, and pre-existing medical conditions are also factors that affect an older person’s postsurgical cognitive functioning. People with higher levels of education tend to have more active brains due to regular mental stimulation. Mental and social activities promote brain health and decrease the risk of dementia and cognitive decline with normal aging.

Pre-existing medical conditions such as obesity, hypertension, coronary artery disease, diabetes, chronic kidney disease, stroke, and dementia predispose older adults undergoing surgery to more risk of postoperative cognitive decline. The reason these diseases cause cognitive decline is related to systemic inflammatory markers in the blood — proteins that are released into the bloodstream as a result of inflammation in the body. These markers enter the brain following a break in the blood-brain barrier (protective membrane) during the postoperative period, resulting in inflammation in the brain. This blood-brain barrier dysfunction is frequently seen in older people (even in the absence of surgery), and has been seen in approximately 50% of patients undergoing cardiac surgery.

Does the type of surgery and anesthesia matter?

Many surgical factors and techniques, blood pressure fluctuations during surgery, and longer time in surgery can adversely affect the cognitive function of older patients. Each factor affects cognitive functioning in a unique way. Younger patients tend to respond better to surgical stresses compared to older people.

Minor surgical procedures such as skin biopsies, excision of cysts, suturing of lacerations, and related procedures performed on an outpatient basis are unlikely to result in cognitive decline. However, as the complexity of a surgical procedure increases, with longer operative periods and greater exposure to more anesthesia medication, the likelihood of postoperative cognitive decline increases. This is especially true for cardiac surgery.

Studies suggest that incidence of postoperative cognitive decline is approximately 30% to 80% after cardiac surgery, while for noncardiac surgeries the prevalence is approximately 26%. While all major surgeries (such as orthopedic, abdominal, or gynecological) pose a risk for cognitive decline, cardiac surgeries have a much higher proportion of cognitive decline after surgery. The most common determinants of cognitive decline involving cardiac surgical procedures are the presence of pre-existing cognitive dysfunction and the use of bypass machines to replace the function of the heart and lungs during the surgery.

Anesthesia management before and during surgery affects what happens after surgery

The perioperative period refers to the time span of a surgical procedure, and includes three phases: preoperative, operative, and postoperative. Anesthesia management encompasses all three phases. The type and dose of anesthesia medication, the use of opioid analgesics, fluid, and glucose management can all influence a person’s cognitive function in the perioperative period. The use of multimodal anesthesia (where a combination of intravenous medications is used, instead of only inhaled agents) may protect against some cognitive dysfunction, as may using non-opioid analgesics for pain management in the postoperative period.

Are there strategies to avoid cognitive decline in the postoperative period?

Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure.”  No other condition exemplifies this saying better than preventing postoperative cognitive decline.

The following are some strategies you and your caregivers can use to prepare for surgery.

Before surgery is scheduled:

  • Eat healthy, balanced meals. Foods rich in polyunsaturated fatty acids are protective for your brain health.
  • Exercise regularly, or as much as allowed by your cardiac conditions. Physical activity promotes brain health.
  • Maintain a healthy weight.
  • Remain socially active and connected.
  • Reduce stress. Meditation significantly reduces stress and promotes a sense of calm and overall well-being.
  • Practice good sleep habits and try to get six to eight hours of sleep a night.

When surgery is scheduled:

Schedule a comprehensive geriatric assessment. This enables your physician to diagnose reversible aspects of frailty preoperatively (if they exist) and take adequate measures in a timely manner, such as altering medications you may be taking, and/or postponing surgery if you are extremely frail, to improve nutrition and incorporate lifestyle changes.

Talk to your surgeon about the risks and complications of the procedure. If you are having heart surgery, ask if a cardiopulmonary bypass machine will be used, and whether it is important to your surgery.

Talk to your anesthesiologist about

  • The types of medications they plan to use, and if there are alternatives for those medications. Have a conversation about need for opioid analgesics, and if alternative non-opioid pain medication can be used to decrease the risk of postoperative cognitive decline.
  • The methods of measuring medications that can reduce your risk of cognitive changes. For example, use of EEG machines during surgical procedures enhances the anesthesiologist’s ability to monitor the depth of anesthesia. Anesthesia depth is the degree to which the central nervous system is depressed by an anesthetic medication. EEG monitoring will result in adequate usage of anesthetic agents, avoid overuse, and reduce risk for postoperative cognitive decline by reducing anesthesia exposure.
  • Gather relevant information on your perioperative management. Discuss which medications you currently take and should continue taking, and which ones should be avoided.

After surgery and during recovery:

Caregivers need to be informed about the need for keeping their loved one active and following physical rehab recommendations, and providing mental stimulation in the postoperative period. Puzzles, sudoku, board games, books, etc., will keep someone entertained while simultaneously providing them with some brain activity.

Finally, it is necessary to understand that although there is no cure for postoperative cognitive decline, preventive strategies and pre-planning with your team of surgeons, anesthesiologists, and geriatricians can help reduce the risks of cognitive problems that older adults often face following surgery.

References

Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis. The American Journal of Surgery, August 2019.

Postoperative cognitive dysfunction — current preventive strategies. Clinical Interventions in Aging, November 8, 2018.

Neurocognitive Function after Cardiac Surgery: From Phenotypes to Mechanisms. Anesthesiology, October 2018.

The post Reducing your risk of changes in thinking following surgery appeared first on Harvard Health Blog.

Thursday, May 21, 2020

Avoid single patient, single source COVID-19 stories – especially on “cures”

This is a lesson for news readers from Fargo to Duluth to Toronto and places in between and beyond.  The lesson is that you can’t jump to conclusions based on news stories about a single patient, or about a single researcher’s belief in a cure.

Single anecdote stories

There simply isn’t much you can say about apparent treatment results in one person.  Except that it only seems to be apparent. It’s not proof that a treatment worked.  And it’s only in one person.

The Forum of Fargo-Moorhead published a story, “Man credits treatment method that’s almost 100 years old with saving his life from COVID-19.”

It wasn’t a bad local story. It contained a lot of information.  I’ll offer some tips later on.  But it’s what happened with the story after it appeared in Fargo-Moorhead that caught my eye. More on that later, too.

The story began:

Gene Bad Hawk’s battle with the coronavirus began with headaches and fever. Over the ensuing 20 days since his diagnosis he would bounce between motel isolation rooms and hospital beds.

A bit deeper in the story:

Given his deteriorating condition, Bad Hawk’s doctors at Essentia Health decided he was suitable for a research trial and he readily agreed to receive what’s called convalescent plasma — blood plasma containing neutralizing antibodies from a patient who recovered from COVID-19

The story explained that:

Essentia has access to the plasma through a trial conducted by the Mayo Clinic. Although early reports are encouraging, there still is no clear proof that convalescent plasma is effective.

The Mayo Clinic patient information website itself has stronger caveats than what the story contained, including this simple but important reminder for anyone in any trial: “You might not experience any benefit.”

Some tips for how this story could have been better

That reminder – “You might not experience any benefit” –  could have been in the story, which could have linked to the Mayo Clinic website page for patient care and health information.

So this one man featured in the story thinks he got a benefit. Of course, that can’t be proven. The story quoted an Essentia physician:

“We have given it to six patients at Essentia Health in Fargo,” he said. “We have seen improvement in some,” but two patients died.

How many is “some” in  “improvement in some”? How much improvement? The story should have given these details – and whether any of the trial results have been published.  It also could have emphasized that no conclusions can be drawn from the experience of one person.

Is this Fargo? Or Duluth?

I didn’t see the original Fargo-Moorhead newspaper story.  I saw it on the website of the Duluth News Tribune.  The papers are owned by the same company.

I live in the land between Fargo and Duluth and I know that Essentia Health has facilities in both cities. So, having seen it in the Duluth paper, I assumed this took place at Essentia in Duluth.  It didn’t. The Duluth paper simply picked up a freebie story from a sibling paper in Fargo to help fill the day’s paper.  Essentia in Duluth is also part of the Mayo plasma trial, but that wasn’t mentioned when the Duluth paper copied the Fargo story.

So what relevance did this one-person story out of Fargo have for Duluth readers?  This is happening more often with declining revenues and staffing for many news organizations.  The day’s news is often filled with recycled stories apparently without enough thought put into what it means – or often, doesn’t mean – for locals.

Now on to Toronto…and a cure?

A friend in Canada sent me this column from the Toronto Star:  This U of T scientist says he’s invented a ‘cure’ for COVID-19. Will patients ever see it? It’s behind a paywall, so unless you subscribe you’ll only see a headline, a photo, and a few words.

The column is nearly 2,000 words long, which is unusual in a newspaper.  One could infer that the paper thought this was particularly worthy of 2,000 words. Here’s how the story is framed:

When Sachdev Sidhu talks about what his team has accomplished in their lab at the University of Toronto’s Donnelly Centre for Cellular and Biomolecular Research, the words are entirely his own. And they stun.

A cure. For the coronavirus. For SARS-CoV-2. For the COVID-19 disease that has killed upwards of 320,000 people around the planet.

A knockout punch.

“Yes, I believe ‘cure’ is the proper word,’’ the molecular engineer says, almost blandly. “They would no longer be ill. They would no longer have the virus in their system. That’s a cure.’’

He’s done it. He’s certain.

You might be thinking: “Wow, that research team must have collected some impressive clinical trial results.” Right? If you could read on, you’d learn:

…the lab will be doing small animal tests for safety over the next few weeks.

In the entire ~2,000 words, the only scientist quoted is Professor Sidhu. An agent or publicist couldn’t get better results than this. Will the Toronto Star profile other leading researchers with similar fanfare?  If not, why not?

The columnist who wrote the piece is known for covering sports and current affairs.  COVID-19 research news is not sports news. Maybe the newspaper should assign a health/medical/science journalist to write about such stuff – if there are any left to take on the assignment.

Single-mindedness

Just as the patient in our first example has every right to believe that his life was saved by an experiment, so is this scientist entitled to believe that he has “the cure.” However, their personal beliefs are not necessarily newsworthy.

To be clear, as it should be already, this analysis is not about those two individuals.  It is about the responsibility of journalism to provide evidence, to independently vet claims, and to be accurate, balanced and complete.

The cutbacks in staffing in news organizations are deep and terribly disruptive to quality journalism.  But we still do have terrific journalism about COVID-19 being delivered every day by leading news organizations.  The news organizations that can’t evaluate evidence, can’t analyze claims, can’t find independent sources (which we can help with) – these organizations would be better off not reporting on the pandemic  Because when they mislead, they harm more than help.