Weight Training Plus Aerobics Is Best to Ward Off Obesity

Participation in either strength training or aerobic exercise is associated with a lower prevalence of obesity, but combining both is the most effective way to reduce the likelihood of becoming obese, researchers say.
In a large survey of roughly 1.7 million US adults, those who met both aerobic and muscle-strengthening exercise guidelines — which call for ≥ 150 minutes of moderate aerobic exercise and at least two muscle-strengthening exercises per week — had a lower prevalence of obesity than those who did not.
Of interest, the survey also showed that the greater the level of obesity, the larger the benefit that was derived from combining both modalities, said lead author Jason A. Bennie, PhD, of the University of Southern Queensland Physically Active Lifestyles (USQ PALs) research group, Australia. The findings were published online in Obesity.
“I am a behavioral physical activity epidemiologist and my area of interest is in physical activity and chronic disease,” Bennie told Medscape Medical News.
“Both aerobic and muscle-strengthening exercise are recommended for obesity prevention, but it is not known which modality is most effective at the population level,” he explained.
“Most of the evidence around health is based on aerobic exercise like walking, cycling, and jogging. But in this particular study, I was interested in looking at the association between different combinations of strength training and aerobic exercise and how they affected weight,” he said.
In an accompanying editorial, Timothy S. Church, MD, PhD, Pennington Biomedical Research Center, Baton Rouge, Louisiana, notes: “This is by far the largest study to ever examine the combination of aerobic and strength training, and it provides further evidence for the value of combining the two exercise modalities.”

“Epidemiologists Like Big Data”

Bennie and colleagues say the independent and/or combined associations of moderate to vigorous physical activity (aerobic exercise) and muscle-strengthening exercise with obesity at the population level are largely unknown.
“To our knowledge, this is the first population-level study examining the associations between muscle-strengthening exercise, combined moderate to vigorous physical activity and muscle-strengthening exercise, and obesity,” they write.
Bennie and his team pooled data on 1,677,108 adults age 18 years and older from four US Behavioral Risk Factor Surveillance System (BRFSS) surveys for 2011, 2013, 2015, and 2017.
“This is a big survey which is run every year in the United States, but every second year they include a physical activity component. I pulled all the data on people’s physical activity and how this was associated with their body mass index (BMI). The reason why we chose US data is because the United States has a good surveillance system to monitor their population,” Bennie said.
And “epidemiologists like big data,” he observed.
Just over one fourth of respondents were ≥ 65 years, 51.6% were female, and most were white or Hispanic.
Over half had never smoked, and 18.6% reported “excellent” health.
To determine exercise habits, physical activities were coded as “aerobic” or “nonaerobic” using a list of 56 activities, with examples of aerobic activities including walking, jogging, tennis, and soccer. To assess strength training, participants were asked: “Do not count aerobic activities like walking, running, or bicycling. Count activities using your own body weight like yoga, sit-ups, or push-ups, and those using weight machines, free weights, or elastic bands.”
Forty percent of respondents reported they did not meet guidelines for aerobic or strength-training exercise, 9.5% met strength-training guidelines only, 30.2% met aerobic guidelines only, and 20.2% met guidelines for both.
Overall, 35.6% had a BMI of 18.5-24.9 kg/m² (healthy weight), and 28.9% had a BMI of ≥ 30 kg/m² (obese).
Obese respondents were further categorized into the following three classes:

• Class I obesity and above (BMI ≥ 30.0 kg/m² but < 35.0 kg/m²)
• Class II obesity and above (BMI ≥ 35.0 kg/m²  but < 40.0 kg/m²)
• Class III obesity and above (BMI ≥ 40.0 kg/m²)

Associations Were More Pronounced for Higher Obesity Classes

Analysis of the data showed that respondents who met both exercise guidelines had the lowest adjusted prevalence ratios (APRs) for obesity across all classes of obesity compared with those in the other exercise categories. Their APRs ranged from 0.27 to 0.50.
Interestingly, noted Bennie, the prevalence ratios (PRs) were lowest for all physical activity categories for those with Class III obesity.
Adjusted Prevalence Ratios (APRs) for Meeting Both Exercise Guidelines

Obesity Class	APR	95% CI
Class I obesity and above (BMI ≥ 30.0 kg/m2)	0.54	0.53 – 0.54
Class II obesity and above (BMI ≥ 35.0 kg/m2)	0.32	0.31 – 0.33
Class III obesity and above (BMI ≥ 40.0 kg/m2)	0.21	0.20 – 0.21

The associations remained after adjusting for gender, socioeconomic status, education, lifestyle characteristics, and chronic health conditions, Bennie said.
“The bottom line is that it is the combination of both weight training and aerobics that is the most effective for reducing the likelihood of obesity,” he stressed.
“The real problem is that once you get into the higher levels of obesity, it is very difficult to go back into normal weight. It’s a very slippery slope. We need to help stop people from getting into those higher levels of obesity, when things really start going awry with their metabolism, their blood glucose, their depression,” he emphasized.
“While prospective studies and controlled designs are needed to better support causal evidence, this study suggests that a combination of moderate to vigorous physical activity and muscle-strengthening exercise has the most beneficial associations with overall obesity and obesity severity,” Bennie and colleagues reiterate.

Emphasize Importance of Combining Aerobic and Strength Training

In his editorial, Church notes that “while cross-sectional designs do not allow for cause-and-effect determination, this manuscript is still a valuable contribution to the literature.”
He emphasizes that BMI does not differentiate fat mass from lean muscle mass, and the fact that strength training promotes muscle mass creates the opportunity for misclassification, “yet the weight training was still found to be associated with a lower risk of obesity as defined by BMI.”
“In my experience, few individuals are aware of the strength training recommendations. This is unfortunate, as the evidence is clear that while strength training has health benefits, aerobic training has more; however, doing both is optimal,” he adds.
This study “provides further evidence of the need for emphasis on the importance of including strength training in one’s physical activity program.”
“For those individuals focused on preventive measures to promote healthy aging, the importance of combining aerobic and strength training exercise needs to be emphasized,” he concludes.
Bennie and Church have reported no relevant financial relationships.
Obesity 2020;28:224,371-378. Full text, Editorial
https://www.medscape.com/viewarticle/924131#vp_1

Human and Analogue Insulins Equivalent for Major Outcomes

There was no difference between human and analogue insulin in terms of cardiovascular and mortality outcomes, but cost is another matter, said authors of a large retrospective study.
With data on 127,000 adults with type 2 diabetes who initiated insulin during 2000-2013 and median 2.5 years of follow-up, users of human versus analogue insulin products had similar rates of major cardiovascular events, cardiovascular mortality, and overall mortality, reported Patrick O’Connor, MD, of the HealthPartners Institute in Minneapolis, and colleagues.

More specifically, as they outlined in JAMA Network Open, the study’s five main outcomes had the following adjusted hazard ratios for human versus analogue insulin:

• Overall mortality: HR 1.15 (95% CI 0.97-1.34)

• Cardiovascular mortality: HR 1.26 (95% CI 0.86-1.66)

• Myocardial infarction: HR 1.11 (95% CI 0.77-1.45)

• Cerebrovascular accident: HR 1.30 (95% CI 0.81-1.78)

• Congestive heart failure hospitalization: HR 0.93 (95% CI 0.75-1.11)

“Our results suggest that cardiovascular outcomes and mortality should not be a motivating factor in the decision to start human vs analogue insulin therapy in insulin-naive adults with type 2 diabetes,” the researchers wrote. “Other relevant factors to consider include hypoglycemia, glycemic control, cost, and ease of use. Recent reports have shown similar effects of human and analogue insulins on control of glucose levels and serious hypoglycemic events in primary care practice, which suggest that human and analogue insulins are safe and effective treatments in type 2 diabetes.”
Most insulin users in the U.S. — approximately 90% — use analogue insulins, which were first introduced in 1996. They became widely used despite higher costs, in part because studies indicated lower rates of mild hypoglycemia.
O’Connor and co-authors added that while hypoglycemia rates have been well studied, the effects of human versus analogue insulin on cardiovascular events and mortality have not. Both types of insulin were introduced before 2008 when the FDA mandated cardiovascular outcomes trials for diabetes drugs. Some major clinical trials, such as the Diabetes Control and Complications Trial and the U.K. Prospective Diabetes Study, did not include analogue insulins.
A 10-mL vial of human insulin lists for approximately $25, compared with more than $280 for analogue insulin, O’Connor’s team noted. “The price differential between human and analogue insulins and the lack of significant differences in rates of serious hypoglycemia in recent reports have sparked new interest in the use of human insulin as a way to make health care more affordable to patients with diabetes.”

Previous research on this topic, however, reported mixed results. Those studies also had significant limitations in terms of participant selection, sample size, and analytic details. The current study improved on that research by including a large number of U.S. participants who received care in community-based clinics, by having relatively complete clinical outcome data, and by using machine learning and other advanced statistical methods to analyze the data, O’Connor and co-authors explained.
The 127,600 study participants were treated in four different healthcare systems: HealthPartners in Minnesota, Kaiser Permanente Colorado, Kaiser Permanente Northern California, and Kaiser Permanente Southern California. The mean age of participants was 59, and approximately half were men.
Most participants (85%) used human insulin. Two exposure groups defined by continuous treatment with the same insulin therapy, either human or analogue, were compared. The investigators analyzed medical records for outcomes, controlling for factors that included patient demographics, comorbidities, concomitant medications, and smoking.
Robert Eckel, MD, of the University of Colorado Anschutz Medical Campus in Aurora, who was not involved in the research, said the large number of human insulin users was unusual. Still, “with all of the limitations of retrospective analysis of medical records, the results are not surprising,” he told MedPage Today via email. “However, the discrepancy between clinics in insulin use is of note with three of four locations using mostly human insulin. Moreover, the ongoing use of human insulins 10-15 years after analogue insulins were FDA approved is unexpected based on U.S. data in 2010, and despite the escalating cost of analogues.”
A chief limitation of the study, O’Connor and colleagues said, was its retrospective design. “However, owing to the high cost of conducting large randomized trials in a rapidly evolving insulin market, there is little chance that a large randomized trial will address cardiovascular outcomes of human vs other insulins, although manufacturers have compared newer and older analogue insulins,” the team wrote. “Results show few differences in cardiovascular events, suggesting that newer analogue insulins are unlikely to have better cardiovascular outcomes than the analogue insulins we evaluated.”

The study was supported by the National Institutes of Health (NIH).
O’Connor reported grants from the NIH and the Patient-Centered Outcomes Research Institute; one co-author reported a relationship with a pharmaceutical company (Merck) outside of the study.

• Primary Source

  JAMA Network Open

  Source Reference: Neugebauer R, et al “Comparison of mortality and major cardiovascular events among adults with type 2 diabetes using human vs analog insulins” JAMA Network Open 2020; 3(1): e1918554.

https://www.medpagetoday.com/cardiology/diabetes/84521

China built Wuhan lab to study SARS, Ebola; experts warned of virus ‘escape’

• The Wuhan National Biosafety Laboratory is the only lab in China designated for studying dangerous pathogens like SARS and Ebola
• Ahead of its January 2018 opening, biosafety experts and scientists from the US expressed concerns that a virus could escape the lab
• In 2004, a SARS virus ‘leaked’ from a lab in Beijing 
• Experts say the coronavirus that’s infected more than 800 people mutated in animals and became capable of infecting humans at the Wuhan seafood market
• But a 2017 article warned of the unpredictability of lab animals that scientists at the Wuhan lab intended to inject with viruses 

Scientists warned in 2017 that a SARS-like virus could escape a lab set up that year in Wuhan, China, to study some of the most dangerous pathogens in the world.

Now, a SARS-like coronavirus has infected more than 800 there, spread to at least 10 other countries and killed 25 in Wuhan and nearby provinces.

China installed the first of a planned five to seven biolabs designed for maximum safety in Wuhan in 2017, for the purpose of studying the most high-risk pathogens, including the Ebola and the SARS viruses.

Tim Trevan, a Maryland biosafety consultant, told Nature that year, when the lab was on the cusp of opening, that he worried that China’s culture could make the institute unsafe because ‘structures where everyone feels free to speak up and openness of information are important.’

In fact, the SARS virus had ‘escaped’ multiple times from a lab in Beijing, according to the Nature article.

The Wuhan National Biosafety Laboratory is located about 20 miles away from the Huanan Seafood Market and some have wondered if the outbreak’s epicentre is coincidental, but the scientific community currently believes that the virus mutated through and jumped to people through animal-human contact at the market.

But, ‘at this point there’s no reason to harbour suspicions’ that the facility had anything to do with the outbreak, besides being responsible for the crucial genome sequencing that lets doctors diagnose it, Rutgers University microbiologist Dr Richard Ebright told DailyMail.com.

China’s highest-grade lab for studying viruses is located in Wuhan, the same city at the centre of the current coronavirus outbreak

The Wuhan National Biosafety Laboratory, housed at the Wuhan Institute of Virology, was set up in the hopes of helping China contribute research on the world’s most dangerous viruses.

Constructed in 2015, the lab was still undergoing safety testing, but near ready to open in 2017.

It was the first ever lab in the country designed to meet biosafety-level-4 (BSL-4) standards – the highest biohazard level, meaning that it would be qualified to handle the most dangerous pathogens.

BSL-4 labs have to be equipped with airtight hazmat suits or special ‘cabinet’ work spaces that confine viruses and bacteria that can be transmitted through the air to sealed boxes that scientists reach into using attached high-grade gloves.

There are about 54 BSL-4 labs worldwide.

China’s first, in Wuhan, received federal accreditation in January 2017.

Upon opening, it planned to first take up a project that required only BSL-3 precautions to be in place: a tick-borne virus that causes Crimean-Congo hemorrhagic fever.

It’s as highly fatal disease, killing 10 to 40 percent of those it infects.

SARS, too, is a BSL-3 virus. According to Nature’s interview with the lab’s director, Yuan Zhimin, the Wuhan National Biosafety Laboratory planned to study the SARS virus.

In January 2018, the lab was operational ‘for global experiments on BSL-4 pathogens,’ wrote Guizhen Wu in the journal Biosafety and Health.

After a SARS virus escaped in a ‘leak’ from another lab in 2004, Chinese officials worked to improve safety, but also to expand the country’s capacity to continue to study the very viruses its lab had let out.

These Hazmat suits are intended to protect scientists from easily transmitted viruses, like those that can be caught by breathing in, while working at the Wuhan lab

‘After a laboratory leak incident of SARS in 2004, the former Ministry of Health of China initiated the construction of preservation laboratories for high-level pathogens such as SARS, coronavirus, and pandemic influenza virus,’ wrote Guizhen Wu.

It’s not clear what or where those labs were.

The Wuhan lab is also equipped for animal research.

In 2017, the scientists who spoke to Nature acknowledge the opportunity this presents for the development of vaccines and treatments.

Regulations for animal research – especially that conducted on primates – are much looser in China than in the US and other Western countries, meaning these studies are less costly and face fewer barriers that could limit or slow them.

But that was also cause for concern for Trevan.

Studying the behaviour of a virus like 209-nCoV and developing treatments or vaccines for it requires infecting these research monkeys, an important step before human testing.

Monkeys are unpredictable though, warned Ebright.

‘They can run, they can scratch they can bite,’ he said, and the viruses they carry would go where their feet, nails and teeth do.

https://www.dailymail.co.uk/health/article-7922379/Chinas-lab-studying-SARS-Ebola-Wuhan-outbreaks-center.html

Sacked Moffitt Officials Didn’t Report Chinese Financial Ties

Top officials and researchers who resigned from Moffitt Cancer Center in Tampa, Florida, last month didn’t make requisite disclosures about foreign financial ties, according to new details that emerged this week in documents released by state lawmakers.
They didn’t report personal payments or bank accounts in China that totaled hundreds of thousands of dollars in research subsidies and annual salaries, as was required by their institution and the National Institutes of Health, according to the report.
The Moffitt shake-up is the latest event in the federal government’s push to thwart intellectual property theft by China at U.S. research institutions. It was perhaps the highest-profile case yet: President and CEO Alan List, MD, and vice president and center director Thomas Sellers, PhD, resigned under pressure along with four researchers who hid their relationship with China’s Thousand Talents Program for global recruitment.
Florida lawmakers have been investigating “whether our taxpayer-supported research institutions may have been compromised or vulnerable to intellectual property theft by foreign governments.”
Shifting Tides
The NIH had encouraged and contributed to scientific cooperation with China over the past 30 years but did a recent about-face as the FBI and congressional leaders raised concerns about the risk of intellectual property and technology theft. In March 2018, the NIH clarified how serious it was about conflict of interest disclosures that any personal income or research funding from foreign institutions be reported to one’s U.S. institution.
As a result, MD Anderson Cancer Center cut ties with three scientists in April 2019 and Emory University fired two neuroscientists in May for failing to disclose foreign research ties or undermining the integrity of research funding. All five were Asian Americans, whereas only one of the six at Moffitt is ethnic Chinese.
That Moffitt researcher, immunologist Sheng Wei, MD, was a key figure in the affiliation the Florida center started in 2008 to provide training and consultation to Tianjin Medical University Cancer Institute and Hospital.
Wei was first to be recruited by the Thousand Talents Program and, in turn, recruited List and then others at Moffitt to collaborate with Tianjin Medical University. Aside from Sellers, others involved were Daniel Sullivan, MD, a director of Moffitt’s clinical science program who oversaw the Tianjin partnership, and cancer biologist Pearlie Epling-Burnette, PharmD, PhD.
Pharmacogenomicist Howard McLeod, PharmD, also fired in December from Moffitt, was already participating in the Thousand Talents Program through another Chinese institution when he came to Moffitt in 2013.
Improper Disclosure
While these relationships and even participation in the Thousand Talents Program did not violate Moffitt policies, the center and NIH regulations required timely disclosure and advance approval after assessment for possible conflicts of interest or other compliance risks.
Those disclosures didn’t happen properly, with the “possible limited exception” of McLeod, according to the report.
They didn’t report personal payments or opening or maintaining personal bank accounts in China to receive Talents program compensation that could have been as much as $142,000 up front and research subsidies of up to $711,000 along with annual salaries of $36,000 to $64,000. There were also fully-paid escorted tourist trips in China, cash honoraria for speeches, and cash travel reimbursements while in China — many not disclosed to Moffitt.
Notably, “List did not disclose to Moffitt his participation in Chinese Talents programs, any Talents program payments, or his Chinese personal bank account, until specifically asked by Moffitt’s Compliance Office in late September 2019,” the report noted.
Importantly, List and three others opened those Chinese bank accounts to get compensation in November 2018 — “at a time well after these foreign influence issues had been brought to their attention by Moffitt and by the NIH through national academic and medical community announcements and public media reports.”
Others at the University of Florida including a College of Medicine faculty member and biomedical engineer were also sacked recently for similar transgressions.
What exactly was done in exchange for the money isn’t clear, but “[t]here is no evidence to date that intellectual property has been stolen or that research or patient care has been compromised,” the report reiterated.
Moffitt has said it is “reviewing its 12-year research and education partnership with the Tianjin Medical University Cancer Institute and Hospital, a 2,400-bed hospital outside of Beijing,” as reported by the Tampa Bay Times.
Similar compliance reviews and probes are underway around the country. “At least 200 people are being investigated at 71 US hospitals, universities, and research institutions,” according to The BMJ.
https://www.medpagetoday.com/publichealthpolicy/ethics/84502

Time to Unleash Drug Treatments for Addiction

A National Academies panel on Thursday urged radical changes in state and federal law to improve treatment and prevention of opioid use disorder, which in turn would cut the nation’s infectious disease burden.
The committee’s 10 members — comprising academics, medical professionals, epidemiologists, nurses, and health policy specialists — recommended scrapping mandatory waivers for buprenorphine prescribers; eliminating prior authorization requirements for buprenorphine and all FDA-approved treatments for opioid use disorder; and allowing methadone treatment to be delivered in primary care settings.

The committee held that one reason for the “unprecedented number of HIV and viral hepatitis outbreaks” is that substance use disorder treatment is siloed from delivery of other medical care.
Also, “well-intentioned policies” such as increasing reliance on prescription drug monitoring programs, intended to curb access to prescription opioids, have had unintended consequences — sometimes driving people to illicit injected drugs such as heroin.
As the number of people who inject drugs increased, so did the risk of infectious disease.
The good news is that preventing and treating opioid use disorders can improve infectious disease outcomes, the authors noted.
For instance, patients with a co-occurring opioid use disorder and HIV will be better at complying with their HIV medication regimens if their treatment plan also includes medication for opioid use disorder.
“In this way removing barriers for opioid use disorder treatment is, in itself, a process to improve prevention, and treatment for infectious disease,” the report said.

Moreover, when substance use disorder and infectious disease services are better coordinated, co-located or, ideally, fully integrated, healthcare becomes “simpler, more accessible and patient centered.”
End DATA Waiver, Prior Authorization
One of the report’s most dramatic recommendations is to eliminate state-level prior authorization requirements for buprenorphine. The authors say this additional step delays access to evidence-based care for patients with opioid use disorder and increases the risk of infectious disease due to patients’ continued drug use.
To put federal teeth into such a policy, the Centers for Medicare & Medicaid Services should withhold approval of any requests for Medicaid state plan amendments from states that maintain prior authorization requirements, the report said.
A federal law enacted two decades ago mandates that providers seeking permission to prescribe buprenorphine complete an 8- to 24-hour training course. But the committee said this waiver “poses a barrier for some providers.”

For that reason, the committee recommended that Congress amend the legislation to drop that requirement.
In speaking with clinician prescribers, the report’s authors found that many believed the mandated training was “inadequate and clinically irrelevant.”
For that reason, the committee recommended that any organizations that currently offer training should examine its curriculum and its usefulness and “provide newly trained providers with greater access to experienced peers.”
Another recommendation: the Substance Abuse and Mental Health Services Administration (SAMHSA) should offer additional funds and grants aimed at “expand[ing] mentorship networks for providers.”
Additionally, the report called on Congress to eliminate the cap on the number of patients that prescribers can serve.
The report also addressed barriers to methadone treatment for opioid use disorder. It recommended federal legislation to let clinicians provide the drug in primary care settings. As the law now stands, methadone can only be prescribed for addiction treatment in certain licensed and regulated facilities — i.e., dedicated opioid treatment programs.

Conversely, the committee noted that with 1,600 opioid treatment programs across the country in 2018 serving 380,000 patients each year, it’s a mistake — a “missed opportunity” — that such programs do not frequently offer testing and treatment for infectious disease.
The committee therefore suggested that the Department of Health and Human Services consider instituting “universal, opt-out-testing and connection to treatment for infectious diseases,” particularly in methadone-based opioid treatment programs.
But on the thorny issue of 42 CFR Part 2, often known simply as “Part Two” — the federal rule that defines the right of access among different stakeholders to patients’ records from substance use disorder treatment programs — the committee mostly punted.
The report suggested that SAMHSA either align Part Two with the Health Insurance Portability and Accountability Act or “alter the definition of which specific service programs” are encompassed in Part Two.
“[T]here is significant debate about whether and how changing this regulation would jeopardize patient privacy or allow providers to deliver more coordinated, effective care,” the authors noted.
SAMHSA should “formally engage with patients, advocacy groups, the general public, and legal experts” to weigh the pros and cons of wider data sharing, the report concluded.

https://www.medpagetoday.com/psychiatry/addictions/84534

Could Novel Coronavirus Become Low-Level Pandemic?

So far, this novel coronavirus from China (2019-nCoV) appears to be a milder virus than SARS, but that could mean it has the potential to spread further and wider than SARS, researchers argued.
While the virus seems “relatively mild” compared with fellow coronaviruses SARS and MERS, it could potentially spread more easily if infected people are not seriously ill, reported Vincent Munster, PhD, of the Laboratory of Virology of the National Institute of Allergy and Infectious Diseases in Hamilton, Montana, and colleagues.

“The severity of disease is an important indirect factor in a virus’ ability to spread,” the authors wrote in a Perspective piece in the New England Journal of Medicine.
“If infection does not cause serious disease, infected people will probably not go to health care centers. Instead, they will go to work and travel, potentially spreading the virus to their contacts, possibly even internationally,” Munster and colleagues added, noting that the virus also needs “efficient human-to-human transmission” for large-scale spread.
As of Jan. 24, 2020, at least 830 cases of novel coronavirus were confirmed in nine countries, including two travel-associated cases in the U.S. But the 26 reported deaths occurred mainly in patients with underlying illness, the researchers said.
On the other hand, they argued that the relative lack of severe disease with 2019-nCoV may make it harder to contain, because contacts and tracing become more difficult.

“Identification of chains of transmission and subsequent contact tracing are much more complicated if many infected people remain asymptomatic or mildly symptomatic,” the team wrote. “More pathogenic viruses that transmit well between humans can generally be contained effectively through syndromic (fever) surveillance and contact tracing,” such as the case of the Ebola virus, and SARS itself.
Risk of nosocomial spread may also be a key factor with emerging coronaviruses, as was the case for SARS and MERS.
“In addition to the vulnerability of health care settings to outbreaks of emerging coronaviruses, hospital populations are at significantly increased risk for complications from infection […] Thus, emerging viruses that may go undetected in healthy people can pose a significant risk to vulnerable populations with underlying medical conditions,” the authors wrote.
Ultimately, they concluded that a virus that causes less severe disease could have worse implications for population-level health, especially if it proves that it can be transmitted efficiently between people.
“A virus that poses a low health threat on the individual level can pose a high risk on the population level, with the potential to cause disruptions of global public health systems and economic losses,” Munster and co-authors wrote. “This possibility warrants the current aggressive response aimed at tracing and diagnosing every infected patient and thereby breaking the transmission chain of 2019-nCoV.”

The authors disclosed no conflicts of interest.

• Primary Source

  New England Journal of Medicine

  Source Reference: Munster VJ, et al “A novel coronavirus emerging in China — Key questions for impact assessment” N Engl J Med 2020; DOI: 10.1056/NEJMp2000929.

https://www.medpagetoday.com/infectiousdisease/publichealth/84537

Fla.’s Scott calls for public health emergency over new coronavirus

A GOP senator wants the Trump administration to declare the coronavirus outbreak a public health emergency.
“We have to get serious about the threat of coronavirus coming from China. I don’t trust Communist China to coordinate in a transparent and efficient manner when it comes to combatting the threat of the virus, so we have to do everything we can to protect Americans,” Sen. Rick Scott (R-Fla.) said in a statement.
“While all of the cases are still travel-related, we must take every precaution,” he added.

Scott’s comments came after top health officials from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) briefed senators Friday on efforts to try to stop the virus from spreading in the U.S.
There have been two confirmed cases of the coronavirus in the U.S. — in Washington state and Chicago — and officials say more cases are likely, with a third potential case being investigated in Texas.
However, all of the confirmed cases are people who recently traveled from China, meaning there is no known transmission of the virus inside the United States.
Most senators leaving the briefing on Friday said they felt satisfied that administration officials were taking appropriate steps.
The U.S. has already put in place screenings for fever and other symptoms at five major U.S. airports. The State Department and the CDC have also issued a travel advisory, telling U.S. citizens not to take unnecessary trips to the affected areas in China.
Scott did not specify what additional steps he wants the administration to take beyond calling for them to declare a public health emergency. A spokesperson said Scott wants to make sure the administration is using all available resources to combat the virus.

A public health emergency could allow federal officials to loosen certain regulations, issue grants and pave the way for spending additional money.
However, health officials told senators on Friday they don’t need more money. They also praised China’s cooperation on the outbreak.
“I was involved very deeply with the SARS response. And with SARS, the Chinese were not particularly transparent …  It was an embarrassment for them. I think they regretted that. Right now, from what I can see, they’re being quite transparent,” Anthony Fauci, head of the infectious disease unit at NIH, told reporters.
Fauci said he was “impressed” with China’s cooperation.
“There was some skepticism because in the past it wasn’t — in some cases they didn’t want the bad publicity and they didn’t move as quickly as they should. This is different.” Sen. Dick Durbin (D-Ill.) said of Chinese officials.
https://thehill.com/policy/healthcare/479804-gop-senator-calls-for-public-health-emergency-over-coronavirus