U.S. is failing to care for traumatic brain injury survivors

 Every year, nearly 5 million Americans are evaluated for traumatic brain injury in emergency departments across the country.

These injuries can happen in many different ways -- from car crashes and military conflict to falls and everyday activities -- and they're diagnosed in around 2% of all United States emergency department visits.

Awareness of the magnitude of TBIs has increased over the last several decades, particularly in sports and the military. But a group of experts from across the nation say the country's current system of care is often failing to meet the needs of the individuals, families and communities affected by traumatic brain injury.

"We as physicians are frustrated that there are significant limitations to what we can do for our patients for an injury that has real-life, debilitating consequences," said Frederick Korley, M.D., Ph.D., associate professor of emergency medicine at Michigan Medicine. "There are many important, structural changes that need to be made to provide better care for patients who often go through a prolonged recovery process."

Korley is part of a select team of researchers who recently authored a report analyzing the health care system's response to TBI for the National Academies of Sciences, Engineering, and Medicine. The study, funded by the U.S. Department of Defense, found that the lack of a comprehensive framework for classification, care and research poses significant burdens for everyone involved -- leading to needless death, squandered human potential and soaring costs. Their report contains numerous recommendations for improving TBI care and research.

TBI classification

When those near-5 million Americans arrive at the ER each year to be evaluated for brain injuries, they are placed into one of three categories: mild, moderate or severe.

It seems simple. The driver who is comatose after a devastating car crash would be considered severe, while the student who has a headache after slipping on black ice could be seen as mild. To Korley, who sees many of these so-called "mild" cases in the emergency department, the classification is inadequate -- and, in some cases, insulting to patients.

"Some people who are considered 'mild' can't go to work; they have horrible headaches and memory problems that can result in losing a job or dropping out of school," he said. "Conversely, there are some people classified as 'severe' but actually do way better than we expect. Those cases don't all result in death or devastating disability."

This lack of distinction, the report notes, leads to suboptimal care across the spectrum of TBI and can include withdrawing life-sustaining treatment for patients who could have improved.

Instead of the shorthand, the researchers recommend using the full Glasgow Coma Scale score, a system that grades the severity of TBI on a scale from three to 15, in addition to results from brain CT scans and blood tests to classify patients. This approach provides a more accurate, nuanced assessment of the injury, Korley said.

"Let's say we have two cases of 'mild' TBI," he said. "One is a patient who has a concussion and experienced light sensitivity but felt fine not long after, and the other is someone who is awake but so out of it that they ask the same question repeatedly. The first would be a GCS 15, and the second would be a GCS 13. Calling both patients 'mild' is an oversimplification. Saying one is a GCS 15 TBI and the other is a GCS 13 TBI is more descriptive and will inform additional treatment plans."

Emergency physicians also rely heavily on neuroimaging through CT scans to find evidence of brain bleeding and determine if surgery is necessary. Recently, they have started using blood tests to justify neuroimaging and reduce the number of unnecessary scans. These blood tests can also help physicians better characterize the severity of the injury. The research team advocates for a classification system utilizing all three methods.

"This full range of analysis will make for a more accurate and sophisticated description of the injury that will inform individualized treatment and aid in predicting long-term outcomes more accurately," Korley said.

Delivery and continuity of care for patients with TBI

To many, the "traumatic brain injury" suggests an isolated event. A dramatic scene of a crash victim or wounded soldier receiving lifesaving medical intervention, possibly being cured.

This is a misleading view, Korley says. Think of TBI like COVID-19.

Many people who are hospitalized with the virus do not die, which could be seen as a 'recovery.' But almost half of those people experience significant functional decline after they're discharged. And scores of people with 'mild infection' end up with lingering symptoms of long COVID that can impact their lives.

Like COVID-19, many of those 'recovering' from TBI experience a chronic phase of the injury. However, only 13 to 25% of patients with moderate-to-severe traumatic brain injury end up receiving interdisciplinary inpatient rehabilitation.

"There is the notion that once you leave the hospital after TBI, that's as good as it gets, but it's only the beginning of the battle," Korley said. "The acute phase is when you try to limit secondary brain injury. The chronic phase is a much longer healing process."

For an injury that researchers say is vastly undercounted, they note the United States has no mechanism for long-term TBI care. And for what is available, many survivors do not have, or cannot afford, access.

"Many people actually max out their benefits at that point [of inpatient rehab]," said one TBI patient quoted in the report. "Then when they are home, they have problems and don't have the insurance funds to help with those. To me, it's just criminal that so many victims of TBI are just forced by insurance companies into bed rest, which is just killing their chances of a good recovery."

Korley and the committee recommend creating a national framework for TBI care. They say it should build on the successes of regional trauma systems by establishing local and regional integrated care delivery systems across acute, rehabilitation and recovery phases of the injury. They also want health insurers, Medicare and Medicaid services to offer coverage for TBI care that aligns with clinical guidelines, ensuring equity in access and affordability.

"[Taking these steps] would require a level of continuity and acceptance of responsibility that American health care does not often achieve for chronic illnesses," researchers wrote.

Research and innovation

To date, there is no FDA-approved therapy that can treat damage from traumatic brain injury on its own. Several promising therapies have failed to promote recovery in large clinical trials.

Meanwhile, the committee says research on TBI is feeble compared to other important conditions, such as cancer or heart disease. They called for government organizations -- the National Institutes of Health, the Department of Defense -- and private sector funders to commit to a much larger investment in basic and clinical research to improve the health and well-being of TBI survivors.

Working with the Department of Defense, the Weil Institute for Critical Care Research and Innovation at University of Michigan hosts an annual Massey TBI Grand Challenge, which provides funding for early-stage, innovative and high-risk research to develop the next generation of diagnostics, devices and therapeutics for severe TBI. Researchers make 'Shark Tank'-style pitches to a panel of clinicians and commercialization experts for innovative ways to advance early care. Over six years, 39 teams have been funded with over $4 million awarded.

"This program provides a unique and vital mechanism to bring together diverse expertise from across U-M to propose and develop the almost-science fiction solutions and technologies that will be required to significantly impact the care of victims of TBI," said Kevin Ward, M.D., executive director of the Weil Institute and professor of emergency medicine and biomedical engineering at Michigan Medicine. "The program encourages collaboration across the medical, engineering, basic and computational sciences, and it is really helping us shorten the research and development cycle through strategic de-risking."

Without an entity taking charge to establish clear goals and conduct oversight, experts say, progress is unlikely.

"We want to drive more progress as we create a blueprint for clinicians, researchers and stakeholders who are committed to solving this problem," Korley said. "We are hoping that governmental leaders will pay attention and help redirect funding priorities. A lot of the recommendations we are proposing will take significant funding to implement. This is how our nation will start showing up for survivors of traumatic brain injury, their caregivers and communities."

This activity was supported by Contract No.W81XWH20C0126 between the National Academy of Sciences and the United States Army Medical Research and Development Command of the Department of Defense. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of any organization or agency that provided support for the project. The views, opinions and/or findings contained in this report are those of the author(s) and do not necessarily reflect the views of the United States Army Medical Research and Development Command (USAMRDC).

Story Source:

Materials provided by Michigan Medicine - University of Michigan. Original written by Noah Fromson. Note: Content may be edited for style and length.

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Journal Reference:

1. National Academies of Sciences, Engineering, and Medicine. Traumatic Brain Injury: A Roadmap for Accelerating Progress. Washington, DC: The National Academies Press, 2022; DOI: 10.17226/25394

https://www.sciencedaily.com/releases/2022/02/220201144006.htm

Hepatitis E virus defies alcohol-based hand disinfectants

 The hepatitis E virus (HEV) can cause serious liver inflammation and is the most common cause of acute virus-mediated hepatitis worldwide. Infection can be prevented through appropriate hygiene measures. Scientists from TWINCORE, Centre for Experimental and Clinical Infection Research, the Hannover Medical School (MHH) and the Ruhr Universität Bochum (RUB), together with partners from industry, have investigated the effectiveness of various common hand disinfectants against HEV. They were able to show that most formulations do not completely inactivate the virus.

They have now published these results in the Journal of Hepatology from 24 january 2022.

Infection from pork

In Germany and Europe, HEV has its natural reservoir in pigs. The infection can spread from animals to humans, which is called a zoonosis. This often happens through incompletely heated or raw meat products such as minced meat. In tropical regions of the world, infections occur via contaminated water, sometimes causing large outbreaks. "Some of these infections could possibly be prevented with the right hygiene measures," says Dr. Patrick Behrendt, physician in the Department of Gastroenterology, Hepatology and Endocrinology at the MHH and head of the junior research group "Translational Virology" at TWINCORE. This includes, above all, correct hygienic hand disinfection in everyday clinical practice when dealing with hepatitis E patients and infected animals.

Together with the team of Professor Eike Steinmann, head of the Department of Molecular and Medical Virology at RUB, Behrendt has investigated whether common hand disinfectants can render the virus harmless. "We tested the effect of the alcohols ethanol and propanol, both individually and in the mixing ratios recommended by the WHO, and also commercial hand disinfectants," says Steinmann. "However, only one product that contained another component was effective."

Alcohol alone is not effective

Normally, HEV occurs non-enveloped and, like all non-enveloped viruses, is very resistant to chemical influences. However, virus particles circulating in the blood of patients are surrounded by a lipid envelope. "Not all disinfectants are effective against enveloped and non-enveloped viruses at the same time," says Steinmann. "We used both forms of HEV for our tests."

Although some of the disinfectants tested are certified to inactivate both enveloped and non-enveloped viruses, they were not sufficiently effective against HEV. "The alcoholic components dissolve the lipid envelope, but the resulting "naked" viruses are still infectious," says Behrendt. So HEV is literally hard to break down. The decisive advantage was a product that contains phosphoric acid as well as alcohol. This neutralised all the virus particles sufficiently.

"We were able to show that HEV can resist most common hand disinfectants," says Behrendt. "We hope that these findings will be taken into consideration in the future when hygiene measures are recommended for handling contaminated meat products and in HEV outbreak situations."

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Story Source:

Materials provided by Ruhr-University Bochum. Note: Content may be edited for style and length.

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Journal Reference:

1. Patrick Behrendt, Martina Friesland, Jan-Erik Wißmann, Volker Kinast, Yannick Stahl, Dimas Praditya, Lucas Hueffner, Pia Maria Nörenberg, Birgit Bremer, Benjamin Maasoumy, Jochen Steinmann, Britta Becker, Dajana Paulmann, Florian H.H. Brill, Joerg Steinmann, Rainer G. Ulrich, Yannick Brüggemann, Heiner Wedemeyer, Daniel Todt, Eike Steinmann. Hepatitis E virus is highly resistant to alcohol-based disinfectants. Journal of Hepatology, 2022; DOI: 10.1016/j.jhep.2022.01.006

https://www.sciencedaily.com/releases/2022/02/220201115219.htm

Natural Immunity Lasts For At Least 18 Months: Study

 by Zachary Stieber via The Epoch Times (emphasis ours),

The protection people experience after recovering from COVID-19, known widely as natural immunity, lasts for at least 18 months, according to a recently published study.

Researchers in Italy analyzed the level of antibodies in 36 patients who were documented as contracting COVID-19 in March 2020. About half of the patients went on to get COVID-19 vaccines, but the rest remained unvaccinated. Samples from all but two were tested at timed intervals, ending in September 2021, using assays that have received clearance from the U.S. Food and Drug Administration.

“At 18 months, 97% participants tested positive for anti-NCP, hinting towards the persistence of infection-induced immunity even for the vaccinated individuals,” researchers wrote in the preprint paper, which was published on the medrxiv website.

NCP stands for nucleocapsid, a part of SARS-CoV-2. Antibodies are believed to protect people against against infection from the virus.

“Antibodies against nucleocapsid will be present only in recovered individuals and not vaccinated,” Dr. Asiya Zaidi, a research fellow at the Associazione Naso Sano and one of the authors, told The Epoch Times in an email.

That means even the people who got vaccinated received protection from natural immunity.

Researchers did find that vaccination with Pfizer-BioNTech COVID-19 vaccines gave those with prior infection a significant boost, but that the increase in protection waned relatively quickly.

“Our study findings demonstrate that while double dose vaccination boosted the IgG titers in recovered individuals 161 times, this “boost” was relatively short-lived. The unvaccinated recovered individuals, in contrast, continued to show a steady decline but detectable antibody levels. We do believe that further studies are required to re-evaluate the timing and dose regimen of vaccines for an adequate immune response in recovered individuals,” Zaidi said.

Limitations of the longitudinal observational study include the small number of patients.

The researchers, who fund their own research, said the limited sample size was due to a lack of funding because repeated serology tests for each patient for 18 months was expensive and because following up with all the patients and reminding them of the testing was difficult.

Its strengths include the remarkable length of time.

“This is the longest observation (March 2020-September 2021) for the presence of antibodies against SARS-CoV-2 in recovered individuals along with the impact of 2 dose-BNT162b2 vaccination on the titers,” the researchers wrote.

SARS-CoV-2, also known as the CCP (Chinese Communist Party) virus, causes COVID-19. BNT162b2 is the trade name for the Pfizer jab.

Previous studies have demonstrated the powerful effect of natural immunity against the virus, including a study published in Nature in mid-January that found that the response of memory B cells, a marker of protection against severe COVID-19, evolved in the months following infection “in a manner that is consistent with antigen persistence.”

Other markers of protection were observed in studies in 2021 to last at least over 7 months, at least 8 months, at least 10 months, at least 11 months, at least 13 months, and at least 14 months. The studies were completed before the emergence of the Omicron virus variant, which early data indicate is better at evading both natural immunity and vaccine-derived protection.

https://www.zerohedge.com/covid-19/natural-immunity-lasts-least-18-months-study

Quebec Scraps Planned Tax On Unvaccinated Residents Amid Growing Backlash

 Perhaps seeing the massive response to the Canadian truckers' "Freedom Convoy" this weekend - and, more importantly, their prime ministers' cowering response before he conveniently tested positive for COVID himself just weeks after receiving his booster - was enough to make the provincial government in Quebec rethink its plans to tax any adult who refuses the vaccine.

Plans for the "health tax" have reportedly been scrapped, according to Francois Legault, the premier of the French-speaking province, who made the announcement during a news conference earlier on Tuesday. Even Legault acknowledged that the planned tax had "deeply divided Quebecers."

"Right now we have to build bridges," he added. "To move Quebec forward in a calm social climate, I am announcing that the government will not introduce this bill on the health contribution."

In early January, Legault had announced plans to tax residents who had not yet taken the COVID vaccine, citing a "burden" they were placing on the province’s health-care networks.

"Those who refuse to receive their first dose in the coming weeks will have to pay a new health contribution," Legault said at the time. "I know the situation is tough, but we can get through this together. We need to focus our efforts on two things: Getting the first, second, and third doses of vaccine and reducing our contacts, especially with older people."

As a reminder, Quebec has faced levels of oppression and encroachment on personal liberty that are unmatched anywhere outside of China. /p>

Last week, Quebec’s Health Ministry required "anyone without a vaccination passport must be accompanied at all times by a store employee and cannot purchase products other than those related to the pharmaceutical service they are receiving."

While MSM reports didn't mention them until lower in the story, it's clear the reaction to the Canadian truckers, who held a "Freedom rally" in Ottawa over the weekend, likely contributed to the governor's decision.

Of course, public opinion polling has shown that a majority of Canadians want all COVID restrictions removed, as the Epoch Times has reported.

Meanwhile, RCMP units have reportedly been called in to arrest truckers blocking the border between the US and Canada in Alberta, according to the CBC. Police are reportedly moving in ready to make arrests and seize equipment.

Update (1600ET): The RCMP has reportedly started with "enforcement actions

Although some local towing companies have reportedly refused service.

Monday's announcement marked the second time the Quebec government has walked back public health measures meant to slow the spread of the coronavirus. It also nixed compulsory inoculations for all health care workers last year fearing it would lead to thousands of nurses quitting their jobs, worsening an already severe worker shortage in the sector.

https://www.zerohedge.com/political/quebec-scraps-planned-tax-unvaccinated-residents-amid-growing-backlash

Could Covid-19 still be affecting us in decades to come?

 Surviving a pandemic isn't always the end of the story – some viruses can have health effects that linger on for decades, eventually leading to a range of devastating diseases.

I

In the 1960s, epidemiologists studying the long-term prognosis of survivors of the 1918 Spanish Influenza began to notice an unusual trend. Those who were born between 1888 and 1924 – meaning they were either infants or in young adulthood at the time of the pandemic – appeared to have been two or three times more likely to develop Parkinson’s disease at some point in their life than those born at different times.

It was a striking finding. For while the potential neurological consequences of flu infections have been documented by doctors for centuries – there are medical reports of this which date back to 1385 – the sheer scale of the Spanish Flu, which infected around 500 million people globally, meant scientists could link a heightened risk of disease to the pandemic.

In recent years, an elevated risk of Parkinson's has also been identified in the survivors of outbreaks of HIV, West Nile virus, Japanese encephalitis, Coxsackie, Western Equine virus and the Epstein-Barr virus. Neurologists attempting to understand why this happens believe that each of these viruses are capable of crossing into the brain, and in some cases damaging the fragile structures which control the co-ordination of movement, known as the basal ganglia, initiating a process of degeneration which can lead to Parkinson's.

Now scientists are keen to monitor whether the current pandemic will also trigger a higher rate of Parkinson's cases in decades to come.

"We don't know but we need to consider that this could become the case," says Patrik Brundin, a Parkinson's researcher at the Van Andel Institute, in Grand Rapids, Michigan. "There are several studies highlighting that people who have recovered from Covid often have long-term central nervous system deficits including loss of sense of smell and taste, brain fog, depression, and anxiety. The numbers are troubling."

While Sars-CoV-2 can invade brain tissue, the scientific jury remains open on whether it will contribute to neurodegenerative disease. Coronaviruses are generally known as "hit and run viruses", because they tend to cause fairly short disease, even if this proves deadly in some cases. In contrast, DNA viruses such as Epstein-Barr can linger permanently in the body and are more associated with long-term illness.

But there have been some indications in the past there might be more to coronaviruses than we perhaps suspect. In the 1990s, Canadian neurologist Stanley Fahn published a study which identified antibodies to the coronaviruses that cause the common cold in the cerebrospinal fluid of Parkinson's patients.

Over the past year, scientists like Brundin have been concerned by the emergence of a small handful of case studies describing patients who have developed what doctors term acute Parkinsonism – abnormalities such as tremors, muscle stiffness, and impaired speech – following Covid-19 infection. More research has found that some Covid-19 patients have disruptions in one of the body's most critical systems, known as the kynurenine pathway. This runs from the brain to the gut, and is used to produce a number of crucial amino acids required for brain health. But when it malfunctions, it can lead to the accumulation of toxins which are thought to play a role in Parkinson's disease.

Other neurologists, however, warn it is still far too early to draw any link between Covid-19 and Parkinson's.

The 1918 flu pandemic was still affecting the health of the global population over 40 years later (Credit: Getty Images)

Alfonso Fasano, a neurology professor at the University of Toronto, points out that the cases of acute parkinsonism which have been described could simply involve patients who were already in the early stages of the disease, and the stress of being infected with Covid-19 simply accelerated or "unmasked" the symptoms. "So far, we're talking of about a dozen cases, usually lacking detailed information," he says. "It's true that what we call a post-encephalitic parkinsonism can occur after a viral infection, but not every pandemic is the same. The Spanish Flu was caused by a completely different virus."

However many feel that there is a need for continued monitoring of any Parkinson’s-like symptoms which emerge in people who have previously been infected with Covid-19, in case the coming years reveal a gradual spike in cases.

But Parkinson's is not the only concern. Experts around the world are trying to figure out if Covid-19 will induce a hidden wave of other illnesses, related to the disruption Sars-CoV-2 causes to the human immune system. If this pans out it would have major public health implications, but it could also help us find new ways of detecting these diseases at an early stage, and even pave the way to new treatments and vaccines.

The diabetes dilemma

In the spring of 2020, Francesco Rubino, a metabolic and bariatric surgeon at Kings College London, began to hear an increasing number of reports about Covid-19 patients coming into hospital with unusually high blood sugar levels, even though they had no previous history of diabetes.

At the same time, doctors were also noticing that patients who already had diabetes appeared to be particularly vulnerable to the disease. Rubino was curious to see whether this strange relationship was a sign that Covid-19 was directly impacting the pancreas, a complex organ which contains beta cells for producing insulin, the hormone that helps the body metabolise sugar molecules from the blood.

He set up a global database called the CovidDiab registry to follow these patients, and find out what happened to them. So far they have been tracking 700 cases over the past year, and the hope is that their data might help solve an enduring problem that has intrigued scientists for many years, namely whether viruses can directly trigger type 1 diabetes.

A number of viruses have been linked to the rare neurological condition Guillain-Barré syndrome. One is Zika, which may have led to a spike in cases in 2015 (Credit: Getty Images)

In the past, associations have been made between type 1 diabetes – a chronic condition which typically develops in childhood or adolescence as patients' pancreases become steadily unable to produce insulin – and various viruses such as Coxsackie B, rubella, cytomegalovirus, and mumps. Scientists suspect that these viruses may be capable of infecting the pancreas, either by escaping from the lungs or leaking out of the gut and into blood vessels. In 2015, researchers at the Oslo Diabetes Research Centre discovered a persistent, low grade viral infection in beta cells extracted from pancreas tissue biopsies of newly diagnosed type 1 diabetes patients, but there have been too few cases to establish concrete proof.

"There's been epidemics before which have been associated with new cases of diabetes," says Rubino. "But this link has been based on a handful of medical reports. So we're hoping that by looking at several hundred cases, we might see an association which is more informative."

Since the beginning of the Covid-19 pandemic, there have already been repeated indications of an abnormal spike in type 1 diabetes cases. By the summer of 2020, hospitals in North West London were already reporting double the number of cases they would typically see, while a paper in Nature earlier this year found Covid-19 survivors in the US were around 39% more likely to have a new diabetes diagnosis in the six months following infection compared to non-infected individuals.

Scientists are now trying to prove that Covid-19 is actually directly contributing to this rise in cases. Shuibing Chen, a stem cell biologist at Weill Cornell Medicine, feels there is evidence which suggests that the virus can attack beta cells, and also generate inflammation in the pancreas and other organs, causing damage to various systems which control blood sugar levels.

"We have detected viral antigens in human pancreatic beta cells in autopsy samples of Covid-19 patients, which supports the role of direct infection," Chen says.

But not everyone is so convinced. Others point out that patients appearing to develop diabetes as a result of Covid-19 could actually be incurring pancreas damage due to intensive steroid treatment while in hospital. Or they may have already been in the early stages of developing diabetes, and Covid-19 again may simply have unmasked the disease.

It's thought that certain viruses can trigger an immune response which later increases the risk of a person developing Parkinson's disease (Credit: Getty Images)

"There have been some reports arguing that Sars-CoV-2 can not only directly infect beta cells, but also might kill them," says Matthias Von Herrath, a professor of autoimmunity at the La Jolla Institute for Immunology. "A follow up report, however, argues against the notion that it commonly affects beta cells. So the jury as to how specific and dangerous it is in causing beta cell functional loss is still out."

Over the coming months, the hope is that the CovidDiab database will yield some more concrete answers. "We don't expect to be able to answer all the questions, but we hope to learn a lot from these 700 cases which probably represents the largest cohort of virus-related diabetes," Rubino says. "How plausible is it that Covid might have been behind these cases? Is there a direct mechanism and if so, what is it?"

But type 1 diabetes is not the only autoimmune disease being linked to Covid-19. Over the past year, a number of reports have associated Sars-CoV-2 infection with other autoimmune disorders such as Guillain–Barré Syndrome, a rare and serious condition in which the immune system attacks the nerves, causing numbness, issues with balance and coordination, weakness, and pain, and sometimes paralysis..

Scientists believe that patients who have been admitted to hospital with Covid-19 are particularly prone to going on to develop such complications as they are more likely to have auto-antibodies in their blood – a form of protein produced by the immune system which is directed against the body's own tissues, leading to complications. A consortium of scientists at the University of Birmingham are now following a cohort of individuals who had been severely ill with Covid-19, to see how many develop longer term autoimmune problems and what makes certain people particularly vulnerable.

"We can't predict the future," says Russell Dale, who researches autoimmune illnesses at the University of Sydney. "But there are a number of precedents of infectious diseases leading to inflammatory and autoimmune problems."

Diagnostics and vaccines

The prospect of Covid-19 leading to a silent surge of chronic illnesses is a sobering one, but if conclusive links can be established between viral infection and different conditions, it could transform the way we look for and treat many of these diseases in future.

In the case of type 1 diabetes, scientists are particularly keen to study exactly what happens after beta cells become infected with Sars-CoV-2 to see if there is a way to prevent their destruction, and hence halt the onset of the disease before it fully develops. "Understanding the link between viral infection and type 1 diabetes might facilitate early diagnosis and prevention," says Chen.

Coxsackie B virus has been linked to the development of type 1 diabetes – and now scientists are wondering if Covid-19 could also make people more susceptible (Credit: Alamy)

Knut Dahl-Jørgensen, a consultant in pediatric endocrinology and diabetes at the Oslo Diabetes Research Centre, told the BBC his colleagues are initiating a clinical trial to see whether antiviral treatment can help protect the pancreas in children who have been newly diagnosed with type 1 diabetes.

Chen is also leading a project which involves sifting through a large library of different chemical compounds to see if any can make beta cells more resilient to viral attack. So far they have already identified one particular compound called trans-ISRIB, which appears to be capable of protecting the insulin-producing capacities of beta cells when infected with Sars-CoV-2 in a petri dish. While this is not yet approved by regulators nor tested in humans, and so cannot be used in Covid-19 patients experiencing blood sugar abnormalities at the moment, Chen hopes that in future it could be administered as a preventative drug for vulnerable individuals in the aftermath of infection.

A strong link between Covid-19 and different autoimmune conditions could also encourage the development of protective vaccines against other viruses which have been previously associated with these illnesses. Researchers at the Karolinska Institute, Tampere University, and the University of Jyväskylä have developed a potential vaccine candidate which protects against all six strains of Coxsackie B, and has been shown to prevent mice from developing virus-induced type 1 diabetes.

Gunnar Houen, an immunologist at the State Serum Institute in Copenhagen, believes it could also lead to further investment in vaccines against Epstein-Barr, a virus which has been associated with the development of rheumatoid arthritis and multiple sclerosis, as well as certain cancers.

"Vaccines are very likely to be effective against Epstein-Barr if given early enough, as most people are infected by this virus during the first one or two years of life," says Houen. "There will be a market for this, since the associated diseases cause as much or even more harm as Covid-19."

In the meantime, scientists hoping that the coming months and years will reveal more about the propensity of Covid-19 to trigger each of these illnesses.

"All these questions will not be answered tomorrow, or in the next couple of months, but over the next year we hope to be able to look into this data and begin to answer certain questions, start to see some patterns and maybe have some answers," says Rubino.

https://www.bbc.com/future/article/20220127-could-covid-19-still-be-affecting-us-in-decades-to-come

Many people say they’ve gotten false negatives on at-home, COVID-19 tests. Why?

 Jackie Kramer thought she had COVID-19 late last month.

Everyone in her family tested positive. And she had symptoms: congestion, a headache and fatigue.

Yet the Andersonville woman kept testing negative, over and over again. She took several PCR tests and rapid, at-home COVID-19 tests every day for a week.

“I don’t understand why I tested negative for a week when I had all the symptoms,” said Kramer, 56. “I’d stare at it, like, how can this be?” She spent the week isolating from her husband, 21-year-old daughter and 18-year-old son, to avoid catching COVID-19, just in case the tests were right.

Finally, after a week of testing negative, an at-home test came back positive, confirming what she had suspected — but wasn’t 100% sure of — all along. She called the experience “extremely frustrating.”

Like Kramer, many people during this surge have gotten negative results on at-home tests only to later learn that they actually had COVID-19 — a fact that comes as the federal government pushes to get more free at-home tests into people’s hands. Experts, however, say the at-home tests remain as accurate as they’ve ever been, even with the omicron variant. Rather, experts attribute the false negatives to other possible factors: no test is 100% accurate, people may not be administering them correctly, or people are testing too early to detect their COVID-19 infections.

“You should never do just one test,” said Dr. Emily Landon, hospital epidemiologist at University of Chicago Medical Center. “There’s a reason there’s two tests in the box.”

It can take time for the amount of the virus in a person’s body to reach a high enough level that an at-home test would detect it, she said. A vaccinated person might get symptoms of COVID-19 before an at-home test would turn out a positive result, because the person’s body has already been primed to fight the infection and starts doing so with only a small amount of the virus in the body, Landon said.

Like Kramer, people who feel ill and get a negative result on an at-home test should take the tests repeatedly, as often as daily, depending on the specific test’s instructions and if they have enough tests on-hand, Landon said. If there is only one at-home test available, wait until the second or third day of symptoms to test, and if the test is negative, get a PCR test, she said.

PCR tests can detect COVID-19 for a longer window of time than at-home tests.

In recent weeks, it wasn’t always possible for people who felt ill to use at-home tests every day, given that they were tough to find on store shelves and could cost $20 to $30 a package. The federal government is now sending four free tests to each household, and health insurance companies are now covering up to eight tests per month per person, though that doesn’t apply to people on Medicare.

People should take advantage of those programs, and get plenty of tests, Landon said. If people are treating at-home tests like precious resources, they’re not using them correctly, she said.

“They’re best used regularly and in an ongoing way as we battle the pandemic,” Landon said. “If you have them on-hand like toilet paper ... and stockpile them, you’re going to have enough.”

Lisa Guo knows she was fortunate to have several COVID-19 tests on-hand last month, after she was exposed to a co-worker with COVID-19.

Guo took an at-home test about two days after the exposure, and that test came back negative. The next morning Guo, 33, of Lakeview, woke with a headache, dry cough and low fever. She took another at-home test that, again, came back negative.

She began to feel frustrated, not knowing exactly what she had or how long she’d have to stay home from work.

Still feeling sick the next day, she again swabbed her nose at home. Finally, the test was positive — and she felt relieved to finally know what she had and how to proceed.

“I knew I had something and I was pretty sure it was COVID, and that’s why I kept testing,” said Guo, who was sick for about two weeks but has since recovered. She also tested repeatedly because of guidance from her father, who is an emergency room doctor, she said.

It’s possible, experts say, that not everyone understands they’re supposed to take multiple at-home tests if they feel sick and get negative results. The instructions that come with at-home tests tell people to take a second test, and explain that more frequent testing may help detect COVID-19 more quickly, but not everyone may read through all the instructions.

For Abbott Laboratory’s popular BinaxNOW test, for example, some of those directions and warnings are spelled out over four pages of fine print on the back of the instructions for administering the test.

The tests could also be producing some false positives because that’s the nature of tests, experts say. No test is perfect. COVID-19 at-home tests generally have 70% to 90% accuracy, depending on the brand, in detecting COVID-19 compared with PCR tests, which take longer to return results.

At-home tests also, generally, aren’t as effective when used by asymptomatic people, such as after an exposure, Landon said. Those people should likely get PCR tests instead, or, if they’re going to use at-home tests, take them every other day starting three days after the exposure until nine days after.

“There’s a reason we don’t routinely have medical tests available at the pharmacy — because they’re really hard to interpret,” Landon said. She noted that pregnancy tests are one of the few tests widely available, and those are simpler to perform and easier to interpret. “You have to understand the benefits and risks of the tests, follow complex instructions and understand what to do for follow-up based on results of the test.”

Still, despite the limitations of at-home COVID-19 tests — and negative test results in people who actually have COVID-19 — experts say they’re still valuable.

“What these tests are good for is picking up the highly contagious people,” said Dr. Robert Murphy, executive director of the Havey Institute for Global Health at Northwestern University Feinberg School of Medicine.

People who test positive on at-home tests likely have so much virus in their bodies that they’re more likely to be contagious than those who test negative, even if they have COVID-19, he said.

Murphy still recommends people use at-home tests before gatherings with people outside their households.

“I test everybody, knowing it’s not such a sensitive test, but it gives me some extra reassurance that you’re going to pick out the superspreaders, the people who are highly contagious,” he said.

It can also be a good type of test for people who feel ill, if they take it repeatedly, he said. And at-home tests are preferable to sending everyone who starts coughing to get a PCR test, given that PCR tests often require appointments and can take days to get results.

At-home tests aren’t a perfect test, but they’re the best option out there at the moment for testing large numbers of people frequently, in hopes of limiting the spread of COVID-19, experts said.

“They are useful, but everything has its limitations, and this is just one tool we have,” Murphy said.

https://www.chicagotribune.com/coronavirus/ct-coronavirus-covid-at-home-tests-false-negatives-20220201-szrpf43ewrav7bukaivvrt7qi4-story.html