Socioeconomic Disparities in Patient Use of Telehealth During the Coronavirus Disease 2019 Surge

Ilaaf Darrat, MD, MBA1; Samantha Tam, MD, MPH1; Marwan Boulis, MD1; et alAmy M. Williams, PhD1
Author Affiliations Article Information
JAMA Otolaryngol Head Neck Surg. Published online January 14, 2021.

 doi:10.1001/jamaoto1.2020.516

Key Points

Question What demographic and socioeconomic factors were associated with patient participation in telehealth during the coronavirus disease 2019 (COVID-19) pandemic surge?

Findings In a cohort study of 1162 patients at a large, urban tertiary care center in the Midwest, age, sex, median household income, insurance status, and marital status were associated with patient participation in telehealth during the COVID-19 pandemic surge.

Meaning Similar characteristics that are associated with inequitable access to in-person medical care are also associated with inequitable access to telehealth; a focus on vulnerable patient populations in a changing landscape is necessary to provide timely and essential medical care.

Abstract

Importance The coronavirus disease 2019 (COVID-19) pandemic required the rapid transition to telehealth with the aim of providing patients with medical access and supporting clinicians while abiding by the stay-at-home orders.

Objective To assess demographic and socioeconomic factors associated with patient participation in telehealth during the COVID-19 pandemic.

Design, Setting, and Participants This cohort study included all pediatric and adult patient encounters at the Department of Otolaryngology–Head & Neck Surgery in a tertiary care, academic, multisubspecialty, multisite practice located in an early hot spot for the COVID-19 pandemic from March 17 to May 1, 2020. Encounters included completed synchronous virtual, telephone, and in-person visits as well as visit no-shows.

Main Outcomes and Measures Patient demographic characteristics, insurance status, and 2010 Census block level data as a proxy for socioeconomic status were extracted. Univariate and multivariate logistic regression models were created for patient-level comparisons.

Results Of the 1162 patients (604 females [52.0%]; median age, 55 [range, 0-97] years) included, 990 completed visits; of these, 437 (44.1%) completed a virtual visit. After multivariate adjustment, females (odds ratio [OR], 1.71; 95% CI, 1.11-2.63) and patients with preferred provider organization insurance (OR, 2.70; 95% CI, 1.40-5.20) were more likely to complete a virtual visit compared with a telephone visit. Increasing age (OR per year, 0.98; 95% CI, 0.98-0.99) and being in the lowest median household income quartile (OR, 0.60; 95% CI, 0.42-0.86) were associated with lower odds of completing a virtual visit overall. Those patients within the second (OR, 0.53; 95% CI, 0.28-0.99) and lowest (OR, 0.33; 95% CI, 0.17-0.62) quartiles of median household income by census block and those with Medicaid, no insurance, or other public insurance (OR, 0.47; 95% CI, 0.23-0.94) were more likely to complete a telephone visit. Finally, being within the lower 2 quartiles of proportion being married (OR for third quartile, 0.49 [95% CI, 0.29-0.86]; OR for lowest quartile, 0.39 [95% CI, 0.23-0.67]) was associated with higher likelihood of a no-show visit.

Conclusions and Relevance

 These findings suggest that age, sex, median household income, insurance status, and marital status are associated with patient participation in telehealth. These findings identify vulnerable patient populations who may not engage with telehealth, yet still require medical care in a changing health care delivery landscape.

Figure. Percentage Distribution of Types of Visits During the Coronavirus Disease 2019 (COVID-19) Surge
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Table 1. Patient Characteristics Based on Visit Type From March 17 to May 1, 2020
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Table 2. Univariate and Multivariate Analysis of Virtual Visit Compared With All Other Visits
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Table 3. Univariate and Multivariate Analysis of Virtual Visit Compared With Telephone Visit
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Table 4. Univariate and Multivariate Analysis of Virtual Visit or Telephone Visit Compared With No-Show Visit
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Metformin use reduces risk of death for patients with COVID-19 and diabetes

Use of the diabetes drug metformin -- before a diagnosis of COVID-19 -- was associated with a threefold decrease in mortality in COVID-19 patients with Type 2 diabetes

UNIVERSITY OF ALABAMA AT BIRMINGHAM

Research News

 

IMAGE: ANATH SHALEV view more 

CREDIT: UAB

BIRMINGHAM, Ala. - Use of the diabetes drug metformin -- before a diagnosis of COVID-19 -- is associated with a threefold decrease in mortality in COVID-19 patients with Type 2 diabetes, according to a racially diverse study at the University of Alabama at Birmingham. Diabetes is a significant comorbidity for COVID-19.

"This beneficial effect remained, even after correcting for age, sex, race, obesity, and hypertension or chronic kidney disease and heart failure," said Anath Shalev, M.D., director of UAB's Comprehensive Diabetes Center and leader of the study.

"Since similar results have now been obtained in different populations from around the world -- including China, France and a UnitedHealthcare analysis -- this suggests that the observed reduction in mortality risk associated with metformin use in subjects with Type 2 diabetes and COVID-19 might be generalizable," Shalev said.

How metformin improves prognosis in the context of COVID-19 is not known, Shalev says. The UAB findings suggest that the mechanisms may go beyond any expected improvement in glycemic control or obesity, since neither body mass index, blood glucose nor hemoglobin A1C were lower in the metformin users who survived as compared to those who died.

"The mechanisms may involve metformin's previously described anti-inflammatory and anti-thrombotic effects," Shalev said.

The study -- first made available in MedRxiv and now published in the peer-reviewed journal Frontiers in Endocrinology -- included 25,326 patients tested for COVID-19 at the tertiary care UAB Hospital between Feb. 25 and June 22 of last year. Of the 604 patients found to be COVID-19-positive, 311 were African Americans.

The primary outcome in the study was mortality in COVID-19-positive subjects, and the potential association with subject characteristics or comorbidities was analyzed.

Researchers found that Blacks, who are only 26 percent of Alabama's population, were 52 percent of those who tested positive for COVID-19, and only 30 percent of those who tested negative. In contrast, only 36 percent of the COVID-19-positive subjects were white, while whites made up 56 percent of those who tested negative, further underlining the racial disparity. Once COVID-19-positive though, no significant racial difference in mortality was observed.

"In our cohort," Shalev said, "being African American appeared to be primarily a risk factor for contracting COVID-19, rather than for mortality. This suggests that any racial disparity observed is likely due to exposure risk and external socioeconomic factors, including access to proper health care."

Overall mortality for COVID-19-positive patients was 11 percent. The study found that 93 percent of deaths occurred in subjects over the age of 50, and being male or having high blood pressure was associated with a significantly elevated risk of death. Diabetes was associated with a dramatic increase in mortality, with an odds ratio of 3.62. Overall, 67 percent of deaths in the study occurred in subjects with diabetes.

The researchers looked at the effects of diabetes treatment on adverse COVID-19 outcomes, focusing on insulin and metformin as the two most common medications for Type 2 diabetes. They found that prior insulin use did not affect mortality risk.

However, prior metformin use was a different matter. Metformin use significantly reduced the odds of dying, and the 11 percent mortality for metformin users was not only comparable to that of the general COVID-19-positive population, it was dramatically lower than the 23 percent mortality for diabetes patients not on metformin.

After controlling for other covariates, age, sex and metformin use emerged as independent factors affecting COVID-19-related mortality. Interestingly, even after controlling for all these other covariates, death was significantly less likely -- with an odds ratio of 0.33 -- for Type 2 diabetes subjects taking metformin, compared with those who did not take metformin.

"These results suggest that, while diabetes is an independent risk factor for COVID-19-related mortality," Shalev said, "this risk is dramatically reduced in subjects taking metformin -- raising the possibility that metformin may provide a protective approach in this high-risk population."

The researchers say future studies will need to explore how metformin is protective, as well as assess the risks and benefits of metformin treatment and the indications for its use in the face of the ongoing COVID-19 pandemic.

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This study is part of a new Precision Diabetes Program, a collaboration between the UAB Comprehensive Diabetes Center and the Hugh Kaul Precision Medicine Institute at UAB.

Co-authors with Shalev for the paper, "Metformin use is associated with reduced mortality in a diverse population with COVID-19 and diabetes," are Andrew B. Crouse and Matthew Might, the Hugh Kaul Precision Medicine Institute at UAB; Tiffany Grimes and Fernando Ovalle, the Comprehensive Diabetes Center and the Department of Medicine Division of Endocrinology, Diabetes and Metabolism at UAB; and Peng Li, UAB School of Nursing.

Support came from National Institutes of Health grants DK078752, DK120379 and TR001417.

Shalev is a professor in the UAB Department of Medicine Division of Endocrinology, Diabetes and Metabolism, and she holds the Nancy R. and Eugene C. Gwaltney Family Endowed Chair in Juvenile Diabetes Research.

 

New study: Without right messaging, masks could lead to more COVID-19 spread

UNIVERSITY OF VERMONT

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IMAGE: A NOVEL STUDY SUGGESTS THAT THE BEHAVIOR PUBLIC OFFICIALS ARE NOW MANDATING OR RECOMMENDING UNEQUIVOCALLY TO SLOW THE SPREAD OF COVID-19--WEARING A FACE COVERING--SHOULD COME WITH A CAVEAT. IF NOT... view more 

CREDIT: JOSHUA BROWN

A novel new study suggests that the behavior public officials are now mandating or recommending unequivocally to slow the spread of surging COVID-19--wearing a face covering--should come with a caveat. If not accompanied by proper public education, the practice could lead to more infections.

The finding is part of an unique study, just published in JMIR Public Health and Surveillance, that was conducted by a team of health economists and public health faculty at the University of Vermont's Larner College of Medicine in partnership with public health officials for the state of Vermont.

The study combines survey data gathered from adults living in northwestern Vermont with test results that showed whether a subset of them had contracted COVID-19, a dual research approach that few COVID studies have employed. By correlating the two data sets, researchers were able to determine what behaviors and circumstances increased respondents' risk of becoming sick.

The key risk factor driving transmission of the disease, the study found, was the number of daily contacts participants had with other adults and seniors.

That had relevance for two other findings.

Those who wore masks had more of these daily contacts compared with those who didn't, and a higher proportion contracted the virus as a result.

Basic human psychology could be at work, said Eline van den Broek-Altenburg, an assistant professor and vice chair for Population Health Science in the Department of Radiology at the Larner College of Medicine and the study's principal investigator.

"When you wear a mask, you may have a deceptive sense of being protected and have more interactions with other people," she said.

The public health implications are clear. "Messaging that people need to wear a mask is essential, but insufficient," she said. "It should go hand in hand with education that masks don't give you a free pass to see as many people as you want. You still need to strictly limit your contacts."

Public education messaging should make clear how to wear a mask safely to limit infection, van den Broek-Altenburg added.

The study also found that participants' living environment determined how many contacts they had and affected their probability of becoming infected. A higher proportion of those living in apartments were infected with the virus compared with those who lived in single family homes.

"If you live in an apartment, you're going to see more people on a daily basis than if you live in a single family home, so you need to be as vigilant about social distancing," van den Broek-Altenburg said.

The study controlled for profession to prevent essential workers, who by definition have more contacts and are usually required to wear masks, from skewing the results.

"It's generally known that essential workers are at higher risk, and our study bore that out," van den Broek-Altenburg said. "We wanted to see what else predicted that people were going to get sick," she said.

Reported cases in Chittenden County, Vermont only one-fifth of likely total

The study provides the first estimate of unreported cases in Vermont's Chittenden County, where most study participants live. The survey found that 2.2 percent of the survey group had contracted the virus, suggesting that an estimated 3,621 Chittenden County residents were likely to have become ill, compared with just 662 reported cases, just 18%.

That figure translates to a hospitalization rate of 1.2% and adjusted infection fatality rate of 0.55%.

This finding is important for policy-makers, van den Broek-Altenburg said, in and out of Vermont.

"If you know how many people are sick or have been sick, you're much better equipped to make precise predictions of will happen in the future and fashion the appropriate policies," she said.

It also shows the importance of serologic and PCR testing of the general population, she said.

"If you only test symptomatic patients, you'll never be able to find out how many people have already had the virus. With our random sample study we were able to show that Vermont has so far only tested less than one-fifth of the people who have likely had the virus. To capture the larger population, random samples of the population are needed so we can also capture asymptomatic patients, which appears to be the majority of COVID-19 cases."

The study, among other things, is a proof of concept, van den Broek-Altenburg said.

"I hope it leads to other, larger studies that combine survey data with widespread testing. This approach is essential to both understanding the dynamics of this pandemic and planning our response to futures ones."

Ten of the 454 survey respondents who took the serologic test had antibodies for Covid-19, and one tested positive for the virus. Given the small number, researchers simplified their models and were able to reach a high confidence level in the two key findings.

"We tested our models and found that the results were robust through several different model specifications," van den Broek-Altenburg said.

To create the study group, the researchers sent a survey to 12,000 randomly selected people between the ages 18 and 70 who had at least one primary care visit at the University of Vermont Medical Center, which services primarily northwestern Vermont, in the past three years.

Turn off that camera during virtual meetings, environmental study says

Simple tips to go green with your internet use during a pandemic

PURDUE UNIVERSITY

Research News

 

IMAGE: A NEW STUDY ESTIMATES THE APPROXIMATE CARBON, WATER AND LAND FOOTPRINTS ASSOCIATED WITH EACH HOUR OF DATA SPENT IN POPULAR INTERNET APPS. view more 

CREDIT: PURDUE UNIVERSITY/KAYLA WILES

WEST LAFAYETTE, Ind. -- It's not just to hide clutter anymore - add "saving the planet" to the reasons you leave the camera off during your next virtual meeting.

A new study says that despite a record drop in global carbon emissions in 2020, a pandemic-driven shift to remote work and more at-home entertainment still presents significant environmental impact due to how internet data is stored and transferred around the world.

Just one hour of videoconferencing or streaming, for example, emits 150-1,000 grams of carbon dioxide (a gallon of gasoline burned from a car emits about 8,887 grams), requires 2-12 liters of water and demands a land area adding up to about the size of an iPad Mini.

But leaving your camera off during a web call can reduce these footprints by 96%. Streaming content in standard definition rather than in high definition while using apps such as Netflix or Hulu also could bring an 86% reduction, the researchers estimated.

The study, conducted by researchers from Purdue University, Yale University and the Massachusetts Institute of Technology, is the first to analyze the water and land footprints associated with internet infrastructure in addition to carbon footprints. The findings are published in the journal Resources, Conservation & Recycling.

"If you just focus on one type of footprint, you miss out on others that can provide a more holistic look at environmental impact," said Roshanak "Roshi" Nateghi, a Purdue professor of industrial engineering, whose work looks to uncover gaps and assumptions in energy research that have led to underestimating the effects of climate change.

A number of countries have reported at least a 20% increase in internet traffic since March. If the trend continues through the end of 2021, this increased internet use alone would require a forest of about 71,600 square miles - twice the land area of Indiana - to sequester the emitted carbon, the study found.

The additional water needed in the processing and transmission of data would also be enough to fill more than 300,000 Olympic-size swimming pools, while the resulting land footprint would be about equal to the size of Los Angeles.

The team estimated the carbon, water and land footprints associated with each gigabyte of data used in YouTube, Zoom, Facebook, Instagram, Twitter, TikTok and 12 other platforms, as well as in online gaming and miscellaneous web surfing. As expected, the more video used in an application, the larger the footprints.

Because data processing uses a lot of electricity, and any production of electricity has carbon, water and land footprints, reducing data download reduces environmental damage.

"Banking systems tell you the positive environmental impact of going paperless, but no one tells you the benefit of turning off your camera or reducing your streaming quality. So without your consent, these platforms are increasing your environmental footprint," said Kaveh Madani, who led and directed this study as a visiting fellow at the Yale MacMillan Center.

The internet's carbon footprint had already been increasing before COVID-19 lockdowns, accounting for about 3.7% of global greenhouse gas emissions. But the water and land footprints of internet infrastructure have largely been overlooked in studies of how internet use impacts the environment, Madani said.

Madani teamed up with Nateghi's research group to investigate these footprints and how they might be affected by increased internet traffic, finding that the footprints not only vary by web platform, but also by the country. The team gathered data for Brazil, China, France, Germany, India, Iran, Japan, Mexico, Pakistan, Russia, South Africa, the U.K. and the U.S.

Processing and transmitting internet data in the U.S., the researchers found, has a carbon footprint that is 9% higher than the world median, but water and land footprints that are 45% and 58% lower, respectively.

Incorporating the water and land footprints of internet infrastructure painted a surprising picture for a few countries. Even though Germany, a world renewable energy leader, has a carbon footprint well below the world median, its water and land footprints are much higher. The country's energy production land footprint, for example, is 204% above the median, the researchers calculated.

Purdue graduate students Renee Obringer, Benjamin Rachunok and Debora Maia-Silva performed the calculations and data analysis in collaboration with Maryam Arbabzadeh, a postdoctoral research associate at MIT. The estimates are based on publicly available data for each platform and country, models developed by Madani's research group and known values of energy use per gigabyte of fixed-line internet use.

The estimates are rough, the researchers say, since they're only as good as the data made available by service providers and third parties. But the team believes that the estimates still help to document a trend and bring a more comprehensive understanding of environmental footprints associated with internet use.

"These are the best estimates given the available data. In view of these reported surges, there is a hope now for higher transparency to guide policy," Nateghi said.

###

The study was supported by the Purdue Climate Change Research Center, the Purdue Center for the Environment, the MIT Energy Initiative and the Yale MacMillan Center.

ABSTRACT

The Overlooked Environmental Footprint of Increased Internet Use

Renee Obringer1,2, Benjamin Rachunok3*, Debora Maia-Silva2*, Maryam

Arbabzadeh4*, Roshanak Nateghi3, Kaveh Madani5,6

1The National Socio-Enviromental Synthesis Center, University of Maryland, 1 Park

Place, Annapolis, MD 21401 USA

2Environmental and Ecological Engineering, Purdue University, 500 Central Drive, West

Lafayette, IN 47907 USA

3School of Industrial Engineering, Purdue University, 315 N. Grant Street, West Lafayette,

IN 47907 USA

4Massachusetts Institute of Technology Energy Initiative, 307 Ames Street E19,

Cambridge, MA 02142 USA

5Department of Political Science, Yale University, 115 Prospect Street, New Haven, CT

06520 USA

6Centre for Environmental Policy, Imperial College London, 16-18 Princes Gardens,

London SW7 1NE, UK

*These authors contributed equally to this work.

DOI: 10.1016/j.resconrec.2020.105389

The environmental costs of adopting new technologies and habits are often recognized too late, typically when changing the adopted technologies and behavioral norms is difficult. A similar story may unfold if society continues to blindly transition to an unregulated and environmentally unaudited digital world, a transition path that has been facilitated by the fourth industrial revolution and is now accelerated by the global COVID-19 crisis. The newly developed digital lifestyle has major environmental benefits, including the reduction of travel-related CO2 emissions. Yet, increased Internet use has some hidden environmental impacts that must be uncovered (Figure 1a) to make the transition to a low-carbon and green economy successful.

 COVID-19 reduced US life expectancy, especially among Black and Latino populations

Life expectancy at birth will shorten by more than one year

UNIVERSITY OF SOUTHERN CALIFORNIA

NEWS RELEASE 14-JAN-2021

Research News

 

The COVID-19 pandemic, which claimed more than 336,000 lives in the United States in 2020, has significantly affected life expectancy, USC and Princeton researchers have found.

The researchers project that, due to the pandemic deaths last year, life expectancy at birth for Americans will shorten by 1.13 years to 77.48 years, according to their study published Thursday in the Proceedings of the National Academy of Sciences.

That is the largest single-year decline in life expectancy in at least 40 years and is the lowest life expectancy estimated since 2003.

The declines in life expectancy are likely even starker among minority populations. For Blacks, the researchers project their life expectancy would shorten by 2.10 years to 72.78 years, and for Latinos, by 3.05 years to 78.77 years.

Whites are also impacted, but their projected decline is much smaller -- 0.68 years -- to a life expectancy of 77.84 years.

Overall, the gap in life expectancy between Blacks and whites is projected to widen by 40%, from 3.6 to more than 5 years -- further evidence of the disease's disparate impact on disadvantaged populations.

"Our study analyzes the effect of this exceptional number of deaths on life expectancy for the entire nation, as well as the consequences for marginalized groups," said study author Theresa Andrasfay, a postdoctoral fellow at the USC Leonard Davis School of Gerontology. "The COVID-19 pandemic's disproportionate effect on the life expectancy of Black and Latino Americans likely has to do with their greater exposure through their workplace or extended family contacts, in addition to receiving poorer health care, leading to more infections and worse outcomes."

COVID-19 appears to have eliminated many of the gains made in closing the Black-white life expectancy gap since 2006. Latinos, who have consistently experienced lower mortality than whites -- a phenomenon known as the "Latino paradox" -- would see their more than three-year survival advantage over whites reduced to less than one year.

"The huge decline in life expectancy for Latinos is especially shocking given that Latinos have lower rates than the white and Black populations of most chronic conditions that are risk factors for COVID-19," said study co-author Noreen Goldman, the Hughes-Rogers Professor of Demography and Public Affairs at the Princeton School of Public and International Affairs. "The generally good health of Latinos prior to the pandemic, which should have protected them from COVID-19, has laid bare the risks associated with social and economic disadvantage."

The study's authors estimated life expectancy at birth and at age 65 for 2020 for the total U.S. population and by race and ethnicity. They used four scenarios of deaths -- one in which the COVID-19 pandemic had not occurred and three others that include COVID-19 mortality projections by the Institute for Health Metrics and Evaluation, an independent global health research center at the University of Washington.

"The bigger reductions in life expectancy for the Black and Latino populations result in part from a disproportionate number of deaths at younger ages for these groups," Goldman said. "These findings underscore the need for protective behaviors and programs to reduce potential viral exposure among younger individuals who may not perceive themselves to be at high risk."

Life expectancy as an indicator of population health

Of the analyzed deaths for which race and ethnicity have been reported to the National Center for Health Statistics, 21% were Black and 22% Latino. Black and Latino Americans have experienced a disproportionate burden of coronavirus infections and deaths, reflecting persistent structural inequalities that heighten risk of exposure to and death from COVID-19.

The researchers say life expectancy is an important indicator of a population's health and an informative tool for examining the impact of COVID-19 on survival.

In the decades before the COVID-19 pandemic, annual improvements in U.S. life expectancy had been small but overall life expectancy had rarely declined. An exception was the annual reduction of 0.1 year for three consecutive years -- 2015, 2016, and 2017 -- which were attributed in part to increases in so-called "deaths of despair" among middle-aged whites related to drug overdoses, including opioids, as well as alcohol-related liver disease and suicide.

The projected pandemic-related drop in life expectancy is about 10 times as large as the declines seen in recent years.

The last major pandemic to significantly reduce life expectancy in a short period of time was the 1918 influenza pandemic, which research indicates reduced life expectancy by an extraordinary 7-12 years.

As of Wednesday, more than 10 million Americans had received their first COVID-19 vaccination dose, according to the U.S. Centers for Disease Control and Prevention. But the vaccines may not be enough to immediately reverse the impact of the disease on U.S. life expectancy.

"While the arrival of effective vaccines is hopeful, the U.S. is currently experiencing more daily COVID-19 deaths than at any other point in the pandemic," Andrasfay said. "Because of that, and because we expect there will be long-term health and economic effects that may result in worse mortality for many years to come, we expect there will be lingering effects on life expectancy in 2021."

"That said," she added, "no cohort may ever experience a reduction in life expectancy of the magnitude attributed to COVID-19 in 2020."

The study authors say they are now studying occupational exposures to COVID-19 by race and ethnicity to further comprehend its disproportionate impact.

###

The research was supported by the National Institute on Aging (grant number T32AG000037).

 

COVID-19: Science scepticism may be reinforced by UK rush to approve vaccines

SAGE

Research News

 

Former director of public health Professor John Ashton has said that scientific scepticism may be reinforced by the UK's rush to approve COVID vaccines for public use and the apparent political desire to be the first out of the blocks in contrast to our European neighbours.

Writing in the Journal of the Royal Society of Medicine, Prof Ashton says that to risk the trust of the public for the sake of a couple of weeks propaganda advantage could prove to be unforgivable should vaccine uptake fall below that required for the ubiquitous 'herd immunity' as a result of giving oxygen to the sceptics.

"In this age of scientific rationality, superstition and anti-science still run deep," he writes. "When an overwhelming majority of the public welcomes the arrival of COVID vaccination, it is salutary to remind ourselves of the main arguments deployed against its value and use."

As well as the readily understood fear of injections, Prof Ashton writes that other objections have included that vaccination is 'unchristian', that it is an infringement of personal liberty and that it is part of a more general suspicion of scientific medicine.

In his paper, Prof Ashton draws on the experience of the Victorian anti-vaccination leagues which were set up in the 19th century to campaign against smallpox vaccination and which offer a history lesson on the breakdown of trust between the government and the public.

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Temperature scanners of limited value in detecting Covid-19

THE PHYSIOLOGICAL SOCIETY

Research News

 

Making people stand in front of a scanner to have their body temperature read can result in a large number of false negatives, allowing people with Covid-19 to pass through airports and hospitals undetected.

Leading experts in physiology have suggested instead that taking temperature readings of a person's fingertip and eye would give a significantly better and more reliable reading and help identify those with fever. The study is published in Experimental Physiology.

Professor Tipton, of the University of Portsmouth, said: "If scanners are not giving an accurate reading, we run the risk of falsely excluding people from places they may want, or need, to go, and we also risk allowing people with the virus to spread the undetected infection they have."

The study found four key factors:

• Temperature alone isn't a good indicator of disease -- not all who have the virus have a fever and many who do, develop one only after admission to hospital;
• Measuring skin temperature doesn't give an accurate estimation of deep body temperature (raised in a fever). A direct measure of deep body temperature is impractical;
• A high temperature, even one taken from deep body, does not necessarily mean a person has Covid-19; and
• Taking two temperature measurements, one of the finger, the other of the eye, is likely to be a better and more reliable indicator of a fever-induced increase in deep body temperature.

Professor Tipton said: "Using a surface temperature scanner to obtain a single surface temperature, usually the forehead, is an unreliable method to detect the fever associated with Covid-19. Too many factors make the measurement of a skin temperature a poor surrogate for deep body temperature; skin temperature can change independently of deep body temperature for lots of reasons. Even if such a single measure did reflect deep body temperature reliably, other things, such as exercise can raise deep body temperature.

"The pandemic has had a devastating global effect on all aspects of our lives, and unfortunately, it's unlikely to be the last pandemic we face. It's critical we develop a method of gauging if an individual has a fever that's accurate and fast."

The most common symptom of 55,924 confirmed cases of Covid-19 reported in China up to February 22, 2020 was fever, followed by other symptoms, including dry cough, sputum production, shortness of breath, muscle or joint pain, sore throat, headache chills, nausea or vomiting, nasal congestion, and diarrhoea.

However, the researchers say a significant proportion (at least 11 %) of those with Covid-19 do not have a fever, and that fewer than half those admitted to hospital with suspected Covid-19 had a fever. Although the majority of positive cases go on to develop a high temperature after being admitted to hospital, they were infectious before their temperature soared.

Professor Tipton said: "We think we can improve the identification of the presence of fever using the same kit but looking at the difference between eye and finger temperature - it's not perfect, but it is potentially better and more reliable."

The same scanners can easily be adapted to take these two measurements.

The new study argues that taking temperature readings of a person's fingertip and eye would give a significantly better and more reliable reading and help identify those with fever.

A change in deep body temperature is a critical factor in diagnosing disease with as little as a one degree increase indicating a potential disease.

The many methods of detecting deep body temperature, widely used in hospitals, are too expensive, invasive and time consuming to be widely used outside hospitals.

Professor Tipton said: "During the SARS epidemic, in 2003, there was a need for a fast, effective mass screening method and infrared thermography became and remains the cornerstone measurement, despite concerns over its reliability."

A 2005 study of 1,000 people comparing forehead temperature with three different infrared thermometers gave different temperatures, ranging from 31 °C to 35.6 °C. The infrared thermometers measurements alone varied by as much as 2 °C. In another study, more than 80 per cent of the 500 people tested using infrared, gave a false negative result.

Such differences in skin temperature could be due to a range of reasons, including whether the individual has recently exercised, has an infection, sunburn or recently drunk alcohol, how close an individual stands to a scanner, how warm or cool the air is, how much fat a person has on their body and even their blood pressure.

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Scientists discover the secret of Galápagos' rich ecosystem

UNIVERSITY OF SOUTHAMPTON

 Research News

 

IMAGE: A GALÁPAGOS TOROISE view more 

CREDIT: ALEXANDER FORRYAN

New research has unlocked the mystery of how the Galápagos Islands, a rocky, volcanic outcrop, with only modest rainfall and vegetation, is able to sustain its unique wildlife habitats.

The Galápagos archipelago, rising from the eastern equatorial Pacific Ocean some 900 kilometres off the South American mainland, is an iconic and globally significant biological hotspot. The islands are renowned for their unique wealth of endemic species, which inspired Charles Darwin's theory of evolution and today underpins one of the largest UNESCO World Heritage Sites and Marine Reserves on Earth.

Scientists have known for decades that the regional ecosystem is sustained by upwelling of cool, nutrient-rich deep waters, which fuel the growth of the phytoplankton upon which the entire ecosystem thrives.

Yet despite its critical life-supporting role, the upwelling's controlling factors had remained undetermined prior to this new study. Establishing these controls, and their climate sensitivity, is critical to assessing the resilience of the regional ecosystem against modern climatic change.

In this new research, published in Nature Scientific Reports, scientists from the University of Southampton, National Oceanography Centre and Universidad San Francisco de Quito in Ecuador used a realistic, high-resolution computer model to study the regional ocean circulation around the Galápagos Islands.

This model showed that the intensity of upwelling around the Galápagos is driven by local northward winds, which generate vigorous turbulence at upper-ocean fronts to the west of the islands. These fronts are areas of sharp lateral contrasts in ocean temperature, similar in character to atmospheric fronts in weather maps, but much smaller.

The turbulence drives upwelling of deep waters toward the ocean surface, thus providing the nutrients needed to sustain the Galápagos ecosystem.

Alex Forryan of the University of Southampton, who performed the research, said: "Our findings show that Galápagos upwelling is controlled by highly localised atmosphere-ocean interactions. There now needs to be a focus on these processes when monitoring how the islands' ecosystem is changing, and in mitigating the ecosystem's vulnerability to 21st -century climate change."

Professor Alberto Naveira Garabato, also of the University of Southampton, who led the project supporting the research, said: "This new knowledge of where and how the injection of deep-ocean nutrients to the Galapagos ecosystem happens is informing ongoing plans to expand the Galápagos Marine Reserve, and improve its management against the mounting pressures of climate change and human exploitation."

CAPTION

Iguana on the Galápagos Islands

Spectacular fossil discovery:

150 million-year-old shark was one of the largest of its time

UNIVERSITY OF VIENNA

 NEWS RELEASE 14-JAN-2021

Research News

 

IMAGE: TENTATIVE LIFE RECONSTRUCTION OF THE HYBODONTIFORM SHARK ASTERACANTHUS; FOR SCALE SEE SILHOUETTES AT THE RIGHT LOWER CORNER view more 

CREDIT: © SEBASTIAN STUMPF/FABRIZIO DE ROSSI

In a new study, an international research team led by Sebastian Stumpf from the University of Vienna describes an exceptionally well-preserved skeleton of the ancient shark Asteracanthus. This extremely rare fossil find comes from the famous Solnhofen limestones in Bavaria, which was formed in a tropical-subtropical lagoon landscape during the Late Jurassic, about 150 million years ago. The almost complete skeleton shows that Asteracanthus was two-and-a-half meters long in life, which makes this ancient shark one of the largest of its time. The study is published in the journal Papers in Palaeontology.

Cartilaginous fishes, which include sharks and rays, are one of the most successful vertebrate groups still alive today. Due to their life-long tooth replacement, teeth of cartilaginous fishes are among the most common fossil vertebrate finds. However, the low preservation potential of their cartilaginous skeletons prevents fossilization of completely preserved specimens in most cases. The extremely rare preservation of fossil cartilaginous fish skeletons is therefore linked to special conditions during fossilization and restricted to a few fossil-bearing localities only.

The Solnhofen limestones in Bavaria, Germany, which were formed during the Late Jurassic, about 150 million years ago, is such a rare occurrence. They are world-renowned for having produced skeletons of the small feathered dinosaur Archaeopteryx and have yielded numerous shark and ray skeletons, recovered during excavations over the past 150 years. A new study published in the journal Papers in Palaeontology and led by the paleontologist Sebastian Stumpf from the University of Vienna presents the largest fossil shark skeleton that has ever been discovered in the Solnhofen limestones. The specimen is represented by an almost completely preserved skeleton of the extinct hybodontiform shark Asteracanthus, the total length of which was two-and-a-half meters in life, which made it a giant among Jurassic sharks.

Hybodontiform sharks, which are the closest relatives of modern sharks and rays, first appeared during the latest Devonian, about 361 million years ago, and went extinct together with dinosaurs at the end of the Cretaceous, about 66 million years ago. They had two dorsal fins, each supported by a prominent fin spine. The body size of hybodontiform sharks ranged from a few centimeters to approximately three meters in maximum length, which consequently makes Asteracanthus one of the largest representatives of both its group and its time. In contrast, modern sharks and rays, which were already diverse during the Jurassic, only reached a body size of up to two meters in maximum length in very rare cases.

Asteracanthus was scientifically described more than 180 years ago by the Swiss-American naturalist Louis Agassiz on the basis of isolated fossil dorsal fin spines. However, articulated skeletal remains have never been found - until now. The dentition of the skeleton is exceptionally well-preserved and contains more than 150 teeth, each with a well-developed central cusp that is accompanied on both sides by several smaller cusplets. "This specialized type of dentition suggests that Asteracanthus was an active predator feeding on a wide range of prey animals. Asteracanthus was certainly not only one of the largest cartilaginous fishes of its time, but also one of the most impressive." says Sebastian Stumpf.

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Publication in Papers in Palaeontology: Stumpf, S., López-Romero, F.A., Kindlimann, R., Lacombat, F., Pohl, B. & Kriwet, J. 2020. A unique hybodontiform skeleton provides novel insights into Mesozoic chondrichthyan life. Papers in Palaeontology.

DOI: https://doi.org/10.1002/spp2.1350

How aerosols are formed

ETH ZURICH

Research News

 

IMAGE: THE EXPERIMENTAL SETUP IN AN ETH ZURICH LABORATORY. view more 

CREDIT: ETH ZURICH / RUTH SIGNORELL

Aerosols are suspensions of fine solid particles or liquid droplets in a gas. Clouds, for example, are aerosols because they consist of water droplets dispersed in the air. Such droplets are produced in a two-step process: first, a condensation nucleus forms, and then volatile molecules condense onto this nucleus, producing a droplet. Nuclei frequently consist of molecules different to those that condense onto them. In the case of clouds, the nuclei often contain sulphuric acids and organic substances. Water vapour from the atmosphere subsequently condenses onto these nuclei.

Scientists led by Ruth Signorell, Professor at the Department of Chemistry and Applied Biosciences, have now gained new insights into the first step of aerosol formation, nucleation. "Observations have shown that the volatile components can also influence the nucleation process," Signorell says, "but what was unclear was how this was happening at the molecular level." Previously it was impossible to observe the volatile components during nucleation in an experimental setting. Even in a famous CERN experiment on cloud formation, the "Cloud" experiment, certain volatile components could not be directly detected.

Volatile components detected for the first time

The ETH researchers developed an experiment aimed at the first microseconds of the nucleation process. In the experiment, the particles formed remain intact during this time and can be detected using mass spectrometry. The scientists looked at nucleation in various gas mixtures containing CO2 and for the first time, they were able to detect the volatile components as well - in this case, the CO2. The researchers could show that the volatile components were essential for the formation of nuclei and also accelerated this process.

An analysis of the experimental data revealed that this acceleration is the result of the volatile components catalysing the nucleation of other, less volatile components. They do this by forming short-lived, heterogeneous molecular aggregates, known as chaperon complexes. "Because temperature determines the volatility of gas components, it also plays a decisive role in these processes," Signorell explains.

One reason the new research results are interesting is that they improve the understanding of nucleation, its molecular mechanisms and speed, in order to properly account for it in models for, say, cloud formation in the atmosphere. In addition, the results should help to improve the efficiency of technical processes for producing aerosols - such as the use of rapid cooling to capture CO2 from natural gas.

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Reference
Li C, Krohn J, Lippe M, Signorell R: How volatile components catalyze vapor nucleation, Science Advances, 13 January 2021, doi: 10.1126/sciadv.abd9954