It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Thursday, April 22, 2021
Ground and satellite observations map building damage after Beirut explosion
Days after the 4 August 2020 massive explosion at the port of Beirut in Lebanon, researchers were on the ground mapping the impacts of the explosion in the port and surrounding city.
The goal was to document and preserve data on structural and façade damage before rebuilding, said University of California, Los Angeles civil and environmental engineer Jonathan Stewart, who spoke about the effort at the Seismological Society of America (SSA)'s 2021 Annual Meeting.
The effort also provided an opportunity to compare NASA Jet Propulsion Laboratory satellite surveys of the blast effects with data collected from the ground surveys. Stewart and his colleagues concluded that satellite-based Damage Proxy Maps were effective at identifying severely damaged buildings and undamaged buildings, but were less effective for assessing intermediate levels of structural or façade damage.
"The main take away is that the Damage Proxy Maps can definitely distinguish severe damage from lack of damage" for both structural and façade assessments, Stewart said, "but they are not as good at finer tuning."
"If what you're interested in is a fairly detailed picture of what has happened, it's not able to replace a person who actually knows what they're doing looking at the structure, particularly from the inside," he added.
The reconnaissance of the Beirut blast was organized through the National Science Foundation-sponsored Geotechnical Extreme Events Reconnaissance Association (GEER). In addition to Stewart and his colleagues at the American University of Beirut, the team included members from the University of Illinois and the University of Calabria in Italy. The information analyzed by the GEER team can help engineers learn more about how to build safely against similarly destructive events, including earthquakes, in the future.
Their findings, detailed in a GEER report, also "make some recommendations about how you can optimize human resources when doing these inspections," Stewart said.
On that August day, a fire at the port detonated an estimated 2.75 kilotons TNT equivalent of ammonium nitrate and fuel, an event about the size of a magnitude 3.3 earthquake. Within days, engineers at the American University of Beirut "had set up a hotline where people could call in who were concerned with the stability of damaged structures," Stewart said.
Professors and students made visits to inspect and assess the stability of these structures and others, but the in-person visits were scaled back in September due to COVID-19. After that, the researchers depended on street view surveys, using GoPro 360-degree cameras mounted on cars driven around the city.
The damage was ranked using scales adapted from those used for post-earthquake events, said Stewart. For instance, structural damage was ranked on a scale that began with minor damage to non-load bearing elements up to the complete collapse of a structure. Façade damage was ranked using a scale that begins with cracked windows and extends to complete blowout of windows and doors.
The spatial patterns of damage from an explosion differ from those seen in an earthquake. Site conditions such as underlying soil matter much more when it comes to the structural impact of an earthquake, while explosion damage depends "on how much are you feeling that blast," Stewart explained. "With an explosion, the damage decreases with distance and with the number of buildings between you and the blast that can deflect its effects."
Stewart isn't an expert in explosion seismology, but he has experience in assessing structural damage after earthquakes from his work in post-earthquake zones with GEER. He reached out to a colleague at the American University in Beirut after the disaster to offer his help in collecting observations that could be useful to future researchers and engineers.
"We felt that it was important to gather perishable data that we anticipate will be useful to people who study blast effects in an urban setting, and to learn something from this disaster to improve our resilience to future such disasters," he said.
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Stress test finds cracks in the resistance of harmful hospital bugs
IMAGE: THE OPPORTUNISTIC HUMAN PATHOGEN PSEUDOMONAS AERUGINOSA view more
CREDIT: JOHN INNES CENTRE
Research has identified critical factors that enable dangerous bacteria to spread disease by surviving on surfaces in hospitals and kitchens.
The study into the mechanisms which enable the opportunistic human pathogen Pseudomonas aeruginosa to survive on surfaces, could lead to new ways of targeting harmful bacteria.
To survive outside their host, pathogenic bacteria must withstand various environmental stresses. One mechanism is the sugar molecule, trehalose, which is associated with a range of external stresses, particularly osmotic shock - sudden changes to the salt concentration surrounding cells.
Researchers at the John Innes Centre analysed how trehalose is metabolised by P. aeruginosa to define its role in protection against external stresses.
Combining analytical biochemistry and reverse genetics - using mutated bacteria lacking key functions - they show that trehalose metabolism in P. aeruginosa is connected to biosynthesis of the carbon storage molecule glycogen.
Experiments showed that disruption of either trehalose or glycogen pathways significantly reduced the ability of P. aeruginosa to survive on man-made surfaces such as kitchen or hospital counters.
The study found that while both trehalose and glycogen are important for stress tolerance in P. aeruginosa they counter distinct stresses: trehalose helps the bacteria to survive in conditions of elevated salt; glycogen contributes to survival in dry (desiccated) environments.
The findings raise the possibility of targeting the trehalose and glycogen pathways to limit pathogen survival on man-made surfaces.
"We have shown how a dangerous human pathogen Pseudomonas aeruginosa responds to environmental challenges, such as salt stress or drying out. Disrupting the production of certain stress-tolerance sugars in this bug significantly reduces its ability to survive on kitchen and hospital worksurfaces," said corresponding author of the study Dr Jacob Malone.
An unexpected finding was how the bacteria operates different pathways for different stresses, said Dr Malone: "Conventional wisdom says that trehalose was responsible for both phenotypes, but we have shown that trehalose only protects against osmo-stress and glycogen is needed to protect against desiccation. We were also surprised to see such a marked drop in surface survival when we disrupted the pathways in the bugs."
The next step for the research is to understand how trehalose and glycogen metabolic pathways are regulated in P. aeruginosa and closely related species. The group also wants to understand how glycogen accumulation allows the bacteria to survive in dry environments and provide more explanation of how and when different parts of the pathways are turned on and off.
P. aeruginosa is a significant pathogen in animals as well as humans. In humans it primarily affects immunocompromised individuals, where it is a major cause of pneumonia and hospital-acquired infections. Chronic P. aeruginosa infections occur in 80% of adult cystic fibrosis patients, where it is the primary cause of morbidity and mortality.
This research was funded by UK Research and Innovation | Biotechnology and Biological Sciences Research Council (BBSRC) Institute Strategic Program Grants BB/J004553/1 (Biotic Interactions) and BBS/E/J/000PR9797 (Plant Health) to the John Innes Centre and by two BBSRC DTP PhD studentships. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Researchers identify predictive factors of delirium in Sub-Saharan Africa
IMAGE: DOUGLAS HEIMBURGER, MD, MS, PROFESSOR OF MEDICINE AND CORE FACULTY AT THE VANDERBILT INSTITUTE FOR GLOBAL HEALTH. view more
CREDIT: VANDERBILT UNIVERSITY MEDICAL CENTER
Severity of illness, history of stroke, and being divorced or widowed were independently predictive of delirium in hospitalized patients in Zambia, according to a study published in PLOS ONE.
A collaborative team of researchers from Vanderbilt University Medical Center and the University of Zambia Teaching Hospital published the risk factors as a follow-up look at the prevalence and impact of delirium, a form of acute brain dysfunction, in lower-resourced hospitals. Findings published in February showed delirium is widespread in patients admitted to the University Teaching Hospital, and the duration of delirium predicted both mortality and disability at six months after discharge.
The studies represent novel research in lower-resourced hospitals, and the findings highlight the breadth of a serious health problem that has existed off the radar, said Kondwelani Mateyo, MBChB, MMed, the hospital's chief pulmonary and critical care physician.
The next step is to explore interventional therapies while raising awareness about the prevalence and risks of delirium -- especially given that nearly 50% of people had delirium upon admission to the hospital. In the U.S., for instance, delirium more often develops in patients after admission and while in the ICU.
"We have to start the conversation, and you can't do that with the absence of data or evidence. We are making people aware that delirium is here and it's a widespread problem that has, up to this point, not been quantified. With these data we're able to see it's in our city, and we think this is representative of hospitals in the country and our region. Delirium is a factor in mortality and cognitive impairment," said Mateyo.
The findings on risk factors coupled with the recent data on delirium prevalence is a critical step toward finding ways to screen for and treat patients at high risk for delirium in order to drive improvements in long-term survival and functional status, said Justin Banerdt, MD, MPH, internal medicine resident at Yale School of Medicine, and corresponding author who led the study on the ground in Zambia while an MD/MPH student at Vanderbilt University School of Medicine. For example, findings from the study suggest that widespread use of validated severity of illness scores may allow health care providers in low-income countries to triage patients at high risk of delirium for further assessment and care.
"One of the striking findings in our study is that nearly 50% of patients in this acutely ill non-ICU population had delirium at admission. Not only was severity of illness at admission a powerful, independent predictor of delirium, but there was also a substantial burden of critical illness at hospital presentation, suggesting that severe illness is a significant contributor to the high prevalence of delirium seen in this cohort. This speaks to how in the future we must endeavor to understand what is putting these patients at risk in the community before they even arrive at the hospital so that delirium-- and critical illness more generally-- can be identified earlier and managed more effectively across all levels of the health care system. This is an opportunity to look beyond the walls of the hospital to address inequities in a poor and very vulnerable population through health system strengthening and critical care capacity-building in Zambia," said Banerdt.
Delirium is an independent predictor of long-term mortality as well as cognitive and functional disability. Health care costs attributable to delirium have been estimated to range from $143 billion to $152 billion annually in the U.S.
"Dr. Mateyo is a path-breaker in Zambia and a huge advocate for his patients. Our team's results show that health systems need to be expanded and broadened. Since we found that people are coming to the hospital with delirium, we need to find ways to develop a higher consciousness in communities about what delirium is. Dr. Mateyo's expertise and leadership, and that of his colleagues at the University of Zambia and the Zambia Ministry of Health, will be key in showing the global public health community how to positively impact the lives of patients," said Douglas Heimburger, MD, MS, professor of Medicine and core faculty at the Vanderbilt Institute for Global Health. Heimburger leads projects with grant funding from the Fogarty International Center of the National Institutes of Health (NIH).
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RACIST HEALTHCARE USA
Blacks, Hispanics, impoverished have worse survival rates among teens, adults under 40 with cancer
DALLAS - April 22, 2021 - Being Black or Hispanic, living in high-poverty neighborhoods, and having Medicaid or no insurance coverage are associated with higher mortality in men and women under 40 with cancer, a review by UT Southwestern Medical Center researchers found.
"Survival is not different because of biology. It's not different because of patient-level factors," says Caitlin Murphy, Ph.D., lead author of the study and an assistant professor of population and data sciences and internal medicine at UT Southwestern. "No matter which way we looked at the data, we still saw consistent and alarming differences in survival by race - and these are teens and young adults."
Other findings based on an analysis of Texas Cancer Registry data from 1995 to 2016 showed:
- Black men with non-Hodgkin lymphoma had a 57 percent survival rate compared with 75 percent for white men.
- The survival rate for Black patients with testicular cancer was 88.7 percent, compared with 96.6 percent for white patients. Survival decreased as poverty increased for these highly treatable cancers among all race and ethnic groups.
- Men with private insurance had survival rates 20 percent higher for testicular, colorectal, and kidney cancer, and non-Hodgkin lymphoma than for men with no insurance or with Medicaid.
"By far the strongest predictor or association was race. In particular, the Black race was consistently associated with lower survival, even if patients are not poor and have insurance," Murphy says.
The study, published in the Journal of the National Cancer Institute, included 55,000 female and more than 32,000 male cancer patients ages 15 to 39, a population in which few studies have been conducted as the average age of most cancer patients is 66. The Texas Cancer Registry, established in 1995 by the Texas Department of State Health Services, is one of the largest cancer registries in the United States.
Senior author Sandi Pruitt, Ph.D., associate professor of population and data sciences, says the numbers show a need for greater investments in health care coverage and neighborhood revitalization.
"Where Black teens and young adults are with cancer survival today is worse than it was for white kids about 10 years ago. It's unreal," Pruitt says. "I think it is underappreciated how much the conditions in which we are born and live impact our health, and, in this case, the health of a very special and underserved population - teens and young adults with cancer. Persistent poverty and racism, combined with the low rate of health insurance which is common in Texas, are part of the context that leads to the worse survival for certain population groups we've observed in this study."
The authors call for future research and interventions to address the disparities, including better health insurance coverage, greater inclusion of teens and young adults in clinical trials, more collection of biospecimens from underserved teens and young adults, programs and policies designed to be anti-racist, and additional studies comparing risk factors, treatment, and outcomes.
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This study was supported by the U.S. Department of Defense (award number CA181215).
About UT Southwestern Medical Center
UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution's faculty has received six Nobel Prizes, and includes 23 members of the National Academy of Sciences, 17 members of the National Academy of Medicine, and 13 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,800 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in about 80 specialties to more than 105,000 hospitalized patients, nearly 370,000 emergency room cases, and oversee approximately 3 million outpatient visits a year.
MERS DNA vaccine induces immunity,protects from virus challenge in preclinical model
Dose-sparing regimens and intradermal delivery have important implication for rapid clinical development of effective, well-tolerated and easy-to-distribute vaccines against MERS and other emerging coronaviruses.
IMAGE: WISTAR DRS. DAVID WEINER AND AMI PATEL view more
CREDIT: THE WISTAR INSTITUTE
PHILADELPHIA -- (April 22, 2021) -- A synthetic DNA vaccine candidate for Middle East respiratory syndrome coronavirus (MERS-CoV) developed at The Wistar Institute induced potent immune responses and afforded protective efficacy in non-human primate (NHP) models when given intradermally in abbreviated, low-dose immunization regimen. A similar vaccine candidate was previously shown to be safe and tolerable with a three-dose intramuscular injection regimen in a recently completed human phase 1 study and is currently in expanded studies of phase 1/2a trial.
New results were published today in JCI Insight.
"While several vaccine products are being advanced against MERS and other coronaviruses, low-dose delivery and shortened regimes are crucial to rapidly induce protective immunity, particularly during emerging outbreaks, as the current SARS-CoV-2 pandemic has emphasized," said David B. Weiner, Ph.D., Wistar executive vice president, director of the Vaccine & Immunotherapy Center (VIC) and W.W. Smith Charitable Trust Professor in Cancer Research, who led the study.
Researchers evaluated the immunogenicity and protective efficacy of their MERS synthetic vaccine when delivered intradermally using a shortened two-dose immunization schedule compared with intramuscular delivery of higher doses in NHP.
"Given that human efficacy trials for MERS vaccines may be challenging due to the low number of yearly cases, animal models such as our NHP model are valuable as a bridge with human data coming from early-phase clinical trials," said Weiner.
In this study, Weiner and team report robust antibody neutralizing antibodies and cellular immune responses in all conditions tested. A rigorous virus challenge experiment showed that all vaccination groups were protected against MERS-CoV compared to unvaccinated control animals. However, the low-dose regimen with intradermal delivery was more impactful in controlling disease and symptoms than the higher dose delivered intramuscularly in NHP models.
"To our knowledge, this is the first demonstration of protection with an intradermally delivered coronavirus vaccine," said Ami Patel, Ph.D., Caspar Wistar Fellow at the Vaccine & Immunotherapy Center and one of the lead authors of the paper. "Intradermal delivery of synthetic DNA vaccines has significant advantages for rapid clinical development. It can be dose sparing and has higher tolerability in people compared with intramuscular injection. The positive results of this study are important not only for the advancement of this MERS vaccine but also for development of other vaccines."
"Our team is also advancing a COVID-19 vaccine through clinical trials, and we were able to do so in a very short time thanks to our previous experience developing the MERS vaccine," added Weiner.
Importantly, no evidence of adverse effects on the lungs was observed in any of the dosing groups compared to unimmunized control animals. Through the assessment of a large panel of blood cytokines, researchers showed significant decrease in all mediators of inflammation, which further suggests the vaccine prevents the destructive inflammation induced by coronaviruses.
"In the past twenty years, three new coronaviruses have emerged and caused human outbreaks. The current SARS-CoV-2 pandemic has further emphasized the importance of rapid infection control for coronaviruses and other emerging infectious diseases," said Emma L. Reuschel, Ph.D., a staff scientist in the Weiner lab and co-first author on the study. "Vaccine candidates that are simple to deliver, well tolerated, and can be readily deployed in resource-limited settings will be important to achieve control of infection."
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Co-authors: Ziyang Xu, Faraz I. Zaidi, Kevin Y. Kim, Regina Stoltz, and Kar Muthumani from The Wistar Institute; Dana P. Scott, Friederike Feldmann, Tina Thomas, Rebecca Rosenke, Dan Long, Jamie Lovaglio, Patrick W. Hanley, and Greg Saturday from National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, MT; Janess Mendoza, Stephanie Ramos, Laurent Humeau, and Kate E. Broderick from INOVIO Pharmaceuticals, Inc.
Work supported by: Funding from the Intramural Research Program, National Institutes of Allergy and Infectious Diseases, and the Coalition for Epidemic Preparedness Innovations (CEPI).
Publication information: Intradermal delivery of a synthetic DNA vaccine protects macaques from Middle East respiratory syndrome coronavirus, JCI Insight (2021). Online publication.
The Wistar Institute is an international leader in biomedical research with special expertise in cancer research and vaccine development. Founded in 1892 as the first independent nonprofit biomedical research institute in the United States, Wistar has held the prestigious Cancer Center designation from the National Cancer Institute since 1972. The Institute works actively to ensure that research advances move from the laboratory to the clinic as quickly as possible. wistar.org
Among COVID-19 survivors, an increased risk of death, serious illness
Major study details numerous long-term effects of COVID-19, pointing to massive health burden
IMAGE: A NEW STUDY FROM WASHINGTON UNIVERSITY SCHOOL OF MEDICINE IN ST. LOUIS SHOWS THAT EVEN MILD CASES OF COVID-19 INCREASE THE RISK OF DEATH IN THE SIX MONTHS FOLLOWING DIAGNOSIS... view more
CREDIT: SARA MOSER
As the COVID-19 pandemic has progressed, it has become clear that many survivors -- even those who had mild cases -- continue to manage a variety of health problems long after the initial infection should have resolved. In what is believed to be the largest comprehensive study of long COVID-19 to date, researchers at Washington University School of Medicine in St. Louis showed that COVID-19 survivors -- including those not sick enough to be hospitalized -- have an increased risk of death in the six months following diagnosis with the virus.
The researchers also have catalogued the numerous diseases associated with COVID-19, providing a big-picture overview of the long-term complications of COVID-19 and revealing the massive burden this disease is likely to place on the world's population in the coming years.
The study, involving more than 87,000 COVID-19 patients and nearly 5 million control patients in a federal database, appears online April 22 in the journal Nature.
"Our study demonstrates that up to six months after diagnosis, the risk of death following even a mild case of COVID-19 is not trivial and increases with disease severity," said senior author Ziyad Al-Aly, MD, an assistant professor of medicine. "It is not an exaggeration to say that long COVID-19 -- the long-term health consequences of COVID-19 -- is America's next big health crisis. Given that more than 30 million Americans have been infected with this virus, and given that the burden of long COVID-19 is substantial, the lingering effects of this disease will reverberate for many years and even decades. Physicians must be vigilant in evaluating people who have had COVID-19. These patients will need integrated, multidisciplinary care."
In the new study, the researchers were able to calculate the potential scale of the problems first glimpsed from anecdotal accounts and smaller studies that hinted at the wide-ranging side effects of surviving COVID-19, from breathing problems and irregular heart rhythms to mental health issues and hair loss.
"This study differs from others that have looked at long COVID-19 because, rather than focusing on just the neurologic or cardiovascular complications, for example, we took a broad view and used the vast databases of the Veterans Health Administration (VHA) to comprehensively catalog all diseases that may be attributable to COVID-19," said Al-Aly, also director of the Clinical Epidemiology Center and chief of the Research and Education Service at the Veterans Affairs St. Louis Health Care System.
The investigators showed that, after surviving the initial infection (beyond the first 30 days of illness), COVID-19 survivors had an almost 60% increased risk of death over the following six months compared with the general population. At the six-month mark, excess deaths among all COVID-19 survivors were estimated at eight people per 1,000 patients. Among patients who were ill enough to be hospitalized with COVID-19 and who survived beyond the first 30 days of illness, there were 29 excess deaths per 1,000 patients over the following six months.
"These later deaths due to long-term complications of the infection are not necessarily recorded as deaths due to COVID-19," Al-Aly said. "As far as total pandemic death toll, these numbers suggest that the deaths we're counting due to the immediate viral infection are only the tip of the iceberg."
The researchers analyzed data from the national health-care databases of the U.S. Department of Veterans Affairs. The dataset included 73,435 VHA patients with confirmed COVID-19 but who were not hospitalized and, for comparison, almost 5 million VHA patients who did not have a COVID-19 diagnosis and were not hospitalized during this time frame. The veterans in the study were primarily men (almost 88%), but the large sample size meant that the study still included 8,880 women with confirmed cases.
To help understand the long-term effects of more severe COVID-19, the researchers harnessed VHA data to conduct a separate analysis of 13,654 patients hospitalized with COVID-19 compared with 13,997 patients hospitalized with seasonal flu. All patients survived at least 30 days after hospital admission, and the analysis included six months of follow-up data.
CAPTION
A new study from Washington University School of Medicine in St. Louis shows that even mild cases of COVID-19 increase the risk of death in the six months following diagnosis and that this risk increases with disease severity. The comprehensive study also catalogues the wide-ranging and long-term health problems often triggered by the infection, even among those not hospitalized.
CREDIT
Sara Moser
The researchers confirmed that, despite being initially a respiratory virus, long COVID-19 can affect nearly every organ system in the body. Evaluating 379 diagnoses of diseases possibly related to COVID-19, 380 classes of medications prescribed and 62 laboratory tests administered, the researchers identified newly diagnosed major health issues that persisted in COVID-19 patients over at least six months and that affected nearly every organ and regulatory system in the body, including:
Respiratory system: persistent cough, shortness of breath and low oxygen levels in the blood.
Nervous system: stroke, headaches, memory problems and problems with senses of taste and smell.
Mental health: anxiety, depression, sleep problems and substance abuse.
Metabolism: new onset of diabetes, obesity and high cholesterol.
Gastrointestinal system: constipation, diarrhea and acid reflux.
Kidney: acute kidney injury and chronic kidney disease that can, in severe cases, require dialysis.
Coagulation regulation: blood clots in the legs and lungs.
Skin: rash and hair loss.
Musculoskeletal system: joint pain and muscle weakness.
General health: malaise, fatigue and anemia.
While no survivor suffered from all of these problems, many developed a cluster of several issues that have a significant impact on health and quality of life.
Among hospitalized patients, those who had COVID-19 fared considerably worse than those who had influenza, according to the analysis. COVID-19 survivors had a 50% increased risk of death compared with flu survivors, with about 29 excess deaths per 1,000 patients at six months. Survivors of COVID-19 also had a substantially higher risk of long-term medical problems.
"Compared with flu, COVID-19 showed remarkably higher burden of disease, both in the magnitude of risk and the breadth of organ system involvement," Al-Aly said. "Long COVID-19 is more than a typical postviral syndrome. The size of the risk of disease and death and the extent of organ system involvement is far higher than what we see with other respiratory viruses, such as influenza."
In addition, the researchers found that the health risks from surviving COVID-19 increased with the severity of disease, with hospitalized patients who required intensive care being at highest risk of long COVID-19 complications and death.
"Some of these problems may improve with time -- for example, shortness of breath and cough may get better -- and some problems may get worse," Al-Aly added. "We will continue following these patients to help us understand the ongoing impacts of the virus beyond the first six months after infection. We're only a little over a year into this pandemic, so there may be consequences of long COVID-19 that are not yet visible."
In future analyses of these same datasets, Al-Aly and his colleagues also plan to look at whether patients fared differently based on age, race and gender to gain a deeper understanding of the risk of death in people with long COVID-19.
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This work was supported by the U.S. Department of Veterans Affairs, the Institute for Public Health at Washington University and two American Society of Nephrology and Kidney Cure Fellowship Awards.
Al-Aly Z, Xie Y, Bowe B. High dimensional characterization of post-acute sequalae of COVID-19. Nature. April 22, 2021. DOI: 10.1038/s41586-021-03553-9.
Washington University School of Medicine's 1,500 faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children's hospitals. The School of Medicine is a leader in medical research, teaching and patient care, consistently ranking among the top medical schools in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children's hospitals, the School of Medicine is linked to BJC HealthCare.
During pandemic's first 9 months, depression and anxiety increased sharply among Americans
Surveys of 1.5 million Americans reveal reports of anxiety and depression rose sharply in 2020, Boston College researchers find
Chestnut Hill, Mass. (4/22/2021) - Confirming anecdotal evidence that the spread of the coronavirus has strained Americans' mental health, Boston College researchers found reports of anxiety increased to 50 percent and depression to 44 percent by November, 2020 - rates six times higher than 2019 - according to a new report in the journal Translational Behavioral Medicine.
Among U.S. adults aged 18-29, the impact on mental health was even more severe. Rates of anxiety and depression increased to 65 percent and 61 percent, respectively, of the respondents in that age group, according to the report.
Use of prescription medication, counseling services, and unmet need for mental health services also rose significantly, according to the co-authors of the new study, Boston College developmental psychologist Rebekah Levine Coley and economist Christopher F. Baum, who reviewed survey data from nearly 1.5 million U.S. adults.
Rates of mental health disorders were highest among young, less-educated, single parent, female, Black and Hispanic respondents, Coley and Baum report. Disparities between young versus older and less educated versus more educated adults rose over time. Young, female, and moderately educated respondents also reported higher unmet needs for services.
"Disparities in estimates of mental health disorders and mental health treatment indicate a striking disequilibrium between the potential need for and the use of mental health services during the COVID-19 pandemic," said Coley, a professor in the Lynch School of Education and Human Development. "Rising mental health challenges are being borne largely by young, less advantaged people of color, and women, with the potential for expanded interruptions to optimal functioning and societal recovery from COVID-19."
Despite extensive anecdotal evidence of rising mental health challenges posed by the pandemic, little prior evidence had systematically assessed rates of mental health disorders or use of mental health symptoms through the course of the COVID-19 pandemic, said Coley.
"We discerned a need to track rates of depression and anxiety, as well as rates of use of mental health services and reports of unmet need for such services between April and November, 2020," she said. "We also sought to assess whether the rates of mental health disorders and service use varied across key demographic groups in the U.S."
The researchers analyzed data gathered between April and November 2020 as part of the U.S. Census' Household Pulse Survey, a series of cross-sectional surveys conducted weekly. Survey respondents self-reported their symptoms of anxiety and depression, use of medication, use of counseling services, and unmet need for services. Coley and Baum analyzed these surveys to track trends in mental health disorder symptoms and access to and use of mental health services.
While the researchers expected to see increases in the rates of depression and anxiety, they were surprised by the magnitude of the increases, Coley said.
"The fact that prevalence rates were six times higher than national norms from 2019 was striking, as was the fact that these increases were born primarily by younger adults, aged 18-29 years, whose rates of anxiety and depression were nearly twice as high as those of older adults, aged 70 and above," Coley said.
The analysis reveals a need for continued study of the pandemic's impact on mental health.
The findings suggest the need for increased access to mental health services and other supports to help adults face the economic, social, and psychological stressors of the COVID-19 pandemic, Coley said. There is also a need to assess whether rising mental health challenges continue to grow as the pandemic rages on, and to delineate the longer-term effects of the social, economic, and psychological disruptions caused by COVID-19. For young adults particularly, the pandemic may have interrupted higher education plans and the initiation of careers and social and financial independence, with unknown long-term repercussions.
"The myriad stressors imposed by the COVID-19 pandemic have impaired mental health and well-being," said Baum, who also holds an appointment at BC's School of Social Work. "Although evidence from early in the pandemic revealed elevated rates of mental health conditions, research had not documented whether psychological disorders have continued to rise as the pandemic has persisted, or for whom they have risen most dramatically."
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Why blasphemy is a capital offence in some Muslim countries
Execution for a Facebook post?
The Prophet Muhammad never executed anyone for apostasy, nor encouraged his followers to do so. Nor is criminalising sacrilege based on Islam’s main sacred text, the Koran. In this essay, Ahmet Kuru exposes the political motivations for criminalising blasphemy and apostasy.
Half of the world’s 49 Muslim-majority countries have additional laws banning apostasy, meaning people may be punished for leaving Islam. All countries with apostasy laws are Muslim-majority except India. Apostasy is often charged alongside blasphemy.
\Junaid Hafeez, a university lecturer in Pakistan, had been imprisoned for six years when he was sentenced to death in December 2019. The charge: blasphemy, specifically insulting Prophet Muhammad on Facebook.
According to the U.S. Commission on International Religious Freedom, Pakistan has the world’s second strictest blasphemy laws after Iran. Hafeez, whose death sentence is under appeal, is one of about 1,500 Pakistanis charged with blasphemy, or sacrilegious speech, over the last three decades. No executions have taken place.
Since 1990, however, 70 people have been murdered by mobs and vigilantes who accused them of insulting Islam. Several people who defended the accused have also been killed, including one of Hafeez’s lawyers and two high-level politicians who publicly opposed the death sentence of Asia Bibi, a Christian woman convicted for verbally insulting Prophet Muhammad. Though Bibi was acquitted in 2019, she fled Pakistan.
Blasphemy and apostasy
Of 71 countries that criminalise blasphemy, 32 are majority Muslim. Punishment and enforcement of these laws varies. In Iran, Pakistan, Afghanistan, Brunei, Mauritania and Saudi Arabia, blasphemy is punishable by death. Among non-Muslim-majority cases, the harshest blasphemy laws are in Italy, where the maximum penalty is three years in prison.
Junaid Hafeez was a lecturer in English literature at Bahauddin Zakariya University in Multan, Pakistan. Appointed in 2011, he soon found himself targeted by an Islamist student group who objected to what they considered Hafeez's "liberal" teaching. On 13 March, 2013 Hafeez was arrested – accused of using a fake Facebook profile to insult the Prophet Muhammad in a closed group called "So-Called Liberals of Pakistan". Imprisoned without trial for six years, much of that time spent in solitary confinement, the academic was finally sentenced to death in December 2019
This class of religious laws enjoys considerable popularity across the Islamic world. According to a 2013 Pew survey, about 75% of respondents in Southeast Asia, the Middle East and North Africa, and South Asia favour making Sharia, or Islamic law, the official law of the land.
Among those who support Sharia, around 25% in Southeast Asia, 50% in the Middle East and North Africa, and 75% in South Asia say they support "executing those who leave Islam" – that is, they support laws punishing apostasy with death.
The ulema and the state
My 2019 book Islam, Authoritarianism, and Underdevelopment traces the root of blasphemy and apostasy laws in the Muslim world back to a historic alliance between Islamic scholars and government.
Starting around the year 1050, certain Sunni scholars of law and theology, called the "ulema", began working closely with political rulers to challenge what they considered to be the sacrilegious influence of Muslim philosophers on society.
For three centuries, Muslim philosophers had been making major contributions to mathematics, physics and medicine. They developed the Arabic number system used across the West today and invented a forerunner of the modern camera.
A conspiracy against Sunni Islam? For three centuries, Muslim philosophers had been making major contributions to mathematics, physics and medicine, developing the Arabic number system used across the West today and inventing a forerunner of the modern camera. Yet the conservative ulema felt these philosophers were inappropriately influenced against Sunni beliefs by Greek philosophy and Shia Islam. Their views were reinforced by the brilliant and respected Islamic scholar al-Ghazali, who declared two long-dead leading Muslim philosophers, Farabi and Ibn Sina (a.k.a. Avicenna), apostates for their unorthodox views on God’s power and the nature of resurrection. Their followers, al-Ghazali wrote, could be punished with death
The conservative ulema felt that these philosophers were inappropriately influenced byGreek philosophyandShia Islamagainst Sunni beliefs. The most prominent in consolidating Sunni orthodoxy was the brilliant and respected Islamic scholaral-Ghazali, who died in the year 1111.
In several influential books still widely read today, al-Ghazali declared two long-dead leading Muslim philosophers, Farabi and Ibn Sina (a.k.a. Avicenna), apostates for their unorthodox views on God’s power and the nature of resurrection. Their followers, al-Ghazali wrote, could be punished with death.
As modern-day historians Omid Safi and Frank Griffel assert, al-Ghazali’s declaration provided justification to Muslim sultans from the 12th century onward who wished to persecute – even execute – thinkers seen as threats to conservative religious rule.
This “ulema-state alliance”, as I call it, began in the mid-11th century in Central Asia, Iran and Iraq and a century later spread to Syria, Egypt and North Africa. In these regimes, questioning religious orthodoxy and political authority wasn’t merely dissent – it was apostasy.
Wrong direction
Parts of Western Europe were ruled by a similar alliance between the Catholic Church and monarchs. These governments assaulted free thinking, too. During the Spanish Inquisition, between the 16th and 18th centuries, thousands of people were tortured and killed for apostasy.
Blasphemy laws were also in place, if infrequently used, in various European countries until recently. Denmark, Ireland and Malta all recently repealed their laws. But they persist in many parts of the Muslim world.
In Pakistan, the military dictator Zia ul Haq, who ruled the country from 1978 to 1988, is responsible for its harsh blasphemy laws. An ally of the ulema, Zia updated blasphemy laws – written by British colonisers to avoid interreligious conflict – to defend Sunni Islam specifically and increased the maximum punishment to death.
From the 1920s until Zia, these laws had been applied only about a dozen times. Since then they have become a powerful tool for crushing dissent. Some dozen Muslim countries have undergone a similar process over the past four decades, including Iran and Egypt.
Dissenting voices in Islam
The conservative ulema base their case for blasphemy and apostasy laws on a few reported sayings of Prophet Muhammad, known as hadith, primarily: "Whoever changes his religion, kill him."
But many Islamic scholars and Muslim intellectuals reject this view as radical. They argue that Prophet Muhammad never executed anyone for apostasy, nor encouraged his followers to do so.
Nor is criminalising sacrilege based on Islam’s main sacred text, the Koran. It contains over 100 verses encouraging peace, freedom of conscience and religious tolerance.
In chapter 2, verse 256, the Koran states, "There is no coercion in religion". Chapter 4, verse 140 urges Muslims to simply leave blasphemous conversations: "When you hear the verses of God being rejected and mocked, do not sit with them."
By using their political connections and historical authority to interpret Islam, however, the conservative ulema have marginalised more moderate voices.
Reaction to global Islamophobia
Debates about blasphemy and apostasy laws among Muslims are naturally influenced by international affairs. Across the globe, Muslim minorities – including the Palestinians, Chechens of Russia, Kashmiris of India, Rohingya of Myanmar and Uighurs of China – have experienced severe persecution. No other religion is so widely targeted in so many different countries.
Instead, I find, such harsh religious rules can contribute to anti-Muslim stereotypes. Some of my Turkish relatives even discourage my work on this topic, fearing it fuels Islamophobia. But my research shows that criminalising blasphemy and apostasy is more political than it is religious.
The Koran does not require punishing sacrilege: authoritarian politics do.
Ahmet T. Kuru is Porteous Professor of Political Science at San Diego State University, and FORIS scholar at Religious Freedom Institute. Author of "Secularism and State Policies toward Religion: The United States, France, and Turkey" and co-editor of "Democracy, Islam, and Secularism in Turkey", his works have been translated into Arabic, Bosnian, Chinese, French, Indonesian, and Turkish.
