ADD GUM DISEASE TO THE LIST OF RISK FACTORS FOR COVID 19
Keep flossing: A new study finds that gum disease may raise the chances of hospitalization or death if COVID-19 strikes.
The reason? Gum disease can be a sign of inflammation throughout the body.
“It is well-established that systemic inflammation is not only linked with periodontal disease, but to several other respiratory diseases as well,” explained Dr. James Wilson, president of the American Academy of Periodontology.
“Therefore, maintaining healthy teeth and gums in an effort to avoid developing or worsening periodontal disease is absolutely crucial in the midst of a global pandemic like COVID-19, which is also known to trigger an inflammatory response,” Wilson said in an academy news release.
In the study, researchers compared COVID-19 patients in Qatar who had severe complications — including assisted ventilation, admission to intensive care and death — and those without severe complications.
Of the 568 patients, those with periodontitis — the most severe form of gum disease — were at least three times more likely to have severe COVID-19 complications.
The researchers also found that COVID-19 patients with periodontitis had increased levels of biomarkers (including white blood cell levels, D-dimer, and C-reactive protein) associated with worse COVID-19 outcomes.
The study, by Nadya Marouf of the Oral Health Institute, Hamad Medical Corporation in Doha, Qatar, and colleagues was published online Feb. 1 in the Journal of Clinical Periodontology.
Systemic inflammation is a symptom of COVID-19, and can also be a symptom of gum disease, the researchers noted.
The findings show the importance of good oral care during the COVID-19 pandemic, according to the academy.
Gum disease can cause bleeding gums, bad breath and, if untreated, can lead to tooth loss. Up to half of U.S. adults aged 30 and older have some form of gum disease, according to the U.S. Centers for Disease Control and Prevention.
Previous research has linked gum disease to serious conditions such as diabetes, heart disease and Alzheimer’s disease.
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DR ANNE SULLIVAN – ONCOLOGIST
The U.S. National Institutes of Health explains how to prevent gum disease.
SOURCE: American Academy of Periodontology, news release, Feb. 3, 2021
Since last April, hospital emergency rooms across the United States have seen a sustained surge in visits related to the mental health of school-aged kids, a new report reveals.
The findings suggest the COVID-19 pandemic is taking a toll on children because of disruptions to their everyday life, anxiety about illness and social isolation. That conclusion comes from a U.S. Centers for Disease Control and Prevention review of data on hospitals in 47 states. Those hospitals account for nearly three-quarters of emergency department visits nationwide.
The study tracked emergency visits involving children under age 18 who sought care for a mental health issue between Jan. 1 and Oct. 17, 2020.
“Our study looked at a composite group of mental health concerns that included conditions that are likely to increase during and after a public health emergency, such as stress, anxiety, acute post-traumatic stress disorder and panic,” said lead author Rebecca Leeb, a health scientist at the CDC in Atlanta who is part of its COVID-19 Response Team.
“We found that from March through October, the proportion of mental health-related emergency department visits increased 24% for children aged 5 to 11, and 31% among teenagers aged 12 to 17 years, compared to 2019,” Leeb said.
Pediatric mental health visits actually dropped off dramatically from mid-March to mid-April, when stay-at-home orders were in effect in much of the country. Since then, however, such visits have steadily increased, according to the report.
But Leeb said interpreting the numbers is not straightforward.
On the one hand, she said even the large jumps seen in the report likely underestimate the total number of pediatric mental health emergencies. “Many mental health care encounters occur outside of emergency departments,” Leeb explained.
But additional research indicates emergency department visits as a whole dropped significantly between January and October. And that, Leeb said, might mean that “the relative proportion of emergency department visits for children’s mental health-related concerns may be inflated.”
Regardless, Leeb said the findings show that many kids’ mental health was sufficiently concerning to prompt ER visits at a time when the public was being discouraged from using emergency departments for anything but the most critical care.
As such, the findings “highlight the importance of continuing to monitor children’s mental health during the pandemic to ensure access to mental health services during public health crises,” Leeb said.
The study did not set out to identify specific reasons for emergency visits and Leeb said figuring that out requires more study.
But past research shows that the lost sense of safety and disruption to daily living that often accompanies disasters is a common trigger for stress. And that stress, in turn, can lead to isolation and trigger mental health emergencies, Leeb said.
This is not surprising, according to psychologist Lynn Bufka, senior director for practice, research and policy at the American Psychological Association.
“These are stressful times for many and stress can exacerbate mental health concerns,” Bufka noted. “Previous research indicates that a portion of children do have adverse outcomes from traumatic events, and this pandemic is no different.”
Bufka pointed to the wholesale uprooting of kids’ routines and structure, both in terms of school and socializing.
“Children’s play is one way children explore and understand their world, so not being able to play with friends gives them fewer outlets for fun, but also just fewer general opportunities to cope and explore,” she explained.
Kids may also pick up on parents’ stress, which can magnify their own fears.
“All of this has an impact on children and how they understand their world and interpret the events around them,” Bufka said. Some kids adapt more easily; others will struggle. For youngsters with existing mental health problems, the current stresses will add to them.
But parents and other adults can do a lot to support kids and help those who are struggling.
On that front, Leeb advised parents to foster a supportive environment and learn about behavior that signals kids are under mounting stress. The CDC has a number of helpful resources, she said, including an online primer on talking with your child about the coronavirus.
Leeb and her colleagues published their findings in the Nov. 13 issue of the CDC’s Morbidity and Mortality Weekly Report.
Patients who survive severe Covid 19 after being hospitalized are not necessarily home-free upon discharge, new research warns.
After tracking outcomes among 1,250 Covid 19 patients for two months after being released from the hospital, investigators found that nearly 7% ultimately died in the weeks following their release, while 15% ended up being readmitted to the hospital. Many others said they continued to struggle with symptoms and were unable to resume their usual lifestyle or return to work.
“COVID is not a ‘one-and-done’ disease,” said study author Dr. Vineet Chopra, chief of the division of hospital medicine with Michigan Medicine at the University of Michigan in Ann Arbor. “Rather, there are many complications and consequences that patients continued to struggle with,” he said.
“Our findings suggest that we need to approach post-hospitalization COVID care differently,” Chopra said. “Yes, there are medical needs. But there are also more pressing needs in terms of mental well-being, financial and emotional stress, being able to regain independence, [and] return to work. We need policy and programmatic approaches to help with these issues.”
Among an initial pool of about 1,650 seriously ill covid 19 patients, nearly one-quarter died while undergoing treatment in 38 hospitals across the United States. Investigators focused on the remaining 75% who were discharged at some point between March and July 2020.
On average, released patients were 62 years of age. A little more than half were Black and just over one-third were white. While hospitalized, about 13% had spent part of their time in the intensive care unit (ICU), 6% had been on a ventilator and 70% had been treated with supplemental oxygen.
Nearly 500 patients participated in a follow-up phone survey 60 days out. By that point, nearly one-third said they experienced persistent symptoms; nearly one in five said they experienced new or worse symptoms after release; and about 40% were unable to resume their normal routines. Only about one-quarter said they had been able to return to work, according to the report.
Roughly half said their poor health had a mild or moderate effect on their emotional state of mind. And about half said covid 19 had taken a mild or moderate hit on their finances, with about 10% saying they had used up all or most of their savings.
“In general, we know very little about what happens to patients following discharge from the hospital,” Chopra acknowledged.
“I think we were also surprised to hear of how much of a struggle life after COVID has been for many of the survivors,” he noted. And while acknowledging that some of that struggle might be shared with survivors of other serious illnesses, Chopra stressed the unique challenges covid 19 survivors face.
“Unlike other serious illness when you have support from family, many post-COVID patients found themselves alone, isolated [or] quarantined, experiencing stigma and challenges accessing health care again,” Chopra said. “This is especially true for the vast majority of patients we saw from inner-city areas who were often economically disadvantaged to begin with.”
The findings were published online Nov. 11 in the Annals of Internal Medicine.
Dr. Colin Franz, a physician/scientist with the Shirley Ryan AbilityLab in Chicago, said the finding that stands out for him is that even two months after being released from the hospital many of the patients remained unable to return to work.
Franz pointed to a number of likely reasons why, including “persistent fatuque, brain fog as well as neuromuscular problems stemming from nerve and muscle damage.” Though not part of this study, Franz’s own research has further identified a risk for enduring peripheral nerve and muscle damage that is higher than what’s typically seen among patients coming out of the ICU following other types of illnesses.
The upshot, he said, is that there is an “extreme risk of persistent disability for survivors of covid 19 who required hospitalization.”
Franz noted that some of that disability may ultimately be linked to the risks associated with being hospitalized and undergoing treatment for any serious illness. “For example, patients who spend a long time on a ventilator for reasons other than COVID-19 tend to be very debilitated afterwards,” he said. Figuring out which lingering health issues are directly attributable to the coronavirus will take more investigation, he added.
SOURCES: Vineet Chopra, MD, MSc, associate professor, medicine, and chief, division of hospital medicine, Michigan Medicine, University of Michigan, Ann Arbor; Colin Franz, MD, PhD, physician/scientist, Shirley Ryan AbilityLab, Chicago, and assistant professor, physical medicine & rehabilitation and neurology, Northwestern University’s Feinberg School of Medicine, Chicago; Annals of Internal Medicine, Nov. 11, 2020, online