Covid Schizophrenia: Why This Deadly Mix Can Deepen Knowledge of the Brain Disease


Most of the time, the voices in Keris Myrick’s head don’t bother her. They stay in the background or say nice things. But sometimes they get loud mean — like when a deadly pandemic descended on the world.

“It’s when things go really, really fast they seem overwhelmingly disastrous. That’s when it happens,” said Myrick, who was diagnosed with schizophrenia 25 years ago. “The attacking voices were calling me stupid. … I literally had a meltdown right here in my house. Just lost it.”

She was able to calm herself quiet the voices, as the pandemic wore on, she kept them at bay by keeping busy: continuing her work for a foundation, hosting a podcast, writing a children’s book. She managed, but she worried about other people like her.

“People with schizophrenia were not actually deemed as ‘the priority vulnerable population’ to be served or to be addressed in the same way as people who had other chronic health conditions who were over a certain age,” said Myrick, who lives in Los Angeles. “So we kind of got left out.”

This omission occurred even as new data published in JAMA Psychiatry showed that people with schizophrenia were nearly three times as likely to die from covid-19 as the general population. Their risk of death from the virus is greater than it is for people with diabetes, heart disease, or any other factor aside from older age.

“People’s initial reaction to this was one of disbelief,” said Katlyn Nemani, a New York University school of medicine neuropsychiatrist the study’s lead author.

Some researchers initially questioned whether the disparate death rates could be explained by the often poor physical health of people with schizophrenia or their difficulty accessing health care. But Nemani’s study controlled for those factors: All the patients in the study were tested treated for covid, they got care from the same doctors in the same health care system.

Then studies started rolling in from countries with universal health care systems — the U.K., Denmark, Israel, South Korea — all with similar findings: a nearly three times higher risk of death for people with schizophrenia. A more recent study from the U.K., published in December 2021, found the risk was nearly five times as great.

“You have to wonder, is there something inherent to the disorder itself that’s contributing to this?” Nemani asked.

The immune dysfunction that causes severe covid in people with schizophrenia could be what drives their psychotic symptoms, Nemani said. This suggests schizophrenia is not just a disorder of the brain, but a disease of the immune system, she said.

Although researchers had already been exploring this theory, the data from the pandemic has shed light on it in a new way, opening doors for discoveries.

“This is a really rare opportunity to study the potential relationship between the immune system psychiatric illness, by looking at the effects of a single virus at a single point in time,” Nemani said. “It could potentially lead to interventions that improve medical conditions that are associated with the disease, but also our understanding of the illness itself what we should be doing to treat it.”

In the long term, it could lead to new immunological treatments that might work better than current antipsychotic drugs.

For now, advocates want the data about risk to be shared more widely taken more seriously. They want people with schizophrenia their caretakers to know they should take extra precautions. Earlier in the pandemic, they had hoped people with schizophrenia would get vaccine priority.

“It’s been a challenge,” said Brandon Staglin, who has schizophrenia is the president of One Mind, a mental health advocacy group based in Napa Valley.

When he other advocates first saw Nemani’s data in early 2021, they started lobbying public health officials for priority access to the vaccines. They wanted the Centers for Disease Control Prevention to add schizophrenia to its list of high-risk conditions for covid, as it had done for cancer diabetes.

But they heard crickets.

“It doesn’t make any sense,” Staglin said. “Clearly, schizophrenia is a higher risk.”

In several other countries, including the U.K. Germany, people with serious mental illnesses were prioritized for vaccines from the beginning of the rollout in February 2021. In the U.S., though, it wasn’t until people were getting boosters in October 2021 that the CDC added schizophrenia to the priority list.

“We were happy when that happened, but we wish there had been faster action,” Staglin said.

It’s always like this with mental illness, said Myrick.

“It’s like we have to remind people,” she said. “It’s just sort of, ‘Oh yeah, oh right, I forgot about that.’”

This story is part of a partnership that includes KQED, NPR, KHN.

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As Red States Push Strident Abortion Bans, Other Restrictions Suddenly Look Less Extreme


What is the ultimate goal of the anti-abortion movement? It might be surprising.

To the casual observer, the obvious answer is that abortion opponents want to overturn Roe v. Wade, the 1973 Supreme Court ruling that legalized abortion nationwide. Before Roe, states decided whether when abortion should be legal.

It’s possible opponents of abortion will see that wish granted. Based on comments made by six conservative justices during arguments, the high court this year is expected to either weaken significantly or throw out the nearly 50-year-old precedent of Roe by upholding a Mississippi law banning the procedure after 15 weeks of pregnancy.

In the meantime, state legislatures are scrambling to prepare for that likelihood — either by shoring up laws protecting the procedure (in a few states), by proposing new restrictions, or by ensuring that pre-Roe bans or restrictions could be reinstated if when the Supreme Court acts. According to the Guttmacher Institute, an abortion-rights think tank, 519 abortion restriction bills were introduced in 41 states from Jan. 1 through March 15, including 82 proposed abortion bans in 30 states.

Just last week, West Virginia’s governor signed a law banning abortion for reasons of fetal disability, Idaho’s governor approved a bill that mirrors a Texas ban on abortion after six weeks. The Supreme Court has so far failed to block the Texas law, even though it clearly violates Roe, which, until the justices rule, remains binding precedent.

But it is important to remember that overturning Roe — tossing abortion decisions back to individual states — is only a way station toward opponents’ ultimate destination: ending abortion entirely. “We would like to see every abortion gone, because we know that there are two people in every abortion choice,” Marjorie Dannenfelser, president of the Susan B. Anthony List, told KHN’s “What the Health?” in January.

But anti-abortion forces disagree on two fundamental points: what ending abortion actually means, how fast to try to achieve it.

To settle the first major disagreement, there first must be consensus on what constitutes an abortion, or, to put it another way, when life begins. The “personhood” movement, which has pushed (so far) unsuccessful ballot measures in several states, argues that because human life begins from the moment sperm egg unite to form a zygote, fertilization should mark the start of protections for human life. That would, in practice, bar many forms of birth control in vitro fertilization, give embryos property rights, among other things.

Other abortion opponents suggest banning forms of birth control they consider “abortifacients” (methods they say cause abortions, such as most intrauterine devices the “morning-after” pill), while not banning in vitro fertilization. Still others would continue to support most forms of birth control but not the abortion pill mifepristone, which, unlike the morning-after pill, works after a fetus has begun to develop in the womb.

The second, more public, disagreement is over how quickly to pursue a zero-abortion strategy, assuming the Supreme Court returns that power to the states. This is where some of the more extreme anti-abortion bills are starting to consume the debate’s oxygen. For example, in Missouri, legislators have proposed bills that would ban abortions even in cases of ectopic pregnancies, which are not only nonviable but also life-threatening for the pregnant person, criminalize helping someone travel out of state for an abortion. In Idaho, the new law would allow the family members of some rapists to sue doctors who perform abortions on rape victims.

The problem with these measures, say analysts from Guttmacher, is that “often they are not the main focus of anti-abortion policymakers, but pull attention away from other abortion restrictions bans that are moving quickly through some state legislatures. Moreover, these types of headline-baiting restrictions can make other devastating provisions, such as Texas-style bans or gestational age bans, seem less radical harmful than they really are.”

“There was a time when passing blatantly unconstitutional laws was considered un-American,” said Emily Wales of Planned Parenthood Great Plains Votes in a statement about a bill passed by the Oklahoma House on March 22 that would ban virtually all abortions — making it potentially the strictest ban in the U.S. “The proposed ban is intended to shame, stigmatize, create fear among vulnerable Oklahomans.”

Which raises the idea of the “Overton Window.” Named for Joseph Overton, who helped run a public policy institute in Michigan, the concept is that only policies within a range of acceptance to the public are considered viable. However, by pushing policies that may be outside that window — in other words, extreme — the window can be nudged to make previously unthinkable policies politically acceptable.

Some suggest that’s what is happening with the recent slew of abortion legislation — that anti-abortion forces, whether accidentally or on purpose, are pushing extreme proposals to make formerly radical proposals — like a Texas-style ban on abortion after six weeks, enforced by civil lawsuits rather than state officials — seem moderate by comparison.

Will the strategy work? It’s too early to tell. But things are likely to become clearer in a hurry when the Supreme Court issues its decision, expected sometime before July 4. Fireworks, indeed.

HealthBent, a regular feature of Kaiser Health News, offers insight analysis of policies politics from KHN’s chief Washington correspondent, Julie Rovner, who has covered health care for more than 30 years.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Delays for Autism Diagnosis Treatment Grew Even Longer During the Pandemic


Wylie James Prescott, 3, had to wait more than a year after his autism diagnosis to begin behavioral therapy, even though research shows early treatment of autism can be crucial for children’s long-term development.

His mother, Brandie Kurtz, said his therapy wasn’t approved through Georgia’s Medicaid program until recently, despite her continued requests. “I know insurance, so it’s even more frustrating,” said Kurtz, who works in a doctor’s office near her home in rural Wrens, Georgia.

Those frustrations are all too familiar to parents who have a child with autism, a complex lifelong disorder. And the pandemic has exacerbated the already difficult process of getting services.

This comes as public awareness of autism research on it have grown insurance coverage for treatment is more widespread. In February, Texas became the last state to cover a widely used autism therapy through Medicaid. And all states now have laws requiring private health plans to cover the therapy, applied behavior analysis.

Yet children from Georgia to California often wait months — in many cases more than a year — to get a diagnosis then receive specialized treatment services. Therapies that can cost $40,000 or more a year are especially out of reach for families who don’t have insurance or have high-deductible health plans. Children from minority communities those who live in rural areas may face additional barriers to getting help.

“You would never allow a kid with cancer to experience these waits,” said Dr. Kristin Sohl, a pediatrician at University of Missouri Health Care chair of the American Academy of Pediatrics’ Council on Children With Disabilities Autism Subcommittee.

During the early months of the covid-19 pandemic, many families canceled in-home services, fearing infection. Virtual therapy often didn’t seem to work, especially for nonverbal younger children. With fewer clients, some providers laid off staff or shut down entirely.

And treatment services always face high turnover rates among the low-wage workers who do direct, in-home care for autism. But covid made the staffing problem worse. Companies now struggle to compete with rising wages in other sectors.

The Centers for Disease Control Prevention estimates that autism affects 1 in 44 U.S. children, a higher prevalence rate than ever before. Autism symptoms can include communication difficulties repetitive behaviors can be accompanied by a range of developmental psychiatric health conditions.

Early diagnosis of autism can make a difference, Sohl said. Symptoms of some kids who begin their therapy by age 2 or 3 can be greatly reduced.

Diagnoses are typically done by developmental-behavioral pediatricians, psychologists, psychiatrists, neurologists, all of whom are in short supply. The shortage of developmental pediatricians is especially acute. Even though they do three more years of fellowship training than a general pediatrician does, developmental pediatricians typically earn less.

General pediatricians with training can also do assessments, but insurers often require a specialist’s diagnosis before paying for services, creating a bottleneck for families.

“If we solely rely on specialists, we’re setting ourselves up for failure because there aren’t enough of us. We need the insurance companies on board,” said Dr. Sharief Taraman, a pediatric neurologist president of the Orange County, California, chapter of the American Academy of Pediatrics.

Even in a metro area, getting a child an appointment can take months. “We cannot get these families in fast enough,” said Dr. Alan Weintraub, a developmental pediatrician in suburban Atlanta. “It’s heartbreaking.”

Some parents pay cash for an evaluation with a private specialist, worsening disparities between kids whose parents can afford to skip the wait those whose parents cannot.

Once a child has been diagnosed, many face an equal — or longer — wait to get autism therapies, including applied behavior analysis, a process that aims to improve social, communication, learning skills. These sessions can take more than 20 hours a week last more than a year. ABA techniques have some critics, but the American Academy of Pediatrics says that most evidence-based autism treatment models are based on ABA principles.

Accessing such treatment largely depends on insurance coverage — for many families how well Medicaid pays. The Georgia Medicaid program reimburses well for ABA, Georgia doctors said, while Missouri’s pay is low, leading to a scarcity of options there, Sohl said.

In California, Medicaid reimbursement rates vary by county, wait times for ABA range from about three to 12 months. In the rural northern reaches of the state, where few providers work, some families wait years.

Claire Hise of Orange County, California, has had trouble securing a consistent therapist during the pandemic for her younger son’s autism treatment. “It’s really a year I feel we’ve lost,” says Hise, who declined to share her son’s name so that he can be the one to decide when how to share his diagnosis. (Claire Hise)

During the first year of the pandemic, Claire Hise of Orange County was thrilled with the ABA therapist who worked with her son. But in January 2021, the therapist quit to go back to school. The company she was working with sent others. Hise had to train each new therapist to work with her son, a difficult process that always took more than a month. “It’s a special relationship, each kid with autism is an individual,” Hise said. “It takes time.”

By then, they were out the door, replaced by another after no more than four to six weeks. Sometimes the family waited weeks for a replacement.

Hise tried switching to another company, but they all had a six-month waitlist. “He’s already so far behind,” Hise said. “It’s really a year I feel we’ve lost.”

The average age of diagnosis in the U.S. is about 4 years old, but Black Latino children on average are evaluated later than white kids.

“The impact on families having to wait for diagnosis or treatment can be devastating,” said Kristin Jacobson, founder of the Autism Deserves Equal Coverage Foundation, an advocacy group in California. “They know in their gut something is seriously not right that there is help out there, yet they are helpless to do anything about it.”

Araceli Barrientos helps run an autism support group in Atlanta for immigrant families, for whom language barriers can cause additional snags. It took her over a year to get her daughter, Lesly, diagnosed two more years to secure further treatment.

Sabrina Oxford of Dawson, in rural southwestern Georgia, had to take her daughter Jamelyn more than 150 miles to the Marcus Autism Center in Atlanta to get her diagnosed. “You don’t have any resources around here,” Oxford said.

Dr. Michelle Zeanah, a behavioral pediatrician, draws families from 60 mostly rural counties to her clinic in Statesboro, Georgia. “There’s a massive shortage of people willing able to do an autism diagnosis,” she said.

Getting insurance to pay for autism treatment can be another frustrating process for families. Therapy denials can be triggered by clerical errors or missed paperwork. Insurer approvals can be especially difficult for older children, who can be less likely to get treatment services than younger ones, said Dr. Donna Londino, a child adolescent psychiatrist at Augusta University in Georgia.

Many children with autism also need speech, occupational, physical therapy, all of which are generally easier to secure than behavioral therapy. But even then, Weintraub said, the insurers push back: “They really dictate how many services you can have. These families, literally, meet obstacles at every turn.”

David Allen, a spokesperson for AHIP, an insurance industry trade group formerly known as America’s Health Insurance Plans, said insurers often require prior authorization to ensure that autism services are “medically necessary evidence-based” that patients are treated by “providers with appropriate education training in treating autism.”

Tracy-Ann Samuels of New York said she paid out-of-pocket for speech occupational therapy for her son, Trey, now 15. Two years ago, after 18 months on a waiting list, he finally got ABA services covered by insurance. 

“He’s doing so great,” she said. “My son was nonverbal. Now he’s talking my ear off.”

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Special ultraviolet light prevents indoor transmission of airborne pathogens without harming humans: study


NEWYou can now listen to Fox News articles!

The light at the end of the tunnel for the COVID-19 pandemic might just be overhead.

A new study shows a hands-off approach using ultraviolet light, called far-UVC light, reduced transmission of indoor airborne pathogens by more than 98% in less than five minutes, according to a recent statement.

“Far-UVC rapidly reduces the amount of active microbes in the indoor air to almost zero, making indoor air essentially as safe as outdoor air,” said co-author Dr. David Brenner, director of the Center for Radiological Research at Columbia University Vagelos College of Physicians Surgeons. 

PERMANENT DAYLIGHT SAVING TIME MAY BE HARMFUL TO OUR HEALTH, EXPERTS SAY

“Using this technology in locations where people gather together indoors could prevent the next potential pandemic.” 

The joint study by scientists at Columbia University in the U.K. suggests far-UVC light installed in ceiling lamps can reduce the risk of the next pandemic by effectively reducing airborne indoor transmission of infectious diseases known to cause major outbreaks, such as COVID-19 or influenza.

But the statement notes that far-UVC is a relatively new technology.

Although it’s been known for years that ultraviolet C light (UVC) has properties to destroy germs, its use has been largely limited because it can cause sunburns, skin cancers as well as harm people’s eyes, so its usage has been limited primarily to sterilizing medical equipment, the statement said.

But almost 10 years ago, scientists at Columbia University proposed that a different type of UVC light, called far-UVC light, could destroy germs as efficiently as conventional UVC light without the harmful side effects, because the light’s shorter wavelength does not allow it to penetrate human skin or eye cells, per the statement. 

Studies over the past decade confirmed far-UVC kills airborne bacteria viruses without damaging living tissue as the germs are much smaller than human cells.

Studies over the past decade confirmed far-UVC kills airborne bacteria viruses without damaging living tissue as the germs are much smaller than human cells.
(iStock)

Studies over the past decade confirmed far-UVC kills airborne bacteria viruses without damaging living tissue as the germs are much smaller than human cells, but the studies up to this point were confided in experimental chambers that never mimicked the real-world setting, according to the press release.

LONG COVID SYMPTOMS MAY DEPEND ON THE VARIANT A PERSON CONTRACTED

The current study tested the efficacy of far-UVC light in a chamber the size of a large indoor room that had an equivalent ventilation rate as a typical home or office, which is approximately three air changes per hour.

Researchers continuously sprayed a bacteria called Staphylococcus aureus until the concentration of the microbes stabilized, then turned on overhead far-UVC lamps.

They choose this particular bacteria versus coronavirus, because it is slightly less sensitive to far-UVC light, so the researchers could create a conservative model.

Kecia Harris, with the environmental services department, cleans the room of a patient fighting the coronavirus at Our Lady of Angels Hospital in Bogalusa, La., Monday, August 9, 2021.

Kecia Harris, with the environmental services department, cleans the room of a patient fighting the coronavirus at Our Lady of Angels Hospital in Bogalusa, La., Monday, August 9, 2021.
((Chris Granger/The Advocate via AP))

The study discovered not only the light inactivated more than 98% of the airborne bacteria in only five minutes, but also was able to keep the level of bacteria in the air low over time as microbes continued to be sprayed in the room.

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“Far-UVC light is simple to install, it’s inexpensive, it doesn’t need people to change their behavior, evidence from multiple studies suggests it may be a safe way to prevent the transmission of any virus, including the COVID virus its variants, as well as influenza also any potential future pandemic viruses,” Brenner said.



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AWS teams with THREAD for AI-enabled clinical trials management

THREAD, which develops technology offers consulting services for decentralized clinical trials, announced a new collaboration this week with Amazon Web Services.

WHY IT MATTERS
AWS will help develop new enhancements for the THREAD platform, bringing scalable automation built-in AI to enabling faster more efficient trials by enabling higher quality data capture across the lifecycle of a clinical study.

In addition to improving access for research participants, the companies say they hope the collaboration will speed up the ability to offer initiate co-created configured trials by reducing the start-up time to onboard customers by up to 30%.

Another goal is to enable customers to reduce inefficiencies by 30% achieve up to 25% cost savings when pre-completing data, significantly reducing data capture removing source data verification.

The hope is to provide a more comprehensive view of participant data across studies with enhanced security, AI support operational controls – also to help customers to more precisely assess studies’ success by enabling real-time visibility into richer data streams, real-time grades on study performance.

THREAD is working with AWS Professional Services to design advanced machine learning architecture AI models to automate processes for real-time data capture, auto-populating data workflows more.

THE LARGER TREND
There’s been big momentum for AI machine learning in clinical trial management, especially since the pandemic, in the U.S. around the world.

This past October, Cerner launched Enviza, a new operating unit focused on innovating new approaches to automated data management expanding participation in clinical trials.

That same month, we offered an inside look at how Intel ConsenSys Health are combining blockchain AI for clinical trials management.

ON THE RECORD
“The breadth depth of AWS’s machine learning cloud capabilities will help support THREAD teams as they work to automate processes, reduce inefficiencies, monitor support clinical trials,” said Dan Sheeran, general manager, healthcare life sciences at Amazon Web Services, in a statement.

“In collaboration with Amazon Web Services, we are further scaling our DCT platform with next-level automation, AI/ML offerings, optimized features focused to meet the evolving needs of our customers, research sites, participants,” added THREAD CEO John Reites.

Twitter: @MikeMiliardHITN
Email the writer: [email protected]

Healthcare IT News is a HIMSS publication.





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