With so much misinformation on the internet about CBD oil, one of the most common questions we get from consumers is asking what the difference is between CBD from marijuana vs CBD oil from hemp. To the untrained eye, there may not appear to be any difference between CBD from marijuana vs CBD oil from…
The European Centre for Disease Prevention and Control (ECDC) today warned in its latest COVID-19 risk assessment that cases are rapidly increasing in all of Europe, following rises that look similar to those of China’s Hubei province and Italy and that the risk of overwhelmed health systems is high.
The report comes as cases in Western Europe soar and activity accelerates elsewhere, lifting the overall global total to 460,250 cases in 172 countries, according to the Johns Hopkins online dashboard. Three of the five worst-hit countries are in Europe: Italy, Spain, and Germany. Also, the global number of confirmed deaths passed 20,000 today, with 20,857 reported so far.
WHO advice for locked-down countries
At a media telebriefing today, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, said the many countries that are on lockdown now have a second window of opportunity to suppress the disease.
“We understand that these countries are now trying to assess when and how they will be able to ease these measures,” he said. “The answer depends on what countries do while these population-wide measures are in place.”
On their own, the measures don’t extinguish epidemics, but they reduce pressure on the health system and allow other more precise measures to stop transmission, Tedros said. He urged countries on lockdown to take six key steps: expand and train the public health workforce, implement systems to find every case, ramp up testing, identify facilities to treat patients, develop a quarantine plan, and refocus the entire government on suppressing and controlling the pandemic coronavirus.
“These measures are the best way to suppress and stop transmission, so that when restrictions are lifted, the virus doesn’t resurge, Tedros said. “The last thing any country needs is to open schools and businesses, only to be forced to close them again because of a resurgence.”
ECDC warns of Italian-type trajectories
The ECDC, in its seventh COVID-19 assessment, said that, since Mar 12, all European countries have now reported cases and that 63% of the global cases have been in Europe. With current testing capacity and if nations do not enact mitigation strategies, Europe could see by the middle of April a scenario similar to what China experienced in Hubei province at the beginning of the outbrak.
In Italy, cases peaked on Mar 21, and the number of cases appear to be decreasing, about 2 weeks after lockdowns were ordered, first in northern Italy, followed a few days later by a similar order for the whole country. Other European countries reporting large numbers of cases are likely to see overrun intensive care unit capacities, similar to what hospitals in northern Italy experienced.
The agency’s analysis of the crude case-fatality rates show that the risk and numbers of deaths increase rapidly in those age 60 and over. Of hospitalized patients, 15% have severe disease, and, of those, 12% are fatal. Overall, the ECDC said the risk of severe disease is moderate for the general population and very high for older people and those with underlying health conditions.
The group added that, with effective mitigation measures in place, the risk of widespread community transmission is moderate, but the risk is very high if mitigation measures are inadequate.
Italy, with the world’s second most cases, behind China, today reported 5,210 new cases, along with 683 more deaths, raising its respective totals to 74,386 infections and 7,503 deaths.
Spain, the fourth worst-hit country, after the United States, reported 5,552 new infections today, including 443 more deaths, putting its total at 47,601 cases, 3,434 of them fatal. And Germany reported 2,749 new cases, as well as 27 more deaths, lifting its respective totals to 35,740 and 2,749.
Report: China’s easing of social distancing successful so far
China today reported no new local cases, though it did report 47 more imported cases, according to the latest daily report from the National Health Commission.
In a related development, a modeling group based at Imperial College of London yesterday published an analysis that suggests China’s easing of strict social distancing measures has at this point been successful. The investigators used intra-city movement as a measure of economic activity. Their analysis for Hong Kong also suggests that intermediate levels of local activity can be maintained while holding off a large outbreak.
The modelers emphasized that the findings don’t preclude future epidemics in China, but they do hint that, after intensive social distancing that contained the disease, the country has so far been successful in exiting them. They also stressed that China’s epidemic is at a more advanced stage, but, once it achieves containment, its experience can help guide other countries.
Some parts of Asia are battling a recurrence of COVID-19 activity, following an initial gush of cases in the wake of China’s outbreak. Hong Kong today reported 24 new cases, including 19 patients who had a travel history. And Singapore today reported 73 new cases, 38 of them imported.
Developments in Egypt, Iran
The WHO’s Eastern Mediterranean office (EMRO) today said it wrapped up a technical mission to Egypt and added that the country has solid efforts under way to control its outbreak, especially in disease detection, contact tracing, lab testing, and patient referral.
In light of local transmission, however, the country has an opportunity to prevent community spread with a whole-of-government approach, officials said. They said the WHO will work with Egypt on infection prevention and control, alternate testing methods, and communication, especially with high-risk groups.
Egypt has reported 442 cases so far, 21 of them fatal, according to the WHO.
In Iran, the Middle East country with the most cases, health officials reported 2,206 more cases and 143 more deaths, putting the respective totals at 27,017 and 2,077.
Summary: Cannabidiol isn’t the conclusion of the worldwide hemp trend—far from it! CBN, CBG, and CBC are also all on … CBN, CBG, & CBC — the Future of Cannabinoids with GVB Biopharma Read More » The post CBN, CBG, & CBC — the Future of Cannabinoids with GVB Biopharma appeared first on CBD School.
Today the US Senate is set to vote on the country’s largest-ever stimulus relief bill, meant to inject $2 trillion into the US economy in the wake of the COVID-19 pandemic.
The bill promises relief for many US households and small businesses, which have suffered shutdowns and furloughs in the wake of shelter-in-place orders. It is expected to be voted on by the House as soon as tomorrow, and President Trump is expected to sign the bill by the end of the week, Reuters reported.
Included in the stimulus is $150 billion for hospitals treating coronavirus patients, Vox reported. Of that, $100 billion will go to hospitals, $1 billion will go to the Indian Health Service, and the rest will be used to increase medical equipment capacity, Vox said.
Yesterday the US Department of Health and Human Services (HHS) pledged $100 million to US healthcare systems as they prepare for an influx of COVID-19 patients.
“We cannot beat the COVID-19 pandemic without getting America’s healthcare workers the training and resources they need to respond to this novel threat, and these funds secured from Congress by President Trump will help make that happen,” said HHS Secretary Alex Azar in a press release.
As of this afternoon, according to the USA Today case tracker, the United States has reported at least 62,873 cases, including 894 deaths.
Some signs of slowing in New York
In New York, which has become the epicenter of US COVID-19 activity, Governor Andrew Cuomo said today there were some small signs that virus transmission was slowing following stringent social distancing mandates.
During his daily briefing, Cuomo said state models showed Sunday that hospitalization rates would be doubling every 2 days, but last night the doubling rate was at 4.7 days.
He also showed encouraging data from Westchester County, which was the first area in the United States deemed a “containment zone” in light of several coronavirus cases. “We have dramatically slowed what was an exponential rate of increase,” Cuomo said. “That was the hottest cluster in the United States of America. We closed the schools, we closed gatherings, we brought in testing, and we have dramatically slowed the increase.”
As of Wednesday afternoon, New York reported 30,811 cases, including 17,856 in New York City, the most densely populated city in the United States. New demographic data from NYC Health shows 56% of the city’s COVID-19 patients are men, and 56% are also under the age of 50, with 45% of patients ages 18 to 44.
Queens accounts for 30% of the city’s cases, followed by Brooklyn (28%), and Manhattan (19%). The death toll in the city is 199.
New York University is allowing qualified medical students to graduate 3 months early and begin practicing medicine in an effort to add more healthcare workers to the state’s rosters.
California reports first death in a child
ABC News reported late yesterday that a 17-year-old boy in Los Angeles who tested positive for COVID-19 has died, although there may have been comorbidities. If confirmed, his death would be the first known US death in a teenager.
Also in Los Angeles yesterday, Mayor Eric Garcetti said he will shut off power and water to nonessential businesses that are refusing to close in the face of the state’s shelter-in-place mandate, which was put in place last week. Garcetti also said he expects Los Angeles to peak in cases in 6 to 12 days, and warned citizens the situation will be bad.
Meanwhile both Georgia and Louisiana reported another increase in case counts, as both Atlanta and New Orleans struggle with an influx of COVID-19 patients. Both states crossed the 1,000-case milestone in the past 2 days.
Louisiana officials have reported 1,795 coronavirus cases and 65 deaths, with more than 800 cases in New Orleans. Some reports on Twitter suggest at least half of the emergency medical services staff in that city are currently quarantined after exposure to cases. The state of Louisiana is under a shelter in place mandate.
Only Atlanta residents have been told to shelter in place in Georgia, where the Atlanta Journal Constitution reported a total of 1,097 cases in the state, including 38 deaths.
In other news, a Holland American cruise ship with 87 passengers onboard with flu-like illnesses is making its way to Florida, Bloomberg News reported. The ship will arrive at Ft. Lauderdale on Mar 30, but the company is sending COVID-19 testing kits to rendezvous with the ship before it docks.
Moderna says vaccine could be in limited use this year
Finally today, Moderna reportedly told investors that its mRNA-1273 vaccine against the novel coronavirus could be ready to be used on frontline health workers this fall but would not be ready for wide commercial distribution until 2021.
Moderna’s vaccine launched its phase 1 human trial last week in healthy adults in the Seattle area.
Although the precautionary measures to contain the spread of the new coronavirus and COVID-19 are efforts to protect the community, the notification of your child’s school closing may have landed like one of your worst nightmares. Children thrive on routine and predictability, both of which are in short supply right now for families across the country and well beyond. Despite the uncertainty in the community, you still can try to foster an environment that includes as much routine and predictability as possible. Below are some tips to manage children’s increased time at home.
Before offering some tips on how to manage the day-to-day, my first suggestion is to validate both your and your children’s experiences. Validation acknowledges how a person is feeling without agreeing or disagreeing. It shows children and adults that they are heard and helps them manage their emotions.
Acknowledge for your children that it may frustrating, disappointing, and sad that activities have been canceled or postponed. It also may be worrisome and stressful because none of us are sure when the return to more typical routines will happen. Let your children know that it is okay to have these feelings, and the family is going to do its best to make the most of these changes. Using “and” rather than “but” accepts both thoughts.
Like your children, you also deserve validation. These changes have likely turned your world upside down without sufficient time to prepare. You can feel exasperated and worried even when you’re trying to make the most of these experiences.
Keep a consistent schedule
It may not seem like a certainty right now, but schools will reopen at some point, perhaps sooner in some communities than in others. Sticking with a routine similar to the one practiced for typical school days will help make any return to school smoother, as well as give shape to each day. Try to keep your children’s morning and bedtime routines the same as if they were preparing for school. Keeping meal times the same also can help.
Create a daily schedule that is structured for your children. You can foster a sense of collaboration and control for them by creating a list of activities and allowing your children to pick when they happen. For example, your children can pick during which hour-long blocks of time they do math work, science work, reading, etc.
Be creative with electives. Perhaps children can do a craft during art time, write a song that lasts 20 seconds to sing for future hand-washing for music, see how many jumping jacks they can do or choreograph a dance for phys ed, and do improv skits for theater.
If more than one adult is at home or working from home, it might be helpful to coordinate your schedules as best you can to tag-team monitoring your children’s schedule when needed.
Have a plan for screen time use
Screens may be in use more often now if your children are using online learning programs and virtual classrooms. If you have a screen time plan for your family, you still can keep that in place for the typical after-school hours. Your plan should focus on recreational screen time use, such as the use of video games. Review any screen time plan and limits with your family to avoid potential attempts to negotiate and argue. If you do not have a screen time plan in place yet, the American Psychological Association provides tips for how to create one.
Be creative with socializing
Technology now allows us to get creative with social interactions to help prevent loneliness, while still adhering to social distancing guidelines. You can schedule virtual playdates for your children and FaceTime calls with family members during after-school hours. Platforms such as Google Hangouts and Zoom allow children to have virtual group hangouts, so there are still ways to remain connected to others while staving off loneliness. This differs from online games that allow users to interact with unknown players. It’s important to monitor any virtual interactions that your children are having to make sure those on the other end are known and appropriate connections.
You, too, can plan time to connect with fellow parents online or by phone, to learn which activities have kept children engaged and to simply talk with one another. Check with your child’s school or your town to see if there’s a listserv that promotes this. All of you have a tremendous amount of expertise worth sharing, and you can bond over having more time with your children than you ever could have imagined! Remember that you are not alone; we are in this together and doing our part as a community to keep everyone as healthy as possible.
For information about the new coronavirus and COVID-19, see Harvard Health Publishing’s Coronavirus Resource Center.
In the midst of the fear, worry, and uncertainty surrounding the coronavirus pandemic, each day seems to bring news that’s worse than the day before.
The cause for concern is justified. But, as in most major disasters, tragedies, and public health threats, there are reasons for hope, and even optimism. They may be hard to see, even if you’re a “cup-half-full” or “it could always be worse” type of person. But they are there. Here are a few.
The good news about the coronavirus pandemic
Most people with COVID-19 recover. Estimates now suggest that 99% of people infected with the virus that causes COVID-19 will recover. Some people have no symptoms at all. And while thousands of people have died, the overall death rate is about 1% (or perhaps even lower), far less than MERS (about 34%), SARS (about 11%), or Ebola (90%), though higher than the average seasonal flu (0.1%).The loss of life related to this illness is terrible and far more cases are expected, but based on the fatality rates alone, it could be far worse.
Children seem to be infected less often and have milder disease. According to the CDC, the vast majority of infections so far have afflicted adults. And when kids are infected, they tend to have milder disease. For kids and their parents, that’s good news. However, it’s important to note that children can develop infection. A recent study from China early in the outbreak demonstrated that a small number of kids, especially infants and toddlers, can develop serious infection. As is true generally, it’s likely that kids can spread infection in the absence of symptoms, though how often this happens is unclear. It’s perplexing, though fortunate, that this new coronavirus does not behave the way so many other illnesses do, in which the elderly and the young are particularly vulnerable.
The number of new cases is falling where the outbreak began. During his speech declaring the new coronavirus outbreak a pandemic, the director-general of the WHO pointed out that “China and the Republic of Korea have significantly declining epidemics.” In fact, Wuhan province (site of the very first cases) has just reported no new local cases for the first time since the outbreak began. The only new cases were “imported” from travelers arriving there. While actual numbers are hard to verify, and the methods these countries used to contain infection, such as aggressive diagnostic testing and strict isolation measures, are unlikely to be practical or acceptable everywhere, if the number of new cases in China is truly declining, that’s a good thing and suggests that efforts to contain the spread of this infection can be successful.
The internet exists. We currently have ways to practice social distancing that preserve at least some social and medical connections. People in isolation or quarantine can ask for help, visit friends, “see” family and doctors virtually, and provide updates on their condition.
Our response to future pandemics should improve. The COVID-19 pandemic has exposed shortcomings in healthcare systems throughout the world that provide an opportunity to improve them. For example, a faster global response, better and quicker distribution of testing kits, and more coordinated and coherent public messaging should be expected the next time around. (No guarantees, of course.)
Many people and organizations have stepped up to improve the situation. In the US, for example:
Some major health insurers have promised to cover care and testing related to COVID-19.
A number of celebrities and professional athletes have donated significant resources to help those taking a financial hit by the pandemic, such as the workers at the stadiums where athletes play.
Newly approved legislation provides paid sick leave and paid family and medical leave for some American workers, free testing for people without insurance, and added funding to states for Medicaid.
There are innumerable stories of people helping each other out — here’s one I particularly like.
The bottom line
Make no mistake: the new coronavirus epidemic is a big problem that’s expected to become bigger in the weeks and months to come. For those who are infected as well as those trying to avoid infection, these are trying times. But amid all the doom and gloom, there are some positive stories, positive messages and reasons to remain hopeful.
At a time when the citizenry of this country is so politically divided, we can also hope that this threat brings us together in ways that help us to better recognize commonalities: we’re all human, we get sick, and we worry about loved ones. As social creatures, we try to help one another when bad things happen. If that happens, it would be good news that could not have been foreseen before the pandemic.
Follow me on Twitter @RobShmerling
Baby boomers are used to embracing grandparenting head on. Some of us have moved across the country to be with our grandchildren; others regularly bridge distances via FaceTime and Skype; many take pride in kayaking, rock climbing, jumping on trampolines, and doing yoga with our grandkids. Before the new coronavirus and COVID-19 came along, many grandparents were confident we could do it all. The threats posed by this new virus are humbling and present new conundrums. As schools and daycares temporarily close, many grandparents are wrestling with questions surrounding whether they can safely spend time with their grandchildren, and possibly help their adult children with childcare.
Is it safe to spend time with my grandchildren right now?
COVID-19 affects older people more severely than younger people — and children are notorious for spreading germs, notes Claire McCarthy, MD, a pediatrician at Boston Children’s Hospital and faculty editor for Harvard Health Publishing.
“To be safe, grandparents really shouldn’t be doing childcare,” says Dr. McCarthy. “Even if the child is a baby who doesn’t go out into the world much at all, it’s impossible to be sure that the baby’s parents won’t bring anything home. As sad as it is, older adults are the ones who really need to isolate themselves. In a time of crisis, it’s natural to want to be with family and help them, but in this particular crisis families need to think differently — and keep grandparents safe.”
(See the Coronavirus Resource Center for information on how the virus spreads, how to protect yourself, and who is at highest risk for serious illness.)
Staying connected and helping families
Given current public health recommendations to practice social distancing — even with beloved grandchildren — many grandparents are grappling with two questions. What can I do to stay connected with my grandchildren? How can I help their parents, who may be working from home and trying to cope with their children being home from school?
Ways to stay connected to your grandchildren
Long-distance grandparents often become incredibly skilled and creative with FaceTime, Skype, and other ways of connecting face-to-face. Those who haven’t yet developed these skills can begin building them now. Guided by the age of your grandchildren, their interests, and the nature of your relationship, you can establish a daily meet-up online to read books, play games, or do activities.
Simply calling to chat will get old quickly. Right now the children are home from school or daycare, and missing so much of their daily routines and activities. So, step in with “Nana Academy” or “Granpa Games.” You may begin to teach a young child to recognize the letters of the alphabet, or create interesting history lessons for an older child. Show off dance steps or favorite songs from your youth and have them share theirs. Again, be guided initially by your grandchild’s interests and your own. Start with small, sure-fire activities and expand when you can. Once you get started, you are likely to discover a vast number of possibilities.
If you have grandchildren living in more than one family, try creating a daily or weekly “cousins’ time.” Depending on ages, you can read all of them a story, or encourage the older ones, already readers, to read to younger siblings and cousins. Cousins’ time could also be an opportunity for you to share stories, perhaps from their parents’ childhoods. Or you might tell stories about it was like to live in a time before Velcro and microwaves, let alone iPhones and FaceTime.
Break bread together. One woman I know cooks for her adult daughter, drops the food off at a safe distance outside, then goes home to get online for a virtual meal with her daughter and grandchildren.
Ask children what they do and don’t like about their new routines, and talk together about what each person might like to look forward to. Life may not return to normal for children soon, and not knowing how long this difficult stretch will last is part of the hardship. But hopefully one day, many important aspects of our lives will resume.
How can I help my children?
Many adult children are struggling to balance work and homeschooling. Others may need a break from 24/7 childrearing. You could help by:
Freeing up time for parents. You may decide to video chat regularly with your grandchildren, so that you can remain connected with them, but remember that your efforts will also be helping their parents. Spending a half-hour or more engaging with them daily will free up some time for the parents, and reassure them that responsibility for their children’s education and well-being during this time is not all on their shoulders.
Considering financial help. This crisis will cost all of us financially, but will hurt some more than others. To the extent you can help and to the extent your adult kids could use your financial help, this is a way you can be there for them. It may come in the form of large cash gifts, although most of us cannot make that sort of contribution. Offering to pay for an activity or send a grandchild to camp for a week or two (assuming this becomes possible) gives the child something to look forward to, grandparent and grandchild something to anticipate together, and eases finances a bit for the parents.
Inviting grandchildren to plan virtual celebrations and holidays with you. If a birthday is approaching, you and your grandchild might go online to find something special that can be delivered to the child’s home and opened “together.” And with Easter and Passover on the horizon, you may be able to dye Easter eggs together, and you can surely talk about the 10 — now 11 — plagues in a very real way.
We grandparents take a lot of pride in the energy, youthfulness, creativity, and love that we offer our grandchildren. COVID-19 may temporarily alter the format of our relationships with our grandchildren. This is humbling but it need not be crippling. Whether via FaceTime or Zoom or even old-fashioned telephone, there remain all sorts of meaningful and joyful ways that we can be with our grandchildren despite any distance between us.
For more information on coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.
As we try to predict what will happen here in the US with COVID-19, it’s natural to look at the experience in China, where the epidemic began. In a study published in the journal Pediatrics, we learn about how the pandemic affected children.
What this study tells us
The study looked at information about 2,143 children with COVID-19 infections that were reported to China’s Centers for Disease Control from January 16 to February 8 of this year. Of the infections, about a third were confirmed with a laboratory test for COVID-19. The others were diagnosed based on symptoms and the results of other tests, such as x-rays.
The best news in this study is that 90% of the children had illness that was asymptomatic, mild, or moderate — as opposed to severe or critical. That means that even if the children were sick, with fever and cough, 90% did not have trouble breathing, need oxygen or need to be in the intensive care unit. While 4.4% were reported as asymptomatic, given that only a third had laboratory testing, it’s very likely that the actual number of asymptomatic infections in children during that time period was higher. Only one child died.
In adults, it appears that more like 80% have mild to moderate infections. We don’t know why children appear to have milder disease overall. It’s likely a combination of factors related to body chemistry, immune function, and even social factors such as how children are cared for and spend their days. But whatever the reason, it’s good news.
What else is important to know
However, there is a part of the study we need to pay attention to: younger children are at higher risk of running into trouble. Among children less than a year old, 10.6% had severe or critical disease. For children ages 1 to 5, that number was still high at 7.3%. It dropped to 4.2% for 6-to-10-year-olds, 4.1% for 11-to-15-year-olds, and 3% for those 16 and older. Interestingly, the only child who died was 14 years old.
It’s not really surprising that the youngest children, especially infants, are more vulnerable. In most epidemics, such as influenza, it’s the very young and the very old that have the highest risk.
How can this information help us?
How can we use this information? Aside from all the advice already given to parents about hand washing, social distancing, and maintaining healthy habits, parents of young children should take extra care.
Be especially careful about who has contact with your young children
Choose caregivers carefully. Limit the number overall, and choose those who have limited contact with other people and who can be trusted to practice social distancing, wash their hands frequently, and stay away if they feel at all sick.
Limit the number of people who have contact with or hold young children.
To the extent that it is possible, keep young children at home. If you take them out, keep them inside strollers or otherwise limit what they touch.
Wash their hands even more often. They just can’t stop themselves from touching things and touching their face.
Be particularly watchful should young children get sick
Call your doctor for advice rather than bringing your child in for mild or moderate illness (there’s nothing your doctor can do at the office, and you are just adding the risk of more exposures). However, you should absolutely seek medical care if your child has
any trouble breathing — rapid or forceful breathing, a pale or blue color to skin, trouble feeding or talking, or doing usual activities because of breathing problems
a high fever you can’t get down (while it’s not certain, there have been some concerns raised about using ibuprofen with COVID-19 — out of an abundance of caution, best to use acetaminophen instead)
pain or irritability you can’t soothe
trouble drinking or refusal to drink, and is making less urine.
Follow me on Twitter @drClaireMD
For more information on coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.
Telehealth, the virtual care platforms that allow health care professionals and patients to meet by phone or video chat, seems tailor-made for this moment in time. Also known as telemedicine or digital health, it’s often touted as a convenience for patients who are busy or far away, or when travel isn’t feasible due to severe weather or an urgent condition like a stroke. The current crisis makes virtual care solutions like telehealth an indispensable tool as COVID-19 spreads across US communities. As director of the Center for TeleHealth at Massachusetts General Hospital and vice president of virtual care for Partners Healthcare, I believe it can help flatten the curve of infections and help us to deploy medical staff and lifesaving equipment wisely.
How can telehealth help during the COVID-19 outbreak?
While it’s likely many people will become infected with the coronavirus that causes COVID-19, most will not get seriously ill. Those at greatest risk are over 60, or have underlying health conditions or a compromised immune system. The number one job for all of us is to avoid becoming a carrier and distributor of the virus. By using virtual care for much regular, necessary medical care, and deferring elective procedures or annual checkups, we free up medical staff and equipment needed for those who become seriously ill from COVID-19. Additionally, by not congregating in small spaces like waiting rooms, we thwart the ability of the virus to hop from one person to another. Keeping people apart is called “social distancing.” Keeping healthcare providers apart from patients and other providers is “medical distancing.” Telehealth is one strategy to help us accomplish this.
How can medical staff use telehealth to decide who should come to the hospital?
We think that patients with minor symptoms of COVID-19, such as cough and body aches, can rest at home, drinking fluids and treating this like any flulike illness. Test kits are in short supply and currently being used mainly for certain groups: for example, patients who are high-risk or seriously ill, and medical staff who have symptoms or have been exposed to COVID-19, to help prevent further spread of illness. Telehealth uses video chat, or even a simple phone call, to allow medical staff to ask specific questions and gather information to find out whether care is urgently needed, or if a person can continue to self-monitor symptoms at home while recovering. It can also be used for regular check-ins during recovery, as needed.
How can you make the best use of a clinician’s time on the call?
In the US, health care providers are following guidance provided by the Centers for Disease Control and Prevention (CDC), state and local health departments, and hospital infectious disease experts. The screening questions a clinician asks during the call help establish if a person is in a low-, medium-, or high-risk group, and if they have mild, moderate, or severe symptoms of upper respiratory infection that could be due to COVID-19.
By quickly and consistently gathering key information, the clinician you speak with can help determine if you need to see a doctor or go to the hospital for care, or if you are better off staying at home while recovering.
Before you call write down your symptoms, whether you have a fever, and whether you’ve taken any medicine.
Be ready to answer a few questions that might seem tedious or irrelevant, such as where you have traveled recently. As the infection becomes more widespread, travel questions will be less necessary, since it becomes more likely that you caught it within your own community.
Try to resist the urge to ask reasonable but nonmedical questions that are time-consuming: “Should I cancel our family summer vacation?” or “Can I catch this from petting my neighbor’s dog?” Many calls to triage hotlines go unanswered because call volumes are high. Keeping calls short allows clinicians to help more people. If you have questions about the coronavirus or COVID-19, visit reliable websites, such as the CDC or World Health Organization, to get answers. The CDC website offers information on how to protect yourself and what to do if you’re sick.
What telehealth services are available to me?
If you have health insurance, find out if your plan has an option for telehealth services. If not, several well-known national companies provide services for a fixed fee. Your doctor may be able to suggest a specific service, or you can search for “online urgent care” or “telehealth companies in US” or “telemedicine companies in US.”
Medicare and many health plans are currently reimbursing many types of health care providers for telehealth visits.
How can we help one another?
These are challenging times. Let us look to each other for support, kindness, and compassion. We must protect and care for each other, and lend a hand where we can, all while keeping a safe distance. There is nothing we cannot endure if we keep our humanity front and center, and carefully steward our shared resources. We have enough key health care workers — including but not limited to doctors; nurses; physical, occupational, speech, and respiratory therapists; and social workers — to care for the sick if we can slow the pace at which infection is spreading. We need your help to manage this. It’s well past opening night and we all have a part to play.
For more information about coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center.
Lately, I’ve been hearing a lot from patients and friends who are enthusiastically pursuing a “whole body cleanse” or “colon cleanse,” or a “detoxification cleanse.” And I’ve seen ads about these cleanses promising a number of health benefits, based on the general principle that every so often it’s a good idea to rid yourself of toxins that are undoubtedly accumulating within you.
Spring cleaning for your body? The idea goes back centuries. And sure, cleansing — or cleaning — is clear enough for bathing or mopping a floor. But how does a cleanse work in the human body? Do cleanses really deliver on their claims?
Let’s start with the name
Cleanses go by many names and descriptions, including:
Colon cleansing, also called a “colonic” or “colonic irrigation.” Large amounts of water and other substances, such as coffee or herbs, are flushed through the colon via a tube placed into the rectum.
Detoxification (or detox) diets with names like “Super Cleanse,” “Full Body Cleanse Express,” and “Antioxidant Cleanse.” These are specific, often restrictive diets that last a few days to a month and consist largely of liquified vegetables, fruit juices, and spices.
Periodic fasting to take a break from your usual (and potentially harmful) diet, which is presumed to include an array of toxins, synthetic chemicals, and other poisons. Fasting is often a part of detox diets.
Does it make sense?
If you’ve seen the ads I’ve seen, it doesn’t just make sense — it seems like something we should all be doing regularly! Cleansing means cleaning and who doesn’t like clean?
But it’s not that simple. The normal intestinal tract is teeming with bacteria. While dietary changes, medications, and even exposure to other people (and pets!) can change your intestinal flora, scientific reality dictates that you can’t “cleanse” your body through diet or “detoxify” your colon. It’s not even clear what toxin or toxins a cleanse is supposed to remove, or whether this actually happens.
Advocates of cleanses would argue it makes intuitive sense. You’ll find plenty of testimonials from people who report feeling better in a number of ways (see below) after completing a cleanse. Predictably, the answer to whether a cleanse is a good idea depends on who you ask.
What the ads say
Claims vary by product, but ads often promise a cleanse will
increase your energy level, focus, and sense of well-being
help you lose weight
reduce inflammation (and as a result, relieve arthritis pain and suppress autoimmune disease)
remove toxins from urine, stool, and sweat.
Some ads promise specifics, such as “strengthening the liver, blood, and colon.” What? There are claims about increased sex drive, better mood, and fewer cravings for junk food. According to the ads, the number of ways a cleanse can help seems endless.
What the evidence says
There’s a stark contrast between powerful claims made by those promoting various cleanses and the scant evidence that they do anything good for your health. Searching the medical literature for “detox diets” or “cleanse diets” yields almost no relevant, high-quality medical evidence demonstrating health benefits. For example:
A lemon detox diet is often cited as evidence supporting detox diets to improve health. A single study found that overweight women following a very-low-calorie diet with “organic maple and palm syrups and lemon juice” reduced body fat and insulin resistance, and had lower levels of inflammation. However, the study was small, lasted only 11 days, and most of the positive changes were also observed among subjects on a similarly calorie-restricted diet without lemon juice.
A review of detox diets for weight control and toxin elimination stated that “Although the detox industry is booming, there is very little clinical evidence to support the use of these diets.”
A review of colonic cleanses concluded that “The practice of colonic cleansing to improve or promote general health is not supported in the published literature and cannot be recommended…”
Remember, health claims for cleanses have not been evaluated by the FDA. Read the product disclaimers before you buy and use these products!
Could a cleanse be potentially harmful?
Just as there is limited evidence of benefit associated with detox or cleanse programs, there is limited evidence of harm. However, there are reports of side effects and complications. Examples include:
And there’s also cost to consider; product costs are not covered by most health insurance. I found ads for detox diet programs charging $15 to more than $250. Some recommended repeating the program periodically, so the cost can be considerable.
The bottom line
I know there are many people who find intermittent detox diets or cleanses useful, and firmly believe they improve health. And the ads for these programs are filled with glowing testimonials. “It has been an awakening for me!” “I’ve never had this much energy! “Toxins were leaving my body through my pores and digestive system… better sleep, increased energy levels, and I lost weight.“ This one seemed directed at me: “I don’t care who says what about this detox, this stuff works!!! Day 12, no exercise, down 19 pounds!”
Still, given the lack of evidence supporting their use, the risks associated with their use (even if small), and their lack of regulation, it’s hard for me to be enthusiastic about the use of detox diets or cleanses. If you’re concerned about toxins in your body, I say choose a healthy diet and avoid pollution, pesticides, and other harmful substances as best you can. Leave the detoxification to the professionals: your kidneys, liver, and other self-cleaning organs of your body.
Follow me on Twitter @RobShmerling
How does coronavirus spread?
It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.
Is there a vaccine yet?
What makes this outbreak so different?
Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.
What should I do if I feel sick?
How do I get tested?
What if somebody in my family gets sick?
If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.
Should I wear a mask?
No. Unless you’re already infected, or caring for someone who is, a face mask is not recommended. And stockpiling them will make it harder for nurses and other workers to access the resources they need to help on the front lines.
Should I stock up on groceries?
Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.
Can I go to the park?
Should I pull my money from the markets?
That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.
What should I do with my 401(k)?
President Vladimir V. Putin of Russia postponed a referendum on a constitutional change to term limits and ordered a weeklong national holiday to help halt the spread of the coronavirus.