There are two types of people in the world. The type who thoughtlessly store their toothbrushes out in the open, in the same bathroom that harbors a fecal-matter-spewing toilet (gross, right?), and the type who takes pains to cover their toothbrushes when not in use, and even periodically disinfect them in the dishwasher or with a fancy ultraviolet sterilizing device. Of the two groups, guess who is following the CDC and ADA guidelines for taking care of your toothbrush? Surprise, it’s the lazy folks.
But aren’t their toothbrushes covered in bacteria and other gross little microbes? They sure are. All toothbrushes are full of germs, and most of them come from our mouths. This review of studies on toothbrush contamination reports that all of them “found significant bacterial retention and survival on toothbrushes after use.”
Toothbrushes start out with germs on them (after all, they come from the factory clean, but not sterile) and quickly pick up whatever germs you have in your mouth. If you have any disease-causing microbes in your mouth (gum disease, cold sores) they will get on your toothbrush, and you’re not going to be able to fully remove them. And here’s a bonus fun fact: as toothbrushes get older, their surfaces wear down and they are able to harbor even more germs.
You’re not going to die from toothbrush germs
Let’s clear one thing up before we go any further: while the idea of germs on your toothbrush may gross you out, this isn’t actually a health hazard for most people. The CDC reports that people with bleeding disorders or who are immunosuppressed may need to find other ways of performing oral care, and if that’s you, talk to your doctor. For the rest of us: “The Centers for Disease Control and Prevention is unaware of any adverse health effects directly related to toothbrush use.”
Let your toothbrush dry out
The best way to deal with all these germs? According to the CDC and the American Dental Association, air drying is the key.
After you brush, rinse your toothbrush with tap water. This doesn’t remove bacteria, but it does get rid of any globs of toothpaste or other gunk that can interfere with the drying process. Place your toothbrush in a holder that allows it to sit upright and air dry. Drying the bacteria out is what keeps them from multiplying. Keeping used toothbrushes in a container or putting a cap over them is likely to encourage bacterial growth. The few germs you keep out are going to be outnumbered by the germs that are partying on the inside.
For more on proper toothbrush care:
Don’t share toothbrushes; keep your bodily fluid residue to yourself.
For the same reason, don’t let your toothbrush come into contact with anybody else’s toothbrush.
Replace your toothbrush when it gets frayed, or about every three to four months. Toothbrushes clean your teeth best (and harbor fewer bacteria) when they’re in good condition.
If the thought of bacteria grosses you out so much that you feel you must do something about it, the ADA says you can soak your toothbrush in Listerine or in 3% hydrogen peroxide (the stuff you get in the brown bottle at the drugstore). This won’t kill all the bacteria, but it may reduce levels by 85%. (Now, 85% of a bajillion is still a bajillion, but maybe that makes you feel better.)
Don’t put your toothbrush into the dishwasher or the microwave; this might kill bacteria, but it will also damage your toothbrush. The experts seem to be split on ultraviolet (UV) sterilizers. The CDC says they “may damage” toothbrushes; the ADA acknowledges that they exist but doesn’t make a recommendation for or against them.
So is there poop on my toothbrush or not?
So what about those toilet plumes, anyway? It’s true that toilets can send droplets into the air, with some of those evaporating into aerosols that can float around the room and possibly eventually settle down onto your toothbrush or other objects.
But there’s no research that directly connects toilet-derived aerosols to toothbrushes making people sick. Instead, we have studies like this dissertation that found traces of potentially fecal-derived bacteria on 60% of toothbrushes stored in communal bathrooms (the average bathroom was shared by nine people). But there was no control group in that study; this wasn’t a comparison of toothbrushes stored in bathrooms versus toothbrushes stored elsewhere, it was just a survey of toothbrushes. (It also found that the bacteria were more common on toothbrushes that were rinsed in mouthwash, suggesting that a mouthwash soak may not be the best way of alleviating your germophobia.)
On the other hand, a microbiome project sequenced the microbes found on toothbrushes from volunteers across the country and weren’t able to find any conclusive evidence that toothbrushes are being colonized by fecal bacteria. (Earlier studies, including the dissertation, used methods that couldn’t tell for sure whether the germs came from poop, just that they appeared to be in the same sorts of families as common poop germs.) “It’s reasonably unlikely to find bacteria from our poop on your toothbrush,” one of the authors told Gizmodo.
Whether there are poop germs on your toothbrush or not, we’ve already established that it’s better to let germs dry out than to incubate them in a closed container. You could store your toothbrush in a different room, if you prefer, but watch out for whatever stealthy sources of germs are in that room.
A homeopathic treatment being sold in Germany.Photo: Oskar Poss/ullstein bild (Getty Images)
Research on homeopathy, a 200-year-old form of alternative medicine, is often biased to make it look more effective than it really is, according to a new study out this week. Homeopathy researchers routinely neglect to register the details of their clinical trials before they publish their results, and unregistered trials usually provide rosier results than registered ones, the study found. Over a third of registered homeopathy trials in the past two decades have also never been published, which can be a sign of burying unflattering findings.
Homeopathy was invented by German physician Samuel Hahnemann just around the turn of the 19th century. It’s claimed to work on a principle of “like treats like.” In practice, this means finding a substance known to cause similar symptoms as whatever illness a person is experiencing, then diluting it in water so thoroughly that essentially nothing of the original substance should even be present. This “memory” left behind in the water is supposed to unlock its therapeutic potential and can be given to someone as is (or sprinkled onto a sugar pill) to cure what ails them.
To be clear, homeopathy’s theory of medicine isn’t supported by modern science, nor are its purported benefits, and scientists routinely remind people of just that. Even if homeopathy’s underlying principles don’t pass the sniff test, though, it still has its fans and practitioners. Absurdly, homeopathic treatments can be found in big pharmacy chains like CVS. But because they fall under the same umbrella as dietary supplements in many countries, including the U.S., there’s often little regulation of these products or their claims.
Since homeopathic treatments aren’t as closely scrutinized as approved drugs, the authors of this new study note, the scientific literature is really the only way to know whether the products actually work. And perhaps unsurprisingly, the literature on homeopathy looks to be just as shoddy as the theory behind it.
Researchers in Austria and the U.S. looked at registries containing clinical trials of homeopathic treatments dating back to the early 2000s. Trial registration is an important but often optional part of ethical clinical research. By registering trials beforehand, other scientists can better double check the work for signs of research bias or even outright fraud. Researchers who veer off course and conduct analyses of their results that weren’t outlined in their registered plan, for instance, might do so because their first findings didn’t give them what they wanted. Similarly, scientists might register but never publish a study because the results weren’t what they hoped for.
These issues are sadly systemic throughout science, but the field of homeopathy seems to be an especially bad culprit, the researchers found. Since 2002, they found, 53% of published homeopathy trials were never registered, and about 38% of registered trials went unpublished. Unregistered trials also claimed to show larger treatment effects on average than did registered trials. But even when researchers did publish the results of registered trials, they changed the outcomes they were looking for from the original plan about a quarter of the time.
Any one of these things may not be so bad in isolation, but put together they’re exactly the recipe for inflating how effective homeopathic treatments look in the clinical trial literature.
“Overall, the findings suggest a concerning lack of scientific and ethical standards in the field of homeopathy and a high risk for reporting bias,” the scientists wrote in their paper, published Wednesday in the journal BMJ Evidence Based Medicine.
Again, this shouldn’t come as a surprise, given that nothing about homeopathy makes much sense. But journals still publish these studies, some countries still endorse its use (including during the pandemic), and plenty of people will buy homeopathic “medicine” at their local pharmacy without knowing any better. While these products are usually little more than a fancy placebo, they can sometimes be so poorly made that they actually contain the poison that was supposed to be diluted away—accidents that have landed people in the emergency room and likely led to a string of infant deaths in recent years.
Homeopathy is probably the clearest modern day example of junk medicine still around, and as this new research suggests, so too is the science meant to support it.
In addition to our skin and our hair, winter also can take a toll on our eyes—and for many of the same reasons. When it’s cold outside, we want to spend more time inside, where it’s warm and dry. Unfortunately, these warm and dry conditions have a tendency to make our eyes feel dry and irritated.
But then, if we walk outdoors and it’s windy and/or cold out, our eyes can start to water—while somehow remaining dry. Really, it’s not ideal. Here’s what to know about winter dry eye, including symptoms to look for, and how to treat it.
What is winter dry eye?
“Dry eye” doesn’t only describe what you’re experiencing—it’s also the name of the condition. It’s possible to experience dry eye any time of year, as it’s the result of low tear production or quality, but according to Marissa K. Locy, O.D., a professor at the University of Alabama at Birmingham’s Department of Ophthalmology, it tends to get worse during the winter.
“On average, the humidity drops in the winter with the colder weather,” Locy explains. “In addition, most people turn on the heat in their homes or offices to combat the cold. So, what you end up having is lower humidity outside, and even lower humidity inside, making for warm, dry conditions where moisture can evaporate from the eye faster than normal.”
What are the symptoms of winter dry eye?
The symptoms of winter dry eye tend to occur in both eyes, and be worse for people who wear contact lenses. According to the Mayo Clinic, these symptoms can include:
A stinging, burning, gritty, or scratchy sensation in your eyes
Watery eyes
Eye redness
Stringy mucus in or around your eyes
Sensitivity to light
Blurred vision or eye fatigue
How to treat winter dry eye
The bad news is that there is no cure for dry eye. But the good news is that there are different ways to manage the condition, including:
But if you’ve already tried all of the above and continue to experience dry eye over extended periods of time, it’s time to see a doctor. They can assess the situation, and either recommend other treatment options, or refer you to a specialist.
A pharmacy technician grabs a bottle of drugs off a shelve at a pharmacy. Photo: George Frey (Getty Images)
In a new case report this week, medical professionals in California say that at least two of their patients have experienced substantial and rapid relief from their long covid symptoms with the help of over-the-counter antihistamines. Importantly, the findings are only anecdotal at this point, but they may point to new avenues of research for understanding and treating this complex condition.
The report, published Monday in the Journal for Nurse Practitioners, concerns two middle-aged women believed to have caught covid-19 during the first year of the pandemic. Both were generally healthy and regularly exercised prior to their illness, and both developed a variety of lingering symptoms following their initial bout of sickness. These chronic symptoms included fatigue, cognitive impairment (often known as brain fog), and an inability to tolerate exercise, while one patient even appeared to develop “covid toes”—the discoloration and pain along a person’s toes and fingers that have been seen in some patients post-covid.
Despite seeking medical care, neither patient’s symptoms improved much over the next several months. Both had a history of allergies and sometimes used antihistamines to treat them, though.
In one case, six months after her initial symptoms began, the woman (who had a history of allergies triggered by dairy) ate a piece of cheese, which led her to take an over-the-counter antihistamine medication. Soon after, she experienced “considerable relief of fatigue and improved ability to concentrate,” which then returned over the next three days when she stopped taking the medication. In the second case, the woman switched to a different antihistamine medication than usual 13 months into her long covid, after which she experienced the same pattern of almost immediate relief. Both women have since continued to routinely take antihistamines, and both have reported a near-full recovery of their symptoms, even allowing them to exercise regularly again.
There have been reports among long covid patient groups on social media about the possible benefits of antihistamines. These cases were even brought to the attention of these researchers, primarily from the University of California, Irvine, through members of Survivor Corps, a long covid advocacy group hosted on Facebook. But near as they can tell, these are the first case reports in the literature to document the potential of antihistamines for patients with long covid, also known as postacute sequelae of SARS-CoV-2, or PASC.
“The clinical presentations described here are consistent with other research on PASC and offer anecdotal evidence for treatment of PASC symptoms with a highly accessible over-the-counter histamine antagonist,” the authors wrote.
As the authors note, there is clear evidence that a dysfunctional immune system can contribute to covid symptoms, including aspects of our immunity that could be regulated through antihistamines. So there may be a plausible mechanism for their success here. But there are some very important considerations to be noted as well.
For one, neither woman tested positive for an active case of covid-19, though they did experience common acute symptoms such as fever, cough, and body aches (in one case, the woman’s illness reportedly began in January 2020, when PCR testing was severely limited). Nor did either patient test positive for antibodies for the coronavirus at a later date. These negative results do not mean that they didn’t contract covid-19. Neither PCR nor antibody tests are 100% accurate and people’s antibody levels can wane over time, while some never develop a robust antibody response to infection. But it could hold some importance for comparing the potential of these treatments for those with antibodies and those without.
Another factor is that long covid is suspected to have more than one root cause. So even if antihistamines can benefit some patients, they may not do much of anything for others. In any case, the authors say that more research is needed to test out the promise of these drugs for long covid. And they also advise that if patients want to explore these treatments right now, they should ideally work together with their medical providers to do so.
“Most patients tell us that providers have not recommended anything that has helped. If patients wish to try OTC antihistamines, I urge them to do so under medical supervision. And because providers may not know about new potential treatments, I would encourage patients to be active in their care and consider taking research and case reports like ours to appointments with providers so they can help create a regimen that will work,” said study author Melissa Pinto, an associate professor of nursing at UCI, in a statement. “The next steps for this research into antihistamine treatment are to conduct broad-based trials in order to evaluate efficacy and to develop dosage schedules for clinical practice guidelines.”
A man in Thailand’s bong session went disastrously wrong, according to his doctors. In a new case report, they describe how he “completely amputated his penis” using scissors, apparently due to a rare episode of cannabis-induced psychosis. Though the man’s delusional symptoms faded after being admitted to the hospital and his injuries were treated, doctors weren’t able to reattach the lost appendage.
The bizarre injury was detailed in a paper published over the weekend in the Journal of Medical Case Reports by doctors from Chiang Mai University in Thailand.
The 23-year-old man had reportedly been a regular cannabis user for the past two years but had stopped for the preceding three months. He then got back into his habit by smoking two bongs of cannabis, equivalent to two grams worth, according to the paper. Two hours later, he began to experience an unwanted erection, along with a severe and persistent sharp pain in his penis; he also reported that his glans (the tip of the penis) looked “distorted” to him. In an attempt to stop the pain, he decided to grab a pair of scissors and to “trim the penile skin several times.” Eventually, he severed his penis clean off, leaving behind an inch-long stump.
Unsurprisingly, the home surgery caused the man to bleed out. He was admitted to the hospital two hours after the amputation and immediately treated with antibiotics and a tetanus booster. Emergency surgery stopped the man’s bleeding and cleaned his wounds, while he underwent a procedure to create a new opening so he could still urinate through his urethra. Unfortunately, though the penis was recovered, it was deemed too dirty and fragile to be reconstructed and reattached. By the time doctors saw the man, his amputated member had even been left crawling with ants (Yes, there are pictures of the penis and stump in the paper, but I wouldn’t recommend viewing them if you have a weak stomach).
Given the man’s behavior, he was psychologically evaluated as well. Upon admission, he reported experiencing visual and auditory hallucinations, which included seeing moving shadows and hearing birds and insects. But he was otherwise coherent, not suicidal, and denied having a family or personal history of depression, self harm, and any other issues related to his prior drug use. The man was hospitalized for two weeks and given antipsychotics. And by the time he was discharged, he no longer reported any delusional symptoms.
Because the man’s symptoms happened soon after he ingested cannabis and went away after a month of not taking the drug—along with no other likely explanation—the doctors diagnosed him with substance-induced psychotic disorder. Cases of people self-amputating their penis during a drug-induced psychosis aren’t unheard of, though they are rarely reported. Even rarer is a case seemingly brought on by cannabis-induced psychosis, they wrote.
Many studies have shown a link between cannabis use and an increased risk of acute schizophrenia-like symptoms, though it’s less clear whether cannabis actually increases the risk of schizophrenia itself. And while this risk is rare in general, possible factors include being young and ingesting cannabis high in THC, the primary ingredient responsible for making you feel high. The sharp and persistent pain in the man’s penis that prompted his amputation may have been a subjective sensation brought on by his delusion, but it also could have been the result of a genuine unwanted erection caused by the cannabis—it’s simply not possible to tell either way, the doctors concluded.
“In summary, cannabis-induced psychosis is an adverse effect of cannabis, which may lead to impaired judgement and unexpected self-harm,” they wrote.
As for the man himself, the doctors did plan to perform another surgery that would have lengthened and reconstructed his penis further. But the patient apparently relocated and they’ve since lost touch with him.
People at a testing site located in the international terminal at Los Angeles International Airport (LAX) on December 21, 2021 Photo: Mario Tama (Getty Images)
Fresh off the Christmas holiday, the Centers for Disease Control and Prevention has updated its guidance on how long people should isolate away from others if they’ve been infected by or exposed to the coronavirus. The change effectively cuts the waiting period in half for many people, particularly those without symptoms. But at least some experts aren’t too pleased, arguing that the new recommendations are too lenient, since they largely won’t depend on testing, and that people’s health is being placed in danger to placate business interests.
The CDC announced the changes on Monday afternoon. Previously, people who tested positive for covid-19 have been told to isolate at home for 10 days, starting from their positive test result. Now, the CDC says that people should isolate for five days, then, if they have no symptoms, they can interact with others but should wear a mask for the remaining five days.
For those who suspect they’ve been recently exposed, the CDC now recommends that people who are unvaccinated or who had received their primary vaccine series more than six months ago should quarantine for five days, then wear a mask for the remaining five days (ideally getting tested for covid-19 around day five). If they’re unable to quarantine, then they should wear a mask all 10 days. Lastly, for those exposed who have gotten all their shots, including a booster, they’re recommended to wear a mask for 10 days but don’t have to quarantine/isolate if they’re not experiencing symptoms.
There have been numerous studies suggesting that people are most infectious right before they get sick and for a few days afterward. Other research has shown that this window of infection may close even sooner for vaccinated people who develop a breakthrough infection. And in justifying the new guidance, the CDC did reference this data. “The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after,” the CDC wrote in its explanation of the changes Monday.
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Yet, the evidence isn’t as cut-and-dry as the CDC makes it appear, according to Justin Feldman, a social epidemiologist at Harvard who has studied the disparate impacts of the pandemic within the U.S.
“The CDC’s move to shorten isolation to 5 days, with no requirement to test negative before going back to work, is reckless and dangerous,” Feldman told Gizmodo. “There is a lot of variability in how long people stay contagious, and many can still infect others after 5 days.”
Ellie Murray, an epidemiology professor at the Boston University School of Public Health, notes that the data cited by the CDC to warrant this change isn’t particularly ground-breaking. “Shortening the isolation period does not seem to be based on any new data about the virus or how it spreads, and epidemiologically there’s no new evidence to support this change. I do not think that it will help if the goal is to keep cases as low as possible,” she told Gizmodo.
Indeed, while some experts are generally supportive of the isolation period being made shorter, they’ve still been critical about the lack of advice for people to get tested before leaving isolation. The UK recently shortened its recommendations for isolation from 10 days to seven days for most people, but only if the person tests negative on two rapid lateral flow tests two days in a row. Strangely enough, the CDC did follow in the UK’s footsteps, but only for healthcare workers. As of last week, healthcare workers are now recommended to return to work after seven days, if they test negative and are asymptomatic; however, “isolation time can be cut further if there are staffing shortages.”
“It makes a great deal of sense to allow some people to leave isolation in fewer than 10 days,” Carl Bergstrom, a professor of biology at the University of Washington, told Gizmodo. “The devil is in the details though. How much fewer, and what precisely should be the criteria? The CDC press release doesn’t answer this.”
Adding to the confusion is that the five-day rule is ostensibly meant for people who are asymptomatic—in other words, not feeling sick at all. Yet on the same page explaining the change, the CDC later says that this also applies to people whose symptoms are “resolving” after five days. Those with fever, however, are still being told to isolate longer.
“For previous strains, the infectious period was considerably longer than five days in many though not all patients. Does the CDC believe that this is changed?” Bergstrom said. “Is the thought that vaccination or prior infection status reduces the infectious interval—and if so, should that be accounted for in the recommendation? Is this some kind of cost-benefit calculation? We aren’t given enough information to know.”
The elephant in the room is that these changes do not appear to be solely motivated by the science surrounding covid-19 transmission. Just a week ago, Delta Air Lines CEO Ed Bastian publicly pleaded with the CDC to cut the recommended isolation period for fully vaccinated people with breakthrough infections, citing the impacts it was having on his workforce. And many experts, along with workers’ unions, do believe that this is more about getting people to work than keeping others safe from covid-19.
“It is a clear case of prioritizing corporate profit over public health, and it’s happening at a time when many hospitals are starting to become overwhelmed with covid-19 patients,” Feldman said.
The country is in the midst of a resurgent wave of the pandemic, with case loads rising in some areas to the highest levels seen yet, fueled by the emergence of the Omicron variant. And while Omicron does appear to be milder than the recently dominant Delta variant, it may not be any less of a problem than past strains of the coronavirus. Much like previous waves, it’s not just cases but hospitalizations and deaths that now appear to be on the rise.
It’s possible that this change may not affect the trajectory of the pandemic much, since people are generally less infectious after a few days. But it’s perhaps another example of the CDC losing the trust of the public in recent months (on social media, scientists and others are now parodying the CDC’s business-friendly advice). The new recommendations may also just be counterproductive, according to Murray, if you’re hoping to get everyone back to work as soon as possible.
“It seems very short-sighted to imagine that workplace absences are not going to be coupled to case levels. Workplaces being full of infectious employees will just mean more and more staffing issues,” she noted. “Accepting some closures now to get this surge under control would result in fewer staffing issues in January—if that’s really all they care about—and less covid.”
Heartworm disease is a potentially deadly condition that requires extensive treatment—think multiple medications and at least two months of complete rest—which is why veterinarians and dog owners work so hard to prevent it. The most common preventative treatment is an oral or topical medication given once a month, but recently, vets in the U.S. have started offering anti-heartworm shots that last for six or 12 months.
The biggest difference between heartworm shots and other heartworm medications is the type of anti-parasitic medication they use. ProHeart injections use moxidectin, and come in either six– or 12-month formulations; many topical medications (Advantage Multi and Advocate) also use moxidectin. HeartGard, a popular chewable tablet, uses either ivermectin or a combination of ivermectin and pyrantel. All of these medications are FDA-approved and effective, so the choice comes down to which format works better for you and your dog. Here are the pros and cons of switching to a shot.
The good: Convenience and price
A once- or twice-yearly heartworm shot can be more convenient than monthly doses. As long as they’re not getting vaccine boosters at the same appointment, your dog can can get the shot as part of a checkup—and you don’t have to worry about it until the next one. (Your vet may decide it’s safe to administer future heartworm shots and boosters at the same time, but until they know how your dog reacts, it’s best to spread them out.)
As you might expect, the cost of heartworm shots depends on how big your dog is and what your vet’s office charges for them. (Larger doses for big dogs cost more than smaller doses for little dogs, plus visit fees and labor costs.) But while shots are more expensive than oral and topical medications up front, the cost of the meds themselves work out to roughly the same price per year.
The bad: You can’t do them at home, and there’s no protection against other worms
Heartworm shots must be administered by a qualified veterinarian or technician, so you can’t do them on your own. If you’re already paying for a checkup, this is no big deal; if you need to schedule one just for the shot, it can wind up being more expensive than necessary.
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The final downside to shots is potentially the biggest: Unlike some other anti-parasitic medications, moxidectin only protects against heartworm. While heartworm disease is more dangerous than other types of parasitic infections, it’s not the only one. Hookworms can cause severe anemia; tapeworms can cause weight loss and diarrhea; roundworms can stunt a dog’s growth, making them especially dangerous for puppies. Depending on your dog’s risk factors for non-heartworm infections, your vet may recommend a combination drug that protects against more than one parasite.
There’s no universally right or wrong choice here. Heartworm shots are an ideal solution for lots of dogs, but not all of them. If you’re considering switching medications, talk to your vet first—they’ll give you the personalized advice you need to make your decision.
A doctor tends to a patient in the covid-19 intensive care unit at University Hospital Leipzig on November 18, 2021 in Leipzig, Germany.Photo: Jens Schlueter (Getty Images)
New research this week finds that people hospitalized with severe covid-19 often pay a heavy price afterward. The study concluded that these survivors were more than twice as likely to die in the subsequent 12 months compared to people who had tested negative for the virus. This relatively increased risk of death was even higher for people under the age 65.
While there remains much research to be done, studies thus far have made it clear that many covid-19 survivors can experience lingering symptoms even after the infection itself has cleared up. And those who are hospitalized are all the more vulnerable to these aftereffects. Severe covid often seriously damages the lungs and other organs, while life-saving interventions like steroids, ventilators, and life support devices like ECMO can take a toll on the body as well.
Researchers from the University of Florida had already published a study in July showing that hospitalized survivors were significantly more likely to be hospitalized again within six months, compared to those with mild to moderate covid-19. This new study of theirs, based on an examination of anonymous electronic health records, instead looked at the long-term mortality risk of patients up to a year later.
Nearly 14,000 patients in the same health care system were studied. These included 178 diagnosed with severe COVID-19 and 246 diagnosed with mild to moderate covid-19, as well as many others who tested negative for the virus but may have been sick for other reasons and received medical care in some way. Compared to covid-negative patients, and even after accounting for other factors like age and sex, those with severe covid were 2.5 times more likely to die in the next 12 months after their illness. Overall, just over 52% of severe covid patients died in a year’s time. There was no significant increased risk of mortality for mild to moderate cases, however.
“This study provides evidence that the increased risk of death from covid-19 is not limited to the initial episode of covid-19, but a severe episode of covid-19 carries with it a substantially increased risk of death in the following 12 months,” the authors wrote in their study, published Wednesday in the journal Frontiers in Medicine.
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About 20% of the deaths among these patients post-infection were attributed to problems with either the respiratory or cardiovascular system, the authors noted, the areas of the body that tend to be affected directly by infection from the coronavirus. But it’s well known that the symptoms of severe covid are often the result of an overzealous immune response, one that can wreak havoc all throughout the body. And it’s this potential for widespread damage that is likely to blame for the majority of added deaths seen in these survivors.
“Since these deaths were not for a direct covid-19 cause of death among these patients who have recovered from the initial episode of covid-19, this data suggests that the biological insult from covid-19 and physiological stress from covid-19 is significant,” they wrote.
Older people are more likely to develop severe illness and die from covid-19. But among patients in this study, the associated risk of dying was actually relatively greater for survivors of severe covid under age 65 than it was for patients over 65. Compared to similarly aged but non-infected people, they were more than three times more likely to die in the months after their hospitalization.
The results are yet another reminder that the harms of the pandemic run deeper than any official death toll can illustrate. As many as 7.5 million Americans have been hospitalized by covid-19, the Centers for Disease Control and Prevention has estimated. Given the risks that hospitalized survivors will face even after their initial ordeal, the authors say it’s “clear that prevention of significant covid-19 infection is the most effective way to decrease the risk of death following covid-19.”
A red traffic light in Moscow, Russia.Photo: Alexander Nemenow/AFP (Getty Images)
Three minutes of staring into a red light once a week may help our eyesight as we get older, new research this week suggests. Researchers in the UK found that volunteers given a weekly session with red light in the morning performed better on tests of their color vision. The findings are the latest to indicate that red light might be a cheap and easily accessible treatment for age-related declines in color vision.
Last year, researchers from University College London published the results of a small human trial involving red light therapy. Healthy volunteers were asked to stare at a red light “torch” using their dominant eye for three minutes every day for two weeks. Tests afterwards found that people over the age of 40 improved on tests meant to measure how well they could see contrast between colors—a function of the retina’s cones. Lead author Glen Jeffery told Gizmodo at the time that the findings provided a proof-of-concept for their theory.
Mitochondria are the part of the cell that produces most of its energy. But as we age, the retina’s mitochondria begin to break down faster than elsewhere, which is thought to contribute to the decline of our retina, particularly our cones, and the gradual loss of our ability to see color. “However, mitochondria absorb some forms of light, including deep red, and this recharges the battery, improving cell function—this works well in the retina because they have so many mitochondria. Hence we use this to improve vision,” explained Jeffrey.
This new research of theirs wanted to test the possible limitations of their therapy. Instead of using the light every day, they scaled it back to once a week. And they opted for a lower-energy light as well. The same wavelength of deep red light (670 nanometers) was used. The study involved 24 people between the ages of 34 and 70, all with healthy vision. Most who received the therapy were given it in the morning. Some also received it in the afternoon as part of a later experiment, and others acted as a control group. They were then evaluated on their color vision, based on tests of distinguishing color contrast, up to a week later.
Overall, those who got the treatment in the morning showed a 17% improvement in their color vision on average, even a week later. Those who got the treatment in the afternoon did not have any improvement, likely due to changes in how mitochondria reacts to light over the course of the day that the team’s past research has documented. The new study’s findings are published in Scientific Reports.
“We demonstrate that one single exposure to long wave deep red light in the morning can significantly improve declining vision, which is a major health and wellbeing issue, affecting millions of people globally,” said Jeffrey in a statement from the University College London.
The findings do support their earlier work, and they might improve the practicability of the treatment, since a once-weekly staring session is easier to stick to than a daily regimen. But the team’s promising results are still based on very small sample sizes of healthy volunteers. Larger trials would be needed to confirm any benefits of red light therapy.
Even the authors acknowledge that there are still many questions left to be answered. Some of their volunteers, for instance, had a significantly greater response to the treatment than others, even among those similarly aged, suggesting that there might be unique factors that predict how well the therapy works for any one person.
“In the near future, a once a week three-minute exposure to deep red light could be done while making a coffee, or on the commute listening to a podcast, and such a simple addition could transform eye care and vision around the world,” Jeffrey said in the University College London release.
Given its low cost (as little as $15 per device, Jeffrey previously told Gizmodo) and simplicity though, the team is excited about the potential of their therapy, should the research continue to pan out.
Cassie Holcomb learned she was pregnant in January 2021, a few weeks after COVID-19 vaccines had become available. The 35-year-old from Arlington, Virginia, had registered to get the shot before getting pregnant but ultimately waited until after giving birth to get vaccinated, due to the terrifying amount of conflicting information thrown at her. “As we went through the pregnancy, both the CDC and WHO’s recommendations changed a bunch of times, as did my doctor’s,” Holcomb told Jezebel.
During her first prenatal visit, her doctors said they weren’t recommending the vaccine; at a later appointment, they changed course and offered it to her on the spot. It seemed like a fast switch, and Holcomb wasn’t comfortable with making the decision that day. By the time she was five months pregnant, her doctors reversed course again and recommended against it. They said the vaccine wasn’t linked to miscarriage or preterm birth, but said there wasn’t information on whether it affected child development, because it was just too new. Holcomb said this was very convincing, especially since she didn’t have job-related exposure—she had worked as a pastry chef, but was laid off during the pandemic. “That’s really what solidified my decision to wait until after I gave birth to get the vaccine,” she said. “But they reversed again about 10 days before my due date.”
During that August visit, Holcomb says the doctor strongly recommended she get the vaccine that day and told her about unvaccinated pregnant people dying from COVID and their babies being admitted to the NICU. “It scared the shit out of me,” she said, but she was so close to her due date that she chose to wait. “I’m glad I waited until after, but it was scary to get through nine months with people dying trying not to get COVID,” she said. She felt embarrassed telling people she wasn’t vaccinated and always prefaced her answer with an explanation of all the back-and-forth and uncertainty she experienced.
Scenarios like this one are preventable—they happen because pharmaceutical companies exclude pregnant people from their clinical trials, and public health agencies push decision-making risks onto individual citizens. Undergirding these interlocking failures is the fetal exceptionalism in the United States and the immense amount of judgement and paternalism US society heaps on pregnant people. The lack of early safety data on pregnant people and seeming disagreement from global health agencies opened a gaping hole where anti-vaccine misinformation seeped in.
Vaccination rates among pregnant people are about half that of the adult population: 34.8 percent of pregnant people ages 18-49 are fully vaccinated as of October 23, compared to 69.8 percent of people over 18 as of November 4, according to the CDC.
Holcomb and her baby are healthy, but other families have experienced tragedy: As of November 1, at least 24,000 pregnant women were hospitalized with COVID-19, at least 218 pregnant women have died, and an unknown number had near-death ICU stays, to say nothing of unvaccinated women infected with COVID who have experienced premature births, miscarriages or stillbirths.
The exclusion of pregnant people from clinical trials is a longstanding problem, and in this case it was magnified by the fact that experts were dealing with a new virus and evolving knowledge, said Jamila Perritt, MD, MPH, an OB/GYN and the president and CEO of Physicians for Reproductive Health.
“The part that we’re not communicating really well as providers and public health folks is that what the public is experiencing is science happening in real time,” Dr. Perritt told Jezebel. “Folks are concerned, they feel like they’re hearing something different now than they did last year or last month, right? And to a certain degree, that’s true.” In the beginning of the vaccine rollout, the phrase “talk to your doctor” was everywhere for a reason, she said: Providers were “trying to support folks in making an autonomous decision in a data-free zone.”
Why Exclude Pregnant People from Clinical Research?
The disaster of the morning-sickness drug thalidomide causing birth defects in the 1960s looms over all discussions of the risks of pregnancy research, even though the FDA never approved that drug for use in the US. During the 2009 H1N1, or swine flu, pandemic, Anne Lyerly, MD, an obstetrician and bioethicist at the University of North Carolina-Chapel Hill’s department of social medicine, and others noted that flu vaccine hesitancy among some pregnant people and their providers is directly tied to the exclusion of pregnant people from clinical trials.
Dr. Lyerly told Jezebel she was hopeful at the start of the COVID-19 pandemic, because it seemed like there was heightened awareness of the need to get pregnancy-specific data as early as possible in order to help stave off reticence people might have in using medications and vaccines for the virus ripping through the country. Women and pregnancy-capable people are overrepresented among frontline workers in fields like healthcare, education, retail and hospitality, and it was clear they might be among the first to want this vaccine. The early vaccine candidates, made by Pfizer and Moderna, both used mRNA technology, which doesn’t use any live virus and doesn’t have what researchers call a “theoretical risk” to pregnant people, she said. Researchers should probably be more comfortable with the mRNA vaccines than they are with the yellow fever vaccine, which contains a live, replicating virus and is still given to pregnant people at risk of catching it.
And yet it didn’t happen: Pregnant people were barred from enrolling in the clinical trials, though some people got pregnant after enrolling. “This was a really important opportunity for pregnant people to be enrolled in the studies, but they weren’t,” Dr. Lyerly said. (Animal research is done before any humans are studied, the researchers told me, and after a few months of human trials, vaccine manufacturers could have seen that it’s safe for people generally and enrolled a separate arm of the trial that just follows pregnant people who opt to get the shot.)
At a country level, it seemed we learned nothing from a decade prior. We are still, Dr. Lyerly said, protecting pregnant people to death. “Pregnant people have been protected from research rather than being protected through research, which is how we attend to most other populations,” Dr. Lyerly said.
The exclusion creates a catch-22 where risk concerns keep pregnant people out of the very trials that are needed to recommend treatments for them, said Geeta K. Swamy, MD, professor of obstetrics and gynecology at Duke University, who’s also a member of the American College of Obstetrician and Gynecology’s COVID-19 expert working group. “You’re basically punishing pregnant women from the beginning,” Dr. Swamy told Jezebel. (Pfizer did start a study with pregnant women in February 2021, but it’s a randomized, placebo-controlled trial. “Why would you go get a placebo when we know that a vaccine is already working?” Dr. Swamy asked.)
ACOG and other groups were meeting with officials from the CDC, NIH, and FDA about including pregnant people in trials, but “no one really picked up this charge and carried it forward,” Dr. Swamy said. “That’s just a fact, otherwise we wouldn’t be where we are today. I don’t mean they didn’t care, and I don’t mean that they were indifferent and they didn’t understand it was a problem, but they just didn’t, for whatever reasons.” In her view, the government should pass legislation requiring researchers to justify why they aren’t enrolling pregnant people. As Dr. Perritt said, “the data that we have now about the vaccine and pregnancy is not because people were enrolled in the trials during pregnancy, but because they happened to get pregnant.”
One possible reason for this research exclusion is doctors and the state prioritizing the fetus ahead of the person carrying it when thinking about the risks of medications, vaccines, and other interventions, Dr. Lyerly said. It’s a problematic kind of protection—a misprotection, even—where researchers and government agencies ignore the fact that the health of the two beings are intertwined, and inadequate treatment can be dangerous for both. “People fail to also recognize that the best way to take care of the health of the child is to make sure its mother is as healthy as possible,” she said.
Even well-meaning people and groups sharing information around pregnancy do things that Dr. Lyerly said are “highly problematic.” In January 2021, the CDC said pregnant women should talk to their doctors about the vaccine, but at the same time, the WHO said pregnant people shouldn’t get the shot unless they were at high risk of contracting COVID because of their jobs or preexisting health conditions. The WHO message was bad for leading with precaution, rather than emphasizing the benefits of protection from the virus, she said, but the CDC’s tack wasn’t great either. “People will talk to their doctors,” she said, “but there isn’t a particular reason or set of circumstances that people should parse through with their doctor that could lead to a reasoned decision not to get vaccinated based on science.”
“Talk to your doctor” language is “in some ways an effort to sort of push responsibility for any imagined risk away from the organization and into the realm of the pregnant person and her doctor, which isn’t really fair, frankly,” Dr. Lyerly said.
One task force, which included ACOG, took a better approach, releasing guidance in February that pregnant people who want the vaccine shouldn’t be denied it by their healthcare providers—a step the Centers for Disease Control and Prevention did not take. ACOG recommended the vaccine for pregnant people at the end of July, and the CDC recommended it on August 11, shortly before the Pfizer vaccine got full FDA approval. The CDC updated its language on September 29 to “strongly” recommend the shot after seeing more pregnant people hospitalized during the late summer. When the CDC did recommend “urgent action” to get pregnant people vaccinated, it was via a rare health advisory, and Dr. Lyerly said she just wished they’d done it sooner. “A lot of pregnant people—nearly 160 at that point—had already died.”
Maven Clinic, a virtual clinic for women’s and family health, commissioned a representative survey in mid-October of 500 pregnant people in the US and the results are illuminating: Just 39 percent of respondents said they knew the CDC recommends all pregnant people get the vaccine, two full months after the agency had done so, and only 29 percent said they knew that pregnant people are more likely than others to get severely ill from COVID. Nearly 70 percent of people surveyed said at least one source advised they not get the vaccine during pregnancy and, of those people, 29 percent said a medical provider made that suggestion. (In September, Mississippi’s state health officer issued a standing order for pharmacists to vaccinate pregnant people after reports that some had refused to do so.)
Despite loadsoffact–checking, a mere 35 percent said they knew the vaccine doesn’t cause infertility. The myths still persist and gain news coverage: In October, ESPN reporter Allison Williams announced she was leaving the network over concerns that its vaccine requirement would affect her future fertility, when there is no evidence of fertility problems. Days later, right-wing site The Daily Wire announced that Williams was coming on board to host a new series billed as “sports without the woke.”
The genuine vaccine hesitancy some people experienced around pregnancy due to the botched vaccine information rollout has, in effect, given birth to a more toxic brand of anti-vaxxer propaganda that is not based at all in science or reasonable thought.
The Specter (and Guilt) of Pregnancy Loss
There’s also another subconscious reason why some pregnant people are hesitant to get the vaccine, Dr. Perritt says: internalized guilt over pregnancy loss that is rampant in our culture. “So: ‘You made the decision to move forward in this way, and it harmed your baby, and that was your fault,’” she said. “There is a really tight association between othering and punishing pregnant people that I think is deeply embedded in this and never discussed in this vaccine debate.”
Black and brown pregnant people may not only face individual guilt, but they are more likely than white women to be criminalized for their pregnancy outcomes, Dr. Perritt said. In one recent Oklahoma case, a 21-year-old Native American woman, Brittany Poolaw, was convicted of first-degree manslaughter and sentenced to four years in prison after a miscarriage. (Poolaw had tested positive for drugs and the fetus had congenital abnormalities but even experts involved in the case said it was unclear what caused the miscarriage and the drugs weren’t directly responsible). While this case involved illicit substances, “whether you’re incarcerated or just simply stigmatized and blamed, I think that it’s all part and parcel of the same culture,” Dr. Perritt says. And without the (limited) protections of Roe v. Wade, even more pregnant people will be charged for miscarriages and stillbirths.
For Black women, layered on top of these concerns is the historical and often personal experience of medical providers doing them harm. “It’s not enough to say [to pregnant Black women] ‘oh go get vaccinated,’” Dr. Perritt said. “There are lots of complicated reasons why people may or may not interact with the health care system.”
Holcomb, who is white, also felt guilty when making her choice to wait to get the vaccine, noting that pregnant people are surveilled and judged when they so much as drink a cup of coffee in public. “People are so judgmental of decisions you make now,” she said. The vaccine was one of many loaded decisions. “If you got the vaccine and something did happen to your child, what does that look like?” Holcomb said. “The amount of guilt that comes along with making that decision is just tremendous.”
While she would have felt guilty for getting it, she also felt bad for waiting—it was a lose-lose situation. “I felt irresponsible for not being vaccinated. But at the same time, I did feel like it was the best decision I could make with the information that I had for my daughter,” Holcomb said, adding that she would have gotten vaccinated before giving birth if she had gotten pregnant later when there was more data available.
And the flip-flopping doctors did not help. “I could have been told not to get it at the same time somebody else could have been getting told, ‘absolutely get it.”
Dr. Swamy said we will keep having these problems until pharmaceutical companies are forced to update their practices. “If we never enroll [pregnant people] in trials, we will never improve upon pregnancy itself. We will never be able to get to a place where we have healthier mothers and healthier babies,” she said. Without it, “I’m not sure we’re going to see a significant sea change.”