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COVID-19 ‘immunity passports’ pose range of issues

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A grieving widower played by Matt Damon flashes a shiny coded wristband for security guards to scan in the 2011 movie “Contagion.”

After a quick beep and a green light, Damon is allowed into a store to buy a prom dress for his daughter.

That wristband was an “immunity passport” — a certification of his character’s immunity to the movie’s deadly virus.

With fiction quickly becoming reality, immunity passports are now being touted as a means to reopen the world following COVID-19 lockdowns. But experts worry that a host of practical and ethical problems make the concept unworkable and potentially dangerous to privacy and liberty.

Governments and private businesses are currently developing similar programs that would allow people who have proven immunity against COVID-19 to move freely about, without hewing to social distancing guidelines or public health measures.

For example, Chile is issuing three-month “medical release certificates” to people who have recovered from COVID-19, and Britain has announced plans to issue “antibody certificates” to those who test positive for coronavirus antibodies.

The private sector is moving even more rapidly toward adopting immunity passports, said Natalie Kofler, a lecturer with Harvard Medical School’s Center for Bioethics.

“You have these private companies developing these immunity passport apps,” Kofler said. “You have them partnering with other private businesses to help them use these immunity passports as ways to limit access either for customers or employees.”

But there are fundamental problems with these immunity passports, in terms of how they would work and how they would be used, Kofler and other experts say.

Antibodies may equal immunity

At this point, medical science can’t even say whether a person who has recovered from COVID-19 is indeed immune from the disease, or if the presence of coronavirus antibodies in your bloodstream conveys any level of immunity, said Gigi Kwik Gronvall, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore.

For example, people might need a certain level of coronavirus antibodies in their blood to be immune, Gronvall said. Immunity might not even depend on antibodies at all instead, other factors like the immune system’s innate memory might be the only thing that would prevent reinfection.

Worse, the accuracy rate of current antibody tests is so iffy that a person without immunity might actually get a false positive, getting a passport they shouldn’t have and increasing their risk of catching and spreading the virus, Kofler said.

Guidelines issued last week by the U.S. Centers for Disease Control and Prevention state that given their lack of accuracy, antibody test results “should not be used to make decisions about grouping persons residing in or being admitted to congregate settings, such as schools, dormitories, or correctional facilities,” or to “make decisions about returning persons to the workplace.”

“While I do think that there is a degree of immunity that individuals who have recovered from COVID possess, it will be very hard to operationalize an immunity passport,” agreed Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
“There are many questions about immunity, including its duration, its durability, and how to measure it that makes it difficult to rely completely on. That said, I do believe those with antibodies — as assessed by a highly specific test — do have some protection for a period of time from reinfection,” Adalja said.

Even if antibody tests say something meaningful, there’s not nearly enough access to testing to conduct an immunity passport program in a fair manner, said Françoise Baylis, a professor of ethics at Dalhousie University in Nova Scotia, Canada.

Nations would need at least double as many test kits available as there are citizens in their country, to conduct an equitable program, she said.

“In theory, you test everybody once, but not everybody is going to test as having been exposed to the virus and having recovered from COVID-19,” Baylis said. “So you’ve got to at least offer people a second chance, right? That gets you to two tests. People might fail this on the second attempt as well, so you’re going to have to be constantly able to test your population.”

There are 38 million people in Canada, but that country has said it would only be able to conduct 1 million antibody tests within the next two years, Baylis noted.

“What happens to the other 37 million Canadians?” she asked.

The United States would need even more tests — 660 million tests at minimum, to offer at least two opportunities for each of the country’s 330 million residents.

A small percentage infected

Additionally, too few people have been infected with COVID-19 at this point to make immunity passports a linchpin for reopening the economy in the United States or elsewhere.

Only 2 percent to 3 percent of the global population has recovered from the coronavirus, Kofler noted.

“A business isn’t going to want only 1 percent to 2 percent of their customers able to enter their store,” Kofler said. “You’re not going to be able to run a business if only 1 percent to 2 percent of your employees are able to work freely.”

Baylis noted that even in COVID-19 hotspots, only 15 percent to 30 percent of people have recovered from infection.

“You don’t reopen the economy with 30 percent of your population,” Baylis said.

Beyond those practical concerns, there also are ethical roadblocks to instituting an immunity passport program, experts said.

Privacy is a problem

A physical passport worn by a recipient would “make it very easy to tell across the street if somebody has a wristband that signifies them as immune or not immune,” said Dakota Gruener, executive director of the ID2020 Alliance, a global public/private alliance focused on the development of digital ID programs.

Gruener said many also are uncomfortable with the notion of centralized databases maintained by government organizations that would be “pinged” every time someone is asked to prove their COVID-19 immunity.

Gruener favors a decentralized system, where a person would carry their immunity passport around with them on their smartphone.

“Your data remains your own, stored locally on your own device,” Gruener said.

But what if you don’t have a smartphone because you can’t afford one? What if you can’t afford to be tested in the first place? Economic concerns like these would put people who earn less money at a disadvantage, Baylis said.

Experts also are concerned that authorities would use immunity passports as one more means of harassing blacks and other minorities, promoting “stop-and-frisk” policies.

“We see this as one more reason to stop somebody who’s freely walking about to be able to demand, ‘Do you have the right certification to be out in public?'” Baylis said.

These sort of concerns are being bulldozed by companies eager to get folks back to work, Gruener said, and officials and ethicists need to work with private firms to make sure these problems are addressed.

But Baylis countered that any efforts by private companies to develop immunity passports should be halted, rather than accommodated.

“It’s wrong to allow the private sector to answer that question for us and then to think that society, by its governance, just has to respond by putting parameters that would somehow satisfy certain kinds of ethical or social concerns,” Baylis said.

“The first question is whether we should be doing this,” Baylis said. “Only when you answer that question in the affirmative do you then move on to the second series of questions about how we do this ethically.”

More information

The U.S. Centers for Disease Control and Prevention has more about COVID-19.

Copyright 2020 HealthDay. All rights reserved.



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Low-dose electrical stimulation helps adults with dyslexia read, study finds

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Sept. 8 (UPI) — Electrical stimulation of the brain improves reading accuracy in adults with dyslexia, according to a study published Tuesday by PLOS Biology.

Transcranial alternating current stimulation, a non-invasive procedure that delivers low-dose electricity to the brain over a period of 20 minutes, was found to improve phonological processing — or ability to discern how words sound or are pronounced — and reading accuracy in 15 adults with dyslexia, the researchers said.

The beneficial effect on phonological processing was most pronounced in those individuals who had poor reading skills, while a slightly disruptive effect was observed in very good readers, they said.

Dyslexia, known commonly as a reading disorder, affects up to 10% of the population, and is characterized by lifelong difficulties with written material,” according to the researchers, who are from the University of Geneva in Switzerland.

Although several possible causes have been proposed for dyslexia, the predominant one is a phonological deficit, or a difficulty in processing word sounds, the researchers said.

The phonological deficit in dyslexia is associated with changes in rhythmic or repetitive patterns of electrical activity in the brain, specifically “low-gamma” oscillations, measuring at 30 hertz or volts, in the left auditory cortex, they said.

However, studies have yet to prove that these these oscillations affect a person’s ability to process word sounds and cause dyslexia, the researchers said.

For this study, the researchers applied transcranial alternating current stimulation over the left auditory cortex in 15 adults with dyslexia and 15 fluent readers for 20 minutes.

At a dose of 30 hertz or volts, the approach resulted in significant improvement in reading accuracy in those with dyslexia, the researchers said.

However, the same improvements were not seen following application of a higher, 60-hertz dose, they said.

The results demonstrate for the first time that low-gamma oscillatory activity causes deficits in phonemic processing and may pave the way to non-invasive treatments aimed at normalizing oscillatory function in auditory cortex in people with dyslexia, the researchers said.

They plan “to investigate whether normalizing oscillatory function in very young children could have a long-lasting effect on the organization of the reading system [and] explore even less invasive means of correcting oscillatory activity,” study co-author Silvia Marchesotti, a post-doctural researcher at the University of Geneva, said in a press release.



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Surgery may help sleep apnea patients who struggle with CPAP

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Continuous positive airway pressure may be the go-to treatment for sleep apnea, but many people struggle to use it every night. For those who cannot tolerate CPAP, new research finds that a combination of surgical techniques may bring relief.

The “multilevel” treatment includes removing the tonsils, repositioning the palate — roof of the mouth — and using radiofrequency to slightly reduce the size of the tongue. In combination, these procedures open up the airway and reduce breathing obstruction, the researchers said.

The study found that the multilevel surgery technique reduced the number of times people stopped breathing — apnea events — during sleep and improved daytime sleepiness. People also reported better quality of life after the treatment.

“Obstructive sleep apnea is common and many people cannot use the main treatments, like CPAP masks. Surgery is a valid option when an expert surgeon is involved, and it can improve outcomes,” said the study’s lead author, Dr. Stuart MacKay. He’s an honorary clinical professor of otolaryngology, head and neck surgery at University of Wollongong, in Australia.

The researchers said that nearly one billion people worldwide suffer from sleep apnea. The airway becomes blocked during sleep, and as a result people stop breathing for short periods of time, multiple times throughout the night. People with sleep apnea have a higher risk of daytime sleepiness, motor vehicle crashes, and heart disease and stroke.

CPAP does a good job at keeping your airway open as you sleep, but the treatment — including a mask and a long tube — can be hard to get used to. The study authors said only about half of people with sleep apnea try CPAP.

For the new study, the researchers recruited 102 overweight or obese people with sleep apnea from six clinical centers in Australia, who were in their 40s, on average. The goal was to see if surgery could help adults with moderate or severe obstructive sleep apnea who weren’t able to tolerate or adhere to CPAP devices.

Half of the volunteers were randomly assigned to receive the sleep apnea surgery, while the other 51 continued with medical treatment. Medical management consisted of encouraging weight loss, drinking less alcohol, changing sleep posture and medical treatment for nasal obstruction.

MacKay said the multilevel surgical technique is widely available in many parts of the world. For the patients in this study, surgeries were performed by seven experienced surgeons.

Six months after the surgical procedures, volunteers in the surgery group had about a 27% decrease in the number of apnea events at night. Those on medical treatment had just a 10% decrease.

People in the surgical group also had major improvements in levels of snoring and daytime sleepiness, as well as a boost to quality of life.

As with any surgical procedure, there are risks.

“The main risks of pain and bleeding are confined to the two weeks after surgery. Bleeding occurs in about one in every 25 patients. Long-term risks related to taste disturbance, feeling of sticking in the throat, swallow dysfunction are very rare, although they do occur transiently in some,” MacKay said.

Dr. Steven Feinsilver is director of the Center for Sleep Medicine at Lenox Hill Hospital in New York City. He said, “Sleep apnea is a very common disease, about as common as diabetes, and similar to diabetes is associated with increased risk for cardiovascular events, such as stroke and heart disease.”

He added that “CPAP works, but is a difficult treatment.”

Feinsilver said that surgery that could provide a permanent cure has long been the goal for treatment.

“This study shows that relatively minor surgery, performed in a standardized fashion by skilled surgeons, can significantly improve sleep apnea compared to ‘medical treatment’ (essentially no treatment),” he said.

But he noted that even though people reported improvement, their nighttime breathing wasn’t back in the normal range.

“This is certainly a major improvement, but it remains unclear whether outcomes (such as cardiovascular risk) will be significantly impacted,” Feinsilver said. Also, he suggested that this multilevel surgery may only be an option for a select group of patients.

The report was published online Sept. 4 in the Journal of the American Medical Association.

More information

Learn more about sleep apnea treatments from the U.S. National Heart, Lung, and Blood Institute.

Copyright 2020 HealthDay. All rights reserved.



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COVID-19-related heart, lung issues ease over time in survivors, study shows

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Long-term heart and lung damage can occur in COVID-19 patients, but it may ease with time, according to a new study.

A second study found that COVID-19 patients recover faster if they begin rehabilitation as soon as possible after getting off a respirator or leaving intensive care.

“The bad news is that people show lung impairment from COVID-19 weeks after discharge the good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves,” said researcher Sabina Sahanic, a clinical Ph.D. student at University Clinic in Innsbruck, Austria.

“The findings from this study show the importance of implementing structured follow-up care for patients with severe COVID-19 infection. Importantly, CT unveiled lung damage in this patient group that was not identified by lung function tests,” she said.

Both studies were presented at a virtual meeting of the European Respiratory Society.

Sahanic’s research included 86 hospitalized COVID-19 patients in Austria who were enrolled between April 29 and June 9.

The patients, average age 61, were evaluated six, 12 and 24 weeks after leaving the hospital. At their first visit, more than half had at least one persistent symptom — mainly breathlessness and coughing. CT scans showed that 88% still had lung damage.

By their second visit at 12 weeks, patients’ symptoms had improved and 56% had signs of lung damage. Findings from the evaluations at 24 weeks weren’t available yet.

“Knowing how patients have been affected long-term by the coronavirus might enable symptoms and lung damage to be treated much earlier and might have a significant impact on further medical recommendations and advice,” Sahanic said in a meeting news release.

The other study included 19 patients with severe COVID-19. They spent an average of three weeks in intensive care and two weeks in a pulmonary ward before being transferred to a clinic for about three weeks of pulmonary rehabilitation.

A walking test evaluated their weekly progress. At the start of rehab, they could walk only an average of 16% of the distance they should manage to walk if healthy.

That average increased to 43% after three weeks of rehab. While a significant improvement, it’s still far below normal, the researchers noted.

“The most important finding was that patients who were admitted to pulmonary rehabilitation shortly after leaving intensive care progressed faster than those who spent a longer period in the pulmonary ward where they remained inactive,” said study author Yara Al Chikhanie. She’s a Ph.D. student at the Dieulefit Santé clinic for pulmonary rehabilitation and the Hp2 Lab at Grenoble Alps University in France.

“The sooner rehabilitation started and the longer it lasted, the faster and better was the improvement in patients’ walking and breathing capacities and muscle gain,” Al Chikhanie said in the release.

Patients who started rehabilitation in the week after coming off their ventilators progressed faster than those who were admitted after two weeks, she added. But how soon they can start rehab depends on when their doctors deem them medically stable.

“Despite the significant improvement, the average period of three weeks in rehabilitation wasn’t enough for them to recover completely,” Al Chikhanie said.

Data and conclusions presented at meetings are usually considered preliminary until peer-reviewed for publication in a medical journal.

More information

The U.S. Centers for Disease Control and Prevention has more on COVID-19.

Copyright 2020 HealthDay. All rights reserved.



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