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Face shields a potential alternative to masks, experts say

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Hundreds of millions of Americans heeded recent government advice and rushed to wear cloth face masks, hoping they might prevent transmission of the new coronavirus.

But there’s another option: The clear plastic face shield, already in use by many health care personnel.

Now, a team of experts say face shields might replace masks as a more comfortable and more effective deterrent to COVID-19.

“Face shields, which can be quickly and affordably produced and distributed, should be included as part of strategies to safely and significantly reduce transmission in the community setting,” said a trio of physicians from the University of Iowa.

Reporting in the April 29 Journal of the American Medical Association, experts led by Dr. Eli Perencevich, of the university’s department of internal medicine, and the Iowa City VA Health Care System, said the face shield’s moment may have come.

While the U.S. Centers for Disease Control and Prevention began advocating the use of cloth masks to help stop COVID-19 transmission in April, laboratory testing “suggests that cloth masks provide [only] some filtration of virus-sized aerosol particles.”

According to Perencevich’s group, “face shields may provide a better option.”

To be most effective in stopping viral spread, a face shield should extend to below the chin. It should also cover the ears and “there should be no exposed gap between the forehead and the shield’s headpiece,” the Iowa team members said.

Shields have a number of advantages over masks, they added. First of all, they are endlessly reusable, simply requiring cleaning with soap and water or common disinfectants. Shields are usually more comfortable to wear than masks, and they form a barrier that keeps people from easily touching their own faces.

When speaking, people sometimes pull down a mask to make things easier — but that isn’t necessary with a face shield. And “the use of a face shield is also a reminder to maintain social distancing, but allows visibility of facial expressions and lip movements for speech perception,” the authors pointed out.

And what about the ability of a face shield to prevent coronavirus transmission?

According to the Iowa team, large-scale studies haven’t yet been conducted. But “in a simulation study, face shields were shown to reduce immediate viral exposure by 96 percent when worn by a simulated health care worker within 18 inches of a cough.”

“When the study was repeated at the currently recommended physical distancing distance of 6 feet, face shields reduced inhaled virus by 92 percent,” the authors said.

No studies have yet been conducted to see how well face shields help keep exhaled or coughed virus from spreading outwards from an infected wearer, Perencevich and his colleagues said, and they hope that studies on that issue will be conducted.

And they stressed that face shields should only be one part of any infection control effort, along with social distancing and hand-washing.

There will never be any intervention — even a vaccine — that can guarantee 100 percent effectiveness against the coronavirus, the authors said, so face shields shouldn’t be held to that standard.

Dr. Robert Glatter is on the front lines of the COVID-19 pandemic in his role as emergency physician at Lenox Hill Hospital in New York City. Reading over the new report, he agreed that “common sense” measures are crucial in curbing infections.

“One approach that makes the most sense, especially in light of the limitations of face masks and face coverings, is the use of face shields,” Glatter said.

“While we don’t have hard trials or data on the efficacy of face shields at this time, early data from their use in patients with influenza [which is droplet-spread] is promising,” he noted. “What’s clear is that their success in hospital settings provides the basis for their utility in the community setting as we relax physical distancing going forward.”

More information

The U.S. Centers for Disease Control and Prevention has more on the new coronavirus.

Copyright 2020 HealthDay. All rights reserved.



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Study finds differences in heart failure trends between former East, West Germany

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July 1 (UPI) — Differences in heart health between people in the eastern and western parts of Germany show a long-term effect of the Berlin Wall on the country, according to new findings presented Wednesday on HFA Discoveries.

Germany was divided in the aftermath of World War II, and different healthcare structures developed in East and West Germany. The country became unified again in 1990, but new research shows effects of the decades-long separation persist, researchers say.

From 2000 to 2017, the absolute number of hospital admissions due to heart failure throughout Germany increased continuously by nearly 94 percent — to approximately 465,000 from just under 240,000 — researchers said.

However, the increase was much higher, at 119 percent, in the region that once encompassed East Germany, compared to just over 88 percent in the region once known as West Germany, they said.

Study co-author Marcus Dörr, a professor at the University Medicine Greifswald in Germany, said differences between the two regions in prevalence of heart failure risk factors may explain the findings.

“In fact, previous research has shown that, for example, hypertension, diabetes and obesity are much more common in East than in West Germany,” Dörr said in a press release.

In addition, lingering differences in patient care, as well as in the management of healthcare systems between the two regions, still might exist, Dörr said.

In general, heart failure is the most common reason for hospital admissions in the United States, Germany and much of the world, he said.

For their research, Dörr and his colleagues analyzed data from the Federal Health Monitoring project, an annual census of routine health data in Germany, for 2000 through 2017.

Heart failure was the leading cause of disease-related hospitalization in Germany in 2017, they found.

However, heart failure hospitalization rates nearly doubled in the former East Germany — to 2.9 percent from 1.5 percent — from 2000 to 2017, while it increased to 2.2 percent from 1.4 percent in the former West Germany over the same period, the researchers said.

While the overall length of hospital stays decreased continuously over the same period, the total number of heart failure-related hospital days increased by 51 percent in East Germany, compared to 35 percent in West Germany.

In 2017, heart failure was by far the leading cause of in-hospital death across Germany, accounting for 8.2 percent of deaths, they found.

However, in the region that once was East Germany, heart disease caused 65 deaths per 100,000 inhabitants in 2017, compared to 43 deaths per 100,000 inhabitants in the former West Germany, they said.

The differences may have to do with the average age of people in East Germany — four years older than it is in the West — but the differences in heart failure-related parameters were similar after standardization, the researchers said.

Before reunification in 1990, East and West Germany had distinct healthcare systems, Dörr said. The system in East Germany was essentially run by the state, with less than 1 percent of physicians working in private practice, and there were often shortages of technical equipment, he said.

“Since 1990, both regions have the same federal healthcare system with more physicians in private practice and similar clinical care pathways” Dörr said. “More research is needed to explain the huge differences observed between East and West Germany.”



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Discrimination increases hypertension risk by 49 percent in black Americans, study finds

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July 1 (UPI) — Facing racial discrimination increases risk for high blood pressure among black Americans, according to a study published Wednesday by the journal Hypertension.

Black people who reported “medium levels” of lifetime discrimination had a 49 percent increased risk for high blood pressure, or hypertension, compared to those who indicated low levels of lifetime discrimination, the researchers found.

The study was based on nearly 2,000 black Americans who participated in The Jackson Heart Study, which focused on cardiovascular disease among residents in the tri-county region of Jackson, Mississippi.

“African Americans continue to be disproportionately affected by hypertension, making it imperative to identify the drivers of hypertension in this population,” co-author Allana T. Forde, said in a statement.

“Greater lifetime discrimination was associated with an increased risk for hypertension among African Americans in this study, which reflects the impact of cumulative exposure to stressors over one’s lifetime and the physiological reactions to stress that contribute to deleterious health outcomes,” said Forde, a postdoctoral research fellow at the Urban Health Collaborative at Drexel University.

Forde and colleagues reviewed data on 1,845 black Americans, aged 21 to 85, who were enrolled in The Jackson Heart Study. None of the participants had a history of hypertension at the start of the research, the authors said.

Participants self-reported their discrimination experiences through in-home interviews, questionnaires and in-clinic examinations, researchers said.

For the purposes of the study, having hypertension was defined as taking blood pressure-lowering medication, having a systolic blood pressure of 140 mm Hg or above or having diastolic blood pressure higher than 90 mm Hg at follow-up visits, according to the authors.

During the follow-up period, more than half of the participants — 954, or 52 percent — developed hypertension.

The study results, Forde said, “suggest how social determinants such as racism and discrimination affect health in measurable ways.”

Strategies to reduce health inequities and improve health are needed to address these broader social determinants, she added.

Although the study included experiences of discrimination among a large sample of black Americans, discrimination was measured at a single point in time, which limited the researchers’ ability to capture changes in discrimination experiences over the entire follow-up period, according to the researchers.

In all, nearly 80 million American adults are living with high blood pressure, including more than 40 percent of black Americans, according to the American Heart Association.

“Previous studies have shown that discrimination affects African Americans’ health,” Forde said.

“Traditional risk factors, such as diet and physical activity, have been strongly correlated with hypertension, yet important psychosocial factors like discrimination, which also have the potential to negatively impact health, are rarely considered,” she said.



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Official COVID-19 count may underestimate deaths by 28 percent

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July 1 (UPI) — Official counts of COVID-19 cases in the United States may underestimate deaths by as much as 28 percent, according to an analysis published Wednesday by JAMA Internal Medicine.

From March 1 through May 30, an estimated 122,300 Americans died after being infected with the new coronavirus, SARS-CoV-2, the researchers said. That’s higher than the Center for Disease Control and Prevention’s tally of 95,235.

The difference is based on the researchers’ assessment of “excess deaths” across the country — the actual number of reported deaths compared to figures from the same period for the previous five years.”

There have been questions about whether the reported statistics overcount COVID-19 deaths, but our analyses suggest the opposite,” study co-author Daniel Weinberger, an associate professor of epidemiology at Yale University School of Medicine, told UPI.

“The number of reported COVID-19 deaths likely represents an undercount of the true burden caused by the virus.”

Analyses of “excess deaths” have been used to estimate deaths caused by infectious diseases in the past, including pneumonia, the flu and HIV, according to Weinberger and his colleagues.

As of Wednesday morning, nearly 2.7 million people in the United States have been diagnosed with COVID-19, and more than 127,000 have died, according to figures from Johns Hopkins University.

CDC officials acknowledged last week that the total number of people actually infected with COVID-19 may be 10 times higher than official estimates because many who are infected don’t experience symptoms and don’t know they have it.

For the study, researchers reviewed mortality data from the CDC’s National Center for Health Statistics.They compared the “expected” number of deaths for the period — based on an average of totals for 2015-19 — and compared it to the total for 2020. The period covers the peak of the COVID-19 outbreak so far in parts of the United States.

The excess deaths for the three-month period in 2020 could be attributed to COVID-19, but may also be influenced by “people avoiding care for emergency medical conditions, like heart attacks,” as well as declines in certain categories of deaths, like car accidents, Weinberger said.

“Excess deaths can provide useful information in addition to the traditional statistics that are based on laboratory testing, [but] the data need to be interpreted with caution,” Weinberger said. “Looking at changes in deaths due to any cause provides a more complete picture of the epidemic.”



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