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How Hospitals Can Assist Sufferers and the Planet

How Hospitals Can Help Patients and the Planet

This article is part of our new series on the Future of Healthcare, which examines changes in the medical field.

As climate change evolves from a model of the future to a reality of the present, health systems across the country are facing tough questions. What should doctors do when forest fires, rising floods, or other natural disasters endanger their ability to care for patients? How can these institutions be resilient in the face of these disasters?

For Ramé Hemstreet, these are not abstract questions. Mr. Hemstreet is Vice President of Operations and Chief Sustainable Resources Officer for Kaiser Permanente, the California-based healthcare system. The state is already addressing the effects of climate change: During the Northern California wildfires in 2017 and 2019, Kaiser Permanente had to evacuate more than 100 patients from a Santa Rosa facility and find a way to care for the surrounding communities.

“The climate crisis is a human health crisis and we already live that in California,” said Hemstreet.

For the past decade, Mr. Hemstreet and his colleagues at the company have attempted to remove it from fossil fuels in an attempt to largely reduce the company’s contribution to climate change. However, it has also become clear that fossil fuel dependency is an obstacle to health care as the effects of climate change are increasingly part of the lived experience of many Americans.

Hospitals and health systems across the country are trying to answer the key question of how to care for patients when climate change threatens their ability to keep hospitals open. Many of the changes to improve resilience are not lean, technically advanced responses to crisis. Rather, they often represent sensible solutions: relocation of technical equipment from basements, in which floods could damage them, to higher floors; Arranging patient transfers before disasters; Improving energy efficiency; better air filters; and more backup systems and redundancies, just in case.

Since 2012, Boston Medical Center has reduced its energy use by nearly 40 percent and its greenhouse gas emissions from all energy sources by 90 percent while caring for more patients. Some of these savings can be attributed to a CHP power and heat plant that is 35 percent more efficient than the electricity supplier, who uses their energy needs separately. The hospital also bought enough solar power from a solar farm in North Carolina to cover all of its electricity.

BMC, the largest safety net hospital in New England serving the uninsured and underinsured community in the Boston area, has expanded its sustainability efforts beyond renewable electricity and heating, including a rooftop garden in the hospital that grows about 6,000 pounds of food a year for its pantry, stationary meals, and a hospital farmers’ market, and a biodigester that converts food waste into water.

Robert Biggio, an engineer who served in the Merchant Navy and is now senior vice president of facilities and support services for the hospital, learned resilience on the high seas. “People can’t reach you on a ship in the middle of the sea,” he said. “You don’t have a choice to be resilient.”

While it is often argued that sustainability and climate friendliness are too expensive, all system upgrades – including a cogeneration power plant and a cooling system with chilled water circuit instead of an expensive new tower – have saved BMC, a non-profit, significant amount of money.

“Waste reduction is more efficient and also improves resilience,” said Biggio. “They go hand in hand.”

Healthcare in the United States is responsible for an enormous amount of waste and a significant amount of greenhouse gas emissions. For every hospital bed, the American healthcare system produces about 30 pounds of waste every day. Overall, it accounts for around 10 percent of national greenhouse gas emissions.

Much of the waste comes from the shift towards disposable items for single use, apart from personal protective equipment, which is intended for single use only. Many hospitals use outside companies to clean and reprocess many of these items. Kaiser Permanente has committed to recycling, reusing or composting 100 percent of its non-hazardous waste by 2025.

In terms of greenhouse gas emissions, hospitals need to have backup power, usually provided by diesel generators. These run on fossil fuels and produce particulate matter known as PM 2.5, which contributes to asthma and other diseases. The air quality in hospitals, which have to test their generators regularly, is often poor.

A recent study found that colored people are more exposed to PM 2.5 from all sources compared to whites, and black Americans are most affected. As a result, these communities, which often do not have access to health care, are more likely to suffer the health consequences of this exposure. PM 2.5 is also responsible for 85,000 to 200,000 deaths per year in the US (according to the study), and long-term exposure to PM 2.5 correlates with hospitalization from Covid-19.

During the fire season and heatwaves, power may go out or utilities may turn off power to avoid sparks or system-wide blackouts. Both mean that hospitals have to be operated with their generators.

That hospitals are partially responsible for this pollution is an unacceptable irony, said Hemstreet.

Kaiser Permanente has been buying supply-scale renewable energy since 2015 and signed a contract in 2018 to purchase 180 megawatts of wind and solar energy and 110 megawatts of battery storage, which is currently under construction. Since 2010, the company has installed 50 megawatts of solar power in its systems and is installing a 9-megawatt-hour battery on the company’s campus in Ontario, California, which can be used to completely take most of the system off the grid.

In New York City, space constraints and less sunshine make ambitious installations difficult, but heatwaves present a similar challenge – the possibility of power outages and rolling outages that turn off air conditioning, with higher temperatures putting some older adults and the sick, in particular, at risk.

Like BMC, NYU Langone Health has built a cogeneration power plant for air conditioning powered by electricity, heat and steam. It’s 50 percent more efficient than electricity, according to Paul Schwabacher, senior vice president of facility management at NYU Langone.

Construction of the CHP plant was in progress prior to Hurricane Sandy in 2012, which was an eye-opening experience for the hospital system. During the storm, the flood reached the lower floors of the hospital, leaving 15 million gallons of contaminated water. More than 300 patients had to be evacuated from the hospital, including newborns in the intensive care unit who were carried down many flights of stairs by doctors and nurses.

The hospital was closed for two months after the storm. During that time, about 100 electricians were working on repairs, Schwabacher said. “We made lemonade,” he said, adding that they did repairs that would have been much more difficult with the hospital open, like cleaning all of the air ducts. They also rebuilt and expanded the emergency room, which was flooded during the storm.

Since then, the hospital has built a new building and restored older ones.

However, NYU Langone’s biggest effort towards resilience is new flood barriers around campus designed to protect against a storm surge seven feet above the level caused by Hurricane Sandy. The campus also has a 12-foot steel storm barrier on the loading ramp that can be raised hydraulically or manually. Valves on drains and sewers to prevent backflows outside the streets from being flooded; and steel gates and doors to contain the flood at critical points throughout the facility.

But building walls are not going to keep the effects of climate change away. This will be due to the reduction in greenhouse gas emissions across society, Schwabacher said.

“We are very, very confident that we will be protected, but we know that the next disaster will be different from the last.”

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Health

Vaccines Received’t Defend Thousands and thousands of Sufferers With Weakened Immune Programs

Vaccines Won’t Protect Millions of Patients With Crippled Immune Systems

Dr. Andrew Wollowitz has been at the monastery for the most part at his Mamaroneck, NY home for more than a year

As medical director for emergency medicine at Montefiore Medical Center in the Bronx, 63-year-old Dr. Wollowitz eager to treat patients when the coronavirus raged in town last spring. However, cancer treatment in 2019 had wiped out his immune cells, leaving him defenseless against the virus. Instead, he arranged for his employees to be managed through Zoom.

A year later, people return to Dr. Wollowitz’s life returned to a semblance of normalcy. His wife, dancer and choreographer, is preparing to work for the Austrian National Ballet Company. His vaccinated friends meet, but he only sees them when the weather is nice enough to sit in his back yard. “I spend very little time in public areas,” he said.

Like his friends, Dr. Wollowitz vaccinated in January. But he wasn’t producing antibodies in response – and he hadn’t expected it either. He is one of millions of Americans with weakened immune systems whose bodies cannot learn to use immune fighters against the virus.

Some immunocompromised people were born with missing or faulty immune systems, while others, like Dr. Wollowitz, have illnesses or have received therapies that wipe out their immune defenses. Many of them make little to no antibodies in response to a vaccine or infection, which makes them susceptible to the virus. If infected, they can suffer from prolonged illness, with a death rate of up to 55 percent.

Most people who have lived with immunodeficiency for a long time are probably aware of their vulnerability. However, others have no idea that drugs could put them at risk.

“They’ll be walking around outside thinking they’re protected – but maybe not,” said Dr. Lee Greenberger, scientific director of the Leukemia Lymphoma Society, which funds research into blood cancer.

The only recourse for these patients – other than housing until the virus is withdrawn – may be to regularly infuse monoclonal antibodies, which are mass-produced copies of antibodies obtained from people who have contracted Covid-19 have recovered. The Food and Drug Administration has approved several monoclonal antibody treatments for Covid-19, but some are now also being tested to prevent infection.

Convalescent plasma or gamma globulin – antibodies distilled from the blood of healthy donors – can also help immunocompromised people, although a version of the latter that contains antibodies to the coronavirus is still months away from being available.

“It is a clear area where the need cannot be met,” said Hala Mirza, a spokeswoman for Regeneron, who made their monoclonal antibody cocktail available to a handful of immunocompromised patients through a compassionate application program. (Regeneron released experimental results this week showing the cocktail reduced symptomatic infections by 81 percent in people with normal immune systems.)

It is unclear how many immunocompromised people do not respond to coronavirus vaccines. But the list seems to include at least blood cancer survivors, organ transplant recipients, and anyone taking the widely available drug Rituxan or the cancer drugs Gazyva or Imbruvica – all of which kill or block B cells, the immune cells that develop antibodies – or Remicade, a popular one Drug used to treat inflammatory bowel disease. It can also include some people over the age of 80 whose immune responses have stalled with age.

“We are extremely concerned and interested in finding out how we can help these particular patients,” said Dr. Elad Sharon, an immunotherapy expert at the National Cancer Institute.

As the pandemic spread, doctors who specialized in treating blood cancer or caring for immunocompromised people expected at least some of their patients to encounter difficulties. Dr. Charlotte Cunningham-Rundles, an immunologist at the Icahn School of Medicine on Mount Sinai in New York, has about 600 patients who rely almost exclusively on regular doses of gamma globulin to protect against pathogens.

Nevertheless, 44 of their patients became infected with the coronavirus; four died and another four or five had long-term illnesses. (Chronic infections can give the virus the opportunity to develop into dangerous variants.)

Steven Lotito, 56, one of Dr. Cunningham-Rundles, was diagnosed with a condition known as common variable immunodeficiency when he was 13 years old. Before the pandemic, he had an active lifestyle, exercised, and ate well. “I’ve always known that I take special care of my body,” he said. This included infusions of gamma globulin every three weeks.

Despite careful precautionary measures, Mr Lotito caught the virus from his daughter in mid-October. He had a fever for almost a month and spent a week in the hospital. Convalescent plasma and remdesivir, an antiviral drug, provided relief for a few weeks, but his fever returned. After another infusion of gamma globulin that sweated through four shirts, he finally felt better.

Updated

April 18, 2021, 11:00 p.m. ET

Nevertheless, after almost seven weeks of illness, Mr. Lotito no longer had any antibodies to show. “I still have to take the same precautions that I took a year ago,” he said. “It’s a little daunting.”

People like Lotito-san rely on those around them to get vaccinated to keep the virus at bay, said Dr. Cunningham-Rundles.

“They hope that all of your family members and all of your close co-workers will go out and get a shot, and they will protect you with herd immunity,” she said. “You have to start with that.”

Dr. Cunningham-Rundles has tested their patients for antibodies and has registered some for Regeneron’s monoclonal antibody cocktail. However, many other people with these conditions are unaware of their risks or treatment options.

The Leukemia Lymphoma Society has set up a registry to provide information and antibody tests to people with blood cancer. Several studies are looking at the response to coronavirus vaccines in people with cancer, autoimmune diseases like lupus or rheumatoid arthritis, or in patients taking drugs that suppress the immune response.

What You Need To Know About The Johnson & Johnson Vaccine Break In The United States

    • On April 13, 2021, U.S. health officials called for an immediate halt to use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the U.S. developed a rare blood clot disorder within one to three weeks of being vaccinated.
    • All 50 states, Washington, DC, and Puerto Rico have temporarily stopped using the vaccine or recommended providers are suspending use of the vaccine. The U.S. military, government-run vaccination centers, and a variety of private companies, including CVS, Walgreens, Rite Aid, Walmart, and Publix, also paused the injections.
    • Fewer than one in a million Johnson & Johnson vaccinations are currently being studied. If there is indeed a risk of blood clots from the vaccine – which has yet to be determined – the risk is extremely small. The risk of contracting Covid-19 in the United States is much higher.
    • The hiatus could complicate the country’s vaccination efforts at a time when many states are facing spikes in new cases and are trying to address vaccine hesitation.
    • Johnson & Johnson has also decided to delay the launch of its vaccine in Europe amid concerns about rare blood clots, which is taking another blow to the vaccine surge in Europe. South Africa, devastated by a contagious variant of the virus found there, also stopped using the vaccine. Australia announced that it would not buy cans.

In one such study, British researchers tracked nearly 7,000 people with Crohn’s disease or ulcerative colitis from 90 hospitals across the country. They found that less than half of the patients who took Remicade had an immune response after contracting coronavirus infection.

In a follow-up, the scientists found that 34 percent of people who took the drug were protected after a single dose of the Pfizer vaccine and only 27 percent after a single dose of the AstraZeneca vaccine. (In the UK, the current practice is to delay second doses to increase vaccine availability.)

Likewise, another study published last month showed that fewer than 15 percent of patients with blood or immune cancer and fewer than 40 percent of patients with solid tumors produced antibodies after receiving a single dose of the Pfizer BioNTech vaccine.

And a study published last month in the journal JAMA reported that only 17 percent of the 436 transplant recipients who received a dose of the Pfizer BioNTech or Moderna vaccine had detectable antibodies three weeks later.

Despite the small likelihood, immunocompromised people should receive the vaccines because they may produce some immune cells that protect, even antibodies in a subset of patients.

“These patients should likely be prioritized for optimally balanced two doses,” said Dr. Tariq Ahmad, gastroenterologist with the Royal Devon and Exeter NHS Foundation Trust who was involved in the infliximab studies.

He suggested that doctors routinely measure antibody responses in immunocompromised people even after two doses of vaccine to identify those who may also need monoclonal antibodies to prevent infection or a third dose of the vaccines.

Wendy Halperin, 54, was diagnosed with a condition known as common variable immunodeficiency when she was 28 years old. She was hospitalized with Covid-19 in January and stayed there for 15 days. However, the coronavirus caused unusual symptoms.

“I had trouble walking,” she recalled. “I just lost control of my limbs like I couldn’t walk down the street.”

Since she was being treated for convalescence plasma for Covid-19, Ms. Halperin had to wait three months for the immunization and has made an appointment for April 26th. However, despite her condition, her body managed to produce some antibodies against the initial infection.

“The takeaway message is that everyone should try to get the vaccine,” said Dr. Amit Verma, oncologist at Montefiore Medical Center.

Gambling has settled in Dr. Wollowitz’s case not paid off. With no antibodies in his system to protect him, he still works from home – a privilege he is grateful for. He was an avid mountain biker and advanced skier both at risk of injury, but he is playing it safe with the coronavirus.

In anticipation of a return to his normal lifestyle, Dr. Wollowitz his bicycles. But he said he had foreseen he would live like this until enough other people are vaccinated and the number of infections in the city drops.

“I’m not exactly sure what that date is,” he said. “I’m really waiting to get out again.”

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Business

Vaccines Gained’t Shield Hundreds of thousands of Sufferers With Crippled Immune Methods

Vaccines Won’t Protect Millions of Patients With Crippled Immune Systems

Dr. Howard Wollowitz has been at the monastery for the most part at his Mamaroneck, NY home for more than a year

As chief of emergency medicine at Montefiore Medical Center in the Bronx, 63-year-old Dr. Wollowitz eager to treat patients when the coronavirus raged in town last spring. However, cancer treatment in 2019 had wiped out his immune cells, leaving him defenseless against the virus. Instead, he arranged for his employees to be managed through Zoom.

A year later, people return to Dr. Wollowitz’s life returned to a semblance of normalcy. His wife, dancer and choreographer, is preparing to work for the Austrian National Ballet Company. His vaccinated friends meet, but he only sees them when the weather is nice enough to sit in his back yard. “I spend very little time in public areas,” he said.

Dr. Wollowitz, like his friends, was vaccinated in January. But he wasn’t producing antibodies in response – and he hadn’t expected it either. He is one of millions of Americans with weakened immune systems whose bodies cannot learn to use immune fighters against the virus.

Some immunocompromised people were born with missing or faulty immune systems, while others, like Dr. Wollowitz, have illnesses or have received therapies that wipe out their immune defenses. Many of them make little to no antibodies in response to a vaccine or infection, which makes them susceptible to the virus. If infected, they can suffer from prolonged illness, with a death rate of up to 55 percent.

Most people who have lived with immunodeficiency for a long time are probably aware of their vulnerability. However, others have no idea that drugs could put them at risk.

“They’ll be walking around outside thinking they’re protected – but maybe not,” said Dr. Lee Greenberger, scientific director of the Leukemia Lymphoma Society, which funds research into blood cancer.

The only recourse for these patients – other than housing until the virus is withdrawn – may be to regularly infuse monoclonal antibodies, which are mass-produced copies of antibodies obtained from people who have contracted Covid-19 have recovered. The Food and Drug Administration has approved several monoclonal antibody treatments for Covid-19, but some are now also being tested to prevent infection.

Convalescent plasma or gamma globulin – antibodies distilled from the blood of healthy donors – can also help immunocompromised people, although a version of the latter that contains antibodies to the coronavirus is still months away from being available.

“It is a clear area where the need cannot be met,” said Hala Mirza, a spokeswoman for Regeneron, who made their monoclonal antibody cocktail available to a handful of immunocompromised patients through a compassionate application program. (Regeneron released experimental results this week showing the cocktail reduced symptomatic infections by 81 percent in people with normal immune systems.)

It is unclear how many immunocompromised people do not respond to coronavirus vaccines. But the list seems to include at least blood cancer survivors, organ transplant recipients, and anyone taking the widely available drug Rituxan or the cancer drugs Gazyva or Imbruvica – all of which kill or block B cells, the immune cells that develop antibodies – or Remicade, a popular one Drug used to treat irritable bowel disease. It can also include some people over the age of 80 whose immune responses have stalled with age.

“We are extremely concerned and interested in finding out how we can help these particular patients,” said Dr. Elad Sharon, an immunotherapy expert at the National Cancer Institute.

As the pandemic spread, doctors who specialized in treating blood cancer or caring for immunocompromised people expected at least some of their patients to encounter difficulties. Dr. Charlotte Cunningham-Rundles, an immunologist at the Icahn School of Medicine on Mount Sinai in New York, has about 600 patients who rely almost exclusively on regular doses of gamma globulin to protect against pathogens.

Nevertheless, 44 of their patients became infected with the coronavirus; four died and another four or five had long-term illnesses. (Chronic infections can give the virus the opportunity to develop into dangerous variants.)

Steven Lotito, 56, one of Dr. Cunningham-Rundles, was diagnosed with a condition known as common variable immunodeficiency when he was 13 years old. Before the pandemic, he had an active lifestyle, exercised, and ate well. “I’ve always known that I take special care of my body,” he said. This included infusions of gamma globulin every three weeks.

Despite careful precautionary measures, Mr Lotito caught the virus from his daughter in mid-October. He had a fever for almost a month and spent a week in the hospital. Convalescent plasma and remdesivir, an antiviral drug, provided relief for a few weeks, but his fever returned. After another infusion of gamma globulin that sweated through four shirts, he finally felt better.

Updated

April 15, 2021, 2:02 p.m. ET

Nevertheless, after almost seven weeks of illness, Mr. Lotito no longer had any antibodies to show. “I still have to take the same precautions that I took a year ago,” he said. “It’s a little daunting.”

People like Lotito-san rely on those around them to get vaccinated to keep the virus at bay, said Dr. Cunningham-Rundles.

“They hope that all of your family members and all of your close co-workers will go out and get a shot, and they will protect you with herd immunity,” she said. “You have to start with that.”

Dr. Cunningham-Rundles has tested their patients for antibodies and has registered some for Regeneron’s monoclonal antibody cocktail. However, many other people with these conditions are unaware of their risks or treatment options.

The Leukemia Lymphoma Society has set up a registry to provide information and antibody tests to people with blood cancer. Several studies are looking at the response to coronavirus vaccines in people with cancer, autoimmune diseases like lupus or rheumatoid arthritis, or in patients taking drugs that suppress the immune response.

What You Need To Know About The Johnson & Johnson Vaccine Break In The United States

    • On April 13, 2021, U.S. health officials called for an immediate halt to use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the U.S. developed a rare blood clot disorder within one to three weeks of vaccination.
    • All 50 states, Washington, DC, and Puerto Rico have temporarily suspended use of the vaccine or suspended from recommended vendors. The U.S. military, government-run vaccination centers, and a variety of private companies, including CVS, Walgreens, Rite Aid, Walmart, and Publix, also paused the injections.
    • Fewer than one in a million Johnson & Johnson vaccinations are currently being studied. If there is indeed a risk of blood clots from the vaccine – which has yet to be determined – the risk is extremely small. The risk of contracting Covid-19 in the United States is much higher.
    • The hiatus could complicate the country’s vaccination efforts at a time when many states are facing spikes in new cases and are trying to address vaccine hesitation.
    • Johnson & Johnson has also decided to delay the launch of its vaccine in Europe amid concerns about rare blood clots, which is taking another blow to the vaccine surge in Europe. South Africa, devastated by a contagious variant of the virus found there, also stopped using the vaccine. Australia announced that it would not buy cans.

In one such study, British researchers tracked nearly 7,000 people with Crohn’s disease or ulcerative colitis from 90 hospitals across the country. They found that less than half of the patients who took Remicade had an immune response after contracting coronavirus infection.

In a follow-up, the scientists found that 34 percent of people who took the drug were protected after a single dose of the Pfizer vaccine and only 27 percent after a single dose of the AstraZeneca vaccine. (In the UK, the current practice is to delay second doses to increase vaccine availability.)

Likewise, another study published last month showed that fewer than 15 percent of patients with blood or immune cancer and fewer than 40 percent of patients with solid tumors produced antibodies after receiving a single dose of the Pfizer BioNTech vaccine.

And a study published last month in the journal JAMA reported that only 17 percent of the 436 transplant recipients who received a dose of the Pfizer BioNTech or Moderna vaccine had detectable antibodies three weeks later.

Despite the small likelihood, immunocompromised people should receive the vaccines because they may produce some immune cells that protect, even antibodies in a subset of patients.

“These patients should likely be prioritized for optimally balanced two doses,” said Dr. Tariq Ahmad, gastroenterologist with the Royal Devon and Exeter NHS Foundation Trust who was involved in the infliximab studies.

He suggested that doctors routinely measure antibody responses in immunocompromised people even after two doses of vaccine to identify those who may also need monoclonal antibodies to prevent infection or a third dose of the vaccines.

Wendy Halperin, 54, was diagnosed with a condition known as common variable immunodeficiency when she was 28 years old. She was hospitalized with Covid-19 in January and stayed there for 15 days. However, the coronavirus caused unusual symptoms.

“I had trouble walking,” she recalled. “I just lost control of my limbs like I couldn’t walk down the street.”

Since she was being treated for convalescence plasma for Covid-19, Ms. Halperin had to wait three months for the immunization and has made an appointment for April 26th. However, despite her condition, her body managed to produce some antibodies against the initial infection.

“The takeaway message is that everyone should try to get the vaccine,” said Dr. Amit Verma, oncologist at Montefiore Medical Center.

Gambling has settled in Dr. Wollowitz’s case not paid off. With no antibodies in his system to protect him, he still works from home – a privilege he is grateful for. He was an avid mountain biker and advanced skier, both of which were at risk of injury, but he is playing it safe with the coronavirus.

In anticipation of a return to his normal lifestyle, Dr. Wollowitz his bicycles. But he said he had foreseen he would live like this until enough other people are vaccinated and the number of infections in the city drops.

“I’m not exactly sure what that date is,” he said. “I’m really waiting to get out again.”

Categories
Health

Panicked sufferers name medical doctors as Covid vaccine hesitancy rises with J&J blood clot challenge

Panicked patients call doctors as Covid vaccine hesitancy rises with J&J blood clot issue

More Americans are likely to refuse to receive the Covid-19 vaccine from Johnson & Johnson after U.S. health officials said six women developed a rare bleeding disorder with one dead and another in critical condition, experts said for public health and vaccines using CNBC on Tuesday.

The Food and Drug Administration asked states early Tuesday to temporarily stop using J & J’s single-shot vaccine “out of caution” after six women aged 18 to 48 out of the roughly 6.9 million people who received the shot developed blood. A coagulation disorder known as cerebral venous sinus thrombosis, or CVST.

All women developed the condition that occurs when a blood clot forms in the venous sinuses of the brain that prevents blood from flowing back to the heart within about two weeks of receiving the shot from the brain, health officials told reporters on a phone call .

“People who have recently received the vaccine in the past few weeks should be aware if they are looking for symptoms,” said Dr. Anne Schuchat, the deputy chief director of the Centers for Disease Control and Prevention, during a press conference on Tuesday. “If you have received the vaccine and have severe headache, stomach pain, leg pain, or shortness of breath, you should contact your doctor and see a doctor.”

Shortly after the FDA issued the warning, more than a dozen states, as well as some pharmacies, took steps to stop vaccination with J & J’s vaccine. Some replaced scheduled appointments with either the Pfizer or Moderna vaccine. Some doctors say they are already taking calls from worried patients.

People were already skeptical of vaccines before the coronavirus emerged as a new pathogen in China in December 2019, infecting more than 31.2 million Americans and killing at least 562,718 people in just over a year. Warning from U.S. health officials to states is likely to be even more reluctant to take J & J’s shot and the other vaccines, and threatens to hold back the nation’s recovery from the pandemic, health experts told CNBC.

“Unfortunately, this is likely to exacerbate those who are a little hesitant about getting a vaccine,” said Isaac Bogoch, an infectious disease specialist who served on several drug data and safety oversight panels. “Senior public health officials need to continue to be open, honest, transparent, and most importantly, contextualize that this is a low risk.”

According to Dr. Anthony Fauci, President Joe Biden’s chief medical officer, the goal is to vaccinate between 70% and 85% of the US population – or about 232 to 281 million people – to achieve herd immunity and suppress the pandemic.

To date, more than 120 million Americans, or 36% of the total US population, have received at least one dose of a Covid-19 vaccine, according to the CDC. Around 74 million Americans, or 22% of the total US population, are fully vaccinated, according to the CDC. Children under the age of 16 are not yet eligible to shoot in the United States, and some adults are likely to refuse to get a vaccine.

“This puts a wrench in the plans. It will slow down the rollout,” said Dr. Jeffrey Kahn, director of the Berman Institute of Bioethics at Johns Hopkins University. “People will say, ‘I don’t want this, I want one of the others who don’t have this problem,’ even if it’s an extremely rare occurrence.”

Some Americans, especially in black, Hispanic, and rural communities, have already been reluctant to get the J&J vaccine, especially because they found it to be worse than Pfizer and Moderna’s. The highly effective J&J shot, especially against serious illnesses, showed 72% effectiveness in protecting against Covid in the US about a month after inoculation. This is comparable to the effectiveness of Pfizer and Moderna vaccines with two doses of around 95%.

Single-dose vaccines like J & Js were critical to “getting into communities where a two-dose regimen was impractical or even possible,” Kahn said. US health officials used J & J’s vaccine primarily to reach poorer urban and rural areas where residents could not easily get to a vaccination clinic or did not have reliable internet access.

“These communities are also the hardest hit by Covid,” said Kahn. “Interrupting Use of J & J. [is] one stroke to do that effectively and quickly. “

Dr. Stephen Schrantz, who was part of the team leading a J&J vaccine study at the University of Chicago Medicine, said he already had patients who didn’t want the J&J vaccine and said the news would give them more evidence give to say, “See, I told you.”

“I suspect that vaccine adoption and uptake will slow down, there will be a move away from the J&J vaccine even if the CDC and FDA conclude that there is no causal link,” he said. “And as the wearing of masks wears off, there may be more cases like we have in Michigan.”

Dr. Scott Gottlieb, who sits on Pfizer’s board of directors, predicted the move will fuel “the reluctance” of some people to get a Covid vaccine.

“Even if there is no causal link, even if it is extremely rare, we will see that the whole conversation is now ignited on social media,” he told CNBC in an interview.

Dr. Purvi Parikh, an infectious disease allergy and immunology specialist at NYU Langone Health, described the FDA warning Tuesday as a “double-edged sword” and said it would likely raise concerns for already reluctant Americans. She also said she had already received “panic calls” from her own patients about the J&J vaccine.

“But if anything, I would like to repeat again: This only gives me more confidence in our system because these security checks work. Hopefully it will give some people peace of mind,” she added on “Squawk on the Street”. “” “Again, to look at the bigger picture, the benefits still far outweigh the risks of this vaccination.”

Dr. Archana Chatterjee, pediatric infectious disease specialist and member of the FDA’s Advisory Committee on Vaccines and Related Biological Products, echoed Parikh’s remark. She added that there is nothing “unusual” in the way US health officials are addressing the problem.

“This is a normal procedure that occurs,” she said.

“But of course whenever a serious adverse event is reported about a vaccine that raises public concern,” she added. “If you talk about vaccine trust or vaccine reluctance, could it have an impact? It certainly is possible.”

Dr. Paul Offit, another member of the Advisory Committee on Vaccines and Allied Biological Products, hopes Americans will be “rational” about the problem, adding that cases of blood clots seem extremely rare. He noted that convincing people in hard-to-reach communities could be a challenge.

“It should be reassuring to the people that the officials are still looking [at the vaccine], even for rare side effects, “he said.

– CNBC’s Kevin Stankiewicz contributed to this article.

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Health

When Sufferers Select to Finish Their Lives

When Patients Choose to End Their Lives

Ms. Rehm said her goal is that no patient should suffer the outrage that her husband experienced at the end of his life. She described his death as “excruciating to bear testimony,” although the lack of food and water is usually quite bearable for the patient after about two days.

Dr. Jessica Nutik Zitter, a palliative care practitioner at Highland Hospital in Oakland, Calif., Said in an interview, “The concept of medical euthanasia is gaining acceptance, but it takes time for people to become familiar with it. Doctors are trained to keep adding technology to patient care regardless of outcome, and technology withdrawal is an abomination for what we are taught. “

As a result, doctors can convince dying patients and their families to accept treatments “that lead to terrible suffering,” said Dr. Zitter, author of the book “Extreme Measures: Finding a Better Way to the End of Life”. In their experience, fear of losing control is the number one reason patients seek medical attention when they die. However, when they have access to good palliative care, this fear often disappears.

A third of patients eligible for medical assistance in dying are not consuming the lifelong medications they are given, she said, explaining that after the option, they regain a sense of autonomy and are no longer afraid of losing control . In a study of 3,368 lethal drug prescriptions drafted under Oregon and Washington state laws, the most common reasons for seeking medical help in dying were loss of autonomy (87.4 percent). Impairment of quality of life (86.1 percent) and loss of dignity (68.6 percent).

Of course, many doctors view medical assistance in dying as contrary to their education, religious beliefs, or philosophy of life. Dr. Joanne Lynn, a non-supporter geriatrician in Washington, DC, said the focus should be on better care for people who are very sick, disabled, or the elderly.

“We should resist medical assistance in dying until we can offer people who have opted for medically assisted death a real choice of well-supported, meaningful, and comfortable life,” said Dr. Lynn. “There is currently no strong pressure on decency in long-term care. It is not a real choice when a person’s alternative is to live in misery or to impoverish the family. “

Barbara Coombs Lee, president emeritus of Compassion & Choices, a Portland, Oregon nonprofit that seeks to expand options for the end of life, said: “The core principle of medical assistance in dying is empowerment for someone who is terminally ill . “

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‘It Takes Time’: I.C.U. Staff Assist Their Former Covid Sufferers Mend

‘It Takes Time’: I.C.U. Workers Help Their Former Covid Patients Mend

LOS ANGELES – Three days after his release from Martin Luther King Jr. Community Hospital, Gilbert Torres returned on a stretcher. A clear hose snaked from his nose to an oxygen tank. It was the last place he wanted to be.

But 30-year-old Torres, who had just spent two weeks in intensive care on a ventilator, was absent because his condition had worsened. He was there to visit a new outpatient clinic for Covid-19 survivors, to treat their remaining physical and psychological wounds – and to prevent them from having to be readmitted.

Several medical centers across the country, including Massachusetts General Hospital, have set up similar clinics, a sign that the need to address the long-term effects of Covid is increasingly recognized. Other hospitals that already had aftercare programs in the intensive care unit have added large numbers of Covid patients to their list: Indiana University Health Methodist Hospital, for example, has treated more than 100 patients. And some facilities, like Providence St. Jude in Fullerton, Calif., Have been doing recovery programs that also serve coronavirus patients who have never been hospitalized.

“We put a thousand percent of our energy into these patients,” said Dr. Jason Prasso, one of the intensive care physicians at the MLK hospital who started the clinic there. “We feel responsible for ensuring that they feel better after they leave the hospital.”

Long before the pandemic, doctors knew that some patients recovering from critical illness developed a constellation of symptoms known as post-intensive care syndrome, which can include muscle weakness and fatigue. Depression, anxiety, and cognitive impairment occur in about half of people who have spent time on ventilators in an intensive care unit. About a quarter of these patients develop post-traumatic stress disorder. The risk is higher in patients who have stopped breathing, have long hospital stays, and are being treated with medication to calm or paralyze – all of which are common in sick coronavirus patients. A new, peer-reviewed study of 45 ex-ICU patients with Covid-19 at Mount Sinai Hospital in New York found that more than 90 percent met the criteria for the syndrome.

Dr. Prasso and his colleagues started the clinic at MLK after discovering that many of the patients whose lives they had saved received little follow-up care. The hospital is in a low-income neighborhood where health services, which were inadequate before the pandemic, have become increasingly scarce.

Since opening in August, the clinic has seen more than 30 patients. Visits that take place on Tuesday morning and include a physical exam and mental health screening often involve discussions about housing, food security, and employment issues that can arise from long-term symptoms. Spiritual care is also offered to patients.

The first to go to Mr. Torres’ exam room in February was Rudy Rubio, a hospital chaplain who had often visited him in the intensive care unit. The pastor asked if they could pray together and offered to get him a Bible.

Mr Torres, whose parents fled the war in El Salvador, grew up in the neighborhood cleaning large rigs in a Blue Beacon truck wash. Although he was morbidly obese – a risk factor for severe Covid – he liked to run and cycle and was rarely needed to see a doctor. Little did he know how he got infected with the coronavirus or got so sick that doctors had to insert a breathing tube within hours of arriving at MLK. Before he showed any signs of improvement, they feared that he would not survive.

“You were spared,” said the chaplain in the clinic. “What are you going to do with this opportunity?”

When Dr. Prasso entered the room, Mr. Torres did not recognize him at first without protective clothing and helmet. “It was you,” he said when realization dawned.

When the doctor examined him, Mr Torres said he could walk short distances, but feared that if he did, his oxygen levels would drop. “It’s a bit of a mind game,” said Dr. Prasso. “You may feel short of breath, but your oxygen may still be completely normal.”

The clinic would ensure Mr. Torres got a portable oxygen machine as small tanks are in short supply nationally, the doctor said. He explained that it could take a few weeks to several months for patients to be weaned. Some may need it indefinitely.

Updated

April 1, 2021, 11:02 p.m. ET

Mr Torres raised another problem. A physiotherapist who was supposed to visit him had canceled. “Many of the agencies are a little bit against going into people’s homes because of Covid,” said Dr. Prasso. He said the clinic could instead enroll Mr. Torres on a pulmonary rehabilitation program so that he could work with therapists who would focus on restoring his lungs.

Mr Torres said he was concerned and was haunted by memories of ICU monitors beeping and a feeling of suffocation. He had hardly slept since his return and had not yet seen his 5-year-old son, who was temporarily living with grandparents. Mr. Torres was afraid of collapsing in front of him.

“Everything you feel is normal,” said Dr. Prasso. “Just know that what you went through was trauma. It takes time for this to heal. “

The two exchanged memories of the moment when Mr. Torres’ breathing tube was removed. “You asked me to take the tube out and as soon as we took the tube out you asked for it to be put back in,” said Dr. Prasso.

“It was hard to breathe,” said Mr Torres. “I didn’t want to be awake.”

“This guy had a vice handle on my hand,” said Dr. Prasso to Mr. Torres’ partner, Lisseth Salguero, who had joined him in the exam room. Family members who are themselves at risk for mental health problems are encouraged to accompany patients to the clinic. Ms. Salguero had developed Covid symptoms on the same day as Mr. Torres but recovered quickly. Since he had returned home she had woken up to check Mr. Torres’ oxygen levels at night. “I’m happy as long as he’s okay,” she said.

The extraordinary stress of being in intensive care during the Covid-19 era is often compounded by almost unbearable loneliness. Visitor restrictions designed to lessen the transmission of the virus can mean weeks apart from loved ones. “I kept asking for someone to hold my hand,” Mr. Torres recalled. “I wanted contact.”

The employees became de facto family. “You have no one but your nurses,” said Mr Torres.

For these ICU carers, caring for Covid patients while being among the few connections to their family leads to deep emotional ties. Nina Tacsuan, one of Mr. Torres’ nurses, couldn’t hold back her tears when she saw him in the clinic.

“Thank you for keeping me alive and for giving me a second chance,” Mr. Torres said to her. “I’m thankfull.”

“You are my age,” said Ms. Tacsuan. “It was just very difficult all along.”

Often the experience ends with heartbreak: at the time of Mr. Torres’s hospitalization, only about 15 percent of Covid patients at MLK treated with ventilators had survived to go home.

Those who survive, like him, inspire employees to keep going. As a rule, however, intensive care workers have no way of seeing their ex-patients once they are better. The clinic has changed that.

Ms. Tacsuan and a nurse manager, Anahiz Correa, joked that Mr. Torres was no longer welcome in their intensive care unit

When the ambulance picked him up to go home, Mr Torres said he was feeling much better than when he arrived. He reunited with his young son Austin a few days later and has continued to improve over the past few weeks.

Mr. Torres visited the clinic twice more, in February and March. Although he refused outpatient rehabilitation and instead chose to climb stairs and do other exercises at home, he said he felt cared for and was glad to have left.

A social worker there connected him to a family doctor in the MLK system for further follow-up examinations. An osteopath manipulated his back and taught him to stretch to alleviate the persistent discomfort from his time in the hospital bed. And last week, at his last appointment, the clinic put up a congratulatory banner shouting, “Surprise!” As he walked in to mark his “graduation” because he didn’t need to use an oxygen tank.

He said he needed more strength and stamina to return to his physically demanding truck wash job, but “I do a lot more things.” And fear is no longer haunted by him, he added. “I feel great.”

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A ‘Recreation Changer’ for Sufferers With Esophageal Most cancers

A ‘Game Changer’ for Patients With Esophageal Cancer

Chemotherapy has difficult side effects, and the radiation causes a burning sensation that makes it difficult to swallow. “The food won’t go down,” said Ms. Mordecai. “You just feel lazy.”

The next step is major surgery. A doctor removes most of the patient’s esophagus, with the tract going from the mouth to the stomach. He then grabs the stomach, pulls it up, and attaches it to a leftover esophageal stump.

The result is a stomach that is vertical rather than horizontal and that lacks the sphincter muscle that normally prevents stomach acid from leaking out. For the rest of their lives, patients can never lie flat – when they do, the contents of their stomach, including acid, flow down their throats. They can choke, cough, and aspirate.

Recovery is difficult and morbidity and mortality are high. But most patients do the surgery once they have weighed their options. Refusing treatment means giving up and letting the cancer close the esophagus so much that some cannot even swallow their own saliva, said Dr. Paul Helft, professor of surgery and ethicist at Indiana University School of Medicine.

The treatment is so long and harrowing that Dr. Often used to help educate medical students and other trainees about informed consent – how patients need to be fully informed before starting any given treatment. In particular, patients with esophageal cancer should be warned that they are likely to recur within the first year.

Ms. Mordecai said that her husband had an operation in late September 2008. By December 6th, he had untreatable metastases in his liver. Now, she said, the patients might have a glimmer of hope.

Dr. Ilson, who has spent his career developing therapies to help patients with esophageal cancer, said he did not expect this treatment to be successful: “We all become nihilistic after years of negative study.”

“This is really a milestone,” he added, and the drug “will set a new standard for care.”

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Some Covid-19 Sufferers Say They’re Left With Ringing Ears

Some Covid-19 Patients Say They’re Left With Ringing Ears

The suicide of Kent Taylor, the founder and CEO of the Texas Roadhouse restaurant chain, has drawn attention to a possible link between Covid-19 and tinnitus, the medical name for a constant ringing in the ears.

Mr Taylor suffered from a variety of symptoms, including severe tinnitus, following his illness, his family said in a statement, adding that his condition has become “unbearable”.

Whether tinnitus is related to Covid-19 – and if so, how often it occurs – is an unanswered question. Neither the World Health Organization nor the Centers for Disease Control and Prevention describe tinnitus as a symptom, although hearing problems are common with other viral infections.

But tinnitus is on the list of symptoms of long covid published by the UK’s National Health Service, along with fatigue, shortness of breath, dizziness and much more. Some recent case reports and studies have suggested a possible link.

A study published Monday in the Journal of International Audiology that examined nearly 60 case reports and studies found that 15 percent of adults with Covid-19 reported symptoms of tinnitus. The authors believe respondents described either a new or a worsening condition, although they follow up with the roughly 60 researchers to make sure how the surveys were worded.

“I’ve received about 100 emails in the 24 hours since we were published,” said Kevin Munro, professor of audiology at the University of Manchester and co-author of the study. “Almost all of them said, ‘I was so happy to read about it because my doctor thought I was crazy when I mentioned tinnitus and now I know I’m not the only one.'”

There is also evidence that Covid-19 can make symptoms worse in people who had tinnitus before they contracted the disease. A study published in Frontiers in Public Health magazine late last year surveyed 3,100 people with tinnitus and found that 40 percent of the 237 respondents who contracted Covid-19 said their symptoms were “significantly worse” after infection .

“There are many viruses that affect the ears, including measles, mumps, and rubella,” said Dr. Eldre Beukes, audiologist at Anglia Ruskin University in England, who led the study. “It could also be the case that drugs to fight Covid are making the tinnitus worse. And there’s a well-known relationship between tinnitus and stress. “

Recognition…Ron Bath / Texas Roadhouse, via Associated Press

The study cited a number of factors that have increased stress for almost all pandemic sufferers, including fear of contracting the coronavirus and social distancing rules that have increased isolation and loneliness.

Home schooling has also increased stress levels, as has coffee and alcohol consumption, added Dr. Beukes added.

Covid-19 has made life difficult for tinnitus sufferers even if they haven’t contracted the virus, said Kim Weller, an IT specialist who lives in Houston and is part of a tinnitus support group based there.

“There is a gentleman in Ohio that I text and phone with and I would describe him as at the end of his rope,” she said. “He doesn’t work, has trouble sleeping and lives alone. His situation is definitely worse because of Covid because he’s just so isolated. “

Why tinnitus affects certain people is a mystery. There are approximately 200 causes of the condition, including exposure to loud noises, stress, hearing loss, and perforated eardrum. There is currently no cure. Patients are often treated with cognitive behavioral therapy – essentially talk therapy to rewire thoughts and behaviors – or they are trained in how to get used to the condition.

In a 2011-2012 survey – the most recent data available – the CDC found that 15 percent of respondents said they had tinnitus. Of them, 26 percent said it was constant or near constant ringing, and 30 percent said the condition was a “moderate” or “very large” problem in their life.

A very small group of people in Dr. Beukes’ study – seven – reported that Covid-19 caused tinnitus for the first time. Just over half of people with tinnitus said the disease had left their symptoms unchanged.

Oddly enough, 6 percent said they had less tinnitus after contracting the disease. Dr. Beukes speculates that a life-threatening illness in these people caused the noise in their head to be redefined.

“Signing Covid meant they were struggling to survive in some cases, and that left them from a very different perspective,” she said.

Around 40 percent of respondents who said Covid-19 made their tinnitus worse include people like Aisling Starrs of Derry in Northern Ireland. She had coped with hearing loss in her right ear all her life. Two years ago she gave birth to a daughter and within minutes noticed a buzz in both ears that did not subside.

“Then I got Covid in September and it went straight into my ear,” said Ms. Starrs, an occupational therapist. “On a scale from one to ten, it was a three ahead of Covid. It’s been a seven since then. “

Little did she know that exacerbated tinnitus could be a Covid problem until she found out otherwise on the website of the British Tinnitus Association, a co-sponsor of the Anglia Ruskin study.

“I thought ‘thank god’ when I realized I wasn’t the only one out there,” she said. “Through my work I have met people who do not know that there is a medical term for the ringing in their ears. Just knowing that other people are in the same condition is a tremendous relief. “

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Some Lengthy Covid-19 Sufferers Really feel Higher After Vaccine Doses

Some Long Covid Patients Feel Better After Getting the Vaccine

A survey of 345 people, mostly women and mostly in the UK, found that two weeks or more after their first dose of vaccine, 93 felt slightly better and 18 felt normal again – a total of 32 percent reported improved long-term Covid symptoms.

In this survey by Gez Medinger, a London-based filmmaker who experienced post-Covid symptoms, 61 people, just under 18 percent, felt worse. Most of them reported only a slight decrease in their condition. Almost half – 172 people – said they didn’t feel any different.

Another survey by the Survivor Corps, a group of over 150,000 Covid survivors, found that on March 17, 225 out of 577 respondents reported some improvement, while 270 felt no change and 82 felt worse.

Jim Golen, 55, of Saginaw, Minnesota, believes some long-term Covid symptoms have worsened since he was vaccinated. Mr. Golen, a former hospice nurse who also has a small farm, has had months of trouble including blood clots in the lungs, chest pain, brain fog, insomnia, and shortness of breath with every effort. At the end of last year, after seeing several doctors, “I finally felt better,” he said.

Since receiving the second dose of the Pfizer vaccine in mid-January, his chest soreness and shortness of breath have returned with a vengeance, especially when taxing himself on activities like collecting sap from maple trees on his farm. Even so, Mr Golen said he was “very happy” to be vaccinated, stressing that the effects of Covid were worse and that it was crucial to prevent it.

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Some Lengthy Covid Sufferers Really feel Higher After Getting the Vaccine

Some Long Covid Patients Feel Better After Getting the Vaccine

A survey of 345 people, mostly women and mostly in the UK, found that two weeks or more after the second dose of vaccine, 93 felt slightly better and 18 felt normal again – a total of 32 percent reported improved long-term Covid symptoms.

In this survey by Gez Medinger, a London-based filmmaker who experienced post-Covid symptoms, 61 people, just under 18 percent, felt worse. Most of them reported only a slight decrease in their condition. Almost half – 172 people – said they didn’t feel any different.

Another survey by the Survivor Corps, a group of over 150,000 Covid survivors, found that on March 17, 225 out of 577 respondents reported some improvement, while 270 felt no change and 82 felt worse.

Jim Golen, 55, of Saginaw, Minnesota, believes some long-term Covid symptoms have worsened since he was vaccinated. Mr. Golen, a former hospice nurse who also has a small farm, has had months of trouble including blood clots in the lungs, chest pain, brain fog, insomnia, and shortness of breath with every effort. At the end of last year, after seeing several doctors, “I finally felt better,” he said.

Since receiving the second dose of the Pfizer vaccine in mid-January, his chest soreness and shortness of breath have returned with a vengeance, especially when taxing himself on activities like collecting sap from maple trees on his farm. Even so, Mr Golen said he was “very happy” to be vaccinated, stressing that the effects of Covid were worse and that it was crucial to prevent it.