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Study of Coronavirus in Pregnant Women Finds Striking Racial Differences Study of Coronavirus in Pregnant Women Finds Striking Racial Differences
(4 days later)
Black and Latino pregnant women in Philadelphia are five times as likely as their white counterparts to have been exposed to the coronavirus, according to data collected from nearly 1,300 women between April and June.Black and Latino pregnant women in Philadelphia are five times as likely as their white counterparts to have been exposed to the coronavirus, according to data collected from nearly 1,300 women between April and June.
The findings, which have not been published in a scientific journal, were based on tests for coronavirus antibodies, which reveal a person’s past exposure to the virus even if it did not cause any symptoms.The findings, which have not been published in a scientific journal, were based on tests for coronavirus antibodies, which reveal a person’s past exposure to the virus even if it did not cause any symptoms.
The study bolsters other research showing that the coronavirus disproportionately affects Black and Latino people.The study bolsters other research showing that the coronavirus disproportionately affects Black and Latino people.
“The racial disparities are striking, and important to bring out,” said Whitney Robinson, a social epidemiologist at the University of North Carolina, who was not involved in the study. “This reinforces what we’ve already seen, and adds more certainty that the racial differences are real.”“The racial disparities are striking, and important to bring out,” said Whitney Robinson, a social epidemiologist at the University of North Carolina, who was not involved in the study. “This reinforces what we’ve already seen, and adds more certainty that the racial differences are real.”
The study’s numbers dwarf previous estimates of the virus’s skewed impact on racial and ethnic minorities. Across the United States, Black and Latino people have been reported to be about three times as likely to contract the coronavirus as white people — a trend roughly mirrored by data collected by the city of Philadelphia. But these patterns have largely been based on tests for active infections, which have struggled to accurately capture where and how the virus has spread.The study’s numbers dwarf previous estimates of the virus’s skewed impact on racial and ethnic minorities. Across the United States, Black and Latino people have been reported to be about three times as likely to contract the coronavirus as white people — a trend roughly mirrored by data collected by the city of Philadelphia. But these patterns have largely been based on tests for active infections, which have struggled to accurately capture where and how the virus has spread.
Although there is increasing awareness that many coronavirus infections cause few to no symptoms, many diagnostic testing centers — stymied by a lack of equipment and trained personnel — have rationed their tests to only people who are noticeably sick. And people who have reliable access to health care and insurance, often white and well-off, are more likely to seek out tests than others.Although there is increasing awareness that many coronavirus infections cause few to no symptoms, many diagnostic testing centers — stymied by a lack of equipment and trained personnel — have rationed their tests to only people who are noticeably sick. And people who have reliable access to health care and insurance, often white and well-off, are more likely to seek out tests than others.
Diagnostic testing sites in many cities, including Philadelphia, have also been cordoned off by ZIP code, said Carmen Guerra, a health disparities researcher at the University of Pennsylvania who was not involved with the study, but is collaborating with the research team on others. Residents who do not own cars or cannot afford public transportation, she said, must surmount enormous barriers to determining their health status.Diagnostic testing sites in many cities, including Philadelphia, have also been cordoned off by ZIP code, said Carmen Guerra, a health disparities researcher at the University of Pennsylvania who was not involved with the study, but is collaborating with the research team on others. Residents who do not own cars or cannot afford public transportation, she said, must surmount enormous barriers to determining their health status.
Tests that look for coronavirus genes also can’t find people who were previously infected and are now virus free. To fill that gap, several health centers in the area are now offering antibody tests in addition to those for active infections, said Dr. Karen Puopolo, a neonatologist at Pennsylvania Hospital and an author of the study, which was posted to the website medRxiv on Friday. But many people decide not to get antibody tests, painting an incomplete picture of exposure throughout the city.Tests that look for coronavirus genes also can’t find people who were previously infected and are now virus free. To fill that gap, several health centers in the area are now offering antibody tests in addition to those for active infections, said Dr. Karen Puopolo, a neonatologist at Pennsylvania Hospital and an author of the study, which was posted to the website medRxiv on Friday. But many people decide not to get antibody tests, painting an incomplete picture of exposure throughout the city.
Keeping tabs on pregnant women, who have continued to seek medical care amid the pandemic, could offer a less biased glimpse into what is going on in the population at large, said Scott Hensley, a virologist at the University of Pennsylvania who also was an author of the study.Keeping tabs on pregnant women, who have continued to seek medical care amid the pandemic, could offer a less biased glimpse into what is going on in the population at large, said Scott Hensley, a virologist at the University of Pennsylvania who also was an author of the study.
Dr. Hensley, Dr. Puopolo and their colleagues searched for coronavirus antibodies in anonymized blood samples from 1,293 women who gave birth at Pennsylvania Hospital or the Hospital of the University of Pennsylvania between April 4 and June 3. These two medical centers see about half of Philadelphia’s live births, Dr. Hensley said.Dr. Hensley, Dr. Puopolo and their colleagues searched for coronavirus antibodies in anonymized blood samples from 1,293 women who gave birth at Pennsylvania Hospital or the Hospital of the University of Pennsylvania between April 4 and June 3. These two medical centers see about half of Philadelphia’s live births, Dr. Hensley said.
Unlike diagnostic tests that search for stretches of genetic material specific to the coronavirus, antibody tests hunt for immune molecules produced in response to the virus and can thus detect infections that have already resolved, even if they did not result in overt symptoms. That potentially gives researchers a window into the past — and a chance to catalog infections that diagnostic tests miss.Unlike diagnostic tests that search for stretches of genetic material specific to the coronavirus, antibody tests hunt for immune molecules produced in response to the virus and can thus detect infections that have already resolved, even if they did not result in overt symptoms. That potentially gives researchers a window into the past — and a chance to catalog infections that diagnostic tests miss.
The researchers found that just over 6 percent of all the women they tested carried coronavirus antibodies.The researchers found that just over 6 percent of all the women they tested carried coronavirus antibodies.
But once teased apart by race and ethnicity, the numbers revealed striking differences. About 10 percent of the study’s Black and Latino participants had been exposed to the coronavirus, compared with 2 percent of the white women and 1 percent of the Asian women, the study found. (The study provided the category “Hispanic/Latino.”)But once teased apart by race and ethnicity, the numbers revealed striking differences. About 10 percent of the study’s Black and Latino participants had been exposed to the coronavirus, compared with 2 percent of the white women and 1 percent of the Asian women, the study found. (The study provided the category “Hispanic/Latino.”)
“When I saw the data, I almost fell out of my chair,” Dr. Hensley said.“When I saw the data, I almost fell out of my chair,” Dr. Hensley said.
Some have questioned the accuracy of certain antibody tests, which sometimes mistakenly detect coronavirus antibodies in a person who has never been infected. But Dr. Hensley said the team confirmed that its laboratory test had a false positive rate of just 1 percent, on par with some of the best commercial tests.Some have questioned the accuracy of certain antibody tests, which sometimes mistakenly detect coronavirus antibodies in a person who has never been infected. But Dr. Hensley said the team confirmed that its laboratory test had a false positive rate of just 1 percent, on par with some of the best commercial tests.
Mounting evidence shows that the pandemic’s outsize effects on Black and Latino people have been driven in large part by a long list of social factors that increase their risk of exposure to the virus, Dr. Guerra said.Mounting evidence shows that the pandemic’s outsize effects on Black and Latino people have been driven in large part by a long list of social factors that increase their risk of exposure to the virus, Dr. Guerra said.
Updated July 7, 2020
The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Black and Latino individuals are more likely to work essential jobs that cannot be done from home. Many live in multigenerational households and rely on public transportation, and have struggled for access to reliable sources of information about Covid-19, the disease caused by the coronavirus.Black and Latino individuals are more likely to work essential jobs that cannot be done from home. Many live in multigenerational households and rely on public transportation, and have struggled for access to reliable sources of information about Covid-19, the disease caused by the coronavirus.
Toxic and chronic stress, born out by decades of persistent racism, have also taken a toll on the health and well-being of Black and Latino people, Rachel Hardeman, a reproductive health equity researcher at the University of Minnesota who was not involved in the study, said in an email.Toxic and chronic stress, born out by decades of persistent racism, have also taken a toll on the health and well-being of Black and Latino people, Rachel Hardeman, a reproductive health equity researcher at the University of Minnesota who was not involved in the study, said in an email.
As health workers and researchers try to ramp up testing efforts nationwide, pregnant women could play a larger role in helping experts track the spread of disease, Dr. Robinson said.As health workers and researchers try to ramp up testing efforts nationwide, pregnant women could play a larger role in helping experts track the spread of disease, Dr. Robinson said.
“We also need more targeted research on pregnant populations” in general, she added.“We also need more targeted research on pregnant populations” in general, she added.
Recent analyses have found that pregnant women infected by the coronavirus may be at higher risk of worse outcomes, Dr. Hardeman said. Pregnant women are also thought to be more vulnerable to certain infections because carrying a fetus tamps down the immune system.Recent analyses have found that pregnant women infected by the coronavirus may be at higher risk of worse outcomes, Dr. Hardeman said. Pregnant women are also thought to be more vulnerable to certain infections because carrying a fetus tamps down the immune system.
The study was not designed to assess whether pregnant women are at higher risk of contracting the coronavirus than other groups. But if evidence of that emerges, it would be “concerning,” given the other known racial disparities among pregnant women, said Dr. Ibukun Akinboyo, a pediatrician and infectious disease specialist at Duke University. For instance, Black women are three to four times more likely than white women to die during or soon after childbirth.The study was not designed to assess whether pregnant women are at higher risk of contracting the coronavirus than other groups. But if evidence of that emerges, it would be “concerning,” given the other known racial disparities among pregnant women, said Dr. Ibukun Akinboyo, a pediatrician and infectious disease specialist at Duke University. For instance, Black women are three to four times more likely than white women to die during or soon after childbirth.
Pregnant women — who tend to be young and healthy members of the work force — do not represent the population as a whole, Dr. Robinson added. “We still need to have samples like this from kids and older people, and unpartnered people.”Pregnant women — who tend to be young and healthy members of the work force — do not represent the population as a whole, Dr. Robinson added. “We still need to have samples like this from kids and older people, and unpartnered people.”
Still, these patterns “reflect the structural inequities in the United States,” and underscore the need to address the factors that underlie them, Dr. Akinboyo said. That is powerful for those trying to curb disease transmission, but it can also help identify and protect those in need.Still, these patterns “reflect the structural inequities in the United States,” and underscore the need to address the factors that underlie them, Dr. Akinboyo said. That is powerful for those trying to curb disease transmission, but it can also help identify and protect those in need.
“Highlighting the groups that are more likely to get infected,” she said, “means we can get resources to the right groups.”“Highlighting the groups that are more likely to get infected,” she said, “means we can get resources to the right groups.”
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