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  1. #1606

    Re: Let's Discuss Science

    If he is on any type of blood thinner, this type of bruising can happen quite easily - particularly as people age. So, there is no telling.
    "And for my next fearless prediction..."

  2. #1607

    Re: Let's Discuss Science

    Agreeing with Jeff and Ti, but to elaborate on what Jeff said: As we get older, the elastic properties of our skin get much worse, such that bruising and even tears of the skin can occur very easily. Obviously, that would be much more likely if he is on a blood-thinner. And a blood-thinner alone could make that happen in someone younger. Sun-damaged skin develops this problem with easy bruising and tears even faster.

    But Ti is also right. An IV in that spot could easily have left such a bruise. Do we have any reason to believe that he had an IV recently??


  3. #1608

    Re: Let's Discuss Science

    Matthew Cappucci @MatthewCappucci
    For the first time in history, a tornado warning has been issued for a likely *fire tornado*.

    These are not "firewhirls." This is a rotating smoke plume being ingested into a pyrocumulonimbus cloud that could produce a bonafide fire-induced tornado.

    Tornadic wind speeds.

    Iowa gets hit by an inland hurricane and now this? It's official name is "pyrocumulonimbus" huh? Fire tornado will do.
    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.

  4. #1609
    Forum Director
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    Winston, a.k.a. Alvena Rae Risley Hiatt (1944-2019), RIP

  5. #1610
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    Re: Let's Discuss Science

    A fun read (with lots of photos) on the colors and patterns you can find in hybrid offspring of different species of angelfish.

    Normal angelfish can be a riot of color. But when different species breed, the hybrid offspring are sometimes even more vibrant.
    Winston, a.k.a. Alvena Rae Risley Hiatt (1944-2019), RIP

  6. #1611

    Re: Let's Discuss Science

    Quote Originally Posted by dryrunguy View Post
    A fun read (with lots of photos) on the colors and patterns you can find in hybrid offspring of different species of angelfish.

    Normal angelfish can be a riot of color. But when different species breed, the hybrid offspring are sometimes even more vibrant.

    This hybrid opened my eyes almost as much as waking up Goffin did for entirely different reasons of course...
    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.

  7. #1612

    Re: Let's Discuss Science

    97,000 People Got Convalescent Plasma. Who Knows if It Works?
    A treatment made from the blood of recovered Covid-19 patients seemed promising in March. Today … well, it’s still just promising.

    "There were elements within this pragmatic design that allowed for something similar to randomization," says one researcher. "I call it pseudo-randomization.”PHOTOGRAPH: GUILLERMO LEGARIA/GETTY IMAGES

    AS OF MONDAY, August 17, a nationwide program to treat Covid-19 patients with a fluid made from the blood of people who’d recovered from the disease—so-called convalescent plasma—had reached 97,319 patients.

    That’s a huge number of people, considering that nobody really knows whether convalescent plasma actually works against Covid-19.

    A spontaneously generated, self-assembling group of clinicians and cross-disciplinary researchers that built the nationwide program to ensure “expanded access” to convalescent plasma also created protocols for randomized, controlled trials, the gold standard for evidence in science. They hoped to test plasma’s ability to prevent disease after exposure, its capacity to treat Covid-19—and what Michael Joyner, an exercise physiologist at the Mayo Clinic who was instrumental in setting up the expanded-access network, called a “Hail Mary” protocol to try to help people who are severely ill, on ventilators.

    The distribution system got approved and built; the trial protocols did not. They never began.

    There are plenty of reasons to think plasma might help fight Covid-19. Physicians have used it for more than a century; it’s made by taking blood from people who’ve recovered from a disease and spinning it in a centrifuge down to a frothy, yellow liquid that contains the sum total of the donor’s immune response—molecules that attack all invading germs, and some that specifically target all the individual pathogens the donor has ever encountered. But actual rigorous trials of the stuff are rare. Dozens of randomized, controlled clinical trials are underway—tests that systematically compare the same kinds of people at similar stages of the disease who get convalescent plasma to those who don’t.

    Even without that rigor, this year tens of thousands of people received plasma for Covid-19. It played out as a one-on-one decision between physicians and patients, not a population-scale experiment designed to elicit knowledge about its efficacy. A preprint from the expanded-access group, not yet peer-reviewed, recounts the outcomes of more than 35,000 of these recipients at hundreds of hospitals. It retroactively splits that population into groups based on when in their illness they got plasma, or how laden the plasma was with the antibodies that actually do the disease-fighting.

    But, as the researchers and outside experts both acknowledge, that’s not as good as a clinical trial in which people get randomly assigned to a group that gets a drug (or procedure or surgery or whatever) versus a group that doesn’t, and then someone compares the results. And that’s a palpable loss.

    “Fifty thousand people have been given a treatment, and we cannot know whether it worked or not,” says Martin Landray, one of the leaders of the Randomised Evaluation of Covid-19 Therapies (or Recovery) Trial in England, a large-scale, multi-center, multi-drug randomized controlled trial that showed that the corticosteroid dexamethasone saved the lives of Covid-19 patients and the autoimmune drug hydroxychloroquine did not. (That 50,000 number was from a few weeks back, just after the plasma preprint came out.) “You wouldn’t need to randomize 50,000 patients. You wouldn’t need to randomize 5,000 patients to get the answer,” he says. “But that one difference is the difference between the effort being worthwhile or not.”

    Here’s another perspective, using the more up-to-date number: “In my mind, treating 98,000 people with plasma and not having conclusive data if it worked is problematic, and we should have a more robust data set before we give 98,000 people a product,” says John Beigel, associate director for clinical research at the National Institute of Allergy and Infectious Diseases’ Division of Microbiology and Infectious Diseases.
    Beigel was the lead author on the study of the drug remdesivir that led to its incorporation into the US standard of care for Covid-19.

    On Wednesday, The New York Times reported that in light of the current lack of efficacy data, the FDA has put on hold plans to issue an Emergency Use Authorization to allow anyone with Covid-19 to be treated with convalescent plasma, even beyond the Mayo-led program. (In an emailed statement, Anand Shah, deputy commissioner for medical and scientific affairs at the FDA, wrote: “Per policy, we are not able to comment on whether or not we will take any action regarding emergency use authorization for convalescent plasma and will render a decision at the appropriate time.”)

    What looked at the beginning of the pandemic like a rare bright spot—that a classic treatment used in pandemics for the past century might prove effective in this one, too, and provide a relatively simple stopgap before monoclonal antibodies and vaccines—now looks dimmer. It’s not that it doesn’t work. It’s worse than that: Because of failures in the system of how science gets done, nobody knows.

    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.

  8. #1613

    Re: Let's Discuss Science


    THIS ISN’T HOW things were supposed to happen. Earlier this year, when I spoke to Joyner, he told me about the three trials they hoped to run. Back in March, Joyner saw work validating plasma’s use as a bridge to more specific therapies—hyperimmune globulin, monoclonal antibodies that attack a carefully chosen part of the virus, and eventually vaccines that build a bodywide response, ideally a permanent one.

    It made sense. Plasma has been used for decades. Health care workers tried it against MERS, against the first SARS, against Ebola. More recently, a small randomized clinical trial of plasma on Covid-19 in China published in JAMA in June—just 103 patients—stopped early but showed indications of improvement. Another small RCT in the Netherlands, published in July as a preprint, didn’t show any efficacy of plasma, but it hinted that timing the dose was the key.

    Mayo spokespeople declined to make Joyner available for an interview this week, but he has said on Twitter that funding sources turned his group’s trials down, that they were more interested in pursuing hyperimmune globulin, a more specific type of blood-derived immunotherapy. Another researcher, who was involved in the construction of the expanded-access program, likewise tells me that they met resistance to their efforts to run randomized trials from the start. “We drew up these trials, and we approached multiple federal agencies and private funders to immediately get these trials going, and we actually didn’t have a lot of luck with that,” says Jeffrey Henderson, a physician and infectious disease researcher at Washington University St. Louis. “We had all these trials in the hopper. We were ready to ride the first wave. We figured, we’re not going to have enough to give to anybody anyway, let’s run trials. We just could not get traction. The studies we’re coming out with now are not the studies we wanted to do. It’s people making the best of the situation.”

    I asked representatives of the National Institutes of Health whether they discussed the studies Joyner proposed, but they haven’t responded. Henderson told me that the Mayo-led consortium approached the Gates Foundation, a major funder of medical research, and were similarly rebuffed. A Gates Foundation spokesperson says the foundation never received a formal proposal of any kind from Joyner’s group—and that the foundation is more focused on funding research into hyperimmune globulin. It doesn’t require a relatively complex infusion, as plasma does, it’s more shelf-stable, and might be more targeted as a treatment.

    The expanded-access program might have been, in one sense, a victim of its own success. Its planners initially expected to reach perhaps 300 hospitals. They instead ended up with a network of more than 2,700, with 14,000 physicians. The team expected to get 5,000 patients signed up, a mark they passed within a few weeks. The vast majority were at hospitals that had no infrastructure or experience with clinical trials, and wouldn’t be expected to run them. At the beginning, the FDA expected a smaller-scale expanded-access program that would be one of three ways people would get convalescent plasma. The other two would be either through an emergency Investigational New Drug (or IND) license that the agency also approved (which would let physicians prescribe plasma they got from other sources), and randomized clinical trials. Patients would get the help they desperately needed, and the proof would come alongside soon after.

    The expanded-use program quickly swamped the other two routes. In that sense, the FDA’s fast and compassionate approval of the expanded-use program might also have wounded the trials. “We were pushing, pushing to get the IND to do studies, assuming that studies would be funded somewhere, and the FDA is moving unusually fast,” Henderson says. “And then what they release is a compassionate use IND. I just remember it was like, silence. Like, wait a minute—is this good? It wasn’t what we were pushing for.”

    On the other hand, R. Scott Wright, director of the Human Research Protection Program at Mayo and another of the expanded-access program’s coordinators, says setting up trials would have been much more difficult than people have made it seem. In March and April, the Mayo-based group didn’t have enough plasma to send to potential trial sites, nor did it have enough placebo—it didn't even know what an appropriate placebo would have been. (Saline is clear and looks different from plasma, though you can add food coloring. But then to keep the study blinded, you also have to disguise that it comes from the pharmacy and not the blood bank.) Also, one of the hallmarks of the Covid-19 pandemic is the speed with which it moves from community to community, which means that by the time some trials got started, they didn’t have any patients to enroll. Travel restrictions meant that even if principal investigators knew where to go to get ahead of the disease, they weren’t allowed to go there to train site leads and study coordinators.

    Even if all of that got figured out, patients were skeptical of signing up for randomized trials of some complicated gunk they’d never heard of. Those who wanted plasma could already get it under the expanded-use program. Why risk getting randomized to the control group and getting a placebo? And as a Wednesday statement from the Mayo Clinic put it, the expanded-access program was “not intended to be a clinical trial to determine the efficacy of convalescent plasma,” even though it did convey “possible signals of efficacy.”

    The expanded-access program has involved the time and energy of thousands of physicians and nearly 100,000 sick people. Yet it has generated little information to help the next set of physicians and patients make a decision about whether to use that same compound. The resulting preprint isn’t nothing, to be sure. It shows that convalescent plasma is safe to use, as it has been in pandemics past.

    The researchers were able to sort their data to extract some knowledge. They kept track of the timing of when plasma was administered—early after a patient showed symptoms, or later. Earlier use seems to translate to lower mortality, according to the preprint.

    A reliable test of the levels of antibodies in the plasma—called antibody titer—didn’t exist when the program started, but the researchers made sure that all the blood banks involved saved samples of the plasma that got administered. Later, when tests did exist, the researchers went back and determined whether plasma given to someone contained high, medium, or low amounts of the various immunological components. So they grouped patient data that way, as well. Higher-titer plasma was most effective.

    “There were elements within this pragmatic design that allowed for something similar to randomization. I call it pseudo-randomization,” says Wright. He’s also an author, with Joyner and many others, on the preprint. “I’d like to see a randomized trial designed to test the hypothesis that our data reveals. And, in the absence of a randomized trial, I believe the data support the earlier use of convalescent plasma, and plasma with more evidence of immune activation.”

    But since none of those outcomes were randomized against control groups, it’s hard to conclude anything … conclusive, if you see what I mean.

    COAXING USEFUL RESULTS from a large-scale trial isn’t impossible. Landray’s Recovery trial has done it. It’s a multi-armed study that began with tests of half a dozen drugs, including the steroid dexamethasone (success! and now part of the Covid-19 pharmacopeia) and the antiinflammatory hydroxychloroquine (bzzzt). Recovery even has an arm studying convalescent plasma, though the decline of cases in the United Kingdom means enrollments have, for now, slowed.

    Recovery owes some of its success at putting drugs through a scientific wringer to the UK’s National Health Service. Every hospital is linked to the same database, with the same interchangeable record format. It’s easy to randomize new patients and collect data on them.

    That’s the kind of thing that has convinced some trialists in the US to advocate for a standing “pandemic protocol,” a pre-prepared network of research hospitals ready to mount trials of whatever, as soon as a pandemic hits. It’d be hard—nobody likes to spend money for no apparent reason, just waiting around for disaster. (Though in fact such a network could do other equally useful work during pandemic halftimes, and might well save money and lives in the long run.)

    Still, it’s hard not to be frustrated by what looks like a lost opportunity this time around. Tens of thousands of people got convalescent plasma, and nobody really knows if it helped them. Nobody really knows if it’ll help anyone else. “Future patients around the world, each one that comes along, you make an arbitrary decision whether to give it or not based on no more information than the last patient. You never learn anything,” Landray says.

    The head of the NIH, Francis Collins, convened a meeting a couple of weeks ago of many of the people receiving agency funding to do randomized, controlled trials on convalescent plasma. Half a dozen researchers, including Joyner, presented their data via videoconference. It might not have been a turning point, but it does suggest renewed interest in coordination of trials.

    Just a few weeks ago, a New York-based trial led by Liise-anne Pirofski, the head of infectious disease at Montefiore Hospital and a professor at Albert Einstein College of Medicine, was stalled at two hospitals (NYU was the other) and only 180 enrolled subjects. Pirofski had put the trial, her first as principal investigator, together in April while she was also treating New York’s surge of Covid-19 patients. “I spent quite a bit of time calling people at sites that were surging, and to be honest I didn’t get a lot of buy-in,” Pirofski says. But now she has $4.5 million in additional NIH funding under “Operation Warp Speed” and has expanded to research centers in Florida and Texas. “When we got funding and we had conversations with NIH, they saw the importance of expanding the trial and really helped us,” she says.

    Her trial is a straight, head-to-head comparison of hospitalized patients randomized to get transfused with either plasma or a placebo made of saline solution. An adaptive approach to the data means that even though she hopes to get at least 300 participants, an independent data team will monitor the ongoing results. If a signal shows up sooner, they’ll let Pirofski know. Results could be a kind of closing-of-the-loop; with Arturo Casadevall of Johns Hopkins, Pirofski wrote one of the early, influential articles advocating for the use of convalescent plasma against Covid-19. “What I really love about our study is that we will get an answer, and the answer will be the following: Plasma works, or plasma doesn’t work,” she says.

    Meanwhile at Hopkins, physician and infectious disease researcher Shmeul Shoham is running one of two companion studies that echo the protocols the expanded-access folks wanted to try—a post-exposure prophylaxis study of people exposed but not yet ill, and another of people who have symptoms but haven’t yet been hospitalized. At first, his money came from the Bloomberg Foundation and the state of Maryland. Then the Department of the Defense came through with $35 million. They’ll have over 1,000 participants at as many as 30 sites across the US, including in the Navajo Nation. “I have not had a good night’s sleep since March—worrying about whether we’re going to get approval, and then funding, and then enrolling patients,” Shoham says.

    That’s just a smattering of the trials that are out there. A team at NYU is trying to use smart statistics to combine, meta-analytically, the data that the small and paused plasma trials have gotten, in an effort to squeeze some useful knowledge out of them. And while it’s tempting to bang on a table about the lost months when thousands of people got plasma without a rigorous evidence base, it’s also true that lots of standard medical practice doesn’t have that evidence—for many of the same reasons of cost, time, tradition, and so on. (Consider medical interventions for low back pain, or the ways oncologists review imaging test results, or nutritional science, or or or.)

    One truism about randomized controlled clinical trials is that they are expensive. Another is that they take forever. And even though it might feel otherwise, Covid-19 is only eight months old. “Having done clinical trials now for 20 years, the time between when an idea is thought of, and the time to when the study is funded and operationalized, is usually a couple of years,” Shoham says. “And then the time from when the study results come in to when it changes therapy in a meaningful way can be another five years after that.”

    The bungled Covid-19 response in the US doesn’t allow that kind of time. Sure, randomized, controlled trials won’t always be possible, or even appropriate. Are they the only way to know about the world? No, of course not. Pragmatic studies like the expanded-use preprint or retrospective and observational studies are all stations on a journey to greater (but never perfect) certainty. “I’m a trialist. I strongly advocate using trials when appropriate. But I think there are other ways to get medical evidence that may not be as powerful as a trial but are important,” Wright says. That’s manifestly so. But in the case of convalescent plasma, a therapy that seemed like a tantalizing possibility in March, remains only that: tantalizing.

    Updated 8/21/20 9:40 AM PDT. This article has been updated to reflect that the New York Times reported that the FDA put its decision on a plasma emergency use authorization is on hold, and did not say it wouldn't issue one. 1:05 PM PDT updated to correct who is running the attempt to aggregate convalescent plasma trial data.
    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.

  9. #1614

    Re: Let's Discuss Science

    FDA to authorize plasma treatment over scientists' objections
    The president will announce the emergency authorization during a press conference with HHS Secretary Alex Azar and FDA Commissioner Stephen Hahn.

    08/23/2020 02:47 PM EDT
    Updated: 08/23/2020 03:27 PM EDT

    The Food and Drug Administration will issue an emergency authorization for blood plasma as a coronavirus treatment, President Donald Trump is set to announce Sunday evening, according to three administration officials.

    The agency held off on the decision last week over concerns from government scientists that evidence for the treatment's effectiveness is thin — prompting Trump to accuse the FDA of slow-walking the therapy to harm his reelection chances without offering any evidence to support his claim. It is not clear whether the FDA has received additional clinical trial data in the last week that would support the therapy's use.

    An emergency authorization normally paves the way for expanded use of an experimental therapy. But it is not clear what effect the FDA's decision will have in the case of so-called convalescent plasma, which more than 70,000 Americans have already received — largely outside of randomized, controlled clinical trials that could prove whether the approach is effective.

    Trump will announce the emergency authorization alongside his health secretary, Alex Azar, and FDA Commissioner Stephen Hahn, in a press conference one day before the start of the Republican National Convention. White House Press Secretary Kayleigh McEnany said the announcement would involve a "major therapeutic breakthrough," but experts have said the treatment is unlikely to be a game-changer in the fight against a pathogen that's killed more than 170,000 in the United States.

    The treatment involves giving the sick antibody-rich plasma extracted from the blood of coronavirus survivors. In theory those antibodies should help recipients fight off the virus. But while plasma treatment has been used safely against diseases from diphtheria to Ebola over the past 130 years, its track record on effectiveness is mixed. And it has not yet been proven to work against the coronavirus.

    Scott Gottlieb, Trump's first FDA commissioner, on Sunday said that plasma is "probably beneficial" for coronavirus patients, as he also acknowledged scientists' concerns about the lack of evidence for the treatment.

    "I think some people wanted to see more rigorous data to ground that decision," Gottlieb said on CBS's "Face the Nation."

    Until now, most Covid-19 patients who have received plasma have gotten it through an expanded-use program the FDA set up with the Mayo Clinic.

    An analysis of data on more than 35,000 patients enrolled in the Mayo Clinic program examined how they fared a month after receiving plasma. It found that a smaller proportion (21.6 percent) of patients who were given the treatment within three days of diagnosis died compared to people who received the treatment later in the course of their disease (26.7 percent).

    But the study, published on Aug. 12 but not peer-reviewed, did not include a control group that would have allowed the researchers to determine whether the plasma treatment reduced the risk of death when compared to standard care.

    A study by researchers at Houston Methodist hospitals reached similar conclusions. The 136 patients who received plasma were more likely to have survived a month post-diagnosis compared to 251 patients who did not get the treatment. The effect was strongest in people who were given plasma within three days of hospital admission. But the study, published on August 10 in the American Journal of Pathology, was not randomized or controlled. The doctors running the study gave every enrolled patient plasma, and later compared their outcomes to other people treated at the hospital.

    It's not clear when definitive evidence on plasma's effectiveness will emerge. Janet Woodcock, head of therapeutics for Operation Warp Speed, told an NIH scientific summit on Thursday that 162 convalescent plasma studies are underway, but only six could produce the type of data needed to support an emergency authorization or approval from the FDA.

    Despite the lack of definitive evidence that the treatment is effective, Trump and members of his coronavirus task force launched a campaign in July urging Covid-19 survivors to donate their blood plasma to help stem the pandemic.

    HHS had spent almost $200 million as of July 9 to acquire the plasma of coronavirus survivors from vendors such as the non-profit America's Blood Centers. The government has also given the American Red Cross almost $70 million to coordinate the collection of convalescent plasma.

    The FDA made the right move to authorize expanded use of the plasma treatment, said Jeffrey Henderson, an infectious disease doctor at Washington University in St. Louis. Even though it's not clear the treatment is effective, he said, there is ample evidence that it is safe.

    But other outside experts — including at least four former FDA chiefs — have urged the agency to hold off an emergency authorization until there is clear data that plasma works.

    "Let's get the trials done & if the results are life saving, let's make it standard of care, thus benefiting hundreds of thousands to millions," former FDA Commissioner Robert Califf tweeted this week. "If not we can avoid the huge expense & effort & keep looking for best treatments."

    Adam Cancryn, Dan Diamond and Sarah Owermohle contributed to this story.
    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.

  10. #1615

    Re: Let's Discuss Science

    My post #3493 on the COVID-19 Updates thread is totally relevant to the above discussion. I discussed there the lack of randomized trial data to support the use of plasma, and other points about the Mayo trial.


  11. #1616

    Re: Let's Discuss Science

    The pandemic is ruining our sleep. Experts say ‘coronasomnia’ could imperil public health.

    Karin Brulliard and
    William Wan
    September 3, 2020 at 2:58 p.m. EDT

    Sara Tibebu tried bubble baths. She curated playlists of low-fi beats, followed guided meditation videos and paid for virtual therapy. In desperation, she even plucked and dried lavender to make sachets to place inside her pillowcase.

    But every night, she still found herself staring at the ceiling — wide-awake. For five months, all Tibebu has wanted is a decent night of shut-eye.

    “The lack of sleep is just driving me crazy,” said Tibebu, 36, a technical writer who lives in Takoma Park, Md., where most nights her eyes snap open around 2 a.m., and she begins to obsess over everything from the dismal U.S. response to the pandemic to the sorry state of her love life.

    As if the novel coronavirus has not already wrought devastation aplenty on the world, physicians and researchers are seeing signs it is doing deep damage to people’s sleep. “Coronasomnia,” as some experts now call it, could prove to have profound public-health ramifications — creating a massive new population of chronic insomniacs grappling with declines in productivity, shorter fuses and increased risks of hypertension, depression and other health problems.

    It’s easy to see why people can’t sleep, experts say. The pandemic has heightened stress and upset routines.

    Bank accounts are strained and children are home. Days lack rhythm and social interaction. The bedroom, which sleep experts say should be an electronics-free sanctuary, also now serves for many as a makeshift office. The news is gripping, bad and breaking around the clock in blue light that discourages shut-eye. The future is uncertain, the end of the crisis indiscernible.

    “Patients who used to have insomnia, patients who used to have difficulty falling asleep because of anxiety, are having more problems. Patients who were having nightmares have more nightmares,” said Alon Avidan, a neurologist who directs the UCLA Sleep Disorders Center. “With covid-19, we recognize that there is now an epidemic of sleep problems.”

    Even before the virus, lack of sleep was a simmering public-health crisis associated with a suite of maladies. Roughly 10 to 15 percent of people worldwide were suffering from chronic insomnia, the struggle to fall or stay asleep at least three nights a week for three months or longer. Crises such as natural disasters or terrorist attacks are known to trigger short-term sleeplessness. But experts say the pandemic’s unprecedented global impact and protracted nature threaten to expand the rate of chronic insomnia, which is much harder to treat.

    “Insomnia is not a benign problem. … The impact of insomnia on quality of life is enormous,” said Charles M. Morin, director of the Sleep Research Center at Université Laval in Quebec, who has called for large-scale campaigns about the value of shut-eye to stem a coronavirus-era sleep crisis. “We hear a great deal about the importance of exercising and good diet, but sleep is the third pillar of sustainable health.”

    Morin is leading a 15-country project to measure the pandemic’s impact on sleep, but there is already evidence of broad deterioration. Prescriptions for sleep medications jumped 15 percent between mid-February and mid-March in the United States, according to Express Scripts, a major pharmacy benefit manager. At the UCLA Sleep Disorders Center, the number of patients complaining of insomnia has risen 20 to 30 percent, and more of them are children.

    Web-based studies in China, France and Italy found insomnia or poor sleep in about 20 percent of respondents, particularly during pandemic-related shutdowns — which, Italian researchers wrote, seemed to cause people to lose track of days, weeks and time itself. In Greece, researchers reported that more than 37 percent of 2,427 people surveyed in April had insomnia.

    While such surveys are not methodologically robust, they provide “an important signal, especially when it’s consistent across countries,” said Orfeu M. Buxton, a sleep researcher at Pennsylvania State University, who said it’s important to view anxiety and sleep troubles as appropriate at a time like this.

    “We evolved these brain mechanisms to help us react to literally existential threats, and they’re piling on right now, especially for the less advantaged,” Buxton said. “The circumstances are such that sleep is a sentinel, a sign that things are really wrong in our country and the world.”

    ‘I can’t continue living this way’

    The word Buxton uses to describe the unprecedented confluence of stressors is dread. Dread about the future is often imagined, he said, but not now. “This is dread that’s real,” he said.

    It is also the word Cheryl Ann Schmidt uses for the heavy, knotlike feeling that hits her solar plexus every time she lies down at night, and even when she tries to nap.

    “I get this sense of dread, like I’m not going to wake up, like something is seriously wrong in the world,” said Schmidt, 65, who lives in East Lansing, Mich.

    Schmidt’s sleep woes began when she was sent home from her job as a recycling director at a Styrofoam company in April. They only got worse a month ago, when she was laid off. For two terrifying weeks before Medicare kicked in, she had no health insurance and didn’t leave the house for fear of injury or illness.

    Now, Schmidt said, she lies awake fretting about finances and lost retirement plans, then chastising herself for self-pity when others are dying of covid-19, the illness caused by the coronavirus. Most nights, she waits in the darkness until she hears the thump of the newspaper hit her front door around 4:30 a.m. That’s when she gives herself permission to rise and read about the country’s latest crises at her dining table.

    “Sometimes, the thought goes through my head that maybe getting this virus really is inevitable, that I should just get infected and get it over with. And if I die, I die,” Schmidt said. “It’s not that I really have a death wish, but in the middle of the night, I think to myself, I can’t continue living this way.”

    The unusual, toxic cocktail of pandemic-era stresses that degrade sleep is so strong that physician Abhinav Singh, director of the Indiana Sleep Center, coined a mnemonic to explain it: “FED UP.” The letters stand for financial stress, emotional stress, distance from others, unpredictability, and personal and professional concerns.

    When shutdowns were imposed in March — freeing people of commutes and sprints to the school-bus stop — some of his patients began sleeping better. Months later, they’re seeking help, as are former patients and many new ones.

    “The unpredictability of when it’s going to end is starting to weigh back on people,” Singh said.

    No end in sight

    Sleep physicians are seeing increasing delays of bedtimes and wake times. Avidan, of UCLA, said some of his patients are “living in L.A., but they’re on Honolulu time zone.” That disrupts the circadian rhythms that regulate sleep cycles, particularly by depriving people of exposure to natural light early in the morning, Avidan said. And it is exacerbated by the artificial light of screens — drivers of pre-pandemic sleep disorders and the way many now connect to work meetings, happy hours, entertainment and news.

    Circadian rhythms are also affected by daily routines — and lack thereof, nowadays — such as meal times, riding the subway or hitting yoga class.

    “Social cues are also circadian cues,” Singh said. And they have been ripped away.

    Carliss Chatman, an associate law professor at Washington and Lee University, expected to get the best sleep of her life once the school closed. Her sleep had never been stellar, but she figured she would slide into her normal summer habits — working from home and sleeping a short night and a solid afternoon nap.

    Before the pandemic, however, the self-described extrovert now realizes, working from home meant writing at coffee shops or libraries that are now shuttered, and lunching with friends. Now, it happens in an upstairs office at her house, where there’s no one to greet.

    Chatman, 41, has eliminated her triple Americanos, limited alcohol and sugar, hung blackout curtains and kept up with exercise. Even so, she finds it impossible to nap. She’s left with sluggish afternoons and about four hours of fitful sleep at night, much of it spent ruminating on what would happen if she gets covid-19.

    “I find myself contingency planning a lot,” Chatman said. “What happens to the class if I can’t teach it?”

    For Karthik Kumar, an attorney in the Washington area, “a switch flipped” in May, as he realized there was no end in sight to the uncertainty. His slumber is now punctuated by apocalyptic dreams: He is stuck in a bunker, methodically counting how many food rations he has left, or wandering through an abandoned city as society crumbles around him.

    Dramatic dreams are a consequence of heightened anxiety, according to clinicians who have seen a rise in patients reporting nightmares, night terrors and sleepwalking. Vivid dreams can also result from sleeping longer or later in the morning, when sleep is particularly dream-rich — but not necessarily restful.

    “The one common thing in my dreams is that things are rapidly falling apart, and I’m attempting to survive,” Kumar said. “I wake up feeling like I spent the night being chased by a bear.”

    Sanctuary in the woods

    The rise in prescription medications, at least early in pandemic, is not surprising, experts say. Many people approach primary-care doctors for sleep problems, and pills they prescribe can be effective and safe in the short term. But they are not recommended for chronic insomnia.

    There is growing recognition in the medical field that the best treatment is cognitive behavioral therapy for insomnia, said Norah Simpson, a clinical psychologist at Stanford University’s Sleep Health and Insomnia Program, which provides non-drug treatments. But few therapists are trained in it, and insurance doesn’t always cover it. Physicians who specialize in sleep are also in short supply.

    The good news, Simpson said, is that therapy can be administered virtually, and such services have expanded during the pandemic. But that requires an Internet connection, an awareness of treatment options and an available practitioner — a combination out of reach for many people.

    Even without professional help, people can take steps to improve their sleep, experts say. Abstaining from electronics for at least an hour before bed, getting light exposure by about 8 a.m. and making time at night for sleep are critical.

    Many experts advise prioritizing exercise and family time, and going on a media diet or fast. Simpson’s top recommendation: Rethink your consumption of news.

    “When we are engaging with news that may be stressful or worrying in the last hour or two before bed, that can really have a negative impact on sleep,” Simpson said.

    Tibebu, the technical writer in Maryland, said online therapy for anxiety helped somewhat. So did focusing on self-care — eating well, buying herself flowers.

    But in the end, what gave her the most relief during a particularly maddening stretch of insomnia last month was grabbing her one-person tent and fleeing to a state park.

    There, below glinting stars, surrounded by the buzz of cicadas and a crackling fire, she got her first full night of sleep in months.

    Almost every weekend since, she has been sleeping outdoors, returning to her condo on Sunday night feeling restored enough to withstand yet another week of pandemic insomnia at home.

    Never mind that “catching up” on sleep over weekends is a myth, according to research. For now, it’s all Tibebu has.

    “That’s the only way I’ve been able to get through the last month,” she said.
    “No matter how cynical I get, I just can't keep up.” – Lily Tomlin.

  12. #1617

    Re: Let's Discuss Science

    Fascinating video for those of you not familiar with LA water supply system.

    Roger forever

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