Yet more data support COVID-19 aerosol transmission – CIDRAP

Last Updated on September 1, 2020 by

Two studies published late last week in Clinical Infectious Diseases highlight the role of airborne spread of COVID-19 and the importance of efficient ventilation systems. One study found that patients can exhale millions of viral RNA particles per hour in the early stages of disease, and the second tied an outbreak affecting 81% of residents and 50% of healthcare workers at a Dutch nursing home to inadequate ventilation.

In the first study, researchers in China analyzed exhaled breath samples from 49 COVID-19 patients from 10 countries, 4 hospitalized patients without COVID-19, and 15 healthy people from Beijing using reverse transcription polymerase chain reaction. They also tested 26 air samples and 242 surface swabs from quarantine hotels, hospitals, and personal belongings.

Of the exhaled breath samples, 26.9% were positive for RNA from SARS-CoV-2, the virus that causes COVID-19, while 3.8% of air samples and 5.4% of surface swabs tested positive. The viral RNA breath emission rate was highest in the first stages of disease.

Breath samples from two patients were positive for coronavirus RNA, but surface swabs of their cell phones, hands, and toilets were negative. Viral RNA was also detected on an air ventilation duct below another patient’s bed.

Semi-enclosed environments

Among the 242 surface swabs, viral RNA was found most often on toilet bowls (16.7%); floors (12.5%); patient hands, pillowcases, mobile phones, and computer keyboards (4.0%); and surfaces that healthcare staff touched (2.6%). But only 2 of 22 mobile phone surface samples tested positive for viral RNA, and all object handles were negative.

The authors said that the viral RNA breath emission rate appears to vary based on factors such as patient activity level and disease stage and may be affected by age. Viral RNA emission was sporadic in at least one patient, whose samples generated different test results on different days.

The findings support previous studies that concluded that COVID-19 is mostly likely spread by aerosols rather than large respiratory droplets or contaminated surfaces, the researchers said. Such studies have documented airborne spread in semi-enclosed environments such as a choir practice in Washington state and a restaurant in Guangzhou, China.

“Though we did not study infectivity or transmission probability and other virus releasing activities such as talking and singing, our study demonstrates that exhaled breath emission plays an important role in SARS-CoV-2 emission into the air, which could have contributed greatly to the observed airborne cluster infections and the ongoing pandemic,” the authors wrote.

Stale indoor air

In the second study, researchers in Rotterdam and Utrecht, the Netherlands, wrote a research letter documenting a COVID-19 outbreak that sickened 17 residents and 17 healthcare staff in one of seven wards in a nursing home for people with psychiatric or behavioral conditions. None of the 95 residents or 106 healthcare staff in the other six wards tested positive.

The authors noted that the Netherlands was experiencing a low prevalence of COVID-19 the week of the outbreak, with only 493 of that country’s residents testing positive, compared with 8,391 cases during the most intense week of the outbreak in April.

To prevent coronavirus transmission, all healthcare workers were assigned to specific wards and required to wear surgical masks during patient care starting Apr 26. Residents lived in individual rooms and spent part of each day in shared living rooms; some residents were mobile.

Suspecting that the ventilation system of the affected ward could have contributed to the outbreak, investigators found that an energy-efficient system had been installed in which indoor air was refreshed only when indoor carbon dioxide (CO2) concentrations detected elevated levels. If CO2 levels didn’t exceed a certain threshold, unfiltered indoor air was simply recirculated throughout the ward. In contrast, the six unaffected wards were refreshed regularly with outside air.

The researchers noted that low CO2 levels produced by inactive patients may have led to stale air in the affected ward, which was cooled by two air conditioning units that also recirculated the air in the shared living areas. SARS-CoV-2 RNA was found in dust on the mesh dust filter of living room air conditioners and in four filters from three of eight ventilation units.

The research letter was written in support of findings of a study published in the same journal on Jul 6 warning of the hazards of airborne COVID-19 transmission in poorly ventilated environments.

“We advise that prevention of COVID-19 transmission should take into account the possibility of aerosol transmission in healthcare facilities and other buildings where ventilation systems recirculate unfiltered inside air,” the authors of the Aug 28 study wrote.

ESC: EMPEROR-Reduced Meets Primary Endpoint in Heart Failure With Reduced Ejection Fraction – Cath Lab Digest

Last Updated on September 1, 2020 by

Sophia Antipolis, France – August 31, 2020:  Empagliflozin reduces the risk of cardiovascular death or hospitalisation for heart failure in patients with heart failure and a reduced ejection fraction. That’s the finding of the EMPEROR-Reduced trial presented in a Hot Line session at ESC Congress 20201 and published in the New England Journal of Medicine. 2

The EMPEROR-Reduced trial was designed to evaluate the effects of empagliflozin 10 mg once daily (as compared with placebo) in patients with heart failure and a reduced ejection fraction, with or without diabetes, who were already receiving all appropriate treatments for heart failure.3

The primary endpoint was the composite of cardiovascular death or hospitalisation for heart failure. Secondary endpoints included adverse renal outcomes, defined as chronic dialysis or renal transplant or sustained reduction of estimated glomerular filtration rate (eGFR).

By adjusting eligibility based on natriuretic peptide levels to the baseline ejection fraction, the trial preferentially enrolled higher-risk patients, who had not been well-represented in earlier studies.

The trial enrolled 3,730 patients with heart failure and a left ventricular ejection fraction of 40% or less, with or without diabetes. Patients were randomly assigned to empagliflozin 10 mg once daily or placebo.

During a median follow-up of 16 months, the primary endpoint occurred in 361 patients in the empagliflozin group and 462 patients in the placebo group (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.65–0.86; p<0.0001). Empagliflozin reduced total hospitalisations for heart failure (HR 0.70; 95% CI 0.58–0.85; p<0.001).

Adverse renal outcomes occurred in 30 patients in the empagliflozin group and 58 patients in the placebo group (HR 0.50; 95% CI 0.32–0.77; p<0.01).

Uncomplicated genitourinary tract infections were more common in the empagliflozin group (1.3% vs. 0.4%), but the frequency of hypotension, volume depletion and hypoglycaemia were similar in the two groups.

Principal investigator Dr. Milton Packer of Baylor University Medical Centre, Dallas, Texas said: “Empagliflozin reduced the risk of serious heart failure events by 30% and decreased the risk of serious adverse renal outcomes by 50%. This trial extends the benefits of SGLT2 inhibitors to higher-risk patients and shows a meaningful benefit on renal outcomes in patients with heart failure for the first time.”

Dr. Packer said: “Based on the combined results of our trial (together with the earlier trial with dapagliflozin), we believe that SGLT2 inhibition with empagliflozin and dapagliflozin will now become a new standard of care for patients with heart failure and a reduced ejection fraction.”

Funding: The EMPEROR-Reduced trial with empagliflozin was sponsored by Boehringer Ingelheim and Eli Lilly and Company. 

Disclosures: Dr. Packer is the Chair of the Executive Committee for the EMPEROR-Reduced trial with empagliflozin, which was sponsored by Boehringer Ingelheim and Eli Lilly and Company. Dr. Packer has consulted for Abbott, Actavis, Akcea, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cardiorentis, Daiichi Sankyo, Gilead, Johnson & Johnson, NovoNordisk, Pfizer, Relypsa, Sanofi, Synthetic Biologics and Theravance. 

References and notes

1Abstract title: Effect of Empagliflozin on Cardiovascular Death and Heart Failure Hospitalizations in Patients With Heart Failure With a Reduced Ejection Fraction, With and Without Diabetes.

2Packer M, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. DOI: 10.1056/NEJMoa2022190

3Packer M, Butler J, Filippatos GS, et al. Evaluation of the effect of sodium–glucose co-transporter 2 inhibition with empagliflozin on morbidity and mortality of patients with chronic heart failure and a reduced ejection fraction: rationale for and design of the EMPEROR-Reduced trial. Eur J Heart Fail. 2019;21:1270–1278.

About the European Society of Cardiology

The European Society of Cardiology brings together health care professionals from more than 150 countries, working to advance cardiovascular medicine and help people lead longer, healthier lives.

About ESC Congress

ESC Congress is the world’s largest gathering of cardiovascular professionals contributing to global awareness of the latest clinical trials and breakthrough discoveries. ESC Congress 2020 takes place online from 29 August to 1 September. 

No Autism Risk Connected to H1N1 Flu Vaccine – MedPage Today

Last Updated on September 1, 2020 by

Children born to women receiving the 2009-2010 H1N1 influenza vaccine during pregnancy had no higher likelihood of developing autism later in life, a Swedish-based population study found.

Babies exposed to the “swine flu” vaccine during pregnancy did not have an increased risk of developing autism spectrum disorder (ASD) or autistic disorder (AD) compared to those born to unvaccinated women, reported Jonas F. Ludvigsson, MD, PhD, of Karolinska Institutet in Stockholm, and colleagues.

In an analysis of first trimester exposures — a period when vaccines could potentially have the most profound effect on fetal neurodevelopment — there was still no link between immunization and autism risk, researchers wrote in Annals of Internal Medicine.

“Both our main analyses… and several additional analyses all show that H1N1 influenza vaccination during pregnancy is not linked to autism in the offspring,” Ludvigsson told MedPage Today in an email.

In an accompanying editorial, Anders Hviid, MSc, DrMedSci, of the Statens Serum Institut and University of Copenhagen in Denmark, stated that this research “is a rare and welcome contribution to a more comprehensive safety evaluation, which goes significantly beyond the perinatal period.”

While the biological plausibility that influenza vaccines may harm fetal development is weak, Hviid emphasized a need for further observational studies that examine the effects of vaccinations not only during pregnancy and immediately after birth, but also into later childhood. This is crucial to determine safety, but also to disprove the skepticism around vaccines that may derail immunization programs.

“A comprehensive and proactive approach to vaccine safety is needed now more than ever with the hopefully imminent arrival of COVID-19 vaccines,” Hviid wrote.

Since the suggested link between the MMR vaccine and risk of autism was put forth in the retracted Wakefield et al. study, several studies have debunked the proposition that vaccinations increase risk of autism; yet, some examining influenza and H1N1 vaccines during pregnancy have been unable to completely reject the hypothesis, Ludvigsson said.

Using Swedish national registry data, Ludvigsson and colleagues conducted a population-based cohort study to examine the risk of autism in children whose mothers received the 2009-2010 swine flu vaccination during pregnancy.

Ludvigsson’s group collected data on singleton live births in Sweden when much of the population was immunized in a swine flu pandemic vaccination campaign. They linked vaccination data to national patient registers, including participants from seven healthcare regions in Sweden.

In their primary analysis, researchers compared the risk of autism spectrum disorder in children who were exposed to the swine flu vaccine in utero to those who were unexposed. The secondary outcome was autistic disorder. Researchers also compared the risks associated with vaccination in the first trimester to other periods of pregnancy, and conducted a sensitivity analysis examining maternal epilepsy, and neurologic and psychiatric disease.

The group controlled for maternal age at delivery, BMI, parity, smoking, country of birth, disposable income, health care region, comorbidities, infant sex, and prenatal study time.

In a cohort of more than 69,000 study participants, nearly 40,000 infants were prenatally exposed to the H1N1 vaccine. Mothers of vaccine-exposed infants were older at delivery and had a higher disposable income, and were less likely to have higher BMI, to have smoked, or to have been born outside of Sweden.

In an average seven-year follow-up, researchers found that 1.0% (394) of children who were prenatally exposed to the H1N1 vaccine were diagnosed with autism spectrum disorder, compared to 1.1% (330) of children who were unexposed.

Compared to unexposed children, there was no increased risk of ASD in those exposed to the swine flu shot (adjusted hazard ratio 0.95, 95% CI 0.81-1.12). There was also no increase in risk for the secondary outcome, AD, in children prenatally exposed to the vaccine (aHR 0.96, 95% CI 0.80-1.16). The sensitivity analyses did not change risk estimates.

Ludvigsson and colleagues recognized that their analysis may be limited by a lack of information on H1N1 infection in pregnant women, and may be subject to additional unmeasured confounding.

The researcher also said that understanding vaccine safety in the pregnant population is significant, especially during the COVID-19 pandemic.

“All vaccination research now is important since it increases our understanding about how vaccines will, and will not, influence fetal development,” Ludvigsson stated. “That is crucial in anticipation of the coming covid-19 vaccines when likely thousands if not millions of pregnant women will be offered vaccinations against covid-19.”

  • Amanda D’Ambrosio is a reporter on MedPage Today’s enterprise & investigative team. She covers obstetrics-gynecology and other clinical news, and writes features about the U.S. healthcare system. Follow

Disclosures

Research by Ludvigsson and colleagues was supported by the Swedish Research Council and the Swedish Council for Working Life and Social Research.

Co-authors reported relevant relationships with the Strategic Research Area Epidemiology program at Karolinska Institutet, the Swedish Research Council, and Janssen.

Hviid reported receiving grants from the Novo Nordisk Foundation during the conduct of the study.

Researchers share praise—and concerns—about how the keto diet and intermittent fasting affect cardiovascular health – Cardiovascular Business

Last Updated on September 1, 2020 by

“With diets like keto and intermittent fasting, social and popular media has been flooded with claims, promises and warnings that are at best unverified and at worst harmful to your health,” co-author Andrew Freeman, MD, director of cardiovascular prevention and wellness for National Jewish Health, said in a statement. “Diets recommended by health experts, such as plant-based and Mediterranean diets, have been extensively studied for safety and efficacy, and demonstrated conclusively to improve cardiovascular health.”

Freeman added that it is “particularly important” for diabetes to speak with a physician before beginning intermittent fasting.

Until larger studies have been carried out on the long-term impact of these dietary approaches, Freeman and colleagues note that neither diet is recommended as a tool for preventing cardiovascular disease.

The full review from Freeman et al. can be read here.

New technique used to map malaria in Africas climate future – Africa Times

Last Updated on September 1, 2020 by

Malaria hits hard on the African continent, home to 93 percent of the world’s 228 million cases in 2018 and 94 percent of its fatalities. What scientists at the universities of Leeds and Lincoln in the UK want to know is how Africans might be affected in the climate change future, because climate – heat, humidity, rainfall – is critical to how the mosquito-borne disease is transmitted.

So they developed a new model to better map where outbreaks are likely, one they say more accurately accounts for water and moisture, and its evaporation, infiltration and flow through rivers. Their study, published in Nature Communications, highlights how river corridors serve as “hot spots” of malaria transmission.

The results point to some changes in where malaria might be observed in the future, despite the public health gains of the past.

Botswana and Mozambique, for example, benefit from more arid conditions that discourage malaria transmission when compared with other African regions. Yet that advantage evaporates, too, when considering projections researchers developed while using the new hydrology mapping.

“Conversely, projected decreases in malaria-suitable areas across West Africa are more pronounced,” the authors said. “The largest difference is in South Sudan, where the study estimates substantial decreases in malaria suitability in the future.”

The Niger and Senegal rivers in Mali and Senegal, and the Webi Juba and Webi Shabeelie rivers in Somalia, are all potential zones for malaria transmission despite the fact they are outside the geographical zones currently identified as malaria-suitable regions.

The scientists say looking at the rivers and the breeding grounds near them is important because Africa’s human populations rely so heavily on its rivers.

“If we are to project the impact of climate change on the geography of malaria transmission, we need to develop more sophisticated ways of representing that envelope of malaria suitability both today and in the future,” said lead author Dr. Mark Smith.

Image: University of Leeds

Ultra-processed food consumption is associated with chromosomal changes linked to biological ageing – EurekAlert

Last Updated on September 1, 2020 by

A new study has shed light on the link between the consumption of ultra-processed foods (UPF) and the shortening of telomeres; sections of chromosomes that can be used as a marker of biological age. The work was conducted by Lucia Alonso-Pedrero and colleagues with the supervision of Professor Maira Bes-Rastrollo and Professor Amelia Marti, University of Navarra, Pamplona, Spain.

The research, being presented at this year’s European and International Conference on Obesity (ECOICO 2020), held online this year (1-4 September), indicates that telomeres were twice as likely to be short in individuals who had a high consumption (more than 3 servings per day) of UPFs. Short telomeres are a marker of biological ageing at the cellular level, and the study suggests that diet may be causing the cells to age faster.

Telomeres are structures formed from a strand of DNA together with specialised proteins, and which are located at the ends of the chromosomes. Each human cell has 23 pairs of chromosomes that contain our genetic code, and while the telomeres do not contain genetic information themselves, they are vital for preserving the stability and integrity of chromosomes and by extension, the DNA that every cell in our body relies on to function. As we get older, our telomeres get shorter since each time a cell divides, part of the telomere is lost, thus telomere length (TL) is considered to be a marker of biological age.

Worldwide, fresh food consumption is decreasing while UPF intake is rising. UPFs are industrial formulations of food-derived substances (oils, fats, sugars, starch, protein isolates) that contain little or no whole food and often include flavourings, colourings, emulsifiers, and other cosmetic additives. The processes and ingredients used in the manufacturing of UPFs make them highly convenient (ready-to-consume, almost imperishable), highly attractive for consumers, and highly profitable (low cost ingredients, long shelf-life) for their manufacturers. These properties also result in them being nutritionally poor or unbalanced, and liable to be over-consumed, often at the expense of less processed and more nutritious alternatives.

Research has associated UPFs with serious diseases including hypertension, obesity, metabolic syndrome, depression, type 2 diabetes, and various cancers. These conditions are often age-related and are linked to oxidative stress, inflammation, and cellular ageing which can also influence TL. Despite this, there have been few studies into the effects of UPF consumption on TL, but those that have been conducted found associations between the intake of sugar-sweetened beverages (SSBs), alcohol, processed meats and other foods rich in saturated fats and sugar with having shorter telomeres. These studies are far from conclusive however, as other research has not shown a link between UPF and TL.

The authors objective was to evaluate the association between UPF consumption and the risk of TL within an elderly study population using the NOVA system method for classifying the degree of processing of different foods.

Data were obtained from participants in the SUN Project: an open prospective cohort of graduates from the University of Navarra and other Spanish universities. Recruitment began in 1999 and is permanently open to any graduate age 20 years old or more, with data collection being done via self-reported questionnaires mailed out every 2 years. This research is based on the analysis of a genetic study performed in May 2008 which all SUN Project participants over the age of 55 were invited to take part. In total, 886 individuals provided saliva samples for DNA analysis as well as accurate records of their daily food intake.

In total 645 men and 241 women with an average age of 67.7 years were included in the analysis and were grouped into 4 groups of equal size (quartiles) from ‘low’ to ‘high’ based on their UPF consumption: less than 2 servings/day, 2 to 2.5 servings/day, more than 2.5 to 3 servings/day, and more than 3 servings/day.

Those in the ‘high’ quartile were more likely to have family history of cardiovascular disease (CVD), diabetes, and abnormal blood fats, and to snack more in between meals. They also consumed more fats, saturated fats, polyunsaturated fats, sodium, cholesterol, SSBs, fast food, and processed meats while consuming less carbohydrates, protein, fibre, olive oil, fruits, vegetables, and other micronutrients. Participants who ate more UPFs were observed to be less likely to adhere to the ‘Mediterranean diet’ which has been linked to improved general health, and in particular a reduced risk of CVD.

The team found that as UPF consumption increased, the likelihood of having shortened telomeres rose dramatically with each quartile above the lowest having a risk increase of 29%, 40%, and 82% for the ‘medium-low’, ‘medium-high’, and ‘high’ UPF consumption groups respectively. The authors also found that UPF intake was associated with the risk of depression (especially in patients with low levels of physical activity), hypertension, overweight/obesity, and all-cause mortality.

The authors conclude: “In this cross-sectional study of elderly Spanish subjects we showed a robust strong association between ultra-processed food consumption and telomere length. Further research in larger longitudinal studies with baseline and repeated measures of TL is needed to confirm these observations.”

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Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Commentary: COVID-19 has exposed how problematic obesity is – CNA

Last Updated on September 1, 2020 by

ABUJA, Nigeria: Growing evidence shows that COVID-19 survivors can suffer from long-term health effects, not least heart-related complications.

New research published in the Journal of the American Medical Association shows that many people who recover from the virus have heart inflammation (myocarditis).

Of 100 survivors in the study, 78 had evidence of previous heart inflammation, and 60 showed ongoing inflammation at the time of observation.

This medical complication should worry us all. As of Aug 25, there were more than 23 million cases of the disease worldwide, 16 million recoveries, and more than 800,000 deaths.

Using that same study as a benchmark, we could conjecture that around 10 million of those survivors have heart inflammation, implying a massive increase in the burden of non-communicable diseases (NCDs).

READ: Commentary: Making sense of shifting goalposts in public policy and the science of COVID-19

LISTEN: The COVID-19 vaccine will be the biggest product launch in history. Can we pull it off?

HEART DISEASE ALREADY A LEADING CAUSE OF DEATH

NCDs were already killing far too many people before the pandemic arrived. 

In 2016, 54 per cent of 56.9 million total deaths were due to at least one of the ten leading causes of deaths, starting with ischemic heart disease (the narrowing of blood vessels) and then stroke – both of which are NCDs of the heart.

A former coronavirus disease (COVID-19) patient who underwent lung transplant surgery, takes a reme

A former coronavirus disease (COVID-19) patient who underwent lung transplant surgery, takes a remedial exercise at Hallym Sacred Heart Hospital ECMO Center in Anyang. (Photo: Reuters)

Myocarditis is a serious condition with life-threatening consequences. When the heart is inflamed, its ability to pump blood is reduced, and it may beat irregularly.

In either case, the supply of blood reaching other parts of the body is reduced, raising the likelihood of stroke and other conditions.

Moreover, several NCDs are themselves risk factors for COVID-19.

According to the World Health Organization, the elderly and people with pre-existing medical conditions such as asthma, diabetes, obesity, cancer, sickle cell disease, and coronary artery disease appear to be more prone to severe illness as a result of the virus.

OBESITY COULD EXPLAIN WHY HIGH-INCOME COUNTRIES HAVE HIGHER COVID-19 RATES

Obesity is a major public-health problem globally, and tends to increase the risk for many other NCDs.

Based on 2016 estimates, in 140 of 192 countries, at least one in 10 of the population is considered obese (compared to 36 per cent in the United States, 28 per cent in South Africa and the United Kingdom, 22 per cent in France and 20 per cent in Italy, compared to 9 per cent in Nigeria).

These obesity statistics may be a factor in the relative severity of COVID-19 across countries, helping to explain why some high-income countries have higher COVID morbidity rates than low- and middle-income countries.

READ: Commentary: How did Melbourne become the centre of the ‘world’s strictest lockdown’?

READ: Commentary: The Philippines hopes lockdown buys time after half-hearted attempts at tackling COVID-19

The interplay between the leading NCDs and COVID-19 constitutes its own health emergency, and requires urgent attention.

First, there needs to be an even greater focus on preventing community transmission in higher-risk populations. As the Journal of the American Medical Association study shows, reducing the number of COVID-19 cases will also reduce the number of people with myocarditis after the pandemic has passed.

Governments and their partners in civil society must step up their efforts to prevent the virus from spreading in the first place.

Public health officials and media outlets should continue to emphasise the importance of wearing face masks, washing hands frequently with soap and running water, using hand sanitiser in the absence of clean water, and practicing social distancing of at least six feet (two meters) in public.

If everyone were to adopt these practices, the number of new COVID-19 cases would likely fall dramatically, as would the number of people facing heart complications in the near future.

FOCUS ON INTERVENTIONS FOR PEOPLE WITH HEART PROBLEMS

Furthermore, public-health authorities need to start devising interventions to provide lifelong cardiovascular support to COVID-19 survivors.

A woman makes a heart gesture outside a seniors&apos; long-term care facility in Montreal

A woman makes a heart gesture outside Residence Herron, a seniors’ long-term care facility, following a number of deaths since the COVID-19 outbreak, in the suburb of Dorval in Montreal Quebec, Canada on Apr 11, 2020. (Photo: REUTERS/Christinne Muschi)

Given the new data on heart-related complications, the broader pandemic response must include provisions for continuing care.

Although such interventions may require the reallocation or reprioritization of existing resources, they would almost certainly be cost-effective when weighed against the costs of not addressing the additional NCD burden.

LOOK AT REDUCING NON-COMMUNICABLE DISEASES

In fact, more attention should be focused on reducing the impact of NCDs more generally. The UK’s experience offers lessons here.

In 2018, the Scottish Shetlands authorised doctors to prescribe interactions with nature (hiking, bird watching, and so forth) as a means of preventing and managing NCDs. Similarly, the British government has pushed physicians to prescribe cycling as a way to address obesity.

And through its Better Health Campaign, public service announcements encouraging weight loss, healthier eating, and physical activity will be running on television, radio, social media, and other channels. All countries with high rates of obesity should be considering similar programmes.

READ: Commentary: Stress-related hair loss on the rise this COVID-19 outbreak

READ: Commentary: The circuit breaker was a time many of us want to forget. Let’s make it count

Finally, the latest science points to the need for better geriatric care. The elderly are at increased risk of both NCDs and more severe complications from COVID-19.

An analysis in July by the Kaiser Family Foundation shows that 80 per cent of those who had died of COVID-19 in the US up to that point were 65 or older.

Applying that rate to the US death toll as of August 21, it follows that around 139,500 of the 174,442 deceased have been elderly.

Meanwhile, more than three million Americans have now recovered from the virus, and among them are elderly survivors and other high-risk individuals who will need additional care, including home services.

In Nigeria, the health-tech platform GeroCare provides affordable care to the elderly in the comfort of their homes through regular doctor visits. Its least expensive plan offers three home visits per month for just $50.

This approach to care needs to be scaled up significantly. The more we can reduce the heart-related and other complications of COVID-19, the more lives we will save.

READ: Commentary: Will COVID-19 spell the end of strata malls?

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Ifeanyi M Nsofor, a medical doctor and Senior Atlantic Fellow for Health Equity at George Washington University, is CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria Health Watch.