#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation.

Coronavirus lockdown steals Gazans’ last vestiges of normal life

Health & BeautySep 13. 2020A photo from the top of Al-Wehda Street in Gaza City, considered the area’s busiest street for traffic, is nearly empty on Aug. 25 because of the lockdown. CREDIT: photo for The Washington Post by Loay Ayyoub. 

By Special To The Washington Post · Hazem Balousha · WORLD, MIDDLE-EAST 
GAZA CITY – It was late at night in Gaza. Adam and Karam, my two little sons, were asleep. But the sound of the bombing was very loud as Israeli jets targeted Hamas military sites. My fear, as always, was that the noise would wake and scare them. But when I checked, they were asleep.

There would be nowhere to go if they did wake up. For the first time since the coronavirus pandemic began, all 2 million Gazans are in home quarantine to slow a growing outbreak. Our movements are always restricted within Gaza’s 140 square miles, bound by the Mediterranean on one side, fenced in by the Israeli army on another. But now, as the jets strike outside for the 20th straight night, we cannot even leave our houses. 

A woman on Al-Nasr Street in Gaza City brings bread from a bakery back to her family on Sept. 10. CREDIT: photo for The Washington Post by Loay Ayyoub.

We are stuck in a lockdown within a lockdown.

For months, we’d recorded only about 100 coronavirus cases in Gaza, all among residents returning from the outside and who were immediately quarantined. But on Aug. 24, the first cases of unknown origin were reported, in the tightly packed Maghazi refugee camp, and Gaza was placed under a complete lockdown that very same night. Since then, we’ve recorded more than 1,400 local cases.

Children look out the window of their house in Gaza City on Sept. 9, amid a lockdown imposed due to the coronavirus. CREDIT: photo for The Washington Post by Loay Ayyoub.

It is beautiful to be a parent. But in Gaza it is also especially difficult. This has been true since Adam was born 10 years ago: It was two months before I even met him because Israel’s blockade of Gaza meant I couldn’t be with his mother, Ruba, when she gave birth in the West Bank, where her family lives.

“Will I be able to shield him and give him a good life in besieged Gaza?” I wondered as I marveled at my tiny boy. In the decade since, the question has never gone away. The constant cycle of escalation between Israel and Hamas, the militant group that governs here, has meant frequent explosive nights and, twice, all-out war. Rockets. More recently, Hamas and other militant groups have launched incendiary balloons that cause fires in nearby Israeli communities and farms. Israel retaliates each night by blowing up Hamas facilities. It is the violent background of our lives.

The boys slept, and I turned on a light to read. We are lucky that we can afford our own solar power system that provides about 70 percent of our household needs. Many of my neighbors in Gaza City, and almost all of the 600,000 people living in Gaza’s eight refugee camps, are spending the lockdown mostly in the dark.

The Israeli army destroyed Gaza’s main power station in the 2006 war. In the best of times, we have only eight hours of electricity a day as blackouts rotate through the neighborhoods. But three weeks ago, as a reprisal against the balloon launches, Israel cut off fuel shipments to Gaza’s last power plant. As the outbreak began to spike in late August, Gaza had only four hours of electricity a day.

– – – 

Being locked in the house while also locked in our small coastal enclave is very annoying. One of the ways to stay sane while living under siege is to move around where it’s possible, to gather with your fellow Gazans at cafes, in mosques or on the beach. In the camps, social life centers on families and friends, gathering on sidewalks and apartment stoops. Now, even that connection to a normal society is cut.

Like everywhere, Gaza has been under coronavirus restrictions for months. Restaurants have been closed or limited to takeout. Mosques and churches were shut. But everyone who entered Gaza through the checkpoints was quarantined for three weeks, and the number of infections remained low.

My boys had returned to school in the second week in August, after an absence of five months. The term started early in hopes that the kids could catch up on what they had missed. They were excited to get back to school and see their classmates. They had heroic achievements to share: Karam had won his karate yellow belt and Adam had learned new soccer moves. School is one of the few places where Gazan life feels normal.

Within weeks, classes stopped again due to a sudden outbreak of new cases. The airstrikes hit every night, the pandemic was closing in and our world was shrinking once again.

The kids miss school as much as their parents do. Now most of their play is on PlayStation. Their social life is when the cousins and friends can join them online for a couple of hours of “Fortnite.”

Maybe it’s good they are still too young to understand the layers of conflict and pandemic pressing on them. We are able to keep them busy. When we are free to move around, we give them a life that is rich by Gaza standards, with extended family, friends, school and public places. You want to shield them. But the reality in Gaza makes that feel increasingly like a mission impossible.

– – – 

Adam and Karam get lessons every day in how their lives are different from the young people they see on their screens. They ask me when we will travel to see their grandmother in the West Bank, something that can require months to plan. Permits are needed from Israel, and sometimes from Hamas and the Palestinian Authority – all three maintain checkpoints at the one crossing into Israel for individuals. Any of them can say no, and Israel often does.

Now, even that possibility is gone.

Technology is a blessing that opens my kids’ minds and expands their knowledge. But it can also be curse in besieged places like Gaza. So much of what we see, we cannot do. The places brought to us by the Internet are forever out of reach. I think of my friends who won scholarships to study abroad but could not get out of Gaza to attend.

For many Gazans, their farthest travel is the edge of the sea, where we cool ourselves in the Mediterranean breezes and look out to a world all but closed to us.

But this being Gaza, even a day on the beach is complicated by conflict. There is not enough electricity to run the waste treatment plants and we cannot swim because of the untreated sewage that is pumped into the sea.

One evening a few days before the lockdown, I took the boys to the beach. It is always a mix of pain and pleasure to sit with them, watching them play but knowing they will run to the water’s edge and back, asking every five minutes if they can swim. I have to say no.

Soon after the pandemic flared up, Israel and Hamas negotiated another cease-fire, brokered by Qatar. The balloons and bombs have stopped for now; we have four more hours of electricity to light our quarantine.

We know from experience that this quiet will soon cycle back to violence. Of the two lockdowns, the one caused by the virus will be the first to be resolved. We can only pray that we can keep our children safe until it is.

When this quarantine is over, we will go back to the beach to claim one of the pleasures available to us. That is the life of a Gaza parent, a cycle of tension and relief, despair and joy. They will be happy in the sand, and I will say no to swimming, waiting as always for the day I can say yes.

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation.

Italy’s Bergamo is calling back coronavirus survivors. About half say they haven’t fully recovered.

Health & BeautySep 09. 2020A patient gets an X-ray at a Bergamo, Italy, convention center that was converted for covid-19 patients in the spring and is now used for follow-up care. MUST CREDIT: Photo by Alberto Bernasconi for The Washington Post. 

By The Washington Post · Chico Harlan, Stefano Pitrelli · WORLD, HEALTH, EUROPE, HEALTH-NEWS 
BERGAMO, Italy – The first wave is over, thousands have been buried, and in a city that was once the world’s coronavirus epicenter, the hospital is calling back the survivors. It is drawing their blood, examining their hearts, scanning their lungs, asking them about their lives.

Twenty people per day, it is measuring what the coronavirus has left in its wake.

“How are you feeling?” a doctor recently asked the next patient to walk in, a 54-year-old who still can’t ascend a flight of steps without losing her breath.

“I feel like I’m 80 years old,” the woman said.

Six months ago, Bergamo was a startling warning sign of the virus’s fury, a city where sirens rang through the night and military trucks lined up outside the public hospital to ferry away the dead. Bergamo has dramatically curtailed the virus’s spread, but it is now offering another kind of warning, this one about the long aftermath, where recoveries are proving incomplete and sometimes excruciating.

Those who survived the peak of the outbreak in March and April are now negative. The virus is officially gone from their systems.

“But we are asking: Are you feeling cured? Almost half the patients say no,” said Serena Venturelli, an infectious-disease specialist at the hospital.

The follow-ups are the basis for medical research: Data on the patients now fills 17 bankers’ boxes, and scientific reports are on the way. Bergamo doctors say the disease clearly has full-body ramifications but leaves wildly differing marks from one patient to the next, and in some cases few marks at all. Among the first 750 patients screened, some 30% still have lung scarring and breathing trouble. The virus has left another 30% with problems linked to inflammation and clotting, such as heart abnormalities and artery blockages. A few are at risk of organ failure.

Beyond that, according to interviews with eight Pope John XXIII Hospital doctors involved in the work, many patients months later are dealing with a galaxy of daily conditions and have no clear answer on when it will all subside: leg pain, tingling in the extremities, hair loss, depression, severe fatigue.

Some patients had preexisting conditions, but doctors say survivors are not simply experiencing a version of old problems.

“We are talking about something new,” said Marco Rizzi, the head of the hospital’s infectious-disease unit.

One patient, Giuseppe Vavassori, 65, has developed short-term memory loss and now lives under a mountain of Post-it notes and handwritten reminders, with names and phone numbers, so he can still run his funeral home business. A post-covid MRI showed dot-like lesions on his brain.

Another, Guido Padoa, 61, recovered well enough that he was able to go on vacation this summer. But he sleeps four extra hours per night and sometimes falls asleep suddenly midday, head on the computer keyboard.

Some patients who were self-reliant before contracting the virus remain so weakened that, when they arrive for their follow-up appointments, they’re helped to the waiting room by relatives, or in wheelchairs. Four people so far were too frail to make it through the several hours of testing and were rushed instead to the emergency room. Other times, people show up months later, having been through the worst – oxygen support, intubations – and are, improbably, almost fine. Doctors say one of the virus’s mysteries is how recoveries can be swift for some and brutal for others.

Venturelli mentioned a man in his 80s who’d come in for his follow-up visit, mostly recovered. His son, who’d also been infected, hadn’t fared as well. When Venturelli tried to refer the father to a specialist, he said he was too busy these days.

Covid had turned the father into his son’s caretaker.

– – –

The Bergamo research is being led by the same doctors who worked frantic 14-hour days in March, sometimes falling sick themselves, while watching patients rapidly outnumber the beds. Now, wearing just masks, those same doctors and patients are sitting down together in a way that was impossible months ago.

“We did feel a moral obligation to call them back,” said Venturelli, who helped start the study in early May. “It was such a tsunami for us. What we saw in March was a tragedy, not a normal hospitalization.”

Bergamo, in March, was a place with six-hour waits for ambulances and 16-hour waits in the ER. At one point, the hospital had 92 people on ventilators – compared with 143 now in all of Italy – and so many who required breathing assistance that it needed to pipe in oxygen from a rush-delivered emergency tank. In the province of 1.1 million people, 10,000 were hospitalized, including more than 2,000 at Pope John XXIII.

“I have a picture in my mind from that time of the ER with eight ambulances queuing outside,” said doctor Monica Casati. Inside the hospital, she said, people were crying, moaning and gasping for air. “It was a noise that would remind you of Dante’s inferno,” she said.

The hospital was admitting only the worst cases, and to keep pace with the influx, it sometimes had to discharge patients before they were fully ready – something confirmed when the hospital started calling people for the follow-ups. In addition to the 440 people who died while hospitalized, 220 died after being told to go home.

The study in Bergamo is one of multiple efforts around the world to examine aspects of covid’s lingering damage. One German study of 100 people found that nearly 80% had heart abnormalities several months after infection. Other studies are underway to look specifically at “long-haulers” – a subset of people, some never hospitalized, who nonetheless have fatigue and other symptoms months after the illness.

Some of the doctors in Bergamo see reasons for encouragement in their findings, especially given the severity of what patients faced in March and April and the trial-and-error treatments they were given. They say that patients’ breathing seems to gradually improve, even though the lung scarring is permanent. Doctors have found nobody with a fever.

“Many of them coming in for repeat visits, they are doing better now than they were in May,” said Caterina Conti, a lung specialist.

For the patients who have been able to regain a semblance of their lives, the last barrier is the trauma itself – the raw memory of being in a hospital where so many were dying, and wondering if they might be next. Padoa, a photographer, said he remembers hearing others in his ward struggling to breathe, and seeing hospital workers remove the bodies, change the bedsheets. With his own lungs on the brink of failure, he worried what might happen if he let his eyes close, so he drew on his training four decades earlier as a paratrooper. Under an oxygen helmet, as it beeped and hissed, he willed himself to stay awake for five days, he said.

“It’s like when you are on a high mountain in the cold,” Padoa said. “If you fall asleep, you die.”

– – –

But the gravest patients of all, like Mirco Carrara, 55, have no recovery in sight.

By the time he arrived for his follow-up, it was late August, and he’d moved back into his home on the outskirts of Bergamo. He’d started going to work again, as a manager at a military parts company. But he was also coming to terms with how drastically his life had changed.

He had spent more than a month in a medically induced coma. In the middle of that, he was transferred on a German medevac plane to a hospital in Cologne. Doctors there saw that his lungs had developed not only scars but also a fungal infection. He was removed from the ventilator, re-intubated after his lung collapsed, then removed again. By the time he returned, conscious, to a rehabilitation center in Italy, Carrara had lost 45 pounds. He needed to relearn to swallow and stand.

And even that he had felt capable of doing, until doctors told him one more thing. The full trauma of covid – the ventilation, the treatment, the compounding infections – meant there were now fungus-filled bubbles inside his lungs, each a bomb-like threat that could critically impair his breathing if it burst.

“I started crying,” Carrara said. “Up until that point, I had thought I’d be able to recover.”

In an interview, Simone Benatti, the doctor at Pope John XXIII who consulted with Carrara, described the air and fungus bubbles as a “bad complication” and mentioned a separate Italian study showing that some deceased covid victims were found to have bacterial or fungal abscesses in their lungs.

“There is an interplay between covid and other infections,” Benatti said.

Carrara said the bubbles were like a “Damocles sword,” and soon enough, in early June, a cough sent his oxygen levels dipping. His girlfriend rushed him to the hospital. He had a tube inserted into his lungs for a week. A month later, it happened again – dipping oxygen; another hospital trip; another surgery to drain his lung – except this time, he wasn’t even sure what set it off. He felt a rage about his body. He said he wished the surgeon would “just cut my lung out.”

He arrived for his follow-up in Bergamo carrying a thick stack of medical paperwork and figured there was only so much more about his body he cared to know. Like the others, he submitted to a CT scan, an echocardiogram and blood tests. But when filling out a survey about how he was feeling and coping, he checked all the boxes in the “middle,” he said – moderate, good, OK.

“I lied,” Carrara said.

He didn’t mention how deep his despair has been, as he comes to grips with his lungs. He didn’t mention the guilt he felt, wondering if he passed the virus to his father, who had not survived. He didn’t mention his first nights back home, when he lay fully awake, one night and then two nights and then three. He didn’t say how his partner then said enough was enough, and went to the pharmacy to get sleeping pills, and how he’d agreed to take them, because that was the one way to briefly quiet his mind six months after being infected with covid-19.

“The bubbles will remain. They’re not going anywhere,” Carrara said, and he figured it was just a matter of time before he was back in the hospital again.

“I live with this terror,” he said.

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation.

Covid-19 may cause prolonged gut infection, scientists say

Health & BeautySep 08. 2020

By Syndication Washington Post, Bloomberg · Jason Gale · NATIONAL, HEALTH, SCIENCE-ENVIRONMENT, HEALTH-NEWS 
Covid-19 patients have active and prolonged gut viral infection, even in the absence of gastrointestinal symptoms, scientists found.

The coronavirus may continue to infect and replicate in the digestive tract after clearing in the airways, researchers at the Chinese University of Hong Kong said in a statement Monday. The findings, published in the medical journal GUT, have implications for identifying and treating cases, they said.

SARS-CoV-2 spreads mainly through respiratory droplets — spatters of virus-laden discharge from the mouth and nose, according to the World Health Organization. Since the first weeks of the pandemic, however, scientists have said infectious virus in the stool of patients may also play a role in transmission.

A February study of 73 patients hospitalized with the coronavirus in China’s Guangdong province found more than half tested positive for the virus in their stool.

“We used to think of SARS-CoV-2 as just a pulmonary or respiratory disease,” said Siew Chien Ng, assistant dean of medicine and associate director of the university’s Centre for Gut Microbiota Research, in an interview Tuesday. “But over the last couple months, a lot of evidence has emerged that SARS-CoV-2 also affects the intestinal tract.”

Ng and colleagues scientists studied stool samples from 15 patients to better understand the virus’s activity in the gastrointestinal tract. They found active gut infection in seven of them, some of whom had no nausea, diarrhea or other digestive symptoms. Patients’ stool continued to test positive about a week after their respiratory samples were negative, Ng said. One patient was still positive after 30 days, she said.

Ng and colleagues plan to conduct further tests to demonstrate virus particles from stool are capable of causing disease after finding surrogate biomarkers that indicate they are infectious.

It’s not yet known how SARS-CoV-2 makes its way to the gastrointestinal tract to cause an infection there, according to Ng. It’s possible some infectious particles survive the stomach’s acidic environment.

Treatments that modulate the gut microbiome should be explored, Ng said. The gut bacteria of patients with a gastrointestinal coronavirus infection showed a loss of protective microbes and a proliferation of disease-causing ones. The effects were worsened in the covid-19 cases treated with antibiotics, she said.

The Chinese University has offered free screening stool tests to travelers arriving at the airport since late March, and identified six infected children among more than 2,000 samples tested. From Monday, up to 2,000 covid-19 tests will be done daily as part of targeted detection of asymptomatic people.

More than one patient tested positive even though their respiratory samples were negative, said Francis K.L. Chan, the university’s dean of medicine and director of the Centre for Gut Microbiota Research.

“Stool test is accurate and safe, making it suitable and more effective for Covid-19 screening for specific groups of people,” Chan said in the statement. Some regulators including the U.S. Food and Drug Administration have reached out about stool tests.

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation.

Vaccine CEOs issue safety pledge amid Trump’s quest for pre-election approval

Health & BeautySep 08. 2020

By The Washington Post · Christopher Rowland · NATIONAL, BUSINESS, HEALTH, HEALTH-NEWS 
The chief executives of nine drug companies pledged Tuesday not to seek regulatory approval before the safety and efficacy of their experimental coronavirus vaccines has been established in Phase 3 clinical trials, an extraordinary effort to bolster public faith in a vaccine amid President Donald Trump’s public rush to introduce a vaccine before Election Day.

“We believe this pledge will help ensure public confidence in the rigorous scientific and regulatory process by which covid-19 vaccines are evaluated and may ultimately be approved,” the executives wrote in their joint statement. The Wall Street Journal first reported Friday that a statement from the companies would be forthcoming.

The statement included a vow that the companies would “only submit for approval or emergency use authorization after demonstrating safety and efficacy through a Phase 3 clinical study that is designed and conducted to meet requirements of expert regulatory authorities such as FDA.”

They also vowed to “always make the safety and well-being of vaccinated individuals our top priority.”

The statement left open the door for partial data from the massive Phase 3 vaccine trials – which require the participation of at least 30,000 test subjects – being used to seek emergency-use authorization. Such trials typically take years to complete and require lengthy follow-up to see how long protection from a vaccine may last.

The executives signing the pledge included the leaders of AstraZeneca, Johnson & Johnson, Merck, Moderna, and Novavax, as well as those heading two joint vaccine projects, Pfizer and BioNTech, and Sanofi and GlaxoSmithKline.

In most contexts, pledges by drug companies that they will adhere to safety and efficacy standards would be unremarkable. But their joint resolve in the current political environment – and the headline pasted on their statement: “BIOPHARMA LEADERS UNITE TO STAND WITH SCIENCE” – make clear their intent to ease growing worries about the race for a vaccine amid intense White House pressure.

The companies issued their statement as Trump has increasingly tied his reelection hopes to introduction of a vaccine before Nov. 3. The White House said in a statement Monday that Trump has no intention of cutting corners.

“The American people can rest assured that any approval will maintain the FDA’s gold standard for safety and testing to ensure a vaccine or therapeutic is effective,” said White House spokesman Judd Deere, in an email. “This false narrative that the media and now the Democratic nominee for vice president (Sen. Kamala Harris) are suggesting that politics is influencing approvals is not only false but is a danger to the American public.”

Harris, D-Calif., said on CNN’s “State of the Union” Sunday that she would “not take his word for it” and would “not trust” Trump’s declarations about the safety of a vaccine.

Vaccine manufacturers want to bolster public faith in the safety and efficacy of a vaccine to counter perceptions that the Food and Drug Administration will cave to political pressure, said Amesh Adalja, senior scholar at the Johns Hopkins University Center for Health Security.

“It just reflects the fact that we have seen political meddling from the start in this pandemic response,” Adalja said.

He cited the FDA’s hasty emergency-use authorization of hydroxychloroquine to treat the novel coronavirus. That authorization was withdrawn in June after clinical trials showed hydroxychloroquine provided no benefit while potentially increasing risks of fatal heart arrhythmia, as well as the botched rollout of last month’s emergency-use authorization for convalescent plasma, when FDA Commissioner Stephen Hahn overstated potential benefits of the transfusions.

Convincing the public that a vaccine is safe and effective will be vital to making sure enough of the population gets immunized against SARS-CoV-2 to stem the tide of the pandemic, Adalja added.

“There is a thriving anti-vaccine movement that will use any kind of misstep when it comes to vaccine safety to undermine confidence in all vaccines,” he said.

The drug executives’ statement Tuesday emphasized that the FDA has established a rigorous set of rules for evaluating vaccines.

“FDA’s guidance and criteria are based on the scientific and medical principles necessary to clearly demonstrate the safety and efficacy of potential covid-19 vaccines,” they said. “More specifically, the agency requires that scientific evidence for regulatory approval must come from large, high quality clinical trials that are randomized and observer-blinded, with an expectation of appropriately designed studies with significant numbers of participants across diverse populations.”

The companies also stated they collectively have previous experience creating 70 successful vaccines “that have helped to eradicate some of the world’s most complex and deadly public health threats.”

Trump’s own top vaccine adviser, Operation Warp Speed co-chief Moncef Slaoui, said in an interview on NPR last week that it is “very unlikely” a vaccine would be authorized before Election Day. Slaoui was responding to reports that the Trump administration had told states to prepare to distribute vaccine by Nov. 1, two days before the election.

“There is a very, very low chance that the trials that are running as we speak could [be completed] before the end of October and therefore there could be – if all other conditions required for an Emergency Use Authorization are met – an approval,” Slaoui told NPR. “I think it’s extremely unlikely but not impossible, and therefore it’s the right thing to do to be prepared, in case.”

Slaoui said in a separate interview with the news site Science that he would not remain in the administration if he detected “undue” political pressure in vaccine approval.

“I would immediately resign if there is undue interference in this process,” he said, adding: “I have to say there has been absolutely no interference.”

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For pediatricians, coronavirus raises a thorny problem

Health & BeautySep 06. 2020File photo 

By The Washington Post · Marlene Cimons · HEALTH, HEALTH-FEATURES
Joanna Dolgoff, a pediatrician in Paulding County, Ga., cringed when she saw the photo on Facebook: a crowded high school hallway full of maskless students, an image that quickly went viral. “I was shocked at how closely the kids were packed together and that they weren’t wearing masks,” she says.

Then it got worse. “I didn’t know where the photo was from,” she says. The moment she learned these students were from North Paulding High School, where some of her patients attend classes, “I got a sinking feeling in my stomach,” she says. “These are my kids. These are the patients I take care of.”

As classes resume in person in some parts of the country, pediatricians – like parents, children and teachers – also are feeling the strain of the ongoing pandemic. They must not only provide a safe space to see patients, who range from newborns to 18-year-olds, and ensure a supply of personal protective equipment, but also determine whether that coughing child with a sore throat and fever has a common cold, the flu – or covid-19. 

“We are facing unprecedented challenges as the school year opens, and we’re scrambling to figure out how to handle everything,” Dolgoff says.

Six students and three staff members from North Paulding High tested positive in the days following widespread circulation of the photo. (For privacy reasons, Dolgoff won’t disclose whether any of her patients were among them.) She is angry that young people risk exposure when school districts such as hers fail to follow established public health measures.

“The rule in the county is that you don’t have to wear a mask,” she says. In addition, she says, the schools are saying they can’t social distance because the buildings aren’t big enough. “It’s not safe to go back to school if they aren’t requiring masks, or enforcing social distancing. It’s just not safe for the kids, their teachers or the staff.”

Parents are in a terrible bind because “they had no choice but to send their kids back to school,” she adds. “Most of them had to go back to work and couldn’t stay home.”

The school year has started in various formats in many parts of the country, making it difficult to protect kids, especially those attending in person. 

“I’ve been practicing for over 30 years and this spring, summer and fall are not like anything I’ve ever seen before,” says Sara “Sally” Goza, president of the American Academy of Pediatrics, whose website has posted a covid-19 resource page for pediatricians. “We’ve seen this all across the country. All practices are a little anxious about what will happen in the fall.”

Katie Lockwood, a pediatrician with Children’s Hospital of Philadelphia, agrees. “Everything has changed,” she says. “There’s a higher stress level that seems universal and . . . the effects of it are visible. My patients are dealing with food insecurity, job furloughs, challenges of distance learning, loss of family members, missing life events, social isolation and more, which impacts their physical and mental health. This fall, we are facing more unknowns as we enter a new season with covid and the added issue of influenza and other viral illnesses.”

Pediatricians are girding for an increase in respiratory illnesses once colder weather sets in. 

“Kids will come in with symptoms – sniffles, a fever, sore throat and cough – that a year ago we would have dismissed as a common cold or flu,” Dolgoff says. “Now we have to take it much more seriously. There’s no way to tell the difference based on symptoms alone. The only way to know is to test.”

When test supplies are limited, “the sickest children will get a test, as well as those who might have been exposed . . . If we don’t have enough tests, we treat all possible covid patients as if they have covid,” she says.

In the absence of a test, “we have to err on the side of caution and quarantine for 10 days from the onset of symptoms, until the symptoms decrease and there is no fever for 24 hours,” she adds, citing guidelines from the Centers for Disease Control and Prevention. “Only patients whose symptoms are not consistent with covid may return to school.”

Elizabeth Murray, who practices emergency pediatric medicine at the University of Rochester Medical Center’s Golisano Children’s Hospital, predicts that local public health officials will be watching disease transmission rates of all common respiratory illnesses closely once all schools open, and likely will advise providers about testing. 

“As pediatricians, we know we will be facing covid-19 in some shape or form, although we don’t know how severe it’s going to be,” she says. “The only certainty is that we are full of uncertainty.”

Children represent 9.5% of all cases, with more than 476,439 cases reported since the onset of the epidemic, according to the pediatrics academy. Between July 9 and Aug. 6, pediatric cases rose by 179,000, a 90% increase from the previous total that “caught everyone’s eye,” Goza says. 

Although most pediatric cases are not severe, and do not require hospitalization, recent research suggests children play a much larger role in community transmission than previously thought, shedding virus for weeks as asymptomatic spreaders. 

“There is risk of infection not just from the symptomatic child, but from asymptomatic children,” says Michael Martin, a Vienna, Va., pediatrician and president of the Academy’s Virginia chapter. “That is the big unknown.”

Moreover, physical symptoms are not the only health issues related to covid-19 that worry pediatricians. Many say they are seeing more mental health problems among their young patients, requiring the intervention of pediatric psychologists. 

“It’s rampant around the country,” says Dolgoff, a member of the academy’s covid-19 task force. “We see anxiety, depression, developmental regression, acting out. They’re scared about dying of covid. They’re scared about their family dying of covid. They’re depressed because they aren’t seeing their friends. Younger kids are wetting the bed. Not having a social structure is leading to depression in children.”

Martin agrees, noting that typical childhood stresses usually ease in the summer “as kids are able to unwind at camps and during family trips,” he says. “This did not happen this year.”

Still, after a drop in the spring, children are returning to pediatric offices for checkups, immunizations and sports physicals. At the start of the pandemic, when many people shunned doctor visits, some offices were forced to furlough staff members they couldn’t pay. Visits still may decrease in areas with virtual learning, since children isolated at home are less likely to get sick – a good thing for public health, although less so for pediatric business.

“No one wants children getting ill with ear infections, colds or the flu, so fewer sick children would be great,” says Gary Bergman, a pediatrician who practices in Alexandria and Fairfax, Va. “But as a business owner, I also have a responsibility to my staff – and their families – to keep them employed.”

When the pandemic began, Bergman says, visits to his office dropped by half. Now they are rising again. 

“Our numbers have rebounded, but not all the way to pre-pandemic numbers,” he says. “It appears parents are finally starting to feel more comfortable coming into a medical office, especially for delayed checkups and overdue vaccinations.”

When patients and children return, they will find waiting rooms looking very different. Children no longer sprawl on the floor, playing with toys or with each other. Parents no longer sit and chat. Instead, they sit in their cars and wait for a call telling them a room is available. Once inside, there is little, if any, wait time. Everyone must wear a mask. Chairs are stacked, or stored. There are no toys, books or magazines. Practices clean and disinfect each room between patients. Doctors and staff all wear PPE, a sight increasingly familiar to young patients.

“Children have been very tolerant of my PPE,” Lockwood says. “Sometimes I don’t recognize my colleagues under our PPE, but the children don’t seem fazed. If a patient does look hesitant, I try to make a joke about my ‘superhero mask’ or ‘bug-eyed goggles.’ “

While protecting patients, pediatricians also must remember to protect themselves, Martin says. “We have experience mitigating this risk,” he says. “Many of us have continued to practice throughout the pandemic without getting ill. We have learned that the risk of infection stems from letting our guard down with each other, and taking masks off in lunchrooms and common areas, and not social distancing with peers when we should.”

To be sure, the pressures are great, but pediatricians are adjusting, Goza says. “It’s amazing how practices are adapting,” she says. “They are making it work.”

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation.

Laguna Phuket holds health fair for guests

Sep 05. 2020

 Laguna Phuket resort complex joined hands with Bangkok Hospital Phuket to host a health fair.

The Laguna Phuket Health Fair featured free consultations and health screening by specialists in dental, eye, heart, sports medicine and well being, for the residents and guests of Laguna Phuket.

The event was its latest initiative for its #StaySafeWithLagunaPhuket campaign, following the announcement of all its seven deluxe hotels being awarded Amazing Thailand Safety and Health Administration Certification and Laguna Phuket hosting the industry awards ceremony in July 2020.

The managing director of Laguna Phuket, Ravi Chandran, said: “For more than 25 years, Bangkok Hospital Phuket has provided on-site medical services from its clinic, located at the heart of Laguna Phuket. This facility is an integral part of our commitment to the health and well being of our Laguna Phuket community. We are delighted to deepen our partnership, as we heighten our practices to safeguard against the current public health situation.”

Assistant director of Bangkok Hospital Phuket, Dr Antika Jacqueline Klein, “Recognised with the industry JCI-accreditation, Bangkok Hospital Phuket is known for its uncompromising medical care. We are honoured to have worked with Laguna Phuket for many years and are pleased to partner Laguna Phuket in extending high-quality medical care and services in consumers’ quest for a healthier lifestyle.”

Laguna Phuket’s other destination facilities, such as residential services, spas, golf, tours, transportation and retail, have also enhanced safety measures to ensure residents, guests and associates can stay safe.

#ศาสตร์เกษตรดินปุ๋ย : ขอบคุณแหล่งข้อมูล : หนังสือพิมพ์ The Nation.

Eat a variety of food for best nutrition, advises expert

Sep 01. 2020

By THE NATION

A nutrition expert has advised people against eating the same thing over and over again, as the body will not be able to absorb enough nutrients.

Dr Adune Ratanavichitrasin, the deputy dean of the Faculty of Medicine at Siriraj Hospital, Mahidol University, said in a Facebook post on Tuesday (September 1) that eating the same food every day is not beneficial to the human body.

He said people should consume a variety of foods because not only is it less boring, but also because human beings need a variety of nutrients.

The doctor also said that consuming the same items, especially vegetables, will increase the risk of toxicity, especially from pesticide, and explained that the human body requires low amounts of salt, minerals and vitamins.