Month: June 2021

As if stubbornly high rates of COVID-19 aren’t giving us enough to worry about, welcome to cold and flu season!

Yes, colds and influenza, two well-known upper respiratory infections, will soon be on the rise. Last year we saw remarkably low rates of flu. Many experts don’t think we’ll be so lucky this year.

Think zinc?

A new analysis reviewing available research suggests that over-the-counter zinc supplements could be one way to make cold and flu season a bit easier. Of course, this isn’t the first study to look into zinc as an antiviral remedy, including for COVID-19. But the results of past research have been mixed at best: some studies find modest benefit, others find no benefit, and the quality of the research has been low. Also, some people experience bothersome side effects from zinc, such as upset stomach, nausea, and in some cases, loss of the sense of smell.

What did the study say?

Published in November 2021 in BMJ Open, the study looks at zinc for preventing or treating colds and flulike illness. The researchers reviewed more than 1,300 previous studies and narrowed the analysis down to 28 well-designed trials, which included more than 5,000 study subjects. Here’s what they found:

For preventing colds and flu-like illness:

• Compared with placebo, zinc supplements or nasal spray zinc are associated with fewer upper respiratory infections. The estimated effect was modest: about one infection was prevented for every 20 people using zinc. The strength of the evidence for these findings is considered low.
• A few studies suggest preventive effects were largest for reducing severe symptoms, such as fever and flulike illness. It’s worth noting that the studies didn’t confirm whether participants had flu infections.
• Small studies of intentional exposure to cold virus found that zinc did not prevent colds.

For treating colds and flulike illness:

• Compared with placebo, those who took zinc had symptoms go away about two days sooner. The study estimated that of 100 people with upper respiratory infections, an extra 19 people would have completely recovered by day seven due to zinc treatment. The strength of the evidence for these findings is considered low.
• Some measures of symptom severity were lower for those treated with zinc (versus placebo): on day three of the infection, those taking zinc had milder symptoms. Further, there was an 87% lower risk of severe symptoms among those taking zinc. However, the daily average symptom severity was similar between those taking zinc and those taking placebo. The data quality and certainty of these findings were low to moderate.

What else to consider before stocking up on zinc

While these findings suggest promise in the ability of zinc to prevent or temper cold and flulike illness, here are other points to consider:

• Side effects. Side effects occurred more often in those taking zinc (versus placebo), including nausea and mouth or nose irritation. Fortunately, none were serious. But they might be bothersome enough for some people to stop using zinc.
• Cost. Zinc supplements are generally inexpensive. A daily dose of zinc lozenges for a month may cost less than $2/month (though I also found certain brands for sale online for as much as $75/month).
• Zinc deficiency. Study subjects either had normal zinc levels or were otherwise considered unlikely to be zinc deficient. There’s a big difference between taking a zinc supplement to prevent or treat respiratory infections and taking it because your body lacks enough of the mineral. Zinc deficiency is more likely among people with poor nutrition or digestive conditions that interfere with mineral absorption; they require supplementation to avoid serious complications such as impaired immune function and poor wound healing.
• Different doses or types. Additional research is needed to determine the best way to take zinc.
• COVID-19. None of the studies in this analysis assessed the impact of zinc supplements on SARS-CoV-2, so these conclusions do not apply to COVID-19.

You know the drill

Perhaps this new analysis will convince you to take zinc this winter. Or perhaps you’re still skeptical. Either way, don’t forget tried and true preventive measures and treatments during cold and flu season, including these:

• Get a flu shot
• Wash your hands frequently
• Avoid contact, maintain physical distance, and wear a mask around people who are sick
• Get plenty of sleep
• Choose a healthy diet.

If you do get sick:

• Stay home if possible
• Wear a mask if you can’t avoid contact with others
• Drink plenty of fluids
• Take over-the-counter cold and flu remedies to reduce symptoms
• Contact your doctor if you have symptoms of the flu; early treatment can shorten the duration of the illness. In addition, other conditions (especially COVID-19) should be ruled out.

Many of the measures recommended for cold and flu season overlap with those recommended to prevent or treat COVID-19.

The bottom line

Colds and flulike illnesses afflict millions every winter. You might feel as though it’s inevitable you’ll be among them. But you may be able to spare yourself the misery by following some simple, safe, and common-sense measures. As evidence mounts in its favor, perhaps these measures should include zinc.

As for me, I remain steadfastly on the fence. But it wouldn’t take much — perhaps one more large, well-designed, randomized controlled trial — to push me onto the zinc bandwagon.

Vaccination against the virus that causes COVID-19 is the most important lifesaving tool we have in this pandemic. Fortunately, the vaccines authorized in the US have proven remarkably safe and effective. And we’ve known from the start that the strong protection they provide would likely wane over time.

But has protection declined enough to warrant booster shots? Studies published in the last few months by researchers in the UK, Israel, and the US (reviewed here and here) raised this possibility, and Israel and the UK have already started ambitious booster programs.

First things first: Vaccinate everyone

In the US, the CDC and FDA have reviewed the necessity, safety, and effectiveness of boosters for the Pfizer/BioNTech, Moderna, and Johnson & Johnson vaccines. I’ll discuss these recommendations in a moment.

But first, it’s important not to overlook this fact: vaccinating the unvaccinated should be a much bigger priority than giving booster shots to those who’ve received vaccines. That goes for people in the US who have been unable or unwilling to get the vaccine, and people in places throughout the world with limited access to vaccines.

Broadening the pool of people with initial vaccinations would not only save more lives than promoting boosters, but would also reduce COVID-related healthcare disparities between richer and poorer countries. That’s why the World Health Organization (WHO) called for a moratorium on booster doses. Meanwhile, the Biden administration has announced a promise to donate another half billion vaccines to countries with low vaccination rates, bringing the total US commitment to donate 1.1 billion doses. The administration emphasizes that starting a booster program in the US and helping other countries get their citizens vaccinated are not mutually exclusive.

Is there a difference between a booster dose and a third shot?

It’s not trick wording: not all extra vaccine doses are boosters. In August 2021, the FDA approved a third dose of the Pfizer or Moderna vaccine for people who are immunocompromised. This includes people who have HIV and those receiving treatment for cancer that suppresses the immune system. For them, the extra dose is not a booster; it’s considered part of their initial immunization series.

Getting the timing and dose right on vaccine boosters

Ideally, vaccine boosters are given no sooner than necessary, but well before widespread protective immunity declines. The risks of waiting too long are obvious: as immunity wanes, the rates of infection, serious illness, and death may begin to rise.

But there are downsides to providing boosters too early:

• Side effects might be more common. While studies published to date suggest that boosters are safe, we don’t yet have long-term data.
• The benefit may be small. It may be better to wait on boosters if most people are still well-protected by their initial vaccinations.
• Current boosters may not cover future variants. If new variants of concern emerge in the coming months, boosters may be modified to cover them.
• Waiting longer before a booster might lead to a stronger immune response. As noted by Dr. Anthony Fauci recently: “If you allow the immune response to mature over a period of a few months, you get much more of a bang out of the shot.”

The recommended dose for the Pfizer/BioNTech booster and Johnson & Johnson booster is the same as the initial dose. For the Moderna booster it’s a half-dose, which may reduce the risk of side effects and increase the number of doses available to others.

Recommendations for vaccine boosters

In the US, adults 18 or older who have had a COVID vaccine are eligible for a booster shot.

• If you had the Pfizer/BioNTech or Moderna vaccine The FDA and CDC have authorized Pfizer/BioNTech and Moderna boosters for all adults 18 or older at least 6 months after the initial series. According to the CDC, people 50 or older, or adults 18 or older who live in long-term care facilities should get boosters. Other adults 18 or older may decide whether to have a booster.   
• If you had the Johnson & Johnson vaccine A booster dose of the Johnson & Johnson vaccine has also been authorized for all adults 18 or older two or more months after the first dose.

Mixing or matching booster shots

The FDA and the CDC have concluded that mixing or matching vaccines when getting a booster dose is safe and effective. Regardless of the initial vaccine you received, any of the three available vaccines may be given as a booster.

Plenty of unknowns

The release of these new recommendations for vaccine boosters raises a number of questions:

• How convincing is the safety data? Reports to date suggest boosters are safe, but we need more research and real-world data.
• Will the boosters be modified to protect against emerging variants of concern?
• Will additional boosters be needed in the future? If so, how often?

There are important gaps in our knowledge of how well vaccine boosters work. We need larger and longer-term studies involving a broad range of participants representing all races and ethnicities and people with compromised immune systems. Look for further information in coming months.

What’s next?

You can expect the FDA and CDC to continue to expand recommendations for boosters based on review and analysis of ongoing research. Guidelines for teens and kids under age 18 will be particularly important. In the meantime, we should redouble our efforts to vaccinate people who haven’t yet received vaccines. Boosters can play an important role in protecting individuals. But, as CDC director Dr. Rochelle Wallensky notes, “we will not boost our way out of this pandemic.”

Neurodiversity describes the idea that people experience and interact with the world around them in many different ways; there is no one “right” way of thinking, learning, and behaving, and differences are not viewed as deficits.

The word neurodiversity refers to the diversity of all people, but it is often used in the context of autism spectrum disorder (ASD), as well as other neurological or developmental conditions such as ADHD or learning disabilities. The neurodiversity movement emerged during the 1990s, aiming to increase acceptance and inclusion of all people while embracing neurological differences. Through online platforms, more and more autistic people were able to connect and form a self-advocacy movement. At the same time, Judy Singer, an Australian sociologist, coined the term neurodiversity to promote equality and inclusion of “neurological minorities.” While it is primarily a social justice movement, neurodiversity research and education is increasingly important in how clinicians view and address certain disabilities and neurological conditions.

Words matter in neurodiversity

Neurodiversity advocates encourage inclusive, nonjudgmental language. While many disability advocacy organizations prefer person-first language (“a person with autism,” “a person with Down syndrome”), some research has found that the majority of the autistic community prefers identity-first language (“an autistic person”). Therefore, rather than making assumptions, it is best to ask directly about a person’s preferred language, and how they want to be addressed. Knowledge about neurodiversity and respectful language is also important for clinicians, so they can address the mental and physical health of people with neurodevelopmental differences.

Neurodiversity and autism spectrum disorder

Autism spectrum disorder (ASD) is associated with differences in communication, learning, and behavior, though it can look different from person to person. People with ASD may have a wide range of strengths, abilities, needs, and challenges. For example, some autistic people are able to communicate verbally, have a normal or above average IQ, and live independently. Others might not be able to communicate their needs or feelings, may struggle with impairing and harmful behaviors that impact their safety and well-being, and may be dependent on support in all areas of their life. Additionally, for some people with autism, differences may not cause any suffering to the person themself. Instead, the suffering may result from the barriers imposed by societal norms, causing social exclusion and inequity.

Medical evaluation and treatment is important for individuals with ASD. For example, establishing a formal diagnosis may enable access to social and medical services if needed. A diagnostic explanation may help the individual or their family understand their differences better and enable community connections. Additionally, neurodevelopmental conditions may also be associated with other health issues that require extra monitoring or treatment. It is important that people who need and desire behavioral supports or interventions to promote communication, social, academic, and daily living skills have access to those services in order to maximize their quality of life and developmental potential. However, approaches to interventions cannot be one-size-fits-all, as all individuals will have different goals, desires, and needs.

Fostering neurodiversity in the workplace

Stigma, a lack of awareness, and lack of appropriate infrastructure (such as office setup or staffing structures) can cause exclusion of people with neurodevelopmental differences. Understanding and embracing neurodiversity in communities, schools, healthcare settings, and workplaces can improve inclusivity for all people. It is important for all of us to foster an environment that is conducive to neurodiversity, and to recognize and emphasize each person’s individual strengths and talents while also providing support for their differences and needs.

How can employers make their workplaces more neurodiversity-friendly?

• Offer small adjustments to an employee’s workspace to accommodate any sensory needs, such as
  • Sound sensitivity: Offer a quiet break space, communicate expected loud noises (like fire drills), offer noise-cancelling headphones.
  • Tactile: Allow modifications to the usual work uniform.
  • Movements: Allow the use of fidget toys, allow extra movement breaks, offer flexible seating.
• Use a clear communication style:
  • Avoid sarcasm, euphemisms, and implied messages.
  • Provide concise verbal and written instructions for tasks, and break tasks down into small steps.
• Inform people about workplace/social etiquette, and don’t assume someone is deliberately breaking the rules or being rude.
• Try to give advance notice if plans are changing, and provide a reason for the change.
• Don’t make assumptions — ask a person’s individual preferences, needs, and goals.
• Be kind, be patient.

Resources to learn more about neurodiversity

Neurodiversity in the Workplace

Preeclampsia is a common and dangerous complication of pregnancy that causes high blood pressure and excess protein in urine. Typically, it occurs during the third trimester or very soon after birth, but there may be a simple way to help prevent it.

If you’re pregnant, preeclampsia can cause kidney and liver abnormalities, blood clotting problems, headache, stroke, and even death. It makes it harder to deliver nutrients and oxygen to a growing fetus. And it’s linked to premature birth and low birthweight in babies. Yet a daily low-dose aspirin may help prevent many of these problems, according to a recent statement from the US Preventive Services Task Force (USPSTF).

Who is most likely to develop preeclampsia?

While preeclampsia can happen without any warning, certain risk factors make it more likely to occur:

• carrying multiples, such as twins or triplets
• having diabetes
• being 35 or older
• having obesity, described as a body mass index (BMI) greater than 30
• having high blood pressure before pregnancy
• having kidney disease or an autoimmune disorder.

Preeclampsia also occurs more often in Black people as a result of structural racism, which restricts access to care, and can also be a source of chronic stress from factors like food and housing insecurity that lead to poorer health and well-being.

Overall, preeclampsia affects about one in 25 pregnancies in the United States. It accounts for almost one out of every five medically-induced premature births. Preventing it will save lives.

What does the task force recommend to help prevent preeclampsia?

In the 2021 statement, the USPSTF recommends that doctors prescribe a daily low-dose (81 mg) aspirin for those at high risk for preeclampsia. The aspirin should be started at the end of the first trimester (12 weeks of pregnancy) and continued until the birth.

This supports a previous recommendation from the task force in 2014. And importantly, the statement reflects findings from a recent systematic review of research. The review looked at the role of aspirin in preventing preeclampsia, and whether aspirin can reduce complications among pregnant people, fetuses, and newborns. It also examined the safety of low-dose aspirin in pregnancy.

What did the review tell us?

Thirty-four randomized clinical trials comparing low-dose aspirin and placebo (a sugar pill) were included in the analysis. Most participants in the trials were young and white. Providing low-dose aspirin to those who were at high risk of preeclampsia successfully reduced risk for

• developing preeclampsia
• preterm birth (births before 37 weeks of pregnancy)
• growth restriction (small babies)
• fetal and newborn death due to preeclampsia.

The review considered whether using aspirin led to more bleeding problems. When comparing the aspirin group and the placebo group, no differences occurred in bleeding problems, such as maternal hemorrhage following a birth, fetal brain bleeding, and the placenta separating from the wall of the uterus too early.

Who should take low-dose aspirin during pregnancy?

Overall, the benefits of taking low-dose aspirin outweigh risks for some pregnant people. Your doctor may recommend it if you

• have had preeclampsia before
• already have high blood pressure or diabete
• are carrying multiples, such as twins or triplets
• have kidney or autoimmune disease.

It’s important to know that there are moderate risk factors to consider, too. When combined, they can increase the chance of preeclampsia and its complications. Your doctor may recommend low-dose aspirin if you have two or more of these factors:

• having your first baby
• having obesity
• having a mother or sister who had preeclampsia
• being 35 years old or older
• having conceived with in-vitro fertilization (IVF)
• having had a baby before who was small for gestational age
• having a difficult pregnancy outcome in the past.

Unequal distribution of healthcare, and social and environmental stress, make preeclampsia and its complications more likely to occur in pregnant people who are Black and those who have lower income. Therefore, the task force recommends low-dose aspirin for these pregnant individuals even if they have only one moderate risk factor.

The bottom line

New evidence supports using low-dose aspirin to help prevent preeclampsia, a dangerous and common complication of pregnancy. If you’re pregnant or considering pregnancy, talk with your doctor or midwife about preeclampsia. It’s important to learn the warning signs of possible problems even if you’re not at high risk. Together, you can decide whether low-dose aspirin is a good choice for you.