There’s a respiratory virus making headlines this year that you’ve likely already had at some point in life. Nonetheless, it’s posing a threat to seniors. Respiratory syncytial virus, known as RSV, resembles the common cold. While most healthy adults and children get better within a couple weeks, the virus, which infects the nose, throat, lungs, and breathing passages of the upper and lower respiratory system, is very dangerous for babies under 6 months and adults 65 and older. Each year in the United States, 60,000 to 120,000 adults over age 65 and 58,000 to 80,000 children under the age of five are hospitalized. Up to 10,000 adults over age 65 and some 100 to 300 children die from the infection.

“RSV has already peaked in the U.S. this season, but I do think that there will be multiple RSV vaccines available for older adults in time for next season,” notes Dr. Amesh Adalja, an infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security.

Here’s a look at what’s known about the new RSV vaccines for older adults, what’s not and what lies ahead for 2023 to protect against the massive harms the virus causes.

Which drug companies are close to making an approved RSV vaccine?

Right now, RSV vaccine trials from drugmakers are still underway, and once they conclude, they will each need to go through a regulatory review and approval process by the U.S. Food and Drug Administration (FDA).

Moderna

On January 17, 2023, Moderna announced their RSV vaccine was 83.7% effective in preventing RSV with two or more symptoms, in people ages 60 and older, and it was 82.4% effective at preventing lower respiratory tract disease with three or more symptoms. No safety concerns were identified during the phase III clinical trial, which enrolled about 37,000 people across 22 countries. The company plans to publish their data in a peer-reviewed journal and file an application for FDA approval of their vaccine in the first half of 2023.

Pfizer

On December 7, 2022, Pfizer announced the FDA granted priority review to their RSV vaccine for older adults 60 years of age or older. On August 25, 2022, the company released data showing the vaccine was 66.7% effective in preventing lower respiratory tract illness in people 60 and over and 85.7% effective at preventing severe disease. Additionally, Pfizer said there were no safety concerns, and that the vaccine was “well tolerated” among participants in the phase III clinical trial. The FDA is currently reviewing the data in the Biologics License Application (known as the BLA), which is tens of thousands of pages long. They are said to decide on whether the vaccine is ready to be marketed by May 2023. If approved, Pfizer’s RSV vaccine will likely be available by fall 2023 to the public. Pfizer is also developing a RSV vaccine for pregnant women, who would be immunized to protect their newborns after delivery.

GlaxoSmithKline (GSK)

On October 13 2022, GSK reported their RSV vaccine was 94.1% effective against severe RSV in adults age 60 years and older with overall efficacy at 82.6%. The vaccine was well tolerated in phase III clinical trial participants with adverse effects typically mild-to-moderate. An FDA decision on that filing, made by GSK in late 2022, is also expected in May 2023.

How do the new RSV vaccines work?

Different types of vaccines work in different ways to offer protection, but none of the RSV vaccine candidates referenced above are “live vaccines.” 

“One of the 11 proteins the RSV virus uses to infect our healthy cells is called the F glycoprotein,” explains Rob Swanda, who holds his doctorate in biochemistry and is a mRNA biochemist. The mRNA RSV vaccine designed by Moderna “gives our cells the instruction (via mRNA) to make the F glycoprotein ourselves,” says Swanda. This, he says, allows our immune system to recognize that this F glycoprotein is not one of our own proteins, create an immune response against it, and then, keep memory of what that protein looks like.

“It’s like receiving a cooking recipe that can’t be stored or saved,” explains Swanda, who is known for his whiteboard videos explaining vaccine science. “You use your own ingredients to make the dish, then you know what the product tastes like, and if you came across that same dish in the future you would remember that you tried it before.”

Researchers have been studying and working with mRNA vaccines for decades — long before the pandemic and the experience in developing the COVID-19 mRNA vaccine played a major role in getting these RSV vaccines close to the finish line.

What are the side effects?

The majority of side effects associated in the RSV vaccine trials included those, according to Swanda, common with any injection:

  • Pain
  • Fatigue
  • Headaches
  • Muscle pain
  • Joint pain

Marty Davey, 64, a registered dietitian from Yonkers, New York, and her husband, Jim Fitzpatrick, 72, are currently participating in one of the RSV vaccine trials. “We each got an RSV vaccine about six months ago, and so far, so good,” she says.

The couple initially saw an ad on Facebook recruiting seniors in good health to be a part of the two-year drug trial, which is run in their area by Drug Trials America in Hartsdale, New York. “We get a notification every Monday to let the researchers know how we are feeling, if we can work, and if we can do daily living activities, and were given thermometers to record our temperature the first two weeks after receiving the vaccine,” she explains.

Since the RSV vaccine candidates are using the same technology as the mRNA COVID-19 vaccines, Swanda said your health care provider should have appropriate information regarding compatibility of the RSV vaccination and any other medications you may be taking.

“The benefit of the vaccines is in preventing severe diseases for RSV and not of use once someone is already experiencing the disease.”

— DR. AMESH ADALJA, AN INFECTIOUS DISEASE SPECIALIST

Can getting the RSV vaccine eventually help older adults hospitalized with the virus?  

If you or a loved one is hospitalized with RSV, it’s natural to want a magic cure or any kind of relief to help. Unfortunately, it’s not that simple.

There is no medication to treat RSV currently. “The RSV vaccine is a preventative vaccine, not a therapeutic vaccine,” Dr. Adalja points out. In other words, getting it while you’re in the hospital with severe RSV isn’t going to do you any good in terms of treatment. “The benefit of the vaccines is in preventing severe diseases for RSV and not of use once someone is already experiencing the disease,” he explains.

While Davey and Fitzpatrick didn’t report any immediate side effects after receiving their RSV vaccine in the trial, they both came down with COVID-19 at the start of 2023. “You’re bound to come down to something when you’re coming in contact with 300-400 people every day,” says Davey, who takes public transportation to work.

RSV is a different virus than COVID-19, and it is currently unclear if people with long COVID, a chronic condition where people continue to experience symptoms such as fatigue, shortness of breath and brain fog after recovering from COVID-19, are more at risk for RSV compared to those who have fully recovered from COVID-19.

It’s possible respiratory viruses in general (i.e., RSV, COVID-19, flu) may be more prevalent in certain regions or there may be more susceptible people due to increased travel, changes in the viruses themselves or disruptions to the usual preventive measures that were in place during the pandemic.

How to reduce your own and an older loved one’s risk of RSV right now

RSV spreads much more through contaminated surfaces, which makes hand washing and cleaning surfaces more critical. Dr. Adalja also recommends older adults who are high-risk “be cautious in crowded, congregated areas and think about wearing masks in those situations.”

As we age, so too does our immune system. Older adults are more vulnerable to other vaccine-preventable diseases like flu, COVID-19, pneumonia and shingles.

“In my experience, professionally, there are an awful lot of folks who say, ‘I’ll get a pill for that.’ But there are preventative things you could be doing to get healthier and have a better quality of life,” notes Davey. “We all lived through a pandemic and know about long COVID. Once you go on a respirator, your lungs are forever changed. Period.” 

Talk with your own and your senior loved one’s health care provider about risks for diseases and an immunization schedule that is best for you both. 



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Ayurvedic remedies for common cold and cough in winter Pic Credit Freepik

Ayurvedic remedies for common cold and cough in winter. Pic Credit: Freepik

A common cold might not seem like much to you, but it can leave you feeling exhausted and low on energy. When combined with symptoms such as sneezing or coughing, it can significantly reduce your productivity and well-being.

When bacteria or viruses get behind the eardrums, they frequently cause painful ear infections. Sometimes, the symptoms of asthma can worsen due to a cold. Long-lasting common colds can also result in acute sinusitis, which can cause sinus swelling and irritation. Other potential side effects of the common cold include strep throat, pneumonia, and bronchitis.

According to a recent Instagram post by Dr. Nitika Kohli, the Ayurveda specialist offers a few potent Ayurvedic nuskhe to treat colds and coughs."Colds and coughs are common during winter. Our body always tries to adapt to changing seasons but when we are in the process sometimes, we get affected and get up catching a cold,'' she wrote.

Put these Ayurvedic remedies to use to combat coughs and colds during the winter

Sesame oil

A few drops of sesame oil can help the nasal passages stay lubricated naturally and can soothe discomfort and sneezing. Sesame oil has a warming impact on the body and lessens coughing, colds, and aches in the muscles.

Inhaling steam

The warmth and moisture in the steam soothe the nasal passages and provide headache relief. By breathing in warm water, you can create steam.

Jalneti

A ritual to clear the nasal passages, this ayurvedic approach aids in nasal cavity cleansing by lowering nasal inflammation. For nasal clearing, the term "jalneti" refers to pouring water into one nostril and removing it from the other.

Keep your hydration game strong by drinking flavoured drinks in addition to getting enough water. Ajwain, cumin, ginger, and cinnamon added to boiling water help support the digestive fire and circulation.

Yoga and pranayama can be useful in clearing nasal massages.

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Tired and without the strength to breathe, Yanomami children with severe malnutrition arrive at the Hospital da Criança Santo Antônio ( Santo Antonio Children's Hospital), in Boa Vista, and need an ICU bed. The lack of food has altered the organism of these malnourished boys and girls, many of whom are just a few months or years old. They are very skinny, have a sad and distant look when awake, and are exhausted from diarrhea and pneumonia associated with malnutrition.

In the ICU, children need to be intubated, a necessary strategy given the impossibility of breathing. Infections are treated, and a protocol for refeeding is initiated. This Wednesday afternoon (25), five beds in the ICU at the Children's Hospital are occupied by Yanomamis. Children from the largest indigenous land in Brazil, which is experiencing a sanitation and public health crisis, are present in practically all sectors of the health unit, with the majority placed in most of these wards.

Folha's reporting team was at the unit and toured its different sectors, which made it possible to verify the size and severity of the lack of health care crisis, with an explosion in cases of severe malnutrition and preventable diseases such as worms and malaria. The Yanomami are in large numbers in the ICU, in wards –where hammocks are set up or improvised to adapt to their customs– and especially in the emergency ward dedicated to cases of respiratory infection.

Translated by Cassy Dias

Read the article in the original language

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Common cold may not seem like a great deal to you but it may leave you fatigued and with low energy. Add to it symptoms like sneezing or coughing, and it can really affect your productivity and sense of well-being. In many cases, common cold can cause painful ear infections when bacteria or virus enters the space behind the eardrums. A cold can also sometimes make asthma symptoms worse. Prolonged common cold can also cause acute sinusitis which can lead to swelling and inflammation in sinuses. Strep throat, pneumonia and bronchitis are other common cold complications that people must be aware of. There is an array of common cold viruses and the most common of them are rhinoviruses. Common cold virus enters your body through mouth, eyes or nose and one can spread it through droplets in the air. (Also read: 5 reasons you are catching cold frequently this winter)



"Cold and coughs are common during winter. Our body always tries to adapt to changing seasons but when we are in the process sometimes, we get affected and get up catching a cold," says Dr Nitika Kohli in her recent Instagram post. The Ayurveda expert also suggests some effective Ayurveda nuskhe to tackle cough and cold.

- Sesame oil: Drops of sesame oil will support natural lubrication of the nasal passages and can relieve irritation and sneezing. Sesame oil has a warming effect on the body and helps to reduce muscle pain, cough and cold.

- Steam inhalation: The combination of moisture and warmth soothes the nasal area and also helps in headaches. You can take steam by breathing in heated water.





- Jalneti ritual for clearing nostrils: By reducing inflammation in the nasal area, this ayurveda technique helps you to cleanse your nasal cavity. Jalneti means to pour water in one nostril and take it out from the other to clear the nasal passage.

- Keep your hydration game stronger: Apart from sufficient intake of water, one can also drink spiced waters. Water boiled with spices like ajwain, cumin, ginger and cinnamon will support digestive fire and circulation.

- Yoga and pranayama also help to clear nasal massages and can be effective.

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Lung health

Lung diseases, excluding lung cancer, cause an estimated 235,000 deaths each year

New Delhi: Like other parts of the body, the lungs are an extremely important organ, which needs utmost care.

According to the National Heart, Blood and Lung Insititute, chronic lower respiratory diseases, including obstructive pulmonary disease (COPD) and asthma are the leading causes of death globally, every year.

Lung diseases, excluding lung cancer, cause an estimated 235,000 deaths each year.

Lungs age faster than other parts of the body since we breathe in toxic air, pollution, and dust, involve in smoking, and other things that deteriorate the organ. With time, the lungs lose their strength, which can make it more difficult to breathe.

But by adopting certain healthy habits, you can better maintain the health of your lungs, and keep them working optimally even into your senior years.

Your body relies on your respiratory system to supply the oxygen necessary for your organs to function. And if you struggle to breathe, your body may not get enough oxygen, and without enough oxygen, other critical organs may shut down.

Warning signs of respiratory distress

It is very important to learn to recognise the signs and symptoms of respiratory problems that may help you protect your life. If you notice any of these symptoms, you must contact your doctor immediately.

Breathlessness

Many people suffer from chronic breathlessness which means they are short of breath and the lungs are not able to get enough oxygen to breathe.

Even though it is normal to get breathless occasionally when you exert more than normal, sudden and regular shortness can be a sign of impending danger.

According to health experts, the lungs are involved in transporting oxygen to your tissues and removing carbon dioxide, and problems with either of these processes affect your breathing. Causes of breathlessness can be due to:

  • Asthma
  • Carbon monoxide poisoning
  • Excess fluid in the lungs
  • COPD
  • Covid-19
  • Lung collapse
  • Pulmonary embolism
  • Tuberculosis
  • Pulmonary fibrosis
  • Lung cancer
  • Croup
  • Anaphylaxis

Change in skin colour or Cyanosis

Health experts say that people who have less oxygen in their blood have a bluish colour to their skin. The condition is known as cyanosis, and it develops along with breathlessness and other symptoms. Cyanosis is caused due to lung problems and is a slow-progressing ailment, which needs immediate attention.

Causes of cyanosis in the lungs include:

  • High altitudes
  • Asthma
  • Respiratory tract infection
  • Blood clots in the arteries of the lungs
  • COPD
  • Pulmonary hypertension
  • Pneumonia

Hemoptysis

Hemoptysis is the coughing up of blood from the respiratory tract. Massive hemoptysis can cause the production of more than 600 ml of blood within 24 hours, and lead to lung collapse.

Doctors say in hemoptysis, the blood arises from this bronchial circulation when there is a trauma causing damage to pulmonary arteries because of a tumour caused by lung cancer. Hemoptysis is also caused by:

  • Severe pneumonia
  • Tuberculosis
  • Severe respiratory tract infection
  • Bronchitis

Wheezing

If you are constantly wheezing or breathing noisily, it could be an indication that your airways have become obstructed and there is a problem with the functioning of the lungs.

Doctors say it is important to report the first sign of experiencing wheezing. It is a result of inflammation and narrowing of the airway in any location from your throat to the lungs.

The most common causes of wheezing are:

Chest pain

If you suffer from lingering chest pain, you must contact your doctor immediately, as it can be due to:

  • A blood clot in the lung is known as a pulmonary embolism, where the artery can block blood flow to lung tissue.
  • Inflammation of the membrane covering the lungs, known as pleurisy in which chest pain, worsens when you inhale or cough.
  • A collapsed lung when air leaks into the space between the lung and the ribs.
  • High blood pressure in the lung arteries is known as pulmonary hypertension. This condition affects the arteries carrying blood to the lungs and can produce chest pain.

Disclaimer: Tips and suggestions mentioned in the article are for general information purposes only and should not be construed as professional medical advice. Always consult your doctor or a dietician before starting any fitness programme or making any changes to your diet.

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A teaching assistant who may not have survived if she hadn’t sought medical treatment when she did, is warning others about the dangers of the flu.

Vicky Allen, 53, of Sutton-in-Ashfield, spent Christmas in isolation in the Critical Care Unit at King’s Mill Hospital.

She had been feeling under the weather for a few days with what she thought was a cold but was well enough to go to work and attend a hairdresser’s appointment.

Almost a week later, Vicky’s condition suddenly deteriorated, leading her partner Wayne Key, 53, to call an ambulance on the morning of Friday 23 December 2022.

Wayne, who is an engineer, said: “Vicky was turning grey and was a right mess. She texted me on arrival at King’s Mill to say she’d tested positive for flu. We were both really surprised that the flu had done this.

“Within hours she had been placed into a coma because being on 100% oxygen wasn’t enough and she needed more support with her breathing.”

Vicky was admitted to Critical Care and put onto a ventilator – without which she would have died.

Wayne said: “I was told if I’d been an hour later calling for an ambulance then it could have been a different story. When I asked the doctor for a prognosis, they could only say that age was on her side.”

Although normally fit and well, Vicky has asthma and receives a flu jab every autumn.

Wayne said: “I thought the flu was just like a cold and you get over it – people need to be aware that it’s not like that for everyone.

“We both fear it could have been even worse if Vicky hadn’t been vaccinated so our message is to get vaccinated if you are eligible. Also, be aware of the symptoms and how quickly things can go downhill.

“We had been planning to kick our shoes off after work and relax and enjoy a quiet Christmas together – it was so far from that.

“I couldn’t visit while she was in isolation so had to rely on updates by phone three times a day. It was a nightmare.”

Vicky Allen scaled

Vicky, who was later diagnosed with pneumonia and then Strep A, came out of the coma after six days on 28 December. After a total of 12 days on the Critical Care Unit she was discharged on 3 January and Wayne has been caring for her at home ever since.

Doctors have told Vicky that it will take several months to return to full fitness, although she may not get back to doing everything she did before this illness.

Vicky said: “I’m getting better and stronger every day. My mind is still cloudy and I’m using a stick to walk. The stairs are still a bit of a struggle, but I realise it will take time to recover.”

Wayne said: “What’s behind us isn’t very nice so the best thing to do is to look forward and advise people to be cautious and get vaccinated.”

Although the number of patients with flu in Sherwood Forest Hospitals has decreased since figures peaked on 4 January 2023, there is still the equivalent of more than one hospital ward full of patients who have Covid, flu or RSV (Respiratory syncytial virus).

On 4 January 2023, there were 68 patients who had flu, including five receiving treatment in the Critical Care Unit plus 64 COVID cases, including four patients in Critical Care.

David Selwyn, Medical Director at Sherwood Forest Hospitals, said: “Although the number of flu cases in our hospitals has decreased, we will have to see if it remains that way now that schools are back and people are mixing more.

“Generally, the patients we are seeing are ‘incidental’ cases rather than flu and COVID being the main reason why they’re in hospital. However, we are treating people every day who are really poorly with flu or Covid.

“If you’re not feeling well, protect others by staying at home and avoiding close contact with others if you can. The vaccine helps protect against the main types of flu viruses but there’s still a chance you might get flu after having the vaccine.

“If you do get flu after vaccination, it’s likely to be milder and not last as long.

“When you visit our hospitals, please wear a mask in areas where they are required.”

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To check your eligibility for flu and Covid-19 vaccines and where to get them, visit the NHS website.

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Patients who are prescribed intermittent oral corticosteroids (OCS) for asthma with increasing frequency have a higher risk of OCS-related adverse outcomes (AO), according to study findings published in Thorax.

Investigators sought to evaluate the association over time between patterns of intermittent OCS prescriptions, cumulative OCS dosages, and OCS-related adverse outcomes in patients with asthma treated with intermittent-only OCS.

The researchers conducted a retrospective cohort study of almost half a million patients with asthma in the UK at least 4 years of age, using electronic medical records data from the Optimum Patient Care Research Database and the Clinical Practice Research Datalink GOLD from 2008 to 2019. All patients included for analysis received only intermittent OCS. Patients were stratified according to the frequency of their OCS prescriptions, as indexed on their first intermittent OCS prescription for asthma, into 3 groups: (1) one-time; (2) less frequent (≥90-day gap); and (3) frequent (<90-day gap).

Investigators matched patients taking intermittent OCS with a control group of patients not taking OCS. Participants were matched 1:1 for sex (56% women), age (16% 4-11 years of age; 8% 12-17 years of age; 62% 18-64 years of age, 15% ≥65 years of age), and index date (time in database pre-index, median 17 years). The researchers used a multivariable Cox-proportional hazard model to assess associations between the OCS prescribing patterns and OCS-related AO risk (stratified by age), Global Initiative for Asthma (GINA) 2020 treatment step, and pre-index inhaled corticosteroid (ICS) and short-acting β2-agonist (SABA) prescriptions. Median follow-up duration was 8.3 years (interquartile range [IQR], 4.2-13.7 years). The mean cumulative OCS dose was 176 mg (IQR, 150-200) for the one-time group, 510 mg (IQR, 300-600) for the less frequent group, and 2357 mg (IQR, 540-1800) for the frequent group.

Increasingly frequent prescribing patterns of intermittent OCS were associated with a higher risk of individual OCS-related adverse outcomes, and this association remained consistent across levels of age, GINA treatment step, and ICS maintenance and SABA reliever use.

Among the 476,167 asthma patients studied, investigators found 41.7% experienced one-time intermittent OCS prescribing patterns, 26.8% experienced less frequent, and 31.6% experienced frequent OCS prescribing patterns. Patients who received more frequent intermittent OCS prescriptions were older and more likely to be women. Increasing frequency of intermittent OCS prescriptions was associated with increased risk of any AO compared with non-use of OCS (one-time hazard ratio [HR], 1.19; 95% CI, 1.18-1.20), (less frequent HR, 1.35; 95% CI, 1.34-1.36), (frequent HR, 1.42; 95% CI, 1.42-1.43) and remained consistent across subgroups of age, GINA treatment step, and ICS and SABA.

The AOs most highly correlated with increasing frequency of OCS prescriptions were sleep apnea and pneumonia. Compared with the non-OCS group, increased risk for all AOs except dyslipidemia were observed at dosages of 0.5-1.0 g.

Significant study limitations include misclassification of intermittent and long-term OCS prescriptions; the possibility of missing data and confounding factors because patient records were not assessed for validity or completeness; residual confounding; and the likelihood of incomplete analysis of AOs among children.

“A considerable proportion of patients with asthma who are prescribed OCS intermittently have a frequent pattern of use at some point. Increasingly frequent prescribing patterns of intermittent OCS were associated with a higher risk of individual OCS-related adverse outcomes, and this association remained consistent across levels of age, GINA treatment step, and ICS maintenance and SABA reliever use,” concluded investigators, who stressed the importance of minimizing intermittent OCS use.

Disclosure: This research was supported by AstraZeneca. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

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This air travels to the alveoli, the small cavities located at the end of the bronchioles that are responsible for allowing gas exchange between air and blood.

In the case of atelectasis, these small air sacs deflate and cannot inflate properly and/or absorb enough air and oxygen.

If the disease affects a large enough area, the blood may not receive enough oxygen, which can trigger various health problems.

Generally, it is not life-threatening, but in some cases it must be treated quickly.

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Atelectasis: what it is

Atelectasis is one of the most common respiratory complications after surgery.

It is also a possible complication of other respiratory problems, including cystic fibrosis, lung tumours, chest lesions, fluid in the lungs and respiratory weakness.

Atelectasis can make breathing difficult, particularly if one already suffers from lung disease.

Treatment depends on the cause and severity of the collapse.

Pulmonary atelectasis, symptoms

What are the signs and symptoms? If atelectasis only affects a small area of the lungs, the person may not even have any symptoms.

But if it affects larger areas, the lungs cannot fill with enough air and the oxygen level in the blood may decrease.

When this happens, annoying and unpleasant symptoms may occur, including:

  • difficulty breathing (shortness of breath; rapid, shallow breathing; wheezing);
  • increased heart rate;
  • coughing;
  • chest pain;
  • bluish discolouration of the skin and lips.

If you experience these symptoms and have difficulty breathing, you should consult your doctor for diagnosis and treatment.

Keep in mind that other conditions, including asthma and emphysema, can also cause chest pain and breathing problems.

Why a lung can collapse

Atelectasis can be triggered by many factors: potentially, any condition that makes it difficult to take deep breaths or cough can lead to a collapsed lung.

Atelectasis can result from airway obstruction (called obstructive atelectasis) or from pressure from outside the lung (non-obstructive atelectasis).

The most common reason for people to develop this disease is surgery.

It must be known that anaesthesia can affect the patient’s ability to breathe normally or cough as it changes the normal breathing pattern and affects lung gas exchange.

All this can cause the air sacs (alveoli) to deflate.

In addition, the pain that is often experienced following surgery may make deep breathing painful: as a result, one may be inclined to adopt continuous shallow breathing, which may favour the development of the disease.

This explains why almost everyone who has undergone major surgery develops a more or less severe form of atelectasis.

Other possible causes of this pathology are:

  • thoracic trauma, e.g. a fall or a car accident, which prevent one from taking deep breaths (due to pain), which can cause compression of the lungs;
  • pressure at the level of the chest: pressure exerted on the lungs, which may depend on a tumour mass outside the bronchus, on a tumour inside the bronchus, which causes airway obstruction. In fact, if air cannot get past the blockage present, the affected part of the lung may collapse;
  • accumulation of mucus in the airways, which may cause a blockage in the airflow. This event commonly occurs during and after surgery because coughing is not possible in such cases. In addition, drugs administered during surgery cause people to breathe less deeply, so normal secretions collect in the airways. Suctioning the lungs during surgery helps to clear them, but sometimes it is not enough. Mucus plugs are also common in children, people with cystic fibrosis and during severe asthma attacks;
  • inhalation of small objects, such as a peanut, the cap of a biro, a small toy, which prevent air from flowing freely;
  • other lung diseases, such as pneumonia, pleural effusions (fluid around the lungs) and respiratory distress syndrome (RDS).

Atelectasis is not to be confused with pneumothorax, another condition that commonly causes a collapsed lung.

It is the presence of air between the lung and chest wall.

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Atelectasis, the risk factors

Factors that increase the likelihood of developing this disease include:

  • advanced age
  • any condition that makes swallowing difficult;
  • bed confinement with rare changes of position;
  • lung disease, such as asthma, COPD, bronchiectasis or cystic fibrosis;
  • recent abdominal or thoracic surgery;
  • recent general anaesthesia;
  • weak respiratory muscles due to muscular dystrophy, spinal cord injury or another neuromuscular condition;
  • use of drugs that may cause shallow breathing;
  • pain or injuries that may make it painful to cough or cause shallow breathing, including stomach pain or rib fracture;
  • cigarette smoking.

What is involved in atelectasis

A small area of atelectasis, especially in an adult, is usually curable.

However, one should be aware that this disease can give rise to the following complications

  • a low level of oxygen in the blood (hypoxemia). Atelectasis makes it more difficult for the lungs to carry oxygen to the air sacs (alveoli) and thus to the rest of the body;
  • pneumonia: the risk of pneumonia continues until the atelectasis disappears. This is because the presence of mucus in a collapsed lung can lead to infection;
  • respiratory failure: the loss of a lobe or an entire lung, particularly in an infant or in people with lung disease, can be life-threatening.

Prevention of post-surgery atelectasis

Some research suggests that performing deep breathing exercises and muscle training may reduce the risk of developing atelectasis after surgery.

In addition, many patients in hospital are given a device called an incentive spirometer that can encourage them to take deep breaths, thus preventing and treating atelectasis.

If you smoke, you can reduce your risk of developing the condition by stopping smoking before any operation.

Atelectasis in children is often caused by an airway blockage.

In such cases, to reduce the risk of atelectasis, keep small objects out of reach of children.

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The latest published research the “Mechanical Ventilators Market” report provides the overall growth and business outlook of the global industry. The assessment presented in the Coherent Market Insights research report gives thorough data and analysis of major important facets such as growth drivers, challenges, restraints, present and historical trends, and growth opportunities in the market. The report research covers valuable information on the business with insights, applications, and the industrial chain structure. And this adding report provides market sizing and forecast across the globe. It helps organization leaders make better decisions when currency exchange data is readily available. Additionally, it contains knowledge of the worldwide market competition landscape, development status, segments, and sub-segments of an industry that influence the growth scenario of the present market.

Mechanical ventilators are machines that assist patients in breathing during surgery or critical illness. Mechanical ventilators are mostly found in hospitals and transportation systems like medical evacuation air transport and ambulances. Being on a ventilator for an extended period of time can increase the risk of pneumonia as well as other risks such as vocal cord damage. Ventilators are used when there is respiratory failure or difficulty breathing. When a person is unable to breathe properly, his or her body organs do not receive enough oxygen to function properly, and too much carbon dioxide can accumulate in the blood, which must be expelled. Acute respiratory distress syndrome, asthma, a head injury, cardiac arrest, and other conditions.

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Market Competitor Analysis:

The report also includes the profiles of key companies along with their SWOT analysis and market strategies in the Mechanical Ventilators market. In addition, the report focuses on leading industry players with information such as company profiles, components, and services offered, financial information for the last 3 years, and key development in the past five years.

Further, the report presents profiles of competitors in the market, Top Key Players include:

  • Shenzhen Mindray Bio-Medical Electronics Co., Ltd.
  • Getinge AB
  • General Electric Company
  • Hamilton Medical
  • Medtronic
  • ICU Medical, Inc.
  • Dragerwerk AG & Co. KGaA
  • ZOLL Medical Corporation
  • Koninklijke Philips N.V.
  • VYAIRE
  • Fisher & Paykel Healthcare Limited
  • ResMed
  • Max Ventilator (A.B.Industries)
  • NIHON KOHDEN CORPORATION
  • Inspiration Healthcare Group plc.
  • CorVent Medical Inc.
  • Inovytec
  • InnAccel Technologies Pvt Ltd.
  • OES Medical

Mechanical Ventilators Market: Segments and Scope

The segmental analysis section of the report includes a thorough research study on key types and application segments of the Mechanical Ventilators market. The report market segments are considered based on market share, growth rate, recent developments, technology, and other critical factors during the forecast period. The report also tracks the most recent market dynamics, like driving factors, restraining factors, and industry news like mergers, acquisitions, and investments.

Detailed Segmentation:

By Product Type:

  • Critical Care Mechanical Ventilators
  • Neonatal Mechanical Ventilators
  • Transport and Portable Mechanical Ventilators

Benefits of Mechanical Ventilators Market Reports:

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Global and Regional Market Analysis:

The Mechanical Ventilators Market report provides information about the market area, which is further subdivided into sub-regions and countries/regions. In addition to the market share in each country and sub-region, this chapter of this report also contains information on profit opportunities. This report mentions the market share and growth rate of each region, country, and sub-region during the estimated period. Additional information, the Mechanical Ventilators market study covers noteworthy research data and proofs to be a handy resource record for managers, analysts, industry experts, and other key people to have a ready-to-access and self-analyzed study to help understand market patterns.

☑ North America (United States, Canada, and Mexico)
☑ Europe (Germany, France, UK, Russia, and Italy)
☑ Asia-Pacific (China, Japan, Korea, India, and Southeast Asia)
☑ South America (Brazil, Argentina, Colombia, etc.)
☑ The Middle East and Africa (Saudi Arabia, UAE, Egypt, Nigeria, and South Africa)

Key Reasons to Purchase Mechanical Ventilators Market Report:

►The report analysis by geography highlights the consumption of the product/service within the region and also as indicating the factors that are affecting the market within each region

►The report provides opportunities and threats faced by the vendors in the Mechanical Ventilators Market. The report indicates the region and segment that’s expected to witness the fastest growth

►The competitive landscape includes the market ranking of the main players, along with new product launches, partnerships, business expansions

►The report provides extensive company profiles comprising of company overview, company insights, product benchmarking, and SWOT analysis for the main market players

►The report gives the present as well as the future market outlook of the industry regarding recent developments, growth opportunities, drivers, challenges, and restraints of both emerging also as developed regions

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Key Questions Answered in This Mechanical Ventilators Market Report :

✓ How much revenue will the Mechanical Ventilators market generate by the end of the forecast period?

✓ Which market segment is expected to have the maximum market share?

✓ What are the influencing factors and their impact on the Mechanical Ventilators market?

✓ Which regions are currently contributing the maximum share of the overall Mechanical Ventilators market?

✓ What are the main advances in the Mechanical Ventilators market?

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Lack of exercise is a well-known risk factor for conditions such as cardiovascular disease, diabetes and certain forms of cancer. But some research also suggests that physical inactivity should be considered a risk factor for respiratory infections caused by the common cold, influenza, pneumonia and COVID-19. 

Studies show that regular exercise, of moderate intensity, is associated with a decreased risk of respiratory infections. More severe outcomes with COVID-19 also have been linked to low physical activity.

The latest study, published Tuesday, found that children with higher levels of daily physical activity are less susceptible to upper respiratory tract infections, such as the common cold. For every 1,000 average daily steps taken, children experienced 4.1 fewer days of respiratory symptoms. Children who played sports for at least 3 hours each week also tended to have fewer respiratory infections.

The study, which involved 104 children ages 4-7, did not establish a direct cause-and-effect relationship because it was observational. But the researchers had a few theories for their findings. Higher levels of physical activity reduce levels of inflammatory cytokines, which are associated with chronic inflammation and disease. They also promote stronger immune system responses. 

Another possibility is that additional immunity comes from small extracellular vesicles – small, cell-derived particles – released by the muscles after exercise, the researchers said. 

Still, health officials emphasize that vaccination and other preventive measures, such as frequent hand-washing, wearing a mask in high-risk settings, drinking fluids and getting enough sleep, are the most effective ways to reduce the risk of respiratory infection.

Too much exercise may have the reverse impact on the immune system. Some studies have suggested that too much physical activity increases the risk of infection. In one study, exercise stress was linked to an increase in influenza severity and risk of death. 

Another study found that 90 minutes of high-intensity endurance exercise can make athletes more vulnerable to illness for up to 72 hours after their workouts. Some researchers theorize that during intense physical exercise, the body produces hormones that may temporarily lower immunity. Additional research found that intense exercise before or during a respiratory illness can worsen the infection. 

National exercises guidelines advise that adults get 150 minutes of moderate physical activity each week. Moderate activities include walking briskly, recreational bicycling, gardening and vigorous housecleaning. The American Lung Association says that aerobic and muscle-strengthening activities can strengthen the lungs and tone breathing muscles, such as the diaphragm.

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Ai Fen, director of the emergency department at the Central Hospital of Wuhan, was on the frontline when she started seeing patients with a mysterious SARS-like pneumonia.

A snapshot of her initial report – which warned that the illness was likely to be highly contagious and dangerous – was shared by eye doctor Li Wenliang, one of the first whistle-blowers to the public about the emergency that later became known as COVID-19, which also killed him.

Ai was reprimanded by hospital officials for her report and accused of spreading rumours, but she continued to emphasise the importance of preparedness to her staff, insisting that they wear masks, wash their hands and offer masks to patients.

Now, after weeks of fighting the renewed wave of COVID-19 infections – which has ripped through the population at a much larger scale compared to three years ago – Ai said the healthcare system had learned the lessons and was better prepared.

Hospitals in Wuhan did not experience the shortages of drugs and medical supplies reported in other cities, but more could still have been done, she said.

“Compared to 2020, it’s obvious that this time we prepared more comprehensively, including in leadership management, the coordination of resources (and) the stockpiling of supplies,” Ai said.

Another possible reason for Wuhan’s resilience is that the city had already been through the challenge in 2020, she added. “At least people were mentally prepared.”

In the latest surge, all departments at her downtown hospital were required to admit patients with fever or COVID-19 unconditionally. This took much of the burden from the emergency room, as well as the respiratory diseases department and intensive care unit, Ai said.

The hospital had also stockpiled enough medical supplies – including gloves, N95 masks, ventilators and high-flow nasal cannula oxygen therapy devices – to be able to run at an overloaded capacity for three months.

In 2020, when the Central Hospital was designated to treat COVID-19 patients, it struggled with oxygen shortages, Ai said. This time, the hospital has built oxygen tanks two storeys tall, which have helped significantly in giving relief to patients in need.

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Topical antiseptics such as hydrogen peroxide, iodine, or a combination of the two are not safe to inhale and not proven to treat respiratory infections, contrary to social media claims that breathing in these liquids is a good idea.

Both hydrogen peroxide and iodine solutions have been used as a mouth rinse to reduce numbers of oral bacteria and viruses, but experts say that inhaling or nebulizing them has not been tested in high doses because they have the potential to damage tissue and to be poisonous.

Still, social media users are sharing a video that claims using a nebulizer to make a vapor from a mixture of hydrogen peroxide and iodine can treat respiratory infections like sore throat.

A Facebook video with more than 14,000 shares at the time of writing claims that combining “the pathogen killing potential” of 3% hydrogen peroxide with iodine in a nebulizer will create a “super oxygenated system” that is “coating your entire upper respiratory tract” when breathing it in (here). Versions of the clip have been shared online since at least October 2021 (here).

Claims that inhaling hydrogen peroxide would treat respiratory illnesses such as COVID-19, flu and pneumonia date to at least 2021, when Reuters reported that medical professionals “strongly” advise against the unproven home remedy (here).

Inhaling hydrogen peroxide does not treat general illnesses and can instead complicate “the course of any successful treatments,” Panagis Galiatsatos, M.D., an associate professor at Johns Hopkins Bayview Medical Center, told Reuters at the time.

The Asthma and Allergy Foundation of America has also warned against inhaling hydrogen peroxide from a nebulizer machine, which is normally used to turn liquid asthma medicine into a mist inhaled through a mask or mouthpiece (here).

Hydrogen peroxide can be toxic if ingested, inhaled, or exposed to the eyes, and inhaling the household-strength hydrogen peroxide (3%) recommended in the video can cause respiratory irritation, according to the U.S. Agency for Toxic Substances and Disease Registry (here).

Both hydrogen peroxide and iodine solutions are used on the skin, usually to prevent infection of minor cuts and scrapes (here). And both can be used in mouthwashes to reduce oral bacteria (here ), (here).

Evidence from studies of accidental inhalation shows that hydrogen peroxide can damage tissue and iodine can be toxic.

A safe concentration of hydrogen peroxide in the air, for example, is one part per million, or 0.0001% (here), (here) but the concentration needed to kill viruses or bacteria is much higher.

“If we’re speaking about stuff that kills microorganisms, that’s like 3% - huge difference,” Dr. Naftali Kaminski, chief of pulmonary, critical care and sleep medicine at the Yale School of Medicine, told Reuters. “Nebulizing it is terrible, it’s really dangerous because when it hits mucosal surfaces, it will kill cells, cause inflammation.”

Encouraging the use of iodine in a nebulizer dates to at least 2020, as the U.S. Food & Drug Administration (FDA) issued a warning letter to a website selling iodine solution while claiming it would treat COVID-19 at the time (here).

The dangers of inhaling vaporized iodine include increased pulmonary flow resistance, decreased ventilation rates and irritation to mucous membranes, according to the California Department of Justice Bureau of Forensic Services (here). Specifically, iodine can irritate the lungs and higher exposures “may cause a build-up of fluid in the lungs (pulmonary edema), a medical emergency,” according to the Centers for Disease Control and Prevention (CDC) (see page 1-2) (here).

Dr. Sayantani Sindher, a clinical associate professor of medicine at Stanford Medicine (here), told Reuters that “the use of nebulizers to create at-home formulations is highly dangerous” and “there is a high risk of poisoning yourself.”

The claim that combining hydrogen peroxide with iodine will create a “super oxygenated system” is also misleading, as “mixing hydrogen peroxide and iodine does create oxygen, but this does not mean that is safe or healthy,” Sindher said. “While we need oxygen to survive, too much oxygen is toxic to your body and when oxygen is provided to patients it is mixed with other gases to create mixtures that are safe for use.”

Studies on the combination of hydrogen peroxide and iodine in a nebulizer are needed to prove its safety, but “I don’t think any institutional review board will approve a study like that because [of] the potential for injury,” Kaminski said.

Ultimately, human lungs are only meant to breathe air, Kaminski said, so “never nebulize anything into your lungs” unless it received FDA approval and was proven to be safe.

VERDICT

False. There is no evidence that combining hydrogen peroxide and iodine in a nebulizer will treat respiratory symptoms, and the practice is potentially damaging and toxic, experts told Reuters.

This article was produced by the Reuters Fact Check team. Read more about our work to fact-check social media posts here .

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Jan. 23—The triple threat of influenza, respiratory syncytial virus (RSV) and COVID-19 have caused an increase in hospitalizations across the country. In Cass County, the combination of viruses has resulted in an increase in illnesses and a decrease in cold and flu medicine in stores.

"It's hard to distinguish them without testing," Cass County Health Educator Debbie Grimes said. "They're all treated the same. They're all viral."

According to data from The New York Times, Indiana reported 2,960 new COVID cases Jan. 18. However, the Indiana Department of Health reported Jan. 17 that hospitalizations and deaths related to COVID have decreased. During the first week of January, Cass County reported 94 new cases of COVID-19. The number of new cases decreased to 42 during the week of Jan. 12 and is currently around 17.

While the county and state are seeing a decrease in COVID cases, RSV and influenza are still rampant. According to WFYI, the state saw 82 deaths from influenza last year. This year, the Indiana Department of Health said influenza has caused at least 132 deaths so far this flu season.

RSV has also been a concern. Grimes said that while many people think of RSV as especially dangerous for babies, it can be deadly for people in all age demographics.

"People think that RSV is just dangerous for children, but it's people with a weakened immune system," she said. "It's young people and old people and anyone with a compromised immune system."

Grimes said any respiratory virus can lead to further complications even in healthy adults. She advised people to take precautions to stay healthy.

"They can lead to pneumonia and other things," she said. "People just need to continue washing their hands frequently, wearing their masks, limiting their exposure to crowds and people and cleaning surfaces the same as they did during the pandemic. It hasn't really stopped."

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Introduction

Climate change is perhaps the greatest threat humans face today, with far-reaching implications for food supply chains, migration patterns, shifting habitats, extreme weather events, and human health. The average global surface temperature in July 2022 was the sixth warmest for July since 1880 when record keeping began,1 and global temperatures are expected to continue rising over the next several decades.2 As of 2016, global atmospheric CO2 concentrations have permanently crossed above 400 ppm, an important threshold with implications for further rising global temperatures and other climate impacts. According to the World Health Organization, climate change has both direct and indirect effects on health and disproportionately impacts vulnerable groups like children, the elderly, racial and ethnic minority groups, low-income populations, and citizens of developing nations.3 Some of the many climate-sensitive health risks include injury or death from extreme weather events, heat-related illnesses, increase in waterborne and vector-borne diseases, malnutrition, and respiratory illnesses. Similar effects of rising global temperatures on survival have been described in animals.4

Earth’s changing climate is primarily the result of human activity, namely the production of greenhouse gases due to our reliance on burning of fossil fuels for energy.5 Toxic pollutants like black carbon, sulfur dioxide (SO2), nitrogen oxides (NOx), volatile organic compounds (VOC), particulate matter (PM), and polyaromatic hydrocarbons emitted as a result of burning of fossil fuels worsen air quality and increase absorption of solar radiation that further increases temperatures.6 Higher temperatures accelerate formation of ground-level ozone (O3) from NOx and VOC precursors that increase risk of cardiopulmonary morbidity and mortality. Drought conditions leading to wildland fires and desertification effects increase air particulates that exacerbate respiratory conditions like asthma and COPD and increase the risk for emergency department (ED) visits and hospitalizations.7

Viral respiratory tract infections are most common illnesses in humans,8,9 with estimated 17 billion incident cases globally in 201910. Common viruses causing respiratory tract infection include influenza, respiratory syncytial virus (RSV), rhinovirus (RV), and SARS-CoV-2. Viral respiratory infection imposes a substantial burden on populations and health systems.11 Non-influenza viral respiratory infections were estimated to cost the US economy $40 billion annually.11 Viruses are also the primary trigger for acute asthma exacerbations12 and a major cause of COPD exacerbations.13 While most viral respiratory infections are mild and self-limited,11 they can lead to severe complications in susceptible patients, including pneumonia and even respiratory failure.14,15 The SARS-CoV-2 pandemic in particular has contributed to over 3 million deaths worldwide.16

More than 90% of the world's population is exposed to polluted air.17 Convincing epidemiologic data has linked air pollution exposure with increased incidence of viral respiratory infections like upper respiratory tract (URI) infections,18,19 bronchitis,20 and lower respiratory tract infections (LTRI)21,22 such as pneumonia23,24 and bronchiolitis.25,26 Similarly, temperature,27,28 humidity,29 and extreme weather events30–32 have also been directly and indirectly associated with respiratory infections.

Climate change, air pollution, and viral respiratory infection are highly interconnected, and without interventions to halt global warming, we can expect the burden of viral respiratory disease to increase worldwide. This review will summarize the epidemiologic and experimental evidence for a relationship between climate change/air pollution and susceptibility to viral respiratory disease as well as future research priorities (Table 1).

Table 1 Summary Points and Knowledge Gaps

Methods

We conducted a search for peer-reviewed studies pertinent to climate change, air pollution, and viral respiratory infection using PubMed and Google Scholar databases. We applied the keywords: climate change, air pollution, particulate matter (PM), nitrogen dioxide (NO2), O3, RSV, RV, influenza, SARS-CoV-2, COVID-19, asthma, COPD, viral respiratory infection. Studies were included if they were 1) relevant to the aims of this review, 2) published in peer-reviewed journals, and 3) written in English.

Climate Change and Respiratory Viral Infection

Temperature, humidity, and extreme weather events are linked with respiratory infection incidence (reviewed by33). In temperate climates, lower temperature was usually associated with higher infection incidence. A study conducted in Sweden observed that lower temperature and larger weekly drop in temperature were associated with higher influenza incidence the following week.34 Lower temperature was associated with higher incidence of influenza A, respiratory syncytial virus (RSV), human metapneumovirus, bocavirus, and adenovirus, while no association with temperature was observed for human rhinovirus and enterovirus infection incidence.34 A US study found that warmer winters were associated with more severe epidemics of influenza A and B during the following winter season.27 Specifically, a mild winter was followed by a more severe than average influenza epidemic 72% of the time, and this epidemic had a growth rate 40% higher and peaking 11 days earlier than average.27 A study of RSV seasons over 8 years in the Netherlands reported a negative correlation between minimum temperature and RSV incidence (r=−0.338),28 with others reporting similar findings.35 For RSV specifically, some experts have proposed that climate change and resulting warmer winters may be beneficial in terms of shortening RSV seasons.36 In contrast, Zoran et al observed a positive correlation between COVID-19 cases and air temperature (r=0.67), indicating high transmission during warmer temperatures, which may partially explain continued high levels of transmission of the SARS-CoV-2 virus observed even during the summer months.37

In tropical climates, increased temperature was associated with higher rates of respiratory infections. Phung et al reported that among urban children <5 years of age in the Mekong Delta region of Vietnam, rates of hospital admissions for respiratory infections increased by 3.8% (95% CI 0.4, 7.2) for every 1°C increase in 2-day moving average temperature.38 Temperature variability was also linked to viral respiratory infection incidence. Greater temperature variability, day-to-day and within the same day, was positively associated with greater frequency of healthcare visits for acute bronchitis39 and pneumonia in children.40,41 However, most analyses did not account for air pollution, socioeconomic status, or behavior factors, which could have influenced infection frequency.

The relationship of humidity to viral respiratory disease incidence is inconsistent and may vary depending on the specific respiratory virus. Chowell et al reported a strong negative correlation (r=−0.70) between relative humidity and peak incidence of H1N1 influenza during the 2009 pandemic.29 Similarly, an inverse relationship was observed between COVID-19 cases and relative humidity levels in the Lombardy region of Italy during early 2020 (r=−0.47), suggesting that dry air favors virus transmission.37 In contrast, RSV incidence was positively correlated with relative humidity,28,35 suggesting that higher humidity was associated with higher RSV activity.

Extreme weather events such as wildfires, heavy rainfall with flooding, and heat waves have been linked with respiratory infection risk as well. In addition to direct effects, these events can also have indirect effects on risk of respiratory infections, such as displacement of large groups of people from their homes, indoor crowding and increased time spent indoors, and inadequate food supply with malnutrition that enhance susceptibility to and transmission of disease. Increased time spent indoors may also increase exposure to indoor pollution sources such as burning biomass that contribute to respiratory symptoms.

A systematic review of air pollution exposure during natural disasters including wildland fires and volcanic eruptions concluded that PM generated by these events was associated with increased rates of acute respiratory infection, pneumonia, bronchitis, and bronchiolitis.30 A consistent association across multiple studies was observed between exposure to wildfire-related particulate matter less than 2.5 µm in diameter (PM2.5) and increased ED visits and hospitalizations for acute respiratory infection.31,42–47 Delfino et al found that during wildfires in Southern California, the number of hospital admissions for pneumonia increased by 1.3x (95% CI 1.17, 1.48) and admissions for acute bronchitis/bronchiolitis increased by 1.6x (95% CI 1.09, 2.29) among area residents.46 Rappold et al reported similar findings following wildfires in North Carolina, with residents from exposed counties experiencing an increased risk of ED visits for bronchitis and pneumonia (cRR 1.59, 95% CI 1.07, 2.34).43

Extreme rainfall and flooding were linked with acute respiratory infections as well. Phung et al reported a significant relationship between extreme river water levels in the Mekong Delta region and daily pediatric hospitalizations for respiratory infection (cRR 1.66, 95% CI 1.57, 1.74).32 A retrospective study from the Netherlands reported that exposure to floodwater and performing clean-up after flooding were associated with higher odds of acute respiratory infection (aOR 3.3, 95% CI 2.0, 5.4).48

Heat waves may also contribute to increased respiratory infections. In California, more ED visits for respiratory infections were observed among all age groups during the July–August 2006 heat wave compared to reference periods immediately before and after the heat wave.49 Similarly, a time-stratified case–crossover study conducted in China over a 2-year period observed that heatwaves increased the risk of outpatient visits for respiratory infection among all ages (RR 1.31, 95% CI 1.18, 1.45), with children (1.74, 95% CI 1.52, 1.99) and the elderly (1.41, 95% CI 1.11, 1.79) at particularly elevated risk.50 The contribution of unmeasured factors such as increased time spent indoors during periods of extreme heat is unknown. A mechanism by which extreme heat may directly contribute to increased risk of infection is unclear, though heat stress has been shown to impair airway innate immune responses in animal studies.51 Chronic heat stress in mice was associated with a reduced production of inflammatory cytokines IL-6 and IFN-β, increased viral load and increased mortality rate following avian influenza H5N1 infection.

Air Pollution and Respiratory Infection: Epidemiologic Evidence

Short- and long-term exposure to air pollution has been extensively linked with increased susceptibility to respiratory infection. Short-term exposure to increased PM was associated with increased susceptibility to respiratory infections including influenza24,52 and influenza-like illness,53–55 RSV bronchiolitis,25,26,56 and acute lower respiratory tract infections (LTRI)22 including pneumonia.23,24,57 Chen et al observed that across 47 Chinese cities, a 10 μg/m3 increase in PM2,5 was associated with an increased risk of influenza (RR 1.020, 95% CI 1.006, 1.034) at lag days 2–3, after controlling for seasonality and weather conditions.52 Croft et al examined data from 500,000 ED visits and hospitalizations from New York state and found that IQR increases in PM2.5 during the prior week were significantly associated with higher rates of ED visits for influenza (3.9%, 95% CI 2.105.6%; at 7 days) and culture-negative pneumonia (2.5%, 95% CI 1.4–3.6%; at 6 days).24 Similarly, in two studies in Italy, RSV infection incidence and risk of hospitalization for RSV bronchiolitis in infants were positively associated with concentrations of PM less than 10 µm in diameter (PM10) during the prior 1–2 weeks.25,26 Using both single and multipollutant exposure models to estimate the association between air pollutants and respiratory infection in preschool-aged children, Zhang et al observed a significant association between PM2.5 levels and respiratory infections in children 6 months of age and under (single pollutant model: OR 1.012, 95% CI 1.008–1.018) (multipollutant model: 1.019, 95 CI 1.012–1.026).58 Similar associations with viral respiratory infections were seen with O3 (1.025, 95% CI 1.018–1.033) in children ≤6 months of age, with smaller but significant associations in 7–12 month old and 1–3-year-old children. PM10 levels were associated with viral respiratory infections as well (1.025, 95% CI 1.008–1.042) but only among 3-6-year-old children.

NO2 exposure was also implicated to increase susceptibility to viral respiratory infections. Elevated NO2 concentrations were associated with increased hospital admissions for acute respiratory infections,19 including croup20,59 and viral infection-induced asthma exacerbation,60 pneumonia,21 and influenza.21 Exposure to increased O3 was also associated with hospital admission for pneumonia21,61 and influenza21 infection.

Further, in a systematic review and meta-analysis of ambient air pollution and pneumonia in children, Nhung et al reported an overall positive association between pediatric hospitalization for pneumonia and exposure to air pollutants, including PM2.5, PM10, SO2, O3, and NO2. The largest association observed was for SO2, with ER visits increasing by 2.9% (95% CI 0.4–5.3%) per 10 ppb increase. The authors noted significant effect modification by study location, with stronger associations observed in low- and middle-income countries compared to high-income countries.23 The same authors later reported that higher O3 and PM10 concentrations were associated with an increased length of hospital stay among children 5 years and under admitted for lower respiratory infection, with no relationship between PM2.5, SO2, or NOx and length of stay.62 Specifically, per IQR increase in O3, there was a 5% (95% CI 2–8%) decrease in odds of hospital discharge, and for PM10, there was a 6% decrease in odds of hospital discharge in the 2–5-year-old group only.

There is also convincing evidence suggesting that long-term exposure to air pollutants predisposes to respiratory infection, though it is unclear whether this susceptibility is a function of exposure during the prenatal period, postnatal period, or both. Within the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort, Brauer et al observed that long-term exposure to traffic-related pollutants (PM2.5, NO2, soot) was associated with higher odds of ear, nose, and throat infections at 2 years of age63 as well as influenza and serious cold infections at 4 years of age.64 A meta-analysis of over 16,000 children from 10 birth cohorts from the ESCAPE project found that physician-diagnosed pneumonia during the first 2 years of life was significantly associated with annual average air pollution levels of PM10 (OR 1.76, 95% CI 1.00, 3.09 per 10 μg/m3) and NO2 (1.30, 95% CI 1.02, 1.65 per 10 μg/m3), but not PM2.5 (2.58, 95% CI 0.91, 7.27).65

Air Pollution and SARS-CoV-2

Many have hypothesized that air pollution contributed to the initial spread of SARS-CoV-2 during the early days of the pandemic66–68 and may also increase the risk of mortality.69,70 Air particulates from indoor71 and outdoor samples were shown to contain SARS-CoV-2 viral particles.72,73 In addition to having high levels of air pollution, densely populated urban centers like Wuhan and New York City were also hot spots for SARS-CoV-2 transmission and COVID-19-related mortality. Concentrations of PM2.5, PM10, NO2, and O3 in the prior 2 weeks were significantly associated with daily confirmed COVID-19 cases in an analysis of data from 120 cities in China between January and February 2020, with the largest association observed with per 10 μg/m3 increase in NO2 (6.94%, 95% CI 2.38%, 11.51%).74 Higher SO2 concentrations were associated with a decrease in new COVID-19 cases. Moderate correlations were observed between air pollutants and COVID-19 cases (Pearson’s r ranging from 0.41 for PM10 to 0.58 for PM2.5) in hard-hit regions of Italy.75 In China’s Hubei province, a significant correlation was observed between NO2 levels and SARS-CoV-2 transmission rate in 11 cities (r > 0.5), indicating that SARS-CoV-2 transmission was higher in regions with higher NO2 exposure.76 The same group reported a significant association between higher COVID-19 case fatality rates and higher levels of PM2.5 and PM10 in Wuhan, China.77 Ogen observed that over 80% of COVID-19-related fatalities in Europe during the first 2 months of the SARS-CoV-2 pandemic occurred in places with the highest NO2 concentrations, particularly the Lombardy region of Italy.69 In the majority of studies, potentially confounding health variables such as age and pre-existing disease could not be accounted for, limiting the ability to accurately estimate the impact of pollutant exposure on outcomes. Another uncertainty is the effect of length of exposure and whether short- or long-term exposure is more important in terms of risk of contracting SARS-CoV-2 infection, disease severity, and mortality risk. A recently published prospective study of residents in Varese, Italy, found that long-term exposure to airborne pollutants PM2.5, PM10, NO2, and NO increased the incidence of COVID-19.78 The largest effect was seen in single and bi-pollutant models of PM2.5, which was associated with a 5% increase in COVID-19 incidence (95% CI 2.7%, 7.5%). Further studies are needed to answer remaining questions about the relationship between air pollution and SARS-CoV-2 infection.

Summary of Epidemiologic Studies

The totality of the epidemiological evidence supports a link between air pollution exposure and increased susceptibility to viral respiratory infection. However, our review of the literature has several limitations. Population-level studies are limited in their ability to accurately estimate an individual’s pollutant exposure. Additionally, under real-world conditions, populations are exposed to a mixture of air pollutants. Differences in study outcomes were influenced by differences in study design, exposure assessment, and adjustment for potential confounders. Further work is needed to address important research questions about the causal pathway between air pollution exposure and viral respiratory infection, particularly for SARS-CoV-2 virus. It is currently unclear whether air pollutants predominantly influence transmission and susceptibility to viral infection or if they significantly impact disease severity and mortality risk. The impact of short- versus long-term exposure to pollutants on infection risk is another poorly understood area in need of high-quality research.

Air Pollution and Increased Susceptibility to Viral Respiratory Infection: Mechanistic Evidence

Since it is not possible to separate out the health effects of individual pollutants in epidemiologic studies, in vitro studies, animal model studies, and human controlled exposure studies have been performed to help establish the mechanisms of the apparent synergistic relationships between exposure to air pollutants and viral respiratory infection (Figure 1).

Figure 1 Proposed mechanisms by which air pollutants contribute to viral respiratory infection susceptibility and severity.

Altered Immune Response to Viral Infection

Exposure to air pollutants augments airway inflammatory responses to viral infection, through exaggeration or impairment of the innate and adaptive immune responses and/or skewing of the response from predominantly antiviral to an allergic, Th2-predominant response. In human bronchial epithelial cells exposed to urban PM, enhanced activation of the NLRP3 inflammasome was observed with increased production of interleukin (IL)-1β following influenza A infection, but not RSV infection, suggesting an exaggerated inflammatory response.79 Similar to PM, DEP exposure was associated with enhanced susceptibility and inflammatory response to influenza infection in primary human bronchial epithelial cells80,81 and mouse models.82

Primary human nasal epithelial cells infected with RV and exposed to NO2 or O3 showed enhanced release of the inflammatory cytokine IL-8 compared to RV infection alone or pollutant exposure alone, suggesting that epithelial-derived inflammation from viral respiratory infection is enhanced by exposure to air pollutants.83 However, other groups observed a reduction in virus-induced lung injury84 and mortality85 when mice were exposed to O3 during influenza infection, potentially owing to dampening of the immune response to infection.84 Similarly, alveolar macrophages exposed to O3 showed diminished cytokine production after infection with RSV.86 The effects of O3 exposure on respiratory viral infection may be virus-specific.

Mice exposed to ultrafine carbon black prior to RSV infection showed skewing of the immune response away from an antiviral Th1 milieu (IFN-gamma, IL-12, and IP-10) towards an allergic, Th2-predominant inflammatory milieu (RANTES, eotaxin, MCP-1, MIP-1a, MIP-1b, and IL-13).87,88 Ultrafine PM exposure in neonatal mice resulted in increased amounts of immunosuppressive T-regulatory (Treg) cells and IL-10 following influenza infection and showed decreased influenza-specific T-cell responses.89 Exposure to carbon black particles was associated with increased morbidity from RSV in these mice, including increased airway hyperresponsiveness.90 Similar Th2 skewed airway inflammation was observed after exposure of primary respiratory epithelial cells to diesel exhaust particles (DEP), a type of PM,80 which may increase susceptibility to viral infection. Chronic exposure to DEP was associated with decreased interferon production in response to influenza infection in mice; infection-specific antibody titers were also reduced compared to controls.91

Altered Epithelial Barrier Function

The epithelial barrier represents the first line of defense against inhaled pathogens. Integrity of epithelial junctions, mucociliary clearance, and antioxidant and antimicrobial protein composition of airway lining fluid are key defenses. Exposure to O3,92,93 NO2,94,95 and PM96 has been shown to alter airway epithelial permeability.66 Rats exposed to O3 and injected with an IV tracer showed increased presence of tracer in bronchoalveolar lavage fluid (BAL) compared to rats exposed to clean air, suggesting disruption of the airway epithelium induced by O3.93 Short-term exposure of hamsters to NO2 showed significant but transient disruption of bronchiole tight junctions (TJ) with as little as 6 hours of exposure.97 Experiments testing the effect of long-term NO2 exposure in hamsters showed significant, non-reversible TJ disruption.94 Liu et al showed that PM exposure of primary human bronchial epithelial cells infected with Pseudomonas aeruginosa resulted in oxidative injury with degradation of TJs and increased intracellular bacteria.96 PM was also shown to impair airway mucociliary clearance,98 and increase production of the pathogenic glycoprotein mucin MUC5AC.99 Exposure to O3100 in vivo and NO2101 ex vivo were associated with depletion of antioxidant proteins from lung lining fluid. Epithelial cell-derived defense proteins like surfactants SP-A and SP-D are important in the defense against respiratory viral infection.102,103 Ciencewicki et al observed that DEP exposure of mice increased susceptibility to infection with influenza virus by reducing expression of SP-A and SP-D.82 Interestingly, SP-D was previously shown to bind SARS-CoV-1 spike protein, which could suggest a defensive role against SARS-CoV-2.66,104

Altered Cell Surface Receptor Expression and Viral Entry

Pollutants may enhance susceptibility to viral infection by altering viral entry into respiratory epithelial cells. Exposure of rat lung epithelial cells to DEP resulted in upregulated expression of intercellular adhesion molecule 1 (ICAM-1), the receptor used by RV to gain entry into the cell, in a concentration-dependent manner, increasing opportunities for viral entry;105 similar effects were observed with NO2 exposure in vitro.83 Human nasal and bronchial epithelial cells exposed to DEP showed increased influenza virus attachment to epithelial cells and increased numbers of influenza-infected cells 24 hours after application of virus.80 Similarly, mice exposed to DEP had more severe influenza infection assessed by the presence of lung consolidation, increased viral replication and decreased antiviral interferon production compared to controls.91 Mice exposed to PM2.5 showed upregulation of ACE2 expression in the lungs,106 and it was suggested that PM-induced overexpression of ACE2 may impact susceptibility to SARS-CoV-2 infection and infection severity.107 The effects of O3 exposure on viral respiratory infection are less consistent. O3 exposure of human nasal epithelial cells resulted in increased expression of proteases that cleave influenza HA surface protein, an essential step in viral entry into the cell, thus promoting viral entry and enhancing viral replication.108 However, primary human bronchial epithelial cells exposed to O3 prior to RSV infection showed decreased viral production.109 Mice exposed to O3 and infected with influenza showed reduced severity of lung injury and reduced immune response to infection with fewer T and B cells recovered from the lungs and reduced influenza-specific antibody titers in serum.84

Impaired Cytotoxicity

Pollutant exposure may impact the ability of immune cells to engulf and/or kill viral-infected cells.110–112 Rose et al found that mice exposed to NO2 required 100-fold lower amounts of murine cytomegalovirus to become infected compared to mice exposed to clean air, and NO2-exposed mice also showed signs of decreased clearance of the virus by macrophages.112 Alveolar macrophages exposed to PM10 infected with RSV showed reduced activation, cytokine production, and uptake of viral particles, suggesting impairment of the antiviral response.110 Guinea pig alveolar macrophages exposed to PM10 and infected with RSV showed markedly reduced viral replication and infection-induced inflammatory cytokine production.111 Using a macrophage cell line, Renwick et al observed that exposure to ultrafine particulates significantly impaired phagocytic activity.113 Natural killer (NK) cells stimulated with polyinosinic:polycytidylic acid (pI:C) to simulate viral infection and DEP showed reduced production of IL-1β, IL-8 and TNFα and reduced expression of granzyme B and perforin. Cell-mediated cytotoxicity functional assay showed a significant reduction in cytotoxic activity with pI:C+DEP compared to pI:C alone.114 BAL fluid cells from volunteers with repeated exposure to NO2 showed reduced quantities of cytotoxic T cells and NK cells but intact phagocytic activity of alveolar macrophages.115

Direct Viral Transmission

In addition to increasing susceptibility to viral respiratory infection, PM may serve as a carrier for viral particles. Hsiao et al detected influenza virus within samples of PM2.5 and suggested that this could be a mode of direct transmission of virus to the airway epithelium.116 Multiple research groups have identified SARS-CoV-2 virus within PM2.5 from air samples supporting this conclusion, with the caveat that temperature, humidity, and other weather conditions can also affect the efficiency of viral transmission.71,73,117 However, the World Health Organization (WHO) has concluded based on properties of the virus that ambient air pollution is not likely to contribute to SARS-CoV-2 transmission.118

Conclusion

There is substantial evidence supporting the relationship between natural and anthropogenic sources of climate change, namely air pollution, and increased susceptibility to respiratory infections through several proposed mechanisms. Conversely, it is possible that climate change could have some positive effects on respiratory viral infection due to shorter, warmer winters, particularly in the case of RSV. However, this comes at the expense of increased exposure to toxic air pollutants and susceptibility to respiratory viruses whose transmission is not impaired by warmer temperatures (as appears to be the case with SARS-CoV-2, for example). Another important consideration is that climate change also alters animal migration patterns and shifts habitats such that humans and domesticated animals are in closer proximity to wild animals.119 These changes can be the catalyst for the emergence of new zoonotic viruses with potential to cause future pandemics. The need has never been greater for aggressive interventions to reduce emissions of greenhouse gases and toxic pollutants to mitigate the effects of climate change. The initial rapid fall in air pollutants around the world during the initial COVID-19 lockdowns showed us what is possible, though at a significant economic price. A report from a joint workshop between the WHO, the European Respiratory Society, and several other scientific societies noted that the COVID-19 pandemic has brought to light the vast interconnectedness between climate change and infectious disease.118 Without significant long-term strategies for phasing out fossil fuel use in favor of green energy, we will likely see an increase in the burden of respiratory viruses in human populations, particularly in vulnerable groups such as children, the elderly, and those with chronic respiratory disease.

Disclosure

The author has no conflicts of interest in this study to disclose.

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Several children are presenting with symptoms of cough at paediatric centres across the city. Paediatricians, who are seeing a steady flow of such children to the outpatient units, said these were primarily viral respiratory infections.

A senior doctor at the Institute of Child Health and Hospital for Children said there was a small increase in the number of children coming in with complaints of cough and cold that lasted for a week. “There are very few cases of fever. We are also seeing children with throat pain. However, there are no severe cases,” the doctor said.

At Government Stanley Medical College Hospital’s Institute of Social Paediatrics, a doctor said that though there is no spurt in cases, they were seeing children with seasonal cold and fever.

However, a number of private hospitals and clinics in Chennai have been reporting far more such cases. At Kanchi Kamakoti CHILDS Trust Hospital, 30% to 40% of outpatients came in with symptoms of respiratory infections. “There are a lot of viral respiratory infections affecting all ages now. We are seeing children with symptoms of fever, cough and breathing difficulty. While older children are being managed as outpatients, infants less than six months required hospitalisation for nebulisation and sometimes, Intensive Care Unit admission for High Flow Nasal Oxygen,” Janani Sankar, deputy medical director of the hospital, said.

Though they have been seeing such respiratory infections since October-November 2022, she said that the number of cases usually dropped after the second week of December. “This time, it is unusual that we are seeing such symptoms in January. This may be due to the cold weather and lack of immunity in children,” she said.

Vidya Krishna, Paediatric - Infectious Diseases specialist, Apollo Children’s Hospital, said almost 50-60% of children now come with cough and cold to the outpatient department. “There are a lot of viral respiratory infections, and most of them are not being COVID-19 but more of influenza and other respiratory viruses. We are seeing adenoviruses as well. In some, fever lasts longer for a duration of seven days, while there were some cases of conjunctivitis + pneumonia though not very severe,” she said. She said that the cough lasted longer, even up to 10 days and was affecting sleep in children.

If a child was sick, he/she should stay away from school to prevent spread of infection, she said.

A senior paediatrician said cough and wheeze were more in children due to the winter, while fever was less because more are due to self-limiting viral illnesses and allergies. “Physical distancing, masking and washing hands with soap is important. Masking prevents exposure to cold too,” he said. He added that it was important to vaccinate children against flu every year till five years of age.

Dr. Janani Sankar said that masking, especially in schools, will help, and crowded places should be avoided.

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By Staff

Editor’s note: This story first appeared in Fierce Pharma.

Direct Relief has donated enough Covid-19 vaccines to reach more than 19 million people, along with enough innovative therapies to treat more than 350,000 patients with mild to moderate Covid infections and treat more than 80,000 patients hospitalized with severe Covid infections. The products primarily benefited people in low- and middle-income countries in all regions of the world, as well as Native American communities within the USA.

The Covid-19 products provided had Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) and/or the European Union's European Medicines Agency (EMA). Prior to the Covid-19 pandemic, Direct Relief had never donated Emergency Use Authorization (EUA) medicines or vaccines. Because these medicines hadn't yet received standard regulatory approval, Direct Relief needed to secure special humanitarian import authorization from the government of each recipient country.

  • Direct Relief's humanitarian provision of critical Covid-19 products under Emergency Use Authorization (EUA) includes:
  • Covid-19 vaccines made by Pfizer, Moderna, Johnson & Johnson, and AstraZeneca and provided by Direct Relief in coordination with the U.S., Mexican, and other overseas governments and partners
  • Cold-chain monoclonal antibodies from Eli Lilly and Company administered via infusion for high-risk patients with mild to moderate Covid-19 infections to reduce progression to hospitalization
  • Oral therapies from Lilly for hospitalized patients requiring supplemental oxygen with severe Covid-19 infections
  • Covid-19 therapies from Merck & Co. and Pfizer that reduce progression to hospitalization for those with mild to moderate Covid-19 infections

According to the WHO Coronavirus (Covid-19) Dashboard, globally since early 2020, there have been over 657 million confirmed Covid-19 cases that have resulted in the death of over 6.6 million individuals. A significant percentage of deaths have taken place in the developing world, where it is assumed given the lack of Covid-19 test diagnostics, that not all cases were confirmed and or deaths attributed to Covid-19. Direct Relief has focused the majority of its Covid-19 Rx support outside of the U.S. and Europe, instead focusing on countries that lacked access to vaccines and therapies to address Covid-19.

"Egypt's Ministry of Health welcomed Direct Relief's donations of the combination monoclonal antibodies bamlanivimab + etesevimab and the orally administered antiviral drug molnupiravir which were utilized to help treat Egyptians with mild to moderate Covid-19 infections, as well as the baricitinib used to treat our Covid-19 hospitalized patients," stated Egypt's Minister of Health and Population, Honorable Prof. Khaled Abdel Ghafaar. "These donated therapies represented an important and vital tool in fighting the Covid-19 epidemic in our country at times when we had high caseloads, which led to decreasing the pressure on the dedicated Covid-19 hospital units and improving patient care and outcomes."

In addition, Direct Relief provided to its overseas partners in the developing world over 2,500 shipping pallets of antibiotics, vasopressors, blood thinners, steroids, inhalers, intravenous fluids and other prescription medicines required in treating patients hospitalized with serious Covid-19 infections. Many of these patients were hospitalized with pneumonia or cardiovascular conditions. Direct Relief also provided over 35,000 oxygen concentrators for improved breathing for patients with serious Covid-19 infections.

"Direct Relief's ability to work through the toughest logistics challenges in global drug delivery, combined with the generosity of our pharmaceutical partners, enabled many millions of individuals around the globe to be treated for Covid-19 infections or avoid becoming infected," said Tom Roane, Direct Relief's vice president of corporate engagement. "This was especially challenging during an era of mandatory shutdowns and limited staff in many of the countries receiving these EUA products."

The monoclonal antibodies initially provided were challenging to deliver to the developing world, as they required consistent refrigerated temperature control during distribution, as well as infusion facilities for systemic administration of the medicines. The oral therapies that emerged later have been significantly more straightforward to provide to lower-income countries. Access to these innovative therapies has been vitally important given the very low Covid-19 vaccine rates in most of the recipient countries.

For the Covid-19 vaccines, shipping and logistics were an even greater challenge, as these products required either cold-chain (2° to 8° Celsius) and or ultra-cold-chain (either -20° C or -80° C) throughout their storage and shipping. Direct Relief's transportation department had to establish or validate shipping lanes to countries little served by commercial transportation, and to use sophisticated software to ensure that the products were packed in a way that would maintain consistent temperature throughout the medicine's journey. Direct Relief takes these measures for all of its cold-chain shipments in order to maintain the integrity of the products.

"Lilly is incredibly grateful for the collaboration with Direct Relief that enabled patients around the world to be treated with our Covid therapies," said Ilya Yuffa, president of Lilly International. "We are committed to equitable access to our medicines and nonprofit collaborations like this one are essential to making life better for all people, including those in resource-limited settings."

"Pfizer remains firmly committed to continue working towards equitable and affordable access for COVID-19 vaccines and therapeutics for people around the world," said Caroline Roan, senior vice president of Global Health & Social Impact at Pfizer Inc. "We are proud of Direct Relief's work to reach underserved communities, including people living in low- and middle-income countries."

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Deja flu: Mystery, Covid-like disease kills 21 in Afghanistan

  • The disease has swept through the Wakhan district over the last fortnight 
  • Health chiefs have been dispatched to the area to investigate nature of illness
  • Health officials have raised concerns that it is 'very similar' to Covid-19 

Twenty-one people have been killed by a 'mysterious disease' in Afghanistan, local media has claimed. 

Cases have all been logged in the mountainous Wakhan region in the north-east of the country, which borders Tajikistan and Pakistan.

Health chiefs have now been dispatched to the area to investigate the nature of the illness. 

The cases have all been reported in the mountainous Wakhan district, 230 miles northeast of Afghanistan's capital, Kabul

The cases have all been reported in the mountainous Wakhan district, 230 miles northeast of Afghanistan's capital, Kabul 

Health officials have raised concerns that the 'mysterious' respiratory disease shares similarities with Covid-19

Health officials have raised concerns that the 'mysterious' respiratory disease shares similarities with Covid-19  

Details on what the actual illness is are scarce. 

But the Afghanistan Times reported that officials described it as being 'very similar' to Covid. 

Covid itself, a type of coronavirus, was behind a mysterious outbreak in the Chinese city of Wuhan three years ago. 

The first deaths occurred a fortnight ago, the Afghanistan Times claimed. 

Kyrgyzstan, which doesn't border Afghanistan, has dispatched a representative to the region amid fears that it could spread further.

Wakhan is a sparsely-populated, narrow strip of territory which includes the Pamir Mountains. 

Afghanistan has recently been hit by outbreaks of Cholera and Polio. 

British health chiefs are also monitoring cases of Crimean-Congo haemorrhagic fever, a viral disease mainly transmitted by ticks, which can prove fatal for up to 40 per cent of cases. 

Wakhan is a sparsely-populated, narrow strip of territory which includes the Pamir Mountains. Pictured above, cereal fields in the Wakhan valley

Wakhan is a sparsely-populated, narrow strip of territory which includes the Pamir Mountains. Pictured above, cereal fields in the Wakhan valley

It comes as the Taliban-controlled Bakhtar News Agency last week reported that at least 50 children have died due to respiratory diseases in just a month in the Baghlan province, northern Afghanistan.  

According to the the agency, Baghlan Hospital officials confirmed that 1,000 children had been infected with respiratory diseases in the province over the last month. 

The International Committee of the Red Cross (ICRC), which supports 33 hospitals across Afghanistan, also revealed in November that it had seen the number of children treated for pneumonia surge over 50 per cent in 2022, compared to the same time in the previous year. 

Data shared with The Independent earlier this month by the ICRC, also showed that pneumonia cases in the country jumped by 35 per cent in a year to 213,049 in 2022. 

What is the 'mysterious disease'? 

What do we know about the outbreak?

Health officials yesterday confirmed 21 people have died after contracting the 'mysterious' respiratory disease. 

All of the victims lived in the mountainous Wakhan region in northeastern Afghanistan.

What is the disease? 

Experts are baffled by the outbreak and do not yet know what virus is causing people to become unwell.

According to news agency AT News, the disease is respiratory and 'similar to Covid'.  

Is it spreading? 

A team of health experts have been sent to to investigate the nature of the illness amid fears it could be spreading. 

The Kyrgyzstan foreign ministry also announced earlier this month that a representative of Kyrgyz Embassy in Kabul had been dispatched to the region. 

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Chinese are turning to social media influencers and celebrities for tips about treating COVID-19 after the country’s whipsaw reversal in virus strategy undermined trust in government advice and health officials.

China’s rapid dismantling of pandemic restrictions over a matter of weeks at the end of last year led to a quick surge in infections, with COVID-19 spreading through cities and towns that have had little experience with the virus until now. With the government hastily retreating, people are increasingly looking to social media for answers, resulting in a corresponding increase in misinformation and even dangerous advice.

Search queries about treating common COVID-19 maladies, from whether the XBB sub-variant causes diarrhea to how best to treat pneumonia, throw up a raft of responses on the Chinese internet: adopt a vegan diet, take multiple antibodies, or even ways to buy illegal enzymes from online celebrities.

In a time of both misinformation and too much information, quality journalism is more crucial than ever.
By subscribing, you can help us get the story right.

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Persistent, hacking coughs seem to be the soundtrack to winter this year.

It’s perhaps inevitable, given that flu cases rose by almost 50 per cent in the first week of January, Covid cases remain high — a dry, persistent cough is the most commonly reported symptom — and a ‘monster’ cold appears to be doing the rounds.

Last week, Professor Kamila Hawthorne, chair of the Royal College of GPs, said doctors were noticing that coughs were lingering longer than usual this winter.

The suggestion is that this may be down to people catching one infection after another — possibly due to our reduced resistance to infections after socially isolating for two winters.

It¿s perhaps inevitable, given that flu cases rose by almost 50 per cent in the first week of January, Covid cases remain high ¿ a dry, persistent cough is the most commonly reported symptom ¿ and a ¿monster¿ cold appears to be doing the rounds

 It’s perhaps inevitable, given that flu cases rose by almost 50 per cent in the first week of January, Covid cases remain high — a dry, persistent cough is the most commonly reported symptom — and a ‘monster’ cold appears to be doing the rounds

The reason menthol cough lozenges ¿ or throat sprays ¿ help is that they provide a cooling sensation to the throat, which can help counter the ¿tickling feeling you get that makes you want to cough¿, says Ashley Woodcock, a professor of respiratory medicine at the University of Manchester

The reason menthol cough lozenges — or throat sprays — help is that they provide a cooling sensation to the throat, which can help counter the ‘tickling feeling you get that makes you want to cough’, says Ashley Woodcock, a professor of respiratory medicine at the University of Manchester

As Professor Paul Hunter, an expert in infectious diseases at Norwich Medical School, told Good Health last week, the longer it is since previous exposure, the greater our chance of catching an infection. So what can you do about that cough?

When you develop a respiratory infection, the body steps up mucus production to trap the viruses responsible.

Coughing is a reflex action to clear the airways of this mucus, explains Dr Edward Nash, a consultant in respiratory medicine at Heartlands Hospital in Birmingham.

The hacking bark that can accompany a cough is down to inflammation, which is part of the body’s immune response, and infection of small tubes in the lungs, explains Dr Anindo Banerjee, a respiratory consultant at University Hospital Southampton NHS Foundation Trust.

‘The tubes become floppy and narrowed so that when you blow hard — that is, cough — the velocity of air flow through them causes changes in sound.

‘There is no benefit in trying to suppress a cough since the reason you’re coughing is because the body perceives it needs to get rid of some source of irritation.’

But why can the cough persist after the initial cold or infection that triggered it has gone? ‘Coughing for more than three weeks, even after the virus has gone, means you may have a persistent inflammatory response,’ says Dr Banerjee.

When you develop a respiratory infection, the body steps up mucus production to trap the viruses responsible. Coughing is a reflex action to clear the airways of this mucus, explains Dr Edward Nash, a consultant in respiratory medicine at Heartlands Hospital in Birmingham

When you develop a respiratory infection, the body steps up mucus production to trap the viruses responsible. Coughing is a reflex action to clear the airways of this mucus, explains Dr Edward Nash, a consultant in respiratory medicine at Heartlands Hospital in Birmingham

And that’s why convalescing — in other words, taking it easy and pacing yourself before returning to normal activities and exercise — after a bad cough is important, he adds, as it’s a sign the body is still healing.

So taking energy from elsewhere — for example, by resuming a strenuous exercise regimen — could slow down your recovery.

What’s more, even low-grade inflammation in the body leads to fatigue as it changes the way cells use energy. ‘Lingering inflammation within the muscles and airways can also cause lethargy — battling viruses can leave us exhausted,’ says Dr Banerjee.

If there’s no benefit in trying to resist the urge to cough, there are ways to manage it.

The reason menthol cough lozenges — or throat sprays — help is that they provide a cooling sensation to the throat, which can help counter the ‘tickling feeling you get that makes you want to cough’, says Ashley Woodcock, a professor of respiratory medicine at the University of Manchester. ‘This tickling is due to a change in nerve sensitivities in the throat which can drive the cough reflex. Menthol is soothing to the throat and so you’re less likely to cough.

‘But the impact in terms of controlling your cough may only last 20 minutes to half an hour.’

Cough syrups help because swallowing liquid soothes the throat — which is why Dr Banerjee suggests mixing over-the-counter cough medicine with water.

‘This is how these products were originally supposed to be taken,’ he says. ‘Whichever product you use, mix the recommended dose with the same amount of warm water and sip it slowly. It’s more soothing — and means you drink it over a longer period, so the impact will last longer.’

Breathing exercises may be another tool ¿ an idea first suggested in the 1950s when Russian scientist Dr Konstantin Buteyko noticed people who breathed through their mouths and kept clearing their throats would suffer dry, irritable coughing spasms

Breathing exercises may be another tool — an idea first suggested in the 1950s when Russian scientist Dr Konstantin Buteyko noticed people who breathed through their mouths and kept clearing their throats would suffer dry, irritable coughing spasms

But he says any liquid could soothe and coat the throat — hot drinks and soup, too, will help ease the cough and the fluid will help thin the mucus, making it easier to budge. And keep your home warm — 18 to 21C, suggests GP Dr Andrew Whittamore, Clinical Lead at Asthma + Lung UK.

Some research, such as a study published in the Proceedings of the National Academy of Sciences, has found that the immune response — certainly in rodents — is reduced at lower temperatures.

Breathing exercises may be another tool — an idea first suggested in the 1950s when Russian scientist Dr Konstantin Buteyko noticed people who breathed through their mouths and kept clearing their throats would suffer dry, irritable coughing spasms.

‘Breathing in through the nose helps to warm, humidify and filter the air coming in,’ says Emma Tucker, a respiratory physiotherapist and post-Covid rehabilitation coordinator at Oxford Health NHS Foundation Trust.

‘When our noses are blocked we don’t do this, which can lead to throat irritation and therefore further coughing.’

She suggests trying the following exercise which she recommends to patients in her own clinic — and does herself when she has a lingering cough — to help clear the mucous causing it.

Lie on your back on a soft surface, place your hands on your tummy and concentrate on breathing in through the nose and moving the air down towards the belly, feeling it gently rise and fall with the breath. ‘Try to concentrate on the size of the breath — we advise that a normal, restful breath is around 450ml to 500ml (slightly more than a can of cola).’

And that standard advice to drink plenty of fluids throughout the day is not simply because the liquid will soothe and lubricate the throat to reduce the urge to cough, but it will also thin out the mucus, with similar effect.

Lie on your back on a soft surface, place your hands on your tummy and concentrate on breathing in through the nose and moving the air down towards the belly, feeling it gently rise and fall with the breath. ¿Try to concentrate on the size of the breath ¿ we advise that a normal, restful breath is around 450ml to 500ml (slightly more than a can of cola)¿

Lie on your back on a soft surface, place your hands on your tummy and concentrate on breathing in through the nose and moving the air down towards the belly, feeling it gently rise and fall with the breath. ‘Try to concentrate on the size of the breath — we advise that a normal, restful breath is around 450ml to 500ml (slightly more than a can of cola)’

A possible complication of repeated coughing is the impact it has on our chest muscles. The violent contraction of the muscles between the ribs it causes can damage the muscle fibres and cause pain, says Dr Nash. For this he suggests ‘paracetamol or ibuprofen for a couple of days’.

If you have more persistent pain — over three to four weeks — it’s important to get it checked, as it might be a sign of pneumonia, an infection of the lung tissue and airways (which can cause pain as you breathe in or out). Don’t sniff at traditional remedies, says Dr Banerjee.

‘Many of the remedies of old wives’ tales — honey and lemon, or fresh ginger in tea — are antiseptics of various types to help the body fight infection and make you feel better.’

If you have been unwell and less active than usual, then Dr Banerjee reiterates that it’s important to take it easy for the next few days or weeks if necessary.

‘The important thing,’ he says, in getting back to normal daily life, is to do it slowly — with exercise in particular, don’t start at previous levels. ‘Work yourself back gradually to what you could do before you were ill.’

With exercise, ‘pushing yourself before you’re ready can set you back and make you even more exhausted’, says Dr Gavin Francis, a GP and author of Recovery: The Lost Art of Convalescence.

‘That’s why it’s so important to listen to your body and how it responds. I liken this to snakes and ladders — it’s easy to land on a “snake” by pushing yourself too hard, too fast and slide further down the board away from health.’

‘Recovery can be a long journey,’ adds Dr Banerjee. ‘The key is to rest and pace yourself as you go.’

5 OF THE BEST COUGH REMEDIES 

BY CAROLINE JONES FOR THE DAILY MAIL 

We asked immunologist Dr Ross Walton to select five of the best over-the-counter remedies for a hacking cough.

ASDA Flu-Max All-in-One Chesty Cough & Cold Tablets

16 tablets, £3

This targets coughs with an ingredient called guaifenesin, which makes mucus thinner and easier to clear. It also contains phenylephrine hydrochloride to ease nasal congestion, and paracetamol to reduce a fever and ease aches and pains. As a combined product it is the cheapest way to get these effective ingredients together.

Covonia Original Bronchial Balsam

150ml, £5.50, most pharmacies.

Most cough syrups work as a so-called ‘demulcent’ — they have a moderate effect on suppressing the cough reflex by coating the throat with honey or glycerol (a natural lubricant) to soothe inflamed tissue. In many cases, a spoonful of honey in a hot drink would work just as effectively.

It works by binding to receptors in the brain¿s cough centre (the medulla oblongata), effectively blocking the nerve signals there, so the message that triggers the cough reflex isn¿t sent as frequently

It works by binding to receptors in the brain’s cough centre (the medulla oblongata), effectively blocking the nerve signals there, so the message that triggers the cough reflex isn’t sent as frequently

This product is distinct in that it also contains dextromethorphan, which research has shown to be the most effective ingredient at reducing cough frequency. It works by binding to receptors in the brain’s cough centre (the medulla oblongata), effectively blocking the nerve signals there, so the message that triggers the cough reflex isn’t sent as frequently.

Strepsils Sore Throat and Cough Lozenges

24 lozenges, £5, most pharmacies.

The action of sucking a lozenge produces lubricating secretions in the throat which reduce the irritation and dryness that worsen a cough — drinking a hot mixture of honey and lemon will have a similar effect. But this popular remedy has an added antiseptic effect (in the form of 2,4-dichlorobenzyl alcohol and amylmetacresol) that can help numb throat pain, plus menthol which evidence suggests can suppress coughs.

Bronchostop Junior Syrup

120ml, £6.99, most pharmacies.

Unlike most cough remedies, this syrup can be used from age one. It contains honey and, like most syrups, works by coating the throat, which soothes the inflamed tissues, making coughs less frequent. It contains the herb marshmallow root which has a natural anti-inflammatory ingredient, called mucilage, recognised by the European Medicines Agency as a treatment for dry coughs.

Vicks VapoRub

100g, £4.35, most pharmacies.

Try melting some in a bowl of hot water and gently inhaling for ten minutes before bed

Try melting some in a bowl of hot water and gently inhaling for ten minutes before bed

As well as easing nasal congestion thanks to the menthol and eucalyptus, research suggests this old favourite can suppress the cough reflex for eight hours. We think this might be because it has a cooling effect on the airways when inhaled which seems to have a calming effect on the cough receptors at the back of the throat. Try melting some in a bowl of hot water and gently inhaling for ten minutes before bed.

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Patients with asthma who develop COVID-19 are at increased risk for hospitalization if they are male, currently smoke, and/or take inhaled corticosteroids (ICS) with long-acting beta-agonists (LABA), according to study findings published in Respiratory Medicine.

Investigators sought to evaluate long COVID outcomes at 6 and 12 months post-acute disease in patients with asthma. The researchers also sought to identify clinical features associated with acute COVID-19 infection in these patients and to examine the effect of COVID-19 infection on asthma outcomes.

The researchers conducted a single-center, consecutive, observational, retrospective study at La Paz University Hospital, Madrid, Spain, from March to December in 2020. The study included 173 adult patients with asthma (average age, 55 years; 67% women; 22% smokers; 61% type 2 [T2]-asthma) admitted to the emergency department with COVID-19 confirmed by polymerase chain reaction. Study participants had not been vaccinated (because the vaccine was unavailable) and did not discontinue use of oral corticosteroids (OCS), inhalers, and omalizumab for asthma during the acute phase of COVID-19.

Participants in the acute phase of COVID-19 infection experienced various symptoms (80% cough, 75% dyspnea, 26% chest pain; ageusia, anosmia, and wheezing all <16%). A total of 67% of participants were hospitalized and 5% were admitted to the intensive care unit (ICU); pneumonia was diagnosed with thoracic x-ray or computerized tomography in 60% of patients. Mortality was 11% at 12 months.

Using a univariant model, investigators found a significant association between COVID-19 pneumonia and male sex (odds ratio [OR]=2.83; P =.005), current smoking (OR=2.57; P =.024), and use of ICS-LABA prior to COVID-19 infection (OR=3.12; P =.001). COVID-19 pneumonia was identified as a risk factor at 6 and 12 months post-COVID for chest pain (OR=5.63; P =.01).

Multivariate regression showed a significant association after 6 and 12 months between COVID-19 pneumonia and male patients (P =.02) as well as chest pain (P =.019). Investigators found a higher risk of hospitalization for long COVID in men (OR=2.00; P =.047), current smokers (OR=4.80; P =.001), and patients previously treated with ICS-LABA (OR=2.79; P =.002). There was a lower risk of hospitalization for long COVID among patients with T2-asthma (OR=.32; P =.002), and patients previously treated with ICS (OR=.27; P =.006).

[A]s expected, T2-asthma patients had a lower risk of acute SARS-CoV-2 pneumonia (OR=0.320), which probably influenced the clinical presentation of prolonged COVID.

The researchers found no association between ICU admission and baseline characteristics (sex, T2-asthma, ICS use pre-COVID-19, OCS use pre-COVID-19, ICS-LABA use pre-COVID-19, or obesity). There were no significant associations between ICU admission and dyspnea, chest pain, or cough after 6 or 12 months.

With respect to long-COVID outcomes at 12-months after acute COVID-19 infection, investigators found that 30% of patients had dyspnea, 12% had chest pain, and 12% had cough. The mean (SD) asthma control test (ACT) score at 12 months was 21.6 (4.36), the average number of exacerbations was 0.12 (0.44), and forced expiratory volume in 1 second (FEV1) was 83.15% (21.23). Univariant and multivariate regression showed no statistical significance for dyspnea, cough, and corticosteroid requirement after 12 months. Notably, in those with T2 asthma, chest pain was less prevalent and there was a lower necessity for long-acting muscarinic antagonist in patients with T2 asthma.

Study limitations include the retrospective design and underpowered sample size in subgroups.

Overall, study investigator concluded that “[A]s expected, T2-asthma patients had a lower risk of acute SARS-CoV-2 pneumonia (OR=0.320), which probably influenced the clinical presentation of prolonged COVID.” Moreover, COVID-19 appeared to have little effect on asthma outcomes, including lung function parameters, asthma control, and exacerbations.

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