MA Governor signs new health care law.

After signing the bill on New Year’s Day, Baker said  that the commonwealth – and the nation as a whole – needs to come up with a long-term plan to make telehealth a standard of care and pay providers for its use.

“I’ve thought for a long time that because as a country we underinvest in primary care and behavioral health services a lot of people who could be treated in the community end up in the hospital and we will basically have a chance here to study this question,” he said. “I think we’ll discover that by investing more or giving people more options to access care and supports they will stay healthier and spend less time in the hospital.”

The provisions of the new law include:

Requiring coverage of telehealth services including behavioral health care

Telehealth visits became much more common during the pandemic, the new law mandates equal coverage for virtual visits, including behavioral health.


Expanding Scope of Practice for Advanced Practice Nurses and Optometrists

The scope of care was increased for some practitioners to help address the increased need during the pandemic. The law allows for these changes to become permanent for nurse practitioners, nurse anesthetists, optometrists, and psychiatric nurse mental health specialists. Mental health billing companies in Massachusetts are also happy about this new law.


Increasing disclosures around provider costs and network status to protect consumers from surprise medical bills

Among the steps to address surprise bills, providers must now tell a patient if a procedure is in network or out of network. 


Removing barriers to urgent care centers for MassHealth members

The new law requires urgent care to those with mass health. It also does away with referral requirements and coordinating with a patient’s primary care physician to allow easier access to Urgent Care clinics for MassHealth members.


Extending insurance coverage and access to COVID-19 testing and treatment

The Baker administration said the law also extends requirements for all insurance carriers in Massachusetts to cover COVID-19 testing and treatment.

The new law requires insurance companies, including MassHealth, to cover all inpatient, emergency, and cognitive rehab services related to COVID-19 care, as well as necessary outpatient testing. This includes testing for people who are asymptomatic. The law also calls for a study and report on how the pandemic affected the health care system.


Directing a study and report of the impacts of COVID-19 on the health care system

The legislation also directs the Health Policy Commission and Center for Health Information and Analytics to analyze and report on the effect of COVID-19 on healthcare accessibility, quality and fiscal sustainability in both the short and long term, as well as those effects on long-term policy considerations, including an examination of existing healthcare disparities due to economic, geographic, racial or other factors


“Massachusetts has long been a leader in ensuring health care quality and access and with this new law, we are making further progress in building a strong, accessible and affordable health care system, a goal that is more important now than ever,” Baker said

Medical Billing Outsourcing To Flourish At Double Digit between 2020–2026

A market research report published by Zion Market Research provides an insightful comprehension about the growth aspects, dynamics, and working of the global medical billing outsourcing market. The report entails details about the market with data collected over the years with its wide-ranging analysis. It also comprises the competitive landscape within the market together with a detailed evaluation of the leading players within the global Medical Billing Outsourcing Market.

In addition, it sheds light on the profiles of the key vendors/manufacturers comprising thorough assessment of the market share, production technology, market entry strategies, revenue forecasts, and so on. Further, the report will encompass the fundamental strategic activities such as product developments, mergers & acquisitions, launches, events, partnerships, collaborations, and so on. Apart from this, it will also present the new entrants contributing their part in the market growth.

The Medical Billing Outsourcing Market report also entails exhaustive examination of the key factors likely to propel or restrict the expansion of the global Medical Billing Outsourcing Market during the forecast period in addition to the most recent and promising future trends in the market. Moreover, the report uses SWOT analysis and other methodologies to analyze the numerous segments [Product, Applications, End-Users, and Major Regions] of the global Medical Billing Outsourcing Market. Furthermore, it comprises valuable understanding about the segments like their growth potential, market share, and developments. It also evaluates the market on the basis of its major geographical regions [Latin America, North America, Asia Pacific, Middle & East Africa, and Europe]. It entails quantitative and qualitative facets of the market in association to each country and region enlisted in the report.

We discussed this report with a podiatry billing company in Wisconsin, and a mental health billing provider in Minnesota and they are all hopeful that this project growth will not be hindered by the recent corona virus crisis hitting the healthcare sector.


Surprise medical billing efforts in corona virus stimulus package crashes

Emergency efforts to include surprise hospital billing reform in the new coronavirus relief bill has reportedly crashed. Surprise billing is a tactic used by hospitals and other medical providers to manipulate bills so that patients and insurance companies end up paying huge amounts for treatment.

Wendell Primus, senior policy adviser to House Speaker Nancy Pelosi had plans to send a proposal on surprise medical billing to Senate Majority Leader Mitch McConnell, according to four sources with knowledge of the negotiations. By Monday night, however, the effort had been rebuffed.

“There’s still work that needs to be done with the committees,” a senior Democratic aide said.

BOSTON, MA - MAY 30: U.S. Representative Richie Neal is pictured as he is interviewed by Globe reporter Josh Miller (not pictured) at the AT&T Store on Boylston Street in Boston as part of the Political Happy Hour Series on May 30, 2017. (Photo by Jim Davis/The Boston Globe via Getty Images)

Rep. Richie Neal, D-Mass., is interviewed by Boston Globe reporter Josh Miller as part of the “Political Happy Hour” series on May 30, 2017, in Boston.


Photo: Jim Davis/The Boston Globe/Getty Images

McConnell was not interested in including the provision, according to three Senate aides. Neal was also an obstacle to getting reform into the Covid-19 bill, said one member of Congress briefed on the talks. “The one stumbling block has been of course, Richie trying to scuttle it,” the member said.

Neal has drawn criticism for his opposition to ending surprise medical billing and his ties to Blackstone, his top funder this cycle. The progressive group Fighting Corporate Monopolies ran ads attacking Neal, during his primary against Holyoke Mayor Alex Morse, over “protecting Blackstone’s profits” by helping last year to end a Senate compromise deal that would have ended surprise billing, The Intercept previously reported. Neal pulled in major donations from Blackstone executives at the same time he went to work against surprise billing — an unusually close link between campaign contributions and congressional action. Many private equity executives are known to own vacation homes in the Berkshires, which Neal represents.

Surprise billing happens when a patient is in a hospital or medical facility that is within their insurance network but is treated, perhaps only during a single round, by a doctor who is out of network. Patients, of course, don’t know whether the doctor making rounds is in their network or not, so private equity firms have purchased providers and arranged service to maximize the number of times an out-of-network doctor can treat a patient. Those bills are then exponentially higher, landing at the feet of both patients — in the form of copays and deductibles — and insurance companies, who pay the remainder.

The ongoing coronavirus pandemic has increased the issue, with people who went to the emergency room for Covid-19 symptoms receiving surprise medical billing even when insurers have promised to cover out-of-network care related to the novel virus.

Neal tried to muscle his own version of the bill through, even though Energy and Commerce Committee had a proposal that would have relied on median-in network insurance rates to institute federal benchmarks for payment disputes. Under the proposal, bills over $750 would go to independent arbitration.

The Neal proposal would allow providers and insurance companies to settle disputes through an open negotiation process. If that fails, they could move to an independent mediation process, with a suggestion to consider the mean network rate — regardless of the size of the bill. That cumbersome process would do little to reform the system, leaving provider profits in place and potentially leading to higher premiums. Neal told reporters he wanted to punt the issue to next year, Politico reported onTuesday.

“Providers really want arbitration, because they want the ability to be able to get more money,” said one congressional aide close to the process. “Especially through private equity, because they know they can win this process. Because it almost always goes toward the provider.” 

A Ways and Means Committee spokesperson defended Neal’s bill in a statement. “The Chairman wants to find a balanced path forward on this issue that prioritizes patients but also treats fairly community doctors and hospitals that have been completely overwhelmed by the COVID crisis. He has repeatedly asked for the other committees to make the updated legislative text of their proposal public, but they have not agreed to that transparency.”

I spoke with a provider of mental health billing in Massachusetts about this and the company really hopes this issue gets resolved because it really hurts patients.

Researchers get to the roots of chronic stress and depression

A study in mice provides clues about the common molecular origins of chronic stress and depression. The discovery could inform new treatments for mood disorders.

woman in bed checking phoneShare on Pinterest
Image credit: PhotoAlto/Frederic Cirou/Getty Images

Millions of years ago, our ancestors evolved the physiological responses needed to survive in the face of sudden threats from rivals and predators.

The release of hormones, including epinephrine (adrenaline), noradrenaline (norepinephrine), and the steroid hormone cortisol, trigger these “fight-or-flight” stress responses.

However, sustained or chronic stress that does not resolve when the immediate threat passes is a major risk factor for the development of mood disorders such as anxiety and depression.

Traumatic experiences, for example, in military combat, can also damage the body’s ability to regulate its stress responses, causing post-traumatic stress disorder.

People with these mood disorders have abnormally high and sustained stress hormone levels, which puts them at an increased risk of developing cardiovascular disease.

Researchers at the Karolinska Institutet in Stockholm, Sweden, suspected that a protein called p11 plays a pivotal role in damping down stress responses in healthy brains after an acute threat has passed.

Serotonin signal boost

Their previous research found that p11 enhances the effect of the hormone serotonin, which regulates mood and has a calming effect.

Unusually low levels of p11 have been found in the brains of people with depression and in individuals who died by suicide.

Mice with reduced p11 levels also show depression and anxiety-like behaviors. In addition, three different classes of antidepressants that are effective in humans increase levels of this protein in the animals’ brains.

Now the Karolinska researchers have discovered that reduced p11 levels in the brains of mice make the animals more sensitive to stressful experiences.

The scientists also demonstrated that the protein controls activity in two distinct stress signaling pathways in the brain. It reduces not only the release of cortisol via one pathway but also adrenaline and noradrenaline via the other.

“We know that an abnormal stress response can precipitate or worsen depression and cause anxiety disorder and cardiovascular disease,” says first author Vasco Sousa. “Therefore, it is important to find out whether the link between p11 deficiency and stress response that we see in mice can also be seen in patients.”

The study, which appears in the journal Molecular Psychiatry, was a collaboration between the Karolinska Institutet and researchers at VU University in Amsterdam, The Netherlands.

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Knockout mice

To investigate the role of p11 in stress responses, the scientists bred “knockout” mice that lack the gene that makes this protein.

They compared their behavior with normal mice using a variety of standard tests. These suggested that those without p11 experienced heightened stress and anxiety.

For example, in one test, mice pups were separated from their mothers for 3 hours a day. The researchers found that pups lacking p11 produced more high-pitched distress calls, known as ultrasonic vocalizations, compared with normal pups.

In another test of anxiety-like behavior, the team gave the adult mice a choice of spending time in a brightly lit area or a dark space. Mice that were deficient in p11 chose to spend less time in the brightly lit area compared with normal mice.

In addition, their heart rates took longer to return to normal after a stress-provoking stimulus.

The scientists also monitored stress hormone levels in the animals, revealing hyperactivity in two distinct stress pathways in the mice that lacked p11.

One such pathway, called the sympathetic-adrenal-medullary (SAM) axis, is responsible for the immediate surge in adrenaline and noradrenaline that occurs in frightening situations, triggering physiological changes such as increased heart rate.

The other pathway, known as the hypothalamus-pituitary-adrenocortical (HPA) axis, responds slightly less quickly and leads to the release of cortisol. This stress hormone raises blood sugar levels, among other metabolic changes, and suppresses functions that the body does not need for the fight-or-flight response.


Flu vaccinations not linked to increased COVID-19 risk

According to a recent study, the flu vaccine does not increase a person’s risk of getting COVID-19 and is not associated with severe illness and death from the disease.

Doctor placing Bandaid over vaccination site
This year, the flu vaccine is more important than ever.

The research, which features in the Journal of Clinical and Translational Science, reveals that the flu vaccine is the single most important way to protect people’s health this fall and winter.

Seasonal flu activity can be unpredictable, and it is common for otherwise healthy people to be hospitalized due to critical respiratory infection each year.

Statistics from the Centers for Disease Control and Prevention (CDC) show that during the 2019-2020 United States flu season, there were 39–56 million cases of the disease. There were also 18–26 million flu medical visits, requiring up to 740,000 hospitalizations. Furthermore, flu may have caused the deaths of as many as 62,000 people in the U.S.

Preventing a ‘twindemic’

Studies investigating the 1918 flu pandemic suggest that a second wave of COVID-19 is possible in the fall and winter of 2020. This would overlap with seasonal flu’s most active phase.

Preventive measures, such as physical distancing, have also reduced the spread of the flu. The CDC reported that positive test results dropped from more than 20% to 2.3% during the pandemic and have remained at “historically low interseasonal levels.”

As the flu season merges with the COVID-19 pandemic this fall, getting the flu vaccine is more important than ever. This will help prevent a “twindemic” — the collision of flu and COVID-19.

Cleveland Clinic study

In this recent study, a team of researchers led by Dr. Joe Zein used data from individuals enrolled in Cleveland Clinic’s COVID-19 Registry. This dataset includes all individuals who underwent testing for the disease at Cleveland Clinic, not just those who tested positive.

The team analyzed more than 13,000 people who received a test between March 8 and April 15, 2020.

The investigators compared those who had received adjuvant-free influenza vaccines in the fall or winter of 2019 (4,138 patients) with those who did not receive the vaccine (9,082 patients).

An adjuvant is an ingredient that manufacturers add to a vaccine to create a stronger immune response. However, adjuvanted vaccines can cause more side effects — including swelling, fever, and body aches — than adjuvant-free vaccines.

The findings revealed no difference in COVID-19 incidence or severity between people who received adjuvant-free influenza vaccines in the fall or winter of 2019 and those who did not receive the vaccine. Both groups had a comparable risk for hospitalization, admission to an intensive care unit, and death.

“[G]etting the annual flu vaccine remains the best safeguard against the influenza virus — both for yourself and the people around you.”

Thus, researchers and clinicians believe that the population’s adherence to widespread and early flu vaccination will help reduce the risk of simultaneous viral infections and epidemics or pandemics.

Further, the study team advises people to get the flu shot because this may result in fewer people with other COVID-19-like illnesses attending doctor’s offices and emergency departments.

“We have already seen the stress that COVID-19 can put on our hospitals and resources,” says Dr. Zein. “While we’re not yet sure how flu season will affect COVID-19 susceptibility and infections, we strongly advise people to get their influenza vaccines, both for their individual health and the collective health of our care systems,” he adds.

Although the findings affirm the safety and urgency of flu vaccination, the study authors acknowledge that much remains unclear about both the disease pathology and burden to the healthcare system of having concurrent SARS-CoV-2 and flu infections.

The authors hope that other scientists will collect surveillance data in the fall of 2020 to analyze the possible outcomes of coinfection and evaluate the interaction between influenza vaccinations and any newly developed vaccine against COVID-19 infection.

Through my eyes: Surviving cancer twice

“Helen, I’m so sorry to tell you that you have stage 4 ovarian cancer.” I will never forget hearing those words.

through my eyes surviving cancer
Cancer treatment was pretty grueling in the 1980s, and outcomes were a lot gloomier than they are today.

Nothing could ever prepare you for hearing your doctor say you have cancer. My life flashed before my eyes. I was in disbelief. How could I have cancer for the second time in my life?

I was only 48 years old at the time of my second cancer diagnosis, and I was already a survivor of a radical mastectomy due to breast cancer at the age of 32, just 2 years after I had given birth to my daughter, Julianne.

I received my diagnosis of breast cancer in 1972, and in those days, treatment was limited. The surgeon believed that a radical mastectomy of my right breast would give me the best outcome.

The doctor would prove to be correct, but I was no less devastated in the interim. I was the mother of three children, and instead of tending to my active children, I now needed to focus on my health and well-being.

However, I continued to live a blessed life. I was the wife of an Orthodox priest, a secretary, and a preschool Sunday school teacher. I was like any other mother, trying to prioritize my life. The difference being, if I got my priorities wrong, it could cost me my life.

Second cancer diagnosis

The second episode began almost 2 decades later when I woke up feeling very bloated and fatigued.

I didn’t think much of it at first and thought I would feel better the next day. Yet the bloating continued, especially after eating, and I began feeling pressure in my lower abdomen. I decided it was time to contact the family physician.

The doctor ordered tests, but various X-rays, an ultrasound, and an MRI showed nothing. My doctor thought it was a case of gastritis and that I needed to rest and relax. However, 2 years later, my belly was now protruding, and I felt horrible pressure, so I asked my doctor for another test. This time they ordered a CT scan.

The CT scan showed something was not right, and I would need exploratory surgery to get more information. They found ovarian cancer tangled and webbed intricately through a large part of my lower anatomy.

The surgery lasted many hours, and my surgeon believed he had debulked 90% of the cancer. He also told me that I needed to undergo chemotherapy.

Cancer treatment was pretty grueling in the 1980s, and outcomes were a lot gloomier than they are today. I had already beaten cancer once, and the chance of surviving a second round seemed bleak.

I was offered a cocktail of Cisplatin, anthramycin, and Cytoxan as my best defense. Chemotherapy lasted 7 hours a day, and my side effects lasted even longer.

I was unable to complete my final round of chemo as my white blood count dropped too low. My oncologist thought the last round of chemo might have done more harm than good, so he discontinued the therapy one month short of 6 months.

The surgeon didn’t mention a survival time frame to me, of course. He knew I had enough on my mind and didn’t need to tell me that the consensus was that I had 6 months to live.

I guess God had a different plan.

Road to recovery

I was sitting at the dinner table, having no appetite, looking frail and gaunt, with numbness and tingling in both my hands and feet. I was so tired and thinking that I can’t go on.

I didn’t realize that I had said that out loud until I was snapped out of my daze by my daughter telling me: “You can’t give up, you already lived longer than the doctor said you would.”

I was shocked. I expected to be gone already but felt emboldened by the fact that I wasn’t.

Like a boxer in the late rounds of a fight, I summoned energy I didn’t know I had. I vowed to not only go another round but to win this fight. I did it once, and I’ll do it again.

I got a second wind, but I needed something more, so I began exploring other avenues to find my cure. This wasn’t an easy task in the days before internet searches, and it would take considerable effort.

In retrospect, I feel there were three things I did that helped in my healing and recovery. The surgery and chemotherapy were a big part of my treatment plan, but I knew I couldn’t sit back and relax and let the doctors do all the work.

I went to church many nights, sometimes by myself. With my head bowed and body low, I asked God for forgiveness and strength, and to help rid me of any anger or resentment I had. As the wife of a priest, I received a lot of support, and people began praying for me all over the United States.

I also began juicing (long before the juicing craze began). I juiced mainly carrots, and once in a while, I would add garlic or an apple. I actually developed carotenosis, a condition that turns your skin orange — I drank so much carrot juice that I looked like a carrot!

The juice gave me valuable nutrition, and I found it easy to digest. The juicing seemed to provide me with energy, so I could continue to take care of my daily needs and responsibilities.

The third and possibly the most interesting approach that I discovered through a dear friend was a technique called “hands on therapy” by Janet Ziegler.

I met Janet through a friend, and during the introduction, I told her my name is Helen, and I have cancer. She turned towards me with a gentle, compassionate touch and told me, “You are Helen, and you had cancer.”

She taught me a process called visualization. It was as if she retrained my mind into thinking the opposite of what I knew as fact.

Before falling asleep that night, I remember asking God to give me a sign of a rainbow that things would be alright. It was that evening I clearly saw a rainbow full of vibrant color. I woke up the following morning feeling refreshed and thankful. Shortly after that experience, I no longer believed I had cancer.




People with eating disorders negatively affected by lockdown

New research shows that people with a history of eating disorders experienced significant negative effects during the COVID-19 lockdown.

An image of dishes drying in the dish rack to accompany the article, "People with eating disorders negatively affected by lockdown"
A new study finds that during lockdown, eating disorder symptoms worsened in people with a history of eating disorders.

The research, which appears in the Journal of Eating Disorders, raises awareness of the pandemic’s detrimental effects on people’s mental health, and could be valuable for the future development of health services.

COVID-19, the disease caused by SARS-CoV-2, has hospitalized hundreds of thousands of people worldwide and resulted in a significant number of deaths.

However, the pandemic and the emergency measures responding to it, have also had a significant effect on people’s mental health.

To slow the spread of COVID-19, governments across the world introduced various emergency measures that typically involved some degree of physical distancing or lockdown.

While these lockdowns have been crucial in reducing the disease’s spread and saving lives, they have also been profoundly disruptive to individuals and society.

Everyday routines changed overnight as people worked from home, became furloughed from their jobs, or were made unemployed.

People living with friends or family were able to maintain some face-to-face socializing. However, people living on their own or with strangers could only see these friends and family virtually — and only if they had access to the necessary technology.

As with physical health, it has become clear that while the virus can affect anybody’s mental health, it does not do so equally.

Understandably, the pandemic has negatively affected people’s general mental health. For example, an article in The Lancet found that, in the United Kingdom, people’s mental health was generally worse during the pandemic than before. The authors also discovered young people, women, and those living with young children were particularly affected.

However, experts know less about the effects of the pandemic on people with pre-existing mental health diagnoses.

Eating disorders

In the present study, the researchers wanted to explore the pandemic’s effects on people who had experienced an eating disorder.

According to the National Institute of Mental Health, common eating disorders include:

  • anorexia, where people see themselves as overweight when they are underweight
  • bulimia, where people uncontrollably eat significant amounts of food and then compensate for this through behavior that can damage their health
  • binge-eating, where people lose control over the ability to stop eating food, often resulting in overweight or obesity

In early April, 2 weeks after a lockdown was enforced in the U.K., the researchers recruited 153 people through social media to take part in a questionnaire. These participants had to be U.K residents over 16 years of age, with experience of an eating disorder, including being in recovery.

After excluding people who didn’t meet these criteria, there were 129 suitable participants between the ages of 16 and 65. Of these, 93.8% were female.

In total, 62% described themselves as currently having an eating disorder. 6.2% had been in recovery for less than 3 months, 6.2% had been in recovery for between 3 months and 1 year, and 25.6% had been in recovery for more than 1 year.

The questionnaire included closed and open-ended questions about the social effect of the lockdown, the respondent’s internet usage, their exercise and food behavior, and the pandemic’s general impact on their eating disorder.

Worsened symptoms

The researchers found that 87% of the respondents said their eating disorder symptoms had worsened, while over 30% reported their symptoms were much worse.

The respondents said the pandemic had a significant negative effect on their psychological wellbeing. They reported feeling less in control and more socially isolated. They also experienced more rumination about their eating disorder and felt less socially supported.

The researchers believe that key triggers for these feelings include:

  • changes to everyday routine
  • their living situation
  • the amount of time they spent with family and friends
  • their ability to access treatment
  • how much physical activity they were doing
  • their relationship with food
  • how much they were using technology


How does weather affect COVID-19?

Research shows there are more COVID-19 cases as temperature and humidity fall. A recent study points to more severe cases in cold and dry weather. Do these findings suggest COVID-19 is seasonal? Experts disagree.

A couple walks in the fall to accompany an article about weather and COVID-19.Share on Pinterest
Some research suggests COVID-19 may be more prominent in cooler temperatures.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date. 

Why are these findings so controversial, and why has the United States seen most cases during its hot and humid summer? In this special feature, we investigate which weather conditions are most associated with COVID-19 cases.

We look at what factors might confound these studies and make them hard to interpret. And we describe how one international study tries to get around these problems.

There are good reasons to expect a respiratory virus to show seasonal variation. Infections from influenza and respiratory syncytial virus are more common during winter in temperate areas of the world.

“But the fact is that respiratory viruses are generally seasonal, probably as viruses that transmit on water droplets do so less well if the droplet dries up faster, and temperature, humidity, and UV may be part of the lull in transmission we are now seeing. The flip side, alas, is that the opposite will be true in the autumn and beyond.”

– Prof Ian Jones, Professor of Virology, University of Reading, United Kingdom

Studies of the first SARS-CoV in 2003 suggest weather might be important for coronavirus spread. While this virus did not circulate long enough to establish any potential seasonal pattern, daily weather was associated with the number of cases. In Hong Kong, new cases were 18 times higher in lower temperatures — under 24.6°C, 76°F — than more elevated temperatures.

The epidemic died out during a warm, dry July in 2003, but tight public health control measures were also in place. A recent review of the seasonality of respiratory infections describes how cold, dry winter weather makes us more susceptible to viruses in general.

In these conditions, the mucous lining in our noses dries up, which in turn impairs the function of cilia, the tiny hairs that line the nasal passage. These beat less often, meaning they may fail to clear viruses from the nose. The review concludes that a relative humidity of 40–60% might be ideal for respiratory health.

Americans spend 87% of their time indoors, so how does the outside weather affect them so much? When cold, dry air meets warm air from indoors, it reduces the air’s humidity inside by up to 20%. During winter, indoor humidity levels are 10–40%, compared to 40–60% in fall and spring. The lower humidity aids the spread of virus aerosols and could make the virus more stable.


Humidity and rainfall

Laboratory and observational studies of cases of COVID-19 patients show an impact of humidity on the SARS-CoV-2 virus.

A laboratory-generated aerosol of SARS-CoV-2 was stable at a relative humidity of 53% at room temperature, 23°C, 73°F. The virus had not degenerated much even after 16 hours and was more robust than MERS and SARS-CoV. This helps explain its higher levels of airborne infectivity.

Laboratory studies do not necessarily predict how a virus will behave in the real world. However, a study of 17 cities in China with more than 50 cases of COVID-19 found a link between rises in humidity and reductions in COVID-19 cases.

The team measured humidity as absolute humidity, or the total amount of water in the air. For every gram per cubic meter (1 g/m3) increase in absolute humidity, there was a 67% reduction in COVID-19 cases after a lag of 14 days between the humidity increase and the number of cases.

Experts report similar associations between the number of cases and humidity in Australia, Spain, and for both cases and deaths in the Middle East.

The way temperature and humidity interact provides different weather patterns, which are determined by latitude.

A comparison of climate data looked at eight cities with high levels of COVID-19 spread:

  • Wuhan, China
  • Tokyo, Japan
  • Daegu, South Korea
  • Qom, Iran
  • Milan, Italy
  • Paris, France
  • Seattle, U.S.
  • Madrid, Spain

These cities were compared with 42 other cities worldwide with a low COVID-19 spread. All of the first eight cities lay in a narrow band between 30°N and 50°N latitudes.

Between January and March 2020, the affected cities had low mean temperatures of 5–11°C, 41–52°F, and low absolute humidity of 4–7 g/m3. The authors conclude these findings are:

“consistent with the behavior of a seasonal respiratory virus.”

Studies of influenza show tropical areas where rainfall drives humidity have a higher transmission in humid-rainy conditions.

American researchers established a threshold of 18–21°C (64–70°F) and specific humidity below 11–12 g/kg, approximately equivalent to 13–14 g/m3, for increased winter transmission. Tropical countries with temperature and humidity levels above these had higher influenza transmission when rainfall was high, defined as greater than 150 mm per month.

Brazilian researchers looked at rainfall worldwide, and confirm COVID-19 cases also increase with greater precipitation. For each average inch per day of rain, there was an increase of 56 COVID-19 cases per day. No association was found between rainfall and COVID-19 deaths.



Links between COVID-19 cases and temperature are less certain. Studies from China have both found and not found an association with environmental temperature.

Similarly, researchers report no effect of temperature and COVID-19 transmission or deaths in Australia, Spain, and Iran.

However, higher temperatures are associated with a lower number of cases in Turkey, Mexico, Brazil, and the U.S., but it appears there is a threshold. Higher temperatures do not cause a further decline in COVID-19 transmission, which could account for some of the disparities.

This is consistent with laboratory studies that show the SARS-CoV-2 virus is highly stable outside the body at 39.2°F (4°C) but increasingly unstable at temperatures above 98.6°F (37°C).

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Hours of sunshine and UV light

A study in Spain found after 5 days of lockdown, the longer the hours of sunshine, the more cases there were of COVID-19. This positive association held true with a lag — between sunshine hours and cases — of 8 and 11 days. There was no link between the hours of sunshine before lockdown and during the first 5 days.

This contradicts findings from influenza research, which suggests lower transmission with longer hours of sunshine. The authors say:

“The positive sign of sunshine may well be another instance of behavioral adaptations, whereby compliance with lockdown orders weakens on sunny days.”

In contrast, there appears to be no effect of solar UV light, as the wavelength required to kill viruses and bacteria is under 280 nanometers (nm).

This type of UV light (UVC) does not reach Earth as it is absorbed in the ozone layer. If it did reach Earth, humans would suffer severe burns to their skins and eyes within minutes.

Some minor effects of UVB light, defined as 280–320 nm, have been proposed to explain the contradictory findings of lower transmission of COVID-19 in cold and dry conditions at a higher altitude. However, other factors, such as higher vitamin D levels within people in these regions, might be more important.

“This virus demonstrates no seasonal pattern as such so far. What it clearly demonstrates is that if you take the pressure off the virus —the virus bounces back. That’s the reality, that’s the fact.”

– Dr. Michael Ryan, WHO press briefing 8/10/2020 @ 20:51 mins

Researchers in Oxford, United Kingdom list reasons why people should not use observational studies on the number of COVID-19 cases and associated weather conditions to establish the seasonality of COVID-19 transmission.

They argue that testing capacity has been a major problem in most countries, which means there are many more cases than are reported.

Therefore, any factor linked to the weather and increased chances of testing could make it seem like the number of cases was due to weather, while increased testing is simply driving the numbers.

For example, other respiratory illnesses are common in winter months and could prompt people to have a test for COVID-19. Milder cases will be identified, which would not have come to light without another virus’s respiratory symptoms.

Furthermore, other conditions, such as cardiovascular diseases, are more common in cold weather. Patients who present at the hospital are more likely to be tested, which leads to further identification of cases. However, these would be related to other conditions linked to the weather and not necessarily COVID-19.

Nevertheless, COVID-19 deaths are less likely to be confounded by testing capacity since those with severe symptoms are expected to attend the hospital independently of the weather. Some studies above report an association between deaths and changes in the weather.

During a pandemic, a new virus will spread rapidly through a population where no one has immunity. The National Academies of Sciences, Engineering, and Medicine state in their consensus report on COVID-19 transmission there have been:

“[Ten] influenza pandemics in the past 250-plus years—two started in the northern hemisphere winter, three in the spring, two in the summer and three in the fall. All had a peak second wave approximately 6 months after the emergence of the virus in the human population, regardless of when the initial introduction occurred.”

Researchers at Princeton University and the National Institutes of Health, Bethesda, have modeled the spread of SARS-CoV-2 in relation to the weather using data on two beta coronaviruses, similar to SARS-CoV-2, which usually cause the common cold.

They found pandemic transmission in the community was likely to be so strong it would negate the minor effects of weather changes, such as higher temperatures and humidity.

The model explains why some countries with weak public health control measures, such as avoiding close contact, closed spaces, and crowds, and where this is not possible, wearing masks, are showing high transmission rates in the hot and humid summer conditions.

“As Rachel [Baker] argues in the paper, there is likely a seasonal impact on transmission, but given the high rate of susceptible people, it was unable to suppress transmission. The current outbreak in the US would likely be worse if we didn’t have the weather on our side, and is likely to get worse going into the fall and winter, assuming everything else stays the same. Once we have enough people who are vaccinated or recovered, we will probably see small, seasonal outbreaks of COVID-19 returning every winter, similar to colds and the flu.”

– Marta Shocket, PhD, Postdoctoral Fellow, UCLA, personal communication 8/12/2020


A new study explores COVID-19 severity and weather

To overcome the problem of non-weather factors that confuse the picture of seasonality and COVID-19, an international group of researchers has analyzed the severity of COVID-19 instead of the number of cases.

Using data from admissions to six European hospitals and 13 hospitals in the Zhejiang province in China, they found decreases in deaths, the average length of stay, and admission to intensive care units for COVID-19 with each additional day of the pandemic.

This was found in most of the European hospitals, but not the Chinese hospitals. China’s pandemic rise took place entirely during winter, while in Europe, COVID-19 spread throughout the winter and spring months.

Deaths decreased in the European hospitals with each unit of temperature increase but not in the Chinese hospitals. The authors disregarded improvements in treatment during February and July, citing only a small impact from the use of dexamethasone.

They hypothesize the decrease in severity is related to humidity-driven changes in nasal mucous and viral clearance by nasal cilia.

The findings of decreasing severity were corroborated in their U.S. and UK data set of four million citizens self-reporting symptoms associated with COVID-19. Over 37,000 people had a symptom cluster with a close correlation to positive COVID-19 testing. There was a similar decrease in symptom duration across the course of the study.

What this study means

This research is a preprint and observational study. Therefore, it cannot establish causal links, but it does go some way to overcome the potential confounding factors in earlier weather and COVID-19 case studies.

If COVID-19 is seasonal, experts will likely establish this in 2021 or 2022 after the main pandemic waves.

In the meantime, the authors suggest the importance of considering hydration for patients and the public, including the ancient practice of nasal irrigation.

“… providing humidified air to patients in the early stages of the disease may be beneficial. [and] … in the situation of rapidly progressing COVID-19 pandemics it would be essential to actively promote universal humidification of dry air in all public and private heated spaces, as well as active nasal hygiene and hydration.”

Lack of sleep predisposes us to negative thinking

Researchers in Italy found that a continued lack of sleep for 5 consecutive nights predisposes people to see pleasant and neutral images adversely, indicating that poor sleep may generate a negative emotional bias.


The feeling of having a sleepless night is a familiar one to many people. Lack of sleep can affect a person’s performance at work, as well as their emotional state.

People are more likely to be irritable and frustrated when they have not slept properly the night before.

The influence of limited sleep on emotional well-being is of growing interest as a lack of sleep is widespread in modern society. The Centers for Disease Control and Prevention (CDC) report that about 35% of adults in the United States sleep less than 7 hours per night.

Although several reports suggest that lack of sleep influences our emotional state, a new study published in the Journal of Sleep Research has formalized this.

In the study, participants looked at “pleasant and neutral images” after 5 nights of normal sleep and 5 nights of restricted sleep. The results showed that the participants were more likely to have negative responses to these images after the periods of disturbed sleep than after normal sleep.

The authors conclude that lack of sleep imposes a negative emotional bias on people and has important implications for daily life, as well as in clinic settings.

Continued sleep restriction

Numerous studies have investigated the behavioral effects of lack of sleep. However, most have looked at the impact of a total lack of sleep, rather than slightly reduced sleep over a more extended period.

To test the impact of partial sleep deprivation on emotional reactions, the researchers behind this study asked 42 people to change their sleep patterns for 2 weeks.

During the 2-weeks, participants had 5 consecutive nights of normal sleep followed by 5 consecutive nights of restricted sleep in which they could sleep no more than 5 hours per night. In the sleep-restricted phase, participants went to bed at approximately 2 am and woke up at about 7 am.

The researchers switched the order of the sleep patterns between the participants, with a two-day ‘wash out’ period in-between to allow people to reset before the next period.

The morning after each 5-day period, the researchers asked the participants to rate images on a nine-item scale of emotions.

The researchers took the images from the International Affective Picture System (IAPS), a database of pictures that psychologists use to study emotion and attention. The database contains a vast, wide-ranging selection of images that depict pleasant, neutral, and unpleasant events.

The researchers randomized the order of the pictures and assessed the emotion the image evoked, as well as the intensity of the emotion.

Impact on emotional outlook

The researchers found that participants rated pleasant and neutral images more negatively after having 5 nights of restricted sleep than when they had slept normally.

Even when the researchers took account of mood changes, they continued to find that people viewed images more negatively under restricted sleep conditions.

“Insufficient sleep may impose a negative emotional bias, leading to an increased tendency to evaluate emotional stimuli as negative.”

– Daniela Tempesta, Ph.D., of the University of L’Aquila in Italy

This suggests that sleep-deprived people are likely to perceive emotional stimuli — such as events or personal interactions in their daily life — as worse than they really are.

The researchers did not find any significant difference in how people rated the unpleasant pictures under different sleep conditions.

Culled from Medicalnewstoday

The close relationship between sleep and mental health

Not getting enough sleep skews our ability to regulate our emotions. In the long run, this can increase our risk of developing a mental health condition. In turn, conditions such as anxiety and depression may cause further sleep disruption.
Fortunately, there are proven ways to improve sleep quality and break out of this vicious cycle. In this Special Feature, we discuss sleep and its deep relationship with mental health.

More than 400 years ago, William Shakespeare described the gift of sleep and the distress of insomnia:
O sleep! O gentle sleep!
Nature’s soft nurse, how have I frighted thee,
That thou no more wilt weigh my eyelids down
And steep my senses in forgetfulness?

– Henry IV, Part 2

Shakespeare’s description of sleep as “nature’s soft nurse” was closer to the truth than he could have known.

According to the Centers for Disease Control and Prevention (CDC), insufficient sleep increases the risk of type 2 diabetes, cardiovascular disease, and obesity.

Sleep is essential for the physical upkeep of the body, but it also helps maintain cognitive skills, such as attention, learning, memory, and emotional regulation.

Getting a good night’s rest even underpins our ability to perceive the world accurately. Research suggests that going completely without sleep for 3 or more nights in a row results in perceptual distortions, hallucinations, and delusions.

The latest discoveries about the importance of sleep for physical and mental well-being come at a time when technology is putting pressure on sleep time as never before. Social media, the internet, TV on demand, and video games are increasingly keeping us from our beds in the evenings.

The CDC advise that adults get between 7 and 9 hours of sleep a day, with the specific recommendation varying by age.

However, according to the 2012 National Health Interview Survey, almost one-third (29%) of adults in the United States sleep for less than 6 hours each night.

Two-way link to mental health
Poor sleep is a recognized risk factor for the development of a range of mental health issues.

A study that followed 979 young adults in Michigan, for example, found that insomnia was associated with a four-fold higher risk of depression 3 years later.

A review of research found evidence that insomnia preceded the development of not only depression but also bipolar disorder and anxiety disorders. The researchers also found a link between insomnia and an increased risk of suicide.

In 2020, a study published in JAMA Psychiatry identified an association between sleep problems in early childhood and the development of psychosis and borderline personality disorder in adolescence.

As well as increasing the risk of developing mental health problems, sleep disturbances are also a common feature of most mental illnesses, including anxiety, depression, bipolar disorder, and schizophrenia.

Prof. Daniel Freeman, a psychiatrist, and his colleagues at the University of Oxford in the United Kingdom believe that the two-way relationship between sleep problems and poor mental health can result in a downward spiral.

Writing in The Lancet Psychiatry, they say that doctors can be slow to address these issues in people with mental health problems:

“The traditional view is that disrupted sleep is a symptom, consequence, or nonspecific epiphenomenon of [mental ill health]; the clinical result is that the treatment of sleep problems is given a low priority. An alternative perspective is that disturbed sleep is a contributory causal factor in the occurrence of many mental health disorders. An escalating cycle then emerges between the distress of the mental health symptoms, effect on daytime functioning, and struggles in gaining restorative sleep.”

A form of cognitive behavioral therapy for treating insomnia (CBT-I) has proven its worth as a way to tackle this cycle of sleep problems and mental health conditions.

When Prof. Freeman and his colleagues randomly assigned 3,755 students with insomnia from 26 universities in the U.K. to receive either CBT-I or usual care, they found that the treatment was associated with significant improvements.

Students who received CBT-I not only slept better, but they also experienced less paranoia and had fewer hallucinations.

According to a 2015 meta-analysis, CBT-I may also be an effective treatment for anxiety and depression in people with insomnia.

How does CBT for insomnia work?
The treatment involves educating people about sleep and aims to change their sleep-related behaviors and thought processes.

People learn about good sleep hygiene, which involves practices such as limiting daytime naps, avoiding alcohol, nicotine, and caffeine in the evening, and refraining from using digital devices at bedtime.

The behavioral techniques include:

Sleep restriction: Reducing the time the person spends in bed to match more closely the amount of sleep they need.
Stimulus control: For example, using the bedroom only for sex and sleeping, going to bed only when sleepy, and getting out of bed after 15–20 minutes of wakefulness.
Relaxation: For example, tensing and relaxing the muscles while in bed, or focusing on the breath.
The cognitive techniques include:

putting the day to rest, which involves setting aside time before bed to reflect on the day
paradoxical intention, or trying to stay awake
belief restructuring, which means addressing unrealistic expectations about sleep
mindfulness, in which the person acknowledges their thoughts and feelings before letting them go
imagery, which requires a person to generate positive mental images
A trio of biological causes
Psychiatrists have proposed three interrelated factors to explain the close two-way relationship between sleep and mental illness:

emotional dysregulation
genetics, in particular relating to the circadian “clock” that regulates the sleep-wake cycle
disruption of rapid eye movement (REM) sleep
Most of us have intuited from personal experience that a night of disturbed sleep can make us feel a little down and grumpy the next day.

Research backs up our intuition. A 2005 study of medical residents in Israel, for example, found that poor sleep increased negative emotional responses when the going got tough at work the following day. It also decreased positive emotional responses when things went well.

More recently, a study in Norway found that delaying going to bed for 2 hours, but still getting up at the normal time, stifled positive emotions, such as joy, enthusiasm, and a sense of fulfillment. This effect increased with every consecutive day of delayed sleep.

Relatively mild, temporary emotional disturbances of this sort can set in place a vicious cycle. Ruminating about the past day’s events, for example, or anxieties about tomorrow may prevent a person from falling asleep once again.

Individuals with a predisposition to a particular mental health condition and those who already have the condition may be particularly prone to this mutually reinforcing effect.

Someone with bipolar disorder, for example, might feel too “wired” to sleep during a manic episode. A person with an anxiety disorder, on the other hand, might feel too anxious.

Faulty clocks
Research has linked genes that regulate the daily cycle of wakefulness and sleepiness — known as circadian clock genes — to particular psychiatric disorders, including bipolar disorder, seasonal affective disorder, and schizophrenia.

Continual misalignments between a person’s internal “clock” and their actual sleeping pattern may contribute to their vulnerability to these conditions.

Interestingly, scientists have yet to find any association between circadian clock genes and major depression. However, several lines of evidence implicate a sleep stage known as REM sleep.

After you fall asleep, your brain enters three progressively deeper stages of non-REM sleep, which is mostly dreamless. After about 90 minutes, it enters REM sleep, which is when most dreaming occurs.

Normally, the brain will cycle through these stages several times in the course of a night’s sleep, with the REM stages getting progressively longer.

However, people with major depression tend to enter their first REM sleep stage more quickly than usual after falling asleep, and it lasts longer.
Emotional memories
Research suggests that we process emotional memories during healthy REM sleep, helping us “unlearn” frightening or painful experiences.

Els van der Helm and Matthew Walker, sleep scientists at the University of California, Berkeley, have speculated that the normal pattern of emotional processing that occurs during REM sleep breaks down in people with depression.

So rather than helping them unlearn negative associations, these memories somehow become consolidated during their REM sleep. Over time, this contributes to an increasingly bleak mindset.

In support of their hypothesis, the researchers note that many antidepressants suppress REM sleep, which may steadily improve mood by preventing this consolidation of negative emotional memories from happening.

Interestingly, in some people, total sleep deprivation can rapidly lift depression, though only temporarily. Van der Helm and Walker believe that this may work in much the same way as the antidepressants — by depriving the brain of this dysfunctional type of REM sleep.

Recurrent nightmares
Problems with REM sleep also appear to play a role in post-traumatic stress disorder (PTSD).

In the recurrent nightmares that people with PTSD typically experience, it is as though the brain is repeatedly trying and failing to remove the emotional label associated with the memory of a traumatic event.

A review of research suggests that the drug prazosin, which doctors usually prescribe for high blood pressure, can relieve the nightmares of military combat veterans with PTSD.

The drug seems to do this by lowering levels of noradrenaline, which is one of several brain hormones that determine our progression through the different stages of sleep as their levels change.

Noradrenaline suppresses REM sleep. By reducing the hormone’s concentration in the brains of veterans with PTSD, prazosin may promote more effective REM sleep, which then erases the emotional label that is causing their recurrent nightmares.

Breaking out of the cycle
This year, psychiatrists in the Netherlands have launched a major investigation of sleep problems in people with newly diagnosed mental health conditions, including bipolar disorder, depression, anxiety, PTSD, and schizophrenia.

As well as assessing the incidence and nature of sleep difficulties in people with these conditions, the researchers will randomly assign participants with sleep problems to receive either their usual care or treatment at a sleep clinic.

Describing their forthcoming study in the journal BMC Psychiatry, the psychiatrists write:

“Despite a high occurrence of sleep disorders and established negative effects on mental health, little attention is paid to sleep problems in mental health care. Sleep disorders are frequently diagnosed years after onset; years in which poor sleep already exerted detrimental effects on physical and mental health, daytime functioning, and quality of life.”

If successful, their clinical trial will provide hope that there is a way to slow down or even prevent the vicious cycle of poor sleep quality and worsening mental health.