If you live in any of the following states, use these tips to fight unfair medical bills: Alabama, Alaska, Arkansas, Hawaii, Idaho, Kansas, Kentucky, Louisiana, Montana, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Wisconsin, and Wyoming.
Imagine you go to a hospital for a routine procedure. You’ve made sure your hospital and doctor are covered by your insurance. The procedure goes well, and you head home to recover. Two weeks later, you get the bill, but instead of owing the copayment you expected, you get a bill for nearly $4,000. It turns out that the anesthesiologist who assisted with your procedure — and who you did not choose — was “out of network,” so your insurance won’t cover that bill as expected. You now owe the difference between what your insurance will pay the out-of-network anesthesiologist and what you were billed.
These types of surprise medical bills are exceedingly common. Studies have shown that roughly one in six scheduled hospital or emergency visits results in one — and they’re expensive. An average emergency room surprise bill isaround $600, and some costtens of thousands of dollars.
Patients who have insurance coverage through Medicare or Medicaid, or who are on Veterans Affairs Health Care, are protected from surprise medical bills.
Over the past few years,most stateshave enacted some form of consumer protections. U.S. PIRG Education Fund has put togethertip sheetsthat help explain some of these state policies.
However, 17 states still offer no protections at all: Alabama, Alaska, Arkansas, Hawaii, Idaho, Kansas, Kentucky, Louisiana, Montana, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Utah, Wisconsin, and Wyoming. Don’t fret: If you have private insurance and live in one of these states, you can take steps to avoid getting one of these surprise bills and to lower the cost if you do receive one.
Do your best to prevent a surprise medical bill.
Check with your insurer to make sure you are choosing a provider that is covered by your insurance. Make sure that the hospital or health care facility (lab, diagnostic center, surgery center) is in your insurance network before you get treated there.
When planning hospitalizations at an in-network facility, check with the facility to ensure that all providers (surgeons, anesthesiologists, and others), lab services (such as blood work) and imaging services (such as X-rays, MRIs) are covered by your insurance plan. Furthermore, specifically request that any additional services you may need are covered by your insurer.
Know where your nearest in-network emergency room is for those times when it is possible to choose.
Try to reduce the amount you owe.
Ask for an itemized bill and check that you are not being mistakenly billed for treatment you did not receive.
Compare the itemized bill to your Explanation of Benefits to see whether your insurer is paying its share. Sometimes patients are billed for services because their provider sent the wrong billing code to the insurer.
Contact your provider and ask about anything you don’t understand.
Contact your insurer to see if any mistakes were made on their end. Ask them to explain any charges you don’t understand.
Even if there are no mistakes, you can try to negotiate with your provider. Many hospitals have patient advocate departments to help you manage your bills.
If you have a problem with your insurance company, contact your state’s insurance department to file a complaint. If you have a complaint about your hospital’s billing, contact your state’s health department or consumer affairs office. They may be able to help you fight the bill.
Keep careful notes of all conversations you have. Get the names of the people you are speaking to. Keep your files in one place for easy access.
Be patient and clear in your requests.
Don’t delay in handling concerns and questions about your bill. You want to prevent your bills from being sent to a debt collections company while you negotiate.
If you live in states where the percentage of people without health insurance is high or where many people have high deductible costs for medication, this is the most important tip to save significant healthcare costs. You can consider using the #1 prescription discount card in ND, AR, NC, IN, MS, NV, SC, AZ, TN, MOif you live in any of these states to save up to 80% on high prescription deductibles.
Special information during the COVID-19 pandemic
Testing for COVID-19 is free for both insured and uninsured consumers. Health plans are required to cover the cost of testing (even if you don’t have symptoms or have not been exposed to someone with COVID). This means that if you want to be tested for any reason, such as before visiting a family member, your insurance must pay for the test and cannot bill you for any copay, coinsurance, or deductible.
Even though the test is free, many people have been billed for other fees, such as a “facility fee.” When you choose a testing site, call to be sure there are no additional fees the site will charge. There are sites in each state that offer testing with no additional fees. The federal government has alist of locations. To find out more about COVID testing in your state, use thisresource.
All plans are required to pay for any approved COVID vaccine and any administration costs. You are not required to pay any cost-sharing (copay, coinsurance, or deductible) related to getting a vaccine against the COVID-19 virus.
Good news! New consumer protections are coming in January 2022
In a victory for consumers, Congress recently passed theNo Surprises Actto expand surprise billing protections to all insured Americans beginning in January 2022. The federal law will protect patients from surprise out-of-network bills for emergency treatment and from surprise bills for non-emergency treatment at in-network hospitals. The law will also prevent air ambulances from sending out-of-network surprise bills.
Until the consumer protections from the No Surprises Act go into effect next year, it is important to try to avoid receiving out-of-network care. It is always important to understand your protections and know how to fight an unfair and unexpected bill.
The rise of Technology has meant that people are more connected than we have ever been in the history of time. But our reliance on technology can have a detrimental effect on our mental health.
While social media platforms can have their benefits, using them too frequently can make you feel increasingly unhappy and isolated in the long run.
The constant barrage of perfectly filtered photos that appear on Instagram are bound to knock many people’s self-esteem, while obsessively checking your Twitter feed just before bed could be contributing towards poor quality of sleep.
Here are six ways that technology could be negatively affecting your mental health without you even realising.
According to Dr. Saju Matthew a board-certified family medicine physician, excessive exposure to bright lights from your smartphone, computer, and tablet can block the secretion of the hormone that helps you sleep. So it is advisable that you set a bedtime and you put away your phone and other smart devices that can interfere with your sleep as this time approaches. Sleep is very important to our health because it removes toxins that build up while you are awake from your brain, it also allows your body to repair itself. Poor sleep can affect your mood by causing anxiety disorders which weakens your body’s ability to fight diseases.
Are you always eager to know what’s up online past your bedtime? You may be suffering from problematic internet use. If you find it difficult to keep up with work demands or your relationships due to your mobile device. This may be a sign that it has taken over your life, and you should see a mental health physician.
Although social media connects you to the world. Its prolonged use can disconnect you from family and friends in real life. It can make you feel inadequate and dissatisfied with your life when you compare your achievements to others. These negative emotions can affect your mood in a bad way by making you feel stressed and anxious. These symptoms will further increase your addiction to social media and the cycle continues if you don’t seek medical help on time. If you discover that your use of social media is making you angry, aggressive, or distracted, you need to control your use of it by reducing time spent online. Also, in a situation where you suffer from cyberbullying or you find yourself doing crazy things to get likes and shares, you need to re-access your use of social media.
Digital Eye Strain
Do you experience eye discomfort when viewing digital screens for extended periods? You may be having digital eye strain. Digital eye strain goes along with symptoms such as dry eyes, itchy eyes, blurry vision, headache, difficulty in concentrating when reading, and increased sensitivity to light. Other factors are bad lighting, screen glare, and bad viewing distance. A poor vision can affect your daily tasks and even your social life which in turn will affect your mental health. To relieve your eyes from strain, reduce your screen time, and adjust the lighting around you.
According to a study, using smartphones for extended hours can cause problems in the nerves, joints, tendons around the shoulders and arm resulting in musculoskeletal disorders. Leaning forward when using a smartphone can stress your neck, spine, and shoulders. You can also experience repetitive stress injuries around the wrist and arms. Repetitive stress injury occurs when you stress the same muscles over time through bad posture. Symptoms include swelling, stiffness, weakness, numbness, and pain ranging from mild to severe. With this disorder, carrying out your daily activities can become a problem. It can lead to depression if you don’t get social support on time.
If you are feeling pain from the use of technology, maintaining a proper posture while working and taking frequent breaks to stretch will reduce these issues but if symptoms persist, see a physician.
Children and Technology
Adults are not the only ones that suffer from the negative use of technology, technology affects the mental health of children and teenagers too because they spend a lot of time watching television, playing video games, and using tech toys. Too much screen time can cause sleep problems and behavioral problems in children. Low academic performance and creativity have been associated with children who overuse technology. To control the negative effect of technology on children and teens, use the American Academy of Pediatrics’ screen time recommendation as a guide:
Reduce the amount of time spent watching educational programs for children between 18 – 24 months.
For children between ages 2-5 years, reduce non-educational programs to 1 hour per weekday and 3 hours during weekends.
Incorporate healthy screen habits for children between ages 6 and older.
Use the screen to build creativity and togetherness with family and friends.
Help your child learn other activities like music, arts, and sports that do not involve a screen.
Positive Effects of Technology
With over 800 apps dedicated to mental health alone, technology has made mental therapy accessible via some mental health apps. Some of these applications provide valuable insights into how you can feel much better whenever you are feeling depressed. They come either free or affordable, making it easier for many people to get.
Many people living in areas far away from their primary care providers can access online treatment in a timely fashion. While using smartphone apps cannot be compared to doctor-to-patient physical consultation, they provide vital information to mental health professionals.
Imagine a world without technology. Navigating physical interactions and mental wellbeing will have been impossible especially in a time like this when various lock-down restrictions are put in place to reduce the spread of the coronavirus. The pandemic increased online engagements across various social media platforms. And most importantly, it has offered avenues for many websites to provide social support.
Optimizing the Use of Technology to Boost Mental Health?
You need no soothsayer to predict that technology will continue to change the world. Rather than exploit it to the point where it becomes harmful to your health, you can explore new ways to maximize its power to improve your health. This can be achieved by using wearable devices, telehealth, and health apps while you enjoy the bond that comes with spending time with real-life friends.
More health care workers can now get the coronavirus vaccine in Massachusetts. Gov. Charlie Baker announced Thursday that all groups in Phase 1 of the state’s vaccination plan are immediately eligible for the shot.
“Today we’re moving ahead with the process of including all groups in Phase 1 of the state’s vaccination plan, including home health care workers and non-covid-facing health care workers,” he said. “These groups are now eligible to receive vaccines.”
The state has already started vaccinating coronavirus health care workers, first responders and those in congregate care settings, such as prisons and shelters.
Those eligible can make appointments at over 150 locations in the state, including the first mass vaccination site at Gillette Stadium.
Those who don’t come into contact with patients, such as back office employees, remote workers and lab researchers, are not part of Phase 1, the state said, and should wait until they are eligible in Phase 2 or 3.
Here is a full list from the state on the new groups that are now eligible for the vaccine.
Home-based health care workers
PT/OT/SLP therapists who work with medically complex home students
Personal Care Attendants (PCAs)
Home Health, hospice, and home care agency staff performing visits in the home
Independent Nurses and Continuous Skilled Nursing staff performing visits in the home
Aging Service agency staff performing regular visits in the home
State Agency staff performing direct care in the home, including DCF Emergency Response Workers, DMH case managers and DDS care coordinators
Mental and behavioral health providers providing in home treatment (e.g., ACCS integrated team, PACT, CBHI, ABA, ESP)
Adult Foster Care and Group Adult Foster Care workers performing work in the home
Independent Therapists (physical therapists, occupational therapists, Speech & Language therapists) performing work in the home
Home-Based Respite and Individual/Family Support staff (DDS and DDS Self Directed)
Health care workers doing non-COVID-facing care, including:
Dentists/dental students, and dental hygienists (unless routinely working with COVID-19 positive or suspected patients such as Oral Surgeons covering the ER, in which case should be considered COVID-facing);
Medical and nursing students (unless routinely working with COVID-19 positive or suspected patients, in which case should be considered COVID-facing);
Inpatient and outpatient physical therapists (unless routinely working with COVID-19 positive or suspect patients, in which case should be considered COVID-facing);
Interpreters who work in hospitals (unless routinely working with COVID-19 positive or suspected patients, in which case should be considered COVID-facing);
Behavioral health clinicians not already covered in congregate care or direct care;
Non-COVID facing Laboratorians;
Blood donation workers;
Organ donation procurement worker;
Hospice/palliative care professionals;
Non-COVID facing Imaging Professionals;
Dialysis center workers and patients;
Audiologists and speech and language pathologists (unless routinely working with COVID-19 positive or suspected patients, in which case should be considered COVID-facing);
Podiatrists and pedorthists (unless routinely working with COVID-19 positive or suspected patients, in which case should be considered COVID-facing);
Program of All-inclusive Care for the Elderly (PACE) staff;
SUD treatment program staff (if program is non-residential);
Asthma and allergy specialists;
Diagnostic sleep testing center staff;
School nurses (other than those working as vaccinators/testers)
Members of the clergy (if working in patient-facing roles)
Research report provided by Reports Monitor Medical billing and Coding Market, is a Skillful and Deep Analysis of the Present Situation and Challenges. Experts have studied the historical data and compared it with the current market situation. The Research Report covers all the necessary information required by new market entrants as well as the existing players to gain a deeper insight into the market.
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The Major Manufacturers Covered in this Report:
STARTEK Health, Oracle, Verisk Analytics, Aviacode, Maxim Health Information Services, nThrive, Medical Record Associates, R1 RCM, Allscripts, Cerner, EClinicalWorks, GE Healthcare, Genpact, HCL Technologies, Kareo, McKesson, Quest Diagnostics, The SSI Group, 3M, MRA Health Information Services, Dolbey
Years that have been considered for the study of this report are as follows:
Forecast Year:2021 to 2024
North America (The US, Canada, and Mexico)
Europe (Germany, France, the UK, and Rest of the World)
Asia Pacific (China, Japan, India, and Rest of Asia Pacific)
Latin America (Brazil and Rest of Latin America.)
Middle East & Africa (Saudi Arabia, the UAE, , South Africa, and Rest of Middle East & Africa)
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Primary worldwideGlobal Medical Billing and Coding Market manufacturing companies, to specify, clarify and analyze the product sales amount, value and market share, market rivalry landscape, SWOT analysis and development plans for the next coming years.
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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
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.
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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.
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 orchronic stressthat 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, causingpost-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.
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 authorVasco 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 journalMolecular Psychiatry, was a collaboration between the Karolinska Institutet and researchers at VU University in Amsterdam, The Netherlands.
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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.
“Helen, I’m so sorry to tell you that you have stage 4 ovarian cancer.” I will never forget hearing those words.
Nothing could ever prepare you for hearing your doctor say you havecancer. 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 radicalmastectomydue tobreast cancerat 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, anultrasound, and anMRIshowed 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 aCT 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 undergochemotherapy.
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.
New research shows that people with a history of eating disorders experienced significant negative effects during the COVID-19 lockdown.
The research, which appears in theJournal 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 inThe Lancetfound 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.
In the present study, the researchers wanted to explore the pandemic’s effects on people who had experienced an eating disorder.
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.
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
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.
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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 andrespiratory syncytial virusaremore commonduring 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 were18 timeshigher in lower temperatures — under 24.6°C, 76°F — than more elevated temperatures.
The epidemic died out during awarm, dry Julyin 2003, but tightpublic health control measureswere also in place. A recentreviewof 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 spend87%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 byup to 20%. During winter,indoor humidity levelsare 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.
Stay informed withlive updateson the current COVID-19 outbreak and visit ourcoronavirus hubfor more advice on prevention and treatment.
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-2was stableat 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 helpsexplainits 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 withmore than 50 casesof 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 inAustralia,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.
Acomparisonof climate data looked at eight cities with high levels of COVID-19 spread:
Daegu, South Korea
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 researchersestablisheda 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 researcherslookedat 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 bothfoundandnot foundan association with environmental temperature.
Similarly, researchers report no effect of temperature and COVID-19 transmission or deaths inAustralia,Spain, andIran.
However, higher temperatures areassociatedwith 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 highlystableoutside the body at 39.2°F (4°C) but increasingly unstable at temperatures above 98.6°F (37°C).
Hours of sunshine and UV light
Astudyin 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.
Thiscontradictsfindings 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 beno effectof 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 thecontradictoryfindings 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 listreasonswhy 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 consensusreporton 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, havemodeledthe 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 theseverityof 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 ofdexamethasone.
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 citizensself-reporting symptomsassociated 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
Thisresearchis 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 ofnasal 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.”