Category Archives: Preventative Medicine

Throughout the pandemic, the SARS-CoV-2 virus has laid bare weak points in the worlds health care systems. This has been true in arguably every country and every community, but the fractures have been especially apparent in rural areas, where poor access to health care long predated the pandemic.

In this three-part story, Undark explores the gaps in rural health care systems around the world, following the daily work of a village health worker in a small township in central Zimbabwe; a newly graduated rural doctor on a required year-long stint at a remote clinic in northern Ecuador; and a family doctor at a private practice in upstate New York.

Rural life in each of these countries is vastly different, and the challenges that the health care workers face, in some cases, also vary. In Hoja Blanca, Ecuador, for instance, its a three-day round trip just to send a Covid-19 test for analysis, requiring travel by motorcycle, bus, and ferry, and in Makusha Township, Zimbabwe, the health care worker gets around on a bike. Meanwhile, doctors in New York State have access to couriers and can hop in a car for house calls. There are also inequalities when it comes to vaccine availability, funding, and even access to basic medicines like ibuprofen.

But Covid-19 has also revealed common problems. There are far fewer doctors and nurses in these remote areas compared to their urban counterparts. Each rural community feels the pinch of badly broken health care systems on the national level. Covid misinformation and disinformation, as well as pandemic fatigue, reaches even the most remote areas. And as the pandemic lingers, all of the health care workers, no matter their country of origin, continue to toil to keep their villages safe.

This reporting project was created in partnership with Undark and produced with the support of the International Center for Journalists and the Hearst Foundations as part of the ICFJ-Hearst Foundations Global Health Crisis Reporting Grant.

On a recent Sunday, Lucia Chinenyanga, 42, navigates her bicycle through the bumpy terrain of Makusha Township in Shurugwi District in rural Zimbabwe, 200 miles outside the countrys capital city of Harare.

Chinenyanga, a village health worker, is headed to a nearby home to educate a family on vaccines and other Covid-19 protection measures. On her way, she meets Robert Nyoka, a local. As they talk, he expresses concern about his pregnant wife receiving her second dose of the Covid-19 vaccination.

Chinenyanga assures him its safe. Your wife can receive her second jab, she says. But should she feel any slightest side effect afterwards, she must report to the nurses to check her.

As a village health worker, Chinenyanga oversees and responds to the health needs of people in Makusha Townships Ward 9. She works at the local clinic. Her tasks include education around tuberculosis, home-based care for the elderly, monitoring pregnant women, and health awareness programsespecially on Covid-19 vaccines. The position required three weeks of training conducted by the Ministry of Health and Child Care, which coordinates health workers. She has worked in the village since 2019, the year before the pandemic hit Zimbabwe.

While nearly two-thirds of Zimbabwes 15.3million people lived in rural areas like Makusha Township as of 2020, rural health facilities in the country are often under-resourced, with fewer nurses and doctors compared to urban hospitals. Village health workers such as Chinenyanga fill the gap. And although the village health workers play an essential role in the primary health care system, providing care for the marginalized or remote communities in rural areas, they receive little paythe equivalent of $42 every month from nongovernmental organizations that work with the government.

The health sector in Zimbabwe is a mix of public and private facilities; the latter are costly, charging more and offering better services compared to government-run institutions. In Shurugwi, there are three private facilities, but most local residents cannot afford those services due to poverty and opt for the public clinics. Others rely entirely on the services of health workers who do community rounds. Shurugwi consists of 13 wards, with a population of 23,350 according to a 2014 census.

The pandemic has stretched the system even more. Over the past months, Covid-19 has increasingly become a dominant problem, killing high numbers of community members, Chinenyanga says in January following a spike in Covid-19 cases in the country. The deaths came with shortages of pretty much every necessity: quarantine facilities, personal protective equipment, medicines, and doctors. Like many places around the world, the country has also struggled with people sharing fake news about the dangers of vaccination.

Enforcing Covid-19 protocols can be draining for Chinenyanga. Every day she has to convince the rural villagers, mostly small-scale gold miners in the area, many of whom are skeptical of vaccines, to mask up, practice physical distancing, sanitize, and avoid gatherings at places like pubs, where people tend to forgo prevention measures.

Despite some pockets of vaccine hesitancy, as ofJune 7,2022, a total of4.3million Zimbabweans have been fully vaccinated for Covid-19, amounting to about28percent of the population.More than a millionhave received a booster shot.

In Shurugwi, people grew scared when family members started dying of Covid-19, Chinenyanga says. One family would lose both the wife and the husband at the same time. This is when locals started understanding that Covid-19 wasnt just a flu, but a deadly disease which had come to our community.

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When Zimbabwe gained independence from the United Kingdom in 1980, the new countrys health sector adopted a strong focused health care system, moving from only providing more advanced health care services for the urban population to involving more vulnerable sections of the society in rural areas. Health workers like Chinenyanga now play a pivotal role in the countrys health systems, says Samukele Hadebe, a senior researcher at the Chris Hani Institute, a South African think tank.

In rural areas, the health workers must be empowered with both finances and resources to do their job effectively, he adds, as a majority of people rely on them.

If you come from a health background you will realize those who have succeeded in building universal health care or a viable health care system, it is not the specialist doctors, he says. Wherever there is a successful health care system, it is actually the basic community health care, the one that in some countries where they dont even earn salaries. Those are the people fighting to just get recognized. Those are the people who manage the fundamental work.

But over the years, Hadebe says, Zimbabwes government neglected the rural health sector by not taking care of its health care professionals and paying them inadequate salaries, which pushed many qualified workers to leave the country for better opportunities overseas. In Zimbabwe, the infrastructure is gone, he adds, and health workers from the basic to the specialist are leaving the country. Why? Not just because of the salaries, but because someone will leave the country because they are worried about social security.

Zimbabwes 2010 Health System Assessment from USAID, a U.S. federal agency focused on foreign development, shows that there was a dramatic deterioration in Zimbabwes key health indicators beginning in the early 1990s. The current life expectancy for Zimbabwe in 2022 is just under 62 years, a 0.43 percent increase from 2021, according to projections from the United Nations.

With little hospital funding from the government, village health workers have to do their work with limited resources. Clinics likeChinenyangasin Makusha are poorly resourced and cannot accommodate patients with severe Covid-19 or other critical ailments, as there are no relevant medicines or oxygen tanks.

Even larger hospitals in Zimbabwe dont always provide oxygen to every patient, especially if the patient cant pay. You must have money upfront, Hadebe says. And how many people can access that? So, its a dire situation.

Itai Rusike, who heads the Community Working Group on Health in Zimbabwe, agrees that most rural health care facilities in the country were not equipped to deal with severe cases of Covid-19. In addition to the lack of oxygen tanks, he says, we also do not have intensive care units in our rural health facilities. Most of the rural facilities have no doctors, he adds, and the nurses who do work in rural areas may also not be well-equipped and skilled enough to deal with severe cases of Covid-19.

In November 2021, the Minister of Finance and Economic Development, Mthuli Ncube, announced that the country had acquired 20 million doses of vaccines. China reportedly committed in mid-January to donating 10 million doses over the course of 2022, which can be used for both initial and booster shots.

Rusike says that to ramp up the vaccination drive program, community outreach is needed, especially in rural areas. We need to take vaccination to the people, he says, rather than just wait for the people to come to the health facility and get vaccinated.

I think it is important, especially in remote locations, we come up with innovative strategies to take vaccination to the people, he adds. We know there are certain hard-to-reach areas where we can even use motorbikes to make sure that people can be vaccinated where they are, in their communities.

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In addition to resource shortages, Chinenyanga has experienced another serious challenge most days in her work: vaccine misinformation and disinformation.

The problem is common across rural Zimbabwe, according to Rutendo Kambarami, a communication officer at UNICEF, who says that the most common reason communities are not taking the vaccine is fear.

Even though much of Zimbabwes population lives in rural areas, they still are connected on social media through mobile devicesand the mobile devices and social media platforms allow for plenty of access to inaccurate information and outright conspiracies about vaccines. So we realized that we needed to give more information in order to dispel misinformation, she said at a December workshop on Covid and mental health for journalists in Zimbabwe.

Village health workers, as front line workers, and even the teachers were saying: We needed to do more interpersonal communication within those areas. So, front line workers play an incredibly huge role in terms of even misinformation and disinformation.

As Chinenyanga wraps up her day, after visiting several homes, she agrees that social media has contributed to misinformation. The people she serves in the Makusha community often share with her unproven remedies to treat Covid-19. She lists some of the misinformation that shes seen so far. People believe in steaming, that it helps. They also believe that eating Zumbani, a woody shrub that grows in the country, also prevents Covid-19, she says.

Still, she manages to smile as she leans against her bicycle. She says she loves her job and its usefulness to the community. As village health workers, our role is to share information we are taught by the Ministry of Health, she says. We prioritize prevention as the most effective tool against Covid-19.

Karen Topa Pilalooks around the windowless reception area in the small health care station of Hoja Blanca, Ecuador, its pale yellow walls stained with patches of mold. When did the electricity go out last night? Topa Pila, a doctor in this remote corner of the country, asks. Her co-workers shrug, throwing worried glances at a small container filled with ice packs. Its only 8:30 a.m. one morning in December 2021, but outside its already over 70 degrees.

Topa Pila closes a cooler containing 52 Covid-19 nasal swabs. Those tests need to be refrigerated and we only have one fridge, which is exclusively for vaccines, she says. Her team has nowhere to store the tests, she adds, and so to avoid getting them spoiled in the jungle heat, the clinic wants to use up all of them on the same day. The very next morning, a health care worker is going to take them to the laboratory in the district hospital.

Topa Pila, 25, and her team arrived in Hoja Blanca, a village of 600 located in the heart of Ecuadors Esmeraldas province, in September 2021. As freshly graduated health care professionals, they all are required to serve an ao rural, working one year in a rural community in order to get their professional license or advance into postgraduate courses in medicine. (The Ministry of Public Health implemented the ao rural in 1970, and the practice is also common across Latin America.) Topa Pilas team is the third deployed in Hoja Blanca since the start of the pandemic. The Hoja Blanca station is also responsible for six other communities, made up of mestizos, Indigenous Chachis, and Afro-Ecuadoriansabout 3,000 people in total. Some of the communities are so remote that to reach them, the health care workers traverse thick rainforest and then travel by canoe for a whole day.

Ecuador has suffered big losses from the pandemic. In the early months,corpseslittered the streets of the countrys biggest city, Guayaquil. By June 2020, the mortality rate from the virus reached8.5 percent, one of the highest in the world at the time. As of June 5, 2022, the countryrecorded35,649 official Covid deaths, although the real count is likely far higher.

Many public health experts agree that Covid-19 has also surfaced deep-rooted systemic problems in Ecuadors rural health care system. In 2022, Ecuador, the smallest of the Andean nations, reached more than 18 million inhabitants; an estimated 36 percent live in rural communities. As with private health care providers, the countrys public health care system is fragmented, divided among various social security programs and the Ministry of Public Health. There are about 23 physicians and 15 nurses per 10,000 people on average. But only a small portion of the countrys health care professionalsroughly 9,800, by the estimate of Dr. John Farfn of the National Association of Rural Doctors serve the more than 6.3 million rural Ecuadorians.

Although Ecuador is relatively financially stable, many Ecuadorians lack access to adequate medical care and the country has some of the highest out-of-pocket health spending in South America. In rural areas, access to hospitalas well as clinics like Hoja Blancasis hampered by bad infrastructure and long distances to facilities. Before the pandemic, Ecuador was undergoing budget cuts to counter an economic crisis; public investment in health care fell from $306 million in 2017 to $110 million in 2019. As a result, in 2019, around 3,680 workers from the Ministry of Public Health were laid off. Ecuador has also experienced long-standing inconsistencies in health leadership. Over the last 43 years, the country has had 37 health ministersincluding six since the start of the pandemic.

Before the Ministry of Public Healths selection system placed Topa Pila for her service, she had never been to Hoja Blanca, and it took her more than eight hours to get there. She says that when she first arrived at the modest health care station, she thought, This is going to collapse.

Early in the pandemic, Ecuador weathered shortages in everything: face masks, personal protective equipment, medications, and even health care workers. By April 2020, the government had relocated dozens of doctors and nurses from rural areas to urban hospitals and health centers, leaving many communities without medical attention.

At one point, says Gabriela Johanna Garca Chasipanta, a doctor who spent her ao rural in Hoja Blanca between August 2020 and August 2021, her team didnt even have basic painkillers like acetaminophen or ibuprofen. It was an infuriating experience, she says. I even had to buy medication out of my own pocket to give to some patients, the ones who really needed it and didnt have the economic means to get it. Some rural outposts had to resort to desperate DIY solutions during the worst months of the pandemic, says Esteban Ortiz-Prado, a global health expert at the University of Las Americas in Ecuadorjury-rigging an oxygen tank to split it between four patients, for instance, and using plastic sheets to create isolation tents in a one-room health center.

The pandemic has strained rural doctors in other ways, too. In 2020 and 2021, Ecuadors National Association of Rural Doctors received many complaints of delayed salaries, some more than three months late. There were rural health care workers who were even threatened by their landlords that they were going to be evicted, saysFarfn, a doctor and former association president.

Even under better conditions, remote health care outposts are only equipped to provide primary care. Anything more serious requires referral to the district hospital, which in Hoja Blancas case means a 300-mile round trip to the parish of Borbn.

The health administration used to take into account Ecuadors geographical and cultural diversity and the poor infrastructure in rural areas. But in 2012, the government restructured the system into nine coordination zones that public health experts say no longer follow a geographical logic. You cannot make heads or tails of it, saysFernando Sacoto, president of the Ecuadorian Society of Public Health. This is not just a question of bureaucracy, but also something that has surely impacted many peoples health.

Although there have also been significant developments in the health care sector in the past 15 yearsincluding universal health coverage and a $16 billion investment in public health from 2007 to 2016it mostly focused on the construction of hospitals, says Ortiz-Prado. But the countrys leadership didn't pay too much attention to prevention and primary health care, he adds. The system was not built to prevent diseases, but was built to treat patients.

In 2012, the government also dismantled Ecuadors Dr. Leopoldo Izquieta Prez National Institute of Hygiene and Tropical Medicinewhich was responsible for emerging diseases research, epidemiological surveillance, and vaccine production, among other things. (It was replaced by several smaller regulatory bodies, one of which failed completely, according to Sacoto.) The majority of a nationwide network of laboratories shut down as well. Sacoto and other experts believe that if the government had continued investing in the Institute rather than dismantling it, it would have lessened the severity of the pandemics impacts in Ecuador.

Initial plans to track and trace Covid-19 cases faltered; the country had barely any machines to process PCR tests, the gold-standard Covid-19 tests. During the first days of the pandemic, samples collected in Guayaquil were taken to Quito by taxi, Sacoto says, because that was the only place PCR tests were being analyzed. But public transportation to rural communities is limited, so even the few rural residents who had access to tests sometimes waited two weeks for test results.

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Topa Pilas team tries to convince everyone they cross paths withthe butchers wife, people waiting for the bus, men at the cockfighting arenato take a Covid-19 test. While the PCR results are faster than they used to be, they still take a week, as one of the health care workers has to personally shuttle the samples to Borbna 3-day roundtrip that involves a motorcycle, two different buses, and crossing a river with a shabby ferry. Up until yesterday, we had Covid-19 rapid tests. Today, the [district] leader took all the tests we had, says Topa Pila. The district hospital had requested the rapid tests, she adds, because theyve run out of tests and they need them.

Since Hoja Blanca is fairly isolated, the community has had very few Covid-19 cases, and all were mild. Topa Pila fears having any patients in a critical condition, Covid-19 or otherwise, because all she can do is ask the villagers and ferry operator for help with transport. There are no ambulances. We dont have oxygen because the tank we have over there is expired and you cant use it anymore, she says. Weve asked for replacement but nothing has happened.

The way Topa Pila sees it, its a lot to ask of the inexperienced health care workers on their ao rural. We start from zero without knowing anything every year, she says, recalling that the previous team had already left by the time she arrived in Hoja Blanca. And all of those patients whose treatments have been supervised by a doctor for a year lose their treatments, because they knew the doctor would come to their house, she says. We arrive and dont know where they live, since as you can see there are no addresses here. The Covid-19 pandemic has further distanced the rural doctors from their patients, she adds. Between the lockdowns and the coronavirus, other health matters like childhood vaccinations have been put off.

As in other parts of Latin America, the Covid-19 crisis in Ecuador also allowed corruption to fester. Sacoto says he believes the health care sector has become a bargaining chip among politicians. There really are mafias embedded in, for example, public procurement, he says, because the public procurement system is so convoluted that only the person who knows how the fine print works benefits. Between March and November 2020, the countrys Attorney Generals office reported196corruption cases related to the Covid-19 pandemic, including allegations of embezzlement and inflated pricing of medical supplies.

Lately, there have been signs of improvement. After taking office in May 2021, the government of Guillermo Lasso has accelerated vaccination efforts against Covid-19, approved a new program to tackle childrens malnutrition, and announced a Ten-Year Health Plan to improve health equity.

Sacoto says he remains skeptical whether these plans will translate to concrete and lasting actions. A good start would be decentralizing the health care system by building more rural clinics, he says, which could build up a network for preventative care for everything from childhood malnutrition to future pandemics. Ortiz-Prado says the country should better integrate its fragmented health care systems to make it easier for patientsand their recordsto move between them when needed. And it needs to improve the working conditions and salaries of rural health care workers to make the work more appealing, Farfn says, while also creating more permanent positions focused on rural communities. There is a lack of concern, lack of budget, he says, adding, Its a vicious circle, and sadly, governments are trying to apply Band-Aid solutions for the health issues here.

But all of that is in the future. Now, back at the Hoja Blanca health care station, the lights flicker back on in less than a day. The vaccines in the fridge are safe. But the 52 Covid-19 tests are still at risk: A health care worker must take the cooler to the lab in Borbn. There were heavy rains the night before, though, and water levels havent dropped enough for the river ferry to restart operations. Its just the first leg of what will ultimately be a 13-hour journey, and the icepacks are quickly melting amid the balmy equatorial heat.

Before Covid-19, there were no doctors in the village of Otego in central New York. Now there is one. During the pandemic, Mark Barreto quit his job at the Veterans Affairs hospital 89 miles away in Albany and opened a family medicine practice in his basement.

Just 910 people live in Otego, which sits along the Susquehanna River in Otsego County, a pastoral landscape of rolling hills and narrow creek valleys. Barreto lives on a dead-end road, a single street with pastureland on both sides. The downstairs waiting room looks like it could be anywhere in rural Americaa row of identical burgundy chairs against a pale beige wall, kids art hanging above.

In early December 2021, two of Barretos neighbors make an appointment. April Gates and her spouse Judy Tator are both in their 70s. They live around the corner. A friend joined them for Thanksgiving dinner and subsequently came down with Covid. Two weeks later, neither woman has symptoms and both got negative results with at-home tests. But theyre worried. Theyve come to take PCR tests, plus get a blood pressure check for Tator.

You dont have to be symptomatic. Its never bad to get tested if youve had a positive exposure, says Barreto. Are we being overly precautious? Maybe. But particularly with your cardiac history, youre at higher risk.

I worry most about giving it to someone else, Gates says. Thats the biggest thing.

New York State has an estimated 20.2 million residents. Two years into the pandemic, over one quarter of the population has had Covidmore than 5 million cases and more than 71,000 deaths, according to the state department of health. In the first six months of the pandemic, New York hospitals were overwhelmed with more Covid patients than beds. While they've continued to be overstretched, thelimiting factoris staffing. A similar situation has played out across the country: Medical personnel have quit in record numbers, according to the U.S. Bureau of Labor Statistics. Turnover rates were four times higher for lower-paid health aides and nursing assistants than physicians, peaking in late 2020, JAMA reported in April.

The problems are most acute in rural areas that were already chronically understaffed. We have a health care shortage in the county, in the region, says Amanda Walsh, director of public health for Delaware County, just across the river from Otego. Walsh and her nursing staff averaged 12 hour days, seven days a week, for all of 2020. It was an insane amount of time, she says. The hours only eased after the state established phone banks with remote contract tracers, and Walsh started sending her team home by six, even though the work wasnt done.

In Barretos office, after 40 minutes chatting with Gates and Tator about their health concerns, Barreto swabs both patients, walks them out, and then calls a courier to pick up the tests. While he waits, he pulls up the Otsego County webpage. The Covid dashboard shows 7,235 total cases, and the county recently broke its record for most active cases, at 386. Before December, that number had never climbed above 300.

Barreto swivels away from his desk. In the first months of Covid, he says, medical systems that were already dysfunctional simply fell apart. Commuting to Albany on empty highways, hed pass a digital DOT sign reprogrammed to read: Stay home, save lives. He took the message to heart, wondering, he recalls: What is my role as a health care provider? Because we're expected to put ourselves in harm's way to help people. The problem is we didn't know what to do to help them.

For 15 years working in hospitals, Barreto had been dissatisfied with how he saw patients treated. He notes two problems. One is getting access in a reasonable amount of time. And two is continuity of care, he says. The ongoing relationship is key, someone who knows your full story, he says, because thats what your medical history is, its a story.

When Covid hit, he adds, things only got worse.

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With each successive wave of Covid, the disease spikes in cities and then rolls out to rural areas. Towards the second half of 2020, both case rates and mortality rates were highest in rural counties, according to USDA researchespecially those only with communities of 2,500 people and under. The study pinpointed four contributing factors: older populations, more underlying health conditions, less health insurance, and long distances from the nearest ICU.

In December, omicron followed the same pattern, peaking in New York City two weeks before it really hit Otsego County, says Heidi Bond, who directs the countys department of public health. By early January, active cases in Otsego County shot up to 1,120 before the county abruptly stopped reporting the data. The health department was swamped, Bond says, and it was not possible to get an accurate number with the limited contact tracing and case investigation that is being done.

Sparsely populated regions like central New York, which have smaller health departments and hospitals, are easily overwhelmed during surges, says Alex Thomas, a sociologist at SUNY Oneonta who studies rural health care. Otsego County has fewer than 10 public health staff working on Covid, and 14 ICU hospital beds. Neighboring Delaware County has no ICUs.

In a 2021 study of New York public health staff, Thomas and his team found that 90 percent felt overwhelmed by work, and nearly half considered quitting their jobs. A survey from the Centers for Disease Control and Prevention of about 26,200 public health employees found similar results, with anxiety, depression, PTSD, and suicidal ideation among the fallouts. Thomas predicts dire consequences: We have a serious public health emergency, and there's nobody to take care of it.

Covid revealed long-term flaws in the system, and Barreto predicts the U.S. health care system will eventually collapse on itself. Bond has a more positive perspective: Health care is stronger now after the trial by fire, largely because we know a tremendous amount more than we did two years agoabout Covid, but also about how to help institutions adapt to evolving medical needs.

Before Covid, Bond adds, public health was certainly not a priority at the state or local level. Few elected officials wanted to invest enough or plan for providing robust care for a future crisis. Establishing better partnerships with community organizations let her team overcome these funding deficiencies. Having those in place moving forward, you know, things will happen much more quickly, she says, because we know who to reach out to, to just lend us a hand.

In Otsego County, dealing with the fallout of Covid became a community effort. Volunteers sent up a local Facebook group to share information and services; it quickly had more than 1,000 members. The local hospital organized an ad hoc County Health and Wellness Committee that met biweekly on Zoom. And between 50 and 100 locals representing medicine, public health, and social service agencies, non-profits, and churches exchanged information and ideas and then stepped up to help, says Cynthia Walton-Leavitt, a pastor at a church in Oneonta.

Still, Bond says she worries that public opinion will hamper her departments ability to prepare for the future. What I worry about is the fatigue, the kind of mental fatigue of Covid, she adds. We can't let our guard down.

***

Before Christmas, Barreto drives about 15 minutes to Oneonta to see his own doctor. Oneonta is the biggest city in six counties with 13,000 residents and has the closest hospital to Barretos home practice.

Barreto brings a list of questions, knowing how hard it can be to squeeze out answers from his doctor in the allotted 15 minutes. There are always two agendas. There's your agenda as a doctor, why you wanted to see the patient, he says. And then there's a patient's.

After his appointment, Barreto grabs breakfast and then heads to his first house call of the day. He says he enjoys making home visits like an old-time country doctor. He crisscrosses three counties to see patients, 50 miles in any direction, and gives them his cell number, encouraging them to call whenever they need him. He sees two or three people per daycompared to eight to 15 in former hospital jobs.

Barreto guides his minivan to the interstate and then climbs out of the valley to visit Al Raczkowski, age 88. A former combat medic, Raczkowski still struggles with PTSD, has partial heart failure and some dementia, and requires weekly visits from nurses and therapists through a palliative care agency.

The family has no yardthe hemlocks grow right to the door. Barreto knocks then peeks in. Raczkowski stands in his semi-finished basement wearing a winter coat. Hes not wearing his hearing aid so Barreto shouts: Al, is Maureen here? Do you know why I came?

Raczkowski sits down on a futon. You're here to check on me, he says. With that, Barreto gets to work. The room is crowdedfirewood and tools jumbled by a woodstove, cardboard boxes, cases of soda and seltzer. A miniature Christmas tree stands on one table, an unfinished instant soup cup on another. Barreto unearths a stool and sets up his laptop beside the soup.

Do you remember why were wearing these masks? Barreto asks. Raczkowski isn't sure. Remember about Covid? Were wearing these masks to prevent spreading disease. Raczkowski nods.

Maureen, Al's wife, appears and shuffles to a seat. For the next hour, the three converse as Barreto performs his examination, mostly asking Raczkowski questions that Maureen answers. How are things with the care agency? Without their help I dont even think we would be here, Maureen tells him. Living on this mountain for 76 years. The nurses give Raczkowski showers, check his blood pressure and vitals, and keep him company.

Barreto asks how the medication is going. Its OK, Raczkowski says, but youd do better with a bottle of brandy.

Maureen complains about her husbands other health care. She drove him 80 miles to the Albany VA to try his new hearing aid, only to learn it had been mailed. As for the new psychiatrist? She closed our case, Maureen says. An appointment scheduled for September never happened, she adds, and no one ever answered her phone calls.

After Raczkowskis appointment, back in his car, Barreto vents frustration: If you look at a hospital system, and you count the number of medical personnel, versus the number of administration, there's a skew that shouldn't be there. All that oversight, he adds, doesn't help your relationship with your patient. It doesn't help them get the medicine.

Then he winds back down the mountain road to his next appointment.

See more here:
On Three Different Continents, Rural Health Strains under the Weight of the Coronavirus - Scientific American

Within the serene greenery of Burlingtons landscape lies an intimate yet vibrant campus that is the fifth-oldest university in New England, after Harvard, Yale, Dartmouth, and Brown. This is the University of Vermont (UVM), a top research university championing multidisciplinary learning at all levels of study. Here, ideas and opportunities flow dynamically between student and faculty, enhanced by its stunning natural landscapes that foster some of the countrys brightest minds.

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Taking the reins in innovation, UVMs Larner College of Medicine has been at the forefront of reimagining a holistic approach to healthcare for generations. Since its founding in 1822, this seventh-oldest medical school in the US is ranked first nationally in active patient care and primary care physicians per capita, and is home to over 300 graduate students across multiple branches of medical studies.

With the University of Vermont Medical Centre on campus, students benefit from a vast network of clinical programmes and services firsthand, which they will repeatedly interact with throughout their studies. The direct student-faculty engagement is key to foster an immersive and experiential environment for cultivating advanced clinical and research skills.

For instance, the Master of Science in Pharmacology offers a thesis-based degree option where experimentation in areas such as cardiovascular regulation and medicinal chemistry can be conducted in any pharmacology-focused lab within the university. The faculty also train doctoral students in cross-disciplinary programmes such as neuroscience or cellular, molecular and biomedical sciences.

The college-town environment of Burlington and close-knit research community at the university encourage greater interactivity among students for dynamic idea exchange. Source: Graduate College, the University of Vermont

The result of this collaborative nature in disseminating knowledge speaks for itself: students go on to write award-winning original theses, while faculty members are inducted into prestigious scientific academies such as the National Academy of Sciences and the American Association for the Advancement of Science (AAAS).

Aside from the Doctor of Medicine (MD) qualification, the college is home to other cutting-edge graduate programmes in health sciences. If youre keen on pursuing your passion to the fullest, the doctorate programmes at the college can prepare you for promising futures in academia, industry, or governmental work.

The 100% online Master of Public Health takes population health beyond pathology to explore larger issues shaping policies and crisis interventions to tackle current and emerging challenges in healthcare disparities. Theres also the option to pursue graduate certificate courses if you cant commit to long-term study. Earn a more thorough understanding in fields such as epidemiology and professional end-of-life care to progress to the next rung of your career ladder within the sector while surrounded by a close-knit scientific community.

Actionable science starts here

Part of the solution in improving patient care access starts with training adept and compassionate health practitioners. UVM has all the tools and expertise in its arsenal to consistently push the boundaries of medicine for the betterment of collective wellbeing through evidence-based studies.

The Graduate Colleges health-based programmes not only conform to the most current development in scientific research; theyre also humane in practice, putting patients needs as a top priority in delivering efficient and quality care. It may be science that drives UVMs trailblazing achievements in healthcare, but its empathy that makes all the difference in a patients healing journey.

To join a team of outstanding healthcare practitioners at the Graduate College, click here.

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University of Vermont: Advancing healthcare through impactful medicine - Study International News

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If you find a lump in your breast, don't delay -- see your doctor as soon as possible. Anything you notice that's different from your normal breast tissue should be investigated. The good news is that more than 80 percent of breast lumps turn out to be benign tumors or cysts.

How can my doctor tell whether a lump is cancerous?

If a breast exam, mammogram, or follow-up ultrasound turns up a suspicious mass in your breast, you may want to have a biopsy -- a procedure in which a doctor takes a small tissue sample from the lump and a pathologist looks at it under a microscope. That's the only way to be sure whether a lump is cancerous. There are a number of different biopsies you can get, and each procedure has its pros and cons. An excisional biopsy (removing the whole lump) should be definitive, but it is also a more invasive procedure. A needle or core biopsy (in which fluid or tissue are extracted) may be quick and only needs local anesthesia, but also may require a follow-up biopsy since it more easily misses cancer cells. Afterwards, even if the biopsy is negative, the lump should be followed -- and removed if it grows or changes.

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If it's not cancer, what could it be?

In addition to the many kinds of completely harmless breast lumps, there are some that may slightly increase your risk of getting breast cancer in the future and a few that may not be cancer but should be removed anyway. Here's a guide to some of the most common types of breast lumps and what you should do about them.

Most breast lumps are caused by fibrocystic breast changes, also known as benign breast disease or mammary dysplasia. In spite of the intimidating names, this condition is harmless. At least half of all women have it at some point, usually during their childbearing years.

Some of the lumps are solid, and some are fluid-filled cysts. (A cyst may form when one of your milk ducts becomes blocked.) No one knows what causes these changes in the breasts, but estrogen and progesterone, the hormones that control the menstrual cycle, can make lumps or cysts more prominent or painful during the week before your period begins. You may feel one lump or many. Some women say their breasts feel like bags of peas; others don't feel the lumps at all.

These masses usually show up on both mammograms and ultrasound scans. To determine whether a suspicious lump is fibrocystic rather than cancerous, your doctor may need to do a biopsy. If the lump is a cyst, the fluid can be drained with a needle and syringe in the doctor's office. Having fibrocystic changes may slightly increase your risk for getting breast cancer. In rare cases, the cells from a fibrocystic lump show some precancerous changes called atypical hyperplasia, a condition that may increase your chance of developing breast cancer. How big a risk atypical hyperplasia presents depends on a woman's other risk factors -- family history and age of first pregnancy among them. If you have this condition, you may want to talk to your doctor to see if a preventative course of tamoxifen would be appropriate for you. Also discuss with your doctor how often you should have breast exams and mammograms.

Not all women have pain or other symptoms as a result of fibrocystic changes. Some women do find that their symptoms improve when they cut back on caffeine and salt or take diuretics, although studies have found no benefit from this. Some physicians recommend vitamin E or capsules of evening primrose oil. If your symptoms are severe, ask your doctor about the prescription drugs danazol (Danocrine) and bromocriptine (Parlodel), but be aware that they're expensive and can have serious side effects. Particularly bothersome lumps that don't respond to any of these treatments can be surgically removed.

A movable lump that feels like a marble in your breast may be a fibroadenoma. This is a benign mass made up of both connective and glandular tissue (tissue from the milk ducts and glands). Fibroadenomas are most common in women who are in their 20s and 30s. Some are too small to feel; others may be several inches across. Doctors sometimes recommend that you have this kind of lump surgically removed to make sure that it's not cancerous, even if the biopsy was negative. Some studies show that women with fibroadenomas have a slightly increased risk of getting breast cancer later on.

Rarely, a lump may turn out to be a phyllodes tumor. Most often benign, this kind of lump also consists of both connective and glandular tissue, but the connective-tissue cells may have started to grow too fast. Most of the time you'll have the lump removed, along with a roughly one-inch margin of healthy breast tissue. It's important to have a clear margin of normal tissue because, even when they're benign, these tumors have a high rate of local recurrence. In very rare cases, the lump will be malignant, and you may need to have your breast removed.

If you notice a bloody discharge from your nipple, you may have an intraductal papilloma -- usually a small growth in a milk duct behind the nipple. If the lump isn't large enough to be felt, a ductogram may be needed. This is a mammogram that's taken after liquid is injected through the nipple into the milk duct. On the x-ray, the location of the liquid shows whether the duct contains a mass. A papilloma is usually removed, along with a segment of the milk duct. Ductoscopy, a technique for directly visualizing the inside of the duct using tiny scopes, is now used to aid in the diagnosis and treatment of bloody nipple discharge. The technique allows the doctor to see the growth before it's removed so that less of the duct needs to come out with it.

A firm, movable lump measuring half an inch to an inch across may be a granular cell tumor. These masses are very rare and almost always benign, but they should be removed anyway. Having one doesn't make you more likely to get breast cancer.

A lump that develops after you've had surgery, a breast injury, or radiation treatment may be caused by fat necrosis, or scar tissue overlying an area of fatty tissue that has been damaged. Its firmness makes it difficult to distinguish from cancerous lumps by feel. Sometimes, instead of forming scar tissue, the damaged fat cells die and release the fat inside, which collects to form an oil cyst. This can be drained with a needle and syringe.

If a lump is soft and diffuse, it's likely to be a lipoma, a pocket of fat that's become encased in scar tissue. Lipomas are soft and mobile nodules that are usually surrounded by a thin connective tissue capsule. They feel like fatty pillows in the breast. They can be mistaken for cancer if they're particularly firm, but a biopsy will sort things out. Lipomas are quite common and aren't dangerous at all. They don't increase your chances of getting cancer or need to be removed.

American Cancer Society. Benign Breast Conditions: Not All Lumps Are Cancer.

American Cancer Society. What Are Risk Factors for Breast Cancer? American Cancer Society. For Women Facing a Breast Biopsy.

Johnson C. Benign breast disease. Nurse Pract Forum. Vol. 10(3):137-44.

Ziegfeld CR. Differential diagnosis of a breast mass. Lippincotts Prim Care Pract. Mar-Apr;2(2):121-8.

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Retiree Active lifestyle walking outdoors

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Experiencing arthritis and inflamed joints with age is common among adults, but according to a new study, one routine part of your day could help battle these conditions. Recent research published in Wiley Online Library noted that walking could keep knee pain at bay for those with osteoarthritis. Dr. Grace Hsiao-Wei Lo, an assistant professor at Baylor College of Medicine in Houston and the lead author on the study, says this finding symbolizes "a paradigm shift," as "this highlights the importance and likelihood that interventions for osteoarthritis might be something different, including good old exercise."

The team of researchers came to this conclusion after surveying over 1,000 people over the age 50 who had knee osteoarthritis, starting in 2004. The scientists found that the participants had varying experiences with pain; some had discomfort from the start and others did not. Over the course of four years, the people who had constant knee pain and walked as a form of exercise cut their risks of experiencing new structural damage or stiffness around these joints.

Related: Taking 7,000 Steps Each DayInstead of the Previously Recommended 10,000Can Help Reduce Heart Disease Risks

The participants' physical progress was studied by X-ray, which showed the state of the joint. From there, the researchers told the participants to document their exercise routines and checked in on their pain-related symptoms during visits. After the study period, 37 percent of the volunteers who didn't walk for exercise (this didn't include baseline trips, like running errands) experienced new knee pain. Only 26 percent of those who did walk ended up developing consistent knee pain.

Research from this study also proves how walking can be a preventative tactic for inflammatory conditions. Ultimately, Dr. Lo recommends that those who are at risk for developing knee osteoarthritis take a daily walk to ward off symptoms. Plus, this simple tactic has benefits for other areas of the body. The new study notes that walking can help ease pain in other joints, as well, specifically the hips, hands, and feet.

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Do You Suffer from Knee Pain Due to Inflammation or Arthritis? Taking More Walks Will Help, a New Study Shows - Yahoo Life

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Murine typhus is spread by fleas living on vermin such as rats and mice.

Flea-borne typhus has been found in northwest Auckland after three locals were hospitalised with the rare disease.

This type of typhus also known as murine typhus is usually carried by vermin, such as rats and mice, and spreads to humans and other animals via infected fleas living in the animals fur.

Dairy Flat Veterinary Clinic was notified of the outbreak on June 3, after a family in the Kaukapakapa area told clinic staff the stray kittens they had treated were carrying the disease.

Dr Angela Matthews, a vet at the clinic, said the cases were connected to two adults in the family and their employee who had handled the kittens while trying to rehome them.

READ MORE:* Auckland rabbit owners ordered to get rid of 300 pets after neighbours complain* Plea for Australian government to declare mouse plague a natural disaster* Overgrown, rat infested vacant site a fire hazard, neighbours warn

The family told the clinic because they were very worried about the disease being in the area and wanted locals to be aware of it, Matthews said.

The three have been released from hospital and are recovering at home.

Animals do not become sick if they have murine typhus, but humans do.

When the family first brought the stray litter into the vet clinic, they were told to check the kittens did not have toxoplasmosis, Matthews said.

Toxoplasmosis is an unrelated infection caused by parasites found in cat faeces and, in humans, has similar symptoms to murine typhus.

Supplied

The best way to prevent murine typhus is to keep your pets flea and worm treatments up to date.

The best way to avoid being infected by murine typhus or other diseases carried by fleas, is to make sure all of your animals are up to date with their flea and worm treatments.

Preventative medicine should be the first step, not just for your cats but rabbits and dogs too, Matthews said.

This treatment is not only for keeping your pets well, but their owners and the community who might come into contact with them.

Matthews said it was important to set up vermin controls, especially if you have old sheds or barns, where rats or mice are likely to live.

This is not the first time an outbreak of murine typhus has occurred in the Kaukapakapa and Helensville area, with a few cases popping up in 2010.

SPCA/Supplied

Helensville locals were infected by murine typhus due to handling stray kittens that had not been treated for fleas.

There can be years between the cases, so people sometimes forget that infection is a possibility, Matthews said.

An Auckland Regional Public Health Service (ARPHS) spokesperson confirmed it was notified of a probable case of murine typhus in early June, and that others from the same household were "suspected of having the illness.

The symptoms of murine typhus can include fever, headache, malaise, swollen lymph nodes, sore muscles and a rash, the spokesperson said.

ARPHS advised locals to keep tight lids on rubbish and compost bins, wear gloves if handling sick animals, and use insect repellant if you are spending time outside.

Department of Conservation/Supplied

Dr Angela Matthews said it is important for locals to have vermin controls in place.

Matthews said anyone who started to develop symptoms should let their doctor know if they had recently handled a stray animal, or been in contact with vermin.

People are infected with the disease can be very sick for a number of weeks, she said. The best course of action is swift diagnosis followed by prompt treatment.

Matthews said the threat of murine typhus did not mean locals could not handle strays or help rehome them, but they should be aware of the disease.

STUFF

In 2019, one pest bugged New Zealanders more than most. Here's how to stop it in its tracks.

The first thing to do is to flea [the animals], but do not bring them into your home, Matthews said.

Be cautious if you find them in a shed or a barn where there is likely to be vermin living in. Get them into an area that is easy to clean.

ARPHS said cases in murine typhus in Auckland are rare, with the most recent case before this outbreak recorded in 2017.

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Flea-borne typhus outbreak puts three Aucklanders in hospital - Stuff

At-home COVID-19 tests results have no reporting system, creating a challenge for experts to track accurate COVID-19 case counts.

SEATTLE The Washington State Department of Health (DOH) said only a fraction of COVID-19 cases are being reported to the state.

This is making it difficult for health experts to predict when a new surge of infections is coming.

At-home COVID-19 tests are easy, accessible and free through the federal government.

But the experts who study COVID-19 trends said at-home tests create inaccuracy with data.

We are definitely missing cases, said Dr. Helen Chu, Associate Professor at UW Medicine Department of Epidemiology

A vast majority of positive COVID-19 cases are not reported to the state, Chu said.

We are probably only capturing 10% of positive cases through the reporting," Chu said.

In a statement to KING 5, the DOH said due to at-home testing and other factors (such as people not testing at all) cases reported likely only represent approximately 15% of infections in Washington.

According to Chu, this makes it hard to predict when a new wave of cases is headed our way.

So people still look at the dashboards and they say, you know, the numbers don't look that high," Chu said. "They look like they may be going down. But that's because we don't have the data."

Now, instead of case numbers, the department of health is using hospitalization data to understand COVIDs prevalence.

At this stage in the pandemic, our focus has though shifted away from case counts and towards hospital capacity as a key indicator of the health of the state," DOH said in a statement.

Chu said UW Medicine is using the same metrics but argues the system has its flaws as well.

Hospitalizations only go up one to two weeks after the numbers of cases in the community go," Chu said. "So, we can track it, but we are probably a couple of weeks delayed in identifying an oncoming surge. I think that we missed the boat here with not developing a system to mandate capture of home antigen test data.

To report a positive COVID case from an at-home test to the state, call the COVID-19 hotline at 1-800-525-0127.

Even with the difficulty in reporting cases, the state still recommends at-home COVID testing, along with other preventative measures, the agebct said in a statement:

Along with vaccination, wearing a mask, hand washing, and physical distancing, frequent at-home testing can help you protect your families and friends, and is a great way to help in the fight against COVID-19. We recommend testing if you are feeling sick, think you may have been in contact with someone with COVID-19, are planning to attend a gathering or large event, or are traveling. Households across the state are eligible to receive free COVID-19 tests from the Department of Health through our Say Yes! COVID Test initiative. This is in addition to the Federal initiative. Households can place two orders each month, which includes up to 10 free tests per month. Orders can be submitted online via sayyescovidhometest.org or the DOH COVID Hotline."

If someone does test positive for COVID it is important to stay home and continue to take all precautions necessary to keep you and those around you safe.

People can also report their test results from an at-home test via the DOH hotline.

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'We are definitely missing cases:' Just a fraction of COVID-19 cases reported in Washington - KING5.com

Nurses have the potential to play a significant role in preventive care by helping people live longer and healthier lives

Published: Thu 12 May 2022, 9:00 AM

Undoubtedly, caring for the sick is one of the purposes of healthcare. But creating a growing population of sound and healthy individuals is inarguably more impactful. Medicine and healthcare are thus, no longer about only curing diseases; they must prevent diseases.

Throughout history, as societies advanced, medicine and healthcare progressed, and populations exploded, leading to rising disease statistics, a new reality dawned on humanity: we must return to the age-old truth of preventative medicine.

Preventive medicine is not a new concept; on the contrary, its in-built and an intrinsic aspect of medicine, and it is the best way to build healthier societies. One of the finest promoters of preventive healthcare are nurses, whose role has evolved through the decades, from focusing on disease management to actively promoting disease prevention. And its easy to understand why.

Nurses are central to a patients ecosystem. Through the vulnerable period of sickness, a patient exhibits a high dependency on a nurse in all matters. Nurses are the first base, the constant point of contact, and the go-to resource throughout a patients journey back to health. They offset patients vulnerabilities by always being in close communication.

It wont be an exaggeration to say that many patients lack the knowledge to navigate healthcare services. They are anxious, stressed, and uncertain about how to seek information about their illness. A nurses constant supervision, empathy and guidance opens many avenues for patients to share and unburden their concerns.

Modern-day nurses are trained to educate patients in numerous ways. They use evidence-based information, observation, and insights gained from experience to counsel patients on proactive self-care. Their advisory can range from disease prevention, medication protocols, disease risk mitigation, diet, nutrition, the importance of follow-ups and health plan details and information on services. This educational approach is used for both daycare patients and in-patients, as nurses initiate preventive health discussions, contributing to raising community-wide health awareness.

As they interact across the demographics spectrum, nurses are highly tuned to spot high-risk disease patterns in different communities. It is an invaluable skill that promotes preventive healthcare and helps it fulfil its mission of offering medical assistance and an emotional and socio-cultural lifeline to individuals.

In the modern world that facilitates medical tourism and acknowledges multiculturalism as a social staple, a nurses innate skill to be sensitive to a patients background, culture, and socio-ethnic values is a tremendous asset. It is a core competence that promotes preventive health because cultural norms significantly influence an individuals attitude to health and beliefs, and understanding them is the key to empowering them.

However, we would not be amiss if we view these contributions by nurses as not just skills but as investments that create a lasting patient-provider trust that transforms a patients life. This trust enables patients to cross over from disease to health and keep moving ahead and not looking back.

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Promoters of Preventive Health A Key Role in Nursing - wknd.

North Korea's first-reported Covid-19 outbreak is the "greatest turmoil" to befall the country since its founding more than 70 years ago, according to its leader Kim Jong Un, as the isolated and impoverished nation scrambles to curb the spread of a highly transmissible virus that risks causing a major humanitarian crisis.

North Korea reported 21 more deaths and 174,440 new "fever cases" Friday, according to state media KCNA, though it did not specify how many of the deaths and cases were linked to Covid, likely due to the country's extremely limited testing capacity.

The climbing death toll and surging "fever cases" come after North Korea said Thursday it had identified its first ever case of Covid-19 -- an alarming development for a country with one of the world's most fragile public health systems and a largely unvaccinated population.

But given the opaque nature of the regime and the country's isolation from the world -- a trend that has only exacerbated since the pandemic -- it is extremely difficult to assess the real situation on the ground.

Foreign diplomats and aid workers had fled North Korea en masse in 2021 due to shortages of goods and "unprecedented" restrictions on daily life, making it all the more impossible to obtain information from the country other than through official state media.

But North Korean state media reports have been vague, and many important questions remain unanswered, including the country's vaccine coverage and the lockdown's impact on the livelihood of its 25 million people.

Here is what we know, and what we don't know about the outbreak:

North Korean authorities have not announced the cause of the outbreak.

North Korea's borders have been tightly sealed since January 2020 to keep the virus at bay, making the so-called "hermit nation" even more isolated from the world. It even declined invitations to send teams to compete at the Tokyo and Beijing Olympics, citing the threat of Covid-19.

And as new variants began to emerge, it stepped-up those efforts, cutting off nearly all trade with China -- the country's biggest trading partner and economic lifeline for the Kim regime -- with imports from Beijing dropping 99% from September to October 2020.

It remains unclear how the virus slipped through the country's tightly-sealed borders.

When KCNA reported on the first identification of Covid-19 in the country on Thursday, it did not even specify how many infections had been defected. It simply said samples collected from a group of people experiencing fevers on May 8 had tested positive for the highly contagious Omicron variant.

By Friday, KCNA was reporting that 18,000 new "fever cases" and six deaths were recorded on Thursday, including one who tested positive for the BA.2 sub-variant of Omicron.

"A fever whose cause couldn't be identified explosively spread nationwide since late April," the newspaper said. "As of now up to 187,800 people are being isolated."

On Saturday, KCNA said a total of 524,440 people had reported "fever" symptoms between late April and May 13. Among them, 280,810 people were still being treated in quarantine, while the rest had recovered.

An outbreak of Covid-19 could prove disastrous for North Korea. The country's dilapidated health care infrastructure and lack of testing equipment is unlikely to be up to the task of treating a large number of patients with a highly infectious disease.

North Korea's lack of transparency and unwillingness to share information also poses a challenge.

North Korea has never formally acknowledged how many died during a devastating famine in the 1990s that experts suggest killed as many as 2 million. Those who fled the country at the time shared horrific stories of death and survival, and a country in chaos.

"North Korea has such a limited supply of basic medicine that public health officials need to focus on preventative medicine. They would be ill-equipped to deal with any kind of epidemic," Jean Lee, director off the Hyundai Motor-Korea Foundation Center for Korean History at the Washington-based Woodrow Wilson Center, told CNN at the outset of the pandemic.

Doctors who have defected in recent years often speak of poor working conditions and shortages of everything from medicine to basic healthcare supplies.

Choi Jung-hun, a former physician in North Korea who fled the country in 2011, said when he was helping to combat a measles outbreak in 2006 to 2007, North Korea did not have the resources to operate round-the-clock quarantine and isolation facilities.

He recalled that after identifying suspicious cases, manuals for doctors said patients were supposed to be transferred to a hospital or a quarantine facility for monitoring.

"The problem in North Korea is that manuals are not followed. When there wasn't enough food provided for the people at hospitals and quarantine facilities, people escaped to look for food," Choi said during an interview with CNN in 2020.

North Korean state media declared the situation a "major national emergency" upon admitting the first officially reported Covid infection.

On Thursday, Kim placed all cities into lockdown and ordered "people with fever or abnormal symptoms" into quarantine; he also directed the distribution of medical supplies the government had reportedly stocked in case of a Covid emergency, according to KCNA.

Kim later chaired a meeting of the country's powerful politburo, which agreed to implement "maximum" emergency anti-epidemic measures. The measures include isolating work units and pro-actively conducting medical checkups to find and isolate people with "fever and abnormal symptoms," the KCNA reported Friday.

"Practical measures are being taken to keep the production going at a high rate in the major sectors of the national economy and to stabilize the life of the people to the maximum," KCNA said.

According to KCNA, the politburo criticized the country's anti-epidemic sector for "carelessness, laxity, irresponsibility and incompetence," saying it "failed to respond sensitively" to increasing Covid-19 cases across the world, including in neighboring regions.

A reporter for Chinese state media CGTN released a rare video from Pyongyang on Friday, recounting his experience on the ground.

"As far as we know, not many people in Pyongyang have been vaccinated, and the medical and epidemic prevention facilities are in short supply," reporter Zang Qing said in a Weibo post.

"Because the capital is in lockdown, the food I have at home is only enough for a week. We are still awaiting what policy the government will announce next."

At a meeting Saturday, Kim inspected the country's emergency epidemic measures and medical supplies. He also urged North Korean officials to learn from China's "advanced and rich quarantine results and experience they have already achieved in their fight against the malicious infectious disease," according to KCNA.

North Korea is not known to have imported any coronavirus vaccines -- despite being eligible for the global Covid-19 vaccine sharing program, Covax.

Assuming most North Koreans are unvaccinated, an outbreak in the country -- which has limited testing capabilities, inadequate medical infrastructure and which has isolated itself from the outside world -- could quickly become deadly.

Calls are mounting on the country's leadership to provide access to vaccines.

"There is no evidence to show that North Korea has access to enough vaccines to protect its population from Covid-19. Yet, it has rejected millions of doses of AstraZeneca and Sinovac vaccines offered by the WHO-led Covax program," said Amnesty International's East Asia researcher Boram Jang, in a statement.

"With the first official news of a Covid-19 outbreak in the country, continuing on this path could cost many lives and would be an unconscionable dereliction of upholding the right to health."

In February, Covax reportedly scaled back the number of doses allocated to North Korea because the country failed to arrange for any shipments, according to Reuters.

A spokesperson for Gavi, the Vaccine Alliance, said Covax has moved to "needs-based vaccine allocations" and "has currently not committed any volume" for North Korea.

"In case the country decides to start a Covid-19 immunization program, vaccines could be made available based on criteria of Covax objectives and technical considerations to enable the country to catch up with international immunization targets," the spokesperson said.

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Instagram accounts dedicated to the topic of glucose and the intersection of skin, hormones and fatigue are few and far between. However, biochemist and author Jessie Inchausp, otherwise known as @glucosegoddess, is the exception.

Inchausp has been educating her 515,000 followers on balancing blood sugar since 2019 with clever graphs and visuals to make metabolic health digestible. A few years ago, before she started, people didnt seem to care about their glucose levels but times have changed.

Today, an array of tests and continuous glucose monitors on the market are measuring metabolism and providing valuable insights to inform more than just the rise and fall of blood sugar levels.

According to the Global Wellness Institute, preventive and personalized medicine and public health is a $575 billion-dollar market. This sector includes expenditures on medical services that focus on treating well people, preventing disease, or detecting risk factors for example, routine physical exams, diagnostic and screening tests and genetic testing.

That said, a slew of brands like Lumen, Levels, and Everlywell are utilizing continuous glucose monitors, devices, apps and diagnostic testing to give users the opportunity to gain insight into their metabolic health.

Personalized medicine is the future, said Chika Okoli, MD, founder of functional medicine practice, Re-well. And metabolic health encompasses our overall health. Its what connects all of our systems together, whether its our hormone system, the health of our cells, our digestive system, our central nervous system and our brain health.

Lumen, a handheld, portable breathalyzer that measures the bodys carbon dioxide concentration, is meant to help indicate the type of fuel the body is using to produce energy. The app then provides a personalized nutrition program on when and what to eat based on the users metabolism.

Until now, the health and wellness industry has been experiencing a major lack of data and real-time insights in the nutrition sphere, said Michal Mor, founder and chief of metabolic health at Lumen. Our goal is to take the guesswork out of what or when you should eat and how you should exercise on a daily basis from moment to moment.

Trendalytics reported that metabolism searches for Lumen as a brand are up 13 percent.

By understanding how your body reacts to what you eat and how you exercise throughout the day, you can give your body exactly what it needs, added Mor. Essentially, we are teaching your body how to better fuel itself and function properly for life.

Similarly, Levels, an app that leverages a continuous glucose monitor, provides real-time feedback on how diet and lifestyle choices impact metabolic health. There are so many different health conditions related to glucose, said Dr. Casey Means, Levels cofounder and chief medical officer. Were focused on the root cause approach at Levels, which is if you can stabilize your glucose and increase your metabolic health, it can have multifarious positive effects on different parts of the body. For example, for someone who is trying to get on top of their acne or their wrinkles, by stabilizing their glucose and improving their glycemic variability and their metabolic health, they are going to be on a similar path to someone who may be trying to stabilize blood glucose.

Lara Briden, naturopathic doctor and author, agrees that insulin resistance is a well-known driver of breakouts, and with perimenopause, most women will experience a greater risk of insulin resistance. Not everyone that has insulin resistance will get bad skin, but its a common risk because in women, insulin increases testosterone, but not in a good way, she said. So thats the classic [polycystic ovary syndrome] picture. And during menopause, its safe to say that will accelerate aging to some extent, wrinkles and things like that, but its not the only factor.

More recently, Levels added a new service, offering users the ability to have a phlebotomist come to their home and draw blood to do a series of lab tests, $179, that aim to provide understanding and a more comprehensive picture of metabolic health.

Its the tests that your doctor is probably not going to order, but the research shows they are really important for metabolic health, said Means. For example, a fasting insulin test, which is something that most people have never had before. Itll also have some standard things like a full cholesterol panel and a fasting glucose test, a hemoglobin A1C, but also inflammatory markers. Then youre able to get these labs reported through your Levels app. And what weve done is work with our advisory board to create content, showing people what the optimal ranges for these tests are and how to interpret the labs in a really nuanced way, as opposed to the very generalized feedback we often get from the doctors office.

Everlywell, too, believes in the importance of understanding more about an individuals metabolism by testing three different hormones, cortisol, free testosterone and thyroid-stimulating hormone. One thing that I always emphasize is we are one part of a solution, said Julia Cheek, chief executive officer and founder of Everly Health. We are not the full suite. And its really important that we take part in responsibility in helping people navigate toward next steps or other solutions as necessary. Metabolism specifically, is responsible for daily energy, daily mood, how you feel and how you show up in the world every day. Five years ago, people talked a lot about metabolism solely related to weight.

Okoli echoed that sentiment and believes the best approach to beauty is from the inside out. I based my training that most skin conditions are inflammatory and metabolic health is very closely tied to inflammation, she said. Glucose causes inflammation and sugar causes inflammation. So when youre eating those foods and your body sees that as stressful, youre getting inflammation from a couple of different sources, which can exacerbate a skin condition.

Because metabolic health is linked to hormones, Veracity makes it its mission to test five hormones that are scientifically linked to specific skin conditions. Were focused on hormones from a skin perspective, said Allie Egan, founder and CEO of Veracity. We are not specifically giving you all the details into your metabolic health. We cant really do that through what were measuring or what were focused on. But were taking a whole health approach and helping to push the study between these connections and giving our customers some resources and insights into things that they can be doing to improve this as well. If you have more balanced hormones, youre going to have better skin. Youre going to have a better metabolism. Youre going to have better digestion.

Trendalytics reported that searches for hormonal health are up 7 percent to last year. Hormonal health is becoming a part of the larger conversation of wellness, said Kristin Breakell, content manager at Trendalytics.

One thing to keep in mind about blood sugar is lots of things affect it, added Briden. Stress affects it, how much sleep youve had. Its a lot of data that you dont quite know what to do with.

Enter Hearty, a digital clinic that offers a tailor-made health program providing in-depth health insights through in-home testing and monitoring. The $500-a-month membership comes with a slew of wearables like the Oura Ring and a continuous glucose monitor by Dexcom, in-home testing, a concierge medical team, and an app to track progress and aggregate information.

Metabolic health is a big issue right now and how it impacts daily life, said Dr. David Luu, MD, founder of Hearty. We gather what you eat, the impact of what you eat on your health, how you sleep, your stress, how you exercise, your body composition, combined with all the different genetics, and understanding where you start and where you can optimize. The less inflammation, the better your skin, the better metabolic flexibility, the better body composition, the better lipid panel, the better sleep. And so we monitor that. Thats why we use wearables to keep people accountable, but to show results.

Last year, a study came out of the University of North Carolina that showed 88 percent of Americans are metabolically unhealthy. This means only 12 percent of Americans are healthy metabolically, noted Okoli, which translates clinically into things like obesity, high blood pressure, and cardiac cancer. So we cannot talk about hormone health, metabolic health, and blood testing without talking about what were eating and its effect.

Top 3 Takeaways:

1: Doctors are linking inflammation, often caused by different foods, with skin conditions.

2: A new crop of companies has emerged aiming to give people more insight into their metabolic health through glucose monitors, devices, apps and diagnostic testing.

3: Consumers are willing to spend on preventative medical services preventative and personalized medicine and public health is a $575 billion market, according to the Global Wellness Institute.

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Heres what you need to know about the Paxlovid antiviral drug, monoclonal antibodies and other COVID-19 treatment options.

In late April, the White House announced that it was increasing access to Paxlovid, an antiviral pill manufactured by Pfizer, as well as other COVID-19 treatments.

As more contagious COVID-19 variants emerge and cases are on the rise in parts of the United States, interest is spiking in Paxlovid, monoclonal antibodies and other treatments.

The conversation on social media has turned specifically to Paxlovid. Some people have said the drug is reserved for high-risk patients, while others are discussing reported cases of relapse in COVID-19 symptoms after a course of the drug.

VERIFY explains the facts about Paxlovid and other COVID-19 treatments.

THE SOURCES

FAST FACTS

Paxlovid authorized for high-risk patients:Paxlovid, an antiviral pill manufactured by Pfizer, is authorized for emergency use by the FDA for treatment of mild to moderate coronavirus disease in adults and patients 12 and older who are at high risk for severe COVID-19. This includes people with common conditions like asthma, diabetes, high blood pressure and depression, among others.

Potential COVID-19 relapse after Paxlovid: Federal health agencies are investigating reports of relapse in COVID-19 symptoms after a course of Paxlovid. Its unclear right now what might be causing this, but health experts still say the pill is effective at reducing COVID-19 symptoms and rates of hospitalization.

Second antiviral pill: Molnupiravir, manufactured by Merck, is the second antiviral pill authorized for emergency use to treat COVID and its available to people ages 18 and older who are at high risk for severe COVID-19.

Monoclonal antibody treatment:Some people with mild to moderate COVID-19 illness may also qualify for treatment with monoclonal antibodies, which are given intravenously soon after a person develops symptoms.

PAXLOVID

In December 2021, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization for Pfizers Paxlovid, the first antiviral drug to treat COVID-19. Its available by prescription only and should be started as soon as possible after a COVID-19 diagnosis and within five days of symptoms.

The entire idea is to catch it [COVID] when it's early. It can kind of start off as a sniffle ora body ache, and then progress. And its usually that week later where people get extremely sick and hospitalized, said Shira Abeles, M.D., an infectious disease specialist at the University of California San Diego.

The drug is given as three tablets taken together twice daily for five days, for a total of 30 tablets. It is not authorized for use for longer than five days in a row, according to the FDA.

When applying for FDA authorization, Pfizer presented clinical trial data collected before omicron took hold in the U.S. that showed unvaccinated people who took the drug were 89% less likely to be hospitalized or die from COVID-19 compared to people in the placebo group.

A study published by the New England Journal of Medicine in March 2022 also found that the ingredients in Paxlovid are similarly effective against the omicron variant compared to other variants of concern.

If youre prescribed Paxlovid, two of the pills in your three-pill dose will be nirmatrelvir, which inhibits the SARS-CoV-2 protein from replicating, infectious disease experts at Yale Medicine explain. The other pill is ritonavir, a drug that was once used to treat HIV/AIDS, but is now used to boost levels of antiviral medications.

As a COVID-19 treatment, ritonavir essentially shuts down nirmatrelvirs metabolism in the liver, so that it doesnt move out of your body as quickly, which means it can work longer giving it a boost to help fight the infection, according to Yale Medicine experts.

Paxlovid is authorized for the treatment of mild to moderate coronavirus disease in adults and patients ages 12 and older who are at high risk for progression to severe COVID-19, including hospitalization and death, the FDA said.

But the risk factors that qualify someone to receive Paxlovid include some common medical conditions, in addition to more serious or rare ones.

The Centers for Disease Control and Prevention (CDC) lists medical conditions on its websitethat make a person more likely to get very sick with COVID-19, including cancer, chronic kidney or liver disease, and heart conditions. Other more common medical conditions like moderate to severe asthma, diabetes and high blood pressure, mood disorders like depression, and being overweight or obese also make someone more likely to get very sick with the virus.

The full list is available online but may not include all conditions that put someone at higher risk of severe coronavirus illness.

Adults ages 50 and older are also more likely to be hospitalized or die from COVID-19, especially if they are unvaccinated, according to the CDC.

The FDA says health care providers should consider the benefit-risk for an individual patient when prescribing Paxlovid.

Paxlovid has not been used to treat pregnant or breastfeeding people, but the benefit of taking the drug may be greater than the risk from treatment for a mother and unborn baby, according to the FDA.

Does Paxlovid have side effects?

Common side effects of Paxlovid include an altered sense of taste, diarrhea, high blood pressure or muscle aches.

Are people relapsing after taking Paxlovid?

In a blog post for the New England Journal of Medicines Journal Watch, contributing editor Paul Sax, M.D., documented a case where his patient with HIV relapsed, meaning her COVID-19 symptoms returned, after taking Paxlovid. The patient had more nasal congestion, cough and fatigue not as bad as when the illness started, but unmistakably a relapse, Sax wrote.

The patients at-home COVID-19 test was also positive again after her symptoms returned, meaning its safe to assume she was still contagious, Sax added.

The National Institutes of Allergy and Infectious Diseases (NIAID) confirmed there are anecdotal reports of cases where the amount of virus in a person increased after finishing a course of treatment with Paxlovid. NIAID said the reports are being evaluated by the FDA and that agency will share additional recommendations on this topic, if appropriate.

A spokesperson for Pfizer said the company believes the viral rebound is unlikely to be related to treatment with Paxlovid, and we remain very confident in its clinical effectiveness at preventing severe outcomes from COVID-19 in high-risk patients.

MOLNUPIRAVIR

Molnupiravir, manufactured by Merck, is the second antiviral pill authorized by the FDA for emergency use. It should be started as soon as possible after COVID-19 diagnosis and within five days of symptoms.

The drug is given as four capsules taken every 12 hours for five days, for a total of 40 capsules. It is not authorized for use for longer than five consecutive days.

An interim analysis in 2021 found that Molnupiravir reduced the risk of hospitalization and death by about 50%, according to Merck.

How does Molnupiravir work?

When Monulpiravir enters a persons bloodstream, it blocks the ability of the virus that causes COVID-19 to replicate, Albert Shaw, M.D., Ph.D., a Yale Medicine infectious diseases specialist, explained.

Who can take Molnupiravir?

The drug is authorized for adults 18 and older who are at high risk for progression to severe COVID-19, including hospitalization or death. Its use should also be limited to situations in which other COVID-19 treatments such as Paxlovid "are not accessible or clinically appropriate, according to the FDA.

The drug is not authorized for people under the age of 18, and it isnt recommended for pregnant people because it could cause fetal harm.

Does Molnupiravir have any side effects?

Health experts say possible side effects of the drug include diarrhea, nausea and dizziness. Some allergic reactions have also been reported.

MONOCLONAL ANTIBODIES

What is monoclonal antibody treatment?

In February 2022, the FDA authorized a monoclonal antibody treatment called bebtelovimab. The treatment, made by Eli Lilly, is given intravenously soon after a person develops symptoms.

This treatment should also be used when others approved or authorized by the FDA are not accessible or clinically appropriate.

The U.S. Department of Health and Human Services (HHS) said in February that two other monoclonal antibody treatments another made by Lily and one made by Regeneron are highly unlikely to work against omicron. Early data suggest that bebtelovimab works against the omicron variant and omicron subvariant BA.2, according to HHS.

Who can receive monoclonal antibodies?

Bebtelovimab can be used to treat adults and children over the age of 12 who are not in the hospital, have mild to moderate COVID-19 symptoms, and who are at risk for severe COVID-19 or hospitalization, like Paxlovid.

PREVENTATIVE MEDICATION

Is there a preventative medication for COVID-19?

Some people ages 12 and older might be eligible for a preventative medication for COVID-19 called Evusheld, which has received emergency use authorization from the FDA.

Those who might qualify include moderately or severely immunocompromised people who might not have an adequate immune response to the COVID-19 vaccination or have had a history of allergic reactions to vaccines.

According to the CDC, the preventative medication contains two different antibodies that can help prevent COVID-19 and must be given before youre exposed to COVID-19.

What should you do if youre not at high risk of severe disease and test positive?

If you have COVID-19 and your doctor has told you to recover at home, you should get plenty of rest, stay well-hydrated, and take acetaminophen, ibuprofen or naproxen to reduce aches and pains.

Despite concerns earlier in the pandemic, it is safe to take ibuprofen and naproxen when you have COVID-19 and the CDC recommends the medications. Additionally, the World Health Organization (WHO) says there is no evidence ibuprofen has any negative effects for people with the virus.

The VERIFY team works to separate fact from fiction so that you can understand what is true and false. Please consider subscribing to our daily newsletter, text alerts and our YouTube channel. You can also follow us on Snapchat, Twitter, Instagram, Facebook and TikTok. Learn More

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VERIFY Fact Sheet: COVID-19 treatments - VERIFYThis.com