I have lots of people to thank, but I’d like to start with those of you who’ve been regular readers of Second Opinion. Over the years, I’ve had thoughtful e-mail exchanges with many of you, and I’ve also read with interest all the comments that you posted at the end of my articles. Early on, I realized I would not be able to respond to every comment (I simply didn’t have the time), but I did read and learn from them. Many of the points you made helped to inform what I wrote the next time I covered the topic.

From the beginning, I wanted Second Opinion to be an evidence-based column, one that looked at what the actual scientific evidence had to say on issues related to consumer health. That focus on evidence became my lodestar each day as I chose the next topic to write about.

And just for the record: In all the years I’ve written the column, no editor — nor anyone else — ever told me what to leave in or leave out. I selected the topic of each column. I also decided how I would approach it. Admittedly, I didn’t always make the best decision (some of the research I wrote about didn’t hold up in future studies), but the responsibility lies fully with me.

I have worked with many wonderful, talented people at MinnPost, but I am especially indebted to Susan Albright, my exceptionally skilled and steady long-time editor, and to Corey Anderson, who managed (with a sense of humor) every morning to come up with photos and other images for articles that often didn’t lend themselves to any kind of visuals.

I want to particularly thank, however, Laurie and Joel Kramer, who had the vision and courage to launch a nonprofit online newspaper in 2007, right in the midst of the Great Recession. I am grateful for having been part of this remarkable adventure in journalism. It’s been quite a journey.

Not surprisingly, the doctors also report a huge increase in telehealth (the delivery of health care through phone or video calls) since the start of the pandemic. A large majority of the doctors say this alternative to in-person visits is meeting the needs of their patients, and most believe its use should continue.

Minnesota’s doctors are worried, however, about how the next wave of the COVID-19 pandemic will affect the delivery of care to their patients, as well as the survival of their medical practices.

These are some of the key findings from a study, “Minnesota Physicians Respond to COVID-19,” released Wednesday by the Minnesota Medical Association (MMA). For the study, a representative group of 641 Minnesota physicians were surveyed between June 16 and July 13, 2020. (A second survey reported on in the study was completed by 92 medical practice administrators.)

“Given how quickly the health care world is changing during this pandemic, we realize these results are just a point in time,” says Dr. Keith Stelter, president of the MMA, in a released statement. “But they do confirm a lot of what we’ve been hearing anecdotally — even for patients without COVID-19, their health is suffering, the pandemic has accelerated use and acceptance of telehealth by both patients and physicians, and there are serious concerns about what happens with the next wave.”

Poorer outcomes

In the survey, 53 percent of the physicians reported that delays in medical care had resulted in some of their patients experiencing adverse health outcomes. Almost one in five (19 percent) said patients had delayed routine or preventive care, and a similar share (17 percent) said their patients feared seeking care because of the potential of being exposed to the COVID-19 virus.

Five percent of the doctors reported that these delays in care had led to a patient’s death.

“Patients are afraid to come back for visits, testing, etc. I am concerned that people may not be getting the care they need,” said one of the surveyed doctors. “Also, there are patients on clinical trials that are hesitant to come back for visits, so this is impacting clinical research.”

“Several elderly patients have put off their patient appointments and had significant worsening of their pain issues,” said another. “Also, many had injections for pain rescheduled and are having increased use of opioids due to worsening pain.”

A surge in telehealth services

The survey also revealed that telehealth services grew by 833 percent since the start of the pandemic. In 2019, only 3 percent of doctor-patient encounters in Minnesota were “virtual” visits.  In March 2020, that proportion jumped to 28 percent.

More than 80 percent of the physicians surveyed indicated that their patients are satisfied with receiving medical care this way and that it is meeting their patients’ needs.

“Most of what we do is talk to people,” said one doctor. “Telehealth is a lot like doing house calls. I am a guest in their home, and the patient is much more comfortable. I hear the sounds of their life. Many of my elderly patients have difficulty leaving their homes.”

“It is odd for us all not to be face to face,” he added, “but it is fine. I think that many people are also learning that much of what they consider ‘urgent’ is not.”

“We’re glad to see the expanded use of telehealth,” says Stelter. “However, not all patients can currently access it. Many Minnesotans don’t have access to broadband. Variation in technology platforms can also drive patient comfort and use. For telehealth to be truly helpful everyone needs to have the ability to use it effectively. This is yet another example of the health care disparities that exist in Minnesota.”

Other concerns

A large majority of the surveyed doctors said they were worried about whether their medical practice or the organization for which they work will be able to financially withstand a second wave of the virus.

“More than a third of administrators and physicians noted the need for additional financial support should Minnesota experience a second wave of COVID-19,” the report points out. “They also highlighted the need for more PPE, payment parity for in-person and telehealth services, and clear communication, policies, and plans from government and organization leaders.”

Overall, the state’s medical practices saw the volume of their services and their revenue decline by more than 45 percent between March 16 and May 10, compared to the same period last year, the survey revealed.

As for how Minnesota’s physicians view government responses to the pandemic, the verdict is missed. A large majority (80 percent) rate the Minnesota government’s response to COVID-19 as “good” or “very good.”

And the federal response? Three quarters (76 percent) of the physicians said it has been “poor” or “very poor.”

FMI:  You can read the MMA report on the survey on the organization’s website.

Each year, on average, about 3,700 visits to hospital emergency rooms for respiratory problems by people aged 65 and older can be attributed to thunderstorms, the study estimates.

That’s not a trivial number. And it’s likely to grow. As the study’s authors point out, global warming is expected to increase the number of severe thunderstorms in the United States in the coming years.

This is not the first evidence of the phenomenon that has been dubbed “thunderstorm asthma.” Several places — most notably, Melbourne, Australia, in 2016 — have reported rare outbreaks of asthma in the immediate aftermath of a thunderstorm. The outbreaks are sometimes so large that they’ve overwhelmed the local health care system. They’ve also led to deaths.

Events on that scale have not been reported in the United States, but the authors of the current study — a team led by economist Eric Zou of the University of Oregon — were curious to see what happens regarding respiratory illnesses in the U.S. during the days surrounding a thunderstorm. They focused on older adults on Medicare (those aged 65 and up) because of their detailed health records.

Study details

For the study, Zou and his colleagues used two sets of data: 1) health information collected from 46.5 million Medicare beneficiaries during the period 1999-2012 and 2) weather data amassed by the National Oceanic and Atmospheric Administration for all 3,127 U.S. counties during those same years. The data revealed more than 22 million visits to hospital emergency rooms for asthma or COPD by the Medicare beneficiaries and more than 822,000 days of thunderstorms in the various counties. (Thunderstorms were defined by the presence of lightning and rain, accompanied by strong, or above-average, winds.)

The weather data showed typical atmospheric changes before and after the thunderstorms, including a rise in temperature and in the amount of tiny particulate matter (PM 2.5) circulating in the air on the day before the storms. Pollen counts, on the other hand, as well as levels of nitrogen dioxide, ozone, sulfur dioxide and carbon monoxide, were unchanged before the storms and dropped afterward.

The Medicare data showed a modest, but statistically significant, increase in emergency department visits for both asthma and COPD in the days leading up to a thunderstorm. These visits peaked on the day before the storm, with an average of 1.8 additional hospital visits per million people.

Over the 14-year period of the study, those visits added up. The study estimates that about 52,000 extra hospital visits for asthma and COPD occurred because of the thunderstorms — or about 3,700 per year, on average.

As a “control,” the researchers also looked to see if a relationship existed between thunderstorms and either sepsis or pulmonary embolism, two medical conditions with no known relationship to stormy weather. As expected, they found none.

Limitations and implications

It’s been proposed that large “thunderstorm asthma” outbreaks, such as the 2016 one in Melbourne, result from heavy rain rupturing pollen grains, whose tiny particles then get swept up by the wind and inhaled by susceptible people, causing asthma. In the current study, however, emergency room visits for breathing problems peaked on the day before the thunderstorm. That finding suggests that the mechanism behind the thunderstorm-related U.S. cases was not rain-released pollen.

The cases were more likely linked to the rises in temperature and tiny particulates that occurred before the storms, say the study’s authors. Both factors are already known to exacerbate respiratory illnesses like asthma and COPD.

Of course, the study is observational, so it can’t prove a direct link between thunderstorms and increased incidents of hospital visits for respiratory illnesses. In addition, the study involved only older Americans, so its results may not be generalizable to younger populations or to older people living in other countries.

Still, the findings are intriguing — and yet another reminder of how global warming is impacting our health.

“While big thunderstorm asthma outbreaks are fortunately rare, we shouldn’t forget that daily, routine fluctuations in the content of the air we breathe — in this case, around/before storms — affect health in ways that can add up,” wrote pulmonologist Dr. Christopher Worsham, one of the study’s co-authors and a health services researcher at Harvard University, in a Twitter post.

“Our health is tied to our environment,” he added.

FMI:  The study, which was published as a research letter, can be found on the JAMA Internal Medicine website, although the full paper is behind a paywall.

Last June, Chinese researchers at Yangzhou University reported that the strong turbulence caused by flushing a toilet sends a cloud of tiny aerosol particles from the waste and water in the toilet spewing into the air. Using mathematical modeling, the researchers determined that up to 60 percent of those ejected particles travel above the toilet seat. Within 35 seconds, some reach a height of almost 3 feet and may linger in the air for up to 70 seconds.

But toilets aren’t the only concern. Last week, the same group of researchers reported similarly “alarming results” regarding urinals. Using the same type of mathematical modeling, they found that 57 percent of the tiny aerosol particles ejected by flushing a urinal leave the urinal. The particles then quickly reach a height of 2.75 feet, or, as the authors put it, the height of a man’s thigh.

How quickly? Within 5.5 seconds, which is seven times faster than occurs after a toilet is flushed.

Both studies were published in the journal Physics of Fluids, which is published by the American Institute of Physics.

‘A challenge to public health’

There’s more than just an “eew” factor involved here. Previous research has detected the COVID-19 virus (SARS-CoV-2) in stool and urine samples. And although you are much less likely to become infected with COVID-19 by this form of transmission (inhaling a cloud of infected particles from a flushed toilet or urinal) than you are by inhaling the respiratory droplets generated by an infected person’s breathing, coughing and sneezing, the authors of the new study urge people to take precautions. They claim that China has documented a handful of cases in which people became infected from a public toilet.

“Wearing a mask should be mandatory within public restrooms during the pandemic, and anti-diffusion improvements are urgently needed to prevent the spread of COVID-19,” says study co-author Xiang-Dong Liu of Yangzhou University, in a released statement.

“It can be predicted that in public restrooms, especially those in densely populated areas, urinals are used more frequently and particles will travel faster and fly farther, which poses a great challenge to the public health,” add Liu and his colleagues in their latest paper.

Keep hands clean, too

Of course, you should also avoid touching surfaces as much as possible in a public restroom, as infected aerosol droplets, whether from a flushed toilet or a person’s cough, may have contaminated some of the room’s surfaces. A study published last spring in the New England Journal of Medicine found that SARS-CoV-2 can live in a laboratory on stainless steel and plastic surfaces for several days, although it’s not entirely clear that the amounts that survive on such surfaces in a “real world” environment would be enough to get someone sick.

Good hand hygiene — washing your hands with soap and water for at least 20 seconds or using a hand sanitizer comprised of at least 60 percent alcohol — is strongly recommended in public restrooms, as it is everywhere else. Such practices can easily destroy the COVID-19 virus, as well as other unwanted pathogens.

Practice social distancing in restrooms, too.

FMI: You can read both the “toilet” and the “urinal” studies in full on the Physics of Fluids website.

People also tend to express more trust in a new acquaintance who shares their political leanings than in a long-time friend who doesn’t, the study found.

The study’s findings support what anecdotal accounts and various surveys have already suggested: In our current highly polarized political climate, maintaining friendships across political lines has become challenging.

“Friendships are important in life,” write the study’s authors, psychologists Elana Buliga and Cara MacInnis of the University of Calgary. “They are associated with greater well-being, including heightened positive affect and physical health benefits.”

“Uncovering factors — such as political group membership — that may influence friendship is therefore important,” they add. “Our results provide some potential reasons for why cross-political [friendships] are not more common.”

Past research has suggested that many Americans — on both the left and the right — are pretty intolerant toward those with different political persuasions. That appears to have become particularly true in recent years. In a Reuters/Ipsos poll taken shortly after Donald Trump was elected president in 2016, significant shares of respondents said the election had caused them to stop talking to a family member or close friend (16 percent), block a family member or close friend from social media (17 percent) or end a relationship with a family member or close friend (13 percent).

On the other hand, one in five (20 percent) of the respondents said the election had led them to become friends with someone they had not been friends with previously.

“In the light of these recent accounts and the well-established positive influence of friendships on well-being, we were interested in how political group membership discoveries influence friendship outcomes, especially in a highly polarized political climate,” write Buliga and MacInnis.

Study details

For their study, the researchers recruited 70 Republicans and 142 Democrats (109 men and 103 women) through the online research platform TurkPrime (now known as CloudResearch). Almost 75 percent of the participants were white, and about 87 percent had more than a high school education. Their average age was 34.

After indicating the political party with which they identified, the participants ranked their social and economic views on a scale from “very Liberal” (0) to “very Conservative” (10). Other questions asked them to indicate how important their political orientation was to them (from “not important at all” to “extremely important”) and how favorably or unfavorably they felt toward members of various political parties.

They were also asked if they had any romantic partners, friends, relatives, coworkers or supervisors who held different political views than theirs and how much they discussed politics with those people.

The participants were then presented with four separate vignettes. In one they were asked to imagine meeting a friendly stranger at a social event (similar in age to them and with mutual interests) who shares their political views. In another vignette, the situation was similar, except the new acquaintance turns out to hold political views that oppose theirs.

In the final two vignettes, participants were asked to imagine a close friend whose political views are unknown to them. (If they did not have such a friend, they were asked to imagine that they did.) In one scenario, the friend reveals that they agree with the participant’s political views. In the other, the friend discloses that their political ideology is on the opposite end of the spectrum.

Participants were asked to describe how excited, happy, pleased, satisfied, surprised, upset, anxious, worried and threatened they would feel in each of the four situations. They were also asked to indicate how much they would trust the stranger or friend upon learning of their political beliefs and how hopeful they were about the friendship lasting for many years.

Key findings

The study found that the participants generally expressed more positive emotions toward people who shared their political views (“in-group members”) than those who didn’t (“out-group members”). They also had more trust in politically like-minded people than they did in people with different political bents, and were more likely to believe that their friendships with the like-minded people would last.

In addition, the participants expressed more negative emotions about people — both potential and established friends — who didn’t share their political beliefs.

In fact, the participants were more positive — and less negative — in all these regards toward strangers who shared their political views than toward close friends who didn’t. That finding may be because people have much more invested in their close friendships, which makes learning that the friend doesn’t agree with them politically “a particularly jarring surprise,” say Buliga and MacIness.

“Overall, results were consistent for Republicans and Democrats,” the researchers add. “These findings are in line with previous research where Democrats and Republicans were found to not differ in their likelihood of avoiding the political out-group.”

Limitations and implications

This study comes with important caveats. Most notably, the researchers had no way of knowing whom the participants were imagining in the vignettes about friends. They asked people to think of a close friend, but “it could be argued … that if one does not know their close friend’s political views then that, by definition, is not a close friend,” the researchers write.

The study also examined the participants’ immediate reactions to the four situations. If people had been given a longer time to reflect, they may not have expressed such negative emotions when they imagined learning that a friend had different political views.

It’s also important to point out that plenty of people are able to maintain friendships, family relationships — and even marriages — with people who disagree with them politically.

Still, the findings underscore how strongly politics influences our friendships.

“Our results suggest that political orientation is important in friendships,” Buliga and MacInnis conclude. “In many cases, political group membership mattered even more for expected friendship outcomes than length/closeness of the friendship. … Thus, discoveries of political out-group membership may lead to friendship dissolution.”

FMI:  You’ll find an abstract of the the study on the Journal of Social and Personal Relationships website, but the full study is behind a paywall.

Although the study linked other factors — such as a family history of asthma, a mother who smoked during pregnancy and a low household income to the risk of having asthma during childhood, it identified air pollution as a separate and significant contributor to the disease.

These findings “support emerging evidence that exposure to air pollution might influence the development of asthma,” the study’s authors conclude.

Asthma is one of the most common diseases among children worldwide. It causes airways to become inflamed and narrow, making it difficult to breathe. In the United States, about 6 million children (one in 12 young people under the age of 18) have asthma. Young Black Americans are at particular risk. About 16 percent of Black children in the U.S. have asthma, compared to 7 percent of white children.

Study details

For the study, a team of Danish researchers led by Torben Sigsgaard, a professor of environmental and occupational medicine at Aarhus University, analyzed medical data on more than 3 million children born in Denmark between 1997 and 2014. Before reaching the age of 15, almost 123,000 of those children had developed asthma or persistent wheezing. Most (83 percent) began showing symptoms before their third birthday.

The researchers then compared this information — which of the children developed asthma and which didn’t — to air pollution measurements taken at the children’s residential addresses, as well as to other factors associated with an increased risk of developing asthma: parental asthma, maternal smoking, parental education and household income.

They found that the strongest determinant of whether a child developed asthma or persistent wheezing was having a parent with the disease. “This was expected, as genetic disposition is recognized as a strong risk factor for the development of asthma and allergy,” Sigsgaard and his co-authors write.

Maternal smoking during pregnancy also increased the likelihood that a child would develop asthma, as did having parents with a low income and a low level of education. Children of parents with high incomes and high levels of education, on the other hand, were less likely to have the disease.

Again, these findings were not surprising. “Health behaviour related to socioeconomic status — physical activity, diet, alcohol consumption, smoking, and health care — are suggested to be among the underlying drivers for the development of asthma,” the researchers point out.

Sigsgaard and his co-authors then turned to the air pollution data. They found that children exposed to higher levels of air pollution were more likely to have asthma or persistent wheezing than those who weren’t exposed, even after accounting for the other risk factors.

That link was most robust for exposure to fine particulate matter (PM2.5). These pollutants are quite tiny, with a diameter of less than 2.5 micrometers — or about 3 percent of the diameter of a human hair. When inhaled, they can penetrate deep into the lungs, causing both short-term inflammation and long-term damage.

PM2.5 particles come from a variety of sources, including motor vehicles, power plants, airplanes, residential wood burning, forest fires and dust storms. The current study found that the association between air pollutants and asthma was more pronounced for local rather than distant sources of PM2.5 pollution.

Limitations and implications

The study is observational, so it can’t prove a direct link between air pollution and asthma in children. The data used by the researchers also lacked information about the lifestyle of the children and their families — factors that may influence the development of asthma.

Still, the study’s results are in line with those from other research on this topic, including a 2017 meta-analysis that identified exposure to traffic-related air pollution as a major risk factor for childhood asthma.

Together, these results “suggest that further reductions in PM might help to reduce the number of children who develop asthma and persistent wheezing in highly exposed populations,” write Sigsgaard and his co-authors.

FMI: You can read the study in full on the BMJ’s website. For more information about asthma and children, go to the American Lung Association’s website.

The lifetime risk of being killed by a gun in the United States is slightly greater than that of being killed in a motor vehicle crash. One out of every 109 Americans will die in a motor vehicle crash during their lifetime, the study also found.

These statistics aren’t really new. They’re based on death data previously released by the Centers for Disease Control and Prevention (CDC) for the year 2018. But by presenting the data as cumulative lifetime risks (“one out of every 108 Americans”) rather than as large absolute numbers (“39,740 firearm deaths”) or as small annual rates (“12.1 firearm deaths per 100,000 population”), the study’s author — Dr. Ashwini Sehgal, a professor of medicine at Case Western Reserve University — hopes to make a point.

He wants people to grasp the real meaning behind the numbers: the tragic — and all-too-common — impact that firearm and overdose deaths have on individuals, their families and the broader society.

“While absolute numbers and annual death rates describe mortality over a short period of time, lifetime risk tells us more about long-term consequences,” he says in a released statement.

Translating the data

According to the CDC, 2.8 million Americans died in 2018, including 67,367 from drug overdoses, 39,740 from gun injuries and 39,404 from injuries incurred as a result of a motor vehicle crash. Seghal used that data to estimate the cumulative risk of death from birth to age 85 for each of those three causes.

He found that those risks are substantial and vary considerably by gender, race, ethnicity and state.

Black men are most likely to die of a gunshot wound during their lifetime (one in 38), followed by white men (one in 69), Native American men (one in 79), Hispanic men (one in 115) and Asian-American men (one in 260).

Women are much less likely to be killed by a firearm, although the rates are still grim. The lifetime risk of a gun-related death is one in 287 for Black women, one in 374 for white women, one in 411 for Native American women, one in 802 for Hispanic women and one in 1,225 for Asian American women.

Drug overdoses kill Black and white men in the U.S. at similar rates. One in 44 Black men and one in 47 white men will die of an overdose during their lifetime, according to the Sehgal’s estimates. Among women, whites are far and away the likeliest to die of a drug overdose (one in 88), followed by Native Americans (one in 106), Blacks (one in 118), Hispanics (one in 245) and Asian-Americans (one in 617).

Native American men are most at risk of dying in a motor vehicle crash during their lifetime (one in 77), while Asian-American women are the least likely (one in 291).

State numbers

The lifetime risks also vary greatly across states. People living in Mississippi have the greatest risk of dying from a gunshot (one in 59), while those living in Massachusetts have the lowest (one in 351). For Minnesotans, the risk is relatively low compared to most of the other states: one in 161.

Residents of West Virginia are at the greatest risk of dying from a drug overdose during their lifetime (one in 28 — more than twice the national average), while those living in South Dakota have the lowest risk (one in 196). For Minnesotans, the risk is again relatively low: one in 117.

Mississippians have the highest lifetime risk for death from a motor vehicle crash (one in 57), while New Yorkers have the lowest (one in 239). The risk for Minnesotans is one in 142.

Seghal says he thought about the study’s findings regarding his own state — Ohio — when he recently toured a newly constructed elementary school near his home.

“I had a hard time concentrating on the gleaming whiteboards, the new computers, or the cheerfully decorated walls,” he recalls. “I realized that one child on every floor of the school would likely die from firearms and another one from a drug overdose in the years ahead.”

“If I were across the border in West Virginia, then one child per classroom will have their life ended by an overdose,” he adds.

Limitations and implications

The study assumes that death rates in the coming years will be similar to those in 2018 — an assumption that may under- or overestimate the actual future risk. Also, as Seghal points out in his paper, “The lifetime risk estimates in this analysis are average values, and different individuals may have substantially lower or higher risks.”

Still, the findings are in line with previous research that has looked at demographic differences in death rates from drug overdoses, firearms and motor vehicle crashes, including a 2015 study that found men in the U.S. were six times more likely than women to die from gun-related injuries.

Sehgal hopes his findings will not only educate the public about these mostly preventable deaths, but also prod policymakers to take steps to reduce them, such as by implementing background checks and waiting periods for gun purchases and by increasing access to substance use treatment and needle exchange programs.

He also urges health care providers to talk about gun safety with their patients and to practice more responsible prescribing of opioid medications. (More than 70 percent of overdose deaths in the U.S. in 2018 involved either prescription or illicit opioids.)

The study’s lifetime risk predictions are not inevitable, Sehgal stresses. But to change the trajectories of those predictions, we must get our death rates down.

“Let’s take sensible steps now to help our children avoid the preventable tragedies of firearm and overdose deaths,” he says.

FMI:  You can read the study in full at the American Journal of Medicine’s website.

When people have COVID-19, the loss of smell tends to be sudden and severe, the study found. And, unlike with the cold or flu, the symptom does not usually occur in tandem with a stuffy or runny nose. Most COVID-19 patients who lose their sense of smell continue to breathe freely through their nose.

Perhaps even more significantly, COVID-19 patients also experience a “true” loss of taste — specifically, an inability to identify bitter or sweet tastes.

These findings suggest “that there are altogether different things going on when it comes to smell and taste loss for [COVID-19] patients and people with a regular cold or flu,” says Dr. Carl Philpott, the study’s lead author and an academic surgeon at the University of East Anglia, in a released statement.

“This is very exciting because it means that smell and taste tests could be used to discriminate between COVID-19 patients and people with a regular cold or flu,” he adds. “Although such tests could not replace formal diagnostic tools such as throat swabs, they could provide an alternative when conventional tests are not available or when rapid screening is needed — particularly at the level of primary care, in emergency departments or at airports.”

Study details

The study appears to be the first to directly compare smell and taste symptoms in people with COVID-19 with those in people with upper respiratory illnesses. The inability to smell — amnosia — has become recognized as a common symptom of COVID-19 and may be experienced by as many as half of all patients who become infected with the virus.

Of course, loss of smell can also be a symptom of a bad cold or the seasonal flu. “We wanted to find out exactly what differentiates COVID-19 smell loss with the kind of smell loss you might have with a cold and blocked-up nose,” says Philpott.

For the study, Philpott and his colleagues used standardized tests to assess the smell and taste abilities of 10 COVID-19 patients (about two weeks after the onset of the infection). They then compared those results with similar assessments that had been made of 10 people with a bad cold and 10 healthy people (the “controls”).

“We found that smell loss was much more profound in the COVID-19 patients,” says Philpott. “They were less able to identify smells, and they were not able to identify bitter or sweet tastes. In fact it was this loss of true taste which seemed to be present in the COVID-19 patients compared to those with a cold.”

The patients were followed for an average of 18 days. All reported some improvement in their smell and taste by the end of that period, although only a third of the COVID-19 patients reported a complete recovery. Philpott and his colleagues write in their paper that they expect these symptoms are likely to persist in some COVID-19 patients long after they test negative for the virus. Other research has suggested that about one in 10 patients experience a long-term loss of smell or taste.

Attacks on the central nervous system

As the researchers point out, COVID-19 is believed to affect the brain and nervous system, based on some of the neurological symptoms that some patients develop.

The findings from the current smell-and-taste study seem to support that point. The olfactory (smell) receptor cells, which are located on tissue high in the nose, are connected directly to the brain.

“Our results reflect, at least to some extent, a specific involvement at the level of central nervous system in some COVID-19 patients,” says Philpott. “It is particularly interesting that COVID-19 seems to particularly affect sweet and bitter taste receptors, because they are known to play an important role in innate immunity.”

“More research is needed to see whether genetic variation in people’s bitter and sweet taste receptors might predispose them to COVID-19,” he adds, “or conversely, whether COVID-19 infection changes how these receptors function, either directly or through a cytokine storm — the over-reaction of the body’s immune system.”

A sudden loss of smell or taste is listed as a symptom of COVID-19 on the Centers for Disease Control and Prevention’s and the World Health Organization’s website. It can be one of the first symptoms of the infection. If you experience it, call your doctor and ask if you should get tested for COVID-19.

FMI: You can read the study in full on Rhinology’s website.

The study’s findings add to growing evidence of the disproportionate impact that COVID-19 is having on minority communities within the United States. To address those disparities — why non-whites are being hospitalized at much higher rates than whites — all states need to provide more detailed and consistent reporting of COVID-19 hospitalizations, the study’s authors stress.

To conduct their study, researchers used data from the U of M’s COVID-19 Hospitalization Tracking Project to identify all states that reported the race and ethnicity of individuals hospitalized with COVID-19 from April 30 through June 24. Those 12 states — Arizona, Indiana, Kansas, Massachusetts, Minnesota, New Hampshire, Ohio, Oregon, Rhode Island, Utah, Virginia, and Washington — had a total of 48,788 COVID-19 hospitalizations during that two-month period. (Recently, Florida and New Jersey have also begun to report COVID-19 hospitalization data by race and ethnicity.)

The researchers then compared the percentage of hospitalizations for five racial and ethnicity groups — white, Black, Hispanic, American Indian/Alaskan Native and Asian — with each group’s overall share of the populations in the states.

Significant disparities

“We found that different states represent different types of disparities,” said Pinar Karaca-Mandic, the study’s lead author and a health economist at the U of M’s Carlson School of Management, in an interview with MinnPost. “But there were some consistent results.”

Here are the key findings:

• In all 12 states, Blacks were hospitalized with COVID-19 at higher rates than whites. That difference was greatest in Ohio, followed by Minnesota, Indiana and Kansas. In Minnesota, blacks make up 6.8 percent of the state’s population, but represented 24.9 percent of the hospitalized COVID-19 patients in the study.
• Whites, on the other hand, made up a significantly smaller share of COVID-19 hospitalizations in all 12 states compared with their share of the population in those states. That was particularly true in Minnesota. Although whites comprise 84.1 percent of Minnesota’s population, they represented only 52.9 percent of the hospitalized COVID-19 patients.
• Hispanics were hospitalized with COVID-19 at higher rates than whites in 10 of the 11 states that reported this data. The largest disparities were in Virginia (where Hispanics comprise 9.6 percent of the population, but made up 36.2 percent of the COVID-19 hospitalizations), followed by Utah and Rhode Island. In Minnesota, Hispanics make up 5.5 percent of the state’s population, but represented 15.5 percent of the COVID-19 hospitalizations.
• American Indian/Alaska Natives were hospitalized with COVID-19 at higher rates than whites in all eight states that reported such data. The biggest disparity was in Arizona, where this group accounted for 15.7 percent of the hospitalizations, but only 4 percent of the state’s population. In Minnesota, American Indians comprise 1.4 percent of the population and represented 2.7 percent of the hospitalized COVID-19 patients in the study.
• Hospitalization disparities were less prominent among Asian communities than among other minority groups. In six of the 10 states that reported data on this group, the share of COVID-19 hospitalizations for Asian Americans was smaller relative to their population within the state. That was not true in Minnesota, however. Although Asians make up 5.1 percent of the state’s population, they represented 9.8 percent of its COVID-19 hospitalizations in the study.

Reducing the inequities

“Our data is not able to really speak to the causes of the disparities that we see, but in our opinion the disparities reflect some of the longstanding structural inequities in our health care system,” said Karaca-Mandic.

Such inequities include unequal access to health insurance and quality health care — “areas where Minnesota is vulnerable in terms of its minority populations,” Karaca-Mandic said.  As a result of these and other negative social determinants of health, individuals from minority groups tend to be more likely to have underlying medical conditions, such as heart disease and type 2 diabetes, that put them at greater risk of getting serious ill from COVID-19.

She and her U of M co-authors urge all states to report more demographic information about their hospitalized COVID-19 patients, including breaking down the data by race and ethnicity. That kind of detail can help public health officials reduce the spread of the disease — and save lives.

“It’s not an infection that is affecting everyone in the same way,” said Karaca-Mandic. “But we can now identify communities and groups that are more adversely affected and target resources more appropriately.”

FMI: You’ll find the study, which was published as a research letter, on the JAMA Internal Medicine website, although the full study is behind a paywall.

The authors of the study also estimate that one in eight early deaths in the United States may be linked to people becoming overweight or obese during early and mid-adulthood.

These findings underscore the urgent need for a “greater emphasis on treating obesity early in life,” the study’s authors conclude. For, as the researchers also point out, very few young adults with obesity — less than 1 percent — are successful at bringing their weight down by midlife.

Obesity is a major — and growing — health issue, both for individuals and for the broader society. It’s been linked to a long list of health problems, including high blood pressure, coronary heart disease, stroke, type 2 diabetes, certain cancers (including breast, colon and kidney), osteoarthritis and clinical depression. Obesity has also been linked to an increased risk of severe illness and death from COVID-19.

Currently, 40 percent of American adults — including young adults aged 20 to 39 — have obesity (defined as a body mass index, or BMI, of 30 to 34.9), and 18 percent have severe obesity (a BMI of 35 or higher). Those figures are expected to rise significantly during the next decade. Within 10 years, one in two American adults will have obesity and one in four will have severe obesity, a study published last year estimated.

Minnesota’s obesity rate is currently 30 percent — a figure that’s predicted to jump to 46 percent by 2030.

Past studies have shown that gaining excess weight during adulthood is associated with an increased risk of early death. It hasn’t been clear, however, if that risk can be significantly lowered if people who had obesity in their 20s or 30s manage to shed the weight later. The current study set out to see if it could help answer that question.

How the study was done

The researchers — a team led by Andrew Stokes, an assistant professor of global health at Boston University — used data collected from 24,205 Americans who took part in the National Health and Nutrition Examination Survey (NHAMES) between the years 1998 and 2015. When they filled out the survey, the participants were between the ages of 40 and 74. Using the survey data, the researchers calculated each participant’s BMI. They did the same for the participants’ BMI 10 years earlier and at age 25, although the data used for those calculations was self-reported by the participants.

The study followed the participants for an average of seven years, during which 5,846 of them died. The researchers then looked to see if the data revealed a relationship between BMI change and the likelihood of death during the study period.

The study found that the lowest risk of death occurred among individuals who had a weight within the “normal” range at age 25 and who maintained a weight within that range as they entered midlife (their 40s). But they also found that people whose BMIs dropped from the “obese” range at age 25 to the “overweight” range by midlife were 54 percent less likely to have died during the study period than those whose BMIs had stayed in the “obese” range.

Interestingly, a similar change in weight (from “obese” to “overweight”) after midlife was not associated with a reduced risk of early death. That finding is probably because “weight loss at an older age is often unintentional, associated with underlying health conditions and/or age-related loss of muscle mass, whereas weight loss earlier in life tends to capture changes in fat mass and is less likely to be affected by the onset of chronic diseases,” the study’s authors explain.

All these findings were calculated after the researchers controlled for other factors known to be associated with early death, such as gender, smoking and educational level.

The researchers also point out that significant drops in weights after the age of 25 were rare. Only 0.8 percent of the participants in the study switched categories from “obese” to “overweight.”

Limitations and implications

The study comes with some important caveats. Most notably, the study is observational, so it can’t prove a direct connection between BMI and early death. It also relied on the participants’ self-reports to calculate their BMIs at earlier ages. Those recollections may not have been accurate. In addition, the study did not adjust for physical activity or diet in early adulthood — or whether the weight loss was intentional or unintentional. Those variables may have influenced the findings. Another limitation is the low number of participants who lost weight between early adulthood and midlife — a factor that, as the researchers acknowledge, limits the precision of the study’s estimates.

Still, the findings are robust enough to be both troubling and hopeful. They are troubling because they suggest having obesity from young adulthood through midlife raises the risk of an early death. Today, four in 10 young adults in the U.S. have obesity. But the findings are hopeful, too, because they suggest that losing much of that excess weight — enough to get down to the “overweight” category — may cut the risk of early death in half.

“At the population level, we estimated that weight loss from obese to overweight would prevent more than 3 percent of premature deaths, and preventing weight gain from normal weight could prevent more than 12% of premature deaths,” the researchers conclude.

“Our findings support the importance of population-based approaches to preventing weight gain across the life course and a need for greater emphasis on treating obesity early in life,” they add.

FMI: The study can be read in full on the JAMA Network Open website.