This has been exacerbated by the relative ease of dissemination of unfounded and misleading theories through social media and other web-based communication outlets. It has perpetuated beliefs that led to interference with public health interventions resulting in vaccine avoidance or hesitancy, non-compliance with social distancing recommendations, mask mandate refusal, and utilisation of medications with insignificant scientific data and unproven efficacy, ultimately contributing to increased morbidity and mortality.

Several studies addressing misinformation in health care consistently show that false and misleading claims negatively influence people's attitudes towards vaccines.

A recent paper specifically looking at COVID vaccine presented findings from a global survey of 18,400 individuals from 40 countries and showed a strong association between perceived believability of COVID-19 misinformation and vaccination hesitancy. The study showed that only half of the online users exposed to rumours might have seen corresponding fact-checked information refuting the rumours. Moreover, depending on the country, between six per cent and 37 per cent of individuals considered these rumours believable.

A key finding of this research is that poorer regions were more susceptible to encountering and believing COVID-19 misinformation; countries with lower gross domestic product (GDP) per capita showed a substantially higher prevalence of misinformation.

Undoubtedly, misinformation is partly responsible for the relatively low vaccination rates in many countries which has slowed down the efforts to halt the pandemic. As at the end of October, about 13 billion doses of coronavirus vaccines have been administered around the world. While nearly 70 per cent of the world population has received at least one dose of a COVID-19 vaccine, when you look at low-income countries which include many countries in the Caribbean, Latin America, and Africa, only 23 per cent of people have received at least one dose of a COVID vaccine. More booster doses have been administered in high income countries than total doses in low-income countries.

In the English-speaking Caribbean, Latam and Africa, the story is mixed. In Trinidad and Tobago, for example, only about 50 per cent got at least one dose of the vaccine or are fully vaccinated with only about 12 booster doses for 100 residents. In Belize and Guyana, about 60 per cent of the population received at least one vaccine dose or are fully vaccinated while only about 10 doses of booster vaccines are available per 100 citizens. In Jamaica and Nigeria, less than 30 per cent of the population got at least one dose and less than 25 per cent are fully vaccinated. In both countries, there are only about two booster doses for each 100 residents. About eight countries in the Caribbean have vaccination rates less than 50 per cent. Haiti and Burundi both have less than five per cent of the population fully vaccinated and virtually no booster doses for the population.

Cuba is a remarkable Caribbean vaccination success story with nearly 400 vaccine doses per 100 people with an impressive 95 per cent of citizens receiving at least one dose and almost 90 per cent of the population fully vaccinated. About 75 doses of booster doses are available in Cuba per 100 citizens. Peru and Ecuador are also successful examples in the Latin American region with about 90 per cent of the population receiving at least one dose and about 85 per cent fully vaccinated. In Ecuador, about 90 per cent received at least one dose and about 80 per cent fully vaccinated. In Africa, Mauritius and Rwanda are breakout stories with Mauritius having about 90 per cent of the population receiving at least one dose of the vaccine and another 90 per cent being fully vaccinated while in Rwanda, 72 per cent receiving at least one dose and 70 per cent being fully vaccinated.

Despite enormous public spending and engagement, the US has just about 80 per cent receiving one dose of coronavirus vaccine and 67.5 per cent being fully vaccinated. The poor vaccination rates in many poorer countries and the relatively unimpressive vaccination rates in the USA can at least be partly attributed to misinformation.

COVID and cardiovascular risk

There is very little reliable data specific to Jamaica or the Caribbean as a region. However, as has been widely reported in the literature, novel coronavirus pandemic has significantly impacted cardiovascular health care globally. Patients with pre-existing cardiovascular disease are at higher risk of morbidity and mortality. The COVID-19 pandemic has directly caused significant excess mortality on a global scale. There is emerging evidence that cardiovascular (CV) mortality has increased during the pandemic, independent of COVID infection. This has been attributed to several factors, including patients avoiding health-care environments to avoid exposure to SARS-CoV2, redeployment of specialist health-care staff to support COVID-19 services, and reduced availability of routine investigations and procedures

Patients with pre-existing comorbidities are thought to be at an increased risk of infection with SARS-CoV2 virus and tend to have worse clinical outcomes. Specifically, patients with cardiovascular disease, diabetes and hypertension are thought to have a high complication rate with mortality rate of 10.5 per cent reported in cardiac patients and mortality rates of 7.3 per cent and 6.0 per cent for diabetes and hypertension patients, respectively. COVID-19 is believed to have contributed to 15 million new cases of heart disease worldwide.

A study published in Nature Medicine (Feb 2022) by a group from Washington University looked at data on more than 150,000 patients with COVID-19 and showed that people who have had COVID-19 are at increased risk of developing cardiovascular complications within the first month to a year after infection. Such complications include arrhythmias, myocarditis, myocardial infarction or ACS, heart failure, stroke, or death. Overall, they found that those infected with the virus were 55 per cent more likely than those without COVID-19 to suffer a major adverse cardiovascular event, which includes heart attack, stroke, and death. An earlier study by a Swedish group found strong evidence that heart attacks and strokes risk rise sharply in the weeks following a COVID-19 diagnosis. The findings were published on August 14, 2021, in The Lancet, and included about 87,000 people with a median age of 48. In that study, the week after a COVID-19 diagnosis, the risk of a first myocardial infarction increased by three to eight times. The risk of a first ischemic stroke multiplied by three to six times. In the following weeks, both risks decreased steadily, but stayed elevated for at least a month

Impact of COVID on access to cardiovascular care

Regarding access and availability of cardiovascular services, significant disruptions to access were noted globally and in the Caribbean region. At the Heart Institute of the Caribbean (HIC) and Heart Hospital, we were part of the INCAPS COVID Investigators Group that looked at the International Impact of COVID-19 on the Diagnosis of Heart Disease. Our research study which was published in in the Journal of the American College of Cardiology (JACC) in January 2021 sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practice. The study looked at data from nearly 1000 facilities in 108 countries and found that cardiovascular diagnostic services declined by 40-78 per cent depending on the procedure. In multi-variable regression analysis, significantly greater reduction in services occurred for centres in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and services. The decline in elective procedures and services was thought to be mainly because individuals chose to defer elective cases out of fear of exposure, economic impact from the pandemic and government mandated lock downs that made it difficult for individuals to attend to elective needs.

The panel noted that as the world learns to live with COVID and brace for other potential future pandemics, it is imperative that we learn these lessons from COVID and put measures in place to mitigate the outcomes and be better prepared function within the context of the new normal.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Correspondence to info@caribbeanheart.com or call 876-906-2107

2 new positive cases; 18 active cases
0 new deaths; 0 new recoveries
38,975 fully vaccinated

View the full post Covid-19 update: Grenada Dashboard 9 November 2022 on NOW Grenada.

The number of people with diabetes in the Americas has more than tripled in three decades, PAHO report says

Cristina Mitchell

11 Nov 2022

A team from the University of Oxford collected a total of 50 uncontaminated stool samples from rhesus macaques - a species of monkey - living on an island off the coast of Puerto Rico.

View the full post Minor increase in Coxsackie Virus (Hand, Foot and Mouth Disease) on NOW Grenada.

Ahora, varios estados del oeste del país, como California, buscan cambiar esta situación con nuevas políticas de inscripción continua para los miembros más jóvenes de Medicaid. La posibilidad de cambiar estas normas, vigentes por décadas, surge cuando los estados valoran los cambios causados por la pandemia.

Los legisladores de California han aprobado una propuesta —pendiente de la autorización federal— para que los niños que cumplan los requisitos para recibir Medicaid se inscriban al nacer y permanezcan inscritos hasta los 5 años, a partir de 2025.

Oregon ya ha conseguido la aprobación de una política similar. En 2023, cuando se espera que termine la emergencia de salud pública, Oregon se convertirá en el primer estado en permitir que los niños elegibles para recibir Medicaid se inscriban al nacer y permanezcan en el programa hasta que cumplan 6 años, independientemente de los cambios en los ingresos familiares y sin tener que volver a solicitarlo.

“Se trata de una medida obvia en términos de apoyo a los niños”, dijo Jenifer Wagley, directora ejecutiva de la organización Our Children Oregon. Según Wagley, mantener a los niños con cobertura —sobre todo temprano en su desarrollo— garantizará que no pierdan importantes chequeos y cuidados debido a las brechas en la cobertura.

En julio, el estado de Washington pidió permiso al gobierno de Biden para ofrecer cobertura continua a los niños hasta los 6 años, y se aguarda una decisión en las próximas semanas. Por su parte, Nuevo México ha solicitado comentarios públicos sobre un plan para mantener a los niños inscritos hasta los 6 años y se espera que solicite el consentimiento federal a finales de este año.

La inscripción en Medicaid ha alcanzado niveles récord después que el gobierno federal prohibiera a los estados dar de baja a sus miembros durante la emergencia de salud pública, a menos que murieran o se trasladaran fuera del estado. Esta norma ha contribuido a que la tasa de no asegurados del país alcance un mínimo histórico.

De las casi 90 millones de personas que reciben Medicaid y el Programa de Seguro de Salud Infantil (CHIP), unos 41 millones son niños. CHIP es un programa federal-estatal que cubre a los niños de hogares con ingresos superiores a los que se pueden acoger a Medicaid.

Joan Alker, directora ejecutiva del Centro para la Infancia y la Familia de la Universidad de Georgetown, calificó el hecho de que los estados pasen a tener períodos más largos de cobertura continua para los menores como “una consecuencia positiva de la pandemia”.

Señaló que desde el cuarto trimestre de 2020 hasta el primero de 2022, la proporción de niños sin seguro en Estados Unidos se redujo del 6,7% al 3,7%, en gran parte debido a la norma de emergencia que ha impedido a los estados dejar sin cobertura a los inscritos en Medicaid.

“Los estados tendrán que hacer mucha divulgación sobre esta nueva política para que todos los bebés salgan del hospital con seguro médico y los padres no tengan que preocuparse por la cobertura hasta que el niño vaya al jardín”, señaló Alker.

Si la emergencia de salud pública finaliza el año que viene, casi 5,3 millones de niños podrían perder la cobertura de Medicaid, según un análisis federal publicado en agosto. De ellos, alrededor de 1,4 millones saldrían de las listas porque ya no cumplen los requisitos, pero casi 4 millones de niños que reúnen los requisitos perderían la cobertura por motivos administrativos, como no haber presentado la documentación a tiempo.

Dado que los umbrales de ingresos familiares de Medicaid suelen ser más altos para los niños que para los adultos, es menos probable que los niños pierdan la cobertura por pequeños cambios en los ingresos. Pero pueden perder su derecho a la cobertura si los padres no la renuevan cada año, o no responden cuando el estado busca información para confirmar que los ingresos de la familia se han mantenido lo suficientemente bajos pra mantener la elegibilidad.

Por lo general, los inscritos en Medicaid deben informar de cualquier cambio en los ingresos de la familia u otros criterios que puedan afectar a su elegibilidad durante el año, y los estados deben actuar sobre estos cambios.

Esto supone un reto para los beneficiarios de Medicaid y las agencias estatales, ya que los ingresos de las personas suelen fluctuar. Como resultado, los inscritos pueden perder la cobertura, verse obligados a cambiar entre Medicaid y la cobertura subvencionada del mercado de seguros de la Ley de Cuidado de Salud a Bajo Precio (ACA), o experimentar brechas de cobertura si el papeleo resulta difícil de completar.

Para solucionar este problema, casi la mitad de los estados dan a los niños un año de elegibilidad continua de Medicaid, independientemente de los cambios en los ingresos familiares. Ese grupo incluye estados controlados tanto por republicanos como por demócratas, y estados como Alabama y Mississippi, que no han ampliado Medicaid bajo ACA.

Antes de pasar a la cobertura continua para los niños hasta los 6 años, Oregon les ofrecía 12 meses de elegibilidad continua. Sin embargo, los funcionarios estatales de Medicaid estiman que en 2019, antes del comienzo de la pandemia, más de 70,000 menores de 6 años —un tercio de los inscritos— entraron y salieron de Medicaid. Alrededor de 29,000 de esos niños tuvieron lagunas de cobertura que superaron los seis meses, según dijeron funcionarios estatales a KHN.

Los funcionarios de Oregon estiman que, tras cuatro años de aplicación, la nueva política de inscripción beneficiará a más de 51,000 niños en 2027, a un costo de $177 millones.

“La emergencia de salud pública ha demostrado claramente el valor de tener un seguro de salud continuo, particularmente para las poblaciones que experimentan disparidades de salud y han tenido barreras históricas para el acceso a la atención médica”, afirmó Elizabeth Gharst, vocera de la Autoridad de Salud de Oregon, que supervisa el programa estatal de Medicaid.

La garantía de seis años también reducirá los costos administrativos de Oregon, ya que no tendrá que tramitar algunas solicitudes cada año. Y los funcionarios esperan que reduzca los gastos médicos del programa, ya que los niños que permanezcan en Medicaid tendrán acceso a servicios de atención primaria y preventiva que pueden reducir la necesidad de tratamientos relacionados con los atrasos en la búsqueda de atención.

Oregon ofrece cobertura de Medicaid y CHIP a los niños de familias con ingresos de hasta el 300% del nivel federal de pobreza, que es de $83,250 para una familia de cuatro miembros.

Lori Coyner, asesora principal de políticas de Medicaid en Oregon, dijo que el cambio reducirá las desigualdades en materia de salud porque ayudará a los niños de color a conservar la cobertura y el acceso a la atención médica.

Además de mantener a los niños en Medicaid durante más tiempo, Oregon obtuvo la aprobación federal en octubre para convertirse en el primer estado en dar a los niños de 6 años o más y a los adultos dos años de elegibilidad continua, independientemente de los cambios en los ingresos de su hogar.

A nivel nacional, KFF estima que alrededor del 11% de los niños inscritos en Medicaid perdieron su cobertura durante al menos un día en 2019. El estado de Washington también reporta un 11%.

En California, funcionarios de Medicaid estiman que unos 64,000 —el 6%— de los inscritos menores de 5 años fueron retirados de las listas y luego volvieron a inscribirse en el mismo año.

Mike Odeh, director de salud del grupo Children Now de California, espera que el estado se sume pronto. “Preferiríamos que el estado pagara para que los niños recibieran atención en lugar de pagar por el papeleo”, señaló, y añadió que tener que volver a inscribirse cada año puede ser un obstáculo para las familias de bajos ingresos. “Queremos que estén sanos y preparados para la escuela”, afirmó Odeh.

El Departamento de Servicios de Atención Sanitaria de California, que supervisa Medi-Cal, calcula que el cambio de política costaría $39,1 millones en 2025, suponiendo que se aplique en enero, y $68 millones para el año fiscal 2025-26. El estado todavía está sopesando cuándo buscar la aprobación federal.

Los funcionarios de Medicaid en el estado de Washington aseguraron que hace tiempo que consideran la posibilidad de dar a los niños elegibilidad continua durante varios años. “Las familias de Medicaid están muy ocupadas, y lo último en lo que pueden pensar es en renovar su cobertura, por lo que esto queda relegado al final de su lista de prioridades”, explicó Amy Dobbins, directora de sección en la Oficina de Elegibilidad y Política de Medicaid.

Dobbins señaló que la emergencia de salud pública por covid, durante la cual más niños han tenido cobertura y han recibido servicios de salud, fortaleció la idea de la elegibilidad continua.

Dianne Hasselman, directora ejecutiva interina de la Asociación Nacional de Directores de Medicaid, piensa que algunos estados serían cautelosos a la hora de seguir el ejemplo de Oregon. “A los legisladores estatales también les podría preocupar el aumento de las inscripciones en el programa Medicaid, especialmente en un momento en el que las inscripciones ya han crecido significativamente”, expresó.

Además, los legisladores no verían con buenos ojos ampliar la cobertura a personas con otras opciones de seguro, como el del lugar de trabajo de los padres, agregó Hasselman.

Aunque se alegra de que algunos estados mantengan a los niños en Medicaid hasta los 6 años, Alker, de Georgetown, subrayó que la nueva política de Oregon entrará en vigor —al final de la emergencia sanitaria— justo cuando millones de niños pierdan la cobertura.

“Los estados que no presten atención a las necesidades de los niños cuando termine la emergencia de salud pública probablemente verán un aumento masivo de niños sin seguro”, señaló Alker. “Así que se avecinan situaciones muy diferentes”.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Professor of epidemiology and endocrinology and director of the Caribbean Institute for Health Research (CAIHR) Marshall Tulloch Reid says researchers are trying to be more deliberate, in communicating to participants the purpose and practicality of gathering their data.

"...Another thing that turns them off is when they participate in research studies and they don't know what it means, it has to be a two-way street, they have to get a benefit from participating and they can help us decide what is of priority — that's important too, because sometimes we are thinking one way. The research isn't just something up in the air, it's really something that's supposed to be practical and helpful," the endocrinologist outlined, while speaking on developments in diabetes research this week at the Jamaica Observer Monday Exchange.

He was among a panel of guests from the Ministry of Health and the medical profession addressing the issue in observance of diabetes awareness month.

Professor Tulloch Reid advised that researchers are working on new guidelines for diabetes management, making recommendations for treatment, and that it is important to do so within the Jamaican context.

He noted that CAIHR is conducting a significant follow-up study, based on surveys conducted by the Ministry of Health: "The idea is that you can follow people over time and figure out what's driving the risk factors and understanding what happens to people with certain complications over time, and that requires people to volunteer."

Professor Tulloch Reid said the recruitment drive for volunteers has been slowed by the novel coronavirus pandemic, as persons prioritise other life issues. "It's a very tense time for a lot of patients, balancing a lot of things. We know that it is a bit of a hard sell, we know there are a lot of things competing at this time, but it's the only way we can understand what our story is for Jamaica is for people to volunteer and share with us their experiences and participate in these kinds of studies. This is one of the things that will help us to really make a difference when it comes to diabetes, that we can generate the evidence to make the right decisions, the right recommendations, and to guide in a number of ways that we sometimes don't think about at the beginning of a process."

He said the pandemic changed the way research is carried out, making information gathering more difficult, due to the absence of or limited face-to-face interaction with responds, who prefer this kind of interface.

"It meant a lot more telephone interviewing, which is more challenging both to the interviewer and the patient. It has taken a bit of a hit, there are also a lot of other things happening to people, economic issues, working less, earning less [but] I am hoping that as the pandemic has begun to wane and we begin to move back to some sort of normalcy, we might see people being more willing," he said.

At the same time, he said ongoing research has detected a number of gaps in the knowledge database, such as the speed at which diabetes is developing among the population.

"We know how many people have it but we don't know the rate at which it's increasing [and] that's important. We don't know how many of those who have diabetes have specific complications, that has a lot of implications for a number of areas, because diabetes affects almost every organ, so it's important to know how many of these people could have issues with their eyes, their kidneys, then heart, the feet, which may put them at risk for further complication," he explained.

Professor Tulloch Reid further pointed out that there are also some gaps in understanding best practices in diabetes patient care, and how to assist patients with better managing their condition. He said it is important in drawing from other models of diabetes management, to consider the local resources and determine how best to use these to effect as beneficial a change as obtains elsewhere.

Diabetes Awareness Month is observed in November, with the 14th marked as World Diabetes Day.

Collaboration essential to make promise of health a reality for everyone across the Americas

Cristina Mitchell

9 Nov 2022