November 19 coronavirus news

Delirium was common among elderly patients with Covid-19 who came to the emergency department, according to a study published Thursday in JAMA Network Open, and many of them did not have other typical signs or symptoms of the disease.

“In this multicenter retrospective cohort study, 28% of 817 older patients with Covid-19 infection had delirium on arrival to the ED, and delirium was the sixth most common presenting symptom or sign overall,” read the study, from lead authors Dr. Maura Kennedy of Massachusetts General Hospital and Harvard Medical School and Benjamin Helfand of the University of Massachusetts Medical School.

“Delirium at presentation was significantly associated with increased risk for poor hospital outcomes, including ICU stay, discharge to a rehabilitation facility, and death," the study said.

Of the 226 patients with delirium, 37, or 16%, had delirium as their primary symptom. Importantly, the authors said, 84 of those 226, or 37%, had no fever or shortness of breath. 

More on the study: The study was conducted at seven sites across the United States and included older adults who went to emergency departments on or after March 13. 

Some of the factors associated with delirium included being older than 75, living in a nursing home or assisted living facility, prior use of psychoactive medication, vision or hearing impairment, stroke and Parkinson’s disease. 

“Our study demonstrates that it is critical to recognize that older adults with Covid-19 may present with delirium as the primary or sole symptom,” the study says. “In addition, delirium is an important risk marker to identify patients at high risk for poor outcomes, including death.” 

Remember: The study does have some limitations, including the fact that they suspect that the delirium rate observed is an underestimate, they were unable to evaluate site-specific data and enrollment occurred primarily in the Northeast during a time when it was undergoing a surge in Covid-19 infections. 

New York City Mayor Bill de Blasio said he expects New York Gov. Andrew Cuomo will close indoor dining and gyms in the next week or two.

The mayor said in a news conference this morning that after speaking with the governor at length yesterday and with cases showing a clear uptick, the city will move to the orange zone. In that zone, indoor dining and gyms will be closed.  

The mayor also reiterated, “We will bring our schools back, but we have to reset the equation.”

Yesterday, de Blasio announced that the city's public schools would close today as coronavirus cases rise in the city.

De Blasio said for those who might feel a little better if they knew indoor dining and gyms were going to be closed, “It’s just a matter of time.” 

This comes after the governor said Wednesday New York City’s Covid-19 numbers could warrant putting the city into an orange zone soon.  

Chairman of the NYC Council Health Committee, Mark Levine responds:

Karin Smith, a Florida resident and single mom of a 14-year-old boy, is one of millions of Americans who may lose expanded unemployment benefits on Dec. 26.

She said she is able to qualify for food stamps, but has given up on going to food banks because “if they open at 9, you have to be there at 5 a.m. to hope to get anything.” 

Smith previously worked for the Department of Education in data compliance and has been searching for a new job.

“It's not laziness … A job making $8 an hour is not going to pay my $1,650 rent, let alone all the other expenses I have because I had a good job,” she said. 

Smith said her son is old enough to understand her stress and has tried to help with his own suggestions, like buying a motor home and moving them into it because he doesn’t want to lose their dog or cat. 

Watch:

The economic fallout of the Covid-19 pandemic is driving up food insecurity across America.

"What we've seen, has been, unfortunately, a steady level of greatly, significantly increased need, since the pandemic started," said Katie Fitzgerald, Chief Operating Officer of Feeding America.

Feeding America, the nation's largest hunger-relief organization, says more than 54 million people in the country could soon face food insecurity. That is 17 million more than before the coronavirus outbreak. The non-profit has seen a 60 percent increase in food assistance needs since March.

Several federal programs are available to help people make ends meet during these difficult times.

If you, or someone you know, is one of those people facing food insecurity at the moment, CNN has a list of resources that can help. You can see the full list here.

An ensemble forecast published Thursday by the US Centers for Disease Control and Prevention now projects there will be 276,000 to 298,000 coronavirus deaths in the United States by Dec. 12.

Unlike some individual models, the CDC’s ensemble forecast only offers projections a few weeks into the future.

The previous ensemble forecast, published Nov. 12, projected up to 282,000 coronavirus deaths by Dec. 5.

At least 250,652 people have already died from Covid-19 in the United States, according to data compiled by Johns Hopkins University.

The US just surpassed a tragic milestone of more than 250,000 coronavirus deaths and more than 11.5 million infections nationwide, according to data from Johns Hopkins University.

Just how bad things could get will be determined by Thanksgiving celebrations next week. Health officials have warned against traditional indoor gatherings that seem to be a big driver in the surge of cases.

Each family will need to weigh the risks of celebrating Thanksgiving in person or virtually depending on individual circumstances. As well as taking precautions like masks and hand sanitizer, Dr. Sanjay Gupta has said the dose of the virus you receive might make the difference between being asymptomatic, getting mildly sick or becoming critically ill.

Another way to think of it is like conception: You don't need millions of sperm to fertilize an egg – you only need one – but men make millions of sperm to improve the chances that one will reach the egg, overcome its defenses and fertilize it.

"Each person has a different amount of virus that they need," explains Erin Bromage, an associate professor of biology at the University of Massachusetts, Dartmouth.

Put it all together, and the chance of infection depends on the physiology of the potential host, as well as their personal behaviors and health habits such as smoking status, diet, physical activity and sleep. An elderly or unhealthy host in the face of large, recurrent exposures is clearly the worst case scenario. But a medically fragile person could be sickened by even a low dose of virus; conversely, a healthy person can be overwhelmed with a high enough dose.

If you are planning on gathering with family or friends this holiday season, CNN's Dr. Leana Wen explain some of the safest ways to do so in this video.

US stocks opened lower on Thursday. Investors are worried that the resurgence in Covid-19 cases are clouding the economic outlook.

Weekly jobless claims data from the Labor Department didn’t help matters either: First-time claims for regular state benefits rose for the first time in about a month and were higher than expected.

Here's where things stood at opening:

A healthy 28-year-old emergency room doctor thought he would be fine if he contracted coronavirus. But he went from running nearly every day to being barely able to walk or catch his breath after getting the virus.

After five days with symptoms of Covid-19, Michigan physician Dr. David Burkard said he could not breathe on the sixth day and needed to be hospitalized in the same place where he treats patients. 

Burkard also said that someone reported him to Facebook for spreading “hoax” information. He encouraged people to wear masks and stay home for Thanksgiving. 

“Instead of just like saying mean things from behind the keyboard … imagine what it's like to have that conversation with someone — that you are putting a breathing tube down their throat and they may not be able to say ‘I love you’ to their loved one again — and that's what we're doing every day, constantly,” he said. 

Watch:

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told NPR’s Rachel Martin on Morning Edition Tuesday that his Thanksgiving will be "significantly" different this year than previous holidays.

His three adult daughters, who live in separate parts of the country, got together and said that they did not want to put him, as an elderly person, at risk. Fauci is 79 years old. 

He and his wife will have a meal and Zoom with his daughters to spend time with them.

“I don’t like it that way, but I think they’re making a prudent decision in trying to protect their father and I’m proud of them for that,” he said.