Tag Archives: optimism

Do You Have PPSD*?

(*Post-Pandemic Survival Dysfunction)

Even as daily life seems headed towards recovery, it’s hard to relax. This insightful analysis explains why “burnout” only begins to describe what so many of us have been feeling.

[by Soo Youn, The Washington Post]

Why burnout won’t go away, even as life returns to ‘normal’

For Marcia Howard, the Cheez-Its were a breaking point.

At her son’s first in-person school event this year, she realized she forgot to bring the class snack.

“I just broke down in the car and I started crying,” she said. As a class parent, she was torn up about forgetting the crackers. “It turns out everything has been overwhelming. And there’s no shaking it.”

Howard started a new job at the beginning of the coronavirus pandemic working as a creative operations director at a Fortune 500 company.

“I’m a Black woman. Between the pandemic and everything that happened to George Floyd and the summer of protests. . . . I had that first wave of, ‘Oh, gosh, I’m tired. I don’t feel like I can do anything. I stay up all night, looking at my phone and just really can’t focus,’ ” she said.

Then the fall came around, and it became clear many schools wouldn’t fully reopen for in-person learning.

“I’ve never thought about quitting more,” said Howard, who lives in New York City.

She’s been told by her company that she can take time off as she needs, but it’s just not that simple for her, she said. “It is all really wonderful to hear. But trying to prove myself in a corporate environment as the only Black leader, can I?” Howard said.

In February, she says she was told by her therapist that she was on the verge of depression.

“I feel like everyone is starting to think the world is getting back to normal, and I just can’t even bring myself to be hopeful about it,” Howard said.

With vaccinations initiated for half of Americans over 12, and guidance on masking and social distancing easing, the triage stage of the pandemic is lessening for some in the United States. Yet external progress markers can disguise – or even induce – a flurry of conflicting emotional, physical or cognitive states. Like getting sick right after turning in your last final, for some women who bore the brunt of domestic burdens while juggling work pressures for over a year, the breaking point may come with the breathing room.

As the country races toward a “normal” summer, for women like Howard, the picture doesn’t match up with her reality. She’s still struggling through a burnout unlike any other.

“Traditionally, we think of burnout being a state where someone is increasingly overwhelmed with the tasks in their lives, feeling a markedly decreased sense of accomplishment and effectiveness in what they are doing, and feeling like the things they loved to do now feel like just additional tasks. After a time, there can be mental health consequences,” said Maureen Sayres Van Niel, a Boston-based psychiatrist.

The pandemic magnified that condition exponentially.

“We had women with and without children managing situations that had life and death consequences in their daily lives: how to provide food for their families when the deadly virus was omnipresent or they were suddenly without an income, how to care for an elderly mother without physical contact,” she said. “Burnout in the traditional sense doesn’t capture the sense of the past year’s events.”

By March 2021, 1 in 4 Americans adults suffered the loss of a close friend or relative to the coronavirus, according to the KFF coronavirus vaccine Monitor; about 1 in 3 knew someone who died. And for those with family and friends in countries where death tolls are mounting daily, there is little relief.

“By mid-summer many will likely be feeling conflicting emotions such as relief that they are protected against the virus and happiness to see friends and family again. But having these new freedoms allows us to reflect on what we just lived through, what we endured, and what we lost. We will then be able to really feel our burnout, to let it surface,” said Stanford University sociologist Marianne Cooper. “People will need time to process what they have lived through.”

People are also mourning the loss of jobs – as well as routines, health, opportunities and time.

Baltimore-based psychiatrist Kimberly Gordon says burnout isn’t an adequate term. She treats patients from underserved communities and has lived and worked through traumatic events like Hurricane Katrina. She frames the current conversation as one of moral injury, a term referring to “the strong cognitive and emotional response that can occur following events that violate a person’s moral or ethical code.”

“Burnout suggests that the problem resides within the individual, who is in some way deficient. It implies that the individual lacks the resources or resilience to withstand the work environment,” according to a 2019 study published in the journal Federal Practitioner.

That’s impossible, the authors say: “While there is nothing inherently wrong with any of those practices, it is absurd to believe that yoga will solve the problems.”

The problem with using the term burnout, Gordon said, is that people equate it with a failure of their own, compounding the issue.

“You take these people who are really passionate and energetic, who want to do a good job, and they lose their motivation,” Gordon said. “Moral injury addresses the systems issues that lead to burnout, and calls for systems to address those issues.”

For some, the moral injury felt like betrayal by employers, the government and neighbors.

Jennifer Casaletto, an emergency physician in North Carolina, remembers one of the lowest points in the middle of the pandemic, a period she refers to as “backstabbing.”

“That was one of the hardest humps to get over, realizing we’re still going to work risking our lives and the lives of our family, and our friends telling us ‘This is completely overhyped.'” She recalled an incident during which a neighbor brought their child to Casaletto’s house to get stitches, then told her they were going on vacation to Mexico and were hoping to get around having to mask on the plane.

While the pandemic has been hard on everyone, women are bearing the physical and mental load of burnout unequally, emerging data shows.

In March, the Axios/Ipsos Coronavirus Index found 30% of women said they felt “overwhelmed or burned out” over the past year, compared with 21% of men.

“The pandemic has also laid bare the ways in which the society and its institutions were not created with the biology of women workers in mind,” Sayres Van Niel said.

Mental health professionals suggest telling employers about what you need to be more productive at work.

“We think of ourselves as passive participants in our workplace but we can actually have an active role in the culture,” Gordon said.

For example, say you can work until 7 p.m. but you need child care. One of Gordon’s patients recently told their manager they were manic depressive, and they were able to come up with a more flexible schedule.

“It’s really important to find workplaces or create workspaces, where people can have courageous conversations,” she said.

She also recommended making small changes in everyday life, like exercise or watching a comedy special. Little daily tweaks can be more effective than a week-long vacation over time, she said.

Howard, the Fortune 500 director, says she tries to work in a daily bath and is focusing on a renewed exercise routine. There’s still plenty for her to be stressed out about: an upcoming minor surgery for her son, family reunions with mixed vaccination statuses and a recent emergency room visit for the family cat.

It can feel like the rush to reopen is happening too fast, she said, putting her at odds with others who are thrilled to take off their masks and return to “normal.”

“I’ve just realized that I don’t have to be there. . . . I don’t emotionally have to get there. I can take my time recovering from the past year and a half. I’m sitting with my feelings and it’s still normal to be unable to focus.”

– – –

This story first appeared in The Washington Post’s The Lily publication.

Good News Monday: Yes, Vaccines Work!

Encouraging news from today’s New York Times (Sorry, the formatting is a little wonky):

Why the vaccine news is better than you may think.

By David Leonhardt

Preparing the Pfizer vaccine in Phoenix.Adriana Zehbrauskas for The New York Times


‘We’re underselling the vaccine’
Early in the pandemic, many health experts — in the U.S. and around the world — decided that the public could not be trusted to hear the truth about masks. Instead, the experts spread a misleading message, discouraging the use of masks.

Their motivation was mostly good. It sprung from a concern that people would rush to buy high-grade medical masks, leaving too few for doctors and nurses. The experts were also unsure how much ordinary masks would help.

But the message was still a mistake.

It confused people. (If masks weren’t effective, why did doctors and nurses need them?) It delayed the widespread use of masks (even though there was good reason to believe they could help). And it damaged the credibility of public health experts.

“When people feel as though they may not be getting the full truth from the authorities, snake-oil sellers and price gougers have an easier time,” the sociologist Zeynep Tufekci wrote early last year.

Now a version of the mask story is repeating itself — this time involving the vaccines. Once again, the experts don’t seem to trust the public to hear the full truth.

This issue is important and complex enough that I’m going to make today’s newsletter a bit longer than usual. If you still have questions, don’t hesitate to email me at themorning@nytimes.com.

‘Ridiculously encouraging’
Right now, public discussion of the vaccines is full of warnings about their limitations: They’re not 100 percent effective. Even vaccinated people may be able to spread the virus. And people shouldn’t change their behavior once they get their shots.

These warnings have a basis in truth, just as it’s true that masks are imperfect. But the sum total of the warnings is misleading, as I heard from multiple doctors and epidemiologists last week.

“It’s driving me a little bit crazy,” Dr. Ashish Jha, dean of the Brown School of Public Health, told me.

“We’re underselling the vaccine,” Dr. Aaron Richterman, an infectious-disease specialist at the University of Pennsylvania, said.

“It’s going to save your life — that’s where the emphasis has to be right now,” Dr. Peter Hotez of the Baylor College of Medicine said.

The Moderna and Pfizer vaccines are “essentially 100 percent effective against serious disease,” Dr. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said. “It’s ridiculously encouraging.”

The details
Here’s my best attempt at summarizing what we know:

The Moderna and Pfizer vaccines — the only two approved in the U.S. — are among the best vaccines ever created, with effectiveness rates of about 95 percent after two doses. That’s on par with the vaccines for chickenpox and measles. And a vaccine doesn’t even need to be so effective to reduce cases sharply and crush a pandemic.


If anything, the 95 percent number understates the effectiveness, because it counts anyone who came down with a mild case of Covid-19 as a failure. But turning Covid into a typical flu — as the vaccines evidently did for most of the remaining 5 percent — is actually a success. Of the 32,000 people who received the Moderna or Pfizer vaccine in a research trial, do you want to guess how many contracted a severe Covid case? One.


Although no rigorous study has yet analyzed whether vaccinated people can spread the virus, it would be surprising if they did. “If there is an example of a vaccine in widespread clinical use that has this selective effect — prevents disease but not infection — I can’t think of one!” Dr. Paul Sax of Harvard has written in The New England Journal of Medicine. (And, no, exclamation points are not common in medical journals.)

On Twitter, Dr. Monica Gandhi of the University of California, San Francisco, argued: “Please be assured that YOU ARE SAFE after vaccine from what matters — disease and spreading.”


The risks for vaccinated people are still not zero, because almost nothing in the real world is zero risk. A tiny percentage of people may have allergic reactions. And I’ll be eager to see what the studies on post-vaccination spread eventually show. But the evidence so far suggests that the vaccines are akin to a cure

Offit told me we should be greeting them with the same enthusiasm that greeted the polio vaccine: “It should be this rallying cry.”


The costs of negativity
Why are many experts conveying a more negative message?

Again, their motivations are mostly good. As academic researchers, they are instinctively cautious, prone to emphasizing any uncertainty. Many may also be nervous that vaccinated people will stop wearing masks and social distancing, which in turn could cause unvaccinated people to stop as well. If that happens, deaths would soar even higher.

But the best way to persuade people to behave safely usually involves telling them the truth. “Not being completely open because you want to achieve some sort of behavioral public health goal — people will see through that eventually,” Richterman said. The current approach also feeds anti-vaccine skepticism and conspiracy theories.

After asking Richterman and others what a better public message might sound like, I was left thinking about something like this:

We should immediately be more aggressive about mask-wearing and social distancing because of the new virus variants. We should vaccinate people as rapidly as possible — which will require approving other Covid vaccines when the data justifies it.

People who have received both of their vaccine shots, and have waited until they take effect, will be able to do things that unvaccinated people cannot — like having meals together and hugging their grandchildren. But until the pandemic is defeated, all Americans should wear masks in public, help unvaccinated people stay safe and contribute to a shared national project of saving every possible life.

Good News Monday: Beginning of the End?

The first coronavirus vaccine was given in the U.S., opening a new, hopeful chapter in the battle against a pandemic that has ravaged the country.
Monday, December 14, 2020 9:35 AM EST
Shortly after 9 a.m. on Monday, vaccinations took place in Long Island Jewish Medical Center in Queens, N.Y. The pandemic has scarred New York State profoundly, leaving more than 35,000 people dead and severely weakening the economy.
The vaccinations started after the Food and Drug Administration’s emergency authorization of the Pfizer-BioNTech vaccine on Friday night, and as the U.S. coronavirus death toll approaches 300,000, with a steady surge in new cases daily.
Better late than never?
Photo by Karolina Grabowska on Pexels.com

Send In the Cavalry!

Exciting news these days, as several COVID vaccines show promising results, and it looks as though antibodies in those who’ve survived the disease can last months or even years.

While we wait, it’s also good to know that both mouthwash and baby shampoo have been shown to provide additional protection. (No, we aren’t supposed to gargle with baby shampoo or put mouthwash in our hair. It’s quite straightforward.)

What I really want to see, though, are some additional, mandatory vaccines:

  • Protection against false claims of fake news, fake election results, and generally fake anything you happen to disagree with
  • A vaccine against racism, antisemitism and Holocaust denial
  • 100% protection against ignoring the reality of climate change
  • 99.9% protection against stupidity — 100% being simply unrealistic
  • A vaccine against meanspiritedness, unneighborly behavior and selfishness

And, finally, a shot that will permanently erase 2020.

Photo by Artem Podrez on Pexels.com

Good News Monday (early edition): A Sigh of Relief

Despite the looming threats of new COVID devastation, many are feeling optimistic after Biden’s decisive presidential win. For any readers who are disappointed, I hope this will usher in a new era of civility and a return to classic American values of inclusion. Unless your ancestry is Indigenous, we all came to this melting pot from somewhere and we all deserve to live in a country that welcomes us.

Here’s a great piece — brought to my attention by the Enlightened Mind blog — that shows worldwide jubilation about the end of 45’s reign of terror. I have no doubt he’ll continue to tweet his nastygrams, but hopefully to a smaller audience and without daily media coverage of his sociopathy. Cheers!

Photo by cottonbro on Pexels.com

World now looks at how Biden will reshape U.S. policies after turbulent Trump era

Shibani Mahtani, Miriam Berger  1 day ago


Elections expert Q&A: No evidence of fraud and fail-safes everywhere in US.

The world looked ahead Saturday to new American leadership, with U.S. allies and rivals alike starting to predict what the change in the White House would mean for their relations with the United States and for American engagement more generally.a group of people standing in front of a crowd: Activists join a pro-migrant demonstration on the U.S.-Mexico border at the San Ysidro Crossing Port in Tijuana, Mexico, after Joe Biden was declared winner of the U.S. presidential election. (Guillermo Arias / AFP/Getty Images)Activists join a pro-migrant demonstration on the U.S.-Mexico border at the San Ysidro Crossing Port in Tijuana, Mexico, after Joe Biden was declared winner of the U.S. presidential election. (Guillermo Arias / AFP/Getty Images)

Here are the latest developments:

  • Congratulatory messages poured in from around the world to Biden and vice president-elect Kamala D. Harris.
  • Spontaneous celebrations broke out on streets in London, Berlin and other cities.
  • President Trump has continued to make unsubstantiated allegations of electoral fraud, retweeting misleading claims about the integrity of the vote count.
  • Trump’s far-right allies, notably Brexit party leader Nigel Farage, encouraged him to keep up the fight and railed against mail-in ballots.

It did not take long after Joe Biden’s victory was projected for world leaders to unleash the normal flood of congratulatory messages. But for those abroad who have felt uneasy with President Trump and his norm-breaking style, it was a much-awaited moment of optimism and even jubilation.PlayCurrent Time 0:14/Duration 1:15Loaded: 43.14%Unmute0FullscreenDeath toll from storm Eta soarsClick to expand

Death toll from storm Eta soars
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Biden defeats Trump| The 2020 Fix
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Crowds celebrate Biden-Harris win near White House

Shouts of “Biden!” and cheers broke out in Berlin, London, Toronto and other cities when the excruciating wait for an announcement came to an end. On Twitter, echoing Paris’ mayor, people tweeted out, “Welcome Back, America.”

Many hope that Trump’s unilateralism and America-first populism will give way to an era of renewed U.S. global leadership and an embrace of multilateralism to tackle common challenges.

“It’s good that there are finally clear numbers. We look forward to working with the next U.S. administration,” tweeted German Foreign Minister Heiko Maas. “We want to invest in cooperation for a transatlantic new beginning, a new deal.

Reinhard Bütikofer, a German member of European Parliament, quipped, “I heard a Pan-European sigh of relief, when Biden’s victory was called.”Marianne Hoenow from Connecticut celebrates the victory of president-elect Joe Biden and vice president-elect Kamala D. Harris in front of the Brandenbug Gate next to the United States Embassy in Berlin on Nov. 7, 2020. (Markus Schreiber/AP)Marianne Hoenow from Connecticut celebrates the victory of president-elect Joe Biden and vice president-elect Kamala D. Harris in front of the Brandenbug Gate next to the United States Embassy in Berlin on Nov. 7, 2020. (Markus Schreiber/AP)The U.S. election gripped the world, making way for plenty of memes

Though Trump had yet to acknowledge his defeat, some of the foreign leaders closest to him did not delay in sending their congratulations to Biden and Vice President-elect Kamala D. Harris.

British Prime Minister Boris Johnson tweeted his congratulations., saying, “The U.S. is our most important ally and I look forward to working closely together on our shared priorities, from climate change to trade and security.”

Poland’s right-wing President Andrzej Duda, who has been politically aligned with Trump, cautiously tweeted to congratulate Biden “for a successful presidential campaign.” Egyptian President Abdel Fatah al-Sissi, whom Trump once called his “favorite dictator,” sent his best wishes to Biden, and Indian Prime Minister Narendra Modi congratulated the president-elect. He also noted that Harris’s Indian heritage is “a source of immense pride.”Villagers in Painganadu, India, prepare placards featuring Sen. Kamala D. Harris on Nov. 6, 2020, a day before Joe Biden and Kamala D. Harris were declared winners as president-elect and vice president-elect. (Aijaz Rahi/AP)Villagers in Painganadu, India, prepare placards featuring Sen. Kamala D. Harris on Nov. 6, 2020, a day before Joe Biden and Kamala D. Harris were declared winners as president-elect and vice president-elect. (Aijaz Rahi/AP)

Harris’s family hometown in southern India — the birthplace of her maternal grandfather — had already been holding celebrations in her honor ahead of the traditional Diwali festival. Meanwhile, Jamaica’s prime minister, Andrew Holness, also saluted her family ties to Jamaica, the birthplace of her father, as well as her “monumental accomplishment for women.”

In Biden’s ancestral hometown in Ireland, a crowd gathered to pop champagne. “I want to congratulate the new President Elect of the USA @JoeBiden Joe Biden has been a true friend of this nation throughout his life and I look forward to working with him in the years ahead,” wrote Irish Prime Minister Micheál Martin in a nod to Biden’s Irish heritage.

Perhaps the first foreign leader to congratulate Biden was Frank Bainimarama, the prime minister of Fiji, who said in a tweet — even before the election was formally called — that they must work together to confront a warming planet and rebuild the global economy.

Hours later, congratulations from world leaders and others — who were watching the vote count unfold over days — were finally uncorked as soon as U.S. news organizations declared Biden the winner. Leaders with diverse views and priorities — from Canadian Prime Minister Justin Trudeau and French President Emmanuel Macron to Zimbabwe’s President Emmerson Dambudzo Mnangagwa and Ukrainian President Volodymyr Zelensky — were quick to share their enthusiasm about working with Biden.Residents in Ballina, Ireland, climb a scaffold as they hang out American flags and bunting for president-elect Joe Biden on Nov. 07, 2020 in the ancestral home of the Biden family. (Charles McQuillan/Getty Images)Residents in Ballina, Ireland, climb a scaffold as they hang out American flags and bunting for president-elect Joe Biden on Nov. 07, 2020 in the ancestral home of the Biden family. (Charles McQuillan/Getty Images)

Nigerian President Muhammadu Buhari urged Biden to “deploy his vast experience in tackling the negative consequences of nationalist politics on world affairs — which have created divisions and uncertainties — and to introduce greater engagement with Africa on the basis of reciprocal respect and shared interests.”

Nigerian President Muhammadu Buhari urged Biden to “deploy his vast experience in tackling the negative consequences of nationalist politics on world affairs — which have created divisions and uncertainties — and to introduce greater engagement with Africa on the basis of reciprocal respect and shared interests.”

Some U.S. rivals, however, reacted differently. The People’s Daily China, an official newspaper of the Central Committee of the Chinese Communist Party, chose instead to taunt Trump by retweeting his boast that he’d won the election and commenting “HaHa” with a laughing emoji.

Iranian Supreme Leader Sayyid Ali Khamenei did not directly mention Biden or Trump in a tweet denouncing the election as a sign of the “definite political, civil, & moral decline of the US regime.” But Iranian Vice President Eshaq was more optimistic, saying, “I hope we will see a change in the destructive policies of the United States, a return to the rule of law and international obligations and respect for nations.”a person riding on the back of a motorcycle: A man reads a copy of Iranian daily newspaper Sobhe Nou with a cartoon depicting U.S. president Donald J Trump and a headline reading 'Go to hell gambler', in front of a newsstand in Tehran, November 07, 2020. According to local media reports, many Iranians are rooting for Democratic candidate Joe Biden. (Abedin Taherkenareh/EPA-EFE/REX/Shutterstock)Man reads a copy of Iranian daily newspaper Sobhe Nou with a cartoon depicting U.S. president Donald J Trump and a headline reading ‘Go to hell gambler’, in front of a newsstand in Tehran, November 07, 2020. According to local media reports, many Iranians are rooting for Democratic candidate Joe Biden. (Abedin Taherkenareh/EPA-EFE/REX/Shutterstock) In Europe, few sad to see Trump go

Politics and pandemic

The pandemic has added urgency to Biden’s pledge to reverse Trump’s approach, which has left the United States estranged from the World Health Organization and facing the highest numbers of deaths and new cases at home.

After Trump withdrew from the WHO, Biden promised to rejoin it on his first day in office. Biden is a “globalist at heart,” wrote Natasha Kassam, a research fellow at Sydney’s Lowy Institute political think tank, in the Guardian.

Other Trump policies are also in doubt. The Times of India, which anticipated Biden’s win with the headline “Bye Don, It’s Biden Finally,” said that H1-B work visas — allowing nonimmigrants to work in the United States — are unlikely to return in their previous numbers, even if the Biden administration has a more favorable immigration policy. But it noted that the Democrats could be stronger about challenging human rights violations in India.

In China, relations with the United States have fallen to their lowest point in 40 years amid bitter disputes over trade, technology, human rights and the novel coronavirus. But hopes have been stirred that a Biden win might act as a circuit-breaker and offer possible cooperation in certain areas.

Still, an op-ed in the nationalistic Global Times tabloid noted deep partisan divisions in the United States that it said would not be easily eased.

With Trump determined to contest the election results in court, some foreign commentators expressed their fears.

“The squatter” was the title of the Saturday cover of Der Spiegel, a leading German news magazine. A defiant, fatigue-clad Trump is depicted holding a rifle, barricaded in the Oval Office with a bullet-holed picture of a smiling Biden in the backdrop.Trump’s claims of stolen election have some recent precedents — in Gambia and Guyana

In Britain, the Guardian declared Trump in a “fight against reality,” but noted in an editorial that Biden would have his work cut out to “rebuild the U.S. government’s credibility after Trumpism hollowed out its institutions.”

In Japan, a burger outlet near a U.S. naval base followed a long tradition of naming a burger after every sitting American president by adding the Biden Burger to its menu, according to public broadcaster NHK.

The Biden Burger pays homage to his Scranton, Pa., roots. It comes with Philadelphia-style cheese and potato chips to represent Pennsylvania, a major chip producer. The Trump Burger has a dash of jalapeño, “supposedly reflecting Trump’s sharp tongue,” NHK wrote.

Mahtani reported from Hong Kong and Berger from Washington. David Crawshaw in Hong Kong; Steve Hendrix in Jerusalem; Michael Birnbaum in Latvia, Riga; Kareem Fahim in Istanbul; Danielle Paquette in Dakar; William Booth and Karla Adam in London; Niha Masih in New Delhi; James McAuley in Paris; Susannah George in Kabul; Chico Harlan in Rome; Isabelle Khurshudyan in Moscow; Amanda Coletta in Toronto; Lesley Wroughton in Cape Town, South Africa, and Kate Chappell in Kingston, Jamaica, contributed to this report.

Good News Monday: Writers, Think Pink!

Many of us remain isolated from friends and family during this pandemic. So imagine how difficult it would be to find yourself newly diagnosed with breast cancer — and with no support system to help you through the crisis.

An organization called Girls Love Mail has a novel way of boosting women’s spirits. Since 2011, it’s enlisted thousands of empathetic people to send words of encouragement to strangers; about 167,000 letters have been mailed to date.

Want to share a little hand-written optimism? Visit girlslovemail.com in honor of Breast Cancer Awareness month in October.

Photo by Abstrakt Xxcellence Studios on Pexels.com

Good News Monday: Statins, stat!

For us older folks with cholesterol concerns — mine’s hereditary; thanks, Dad — today’s NY Times article had some heartening info.

For Older People, Reassuring News in the Statin Debate

There is accumulating evidence that the benefits of statins far outweigh possible risks, and nearly all statins on the market are now available as inexpensive generics.

Credit…Gracia Lam
Jane E. Brody

By Jane E. Brody

  • Sept. 21, 2020, 5:00 a.m. ET

Cholesterol-lowering statin drugs, already one of the most popular medications worldwide, may become even more widely used as evidence grows of their safety and value to the elderly and their potential benefits beyond the heart and blood vessels.

Among the latest are reports of the ability of several leading statins to reduce deaths from common cancers and blunt the decline of memory with age. Perhaps such reports will persuade a reluctant 65-year-old friend who has diabetes, and others like him, that taking the statin his doctor strongly advised is a smart choice.

In addition to accumulating evidence that the benefits of statins far outweigh possible risks for the vast majority of people for whom they are now recommended, nearly all statins on the market are now available as inexpensive generics.

Full disclosure: I have a strong family history of heart disease and have been taking a statin — atorvastatin, originally marketed as Lipitor — for many years after dietary changes failed to control a steadily rising blood level of artery-damaging LDL-cholesterol. My prescription is now fully covered by my Medicare Part D insurance with no co-pay.

But cost of a medication is not the only consideration for a drug that can be lifesaving for many people. The primary indication for taking a statin is to reduce the risk of a heart attack or stroke by lowering serum LDL-cholesterol and, in some cases, also triglycerides, both of which can damage coronary arteries when levels rise above normal.

Statins offer further cardiovascular protection by stabilizing the fatty deposits in arteries called plaque that can break loose, block a major artery and cause a heart attack or stroke.

Current guidelines typically recommend statin therapy for:

  • People with a history of heart disease, stroke or peripheral artery disease or risk factors that give them a 10 percent or greater chance of a heart attack within 10 years;
  • People over 40 with diabetes and an LDL-cholesterol level above 70 milligrams per deciliter;
  • People over 21 with an LDL-cholesterol level of 190 or higher (despite dietary changes to minimize saturated fats and achieve a normal body weight).

Currently, more than 60 percent of older people in the United States who, like me, have high cholesterol take a statin to help prevent a heart attack or stroke.

Still, there’s been a long-simmering debate as to whether statins are advisable for people over 75, even though the risk of suffering life-threatening cardiovascular disease rises precipitously with age. Concerns have been raised about side effects associated with statins, potential adverse effects of the drugs on other ailments common in the elderly and possible harmful interactions with the many other medications they often take.

Writing in the Harvard Health Blog last October, Dr. Dara K. Lee Lewis noted, “The paradox that we face is that as our patients age, they are at increased risk for heart attacks and strokes, and yet they also become more sensitive to medication side effects, so it is a tricky balance.”

Statins can sometimes cause blood sugar abnormalities, resulting in a diagnosis of pre-diabetes or diabetes, and possible toxic effects on the liver that necessitate periodic blood tests for liver enzymes. A very small percentage of people prescribed a statin develop debilitating muscle pain. An elderly friend developed statin-induced nightmares. There have also been reports suggesting statin-associated memory problems and cognitive decline, already a common concern as people age.

But likely the biggest deterrent was the existence of meager evidence for the role statins might play for older people at risk of cardiovascular disease. As is true in most drug trials on new medications, relatively few people over 75 were included in early studies that assessed the benefits and risks of statins.

The latest reports, however, are highly reassuring. One followed more than 120,000 French men and women ages 75 to 79 who had been taking statins for up to four years. Among the 10 percent who stopped taking the drug, the risk of being admitted to a hospital for a cardiovascular event was 25 to 30 percent greater than for those who continued taking a statin.

Another study in Israel, published last year in the Journal of the American Geriatrics Society, involved nearly 20,000 older adults followed for 10 years. Among those who stayed on statin therapy, the chance of dying from any cause was 34 percent lower than among those who failed to adhere to a prescribed statin. The benefits were not reduced for those older than 75 and applied to women and men alike.

This year a study published in JAMA by a team headed by Dr. Ariela R. Orkaby of the VA Boston Healthcare System found that among 326,981 United States veterans whose average age was 81, the initiation of statin use was associated with 25 percent fewer deaths over all and 20 percent fewer cardiovascular deaths during a follow-up of nearly seven years.

However, none of these studies represent “gold standard” research. The results of two such studies, the Staree trial and the Preventable trial, both randomized controlled clinical trials of statin therapy to prevent cardiovascular events in the elderly, have not yet been published. Both will also assess effects on cognition.

Meanwhile, a report last year from Australia published in the Journal of the American College of Cardiology found no difference over a six-year period in the rate of decline in memory or cognitive status between statin users and those who had never taken the drugs. In fact, among those who started a statin during the study, the rate of memory decline was blunted. Another observational study by a Swedish team published in Nature found beneficial effects on reaction time and fluid intelligence among statin takers over 65.

Finally, there are several reports that a major class of statins called lipophilic (including atorvastatin, simvastatin, lovastatin and fluvastatin) may have anticancer effects. One study of nearly 2,000 survivors of early-stage breast cancer found a decreased five-year recurrence rate in women who started a statin within three years of diagnosis.

In a report presented in June to a virtual meeting of the American Association for Cancer Research, Dr. Kala Visvanathan of Johns Hopkins Medicine in Baltimore described a 40 percent reduction in deaths from ovarian cancer among more than 10,000 patients who had used statins either before or after their diagnosis. The patients who benefited in this observational study had the most common and aggressive form of ovarian cancer.

Dr. Visvanathan explained that statins inhibit an enzyme in a chemical pathway involved in the growth and proliferation of tumors. At a press briefing, Dr. Antoni Ribas, president of the association, said that if the finding is confirmed in a randomized clinical trial, “this would be a great outcome.”

Good News Monday: COVID Immunity

Reprinted from today’s New York Times

Is herd immunity ahead of schedule?

Mumbai may be among the cities that have already achieved herd immunity, scientists say.Indranil Mukherjee/Agence France-Presse — Getty Images

Today, we’re turning this section over to our colleague Apoorva Mandavilli, who has been covering the pandemic for The Times’s Science desk.

The pandemic will end only when enough people are protected against the coronavirus, whether by a vaccine or by already having been infected. Reaching this threshold, known as herd immunity, doesn’t mean the virus will disappear. But with fewer hosts to infect, it will make its way through a community much more slowly.

In the early days of the crisis, scientists estimated that perhaps 70 percent of the population would need to be immune in this way to be free from large outbreaks. But over the past few weeks, more than a dozen scientists told me they now felt comfortable saying that herd immunity probably lies from 45 percent to 50 percent.

If they’re right, then we may be a lot closer to turning back this virus than we initially thought.

It may also mean that pockets of New York City, London, Mumbai and other cities may already have reached the threshold, and may be spared a devastating second wave.

The initial calculations into herd immunity assumed that everyone in a community was equally susceptible to the virus and mixed randomly with everyone else.

The new estimates are the product of more sophisticated statistical modeling. When scientists factor in variations in density, demographics and socialization patterns, the estimated threshold for herd immunity falls.

In some clinics in hard-hit Brooklyn neighborhoods, up to 80 percent of people who were tested at the beginning of the summer had antibodies for the virus. Over the past eight weeks, fewer than 1 percent of people tested at those same neighborhood clinics have had the virus.

Likewise in Mumbai, a randomized household survey found that about 57 percent of people who live in the poorest areas and share toilets had antibodies, compared with just 11 percent elsewhere in the city.

It’s too early to say with certainty that those communities have reached herd immunity. We don’t know, for example, how long someone who was infected stays protected from the coronavirus. But the data suggests that the virus may move more slowly in those areas the next time around.

Really Good News Monday: Hope on the Horizon?

The first coronavirus vaccine to be tested in people appears to be safe and able to stimulate an immune response against the virus, its manufacturer, Moderna, announced on Monday.

The findings are based on results from the first eight people who each received two doses of the vaccine, starting in March.

Those people, healthy volunteers, made antibodies that were then tested in human cells in the lab, and were able to stop the virus from replicating — the key requirement for an effective vaccine. The levels of those so-called neutralizing antibodies matched the levels found in patients who had recovered after contracting the virus in the community.

The company has said that it is proceeding on an accelerated timetable, with the next phase involving 600 people to begin soon. But U.S. government officials have warned that producing a vaccine that would be widely available could take a year to 18 months. There is no proven treatment or vaccine against the coronavirus at this time.

Marriage, Pandemic Style

Ever wished your partner would spend more time with you? How quaint! This is the universe’s way of testing our relationships. And if the data from China is any indication, we’ll be seeing a wave of divorces once people can get to their lawyers.

Not me, though; one nasty divorce was enough for a lifetime. But since 24-hour togetherness  can strain any partnership, I’m trying to follow a few rules.

  1. Spend time apart.  Encourage separate activities to create some alone time; for instance, I’ll bake or write while my husband paints or works on his computer.  And if you live in a studio apartment, try to at least identify separate work spaces. With luck, this will give each of you something to talk about every evening besides the virus.
  2. Share a laugh: a book, video, joke, photo or film. We’ve just gone through all three Cage Aux Folles movies (note: the subtitled versions are funnier than the dubbed ones).
  3. Plan things to look forward to once life returns to normal — a trip, dinner at a special restaurant, going out with friends, etc.  Fantasizing encouraged.
  4. Connect with others.  We enjoyed a Zoom cocktail hour with two of our favorite couples the other night and are going to make this a regular routine.  Cheers!
  5. Make a big bowl of popcorn and find something fun on TV.  We’ve been watching old Nick and Nora movies from the ’30’s and adventure films such as the James Bond, Kingsman and Indiana Jones franchises.  Pretty much anything that bears no resemblance to today’s world is a good choice.
  6. Stop obsessing over the news.  It helps nothing and makes both parties depressed, which isn’t conducive to a happy home.  Being informed is one thing; worrying about anything outside your own control is counterproductive.
  7. Go for a walk.  It’s reassuring to see the flowers blooming and hear the birds chirping as if the whole world weren’t going to hell in a handbasket.
  8. Take deep breaths whenever your beloved is getting on your last nerve.

My mantra: “Whatever doesn’t make you want to kill your partner makes you stronger.”

two silver colored rings on beige surface

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